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Level 2 Boards > Pulmonary > Flashcards

Pulmonary Flashcards

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1
Q

Asthma values

A

FEV1/FVC < 70%
Decreased FEV1

Normal or decreased FVC

Increased RV
Increased TLC

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2
Q

Obstructive values

A

FEV/FVC < 0.70 (decreased)
FEV < 80 (decreased)
FVC < 80 (decreased)

FRC increased
TLC increased

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3
Q

Restrictive values

A

FEV/FVC increased/ normal

FEV decreased
FVC decreased
FRC decreased
TLC decreased

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4
Q

Albuterol

A

Short acting beta agonist

First line

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5
Q

Salmeterol

A

Long acting beta agonist

Maintenance therapy

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6
Q

Corticosteriods for asthma

A

Prednisone

Beclomethasone

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7
Q

Steps in Asthma treatment

A
  1. Mild intermittent
    <= 2 days/week
    <= 2 nights/month

No daily medications
SABA (albuterol) PRN

  1. Mild persistent
    >2 times/week
    < 1 time/ day
    >2 nights/month

Daily low dose ICS
Albuterol PRN

3. Moderate persistent
Daily
>1 night/week
Low dose ICS + LABA
or Medium ICS + SABA prn
  1. Severe persistent
    Continual
    Frequently night
    Medium dose ICS + LABA
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8
Q

Productive cough

Yellow green sputum
Dyspnea

Frequent infections

Wheezes, rhonchi

  • Name
  • CXR
  • Tx
A

Bronchiectasis

CXR: increased bronchovascular markings, tram lines (parallel lines outlining dilated bronchi)

Tx: Respiratory fluoroquinolone (levofloxacin, moxifloxacin)

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9
Q

Productive cough > 3 months per year for two years

A

Chronic bronchitis

Blue bloater
Overweight

Type of COPD

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10
Q

Test for COPD

A

Spirometry (PFTs)

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11
Q

Emphysema

A

Type of COPD

PInk puffer

Terminal airway destruction and dilation

Thin, wasted appearance with pursed lips, minimal cough

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12
Q

Medications that cause interstitial lung disease

A 
Amiodarone
Busulfan
Nitrofurantoin
Bleomycin
Methotrexate
Radiation
Long term high O2 concentration
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13
Q

Honeycomb pattern

A

Interstitial lung disease

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14
Q

Features of Sarcoid (10)

A

Sarcoid can be GRUELING

Granulomas
aRthritis
Uveitis
Erythema nodosum
Lymphadenopathy (hilar)
Interstitial fibrosis
Negative TB test
Gammaglobulinemia

[Third degree heart block]
[ Arrhythmias]

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15
Q

Erythema nodosum
Hilar adenopathy
Migratory polyarthralgias
Fever

Tx

A

Lofgren syndrome of Sarcoidosis

Triad:
Fever
Bilateral hilar adenopathy
Erythema nodosum

Tx: NSAIDS

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16
Q

Sarcoidosis favors what part of lung

A

Upper lobe

Hilar adenopathy

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17
Q

Also seen with sarcoidosis labs (5)

A

Increased ACE levels

Hypercalcemia
Hypercalciuria

Increased Alk phos

Lymphopenia

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18
Q

Sarcoidosis tx

A

Asymptomatic: observe

Symptomatic: Systemic corticosteriods

Refractory: Immunosuppressants (methotrexate, azathioprine, TNFalpha inhibitors)

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19
Q

Alveolar thickening
Non caseating granulomas

Fine bilateral rales

SOB
Fever
Shivering
Cough
Chest tightness
A

Hypersensitivity pneumonitis

Check travel/ job exposure

Molds, Hot tubs, birds

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20
Q

Insulation
Construction
Ship building

A

Asbestosis

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21
Q

Linear opacities at lung bases

Calcified pleural plaques

Risk?

A

Asbestosis

Increased risk for mesothelioma and lung cancer

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22
Q

Small nodular poacities in upper lung zones

A

Coal workers disease

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23
Q

Mines of quarries

Small nodular opacities in upper lung zones

Egg shell calcifications

Risk?

