Ingrid's Review Flashcards
(159 cards)
1
Q
Trachea
A
composed of 16-20 C-shaped cartilage rings
-posterior (open) part of ring accommodates the esophagus during swallowing
2
Q
Carina
A
location of high concentration of cough receptors
3
Q
Mainstem Bronchi
A
Right Bronchi
4
Q
Right Bronchi
A
More apt to receive foreign objects aspirated into the trachea or to be “tube” during endotracheal intubation due to being shorter and wider
5
Q
Bronchioles
A
transitional airways
6
Q
Terminal Bronchioles - functions
A
heat, humidify, and conduct inspired air
7
Q
Mucous Blanket
A
mucocilliary escalator
8
Q
Mucocilliary escalator
A
submucosal glands and cilia
9
Q
Submucosal glands
A
composition of normal mucous - 95% water
10
Q
Cilia
A
paralyzed by nicotine
11
Q
Major muscles of inspiration
A
diaphragm, sternocleidomastoid, scalene, pectoral minor
12
Q
Diaphragm
A
- principle inspiratory muscle
- most important muscle of inspiration
- –contributes to 70% of increase in thoracic expansion
- innervation of left and right phrenic never
13
Q
Poiseuille’s Law
A
- flow is decreased by a factor of 4
- responses to bronchodilators (albuterol nebulizer therapy)
14
Q
LaPlace’s Law
A
failure of this law = atelectasis
15
Q
Dalton’s Law
A
total pressure exerted by a mixture of gases to sum of pressures exerted by each gas
16
Q
Henry’s Law
A
when a gas is in contact with a liquid, the gas will dissolve in the liquid in proportion to its partial pressure
17
Q
Boyle’s Law
A
decrease in oxygen tension (pressure) results in an increase in the volume
18
Q
Limbic system - Anxiety
A
increase in rate and depth of respiration
19
Q
Temperature
A
decreased body temperature decreases respiration
20
Q
Pain
A
- sudden severe pain brings on apnea
- prolonged pain increases respiratory rate
21
Q
High altitude
A
- decrease oxygen tension
- increase in volume (Boyle’s Law)
22
Q
Irritation of Airways
A
immediate cessation of breathing followed by coughing or sneezing
23
Q
Shift to the Left
A
Increased Hgb affinity for oxygen
24
Q
Increased Hgb affinity for oxygen
A
- alkalosis
- hypocarbia
- hypothermia
- decreased 2,3-DPG
- fetal hemoglobin
- carboxyhemoglobin
- methemoglobin
25
Shift to the Right
decreased Hgb affinity for oxygen
26
Decreased Hgb affinity for oxygen
- acidosis
- hypercarbia
- hyperthermia
- increased 2,3 - DPG
27
Carboxyhemoglobin - Pathophysiology
- hemoglobin has a 200 to 250 times greater affinity for CO than O2
- progressive shift to the left
28
Carboxyhemoglobin - Management
Hyperbaric oxygen therapy aka: dive chamber
29
Methemoglobin - Pathophysiology
- +2 ferrous to a +3 ferric state
| - shift to the left
30
Methemoglobin - Causes
- nitrates and nitrites
| - local anesthetics
31
Methemoglobin - Managment
methylene blue administration
32
Fetal Hemoglobin - Pathophysiology
- two beta chains are absent and two gamma chains are present
- shifts to the left
33
Hypoxia
state of tissue oxygen deficiency
34
Hypoxemic
- most common type
- decreased PaO2
- COPD, pneumo
35
Anemic
- decreased hgb availability
| - anemia, carboxy/methemoglobin
36
Circulatory
- stagnant (slow flow) vs AV shunting (no flow)
| - cardiogenic vs septic shock
37
Methemoglobin - Clinical Manifestations
reddish brown blood, cyanosis (blue people)
38
Histotoxic
- inability of tissue to use oxygen
| - seen in cyanide poisoning (sodium nitroprusside toxicity)
39
normal pH
7.35 to 7.45
40
normal pCO2
35 to 45
41
normal HCO3
22 to 26
42
ROME
respiratory opposite direction and metabolic equal direction
43
Respiratory Acidosis
can't breathe = impaired lung mechanics
| -do not correct with sodium bicarbonate
44
Respiratory Alkalosis
CHAMPS Hyperventilate
- CNS disease
- Hypoxia
- Anxiety
- Mechanical ventilation
- Progesterone or pregnancy
- Salicylates or Sepsis
45
Metabolic Acidosis
MUDPILE CATS
46
MUDPILE CATS
```
Methanol, metformin
Uremia
Diabetic ketoacidosis
Paraldehyde, pregnancy
Isoniazid (INH) and iron
Lactic acidosis
Ethylene glycol
Carbamazepine
