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Flashcards in Uworld Respiratory Deck (35):
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Assessment of malignancy risk for solitary pulmonary nodule? (Diameter, age, smoking, smoking cessation, nodule characteristics)

Low risk: less than 1.5 cm, less than 45 years, never, quit in seven years ago, smooth

Intermediate risk: 1.5 to 2.2 cm, 45 to 60 years, less than 20 per day, quit less than seven years ago, scalloped

High risk: > 2.3 cm, >60 years, >20 per day, never, Corona Radiate/spiculated

1

Next steps depending on the risk of a solitary pulmonary nodule?

Low risk: serial CT scans

Intermediate risk:
1. If 1 cm – PET scan

High risk: surgical excision

2

Peak airway pressure?

Resistive pressure (flow x resistance) + Plateau pressure

3

Plateau pressure?

Elastic pressure + PEEP

4

Elastic pressure?

Tidal volume / compliance

5

Causes of Increased peak pressure with normal plateau pressure?

Bronchospasm, mucous plug, biting ET tube

6

Causes of increased peak pressure and increased plateau pressure

Pneumothorax, pulmonary edema, pneumonia, atelectasis

7

Shunt versus dead space?

Perfusion without ventilation (atelectasus) versus Ventilation without perfusion (PE)

8

In ventilation, goal FiO2 level?

50 to 60%

9

Bacterial causes of empyema?

Strep pneumonia, staph aureus, Klebsiella

10

Patient with PE. Best way to anticoagulate?

Start heparin and warfarin. Stop heparin in 5 to 6 days.

11

Recurrent bacterial infections in an adult patient indicates? Work up?

Humoral immunity defect. Quantitative measurement of serum immunoglobulin levels

12

Wedge shaped pleural-based opacification on x-ray signifies?

PE

13

Diarrhea increases chance of what pulmonary pathology?

PE via dehydration

14

Patient with dry cough, weight loss, pain in the right arm?

Pancoast tumor

15

90% of PEs come from which veins?

Deep veins (iliac, femoral, popliteal)

16

Can present with erythema multiforme and interstitial infiltrates?

Mycoplasma pneumonia

17

Patient with parapneumonic effusion. Aspiration result that would necessitate chest tube for drainage?

Empyema. pH <7.2

18

Common causes of hemoptysis?

1. Pulmonary (bronchitis, PE, bronchiectasis, PNA, lung cancer)
2. Cardiac (mitral stenosis)
3. Infectious (tuberculosis, aspergillosis, lung abscess)
4. Hematologic (coagulopathy)

19

Pickwickian syndrome? Leads to?

Obesity hypoventilation syndrome – obesity impedes expansion of chest and abdominal wall doing breathing. Leads to chronically elevated PaCO2.

20

pH ranges of pleural effusions?

7.64 – normal pleural fluid pH
<7.2 indicates empyema

21

Glucose level <60 in pleural effusion suggests what causes?

Parapneumonic effusion, tuberculosis, rheumatoid arthritis

22

Indicators of a severe asthma attack?

1. Normal/increased PCO2
2. Speech difficulty
3. Diaphoresis
4. Cyanosis

23

Theophylline mechanism of action? Toxicities?

1 Bronchodilation via phosphodiesterase inhibition
2. Increased diaphragm contraction via increased calcium uptake through adenosine channels

Toxicity:
1. CNS stimulation (headache, insomnia, seizures)
2. Cardiac toxicity (arrhythmia)
3. G.I. disturbances (n/v)

24

Antimuscarinics used in COPD?

Ipratropium and Tiotropium

25

Complications of ventilation with a high PEEP?

Alveolar damage, tension pneumothorax, hypotension

26

Lofgren's syndrome?

Erythema nodosum, hilar lymphadenopathy, migratory polyarthralgias, fever

27

Most common adverse associated with inhaled steroids?

Oral thrush

28

When to use non-invasive positive pressure ventilation?

When pt is refractory to medical therapy but not crashing (before intubation)

Specifically, when pH25

29

SVC syndrome?

Dyspnea
Venous congestion
Swelling of head, neck and arms

30

ARDs vs Cardiogenic pulmonary edema?

Wedge pressure < 18 in ARDs

31

Causes of exudative effusions?

1. Infection
2. malignancy
3. pulmonary embolism
4. connective tissue disease
5. iatrogenic

32

COPD, when does oxygen have a mortality benefit?

PaO2 55
Cor pulmonale

34

Complications of PEEP?

Alveolar damage, tension pneumothorax, hypotension

35

dyspnea from long standing HTN leads to? Tx?

Left sided heart failure. Nitroglycerin

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