Term
| Causes of Hypoxic Hypoxia |
|
Definition
| Low ambient PO2, Hypoventilation, Diffusion impairment, R-to-L shunt, V/Q inequality |
|
|
Term
|
Definition
|
|
Term
| Cause of Stagnant Hypoxia |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Causes and Effect of Decreased P50 |
|
Definition
| Causes: low temp, low PCO2, low 2,3-DPG, high pH; Effect: Hb has increased O2 affinity |
|
|
Term
| Causes and Effect of Increased P50 |
|
Definition
| Causes: high temp, high PCO2, high 2,3-DPG, low pH; Effect: Hb has decreased O2 affinity |
|
|
Term
| Effect of Hypoventilation on PCO2 |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| 100 (<60 is considered hypoxemic) |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
PAO2 = (barometric pressure - 47)(0.21)- (PCO2/ 0.8)
Under normal conditions of water vapor pressure, O2 concentration and respiratory exchange ratio |
|
|
Term
|
Definition
= PAO2-PaO2
Normal is 10-30 in adults, can be less than 10 in kids; estimate = age/2
Never increased in hypoventilation; increased with V/Q mismatch, shunt, and impaired diffusion capacity |
|
|
Term
| Respiratory Acid-Base Disorders |
|
Definition
Result from changes in CO2
Increased PCO2 = acidosis (ex: hypoventilation)
Decreased PCO2 = alkalosis (ex: hyperventilation)
PCO2 and pH will change in opposite directions if the cause of acidosis/ alkalosis is respiratory; the condition is acute if there is no change in HCO3 from normal |
|
|
Term
| Metabolic Acid-Base Disorders |
|
Definition
Result from changes in HCO3-
Decreased HCO3- = acidosis
Increased HCO3- = alkalosis
pH and PCO2 will change in the same direction if the cause of the acidosis/ alkalosis is metabolic; can also occur if pH is abnormal, but PCO2 is normal |
|
|
Term
| Causes of Increased Anion Gap |
|
Definition
| MUD PILES: methanol, uremia (renal failure), diabetic ketoacidosis, paraldehyde, intoxication/ ingestion, lactic acidosis, ethanol/ ethylene glycol, salicylates |
|
|
Term
|
Definition
=Sum of Cations - Sum of Anions
Normal range: 9 to 14 |
|
|
Term
| Most Common Cause of Metabolic Alkalosis |
|
Definition
|
|
Term
|
Definition
| Obstructive - need to look at FEV1 to determine severity |
|
|
Term
| FEV1/FVC <70% and FEV1 >80 % |
|
Definition
|
|
Term
| FEV1/FVC <70% and FEV1 50-80% |
|
Definition
| Moderate Obstructive disease |
|
|
Term
| FEV1/FVC <70% and FEV1 30-50% |
|
Definition
| Sever Obstructive disease |
|
|
Term
| FEV1/FVC <70% and FEV1 <30% |
|
Definition
| Very Severe Obstructive disease |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Suggests Restrictive disease - look for FVC >80% and for decreased TLC to confirm |
|
|
Term
| Reversible vs. Irreversible Lung Disease |
|
Definition
| Compare pre- and post-bronchodilator values for FEV1 and FVC; if there was a >200cc (0.2L)improvement AND at least a 12% improvement after bronchodilator administration, then the condition is reversible |
|
|
Term
|
Definition
| A congenital anomaly involving cystic lining of the bronchial epithelium; can lead to infections and lung abscesses |
|
|
Term
| Bronchopulmonary Sequestrations |
|
Definition
| A congenital anomaly in which segments of lung are not connected to normal airways; the blood supply of these sequestrations are derived from the aorta; can either be Intralobar or Extralobar |
|
|
Term
| Intralobar Bronchopulmonary Sequestration |
|
Definition
| A bronchopulmonary sequestration that is covered by visceral pleura, and presents in late childhood |
|
|
Term
| Extralobar Bronchopulmonary Sequestration |
|
Definition
| A bronchopulmonary sequestration located outside the lung, presents in infancy and is often associated wtih other congenital anomalies |
|
|
Term
| Adult Respiratory Distress Syndrome (ARDS) |
|
Definition
| Damage to alveolar membranes; caused by - septic shock, trauma, pancreatitis, diffuse pulmonary infection (viral), O2 toxicity (prolonged exposure to high concentrations of O2 |
|
|
Term
|
Definition
| Rapid onset of tachycardia/ tachypnea; refractory to O2 treatment |
|
|
Term
| Chest X-ray Findings in ARDS |
|
Definition
| Diffuse alveolar infiltrates |
|
|
Term
| Diffuse Alveolar Damage (DAD) |
|
Definition
| Damage to the endothelial cells of alveolar capillaries - this leads to leakage of capillary contents (fibrin, fluid, inflammatory cells, etc.); ultimately results in the formation of hyaline memranes when these things solidify in the alveolar space; hyaline membranes impair gas exchange |
|
|
Term
|
Definition
| Pathologic hallmark of Diffuse alveolar damage (DAD); also seen in Respiratory distress syndrome in neonates (which is AKA Hylaine Membrane Disease) |
|
|
Term
|
Definition
| Seen in Diffuse Alveolar damage, Goodpasture's Syndrome, and Idiopathic Hemosiderosis |
|
|
Term
| S/S of Diffuse Alveolar Damage |
|
Definition
| Progressive cyanosis and hypoxemia |
|
|
Term
| Epidemiology of Transient Tachypnea of the Newborn (TTN) |
|
Definition
| The most common respiratory disorder in newborns (11/1000 live births); males > females; occurs in term/ near term infants who have no other risk factors; seen in babies who were delivered rapidly or via c-section |
|
|
Term
| Cause of Transient Tachypnea of the Newborn |
|
Definition
| Delayed resportion of fetal lung fluid |
|
|
Term
| S/S of Transient Tachypnea of the Newborn |
|
Definition
| Occur immediately after birth; tachypnea, mild distress, may or may not require O2; TTN resolves in 2-5 days with no long-term sequelae |
|
|
Term
| Chest X-ray Findings in Transient Tachypnea of the Newborn |
|
Definition
| Hyperinflation of the lungs, perihilar streaks, fluid in the fissures |
|
|
Term
| Respiratory Distress Syndrome |
|
Definition
| AKA Hyaline Membrane Ds, Surfactant Deficiency; Occurs in 60% of premies (<30wks gestation) and in 30% of babies after maternal steroid adminstration; surfactant production begins at ~26 wks, but babies won't have enough to sustain respirations until 32-34 weeks |
|
|
Term
| Risk Factors for Respiratory Distress Syndrome |
|
Definition
| Prematurity, maternal diabetes, perinatal asphyxia, C-section, 2nd twin to be born, previous infant with RDS |
|
|
Term
| Pathogenesis of Respiratory Distress Syndrome |
|
Definition
| The surfactant deficiency results in atelectasis (which in turn results in a R-to-L shunt) causes metabolic acidosis and hypoxia, which then causes increased capillary permeability, so you get exudative/ inflammatory fluid leakage into the alveoli and subsequent hyaline membrane formation |
|
|
Term
| S/S of Respiratory Distress Syndrome |
|
Definition
| Respiratory distress - tachypnea, hypoxemia, grunting, flaring; Chest X-ray shows ground glass/ reticulonodular pattern |
|
|
Term
| Treatment for Respiratory Distress Syndrome |
|
Definition
| Surfactant replacement (artificial surfactant via ET tube); ventilatory support to prevent hypoxemia, but it may cause barotrauma which may result in chronic lung disease; maintain acid-base balance; IV nutrition |
|
|
Term
| S/S of Meconium Aspiration |
|
Definition
| Initial presentation may be similar to TTN, but with increased O2 requirement, increased work of breathing, and increased acidosis and hypoxemia |
|
|
Term
| Pathogenesis of Meconium Aspiration |
|
Definition
| Meconium causes obstruction and may result in air leaks (pneumothorax, pneumomediastinum); The free fatty acids in the meconium displace the surfactant, resulting in diffuse atelectasis; the enzymes and bile salts in the meconium cause a chemical pneumonitis, which may progress rapidly to pneumonia |
