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Flashcards in Pulmonary Deck (129):
1

what can dullness on percussion indicate?

effusion or pneumonia

2

What can hyperresonance on pulmonary exam indicate?

emphysema or pneumothorax

3

what does increased tactile fremitus indicate?

pneumonia or tumor

4

what does decreased tactile fremitus indicate?

effusion/ pneumothorax

5

total volume of air exhaled after maximal inspiratin

forced vital capacity (FVC)

6

normal amount of air with each breath

tidal volume

7

normal pH for ABGs

7.35-7.45

8

Normal HCO3 for ABG

22-26

9

4 main conditions that can cause respiratory acidosis

COPD, asthma, CHF pneumonia

10

3 main conditions that can cause respiratory alkalosis

hyperventilation, fever, anxiety

11

Conditions that cause metabolic acidosis (MUD piles)

methanol
uremia
DKA
Propylene glycol
isoniazid
lactic acidosis
ethylene glycol
salicylates

12

2 conditions that can cause metabolic alkalosis

vomiting, NG suction

13

triad of asthma

airflow obstruction
bronchial hyperreactivity
inflammation

14

prolonged, severe asthmatic attack
that does not respond to treatment with patient at risk
for ventilatory failure

Status asthmaticus :

15

what will PFTs look like with asthma

Decreased FEV1, decreased FEV1/FVC, increased residual volume and TLC

16

Drugs that – Reverse vagally mediated bronchospasm but not allergen
or exercise induced bronchospasm

anticholinergics

17

Destruction of alveolar walls produces widely
dilated air spaces

emphysema

18

Excessive mucus secretion in the bronchial tree
causing mucus plugging and inflammation,
peribronchiolar fibrosis, narrowing and
obliteration
• Productive cough for at least 3 months during
each of two successive years

chrnoic bronhcitits

19

ABX that help with uncomplicated COPD exacerbations (not >65, FEV1 >50%, >3 exacerbations/year)

doxycycline, batrim, macrolide, cephalosporin

20

ABX good for complicated COPD

fluoroquinolones (floxacins), augmentin

21

abnormal dilataion of the bronchi, chronic purulent sputum, hemoptysis. Ausculatory crackles, digital clubbing

Bronchiectasis

22

Drugs for influenza A

rimantadine

23

drug for influenza A or B

zanamivir, or oseltamivir

24

Major cause of lower respiratory infections of
newborns and children
• Often an epidemic during winter months
• Causes bronchiolitis – inflammation of small
airways

RSV? acute bronchiolitits

25

TX for acute bronchiolitits (RSV)

humidified air, oxygen, ribavirin, albuterol, fluids (steroid not recommended in infants)

26

Highly contagious airborne disease that
classically lasts for 6 weeks before subsiding. Has 3 stages (catarrhal, paroxysmal, convalescent)

pertussis (bordetella pertussis)

27

Tx for pertussis

vaccine, macrolides, or bactrim

28

Parenchymal lung infection
– 1‐10 day history of increasing cough, yellow sputum,
shortness of breath, tachycardia and pleuritic chest pain

community acquired pneumonia

29

typical bacteria that causes CAP

mycoplasma, chlamydia, legionella

30

Lab with CAP

luekjocytosis w/ left shift, CXR_ lobal infiltrates

31

Outpatient Tx for CAP

macrolides, doxy, fluoroquinolones

32

Inpatient tx for CAP

fluoroquinolones, macrolide + Beta-lactam

33

: low grade fever, nonproductive cough,
myalgia, fatigue, mild pulmonary symptoms
that are self‐limited occurring in young
otherwise healthy adults

atypical pneumonia

34

Tx for chlamydia pneumonia

tetracycline

35

Tx for CMV

ganciclovir

36

Treatment for RSV

ribavirin

37

“Caves, Ohio valley, and lower
Mississippi region”, grows in soil with bird or bat
droppings.

histoplasmosis fungal pneumonia

38

tx for histoplasmosis fungal pneumonia

amphotericin B, itraconazole

39

“California disease, valley fever”,
New Mexico area, causes mild sx

coccidiomycosis fungal pnuemonia

40

tx for coccidiomycosis fungal pneumonia

fluconazole, or amphotericin B

41

endemic in N. America around Great
Lakes, Ohio river basin and Mississippi river, broad
base budding organism, extrapulmonary lesions :
skin, bone, prostatitis.

