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Clin Med > Exam 6 > Flashcards

Exam 6 Flashcards

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1
Q

Emphysema definition

A

Airspace destruction
Loss of elasticity
Enlargement of airspaces distal to terminal bronchiole

Blebs/bullae

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2
Q

Chronic bronchitis definition

A

Hypertrophy of mucous glands, more secretions

Lots of inflammation

Excess mucus, daily productive cough for 3+ months per year x2 consecutive years

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3
Q

COPD and liver disease

A

A1 antitrypsin deficiency, may see cirrhosis and/or hepatocellular CA or emphysema in 3rd/4th decade of life

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4
Q

What decade of life do you see COPD?

A

Usually 5th-6th decade

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5
Q

Early presentation and late presentation

A

Early- dyspnea, productive cough

Late- pneumonia, pulmonary HTN, cor pulmonale, chronic respiratory failure

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6
Q

Exacerbations of COPD description

A

Increased cough, dyspnea, sputum production

Often requires change in therapy

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7
Q

Pink puffers

A

Emphysema

Barrel chest, hyperventilation, weight loss

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8
Q

Blue bloaters

A

Bronchitis

Cyanosis, cor pulmonale, obesity

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9
Q

Emphysema physical exam

A

Quiet breath sounds

Barrel chest

Accessory muscles (tripod, pursed lip, intercostals)

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10
Q

Chronic bronchitis exam

A

Cyanotic, coarse breath sounds, comfortable at rest

Ronchi and or wheezes

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11
Q

When do you perform a bullectomy?

A

If a single bulla occupies 30% or more of hemithorax

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12
Q

Asthma definition

A

Clinical syndrome of 3 components:

  1. Recurrent episodes of airway obstruction that resolve spontaneously or with treatment
  2. Exaggerated bronchoconstriction in response to stimuli, “airway hyperresponsiveness”
  3. Inflammation of the airways
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13
Q

Pathology of asthma

A

Edema and hyperemia of bronchial mucosa

Bronchoconstriction

Infiltration of inflammatory cells and chemokines

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14
Q

4 mediators in acute asthma

A

Acetylcholine
Histamine
Leukotrienes
Nitric oxide

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15
Q

Atopic triad

A

Asthma, allergic rhinitis, atopic dermatitis

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16
Q

Samter triad

A

Asthma, nasal polyps, aspirin sensitivity

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17
Q

Clinical findings of asthma

A 
Episodic wheezing
Difficulty breathing
Chest tightness
Cough with excess sputum
Common attacks at night
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18
Q

Exam findings of asthma

A 
Wheezing
Hyperresonance to percussion
Tachycardia/tachypnea
Hypoxia
Accessory muscles
Nasal secretions, polyps, swelling
Atopic dermatitis
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19
Q

Complications of asthma

A 
Exhaustion
Dehydration
Airway infection
Fainting from cough
Pneumo
Hypercapnia and hypoxia
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20
Q

PEFR suggesting severe obstruction

A

<200 L/min

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21
Q

Sarcoidosis is characterized by…

A

Noncaseating granulomatous inflammation

Involvement of lungs, lumps, eyes, skin, liver, spleen, heart, nervous system

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22
Q

Which races is sarcoidosis most common in?

A

North american black and northern european whites

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23
Q

Symptoms of sarcoidosis

A 
Asymptomatic
Malaise, fever
Cough
Dyspnea
Chest discomfort
Other organ involvement
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24
Q

