Pulm 2

Front 1

What are the 3 basic mech of pleural effusion?

Back 1

i)incr drainage of fluid into pleural space ii)incr production of fluid by cells in pleural space iii)decr drainage of fluid from pleural space

Front 2

What is pathophys of transudative effusion?x2

Back 2

i)elevated capillary pressure in visceral or parietal pleura (CHF); ii)decr plasma oncotic pressure (hypoalbumin)

Front 3

What is pathophys of exudative effusion?x2

Back 3

i)incr permeability of pleura ii)decr lymphatic flow bc damage to pleural membranes or vasculature (inflamm/malig)

Front 4

What ratios do exudative effusions have at least one of? x3

Back 4

i)Pleural protein/serum protein >0.5; ii)Pleural LDH/serum LDH >0.6; iii)LDH>2/3 upper limit of nl serum LDH

Front 5

What are causes of transudative pleural effusions? x3

Back 5

i)CHF ii)cirrhosis iii)PE

Front 6

What are causes of exudative pleural effusion?x4

Back 6

i)Malignancy (esp lung and breast). ii)bacterial pneumonia iii)PE iv)Collagen vasc dz

Front 7

What are 2 sxs of effusion? What are 3 signs?

Back 7

i)a)dyspnea on exertion b)PND/orthopnea c)peripheral edema ii)a)dull to percussion b)decr breath sounds over effusion c)decr tactile fremitus

Front 8

What are the causes of elevated pleural fluid amylase? x3

Back 8

i)esophaeal rupture ii)pancreatitis iii)malignancy

Front 9

what is chylothorax? What does it look like?

Back 9

i)lymph in pleural space ii)milky, opalescent fluid

Front 10

what does purulent fluid mean in effusion? What does bloody effusion mean? How does TB present in effusion? What does pH<7.2 mean in fluid?

Back 10

i)empyema ii)malignancy iii)lymphocytes w/exudative fluid iv)parapneumonic effusion or empyema

Front 11

How do you DX effusion? x3 What is thoracentesis good for? x2

Back 11

i)CXR: blunted costophrenic angle. lateral decubitis is better for small effusions and if loculated vs free flowing ii)CT: better than CXR iii)thoracentesis: a)drains b)4 C's: chemistry (glucose/protein/LDH/pH); cytology; cell count (CBC w/diff); culture (gram)

Front 12

How to treat transudative effusion? exudative?

Back 12

i)trans: diuretics and Na restriction; can do parecentesis if dysneic. ii)exu: treat underlying dz.

Front 13

How to treat parapneunic effusion? uncomplicated vs complicated?

Back 13

i)uncomp: Abx alone ii)compl: a)chest tube drainage b)intrapleural injection of thrombolytic agents(streptokinase) c)surgical lysis of adhesion

Front 14

What is diff b/w parapneumonic effusion vs empyema?

Back 14

parapneumonic is uninfected transudative effusion; empyema is infected parapneumonic effusion

Front 15

Wha is cause of empyema? x2

Back 15

i)usually untreated parapneumonic effusion (exudative). ii)other foci of infection like abscess or mediastinitis

Front 16

What are clinical features of empyema? how to DX?

Back 16

i)those of the underlying cause (ie pneumonia). ii)CXR and CT scan

Front 17

How to treat empyema? x3

Back 17

i)aggressive drainage of pleura and Abx ii)if severe and persistent, rib resect and open drainage

Front 18

What is defn of pneumothorax? What are the 2 types?

Back 18

i)air in pleural space (shouldn't be there). ii)traumatic vs spontaneous (no trauma).

Front 19

What is primary spontaneous pneumothorax? What is it due to? How are the resp reserves?
what are causes of 2ndary (complicated)pneumothorax? x4
What

Back 19

a)primary: no DZ (healthy peeps); due to rupture of sublpleural bleb at apex->collapsed lung. Pts have suff resp reserve. b)secondary (complicated): complication of lung dz (usually COPD; asthma, ILD, TB). Life threatening b/c Lack of pulmonary reserve

Front 20

Which procedures do you always need CXR b/c of traumatic pneumothorax?

Back 20

i)Central line ii)thoracentesis iii)transthoracic needle aspiration

Front 21

What are sxs of pneumothorax? x2 What are signs? x4

Back 21

A)i)ipsilateral CP, usually sudden ii)cough B)i)decr fremitus on that side ii)hyperresonance iii)decr breath sounds iv)mediastinal shift towards pneumothorax

Front 22

What is TX of primary pneumothorax is small? If large? what is TX of secondary pneumo?

Back 22

i)small: observe or one way valve tube ii)large: chest tube drainage. iii)chest tube drainage

Front 23

What is pathophys of tension pneumo and what happens?

Back 23

i)tissue around opening into pleural space is a flap->air in pleural space. ii)collapses opposite lung

Front 24

What are causes of tension pneumothorax? x3

Back 24

i)mechanical ventilation w/ass'd barotrauma ii)CPR iii)trauma

Front 25

What are clinical features of tension pneumothorax? x4

Back 25

i)hypotension: cardiac filling impaired due to compression of great veins ii)distended neck veins iii)decr breath on side collapsed; hyperresonance

Front 26

How to treat tension pneumothorax? Why imp?

Back 26

i)tension in pleural space not relieved->hemodynamic compromise (hypoxemia). ii)chest decompression w/large bore needle, then chest tube placement

Front 27

What is defn of ILD?

Back 27

inflamm process of alveolar wall leading to fibroelastic prolif and collagen deposition->get distorted architecture, fibrosis, impaired gas xchange

Front 28

What are the 6 types of ILD? What are exs of each?

