Term
| restrictive disease: FEV1, FVC, FEV1/FVC, peak expiratory flow, residual volume, TLC, vital capacity, DLCO |
|
Definition
FEV1 normal/low
FVC low
FEV1/FVC normal/high
peak exp flow normal
residual volume low
TLC low
vital capacity low
DLCO low |
|
|
Term
| obstructive disease: FEV1, FVC, FEV1/FVC, peak expiratory flow, residual volume, TLC, vital capacity, DLCO |
|
Definition
FEV1 low
FVC low
FEV1/FVC low
peak exp flow low
residual volume high
TLC high
vital capacity low
DLCO variable: normal chronic bronchitis, decreased emphysema, increased asthma |
|
|
Term
| define inspiratory reserce |
|
Definition
|
|
Term
|
Definition
|
|
Term
| define expiratory reserve |
|
Definition
|
|
Term
|
Definition
| air left after normal and additional forced exhale |
|
|
Term
|
Definition
expired air after max inspiration
(inspiratory reserve, tidal volume, expiratory reserve NOT residual volume) |
|
|
Term
| define inspiratory capacity |
|
Definition
max volume inspired
tidal volume and inspiratory reserve |
|
|
Term
| define functional residual capacity |
|
Definition
air at end of passive respiration
expiratory reserve and residual volume |
|
|
Term
| define total lung capacity |
|
Definition
air in lung after max inspiration
inspiratory reserve, tidal volume, expiratory reserve, AND residual volume |
|
|
Term
|
Definition
indicates perfusion or dead space
good for diagnosing PE
normal should be 1 |
|
|
Term
| how long must one have chronic bronchitis for diagnosis |
|
Definition
|
|
Term
| signs of chronic bronchitis |
|
Definition
excess mucous, enlarged mucous glands, smooth muscle hyperplasia narrows airays
chronic cough with sputum
overweight, cyanotic, hypercapnia, hypoxemia, respiratory infections, dyspnea, wheezing, ronchi |
|
|
Term
|
Definition
centgrolobular: destruction of APICAL lung, common in smokers
panlobal: destruction in lung BASES, common in AT1 deficiency |
|
|
Term
|
Definition
hyperlucency, prolonged expiration, pursed lips, leaning forward, thin, tachypnea, dyspnea, accessory muscles, barrel chest, decreased heart sounds, wheezing, ronchi,JVD, morning headache
hyperinflation, flat diaphragm, decreased vascular markings, subpleural blebs and bullae |
|
|
Term
| how is COPD graded and treated |
|
Definition
1) mild: FEV>80, SABA PRN
2) mod: FEV 50-80, SABA + LABA
3) severe: FEV 30-50, SABA + LABA + steroid
4) very sev: FEV <30, SABA + LABA + steroid + tiotropium/ipotropium |
|
|
Term
| when is home O2 indicated in COPD |
|
Definition
O2 <88%
PaCO2<60
PaCO2 55-59 if right heart failure or crythrocytosis
pulmonary HTN
peripheral edema
polycythemia
cor pulmonale |
|
|
Term
| treatment of acute COPD exacerbation |
|
Definition
1) CXR
2) bronchodilators, anticholinergics
3) systemic steroids and PO prednisone
4) prophylactic antibiotics
5) O2 to keep around 90%
6) BIPAP/CPAP/intubate/ventilate if needed |
|
|
Term
| causes of extrinsic asthma |
|
Definition
meds: BB, aspirin (non-IgE mediated response assoc with BL nasal polyps). sulfites
exercise
fall: ragweed, cool air
spring: grass and tree pollon
all year: mold, dust, cockroach, cat, dog, tobacco, viruses |
|
|
Term
| how often should someone with asthma monitor their peak flow rate |
|
Definition
mild (>300): periodically
mod (100-300): daily
severe (<100): daily |
|
|
Term
| grading and treatment of asthma |
|
Definition
mild intermittent: <2x/d, <2PM/mo, FEV>80: SABA PRN
mild persistent: 3-6dx/d, 3-4PM/mo, FEV>80: SABA, steroid (low)
mod persistent: daily, >1PM/wk, FEV 60-80: SABA, seroid (medium), LABA
severe persistent: continous, every PM, FEV<60: SABA, steroid (high), LABA, systemic steroid until under control
exercise or PM type: LABA |
|
|
Term
| treatment of acute asthma exacerbation |
|
Definition
1) SABA neb and O2
2) CXR to rule out pneumonia/PTX
3) steroid IV taper, initiate neb
4) IV Mg reduces bronchospasm
5) intubate if refractory |
|
|
Term
| treatment of status asthmaticus |
|
Definition
bronchodilation, steroids, O3, intubation
keep O2>92
normal CO2 is sign of fatigue and impending respiratory failure |
|
|
Term
|
Definition
permanent dilation of bronchial walls due to infection usually as a child
also: CF, airway obstruction, smoking, TB, fungi, pneumonia, kartegeners, AD polycystic kidney disease, young syndrome, RA, sjogerns, aspergillosis, branchial cysts, chemical corrosion, hypoagammaglobinemia |
|
|
Term
| test of choice and second test for brnchictasis |
|
Definition
1) HRCT: dilated airway, balloned cysts in lower lobes
2) CXR: tram lines parallel to bronchi, bronchial crowding, multiple cysts |
|
|
Term
|
Definition
#1 viruses
S. pneumo, M. catarrhalis, H. influenzae, anaerobes, fungi
chronic: nasal polyps, deviated septum, foreign body, allergic rhinitis, MUCORMYCOSIS IN DM, anaerobes |
|
|
Term
|
Definition
purulent discharge, sinuses pressure and pain, worse bending over, maxillary causes dental pain, frontal causes forehead pain, ethmoid causes retroorbital pain, fever
poor transillumination, x-ray with air fluid levels, CT prefered in chronic or complicated siease |
|
|
Term
| how is allergic rhinitis treated |
|
Definition
| nasal steroids: fluticasone or eclomethasone |