|
|
Term
| Treatment of Meconium Aspiration |
|
Definition
| Neutral thermal environment with minimal handling to prevent development of persistent pulmonary HTN of the newborn (monitor BP and acid/ base levels to assess whether this is developing); O2; mechanical ventilation; surfactant replacement |
|
|
Term
| Complications of Meconium Aspiration |
|
Definition
| Air Leaks, Barotrauma, Hypoxic encephalopathy |
|
|
Term
| Epidemiology and Cause of Neonatal Pneumonia |
|
Definition
| 10X greater risk in preemies b/c of their immature immune system and lungs; Bugs- GBS, E.Coli, Listeria |
|
|
Term
| Risk Factors for Neonatal Pneumonia |
|
Definition
| Maternal fever, prolonged rupture of membranes (>18 hours), GBS positive mother |
|
|
Term
| Treatment of Neonatal Pneumonia |
|
Definition
| Supportive care, O2, maintain acid/ base balance, antibiotics (ampicillin and gentamycin) |
|
|
Term
| Cyclic Episodes of Cyanosis in a Newborn |
|
Definition
| Associated with Choanal Atresia - the baby is fine when it's crying because it's breathing through its mouth, but the baby becomes cyanotic at rest when they're trying to breathe through their nose (newborns are obligate nose breathers) |
|
|
Term
|
Definition
| Atresia (absence/ closure)of one or both sides of the nasal passages; associated with CHARGE syndrome (coloboma, congenital heart defects, choanal atresia, retardation, GU defects, ear anomalies) |
|
|
Term
| Congenital Diaphragmatic Hernia |
|
Definition
| Presents immediately after birth with respiratory distress, and refractory cyanosis; on exam the baby has a scaphoid abdomen, barrel chest, and bowel sounds in the chest; babies with this condition can be born with hypoplastic lungs b/c chest space was occupied by abdominal contents when the fetal lungs should have been developing and therefore the lungs had no room to develop - now, with improved ultrasound technology, these are diagnosed in utero, and can be fixed with fetal surgery |
|
|
Term
| Metabolic Causes of Respiratory Distress |
|
Definition
| Sepsis, Hypoglycemia, Hypothermia |
|
|
Term
|
Definition
Top 3 Risk Factors for PE
1-Immobilization/ Stasis
2-Hypercoaguable States (Pregnancy, CA, factor deficiencies, etc.)
3-Vessel Wall Intimal Damage (due to trauma, surgery, burns, fractures, catheter insertion) |
|
|
Term
|
Definition
| venography, impedence plethysmography, compression ultrasound (most common), D-dimer |
|
|
Term
|
Definition
| D-dimer, spiral CT, V/Q scan (not used much, except for people who can't get CT with contrast), pulmonary angiogram |
|
|
Term
|
Definition
| D-dimers are fibrin degradation products formed during fibrinolysis and coagulation; increased levels aren't diagnostic in someone with risk factors for DVT/ PE, but the test is useful in patients wihtout risk factors; if the level is nroaml, there's a 95% likelihood of not having a PE |
|
|
Term
| S/S of Pulmonary Embolus (PE) |
|
Definition
| Most PEs are silent, when there are S/S they are: dyspnea/ tachypnea, pleuritic chest pain (pain with deep inspiration), cough, hemoptysis, presyncope/ syncope, focal wheezing, new onset atrial fibrillations, respiratory alkalosis, increased A-aDO2, hypoxemia |
|
|
Term
|
Definition
| O2, hemodynamic support, immediate anticoagulation therapy (unless there is a HUGE contraindication) with Low molecular weight heparin (LMWH) or unfractionated heparin (UFH) |
|
|
Term
| Low Molecular Weight Heparin (LMWH)Vs. Unfractionated Heparin (UFH) |
|
Definition
| LMWH is generally preferred over UFH because it doesn't require monitoring since it's pharmacokinetics aren't as complex; the benefit of UFH is that it has a shorter half-life; LMWH is contraindicated in obese patients and patients with renal failure |
|
|
Term
| Precaution in Starting Oral Warfarin Therapy in a PE patient |
|
Definition
| You should only start oral warfarin once the patient has been adequately anticoagulated by IV medications (LMWH, UFH), because warfarin has pro-thrombotic effects at first due to the fact that it depletes proteins C and S; Warfarin in contraindicated in pregnancy |
|
|
Term
| Contraindications for Thrombolytics |
|
Definition
| If the patient has had recent neurosurgery or spinal surgery |
|
|
Term
| #1 Cause of Acute Cor Pulmonale |
|
Definition
|
|
Term
| When to Use an IVC Filter |
|
Definition
| IVC Filters are good for patients with absolute contraindications to anticoagulation therapy or who are at a very high risk for having additional PEs |
|
|
Term
|
Definition
| These are hemorrhagic/ red infarcts; they only occur in people with underlying heart and/or lung disease; they are usually peripheral and wedge-shaped; there must be hemorrhage and necrosis, otherwise it's just a pulmonary hemorrhage |
|
|
Term
| Epidemiology of Primary Pulmonary HTN |
|
Definition
| F>M, 20-40 yo, patients often have an autoimmune disorder |
|
|
Term
| Cause of Primary Pulmonary HTN |
|
Definition
| Idiopathic (that's why it's primary), or (rarely) the result of a mutation in the BMPR2 signalling receptor pathway (which causes a prolferation of vascular smooth m.) |
|
|
Term
| Pathogenesis of Primary Pulmonary HTN |
|
Definition
| Atheromatous deposits, cholesterol clefts, macrophages, intimal and medial hypertrophy in the small vessels of the lungs(there may also be problems in the large vessles, but they're not the cause of the HTN) |
|
|
Term
|
Definition
| The end-stage lesion of the process of medial fibrosis and intimal hypertrophy in pulmonary HTN; looks like a capillary tuft that protrudes from the lumen; can occur in primary or secondary pulmonary HTN, but they tend to be more numerous and severe in primary |
|
|
Term
| Treatment of Pulmonary HTN |
|
Definition
| Vasodilators, lung transplant (before the patient develops cor pulmonole) |
|
|
Term
|
Definition
| Right-side heart failure secondary to lung pathology |
|
|
Term
|
Definition
| Associated with URIs, most are viral, resolve within 7-10 days; includes - acute epiglottitis, croup, gastroesophageal laryngitis, granulomas, nodules, and congenital problems of the larynx |
|
|
Term
| Cause of Acute Epiglottitis |
|
Definition
In Kids - H.influenza type B
In Adults - staph or strep |
|
|
Term
| Cause of Acute Epiglottitis |
|
Definition
In Kids - H.influenza type B
In Adults - staph or strep |
|
|
Term
| Epidemiology of Acute Epiglottitis |
|
Definition
| Usually seen in kids ages 2-6; it is a medical emergency |
|
|
Term
| Presentation of acute epiglottitis |
|
Definition
| S/S develop suddenly with high fever, drooling due to odynophagia; the patient will present sitting forward because leaning back closes off their airway; lateral neck x-ray shows a "thumbprint" sign |
|
|
Term
| Treatment for Acute Epiglottitis |
|
Definition
| Nasal intubation for 2-3 days in the ICU; blood and throat cultures and sensitivities should be done to direct treatment; cefuroxine or ceftriaxone; humidification; steroids in adults |
|
|
Term
| Most common cause of stridor in kids |
|
Definition
|
|
Term
|
Definition
| Parainfluenza virus; the disease is usually seen in fall and spring |
|
|
Term
|
Definition
| Usually seen in patients between the ages of 6 months and 2 years |
|
|
Term
|
Definition
| Barking cough, hoarsness; "steeple" sign and narrow subglottic airway seen on AP neck x-ray; "thumbprint" sign seen on lateral neck x-ray |
|
|
Term