Alcoholic ketoacidosis
Toluene
Salicylates, starvation ketoacidosis
```
47
Metabolic Alkalosis
CLEVER PD
- Contraction
- Licorice
- Endocrine excesses
- Vomiting
- Excess alkali
- Refeeding alkalosis
- Post - hypercapnia
- Diuretics
48
Cardiogenic pulmonary edema
- part of overall problem related to CHF
| - cardiomegaly
49
Non-cardiogenic pulmonary edema
damage to the alveoli or capillary without elevation of the pulmonary capillary wedge pressure
50
High altitude pulmonary edema
most common cause of death from high altitude illness
| -treatment = get them down
51
Neurogenic pulmonary edema
subarachnoid hemorrhage or head trauma
52
Reperfusion pulmonary edema
after removal of blood clot
53
Re-Expansion pulmonary edema
occurs unilaterally status post rapid expansion of collapsed lung in pneumothorax
54
Opioid Overdose
- particularly seen in heroin overdose
| - treatment = naloxone (narcan)
55
Salicylate toxicity
- generally occurs in elderly patients from chronic salicylate toxicity
- treatment = sodium bicarbonate
56
Inhalants
- chlorine gas
| - ammonia
57
Pulmonary embolism - causes
Virchow's triad
- vascular intimal trauma
- venous stasis
- hyper-coagulable state
58
Pulmonary embolism - clinical manifestations
- dyspnea
| - tachypnea
59
Pulmonary embolism - ECG
sinus tachycardia
60
Pulmonary embolism - diagnostic gold standard
pulmonary angiography
| ---CTA or V/Q
61
WHO classification of pulmonary hypertension
- pulmonary arterial hypertension
- left heart disease
- lung disease and/or chronic hypoxemia
- chronic thromboembolic disease
- miscellaneous
62
Pulmonary arterial hypertension
-idiopathic, women, poor prognosis
63
Lung disease/and or chronic hypoxemia
causes include ILD, OSA, COPD and any other cause of chronic hypoxemia
64
Chronic thromboembolic disease
recurrent PE
65
Miscellaneous
tumor
66
Pathophysiology of pulmonary hypertension
- passive resistance of pulmonary venous system
- hyperkinetic
- obstruction
- pulmonary vasoconstriction
67
ARDS - Berlin Criteria
- acute onset
- refractory to O2
- PCWP <18 mmHg
- bilateral infiltrates on CXR
68
ARDS - etiologies
- sepsis is most common risk factor
| - elderly + UTI + pneumonia
69
ARDS - clinical manifestations
- dyspnea, tachypnea, and tachycardia
| - progressive hypoxemia
70
ARDS - Diagnostics
ABG = hypoxemia and any ABG possible
| -wedge pressure <18
71
ARDS - Management
- oxygenation
- mechanical ventilation
- fluid management
- -avoid volume overload
- treat underlying cause
72
Transudative
CHF (most common)
low protein content, few cells
-occurs due to increased hydrostatic pressure or low plasma oncotic pressure
73
Exudative
- high protein content, may contain some white and red cells
- occurs due to inflammation and increased capillary permeability
- pneumonia, cancer, TB
74
evaluated pleural fluid amylase
pancreatitis
75
milky, opalescent fluid
chylothorax
76
frank, purulent fluid
empyema
77
blood effusion
malignancy
78
exudative effusions that are primarily lymphocytic
tuberculosis
79
ph<7.2
parapneumonic
80
Glucose <60
RA
81
empyema - etiologies
untreated exudative pleural effusion
82
empyema - clinical manifestations
pneumonia most common underlying cause
83
empyema - management
aggressive drainage of pleura with antibiotic therapy
84
Chylorthorax - etiologies
tumors - most common cause
-lymphomas
trauma - 2nd most common cause
-surgery is most common cause of traumatic chylorhorax
85
Chylorthorax - diagnostic findings
triglycerides in pleural fluid
86
Chylorthorax - management
- no treatment necessary
- fat restriction
- octreotide may be beneficial in some cases
87
Pleurisy
history, history, history - commonly mimics a heart attack
88
Pleurisy - etiologies
viral (most common) - may lead to epidemic pleurodynia (aka: Bornholm's disease) viral pleurisy is a diagnosis of exclusion
89
Pleurisy - appropriate management
treatment of the underlying etiology
| -indomethacin
90
simple/spontaneous pneumothorax - etiologies
