Respiratory_UW Flashcards
(204 cards)
1
Q
Measuring what levels will help establish diagnosis if you see recurrent bacterial infections in an adult patient which may indicate a humoral immunity defect.
A
Serum Ig levels
2
Q
Recurrent bacterial infections in an adult patient which may indicate?
A
A humoral immunity defect.
3
Q
What are causes of exudative effusions?
A
Malignancy, infection, pulmonary embolism, connective tissue disease and iatrogenic causes.
4
Q
Why do exudative effusions occur?
A
Inflammation and increased capillary and pleural membrane permability or impaired lymphatic drainage.
5
Q
Sudden-onset dyspnea, chest pain, tachycardia, with a hemorrhage, exudative pleural effusion in absence of consolidation on chest imaging suggests?
A
PE
6
Q
What is aspirin exacerbated respiratory disease?
A
Non-IgE mediated reaction that results from aspirin induced prostaglandin/leukotried misbalance.
7
Q
Aspirin exacerbated respiratory disease is most commonly seen in which patients?
A
Patients with a hx of asthma or chornic rhinosinusitis with nasal polyposis.
8
Q
Aspirin exacerbated respiratory disease is characterized by?
A
Bronchospasm and nasal congestion
9
Q
What is the treatment for aspirin exacerbated respiratory disease?
A
Avoidance of NSAIDS, densensitization if NSAIDS ar required and leukotriene receptor antagonists like montelukast.
10
Q
What are the two main COPD diseases
A
Chronic bronchitis and emphysema
11
Q
Signs and sx of COPD
A
progressive dyspnea, cough, decreased breath sounds, PROLONGED EXPIRATORY PHASE. Hypoxemia is common.
12
Q
What therapy/tx has been proven to prolong the survival of patients with COPD and hypoxemia?
A
Long-term supplemental oxygen therapy
13
Q
What is the criteria for long-term supplemental oxygen therapy?
A
PaO2= 55%) or evidence of cor pulmonale.
14
Q
How does the body compensate for chronic hypercapnia (and avoid marked acidosis?)
A
Renal tubular compensation. Retains more bicarbonate.
15
Q
In COPD, what is FEV1, VC and total lung capacity?
A
Due to progressive expiratory airflow limitation - Total lung capacity increases due to air trapping, VC decreases and FEV1 decreases disproportionately compared to VC.
16
Q
What are empyemas?
A
Infection in the pleural space. Collection of pus in a naturally existing anatomic cavity
17
Q
What is Flail chest?
A
When three or more adjacet rib fructures have breaks in 2 places leads to unstable chest wall segment that moves in paradoxical motion with respiration.
18
Q
What x-ray findings are in flail chest
A
Multiple rib fractures overlying lung contusion.
19
Q
How do patients with flail chest present?
A
Respiratory distress, tachypnea.
20
Q
What are the only 2 therapies shown to decreast mortality in COPD
A
Smoking cessation, home oxygen therapy
21
Q
What is the underlying pathologic lesion in sarcoidosis
A
Noncaseating chronic granuloma.
22
Q
How is pulmonary sarcoidosis often diagnosed on chest x-ray?
A
Presence of bilateral hilar adenopahy and/or reticular opacities.
23
Q
What are some common extrathoracic manifestations of sarcoidosis?
A
Skin lesions such as erythema nodosum, uveitis, polyarthralgia.
24
Q
How is asthma diagnosed with PFTs?
A
Reversible airway obstruction, i.e., greater than 12% increased in FEV1 after bronchodilator challenge with normal diffusion capacity for carbon monoxide suggests asthma regardless of age.
25
What is the lights critera for exudates
1) Pleural fluid protein/serum protein ratio > 0.5, 2) Pleural fluid lactate dehyrodgenase (LDH)/serum LDH ratio > 0.6, 3) Pleural fluid LDH > 2/3 of the upper limit of normal for serum LDH
26
What are exudates caused by
Change In capillary permeability
27
What is obesity hypoventilation syndrome?
AKA pickwickian syndrome. Long term consequence of severe obseity and untreated obstructive sleep apnea. These patients don't have respiratory mechanics that allow them to resume normal ventilation during wakefulness (they have hypoventilation overnight like those with sleep apnea) and they develop chronic respiratory failure.
28
What do patients with obesity hypoventilation syndrome develop?
