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278 Cards in this Set
- Front
- Back
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What is normal blood pH
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"7.4
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What is normal pCO2
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"36-44
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What is normal HCO3
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"21-27
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High pCO2
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acidosis
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Low HCO3
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Acidosis
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Metabolic Acidosis
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Low Bicarb
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Metabolic Acidosis
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High Bicarb
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Resp Acidosis
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High pCO2
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Resp Alkalosis
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Low pCO2
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and their pCO2 is lower than the compensation should be what is going on w the pt"
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they have a resp acidosis with an additional 1' resp alkalosis
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Causes of increased anion Gap
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"Methanol
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Causes of a normal anion gap
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"Hyperalimentation
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Decreased anion gap caused by
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"Bromide
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Delta delta issssss
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"Change in AG / change in bicarb
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D/D < 1
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HARD UP + MUDPILES
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D/D = 1 to 2
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MUDPILES
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D/D >2
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MUDPILES and Met Alkalosis
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Typically what resp dx is caused by viruses
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"Colds
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What Resp illnesses are bacteria
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"Pharyngitis
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how is chronic sinusitis defined
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">8 weeks or
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What are typical pathogens in colds
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"Strep pneumo, H. influenza (common)
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how is pharyngitis caused by strep differentiated clinically
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"Sore throat, exudate, cervical lymphadenopathy, petechia on palate"
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Symptoms of atypical pneumo
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"low fever, gradual onset, non-productive cough, mucoid sputum"
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symptoms of typical pneumo
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"acute, high temp, productive cough, purulent sputum"
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Pneumo in new born
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"Group B strep, E. coli"
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Pneumo in children
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"RSV, atypicals, Strep Pneumo"
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Adult pneumo
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"mycoplasma, chlamydia, strep pneumo"
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Older adult pneumo
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"strep, mycoplasma, haemophilus, viral"
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elderly pneumo
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"gram negs, strep pneumo, fungal"
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What is M protein
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"Adhesin for strep, antiphagocytic"
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4 D's of epiglotitis
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"dysphagia, dysphonia, drooling, distress"
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4 stages of lobar pneumonia
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"1: Congestion
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"Dry granular lesions, lower lobes, bilateral, multifocal"
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bronchopneumonia
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Pneumonia complications
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"abscess, empyema, organization, dissemination, "
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What kind of pneumo does strep cause
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lobar pneumo
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"Lobar pneumo, fever, chills, chest pain, gram + diplos"
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Strep pneumo
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Thumb sign"
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H. Influenzae
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Most common bacterial cause of acute exacerbation of COPD
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H. influenzae
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"Bronchopneumonia, with abscess and empyema, usually follows viral infection in healthy adults"
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Staph aureus
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"Lobar pneumonia, bulging lobe on x ray, gelatinous sputum"
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Klebsiella
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Pseudomonas causes what type of pneumonia
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bronchopneumonia
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What kind of pneumonia will not cause hepatization (consolidation)
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Community acquired pneumo
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Antigenic Drift
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"Epidemics, evolves as it moves through a population"
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Antigenic Shift
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"Pandemics
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"Atypical pneumo, seen in younger population, no exudate in aveoli, minimal sputum, elevated cold agglutinins"
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mycoplasma pneumonia
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What are lung abscesses associated with
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"aspiration
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"Sulfur granules, abscess, sinus tract formation, significant fibrosis"
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actinomyces
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where does histoplasmosis attack
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"macrophages, need T cells to overwhelm histo with macros to beat infection"
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"Upper lobe, suppurative granuloma, cough, weight loss, fever, chills"
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blastomyces
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Cup like cysts in the alveoli
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Pneumocystis pneumonia
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What should be ruled out in looking for pneumonia
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"sarcoid, PE, CHF, ARDS, Gases"
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What pneumo is most common in cig smokers
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Haemophilis (it likes nicotine)
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"In a young healthy individual with pneumo, what is most likely"
