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207 Cards in this Set
- Front
- Back
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Sleep Apnea H/P
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fatigue, daytime sleepiness, snoring, gasping/choking during sleep, obesity
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Sleep Apnea Tx
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weight loss
bariatric surg CPAP Phrenic nerve pacemaking for severe cases |
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3 types of apnea
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obstructive, central, mixed
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What commonly causes atelectasis?
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abd surg, asthma, foreign body asp, mass effect from tumors, pulm lesions, lymphadenopathy
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Atelectasis H/P?
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pleuritic cp, dyspnea, fever, dec breath sounds, dullness to perc
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When does atelectasis dev into pna
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72 hours
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How to confirm proper placement of endotracheal tube?
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auscultation, end tidal CO2 should rise after expiration
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When do you switch from endotrach tube to tracheostomy?
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3 wks
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5 predictors of ventilator weaning success
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1. Max ins press <30cm H2O
2. VC >10ml/kg 3. Minute vent <10L/min 4. PaO2:FiO2 >200 5. freq:TV <100 breath/min/L |
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What is croup
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inflammation of larynx causing stridor
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Croup bugs
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Paraflu type1 >2,3
flu RSV Rubeola Adenovirus Mycoplasma pneumoniae |
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common ages for croup
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3-5 mo
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Coup h/p
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barking cough, insp stridor, fever, mild pharyngeal erythema, lymphad
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croup radiology
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steeple sign= subglottic narrowing or airway
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Croup tx
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hydrate
humidified air aerosolized epi/inhaled steroids admit for observation |
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Most common ages for epiglottitis
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2-7 years
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epiglottitis bugs
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Hib, strep, Hflu
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epiglottitis h/p
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dysphagia, drooling, soft stridor, muffled voice, sudden high fever, retractions, leaning forward 'sniffing position', swollen epiglottis
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epiglottitis labs
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swab epiglottis and culture only if prompt intubation is possible cause it could make it worse
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epiglottitis rads?
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thumbprint sign on lateral neck xr
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epiglottitis tx?
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keep child calm, admit, nasotracheal intubation, abx for 7-10 days
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mnemonic for causes of stridor?
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ABCDEFGH
abscess bacterial tracheitis croup diphtheria epiglottitis foreign body gas poisonous hypersens rxn |
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bronchiolitis bug
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RSV or paraflu type 3
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bronchiolitis h/p
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resp distress, nasal cong, cough, wheezing, fever, tachypnea, crackles, prolonged exp phase, hyperresonance
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bronchiolitis rads
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hyperinflation, patchy infiltrates
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bronchiolitis tx
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hyd, hum air, inhaled steroids, B2 agonists
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bronchiolitis complication
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increased risk for asthma
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what is resp dist of the newborn
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preterms are surfactant def = dec lung compliance, atelectasis, resp failure
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resp dist of the newborn h/p
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pres within 2 days, cyanosis, nasal flaring, exp grunting, retractions, RR>60, crackles
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resp dist of the newborn labs
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ABG: dec O2 inc CO2
amnio: is L/S ratio >2 or Phosphatidyl glycerol present in amniotic fluid? If yes, that's good. monitor. If no, give mom steroids in 24 hours prior to delivery if 34-37 wks to increase surf prod |
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resp dist of the newborn rads
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ground glass, b/l atelectasis
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resp dist of the newborn tx
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NICU, maternal steroids within 24 hours of delivery, supp O2, surf replacement
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resp dist of the newborn comp
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inc risk of dev asthma
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meconium asp synd h/p
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meconium stained fluid during delivery, cyanosis, retractions, tachypnea
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meconium asp synd labs
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blood culture to r/o sepsis
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meconium asp synd rads
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atelectasis, areas of hyperinfl, pneumothorax
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meconium asp synd tx
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suction nose, mouth, upper airway, supp O2, maybe surfactant tx, abx
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meconium asp synd comp
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pulm htn, dev asthma later on
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most common fatal autosomal recessive disorder in US
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CF
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what is CF
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AR def in Cl channel in exocrine glands: lungs, pancreas, repro glands, all the ducts get clogged with thick sec
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how long do CFers survive with tx?
