IM-Respiratory Flashcards
(117 cards)
1
Q
Empyemas are exudative effusions with a low glucose concentration due to ___ (2)
A
- A high metabolic activity of leukocytes
- bacteria within the pleural fluid
2
Q
Pt with high dose beta-2-agonists can develop what kind of electrolyte imbalance and pt presentations are (6)
A
Hypokalemia
- Muscle weakness, arrhythmias & EKG abnormalities
- tremor, palpitations and headache
3
Q
The 3 main (>90%) causes of a chronic cough in non-smokers are
A
- Postnasal drip
- GERD
- asthma
4
Q
The main 3 systems that are affected by Theophylline toxicity are
A
- CNS (headache, insomnia, sz)
- GI (N/V)
- Cardiac (arrthytmia)
5
Q
Panacinar emphysema is typical of what cause
A
alpha-1-antitrypsin deficiency
6
Q
Supplemental oxygen in pt with COPD can worsen hypercapnia due to the combination of increased dead space perfusion causing (3)
A
- V/Q mismatch
- decreased affinity of oxyhemoglobin for C02
- Reduced alveolar ventilation
7
Q
Acute exacerbation of COPD often reveals (4)
A
- Wheezes
- Tachypnea
- Prolonged expiration
- Accessory muscles
8
Q
Bilateral wheezing can occur in acute PE due to _______ in response to hypoxia and infarction
A
cytokine-induced bronchoconstriction
9
Q
PE causes V/Q mismatch resulting in an increase in ______
A
A-a oxygen gradient
10
Q
Pneumonia causes hypoxemia due to (2)
A
- Right-to-left intrapulmonary shunting
- An extreme V/Q mismatch
11
Q
Increasing concentration of inspired oxygen does/ does not correct hypoxemia caused by intrapulmonary shunting
A
Does NOT
12
Q
Chronic nonproductive cough in patient with hearth failure is likely an
A
adverse effect of ACE inhibitor
13
Q
How is Massive PE defined?
A
PE complicated by hypotension (syncope) and/or acute right heart strain (JVD & RBBB)
14
Q
What are the pulmonary function tests seen for interstitial lung disease? (4)
A
increased FEV1/FVC ratio
decreased DLCO (diffused lung capacity of CO)
decreased TLC
Decreased RV
15
Q
Pt with interstitial lung disease will have impaired gash exchange resulting in (2)
A
- reduced diffusion capacity of carbon monoxide
- increased alveolar-artery gradient
16
Q
PE, atelectasis, pleural effusion, and pulmonary edema causes the
- V/Q to _
- A-a gradient _
- PaCO2 __
- RR__
A
- V/Q to Mismatch
- A-a gradient _ elevated
- PaCO2 __ decrease (respiratory alkalosis)
- RR__ Increased (to compensate)
17
Q
GERD in pt with asthma can exacerbate asthma through micro aspiration of gastric contents leading to an increased in (2) & how to you treat
A
- Vagal tone
- Bronchial reactivity
-treat with PPI
18
Q
Tx for mild non-allergic rhinitis
A
intranasal antihistamine or glucocorticoids
19
Q
Tx for allergic rhinitis
A
- intranasal glucocorticoids
- antihistamines
20
Q
-Triad of Fever, chest pain, hemoptysis
- Pulmonary nodules with halo sign
- positive culture
- positive cell wall biomarkers (galactomannan, beta-D-glucan)
Dx?
A
Invasive aspergillosis
21
Q
Risk factor for Invasive aspergillosis
A
- Immunocompromise (neutropenia, glucocorticoids, HIV)
22
Q
Tx of Invasive aspergillosis (2)
A
Voriconazole +/- Caspofungin
23
Q
- > 3 months: Weight loss (>90%), cough, hemolysis, fatigue
- Cavitary lesion +/- fungus ball
- Positive Aspergillus IgG serology
Dx?
A
Chronic pulmonary aspergillosis
24
Q
What is the risk factor for chronic pulmonary aspergillosis?