|
|
Term
| when are abx given for sinusitis and which ones |
|
Definition
amoxicillin+/- clavulanate DOC, alt docy, levofloxacine
symptoms >8-10d, purulent drainage |
|
|
Term
| signs and treatment of measles/rubeola, when can they go back to school |
|
Definition
fever, conjunctivitis, coryza, cough, koplock spots, maculopapular rash on face, spreads caudal
vitamin A reduces morbidity and mortality
contagious for 5d before and 4d after onset of rash |
|
|
Term
| criteria for strep pharyngits diagnosis |
|
Definition
1pt ea: fever, tonsillar exudates, anterior cervical adenopathy, ABSENCE OF COUGH, <15yo or >45yo
0-1pt: no abx, no culture
2-3pt: culture, abx if positive
4-5pt: treat empirically |
|
|
Term
| tonsilitis: signs, tx, cause |
|
Definition
ear pain, difficulty swallowing, fever, tonsil exudates
cause: strep
tx: penicillin |
|
|
Term
| retropharyngeal abscess: signs, dx, cause, tx |
|
Definition
odontophagia, dysphagia, trismus, neck pain, muffled voice, torticollis, swelling of posterior pharynx
sinus, ear, or pharynx infection, iratogenic trauma, fishbone
dx CT neck
tx: clindamycin, ampicillin, sublactam |
|
|
Term
| paratonsilar abscess: signs, tx |
|
Definition
hot potato voice, trismus, drooling, displacement of uvula away from abscess, halitosis, dysphagia, neck swelling
tx: amoxicillin, clavulanate, clindamycin, I&D, tonsilectomy |
|
|
Term
|
Definition
| rapid onset fever >100.2, chills, headache, non-productive COUGH, lymphadenopathy, vomiting, diarrhea, congestion, arthralgia |
|
|
Term
|
Definition
preexposure prophylaxis: pregnant women, <5yo, >65yo, COPD, DM
postexposure: within 48h if has severe disease requiring hospitalization or in at risk froup for complications |
|
|
Term
| signs and treatment of laryngotracheitis |
|
Definition
croup: PIV1/2
fall/winter, 3-5mo, barking cough, fever, inspiratory stridor, retractions, worse at night
cool mist, cool air, popsicles, humidified O2, dexamethasone IM 1x, racemic epi |
|
|
Term
| dx, signs and treatment of pertussis |
|
Definition
catarrhal: URI, cough, sneeze, rhinorrhea
paroxysmal (1-2wk): whoop, followed by vomiting or sweating
dx: naso-swab, gordet-gengou medium
tx: macrolide within 3wk if >1yo or within 6wk if <1yo |
|
|
Term
| epigloggitis cause and treatment |
|
Definition
H. influenza B
keep calm, no exam, O2, intubation ASAP
laryngoscopic culture and sensitivity
oxacillin, naficillin, cefazolin, clinda, or vanco with a ceftriaxone or cefotaxime for 1-2wk |
|
|
Term
| cause, signs, tx, bronchiolitis |
|
Definition
RSV
winter, <2yo, premature baby, asthmatics, CHF, CF, URI, low fever, later expiratory wheezing, tachypnea, crackles, cyanosis, nasal flairing, grunting, intercostal retraction, HYPERRESONANCE, HYPERINFLATION
O2, IVF, neb epi or SABA trial, NO NEED FOR STEROIDS |
|
|
Term
|
Definition
productive or dry cough, wheezing, sore throat, tight breath sounds, fever
only CXR if pneumonia is suspected
only abx if high risk |
|
|
Term
| causes of CA pneumonia in different ages and treatment |
|
Definition
neonatal: GBS, E. coli, listeria (ampicillin + gentamycin)
1-4mo: RSV, PIV, pertussus (macrolides +/- cefotaxime)
4mo-4y: RSV, S. pneumo (amoxicillin, ampicillin)
5-15yo: S. pneumo, M. pneumo, C. pneumo, RSV (amoxicillin + clathromycin OR azithromycin OR amoxicillin + doxycycline)
20-60yo: M. pneumo, S. pneumo, viruses, C. pneumo
60yo+: S. pneumo, H. flu, C. pneumo, S. aureus, E. coli, listeria (levofloxacin or moxifloxacin + 2-3rd gen ceph) |
|
|
Term
| causes and signs typical CA pneumonia |
|
Definition
S. pneumo (#1), H. flu (#2), legionella (#3), klebsiella, enterobacter, S. aureus
acute, fever, chills, PURULENT SPUTUM, cough, pleuritic CP, dyspnea, tachycardia, tachypnea, crackles, increased tactile fermentus, egophony
LOBAR CONSOLIDATION |
|
|
Term
| causes and signs of atypical CA pneumonia |
|
Definition
M. pneumo, C. pneumo, C. psittaci, C. burnetti, legionella, influenza virus, adenovirus, PIV, RSV
insidious onset, headache, sore throat, fatigue, DRY COUGH, FEVER WITH NORMAL PULSE, wheezing, crackles
DIFFUSE BILATERAL HAZY CXR |
|
|
Term
| how do you know if your sputum gram stain had a good sample |
|
Definition
| >25 PMN and <10 epightlial cells per low powered field |
|
|
Term
| who gets the pneumococcal vaccine and when |
|
Definition
one time (unless had before 65, then booster at 65)
65yo+, any comorbidity or compromised state, smokers starting at 19yo |
|
|
Term
| causes of nosocomal pneumonia |
|
Definition
<20yo: S. aureus, klebsiella, RSV, GBS in neonate
>20yo: S. pneumo, viruses, H. flu, S. aureus, enterobacter |
|
|
Term
| treatment of nosocomal pneumonia |
|
Definition
| cephalosporins with pseudomonas coverage (ceftazidimine, cefepime), imipenem, pipieacillin, tazobactam |
|
|
Term
| treatment of ventilator pneumonia |
|
Definition
cephalosporin (ceftazidime or cefepime) OR penicillin (piperacillin or tazobactam) OR
carbapenem (imipenem)
PLUS
aminoglucoside OR fluoroquinolone
PLUS
vancomycin OR linezolid |
|
|
Term
| signs of strep pneumo, tx |
|
Definition
productive cough, high fever, RUSTY SPUTUM, pleuritic pain
GPC chains
b-lactams, macrolides |
