Pulmonary Exam: Clinical Flashcards
(164 cards)
1
Q
normal heart size on chest x-ray
A
smaller than half the width of the midline to the outside of the ribs
2
Q
pulmonary edema on CXR
A
bilateral fluffy infiltrates, kerley B lines +/- cardiomegaly
3
Q
pleural effusion on CXR
A
blunting of costophrenic angle (where diaphragm meets ribcage)
4
Q
pneumothorax on CXR
A
absence of pulmonary markings on affected side with visibly deflated lung
5
Q
lobar pneumonia on CXR
A
infiltrate in lobar pattern
6
Q
interstitial lung disease on CXR
A
diffuse honeycombing
7
Q
Normal FVC
A
5L
8
Q
Normal FEV1
A
4L
9
Q
normal FEV1/FVC
A
0.8
10
Q
obstructive lung disease on CXR
A
hyperinflation with flattened diaphragms
11
Q
obstructive lung disease on spirometry
A
reduced FEV1 and reduced FEV1/FVC ratio
12
Q
restrictive lung disease on spirometry
A
Reduced FEV1 and FVC with normal ratio
13
Q
chronic bronchitis criteria
A
productive cough 3 months per year for at least 2 years
14
Q
chronic bronchitis pathophys
A
mucosal hypertrophy, inflammation, increased mucus leading to smaller airway diameter. Shunting from mucus plugs causes cyanosis
15
Q
emphysema pathophys
A
smoke recruits macrophages and neutrophils into alveolar space; subsequent protease production destroys alveolar walls. Increased compliance and loss of elastic recoil
16
Q
why use CO for DLCO
A
it’s diffusion-limited so it’s a good indicator of ability for gas exchange
17
Q
decreased DLCO in COPD indicates
A
emphysema
18
Q
emphysema characteristics
A
high respiratory rate can diminish cyanosis
19
Q
pathophys of alpha-1 antitrypsin deficiency
A
deficiency of protease inhibitor leads to too much elastase that destroys alveoli. Misfolded proteins can occur in liver to cause cirrhosis
20
Q
alpha-1 antitrypsan deficiency emphysema pattern
A
panacinar emphysema that is lower lobe predominant
21
Q
smoking-associated emphysema pattern
A
centriacinar involvement that is upper lobe predominant
22
Q
what is bronchiectasis
A
dilated and thickened airways due to repeated episodes of inflammation/infection
23
Q
causes of bronchiectasis
A
cystic fibrosis, chronic infection, reflux, primary ciliary dyskinesia
24
Q
primary ciliary dyskinesia
A
autosomal recessive, leads to cilia not being able to beat, coexists with infertility and situs inversus
25
2 categories of restrictive lung disease causes
poor breathing mechanics (neuromuscular, structural problems), interstitial lung disease
26
2 hallmarks of restrictive lung disease
low volumes and decreased DLCO
27
general pathophys of interstitial lung disease
inflammation in interstitium and alveoli
28
causes of interstitial lung disease
idiopathic pulmonary fibrosis, systemic autoimmune disease, pneumoconioses, drug toxicities
29
common presentation of ILD
insidious dyspnea, dry cough, fine "velcro" crackles in all lung fields, digital clubbing
30
ILD on CXR
diffuse, bilateral, small irregular opacities
31
idiopathic pulmonary fibrosis pathophys
repetitive epithelial injury with disordered repair leading to increased type II pneumocytes and fibroblasts and decreased type I pneumocytes
32
idiopathic pulmonary fibrosis presentation
insidious onset dry cough, dyspnea, ILD crackles, clubbing
33
idiopathic pulmonary fibrosis prognosis
average survival of 4 years (death due to pulmonary HTN, respiratory failure, lung cancer, arrhythmia)
34
idiopathic pulmonary fibrosis CXR/CT
honeycombing pattern
35
systemic diseases that can cause pulmonary fibrosis
scleroderma, RA, granulomatosis with polyangiitis, sarcoidosis
36
Sarcoidosis pathophys
activated macrophages cause widespread non-caseating granulomas
37
sarcoidosis lab findings
high serum ACE levels, hypercalcemia with elevated vitamin D activation
38
sarcoidosis clinical presentation
cough, dyspnea, fatigue, skin lesions, uveitis
39
sarcoidosis imaging
coarse reticular opacities with bilateral hilar adenopathy
40
sarcoidosis treatment
steroids
41
types of pneumoconioses
coal miner's lung, silicosis, asbestosis, berylliosis, hypersensitivity pneumonitis
42
drug toxicities that can cause ILD
bleomycin, busulfan, amiodarone, methotrexate
43
tidal volume
amount of air moved in a quiet breath
44
inspiratory reserve volume
amount that can be inhaled after quiet inhalation
45
vital capacity
tidal volume plus expiratory reserve plus inspiratory reserve (total lung capacity minus residual volume)
46
functional residual capacity
expiratory reserve volume plus residual capacity (amount of air in lungs at the end of quiet exhalation)
47
total lung capacity
quantity of air in lungs at maximum inspiration
48
inspiratory capacity