A
Lung disease/ damage (Cavity tuberculosis)
25
How do you treat chronic pulmonary aspergillosis (3)
- Resect aspergilloma (if possible)
- Azole medication (voriconazole)
- Embolization (if severe hemoptysis)
26
- Shoulder pain
- Horner syndrome
- C8-T2 neurological involvement
- Supraclavicular lymph node enlargement
- Weight loss
Pancoast tumors
27
The flattened diaphragm in COPD has more difficulty contracting to expand the thoracic cavity resulting in
Increased work of breathing
28
ARDS pt that are on mechanical ventilation will have a required goals to avoid complication of ventilation by (2)
- Low tidal volume ventilation (LTVV) to decrease over-distending alveoli
- Providing adequate oxygenation by increasing FiO2 but avoid toxicity.
- Increases PEEP to improve oxygenation to prevent alveoli collapse at the end of expiration
29
Causes of recurrent pneumonia involving same region of lung (2)
- Local airway obstruction (neoplasm, bronchiectasis, foreign body)
- Recurrent aspiration (GERD, Drug and alcohol use, Sz, dysphagia)
30
Causes of recurrent pneumonia involving different region of lung (3)
- Immunodeficiency (leukemia, CVID, HIV)
- Sinopulmonary disease (CF, immotile cilia..)
- Noninfectious (Vacuities, ...)
31
Daytime sleepiness, snoring, brief choking or gagging sensation while sleeping, morning headache
OSA
32
- Cough for >5days to 3 weeks (+ purulent sputum)
- Absent systemic findings (fever, chills)
- Wheezing or rhonchi, chest wall tenderness
Acute bronchitis
33
How do you diagnoses bronchitis?
Clinical diagnosis
| CXR only when PNA is suspected
34
How to tx bronchitis?
- Symptomatic (NSAIDs &/or bronchodilators)
| - Abx NOT recommended
35
Acute massive PE results in abrupt increase in pulmonary vascular resistance and subsequently _______
Right ventricular pressure
36
- Present <24hr after blunt thoracic trauma
| - Tachypnea, tachycardia, hypoxia
Pulmonary contusion
37
How do you diagnosis Pulmonary contusion? (2)
_ CT scan (most sensitive)
| - CXR with patchy, alveolar infiltrate not restricted by anatomical borders
38
How do you manage pulmonary contusion? (3)
- Pain control
- Pulmonary hygiene (Neb, chest PT)
- Supplemental oxygen and ventilator support
39
Diagnostic testing for acute exacerbation of COPD (2) and they will show?
- Chest xray- hyperinflation
| - ABG: Hypoxia, CO2 retention (Chronic &/or acute)
40
What are the physical findings for cor pulmonale? (6)
- Peripheral edema
- JVD with prominent a wave
- Loud S2
- Right-side heave
- Pulsatile liver from congestion
- Tricuspid regurgitation murmur
41
The 4 common ethioplogies for Cor pulmonale
- COPD
- Interstitial lung disease
- Pulmonary vascular disease (Thromboembolic)
- Obstructive sleep apnea
42
- Dyspena on exerition, fatigue, lethargy
- Exertional syncope ( deceased CO)
- Exertional angina (increased myocardial demand)
Cor pulmonale
43
Imagining used for Cor pulmonale diagnosis (3)
- EKG
- Echo
- Right heart catherterization (Golden standard)
44
What do you expect to see on EKG for cor pulmonale (4)
- RBBB
- Right axis deviation (RAD)
- RV hypertrophy
- Right Atrial enlargement
45
What do you expect to see on Echo for cor pulmonale (3)
- Pulmonary hypertension
- Dilated right ventricle
- Tricuspid regurgitation
46
What do you expect to see on R heart catheterization for cor pulmonale (3)
- R ventricular dysfunction
- Pulmonary hypertension
- No left heart disease
47
In addition to all the medication used for COPD what other medication is needed for acute exacerbation?
