UW 1 Flashcards
(81 cards)
1
Q
Acute bronchitis - etiology
A
preceding resp ilness (90% viral)
2
Q
acute bronchitis - clinical presentation
A
cough for more than 5 days to 3 wks ( +/- purulent sputum, +/- blood)
2. absent systemic findings
3. Wheezing or ronchi, chet wall tenderness
NO FEVER (if present think pneumonia or flu)
3
Q
acute bronchitis - diagnosis + treatment
A
- clinical diagnosis, CXR only when pneumonia suspected
2. symptomatic treatment (eg. NSAID, bronchodilators)
4
Q
Bronchiectasis - sign and symptoms
A
- cough with daily mucupurulent sputum production
- rhinosinusitis, dyspnea, hemoptysis
- crackles, wheezing
5
Q
bronchiectasis - etiology
A
- airway obstraction (eg. ca)
- rheumatic disease (eg. RA, Sjogren), toxic inhalation)
- immunodef (eg. hypogammaglobulinemia)
- Congenital (eg. CF, α-1-antitrypsin def)
6
Q
bronchiectasis - evaluation
A
- high resolution CR (needed for initial diagnosis)
- immunoglobulin quantification
- CF testing, sputum culture (bacteria, fungi, mycobacteria
- PFT
7
Q
the main cause of hypercapnia in COPD
A
increased dead space ventilaiton
8
Q
pneumonia mediated hypoventilation - mechanism
A
R to L intralpulmonary shunting and extreme ventilation /perfusion mismatched
- High O2 inspiration does not correct it
9
Q
causes of hypoxemia (and example)
A
- hypoventilation: CNS depression, neuromuscular weakness
- dead-space ventilation (V/Q=infinity): PE
- diffusion limitation: emphysema, interstitial lung disease
- intrapulmonary shunt (V/Q=0): pneumonia, pulm edema, atelectasis
- intracradiac shunt (R-L): Fallot, Eisenmenger
- Reduced PiO2: high altitude
10
Q
causes of hypoxemia - A-a gradient, corects with O2
A
- hypoventilation: normal, yes
- dead-space ventilation (V/Q=infinity), increased , yes
- diffusion limitation: increased, yes
- intrapulmonary shunt (V/Q=0): increased, no
- intracradiac shunt (R-L): increased, no
- Reduced PiO2: normal, yes
11
Q
PFT in asthma
A
normal to increased TLC
normal FEV1/FVC
normal to increased DLCO
12
Q
PFT in COPD
A
increased TLC
low FEV1/FVC
low DLCO (normal in the beginning)
13
Q
PFT in interstitial lung disease
A
Low TLC
NORMAL FEV/FVC (or increased)
low DLCO
14
Q
PFT in pulm arterial hypertension
A
normal TLC
normal FEV1/FVC
low DLCO
15
Q
Restrictive chest wall disease
A
low TLC
normal FEV1/FVC
normal DLCO
16
Q
DLCO in pulm arterial hypertention
A
low
17
Q
hypersensittivity pneomonitis - - definition / manifestation
A
inflammation of the lung parenchyma caused by antigen exposure
- acute episodes present with cough, breathlessness, fever, malaise that occure within 4-6 h of antigen exposure
chronic: weight loss, clubbing, honycombing of the lung
18
Q
hypersensitivity pneumonitis - management
A
avoidance of responsible antigen
19
Q
sputum and blood culutres in outpatient pneumonia
A
not required
20
Q
lung compliance of ARDS
A
low
21
Q
ARDS - pulm arterial pressure
A
increased due to hypoxic vasconstriction, destruction of lung parechyma, and compression of vascular structures from positive airway pressure in mechanicall ventilated patinets
22
Q
severe asthma exacerbation - management
A
inhaled short acting β2 agonists, inhaled ipratropium , systemic corticosteroids –> elevated or even normal partial pressure of CO2 suggest failure of medical therapy and resp collapse –> entrotracheal intubation
23
Q
systemic epinephrine in severe astham exacerbation
A
only in severe when inhaled therapy cannot be given
24
Q
mild to moderate asthma asthma exacerbation - management
A
inhaled β2 agonists –> if no improvement –> systemic steroids
25
Wegerer - giagnosis
ANCA: PR3, MPO
biopsy: skin (leukocytoclastic vasculitis), kidney (pauci-immune GN) lung (granulomatous vsculitis)
26
Wegener - management
corticosteroids + immunomodulators (MTX, cyclophosphamide)
27
it can increased the chance of FP ANCA
HIV
28
ACEi cause chronic non-productive cough - mechanism
increaesd circulating levels of kinins, substance P, PGE, TXE
(MORE COMMON IN CHINESE)
29
diagnosis from PFT
1. low FEV1/FVC ratio --> obstructive --> DLCO?