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20 to 30
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CF h/p
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recurrent pulm inf, dyspnea, hemoptysis, chronic sinusitis, cough, meconium ileus at birth, steatorrhea, FTT, cyanosis, digital clubbing, rectal prolapse
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CF pulm inf bugs
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Pseudomonas
Staph aureus |
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CF labs
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hyponatremia, sweat test shows increased Na and Cl (>60 in kids, >80 in adults), genetic testing shows CFTR mut
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CF tx
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DNase, chest pt, bronchodilators, nsaids, abx, supp pancreatic enzymes, fat sol vit supp ADEK
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normal Aa gradient
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5-15 mmHg
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normal fev1/fvc
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80%
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obstructive fev1/fvc
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<80%
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restrictive fev1/fvc
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>110%
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what causes increased Aa gradient
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PE, pulm edema, R to L vascular shunts
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pharyngitis bug
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GAS
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what causes false normal Aa gradient
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hypoventilation, high altitude
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complication of untreated strep pharyngitis
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rheumatic heart dz/PSGN
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strep pharyngitis tx
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beta lactams
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lab test for PSGN
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high ASLO titer
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rheumatic heart dz characteristics
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fever
erythema marginatum subq nodules (Aschoff bodies) migratory polyarth mitral prolapse to mitral stenosis elev ESR chorea |
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which PFTs are elevated in obstructive and restrictive dz?
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obs: TLC and RV
rest: fev1/fvc |
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sinusitis bugs
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strep pneumo, Hflu, M catarrhalis, viral
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which sinuses does sinusitis most commonly affect
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maxillary
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Aa grad formula
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713mmHg x .21 - (Paco2/.8) - PaO2
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sinusitis rads
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opacification of sinuses
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sinusitis tx
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amox 2 wks, 6-12 wks in chronic (>3 mo), consider surgical drainage
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bronchitis bugs in smokers
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Strep pneumo, Hfli
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bronchitis bugs in non-smokers
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Mycoplasma pneumoniae
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how to diagnose mycoplasma pneumonia?
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high cold agglutinin titer
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who gets abx for bronchitis?
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smokers, elderly, those with other lung dz
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abx for bronchitis
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fluoroquinolones, tetra, erythro
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admission criteria for pna?
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elderly, comorbids, lab abns, multilobar, signs of sepsis
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viral pna bugs
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flu, paraflu, adeno, cmv, rsv
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6 typical bacterial pnas
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strep pneumo, Hflu, Staph, Kleb, Pseudomonas, GBS
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3 atypical bacterial pnas
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Mycoplasma, Legionella, Chlamydia
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Tx for strep, staph, and Hflu pna
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Beta Lactams
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what about Kleb pna
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alcoholics, long hospital stays, sicklers, currant jelly sputum
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Tx for kleb pna
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ceph, aminoglycosides (genta/tobra)
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what about Mycoplasma pna
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young adults walking pna, positive cold agglutinin test
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Tx for mycoplasma pna
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Macrolides (azithro, clarithro, erythro)
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who often gets pseudomonas pna
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CFers and immunocomp
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Tx for pseudomonas pna
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fluoroquinolones (cipro), aminoglycosides, 3rd gen ceph
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what about legionella pna
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aerosolized water
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Tx for legionella pna
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macrolides, fluoros
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who gets chlamydia pna
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very young and elderly
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Tx for chlamydia pna
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doxy, macrolides
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who gets GBS
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neonates, elderly, nosocomial
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tx for GBS pna
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beta lactams or bactrim
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southwest US pna
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coccidio
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spelunker pna
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histo
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central america pna
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blastomycosis
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tx for fungal pna
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ampho, keto
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what about PCP
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cd4<200, GI sxs
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Tx for PCP
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bactrim
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what is ards
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refractory hypoxemia
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common causes of ards
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AAAARDDDDSSS
aspiration, acute pancreatitis, air/amniotic embolism, radiation, drug od, diffuse lung dz, DIC, drowning, shock, sepsis, smoke inhalation |
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ards labs
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abg: resp alk, dec O2, dec CO2 from hypervent, wedge pressure <18
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ards rads
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b/l pulm edema and infiltrates
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ards tx
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icu, ventilation with peep, maintain sao2 >90%, tx underlying cause, keep fluids low to avoid pulm edema, ecmo in severe cases
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what does it mean when co2 is normal during asthma exac
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mean they're decompensating and gonna crash
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risk factors for tb
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DM, immunosupp, alcohol, lung dz, adv age, homelessness, crowded living cond, health care workers
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TB h/p
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cough, hemoptysis, dyspnea, night sweats, WL, fever, rales
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TB rads
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apical fibronodular infiltrates if reactivated, lower lobes if primary, calcified granulomas/LNs (Ghon complexes)
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TB comp
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meningitis, bone involvement (Pott's dz), widespread dissem to multiple organs (miliary)
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for who is 5mm indurated PPD a positive reading
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hiv+, close contact, signs of tb on cxr
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for who is 10mm indurated ppd a positive reading
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homeless, immigrants, ivda, chronically ill, health care, recent incarceration
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for who is 15mm indurated ppd positive?
