Del Paine Midterm Flashcards
(126 cards)
0
Q
What are the (4) functions of the the lungs?
A
(1) oxygenation of the blood
(2) excretion of CO2 and other volatile substances (eg alcohol)
(3) works with the kidney to maintain acid/base balance
(4) clears inhaled particles by cilia and cough
(5) immune function
1
Q
What are the (3) functions of the nose?
A
(1) warms and humidifies inhaled air
(2) produces 1 quart of fluid per day
(3) filters incoming air removing particles as small as 1 micrometer
2
Q
What are (5) symptoms of pulmonary disease mentioned by Del Paine?
A
(1) cough
(2) dyspnea
(3) pain
(4) sputum
(5) hemoptysis
3
Q
What is cough caused by?
A
Produced by any irritation of the upper airway, lower airway or diaphragm.
4
Q
What are (2) things that can produce dyspnea?
A
(1) hypoxia
(2) hypercapnia
5
Q
What are two types of dyspnea that an individual can get?
A
(1) DOE
(2) SOB
6
Q
How much lung function (%) is decreased at rest for one to feel dyspnea?
A
30%
7
Q
What is a non-pulmonary system that could cause dyspnea?
A
Cardiac function and volume.
8
Q
Where does pulmonary associated pain come from? (4)
A
(1) Parietal plura
(2) bony structures
(3) diaphragm
(4) airways
9
Q
Does the lung parenchyma have pain fibers?
A
Nope.
10
Q
Sometimes referred pain can cause a patient to think they are having pain associated with the pulmonary system. However, their pain could be caused from _______.
A
Shoulder pain could be referring to above and below the diaphragm on the ipsilateral side.
11
Q
What are (4) characteristics (or lack thereof) of sputum that can give you diagnostic information?
A
(1) Quantity - more sputum than usual?
(2) color - yellow or green?
(3) consistency- viscous
(4) lack of sputum - indicates an infection in COPD ptx (who normally cough up sputum)
12
Q
What are two types of hemoptysis?
A
(1) blood tinged sputum
2) frank blood (may indicate lung cancer
13
Q
What are four diagnostic tests that would be useful in assessing lung function?
A
(1) X-ray
(2) PFTs
(3) ABG
(4) CT scan
14
Q
What diagnostic test is not useful for the lungs?
A
An MRI (because of the time needed for the imaging)
15
Q
Spirometry is a PFT- what (5) lung volumes does it examine?
A
(1) TLC
(2) TV ~500mL
(3) IRV ~3L
(4) ERV ~1L
(5) RV ~1.2L
16
Q
What are the (4) categories of pulmonary pathology?
A
(1) infection
(2) obstruction
(3) restriction
(4) vascular disease
17
Q
What are (3) different types of obstruction for the lungs?
A
(1) cancer
(2) aspiration
(3) mucus plug
18
Q
There are two types of vascular pulmonary diseases. What are they?
A
(1) primary - pulmonary embolus/hypertension
(2) secondary - pulmonary edema secondary to heart failure
19
Q
What causes squamous metaplasia (pulmonary)?
A
Smoking
20
Q
What is squamous metaplasia?
A
A benign (non-cancerous) change of epithelium (surface lining cells) to squamous cells.
21
Q
What are the (3) main components of tobacco smoke?
A
(1) nicotine
(2) tar
(3) carbon monoxide
22
Q
There are (12) smoking induced cancer.
A
(1) lung (2) nasopharynx (3) oral mucosa (4) tongue (5) larynx (6) cervix (7) esophagus (8) stomach (9) pancreas (10) kidney (11) bladder (12) colon
23
Q
What are (4) types of pulmonary infection?
A
(1) alveolar infiltrate
(2) interstitial infiltrate
(3) pleural disease
(4) abscess
24
There are 6 types of infectious pneumonia.
(1) mycoplasma
(2) bacterial
(3) TB
(4) Fungus
(5) nosocomial
(6) aspiration
25
What are the (2) causes of pleural fluid?