Signs of sarcoidosis

A 
Skin changes
Lungs (wheezing or normal)
Parotid gland enlargement
Lymphadenopathy
HSM
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25
How often is cutaneous involvement seen in sarcoidosis?
~25% of the time as an early finding
26
Lofgren syndrome
Erythema nodosum Polyarthritis Hilar adenopathy Fever 95% specificity for sarcoidosis
27
Which imaging choice is central to evaluation of sarcoidosis? What do you find?
CXR Symmetric bilateral hilar LAD Diffuse reticular infiltrates
28
What three elements need to be present to make the diagnosis of sarcoidosis?
Compatible clinical and radiographic manifestations Exclusion of other diseases that may present similarly Histopathologic detection of noncaseating granulomas
29
Stage 1 sarcoidosis
Bilateral hilar adenopathy, right paratracheal node enlargement
30
Stage II sarcoidosis
Bilateral hilar adenopathy & reticular opacities
31
Stage III sarcoidosis
Increased reticular opacities | Shrinking hilar nodes
32
Stage IV sarcoidosis
Reticular opacities with evidence of volume loss in lung
33
Pleuritis definition
Chest wall pain due to acute pleural inflammation caused by irritation to the parietal pleura
34
Pleuritic pain
Localized Sharp Fleeting Worse with sneezing, coughing, deep breathing, movement
35
Pleural effusion definition
Accumulation of fluid between parietal and visceral pleura
36
Classifications of pleural effusion
Exudative Transudative Empyema Hemothorax
37
Exudative effusions
Leaky capillaries, often from infection, malignancy, or PE
38
Chylothorax
Disruption or obstruction of thoracic duct resulting in leakage of chyle into the pleural space White, milky
39
Transudative effusion
Increased hydrostatic pressure or decreased oncotic pressure Intact capillaries CHF >90% of cases
40
Physical exam pleural effusion
Decreased tactile fremitus Dullness to percussion Absent/diminished breath sounds Shift of trachea and heart away
41
Which CXR view is most sensitive for pleural effusion?
Lateral decubitus
42
Gold standard to diagnose pleural effusion?
Thoracentesis
43
Grossly purulent fluid
Empyema
44
Light's criteria
Pleural fluid protein : serum protein >0.5 Pleural fluid LDH : serum LDH >0.6 Pleural fluid LDH > 2/3 ULN for serum LDH
45
Solitary pulmonary nodule
3 cm or smaller in diameter Rounded opacity
46
Calcification patterns on CXR that are benign
Diffuse Central Popcorn Laminated
47
Calcification patterns on CXR that are potentially malignant
Stipples Eccentric Spiculated
48
Histoplasmosis
Bird dung Infection Flu like symptoms or asymptomatic
49
Blastomycosis
Fungus in soil Asymptomatic or flu like Infection Rarely calcify or caseate the lungs
50
Coccidioidomycosis
Fungus in soil 60% asymptomatic Moderate flu like symptoms Severe in HIV patients
51
Squamous cell carcinoma
Bronchial epithelium Centrally located Hemoptysis Spread locally, hilar LAD and mediastinal widening **best prognosis
52
Adenoarcinoma
Peripheral nodules or masses Metastasize earlier than squamous cell Better prognosis in bronchioloalveloar cell
53
Large cell carcinoma
Rapid doubling times | Central or peripheral masses
54
Small cell carcinoma
Centrally located, bronchial origin Regional lymph node involvement Aggressive
55
Lung cancer clinical findings
``` Anorexia Dyspnea Weight loss NEW cough or CHANGE in cough Hemoptysis ```
56
T1, T2, T3, T4
T1: <3 cm T2: 3-7 cm T3: >7 cm T4: invasion of organs/vertebrae/carina/tumor nodules in same lobe
57
N0, N1, N2, N3
N0: no lymph involvement N1: ipsilateral bronchopulmonary/hilar N2: ipsilateral mediastinal/subcarinal N3: contralateral hilar/mediastinal, supraclavicular
58
M0, M1
M0: no metastasis m1: bilateral lesions Distant metastasis, malignant pleural effusion
59
Hypersensitivity pneumonitis