- decreased: COPD
- normal/increased: Asthma
2. normal or high FEV1/FVC --> restrictive --> DLCO?
- normal: chest wall weakness
- decreased: interstitial lung disease
30
ARDS - how to improve oxygenation
by increaeing either FIO2 or positive end-expiratory prssure (PEEP
- if high levels of FIO2 (more than 60% are required to mainttain oxygenation, PEEP level should be increased to allow for reduction in the FIO2 as oxygenation improves (prolonged high FIO2 causes O2 toxicity)
ALWAYS KEEP LOW TV
31
increasing of PEEP in ARDS - purpose
reopen of alveoli --> reduce shunting
32
MC SE of inhaled corticosteroid therapy
oropharyngeal thrush (oral candidiasis)
33
bornchodilator respone in asthma
improvement of FEV1 more than 12%
34
asthma severity for patients not on controller medication (step 1)
```
step 1 (intermittent): max 2 days a week symptoms, max 2 nighttime awakening per month
step 2 (mild persistent): more than 2 days / wk, 3-4 awaakenings per month
step 3 (moderate): daily symptoms, more than 1 awakening /wk
step 4 or 5) (severe): throughout day, 4-7 awakening / wk
```
35
asthma treatment
step 1 --> SABA
step 2 --> Low dose inhaled cortic
step 3 --> low dose inhaled cosrticost + LABA or medium inhaled costic
step 4: medium dose inh cortic + LABA
step 5: High dose inh cosrtic + LABA + omalizumab if allegy
step 6: High dose inh cortic + LABA + Oral cortic + Omalizumab if allergy
36
position dependent hypoxemia - mechanism
positional changes that make the consolidation more gravity dependen worsen ventilation/perfusion mismatch --> increase iintrapulmonary shunting --> worsened hpoxemia
37
Aspirin exacerbated resp disease - mechanism
non-IgE mediated raction that results from aspirin induced prostagl/leukotriene misbalance
38
Aspirin exacerbated resp disease - manifestation
mc in history of asthma or chronic rhinsinusitisis with nasal polyposis
- bronchospasm + nasal congestion following aspirin ingestion
39
aspirin-exacerbated resp disease - treatment
avoidance of NSAID, desensitisation if NSAID are required, use of leukotriene receptor antagonists (eg. montelukast)
40
illegal that can cause hemoptysis
inhaler cocaine
41
radiation fibrosis
MC in patients who received lung field radiation --> dyspnea, nonproductive cough, chest pain within 4-24months after therapy
x-ray: volume loss with coarse opacities
42
ARDS - always low TV - why
decrease the likelihood of overdistending alveoli
| (improves mortality) --> causes barotrauma
43
ARDS under ventilator - hypercapnia
setting the ventilator parameters to provide low TV and low RR decreases minute ventilation --> hypercapnia and acidosis
44
ARDS - saturation target
greater than 88%
45
allergic rhinitis - clinical features
1. watery rhinorrhea, sneezing, eye symptoms
2. early age of onset
3. identifiable allergen or seasonal pattern
4. pale/bluish nasal mucosa
5. associated with other allergic disorders (eczema, asthma etc)
46
nonallergic rhinitis - clinical manifestation
1. nasal congestion, rhinorrhea, sneezing, postnasal drainage (dry cough)
2. onset after 20 years old
3. parennial symptoms (may worsen with seasonal changes)
4. erythematous nasal mucosa
47
allergic rhinitis - treatment
intranasal glucocorticoids
| antihistamines
48
nonallergic rhinitis - treatment
mild: intranasal antihistamine or glucocorticoids
| moderate to severe: combination therapy
49
nasal cytology in nonallergic rhinitits
eosinophils
| not required
50
clinical signs of pulm hypertension
1. Left parasternal lift, RV heave
2. Loud P2, right dsided S3
3. pansystolic mmurmur of TR
4. JVD, periperal edema, hepatsplenomegaly
51
systemic sclerosis on the lung
- hyperplasia of the intimal SMCs layer --> incr pulm resistance --> pulm hypertension
- interstitial fibrosis
52
strongest RF for obstructive sleep apnea
obesity
53
there are 2 types of abnormal ventilation during sleeping
1. apnea: cessation of breathing for 10 or more sec)
2. hypopnea: reduced airflow causing SaO2 to decrease by 4%
