Katz 10-3-07 Resp Tract Part 2

Front 1

Pseudomonas is a gram-_____ rod

Back 1

negative

Front 2

the most common pathogen isolated from patients who have been hospitalized longer than 1 week

Back 2

P aeruginosa

Front 3

Pseudomonas AeruginosaX-ray Findings
Resembles _____ pneumonia

Back 3

staph

Front 4

Pseudomonas pneumonia with multiple cystic lucencies

Back 4

?

Front 5

Pseudomonas

Back 5

?

Front 6

Pseudomonas lung abscess

Back 6

round thing

Front 7

Pseudomonas lung abscess

Back 7

round thing?

Front 8

Klebsiella PneumoniaX-ray Findings
Produces excessive amounts of inflammatory ____

Back 8

exudate

Front 9

Klebsiella PneumoniaX-ray Findings

Affected lung gains volume and fissures bulge
Bulging ______ sign

Back 9

fissure

Front 10

Klebsiella with bulging fissure

Back 10

Klebsiella with ....?

Front 11

Cavitating Klebsiella pneumonia

Back 11

?

Front 12

Cavitating Klebsiella pneumonia

Back 12

?

Front 13

Commonest cause of nonbacterial pneumonia

Back 13

Mycoplasma Pneumonia

Front 14

Mycoplasma Pneumonia Primary atypical pneumonia

Organism: ______ agent=pleuropneumonia-like organism (PPLO) – probably a bacterium

Back 14

Eaton

Front 15

1/3 of all pneumonias in service personnel

Back 15

Mycoplasma Pneumonia

Front 16

Mycoplasma PneumoniaX-ray Findings

Acute ______ infiltrate
Lower lobes radiating from hila (early)

Back 16

interstitial

Front 17

Mycoplasma PneumoniaX-ray Findings

Late _______ infiltrates
Usually unilateral and almost always segmental

Back 17

alveolar

Front 18

Mycoplasma pneumonia

Back 18

?

Front 19

Mycoplasma pneumonia with B/L infiltrates

Back 19

?

Front 20

B/L infiltrates

Back 20

Mycoplasma pneumonia with _____

Front 21

Pneumocystis Pneumonia

Fungus pneumocystis ______

Back 21

carinii

Front 22

Pneumocystis Pneumonia

Most common cause of pneumonia in ______ hosts

Back 22

immunocompromised

Front 23

Pneumocystis Pneumonia

Often associated with :
CMV,
herpes simplex, and _______

Back 23

MAI (mycobacterium avium-intracellular complex)

Front 24

Pneumocystis PneumoniaX-ray findings

Most often central location, reticular infiltrate
Resembles ________

Back 24

pulmonary edema

Front 25

Pneumocystis PneumoniaX-ray findings

Pleural effusion ________
Hilar adenopathy does not occur

Back 25

uncommon

Front 26

PCP

Back 26

?

Front 27

PCP

Back 27

?

Front 28

PCP

Back 28

?

Front 29

PCP

Back 29

?

Front 30

SARS produces ______ airspace disease

Back 30

patchy

Front 31

Pneumococcal pneumonia can clear in ___ hrs

Back 31

48

Front 32

Staph produces loculated effusions and pneumato-_____

Back 32

pneumatocoeles

(anything in the pleural space, think staph)

Front 33

Pseudomonas - ____ lobes; multiple small lucencies

Back 33

lower

Front 34

Klebsiella - heavy exudate; bulging __________

Back 34

fissure

Front 35

Suspected pulm infection

If immunocompetent host-->
CXR normal---> ?

Back 35

stop

Front 36

Suspected pulm infection

If immunocompetent host-->
CXR abnormal---> ?

Back 36

medical treatment

F/U with CXR

Front 37

Suspected pulm infection

If immunocompetent host-->
CXR abnormal--->
failed medical treatment-->?

Back 37

HRCT

if nonspecific, do guided BAL

Front 38

Suspected pulm infection

If immunosuppressed host-->
CXR normal---> ?

Back 38

HRCT

if nonspecific, do guided BAL
if specific findings --> medicine

Front 39

Suspected pulm infection

If immunosuppressed host-->
CXR abnormal---> ?

Back 39

see chart

Front 40

with Pneumothorax
Must see _______ pleural white line

Back 40

visceral

Front 41

with Pneumothorax
Absence of lung markings ________

Back 41

peripherally

Front 42

Shift of mediastinal structures ?
none
towards
away

Back 42

None = simple pneumothorax
Away from pneumothorax = tension pneumothorax
Never a shift toward side of pneumothorax

Front 43

Visceral pleural white line marks the edge of the lung

Back 43

?