Chronic hypercapnea/hypoxic respiratory failure, pulmonary hypertension, secondary erythrocytosis, cor pulmonale.
29
Histoplasma Capsulatum a/w?
Endemic to Mississipi, Ohio river valleys and central america. Usually found in soil with high concentration of bird and bat droppings.
30
Histoplasma Capsulatum infection is usually?
Asymptomatic with pulmonary nodule. Extent of disease is determined by amount of exposure and host immune system. Usually it's self limiting fever, non-productie cough, chills.
31
How does GERD exacerbate asthma?
Through increased vagal tone, microaspiration of gastric contents into upper airway, heightened bronchial reactivity.
32
What are the symptoms of Goodpasture's disease?
Pulmonary - cough, dyspnea, hemoptysis. Renal - nephritic range of proteinuria (
33
How is diagnosis for Goodpasture's made?
Renal biopsy showing linear IgG antibodies along glomerular basement membrne.
34
In respiratory alkalosis, what is the urine pH like?
In respiratory alkalosis, there is high serum pH, decreased PaCO2. Kidneys try to excrete bicarbonate ions and retain protons to normalize serum pH. Increased bicarbonate excretion raises urine pH.
35
Bronchoalveolar Lavage is most useful in evaluation of?
Suspected malignancy and opportunistic infection.
36
Bronchoalveolar Lavage is >90% sensitive and specific for what infection? It has less diagnostic utility for?
PCP. Less for other forms of interstitial lung disease such as intersitial pulmonary fibrosis, sarcoidosis and connective tissue diseases.
37
What should be suspected n COPD patients with catastrophic worsening of respiratory symptoms?
Secodnary pneumothorax. Usually due to dilated alveolar blebls that rupture air into pleural space.
38
What accoutns for >90% of chronic cough in nonsmokers who don't have pulmonary disease?
GERD, post-nasal drip, asthma
39
What is post-nasal drip
Upper-airway cough syndrome.
40
What is the initial empiric treatment for patients with suspected post-nasal drip?
First generation anti-histamine (chlorpheniramine) or combined antihistamine-decongestant (bromphneiramine and psuedoephedrine)
41
What are the PFTs of Interstitial Lung disease?
Decreased TLC, decreased RV, normal or increased FEV1/FVC ratio, decreased DLCO (diffusion lung capacity of carbon monoxide)
42
Patients with idiopathic pulmonary fibrosis how increased or decreased DLCO and alveolar-arterial gradients?
IPF is an interstitial lung disease. Have impaired gas exchange => decreased DLCO and increased alveolar-arterial gradient.
43
What is present in 75% of asthma patients - can present with adult onset asthma, symptoms worse after meals, exercise or lying down (nocturnal asthma)?
GERD. GERD induced asthma disease.
44
If GERD is suspected in asthma patients, what pharmacotherapy is most helpful initially?
PPI to help resvolve the GERD - both therapeutic and diagnostic.
45
What is the pathophysiology of ARDS?
ARDS develop when inflammatory mediators, released secondary to local or distant tissue injury, damage the alveoli. Resultant increased alveolar capillary permeatbility allows fluid to leak into the alveoli, causing non-cardiogenic pulmonary edema.
46
What is the mainstay of therapy for ARDS?
Mechanical ventilation with low tidal volume and PEEP (positive end-expiratory pressure).
47
What is the best way to provide adequate oxygentation in ARDS
PEEP (positeve end-expiratory pressure). This prevents alveolar collapse, which directly counteracts the means by which ARDS causes hpoxemia.
48
ARDS causes what refractory to high inspired oxygen concentrations
Hypoxemia.
49
What are some causes of ARDS
Sepsis, severe infection, severe bleeding, toxic ingestions and burns. Acute pancreaititis causes ARDS in up to 15% of patients.
50
What are potential complications of PEEP
Barotrauma and tension pneumothorax
51
In mechanical ventilation, paO2 is mostly influenced by while pCO2 is mainly influenced by?
FiO2 and PEEP level. PCO2 = respiratory rate and tidal volume.
52
What levels of FiO2 are desirable to avoid oxygen toxicity?
No strict cut-off by 50-60% is desirable.
53
What is bronchiectasis?
Condition in which damage to the airways causes them to become flabby and scarred.
54
Recurrent pneumonias in the same lung region is indicative of?
