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Pulmonary Week 2 > Pulmonary General Review > Flashcards

Pulmonary General Review Flashcards

1
Q

In the erect position, pleural pressure is most negative in the ____

A

apex

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2
Q

Where is capillary pressure highest?

A

bases

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3
Q

What is the eqn for O2 content of blood?

A

1.34HbSaO2 + 0.003*PaO2

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4
Q

What is the most importantcontributor to oxygen content of blood

A

Hemoglobin

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5
Q

PND suggest what?

A

suggestive of LV dysfunction however present in other conditions therefore requires further evaluation

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6
Q

Describe normal vesicular breath sounds?

A

prominent inspiration, short passive exhalation with no gap between I & E

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7
Q

Describe bronchial breath sounds?

A

exhalation also prominent; there is a gap between I & E

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8
Q

High-pitched BBS and Egophony are heard in what?

A

consolidation

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9
Q

Difference between CB and emphysema in PFT

A

both have low FEV1:FVC but CB has normal DLCO and emphysema has low DLCO

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10
Q

A restrictive like PFT (low FVC but normal FEV1:FVC) with LOW DLCO is suggestive of what?

A

intrisnic lung disease (IPF, lung resection)

If lung resection, DLCO/Va will be near 100%

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11
Q

Isolated reduced DLCO on PFT suggests what?

A

‘pulmonary vascular disease pattern’

seen in PAH and PE

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12
Q

What is the rescue DOC for COPD?

A

ipratropium

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13
Q

What is the rescue DOC for asthma?

A

albuterol

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14
Q

What is the only modality shown to increase survival other than smoking cessation in COPD?

A

Continuous oxygen therapy if the patient has hypoxia (SpO2 less than 89%)

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15
Q

T or F. Smoking cessation should be addressed at every visit in COPD

A

T.

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16
Q

What is the first controller for COPD?

A

Tiotropium

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17
Q

COPD definition

A

A common preventable and treatable disease, is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases.

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18
Q

T or F. Airflow obstruction is fully reversible in COPD

A

T.

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19
Q

How can you try to prevent exercise-induced bronchospasm?

A

pre-treatment with B-agonist or cromolyn and

slow warm-up helps

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20
Q

How to target eosinophils in asthma?

A

steroids

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21
Q

How is asthma treated?

A

-Albuterol for intermittent asthma

-Add ICS, then LABA, then LTRA, then LAMA/
Omalizumab

22
Q

Why are LABA used before LAMA in asthma?

A

less prominent vagal tone in asthma (conversely, in COPD vagal tone is increased so LAMA is better)

23
Q

Repeated Beta agonist usage can lead to tachyphylaxis. How?

A

by way of down regulation of beta-2 receptors

24
Q

How long does it take pulmonary hemodynamics to return to original levels following PE?

A

in 2-8 weeks

25
Q

How does a PE present on a CXR?

A

Most common is a normal Chest radiograph

Atelectasis (discoid) may be present

Pleural effusions when present are small

26
Q

Why might SaO2 be normal with a PE?

A

Vasodilatation of uninvolved vasculature
helps to decrease the increase in PVR and improves V/Q relationship in uninvolved areas

This improves overall Oxygenation

27
Q

Lab data for a PE?

A

low PaO2, PaCo2 and increased A-a gradient

28
Q

Lights criteria for exudate in pleural effusion

A
  • Fluid protein/serum protein > 0.5
  • Fluid LDH/serum LDH > 0.6
  • Cholesterol over 50

ANY ONE of them= exudate

29
Q

What are some characteristics of a benign lesion in the lungs?

A
  • Well defined nodules (singular)
  • No associated lymph node or mediastinal masses
  • No satellite lesions
  • Calcified nodules
30
Q

What are some types of benign calcifications?

A

-dense, popcorn, lamellar

31
Q

What lung cancer is most associated with smoking?

A

small cell

32
Q

Staging of small cell?

A

limited versus extensive

● Limited→ can include the tumor in one radiation port
○ goal of therapy - cure by radiation + chemo (Etoposide + -platin)

● Extensive→ need multiple radiation ports
○ goal of therapy - improve survival, patients live 3 months w/o therapy, 1 year w/ therapy

33
Q

How are Stage I and II NSCLC treated?

A

Stage I surgery (if surgery cant happen, XRT is given)

II- surgery then chemo

34
Q

How is Stage III NSCLC treated?

A

XRT AND chemo

IIIB- lung tumor is confined to the chest but there is an integral structure involved which means the cancer cannot be removed → not eligible for surgery

35
Q

How is Stage IV NSCLC treated?

A

Chemo (targeted if appropriate); palliative XRT

36
Q

A positive CK-7 (cytokeratin) suggests what?

A

adenocarcinoma/squamous cell

37
Q

A positive CK-20 (cytokeratin) suggests what?

A

colon cancer

38
Q

A positive TTF-1/Napsin A suggests what?

A

lung adenocarcinoma

39
Q

A positive P40/P63 suggests what?

A

squamous cell center

40
Q

What paraneoplastic syndrome is associated what adenocarcinoma?

A

Hypertrophic pulmonary osteoarthropathy (HPO)
/ Clubbing

Painful clubbing, wrists and ankles; new bone formation

41
Q

What are the goals of ‘goal directed resuscitation’ in sepsis?

A

Central venous pressure: 8–12 mm Hg

Mean arterial pressure > 65 mm Hg

Urine output > 0.5 mL/kg/hr

Central venous O2 saturation > 70%

42
Q

What are some patient populations that may be afebrile in sepsis?

A

Very young/old, CKD, DM, Steroid use , NSAIDs, immunocompromised

43
Q

T or F. ARDS is associated with intense inflammation

A

T.

44
Q

Characteristics of ARDS?

A

Severe non-cardiogenic pulmonary edema

Severe hypoxemia due to shunting

Acute decrease in lung compliance

45
Q

What is the purpose of PEEP in ARDS?

A

improves oxygenation by recruiting atelectatic alveoli and increasing functional residual capacity (FRC)

46
Q

What is the most common cause of death in ARDS?

A

multi-organ failure

47
Q

What things improve survival in ARDS?

A

Use of lower tidal volume during mechanical ventilation (MV) reduces mortality

Prone ventilation improves survival

48
Q

Pneumothorax usually seen after the ___ week of ARDS.

A

2nd week

49
Q

Proven therapy for PAH?

A

Epoprostenol and Bosentan

50
Q

What are the 4 Causes of Increased CO2 retention after Supplemental Oxygen?

A

Blunting of Hypoxic Drive

Worsening V/Q mismatch

Haldane Effect

Neuromuscular fatigue

51
Q

Respectability of a tumor depends on what?

A

not only depends on the stage but also the condition/ability of the patient to undergo surgery

For this reason clinicians evaluate patients by way of “performance status”. If performance status is poor, patients will not be able to tolerate surgery, chemotherapy, or even radiation therapy

Pulmonary Week 2 (25 decks)

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