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Flashcards in Pulm Deck (135):
1

XR hint to diaphragmatic rupture

NG tube in the thorax

2

XR hint to diaphragmatic rupture

NG tube in the thorax

3

what occurs with large areas of atelectasis

large ventilation perfusion mist match. hyperventilation to compensate for hypoxemia leading to respiratory alkalosis and decreased PaCO2

4

how does the body compensate for severe COPD causing acidosis

renal retention HCO3

5

apical lung tumor signs and Sx

horner syndrome if compress sympathetic trunk
brachial plexus affected with pancoast tumor
right recurrent laryngeal compression causes hoarse voice
superior vena cava syndrome

6

high Right atrial P and high pulm artery pressure but with normal PCWP

PE

7

risk for RDS in newborn

prematurity
DM, male, perinatal asphyxia and C section without labor

8

CXR for RDS

diffuse reticulogranular pattern (ground glass) with air bronchograms

9

horners

ptosis miosis anhidrosis

10

how to Dx pancoast tumor or superior sulcus

CXR

11

Hypertrophic pulmonary osteoarthropathy

clubbing and arthropathy of fingers and wrists due to lunderlying lung disease like lung cancer, TB, bronchiectasis or emphysema

12

hypoxemia post MVA is worsened with fluid challenge

pulmonary contusion

13

theophylline toxicity

CNS stimulation like HA, insomnia and seizures
GI nausea and vomiting
cardiac toxicity causing arrhythmia

14

PE can cause what arrhythmias

AFib

15

Dx PE

CTA

16

most common causes of secondary clubbing

lung malignancies, CF and right to left cardiac shunts

17

hypertrophic osteoarthropathy

digital clubbing with painful joint enlargement, periostosis of bones and synovial effusions

18

at what Saturation O2 is home O2 warranted for cOPD

19

at what Saturation O2 is home O2 warranted for cOPD

20

what occurs with large areas of atelectasis

large ventilation perfusion mist match. hyperventilation to compensate for hypoxemia leading to respiratory alkalosis and decreased PaCO2

21

how does the body compensate for severe COPD causing acidosis

renal retention HCO3

22

apical lung tumor signs and Sx

horner syndrome if compress sympathetic trunk
brachial plexus affected with pancoast tumor
right recurrent laryngeal compression causes hoarse voice
superior vena cava syndrome

23

high Right atrial P and high pulm artery pressure but with normal PCWP

PE

24

what happens when lay penumonia side down

increase physiologic shunting

25

CXR for RDS

diffuse reticulogranular pattern (ground glass) with air bronchograms

26

horners

ptosis miosis anhidrosis

27

how to Dx pancoast tumor or superior sulcus

CXR

28

Hypertrophic pulmonary osteoarthropathy

clubbing and arthropathy of fingers and wrists due to lunderlying lung disease like lung cancer, TB, bronchiectasis or emphysema

29

hypoxemia post MVA is worsened with fluid challenge

pulmonary contusion

30

theophylline toxicity

CNS stimulation like HA, insomnia and seizures
GI nausea and vomiting
cardiac toxicity causing arrhythmia

31

PE can cause what arrhythmias

AFib

32

Dx PE

CTA

33

most common causes of secondary clubbing

lung malignancies, CF and right to left cardiac shunts

34

hypertrophic osteoarthropathy

digital clubbing with painful joint enlargement, periostosis of bones and synovial effusions

35

does COPD cause clubbing

no

36

at what Saturation O2 is home O2 warranted for cOPD

37

what are the anti cholinergics used in COPD

ipratropium and tiotropium

38

signs of wegeners

blood sputum or nasal discharge, oral ulcers, sinusitis, dyspnea, cough and hemoptysis
renal insufficiency, microscopic hematuria and RBC casts

39

CXR in wegeners

nodular densities and alveolar or pleural opacities

40

what does flattening of diaphragm in COPD do

increase work of breathing

41

normal DLCO but has obstructive pattern

chronic bronchitis

42

what happens when lay penumonia side down

increase physiologic shunting

43

what happens to A-a gradient in idiopathic pulmonary fibrosis

increased

44

what to check in middle aged person with recurrent sinusitis and gastroenteritis

Quantitative measurement of serum Ig levels

45

how does chlorpheniramine work

decrease nasal secretions
H1 R blocker

46

what bacteria cause empyema

step pneumo
staph aureus
klebsiella

47

what do you need to exclude when suspect ARDS in someone without risk factors

echo to rule out hydrostatic pulmonary edema

48

how to differentiate asthma and cOPD

before and after bronchodilator Tx on spirometry

49

high PaCO2 and low PaO2 suggest what

alveolar hypoventilation

50

Aa gradient with hypoventilation

normal with respiratory acidosis

51

why not use Positive pressure mechanical ventilation in someone with hypovolemic shock

it will acutely increase the intrathoracic pressure and so increase right atrial pressure and decrease systemic venous return-- can cause circulatory collapse