Local anatomic obstruction (for example bronchogenic carcinoma or bronchiectasis) or recurrent aspiration (seizures, ethanol or drug use).
55
Recurrent pneumonias in different lung regions is indicative of?
Sinopulmonary diseases (like CF, immotile cilia), noninfectious cuases like (vaculitis), immunodeficiency (HIV, leukemia, decreased immunoglobulins)
56
How does theophylline toxicity manifest? What can alter its therapeutic window
CNS stimulation (headache, insomnia, seizures), GI distrubances (nausea, vomiting), and cardiac toxicity (Arrythmia). Inhibition of cytochrome oxidase system by other meds (like cirpofloxacin), diet, or underlying disease can alater its narrow therapeutic window
57
What is Pancoast syndrome?
When an apical lung neoplasm (superior sulcus/thoracic inlet) compresses the brachial plexus causing pain, paresthesias/weakness in right arm. Characterized by right shoulder pain radiating into the ipsilateral arm in an ulnar distribution.
58
What kind of germ cell tumors produce AFP?
Nonseminomatous germ cell tumors
59
What kind of germ cell tumors produce beta-HCG?
Seminomatous germ cell tumors
60
Anterior mediastinal mass that produces both AFP and bHCG is consistent with?
Non-seminimatous germ cell tumor
61
What is peak airway pressure
Sum of airway resistance + plateau pressure
62
How do you measure plateau pressure
Sum of elastic pressure + PEEP. Calculated by performing end inspiratory hold maneuver.
63
How do you measure PEEP
End expiratory hold maneuver.
64
What should you suspect ina patient with fever, cough with foul smelling sputum after an upper GI endoscopy/or other instrumentation of upper airway/esophagus?
Anaerobic lung infection
65
What is the most commonly used antibiotich for anaerobic lung infections?
Clindamycin
66
Pulmonary TB presents with? What does chest CT reveal?
Fever, cough, hemoptysis. Chest CT reveals upper lobe cavitary lesions
67
What is ventilation?
Respiratory rate X tidal volume
68
In mechanically ventilated patients with respiratory alkalosis in the setting of an appropriate tidal volume, what should be lowered and why?
Respiratory rate should be lowered. If you reduce tidal volume, this can trigger increased ventilatory rate, which can worsen the respiratory alkalosis.
69
What kind of infection may demonstrate a crescent radiolucency next to a rounded mass?
Aspergillosis.
70
When you read of moving lesions on chest X-ray think what kind of infection?
Aspergillosis. Caviatory lesions form because of destrucction of the underlying lung parenchyma. Debris and hyphae colaesce and forms a fungus ball which lies in the cavity and can move around.
71
What is choriocarcinoma
Form of gestational trophoblastic disease that may occur after a normal gestation, molar pregnancy or abortion.
72
What are the malignant forms of gestational trophoblastic disease? Which form is metastatic. What is the msot common site of metastasis
Choriocarcinoma and gestational trophoblastic neoplasia. GTN is almost always locally invasive and choricarcinoma is highly metastatic. Most commonly metastasizes to lungs.
73
What helps confirm the diagnosis of choriocarcinoma
Elevated beta HCG
74
What are signs and syptoms of SVC?
Dyspnea, venous congestion, swelling of the head, arms and neck.
75
What is the most common cause of superior vena cava syndrome?
Malignancy (lung cancer, especially small cell lung cancer) and Non-Hodgkins Lymphoma. Other possible causes, fibrosing mediastinitis (secondary to histoplasmosis or TB) or thrombosis secondary to indwelling central venous devises.
76
What test is warranted when superior vena cava sydnrome is suspected?
Chest xray. Abnormalities on chest x-ray warrant follow-up with chest CT and histology.
77
What effect does glucocorticoides have on blood cells?
Complex effect. They tend to cause neutrophilia by increasing bone marrow release and mobilizing the marginated neutrophil pool. Eosinophils and lymphocytes are decreased.
78
What is a characeristic x-ray finding of pneumocystic jiroveci pneumonia?
Bilateral diffuse perihilar interstitial infiltrates.
79
What is the most common adverse effect of inhaled corticosteroid therapy?
Oropharyngeal thrush (oral candidiasis)
80
What physical exam findings are a/w consolidation?
Bronchial breaths sounds, increased fremitus, dullness to percussion, egophony, bronchophony. Bronchial breath sounds have full expiratory phase.
81
Elderly patients with pneumonia may not have what?
