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179 Cards in this Set

  • Front
  • Back
FEV1/FVC in obstructive pulmonary disease
less than normal (.75-.8)
FEV1/FVC in restrictive pulmonary disease
often normal
what should CO2 be in a patient with acute asthma?
low because patient should be hyperventilating
when should you think about intubation?
any patient whose CO2>50 or whose O2<50
what should you do if a patient has a solitary pulmonary nodule on CXR?
compare with old films; if hasn't changed in 2-3 years it is likely benign
solitary pulmonary nodule in an immigrant?
TB; do skin test
solitary pulmonary nodule in Southwest US exposure?
coccidiodes immitis
solitary pulmonary nodule in a cave explorer/exposure to bird droppings/Ohio/Mississippi river valless?
solitary pulmonary nodule in a smoker over age 50?
lung cancer; order bronchoscopy and biopsy
solitary pulmonary nodule in a person under 40 with no risk factors?
in what pre-op patients is CXR standard?
over 60 or known pulmonary or CV disease
what is the best way to reduce post-op pulmonary complications?
stop smoking preoperatively
most common cause of post-op fever in first 24 hours?
what does ARDS cause?
noncardiogenic pulmonary edema, respiratory distress, hypoxemia
what are common causes for ARDS?
sepsis, major trauma, pancreatitis, shock, near-drowning, drug overdose
during what time frame after the initial insult does ARDS develop?
within 24-48 hours
mottled skin, intercostal retractions, rales/rhonchi, no improvement of hypoxia with O2 administration
how do you treat ARDS?
intubation, mechanical ventilation with high percentage O2, PEEP (while addressing underlying cause)
choice of antibiotics in typical pneumonia?
ceftriaxone, broad-spectrum
choice of antibiotic in atypical pneumonia
azithromycin, fluoroquiniolone (e.g. levofloxacin)
college student with PNA?
mycoplasma or chlamydia
alcoholic with PNA
klebsiella, s. aureus, other enterics
patient with cystic fibrosis and PNA
pseudomonas or staph aureus
immigrant with PNA
COPD patient with PNA
H flu, moraxella
patient with known TB with pulmonary cavitation with PNA
PNA and silicosis (metal, granite, pottery worksers)
think TB
PNA in patient with exposure to AC or aerosolized water
PNA in patient with exposure to bird droppings
chlamydia psittaci or histoplasmosis
PNA in child less than one year
PNA in child 2-5 years old
foreign body is most likely to go down which bronchus?
child with recurrent pneumonias in the same location?
foreign body aspiration (esp if right middle or lower lobe)
if a pneumonia doesn't clear within 4-6 weeks, what is the classic culprit?
malignancy - specifically bronchoalveolar carcinoma (subtype of adenocarcinoma)
what causes infant respiratory distress syndrome?
atelectsis froma deficiency of surfactant
in what infants does respiratory distress syndrome occur?
premies and infants of diabetic mothers
what does ABG show in infant respiratory distress syndrome
hypoxemia and hypercarbia
what does CXR show in infant RDS?
diffuse, granular infiltrates (atelectasis)
how do you treat infant RDS?
O2, surfactant, and intubate if necessary
what are complications of acute or chronic mechanical ventilation in kids?
intraventricular hemorrhage and pneumothorax or bronchopulmonary dysplasia
what in the amniotic fluid indicates fetal lung maturity?
lecithin-to-sphingomyelin ratio greateer than 2:1 or the presence of phosphatidylglycerol
what is the preferred test for fetal lung maturity in diabetic mothers?
what can be seen on CXR in diaphragmatic hernia?
herniated bowel
on what side are 90% or diaphragmatic hernias located?
how does diaphragmatic hernia present? what can it cause?
