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71 Cards in this Set

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What are the extrapulmonary manifestations of cystic fibrosis?
The extrapulmonary manifestations of cystic fibrosis include aspermia in males, recurrent partial intestinal obstruction, pancreatic insufficiency, and cirrhosis
List five causes of nodular or cavitary pneumonia?
Cryptococcus
Norcardia
Bacterial lung abcess
Neoplasm
Aspergillus
What is a catamenial pneumothorax?
Catamenial pneumothorax is described as repeated pneumothoraces in women developing within 72 hours of beginning menses.
What is the triad seen in fat emboli syndrome?
Bergman's triad (mental status changes, dyspnea, petechiae)
Which type of COPD is characterized by thin patients with no signs of cor pulmonale, minimal to no cough, hyperinflated lungs with decreased vascular markings, and increased total lung capacity?
Pink Puffer
On chest radiograph, the right hemidiaphragm is usually higher than the left. What are four reasons that there would be elevation of the left hemidiaphragm?
Unilateral hemidiaphragmatic paralysis
Displacement secondary to intraabdominal mass or ascites
Loss of volume on affected side
Subpulmonic effusion
What are the mechanisms of metabolic alkalosis?
Decreased potassium, decreased hydrogen ions, excess HCO3, or chloride losing diarrhea
What is the most common cause of pneumonia in patients on the ventilator 4 days or less?
More than 50% of pneumonias in this setting will be secondary to Staph aureus, Strep pneumonia, or H. influenza
Is there a difference in the PO2 of venous versus arterial blood?
The PO2 will be lower in venous blood
What are the 3 classifications of bronchodilators drugs used with COPD?
Methylxanthines (theophylline)
Beta-adrenergic agonists
Anticholinergic agents (atrovent will compete with ach at its receptors)
List five causes of nodular or cavitary pneumonia?
Cryptococcus
Norcardia
Bacterial lung abcess
Neoplasm
Aspergillus
In what percentage of people will a primary spontaneous pneumothorax recur?
Approximately 50% of patients will have a second episode.
How is the venous pH different from arterial pH?
The venous pH is lower than the arterial pH
Which focal pulmonary fibrosis occurs first in the upper lobes with enlargement of the hilar lymph nodes and is characterized by multiple egg shell calcifications?
Silicosis
What is the definition of massive hemoptysis?
Massive hemoptysis is defined as greater than 600 ml of blood over 48 hours or sufficient enough to impair gas exchange
What is the definition of chronic bronchitis?
Chronic bronchitis is characterized by a productive cough on most mornings for three or more consecutive months for two or more consecutive years
Which DVT location is associated with the highest risk of a pulmonary embolus?
Deep vein thrombosis above the knee have the highest incidence of resulting in a pulmonary embolus
What is the definition of chronic bronchitis?
Chronic bronchitis is defined as the presence of a productive cough that persists for at least 3 months for 2 consecutive years.
What are the most common causes of massive hemoptysis?
Tuberculous cavitation
Pulmonary mycetomas
Bronchiectasis
Pulmonary alveolar hemorrhage
Cystic fibrosis
Neoplasms
What is the most common symptom of a pleural effusion?
Dyspnea
Is there a difference between venous PCO2 and arterial PCO2?
The venous PCO2 will be higher than the arterial PCO2
What does the term 'blue bloater' describe?
Chronic bronchitis - these patients have chronic cough and peripheral edema secondary to cor pulmonale. They do not appear short of breath and do not feel oxygen deprived
What are the classic EKG changes seen in pulmonary embolism?
Tachycardia and S1Q3T3
What are the two general mechanisms of increased shunt fraction?
Under ventilation
-pneumonia
-pulmonary edema
-respiratory distress syndrome
-mucous plugging

Overperfusion
-loss of pulmonary vasculature
-massiv
List five indications for intubation and mechanical ventilation?
Inadequate oxygenation
Inadequate ventilation
Airway obstruction
Airway protection
Increased work of breathing
Are lung transplants being performed in patients with cystic fibrosis?
Lung transplants are being done in patients with cystic fibrosis who have a FEV1 of less than 30% predicted value
Where is the cystic fibrosis gene locus found?
The cystic fibrosis gene locus is found on the long arm of chromosome 7
What is indicated by a V/Q mismatch <1?
A V/Q mismatch <1 means that the blood flow to a region exceeds the amount of alveoar gas in that region
What is the effect of pressure supported ventilation?
This decreases the work of breathing and increases spontaneous ventilation in patients with respiratory failure
What is the most common etiology of pneumothorax related to lung disease?
COPD
What happens to the PCO2 in respiratory alkalosis?
The PCO2 is decreased in respiratory alkalosis
What is the most common cause of a chronic cough in an immunocompetent patient?
In immunocompetent patients, chronic cough most commonly secondary to postnasal drip syndrome
What is the definition of a hemothorax?
Hemothorax is characterized by plural fluid with a hematocrit which is more than 50% of the systemic hematocrit
What are the most common chest radiograph findings in patients with asbestosis?
Interstitial fibrosis beginning usually at bases and progressing upwards without hilar adenopathy.
What is the other name for Hamman-Rich syndrome?
Idiopathic pulmonary fibrosis
What is the quantity of the normal daily water lost in respiration?
500-700 ml
What is the definitive test for a pulmonary embolus?
A pulmonary angiogram
What are the initial goals when a patient presents with massive hemoptysis?