Inflammation in the alveoli secondary to hypersensitivity to organic inhaled dusts Acute reaction, can become chronic Microbes, animal proteins, or LMW chemical
60
Acute findings of hypersensitivity pneumonitis
Malaise, chills, fever, cough, dyspnea
61
Chronic hypersensitivity pneumonitis findings
Muscle wasting, weight loss
62
Byssinosis
Inhalation of cotton fiber dust Typically occuring when patients return to work after weekend or vacation
63
Cyanide inhalation
Antidote- hydroxocobalamin Headache, weak pulse, vertigo, abnormal heartbeat, vomiting, death
64
Carbon monoxide exposure
Colorless, odorless, tasteless gas Headache, light headed, flu like symptoms, central nervous system toxicity
65
Physical exam finding on CO inhalation
Cherry red skin (actually pallor is more common from the lack of oxygen)
66
Silo fillers. Disease
Toxic pulmonary edema from acute inhalation of nitrogen dioxide in recently filled silos
67
Pneumoconiosis
Chronic, fibrotic lung diseases secondary to hazardous inhalation
68
Coal workers pneumoconiosis
Chronic exposure to coal >10 years causing interstitial lung disease CXR shows diffuse small opacities especially in upper lung fields
69
Silicosis
Fibrosing interstitial lung disease from inhaling fine particles of silica Eggshell calcification
70
Asbestosis
Fibrosing interstitial lung disease from exposure to mineral asbestos Pleural plaques, lower lung involvement, calcified plaques
71
What causes mesothelioma?
Asbestos
72
Mesothelioma
Primary tumor arising from surface lining of the pleura or peritoneum
73
Berylliosis
IARC group 1 carcinogen Aerospace and fiber optics workers Non caseating granulomas
74
Radiation lung disease
Complication of therapy Fibrosis or pneumonitis
75
Bronchiectasis
Disease of large bronchi Permanent dilation and destruction of bronchial wall Recurrent infection or inflammation
76
Causes of bronchiectasis
Cystic fibrosis commonly Infection Obstruction Immunodeficiency
77
Bronchiectasis symptoms
``` Chronic cough Copious purulent sputum Hemoptysis Rhinosinusitis Weight loss, anemia, fatigue ```
78
Signs/exam bronchiectasis
Crackles at lung base Clubbing Foul smelling, copious purulent sputum
79
CXR findings in bronchiectasis
Atelectasis Tram lines, ring shadows
80
CT findings in bronchiectasis
Tree in bud opacities
81
Cystic fibrosis
Most common cause of severe chronic lung disease in young adults Altered CL and H20 transport across epithelial cells Thickened mucus, obstructing airway, GI
82
Signs of CF
``` Pancreatitis Infertility Chronic lung dz Steatorrhea Cough ```
83
Exam of CF
``` Malnourished Clubbing Barrel chest Apical crackles Gallstones ```
84
CF diagnosis
Sweat chloride test
85
Obstructive sleep apnea
Blockage of airway during sleep, resulting in periods of no breathing
86
Risk factors of OSA
Age Gender male Obesity Upper airway abnormality
87
Pickwickian syndrome
Decreased ventilatory drive from obesity
88
OSA has ______ ventilatory effort during apnea
Increased
89
Manifestations of OSA
``` Snoring Waking up gasping or choking Excessive daytime sleepiness Thick neck Large tonsils ```
90
Common OSA screening tool
STOP- bang
91
Atelectasis
Collapse or loss of lung volume/alveolar space
92
Resorptive atelectasis
Alveolar space filling, commonly pneumonia Chest wall pain is common with this type
93
Compressive atelectasis
Pressure from mass effects in chest
94
Exam with atelectasis
Minimal findings Maybe decreased breath sounds, crackles, dullness to percussion
95
5 w's of atelectasis and post op fever
``` Wind Water Wound Wonder drugs Walking ```
96
Acute respiratory failure
Dysfunction of respiratory system Abnormal gas exchange, potentially life threatening, threatens end organs
97
Acute respiratory distress syndrome
Abrupt onset of diffuse lung injury Severe hypoxemia Generalized infiltrates Bilateral infiltrates with pulmonary edema without clinical HF