respiratory difficulty; lung hypoplasia
scaphoid abdomen and bowel sounds in chest
diaphragmatic hernia
what is the most common type of TE fistula
esophagus with blind pouch proximally and fistula between bronchus/carina and the distal esophagus
neonate with excessive oral secretions, coughing or cyanosis with attempted feedings, abdominal distention and aspiration pneumonia
TE fistula
how is the diagnosis of TE fistula maade?
inability to pass NG tube; or injection of air via NG under fluoro shows only proximal esophagus
treatment for TE fistula
early surgical correction
rectal prolapse, meconium ileus, esophageal varices
cystic fibrosis
salty tasting infant
cystic fibrosis
what percent of males with CF are infertile? females?
how is CF diagnosed?
sweat test or DNA test
protein level in infected pleural fluid?
glucose level with infected pleural fluid?
what tests do you order if you are trying to determine if a pleural effusion is a transudate or an exudate?
albumin, lactate dehydrogenase
causes of interstitial lung disease
idiopathic pulmonary fibrosis, collagen vascular disease, granulomatous disorders, pneumoconiosis
are lung volumes higher or lower than normal in obstructive lung disease? in restrictive?
higher in obstructive
lower in restrictive
CXR showing reticular pattern that is more pronounced at the bases; honeycomb pattern in severe disease
interstitial lung disease
what type of lung disease presents with shallow, rapid breathing; dyspnea with exercise; non-productive cough?
interstitial lung disease (restrictive)
non-caseating granulomas
in what patients is sarcoidosis typically seen? when does it present?
black females and Norwegians; most often arises in third/fourth decade
drugs associaed with interstitial lung disease?
busulfan, nitrofurantoin, amiodarone, bleomycin, radiation, long-term high O2 concentratin (ventilators)
treatment for sarcoidosis?
systemic corticosteriods
features of sarcoid?
Rheumatoid arthritis
Erythema nodosum
Interstitial fibrosis
Negative TB test
antigen in farmer's lung?
spores of actinomycetes from moldy hay
antigen in bird fancier's lung
antigens from feathers, poop, serum
antigen in mushroom worker's lung?
spores of actinomycetes from compost
antigen in malt worker's lung?
spores of aspergillus clavatus
antigen in grain handler's lung
grain weevil dust
antigen in bagassosis
spores of actinomycetes from surgarcane
antigen in air conditioner lung
spores of actinomycetes from AC
what happens in hypersensitivity pneumonitis?
environmental exposure to antigens -> alveolar thickening and granulomas
CXR in hypersensitivity pneumonitis?
normal or shows miliary nodular infiltrate (acute); fibrosis in upper lobes (chronic)
treatment for hypersensitivity pneumonitis?
avoid ongoing exposure; give steroids to decrease inflammation
complications of asbestosis?
increased risck of mesothelioma and lung CA (worse in smokers)
work involving manufacture of tile or brake linings, insulation, construction, demolition, or building maintenance
biopsy findings in asbestosis
asbestos bodies
CXR in asbestosis
linear opacities at lung bases and pleural plaques
complications of coal mine disease
progressive masssive fibrosis
CxR in coal mine disease
small nodular opacities (<1 cm) in upper lung zones
spirometry in coal mine disease and silicosis is consistent with what?
restrictive disease
work in mines or quarries or with glass or pottery
classic finding on CXR in silicosis
eggshell calcifications; also see small nodular opacities in upper lobes
what are patients with silicosis at an increased risk for?
TB; need annual skin test
work in high-technology fields such as aerospace, nuclear and electronics plants; ceramics industries; foundries; plating facilities; dental materal sites; dye manufacturing
CXR findings in berylliosis
diffuse infiltrates; hilar adenopathy
treatment for berylliosis
chronic steroids
causes of obstructive pulmonary disease
cystic fibrosis
tracheal or bronchial obstruction
define asthma
reversible airway obstruction secondary to bronchial hyperreactivity, airway inflammation, mucous plugging, and smooth muscle hypertrophy
ABG in asthma eacerbation
mild hypoxia and respiratory allkalosis
CXR findings in asthma
what is a methacholine challenge?