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everyone
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describe sxs pattern for 4 classes of asthma severity
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1. mild int: <2x/wk, awaken at night <2x/mo, PEFR >80%
2. mild persistent: albuterol use >2x/wk, awaken at night >2x/mo 3. mod pers: daily sxs, daily alb use, awaken >1x/wk, PEFR 60-80% 4. severe: sxs with minimal activity, rarely >70% PEFR |
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diag crit for chronic bronchitis
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productive cough for 3 mo of year for >2yrs
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2 forms of emphysema
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centrilobular (common), panlobular (alpha1 antitrypsin def)
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how to diff bw emphysema and chronic bronchitis
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emph has decreased DLCO, CB ;has normal DLCO
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when do you initiate home O2 program for COPDers?
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when resting sat of <88%
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emphysema h/p
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cough, morning ha, JVD, dec heart sounds, wheezing, ronchi, accessory muscle use
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emphysema rads
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flat diaphragm, hyperinflated, subpleural blebs, dec vascular markings
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what is bronchiectasis
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dil of sm and med bronchi
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what causes bronchiectasis
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obstructive dz, tobacco, TB, fungal, sev pna, CF
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bronchiectasis h/p
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copious sputum w cough, hemoptysis, wheezing, rales
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bronchiectasis rads
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mult cysts and bronchial crowding on cxr, ct shows dilation of bronchi
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bronchiectasis tx
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pulm hygiene, chest pt, abx, resection of disesed lung
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bronchiectasis comp
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cor pulm, massive hemoptysis, abscess
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diff for solitary pulm nodule?
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granuloma, hamartoma, cancer, carcinoid, pna
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how often are solitary pulm nodules cancerous?
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40%
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what cancers met to lung?
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breast, colon, prostate, endometrial, cervical
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most common lung ca in smokers
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adenocarcinoma
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what do you do when you find a solitary pulm nodule on cxr
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1. compare it to old films
2. CT if yes or not available |
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characteristics favoring benign pulm lesion
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<35, no change from prior films, uniform with smooth margins, <2cm, no LAD, then f/u with cxr 3-6mo
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characteristics favoring cancerous pulm lesion
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smoker, >45, new/progressing, no calcifications or irregular calcifications, >2cm, irregular margins, then FDG-PET or resection
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lung cancer h/p
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hemoptysis, cough, dyspnea, pleuritic cp, freq pulm infections
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4 types of primary LC
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Squam, Adeno, Small cell, Large cell
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which primary LCs are centrally located vs peripherally located
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squams and small cell are central, Adeno and Large cell and peripheral
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characteristics of squam LC
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cavitary lesions, direct extension to hilar LNs
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characteristics of Adeno LC
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wide mets, increased hyaluronidase levels in effusion
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characteristics of small cell LC
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rapidly growing, early distant mets, several paraneoplastic syndromes
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characteristics of large cell LC
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early cavitation late distant mets
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Squam LC paraneoplastic syndromes
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Dermatomyositis, Hypercal
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Adeno LC paraneoplastic syndromes
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Dermatomyositis, DIC, MAHA, thrombophlebitis
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Small Cell LC paraneoplastic syndromes
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Dermatomyositis, Cushings, SIADH, ectopic GH/ACTH, peripheral neuropathy, subacute cerebellar degen, Eaton-Lambert
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Large Cell LC paraneoplastic syndromes
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Dermatomyositis, gynecomnastia
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common lung mets?
