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PANCE > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

what can dullness on percussion indicate?

A

effusion or pneumonia

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2
Q

What can hyperresonance on pulmonary exam indicate?

A

emphysema or pneumothorax

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3
Q

what does increased tactile fremitus indicate?

A

pneumonia or tumor

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4
Q

what does decreased tactile fremitus indicate?

A

effusion/ pneumothorax

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5
Q

total volume of air exhaled after maximal inspiratin

A

forced vital capacity (FVC)

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6
Q

normal amount of air with each breath

A

tidal volume

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7
Q

normal pH for ABGs

A

7.35-7.45

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8
Q

Normal HCO3 for ABG

A

22-26

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9
Q

4 main conditions that can cause respiratory acidosis

A

COPD, asthma, CHF pneumonia

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10
Q

3 main conditions that can cause respiratory alkalosis

A

hyperventilation, fever, anxiety

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11
Q

Conditions that cause metabolic acidosis (MUD piles)

A 
methanol
uremia
DKA
Propylene glycol
isoniazid
lactic acidosis
ethylene glycol 
salicylates
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12
Q

2 conditions that can cause metabolic alkalosis

A

vomiting, NG suction

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13
Q

triad of asthma

A

airflow obstruction
bronchial hyperreactivity
inflammation

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14
Q

prolonged, severe asthmatic attack
that does not respond to treatment with patient at risk
for ventilatory failure

A

Status asthmaticus :

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15
Q

what will PFTs look like with asthma

A

Decreased FEV1, decreased FEV1/FVC, increased residual volume and TLC

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16
Q

Drugs that – Reverse vagally mediated bronchospasm but not allergen
or exercise induced bronchospasm

A

anticholinergics

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17
Q

Destruction of alveolar walls produces widely

dilated air spaces

A

emphysema

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18
Q

Excessive mucus secretion in the bronchial tree
causing mucus plugging and inflammation,
peribronchiolar fibrosis, narrowing and
obliteration
• Productive cough for at least 3 months during
each of two successive years

A

chrnoic bronhcitits

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19
Q

ABX that help with uncomplicated COPD exacerbations (not >65, FEV1 >50%, >3 exacerbations/year)

A

doxycycline, batrim, macrolide, cephalosporin

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20
Q

ABX good for complicated COPD

A

fluoroquinolones (floxacins), augmentin

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21
Q

abnormal dilataion of the bronchi, chronic purulent sputum, hemoptysis. Ausculatory crackles, digital clubbing

A

Bronchiectasis

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22
Q

Drugs for influenza A

A

rimantadine

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23
Q

drug for influenza A or B

A

zanamivir, or oseltamivir

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24
Q

Major cause of lower respiratory infections of
newborns and children
• Often an epidemic during winter months
• Causes bronchiolitis – inflammation of small
airways

A

RSV? acute bronchiolitits

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25
Q

TX for acute bronchiolitits (RSV)

A

humidified air, oxygen, ribavirin, albuterol, fluids (steroid not recommended in infants)

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26
Q

Highly contagious airborne disease that

classically lasts for 6 weeks before subsiding. Has 3 stages (catarrhal, paroxysmal, convalescent)

A

pertussis (bordetella pertussis)

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27
Q

Tx for pertussis

A

vaccine, macrolides, or bactrim

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28
Q

Parenchymal lung infection
– 1‐10 day history of increasing cough, yellow sputum,
shortness of breath, tachycardia and pleuritic chest pain

A

community acquired pneumonia

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29
Q

typical bacteria that causes CAP

A

mycoplasma, chlamydia, legionella

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30
Q

Lab with CAP

A

luekjocytosis w/ left shift, CXR_ lobal infiltrates

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31
Q

Outpatient Tx for CAP

A

macrolides, doxy, fluoroquinolones

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32
Q

Inpatient tx for CAP

A

fluoroquinolones, macrolide + Beta-lactam

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33
Q

: low grade fever, nonproductive cough,
myalgia, fatigue, mild pulmonary symptoms
that are self‐limited occurring in young
otherwise healthy adults

A

atypical pneumonia

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34
Q

Tx for chlamydia pneumonia

A

tetracycline

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35
Q

Tx for CMV

A

ganciclovir

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36
Q

Treatment for RSV

A

ribavirin

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37
Q

“Caves, Ohio valley, and lower
Mississippi region”, grows in soil with bird or bat
droppings.

A

histoplasmosis fungal pneumonia

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38
Q

tx for histoplasmosis fungal pneumonia

A

amphotericin B, itraconazole

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39
Q

“California disease, valley fever”,

New Mexico area, causes mild sx

A

coccidiomycosis fungal pnuemonia

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40
Q

tx for coccidiomycosis fungal pneumonia

A

fluconazole, or amphotericin B

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41
Q

endemic in N. America around Great
Lakes, Ohio river basin and Mississippi river, broad
base budding organism, extrapulmonary lesions :
skin, bone, prostatitis.