tests for bronchial hyperrespnsiveness; allows definitive dx of asthma
when should a methacholine challenge be performed?
at least 3 months after an acute episode
continual day asthma sx; frequent night sx
severe persistent asthma
daily sx; 1 night/wk sx
moderate persistent asthma
2x/wk but <1/day & >2 nights/month
mild persistent asthma
less than 2 days/wk; less than 2 nights/month
mild intermittent
meds for mild intermittent asthma
none daily; PRN short-acting bronchodilator
meds for mild persistent asthma
low dose inhaled corticosteroids; PRN short-acting bronchodilator
meds for moderate persistent asthma
low-medium dose inhaled corticosteroids + long-acting inhaled beta2 agonists; PRN short acting bronchodilator
meds for severe persistent asthma
high-dose inhaled corticosteriods + long-acting B2 agonists; possible PO steroids; PRN short-acting bronchodilator
disease caused by cycles fo infection and inflammation in the bronchi/bronchioles that leads to permanent fibrosis, remodeling, and dilatation of bronchi
how does bronchiectasis present?
frequent bouts of green sputum accompanied by cough, dyspnea, and possible hemoptysis and halitosis
exam in bronchiectasis?
rales, wheezes, rhonchi, purulent mucus, occasional hemoptysis
tram lines on CXR
parallel lines outlining dilated bronchi as a result of peribronchial inflammation and fibrosis
CXR findings in bronchiectasis
tram lines and honeycombing
CT showing dilated airways and ballooned cysts at the end of the broncus (mostly lower lobes)
define chronic bronchitis
productive cough less than/equal to three months per year for two consecutive years
define emphysema
terminal airway destruction that may be due to smoking or to alpha-1 antitrypsin deficiency
centrilobular emphysema
panlobular emphysema
a1 antitrypsin deficiency
dyspnea, pursed lips, minimal cough, decreased breath sounds
emphysema (pink puffer)
productive cough, cyanosis wiht mild dyspnea; overweight with edema, rhonchi, end-expiratory wheezing; JVD, barrel chest
chronic bronchitis (blue bloater)
CXR findings in COPD
hyperinflated and hyperlucent lungs, flat diaphragms, increased AP diameter, narrow mediastinum, large upper bullae
hypoxemia with acute respiratory acidosis (increased PCO2)
treatment of acute COPD exacerbation
O2, inhaled B-agonists, anticholinergics (ipratropium), IV steriods, antibiotics
what vaccines should be given to patients with COPD
pneumococcal and flu vaccines
if patient on ventilator is hypoxic what do you do?
increase O2 saturation by increasing FiO2; increase PEEP or increase I/E ratio
for patients on ventilator who are hypercapnic
increase minute ventilation (by increasing tidal volume or increasing respiratory rate)
pathogenisis of ARDS?
endothelial injury
criteria for ARDS diagnosis?
Acute onset
Ratio (PaO2/FiO2)<200
Diffuse infiltration
Swan-Ganz wedge pressure <18 (no evidence of cardiac origin)
treatment for ARDS
treat underlying disease and maintain adequate perfusion and O2 delivery to organs (use mechanical ventilation with PEEEP and low tidal volumes because of decreased lung compliance)
Definition of pulmnonary HTN
mean PA pressure greater than 25 (normal is <15)
loud, palpable S2 (often split), SEM, S4 or parasternal heave
pulmonary HTN
Virchow's triad
stasis, endothelial injury, hypercoagulable states
respiratory alkalosis (hyperventilation) with PO2 <80
classic EKG triad in PE
S1Q3T3 - S wave in lead I, Q wave in III, inverted T wave in III (acute right heart strain)
risk factors for sleep apnea
male, obesity, sedative use for sleep, nasal obstruction, hypothyroidism, macroglossia, acromegaly
PFTS in sleep apnea?
in what types of patients is central sleep apnea seen?