Fever or elevated white blood cell count.
82
What criteria can be used to assess pre=test probability of acute PE?
Modified Wells criteria
83
Patients with likely PE based on modified Wells critiera should be further evaluated with what?
Computed tomography angiography (CTA). Patients with negative CTA are not likely to have PE.
84
What is cor pulmonale
Isolated Right heart failure from pulmonary hypertension.
85
What is the most common cause of Cor pulmonale in the US? What are some other causes of cor pulmonale
COPD, interstitial lung disease, pulmonary vascular disease (thromboembolic)
86
What are signs of RHF
Right ventricular heave (hypertrophy), increased P2 sound, jugular venous distension, hepatomegaly, pitting edema and possible ascites
87
Mitral stenosis is commonly due to what and presents with?
Commonly due to rheumatic heart disease and presents with gradual and progressively worsening dyspnea or orthopnea.
88
What can longstanding mitral stenosis show on x-ray?
Elevation of left main bronchus due to left atrial enlargement
89
Chest CT shows what in pulmonary embolism?
Wedge-shaped infarction
90
Pulmonary embolism classically presents with what?
Sudden-onset pleuritic chest pain, cough, dyspnea, and hemoptysis.
91
What pharmacotherapy is the mainstay of symptom management in COPD?
Anti-muscarinic agents like ipatropium combined with short acting beta adrenergic agonists.
92
What are the risk factors for aspiration pneumonia
Altered consciousness due to excessive alcohol intake, neurologic dysphagia or mechanical disurption of glottic closure.
93
If you see foul smelling sputum in recurrent pneumonia, think?
Excessive alcohol intake / aspiration pneumonia.
94
How do ACE inhibitors cause chronic cough?
Decreased degradation of bradykinin and substance P leads to the accumulation of these products causing cough. Also possibly due to activation of arachidonic acid pathway.
95
PE has what kind of A-a gradient.
Elevated A-a gradient.
96
What is the formula for PAO2?
( FiO2x (Patm-Ph20)) - (PCO2/R)
97
In patients with acute asthma axacerbation, normal/elevated PaCO2 suggests what? What is the tx for the patient in this case?
Decreaed respiratory drive and impending respiratory failure. Tx: endotracheal intubation and mechanical ventilation, inhaled short acting beta2 agonist, inhaled ipratropium and systemic corticosteroid (note that the steroids is for symptomatic improvement but its effects aren't clinically apparent for hours after administration.). 1 time infusion of IV magnesium sulfate is also recommended for severe asthma exacerbation without improvement after 1 hour of therapy.
98
What is hypersensitivity pneumonitis?
Alveolar inflammatino caused by repeated inhalation of inciting antigen.
99
What are the classifc x-ray findings for hypersensitivity pneumonitis
Ground glass opacity, "haziness" of lower lung fields, honeycombing of lungs.
100
How do acute episodes of hypersensitivity pneumonitis present?
Cough, breathlessness, fever and malaise occur within 4-6 hours after antigen exposure and lasts several days
101
What is the best tx for hypersensitivity pneumonitis (bird fancier's lung, farmer's lung)
Avoidance of antigen exposure. In many patients this produces complete remission.
102
Is Brain death a legally acceptable definition of death?
Yes. It refers to a total loss of brain function. No additional steps are needed when deciding to take patient off ventilation
103
What is the most common acid base distrubance in PE?
Respiratory alkalosis due to hyeprventiation to overcome hypoxia and v/Q mismatch.
104
Low Ph and elevated PCO2 is consistent with what acid-base disturbance.
Respiratory acidosis due to hypoventilation
105
Low Ph and low bicarbonate is consistent with what acid-base disturbance.
Metabolic acidosis
106
What are the primary theraptuetics for asthma and COPD
Asthma: primary long term intervention - inhaled corticodsteroids. COPD: long-acting anticholinergic inhaler.
107
What is mild intermittent asthma, what are the PFTs?
sx
108
For mild intermittent asthma, what are the required drugs?
Short acting beta2 agonist like albuterol PRN.
109
What are typical signs and sx of asbestosis?
Progressive dyspnea, clubbing, end-inspiratory crackles.
110
What are the PFTs with asbestosis?
Restrictive lung pattern: decreased residual lung volume, decreased diffusion lung capacity, normal FEV1/FVC ratio.
111
What are the hallmarks (imaging) of asbestosis?