(1) transudative
| (2) exudate
26
What are the (3) different types of transudative fluid in the pleural spaces? (Hint: protein contents are low)
(1) CHF
(2) Cirrhosis
(3) nephrotic syndrome
27
What are the (6) different types of exudate fluid in the pleural spaces? (Hint: protein contents are high)
(1) pneumonia
(2) pulmonary embolus
(3) cancer
(4) pancreatitis
(5) trauma
(6) chylous
28
Obstructive Airway Disease a a generic term that encloses several (3 common & 3 less common)
(1) asthma
(2) emphysema
(3) chronic bronchitis
Less common:
(1) glass blowers
(2) trumpet players
(3) alpha 1 antitripsin deficiency
29
What is the definition of asthma?
A decrease in FEV1 which improves by at least 12% with a bronchodilator OR positive methacholine challenge.
30
What are some symptoms of asthma?
- cough
- wheezing
- SOB
- EIB (exercise induced bronchospasm)
- chest tightness
- nocturnal SOB
31
There are several purposes of office Spirometry. Name some (5)
(1) to estimate severity of asthma
(2) evaluate reversibility of pulmonary pathology
(3) assessment of compliance with medication
(4) determine if therapy can be increased/decreased
(5) evaluate smokers over 45 y.o. For obstructive lung disease
32
What does it mean for a patient to be diagnosed with COPD?
The ptx now has an irreversible airway dysfunction
33
What are the (3) types of COPD?
- Emphysema
- chronic bronchitis
- alpha 1 antitrypsin
34
There are 4 mentioned restrictive lung diseases?
(1) interstitial scarring
(2) pleural scarring
(3) pregnancy
(4) obesity (>40) - pickwickian syndrome
35
What are some (4) secondary vascular diseases in the lungs?
(1) left heart failure
(2) mitral stenosis
(3) regurgitation
(4) pulmonary arteriole hypertension
36
What are (8) risk factors for pulmonary hypertension?
(1) obesity
(2) recent surgery (especially pelvic, abdominal, limb)
(3) immobility
(4) hyper-coagulable state
(5) Mechanical obstruction of LE (pregnancy)
(6) heart disease
(7) cancer
(8) drugs (estrogen, nicotine)
37
What is westermark sign?
Dilation of pulmonary vessels proximal to the embolism along with collapse of distal vessels (sharp cut off seen on X-ray)
38
Where can an MI refer pain to?
Between the scapula, jaw pain, neck pain, UE pain.
39
Where can aortic aneurysm refer pain to?
Pain between the scapula, low back pain, left flank pain
40
Where can renal/urologic pain refer to?
Low back pain and shoulder pain
41
Pleuropulmonary pain can refer to what parts of the body?
Shoulder and between the scapula, or anywhere over the lung fields.
42
If a patient is having paraspinal pain that worsens upon respiration, what might this indicate?
Pleuritic type pain
43
If a patient is obese and has just had pelvic surgery, what should you be worried about?
Pulmonary embolus
44
What should you be worried about for a patient who has pain along the clavicle and shoulder in a smoker who has not responded to therapy?
Cancer (because of smoker and pain that doesn't resolve)
45
A 68 y.o. patient is post op knee replacement and is SOB. He has a history of COPD. What should we ask him?
Is this your baseline SOB?
46
A 82 y.o. female is referred for mid back pain radiating around the chest to the sternum. She has IPF which she has been taking prednisone for. What is wrong?
Compression fracture (somewhere between T4-T9) because of the prednisone
47
47 y.o. male is having radiating back pain and jaw pain. He has a long history of GERD. Could this be causing the referred pain?
Yes.
48
67 y.o. smoker with diabetes (TII) has pleuritic pain that has worsened in the past 2 weeks. In addition has lost 5 pounds in 3 weeks. What are the possible pathologies?
(1) pneumonia
(2) pulmonary fibrosis
(3) cancer
(4) rib fracture
49
What are 4 things that can effect Cardiac output?