A

Silcosis

Increased risk for TB
Need annual TB skin test

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24
Q

Calcifications upper lobes

A

Silicosis

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25
Calcifications in lower lobes
Asbestosis
26
Aerospace engineer
Berylliosis
27
Interstitial lung disease Diffuse infiltrates Hilar adenopathy
Berylliosis
28
25 AA with painful bumps on shins, WL and cough Exam reveals prominent 1 cm right axillary LN Diagnosis?
Sarcoidosis
29
Low PaO2
Hypoxemia ``` V/Q mismatch Right to left shunt Hypoventilation Low inspired O2 content (high alt) Diffusion impairmetn ```
30
Low PaO2 | A-a gradient normal
Hypoventilation | Low inspired oxygen
31
Low PaO2 | A-a gradient increased
V/Q mismatch | R-L Shunting
32
Low PaO2 A-a gradient increased PaO2 correctable w/ O2
V/Q mismatch 1. Airway disease (asthma, COPD) 2. Interstitial lung disease 3. Alveolar disease (atelectasis, pneumonia, pulmonary edema) 4. Pulmonary vascular disease
33
Low PaO2 A-a gradient increased PaO2 not correctable w/ O2
Shunt (right to left) 1. Intracardiac shunt 2. Vascular shunt within lungs
34
Low PaO2 A-a gradient normal PaCO2 is increased
Hypoventilaition 1. Decreased respiratory drive 2. Neuromuscular disease
35
Low PaO2 A-a gradient normal PaCo2 is not increased
Decreased FiO2 (high altitude)
36
A-a gradient
([Patm - 47] X FiO2 - [ PaCO2/ 0.8]) - PaO2
37
Acute Respiratory Distress syndrome - Timeline - Features (7) - Lung changes (2) - CXR appearance
Acute onset 12-48 hrs ``` Tachpnea Dyspnea Tachycardia Fever Cyanosis Labored breathing High pitched rales ``` Widening A-a gradient Decreased lung compliance *Ground glass Lungs Cant Handle Toxic Toxins For Days
38
A 25 y.o man in the ICU is intubated following an acute asthma exacerbation. A repeat ABG is sent after intubation and shows a pH of 7.5, PaCO2 of 33 and HCO3 of 26. What adjustments
Uncompensated respiratory alkalosis caused by increased ventilation To decrease ventilation, tidal volume can be decreased of respiratory rate can be slowed However, reducing tidal volume can trigger an increase in ventilatory rate, exacerbating the situation
39
Increases oxygenation
Increase FiO2 | Increase PEEP
40
Increases Ventilation
Increase Respiratory rate | Increase Tidal volume
41
Just gave birth Seizure Bleeding from IV
Amniotic fluid embolism Hypoxemic respiratory failure Intubate
42
1 hr after RBC given for anemia Respiratory distress Grunting with retractions Tachycardia S3 gallop no friction rub Diffuse crackles bilaterally Tx
Transfusion associated circulatory overload Tx: Furosemide
43
Post surgery Tachypneic SOB no chest pain Lab values
Post operative atelectasis Hypoxemia (low PaO2) V/P mismatch Increase in RR which compensates for reduce TV Hyperventilation —> Decreased PaCo2 and increased pH (respiratory alkalosis)
44
Worsening productive cough with sputum fever and SOB for a week Blood streaks Similar episodes in past Fatigue WL Crackles in upper lung fields
Bronchiectasis CF
45
Exertional SOB Light headed Raynaud phenomenon and finger tip ulcerations Severe heart burn
Pulmonary HTN CREST syndrome - Calcinosis cutis - Raynaud phenomenon - Esophageal dysmotility - Sclerodactylyl - Telangiectasia Pulmonary arterial HTN is common RV heave RV enlargement
46
Lung with pulmonary htn
Arterial intimal hyperplasia Normal FEV1 FEV1/FVC ratio
47
Seen w/ COPD
Air trapping during expiration ``` Increased FRC (Functional reserve capacity) Increased TLC ``` Increased lung distensibility Increased compliance
48
Elevated triglycerides | Fusion in lung
Chylothorax Disruption of the thoracic duct
49
Fever Leukocytes > 60,000 Right lower lung opacity
Empyema
50
Serum osmolality calculation
(2 x serum sodium ) + serum glucose/18) + (serum BUN/ 2.8)= Low < 275 High > 295
51
Low Serum osmolaity | Euvolemic
Uosm < 100 mOsm/kg - Psychogenic polydipsia - Beer potomania Uosm >100 mOsm/kg UNa> 40 - SIADH
52
Low serum osmolality | Hypovolemic
U Na < 40 - Nonrenal salt loss (vomiting, diarrhea, dehydration) UNa> 40 mEq/L - Renal salt loss (diuretics, primary adrenal insufficiency)
53