tall, lean, young men +/- smokers
91
simple/spontaneous pneumothorax - clinical manifestations
mediastinal shift toward side of pneumothorax
92
Open pneumothorax
penetrating trauma = sucking chest wound
| -cover the entry wound with a three-sided occlusive dressing
93
Tension pneumothorax
accumulation of air within the pleural space such that the tissues surrounding the opening in the pleural cavity act as valves, allowing aria o enter but not escape
-absent breath sounds
94
tension pneumothorax - CXR or physical exam findings
shift of trachea away from the side of pneumothorax
95
tension pneumothorax - treatment
chest needle decompression in 2nd or 3rd intercostal space above rib
96
Hemothorax
- blood accumulating in pleural cavity
| - tube thoracotomy
97
Fail chest/pulmonary contusion
- two or more ribs broken in two or more place
| - severe blunt force trauma
98
Stridor - causes
narrowed upper airway
99
cough, congestion, and rhinorrhea
viral croup (MC)
100
drooling, trismus, torticolis, inability to extend the neck or uvular deviation
peritonsillar abscess
101
"steeple" sign
croup
102
"thumbprint" sign
epiglottis
103
Neonatal respiratory distress - causes
transient tachypnea of the newborn is most common cause
104
Neonatal respiratory distress - clinical findings
respiratory distress, tachypnea, grunting, hypoxia, increased work of breathing
-symptoms may begin at birth and lasts up to 24 hours
105
Neonatal respiratory distress - Management
- supportive
| - oxygen or CPAP may be required
106
Croup - causes
parainfluenza virus serotypes
107
Croup - Clinical Findings
barking cough, stridor worse with irritation
- fever usually absent
- cough with no drooling
108
Croup - CXR
steeple sign
109
Croup - mangement
Westley criteria to determine severity
- humidified oxygen
- steroid
- racemic epinephrine, nebulizer
110
Epiglottitis - causes
Hemophilus influenzae type B
| Streptococcus spp.
111
Epiglottitis - clinical findings
- drooling
| - tripod positioning or sniff dog positioning
112
Epiglottitis - CXR
thumbprint sign
113
Bronchiectasis - causes
cystic fibrosis - pseudomonas most common cause
114
Bronchiectasis - clinical findings
cough with expectoration of large amounts of purulent ad foul-smelling sputum
- hemoptysis
- halitosis - bad breath
115
Bronchiectasis - CT Scan
-tram-track appearance
| Signet sign
116
Bronchiectasis - Management
antibiotics are mainstay of treatment
117
Acute Bronchiolitis
- respiratory syncytial virus (RSV) most common cause
| - humidified O@ is mainstay of therapy
118
Bronchiolitis Obliterans
```
CXR = cuffing
CT = mosaic
```
119
Cryptogenic Organizing Pneumonia (COP)
fibrotic scaring
| -no response to antibiotics
120
Cystic fibrosis - causes
autosomal recessive disorder
- meconium ileus and intussusception
- pancreatic insufficiency and pancreatitis
- chloride sweat test
121
Cystic fibrosis - management
```
airway clearance therapies
-SABA and LABA
-antibiotics
-decongestants
regular exercise and proper nutrition
```
122
Community acquired pneumonia - causes
streptococcus pneumonias
123
Community acquired pneumonia - clinical manifestations
fever, cough, tachypnea, elevated WBC with leftward shift
124
Community acquired pneumonia - management
empiric antibiotic therapy
| -admit all children <3 months
125
Apparent life-threatening
event in which infant has episode frightening to observer
- apnea
- color change
- changes in muscle tone
- choking or gagging
- breath holding
126
Apparent life-threatening - causes
50% - idiopathic
| identified causes are related to GI, neurologic, and respiratory systems
127
Apparent life-threatening - clinical manifestations
retinal hemorrhages
128
Apparent life -threatening - management
hospitalization for patients with unexplained ATLE
| -home apnea monitoring
129
Sudden Infant death syndrome - risk factors
```
Maternal = smoking and bed sharing
Infant = prone sleep position
```
130
What do you expect on chest x-ray with asbestos exposure?
