Term
| second hand smoke accounts for __% of lung cancer |
|
Definition
|
|
Term
| Asbestos increases risk of lung cancer ___x, smoking increases risk ___x, together they increase risk ___x |
|
Definition
|
|
Term
| ____ is a type of lung cancer often accompanied by adenopathy |
|
Definition
|
|
Term
"___ ___" are COPD pts with chronic bronchitis, hyperplasia of mucus cells, and boggy airways
"___ ___" are COPD pts with emphysema, swiss cheese lungs |
|
Definition
blue bloaters
pink puffers |
|
|
Term
| pt with nocturnal hypoxemia... think what disease? |
|
Definition
|
|
Term
| A "small" pneumothorax is considered __-__% of a hemithorax |
|
Definition
|
|
Term
| If a right pneumothorax is suspected, get what xray? |
|
Definition
|
|
Term
| It is important to differentiate between ___ & penumothorax via cxr, DVT< hx, risk factors, and lung sounds |
|
Definition
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|
Term
| It is important to differentiate ___ from pneumothorax via lung sounds, fremitus, onset, and fever |
|
Definition
|
|
Term
| Pleural effusion with >31 g/L protein level in serum and pleural fluid, then its exudate or transudate? |
|
Definition
|
|
Term
| What test should you always get on a pt with hemothorax? |
|
Definition
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|
Term
| If PE is suspected, always get ___. |
|
Definition
|
|
Term
| Greater than or equal to 2 segmental perfusion defects with normal ventilation is indicative of ?? |
|
Definition
|
|
Term
| Infection of the alveoli, distal airways, and interstitium wiht consolidation = ?? |
|
Definition
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|
Term
| Hospitalize a pt with pneumonia with a PORT score of >___ |
|
Definition
|
|
Term
| At what age should a person get yearly penumonia vaccines? |
|
Definition
|
|
Term
| ___ is the most common cause of community acquired pneumonia |
|
Definition
|
|
Term
| ___ are the most common cause of aspiration pneumonia |
|
Definition
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|
Term
| ___ can be diagnosed from lung mucus |
|
Definition
|
|
Term
Cough
fever
dyspnea
rigors
night sweats
pleuritic chest pain
tachypnea
tachycardia
mental changes
decrease in O2
increase in fremitus
dullness
rales & rhonchi
What diagnosis? |
|
Definition
|
|
Term
| CXR that shows infiltrate in one lobe of the lung... think what dx? |
|
Definition
|
|
Term
CXR: patchy or diffuse inflammation of interstitium and alveolar walls
what dx? |
|
Definition
|
|
Term
CXR: patchy infiltrate in posterior lungs
what dx? |
|
Definition
|
|
Term
| CXR: bilateral small lesions seen in an immunocompromised pt |
|
Definition
|
|
Term
|
Definition
macrolides
doxycycline
fluoroquinolone |
|
|
Term
|
Definition
cephalosporin
amoxicillin |
|
|
Term
Hospital acquired pneumonia:
__-__% mortality
__% result in pleural effusion
__-__% are recurrent in 10 years |
|
Definition
5-30% mortality
40% pleural effusion
10-15% recurrent |
|
|
Term
| most common causative agent of hospital acquired pneumonia |
|
Definition
gram neg bacteria
the rest are staph aureus |
|
|
Term
___ is dilated bronchi
Its from toxins, recurrent pneumonia, and chronic inflammation
sx: chronic productive cough, recurrent airway infections, hemoptysis, wheezing, dyspnea
CXR: normal or tubular shadown, air fluid levles
Tx? |
|
Definition
bronchiectasis
abx
decrease inflammation
decrease secretions
segmental resection |
|
|
Term
| most common casuative agent of TB |
|
Definition
| mycobacterium TB, an acid-fast bacillus |
|
|
Term
| untreated active tb has a __-__% 5 year survival |
|
Definition
|
|
Term
| __-___% of the world has TB |
|
Definition
|
|
Term
| a person with untreated active TB can infect __-__ people per year |
|
Definition
|
|
Term
| CXR with granuloma - think what? |
|
Definition
|
|
Term
gas exchange (biochemical respiration) occurs in the ___ unit of the lungs. The ___ & ____.