|
Definition
| Cold humidification, racemic epinephrine, steroids, O2, fluids; the patient needs to be hospitalized if they have tachypnea (>40 breaths/ min), retractions and cyanosis |
|
|
Term
|
Definition
| A sensation of a lump in thr throat; associated with gastroesophageal laryngitis |
|
|
Term
| Gastroesophageal Laryngitis |
|
Definition
| The most common manifestation of GERD in the upper airway; S/S - hoarseness that is worse in the AM, dysphonia, sensation of the need to clear the throat/ globus pharyngeus, posterior laryngitis with red arytenoids and edema |
|
|
Term
| Congenital Disorders of the Larynx |
|
Definition
| Laryngomalacia, webs, hemangiomas |
|
|
Term
|
Definition
| NREM; light sleep, alpha waves, varying respiratory pattern with central apneas |
|
|
Term
|
Definition
| NREM; light sleep, K complex, spindles, less variable varying respiratory pattern (than stage I), resolving central apneas |
|
|
Term
|
Definition
| NREM; deep sleep, <50% delta waves, decreased muscle tone, regular respirations |
|
|
Term
|
Definition
| NREM; deep sleep, >50% delta waves, decreased muscle tone, regular respirations |
|
|
Term
|
Definition
| Deep sleep, REMs, loss of muscle tone of accessory respiratory muscles, varying respiratory rate and tidal volume; frequently associated with hypoventilation (increased PCO2 and decreased PO2) |
|
|
Term
| Definition and S/S of Obstructive Sleep Apnea |
|
Definition
| AKA: Upper Airway Resistance Syndrome; > 10 sec cessation of airflow despite respiratory effort; excessive daytime somnolence (EDS) associated with the occurrence of excessive (>5/ hr) obstructive respiratory events during sleep |
|
|
Term
| Epidemiology of Obstructive Sleep Apnea |
|
Definition
| Occurs in 40% of adults; M>F, increase in incidence in women after menopause so that M=F; increased incidence in obese patients and in patients with facial deformities; increased risk in M with a neck size greater than or equal to 17 and in W with a neck size greater than or equal to 15 |
|
|
Term
| Degrees of Severity of Obstructive Sleep Apnea (OSA) |
|
Definition
Normal (No OSA): <5 events/ hour
Mild:5-20 events/ hr
Moderate: 20-40 events/ hr
Severe: >40 events/ hr |
|
|
Term
| Comorbidities of Obstructive Sleep Apnea |
|
Definition
| HTN, Cardiovascular ds, Metabolic Disorders |
|
|
Term
| S/S of Obstructive Sleep Apnea |
|
Definition
| Snoring; morning HA; awakenings associated with choking, acute dyspnea, GERD sxs; nocturia/ enuresis; impairment in memory/ consciousness; depression; decreased libido; daytime fatigue; personality changes/ increased irritability |
|
|
Term
| Treatment of Obstructive Sleep Apnea |
|
Definition
| Avoid things that decrease m. tone (EtOH, narcotics, benzos); weight loss; treat underlying hypothyroidism if present; surgical/ non-surgical relief of upper airway obstruction (uvulopalatopharyngeoplasty - UPPP - is the first line surgical approach); Positive airway pressure is the treatment of choice - CPAP or BiPAP |
|
|
Term
| Definition of Central Sleep Apnea |
|
Definition
| Cessation of airflow associated with the absence of respiratory effort; primary = idopathic, secondary is more common and is due to pharmacologic, neurologic and/ or cardiogenic causes |
|
|
Term
| S/S of Central Sleep Apnea |
|
Definition
| Associated with recurrent arousals and signficant excessive daytime somnolence; may see Cheyne-Stokes respiratory pattern |
|
|
Term
| Treatment of Central Sleep Apnea |
|
Definition
| Minimize narcotic and sedating medications; maximize cardiac function (O2, drugs, pacemaker, transplant); medication - theophylline, progesterone, acetozolamide; PAP - especially BiPAP ST |
|
|
Term
|
Definition
| A Carbonic Anhydrase Inhibitor; it makes the patient acidemic, which causes respiratory alkalosis, which in turn increases the patients respiratory drive; used to treat central sleep apnea |
|
|
Term
|
Definition
| A type of positive airway pressure administration; the ST stands for spontaneous time; it has a set respiratory rate, so that if the patient forgets to breathe, it forces pressure at a certain rate as a reminder/ back-up |
|
|
Term
| Hypoventilation Associated with COPD |
|
Definition
| Due to the loss of intercostal m. activity during REM and impaired diaphragmatic function - these patients' diaphragms are too flattened to fully ventilate the patient when the accessory m. of respiration are taken out of the picture; REM associated hypoxemia is seen in about 27% of COPD patients with a PAO2 >60 mmHg |
|
|
Term
| Most Common Presenting Symptom in Lung Cancer |
|
Definition
|
|
Term
| Frothy, white sputum is associated with what type of cancer? |
|
Definition
| Bronchoalveolar carcinoma (a type of adenocarcinoma) |
|
|
Term
|
Definition
| Facial edema and dilatation of superficial collateral v. - associated with Small Cell Lung Cancer (SCLC) |
|
|
Term
|
Definition
| A superior sulcus tumor that often involves the brachial plexus (causing weakness and pain radiating down the arm) and Horner's Syndrome |
|
|
Term
| Where does lung cancer typically metastasize to? |
|
Definition
| Brain, bone, adrenals and liver |
|
|
Term
| Hypertrophic Pulmonary Osteoarthropathy |
|
Definition
| A paraneoplastic syndrome associated with adenocarcinoma that involves periostitis which causes pain in the long bones |
|
|
Term
| Which type of Lung Cancer is Associated with digital clubbing? |
|
Definition
|
|
Term
| Paraneoplastic Syndromes Associated with Adenocarcinoma |
|
Definition
| Hypertrophic Pulmonary Osteoarthropathy and digital clubbing |
|
|
Term
|
Definition
| A Paraneoplastic syndrome associated with squamous cell carcinoma |
|
|
Term
|
Definition
| A paraneoplastic syndrome associated with small cell lung cancer (SCLC) |
|
|
Term
| Cushing's syndrome can be a paraneoplastic associated with which type of lung cancer? |
|
Definition
| Small Cell Lung Cancer (SCLC) |
|
|
Term
|
Definition
| A paraneoplastic syndrome associated with small cell lung cancer that involves muscle weakness (espeically of the pelvis) that improves with exercise |
|
|
Term
| What are the paraneoplastic syndromes associated with SCLC? |
|
Definition
| Hyponatremia, Cushing's syndrome, and Eaton- Lambert syndrome |
|
|
Term
| What paraneoplastic syndromes are associated with Squamous Cell Carcinoma? |
|
Definition
| SVC Syndrome and hypercalcemia |
|
|
Term
| Which types of lung cancer are typically centrally located? |
|
Definition
| Squamous Cell Carcinoma and Small Cell Lung Cancer - you can differentiate between the two based on the fact that squamous cell tumors tend to cavitate |
|
|
Term
| Which types of lung cancer are typically peripherally located? |
|
Definition
| Adenocarcinoma and Large Cell Carcinoma |
|
|
Term
|
Definition
| A type of Non-small cell lung cancer (NSCLC) that is common in smokers; it occurs in M>F and comprises 45% of NSCLC; tumors are usually hilar/ central, grow rapidly, and will show keratinization; Avastin (a VEGF inhibitor) is contraindicated in treatment of these tumors becuase of the likelihood of massive pulmonary hemorrhage |
|
|
Term
|
Definition
| A vascular endothelial growth factor (VEGF) inhibitor, which attempts to kill off the blood supply to a tumor; contraindicated in treatment of Squamous cell carcinoma |
|
|
Term
|
Definition
| A slow growing non-small cell lung cancer (NSCLC) that is weakly associated with smoking/ the most common lung CA in nonsmokers; F>M; tumors are usually peripheral and many will have EGFR mutations; accounts for 45% of NSCLC |