- small irregular opacities in lower lung fields
- pleural plaques
- blunting of costrophrenic angle
131
presentation of sarcoidosis
- noncaseated granuloma
| - required the presence of involvement of 2 or more organ systems
132
What to look for with a person who has worked in coal mines?
- large masses of dust and collagen tissue
- chronic bronchitis
- appears about 10 years after exposure
- inspiratory crackles
- clubbing
- cyanosis
133
Presentation of IIP
fever, hemoptysis, pleuritic chest pain, bilateral basilar
- wet quality = alveolar filling
- dry quality = no alveolar filling = Velcro rales
134
Treatment of IIP
- eliminate further exposure
- supplemental oxygen
- glucocorticoids
- refer to pulmonologist
135
Lofgren's sign
erythema nodosum and Hilar adenopathy
136
Simple fibrosis
-fine crackles
-coarse crackles (end inspiration)
CXR = innumerable small rounded opacities in upper lung fields
137
PMF
no crackles
| -small opacities, gradually enlarge and connect to for larger opacities distributed in the upper and middle lung fields
138
Sings and symptoms of lung cancer
cough, dyspnea, hemoptysis, weight loss, anorexia, clubbing, Horner syndrome, superior vena cava obstruction, bone pain
139
American College fo Chest Physicians (ACCP)
use 7th edition of TNM (tumor size, nodes, and metastasis) staging system for prognosis and placement into clinical trials
140
U.S Preventative Service Task Force (USPSTF)
- support annual low dose CT to screen for lung cancer in patients 55 to 80 years of age with at least a 30-pack year history who currently smoke or have quit within past 15 years
- screening every patient for tobacco use and encourage smoking cessation for smokers at every appointment
141
What are some of the characteristic of malignant nodule?
- subsoild nodules: purse ground glass or part solid in nature, non calcified or eccentric calcification
- irregular or speculated borders
- double in size from 1 month to 1 year
- size is >10 mm
142
When would a PET scan be cost effective in assessing a nodule?
most cost effective when the clinical pretest probability of malignancy and the results of the CT are discordant
143
Presentation of lung cancer
cough, weight loss, dyspnea, chest pain, hemoptysis, bone pain, clubbing, fever, night sweats, weakness, anorexia
144
Diagnostics of lung cancer
CXR, Chest CT, PET Scan
145
What would make you consider malignant mesothelioma?
asbestos exposure
146
Central Endobronchial Growth of Primary Tumor
cough, hemoptysis
| dyspnea, wheeze
147
Peripheral Growth of Primary Tumor
- pain from pleura or chest wall involvement
- dyspnea
- lung abscess from tumor cavitation
148
Regional Spread of Tumor in Thorax
- tracheal obstruction, esophageal compression
- laryngeal paralysis - hoarseness
- Horner's syndrome = ptosis, enopthalmos, mitosis, and anhidrosis
149
Malignant Pleural Effusion
-pain, dyspnea or cough
150
What presentation do you expect with a superior sulcus tumor?
Pancoast syndrome - pain that may arise in the shoulder or chest wall or radiate to the neck
Horner's syndrome - enopthalmos, ptosis, mitosis, and anhidrosis
151
What presentation would key you toward bronchial carcinoid tumor?
hemoptysis, cough, focal wheezing, and recurrent pneumonia
152
How does Strep Pneumoniae present?
productive cough (rusty)
153
What is atypical CAP?
walking pneumonia - mycoplasma pneumoniae
- fever, dry cough
- bullous myringitis
- erythema multiforme
154
What infections do you expect to see in AIDS patient?
pneumocystis jiroveci
155
What infections do you expect to see in a smoker?
- acute bronchitis
| - C. pneumoniae (most common in smokers)
156
Air conditioning can cause what type of infections?
legionella pneumophila
157
What physical features do you expect to see in someone with pneumonia?
abrupt onset of fever, cough (w/wo sputum), pleuritic chest pain, dyspnea, fatigue, sweats, chills, rigors, anorexia, myalgia, headaches
158
What is the pathology of bronchitis?
most common cause by virus
- rhinovirus
- coronavirus
- RSV
159
Treatment of bronchitis
```
when lasted longer than 2 weeks
antibiotics indicated for
-elderly patients
-patients with underlying cardiopulmonary disease
-immunocompromised patients
```
