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Flashcards in Step Up to Med - Pulmonary Deck (293):
1

two types of chronic obstructive pulmonary disease

chronic bronchitis
emphysema

2

clinical diagnosis of chronic bronchitis

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

3

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

emphysema

4

fourth leading cause of death in the US

COPD

5

two main risk factors for emphysema

tobacco smoke
alpha 1 antitrypsin deficiency

6

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

7

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

emphysema

8

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

increase
decrease
increase

9

definitive diagnostic test in COPD

pulmonary function testing (spirometry)

10

what are the critical spirometry findings in COPD

decrease FEV1/FVC ratio
increase TLC residual volume and FRC

11

GOLD staging is based on

FEV1

12

GOLD staging and FEV1

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

13

CXR changes in COPD

hyperinflation
flattened diaphragm
enlarged retrosternal space

14

in what conditions is CXR useful in COPD

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

15

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

alpha 1 antitrypsin

16

the most important intervention for COPD'ers

smoking cessation

17

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

18

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

ipratropium bromide
albuterol
corticosteroids

19

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

oxygen therapy

20

requirements for home O2 (2)

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

21

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

22

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

acute exacerbation

23

where is the o2 saturation goal for a chronic COPD patient

90-93#

24

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

IV methylprednisone with prednisone taper once clinical improved

25

3 most common causes for acute exacerbations

infection
noncompliance
cardiac disease

26

what is one of the main long term complications of COPD

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

27

airway inflammation
airway hyperresponsiveness
reversible airflow obstruction

asthma

28

T/F asthma can begin at any age

T

29

what is the typical clinical picture with extrinsic asthma

atopic, hay fever and eczema

30

asthma symptoms are typically worse at what time of the day

night

31

Sob wheezing tightness and cough

asthma

32

what testing is required for diagnosis of asthma

PFTs

33

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

34

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

12%

35

useful meassurement of airflow obstruction in asthma

peak flow

36

useful when asthma is suspected but PFTs are nondiagnostic

bronchoprovocation

37

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

muscarinic agonist
bronchoprovocation in asthma

38

when is CXR helpful in asthma

severe cases to r/o other causes PNA PTX etc

39

when should ABGs be considered in a patient with asthma

severe respiratory distress

40

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

normal or elevated PaCO2

41

if PaCO2 is normal or increased in asthmatic

admit and consider intubation

42

acute asthma exacerbation first step

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

43

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

IV steroids

44

third line agent in acute asthma exacerbation in the hospital

IV magnesium
reduces bronchospasm

45

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

46

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

bronchiectasis

47

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

bronchiectasis

48

most common cause for bronchiectasis

CF

49

rare congenital cause for bronchiectasis

kartagener syndrome

50

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

bronchiectasis

51

diagnostic study of choice in bronchiectasis

high resolution CT

52

acute exacerbation of bronchiectasis requires what initial treatment

ABX

53

bronchial hygeine steps in bronchiectasis

hydration
bronchodilators
chest physiotherapy

54

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

CF

55

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)

56

most common lung cancer

Nonsmall cell lung cancers

57

biggest risk for lung CA

smoking

58

lowest association with smoking of all the lung cancers

adenocarcinoma

59

common in shipbuilding and construction industry, car mechanics, painting

increasing lung CA risk

asbestos

60

high levels found in basements

increase riskl for lung CA

radon

61

cough
hemoptysis
obstruction
wheezing
dyspnea
recurrent PNA


most associated with what lung CA

squamous cell CA

62

anorexia
weight loss
weakness

associated prognosis with lung CA

bad (progressive at this point)

63

SVC synbdrome most commonly occurs in what type of lung CA

SCLC

64

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

SVC syndrome

65

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

phrenic nerve

66

hoarseness secondary to lung cancer

recurrent laryngeal nerve injury

67

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

superior sulcus tumors

68

superior sulcus tumors almost always of what type

squamous cell

69

what syndrome can be involved with superior sulcus tumors

horners syndrome

70

why is the prognosis so poor associated with malignant pleural effusion

equivalent to distant metastasis

71

SIADH occurs with what pulmonary cancers

small cell lung cancer

72

ectopic ACTH secretion occurs with what lung cancers

small cell lung cancers

73

PTH like hormone secreting lung cancer

squamous cell carcinoma

74

hypertrophic pulmonary osteoarthropathy occurs in what two types of lung cancer

adenocarcinoma and squamous cell

75

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

lambert eaten syndrome

76

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

digital clubbing

77

digital clubbing usually iindicates

lung ca

78

most important radiologic study for the diagnosis of lung cancer

CXR

79

CXR criteria associated with benign lung tumor

stable over a 2 year period

80

useful test for staging of lung carcinoma

CT scan

81

cytologic exam of sputum in lung cancer useful for what type

central tumors

82

useful for diagnosing central visualized tumors but not peripheral lesions

fiberoptic bronchoscopy

83

best management for NSCLC

Surgery

84

treatment used as an adjunct following surgery for NSCLC

radiation

85

what is the treatment for management for SCLC

radiation and chemotherapy

86

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

50

87

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

F (smoking definitely increases malignancy chance)