(1) sympathetic/parasympathetic output
(2) hormones
(3) volume status
(4) pressure of arteries and veins
50
What are the (5) diseases of the CV system?
(1) structural abnormalities
(2) conduction system problems
(3) hypertension
(4) CHF
(5) atherosclerotic vascular disease
51
What are the 7 causes of chest pain?
(1) cardiac muscle
(2) pericardium
(3) ribs
(4) esophagus
(5) aorta
(6) parietal pleura
(7) diaphragm
52
What are (3) structural diseases of the heart?
(1) valve deformity
(2) congenital ASD - atrial septal defect
(3) congenital VSD
(4) Marfans
53
What are (3) mentioned conduction abnormalities? (And which is most common)
(1) atrial abnormalities (most common) - include afib, flutter, PVC
(2) ventricular abnormalities
(3) QT prolongation - can lead to cardiac death
54
What are (5) things that can increase sympathetic tone (and will increase SBP)?
(1) pain
(2) anxiety
(3) fever
(4) hyperthyroidism
(5) exercise
55
What percentage of patients with hypertension have primary hypertension?
95%
56
What are (3) types of secondary hypertension?
(1) adrenal/hormonal causes
(2) renal artery stenosis
(3) coarctation of the aorta
57
What (8) risk factors are there for hypertension?
(1) genetics (including race)
(2) obesity: men and post-menopausal women
(3) drugs: Effexor, HRT, cyclosporine, NSAIA, anti-depressants, cocaine, Ritalin
(4) age
(5) heavy alcohol consumption
(6) sedentary lifestyle
(7) diabetes
(8) smoking
58
What is the goal for patients hypertension?
Lower BP to less than 125/85 in patients with diabetes and renal disease
59
What are the (4) possible treatments of HTN?
(1) drugs
(2) exercise
(3) weight loss
(4) smoking cessation
60
What is orthostatic hypotension?
Changes in BP with change in position.
61
What are (5) causes of orthostatic hypotension?
(1) autonomic neuropathy
(2) POTS (postural orthostatic tachycardia syndrome)
(3) cortisol deficiency
(4) BP meds
(5) aging
62
What are the (6) symptoms of low blood pressure?
(1) dizziness and unsteadiness
(2) syncope -LOC
(3) blurred vision
(4) confusion
(5) pallor
(6) tremor
63
What is vasovagal reaction?
Vagal stimulation can result in slowing of the HR, loss of BP and other symptoms of vandal stimulation
64
What is heart failure?
Any change in cardiovascular function which causes an inability to maintain an adequate cardiac output.
65
What are some (7) causes of heart failure?
(1) ischemia
(2) constrictive cardiac disease
(3) valvular disease
(4) abnormalities of electrical conduction
(5) inadequate venous return
(6) sepsis
(7) lung disease
66
What are some (2) examples of constrictive cardiac disease?
(1) cardiomyopathy
| (2) pericardial disease
67
What are some (3) things that can cause inadequate venous return?
(1) blood clots
(2) anemia
(3) bleeding
68
What are (3) symptoms of heart failure?
(1) peripheral edema- both right and left heart failure
(2) SOB
(3) Fatigue
69
What are the (7) signs of CHF?
(1) JVD
(2) diffuse PMI - peruse maximal impulse
(3) Rales in chest
(4) peripheral edema
(5) mitral valve regurgitation
(6) tricuspid regurgitation
(7) hepatomegaly
70
What are (5) drug therapy treatments of CHF?
(1) diuretics
(2) ACE/ARB inhibitors
(3) beta blockers (slow HR)
(4) digoxin
(5) statin
71
What is arteriosclerosis?
Thickening of plaque formation in the arterial system (CAD, PVD, CVD)
72
What are the physiologic changes of the arteries in arteriosclerosis?
- Hardening of the arteries makes them less elastic
| - lack of elasticity results in an increase in BP
73
What are 11 risk factors for atherosclerosis?