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strep or mycoplasm
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most likely cause of pneumo in an elderly ICU pt
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"Gram negs and staph
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What is a Type I hypersensitivity rxn
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Immediate immunologic reaction after combination of an antigen with an antibody bound to a mast cell in individuals previously sensitized to the antigen
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Signature cytokine
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IL4 makes B cells switch to IgE
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What occurs in the immediate reaction
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"Histamine, proteases and chemokines cause vasodilation, bronchoconstriction, smooth muscle spasm"
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what occurs in late phase
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"leukocyte infiltraion, epithelial damage, bronchospasm"
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What are preformed mediators of allergy
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"heparin, chrondroitin sulfate, TNF-a, histamine"
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What are the second wave of mediators
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"IL4, TNF-a, Prostaglandins, leukotrienes"
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1st gen H1 antagonists
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"Alkylamines, Ethanolamines, Piperazines, Phenothiazines"
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2nd gen H1 antagonists
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"Loratadine
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Diphenhydramine
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"sedation effects, anticholinergic
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How does theophyline work
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"Prevents cAMP breakdown by phosphodiesterase
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Aminophylline
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"IV admin, slow, low potency increases muscle contractility and mucociliary movement"
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Why is levalbuterol a better choice than albuterol
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"binds receptor better, avoids paradoxical spasm as in albuterol"
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ipratropium
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"slow onset, used w a beta2, reduces sputum volume (cholinergic effect)"
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tiotropum
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"anticholinergic, used in COPD"
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"Cromolyn, Nedocromil"
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"mast cell stabilizers
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Zafirlukast
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"antileukotriene
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montelukast
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"antileukotriene
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omalizumab
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"IgE monoclonal antibody
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Portion of lung completely seperated from lung and bronchial tree
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Pulmonary sequestration
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"Single cyst filled with mucus/air, risk of PTX or atelectesis"
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Bronchogenic Cyst
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"cyst with glandular tissue, solitary lesion with multiple cysts"
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cystic adematoid malformations
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Where to cystic adematoid malformations tend to form
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lower lobes in neonates
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Obstruction of the bronchi can lead to
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resorption atelectesis
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What is the mechanism of resorption atelectasis
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the lung begins to resorb air since no new air can get into that portion of lung and the lung collapses in that section
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a lack of surfactant leads to
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Microatelectasis aka Shock lung
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What pathologies are considered COPD
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"asthma, ephysema, chronic bronchitis, and bronchiectasis"
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"Mucous gland hyperplasia and hypersecretion, cough and sputum production"
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Chronic bronchitis
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"dilated and scarred bronchi as a result of infection. cough, purulent sputum, and fever"
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bronchiectasis
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"excess mucous and inflammation, smooth muscle hyperplasia"
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Asthma
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enlargement of the acinus and destruction
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Emphysema
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Extrinsic asthma
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exposure by extrinisc antigen
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Intrinsic Athma
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"non immune, exercise induced, ASA induced"
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Atopic asthma
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"Triggered by dust, pollen, dander
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Curshman's spirals
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whirls of shed epithelium
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Centrilobar emphysema
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"seen in smokers, involves middle of acinus
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panacinar emphysema
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"A1 antitrypsin deficiency
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what kind of emphysema has a risk of rupturing into pleural space resulting in PTX
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Distal acinar emphysema
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how do you make the dx of chronic bronchitis
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persistant productive cough for 3 months in 2 consecutive years
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"Hyperemic mucosal lining, hypertrophic glands, squamous metaplasia"
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Chronic bronchitis
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Chains of conidia with septated hyphae
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aspergillus
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in tissue is spherule containing endospores"
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coccidiomycosis
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"Pt has erythmematic lesions on body, what fungal infection is suspected"
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coccidiomycosis
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Dry arid areas are at higher risk for
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coccidiomycosis
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Mississippi/ohio river valley has risk for
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histoplasmosis and blastomycosis
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"Liver, spleen, lungs, and lymph nodes are sites of spread for what fungus"
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histoplasmosis
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thick walled broad based budding yeast
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Blastomycosis
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"you suspect fungal infection in a pt with abscesses and ulcers, what fungus is most likely"