in symptomatic paitnes, experiencing 5 or more obstructive resp events (apneas or hypopneas) per hour is diagnostic of obstructive sleep apnea)
54
Obesity hypoventilatin syndrome - diagnostic criteria
1. BMI more than 30
2. awake daytime hypercapnia (more than 45)
3. no alternate cause of hypoventilation
55
obesity hypoventilation syndrome - workup
ABG on room air (normal Aa gradient, hypercapia))
2. no intrinsic pulm disease on chest x-ray
3. restrictive PFT
4. Normal TSH
5. polysomonography
56
obesity hypobentilation synrome - treatment
1. nocturnal positive pressure ventilation as 1st line
2. wight loss
3. avoidance of sedative medication
4. resp stimulants (acetazolamide) as last choice
57
test to confirm bronchiectasias
high resolution CT
58
Beta 2 agonists - SE
1. hypokalemia --> muscle weakness, arrhythnia, EKG abnormalities
2. tremor
3. palpitations
4. headache
59
asthma related with GERD - management
omeprazole
60
sarcoidosis effect on the musculoskeletal system
acute polyarthritis
| chronic arthritis
61
Lofgren syndrome
1. erythema nodosum
2. hilar adenopathy
3. migratory polyarthralgia
4. fever
62
ankylosing spondylitis effect in lungs
limited chest expansion + spinal mobility--> restrictive lung disease
63
sleep apnea syndrome - best initial steps
weight reduction, avoidance of sedatives, avoid alcohol, acoid supine posture during sleep
64
peak airway pressure
the maximum pressure measured as the TV is being delivered = the sum of the resistive pressure (flow x resistance) and the platue pressure
65
COPD - seizures after 02 supplementation
increased CO2 retention due to
- loss of compensatory vasoconstriction in areas of ineffective gas exhange worsens V/Q mismatch
- increase on HbO2 reduces the uptake of CO2 from tissues
- Decreased resp drive and slowing of the resp rate causes reduced minute ventilation
- -> reflex cerebral vasodilation --> seizures
66
pulm contusion - symptoms can be worsen by
fluid overvolume
67
resp arkalosis in incubated patient - next step
if appropriate TV --> decrease RR
68
intemediate vs low risk solitary pulm nodule
interm is 8 mm or bigger
69
pneumothorax - hypertension and tachycardia due to
compression of structures in the mediastinum --> impaired RV filling
70
ideal location of endotracheal tube / if displaced to bronchus, which bronchus MC
2-6 cm above carina
| - right (so left atelectasis)
71
intubated patients - atelectasis due to misplacement vs pneumothorax
pneumothorax causes hemodynamically instability
72
parapneumonic effusions - uncomplicated vs complicated regarding etiology
uncompl: sterile exudate in pleural space
complicaetd: bacterial invasion of pleural space --> continue to have symptoms despite antibiotics
73
parapneumonic effusions - uncomplicated vs complicated regarding pleural fluid analysis
uncompl: ph 7.2 or more, glucose 60 or more, WBC 50.000 or less
complic: ph less than 7.2, glucose less than 60, WBC more than 50.000
74
parapneumonic effusions - complc vs uncomplicated regarding gram stain + culture
uncompl: negative
complic: FN due tto low bacter count
75
parapneumonic effusions - uncomplc vs complic regarding treatment
uncomplicated: antibiotics
complic: antibiotics + drainage
76
increased risk of pneumonia complicated with pleural effusion
immunodeficiency
77
acute exacerbation of COPD is characterized by a change in at least 1 of the following
1. cough severity or frequency
2. volume or character of sputum production
3. levels of dyspena
78
Light criteria
at least 1
1. Pleural protein/serum protein more than 0.5
2. pleural LDH/ serume LDH more than 0.6
3. Pleural LDH more than 2/3 of the upper limit of normal for serum LDH
79
exercise induced bronchoconstriction - management
short acting beta-adrenergic agnostis administered 10-20 mins before exercise are the 1st line treatment if only few times a week
- if daily: inhaled corticosteroids or antileukotriene
80
normal pleural fluid ph / trandudate fluid ph / edudate
- 7.6
- 7.4-7.55
- exudate: 7.3-7.45 (may be lower)
81
CHF - where is the fluid
61% bilateral
27% only R
12% only left