|
|
Term
| signs of H. influenza, tx |
|
Definition
GNCB
COPD or sickle cell pt
b-lactams, TMP-SMX |
|
|
Term
|
Definition
nosocomal, compormised, lobar, abscess
B-lactams, MRSA coverage |
|
|
Term
|
Definition
GNR
alcoholic, aspiration, nosocomal, sickle cell
CURRENT JELLY SPUTUM
cephs, aminoglycosides |
|
|
Term
|
Definition
compormised, CF, nosocomal, ventilator, central line placed
follow tx for ventilator pneumonia |
|
|
Term
|
Definition
GPC
infant, respiratory distress, lethargy
B-lactam, gentamycin |
|
|
Term
|
Definition
nosocomal, elderly
TMP-SMX |
|
|
Term
|
Definition
young adult, POSITIVE COLD AGLUTININ, rash, not super sick, headache, fatigue, myalgia, low fever, dry cough
macrolide: azithromycin |
|
|
Term
|
Definition
aerosolized water, confusion, ataxia, DIARRHEA
dx urine antigen, high LDH
macrolide, fluoroquinolones |
|
|
Term
|
Definition
very young or old, sinusitis
doxycycline, macrolides |
|
|
Term
| signs chalmidophilia psitaci |
|
Definition
| interstitial pneumonia, BIRD HANDLERS, dry cough, UL lower lobe infiltrate |
|
|
Term
| signs, dx, tx coccidiomycosis |
|
Definition
southwest US, central and south america, mexico, san jaquin velley
3-4wk incubation, flu like, arthralgia, meningitis, pneumonia, erythma nodosa
biopsy: spherules filled with endospores
tx: self limited, disseminated get emphotericin B or fluconazole |
|
|
Term
|
Definition
cave, spleunker, bats, bird poo in soil
midwest and southwest US
high risk in AIDS
10-14d incubation, fl like, mucosal ulcers, pancytopenia, HSM, skin lesions, adrenal meagly
amphotericin B, itraconizole if disseminated |
|
|
Term
|
Definition
north est US, around rivers and streams (Ohio and mississippi river)
affects skin, lung, bone
itraconizole |
|
|
Term
|
Definition
PIGEON POO
high risk in AIDS
pulmonary and CNS disease
STAINS WITH INDIA INK
yeast like fungus |
|
|
Term
| inhalation anthryx signs, dx, tx |
|
Definition
terrorism, animal/sheep hide
spore producing rod
phase 1: fever, malaise, nausea, hemoptysis, CP, odontophagia
phase 2: dyspnea, hypoxemia, respiratory failure, shock
CXR: wide mediastinum
TX: CIPRO |
|
|
Term
| bugs causing lung abscess |
|
Definition
| S. aureus, S. pneumo, aerobic GN, prevotella, peptostreotococcus, fusobacterium, bacteroides |
|
|
Term
|
Definition
| food aspiration, sputum aspiration (alcoholis, drugs, CVA, seizure, anesthesia, NG tube), acute necrotizing pneumonia (GNR), hematogenous spread, poor dental hygiene |
|
|
Term
|
Definition
cough with foul smelling sputum (anaerobic), night sweats, SOB, fever, shills, fatigue, malaise, weight loss
thick wall cavitation with AIR FLUID LEVELS, in dependendent poorly ventilated lobes |
|
|
Term
| treatment of lung abscess |
|
Definition
1) clinda if aspiration (alt metro), ampicillin +/- vanco with fluoroquinolone if not
2) drain if refractory
3) lobectomy/pneumonectomy if refractory |
|
|
Term
|
Definition
ghon focus: primary lesion in mid to lower zone of lung, small area of granuloma inflammation
ghon complex: calcified focus with hilar lymphadenopathy
rankes complex: ghon complex with fibrosis and clacification
upper lobe infiltrates with cavitations and pleural effusions |
|
|
Term
|
Definition
| weakly positive acid fast stain definitive diagnosis, take 3 mornings in a row of sputum, culture takes 4-8wks |
|
|
Term
| interpertation and action upon PPD results |
|
Definition
>15mm - no risks
>10mm - homeless, immigrant in last 5y, high risk area, prisoner, health care worker, nursing home, close contact, alcoholic, DM
>5mm - HIV, steroids, organ transplant, close contact with active TB, radiographic evidence
false negative: malnutrition, steroids, immune compormise
if positive: repeat PPD, get CXR even if had vaccine (PPD should be negative 10y after vaccine if recieved within 1st year of life)
positive PPD no active disease on CXR: isoniazid 9mo even if had vaccine |
|
|
Term
|
Definition
isoniazid, rifampin, pyrazinamide, ethambutol or streptomycin for 2mo then 4mo isoniazid and rifampin
B6 to prevent peripheral neuritis |
|
|
Term
| signs of benign vs risky lung nodule |
|
Definition
benign: <35-50yo, no change from previous CXR, uniform, smooth margins, <2cm, no lymphadenopathy, bulls eye/popcorn calcification (often harmatoma)
risky: smoker,>?50, new or progressive lesion, no calcifications, irregular clacifications, >2cm, irregular margins, lymphadenopathy |
|
|
Term
| what do you do if you find a lung nodule and it is likley benign |
|
Definition
| follow for 2y with serial chest CT, first one in 6mo |
|
|
Term
| small cell lung ca: location, morphology, associations, signs |
|
Definition
CENTRAL
sheets of small round cells, scant cytoplas, fine granular chromatin, kluchtsky peribronchi cells may be origin
SMOKING
cushings, SIADH, eaton-lambert |
|
|
Term
| squamous cell lung ca: association, morphology, location, signs |
|
Definition
SMOKING
CENTRAL
keratin pearls, large irregular nuclei, coarse chromatin, extends to hilar nodes, causes cavitation
hypercalcemia (PTH), pancost tumor |
|
|
Term
| adenocarcinoma of lung: location, association, morphology, signs |
|
Definition
ASBESTOS, A1-AT DEFICIENCY, NON-SMOKERS, YOUNGER