52

what happens to Aa and V/q with pneumonia

Aa increases and there is a V/Q mistmatch

53

solitary pulmonary nodule, management

high risk malignancy- resect
mod risk- further imaging and studies

54

VC in COPD

decreased from air trapping

55

what are the anti cholinergics used in COPD

ipratropium and tiotropium

56

Rx used for acute pulmonary thromboembolism

unfractionated heparin

57

exudative fluid

fluid protein/ serum protein is >0.5
fluid LDH/serum LDH >0.6

58

what cause exudative pleural effusions

infection, autoimmune, neoplasm

59

what mechanism causes the exudate in pleural effusions

increased capillary permeability

60

transudative mechanism

increased hydrostatic pressure or decreased capillary oncotic pressure

61

what causes cough in ACEI Tx

increased kinin

62

how to Dx CF

positive screening
increased sweat Cl test on 2+ occasions (quantitative pilocarpine iontophoresis)
identification of 2 CF mutations

63

Bruton tyrosine kinase gene mutation

X linked agamma globulinemia

64

what do we measure exhaled nasal nitric oxide for

primary ciliary dyskinesia

65

best way to prevent post op pneumonia

incentive spirometry

66

what are the complications of PEEP

alveolar damage, tension pneumo, hypotension

67

Tx tension pneumo

needle insertion 2nd ICS MCL

68

recurrent pneumonias in adult in same anatomic region every time

do CT to evaluate for potential obstructions

69

what causes a increase in plateau pressure or (compliance)

pneumothorax
PE
pneumonia
atelectasis
right mainstem intubation

70

what happens to Aa and V/q with pneumonia

Aa increases and there is a V/Q mistmatch

71

exudative fluid

fluid protein/serum protein >0.5
LDH fluid/serum LDH >0.6
pleural fluid LDH >2/3 uper limit normal serum LDH

72

pleural effusion fluid with glucose

rheumatoid pleurisy, parapneumonic effusion or empyeme, malignant effusion, TB pleurisy, lupus pleuritis, esophageal rupture

73

where do bronchogenic cysts occur

middle mediastinum

74

complication bronchilitis in infant

apnea

75

what cause V/Q mismatch

obstrucive lung disease, atelectasis, pulmonary edema and pneumonia

76

what is Aa gradient in V/Q mistmatch

increased

77

what type of lung pathology does not correct with supp O2

shunt

78

what causes increased tactile fremitus

consolidation lobar or pneumonia

79

what cause decreased tactile fremitus

pleural effusion COPD and pneumothorax

80

what is mainstay ventilation settings for ARDS

low tidal volumes and PEEP

81

ARDS is from what underlying physiologic process

pulmonary edema from leaky alveolar capillaries

82

COPD excacerbation not improving with medicaitons. next step

Noninvasive positive pressure ventilation

83

what are Sx for someone requiring albuterol and corticosteroids

mild persistent asthma (more than 2x a week and 3-4x night awakenings a month)

84

next step in pleural effusion management once diagnosed by CXR

thoracocentesis to find cause. transudate or exudate

85

in newborn with polyhydramnios nasal flaring, barrel chest, breath sounds absent on left and heart sounds loudest at right. abdomen is scaphoid

congenital diaphragmatic hernia pushing everything to the right

86

recurrent pneumonias in adult in same anatomic region every time

do CT to evaluate for potential obstructions

87

location of adenocarcinoma of lung

peripheral. most common lung CA

88

Tx for non allergic rhinitis

intranasal antihistamines or glucocorticoids

89

effects of squamous cell carcinoma of lung

hypercalcemia

90

what can small cell carcinoma of lung cause

cushing, SIADH, lambert eaton

91

where does large cell carcinoma in lung occur

peripheral and can cause gynecomastia and galactorrhea

92

intial management of PE

anticoagualte if no contraindicaitons

93

what lung pathogen can cause lytic bone lesions

blastomycosis

94

what lba test is most helpful indetermining need for chest tube in papapneumonic effusion

pH lower than 7.2 indicates empyema

95

spontaneous pneumothorax usually caused by

alveolar bleb rupture

96

hours after gastric secretion aspiration have cough and decreased O2 saturation

pneumonitis from inflammation from the gastric acid

97

new solitary pulmonary nodule compared to 2 years ago on CX

need a CT to evaluate

98

management of laryngomalacia in child

reassurance
sometimes supraglottoplasty

99

diagnosis laryngomalacia

flexible laryngoscopy showing collapse of supraglottic structures with inspiration and omega shaped epiglottis