Antibiotics
48
Progressive dyspnea, clubbing and end-inspiratory crackles with person working in industrial process
Asbestosis
49
Pleural plaques on imaging are the hallmark for
Asbestosis
50
The 3 main complication of Positive pressure ventilation are
- Alveolar damage
- Pneumothorax
- Hypotension
51
3 pulmonary causes of hemoptysis
- Bronchitis
- Lung cancer
- Bronchiectasis
52
Cardiac causes of hemoptysis
Mitral stenosis/acute Pulmonary edema
53
4 infectious causes of hemoptysis
- TB
- Lung abscess
- Bacterial pneumonia
- Aspergillosis
54
2 vascular causes of hemoptysis
- Pulmonary Embolism
| - Arteriovenous malformation
55
2 systemic disease causes of hemoptysis
- Granulomatosis with plyangitis
| - Goodpasture syndrome
56
Othe causes of hemoptysis that are not systemic cause
- trauma
| - Cocaine (inhalation use)
57
Sinusitis/otitis, saddle-nose deformity, lung nodules/cavitation, rapidly progressive granumloma, Skin:Livedo reticularis, nonhealing ulcers
Granulomatosis vasculitis (Wegener granulomatosis)
58
Granulomatosis vasculitis (Wegener granulomatosis) treatment (2)
-Corticosteroids and Immunomodulators (MTX, cyclophosphamide)
59
Granulomatosis vasculitis (Wegener granulomatosis) Is diagnositic methods (2)
- ANCA
| - BIopsy
60
What is found on skin biopsy for Granulomatosis vasculitis (Wegener granulomatosis)
-Leukocytoclastic vasculitis)
61
What is found on kidney biopsy for Granulomatosis vasculitis (Wegener granulomatosis)
- Pauci-immune GN
62
What is found on lung biopsy for Granulomatosis vasculitis (Wegener granulomatosis)
-Granulomatous vasculities
63
3 things shown on Right heart catheterization for PE
- Elevated Right atrial
- Elevated pulmonary artery pressures
- Normal PCWP
64
In COPD Vital capacity is _____ and total lung capacity is ___
VC decreased
| TLC increased
65
_____ is associated with mortality benefit and reduced progression of disease in pt with COPD
- Smoking cessation
66
What is the most effective way to differentiate asthma with COPD?
Spirometers before and after administration of bronchodilator ( reversal of airway obstruction with asthma)
67
What are the 2 markings for complicated parapneumonic effusions or empyemas
- Very low pH (<7.2)
| - Glucose (<60mg/dL)
68
Dullness or percussion
Increased intensity of breath sounds
Increased tactile fremitus
Lung consolidation (lobar PNA)
69
What are the 2 aspiration syndromes affecting lung
- Pneumonia
| - Pneumonitis
70
What is the pathophysiology of pneumonitis caused by aspiration
Lung parenchyma inflammation with aspiration of gastric acid causing direct tissue injury
71
What is the pathophysiology of pneumonia caused by aspiration
Lung parenchyma infection , aspiration of upper airway or stomach microbes (anaerobes)
72
Abx for aspiration PNA (2)
Clindamycin or beta-lactam & Beta-lactamase inhibitor
73
which type of the two aspiration syndromes, does the presentation occurs within hours instead of days after the aspiration?
Pneumonitis in hours
| no abx need to treat
74
Oxygenation can be improved in 2 ways on a mechanical ventilated patient
PEEP
| FiO2
75
Pt with PE can have small pleural effusions due to (2)?
hemorrhage or inflammation
76
Pleural effusion from PE is
Exudative and grossly bloody
77
```
Should pain
Ipsilateral ptosis, miosis, enophthalmos and anhidrosis
C8-T2 neurological involvement
Supraclavicular lymph node enlargement
Weight loss
```
Superior pulmonary sulcus tumore (Pancoast tumor)
78
Asbestos exposure increase the risk for two disease
- pulmonary fibrosis
| - Malignancy (Bronchogenic carcinoma most common )
79
The most common endemic mycosis in US?
Histoplasma capsulatum
80
Location of exposure for Histoplasma capsulatum
Midwest (Ohio and Mississippi river valleys)
| Northeast (less extent)
81
Histoplasma capsulatum proliferates most readily in what environment?
Soil contaminated with bat or bird droppings
82
Subacute fever, chills, malaise, headache, myalgias, and dry cough
CXray- mediastinal or hilar lymphadenopathy with focal, reticulonodular or miliary infiltrates, granulomas with narrow-based budding yeasts
Histoplasma capsulatum
| 2-4 weeks after exposure
83
Why does urine sodium decrease in a hypovolemic patients?
decreased renal perfusion-> RAAS activation
84
What are the 2 criteria for patient to a candidate for home oxygen treatment?