Front 44

?

Back 44

?

Front 45

tension pneumothorax

Back 45

?

Front 46

Pneumoperitoneum

Back 46

?

Front 47

Cavitary Lung Lesions

the big 3

Back 47

TB
Abscess
Carcinoma

other things - yes, like fungus

Front 48

What kind of cavity?

wall thickness: thick
inner margin: nodular
A/F level: maybe

Back 48

Carcinoma

Front 49

What kind of cavity?

wall thickness: thin
inner margin: smooth
A/F level: no

Back 49

TB

Front 50

t kind of cavity?

wall thickness: thick
inner margin: smooth
A/F level: yes

Back 50

Abscess

Front 51

obvious lesion
thick walled cavity
smooth
no A/F level
could be carcinoma

Back 51

?

Front 52

not sure

Back 52

?

Front 53

not sure

Back 53

?

Front 54

Mycobacterium tuberculosis
The bacilli have 4 potential fates:

Back 54

(1) they may be killed by the immune system,
(2) they may multiply and cause primary TB,
(3) they may become dormant and remain asymptomatic, or
(4) they may proliferate after a latency period (reactivation disease). Reactivation disease may occur following either (2) or (3) above.

Front 55

Mycobacterium tuberculosis
Chest radiographs may show a patchy or _____ infiltrate

Back 55

nodular

Front 56

Mycobacterium tuberculosis
TB may be found in any part of the lung, but ______-lobe involvement is most common.

Back 56

upper

Front 57

Mycobacterium tuberculosis
The _______ view may better demonstrate apical abnormalities

Back 57

lordotic

Front 58

Mycobacterium tuberculosis
Reactivation is indicated by the following:

Back 58

1) Cavity formation is indicative of advanced infection and is associated with a high bacterial load.
2) Noncalcified round infiltrates may be confused with lung carcinoma.
Homogeneously calcified nodules (usually 5-20 mm) are tuberculomas and represent old infection rather than active disease
3) Miliary TB is characterized by the appearance of numerous small nodular lesions, resembling millet seeds, on chest radiography

Front 59

If the TB lesion gets worse or better, it is ______ disease.

Back 59

ACTIVE

Front 60

Homogeneously calcified nodules (usually 5-20 mm) are tuberculomas and represent old infection rather than _____ disease

Back 60

active

Front 61

Ghon Lesion

Back 61

?

Front 62

Calcified Ghon lesion

Back 62

?

Front 63

calcified ghon lesion

Back 63

?

Front 64

Ranke Complex

Back 64

?

Front 65

TB

Back 65

?

Front 66

TB

Back 66

?

Front 67

miliary TB

Back 67

?

Front 68

miliary TB

Back 68

?

Front 69

A solitary nodule in the lung can be totally innocuous or _______

Back 69

potentially a fatal lung cancer

Front 70

Solitary Pulmonary Nodule:
After detection the initial step in analysis is to compare the film with prior films if available. A nodule that is unchanged for how long? is almost certainly benign.

Back 70

two years

Front 71

Solitary Pulmonary Nodule:
If the nodule is completely calcified or has central or stippled calcium it is benign? or malignant?.

Back 71

benign

Front 72

Solitary Pulmonary Nodule:
Nodules with irregular calcifications or those that are off center should be considered suspicious, and need to be worked up further with a _______ or _______

Back 72

PET scan or biopsy

Front 73

Calcification and Lung Nodules:

If Laminated, ?

Back 73

TB granuloma

Front 74

Calcification and Lung Nodules:

If Central or target, ?

Back 74

Histoplasmoma

Front 75

Calcification and Lung Nodules:

If Popcorn?

Back 75

Hamartoma

Front 76

Lung MassesIncidence:

On routine survey, ___% are malignant nodules

Back 76

<5

Front 77

Lung MassesIncidence:

At surgery, 40% of nodules are cancer, 40% _______

Back 77

granulomas

Front 78

Causes of Lung Nodules-in order

Back 78

Granulomas
Bronchogenic carcinoma
Hamartomas
Metastases

Front 79

If a lesion doubles in volume >6 weeks and <16 months, usually benign? or malignant?

Back 79

malignant


What is the lesion if it triples in volume in the same time?
inflammation, maybe

Front 80

How can you tell that a nodule has doubled in volume?