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blastomycosis
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tuberculate macroconidia
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histoplasmosis
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what puts someone at higher risk for fungal resp infection
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"obstruction of sinuses, nasal polyps, people with allergies, bacterial/viral coinfection, immunocomprimised"
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What fungus only occurs in mold form
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aspergillus
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Guaifenesin
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makes mucus thinner and more liquid
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Terpin Hydrate
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contains codeine no longer OTC
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Benzonatate
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"Do not chew, numb oral mucosa, can cause tongue injury"
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Codeine
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"secretions thicker and drier, CNS depressant, cough supress"
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Caramiphen
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"OTC, supress cough center, anticholinergic effects"
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dextromethrophan
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"NMDA blocker, "
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ipratropium
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"decrease efferent, anticholinergic"
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Pancuronium
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"Decrease resp muscles
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Acetylcysteine
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reduces mucus viscosity
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Kartagener's syndrome
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"cytis inversis, cilia defect, can end in bronchiectasis"
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permenant dilation of bronchi
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bronchiectasis
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"Very foul smelling sputum, hemoptysis, severe cough"
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bronchiectasis
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injured aveoli with hyaline membranes
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ARDS
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pathogenesis of ARDS
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"DAD caused by neutrophil and macrophage activation from shock, infection, toxins"
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What does the interstitium consist of
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"endothelial cells, epithelial cells, collagen, elastic tissue, PGCs, fibroblasts, mast cells, lymphocytes, monocytes"
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what are the 3 catagories of intersitial disease
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"fibrosing, granulomatous, smoking related"
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"exuberant fibroblast proliferation caused by some exogenous agent, giving lungs firm rubbery texture with honey combing"
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Idiopathic pulmonary fibrosis
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what forms the honey combs in intersitial disease
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hyperplastic type II pneumocytes
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middle age pt with progressive dry cough over a period of years
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IPS
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what are the 2 patterns of Nonspecific interstitial pneumo
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"cellular pattern (chronic inflammation)
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young dyspnic pt with dry cough
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nonspecific interstitial pneumo
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"cough, dyspnea, lesions are all same age, focal, resolves spontaneously, no honey comb or fibrosis"
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cryptogenic organizing pneumo
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immunologic factors in sarcoid
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"cell mediated response to an antigen. T helper cells accumulate in interstitium and expand, activate macros and poof granuloma"
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Genetics in sarcoid
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HLA A1 and B8
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Morphology of sarcoid
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"large # of non caseating gran. various sizes all over longs, some invovle peritracheal LN. Schauman bodies: laminated concretions
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Mikulicz Syndrome
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Salivary and lacrimal gland involvement
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in ruling out sarcoid what else can give non caseating granuloma
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hypersensitivity pneumo
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"rapid onset of fever, dyspnea, leading to resp failure, non specific findings"
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acute eosinophilic pneumonia
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"irregular intrapulmonary densities with increased eosinophils, transient lesions and no destruction of parychema"
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simple pulmonary eosinophilia
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"Macrophages in lungs, interstitial fibrosis, clubbing, common in older men"
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Desquamative interstitial pneumonia
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male smokes with dyspnea and cough. submucosal and peribronchial lymphocyte infiltraion
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Resp Bronchiolitis interstitial lung disease
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spores enclosed in a sac- like structure"
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zygomycosis
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what fungal infection are diabetics at increased risk for
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rhinocerebral disease by zygomycosis
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Pneumocystis jiroveci
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"person to person spread via air
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"fever, dyspnea, non productive cough, hypoxemia, bilateral diffuse infiltrates"
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PCP
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Tx for PCP
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Trimethoprim-sulfamethoxaxole
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Penicillium marneffei
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"SE asia, dimorphic, yeast in humans. Tx with Ampho-B switch to intraconazole eventualy"
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Azoles
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"P450, stop ergosterol production, triazoles used more (fluc, intra, voric, and posac)"
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Ampho-B
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Pores into fungus via ergosterol
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Tx for endemic mycosis
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"Ampho- IV
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Tx for coccidiodes
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"with sx- fluc or intra
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Tx for histoplasmosis
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"sx- intra
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Tx for Blastomycosis
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"sx- intra
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how is M. pneumoniae differententiaed from other mycobacteria
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it can metabolize glucose
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What kind of pneumonia does M. pneumoniae cause