Persistent large air leak with chest tube
Perform bronchoscopy Look for tracheobronchial injury
54
COPD intubated glucocorticoids and antibiotics given Respirations improve 45 minutes later, hypoxemia with elevated peak and plateau pressures developed No wheezing, but breath sounds are decreased on the right.
Pneumothorax *Increased peak and plateau pressure
55
Asthma worsening Low pH Low PaO2 High PaCO2
Impending respiratory failure Elevated PaCo2 suggests inability to meet increased respiratory demands Tx: Endotracheal intubation
56
Bilateral hilar adenopathy Feature (1)
Sarcoidosis Noncaseating granulomatous
57
``` Dyspnea Syncope on exertion Fatigue Lethargy Chest pain ```
Pulmonary HTN
58
Pulmonary HTN ausculation
Loud palpable S2 (often split) Flow murmur S4 Parasternal heave
59
PE causes what acidosis/ alkalosis?
Respiratory alkalosis Caused by hyperventilation Decreased PaO2
60
Southwestern US
Coccidioidomycosis
61
Ohio river valley
Histoplasmosis Blastomycosis
62
Benign lung nodules (7)
< 35 y.o Nonsmoker Central Uniform Popcorn calcifications Smooth margins <2 cm
63
Malignant lung nodules (5)
> 45-50 y.o Smoker Absent or irregular calcifications Irregular margins (scalloped, spiculated) > 2 cm
64
Central lung cancer
Small cell Squamous
65
Peripheral lung cancer
Large cell Adenocarcinoma
66
Adenocarcioma of lung
Multiple nodules Prolific sputum production Not associated with smoking
67
Central lung neoplasm Hypercalcemia
Squamous cell carcinoma Keratin pearls
68
Central lung neoplasm Hyponatremia
Small cell
69
Pancoast tumor
Shoulder pain Superior sulcus tumors at apex of lung
70
Transudate effusion due to (3) MOA
Secondary to increased pulmonary capillary wedge pressure (PCWP) or decreased oncotic pressure CHF Cirrhosis Nephrotic syndrome
71
Exudate effusion due to (9)
Secondary to increased pleural vascular permeability ``` Pneumonia TB Malignancy PE RA, SLE Pancreatitis Trauma Chylothorax ```
72
Dull percussion Increased tactile fremitus Crackles
Lung consolidation
73
Dull percussion Decreased tactile fremitus No crackles
Pleural effusion
74
Hyperresonant percussion Decreased tactile fremitus
Pneumothorax
75
Transdative effusions
pH 7.4-7.55 Pleural protein/serum protein <0.5 Pleural LDH/ serum LDH <0.6 Pleural fluid LDH <2/3 the upper limit of normal serum LDH < 60 U/L
76
Exudative effusions
pH 7.30-7.45 Pleural protein/serum protein >0.5 Pleural LDH/ serum LDH >0.6 Pleural fluid LDH >2/3 the upper limit of normal serum LDH >60 U/L
77
COPD Tx
Inhaled bronchodilators like anti-cholinergic medications - Ipratropium - Tiotropium [Anti-muscarinic] Short acting beta agonists (albuterol)
78
Central venous catheter removed Sudden onset of respiratory distress Place in what position
Venous air embolism Place in left lateral decubitus or left lateral Trendelenburg (head down) which traps VAE on lateral wall of right ventricle High flow oxygen
79
Seen with fat embolism (5)
Tachypnea Hypoxemia Neurological abnormalities petechial rash Bilateral scattered ground glass opacities
80
Dyspnea on exertion due to? Back pain which improves as day goes on VC 75% FEV1/FVC 95% FRC 110% of predicted
Ankylosing spondylitis Chest wall motion restriction
81
Post surgery Falls Confused Slurred speech Hypotension Decrased bibasilar lung sounds Distended neck veins New RBBB Pupils dilate
Massive pulmonary thromboembolism * JVD * RBBB
82
Necrotizing fascitis debridement Several hours later dyspnea and hypoxemia New bilateral lung infiltrates
Acute respiratory distress syndrome Due to sepsis from necrotizing fasciitis Leads to diffuse pulmonary edema No correction w/ O2 Low Lung compiance High A-a gradient
83
Cavitary lesion on CXR
Aspergillus
84
Fever Productive cough with green sputum Develops chest pain Pleural effusion on left side
Empyema
85
Nonsmoker Chronic cough with productive large amounts of purulent sputum Recurrent - Name - Seen on imaging (3) - Get what imaging
Bronchiectasis Linear atelectasis Dilated and thickened airways Irregular peripheral opacities Get high-resolution CT
86
Linear atelectasis
Bronchiectasis
87
Chlorpheniramine