blastomycosis fungal pneumonia

42

tx for blastomycosis fungal pneumonia

oral itraconazole

43

potentially fatal disease,
opportunistic infection in AIDS

cryptococcosis fungal pnuemonia

44

tx for cryptococcosis fungal pneumonia

IV amphotericin B + oral flucytosine

45

immunocompromised individuals,
waterfowl, fungal ball on CXR.

treat with any antifungal

46

Nonproductive cough, dyspnea, fever in an individual with HIV pneumonia. 50% will ahve a normal exam. Increased LDH and ilver stain on sputum. Ground glass ppearance on CXR/CT

PCP (pneumocystis jiroveci pneumonia)

47

Tx for PCP pnuemonia

bactrim ?clinda

48

– Walking pneumonia
– + cold agglutinins
– Bullous myringitis

mycoplasma pneumoniae

49

pneumonia if around
poultry, pet shops

chlamydia psittaci

50

“currant
jelly sputum” common in alcoholics

Klebsiella pneumonia

51

common organism in pneumonia in individuals with cystic fibrosis

Pseudomonas

52

pneumonias from rabbit exposure

Tularemia, francisella, tularensis

53

cough, fever, chills, night sweats,
anorexia, fatigue, weight loss , caused from inhaling aerosol droplets

Tuberculosis

54

what will you see on CXR with TB

cavitary infiltrate in a posterior apical
segment of an upper lobe or in a superior
segment of a lower lobe

55

what will sputum show with TB

positive acid fast bacilli

56

Tx for latent dz of TB

isoniazid for 9 months

57

4 drug tx for TB

isoniazid
rifampin
pyrazinamide
ethambutol

58

• Acute onset of respiratory failure due to
↑ permeability of the alveolar capillary
membranes leading to severe pulmonary
edema, hypoxia and dyspnea
– 30‐40 % mortality

ARDS

59

what will the PaO2:FIO2 ratio be with ARDS

<200

60

causes of ARDS

sepsis, multiple trauma, aspiration, DIC< shock, blood transfusion, pancreatitis

61

Symptoms tachypnea, frothy pink or red sputum, diffuse
rales, dyspnea, severe hypoxemia

ARDS

62

what will an ABG show with ARDS?

respiratory aidosis (possible acute respiratory alkalosis initially)

63

TX for ARDS

reverse the program, broad spectrum abx for sepsis, , diuretics

64

chest pain caused by pleural inflammation, sharp stabbing pain w/ breathing. Sneezing / coughign makes it worse

Pleurisy

65

Tx for pleurisy

analgesic, NSAIDs, antimicrobials PRN

66

3 main occupational lung diseaes

asbestosis, silicosis, coal workers' pneumoconiosis

67

Diffuse interstitial cellular and fibrotic reaction of the lung to inhaled asbestos fibers

asbestosis

68

lung condition that presents with breathlessness, digital clubbing, basilar rales. CSR will show hazy infiltrats in the lwoer lung zones, interstitial fibrosis, thickened pleura, calcified plaques on the diaphragms or lateral chest wall

asbestosis

69

what cancer does asbestosis cause

mesothelioma

70

lung condition on CXR will show numerous small, rounded opacitites scattered throughout the lungs and hilar lymph nodes may be calcified

silicosis

71

lung condition- CXR shows small opacities that are prominent in the upper lung fields. Restrictive dysfunction on PFTs

coal workrs pneumoconiosis

72

accumulation of fluid between teh lung and thoracic wall

pleural effusion

73

what causes a transudative pleural effusion

CHF

74

what are some causes of exudative pleural effusions

malignancy, blood (trauma), infection

75

PE with pleural effusion

dullness to percussion in lower lung field, decreased breath sounds, decreased tactile fremitus

76

Tx for pleural effusion

thoracentesis

77

accumulation of pus in the pleural space

empyema

78

Tx for empyema

chest tube, abx (will often need thoracoscop or thoracotomy)

79

lymph fluid accumulation int he pleural space to to injury of the thoracic duct by laceration of obstruction by trauma or tumor

Chylothorax

80

what will be present in the fluid from a chylothorax

triglycerides, it will be milk white

81

Tx for chylothorax

chest tube, NPO, TPN

82

PE with pneumothorax

Hyperresonance, decreased tactile fremitus, decreased breath sounds

83

Air in the pleural space causing a mediastinal
shift to the contralateral side and impaired
ventilation leading to cardiovascular
compromise

tension pneumothorax

84

What will ABGs show with pulmonary embolism

respiratory alkalosis, hypoxia

85

What will ECG show with pulmonary embolism

tachycardia, anterior ST segment changes, T wave inversion. RBBB, S1Q3T3

86

what is the first choice diagnosis for PE?