|
|
Term
| Bronchoalveolar Carcinoma |
|
Definition
| A subtype of adenocarcinoma; Solitary nodules have a 50-75% 5 year survival rate, while multifocal nodules have a 25% 5 year survival; M=F |
|
|
Term
|
Definition
| A type of non-small cell lung cancer (NSCLC) that is usally peripherally located, tends to be undifferentiated and is usually more aggressive than other types of NSCLC; accounts for 9% of NSCLC; M=F |
|
|
Term
|
Definition
| A group of lung cancers that contain neurosecrteory granules and may produce/ secrete ectopic hormones; Includes - Small cell lung cancer (SCLC), Bronchial carcinoid, and Atypical Carcinoid |
|
|
Term
| Small Cell Lung Cancer (SCLC) |
|
Definition
| A highly agressive and malignant neuroendocrine tumor that tends to metastasize early and widely, and has a strong correlation with smoking; M>F; tumors are usually hilar/ central and large hilar masses/ bulky adenopathy may be present |
|
|
Term
|
Definition
| Surgery is never an option; SCLC tumors initally respond well to chemo, but after the initial response the tumor invariably reoccurs; there is a 6-17 week survial without treatment and up to a 1 year survival with treatment |
|
|
Term
|
Definition
| An indolent, low-grade, almost benign-behaving neuroendocrine tumor; M>F, most patients are <40 years old; accounts for 1-5% of all lung tumors and has no association with smoking; these tumors may secrete serotonin creating a condition known as carcinoid syndrome; these tumors rarely metastasize and this type of lung CA has a 50-95% 5 year survival rate |
|
|
Term
|
Definition
| A paraneoplastic syndrome associated with bronchial carcinoid tumors as a result of the fact that they secrete serotonin; characterized by flushing, hypotension and diarrhea |
|
|
Term
|
Definition
| A neuroendocrine tumor that is more aggressive than bronchial carcinoid, but less aggressive than SCLC; Tumors show atypia, necrosis and mitotic activity; distant metastases can occur |
|
|
Term
| What is the most common cause of lung tumors? |
|
Definition
| Metastatic cancer from another primary site |
|
|
Term
|
Definition
| A rare, aggressive and lethal tumor of the pleura (or peritoneal surface)related to asbestos exposure; there is a long latent period between asbestos exposure and development of mesothelioma |
|
|
Term
| General Characteristics of COPD |
|
Definition
| Increased resistance to airflow, decreased expiratory flow rates; concave expiratory curve on spirometry; 4 types - emphysema, chronic bronchitis, asthma, bronchiectasis; FEV1/FVC <70% |
|
|
Term
| General Characteristics of Emphysema |
|
Definition
| Irreversible enlargement of airspaces, destruction of alveolar walls; classification is based on the pattern of acinar involvement - centriacinar, panacinar, distal/ paraseptal, and irregular; emphysema only becomes clinically apparent once 1/3 of the lung parenchyma has been destroyed; death occurs as a result of cor pulmonale |
|
|
Term
|
Definition
| Involves the proximal acinus (respiratory bronchioles) with relative sparing of the distal acinus (alveolar ducts and sacs); strong association with tobacco; more common/ severe in the upper lung lobes; patchy distribution |
|
|
Term
|
Definition
| Involves the entire acinus; associated with A1AT deficiency; more common/ severe in the lower lung lobes; diffuse pattern of lung involvement |
|
|
Term
| Distal/ Paraseptal Emphysema |
|
Definition
| Involves the distal acinus (alveolar ducts and sacs) in peripheral/ paraseptal locations; associated wtih spontaneous pneumothorax |
|
|
Term
|
Definition
| Involves the acinus irregularly; this is the most common form of emphysema and it is usually clincally insignificant; develops adjacent to scars |
|
|
Term
|
Definition
| An antiprotease that is synthesized by the liver and circulates in serum; the gene is located on chr. 14; the main role of this enzyme is to counteract elastase |
|
|
Term
|
Definition
| The major protease in the body; functions in destroying/ digesting elastic tissue (such as that found in lung parenchyma); most plentiful in the cytoplasm of inflammatory cells (especially neutrophils and macrophages) |
|
|
Term
|
Definition
| Normal A1AT phenotype is PI-MM; There are several abnormal phenotypes, but the most severe is PI-ZZ; when there is a deficiency in A1AT, elastase is able to function un-checked, and lung parenchyma is destroyed; associated with panacinar emphysema |
|
|
Term
| Role of Smoking in Panacinar Emphysema |
|
Definition
| Smoking causes an increase in neutrophils and macrophages within the lungs; neutrophils and macrophages contain elastase which gets released and begins to digest elastic tissue in the lungs - this is not necessarily a problem in people with no A1AT deficiency since the A1AT will prevent the elastase activity from going unchecked; however, in someone with an A1AT deficiency, there isn't enough A1AT present to prevent elastase from destroying the lungs and the patient develops panacinar emphysema |
|
|
Term
| Why are patient's with emphysema referred to as "pink puffers"? |
|
Definition
| "Pink" because they're able to maintain normal oxygen concentration, "puffer" because they have difficulty breathing |
|
|
Term
| Why does Cor Pulmonale occur in emphysema? |
|
Definition
| In emphysema there's destruction of the alveolar walls, which also involves destruction of the capillaries within those walls, which causes a decrease in the places where blood can flow, resulting in increased resistance for the right ventricle to pump against |
|
|
Term
|
Definition
| Emphysema is irreversible, so prevention is key (i.e. smoking cessation); for patients where A1AT deficiency is the cause of emphysema, A1AT replacement therapy is possible, but expensive; lung transplants are also a possibility |
|
|
Term
|
Definition
| A type of COPD characterized by persistent cough with sputum production and mucous hypersecretion; symptoms must be present for at least 3 months in a consecutive 2 year period; tends to coexist with emphysema, especially centriacinar emphysema, because they're both associated with smoking; can get microbial infections |
|
|
Term
| Morphology of Chronic Bronchitis |
|
Definition
| Submucosal gland hypertrophy, goblet hyperplasia/ metaplasia (goblet cells appear in areas that are only supposed to have type I and type II pneumocytes; increased Reid Index |
|
|
Term
|
Definition
| A ratio of the mucous gland thickness to the overall bronchial wall thickness; increased (i.e. more than 50%) in chronic bronchitis |
|
|
Term
| Why are patients with chronic bronchitis called "blue bloaters"? |
|
Definition
| "Blue" because of poor oxygenation, "bloated" because of edema secondary to right heart failure |
|
|
Term
|
Definition
| Widespread, but variable airflow obstruction that is usually fully reversible bronchoconstriction; a chronic inflammatory disease of the airways; presents as recurrent episodes of wheezing, breathlessness, chest tightness and cough; classified on the basis of the inciting stimulus |
|
|
Term
| Microscopic findings in Asthma |
|
Definition
| Curschman spirals (whorls of shed epithelium); Charcot Leyden Crystals (a result of the presence of eosinophilic membrane protein); Eosinophils; changes in the architecture of the broncial mucosa can occur in as little as 3 months and can lead to airway remodelling; smooth muscle hyperplasia is a consequence of persistent asthma |