(1) age (2) HTN (3) diabetes (4) lipid abnormalities (5) smoking (6) obesity (7) family Hx (8) male (or post menopause) (9) lifestyle (10) chronic inflammation (11) exogenous estrogen
74
What are the symptoms of CAD/ACS?
- 75% occlusion must occur before a lesion is symptomatic
- sudden death (40%)
- angina, chest which may be substernal pressure with or without radiation to back, shoulder of arm
- SOB with exertion
- fatigue
75
How is CAD diagnosed (7)?
(1) clinical response to NTG (nitroglycerin)
(2) abnormal exercise study
(3) radio labeled tracer
(4) coronary angiogram
(5) CT angiography
(6) cardiac enzymes
(7) EKG (with GXT)
76
What is the (4) drug therapies for CAD?
(1) statins
(2) anti platelet agents (warfarin)
(3) beta blockers
(4) ACE inhibitors
77
Is surgery a treatment for CAD?
Yes. Or stents.
78
What is aortic dissection?
A separation of the aortic walls (leads to bleeding)
79
What are some (5) causes/risk factors of aortic dissection?
(1) family Hx
(2) smoking
(3) heart disease
(4) blunt trauma to the chest
(5) genetic disorders (like Marfans)
80
What are (3) symptoms (or lack thereof) of aortic dissection?
(1) chest pain that may radiate to the back or arm and simulate a heart attack
(2) May be asymptomatic
(3) blood pressure differential
81
What are the (4) different types of PVD?
(1) atherosclerotic
(2) embolic
(3) traumatic
(4) inflammatory
82
If an individual has PVD caused by atherosclerosis, what other medical condition are they almost guaranteed to have?
CAD
83
What is thrombophlebitis?
Swelling of a vein caused by a clot
84
What are some triggering events for thrombophlebitis?
- immobility
- prolonged air travel
- bed rest
- neuro/cardiac problem
85
What are some (4) things that increase your risk of thrombophlebitis?
(1) trauma: surgery, varicose veins, childbirth, fracture
(2) lifestyle: smoking, oral contraceptives, HRT (hormone replacement therapy)
(3) hypercoagulation
(4) obesity
86
A patient had an AAA. You are seeing him for general conditioning to regain muscle after atrophy (sedentary lifestyle). He gets chest pain while on the arm bike. Why?
Probably CAD
87
A patient is smoking while taking HRT after hysterectomy. She developed a frozen shoulder after immobilization for humeral fx. Her UE is now swollen. Why?
Thrombophlebitis of the UE
88
A professional athlete just had an ACL reconstruction. You try to extend the knee when he becomes pale, lightheaded, vomits and sweats. Why?
Vasovagal response
89
A student gets struck in the chest with a baseball and briefly has LOC. He has sternal pain and pain upon breathing and is worse in supine. What's wrong?
Pericardial inflammation
| Pain worse during breath indicates pleuritic pain
90
A 55yo male had a stent in his LAD coronary artery (1yr). He is exercising and develops severe SOB and aching in his arm. He stops and takes nitroglycerine which relieves the pain in seconds. Should you resume exercise?
No. (But d-Paine says it depends on baseline)
91
The 55yo male who had taken NTG in your office after SOB and chest pain now complains of leg pain only during exercise. Why?
PVD
92
Is being premenopausal a risk factor for CVD?
No.
93
What is the purpose of the entire gastrointestinal tract?
to provide nutrients and water for growth and metabolism
94
True or false. The GI tract regulates absorption of nutrients.
False. The GI tract does not regulate absorption.
95
What can damage the protective lining of the stomach?
- Aspirin
- alcohol
- toxins
- NSAIDs (through prostaglandin inhibition)
96
For some reason we need to know that 9 liters of fluid are secreted into the lumen of the jejunum and the ilium.
That's it
97
What are some (9) symptoms of GI disease?
(1) nausea and vomiting (2) pain (3) bloating (4) diarrhea (5) constipation (6) bleeding and melena (metabolized blood) (7) anorexia/weight loss (8) pain (9) cramping
98
Why do we vomit?