CHF, CNS disease
in children, what are most cases of sleep apnea due to?
tonsillar/adenoidal hypertrophy
main locations for lung cancer mets
bone, liver, adrenals, brain
type of lung CA highly correlated with cigarette smoke
small cell lung CA
where are small cell lung cancers typically located and what is their origin?
central; neuroendocrine origin
what is the most common type of lung cancer and where is it typically located?
adenocarcinoma; peripherally
lung cancer associated with multiple nodules, interstitial infiltration, and prolific sputum production
bronchoalveolar carcinoma
central location; 98% seen in smokers
squamous cell lung CA
least common lung CAs; associated with poor prognosis
large cell/neuroendocrine carcinomas
treatment for SCLC
not resectable; often responds to XRT and chemo but always recurs
NSCLC treatment
surgical resection in early stages; palliation for symptomatic but unresectable disease
in whom is primary spontaneuos pneumothorax typically seen
tall, thin young males
what is primary spontaneuos pneumothorax due to?
rupture of subpleural apical blebs
what are some causes of secondary pneumothorax?
COPD, TB, trauma, PCP, iatrogenic factors
Presentation of pneumothorax
pleuritic pain
tracheal deviation
onset sudden
reduced breath sounds (and dyspnea)
absent fremitus
x-ray shows collapse
what should you suspect in the presence of respiratory distress, falling O2 sat, hypotension, distended neck veins, and tracheal deviation
tension pneumothorax
treatment for tension pneumothorax
immediate needle decompression followed by chest tube
where do you do needle decompression?
second intercostal space at mid-clavicular line
postpartum female with SOB and hemoptysis
tests to order for suspected choriocarcinoma
BHCG, CXR, pelvic exam
how does PEEP affect CO?
decreases it
what do you use in an acute COPD exacerbation?
bronchodilators and steriods
lung mass in which biopsy shows cartilage
hamartoma - benign
what is the most common inherited disorder that causes hypercoagulability?
factor V leiden - predisposes to DVT
how do you treat aspirin sensitivity syndrome?
leukotriene receptor antagonists
what is aspirin sensitivity syndrome?
persistent nasal blockage adn episodes of bronchoconstriction (pseudo-allergic reaction)
characteristics of allergic bronchopulmonary aspergillus?
asthma-like symptoms, increased Ige, increased eosinophil count, central bronchiectasis
next steps after PNA doesn't heal after 2 wks of appropriate treatment?
CT chest then bronchoscopy to ensure that bronchus isn't blocked and there is no abscess
upper and lower respiratory tract involvement plus glomerulonephritis
test to order in suspected Wegener's
symptoms of theophylline toxicity
headache, palpitations, vomiting (stimulation of epinephrine release)
crepitus over neck and chest in severe asthmatic
subcutaneous emphysema
what do you order when you suspect subcutaneous emphysema?
CXR to rule out pneumothorax
allergic rhinitis, asthma, and prominent peripheral blood eosinophilia
what is seen in up to 75% of patients with Churg Strauss?
peripheral neuropathy
what class of drugs can cause Churg Strauss?
leukotriene antagonists
what is the most serious complication of bronchiectasis?
mucoid colonies, gram-negative bacilli in upper lobe PNA?
pneumonia, hyponatremia, diarrhea
treatment for Legionella?
pleural plaques on CXR
what happens to the A-a gradient in idiopathic pulmonary fibrosis?
increased due to poor oxygenation
what is the most common lung CA associated with asbestosis?
bronchogenic carcinoma
work-up for suspected PE
CXR, ABG, then EKG and V/Q scan
what is the most common cause of constrictive pericarditis in immigrants?
drug of choice for community-aquired pneumonia in inpatients? outpatients?
levofloxacin; doxycycline or azithromycin
what is the only thing known to prolong survival in COPD?
home O2