|
|
Term
|
Definition
| AKA extrinsic asthma; the most common subtype of asthma; a result of environmental allergens; the patient usually has a family history of asthma; elevated IgE; Type I hypersensitivity |
|
|
Term
| Type I Hypersensitivity associated with Atopic/ Allergic Asthma |
|
Definition
| Immediate Response - Mast cells release their contents (histamine and other chemotactic factors) in response to antigens, these factors cause inflammatory cells to migrate into the lung; Late Response - occurs several hours after the initial response; caused by the release of additional mediators from the inflammatory cells that were attracted to the lung in the immediate response (these prostaglandins and leukotrienes maintain bronchial constriction) |
|
|
Term
|
Definition
| AKA Intrinsic Asthma; associated with respiratory tract infections (usually viral); it is uncommon for the patient to have a family history of asthma; the patient's serum IgE is usually normal; Proposed mechanism - the nerve that controls bronchoconstriction is hypersensitive to viral infections and clamps down on the bronchial walls in response to the infection |
|
|
Term
|
Definition
| Pulmonary function tests such as spirometry; normal spirometry does NOT rule out asthma; physicians often use bronchodilator trials and/ or broncoprovocation tests (methylcholine challenge) |
|
|
Term
|
Definition
| A form of spirometric testing that is used to assess reversibility of an obstructive condition; if there is an improvement of 200mL AND 12% in FVC and FEV1 after the administration of a bronchodilator, the condition is considered to be reversible (ex: asthma) |
|
|
Term
|
Definition
| AKA Methylcholine challenge; methylcholine will cause bronchoconstriction in people with an underlying predisposition toward bronchoconstriction; if the patient is hyper-responsive to bronchoconstriction they MAY have asthma; if the patient does not respond to the methylcholine challenge, they definitely do NOT have asthma |
|
|
Term
| Characteristics of Pediatric Asthma |
|
Definition
| Asthma is the most common pediatric illness; there is a higher incidence in minorities and lower socioeconomic status families |
|
|
Term
| Characteristics of Intermittent Asthma |
|
Definition
Symptoms <1x/week
Nighttime symptoms <2x/month
Patient is asymptomatic between attacks
PEF/FEV1 >80%
PEF Variability <20% |
|
|
Term
| Characteristics of Mild Persistent Asthma |
|
Definition
Symptoms >1/wk, but <1/day
Nighttime symptoms >2/month
Attacks may affect activity
PEF/FEV1>80%
PEF Variability 20-30% |
|
|
Term
| Characteristics of Moderate Persistent Asthma |
|
Definition
Daily Symptoms
Nighttime symptoms >1/wk
Attacks affect severity
PEF/FEV1 60-80%
PEF Variability >30% |
|
|
Term
| Characteristics of Severe Persistent Asthma |
|
Definition
Continuous Symptoms
Frequent Symptoms at Night
Limited Physical Activity
PEF/FEV1 <60%
PEF Variability >30% |
|
|
Term
| Treatment for Intermittent Asthma |
|
Definition
|
|
Term
| Treatment for Mild Persistent Asthma |
|
Definition
Preferred: low-dose Inhaled corticosteroids
Alternate: Cromolyn OR leukotriene receptor antagonist |
|
|
Term
| Treatment for Moderate Persistent Asthma |
|
Definition
Preferred: Low-dose inhaled corticosteroids (ICS) AND a long-acting beta-agonist; OR medium-dose ICS
Alternate: Medium-dose ICS AND leukotriene receptor antagonist; OR theophylline |
|
|
Term
| Treatment for Severe Persistent Asthma |
|
Definition
| Preferred: high-dose ICS AND a long-acting beta-agonist; may need oral steroids; if they do, wean them off of it ASAP |
|
|
Term
| What is the prototypical drug-induced asthma? |
|
Definition
|
|
Term
|
Definition
| A necrotizing infection of the bronchi and bronchioles which results in airway dilatation (as in emphysema,except that in emphysema, it's dilatation of the acini); the lower lobe is more commonly involved than the upper lobe |
|
|
Term
|
Definition
| Cough with foul smelling sputum; can result in abscess and cor pulmonale |
|
|
Term
| Conditions associated with Bronchiectasis |
|
Definition
| Bronchial obstrucion, CF, Kartagener's Syndrome, Congenital Bronchiectasis, necrotizing pneumonia |
|
|
Term
| What affect do anticholinergic medications have on COPD and why do they work? |
|
Definition
| Anticholinergics cause inhibition of the bronchoconstriction and mucous hypersecretion seen in COPD; they work because there is a higher vagal/ cholinergic tone to the airways in people with COPD and the anticholinergic medications target the M3 receptors of airway smooth muscle which is what is responsible for the bronchoconstriction and mucous hypersecretion |
|
|
Term
| Chest X-ray Findings in COPD |
|
Definition
Increased AP Diameter
Hyperinflated ("tall") lungs with a low, flat diaphragm |
|
|
Term
|
Definition
| Short-acting bronchodilator as needed |
|
|
Term
| Treatment of Moderate COPD |
|
Definition
| Short-acting bronchodilator as needed; regular treatment with one or more long-acting bronchodilator; rehab |
|
|
Term
| Treatment for Severe COPD |
|
Definition
| Short-acting bronchodilator as needed; long-acting bronchodilator; inhaled glucocorticoids; rehab |
|
|
Term
| Treatment for Very Severe COPD |
|
Definition
| Short-acting bronchodilator as needed; long-acting bronchodilator; inhaled glucocorticoids; treatment of complications; rehab; long-term O2 therapy; consieration of surgical options |
|
|
Term
| Criteria for O2 Therapy in COPD |
|
Definition
| SpO2 of <88%,OR: SpO2 = 89% AND evidence of cor pulmonale or polycythemia |
|
|
Term
|
Definition
| A response to chronic hypoxemia - increased RBC production due to increased erythropoietin production by the kidney in response to hypoxemia |
|
|
Term
| Pathogens in Acute Exacerbations of COPD |
|
Definition
| S. pneumoniae, M.catarrhalis, H.influenza, viruses |
|
|
Term
|
Definition
| Results in consolidation of lung parenchyma; caused by impaired host defenses and/ or lowered host resistance; two types of classification - offending bug classification or anatomical location classification (the offending bug classification is the one that's more relevant for treatment) |
|
|
Term
| Most common community acquired pneumonia |
|
Definition
|
|
Term
| Most common nosocomially acquired pneumonia |
|
Definition
|
|
Term
| Most common pneumonia seen in patients with COPD |
|
Definition
|
|
Term
| Most common pneumonia seen in alcoholics |
|
Definition
|
|
Term
| Most common pneumonia in CF patients |
|
Definition
|
|
Term
| Complications of Pneumonia |
|
Definition
| Lung abscess, empyema, bacteremia |
|
|
Term
|
Definition
| Uncommon in infancy and old age; 90% of cases are due to S.pneumoniae; confluent infiltrates |
|
|
Term
|
Definition
| AKA Bronchopneumonia; by far the most common type of pneumonia; common in infancy and old age; patchy consolidation; firm, elevated nodules; bugs: staph, strep, h.influenza; alveolar spaces contain neutrophils |
|
|
Term
| What is found in the alveolar spaces of patients with bronchopneumonia |
|
Definition
|
|
Term
| What is found in the alveolar spaces of patients with Desquamative Interstitial Pneumonitis? |
|
Definition
| Mononuclear cells and epithelium |
|
|
Term
| What is found in the alveolar spaces of patients with Pulmonary Alveolar Proteinosis? |
|
Definition
| Amorphous, granular material |
|
|
Term
| What is the characteristic of the Bronchoalveolar Lavage differential in patients with Sarcoidosis? |