plerral effusion, prominent nucleoli, no mucin, early cavitation
gynecomastin |
|
|
Term
| 3 conditions caused by lung cancer extension |
|
Definition
SVC syndrome: obstruction causes face, arm, and chest edema, tx with steroids and shunt
horners: ptosis, miosis, anhidrosis due to sympathetic chain invasion
pancost/superior sulcus tumor: C8-T2 roots, causes shoulder pain down arm, weakness, horners, usually SCC |
|
|
Term
| how are central vs peripheral lung ca diagnosed |
|
Definition
central: fiberoptic bronchoscope
peripheral: CT guided biopsy |
|
|
Term
|
Definition
non-small cell: if no mets resect and radiation, if mets pallative chemo and radiation
small cell: surgery is usually not possible due to spread by diagnosis, chemo is primary therapy |
|
|
Term
| laryngeal cancer: cause, sx, dx, tx |
|
Definition
smoking, alcohol, chew
SCC
hoarseness worsening over time, dysphagia, ear pain, hemoptysis
dx: laryngoscope, biopsy is diagnostic
tx: total or partial laryngectomy, radiation, chemo in advanced disease |
|
|
Term
| causes of mediastinal masses |
|
Definition
most common: metastastic cancer from lung
anterior: thyroid, teratogenic tumor, thymoma, lymphoma
middle: lung cancer, lymphoma, cyst, morgagni hernia
posterior: neurogenic tumor, esophageal mass, enteric yst, aneurysm, bochdalek hernia |
|
|
Term
| how to do a thoracentesis |
|
Definition
between ribs 8-10
go on top of a rib to avoid the VAN on bottom
US guided needle, threaded cath |
|
|
Term
|
Definition
liver, heart, kidney
pale yellow
low protein and LDH
PP:TP <0.5
plasma LDH < 2/3 normal LDH |
|
|
Term
|
Definition
inflammation: malignancy, infection, autoimmune
high protein and LDH
PP:SP >0.5
plasma LDH > 2/3 normal LDH |
|
|
Term
| pleural effusion: puss, smelly, blood, white, brown, black, yellow green, yellow |
|
Definition
puss: empyema
smelly: empyema
blood: CA, asbestos, PE, trauma
brown: abscess
black: asbergillus niger
yellow green: RA
yellow: urine to pleura fistula |
|
|
Term
| pleural effusion: lymphocytic, eosinophilic, neutrophilic |
|
Definition
lymphocytic: chilothorax, lymphoma, RA, sarcoidosis, TB, fungal
eosinophilic: asbestos, cancer, churg strauss, drug reaction, pneumothorax, PE
neutrophilic: empyema |
|
|
Term
| pleural effusion: high/low glucose |
|
Definition
glucose <60: empyema, RA
glucose >60: cancer, lupus, TB, esophageal rupture |
|
|
Term
| pleural effusion: high fat, high amylase, low pH |
|
Definition
high LDL: empyema
high amylase: esophageal rupture, pancreatitis, malignancy
high TG >110: chylothorax
pH <7.2 in parapneumonic effusion and empyema |
|
|
Term
| signs of pleural effusion |
|
Definition
BLUNTING OF COSTOPHRENIC ANGLE IN LATERAL DECUBITUS BEST
decreased fermentus, egophony, tracheal deviation away, dullness to percussion, pleuritic pain, dyspnea |
|
|
Term
| define pearpneumonic effusion |
|
Definition
| noninfected effusion secondary to bacterial pneumonia |
|
|
Term
| cause of pneumothorax: primary, secondary, traumatic, open, closed |
|
Definition
primary: tall, lean, healthy, young men, marfans, family hx, smoking, spontaneous rupture of bleb at apex
secondary: COPD, asthma, interstitial lung disease, neoplasm, CF, TB, smoking
traumtic: blunt or penetrating trauma
open: injury within the lungs, chest wall int act, COPD, TB, blunt trauma, spontaneous or tension pneumothorax
closed: air can get in but not out, open injury to chest wall thoracentesis, biopsy, central line, penetrating trauma |
|
|
Term
| signs and tx of pneumothorax |
|
Definition
ipsilateral CP, dyspnea, decreased breath sounds, hypotension, JVD, hyperresonence, decreased fermentus
<15% or <3cm from apex: repeat CXR 24h, O2
tension: emergent needle in 2-3 intercostal space
spontaneous: chest tube, O2
if recurrent pleurodesis |
|
|
Term
| signs of tension pneumothorax vs spontaneous pneumothorax |
|
Definition
tension: mediastina shift away, trachea shift away
spontaneous: mediastina shift towards |
|
|
Term
|
Definition
asbestos (navy, construction)
nonpleuritic CP, dull to percussion, palpable chest wall mass, scoliosis towards, dyspnea, CXR with pleural thickening
tx: pneumonectomy, chemo, radiation |
|
|
Term
|
Definition
AA, women, noncaseating granulomas
dry cough, erythema nodosum, lymphadenopathy, anterior uveitis, vision loss, conjunctivitis, arrhythmia, conduction blocks, arthralgia, bone lesions, bells palsy, pepilledema, peripheral neuropathy, fever, anorexia, malaise
BILATERAL HILAR ADENOPATHY
GROUND GLASS PULMONARY INFILTRATE
ELEVATED ACE
HYPERCALCEMIA
HYERCALCURIA
INCREASED ALK-P
increased ESR, decreased WBC
anergy to PPD |
|
|
Term
| signs granulomatosis with polyangiitis |
|
Definition
necrotizing granulomas, URI, LRI, GN, hemoptysis, dyspnea, sinusitis, nasopharyngeal ulcerations, saddle nose deformity, hearing loss, proptosis, corneal ulceration
C-ANCA POSITIVE |
|
|
Term
|
Definition
granulomatous vasculitis
asthma
pulmonary infiltrates
eosinophilia
P-ANCA POSITIVE |
|
|
Term
| CXR signs of coal, asbestos, silicosis, berylliosis |
|
Definition
coal: APICAL nodular opacities
asbestos: multinodular opacities, PLEURAL plaques and effusions, linear fibrosis of BASES later