98
A common cause of ARDS
Sepsis about 1/3 of the cases
99
Clinical findings of acute respiratory distress syndrome
Rapid onset of profound dyspnea Hypoxemia, tachypnea, accessory muscle usage Diffuse or patchy bilateral infiltrates
100
Pneumomediastinum
Consider bronchial or esophogeal perforation
101
Idiopathic interstitial pneumonia
Acute or chronic Restrictive pattern on PFT
102
Cryptogenic organizing pneumonia
Previously known as BOOP Follows flu like illness DOE Inflammatory debris in the alveoli Usually responds to steroids
103
Goodpastures syndrome
Glomerulonephritis Pulmonary hemorrhage Antiglomerular basement membrane antibodies
104
Granulomatosis with polyangiitis
Classic triad of upper and lower respiratory tract disease and glomerulonephritis
105
Unusual sign of granulomatosis with polyangiitis
Saddle nose deformity
106
Church strauss syndrome
Allergic angiitis and granulomatosis Skin and lung disease Peripheral eosinophilia
107
Inspiratory stridor is a sign of....
Upper airway obstruction
108
Expiratory wheezing is a sign of...
Lower airway obstruction
109
Acute bronchitis
Self limited inflammation of bronchi due to an upper airway infection Usually a virus
110
Typical presentation of acute bronchitis
Cough >5days Sputum Wheezing, mild dyspnea
111
Physical exam in acute bronchitis
Rhonchi that clear with coughing Wheezing NO signs of parenchyma consolidation
112
What are the criteria to order a CXR with a cough?
Abnormal vital signs Persistent rales or other signs of consolidation Special populations
113
Bronchiolitis
Varied inflammatory processes that effect the bronchioles
114
What is the most common cause of bronchiolitis in children?
RSV
115
Clinical presentation of bronchiolitis
Viral upper respiratory prodrome followed by increased respiratory effort and wheezing usually 3-6 days after onset of illness
116
Lung exam in bronchiolitis
``` Retractions Expiratory wheezing Hyperexpanded chest Hyperresonant to percussion Crackles, rales, rhonchi ```
117
Respiratory syncytial virus
Causes acute respiratory tract illness in persons of all ages 4-6 day incubation Infects small bronchiolitis epithelium- necrosis of epithelial cells, proliferation of bronchiolitis epithelium, release of cytokines and chemokines
118
Presentation of RSV
Airway obstruction, air trapping, increased airway resistance Low grade fever, tachypnea, wheezing, cough, rhinorrhea, conjunctivitis
119
Signs of RSV
Hyperinflated lungs, decreased gas exchange, increased respiratory effort
120
Epiglottitis i
Inflammation and cellulitis of the epiglottis and adjacent supraglottic structures Medical emergency
121
Presentation of epiglottitis
Appears toxic with difficulty breathing Muffled speech, hot potato voice Tripod, doesn't want to lie down Hoarseness, cough, stridor
122
X-ray findings of epiglottitis
Thumb sign
123
Croup
Acute respiratory illness that leads to inflammation in the larynx and subglottic airway Barry cough, stridor
124
Anatomic hallmark of croup
Narrowing of the trachea in the subglottic region
125
Westley croup scores mild moderate and severe
Mild is less than or equal to 2 Moderate is 3-7 Severe is 8 or greater
126
Ap XR in croup
Steeple sign
127
Bacterial tracheitis
Exudative bacterial infection of the soft tissue of the trachea Staph aureus is almost all the cases
128
Primary and secondary presentation of bacterial tracheitis
Primary- fulminant onset, progression of acute respiratory distress <24hrs after onset of minor symptoms Secondary- viral respiratory tract infection prodrome 1-3 days prior to onset of severe symptomatology
129
Signs and symptoms of bacterial tracheitis
``` Fever Stridor Cough Prefer to lie flat Hoarseness Wheezing ```
130
Definitive diagnosis of bacterial tracheitis
Direct visualization of inflamed, exudative covered trachea