100

chronic low back pain in young adult male and also is having trouble breathing, DOE

ankylosing spondylitis that causes restrictive pattern in lungs

101

what are Sx for someone requiring albuterol and corticosteroids

mild persistent asthma (more than 2x a week and 3-4x night awakenings a month)

102

when do you give long acting beta 2 agonist

moderate persistent asthma daily Sx, weekly nighttime awakenings, limits on activities, FEV1 60-80% predicted

103

panacinar empysema from AAT deficiency affects what part of lungs

lower lobes

104

pH of transudate vs exudate

exudate is usually 7.3-7.45
transudate is usually 7.4-7.55

105

manifestations of sarcoid

pulmonary: bilateral hilar adenopathy, interstitial infiltrates
opthalmologic: anterior uveitis and posterior uveitis
reticuloendothelial: peripheral lymphadenopathy, hepatomegaly and splenomegaly
MSK: acute polyarthritis, chronic arthritis with periosteal bone resorption
CNS: central DI, hypercalcemia
Lofgren's syndrome: erythema nodosum, hilar adenopathy, migratory polyarthralgias, fever

106

Tx for non allergic rhinitis

intranasal antihistamines or glucocorticoids

107

Tx for bacterial sinusitis

amoxicillin-clavunate

108

neonate CXR shows bilateral perihilar linear streaking shortly after birth

transient tachypnea of the newborn

109

if a newborn CXR shows clear lungs with decreased pulm vascularity

persisten pulmonary HTN

110

primary problem in RDS newborns

surfactant deficiency

111

massive hemoptysis, next step

secure airway and if bleeding continues do bronchoscopic interventions

112

what lba test is most helpful indetermining need for chest tube in papapneumonic effusion

pH lower than 7.2 indicates empyema

113

what to use to rule in or out PE if PE clinically unlikely? clinically likely?

unlikely based on Wells-- do D-dimer
likely based on Wells-- do CTA

114

metabolic imbalance from Obstructive sleep apnea

metabolic alkalosis to counteract respiratory acidosis. will have low Cl from bicarb retention

115

fungal ball on CT

aspergilloma, most common in preexisting lung cavities like old TB lesion

116

velcro like inspiratory crackles

idiopathic pulm fibrosis

117

Hypersensitivity pnuemonitis

inhalation of inciting Ag leading to alveolar inflammation
ground glass opacity or haziness of lower lung fields

118

outpatient Tx CAP

macrolide or doxy
if have comorbidity: fluorquinolone or beta lactam+macrolide

119

ICU Tx CAP

betalactam + macrolide IV
or
betalactam +fluoroquinolone

120

non ICU Tx CAP

fluoroquinolone
or
betalactam+ macrolide

121

CURB-65

for CAP hospitalization
Confusion
Uremia (BUN>20(
Tachypnea >30
hypotension
Age>65

2 or more will benefit from inpatient. 4 or more ICU

122

skin manifestations wegeners.

painful subcut nodules, palpable purpura and pyoderma gangrenosum-like lesions

123

immunocompromised from chemo and now has pneumonia, pathogen? CXR findings?

P jiroveci
diffuse interstitial infiltrates in perihilar region

124

PE cause transudate or exudate

both

125

male has SOB and cough with some hemoptysis. also UA shows dysmorphic RBC

goodpastures
Ab to basement membrane, alpha 3 chain IV collagen, linear IgG deposits

126

how is recent GI illness risk factor for PE

dehydration and hemoconcentration

127

wedge shaped pleural opacification in CTA

pulmonary emoblism

128

signs hyeprcalcemia

anorexia, constipation, increased thirst and easy fatiguability

129

how does squamous cell carcinoma of lung cause hyperCa

release PTHrp

130

what is produced by non-seminomatous germ cell tumors

bhCG and AFP

131

Aa gradient in PE

high

132

target INR for warfarin in idiopathic DVT patient

2-3 for at least 6 mo

133

Tx aspergilloma

itraconazole, resectino or bronchial artery embolization

134

confirm Dx aspergilloma

IgG serology for aspergillus

135

APGAR stand for

Appearnce(color)
Pulse
Grimace (reaction)
Activity (muscle tone)
Respiratory effort