Pleural plaques
112
What lab test is the most helpful in determining whether a chest tube placement is needed for parapneumonic effusion?
pH test. When less than 7.2, probably is very high that it needs to be drained. Glucose of less than 60mg/dL in pleural fluid also indication for tube thoracostomy. Infected pleural space is usually initially drained with chest tube.
113
What is the most common medical cause of excessive daytime sleepiness in the US and what is it due to?
Obstructive sleep apnea. It is due to poor oropharyngeal tone and results in daytime sleepiness, morning headaches and depression.
114
Why is sputum testing for microbial diagnosis option in the outpatient setting?
Due to low yield of cultue and high success rate of tx with empiric antibiotics
115
What is the treatment for acute exacerbation of COPD?
Supplemental oxygen with target oxygen saturation of 88-92%, inhaled bronchodilators (short acting beta 2 agonists and anticholinergics), antibiotics, and systemic glucocorticoids.
116
What kind of glucocorticoid is methylpredisolone?
IV glucocorticoids
117
What fungal infection is endemic to Ohio River basins, Mississipi River and Great Lakes?
Blastomycosis
118
Characteristics of extra-pulmonary manifestations of blastomycosis?
Ulcerated skin lesions and lytic bone lesions.
119
What confirms the diagnosis of blastomycosis?
Broad-based budding yeast grown from sputum
120
What drugs are used to treat symptomatic disease?
Itraconazole or amphotericin B
121
Patients with chronic nocturnal cough should be suspected of having ?
Asthma. Therefore should be evaluated with spirometry.
122
What sx sets apart Legionnaire's pneumonia with other community acquired pneumonia?
Concurrent GI and CNS sx.
123
How is dx made for legionnaire's pneumonia?
Urine antigen testing is highly specific. Also, in combination with culture.
124
Anaphylaxis requires emergency adminstration of what?
Intramuscular epinephrine to prevent and treat respiratory distress and circulatory collapse.
125
How does the administration of epinenphrine help in anaphylatctic shock?
Acts on adrenergic alpha 1 receptors to increase vasocontriction and beta 2 adrenergic receptors to relax bronchial smooth muscle contraction.
126
Consolidation of the lungs has what kind of breath sounds.
Dullness to percussion, bronchial breath sounds that are louder and more prominent in the expiratory component (assuming patent airways), egophony. Crackles also often heard.
127
What is the pathophysiology of consolidation that occurs in pneumonia?
Alveoli in the affected lung segments become filled with exudative fluid and cellular debris
128
What is the preferred method of respiratory support for AECOPD?
Noninvasive postive pressure ventilation.
129
What should be started prior to pursuing diagnostic testing in patients with high clinical supsicion for PE?
Anticoagulation (low molecular or unfranctionated heparin)
130
What are the useful diagnostic tests for PE?
CT angiography or V/Q scan.
131
What is found in V/Q scan for pulmonary thromboembolism
Large perfusion defect with normal ventilation - mismatched defect.
132
Alpha 1 antitrypsin deficiency is suspected in which patients?
Non-smoking patients
133
What's seen on chest x ray for alpha 1 antitrypsin defieincy?
Pan lobular emphysema on chest x-ray
134
Patients with alpha 1 antitrypsin deficiency are at risk for?
Liver disease - neonatal hepatitis, cirrhosis, liver failure.
135
What is the most common inherited disorder causing hypercoagulability and predisposition to thromboses?
Factor V Leidin which is a point multation that results in factor 5 being resistant to inactivation by protein C.
136
How does non allergic rhinitis present esp compared to allergic rhinitis?
NAR: post-nasal drip/cough, nasah congestion, sneezing, rhinorrhea without a specific etiology. AR: eye sx, rhinorrhea, sneezing with identifiable allergn/seasonal pattern.
137
How are patients with non-allergic rhinitis treated?
Intranasal Antihistamines or intralnasal glucocorticoids or a combination, depending on the severity. Routine allergy testing is NOT needed prior to starting empiric treatment.
138
What is the first treatment for mild to moderate sleep apnea syndrome?
Weight loss, no sedatives/alcohol and avoidance of supine position during sleep
139
In patients with severe renal insufficiency (which is GFR
Unfractionated heparin over low-molecular weight heparain, fondaparinux, and vivaroxaban because reduced renal clearance increased anti-Xa activity levels and bleeding risks.