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BLAB: breast, liver, adrenals, brain
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laryngeal cancer is usually what type
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squam
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laryngeal cancer assoc with what?
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smoking and drinking
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laryngeal cancer h/p
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worsening hoarseness, dysphagia, ear pain, hemoptysis
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Idiopathic pulmonary fibrosis h/p
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progressive exercise intolerance, dyspnea, crackles, JVD, tachypnea, digital clubbing
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what do Idiopathic pulmonary fibrosis PFTs look like
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restrictive pattern
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Idiopathic pulmonary fibrosis labs?
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bronchioalveolar lavage shows increased PMNs, biopsy shows fibrosis and loss of parenchymal architecture
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Idiopathic pulmonary fibrosis rads
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reticulonodular pattern, honeycombing, ground glass
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Idiopathic pulmonary fibrosis tx
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lung txplant, steroids + AZA/Cyclophos
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Idiopathic pulmonary fibrosis prog
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freq mort within 5 yrs
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what is Sarcoidosis
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noncaseating granulomas and hilar LAD, pulmonary infiltrates and skin lesions
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Sarcoidosis risk factors
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black females between 10-40
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Sarcoidosis h/p
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cough, malaise, WL, arthritis, CP, fever, erythema nodosum on shins and arms, LAD, vision loss, CN palsies
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Sarcoidosis labs
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inc ACE, Ca, alkphos, ESR, hypercalciuria
dec WBC, FVC, DLCO |
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Sarcoidosis rads
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B/L Hilar LAD, ground glass infiltrates
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Sarcoidosis tx
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steroids, usually self-resolving
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what about asbestosis
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insulation, boats, building maintenance, needs pleural biopsy with asbestos fibers seen, rads shows multinodular opacities, pleural eff, blurring of heart/diaphragm, chest CT shows linear fibrosis, comp: malignant mesothelioma, synergistic with tobacco
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what about Silicosis
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mining, pottery, sandblasting, rads shows small apical nodular opacities, hilar LAD, increased risk of TB, progressive fibrosis
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what about Coal worker's dz
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small apical nodular opacities
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what about Beryllosis
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electronics, ceramics, tool manufacturing, pulm edema, diffuse granuloma formation, diffuse infiltrates, hilar LAD, increased risk of LC, may need steroids to maintain lung function
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what PFTs pattern will you see with pneumoconioses?
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restrictive pattern
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what is Goodpasture's
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anti GBM Abs: intraalveolar hemm and GN
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Goodpasture's h/p
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hemoptysis, dyspnea, recent resp inf
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Goodpasture's labs
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+ anti-GBM Abs, PFTs restrictive but with increased DLCO from increased Hb in alveoli, UA shows proteinuria and granular casts, renal biopsy shows crescenteric GN and IgG deposition along glomerular capps
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Goodpasture's cxr
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b/l alveolar infiltration
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Goodpasture's tx
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plasmapheresis, steroids
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6 characteristics of Wegener's granulomatosis
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1. Necrotizing vasculitis
2. Necrotizing noncaseating granulomas in lung 3. Necrotizing GN 4. hemoptysis/hematuria 5. perfed nasal septum/ulcerations of nasopharynx 6. c-ANCA + |
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Wegener's tx
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cytotoxic tx like cyclophos, steroids
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where do PEs usually come from
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95% from DVTs in leg
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7 risk factors for PE
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1. Heredity (genetic hypercoag)
2. History (prior PE or DVT) 3. Hypomobility 4. Hypovolemia (dehyd) 5. Hypercoag (cancer, smoking) 6. Hormones (preg, OCPs) 7. Hyperhomocysteinemia |
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PE h/p
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sudden dysp, pleuritic cp, cough, hemoptysis, syncope, impending doom, fever, tachypnea, tachycardia, loud S2
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PE labs
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inc DDimer, increased Aa gradient, V/Q mismatch
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PE ECG
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sinus tachy, nonspecific st-t changes, anterior t wave inversions, classically S1Q3T3 (inverted T in 3)
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PE rads
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cxr: eff, wedge shaped infarct
v/q mismatch pulm angiography is diagnostic feel like CT angio is the best |
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PE Tx
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supp O2, fluids/pressors, Heparin or LMWH for PTT 1.5-2x normal converted to Warfarin for INR 2-3 for 3-6 mo, IVC filter if can't be anticoagulated, thrombolysis for massive PE
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advantages of LMWH
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does not req PTT monitoring and may be assessed by measuring Xa levels