131
What is the #1 infectious cause of death in the US?
Pneumonia
132
What are the three normal defense mechanisms that are at risk in pneumonia?
Cough reflex Mucociliary clearance system Immune responses
133
Mycplasma pneumoniae
Walking pneumonia, young adults
134
Legionella pneumophila
Contaminated water sources Older, sickly men GI symptoms and abnormal LFTs
135
Pneumonia history
``` Fever, chills, rigors, malaise Cough Sputum Chest pain SOB ```
136
Physical exam pneumonia
Bronchial breath sounds Egophony Dullness to percussion Increased tactile fremitus
137
Lobar pneumonia
Bacterial
138
Interstitial pneumonia
Viral or mycoplasma
139
Nodular pneumonia
Fungal
140
Patients with CAP should be treated for a minimum of..
5 days
141
3 categories of nosocomial pneumonia
Hospital acquired Ventilator associated Health care associated
142
Problems with nosocomial pneumonia
Different pathogens Different antibiotic susceptibility patterns Impaired defense mechanisms
143
High risk pathogens in nosocomial pneumonia
Pseudomonas MRSA Acinetobacter
144
True aspiration pneumonia...
Infection caused by less virulent bacteria, primarily anaerobes
145
Where does anaerobic pneumonia usually develop in the lungs?
Dependent lung zones
146
Presentation of anaerobic pneumonia
Constitutional symptoms Cough Foul smelling purulent sputum
147
Pulmonary embolism
Obstruction of the pulmonary artery or one of its branches by something that originated elsewhere within the deep venous circulation
148
What is the 3rd leading cause of death in hospitalized patients?
PE
149
How often does a PE develop if you have a DVT?
50-60% of the time
150
3 acute classifications of PE
Massive Submissive Saddle PE
151
How many PEs result from a DVT?
95% of PE's
152
Virchow's triad
Stasis Injury Hypercoagulability
153
Additional risk factors of PE in women
Obesity Heavy cigarette smoking >25 a day HTN
154
Acute clinical manifestations of PE
``` Sudden dyspnea onset Plueritic chest pain Cough >2 pillow orthopnea Calf or thigh pain or swelling Wheezing ```
155
PE physical exam
Tachypnea (most common) Tachycardia Hypoxia Low grade fever Late findings: HOTN, hemodynamically unstable
156
EKG findings
Tachycardia NSSTTchanges S1Q3T3 changes
157
CXR findings of PE
Atelectasis Westermark sign Hampton hump Pleural effusion
158
What is the imaging diagnostic study of choice for PE?
Helical CT with contrast
159
What wells criteria values are highly likely for PE?
6 or greater
160
Ventilation perfusion scan for PE
Identifies mismatch between areas that are ventilated by not perfumed
161
What is the gold standard test for PE?
Pulmonary angiography
162
What pharmacologic meaure is started ASAP with PE?
Empiric anticoagulation
163
Low and high risk 30 day mortality
1% | 11%
164
Which situations with PE indicate indefinite anticoagulation?
Unprovoked PE | >2 or equal to 2 episodes
165
Pulmonary HTN definition
Elevated pulmonary arterial pressure and secondary RV failure Mean PA pressure >25mmHg at rest
166
Pathophysiology of pulmonary HTN
Low pressure, hypoxemia causes PA vasoconstriction, PA pressure rises to an inappropriate level for the CO
167
Idiopathic pulmonary HTN
Young, middle aged females Absence of other lung or cardiac diseases
168
Group 1 PH
Idiopathic, diseases of small pulmonary muscular arterioles, drugs nad toxins
169
Group 2 PH
Left heart disease
170
Group 3 PH
Lung diseases or hypoxemia
171
Group 4 PH
Chronic thromboembolic HG
172
Group 5 PH
Unclear, multifactorial mechanisms
173
Clinical presentation of PH
Dyspnea Fatigue Chest pain
174
Signs of PH
Narrow splitting of 2nd heart sound, large pulmonary component Systolic ejection click
175
What diagnostic study is needed to confirm diagnosis of HTN?
Right heart catheterization

Clin Med (7 decks)

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