140
What is Wegener's / Granulomatosis with Polyangiitis
Vasculitis of small adnd medium sized arteries.
141
How do patients with Wegener's present?
Kidney sx ( RBCs, glomerulonephritis) and upper/lower respiratory tract disease.
142
How is dx of Wegener's made?
Test for C-Anca. 90% of patients have positivity. Definitive diagnosis is made by tissue biopsy.
143
How is wegener's treated?
High dose corticosteroids and cytotoxic agents.
144
Bronchgenic cysts are found in which mediastinum?
Middle
145
Pathophysiology of CHF exacerbation causing tachypnea?
Left ventricular dysfunction allows fluid to pool into lungs => pleural effusion and hypoxemia due to reduced ventilation.
146
What are the blood gas findings in CHF?
Hypoxia, hypocapnia and respiratory alkalosis.
147
In COPD exacerbation, wha tis the main acid base distrubance
Respiratory acidosis. Hypocapnia.
148
What are the PE findings for CHF?
Fluid overload, S3 and S4 gallops, cardiomegaly, bibasilar crackles. Could also have decreased breath sounds from pleural effusions from cHF.
149
What are indicators of a severe asthma attack.
Normal to increased PCO2 values, speech difficult, diaphoresis, altered sensorium, cyanosis and silent lungs
150
Pancoast tumors most commoly present with?
Shoulder pain
151
What are the findings in pancoast tumors?
Shoulder pain, Horner's syndrom, weaness and atrophy of the hand muscles, pain and or paresthesias in the arm/forearm, enlarged supraclavicular lymph nodes
152
What is the initial evaluation in someone with suspected lung cancer?
Chest imaging such as X-ray
153
Reactivation of TB presents with?
Non specific symptoms such as fever, cough, weight loss, and night sweats
154
Chest X ray for reactivation of TB shows?
Upper lobe infiltrates with cavities.
155
In pneumonia what happens to the A-a gradient and why?
Hypoxia results in increased A-a gradient. There is alveolar and interstitial inflammation leading to a V/Q mismatch.
156
What is the definition of obesity hypoventilation syndrome
BMI => 30kg/m2, daytime hypercapnia (PaCO2 >45mmHg) and alveolar hypoventilation
157
What does ABG show for obesity hypoventilation syndrome?
Respiratory acdisosi, hypercapnia, hypoxemia
158
What is first line treatment for obesity hypoventilation syndrome?
Noninvasive postive pressure ventilation and weight loss
159
What is the most common source of symptompatic pulmonary embolisms?
Proximal deep leg veins
160
PE in patients with pleural effusion show increased or decreased 1) tactile fremitus 2) percussion 3) breath sounds over the effusion
1) Increased 2) dullness 3) decreased breath sounds.
161
Development of clubbing and sudden-onset joint arthropathy in a chronic smoker is suggestive of?
Hypertrophic osteoarthropathy
162
Hypertrophic osteoarthropathy is associated with what?
Lung cancer (and would need to order chest x-ray) and other lung diseases like TB, bronchiectasis and emphysema.
163
What kind of organism is legionella pneumophila and what does sputum gram stain show
Intracellular gram negative. Gram sputum stain shows neutrophils with no organisms
164
What is the tx option for legionnaire's pneumonia
Fluoquinolines like levofloxacin or newer macrolides.
165
Undiagnosed pleural effusion is best evaluated with what procedure?
Thoracocentesis to determine whether it is a transudate or exudate
166
Thoracocentesis is the best way to evaluate undiagnosed pleural effusion except in patients with?
clear cut evidence of CHF
167
When should antibiotics be given to a patient with acute exacerbation of COPD?
2 of 3 cardinal symptoms (increased cough, sputum production, dyspnea), Moderate to severe exacerbation, Or those needing mechanical ventilation
168
Recommended antibiotics for patient with acute exacerbation of COPD?
Recommendend antibiotics: macrolides (azithromycin), fluoroquinolones (levofloxin) or pencillins/beta-lactamase inhibitors. Duration of antibiotic therapy – 3-7days
169
What does chest x ray show for ARDS?
Bilateral alveolar infiltrates.
170
ARDS is a dx of?
Exclusion. Objective assessment is needed to definitely exclude hydrostatic pulmonary edema
171
What is required in an empyema that shows a complex loculated effusion with a thick surrounding peel?
