Step Up- Pulmonary Flashcards by Ben Dover

Acid base derrangement present in chronic COPD’ers

Respiratory acidosis with metabolic alkylosis

How well did you know this?

Not at all

Perfectly

These two agents together are good for control of COPD

B-agonist with inhaled anticholinergic like ipratropium

How well did you know this?

Not at all

Perfectly

This therapy has been shown to increase survival and quality of life in patients with COPD and chronic hypoxemia

Continuous O2

How well did you know this?

Not at all

Perfectly

These vaccines should be given to all COPD’ers

Pneumococcal

Influensza

How well did you know this?

Not at all

Perfectly

Interventions important in acute COPD exacerbation

B2 agonist with anticholinergic

ABX (azithro or levoflox)

Supplemental O2 to Sat>90%

PPV (invasive or non)

How well did you know this?

Not at all

Perfectly

Asthmatic patient with increasing PCO2…cause? Tx?

Cause: Impending respiratory failure

Treatment: Mechanical ventilation

How well did you know this?

Not at all

Perfectly

Most common cause of bronchiectasis

How well did you know this?

Not at all

Perfectly

PFT in bronchiectasis

reveal obstructive pattern

How well did you know this?

Not at all

Perfectly

Infections frequently seen in CF patient?

Pseudomonas

How well did you know this?

Not at all

Perfectly

Type of lung cancer that is least associated with smoking?

Adenocarcinoma

How well did you know this?

Not at all

Perfectly

65 Year old smoker presents with right sided facial fullness and arm swelling as well as redness and sweating on the right face…dx?

SVC syndrome- obstruction of SVC by mediastinal tumor

How well did you know this?

Not at all

Perfectly

65 year old smoke with shoulder pain radiating down the arm and arm weakness

pancoast tumor

How well did you know this?

Not at all

Perfectly

Most common sites of lung cancer metastasis?

Brain, bone, liver, and adrenal glands

How well did you know this?

Not at all

Perfectly

Proximal muscle weakness and fatigability in a 65 year old smoker? What subtype?

Eaton-lambert syndrome

typically SCLC– Ab again Ca channels presynaptic

How well did you know this?

Not at all

Perfectly

What features of the following suggest malignancy in lung nodules…

Age-

Smoking-

Size-

Borders-

Calcification-

Change in size-

Age- >50=50% malignant

Smoking- increses risk

Size- <1cm less likely >2cm more likely

Borders- More irregular= more likely malignant

Calcification- eccentric and asymmetric=more likely malignant. dense and central = less likely

Change in size- enlarging suggests malignancy

How well did you know this?

Not at all

Perfectly

Causes of masses in the anterior mediastinum…

4 Ts

Thymoma

Teratoma

Terrible lymphoma

Thyroid tumor

How well did you know this?

Not at all

Perfectly

Three general causes of pleural effusions

increased drainage of fluid in to the pleural space
Increased production of fluid by pleural cells
Decreased drainage from the pleural space

How well did you know this?

Not at all

Perfectly

Tests to be performed on an exudative effusion…

cell count

Glucose

amylase

triglycerides

micro

cytology

How well did you know this?

Not at all

Perfectly

Characteristics of an exudative effusion….

Protien (pleural)/(serum) >0.5

LDH (pleural)/(serum) >0.6

Pleural LDH > upper two thrids of normal serum

How well did you know this?

Not at all

Perfectly

With a pleural effusion glucose of <60, what disease should be ruled out….

How well did you know this?

Not at all

Perfectly

FEV1/FVC in intersitial lung disease?

increased (restrictive pattern)

Both findings are decreased but the ratio is increased

Most popular extrapulmonary manifestation of sarcoidosis?

Anterior uveitis and erythema nodosum

Granulomatous vasculitis seen in patients with asthma?

Chrug-strauss syndrome

pulmonary infiltrates with rash and eosinophilia and +p-ANCA

Churg-strauss syndrome

egg shell calcifications on CXR

Silicosis

Bilateral linear opcities and hazyn infiltrates on CXR combined with pleural plaques increase the risk of previous exposure to...

Asbestos

Silicosis is associated with an increased risk of this infection

autoimmune disease caused by IgG Ab against glomerular and alveolar basement membranes

Goodpasture syndrome Presents with hymoptyisis and dyspnea

Causes of acute hypoxemic respiratory failure? Main mechanism leading to it?

Causes are intrinsic lung pathology- ARDS, PNA, pulmonary edema Mechanism is a V/Q mismatch THINK-- if PaO2 is low but PCO2 is normal or low then this mean CO2 exchange is taking place however O2 is not!

Cuases of hypercarbic respiratory failure

Underlying lung disease: COPD, Asthma, CF, severe bronchitis

Mechanism of hypercarbic respiratory failure

Either a decrease in minute ventilation or increase in dead space Minute vent= Tv \* f

Will a V/Q mismatch respond to supplemental O2?

Yes

Is hypoxemia 2/2 a shunt responsive to O2?

No-- blood flow is good, however there is reduced ventilation in the area of the shunt.

Criteria to Dx ARDS

Hypoxia resistent to O2 supplementation Bilateral r/o other causes (like cardiac)

Physiologic event leading to ARDS

Massive atelectasis leading to shunting and poor oxygenation Damage to alveolar membranes causes increased dead space

How does PCWP help differentiate ARDS from cardiogenic pulmonary edema

PCWP elevated (\>18) cardiac cause more likely PCWP normal/low (\<18) ARDS more likely

PCWP goal in ARDS to avoid fluid overload?

12-15mm Hg

Initial Vt in intubated patient?

8-10mL/kg rate 10-12/min

Should tidal volumes be lower or higher in ARDS?

Lower

What is the effect of PEEP on cardiac output?

decreases it due to decreased venous return

Pressure associated with pumonary HTN?

\>25mmHg at rest \>30mmHg during exercise

Patient with RVH and right atrial abnormality with substernal heave

pulmonary HTN

This drug promotes the action of ATIII

Heparin

When to put COPD'ers on O2

PO2 \<55 (\<60 in right heart failure) O2 sat \<88% (\<90% in R sided heart failure)

Asmatic patient with recurrent episodes of brown-flecked sputum on xray

Allergic brochopulmonary aspergillosis

This is the best alternative to TMP/SMX in PCP tx

Pentamadine or primaquine IV

Alternative to TMP/SMX for PCP prophylaxis

atovaquone or dapsone

This value is diagnostic for ARDS

pO2/FIO2= \<300 O2 on abg is 105 Room air= FIO2 of .21 (21%) 105/.21= 500= ARDS

CT finding in ARDS

Consolidation with air bronchograms

Appropriate TV for ARDS?

6mL/kg Low tidal volumes are best to avoid barotrauma

Target plateau pressure in ARDS

less than 30cmH20