silicosis: small APICAL nodular opacities, hilar adenopathy
berylliosis: BL hilar adenopathy, diffuse infiltrates |
|
|
Term
| major complication of coal, asbestos, silicosis, berylliosis |
|
Definition
coal: no risk of lung ca, fibrosis
asbestos: fibrosis, mesothelioma, synergistic with tobacco
silicosis: TB, fibrosis
berylliosis: lung cancer |
|
|
Term
| cause and signs of hypersensitivity pneumonitis |
|
Definition
hay/mold (farmer lug), bird lung (poo), air conditioner lung, bagassosis (sugar cane mold), mushroom lung (compost)
fibrosis, fever, chills, cough, dyspnea, pulmonary infiltrates |
|
|
Term
|
Definition
IgG to glomerular and alveolar BM
hemoptysis, dyspnea, recent respiratory infection, proteinuria, granular casts, hematuria, renal biopsy crecentric GN/IgG, BL alveolar infiltration
tx: PLASMAPHORESIS, CYCLOPHOSPHAMIDE, STEROIDS |
|
|
Term
| pulmonary alveolar proteinosis cause, sx, tx |
|
Definition
accumulation of surfactant like protein and phospholipids in alveoli
dry cough, dyspnea, hypoxia, rales
ground glass CXR, BL alveolar infiltrates in BAT SHAPE
TX: NO STEROIDS INCREASED RISK FOR INFECTION, LUNG LAVAGE, G-CSF |
|
|
Term
| idiopathic pulmonary fibrosis causes sx |
|
Definition
AMIODARONE, BLEOMYCIN, BUSULFAN, RADIATION, RA, SLE, scleroderma, sarcoidosis, pullution, smoking
ground glass, HONEYCOMB LOSS OF ARCHITECTURE, PMN ON LAVAGE
dyspnea, dry cough, crackles, JVD, clubbing, fatigue, weakness, CP |
|
|
Term
| cytogenic organizing pneumonitis: cause, sx, dx, tx |
|
Definition
inflammation of lung radiographically similar to infectious pneumonia
cause: viral infection, med, CT disease, idiopathic
cough, dyspnea, flu like
BL patchy infiltrates
abx not effective, use steroids, usually spontaneous recovery |
|
|
Term
| causes of hypoxemic respiratory failure |
|
Definition
| ARDS, pneumonia, pulmonary edema, atelectiasis, eismengers |
|
|
Term
| causes of hybercarbic respiratory failure |
|
Definition
| COPD, asthma, CF, bronchitis, neuromuscular, CNS depression, mechanical restriction, hyperventilation, DKA, hyperthermia, sepsis |
|
|
Term
| treatment of respiratory failure |
|
Definition
1) treat cause
2) if hypoxia give O2 at lowest dose, remember hypoxia drives respiration
3) improve oxygenation: increase inspiration, decubitus upright or prone, increase CO and Hb, remove vasodilators, decrease fever, agitation, movement
4) BIPAP/CPAP: intended to avoid respiratory failure and intubation, must be awake and cooperative
5) intubation and ventilation |
|
|
Term
| what is the #1 cause of ARDS |
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Definition
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Term
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Definition
within 48h of insult
cyanosis, dyspnea, tachypnea, wheezing, rales, ronchi, tachycardia, stiff noncompliant lungs
BL infiltrates, white out
hypoxia
respiratory alkalosis then acidosis
metabolic acidosis if septic
PCWP <18 (differentiate from cardiogenic pulmonary edema) |
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Term
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Definition
1) treat cause
2) O2 to >90%, prone, sedatives, analgesics, paralytics
3) PEEP increases lung volume and opens collapsed alveoli
4) fluids but avoid overload, vasopressors to maintain minimal BP
5) transfusion of Hb <7
6) nutrition: tube feeding > parenteral |
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Term
| indications for mechanical ventilation |
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Definition
respiratory distress or arrest
impaired or reduced conscious/ loss of gag
metabolic acidosis and cant hyperventilate
respiratory muscle fatigue
PaO2 <70
PaCO2 >50
respiratory acidosis pH <7.2 with hypercapnia |
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Term
| explain assisted controlled ventilation |
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Definition
delivers breath when patient initiates breath, it patient does no initate it delivers at predetermined rate
all breaths delivered by bentilator, patient can go above but not below |
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Term
| explain synchronous intermittent mandatory ventilation |
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Definition
| patient must be able to breathe on own above set rate without ventilator, breaths delivered at different time as patient breaths |
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Term
| explain continuous positive airway pressure ventilation |
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Definition
| positive pressure during inspiration and expiration, no volume breaths delivered |
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Term
| explain pressure support ventilation |
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Definition
| pressure delivered with initiated breath to assist breathing, not continous |
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Term
| PEEP: definition, advantages, disadvantages |
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Definition
