PULMO Flashcards
(101 cards)
1
Q
4 lung volumes
A
2
Q
3 lung zones
A
2
Q
4 lung capacities
A
3
Q
V/Q at apex of lung
vs V/Q at base of lung
A
4
Q
V/Q = 0
vs
V/Q = infinity
A
5
Q
How O2 is transported in blood (2)
A
6
Q
How CO2 ins transported in blood (3)
A
7
Q
Increase in the following factors (5) would cause shift to the RIGHT of the 02-Hgb dissociation curve (unloading of 02 from Hgb)
A
8
Q
Main respiratory center in the medulla; sends inspiratory ramp signal to diaphragm
A
9
Q
Central control of both inspiration and expiration (supplements DRG) during exercise
A
10
Q
Decreases duration of inspiration and increases resoiratory rate
A
11
Q
Increases duration of inspiration and decreases respiratory rate
A
12
Q
Reversibility in asthma (spirometry) is demonstrated by
A
13
Q
Physiologic abnormality of asthma
A
Airway hyperresponsiveness
14
Q
Major risk factor for asthma
A
Atopy
15
Q
Pathogenesis behind asthma:
Imbalance favoring TH1 production over TH2
True or False
A
False… kasi dapat…
Imbalance favoring TH2 production over TH1
16
Q
Term for the Whorls of shed epithelium in mucus plugs in asthma
A
Curschmann’s spirals
17
Q
Term for Eosinophilic, hexagonal, double-pointed crystals formed from breakdown of eosinophils in sputum (in asthma )
A
Charcot-Leyden Crystals
18
Q
Characteristic finding in asthamtic airways
A
Thickening of the basement membrane due to subepithelial collagen deposition
19
Q
Key predominant cell in asthma
A
None
Many inflammatory cells are involved in asthma with no key cell that is predominant
20
Q
Most common allergens that trigger asthma
vs
Most common triggers of acute severe asthma exacerbations
A
Dermatophagoides (house dust mites)
vs
URTI: rhinovirus, respiratory syncytial virus (RSV), coronavirus
21
Q
Mechanism of exercise-induced asthma (EIA)
A
hyperventilation
22
Q
Typical presentation of EIA
A
Begins after exercise has ended, and recovers spontaneously within about 30 min.
Worse in cold, dry climates than in hot, humid conditions.
23
Q
EIA is best prevented by regular treatment with
A
ICS
24
Confirms airflow limitation with a reduced FEY,, FEV,/FVC ratio, and PEF
spirometry
25
Confirms diurnal variations in airflow obstruction in asthma
Measurements of PEF twice daily
26
Most common side effects of B2-agonists used in asthma (2)
muscle tremor
palpitations
27
Most common side effect of anticholinergics used in asthma
dry mouth
28
in elderly patients with asthma using anticholinergics, these 2 side effects can be observed...
glaucoma
urinary retention
29
Most effective controllers for asthma
ICS
30
Use of a reliever medication >1x a week Indicates the need for regular controller therapy in asthma
| True or false...
False... kasi dapat...
Use of a reliever medication **>2x a week** Indicates the need for regular controller therapy in asthma
31
Most common reason for poor control of asthma
Noncompliance with medications, usually ICS
32
Drugs that are safe for asthma in pregnancy (3)
* Short-acting B2-agonists
* ICS
* Theophylline
33
Pathogenesis behind emphysema
Imbalance between Protease (Elastase) and Anti-Protease (Alpha 1- Anti-Trypsin)
34
First symptom of emphysema
progressive dyspnea
35
What is Reid's Index
Ratio of mucus gland layer thickness to the thickness of the wall between the epithelium and the cartilage orthe trachea and bronchi
36
Reid's index for chronic bronchitis
more than 0.4
37
Most highly significant predictor of FEV1 in COPD
Pack-years of cigarette smoking
38
Important cause of COPD exacerbations
respiratory infections
39
Most common form of severe alpha 1-AT deficiency
40
Most typical objective finding in COPD
Persistent reduction in forced expiratory flow rates
41
This mechanism accounts for essentially all of the reduction in Pa02 that occurs in COPD
Ventilation-perfusion mismatching
42
Major site of increased resistance in COPD
Small airways < 2 mm diameter
43
Type of emphysema frequently associated with cigarette smoking, characterized by enlarged air spaces found (initially) in association with respiratory bronchioles
44
Type or emphysema usually observed in patients with alpha 1-AT deficiency, characterized by abnormally large air spaces evenly distributed within and across acinar units
45
Type or emphysema distributed along the pleural margins with relative sparing of the lung core or central regions
46
Major physiologic change in COPD
Airflow limitation
47
Characteristic of COPD reflecting the heterogeneous nature of the disease process within the airways and lung parenchyma
non uniform ventilation and VQ mismatching
48
Newly-developed clubbing of-the digits (not a sign ofCOPD) should alert an investigation for
lung cancer
49
Hallmark of COPD
airflow obstruction
50
The only pharmacologic therapy demonstrated decrease mortality rates in COPD
Supplemental O2
51
Strong predictor of future COPD exacerbations
history of prior exacerbations
52
Bacteria frequently implicated in COPD exacerbations (3)
* Streptococcus pneumoniae
* Haemophilus injluenzae
* Moraxella catarrhalis
## Footnote
In addition, Mycoplasma pneumoniae or Chlamydia pneumoniae are found in 5-10% of exacerbations
53
The only three interventions shown to influence the natural history of COPD
54
Most common way microorganisms gain access to the lower respiratory tract in pneumonia
Aspiration from the oropharynx
55
Most common etiology of community-acquired pneumonia
Streptococcus pneumoniae
56
Major risk factor for anaerobic pneumonia
Combination of
* an unprotected airway ( e.g., in patients with alcohol or drug overdose or a seizure disorder)
* and significant gingivitis
57
Organism well known to complicate influenza infection
S. aureus
58
Organism well known to cause necrotizing pneumonia
S. aureus
59
To be adequate for culture, a sputum sample must have
* ____neutrophils
* ____sq cells per lpf
>25 neutrophils
<10 squamous cells per lpf
60
Most frequently isolated pathogen in blood cultures or community·acquired pneumonia
Strep pneumoniae
61
Irreversible airway dilation that involves the lung in either a focal or a diffuse manner
Bronchiectasis
62
Most common form of bronchiectasis
cyclindrical or tubular
63
Most widely cited mechanism of infectious bronchiectasis
Vicious Cycle Hypothesis - susceptibility to infection and poor mucociliary clearance result in microbial colonization of the bron· chial tree.