|
Definition
|
|
Term
| What is the characteristic of the bronchoalveolar lavage differential in patients with idiopathic pulmonary fibrosis? |
|
Definition
|
|
Term
| Viral/ Mycoplasma Pneumonia |
|
Definition
| AKA: pneumonitis/ interstitial pneumonia; interstitial infiltrates (alveolar septal wall); mononuclear cells are found in the alveolar septal walls (lymphocytes, plasma cells, macrophages, etc.); inflammation is interstitial (as opposed to in the alveolar spaces as with bacterial pneumonia) because the viruses need to be within a cell in order to survive |
|
|
Term
| What organisms do you see in pneumonia in immunocompromised patients? |
|
Definition
|
|
Term
|
Definition
| Hemorrhagic pneumonitis with proliferating (crescentic)glomerulonephritis; intra-alveolar hemorrhage; necrosis of alveolar walls |
|
|
Term
| Epidemiology of Goodpasture's Syndrome |
|
Definition
| M:F = 3:1; peak incidence in the 3rd and 4th decade |
|
|
Term
| S/S of Goodpasture's Syndrome |
|
Definition
| Hemoptysis followed by renal manifestations (decreased to no urine output); chest x-ray reveals "white out"; grossly the lungs appear heavy and red-brown |
|
|
Term
| Pathogenesis of Goodpasture's Syndrome |
|
Definition
| Antibodies with alveolar and glomerular basement membrane specificity (anti-GBM Antibody); immunofluorescence shows linear deposition along basement membranes |
|
|
Term
| What conditions are associated with heavy, red-brown lungs? |
|
Definition
Goodpasture's Syndrome
Idiopathic Hemosiderosis
Diffuse Alveolar Damage/ ARDS |
|
|
Term
|
Definition
| A pulmonary hemorrhage syndrome characterized by intra-alveolar hemorrhage and epithelial hyperplasia; presents in children and young adults with insidious onset of hemoptysis and no renal involvement; no anti-GBM antibody; heavy, firm, red-brown lungs are seen grossly |
|
|
Term
|
Definition
| A necrotizing vasculitis/ granulomata that can result in pulmonary hemorrhage and renal disease (proliferating/ crescentic glomerulonephritis in which the kidneys don't work becuase the glomerulous is essentially squished by proliferating cells); associated with c-ANCA (an anti-neutrophilic cytoplasmic antibody); If untreated - death within 1 year; With immunosuppressive therapy - 90% clinical response |
|
|
Term
|
Definition
| A type of Interstitial Lung Ds that results from accumulation of inorganic dust in the lungs and the tissue's reaction to the presence of that dust; whether or not disease occurs depends on the number, size, shape and solubility of the particles inhaled; 4 types - coal worker's pneumoconiosis, silicosis, asbestosis, berylliosis |
|
|
Term
| Simple Coal Worker's Pneumoconiosis |
|
Definition
| Benign clinical course; Black nodules <2cm; reticulonodular pattern on chest x-ray; absence of fibrosis - the patient is asymptomatic except for coughing up black sputum |
|
|
Term
| Complicated Coal Worker's Pneumoconiosis |
|
Definition
| AKA: Progressive massive fibrosis; nodules >2cm; diffuse fibrosis (because the nodules coalesce) - patients are symptomatic with disabling dyspnea, pulmonary HTN and cor pulmonale |
|
|
Term
| Occupations associated with Silicosis |
|
Definition
| Mining of copper, tin and gold; quarrying; sandblasting; ceramic/ glass industry |
|
|
Term
|
Definition
| Intially patients are asymptomatic secondary to the long latency period, but they may progress to dyspnea, cor pulmonale and respiratory failure; +/- rales, wheezes |
|
|
Term
| Simple v. Complicated Silicosis |
|
Definition
| <2cm nodules w/ no fibrosis v. >2 cm nodules w/ fibrosis |
|
|
Term
|
Definition
| Follows intense exposure to fine silica dust; Chest x-ray shows rapidly progressing fibrosis; Symptoms - rapidly progressing dyspnea |
|
|
Term
|
Definition
| The most common form of silicosis; follows decades of exposure to low-levels of dust; chest x-ray shows b/l upper lung fibrosis +/- adenopathy with eggshell calcifications; Symptoms - +/- exertional dyspnea, +/- cough |
|
|
Term
|
Definition
| Associated with chronic silicosis |
|
|
Term
|
Definition
| A combination of rheumatoid disease and large necrobiotic nodules associated with simple silicosis |
|
|
Term
| Conditions associated with Silicosis |
|
Definition
| Caplan's Syndrome, TB, COPD, and bronchogenic CA |
|
|
Term
|
Definition
| Exposure avoidance, steroids, bronchoalveolar lavage, bronchodilators |
|
|
Term
|
Definition
| Can lead to B/L pleural thickening (mid-lung), parenchymal fibrosis (asbestosis), mesothelioma and/ or bronchogenic carcinoma |
|
|
Term
| Occupations associated with Asbestosis |
|
Definition
| Asbestos mining/ processing, insulators, ship building |
|
|
Term
|
Definition
| Progressive pulmonary fibrosis secondary to asbestos exposure; results in progressive pulmonary impairment; S/S - dyspnea, cough, crackles, clubbing, cor pulmonale; PFTs show restrictive pattern with decreased diffusion capacity |
|
|
Term
| Serpentine v. Amphobile Asbestos Fibers |
|
Definition
| Serpentine fibers are curved and are therefore less likely to align themselves in the airstream on inhalation and reach the distal airway and cause alveolitis/ fibrosis; amphibole fibers are straight and can therefore reach the distal airways and cause fibrosis |
|
|
Term
|
Definition
| AKA Ferruginous Bodies; look like dumbells and are covered in iron; you can have asbestos bodies in the sputum/ lung and not have asbestosis, they're just a marker of asbestos exposure, not necessarily of disease |
|
|
Term
| Occupations associated with Berylliosis |
|
Definition
| Beryllium is a light, strong and heat resistant material that was/ is common in modern technology - fluorescent light industry, aerospace, electronics, ceramics |
|
|
Term
|
Definition
| Currently rare; dose-related inflammatory reaction -bronchiolitis, pulmonary edema, chemical pneumonitis |
|
|
Term
| Chronic Beryllium Disease |
|
Definition
| A multisystem granulomatous disorder due to sensitization; develops months to years after beryllium exposure; S/S - similar to sarcoidosis, but Lymphocyte transformation test (LTT) is positive in berylliosis and not in sarcoidosis; chest x-ray shows interstitial fibronodular disease +/- adenopathy |
|
|
Term
| Treatment for Berylliosis |
|
Definition
| Exposure avoidance, long-term steroids for severe disease |
|
|
Term
| Positive Lymphocyte Transformation Test (LTT) |
|
Definition
| Berylliosis/ Chronic Beryllium Ds |
|
|
Term
| Hypersensitivity Pneumonitis |
|
Definition
| Occupational lung ds due to exposure to organic material; may progress to chronic fibrosis (honeycomb lung); usually due to a thermophilic fungus growing in/ on some raw, organic material |
|
|
Term
| Presentation of Hypersensitivity Pneumonitis |
|
Definition
| Acute - fever, dyspnea, cough in response to acute exposure; Chronic - slow, gradual onset of dyspnea due to progressive fibrosis, usually after long-term, low-level exposure |
|
|
Term
| Examples of Hypersensitivity Pneumonitis |
|
Definition
| Farmer's Lung - thermophilic actinomycetes found in hay; Bird Fancier's/ Pigeon Breader's Lung; Byssinosis - inhalation of cotton/ linen fibers, seen in textile workers; Suberosis - moldy cork dust; Bagassiosis - thermoactinomyces sacchari, sugar cane |
|
|
Term
| Pulmonary Alveolar Proteinosis |
|
Definition
| Intra-alveolar accumulation of amorphous, granular material; excessive production and/or defective clearance of surfactant-like material |