It's a protective mechanism to remove toxic material from the stomach and duodenum
99
Where is nausea and vomiting controlled?
Brainstem
100
What causes vomiting?
Chemicals in the blood, pain, and disturbed equilibrium can affect vomiting center and trigger vomiting
101
Where do antiemetics effect the body?
The brain to inhibit the vomiting center in the brainstem
102
What is diarrhea?
Excess quantity or frequency of stool.
103
What are two causes of diarrhea?
(1) infection - secretory
| (2) osmotic - non absorbable compound which draws fluid into the intestinal lumen
104
What is constipation?
Prolonged transit of poop
105
What are the three causes of constipation?
(1) poor coordination of pelvic floor muscles during defication
(2) straining at stool without relaxation of pelvic musculature (May result in hemorrhoids)
(3) inadequate fluid or fiber intake
106
What are the (6) diseases of the esophagus mentioned by del Paine?
(1) hiatal hernia
(2) ulcer
(3) decreased motility
(4) stricture&obstruction
(5) infection
(6) Cancer
107
What can referred pain from the esophagus be confused with?
Pain in the esophagus can be referred to the back and simulate the pain from heart disease.
108
What are the (6) diseases of the stomach and duodenum?
(1) dyspepsia
(2) decreased parastalsis
(3) gastritis
(4) ulcer
(5) atrophy
(6) cancer
109
What is dyspepsia?
The medical term for upset stomach
110
What are the (7) risk factors for ulcers?
(1) H. Pylori
(2) NSAIDs
(3) Aspirin
(4) genetics
(5) toxins (alcohol)
(6) smoking
(7) stress
111
What are (4) treatments for dyspepsia/ulcer?
(1) eradicate H. Pylori
(2) eliminate irritants if possible
(3) drugs
(4) stop smoking
112
What are the drugs that treat dyspepsia and ulcer?
(1) antacids
(2) proton pump inhibitors
(3) sucralafate
(4) misoprostel
113
What are the indications for gastric bypass for obesity?
(1) BMI over 40
(2) BMI over 35 with a complication:
- DM -sleep apnea - hypoventilation - pickwickian syndrome
114
What are some (4) factors that make you a candidate for gastric bypass?
(1) supervised dietary failure
(2) obese for greater than 5 years
(3) age 18 to 65
(4) no uncontrolled psychiatric illness
115
What are 5 diseases characterizations of the small intestine?
(1) decreased peristalsis
(2) increased motility
(3) ulcer
(4) diverticulitis
(5) ischemia
116
What is IBS?
-intermittent bloating -cramps -diarrhea -constipation -flatus -mucus -change in stool caliber
Etiology is stress (however 5% of ptx with IBS have undisguised celiac disease)
117
Treatment of IBS?
Tx: tricyclic antidepressants, amitiza, bulk agents, stool softeners
118
What is celiac disease?
An autoimmune disorder with antibodies at gluten.
119
What ethnicity is more at risk for celiac disease?
European based ethnicity (Irish)
120
What are symptoms of celiac disease?
(1) diarrhea
(2) bloating
(3) mucus
(4) iron deficiency
(5) arthritis
121
What are types of IBD?
(1) Crohn's disease
(2) ulcerative colitis
(3) microscopic colitis
(4) aphthous ulcer
122
What are (6) clinical manifestations of IBD?
(1) bloody diarrhea
(2) fecal urgency and cramps
(3) constipation (occasional)
(4) associated with weight loss, abd tenderness, symptom of dehydration
(5) fistula formation in Crohn's
(6) complications (arthritis, hepatic sclerosis)
123
What are the treatments (or way to reduce symptoms) of IBD?
(1) po steroids
(2) topical steroids
(3) immunosuppressants
124
What are the three classifications of diseases of the pancreas?
(1) pancreatitis
(2) pancreatic cancer
(3) obstruction of the pancreatic duct
125
What are the (7) diseases of the colon and anus?
(1) increased mobility
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