64
Most common clinical presentation of bronchiectasis
Persistent productive cough with ongoing production of thick, tenacious sputum
65
Imaging modality of choice for confirming bronchiectasis
chest CT
66
First step in the diagnostic approach to pleural effusion
Determine whether effusion is a transudate or exudate
67
Leading causes of transudative pleural effusion (2)
LV failure and cirrhosis
68
Lab test that is Virtually diagnostic that the effusion is secondary to congestive heart failure.
pleural fluid NT-proBNP >1500 pg/mL
69
Most common cause of chylothorax
Trauma (most frequently thoracic surgery), but it also may result from tumors in the mediastinum
70
Three tumors that cause ~75% of all malignant pleural effusions
* Lung carcinoma
* Breast carcinoma
* Lymphoma
71
Term for Benign ovarian tumors producing ascites and pleural effusion
Meigs syndrome
72
Condition most commonly overlooked in the DDX of patient with an undiagnosed effusion
pulmonary embolism
73
Treatment of choice for most cases of chylothorax
Insertion of a chest tube plus administration of octreotide
74
Primary spontaneous pneumothoraxes
occur almost exclusively in what px population
smokers
75
how to diagnose OSA/Hypopnea syndrome
76
differentiate apnea vs hypopnea
77
First step in evaluating a mediastinal mass
Place it in one of the three mediastinal compartments
78
most common lesions in the anterior mediastinum (4)
79
masses of vascular origin are found at what compartment of mediastinum
80
hernia through foramen of Bochdalek is found at what compartment of mediastinum
81
Most common preventable cause of death among hospitalized patients.
pulmonary embolism
82
Most common gas exchange abnormalities in Pulmo embo
Arterial hypoxemia and an increased 02 tension gradient,
83
Hallmarks of massive PE (4)
* Dyspnea,
* syncope,
* hypotension,
* and cyanosis
84
Most common symptom of DVT
Cramp of "'charley horse" in the lower calf that persists and intensifies over several days
85
Most common symptom of PE
Unexplained breathlessness
86
Useful rule out test: > 95% of patients with normal levels do not have PE
Quantitative plasma D-dimer ELISA
87
Most frequently cited ECG abnormality in PE (in addition to sinus tachycardia)
vs
Most common ECG abnormality in PE
S1 Q3 T3 sign
vs
T-wave inversion in leads V1 to V4
88
Principal imaging test for the diagnosis of PE
Chest CT Scan with IV contrast
89
Second-line diagnostic test for PE, used mostly for patients who cannot tolerate IV contrast
lung scan
90
Best known indirect sign of PE on transthoracic echo
McConnell's sign: hypokinesls of the RV free wall with normal motion of the RV apex
91
what is McConnell's sign:
* hypokinesis of the RV free wall with normal motion of the RV apex
* best known indirect sign of PE on transthoracic echo
92
Definite diagnostic test for PE which visualizes an intra1uminal filling defect in more than one projection
pulmo angiography
93
Foundation for successful treatment of DVTand PE
anticoagulation
94
diagnostic criteria for ARDS
95
Most cases of ARDS are caused by (2)
Pneumonia and sepsis (-40-60%)
96
3 phases of ARDS
* Exudative
* Proliferative
* Fibrotic phase
97
The only Grade A recommendation in treatment of ARDS
Low VT ventilation
(6 mL/kg of predicted body weight)
98
Mortality in ARDS is largely attributable to
Nonpulmonary causes, with sepsis and nonpulmonary organ failure accounting for >80% of deaths
99
What is type 3 respiratory failure
Respiratory failure due to atelectasis (aka perioperative respiratory failure
100