- PaO2 =55mmHg
| - O2 sat = 88%
85
Alveolar consolidation in PNA causes hypoxemia because of
right-to-left intrapulmonary shunting
86
what position makes v/q mismatch worsen?
gravity dependent (laying on the side of the sick lung)
87
mild leukicytosis, fever, pleuritic chest pain, hemoptysis, wedge-shaped Chest CT
Pulmonary Embolism
88
Tx of SIADH
fluid restriction +/- salt tabs
| Hypertonic saline
89
What is the SE of steroids seen on CBC?
Leukocytosis: Increased Neutrophils
90
low back pain, <40YO, insidious onset, improves with exercise but not with rest, pain at night , Hip & buttock pain, limited chest expansion and spinal mobility, enthesitis, acute anterior uveitis
ankylosing spondylitis
91
50YO smoker with anorexia, constipation, increased thirst, easy fatigability, hypercalemia
SSC of lung
92
The 2 markers for nonseminomatous germ cell tumors are
AFP
| B-hCG
93
Definition of ventilation
RR x VT
94
what is the best drug to use for symptom management in COPD?
Inhaled anti-muscarinic ages like Ipratropium
| - may combine with short-acting beta-adrenergic for greater symptom relief
95
what drug is used for intermittent asthma
PRN short-acting beta2-agonis (SABA)
| -Albuterol
96
What is the number of symptoms frequency that require SABA use in & drug additions
- intermittent
- Mild persistent
- Moderat persistent
- Severe persistent
- intermittent (=2days)- SABA ONLY
- Mild persistent (>2days)-add low dose ICS
- Moderate persistent (1/day)-add moderate dose ICS + LABA
- Severe persistent (ALL day)- High dose ICS+LABA+ ORAL corticosteroids
Might consider malizumab after last step
97
How is diagnosis of Goodpastrure's disease made
bx of renal - shows IgG antibodies in the glomerular basement membrane
98
You will have increased Tactile fremitus in which pulmonary disease
consolidation (lobar PNA)
99
You will have hyper-resonant on percussion in which two lung diseases?
- Pneumothorax
| - Emphysema
100
You will have JUST resonant on percussion in which lung diseases?
It is NORMAL lung
101
You will have dullness on percussion in which 3 lung diseases?
- consolidation (PNA)
- Pleural effusion
- Atelectasis (mucus plugging)
102
In Pleural effusion mediastinal shift is in what direction?
away from effusion if large
103
In Pneumothorax mediastinal shift is in what direction?
Away from the tension pneumothorax
104
In Atelectasis mediastinal shift is in what direction?
Toward the atelectasis
105
The best diagnostic test for bronchiectasis
High-resolution CT (HRCT)
106
The 2 most common symptoms of PE
Acute onset dyspnea (73%)
| Pleuritic chest pain (66%)
107
What is the mean pulmonary arterial pressure at rest to define Pulmonary hypertension?
>/= 25 mmHg at rest
108
RV failure happens late in pHTN and manifests with (5)
- RV heave
- JVD
- Tender hepatomegaly
- Acites
- Edema
109
Cxray in pHTN shows (2)
- Enlargement of the pulmonary arteries with rapid taping of distal vessels (pruning)
- Enlargement of the RV
110
A condition where digital clubbing is accompanied by sudden-onset arthropathy, commonly affecting the wrist and hand joints
Hypertrophic osteoarthropathy (HOA)
111
a subset of HOA where the cladding and arthropathy are attributable to underlying lung disease like cancer, TB, bronchiectasis or emphysema
Hypertrophic pulmonary osteoarthropathy (HPOA)
112
Diagnostic for granulomatosis with polyangiitis (Wegener granumonatosis ) 2
- ANCA
| - Bx; Skin (leukocytoclastic vasculitis); Kidney (Pauci-immune GN), Lung (granulomatous vasculitis)
113
How to manage granulomatosis with polyangiitis using medication (2)
- Cortiosteroids
| - Immunomoedulators (MTX, cyclophosphamide)
114
1st line tx for exercise induced brnchoconstriction if required only a few times a week
short-acting beta-adrenergic agonists 10-20 mins before
115
The peripheral wedge of lung opacity due to pulmonary infarction is called? Seen in?
Hampton's hump, PE
116
Peripheral hyperlucency due to oligemia is called? seen in?
Westermark's sign, PE
117
Enlarged pulmonary artery seen in PE is called?
Fleischner sign
