Step Up to Med - Pulmonary Flashcards by Dahveed Topher

two types of chronic obstructive pulmonary disease

chronic bronchitis

emphysema

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clinical diagnosis of chronic bronchitis

chronic cough productive of sputum for at least 3 months per year for at least 2 consecutive years

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permanent enlargement of air spaces distal to the terminal bronchioles due to destruction of alveolar walls

emphysema

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fourth leading cause of death in the US

COPD

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two main risk factors for emphysema

tobacco smoke

alpha 1 antitrypsin deficiency

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excess mucus production narrowing the airways with productive cough inflammation and scarring occurs with enlargement in mucous glands and smooth muscle hyperplasia leading to obstruction

chronic bronchitis

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destruction of alveolar walls due to relative excess in proteases or relative deficiency of antiproteases in the lungs

emphysema

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tobacco smoke and
number of activated PMNs and macrophages
alpha 1 antitrypsin
oxidative stress

increase
decrease
increase

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definitive diagnostic test in COPD

pulmonary function testing (spirometry)

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what are the critical spirometry findings in COPD

decrease FEV1/FVC ratio

increase TLC residual volume and FRC

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GOLD staging is based on

FEV1

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GOLD staging and FEV1

> 80% pred - mild
50-80 mod
30-50 sev
<30 very sev

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CXR changes in COPD

hyperinflation
flattened diaphragm
enlarged retrosternal space

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in what conditions is CXR useful in COPD

during acute exacerbation to R/O pulmonary causes such as PNA or PTX`

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should be measured in patients with a personal or family historyt of premature emphysema less that 50 y.o

alpha 1 antitrypsin

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the most important intervention for COPD’ers

smoking cessation

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what is the effect of quitting smoking on the rate of decling of FEV1

decreases the RATE of decline to that of a normal person but WILL NOT reverse it

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what are the three medications commonly employed in the treatment for COPD

ipratropium bromide
albuterol
corticosteroids

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dhown to improve survival and QOL in patients with COPD AND chronic hypoxemia

oxygen therapy

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requirements for home O2 (2)

PaO2 <55mHg on ABG
OR
O2 sat <88%

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what two vaccinations are necessary for COPD’er

strep pneumo every 5-6 years, patients with severe disease before 65
anually get the flu vaccination

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.increased dyspnea spuitum production and or cough in a patient with known COPD

acute exacerbation

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where is the o2 saturation goal for a chronic COPD patient

90-93#

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what type of steroids should be used for an acute COPD exacerbation

IV methylprednisone with prednisone taper once clinical improved

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3 most common causes for acute exacerbations

infection noncompliance cardiac disease

what is one of the main long term complications of COPD

pulmonary HTN and cor pulmonale (long standing hypoxia in the pulmonary vasculature

airway inflammation airway hyperresponsiveness reversible airflow obstruction

asthma

T/F asthma can begin at any age

what is the typical clinical picture with extrinsic asthma

atopic, hay fever and eczema

asthma symptoms are typically worse at what time of the day

night

Sob wheezing tightness and cough

asthma

what testing is required for diagnosis of asthma

PFTs

what must be done in PFTs to confirm the diagnosis of asthma

administer PFTs before and after the administration of bronchodilators in order to show reversibility

increase of what magnitude following bronchodilators in PFTs regarding asthma diagnosis is considered reversible

12%

useful meassurement of airflow obstruction in asthma

peak flow

useful when asthma is suspected but PFTs are nondiagnostic

bronchoprovocation

what kind of medication is methacholine and what is it used for?

muscarinic agonist | bronchoprovocation in asthma

when is CXR helpful in asthma

severe cases to r/o other causes PNA PTX etc

when should ABGs be considered in a patient with asthma

severe respiratory distress

increasing levels of what on ABG are highly concerning for impending respiratory failure in an asthmatic

normal or elevated PaCO2

if PaCO2 is normal or increased in asthmatic

admit and consider intubation

acute asthma exacerbation first step

inhaled broncho dilators typically nebulized or MDI | monitor peak flows and clinically for improvement

what should be done in acute asthma exacerbation following trial on inhaled albuterol through nebulizer