|
|
Term
| Interstitial Lung Disease (General) |
|
Definition
| Alveolitis progressing to interstitial fibrosis with subsequent alteration and distortion of lung architecture with resultant impairment of gas exchange; S/S - crackles, tachypnea, clubbing, cyanosis |
|
|
Term
| Increased Serum angiotensen converting enzyme (ACE) level |
|
Definition
| Seen in Sarcoidosis and other granulomatous diseases |
|
|
Term
|
Definition
| Show areas of macrophage activity |
|
|
Term
|
Definition
| Non-caseating granuloma; multi-system disease; Dx of exclusion |
|
|
Term
|
Definition
| 50% of patients are asymptomatic, of the other 50%, S/S include- Lofgren's Syndrome and uveoparotid fever |
|
|
Term
|
Definition
| Fever, uveitis, parotiditis; associated with sarcoidosis |
|
|
Term
|
Definition
| Acute onset of fever, arthralgia, hilar adenopathy and erythema nodosum; associated with Sarcoidosis; good prognosis |
|
|
Term
|
Definition
| Stage I - hilar adenopathy; Stage II - hilar adenopathy and lung infiltrates; Stage III - lung infiltrates - these are the patients that go on to develop end-stage honeycomb lung, which is Stage IV |
|
|
Term
| Morphology of Sarcoidosis |
|
Definition
| Schaumann bodies (concreted Ca++) and Asteroid bodies; neither are specific for sarcoidosis, they're just found in multinucleated giant cells, so they are a clue that you've got granulomas |
|
|
Term
|
Definition
| Gallium Scan shows a "Panda Sign"; Bronchoalveolar lavage differential shows increased lymphocytes (this is accompanied by peripheral lymphopenia), increased angiotensin converting enzyme (ACE) level; negative workup for TB, fungal and malignant processes (Dx of exclusion) |
|
|
Term
| Treatment for Sarcoidosis |
|
Definition
| Steroids (gradual taper of prednisone), ~65% of patients recover completely, ~20% have permanent disability; Tx is Stage-dependent: Stage I - no treatment is necessary, Stage II - treatment is necessary since <50% of patients will spontaneously resolve, Stage III - treatment is necessary since <25% of patients will spontaneously resolve, Stage IV - no treatment is possible/ necessary, the disease is too advanced |
|
|
Term
| Morphology of Idiopathic Interstitial Pneumonia/ Idiopathic Pulmonary Fibrosis (IPF) |
|
Definition
| Interstitial fibrosis, located subpleurally; Type II pneumocyte hyperplasia; patchy distribution; Temporal Heterogeneity (lesions of varying ages/ morphology are present) |
|
|
Term
| Lesions of which disease exhibit Temporal Heterogeneity? |
|
Definition
| Idiopathic Interstitial Pneumonia/ Idiopathic Pulmonary Fibrosis (IPF) |
|
|
Term
| Epidemiology and Presentation of Idiopathic Interstitial Pneumonia/ Idiopathic Pulmonary Fibrosis (IPF) |
|
Definition
| 40-70 y/o; M>F; s/s - exertional dyspnea, dry/non-productive cough, wt loss, fatigue, tachypnea, cyanosis, basilar crackles; PFTs show restrictive disease with decreased diffusion capacity; bronchoalveolar lavge differential shows increased neutrophils |
|
|
Term
| Imaging Findings in Idiopathic Interstitial Pneumonia/ Idiopathic Pulmonary Fibrosis (IPF) |
|
Definition
| Chest x-ray shows increased basilar lung markings; Gallium Scan shows diffuse uptake, but no "Panda sign" becuase the disease is confined to the lungs |
|
|
Term
| Prognosis of Idiopathic Interstitial Pneumonia/ Idiopathic Pulmonary Fibrosis (IPF) |
|
Definition
| The disease generally progresses to severe disease wtih cor pulmonale and respiratory insufficiency over a course of 5 to (rarely) 15 years; Desquamative Interstitial Pneumonitis (DIP, a variant of IPF, may have a better prognosis because it is more responsive to steroids; there is an increased incidence of bronchogenic carcinoma in patients with IPF |
|
|
Term
| Treatment of Idiopathic Interstitial Pneumonia/ Idiopathic Pulmonary Fibrosis (IPF) |
|
Definition
| High-dose prednisone, immunosuppression; anti-fibrotic medications such as interferon, colchicine, d-penicillamine |
|
|
Term
| Desqumative Interstitial Pneumonia (DIP) |
|
Definition
| A form of IPF; involves prominent intra-alveolar mononuclear cells, macrophages and epithelial cells |
|
|
Term
|
Definition
| Typically caused by mycobacterium tuberculosis which is acid fast; caseating granulomas; primary, secondary (reactivation) and progressive (miliary, cavitary and tuberculous bronchopneumonia); can also have non-tuberculous TB caused by M.avium, M.kansasi, M.abscessus, and others |
|
|
Term
|
Definition
| A lung lesion and the draining lymph nodes located in the mid-lung fields seen in primary TB |
|
|
Term
|
Definition
| Chest pain; prolonged, productive cough; hemoptysis; fever, chills, night sweats, fatigue, anorexia/ wt. loss; non-resolving or right upper lobe pneumonia should raise some red-flags indicating TB |
|
|
Term
| Chest x-ray findings in Primary TB |
|
Definition
| Mid/lower lung parenchymal infiltrate; hilar/ mediastinal adenopathy |
|
|
Term
| Chest x-ray findings in Secondary TB |
|
Definition
| Apical lung infiltrates; cavitation |
|
|
Term
|
Definition
| Chest x-ray; PPD/ Mantoux Test; Interferon Gamma test (helpful in cases of non-tuberculous TB, latent TB or in patients who have had the BCG vaccine) |
|
|
Term
|
Definition
| >15mm - positive in anyone; >10 mm - positive in recent (<5 yr) immigrants, IV drug users, people in congregate settings, kids <5; >5mm - positive in HIV patients, immunosuppressed patients, people with chest x-ray changes consistent with prior TB, people with recent contact with someone who has active TB |
|
|
Term
| Dissemination Pathways in TB |
|
Definition
| Erostion into lymphatics: thoracic duct to right heart to pulmonary a. back to lungs, disease remains in lungs; Erosion into Pulmonary a. - remains in lungs; Erosion into Pulmonary v. - left heart to aorta to systemic organs, dissemination throughout body |
|
|
Term
| Treatment for Latent TB in a patient who is PPD +/ HIV - |
|
Definition
| Isoniazid everyday for 9 months |
|
|
Term
| Treatment for Latent TB in a patient who is PPD+/ HIV + |
|
Definition
| Isoniazid everyday for 12 months |
|
|
Term
| Treatment for Latent TB in a patient who is PPD+/ abnormal chest x-ray or silicosis |
|
Definition
| Isoniazid and Rifampin for 4 months OR isonaizid for 12 months |
|
|
Term
|
Definition
| Isoniazid, Rifampin, Pyrazinamide and either ethambutol or streptomycin for 2 months followed by Isoniazid and Rifampin alone for 4 months |
|
|
Term
| Treatment of extrapulmonary TB |
|
Definition
| Treat it the same way you would treat pulmonary TB, except that in bone, joint and meningeal TB you need to use 12 months of treatment because of penetration issues |
|
|
Term
| Treatment for a patient who is M.avium +/ HIV- |
|
Definition
| Isoniazid, Rifampin and ethambutol for 18 months along with streptomycin for the first 8 weeks |
|
|
Term
| Treatment for Disseminated M. avium |
|
Definition
| Lifelong treatment with Clarithromycin or azithromycin, plus ethambutol, +/- Rifampin |
|
|
Term
| Most common fatal Autosomal recessive disorder among Caucasians |
|
Definition
| Cystic Fibrosis; Frequency is 1/2000-3000 live births |
|
|
Term
|
Definition
| Mutations in the CFTR gene located on chr.7; the CTFR protein regulates the movement of Cl- in and out of cells; movement, or lack of movement, of Cl- affects the movement of H2O across membranes as well |
|
|
Term
| Most Common Presenting S/S of Cystic Fibrosis |
|
Definition