diffusion of gases works best with large surface area and with blood supply as close as possible to that area. this is demonstrated by ___ law. |
|
Definition
respiratory unit
respiratory bronchioles and alveolar ducts
Fick's Law |
|
|
Term
structure of pulmonary system:
trachea, segmental bronchi, nonrespiratory bronhioles, bronchioles, alveolar ducts |
|
Definition
|
|
Term
| alveoli have cellular components that creat a lipid-like lubricant called ___ to break up surface tension |
|
Definition
|
|
Term
| why do premature infants often die of respiratory failure/ |
|
Definition
| their lungs can't make surfactant and their alveoli collpase |
|
|
Term
| effects of aging on the pulmonary system |
|
Definition
loss of elastic recoild
stiffening of the chest wall
alteration in gas exchange
increase in flow resistance |
|
|
Term
| When the diaphragm contracts, the chest cavity shrinks/enlarges, reducing/increasing the pressure inside. this causes air to rush into the lungs. |
|
Definition
|
|
Term
| 3 types of airway disorders |
|
Definition
| airway obstruction (tumor, foreign bodies), asthma, COPD |
|
|
Term
|
Definition
| benign pulmonary tumor (rare) |
|
|
Term
| malignancy of the pleural lining |
|
Definition
|
|
Term
What dz?
AKA diffuse parenchymal lung disease
involves injury/scarring to alveoli
~50% of subtypes are idiopathic |
|
Definition
| interstitial lung disease |
|
|
Term
what type of lung disease do all of these fall under?
idiopathic pulmonary fibrosis
occupational/enfironmental fibrosis
sarcoidosis
connective tissue disorder fibrosis |
|
Definition
| interstitial lung dsiease |
|
|
Term
pleuritis, pleural effusions, spontaneous pneumo
are all part of the heading ___ disorders |
|
Definition
|
|
Term
Assessing these factors will assess if the pt has a ____ problem:
resp rate
adventitious sounds
evidence of cyanosis or clubbing
foreign bodies
it is meausred via spirometry |
|
Definition
|
|
Term
| Normal tidal volume is about ___ mL |
|
Definition
|
|
Term
| How do you calculate minute volume? |
|
Definition
Tv x Resp/min
normal: 15 x 500 = 7500 |
|
|
Term
How do you calculate vital capacity?
how do you calculate Inspiratory capacity?
how do you calculate functional residual capacity? |
|
Definition
VC = IC + ERV
IC = IRV + TV
FRC = ERV + RV |
|
|
Term
___ is the total volume exhaled after maximal inhalation
___ is the volume of air expelled during the first 1 second of expiration
___ is the air flow rate at the midpoint 50% of expiration |
|
Definition
Forced vital capacity (FVC)
forced exiratory volume at 1 sec (FEV1)
FEF 25-75% |
|
|
Term
| what is the most common site for ABG measurment? |
|
Definition
|
|
Term
| what all is included in the ABG report and what are normal values? |
|
Definition
pH (7.35-7.45)
PaO2 (70-100 mmHg)
PaCO2 (35-45 mmHg)
[HCO3-] (22-30 nm/ml
Base excess (-2 to +2) |
|
|
Term
| ___ estimates the percentage of Hb binding sites that are bound with oxygen in arterial blood |
|
Definition
|
|
Term
| As pH drops, what happens to the Hb dissociation curve? |
|
Definition
| it shifts right --> lower PO2 and lower sao2 |
|
|
Term
anemia - what happens to each of these?
PaO2
SaO2
CaO2 (total content of O2 in arterial blood)
why? |
|
Definition
normal PaO2 and SaO2
lower CaO2 beceause there is less hemoglobin but SaO2 is normal because the Hb that there is is fully bound with O2 |
|
|
Term
| why does pH drop when we exercise? |
|
Definition
something about carbonic anhydrase catalyzing a rxn and causing higher H+ and thus loewr pH as we breathe harder
the body compensates for this by rising CO2 levels and increasing ventilation rate and by the kidneys conserving HCO3 and excreting H+ |
|
|
Term
| What can cause metabolic acidosis? |
|
Definition
renal failure (most common cause)
ketoacidosis (as seen in DM)
ingestion of acidic compounds (aspirin overdose) |
|
|
Term
| what can cause respiratory acidosis (pH <7.35) |
|
Definition
| anything that reduces ventilatory capacity (respiratory failure) |
|
|
Term
| What can cause metabolic alkalosis (pH > 7.5)? |
|
Definition
Prolonged vomiting
ingestion of large amounts of bicarbonate
|
|
|
Term
| What can cause respiratory alkalosis (pH >7.45)? |
|
Definition
| hyperventilation (low PaCO2) |
|
|
Term
| what does the body do to compensate for falling pH level? |
|
Definition
ventilation rate increases
causes a fall in PaCO2 |
|
|
Term
| How does the body respond to rising pH levels |
|
Definition
ventilation rate and tidal volume falls (and thus minute volume also falls)
rise in PaCO2 |
|
|
Term
| what are some things you would evaluate with chest ct? |
|
Definition
solitary parenchymal lesions
mediastinal lesions
evaluation of pulmonary fibrosis
lung cancer staging
unclear lesions or problems on CXR |
|
|
Term
| what is an indication for chest MRI? |
|
Definition
| discriminated btwn enlarged mediastinal vessels and lymphadenopathy |
|
|
Term
What tests measures carbon monoxide concentraiton in a single breath by comparing CO concentration in inhaled and exhaled air.
