Lung Flashcards Preview

Internal medicine > Lung > Flashcards

Flashcards in Lung Deck (35):
1

What is an pulmonary embolism?

The condition one are in, when a thrombus in another region of the body embolizes to the pulmonary vasculature tree via the RV ang pulm. artery

2

What are the common sources for PE?

1) Lower extremity
- most common
- above the knee(iliofemoral) / deep veins of pelvis/ calf vein
2) Upper extremity
- rare, seen in Iv drug abusers

3

What can be said of DVT + PE in the indication for Tx?

They are one continuum of a disease. Dx of either one is indication for Tx.

4

What are the risk factors for PE?

- Age >60
- Malignancy
- Prior history of DVT/PE
- Hereditary hypercoagulable state: 1) Factor v Leiden, protein C & S def. 2) Antithrombin 3 def.
- Prolonged immibolozation/long distance travel
- Cardiac disease
- Obesity
- Nephrotic syndrome
- Major surgery
- Major trauma
- Pregnancy, estrogen use

5

What is the pathophysiology of PE?

1) Emboli block pulm. vasculature 2) Increased resistance, increased pulm. artery and RV pressure 3) Dead space leads to hypoxemia + hypocarbia 4) tachypnea/dyspnea

6

What are the clinical symptoms of PE?

- Dyspnea 73%
- Pleuritic chest pain 66%
- Cough 37%
- Hemoptysis 13%
- Syncope in large PE
- Decreased general condition

7

What are the clinical signs of PE?

- Tachypnea
- Rales
- Tachycardia
- S4
- Increased P2(?)
- Shock w/ circulatory collapse
- Other: lowgrade fever, decreased breath sounds, dullness on percussion

8

What is "Wells criteria"?

A scoring system that takes into account and helps guide the work- up of PE

9

How do you Dx PE?

1) ABG: PaO2 & PaCO2 are decreased, pH is high (resp.alkalosis)
2) CXR: usually normal- used for exclusion, pleural effusion, atelectasis, Hampton hump, Westermark
3) Venous duplex US of lower extremities
4) CTA: good sens & spec. Test of choice!
5) Pulm. angiography: gold standard - excludes
6) D-dimer: if normal, PE is unlikely

10

How to Tx PE ?

1) O2 supplement, may require intubation
2) Acute anticoagulation: bolus of LMWH, do not wait for confirmation of DX! Continous infusion for 5-10 days. Goal aPTT of 1,5-2,5
3) Oral anticoagulants: Warfarin or novel anticoagulant (e.g. rivaroxaban)
4) Thrombolytic: streptokinase, tPA, for massive PE
5) IVC filter placement
6) Surgical thrombectomy: hemodynamically compromised, large proximal thrombus (saddle)

11

What does pulse oximetry?

Measures % of oxygenated Hb. Follows a sigmoid curve in relationship to partial pressure oxygen in the arterial blood.

12

What is the O2 % established criterion for receiving home oxygen?

=/ < 88%

13

What are the use for pulse oximetry?

When pulm. disease is suspected. Assessing patients w/ dyspnea(chronic or acute). Useful as screening test.

14

What is/does ABG?

Measures partial pressures of O2 and CO2 and pH

15

What are the normal values in ABG?

pH= 7,35-7,45
PaO2= decreases w/ age but 90 is normal in 20y/old
PaCO2= 35-45

16

In ABG, for every 10mmHg increase/decrease in PaCO2..

The pH increase/decrease by 0,08. If change is the same way as PaCO2, the patient have metabolic primary disease. If the opposite direction, disease is respiratory.

17

Explain spirometry

Patient exhales as rapidly & forcibly as possible (max inspiration). Spirometer plots the change in lung volume against time.

18

What is the use of spirometry?

- Distinguish obstructive from restrictive disease
- Assessing degree of functional impairment
- Monitoring effectiveness of Tx
- May detect resp. impairment in asymptomatic patient

19

Explain DLco

Patient breathes in a small, specific amount of CO, and the amount transferred from alveolar air to pulmonary capillary blood is measured. CO is a diffusion limited gas so other variables are eliminated.

20

What is the use of DLco

- Distinguish btw asthma, emphysema and COPD
- Monitoring sarcoidosis

21

Causes for low DLco

- Emphysema
- Sarcoidosis
- Interstitial fibrosis
- Pulmonary vascular disase (PE)
- Anemia, due to decreased CO binding to Hb

22

Causes for high DLco

- Asthma
- Obesity
- Intracardiac left to right shunt
- Exercise
- Pulm. hemorrhage (alveolar RBC bind w/ CO)

23

Explain V/Q scan

Compares degree of ventilation to perfusion, exact match is V/Q=1, but normal ratio is 0,8 (physiologic shunting)

24

What are the use of V/Q scan?

Dx of PE

25

What does methacholine challenge do?

Assess degree of airway hyperactivity. Used for suspected asthma(sensitive in mild form) and COPD.

26

What is interstitial lung disease?

- Inflammatory process involving the alveolar wall
- Resulting in widespread fibroelastic proliferation and collagen deposits
- Can lead to irreversible fibrosis, distortion of lung architecture and impaired gas exchange

27

How is ILD classified

Based on pathologic & clinical characteristics
1) Environmental
2) Alveolar filling disease
3) ILD associated w/ granulomas
4) Hypersensitivity lung disease
5) Drug induced
6) Miscellaneous
Over 100 causes have been identified!

28

What are the environmental ILDs?

- Coal workers pneumoconiosis
- Silicosis
- Asbestosis
- Berylliosis

29

What are the ILDs associated w/ granulomas?

- Sarcoidosis
- Histiocytosis X
- Wegener granulomatosis
- Churg-Strauss syndrome

30

What are the alveolar filling diseases? (ILDs)

- Goodpasture syndrome
- Idiopathic pulm. hemosiderosis
- Alveolar proteinosis

31

What are the hypersensitivity lung diseases? (ILDs)

- HS pneumonitis
- Eosinophilic pneumonitis

32

What are the drugs that may induce ILDs?

- Amiodarone
- Nitrofurantoin
- Bleomycin
- Phenytoin
- Illicit drugs

33

What are examples of miscellaneous ILDs?

- Idiopathic pulm. fibrosis
- Cryptogenic organizing pneumonia (COP)
- ILDs associated w/ connective tissue disease: RA, scleroderma, SLE, mixed CTD
- Radiation pneumonitis

34

What are the clinical symptoms and signs of ILD?

- Sypmtoms: dyspnea(exertion at first), nonproductive cough, fatigue, other secondary (CTD)
- Signs: rales at base, digital clubbing, pulm. HT, cyanosis (advanced)

35

How to Dx ILDs?

- CXR: diffuse changes, reticular, reticunodular, ground glass, honeycombing
- CT: high resolution!
- PFT: restrictive pattern FEV1/FVC ratio increase
- Tissue biopsy
- Urinalysis ( Goodpasture, Wegener)