positive pressure maintained at end of exhalation to keep alveoli open
advantage: increases lung compliance, prevents collapse and atelectasis
dis: bronchotrauma, pneumothorax, low CO due to decreased venous return |
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Term
| what should FiO2 be for ventilation |
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Definition
initially 100%, titrate down to maintain PaO2 50-60 or O2 >90%
generally FiO2 <60% |
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Term
| what is ventilation inspiratory:expiratory |
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Definition
| ratio of time alloted to inspiration and epiration |
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Term
| what FiO2 do these provide: nasal canula, face mask, non-rebreather, CPAP, mechanical ventilation |
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Definition
nasal: 20-40
mask: 50-60
non-reb: 60-90
CPAP: 80
mech: up to 100 |
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Term
| complications of ventilation |
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Definition
anxiety, agitation, discomfort: benzos
tracheal secretions: suction
nosocomal pneumonia: keep <72h intubated
barotrauma: keep pressures low
oxygen toxicity: keep FiO2 <60, if required, no more than 2-3d
hypotension: positive pressure increases intrathoracic pressure causing decreased venous return
tracheomalacia: softening of tracheal cartilage to due ET tube, tracheostomy preformed if ventilation >2wk
laryngeal damage: be careful during intubation
GI: stress ulcers, cholestasis |
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Term
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Definition
| mean pulmonary artery pressyre >25mmHg at rest or 30mmHg with exercise |
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Term
| define and cause of passive pulmonary HTN |
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Definition
aka: post capillary pulmonary HTN
resistance to pulmonary venous drainage, no active vascular disease
mitral stenosis, LV failure, atrial myxoma, pulmonary venoocclusion, constrictive pericarditis |
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Term
| define and cause of hyperkinetic pulmonary HTN |
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Definition
high pulmonary flow
L to R shunts, ASD, PDA |
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Term
| define and cause of obstructive pulmonary HTN |
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Definition
resistance to flow through large pulmonary arteries
PE, stenosis |
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Term
| define and cause of obliterative pulmonary HTN |
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Definition
resistance to flow through small pulmonary vessels due to parenchymal inflammation causing fibrosis
PRIMARY PULMONARY HTN, collagen vascular disease, CREST |
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Term
| define and cause of vasoconstrictive pulmonary HTN |
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Definition
resistance to flow due to hypoxia induced vasoconstriction
chronic hypoxia, COPD, sleep apnea |
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Term
| define and cause of viscous pulmonary HTN |
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Definition
increased blood viscosity
polychthemia (vera) |
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Term
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Definition
dyspnea, fatigue, CP, syncope, cyanosis, clubbing, loud S2, sternal lift, JVD, hepatomeagly, ascites, edema
LARGE CONGESTED PULMONARY ARTERY
large RV with hypertreophy
PEAKED P WAVES IN LEAD II
increased WBC and RBC |
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Term
| gold standard for pulmonary HTN diagnosis |
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Definition
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Term
| treatment of pulmonary HTN |
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Definition
treat cause, O2
vasodilators: epoprosteol, treprostinol, iloprost, bosentan, ambristean, slidenafil, nifedipine
anticoagulation
diuretics |
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Term
| treatment of primary pulmonary HTN |
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Definition
vasodilator trial: inhaled NO, IV adenosine, PO CCB under monitoring to perdict response
vasodilators: IV prostacucline/ epoprostenol, CCB to lower vascular resistance
anticoagulation: warfarin to INR 2
lung transplant |
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Term
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Definition
RV hypertrophy with eveuntal failure
pulmonary HTN
hypoxia, dyspnea, clubbing, cyanosis, hepatomeagly, edema, JVD, parasternal lift, polycythemia, PEAKED P WAVES (P PULMONALE), RV hypertrophy, pulmonary artery enlargement |
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Term
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Definition
