review

Question 1

bohr equation

Answer 1

Vd/Vt = (PACO2- PECO)/PACO2 ||| PECO2 is mixed expired CO2

Question 2

alveolar air eq

Answer 2

PAO2 = (Pb-PH2O)(FiO2)-(PaCO2/.8)

Question 3

blood o2 content

Answer 3

PaO2.0031+1.34hgb*O2sat

Question 4

mixed defect

Answer 4

TLC < 80% and FEV1/FVC < 80%

Question 5

why dyspnea in COPD?

Answer 5

hyperinflation
loss of elasticity
hypoxia, hypercapnia (more in CB)
airway obstruction

Question 6

why airway obstruction in COPD?

Answer 6

loss of airway tethering
effect of active expiration on airways
bronchiolostenosis
in CB, airway inflammation and secretions

Question 7

why COPD hypercapnic

Answer 7

late in dz, mostly CB
high WOB
decreased sensitivity to CO2
V/Q mismatch

Question 8

causes of resp alkalosis

Answer 8

fever, pain anxiety
hypoxia
preg, liver dz, asa

2/5 Hco3 for every 10 pco2

Question 9

cuase of resp acidosis

Answer 9

drugs (opiates, benzos)
severe lugn dz (COPD)
NM, chest wall dz

1/3.5 hco3 for 10 pco2

Question 10

shunt

Answer 10

low v/q
ventilation increased to nearby segments
hypoxic vasoconstriction
predominantly hypoxia

Question 11

dead space

Answer 11

infinity v/q
ventilation to dz segment wasted
perfusion to nearby segments increased

hypercapnia!!

Question 12

what causes increase aa gradient

Answer 12

diffusion impairment
shunt
net hypoventilation
v/q mismatch

Question 13

rising paco2 with 02 in chronic resp failure

Answer 13

hypoventilation b/c loss of hypoxic drive
worsening v/q
haldane effect

Question 14

emphysema tx

Answer 14

anti-cholinergic +/- SABA
LABA, inhaled ster, theo
O2!
Pulm rehav, surgery

Question 15

tx for flares of emphysems

Answer 15

antibx, IV steroids

Question 16

asthma tx

Answer 16

SABA & inhaled steroid
LABA, LT antagonist

Question 17

tx for asthma flare

Answer 17

systemic steroid, O2 for flares (no antibx)

Question 18

most common CAP pathogens

Answer 18

mycoplasma (ambulatory)
strep, pneumo - wards & ICU & ambulatory!
legionella - ICU
resp virsus - ambulatory and wards - more common in kids
chlamydai pneumoniae - ambulatory

Question 19

staph aureua

Answer 19

causes pneumo in very sick patients, post-flu!!!, MRSA

Question 20

consolidation physical findings

Answer 20

palpation - increased fremitus
auscultatory findings: bronchial (tubular) sounds
rales/crackles
egophony
whispered pectoriloquy

Question 21

List the common causes of a transudative pleural effusion

Answer 21

CHARM

Carditis/Cardiac failure
Hypothyroidism
Albuminemia (hypo)
Renal failure
Meig’s syndrome/Malabsorption

Question 22

List some causes of an exudative pleural effusion

Answer 22

PINTARS

Pneumonia (pancreatitis
Infarction
Neoplasm
Tuberculosis/Trauma
Abscess
Rheumatoid arthritis
Sarcoidosis/SLE/Scleroderma

Question 23

what causes low glucose pleural effusion

Answer 23

TB, RA, infection

Question 24

how to identifiy empyema

Answer 24

very high WBC

Question 25

what causes bloody pleural effusion

Answer 25

trauma, asbestos

Question 26

hwo to identify incipient infection for pleural effusion

Answer 26

low PH

Question 27

how to identify complicated parapneymonic

Answer 27

high LDH

Question 28

what causes chylous (high TG) pleural effusion

Answer 28

lymphoma, trauma

Question 29

causes of diffuse intersitital lung disease

Answer 29

IPF with UIP - lower CVD (scleroderma) - lower drugs (amiodarone, bleomycin) sarcoidosis - upper.middle hypersensitivity - upper lympangitic spread

Question 30

neuromuscular dz pfts

Answer 30

restrictive (<80% TLC) but preserved RV normal (when corrected) Dlco, smare in obestiy and poor effort

Question 31

hemodynamic effects of mv

Answer 31

decreased CO due to loss of negatvie IPP descreased venous return compression of pulm capillaries sptal shift tx with fluid, inotropes

Question 32

causes of diffuse alveolar infiltrates

Answer 32

CHF ARDS diffuse pneumo - pcp aspiration dah tumor - adenocarcinoma in situ

Question 33

lung cancer summary

Answer 33

small cell: 15%, no subtypes, central, localized or disseminated staging, chemo or chemo + rad, rarely curable, usally responds & recurs non-small cell: 85%, adeno, squamous, large cell, central or peripheral, tnm, surgery, rad for pall, curable depending on stage

Question 34

PEEP effects

Answer 34

recruits atelectatic alveoli, improves FRC, improves hypoxemia from shunt-like effect of alveolar filling

Question 35

monitoring patients on mech vent

Answer 35

clinical - secretions, mental status, cxr, underlying process gas exchnage - po2, pco2 mechanis - cstat

Question 36

if ppeak-pplat is same

Answer 36

parenchymal problems: pulm edema pulem embolus pneumo ptx anxiety, pain auto-peep

Question 37

if ppeak - pplat is bigger

Answer 37

ETT problems, tubing kinked secretions bronchospasm

Question 38

tx for obesity hypoventilation syndrome

Answer 38

wt loss, bipap, trach, bariatric surgery

Question 39

how to diagnose osa vs ohs

Answer 39

both with psg (high ahi) ohs --> daytime hypercapnia