| Persistent pulmonary infection; failure to thrive (CF is the most common pathologic cause of failure to thrive) |
|
|
Term
| Respiratory Manifestations of Cystic Fibrosis |
|
Definition
| Persistent, productive cough; hyperinflation of lung fields on chest x-ray, increased AP diameter; digital clubbing; chronic bronchitis with or without bronchiectasis; PFTs show a non-reversible obstructive pattern |
|
|
Term
| What organisms tend to colonize the airway of patients with Cystic Fibrosis? |
|
Definition
| S. aureus, H.influenza are common; P.aeruginosa is ultimately present in most patients |
|
|
Term
| Sinus Manifestations of Cystic Fibrosis |
|
Definition
| Sinus ds is present in most CF patients; nasal polyposis in 10-32% of CF patients; panopacification of sinuses on x-ray |
|
|
Term
| Pancreatic Manifestations of Cystic Fibrosis |
|
Definition
| Pancreatic insufficiency is present from birth in most CF patients - insufficient secretion of enzymes leads to malabsorption of fat and protein (steatorrhea); failure to thrive |
|
|
Term
| Intestinal Manifestations of Cystic Fibrosis |
|
Definition
| Meconium ileus is the presenting problem in 10-20% of newborns with CF and is virtually pathognomonic for the ds; episodes of small bowel obstruction may also occur in older children and adults with CF |
|
|
Term
| Reproductive System Manifestations of Cystic Fibrosis |
|
Definition
| In Men - 95% are infertile due to impaired sperm transport; In Women - 20% are infertile |
|
|
Term
| Diagnosis of Cystic Fibrosis |
|
Definition
| Sweat Cl- test is the gold standard - it detects 100%, if sweat Cl- is normal, the patient definitely does NOT have CF; Most newborns with CF will have elevated blood levels of immunoreactive trypsin (IRT) |
|
|
Term
| Treatment of Cystic Fibrosis |
|
Definition
| Antibiotics - oral, IV, aerosolized, macrolides; bronchodilators; airway secretion promoters (DNase, hypertonic saline, N-acetylcysteine); airway clearance devices (PEP mask, Flutter device, Postural drainage); exercise; avoid systemic glucocorticoids, but inhaled glucocorticoids are a mainstay of treatment; NSAIDs; supplemental O2; lung transplant |
|
|
Term
| Disorders of the Mucous Membrane |
|
Definition
| Chronic ds caused by staph and anaerobes; acute ds caused by normal respiratory pathogens (H.influenza, M.catarrhalis); chronic sinusitis - >8wks - with or without polyps (usu. with), eosinophils, IgE; Rhino-sinusitis - AKA the common cold/ acute sinusitis, 1-8 wks; Vasomotor Rhinitis - chronic, the patient gets congested when exposed to temperature changes; Atrophic Rhinitis - the patient has small or absent turbinates, but they feel obstructed as a result of the lack of resistance |
|
|
Term
|
Definition
| Very common; painful; golden yellow crusts that adhere to the nose hairs; S.aureus; occurs at any age; Treatment is hydrogen peroxide on a Q-tip then rub with neosporin; may take weeks to heal |
|
|
Term
| Sympathetic Innervation to the Nose |
|
Definition
|
|
Term
|
Definition
Acute, Localized - Staph folliculitis;
Acute, Diffuse - Swimmer's Ear;
Chronic - itching;
Acute - pain;
Treatment - clean, acidify (vinegar), and dry the ear; for acute diffuse ds use cipro
Psuedomonas is a common pathogen |
|
|
Term
|
Definition
| A frequent diagnosis in kids; follows a cold; may happen after flying |
|
|
Term
| S/S of Acute Otitis Media |
|
Definition
| otalgia, fever, hearing loss, purulent otorrhea; hyperemic, opaque, bulging tympanic membrane with poor mobility; systemically - lethargy, oirritability, anorexia, vomiting, diarrhea; you may see a bubble behind the TM - this means that there's fluid in the middle ear, but it's also encouraging because it means that the eustachian tube is working at least some of the time |
|
|
Term
| Etiology of Acute Otitis Media |
|
Definition
| Obstruction of the Eustachian tube; S.pneumo, H.influenza, M.catarrhalis, S.aureus, S.pyogenes, Beta-hemolytic strep |
|
|
Term
| Complications of Acute Otitis Media |
|
Definition
| Calcification of the ear drum (especially with repeated infections, doesn't interfere with hearing); patients can lose the middle ear space and the TM gets "sucked" down onto the ossicles; erosion of the ossicles; cholesteatoma |
|
|
Term
|
Definition
| Glistening, white; requires surgery; squamous epithelium gets into the middle ear; enzymes are secreted that erode the ossicles |
|
|
Term
| Suppurative/ Draining Otitis Media |
|
Definition
| P.aeruginosa; associated with cholestatoma; treatment is surgery and cipro |
|
|
Term
| Thoracic Trauma (General) |
|
Definition
| Thoracic trauma accounts for about 1/4 of all trauma deaths (2/3 of those deaths occur pre-hospital); only 10-15% of thoracic injuries require thoracotomy |
|
|
Term
| Primary Survey in Trauma Work-up |
|
Definition
A - obtain and maintain Airway;
B- evaluation and support of Breathing - oxygenation and ventilation (rate >25/min, pCO2 > 40 torr);
C- Circulation (pump and volume);
D - Deficits (neurological, vascular, orthopedic);
E - complete Exposure |
|
|
Term
|
Definition
| AKA Chest tube; Make the incision in the anterior axillary line at about the level of the 4th and 5th ribs (nipple line); you need to put your finger into the opening you made to make sure you've gone through the pleura and to make sure you can feel the lung and heart (not abdominal contents); angle the tube up if you're after air, down if you're after fluid |
|
|
Term
|
Definition
| Blood/ Fluid leaks into the pericardial sac, as little as 150cc can cause s/s; you get an equalization of cardiac pressures - contractions and relaxations aren't as effective, systolic and diastolic pressures get closer to each other and cardiac output suffers |
|
|
Term
|
Definition
| Hypotension, distended neck veins, muffled heart sounds; seen with pericardial tamponade |
|
|
Term
|
Definition
| A decrease of >10mmHg of BP on inspiration because of limitations on right heart return; seen with pericardial tamponade |
|
|
Term
|
Definition
| An increase in CVP with inspiration seen in the central lines of patients with pericardial tamponade |
|
|
Term
| What are the similarities of the S/S of Tension Pneumothorax and Pericardial Tamponade? |
|
Definition
| Both exhibit: respiratory distress, hypotension and jugular v. distention (increased CVP) |
|
|
Term
| What S/S Differentiate between Tension Pneumothorax and Pericardial Tamponade? |
|
Definition
Tension Pneumothorax - I/L decreased breath sounds, I/L hyperresonance to percussion, C/L tracheal deviation;
Pericardial Tamponade - tachycardia, muffled or distant heart sounds, pulsus paradoxus > 10mmHg |
|
|
Term
|
Definition
| Accumulation of pus within the pleural space; at least 1/2 are due to pneumonia (pneumonia progresses to abscess which progresses to empyema) |
|
|
Term
|
Definition
| I/L chest pain, heaviness, cough, fever, purulent sputum, dyspnea; decreased breath sounds, dullness to percussion on physical exam (both of which are caused by consolidation) |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Thoracentesis, tube thoracostomy, decortication |
|
|
Term
|
Definition
Empyema necessitatis (draining sinus) - abscess erodes through the chest wall;
costochondritis/ osteomyelitis;
bronchopleural fistula;
mediastinitis/ pericarditis;
dissmeinated (hematogenous) infection - brain and or renal abscesses |
|
|
Term
| Major causes of lung abscess |
|
Definition
| Anaerobic bacteria from oral gingiva (S.viridans, S.mutans, etc.) |
|
|