Back 28

i)Environmental lung dz: silicosis, asbestosis ii)Granulomatous ILD: sarcoid; wegener's; Churg Strauss iii)Aveolar filling dz: goodpastures iv)hypersensitivity lung dz: hypersen pneumonitis; eosino pneumonitis v)drug induced; vi)misc: IPF; ARDS; ILD ass'd w/CT disorders

Front 29

What are signs of ILD? x3

Back 29

i)rales at base ii)digital clubbing iii)signs of pulm HTN and cyanosis

Front 30

What diagnostic modalities are there for ILD? x4

Back 30

i)CT is best image ii)CXR: diffuse honeycomb iii)PFTs: restrictive pattern, but all lung vol decr (FEV1 less so). iv)Tissue BX: need for ILD, done w/bronchoscopy

Front 31

What is sarcoidosis?

Back 31

multiorgan systems affected by noncaseating granulomas, lungs usually involved. PX is good

Front 32

What are symptoms of sarcoid for each system involved?
What are systems involved (x5) and what is cause of death of sarcoid?

Back 32

i)constitutional sxs: malaise, fever, wt loss. ii)lungs: dry cough, dyspnea. iii)skin: erythema nodosum iv)eyes: ant uveitis v)heart: arrhythmia or sudden death vi)arthralgias

Front 33

What is the typical presentation of sarcoid?

Back 33

i)young ii)constitutional sxs iii)resp complaints iv)erythema nodosum v)blurred vision vi)bilat hilar adenopathy

Front 34

How to dx for sarcoid? x4

Back 34

Definitive dx: transbronchial BX: noncaseating granulomas. i)CXR: *bilat hilar lymphadenopathy ii)ACE is elevated iii)hypercalciuria/calcemia iv)Decr FEV1/FVC; decr lung vol; decr DLCO

Front 35

How to treat sarcoid?

Back 35

i)most resolve on own ii)steroids if pt w/severe eye dz, heart block, serious lung dz iii)MTX if steroids refractory

Front 36

What is histiocytosis X? What is ass'n? What are findings x4?

Back 36

i)chronic interstitial pneumonia caused by abnl prolif of histiocytes ii)smoking iii)a)dyspnea, b)nonprod cough, c)spon pneumothorax, d)DI

Front 37

What is Wegener's charaterized by? Where does it affect x3? What are manifestations x3? How to DX x2? how to treat?

Back 37

i)necrotizing granulomatous vasculitis ii)vessels of lung, kidney, upper airway iii)a)upper/lower RTI; b)glomneph; c)pulm nodules. iv)tissue BX. C-ANCA. v)steroids and immunosuppressants

Front 38

What is Churg Strauss Syndrome? how does it present x3? What are its ass'n for DX? How to treat?

Back 38

i)vasculitis w/asthma ii)a)pulm infiltrates b)rash c)eosinophilia. iii)a)blood eosinophilia b)P-Anca iv)steroids

Front 39

What are the diff in asbestosis and silicosis for CXR findings? For location?

Back 39

i)asbestos: diffuse fibrosis, pleural plaques in lower lobe ii)Silicosis: local and nodular fibrosis, eggshell calcifications in upper lobe.

Front 40

What are you at increased risks for in asbestosis (x2) and silicosis? (x1)

Back 40

i)asbestos: malignant mesothelioma (bloody effusion) and bronchogenic CA. ii)silicosis: risk of TB

Front 41

What is hypersensitivity pneumonitis? What is hallmark finding? What does the acute form present as and what is treatment?

Back 41

i)inhaled antigenic agent->immune mediated pneumonitis->chronicity=restrictive lung dz. ii)IgG and IgA to inhaled Ag (can have Ig w/o dz tho) iii)flu like feature w/pulm infiltrates on CXR. iv)removal and steroids

Front 42

What is goodpastures due to and what does it lead to? How does it present? How does it get DXd? How to treat?

Back 42

i)autoimmune IgG to glom and alveolar BM (T2HS). ii)hemorrhagic pneumonitis and glomnephritis iii)present w/hemoptysis and dyspnea iv)anti-GBM Igs v)plasmapheresis, cyclophos, steroid

Front 43

how does IPF present and what is px? Who is it common in?

Back 43

i)gradual onset of progressive dyspnea, nonprod cough. ii)very bad iii)men and smokers

Front 44

how to DX IPF? How does CXR look? What is treatment?

Back 44

i)need lung BX, r/o other causes. ii)honeycombed or ground glass on CXR iii)none, but O2, steroids, or lung xplant

Front 45

What is COP? How to treat?

Back 45

i)inflamm lung dz w/similar clinical and radiographic features to infectious pneumonia. ii)resistant to Abx but treat w/steroids. iii)ass'd w/virus, meds, CT dz

Front 46

what vaccinations do you give for COPD for flu A (x2 weeks)? x2 For flu A and B? What if vaccination won't work for the strain?

Back 46

i)amantadine+influenza ii)influenza + oseltamivir(x2 weeks) iii)use oseltamivir for as long as flu is in community

Front 47

what nonpharm intervention prolongs life of chronic airflow obstruction?

Back 47

smoking cessation and lung vol reduction sx

Front 48

what do you do for COPD in absence of hypoxemia or cor pulmonale?

Back 48

pulm rehab, not O2. it helps dyspneic pts who have reduced exercise tolerance despite pharm. No improvement in pulm fcn, oxygenation, or survival

Front 49

What are signs of cor pulm?

Back 49

i)loud P2, ii)paradoxical S2 split iii)EKG changes