Pulm Flashcards
(135 cards)
1
Q
XR hint to diaphragmatic rupture
A
NG tube in the thorax
2
Q
XR hint to diaphragmatic rupture
A
NG tube in the thorax
3
Q
what occurs with large areas of atelectasis
A
large ventilation perfusion mist match. hyperventilation to compensate for hypoxemia leading to respiratory alkalosis and decreased PaCO2
4
Q
how does the body compensate for severe COPD causing acidosis
A
renal retention HCO3
5
Q
apical lung tumor signs and Sx
A
horner syndrome if compress sympathetic trunk
brachial plexus affected with pancoast tumor
right recurrent laryngeal compression causes hoarse voice
superior vena cava syndrome
6
Q
high Right atrial P and high pulm artery pressure but with normal PCWP
A
PE
7
Q
risk for RDS in newborn
A
prematurity
DM, male, perinatal asphyxia and C section without labor
8
Q
CXR for RDS
A
diffuse reticulogranular pattern (ground glass) with air bronchograms
9
Q
horners
A
ptosis miosis anhidrosis
10
Q
how to Dx pancoast tumor or superior sulcus
A
CXR
11
Q
Hypertrophic pulmonary osteoarthropathy
A
clubbing and arthropathy of fingers and wrists due to lunderlying lung disease like lung cancer, TB, bronchiectasis or emphysema
12
Q
hypoxemia post MVA is worsened with fluid challenge
A
pulmonary contusion
13
Q
theophylline toxicity
A
CNS stimulation like HA, insomnia and seizures
GI nausea and vomiting
cardiac toxicity causing arrhythmia
14
Q
PE can cause what arrhythmias
A
AFib
15
Q
Dx PE
A
CTA
16
Q
most common causes of secondary clubbing
A
lung malignancies, CF and right to left cardiac shunts
17
Q
hypertrophic osteoarthropathy
A
digital clubbing with painful joint enlargement, periostosis of bones and synovial effusions
18
Q
at what Saturation O2 is home O2 warranted for cOPD
A
19
Q
at what Saturation O2 is home O2 warranted for cOPD
A
20
Q
what occurs with large areas of atelectasis
A
large ventilation perfusion mist match. hyperventilation to compensate for hypoxemia leading to respiratory alkalosis and decreased PaCO2
21
Q
how does the body compensate for severe COPD causing acidosis
A
renal retention HCO3
22
Q
apical lung tumor signs and Sx
A
horner syndrome if compress sympathetic trunk
brachial plexus affected with pancoast tumor
right recurrent laryngeal compression causes hoarse voice
superior vena cava syndrome
23
Q
high Right atrial P and high pulm artery pressure but with normal PCWP
A
PE
24
Q
what happens when lay penumonia side down
A
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
```