Stabilize the airway
Maintain oxygenation
Stabilize the vital signs
Establish IV access
What type of plural effusions develop after trauma or obstruction to the thoracic duct?
Chylous effusions can develop in this setting and are associated with plural fluid triglycerides > 115 mg/dL
Which sleeping disorder results from increased weight on the chest wall and diaphragm resulting in compression of the lungs during sleep?
Obesity hypoventilation syndrome
What are the eight mechanisms of development of pleural effusions?
Decreased oncotic pressure
Increased hydrostatic pressure
Trauma or obstruction to the thoracic duct
Decreased pleural pressure (such as a ptx)
Obstructed lymphatic drainage
Diaphragm abnormalities
Iatrogenic
Mic
What are 3 causes of respiratory acidosis?
Intrinsic lung disease
Chest wall disease
CNS depression of the respiratory center
What percentage of patients on ACE inhibitors develop a dry chronic cough?
10-15%
Which two ventilator settings provide end expiratory pressure exceeding ambient barometric pressure, which can result in increased end expiratory volumes and improved V/Q ratios?
PEEP- postitive end expiratory pressure
CPAP- continuous positive airway pressure
What is Mendelson's syndrome?
Chemical pneumonitis secondary to aspiration of stomach contents
On chest radiograph, the right hemidiaphragm is usually higher than the left. What are four reasons that there would be elevation of the left hemidiaphragm?
Unilateral hemidiaphragmatic paralysis
Displacement secondary to intraabdominal mass or ascites
Loss of volume on affected side
Subpulmonic effusion
Oxygen therapy should attempt to maintain PaO2 just over 60mmhg. What are the two phases of oxygen toxicity?
Acute exudative phase
Chronic proliferative phase
What are two common symptoms associated with oxygen toxicity?
Substernal chest pain
Non-productive cough
What is the most common complication of pneumococcal pneumonia?
Empyema
If the PaCo2 of an arterial blood gas is increased by 10, what is the effect on pH?
PaCo2 increased by 10 = pH decreased by 0.08
What happens to the PCO2 in respiratory alkalosis?
The PCO2 is decreased in respiratory alkalosis
Which organisms most commonly cause nosocomial pneumonia?
Gram negative organisms (Pseudomonas, Klebsiella, E. coli, Enterobacter)
What are the Light's criteria for exudative pleural effusions?
Pleural fluid protein to serum protein ratio >0.5
Pleural fluid LDH to serum LDH >0.6
Pleural fluid LDH >2/3 upper normal of serum LDH
Which disorder is characterized by central obstructive apnea during sleep and daytime somnolence?
Sleep Apnea syndrome
What are the blood gas findings of a mixed respiratory acidosis and a metabolic alkalosis?
These patients will have a near normal PH with increased HCO3 concentration and an increased PCO2 concentration
What percentage of malignant pleural effusions are transudative?
Approximately 10-20%
List nine causes of pleural effusions?
Pulmonary infection
CHF
SLE/Rheumatoid arthritis
Pancreatitis
Trauma
PE
Renal disease
Cirrhosis
Malignancy
How often do patients with cystic fibrosis have the 508th amino acid missing in the cystic fibrosis transmembrane regulator (CFTR) protein?
Approximately 70% of patients with cystic fibrosis will have this Delta F508 change
What are three aids to spontaneous ventilation and oxygenation that can be used in the setting of respiratory failure?
Continuous positive airway pressure
Pressure support ventilation
Helium-Oxygen mixtures
What is the most common cause of chylothorax?
Mediastinal tumors, most commonly lymphoma
What are five findings in atelectasis?
fever
decreased breath sounds
tachypnea
tachycardia
increased density on CXR
What should be the primary goal of the history and physical in a patient with hemoptysis?
Rule out the GI tract and nasopharynx as the source of bleeding
Estimate the quantity of bleeding
Evaluate for etiology of hemoptysis
Which occupation related disease is associated with the cotton industry?
Byssinosis
What is the triad seen in fat emboli syndrome?
Bergman's triad (mental status changes, dyspnea, petechiae)
How do you differentiate cardiogenic pulmonary edema from non cardiogenic pulmonary edema (ARDS)?
With pulmonary capillary wedge pressure which reflects the left ventricular filling pressure. The PCWP is normally 6-12 mmhg. This will be increased if pulmonary edema is secondary to cardiogenic causes, but will be normal in ARDS.
Which ventilator setting delivers a breath when the patient initiates a breath, and has a backup mechanism that delivers a breath if the patient does not initiate a breath?
Assist/Control ventilation
Which disorder is characterized by decreased vital capacity, normal expiratory flow rate, normal maximum voluntary ventilation, decreased TLC, decreased compliance, and decreased diffusion of carbon monoxide?
Restrictive ventilatory defect
What are 3 causes of respiratory acidosis?
Intrinsic lung disease
Chest wall disease
CNS depression of the respiratory center
What are the common pleural fluid findings in the setting of pleural effusions secondary to rheumatoid arthritis?
Glucose < 30
LDH > 1000
pH <7
Describe the findings of Cor pulmonale?
These patients have cough with prominent sputum production, persistent signs of right heart failure, frequent periods of profuse oxygen desaturation, and a depressed cardiac output.
What are the indications for placement of a chest tube?
Empyema
Loculation on the chest radiograph
Pleural fluid glucose less than 40-50 mg/dL
Positive culture or gram stain of pleural fluid