88

cutoff for large malignancy of pulmonary nodule

2cm

89

borders indicative of malignancy

irregular

90

type of calcifcation that indicates malignancyu in solitary pulmonary nodule

asymmetric calcification

91

dense calcification suggests

benign pulm nodule

92

enlarging pulmonary nodule suggests

malignancy

93

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

CT

94

low probability nodules management in pulmonary nodules

serial CT scan

95

intermediate probability nodule 1 cm or larger

PET scan

96

PET scan positive in pulmonary nodule

biopsy

97

high probability nodule follow up

biopsy

98

most common cause of mediastinal mass in older patients

metastatic cancer

99

most common cause of anterior mediastinum

FOUR T's
thymoma
teratoma
thymoma
terrible lymphoma

100

middle mediastinum most common causes (5)

lung cancer
lymphoma
aneurysm
cysts
morgagni hernia

101

posterior mediastinum most common causes (5)

neurogenic tumors
esophageal masses
enteric cysts
aneurysms
bochdalek hernia

102

most common symptoms of mediastinal structures

compressive symptoms

103

what kind of pneumonia is common with mediastinal structure

postobstructive PNA

104

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

105

what is the test of choice with mediastinal masses

CT scan

106

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

107

most common cause of pleural effusion

CHF

108

most common malignancy leading to pleural effusion

lung

109

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

pleural effusion

110

blunting of costophrenic angle
sign of what on CXR

pleural effusion

111

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

250ml

112

when is thoracentesis useful in pleural effusion

not obvious etiology

113

what is the complication associated with thoracentesis

PTX

114

treatment for transudative effusions

diuretics and sodium restriction
therapeutic thoracentesis

115

what is the treatment for exudative pleural effusions

treat underlying disease

116

uncomplicated parapneumonic effusions

ABX alone

117

complicated effusions parapneumonic

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

118

exudative pleural effusions if left untreated can lead to

empyema

119

most cases of empyema occur secondary to

bacterial PNA

120

two recommended tests for empyema

CXR and CT

121

treatment for empyema

ABX and thoracentesis

122

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

rib resection and drainage open

123

air in the normally airless pleural space

PTX

124

two major categories of pneumothorax

spontaneous and traumatic pneumothoraces

125

traumatic pneumothoraces are most commonly 2/2

iatrogenic

126

primary spontaneous pneumothoraces are usually secondary to what cause

subpleural blebs in tall lean young men

127

T/F primary spontaneous pneumothorax has a high recurrence

T

128

secondary spontaneous pneumothorax is usually 2/2

COPD

or less commonly
asthma
ILD
neoplasms
CF
TB

129

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

pneumothorax

130

small PTX and patient asymptomatic

observation (resolve spontaneously in ~10 days)

131

PTX larger or patient is symptomatic

administer supplemental oxygen
needle aspiration or chest tube insertion

132

what is the treatment of secondary spontaneous pneumothorax

chest tube drainage

133

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

134

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

tension PTX

135

mechanical ventilation with barotrauma
CPR
trauma

lead to what type of PTX typically

tension PTX

136

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

tension PTX

137

what is the risk with tension PTX

hemodynamic compromise and shock

138

what is the immediate treatment for tension PTX

needle decompression

139

malignant mesothelioma usually secondary to what exposure

asbestos

140

blood effusion common with what malignancy

malignant mesothelioma

141

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

ILD

142

four environmental lung diseases

coal workers pneumoconiosis
silicosis
asbestosis
berylliosis

143

what are the four ILDs associated with granulomas

sarcoidosis
histiocytosis X
wegener granulomatosis
churg strauss syndrome

144

alveolar filling disease as ILD (3)

goodpastures
idiopathic pulmonary hemosiderosis
alveolar proteinosis

145

ILD hypersensitivity lung diseases (2)

hypersensitivity pneumonitis
eosinophilic pneumonitis

146

drug induced ILD 2/2 (5)

amiodarone
nitrofurantoin
bleomycin
phenytoin
illicit drugs

147

ILD associated with connective tissue disorders (4)

rheumatoid arthritis
scleroderma
SLE
mixed connective tissue disease

148

what are the 3 random ILDs

idiopathic pulmonary fibrosis
cryptogenic organizing pneumonia
radiation pneumonitis