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broncopneumonia
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"Non productive cough with rhonchi and rales, min sputum non purulent, can get rashes"
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TB
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Tx for TB
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tetracycline or erythromycin
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what is unique about chlamydia's growth
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"only grows inside cells, energy parasite, steals ATP from mitochondria"
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Chlamydia reproduction
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"Extracellular infections elementary body
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Tx for chlamydia
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"Tetracycline, macros, sulfonamids, fluoroquinolone"
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Common lab findings in legionaires
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"low Na
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What gene is important in both types of lung ca
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p53
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cmyc
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small cell
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rb
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small cell
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ras
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non small cell
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p16
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non small cell
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Elevation in bronchial mucosa seen on bronchoscope
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squamous cell CA
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keratin in a ball with a central keratin pearl
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squamous cell CA
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peripher tumor with varied growth pattern
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adenocarcinoma
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"Peripheral carcinoma that does not form discernable mass, doesnt destroy tissue"
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bronchioaveloar carcinoma
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"Satellite tumors surrounding a central tumor, surgery not very usefull"
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mucinous brachioaveolar carcinoma
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"Undifferentiated epithelial tumor, difficult to determine etiology"
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Large cell Carcinoma
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2ndary path of lung ca
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"emphysema
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what paraneoplastic issue is more common in squamous cell
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hypercalcemia
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Lambert-eaton myathenic syndrome
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autoantibodies against neuronal Ca channels
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"patches asymmetric pulmoay opacification, abundant sputum and risk of 2ndary infection"
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Pulmonary Alveolar Proteinosis
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Scrofula
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lymphadenitis of TB
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Issue with TB testing
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Low sensitivity and low specificity
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Definition of Interstitial lung disease
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heterogeneous and associated with inflammatory and fibrotic reactions within the lung
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Chest xray shows streaky spiderweb opacities
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ILD
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Chest xray shows fluffy white diffuce opacities
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"ARDS, pneumo"
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clinical features of ILD
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"Spontaneous PTX, insideous cough/dyspnea, +/- eosinophilic granuloma"
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Exam features of ILD
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"bibasilar crackles, clubbing, pulm HTN"
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Ground glass appearence on CTX
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early finding of ILD
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what is a classic finding in ILD
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exercise O2 desaturation
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What are the major causes of ILD
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"Poisons
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Hilar adenopathy with interstitial disease
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Sarcoid
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Upper Lobe ILD
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"ASSET
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Lower Lobe ILD
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"BAD BASS
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middle lobe ILD
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"Suck-Up (SUCGP)
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Definition of Resp Failure
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"PO2 <50mmHg
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Cardinal signs of Resp failure
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"restlessness, tachy, confusion, disphoresis, jerking, tremors, HA"
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What causes ARDS
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"Shock
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4 Signs of ARDS
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"Diffuse Alveolar infiltrates on xray
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MOA isoniazid
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inhibition of mycolic acid synthesis
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ADR isoniazid
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heptatotoxicity
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MDR TB
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resistant to isoniazid and rifampin
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XDR TB
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"MDR and resistant to FQ and 1 of (amikacin, kanamycin, capreomycin)"
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Why are people easily reinfected by viruses
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"do not induce strong immunity
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viruses that cause rhinitis
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"rhinovirus
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Viruses that cause pharyngitis
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"adenovirus
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Rhinovirus
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"picornavirus
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Coronavirus
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"Nidovirales
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Adenovirus
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"DNA Naked Icosahedral
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Paramyxoviridae family
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"parainfluenzae
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Ribavirin
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"Guanosine analog
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Palivizumab
|
"Monoclonal antibody that prevents fusion
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Parainfluenzae
|
"1,2 cause croup
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Hantavirus
|
"bunyavirus
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Influenza
|
"Orthomyxovirus
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M2
|