A

blastomycosis fungal pneumonia

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42
Q

tx for blastomycosis fungal pneumonia

A

oral itraconazole

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43
Q

potentially fatal disease,

opportunistic infection in AIDS

A

cryptococcosis fungal pnuemonia

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44
Q

tx for cryptococcosis fungal pneumonia

A

IV amphotericin B + oral flucytosine

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45
Q

immunocompromised individuals,

waterfowl, fungal ball on CXR.

A

treat with any antifungal

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46
Q

Nonproductive cough, dyspnea, fever in an individual with HIV pneumonia. 50% will ahve a normal exam. Increased LDH and ilver stain on sputum. Ground glass ppearance on CXR/CT

A

PCP (pneumocystis jiroveci pneumonia)

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47
Q

Tx for PCP pnuemonia

A

bactrim ?clinda

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48
Q

– Walking pneumonia
– + cold agglutinins
– Bullous myringitis

A

mycoplasma pneumoniae

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49
Q

pneumonia if around

poultry, pet shops

A

chlamydia psittaci

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50
Q

“currant

jelly sputum” common in alcoholics

A

Klebsiella pneumonia

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51
Q

common organism in pneumonia in individuals with cystic fibrosis

A

Pseudomonas

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52
Q

pneumonias from rabbit exposure

A

Tularemia, francisella, tularensis

53
Q

cough, fever, chills, night sweats,

anorexia, fatigue, weight loss , caused from inhaling aerosol droplets

A

Tuberculosis

54
Q

what will you see on CXR with TB

A

cavitary infiltrate in a posterior apical
segment of an upper lobe or in a superior
segment of a lower lobe

55
Q

what will sputum show with TB

A

positive acid fast bacilli

56
Q

Tx for latent dz of TB

A

isoniazid for 9 months

57
Q

4 drug tx for TB

A

isoniazid
rifampin
pyrazinamide
ethambutol

58
Q 
• Acute onset of respiratory failure due to
↑permeability of the alveolar capillary
membranes leading to severe pulmonary
edema, hypoxia and dyspnea
– 30‐40 % mortality
A

ARDS

59
Q

what will the PaO2:FIO2 ratio be with ARDS

A

<200

60
Q

causes of ARDS

A

sepsis, multiple trauma, aspiration, DIC< shock, blood transfusion, pancreatitis

61
Q

Symptoms tachypnea, frothy pink or red sputum, diffuse

rales, dyspnea, severe hypoxemia

A

ARDS

62
Q

what will an ABG show with ARDS?

A

respiratory aidosis (possible acute respiratory alkalosis initially)

63
Q

TX for ARDS

A

reverse the program, broad spectrum abx for sepsis, , diuretics

64
Q

chest pain caused by pleural inflammation, sharp stabbing pain w/ breathing. Sneezing / coughign makes it worse

A

Pleurisy

65
Q

Tx for pleurisy

A

analgesic, NSAIDs, antimicrobials PRN

66
Q

3 main occupational lung diseaes

A

asbestosis, silicosis, coal workers’ pneumoconiosis

67
Q

Diffuse interstitial cellular and fibrotic reaction of the lung to inhaled asbestos fibers

A

asbestosis

68
Q

lung condition that presents with breathlessness, digital clubbing, basilar rales. CSR will show hazy infiltrats in the lwoer lung zones, interstitial fibrosis, thickened pleura, calcified plaques on the diaphragms or lateral chest wall

A

asbestosis

69
Q

what cancer does asbestosis cause

A

mesothelioma

70
Q

lung condition on CXR will show numerous small, rounded opacitites scattered throughout the lungs and hilar lymph nodes may be calcified

A

silicosis

71
Q

lung condition- CXR shows small opacities that are prominent in the upper lung fields. Restrictive dysfunction on PFTs

A

coal workrs pneumoconiosis

72
Q

accumulation of fluid between teh lung and thoracic wall

A

pleural effusion

73
Q

what causes a transudative pleural effusion

A

CHF

74
Q

what are some causes of exudative pleural effusions

A

malignancy, blood (trauma), infection

75
Q

PE with pleural effusion

A

dullness to percussion in lower lung field, decreased breath sounds, decreased tactile fremitus

76
Q

Tx for pleural effusion

A

thoracentesis

77
Q

accumulation of pus in the pleural space

A

empyema

78
Q

Tx for empyema

A

chest tube, abx (will often need thoracoscop or thoracotomy)

79
Q

lymph fluid accumulation int he pleural space to to injury of the thoracic duct by laceration of obstruction by trauma or tumor

A

Chylothorax

80
Q

what will be present in the fluid from a chylothorax

A

triglycerides, it will be milk white

81
Q

Tx for chylothorax

A

chest tube, NPO, TPN

82
Q

PE with pneumothorax

A

Hyperresonance, decreased tactile fremitus, decreased breath sounds

83
Q

Air in the pleural space causing a mediastinal
shift to the contralateral side and impaired
ventilation leading to cardiovascular
compromise

A

tension pneumothorax

84
Q

What will ABGs show with pulmonary embolism

A

respiratory alkalosis, hypoxia

85
Q

What will ECG show with pulmonary embolism

A

tachycardia, anterior ST segment changes, T wave inversion. RBBB, S1Q3T3

86
Q

what is the first choice diagnosis for PE?