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what can cause pulm htn
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PE, valvular dz, L to R shunts, COPD, idiopathic
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pulm htn h/p
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dyspnea, fatigue, loud S2 JVD, hepatomegaly, cyanosis, cp
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pulm htn labs
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inc rbc and wbc
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pulm htn ecg
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RVH pattern: RAD, large R wave in V1 that gets progressively smaller in through V6, S wave persists in V5 and V6
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pulm htn rads
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large pulm art and RV
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pulm htn tx
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supp O2, treat underlying cond
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what could cause pulm edema
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left sided failure, MI, valvular dz, arrhythmias, ARDS
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pulm edema h/p
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dyspnea, orthopnea, PND, S3 or S4, peripheral edema, wheezing, ronchi, rales, dullness to perc
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pulm edema labs
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enzymes and inc bmp could point to cardiac cause
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pulm edema ECG
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t wave abn or QT prolongation
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pulm edema rads
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fluid in lungs, cephalization of vessels, Kerley B lines: prominent horizontal interstitial markings in lower lung fields
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pulm edema tx
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underlying cond, salt rest, O2, diuretics, Nesiritide if cardiac
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how can a swan ganz help you in pulm edema
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wedge pressure >18 suggests cardiac cause for pulm edema, but <18 suggests ARDS
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pleural effusion h/p
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dyspnea, pleuritic cp, weakness, dec breath sounds, dullness to perc, dec tactile fremitus, egophony
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Light's criteria for pleural effusion transudative vs exudative
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Transudate:
Pleural:Serum protein <.5 Pleural:Serum LDH <.6 Pleural LDH <2/3 upper limit of serum LDH Total pleural prot: <3g/dl Exudative is opposites |
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what can cause transudative effusions?
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CHF, cirrhosis, kidney dz (nephrotic)
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what can cause exudative effusions?
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infection, cancer, vasculitis, TB
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pleural effusion labs except for light's criteria
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Glucose (low in TB, malig, autoimmune), pH (acidic in TB, malig, empyema), amylase (high in pancreatitis, esophageal rupture, some malig), TG (high in thoracic duct rupture), CBC, gram stain, cytology
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pleural effusion rads
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blunting of costophrenic angles, also get a decub cxr or CT to see if fluid is free flowing or loculated (empyema vs abscess)
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pleural effusion tx
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thoracocentesis and chest tube placement, pleurodesis if recurrent
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how many pleural effusion are due to neoplasm
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1/4
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pneumothorax causes mnemonic
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A CHEST IN
Asthma, CF, HIV, Emphysema, Spontaneous, Trauma, Iatrogenic, Neoplasm |
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pneumothorax h/p
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unilateral cp, dec chest wall mvmt, unilat dec breath sounds, inc resonance to perc, hypoten, JVD, trach dev
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pneumothorax rads
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lung retraction, mediastinal shift away from affected side, tension pneumos will also have trach dev away from side
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3 types of pneumothorax
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closed, open, tension
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pneumothorax tx
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small <15% of lung field supp O2
large >15% of lung field chest tube If tension: needle decompression b/w 4th and 5th at midax line, or b/w 2 and 3rd at mid clav and chest tube |
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what can cause hemothorax
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trauma, malig, TB, pulm infact
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hemothorax h/p
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dyspnea, pleuritic cp, dec breath sounds, dullness to prec, egophony, dec tac frem
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hemothorax labs
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thoracocentesis shows bloody effusion
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hemothorax rads
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same as for pleural eff: blunting of costophrenic angles
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hemothorax tx
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supp O2, chest tube
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hemothorax comp
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thrombi, fibrosis if it isn't drained from pleural space
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when does malignant mesothelioma occur after asbestos exposure?
|
20 yrs
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malignant mesothelioma h/p
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nonpleuritic cp, dysp, dull to perc over bases, mass, scoliosis towards lesion
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malignant mesothelioma labs
|
pleural biopsy
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malignant mesothelioma rads
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pleural thickening, eff, get a CT and/or PET
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malignant mesothelioma tx
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extrapleural pneumonectomy, chemo, radiation
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