dyspnea, pleuritic CP, cough, syncope, impending doom, delirium, hemoptysis, tachypnea, rales, tachycardia, S4, low fever, decreased breath sounds, dullness on percussion
hypoxia, hypercapnia, respiratory alkalosis, hamptons hump (Wedge opacification), westermark (dilation of pulmonary arteries and distal vessel collapse) |
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Term
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Definition
RBBB
S1Q3T3
mimic anterioseptal MI
sinus tachycardia
non-specific ST changes |
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Term
| diagnosis of PE gold standard and test of choice |
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Definition
helical CT: large gray cloud, test of choice, sensitive, specific, not accurate cannot exclude PE
pulmonary angio: gold standard, most accurate and definitive, can exclude PE |
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Term
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Definition
hemo stable: heparin IV, O2, IVF
hemo unstable: thrombolytic
recurrent: IVC filter
warfarin: 3-6mo post-PE to INR 2-3 |
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Term
| causes and signs of pulmonary edema |
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Definition
CHF, left heart failure, valve disease, MI, arrhythmia, ARDS
dyspnea, orthopenia, paroxysmal noctural dyspnea, tachycardia, frothy sputum, wheezing, rales, dullness to percussion, S3/4, edema, Htn
increased BNP, T WAVE ABNORMALITIES, QT PROLONGATION, CXR clear fluid through out, CEPHALIZATION OF VESSELS, KERALY B LINES |
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Term
| treatment pulmonary edema |
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Definition
NO LIP
nitrates
oxygen
loops
inotropic drugs
positioning with legs off bed |
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Term
| define massive hemoptysis what is usually the cause |
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Definition
>600mL in 24h
brochiectasis
bleeding diathesis |
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Term
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Definition
epworth sleepiness scale >10
polysomnography
increased Hb/HCT |
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Term
| treatment of obstructive sleep apnea |
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Definition
weight loss, stop sedatives and alcohol, positional sleeping
CPAP
appliance: get mandible forward to prevent posterior tongue
modafinil: AM stimulant
surgery |
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Term
| treatment of central sleep apnea |
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Definition
acetazolamide: respiratory stimulant
phrenic nerve pacemaking
CPAP/PIPAP, ASV |
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Term
| what is pretreatment for intubation |
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Definition
lidocaine: blunt ICP in patient with head injury or cancer
fentanyl: blunt pain response and BP elevations
atropine: decrease airway secretions, prevent bradycardia in kids
rapid induction: etomidate, ketamine, midazolam, propofol
rapid paralytic: succinylcholine, rocuronium |
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Term
| what do you do if you cannot see the cords during intubation |
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Definition
moderate cervical flexion
cricoid pressure
laryngoscope use to lift jaw |
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Term
| how do you make sure you intubation is in place |
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Definition
check end tidal CO2
BL lung expansion
ensure no breath sounds in stomach
CXR to make sure |
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Term
| what are the predictors that someone will breath after removing ventilation |
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Definition
max inspiratory pressure <30cm H20
vital capacity >10
minute ventilation <10
Pao2:Fao2>200
frequency:tidal volume <100 breaths/min |
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Term
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Definition
within 2d of birth, tachypnia, cyanosis, nasal flaring, expiratory grunting, intercostal retractions, hypoxia, crackles, decreased breath sounds
low lung compliance, low residual capacity, no phosphatidyl glyceral lecithin:sphingo <2, BL ATELECTASIS GROUND GLASS, DECREASED LUNG VOLUME, AIR BRONCHOGLANDS |
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Term
| treatment of ARDS of newborn |
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Definition
steroids to mom before birth of preme
surfactant down ET tube
CPAP, intubation, ventilation
CPAP prefered if >1500g or if active breathing spontaneously and not inrespiratory failure |
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Term
| signs of transient tachypnea of newborn, risk factor |
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Definition
tachypnea, nasal flaring, grunting, intercostal retractions, cyanosis shortly after delivery