A

CT pulmonary angiography

87
Q

Tx for PE

A

oxygen, bed rest, anticoags (heparin, coumadin), thrombolytics (streptokinase, etc), surgery- IVC filter or thromboembolectomy

88
Q

how to diagnose pulmonary HTN

A

right heart catheterization

89
Q

Tx for pulmonary HTN

A

oxygen, diuretics, anticoags

90
Q

• Disease of the right ventricle that results from
pulmonary HTN secondary to pulmonary
disease

A

cor pulmonale

91
Q

causes of acute cor pulmonale

A

PE, ARDS

92
Q

causes of chronic cor pulmonale

A

COPD, restrictive lung disease

93
Q

S/S of cor pulmonale

A

peripheral edema, liver enlargement, neck vein engorgement.

94
Q

medical tx for cor pulmonale

A

oxygen, diuretics, vasodilators

95
Q

what will interstitial lung dz look like on CXR

A

honeycomb lung, ground grass infiltrate

96
Q

how do you diagnose interstitital lung dz

A

biopsy

97
Q

Dz with noncaseating granulomatous inflammation in in affected organs

A

sarcoidosis

98
Q

what will labs with sarcoidosis show

A

hypercalcemia, hypercalciuria, increase in ACE levels

99
Q

CXR have bilateral hilar and right paratracheal adenopathy with diffuse reticular infilatrates

A

sarcoidosis

100
Q

Tx for sarcoidosis

A

corticosteroids

101
Q

• Progressive autoimmune disease of the lungs
and kidneys
• Produces intra‐alveolar hemorrhage and
glomerulonephritis

A

goodpasture syndrome

102
Q

what causes goodpasture syndrome

A

ati-glomerular basement membrane (anti-GBM) antibodies

103
Q

Tx for goodpasture syndrome

A

plasmapharesis and corticosteroids

104
Q

Classic triad : upper respiratory vasculitis, lower
respiratory vasculitis & glomerulonephritis
Often bloody nasal polyps, chronic sinusitis

A

Wegener’s granulomatosis

105
Q

what 2 labs values will be present with wegener’s granulomatosis

A

+ANCA, ESR

106
Q

Tx for Wegener’s granulomatosis

A

cyclophosphamide +/- prednisone

107
Q

Skeletal abnormality that leads to chronic
deterioration in lung function
• Causes increased stiffness of the chest wall

A

kyphoscoliosis

108
Q

Tx for kyphoscoliosis

A

possible meachnical vent support, corrective intervention when angulation >40

109
Q

what are the 5 main anterior mediastinal masses

A 
thymomas
thyroid tumor
teratoma
parathyroid tumor
lymphoma
110
Q

what is the common middle mediastinal mass

A

bronchogenic tumor/ cyst

111
Q

5 common posterior mediastinal masses

A

neurogenic tumor, esophageal tumor, hiatal hernia, meningocele, thoracic spine dz

112
Q

are most solitary pulmonary nodules benign or malignant

A

benign (usually <2 cm, with distrinct margins)

113
Q

What makes a solitary pulmonary nodule more likely to be malignant?

A

patient >45, >2 cm, indistinct margins, rarely calcified

114
Q

Tx for solitary pulmonary nodules

A

thorascopy or thoracotomy w/ biopsy

115
Q

most common benign lung tumor, is a malformation that resembles a neoplasm. On CXR will look like a popcorn lesion.

A

hamartoma

116
Q

most common type of lung cancer, typically metastasizes. Lung periphery, CEA positive

A

Adenocarcinoma

117
Q

2nd most common type of lung cancer. Central bronchi and metastasizes to regional lymph nodes. Will be a hilar mass w/ cavitation on CXR. Hypercalcemia

A

squamous cell carcinoma

118
Q

neuroendocrine lung cancer, quick to metastizie.

A

small cell carcinoma

119
Q

Tx for small cell carcinoma

A

chemotherapy

120
Q

S/S with small cell carcinoma

A

SIADH, paraneoplastic syndrome

121
Q

slow growing lugn tumro often in central bronchi. Patient can have flushing, diarrhea, wheezing, haert valve lesions, HPOTN

A

carcinoid tumor

122
Q

Tx for carcinoid tumor

A

octreotide

123
Q

standard method for determining if someone has a TB infection

A

Mantoux tuberculin skin test (TST)

124
Q

What causes transient tachypnea of the newborn (tachypnea, nasal flaring, subcostal retractions, cyanosis)?

A

retention of fetal lung fluid

125
Q

lung condition with upper and lower respiratory tract vasculitits. Glomerulonephritis and positive ANCA

A

wegner’s granulomatosis

126
Q

tx for wegner’s granulomatosis

A

cyclophosphamide +/- prednisone

127
Q

when will tactile fremitus be decreased

A

effusion or pneumothorax

128
Q

what is decreased with restrictive lung diseases

A

FVC, lung volume

129
Q

cotton dust exposure causes chest tightness and decreased FEV1

A

byssinosis

PANCE (14 decks)

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