H1 antihistamine receptor blocker Decreases allergic response Exhibits anti-inflammatory effects by blocking histamine release from mast cells Reduces nasal secretions
88
pH 7.23 pCO2 69 [33-45] pO2 57 [75-100] HCO3 25 [22-28]
Acidosis Is is respiratory of metabolic look at pCO2 - elevated pCO2 is respiratory acidosis due to hypoventilation
89
Lactic acidosis labs
pH low Metabolic acidosis with a decreased HCO3
90
Labs seen with Obstructive sleep apnea
Chronic hypoxia Hypercapnia Increased bicarb Decreased chloride reabsorption to main normal pH
91
Alpha 1 antitrypsin deficiency causes destruction in
lower lobes
92
Increased dead space
Seen patients who take short shallow breaths or when ventilation perfusion mismatch (pulmonary embolism)
93
Mediastinal fullness and scattered reticular opacities in upper lobe Hypercalcemia - Name - Lung values (3)
Sarcoidosis Normal FEV1 Decreased TLC Decreased DLCO
94
Congestion Rhinorrhea Harsh cough Inspiratory stridor - Name - MOA
Croup Edema and narrowing of proximal trachea
95
Asthma exacerbation and now leukocytosis
Common effect of systemic glucocorticoids
96
See with PE
Right ventricle dysfunction
97
``` pH 7.19 PaO2 110 (high) PaCo2 70 (high) HCO3 26 (normal) ``` Management?
Increase respiratory rate Primary respiratory acidosis (low pH and high PaCo2) Correction of hypercapnia requires increased ventilation to faciliate removal of excess CO2
98
Continuous cough Nasal drip Few weeks after infection Do what?
Oral first generation antihistamine
99
Fever Pleuritic chest pain Hypoxemia Dullness to percussion with bronchial breath sounds in left lung Why does oxygen saturation change from laying supine to left lateral recumbant
Acute pneumonia *Intrapulmonary shunting
100
All white left lung Narrowing of rib spaces
Atelectasis due to left mainstem bronchial mucus plug Mediastinal shift
101
COPD Irregular rhythm P waves with 3 different morphologies Atrial Rate > 100
Multifocal atrial tachycardia (MAT) Tx COPD
102
Exudative effusion
Low glucose < 60 Low pH < 7.2 High protein
103
Recurrent sinusitis and otitis media Auditory canal ulceration Anemia Hematuria
Granulomatosis with polyangiitis ANCA C-ANCA
104
Bibasilar crackles ``` pH 7.46 pO2 73 (low) pCO2 31 (low) ```
Respiratory alkalosis Has CHF
105
normal pH normal Pco2 normal PO2
pH 7.35-7.45 PCO2 33-45 PO2 75-105
106
How to adjust ventilation for respiraotry alkalosis
Hyperventilation Decrease respiratory rate Decrease tidal volume
107
Tracheal narrowing with ulceration Multiple lung nodules with cavitation Anemia
Granulomatosis with polyangiitis
108
Seen with cystic fibrosis
Absence of vas deferens
109
Once stable decrease what on ventilator
Fraction of inspired oxygen FiO2
110
Elevated pulmonary artery and right atrial pressure
Pulmonary htn which can be due to PE
111
Patchy irregular alveolar infiltrates of the peripheral right middle and lower lobes
Pulmonary contusion
112
2 episodes of hemoptysis over a week span 2 yr history of morning cough with white sputum Smoked for 30 years
Chronic bronchitis
113
Myelocytes Night sweats
Chronic myeloid leukemia Decreased leukocyte alkaline phosphatase score
114
Decompression sickness
Vascular air embolism Mottling and cyanosis of extremities
115
Ventilation what to avoid
Alveolar overdistension Low tidal volume ventilation
116
Pleural/ serum protein > 0.5 or pleural/ serum LDH > 0.6
Exudative effusion Leaky capillaries (secondary to inflammation) ``` Malignancy TB Bacterial or viral infxn PE with infarct Pancreatitis ```
117
Causes of transudative effusion (4) MOA
Intact capillaries and increased hydrostatic pressure HF Liver disease Kidney disease Protein losing enteropathy
118
Tx acute COPD exacerbation
``` O2 Beta 2 agonist - albuterol Muscarinic antagonist - ipratropium Corticosteriods ``` +- antibiotics
119
See with sarcoidosis (5)
``` Dyspnea Bilateral hilar lymphadenopathy Noncaseating granulomas Increase ACE Hypercalcemia ```
120
Tx SVC syndrome
Radiation | Endocascular stenting
121
Acid base disorder in PE
Respiratory alkalosis with hypoxia and decreased PaCO2
122
Lung cancer with hypercalcemia