ion channel in type A allows acid to uncoat virus
|
|
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Human SA residue
|
"alpha 2,6- galactose"
|
|
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Amantidine and Rimantidine
|
"inhibit M2, so stops Type A flu from uncoating"
|
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Zanamivir and Oseltamivir
|
"inhibits NA, good against A and B flus, H1N1 has shown resistance to oseltamivir"
|
|
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Good prognostic factors for lung CA
|
"Stable weight
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|
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EGFR
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"good factor
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ERCC1
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good but dont use cisplatin
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RRMI1
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High # is good
|
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If pt has rib erosion what cell type are you thinking
|
squamous cell
|
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What do you wanna do with a pt with lung cancer esp squamous cell
|
"float them, they are def hypercalcemic need lots of fluid"
|
|
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Virchow's triad
|
"stasis, hypercoag, endothelial injury"
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|
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what affect in ventilation will you see in PE
|
increase in minute ventilation leading to tachypnea and hypoxemia
|
|
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Sx of PE
|
"dyspnea, pleuritic chest pain, dry cough, leg swelling, leg pain, hemptysis, palpitations, wheezing"
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|
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Signs of PE
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"tachypnea, rales, tachycard, S4, increased P2, DVT, diaphoresis, fever, wheezes, homan's sign, RV lift, S3, friction rub"
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|
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dDx for DVT
|
"Bakers cyst
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|
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dDx for PE
|
"Dissecting AA, Pneumo, Bronchitis, CA, Pericard/pleura, CHF, MI, Asthma, PTX"
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Well's criterea
|
"Score of >4 suggests PE
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Lab findings in PE
|
"Resp alkalosis w hypoxemia
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|
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Wacker's Triad
|
"Inc LDH
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What will is the classic EKG in PE
|
"Large S in I, Q wave in III and inverted T in III
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Westermark sign
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dilation of pulm vessels proximal to embolism allon with collapse of distal vessels
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Hamptons hump
|
triangular infiltrate along the diaphragm usually peripheral and sub pleural
|
|
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LMWH
|
"renal metabolized, ok for pregnancy"
|
|
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advantage to UFH
|
"short T1/2
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|
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Definition of Pulm HTN
|
"Mean PA pressure is >25mmHg at rest
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|
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Group 1 causes of PHTN
|
Primary illness on primary vasculature
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Group 2 causes of PHTN
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Left sided heart disease
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Group 3 causes of PHTN
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"States of hypoxemia
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Group 4 causes of PHTN
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Chronic thromboembolic disease
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Group 5 causes of PHTN
|
"Misc
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|
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Signs of PHTN
|
"Prom P2
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|
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Where in the lung do you see simple coal workers pneumoconisosis
|
upper lobes
|
|
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Complicated CWP
|
"coalescing of nodules increased scaring, central necrosis"
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|
|
most common occupational disease in the world
|
silicosis
|
|
|
lipoproteinaceous material within alveoli with macrophage death and inflammation and fibrosis
|
silicosis
|
|
|
what kind of asbestosis is related to mesothelioma
|
amphibole
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|
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2 types of mesothelioma
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"epitheloid : perinucluear keratin staining, microvilli
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ghon complex
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lymph node and parenchymal lesion
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ghon focus
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greay white inflammation and central necrosis
|
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risk factors for TB
|
"immune suppressed
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dDx for TB
|
lots and lots of stuff
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"For a at risk pt, what is a postitive ppd"
|
5 mm
|
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for an avg person with minimal risk for TB what is a postitive PPD
|
10 mm
|
|
|
ranke complex
|
healed gohn complex
|
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Tb Tx
|
"isoniazid 300 mg
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who do u give inh prophylaxis too
|
"<35 yo with exposure
|
|
|
Standard prophylaxis for TB
|
isoniazid 300 mg for 6-9 mo
|
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what pneumoconiosis puts you at risk for TB
|
silicosis
|
|
|
"proliferation of endothelium, SMC, intima narrowing of vasculature"
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Primary pulmonary HTN
|
|
|
"hemosiderin laden macros, heavy lungs, hemopytosis, hematuria"
|
goodpastures
|
|
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diffuse intermittant alveolar hemrrhage
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idiopathic pumpnary hemosiderosis
|
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Difference between renal involvement in wegeners vs goodpastures
|
"wegener is focal necrotizing concentric glomerulonephritis
|
|
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difference between wegeners and TB
|
"wegeners: geographic pattern of necrosis with mixed cellularity
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|
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What is usually responsible for R mediastinal widening
|
"Ascending Aorta
|
|
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L Mediastinal widening
|
Descending aorta
|
|
|
Mediastinal widening
|
"4 Ts
|
|
|
CMV on control
|
"set volume every time, pt cannot breath on own"
|
|
|
Assist Control CMV
|
"Gives set volume every time, but if pt wants to breath, a negative pressure is created and machine will give another breath"
|
|
|
SIMV
|
"weaning mode
|
|
|
CPAP
|
"no pushing in cpap
|
|
|
PEEP
|
leaves some air in the lungs allow oxygen to happen even during expiration
|
|
|
what stimulates Bicarb resoption in the PT
|
"hypokalemia, angiotensin, CO2, hypercalcemia, hypovolemia"
|
|
|
Winter's formula
|
"pCO2= (Bicarb x 1.5) +8 (+/-)2
|
|
|
Osmo Gap
|
Calculated osmolality = 2 x [Na mmol/L] + [glucose mg/dL] / 18 + [urea mg/dL] / 2.8
|
|
|
what is a normal osmo gap
|
<10
|
|
|
BOOP
|
"Bronchiolotis Obliterans Organizing Pneumonia
|
|
|
What are factors in maintaining pleural Fluid
|
"CLIP
|
|
|
What can cause pleural fluid accumulation
|
"LV failure
|
|
|
What will decrease pleural fluid absorbtion
|
"Lymphatic obstruction
|
|
|
Straight line in lung on CXR
|
pneumohydrothorax
|
|
|
What are the 4 transudive effusions
|
"CHF
|
|
|
What causes high RBC count in pleural fluid
|
"Tumor
|
|
|
What 2 infections should you worry about when CD4 is <200
|
HIV or TB
|
|
|
what occurs first in the HIV pt TB or PCP
|
TB
|