tidal volume plus inspiratory reserve volume
49
forced vital capacity
total amount of air exhaled from total lung capacity down to residual volume in a forced maneuver
50
flow-volume loop for obstructive lung disease
wider than normal
51
flow-volume loop for restrictive lung disease
narrower than normal
52
bronchodilator response
increase in FEV1 of 12% and greater than 0.2L
53
main lung volumes measured
TLC and RV
54
definition of restrictive lung disease in lung volumes
TLC below lower limit of normal with reduced FEV1 and FVC but normal ratio
55
a decreased vital capacity in the presence of a normal FEV1/FVC ratio suggests
restriction
56
what might need to be corrected for when measuring DLCO
blood hemoglobin level
57
causes of decreased DLCO
emphysema, interstitial lung disease, lung damage from radiation or drugs, pulmonary embolism, pulmonary HTN
58
basic definition of pneumonia
infection of alveoli
59
basic def of pneumonitis
immune-mediated inflammation of alveoli
60
what is an empyema
purulent exudate in pleural cavity
61
what is a lung abscess
circumscribed collection of pus within the parenchyma
62
pulmonary physiology of pneumonia
impaired alveolar ventilation causes V/Q mismatch with shunting and causes hypoxia due to increased A-a gradient
63
pneumonia risk factors
old age, immobility, immunosuppression, impaired airway protection, chronic diseases, environmental factors (crowded conditions, toxins)
64
which pathogen is associated with ETOH abuse in pneumonia
klebsiella
65
foul-smelling sputum in pneumonia is associated with
aspiration pneumonia
66
most common pathogens in typical community-acquired pneumonia
strep pneumoniae, haemophilus influenzae, moraxella
67
what pathogen is usually responsible for bacterial superinfection in pneumonia
staph aureus
68
CXR CAP (typical)
lobar poorly defined patchy infiltrates with or without effusion
69
definition of community-acquired pneumonia
occurs outside of healthcare setting
70
atypical bacteria causing pneumonia
chlamydophila, mycoplasma, legionella
71
atypical pneumonia viruses
influenza, RSV, adenovirus, COVID
72
atypical pneumonia chest xray
diffuse reticular pattern concentrated in perihilar region
73
pathogens in hospital acquired pneumonia
pseudomonas, enterobacteriaceae, acinetobacter, staph aureus, strep pneumoniae
74
definition of hospital acquired pneumonia
onset >48 hours after admission
75
aspiration pneumonia pathogens
anaerobes and gram negeatives
76
ssx of aspiration pneumonia
immediate: bronchospasms, crackles. Late (24 hours): fever, dyspnea, cough with foul-smelling sputum
77
aspiration pneumonia CXR
depends on position on aspiration
78
bronchopneumonia on CXR
patchy areas spread throughout
79
cryptogenic organizing pneumonia definition
a non-infectious pneumonia of unknown etiology characterized by involvement of the bronchioles, alveoli, and surrounding tissue without response to abx. Supportive treatment only
80
outpatient pneumonia treatment
amoxicillin+azithromycin/clarithromycin or doxycycline
81
inpatient pneumonia treatment
ceftriaxone + azithromycin or doxycycline OR levofloxacin
82
hospital-acquired pneumonia treatment if gram negative
pip-taz or cefepime or ceftazidime+levofloxacin
83
hospital-acquired pneumonia treatment if gram-positive
add vancomycin to gram negative treatment
84
aspiration pneumonia treatment
ampicillin sulbactam or clindamycin
85
etiologies of syncope
vasovagal (psychogenic, stimulation of visceral organs/carotid bodies), orthostatics (dehydration, ANS dysfunction), cardiac valve dysfunction, arrhythmia, neurogenic
86
most common dvt location
popliteal
87
Homans sign
calf pain on dorsiflexion
88
superficial thrombophlebitis
pain ,tenderness, induration and erythema overlying a superficial vein with palpable cord (maybe)
89
superficial thrombophlebitis treatment
hot compress, nsaids, remove offending agent
90
superficial thrombophlebitis risk factors
same as DVT
91
when is indefinite anticoagulation
high-risk patients and those with 2 or more VTE events
92
what anticoagulant to give in case of renal insufficiency
unfractionated heparin
93
what anticoagulant to use in pregnancy
LMWH
94
anticoagulant duration for provoked VTE
3-6 months
95
anticoagulant duration for unprovoked VTE
6+ months and search for underlying cause such as cancer screening
96
part of coagulation cascade affected by enoxaparin
activates antithrombin III
97
part of coagulation cascade affected by heparin
inactivates thrombin and factor Xa
98
Large vessel vasculitis
giant cell, takayasu
99
Giant cell arteritis aka
temporal arteritis
100