SCC Ectopic PTHrP
123
Lung cancer with SIADH
Small cell lung cancer Ectopic ADH
124
Lung cancer associated with Lambert Eaton syndrome
SCLC
125
ARDS (3)
Hypoxemia Pulmonary edema Normal PCWP
126
Increase risk of what infection with silicosis
Mycobacterium tuberculosis
127
Coccidioidmycosis on CXR
Unilateral infiltrate with ipsilateral hilar LAD Spherules with endospores
128
HIstoplasmosis on CXR
Hilar lymphadenopathy Bronchoscopic biopsy reveals granulomas with yeast forms
129
Acute respiratory distress syndrome how to adjust ``` A. Increase fraction of inspired oxygen B. Increased positive end expiratory pressure C. Increased respiratory rate D. Increased tidal volume E. Keep current respiratory settings ```
B. Increased positive end expiratory pressure Oxygen improved by increasing the fraction of inspired oxygen or positive end expiratory pressure
130
New onset CHF effusion
Transudative CHF Cirrhosis Nephrotic syndrome Peritoneal dialysis Hydrostatic pressure Hypoalbuminemia 7.4-7.55 pH
131
42 y.o with difficulty breathing and wheezing Seen otolaryngologist for persistent nasal blockage 2 weeks ago Take aspirin, diltiazem, atorvastatin and albuterol as needed Cause of respiratory symptoms? ``` A. Cell mediated hypersensitivity B. Cytotoxic antibodies C. IgE mediated reaction D. Immune complex disease E. Pseudoallergic drug rxn ```
E. Pseudoallergic drug reaction Aspirin exacerbated respiratory disease (AERD) Not IgE mediated
132
How to improve high altitude sickness
Increased urinary excretion of HCO3 1. Decrease ambient PiO2 —> 2. Peripheral chemoreceptors sense this —> 3. Increase minuted ventilation 4. Increased PaO2 Decreased PaCo2 Increased pH 5. Central chemoreceptors sense increase in pH Ventilation inhibited and Increase PaO2 limited 6. Slow renal HCo3 excretion, gradually increase PaO2 ceiling [If you give acetazolamide —> accelerated HCO3 excretion and decrease in pH —> Rapid increase in PaO2 ceiling]
133
Patient with fever, shakes, chills and sob Lower lobe consolidation 12 hrs later develops significant SOB and is intubated Hazy CXR - Name Prior to intubation? A. Decreased lung compliance B. Increased left ventricular end diastolic pressure C. Increased ratio of arterial oxygen tension to fraction of inspired oxygen D. Normal alveolar arterial oxygen gradient E. Normal pulmonary arterial pressure
Acute respiratory distress syndrome Lung injury —> release of proteins, inflammatory cytokines and neutrophils into alveolar space —> Leakage of bloody and proteinaceous fluid in alveoli, alveolar collapse due to loss of surfactant and diffuse alveolar damage Ventilation perfusion mismatch Lung compliance is decreased Pulmonary arterial pressure in increased due to hypoxic vasoconstriction Partial pressure of arterial oxygen (PaO2) decreases —> increased fraction of inspired oxygen (FiO2) requirement PaO2/FiO2 is decreased
134
Right lower lobe crackles
Pulmonary consolidation = community acquired pneumonia Get CXR Azithromycin (outpatient) Azithromycin + ceftriaxone
135
43 y.o CHF, RA, Chronic hep C and liver cirrhosis has difficulty breathing Dullness to percussion Right pleural effusion Thoracentesis: glucose of 28 and lactate dehydrogenase 252 (45-90) Why low glucose A. High amylase content in pleural fluid B. High WBC content in pleural fluid C. Increased capillary hydrostatic pressure D. Increased permeability of the right hemidiaphragm E. Increased pleural membrane permeability
Pneumonia with parapneumonic effusion Exudative LDH of 252 is > 2/3 upper limit for serum LDH= Exudative Low glucose < 60 is usually due to pheumatoid pleurisy or empyema, malignant effusion, tuberculous pleurisy, lupus pleuritis, or esophageal rupture < 30 suggests empyema or rheumatic effusion Glucose in empyema is decreased due to high metabolic activity of leukocytes in fluid * High WBC content in pleural fluid [A. High amylase= esophageal rupture] [C. high capillary hydrostatic pressure= transudative effusions] [D. Increased perm of right hemidiaphragm= effusions in cirrhosis, transudative] [E. Increase pleural membrane perm due to inflammatory conditions, just established effusion not cause of low glucose]