CXR WITH INCREASED LUNG VOLUME, FLAT DIAPHRAGM, PROMINENT VESSELS FROM HILUM (SUNBURST), FLUID STREAKING INTERLOBULAR FISSURES, PLEURAL EFFUSIONS
risk: c-section |
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Term
| meconium aspiration syndrome sx |
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Definition
| meconium stained amniotic fluid, skin, nails, cyanosis, intercostal retractions, tachypnea, hypoxia, CXR with atelectasis, hyperinflation, pneumothorax |
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Term
| meconium aspiration syndrome tx |
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Definition
| suction nose and mouth, O2, surfactant (meconium breaks down natural surfactant), empiric antibiotics if pneumonia develops |
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Term
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Definition
pseudomonas pulmonary infections, dyspnea, hemoptysis, productive cough, meconium ileus at birth, steatorrhea, cyanosis, clubbing, sinusitis, malabsorption, infertility
hyperinfilation, sweat Cl >60 in kids >80 in adults
nasal transepithelial Cl secretion test: measure abnormalities in ion transport across nasal epithelium |
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Term
| treatment cystic fibrosis |
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Definition
bronchodilators
deoxyribonuclease/dornase alfa: decrease sputum viscosity
hypertonic saline for chronic cough
physiotherapy: cupping, aerobics
asithromycin: PRN for lung infections
pancreatic enzymes
vitamins ADEK |
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Term
| signs of foreign object, tx |
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Definition
6mo-4yo, drooling, stridor, dry cough, decreased breath sounds, smelly
UL obstructive emphysema, air trapping
tx: RIGID BRONCHOSCOPY to control airway and grab object bettwe |
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Term
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Definition
| stridor, crowing respiration, hyperextended neck, NO difficulty swallowing, NO segmental tracheal compression (NOT vascular rings) |
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Term
| signs thyroglossal duct cyst |
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Definition
| midline, level of hyoid, pulling tongue retracts it |
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Term
| signs branchial cleft cyst |
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Definition
on anterior SCM anywhere from targus to base of neck, sometimes open to skin
CT diagnosis |
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Term
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Definition
| base of neck, mushy ill defined mass, occupies entire supraclavicular area, extends deep into chest or mediastinum |
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Term
| what do you do if the patient comes to the office asymptomatic with an enlarged lymph node |
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Definition
| follow for 3-4 wk, if still there work up as neoplasm |
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Term
| signs of SCC oral mucosa, dx, tx |
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Definition
old man, drinker, smoker, rotten teeth, AIDS
metastasis typically of jugular chain
persistent hoarseness
painless ulcer on floor of mouth
persistent unilateral earache
triple endoscopy and panendoscopy looking for primary tumor, biopsy, CT, FNA
resection, radical neck dissection, platinum chemo, radiation |
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Term
| signs nasopharyngeal carcinoma |
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Definition
asian, male, salted fish in diet
EBV signs, UL ear infection as adult |
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Term
| signs and treatment of parotid tumor |
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Definition
painful hard mass suggestive malignant, painless suggestive benign
NEVER OPEN BIOPSY, ONLY FNA
surgical parotidectomy, sparing facial nerve only if benign |
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Term
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Definition
abscess on floor of mouth due to tooth infection
fever, SOB due to compression
emergent I&D, intubation if needed |
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Term
| signs of recurrent laryngeal nerve injury |
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Definition
loss of function to posterior cricoarytenoid (opens vocal cords) causes hoarsness
sensory and motor to all larynx gone EXCEPT CRYCOTHYROID BECAUSE IT IS INNERVATED BY SUPERIOR LARYNGEAL N |
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Term
| what is the difference in age presentation between peritonsilar abscess and ratropharyngeal abscess |
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Definition
peritonsilar is usually >4yo
retropharyngeal is usually <4yo |
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Term
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Definition
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