Giant cell arteritis summary
involves branches of carotid artery, unilateral headache, associated polymyalgia rheumatica, can involve ophthalmic artery
101
Takayasu arteritis summary
commonly affects Asian women<40, involves aortic arch and proximal great vessels, fever, night sweats, skin nodules, arthritis, vision disturbances, weak upper extremity pulses
102
treatment for large vessel vasculitis
steroids
103
medium cell vasculitis
Buerger disease, Kawasaki disease, Polyarteritis nodosa
104
Buerger disease affects
young adult men, smokers
105
Buerger disease ssx
intermittent claudication of extremities leading to gangrene
106
Buerger disease treatment
smoking cessation
107
Kawasaki disease affects
Asian children <4 y/o
108
Kawasaki disease ssx
conjunctival injection, rash, adenopathy, strawberry tongue, hand/foot edema, fever, coronary artery aneurysms
109
Kawasaki disease treatment
IVIG, ASA
110
Polyarteritis nodosa affects
middle aged men who may be HepB positive
111
polyarteritis nodosa ssx
fever, weight loss, malaise, headache, abd pain, melena, HTN, kidney damage
112
polyarteritis nodosa treatment
steroids, cyclophosphomide
113
polyarterteritis nodosa affects what arteries
mesenteric, renal
114
Small vessel vasculitis - immune mediated
Behcet disease, immunoglobolin A, cutaneous small vessel, mixed cryoglobulinemia
115
Behcet disease is associated with what gene
HLA-B51
116
Behcet disease ssx
aphthous/genital ulcers, uveitis, erythema nodosum
117
Behcet disease precipitated by
HSV or parvo
118
Behcet disease treatment
none, self-resolving in 1-4 weeks
119
immunoglobulin A aka
HSP
120
immunoglobulin A follows
URI, IgA immune complex deposition
121
immunoglobulin A ssx
purpura of LE, arthralgia, GI pain
122
immunoglobulin A treatment
supportive, steroids
123
cutaneous small vessel vasculitis due to
response to certain meds or infections
124
cutaneous small vessel vasculitis ssx
palpable purpura
125
mixed cryoglobulinemia due to
viral infections (especially hep C), B cell malignancies
126
mixed cryoglobulinemia ssx
palpable purpura, weakness, arthralgias due to IgG and IgM immune complex deposition
127
small cell vasculitis ANCAs
Churg-strauss, Wegeners, microscopic polyangitis
128
Churg-strauss aka
eosinophilic granulomatosis with polyangiitis
129
Churg-strauss ssx
asthma, sinusitis, skin manifestations
130
Wegeners aka
Granulomatosis with polyangiitis
131
Wegeners ssx
upper respiratory, lower respiratory, renal
132
microscopic polyangiitis
like Wegeners but without nasopharyngeal involvement or granulomas
133
treatment for microscopic polyangiitis and Wegeners
cyclophosphamide, steroids
134
what is an ANCA
an IgG autoimmune reaction to neutrophils
135
other causes of vasculitis
infective endocarditis, syphilis, connective tissue diseases (SLE, RA), fungus
136
pediatric SBP should be
70+age*2
137
definition of shock
inability to remain aerobic metabolism
138
4 kinds of shock
hypovolemic, distributive, cardiogenic, obstructive
139
hallmark of hypovolemic shock
decreased preload
140
hallmark of distributive shock
decreased afterload
141
most common cause of distributive shock
septic shock
142
CO in shock means what kind
distributive
143
hallmark of cardiogenic shock
decreased CO
144
cardiogenic shock treatment
inotropes
145
hallmark of obstructive shock
normal contractility with decreased CO
146
distributive shock treatment
volume with or without pressors
147
low cardiac output and low filling pressures means
hypovolemic shock
148
low cardiac output and high filling pressures means
cardiogenic or obstructive shock
149
shock with low SVR means
distributive shock
150
neurogenic shock
vasodilation due to loss of sympathetic tone above T6 leading to bradycardia, hypotension, decreased SVR
151
neurogenic shock treatment
pressors
152
first sign of hypovolemic shock
narrowed pulse pressure with or without tachycardia
153
distributive shock skin findings
warm, moist
154
signs of obstructive shock
distended neck veins, muffled heart tones, possible tracheal deviation
155
what does a vasopressor do
increase SVR
156
what does an inotrope do
increase cardiac contractility
157
important principle of starting pressors
fill tank before starting pressors
158
goal MAP for septic shock
>65
159
mainstay for inotropes
dobumatine (primarily B1 but also some B2, helps with decreasing SVR)
160
pure vasopressors
vasopressin and phenylephrine
161
when to use pure vasopressors
distributive shock
162
agents with both inotropic and vasopressor activity
norepi, epi, dopamine
163
norepi is primarily
vasopressor (alpha)
164
epi is primarily
inotrope (beta)