IV steroids

third line agent in acute asthma exacerbation in the hospital

IV magnesium | reduces bronchospasm

what are the 3 adjunct therapies to consider on top of albuterol steroids and mag in an acute asthmatic

oxygen therapy ABX intubation if all else fails

permanent abnormal dilation and destruction of bronchial walls with chronic inflammation airway collapse and ciliary loss dysfunction leading to impaired clearance of secretions

bronchiectasis

airway obstruction immunodeficiency allergic bronchopulmonary aspergillosis mycobacterium infections recurrent should raise concern for

bronchiectasis

most common cause for bronchiectasis

rare congenital cause for bronchiectasis

kartagener syndrome

chronic cough with large amounts of mucopurulent foul smelling sputum dyspnea hemoptysis recurrent or persistent PNA

bronchiectasis

diagnostic study of choice in bronchiectasis

high resolution CT

acute exacerbation of bronchiectasis requires what initial treatment

ABX

bronchial hygeine steps in bronchiectasis

hydration bronchodilators chest physiotherapy

excessively thick viscous secretions in the respiratory tract, exocrine pancreas, sweat glands, intestines, genitourinary tract

treatment for CF

``` pancreatic enzyme replacement fat soluble vitamin supplements chest physical therapy vaccinations treatment of infections inhaled rhDNase (breaks down the DNA in respiratory mucus that clogs the airways) ```

most common lung cancer

Nonsmall cell lung cancers

biggest risk for lung CA

smoking

lowest association with smoking of all the lung cancers

adenocarcinoma

common in shipbuilding and construction industry, car mechanics, painting increasing lung CA risk

asbestos

high levels found in basements increase riskl for lung CA

radon

``` cough hemoptysis obstruction wheezing dyspnea recurrent PNA ``` most associated with what lung CA

squamous cell CA

anorexia weight loss weakness associated prognosis with lung CA

bad (progressive at this point)

SVC synbdrome most commonly occurs in what type of lung CA

SCLC

facial fullness facial and arm edema dilated veins over anterior chest arms and face JVD

SVC syndrome

nerve that courses through the mediastinum and can be injured by lung cancer if destructive

phrenic nerve

hoarseness secondary to lung cancer

recurrent laryngeal nerve injury

Apical tumor involved C8 and T1-T2 nerve roots | causing shoulder pain radiating down the arm

superior sulcus tumors

superior sulcus tumors almost always of what type

squamous cell

what syndrome can be involved with superior sulcus tumors

horners syndrome

why is the prognosis so poor associated with malignant pleural effusion

equivalent to distant metastasis

SIADH occurs with what pulmonary cancers

small cell lung cancer

ectopic ACTH secretion occurs with what lung cancers

small cell lung cancers

PTH like hormone secreting lung cancer

squamous cell carcinoma

hypertrophic pulmonary osteoarthropathy occurs in what two types of lung cancer

adenocarcinoma and squamous cell

proximal muscle weakness fatigability diminished deep tendon reflexes paresthesias in lung cancer setting

lambert eaten syndrome

loss of normal angle between the fingernail and nail bed due to thickening of subungual soft tissue

digital clubbing

digital clubbing usually iindicates

lung ca

most important radiologic study for the diagnosis of lung cancer

CXR

CXR criteria associated with benign lung tumor

stable over a 2 year period

useful test for staging of lung carcinoma

CT scan

cytologic exam of sputum in lung cancer useful for what type

central tumors

useful for diagnosing central visualized tumors but not peripheral lesions

fiberoptic bronchoscopy

best management for NSCLC

Surgery

treatment used as an adjunct following surgery for NSCLC

radiation

what is the treatment for management for SCLC

radiation and chemotherapy

50% chance of malignancy for solitary nodule if the patient is over the age of ____

T/F smoking has no effect on the chance of malignancy of a solitary pulmonary nodule

F (smoking definitely increases malignancy chance)

cutoff for large malignancy of pulmonary nodule

2cm

borders indicative of malignancy

irregular

type of calcifcation that indicates malignancyu in solitary pulmonary nodule

asymmetric calcification

dense calcification suggests

benign pulm nodule

enlarging pulmonary nodule suggests

malignancy

follow up of pulm nodule on xray with no old xray or new nodule

low probability nodules management in pulmonary nodules

serial CT scan

intermediate probability nodule 1 cm or larger

PET scan

PET scan positive in pulmonary nodule

biopsy

high probability nodule follow up

biopsy

most common cause of mediastinal mass in older patients

metastatic cancer

most common cause of anterior mediastinum

``` FOUR T's thymoma teratoma thymoma terrible lymphoma ```

middle mediastinum most common causes (5)