149

digital clubbing is common with what type of ILD

idiopathic pulmonary fibrosis

150

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

ILD

151

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

CT

152

FEV1/FVC ratio
FEV1
FVC
DLCO

in ILD

increased
decreased
decreased
decreased

153

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

biopsy

154

what are the two disease in ILD that benefit from UA

goodpastures and wegeners granulomatosis

155

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

sarcoidosis

156

erythema nodosum
plaques subcutaneous nodules maculopapular eruptions

in what ILD

sarcoidosis

157

anterior uveitis common with what ILD

sarcoidosis

158

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

arrhythmias
conduction disturbances such as heart block

159

bell palsy can be seen with what ILD

sarcoidosis

160

bilateral hilar adenopathy is the hallmark of this disease

sarcoidosis

161

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

ACE enzyme

162

hypercalciuria and hypercalcemia are common in what ILD

sarcoidosis

163

definitive diagnosis in sarcoidosis

transbronchial biopsy

164

what can be found in transbronchial biopsy diagnostic for sarcoidosis

noncaseating granulomas

165

what is the least favorable CXR presentation of sarcoidosis

diffuse parenchymal infiltrates without hilar adenopathy

166

what is the most common disease course for sarcoidosis

resolve within 2 years

167

what is the treatment of choice for sarcoidosis

systemic corticosteroids

168

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

in sarcoidosis

systemic corticosteroids

169

used in sarcoidosis with patients that are refractory to systemic corticosteroids