Back 80

Increase in diameter of 25%

Front 81

the most common fatal cancer in the US, accounting for 28% of all cancer deaths

Back 81

Bronchogenic carcinoma

Front 82

Smoking is responsible for as many as _?_% of cases of Bronchogenic Carcinoma

Back 82

85

Front 83

Cell Types of lung carcinoma

Back 83

adenocarcinoma (40%)
squamous cell (17%)
small oat cell (25%)
large cell (15%)
other carcinomas (3%)

Front 84

Chest radiographs may show the following:

Back 84

Pulmonary nodule, mass, or infiltrate
Mediastinal widening
Atelectasis
Hilar enlargement
Pleural effusion

Front 85

Squamous Cell Carcinoma is found in a central location how often?

Back 85

(2/3)

Front 86

What do you see when Squamous cell carcinoma is in the center

Back 86

Mass
Atelectasis
"Reverse S sign of Golden"
Post-obstructive pneumonia

Front 87

What do you see when squamous cell carcinoma is in the Peripheral location (1/3) ?

Back 87

May cavitate

Front 88

Squamous cell carcinoma

Most closely associated with _____

Back 88

smoking

Front 89

Golden S sign

Back 89

?

Front 90

golden s sign

Back 90

?

Front 91

Adenocarcinoma
Usually peripheral nodule

______ lobe distribution (69%)

Back 91

Upper

Front 92

adenocarcinoma

Back 92

?

Front 93

adenocarcinoma

Back 93

?

Front 94

hamartoma

Back 94

?

Front 95

hamartoma

Back 95

?

Front 96

hamartoma

Back 96

?

Front 97

hamartoma

Back 97

?

Front 98

hamartoma
look behind heart

Back 98

?

Front 99

Mediastinal Masses

Anterior (T’s)

Back 99

Terratoma
Thymoma
Thyroid
Lymphoma (t-cell)

Front 100

Mediastinal Masses

Middle

Back 100

Aneurysm
Adenopathy ie. Carcinoma, Sarcoidosis
Lymphoma
Esophagus ie. HH

Front 101

Mediastinal Masses

Posterior

Back 101

Neurogenic (90%)

Front 102

Radiological Mediastinum

Back 102

?

Front 103

Lymphoma

Back 103

?

Front 104

thymoma

Back 104

?

Front 105

thymoma

Back 105

?

Front 106

Aneurysm

Back 106

?

Front 107

Sarcoid
1,2,3 sign

Back 107

?

Front 108

Ganglioneuroma

Back 108

?

Front 109

ganglioneuroma

Back 109

?

Front 110

ganglioneuroma

Back 110

?

Front 111

Chronic Obstructive Lung Disease:
The presence of airflow obstruction due to ________

Back 111

chronic bronchitis or emphysema

Front 112

The airflow obstruction generally is progressive and may be partially reversible in ________

Back 112

chronic bronchitis

Front 113

Chronic bronchitis is defined clinically as the presence of a chronic productive cough for 3 months during each of __?_ consecutive years (other causes of cough being excluded)

Back 113

2

Front 114

Emphysema is defined as an abnormal, permanent enlargement of the air spaces distal to the terminal bronchioles, accompanied by destruction of their walls and without obvious _______

Back 114

fibrosis

Front 115

Chronic bronchitis is defined in clinical terms and ______ in terms of anatomic pathology

Back 115

emphysema

Front 116

Breathlessness is the most significant symptom, but it usually does not occur until the _____ decade of life

Back 116

sixth

Front 117

The primary cause of COPD is exposure to _______

Back 117

tobacco smoke

Front 118

Frontal and lateral chest radiographs reveal signs of hyperinflation, including
?

Back 118

a flattening of the diaphragm,
increased retrosternal air space, and
a long narrow heart shadow.

Front 119

With complicating pulmonary hypertension, the hilar vascular shadows are prominent, with possible ____ ventricular enlargement

Back 119

right

Front 120

HRCT scan is highly specific for diagnosing emphysema, as the outlined _______ are not always visible on a radiograph (usually not necessary for diagnosis)

Back 120

bullae

Front 121

Endotracheal Tubes

Tip should be about 5cm above ___

Back 121

carina

Front 122

Endotracheal Tubes

Tip may change by __cm with flexion/extension

Back 122

2

Front 123

Balloon should never distend tracheal walls; if >2.8 cm, suspect ____

Back 123

laceration

Front 124

Most common malposition: tip in right mainstem bronchus
Leads to ______

Back 124

atelectasis

Front 125

Tube in larynx or pharynx leads to what problems?
_________

Back 125

Damage vocal chords
Aspiration

Front 126

Tracheostomy

Tip half-way between stoma and carina
About what vertebral level ?