``` lung cancer lymphoma aneurysm cysts morgagni hernia ```

posterior mediastinum most common causes (5)

``` neurogenic tumors esophageal masses enteric cysts aneurysms bochdalek hernia ```

most common symptoms of mediastinal structures

compressive symptoms

what kind of pneumonia is common with mediastinal structure

postobstructive PNA

what are the three neuronal type injuries associated with mediastinal masses

hoarseness with recurrent laryngeal nerve injury horner syndrome from sympathetic ganglia diaphragmatic paralysis 2/2 phrenic nerve injury

what is the test of choice with mediastinal masses

CT scan

lights criteria (3)

Protein (pleural)/Protein (serum) >0.5\ LDH (p)/LDH(s) >0.6 LDH> two thirds the upper limit of normal serum LDH

most common cause of pleural effusion

CHF

most common malignancy leading to pleural effusion

lung

Dullness to percussion decreased breath sounds over the effusion decreased tactile fremitus

pleural effusion

blunting of costophrenic angle | sign of what on CXR

pleural effusion

at least what volume of fluid can accumulate before pleural effusion can be detected

250ml

when is thoracentesis useful in pleural effusion

not obvious etiology

what is the complication associated with thoracentesis

PTX

treatment for transudative effusions

diuretics and sodium restriction | therapeutic thoracentesis

what is the treatment for exudative pleural effusions

treat underlying disease

uncomplicated parapneumonic effusions

ABX alone

complicated effusions parapneumonic

chest tube intrapleural injection of thrombolytics if loculated potential surgical lysis of adhesions

exudative pleural effusions if left untreated can lead to

empyema

most cases of empyema occur secondary to

bacterial PNA

two recommended tests for empyema

CXR and CT

treatment for empyema

ABX and thoracentesis

if empyema is severe and persistent regardless of drainage and ABX what can be done

rib resection and drainage open

air in the normally airless pleural space

PTX

two major categories of pneumothorax

spontaneous and traumatic pneumothoraces

traumatic pneumothoraces are most commonly 2/2

iatrogenic

primary spontaneous pneumothoraces are usually secondary to what cause

subpleural blebs in tall lean young men

T/F primary spontaneous pneumothorax has a high recurrence

secondary spontaneous pneumothorax is usually 2/2

COPD ``` or less commonly asthma ILD neoplasms CF TB ```

``` ipsilateral chest pain usually sudden dyspnea cough decreased breath sounds hyperresonance decreased or absent tactile fremitus on affected side mediastinal shift ```

pneumothorax

small PTX and patient asymptomatic

observation (resolve spontaneously in ~10 days)

PTX larger or patient is symptomatic

administer supplemental oxygen | needle aspiration or chest tube insertion

what is the treatment of secondary spontaneous pneumothorax

chest tube drainage

accumulation of air within the pleural space suich that tissues surrounding the opening into the pleural cavity act as valves allowing air to enter but not to escape

tension pneumothorax

accumulation of air in the pleural space and shift of mediastinum to the contralateral side

tension PTX

mechanical ventilation with barotrauma CPR trauma lead to what type of PTX typically

tension PTX

``` hypotension distended neck veins shift of trachea decreased breath sounds on one side hyperresonance to percussion ```

tension PTX

what is the risk with tension PTX

hemodynamic compromise and shock

what is the immediate treatment for tension PTX

needle decompression

malignant mesothelioma usually secondary to what exposure

asbestos

blood effusion common with what malignancy

malignant mesothelioma

defined as an inflammatory process involving the alveolar wall that can lead to irreversible fibrosis, distortion of lung architecture and impaired gas exchange

ILD

four environmental lung diseases

coal workers pneumoconiosis silicosis asbestosis berylliosis

what are the four ILDs associated with granulomas

sarcoidosis histiocytosis X wegener granulomatosis churg strauss syndrome

alveolar filling disease as ILD (3)

goodpastures idiopathic pulmonary hemosiderosis alveolar proteinosis

ILD hypersensitivity lung diseases (2)

hypersensitivity pneumonitis | eosinophilic pneumonitis

drug induced ILD 2/2 (5)

``` amiodarone nitrofurantoin bleomycin phenytoin illicit drugs ```

ILD associated with connective tissue disorders (4)

rheumatoid arthritis scleroderma SLE mixed connective tissue disease

what are the 3 random ILDs

idiopathic pulmonary fibrosis cryptogenic organizing pneumonia radiation pneumonitis

digital clubbing is common with what type of ILD

idiopathic pulmonary fibrosis

rales at the base signf of pulmonary HTN and cyanosis in advanced disease fatigue dyspnea cough

ILD

which diagnostic test shows the extent of fibrosis in ILD better than other tests