Surgery. Removal of the peel is called decortication. Pus then needs to be drained.
172
Asbestos exposure increases risk of?
Pulmonary fibrosis and malignancy. Bronchogenic carcinoma is the most common malignancy.
173
CHF commonly causes what kind of effusions
Transudative effusions (bilateral 61%, uinlateral right sided 27%, unilateral left sided 12%).
174
Normal pleural fluid, transudate and exudate pH?
Normal is 7.6, transudate is 7.4-7.55, exudate is 7.3-7.45.
175
What is common in Hodgkin lymphoma patients treated with chemotherapy and radiation?
Secondary malignancy
176
What are the most common secondary solid tumor malignancies for Hodgkin Lymphoma patients?
Lung (especially smokers), breast, thyroid, bone and GI. Note. HL patients txed with chemotherapy and radiation also have increased risk of developing non HL and acute leukemia.
177
Patients on high doses of beta-2 agonists (for example for acute asthma attacs) may develop?
Hypokalemia, which may present as muscle weakness, EKG abnormalities, arrythmias. Other common side effects are tremors, palpitations and headaches.
178
Empyemas most commonly occur due to?
Untreated pneumonia due to bacterial seeding of pleural effusion.
179
ARDS is a/w what what PF ratio?
PaO2/FIO2
180
ARDS is due to (pathophysiology)
Impaired gas exchange, pulmonary hypertension, decreased lung compliance (stiff lungs).
181
Exudative pleural effusion along with pleural fluid acidosis (pH
Patients with complicated parapneumonic effusions, rheumatoid pleurisy, drug-induced lupus, TB and malignancy
182
DLCO is what in emphysema, chronic bronchitis and interstitial lung disease?
Decreased in emphysema, normal in chronic bronchitis and decreaed in interstitial lung diseases.
183
Patients with layrngeal edema typically present with?
Acute onset dyspnea
184
What should be immediately ruled out in a patient with presents with acute onset dyspnea?
Upper airway obstruction
185
How does bronchiectasis present?
Cough, mucopurulent sputum, and hemoptysis that responds to antibiotices
186
What imaging is done for definitiive dx of bronchiectasis?
High resolution Chest CT. Chest x-ray is frequently abnormal but it's not as sensitive nor specific as high rest CT
187
What are the most common causes of secondary digital clubbing?
Lung malignancies (bronchogenic carcinoma, metastatic cancers, malignant mesothelioma, lymphoma)
188
Does COPD with or without hypoxemia cause digital clubbing?
No
189
Presence of digital clubbing should prompt?
Search of occult malignancy
190
What is hypertrophic osteoarthropathy?
Digital clubbing along with painful joint enlargement, periostosis (excessive bone formation) of long bones, and synovial effusions.
191
What are the criteria for COPD patients to receive home oxygen therapy.
Patients with PaO255% should be started on home oxygen when the PaO2
192
How is atypical pneumonia different from pyogenic pneumonia in its presentation?
More indolent course, non-producrive cough and high incidence of extrapulmonary manifestations
193
What skin lesion is characteristic of mycoplasma pneumoniae?
Erythema multiforme.
194
What is the most common atypical pneumonia in the ambulatory setting?
Mycoplasma pneumoniae.
195
Granulomatosis with Polyangitis (Wegener's) is defined clinically as the triad of?
Systemic vasculitis, upper and lower airway granulomatous inflmammation and glomeruloneprhtiis.
196
What is the gold standfard for diagnosing obstructive sleep apnea
Nocturnal polysomnography
197
What is the ppt for pulmonary sarcoidosis?
Insidious onset dyspnea, dry cough in the absence of constitutional symptoms
198
What are the common skin and eye manifestations of sarcoidosis?
Erythema nodosum and anterior uveitis.
199
Patients with ankylosing spondylistis can develop what kind of lung disease?
Restrictive lung disease due to diminished chest wall and spinal mobility
200
What do PFTs show for ankylosting spondylitis?
Midly restrictive pattern with reduced vital capacity and total lung capacity but normal FEV1/FVC
201
ESR has greatest clinical utility in diagnosing?
Temporal arteritis, polymyalgia rheumatica
202
Thymomas are generally found in which mediastinum?
Anterior
203
Neurogenic cysts are generally found in which mediastinum?
Posterior
204
Rhonchi are usually caused by?
Secretions in the airway