if this value is reduced, it could indicate what? |
|
Definition
diffusing capacity test
alveolar damage or ventilation perfusion mismatch (PE) |
|
|
Term
| What is the main indication for mediastinoscopy? |
|
Definition
| accessing hilar lymph nodes |
|
|
Term
| ___ (general type of lung disease) restricts alveolar diffusing capacity and expansion capacity. |
|
Definition
| interstitial lung disease |
|
|
Term
what type of lung dz?
exertional dyspnea is most common sx
is chronic and progressive
definitive diagnosis only by lung biopsy |
|
Definition
|
|
Term
| Three basic phases of interstitial lung dz |
|
Definition
initiation - parenchymal injury occurs
inflammation (alveolitis)
fibrosis |
|
|
Term
key clinical features of what disease (in general)?
decreased compliance/incrased stiffness due to restrictive nature of dz
decreased lung volumes
disturbances in gas exchange
pulmonary htn due to increased work needed to compensate for loss of elasticity |
|
Definition
|
|
Term
| What disease presents with a CXR of "honeycomb lung"? |
|
Definition
|
|
Term
| ___ is the best choice for diagnosing interstitial disease |
|
Definition
|
|
Term
| drop in intrathoracic pressure caused by obstructive sleep disorder that terminates in arousal by a bodily jerk |
|
Definition
| respiratory effort related arousal (RERA) |
|
|
Term
| What is the difference between central and obstructive sleep apnea? |
|
Definition
central - the brain shuts off respiration
obstructive - airway is blocked by soft tissue |
|
|
Term
| clinical features of sleep apnea |
|
Definition
snoring
excessive daytime sleepiness
obesity (BMI >30)
age (>50)
gender (males > females)
Race possibly
depression
decreased memory
nocturnal gasping/choking
morning headaches
decreased libido |
|
|
Term
| diagnostic factors for sleep apnea |
|
Definition
17 inches in males
15 inches in females
craniofacial anatomy
posteiror oropharynx anatomy
bmi >30 8-12 fold increased risk |
|
|
Term
| 95% of the time, sleep apnea in kids is caused by ___- |
|
Definition
|
|
Term
| how does sleep apnea cause long term heart problems? |
|
Definition
when airflow is obstructed and O2 sat drops, pt get surge of heart rate and bp to arouse the pt from sleep. this assault to the cardiovascular system can lead to long term health consequences.
this process is exaggerated in REM sleep due to REM paralysis |
|
|
Term
| What are some chronic serious diseases that are associated with sleep apnea |
|
Definition
|
|
Term
what is the guideline for a dx of sleep apnea?
More than __min of __% or less O2 sat |
|
Definition
|
|
Term
| sleep apnea interventions |
|
Definition
cpap
dental devices to "advance the mandible"
UPPP - uvulopalatopharyngoplasty (surgery)
maxillomandibular advancement osteotomy
tracheostomy |
|
|
Term
| What is each stage of sleep characterized by? |
|
Definition
Drowsy: alpha waves
Stage 1: theta waves (2-5%)
Stage 2: sleep spindles and K complexes (45-55%)
Stage 3 & 4: delta waves (slow wave sleep) (15-20%_
REM sleep: low voltage sawtooth waves (20-25%) |
|
|
Term
| T/F: missing one hour of sleep a night is the same sleep deb as missing a full night of sleep in that week. |
|
Definition
|
|
Term
| how does recovery sleep work? |
|
Definition
we sleep more efficiently to make up for lost sleep
full recovery of SWS
50% recovery of REM sleep |
|
|
Term
| classic tetrad of narcolepsy |
|
Definition
sleep attacks
cataplexy
sleep paralysis
hypnagogic hallucinations
most narcoleptics have 2-3 of these |
|
|
Term
what disease are these txs for?