FEV1/FVC ratio FEV1 FVC DLCO in ILD

increased decreased decreased decreased

if the CT is not diagnostic for ILD what should be done

biopsy

what are the two disease in ILD that benefit from UA

goodpastures and wegeners granulomatosis

chronic systemic granulomatous disease characterized by noncaseating granulomas often involving multiple organ systems african american female <40years old

sarcoidosis

erythema nodosum plaques subcutaneous nodules maculopapular eruptions in what ILD

sarcoidosis

anterior uveitis common with what ILD

sarcoidosis

what are the two main disturbances of the heart associated with sarcoidosis

arrhythmias | conduction disturbances such as heart block

bell palsy can be seen with what ILD

sarcoidosis

bilateral hilar adenopathy is the hallmark of this disease

sarcoidosis

elevated in serum in about 50% to 80% of sarcoidosis patients

ACE enzyme

hypercalciuria and hypercalcemia are common in what ILD

sarcoidosis

definitive diagnosis in sarcoidosis

transbronchial biopsy

what can be found in transbronchial biopsy diagnostic for sarcoidosis

noncaseating granulomas

what is the least favorable CXR presentation of sarcoidosis

diffuse parenchymal infiltrates without hilar adenopathy

what is the most common disease course for sarcoidosis

resolve within 2 years

what is the treatment of choice for sarcoidosis

systemic corticosteroids

``` symptomatic patients active lung disease pulmonary function deterioration conduction disturbances severe skin or eye involvement ``` in sarcoidosis

systemic corticosteroids

used in sarcoidosis with patients that are refractory to systemic corticosteroids

methotrexate

chronic insterstitial poneumonia caused by abnormal proliferation of histiocytes

histiocytosis X

what are the three forms of histiocytosis X

eosinophilic granulomas letterer Siwe Hand Shuller Christian syndrome

``` sponstaneous pneumothorax lytic bone lesions diabetes insipidus CXR shjowing honeycomb appearance CT scan shows cystic lesions ```

histiocytosis X

what is the treatment for histiocytosis X

corticosteroids | lung transplant may be necessary

characterized as a ILD with necrotizing granulomatous vasculitis

wegener granulomatosis

lungs kidneys upper airway sometimes other organs with ILD

wegener granulomatosis

gold standard for diagnosis of wegener granulomatosis

tissue biopsy

ILD with biopsy positive c-antineutrophilic cytoplasmic antibodies

wegener granulomatosis

treatment for granulomatosis with polyangiitis

immunosuppressive agents and glucocorticoids

granulomatous vasculitis is seen in patients with asthma

churg strauss syndrome

``` pulmonary infiltrates rash eosinophilia systemic vasculitis skin muscle nerve lesions significant blood eosinophilia P ANCA + ```

churg strauss

what is the treatment for churg strauss

systemic glucocorticoids

some patients may develop complicated pneumoconiosis characterized by fibrosis 2/2 carbon and silica

coal workers pneumoconiosis

diffuse interstitial fibrosis of the lung caused by inhalation of asbestos fibers

asberstosis

increased risk of bronchogenic carcinoma and malignant mesothelioma

asbestos

CXR showing hazy infilktrates with bilateral linear opacitis and may show pleural plaques

asbestosis

localized and nodular peribronchial fibrosis | can be acute or chronic

silicosis

ILD associated with increased risk of TB | mining stone cutting and glass manufacturin

silicosis

``` acute disease is a diffuse pneumonitis caused by massive exposure lymphocyte proliferation test is usefulk granulomas skin lesions hgypercalcemia ```

berylliosis

ILD with presence of serum IgG and IgA to the inhaled antigen is a halmmark finding acute form has flu like features CXR during the acute phase shows pulmonary infiltrates

hypersensitivity pneumonitis

fever and peripheral eosinophilia are features eosinophilic pneumonia may be acute or chronic CXR showing peripheral pulmonary infiltrates

eosinophilic pneumonia

autoimmune disease caused by IgG antibodies directed against glomerular and alveolar basement membranes

goodpasture syndrome

hemorrhagic pneumonitis and glomerulonephritis ultimate renal failure is a complication of proliferative glomerulonephritis hemoptysis and dyspnea

goodpasture

serologic evidence of antiglomerular basement mambrane antibodies

goodpastures

three treatments for goodpastures

corticosteroids cyclophosphamide plasmapharesis

accumulation of surfactant like protein and phospholipids in the alveoli

pulmonary alveolar proteinosis

CXR of ground glass appearance with bilateral alveolar infiltrates that resemble bat shape patients at increased risk of infection and should not be given corticosteroids