136
Aspiration pneumonia caused by
Impaired cough reflex
137
COPD long term survival
Long term supplemental oxygen at home [Not vaccinations] [ Not low dose oral corticosteroids]
138
Community acquired Pneumonia Tx
Fluoroquinolone - Moxifloxacin Or beta lactam plus macrolide - azithromycin + ceftraixone
139
Hypoxemia in pneumonia caused by
V/Q mismatch Impairment of alveolar ventilaiton —> R to L intrapulmonary shunting
140
COPD Two types - DLCO
Centriacinar emphysema (low diffusing capacity of lung for carbon monoxide) Chronic bronchitis (normal DLCO) [Asthma increased DLCO]
141
Panacinar emphysema
Alpha 1 antitrypsin deficiency
142
Recurrent infxn Lots of sputum Dilated airways FVC low
Bronchiectasis
143
Feature of interstital lung disease
Increased A/a gradient
144
Persistent dry cough following upper respiratory infection Tx
Acute bronchitis CXR only to rule out pneumonia NSAIDS and bronchodilator
145
COPD acute exacerbation
Oxygen Inhaled bronchodilators Systemic glucocorticoids - Methylprednisolone
146
Digital clubbing
Lung malignancies | Cystic fibrosis
147
Obesity on lung
Obesity hypoventilation syndrome Alveolar hypoventilation
148
79 y.o with fatigue, poor appetite and WL. 4 weeks on nonproductive cough and SOB 99.3 148/72 Patient is thin. There is a dullness to percussion and decreased breath sounds in the right lower and middle chest. A bedside portable ultrasound reveals a right sided pleural effusion. Thoracentesis removes 1.5 L of yellow pleural fluid ``` Protein 4.9 Glucose 40 Nucleated cell count 1200 Lymphocytes 90% Neutrophils 4% Monocytes 6% ``` ``` A. Chylothorax B. CHF C. Empyema D. Hypoalbuminemia E. Pulmonary infarction F. Tuberculosis ```
F. Tuberculosis Exudative Protein> 0.5 Low glucose < 60 Lymphocytic leukocytosis
149
Headaches Worse when leans forward. No fever, vomiting or chest pain Chronic cough Recently diagnosed with small cell lung cancer BP 100/60 JVD What would relieve symptoms
Radiation therapy Superior vena cava syndrome caused by compression of SVC
150
Way to prevent aspiration pneumonia
Elevation of head of bed
151
Needle decompression increased what ``` A. End-expiratory pressure B. Intravascular volume C. Left ventricular contractility D. Systemic vascular resistance E. Venous return ```
E. Venous return Increased intrapleural pressure —> tracheal deviation and neck vein distension —> superior vena cava compression
152
Metabolic acidosis Fever Hypotension Tachycardia Bronchial breath sounds over the right lung base Elevated glucose ABG due to A. Alveolar ventilation/perfusion mismatch B. Impaired renal bicarbonate reabsorption C. Increased gastrointestinal chloride loss D. Increased hepatic fatty acid metabolism E. Increased tissue metabolic acid production
E. Increased tissue metabolic acid production Fever Tachycardia Hypotension Bronchial breath sounds in right lung base = septic shock due to pneumnia Septic shock causes hypermetabolic state, insuffient oxygen delivery to meet metabolic demands of peripheral tissues —> build up lactic acid
153
Left sided pleural effusion Thoracentesis drains 2 liters of yellowish fluid Dizziness after procedure and hypotension Tachycardia On exam, dullness to percussion and absent breath sounds on left side. Caused by? A. Left ventricular outflow obstruction B. Decreased left ventricular preload C. Obstruction of pulmonary artery blood flow D. Increase left ventricular end-diastolic volume E. Decreased left ventricular afterload
Decreased left ventricular preload Hypotension resulting from decreased left ventricular preload secondary to hemothorax Left hemothorax occuring as complication of thoracentesis (effusion wouldnt reaccumulate that rapidly) Bleeding —> intravascular volume depletion —> decreased left ventricular preload
154
Hasten recovery of COPD exacerbation ``` A. ACE inhibitor B. Alpha adrenergic antagonist C. Beta-adrenergic antagonist D. Glucocorticoids E. Leukotriene receptor antagonist F. Loop diuretics ```
D. Glucocorticoids

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