Modafinil (provigil)
Armodafinil (Nuvigil)
Ritalin, adderall
TCAs
SSRIs |
|
Definition
|
|
Term
___ is a pause in breathing lasting longer than 10 sec
___ is shallow breathing that lasts longer than 10 sec |
|
Definition
|
|
Term
| abnormal movemnets or behaviors that intrude into sleep intermittently or episodically during the night without generally disturbing sleep architecture |
|
Definition
|
|
Term
What disorder?
common in children 5-12
rare in adults
arises out of slow wave sleep (3&4) early in the night
lasts less than 10 min
high incidence of family hx |
|
Definition
|
|
Term
| speech or sounds are uttered during sleep that pt is not aware of. typically occurs during NREM sleep |
|
Definition
| somniloquy (sleep talking) |
|
|
Term
Pt wakes up in mid sleep and has a conversaiton with someone
Common in kids before age 5
occurs out of slow wave sleep (3&4)
typically in first third of night
Lasts 30 sec to 5 min
Won't remember it in the morning |
|
Definition
| confusional arousals (nocturnal sleep drunkenness) |
|
|
Term
Abrupt arousal from SWS
piercing scream & acute fear
fast pulse, breathing sweating
peak ages 5-7
lasts 30 sec to 5 min
high frequency of familial cases |
|
Definition
| pavor nocturnus (sleep terrors) |
|
|
Term
| When in the sleep cycle do pts typically have nightmares |
|
Definition
|
|
Term
Loss of REM-related paralysis and violent dream-enacting behavior
self injury or to bed partner
usually middle-aged or elderly men
misdaignosed as psych disorder
90% respond to clonazepam |
|
Definition
|
|
Term
Emotionally charged, complex, bizarre dreams occur in ___ sleep (80% of dreams are these)
Realistic, rational dreams that pt wakes up disoriented or confused occur in ___ sleep (20%) |
|
Definition
|
|
Term
| ___ is the most common cause for missed school/work and medical visits |
|
Definition
|
|
Term
Chronic rhinitis is defined as nasal sx for >__ days/week for >___ weeks/year
OR
as nasal sx complicated by comorbidity |
|
Definition
|
|
Term
| Progression of allergic sx |
|
Definition
| sneezing --> rhinorrhea --> obstruction |
|
|
Term
| ___ is the most common cuase of chronic rhinitis AND of asthma |
|
Definition
|
|
Term
| 2 big rules for treating allergies |
|
Definition
1. treat local sx locally
2. if sx are severe enough for systemic tx, assume all sx are steroid-responsive |
|
|
Term
| When is allergy testing indicated? |
|
Definition
anyone requires tx of significant complications
OR
the chronic use fo any allergy meds
OR
the use of systemic steroid more than once or twice in 5 years |
|
|
Term
| how are allergy shots administered? |
|
Definition
weekly for 6-8 mos
monthly for 3-4 years
>50% of pts have life-long resisitance |
|
|
Term
Studies show that __% of kids with perennial allergies will develop asthma.
if they take allergy shots, their risk is reduced to __% |
|
Definition
|
|
Term
| ___ is an eosinophilic, desquamative bronchitis that can result in irreversible lung disease |
|
Definition
|
|
Term
What dz?
characterized by recurrent chest sx that may awaken pt from sleep and often worsen with smoke, cold air, laughter, or crying.
recurrent bronchitis
Exertional related sob, cough, or wheeze |
|
Definition
|
|
Term
| lung fxn is measured via ___ |
|
Definition
|
|
Term
|
Definition
| measure asthma/perennial allergies |
|
|
Term
| Definition of mild intermittent asthma |
|
Definition
< 2 days/week
<2 nights/mon |
|
|
Term
| Definintion of mild persistent asthma |
|
Definition
> 2 days/week, <1x/day
> 2 nights/mon |
|
|
Term
| What should be the #1 asthma tx? |
|
Definition
|
|
Term
| Tx for each severity of asthma |
|
Definition
Mild intermittent: rescue inhaler
Mild persistent: daily ICS + rescue inhaler
Moderate: daily ICS or daily ICS + long acting bronchodilator AND rescue inhaler
Severe: daily ICS + long acting bronchodilator and rescue inhaler |
|
|
Term
| steroid safety in children with asthma |
|
Definition
| use inhaled steroids aggressively to reduce the need for oral steroids because oral steroids come with increased risk for bone fx |
|
|
Term
What kind of pneumo?
occurs in the absence of underlying lung disease. classic presentation is young male lifting weights |
|
Definition
|
|
Term
what kind of pneumo?
complication of preexisting pulmonary disease, most often COPD |
|
Definition
|
|
Term
What kind of pneumo?
Pt sustains injury to lung during a procedure in the hospital |
|
Definition
|
|
Term
What kind of pneumo?
pt sustains penetrating injury from trauma such as mva |
|
Definition
|
|
Term
What kind of pneumo?
thought to occur from rupture of subpleural "blebs" in response to high negative intrapleural pressure |
|
Definition
|
|
Term
|
Definition
chest pain
sudden onset dyspnea |
|
|