alveolar proteinosis

what are the two treatments for alveolar proteinosis

lung lavage and GCSF

what tests must be down for idiopathic pulmonary fibrosis

CXR open lung biopsy exclude other ILDs

treatment for idiopathic pulmonary fibrosis

supplemental oxygen corticosteroids lung transplant

inflammatory lung disease with similar clinical and radiographic features to infectious pneumonia associated with viral infections medications connective tissue disease but most cases are idiopathic bilateral patchy infiltrates on CXR

cryptogenic organizing pneumonitis

what is the treatment for cryptogenic organizing pneumonitis

steroids

``` occurs in 5 to 15% of patients who undergo thoracic treatment for lung cancer breast cancer lymphoma or thymoma low grade fever cough chest fullness dyspnea pleuritic chest pain hemoptysis acute respiratory distress normal CXR CT with diffuse infiltrates ```

radiation pneumonitis

what is the treatment of choice for radiation pneumonitis

corticosteroids

CNS causes for respiratory failure

drug overdose stroke trauma

neuromuscular disease associated with respiratory failure

MS GBS ALS

upper airway causes for respiratory failure

obstruction stenosis spasms paraylsis

thorax and pleura causes for respiratory failure

kyphoscoliosis flail chest hemothorax

cardiovascular system and blood | causes for respiratory failrue

CHF valvular diseases PE anemia

lower airways and alveoli causes for respiratory failure

asthma copd PNA acute respiratory distress syndrome

hypoxemic respiratory failure O2 sat FiO2

<90% despite 60% FiO2

what is the major pathophysiologic cause for hypoxemic respiratory failure

VQ mismatch | intrapulmonary shunting

hypercapnic respiratory failure is 2/2 what two causes

decrease in minute ventilation or increase in physiologic dead space

caused by a defect in either alveolar ventilation or perfusion typically leads to hypoxia without hypercapnia most common mechanism of hypoxemia responsive to supplemental oxygen

V/Q mismatch

little or no ventilation in perfused areas venous blood is shunted into the arterial circulation without being oxygenated represents one end of the spectrum in V/Q mismatch

shunting

atelectasis or fluid buildup in alveoli, direct right to left intracardiac blood flow in congenital heart diseases type of respiratory failure

shunting

sepsis DKA hyperthermia results in what type of respiratory failure

hypercapnia

this type of lung disease causes hypoxemia without hypercapnia

diffusion impairment

``` inability to speak in complete sentences use of accessory muscles of respiration tachypnea tachycardia cyanosis impaired mentation ```

respiratory failure

3 main causes for hypoxemia

V/Q mismatch intrapulmonary shunting hypoventilation

main cause for hypercapnia

hypoventilation

acid base disturbance with hypercapnia

respiratory acidosis

why should the lowest concentration of oxygen that provides sufficient oxygentation be used

to avoid oxygen toxicity 2/2 oxygen free radicals

what is the problem of using O2 in patients with COPD patients

can lead to V/Q mismatch, the haldane effect and loss of respiratory drive

should be given to a patient that is conscious and has possible impending respiratory failure with administration of oxygen

NPPV

diffuse inflammatory process involving both lungs | neutrophil activation in the systemic of pulmonary circulations is the primary mechanism

ARDS

acute onset bilateral infiltrates on chest imaging pulmonary edema not explained by fluid overload or CHD PaO2/FiO2<300

ARDS

key pathophysiologic event in ARDS

massive intrapulmonary shunting of blood

why is high PEEP required in ARDS

prop open the airways

what is the difference between ARDS and severe cardiogenic pulmonary edema

cause for edema in ARDS it is an increase of pulmonary capillary permeability in cardiogenic pulmonary edema the increase in pulmonary hydrostatic pressure

what is the most common risk factor for ARDS

sepsis

GI risk for ARDS

aspiration of GERD

dyspnea tachypnea tachycardia increased work of breathing progressive hypoxemia

ARDS

most useful parameter in differentiating ARDS from cardiogenic pulmonary edema

PCWP

if PCWP is low and there is an enormous pulmonary infiltrate

ARDS

if PCWP is greater tyhan 18 and massive pulmonary infiltrates

cardiogenic pulmonary edema

O2 saturation should be kept above what level in treatment of ARDS

90%

most important aspect of ARDSnet parameters for ventilatory settings in the setting of ARDS