CT pulmonary angiography

87

Tx for PE

oxygen, bed rest, anticoags (heparin, coumadin), thrombolytics (streptokinase, etc), surgery- IVC filter or thromboembolectomy

88

how to diagnose pulmonary HTN

right heart catheterization

89

Tx for pulmonary HTN

oxygen, diuretics, anticoags

90

• Disease of the right ventricle that results from
pulmonary HTN secondary to pulmonary
disease

cor pulmonale

91

causes of acute cor pulmonale

PE, ARDS

92

causes of chronic cor pulmonale

COPD, restrictive lung disease

93

S/S of cor pulmonale

peripheral edema, liver enlargement, neck vein engorgement.

94

medical tx for cor pulmonale

oxygen, diuretics, vasodilators

95

what will interstitial lung dz look like on CXR

honeycomb lung, ground grass infiltrate

96

how do you diagnose interstitital lung dz

biopsy

97

Dz with noncaseating granulomatous inflammation in in affected organs

sarcoidosis

98

what will labs with sarcoidosis show

hypercalcemia, hypercalciuria, increase in ACE levels

99

CXR have bilateral hilar and right paratracheal adenopathy with diffuse reticular infilatrates

sarcoidosis

100

Tx for sarcoidosis

corticosteroids

101

• Progressive autoimmune disease of the lungs
and kidneys
• Produces intra‐alveolar hemorrhage and
glomerulonephritis

goodpasture syndrome

102

what causes goodpasture syndrome

ati-glomerular basement membrane (anti-GBM) antibodies

103

Tx for goodpasture syndrome

plasmapharesis and corticosteroids

104

Classic triad : upper respiratory vasculitis, lower
respiratory vasculitis & glomerulonephritis
Often bloody nasal polyps, chronic sinusitis

Wegener's granulomatosis

105

what 2 labs values will be present with wegener's granulomatosis

+ANCA, ESR

106

Tx for Wegener's granulomatosis

cyclophosphamide +/- prednisone

107

Skeletal abnormality that leads to chronic
deterioration in lung function
• Causes increased stiffness of the chest wall

kyphoscoliosis

108

Tx for kyphoscoliosis

possible meachnical vent support, corrective intervention when angulation >40

109

what are the 5 main anterior mediastinal masses

thymomas
thyroid tumor
teratoma
parathyroid tumor
lymphoma

110

what is the common middle mediastinal mass

bronchogenic tumor/ cyst

111

5 common posterior mediastinal masses

neurogenic tumor, esophageal tumor, hiatal hernia, meningocele, thoracic spine dz

112

are most solitary pulmonary nodules benign or malignant

benign (usually <2 cm, with distrinct margins)

113

What makes a solitary pulmonary nodule more likely to be malignant?

patient >45, >2 cm, indistinct margins, rarely calcified

114

Tx for solitary pulmonary nodules

thorascopy or thoracotomy w/ biopsy

115

most common benign lung tumor, is a malformation that resembles a neoplasm. On CXR will look like a popcorn lesion.

hamartoma

116

most common type of lung cancer, typically metastasizes. Lung periphery, CEA positive

Adenocarcinoma

117

2nd most common type of lung cancer. Central bronchi and metastasizes to regional lymph nodes. Will be a hilar mass w/ cavitation on CXR. Hypercalcemia

squamous cell carcinoma

118

neuroendocrine lung cancer, quick to metastizie.

small cell carcinoma

119

Tx for small cell carcinoma

chemotherapy

120

S/S with small cell carcinoma

SIADH, paraneoplastic syndrome

121

slow growing lugn tumro often in central bronchi. Patient can have flushing, diarrhea, wheezing, haert valve lesions, HPOTN

carcinoid tumor

122

Tx for carcinoid tumor

octreotide

123

standard method for determining if someone has a TB infection

Mantoux tuberculin skin test (TST)

124

What causes transient tachypnea of the newborn (tachypnea, nasal flaring, subcostal retractions, cyanosis)?

retention of fetal lung fluid

125

lung condition with upper and lower respiratory tract vasculitits. Glomerulonephritis and positive ANCA

wegner's granulomatosis

126

tx for wegner's granulomatosis

cyclophosphamide +/- prednisone

127

when will tactile fremitus be decreased

effusion or pneumothorax

128

what is decreased with restrictive lung diseases

FVC, lung volume

129

cotton dust exposure causes chest tightness and decreased FEV1

byssinosis