methotrexate

170

chronic insterstitial poneumonia caused by abnormal proliferation of histiocytes

histiocytosis X

171

what are the three forms of histiocytosis X

eosinophilic granulomas
letterer Siwe
Hand Shuller Christian syndrome

172

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

histiocytosis X

173

what is the treatment for histiocytosis X

corticosteroids
lung transplant may be necessary

174

characterized as a ILD with necrotizing granulomatous vasculitis

wegener granulomatosis

175

lungs
kidneys
upper airway
sometimes other organs with ILD

wegener granulomatosis

176

gold standard for diagnosis of wegener granulomatosis

tissue biopsy

177

ILD with biopsy positive c-antineutrophilic cytoplasmic antibodies

wegener granulomatosis

178

treatment for granulomatosis with polyangiitis

immunosuppressive agents and glucocorticoids

179

granulomatous vasculitis is seen in patients with asthma

churg strauss syndrome

180

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

churg strauss

181

what is the treatment for churg strauss

systemic glucocorticoids

182

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

coal workers pneumoconiosis

183

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

asberstosis

184

increased risk of bronchogenic carcinoma and malignant mesothelioma

asbestos

185

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

asbestosis

186

localized and nodular peribronchial fibrosis
can be acute or chronic

silicosis

187

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

silicosis

188

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

berylliosis

189

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

190

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

eosinophilic pneumonia

191

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

goodpasture syndrome

192

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

goodpasture

193

serologic evidence of antiglomerular basement mambrane antibodies

goodpastures

194

three treatments for goodpastures

corticosteroids
cyclophosphamide
plasmapharesis

195

accumulation of surfactant like protein and phospholipids in the alveoli

pulmonary alveolar proteinosis

196

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

197

what are the two treatments for alveolar proteinosis

lung lavage and GCSF

198

what tests must be down for idiopathic pulmonary fibrosis

CXR
open lung biopsy
exclude other ILDs

199

treatment for idiopathic pulmonary fibrosis

supplemental oxygen
corticosteroids
lung transplant

200

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

201

what is the treatment for cryptogenic organizing pneumonitis

steroids

202

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

203

what is the treatment of choice for radiation pneumonitis

corticosteroids

204

CNS causes for respiratory failure

drug overdose
stroke
trauma

205

neuromuscular disease associated with respiratory failure

MS
GBS
ALS

206

upper airway causes for respiratory failure

obstruction
stenosis
spasms
paraylsis

207

thorax and pleura causes for respiratory failure

kyphoscoliosis
flail chest
hemothorax

208

cardiovascular system and blood
causes for respiratory failrue

CHF
valvular diseases
PE
anemia

209

lower airways and alveoli causes for respiratory failure

asthma
copd
PNA
acute respiratory distress syndrome

210

hypoxemic respiratory failure
O2 sat
FiO2

<90% despite 60% FiO2

211

what is the major pathophysiologic cause for hypoxemic respiratory failure

VQ mismatch
intrapulmonary shunting

212

hypercapnic respiratory failure is 2/2 what two causes

decrease in minute ventilation or increase in physiologic dead space

213

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

214

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

215

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

shunting

216

sepsis
DKA
hyperthermia
results in what type of respiratory failure

hypercapnia

217

this type of lung disease causes hypoxemia without hypercapnia

diffusion impairment

218

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

respiratory failure

219

3 main causes for hypoxemia

V/Q mismatch
intrapulmonary shunting
hypoventilation

220

main cause for hypercapnia

hypoventilation

221

acid base disturbance with hypercapnia

respiratory acidosis

222

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

to avoid oxygen toxicity 2/2 oxygen free radicals

223

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

224

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

NPPV

225

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

ARDS

226

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

ARDS

227

key pathophysiologic event in ARDS

massive intrapulmonary shunting of blood

228

why is high PEEP required in ARDS

prop open the airways

229

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

230

what is the most common risk factor for ARDS

sepsis

231

GI risk for ARDS

aspiration of GERD

232

dyspnea
tachypnea
tachycardia increased work of breathing
progressive hypoxemia

ARDS

233

most useful parameter in differentiating ARDS from cardiogenic pulmonary edema

PCWP

234

if PCWP is low and there is an enormous pulmonary infiltrate

ARDS

235

if PCWP is greater tyhan 18 and massive pulmonary infiltrates

cardiogenic pulmonary edema

236

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

90%

237

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

high PEEP
low TV

238

what is the goal CVP in ARDS

4 to 6

239

what type of feeding is preferred to treat ARDS

tube feedings

240

what are the two main complications associated with mechanical ventilation

barotrauma
nosocomial

241

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

maintain alveolar ventilation
restore hypoxemia

242

test to assess response to initiation of mechanical ventilation

ABG

243

initial mode used in most patient with respiratory failure

AC

244

use for pressure support

weaning trials

245

settings of ventilation that affect minute ventilation

RR and TV

246

initial tidal volume typically used in most cases

4-8mL/kg

247

normal initial rate set in mech vent

10 to 12

248

settings that affect PaO2

FiO2
PEEP

249

initial FiO2 setting

100 and quickly titrate down

250

what is the normal PEEP

5cm H2O

251

all mechanically ventilated patients should be on what medication

PPI

252

mean pulmonary arterial pressure greater than 25 mm Hg at rest

Pulmonary HTN

253

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

254

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

pulmonary arterial hypertension

255

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

256

ECG in PAH

right axis deviation

257

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

PAH

258

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

PAH

259

Right heart catheterization results of PAH

increased pulmonary artery pressure

260

sildenafil
oral CCBs
prostacyclins (epoprostenol)
endothelin receptor antagonists (bosentan)

used in what group of PAH

group 1

261

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

cor pulmonale

262

cor pulmonale most commonly secondary to

COPD

263

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

cor pulmonale

264

most common DVTs that embolize to the lungs

iliofemoral

265

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

cor pulmonale

266

what type of pathophysiology leads to the tachypnea associated with PE

increase in dead space in increase in hypoxemia and hypercarbia

267

recurrent small sub clinical PE's can lead to

pulmonary arterial hypertension

268

most common symptoms of PE

dyspnea

269

most common sign of PE

tachypnea

270

T/F ABG levels are diagnostic for PE

F (not)

271

what are the CXR levels normally in PE

normal

272

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

hamptom hymp
westermark sign

273

positive venous duplex warrants what treatment in PE

anticoagulation

274

test of choice now in PE

CT angiography

275

test that is useful if there is contraindication to CTA

VQ scan

276

high probability VQ scan treatment

heparin

277

major contraindication for CTA

renal insufficiency

278

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

279

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

before testing

280

contraindications to heparin treatment

active bleeding
uncontrolled HTN
recent stroke
HIT

281

how long should anticoagulation be continued following acute treatment in PE

3-6 months

282

patients with massive PE and hemodynamic instability

thrombolytics

283

most common lung involved due to aspiration

RIght due to anatomy

284

predisposing factors for aspiration

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

285

what is the difference mainly between aspiration pneumonia and aspiration pneumonitis

aspiration PNA takes days to develop

286

what organisms should be covered in aspiration PNA

anaerobics

287

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

ABG

288

five top diagnoses that cause hemoptysis

bronchitis
lung cancer
TB
bronchiectasis
pneumonia

289

fever night sweats weight loss and hemoptysis

TB

290

fevers and chills and history of HIV and hemoptysis

PNA or TB

291

risk factors for coagulation and hemoptysis

PE

292

acute renal failure or hematuria and hemoptysis

goodpasture

293

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

fiberoptic bronchoscopy