Back 126

T3

Front 127

Tracheostomy

Tip placement not affected by flexion/extension
Width of tube about 2/3 width of _______

Back 127

trachea

Front 128

TracheostomyProblems:

Immediately after (3)

Back 128

Subcutaneous emphysema
Pneumomediastinum
Pneumothorax

Front 129

Tracheostomy

Cuff should not be >1½ times diameter of _____

Back 129

lumen

Front 130

Long term Tracheostomy complication

Back 130

Tracheal stenosis

Front 131

Central Venous CathetersProblems

Most often malpositioned in RA or _______
Arrythmias in RA; inaccurate CVP readings elsewhere

Back 131

internal jugular

Front 132

Central Venous CathetersProblems:

Occasionally outside blood vessel
Look for sharp bends in _____

Back 132

catheter

Front 133

Central Venous CathetersProblems:

Arterial placement suggested by _______ flow

Back 133

pulsatile

Front 134

Central Venous CathetersComplications

Back 134

Air embolism
Pneumothorax (5%)
Hemothorax
Cardiac perforation
Sepsis
Venous perforation

Front 135

PICC LinesPercutaneous Intravascular Central Catheters:

Used for long-term intravenous access
Because of small size
Inserted through ______ vein

Back 135

antecubital

Front 136

PICC LinesPercutaneous Intravascular Central Catheters:

Tip should lie within ____

Back 136

SVC

Front 137

Pulmonary Artery Catheters:
Swann-Ganz catheters
Aid in differentiating cardiac from non-cardiac ______ edema

Back 137

pulmonary

Front 138

Pulmonary Artery CathetersWhere:

Tip should lie within right or left pulmonary artery
_?_cm from hila

Back 138

2


Balloon inflated only when measurements are made

Front 139

Pulmonary Artery Catheters Problems:

Most common significant complication is ________
From occlusion by catheter
From embolization off of catheter

Back 139

pulmonary infarction

Front 140

Pulmonary Artery Catheters :

Uncommon complications

Back 140

Cardiac arrhythmia
Pulmonary artery perforation
Intracardiac knotting

Front 141

Pleural Drainage TubesWhere:

Ideal position is anterosuperior for ________

Back 141

Pneumothorax

Front 142

Pleural Drainage TubesWhere:

Ideal position is Posteroinferior for ________

Back 142

effusion



Usually work well no matter where positioned None of the side holes should lie outside of the thoracic wall

Front 143

Pleural Drainage TubesProblems

Back 143

Bleeding 2° laceration of intercostal artery
Laceration of liver or spleen on insertion
Insertion into the lung may lead to
Lung laceration
BP fistula
Rapid expansion of lung may lead to pulmonary edema

Front 144

Pacemakers

Catheter should have _____ curves

Back 144

gentle

Front 145

PacemakersWhere

Tip positioned at apex of _____ ventricle

Back 145

right


Tip may have slight bend as it abuts wall of right ventricle
Not a sharp bend

Front 146

PacemakersWhere:

Some pacers may also have lead(s) in ____ atrium and/or coronary sinus

Back 146

right

Front 147

PacemakersProblems

Back 147

Fracture of leads at pacer, tip or site of venous access
Leads can perforate heart ➙ cardiac tamponade
Look for sharp bends in leads 2° perforation of blood vessel
Leads may be ectopically placed, e.g. hepatic vein
Pacemaker battery may migrate subcutaneously

Front 148

Nasogastric TubesWhere:

Tip should be in _____

Back 148

stomach

Front 149

Nasogastric TubesWhere:

At least __ cm of tube should extend into stomach
Many have side holes that extend up to 10cm on tube

Back 149

10

Front 150

Most commonly malpositioned of all tubes and lines

Back 150

Nasogastric Tubes

Front 151

Nasogastric TubesProblems:

Perforation usually involves ___________
Can also perforate stomach

Back 151

cervical esophagus

Front 152

Nasogastric TubesProblems:

Indwelling tube leads to G-E reflux
May cause esophagitis and ____

Back 152

stricture

Front 153

Feeding Tubes:

Tip of feeding tube should be in _______

Back 153

duodenum

Front 154

Feeding Tubes:
Complications:

Perforation by guide wire
Too proximal ➙ ________

Back 154

aspiration

Front 155

copd

Back 155

?

Front 156

copd

Back 156

?

Front 157

copd

Back 157

?

Front 158

copd

Back 158

?

Front 159

copd

Back 159

?