high PEEP | low TV

what is the goal CVP in ARDS

4 to 6

what type of feeding is preferred to treat ARDS

tube feedings

what are the two main complications associated with mechanical ventilation

barotrauma | nosocomial

what are the two main goals of mechanical ventilation in respiratory failure

maintain alveolar ventilation | restore hypoxemia

test to assess response to initiation of mechanical ventilation

ABG

initial mode used in most patient with respiratory failure

use for pressure support

weaning trials

settings of ventilation that affect minute ventilation

RR and TV

initial tidal volume typically used in most cases

4-8mL/kg

normal initial rate set in mech vent

10 to 12

settings that affect PaO2

FiO2 | PEEP

initial FiO2 setting

100 and quickly titrate down

what is the normal PEEP

5cm H2O

all mechanically ventilated patients should be on what medication

PPI

mean pulmonary arterial pressure greater than 25 mm Hg at rest

Pulmonary HTN

what are the 5 main reasons for pulmonary HTN

passive due to overflow from left heart disease hyperkinetic due to left to right shunting obstruction (PE and Pulmonary artery stenosis) pulmonary vascular obliteration from collagen vascular disease pulmonary vasoconstriction

pulmonary HTN in young woman thickening of pulmonary arteriolar walls familial or idiopathic veno occlyussive

pulmonary arterial hypertension

``` dyspnea on exertion fatigue chest pain syncope loud pulmonic component of the second heart sound and subtle lift of sternum, signs of right heart failure ```

pulmonary artery hypertension

ECG in PAH

right axis deviation

CXR showing enlarged pulmonary artyeries with or without clear lung fields based on the cause of pulmonary hypertension

PAH

echocardiogram showing dilated pulmonary artery dilation/hypertrophy of RA and RV abnormal movement of IV septum

PAH

Right heart catheterization results of PAH

increased pulmonary artery pressure

sildenafil oral CCBs prostacyclins (epoprostenol) endothelin receptor antagonists (bosentan) used in what group of PAH

group 1

right ventricular hypertrophy with eventual RV failure resulting from pulmonary HTN secondary to pulmonary disease

cor pulmonale

cor pulmonale most commonly secondary to

COPD

decrease in execise tolerance cyanosis and digital clubbing signs of right ventricular failure hepatomegaly edema JVD parasternal lift

cor pulmonale

most common DVTs that embolize to the lungs

iliofemoral

if a severe acute PE occurred what could occur as a result

cor pulmonale

what type of pathophysiology leads to the tachypnea associated with PE

increase in dead space in increase in hypoxemia and hypercarbia

recurrent small sub clinical PE's can lead to

pulmonary arterial hypertension

most common symptoms of PE

dyspnea

most common sign of PE

tachypnea

T/F ABG levels are diagnostic for PE

F (not)

what are the CXR levels normally in PE

normal

what are the two CXR signs that are rarely seen with PE

hamptom hymp | westermark sign

positive venous duplex warrants what treatment in PE

anticoagulation

test of choice now in PE

CT angiography

test that is useful if there is contraindication to CTA

VQ scan

high probability VQ scan treatment

heparin

major contraindication for CTA

renal insufficiency

consider this test when risk of anticoagulation is high testing is equivocal or if the patient is hemodynamically unstable and embolectomy may be required

pulmonary angiography

when should patients be given anticoagulation if the clinical suspicion is high for PE

before testing

contraindications to heparin treatment

active bleeding uncontrolled HTN recent stroke HIT

how long should anticoagulation be continued following acute treatment in PE

3-6 months

patients with massive PE and hemodynamic instability

thrombolytics

most common lung involved due to aspiration

RIght due to anatomy

predisposing factors for aspiration

``` reduced consciousness alcoholism extubation excessive vomiting tube feeding anesthesia surgery neuromuscular disease esophageal disorders ```

what is the difference mainly between aspiration pneumonia and aspiration pneumonitis

aspiration PNA takes days to develop

what organisms should be covered in aspiration PNA

anaerobics

low pulse ox | hypercarbia suspected or to evaluate for acid base abnormalities

ABG

five top diagnoses that cause hemoptysis

``` bronchitis lung cancer TB bronchiectasis pneumonia ```

fever night sweats weight loss and hemoptysis

fevers and chills and history of HIV and hemoptysis

PNA or TB

risk factors for coagulation and hemoptysis

acute renal failure or hematuria and hemoptysis

goodpasture

CXR is normal if there is a significant clinical suspicion for lung carcinoma

fiberoptic bronchoscopy

Step Up to Med - Pulmonary Flashcards

(293 cards)