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Pulm sb
clinical medicine
| Question | Answer |
|---|---|
| asthma | chronic inflammatory disorder of the airways |
| atopy | complex interaction between multiple genes and environmental factors, leading to IgE mediated response to allergens |
| asthma clinical findings | cough, sob, wheezing, tachypnea, use of accessory muscles, wheezing, prolonged expiratory phase, agitation, cyanosis |
| differential of cough and wheezing in children | CRADLE (cystic fibrosis, respiratory TI, aspiration, dyskinetic cilia, lung and airwary malformation, edema chf) |
| asthma evolution | plasma cells in lung overreact and tell mast cells about it, in chronic esosinophils degranulate causing airway damage and eventually remodeling-fibrinoblasts lay down collagen |
| inhaled corticosteroid benefits | sx diminish and improve gradually, decreases use of rescues, lung function improves, occurrence of exacerbations reduce |
| COPD | many diseases characterized by chronic airflow obstruction |
| less than 0.7 | post BD- fev1/fvc of_______ confirms COPD |
| Suspect COPD in patients over 40 with | Dyspnea, chronic cough, chronic sputum production, exposure history, family history of COPD |
| Obstruction (PFT) | FEV1 is reduced out of proportion to total volume of forced exhalation (FVC) Ratio of FVV1:FVC is reduced 70% |
| GOLD staging | Gold 1- mild FEV1 >80% Gold 2- mod 50%<FEV1<80% Gold 3- Severe 30%<FEV1<50% Gold 4- very severe FEV1<30% |
| COPD risk factors | Smoking, exposure to products of combustion, occupational dusts/fumes/vapors, airway hyper reactivity, genetics |
| COPD airflow obstruction | Largely determined by resistance in small airways (airway remodeling, loss of elastic recoil, lumenal obstruction with mucous, bronchiolar lumenal narrowing |
| COPD hyperinflation | Obstruction increases end expiratory volume (Increases elastic recoil, increases expiratory flow, mechanical disadvantage, positive alveolar pressure must be overcome to breath) |
| COPD V/Q mismatch | variable from one pt to another, loss of hypoxic vasoconstriction, major determinant of decreases pao2 |
| COPD decreased diffusing capacity | loss of alveolar capillary bed, extent proportional to severity of emphysema |
| COPD alveolar hypoventilation | Adaptive response to increase WOB, increase paco2 decrease pao2 |
| Pink Puffer | emphysema predominates, less alveolar surface are for gas exchange, hyperventilate to compensate, ABG normal |
| Blue Bloater | Chronic bronchitis, alveolar space intact but airways obstructed, decrease ventilation, V/Q mismatch, air trapping, hypercanpia (CO increase) |
| COPD exacerbations | amplification of baseline airway inflammation, precipitated by infections environmental pollutants smoking, major determinant of outcomes in pts |
| COPD tx, FEV1 >60% and no sx | no pharm or a saba |
| COPD tx, FEV1 <60% | saba, laba, ics, pulm rehab, oxygen, azithromycin |
| COPD exacerbation causes | infections (most common), environmental pollution, unknown |
| Pulmonary Hypertension pathology | small pulmonary arteries, vasoconstriction vascular remodeling |
| Pulmonary Hypertension diagnosis | right heart cath, mean pulmonary artery pressure of greater than 25mmHg or mean pulmonary capillary wedge pressure of less than 15mmHg |
| Pulmonary Hypertension symptoms | dizziness +/- syncope SOB chest pain ascities edema fatigue |
| mTB bacteria | aerobic, nonmotile, bacillus with waxy lipid-rich outer wall (acid fast staining) |
| mTB pathogenesis | TB hits alveoli, macrophages engulf, transport to hilar lymphnodes, CD4 Tcells try to kill create caseous granulomas |
| Primary TB | refers to 1st exposure to inhaled infectious particles followed by flu-like illness, spread controlled sub pleural granulomas form, remain stable and no further spreading |
| Latent TB Infection | mTB survive for decades in walled off lesions, not infectious, risk of reactivation |
| Reactivated TB causes | Immune deficiency, AIDs, Immune modulated agents (occurs in 10-15% of pts half within 2 yrs of primary disease) |
| Reactivated TB symptoms | worsen over months, cough with sputum, low grade fever, weight loss, fatigue, hemoptosis and pleuritic pain (severe disease) |
| Miliary TB | initial exposure to mTB fails to incude cell-mediated immunity |
| Miliary TB physical exam | chronically ill-appearing, LAD choroid TB in eyes (dx with transbronchial biopsy) |
| Screening for TB | PPD (purified protein derivative) or interferon gamma release assay (IGRA) |
| Treating TB | RIPE (rifampin, isoniazid, pyrazinamide, ethambutol) and vit b6 |
| Fungal Pneumonia at risk populations | neutropenics, lupus/RA, organ transplant recipients |
| Histoplasmosis | transmitted by airborne spores inhaled from contaminated soil, primarily lungs and lymph chains (bat guano and chicken droppings) |
| Histobelt | southern Ohio, Missouri, Tennessee, Arkansas, Kentucky, Illinois |
| Histo symptoms | fever, fatigue, weight loss, hepatosplenomegaly, cough and dyspnea for greater than one month recurrent pneumonia |
| Histo dx testing | urine histo ag or blood/BM cx |
| Histo, coccidiodomycosis, and blasto treatment | liposomal amphotericin and itraconazole |
| Coccidiodomycosis geographic | american southwest, mexico |
| Coccidiodomycosis | transmitting by inhaling c immitis or c posadasil, 1-4 weeks of mild flu like illness, pleuritic chest pain resolves in a few weeks |
| Coccidiodomycosis DX | IgM/IgG serologies, fungal comp fix panel, tissue biopsy |
| Blastomycosis geographic | along mississippi, north, Canadian border |
| Blastomycosis | least common, can infect lungs skin and bone |
| Ubiquitous fungi | cryptococcus neoformans, aspergillosis |
| Cryptococcus neoformans | more commonly meningitis, yeast, mostly infect immunocompromised |
| cryptococcus neoformans sx | fever, weight loss, malaise, pleuritic pain, cough, wheeze, hemoptysis |
| Cryptococcus neoformans dx test | serum cryptococcal |
| Crytococcus neoformans tx | liposomal amphotercin, fluconazole |
| Aspergillosis | mostly infects immunocompromised (leading cause of death in acute leukemia, bone marrow transplant) |
| Aspergillosis dx | culture, serum galactomannan level, X-ray (solitary/multiple nodules, cavitary lesions) CT (halo sign, crescent sign) |
| Aspergillosis treatment | empiric, surgical excision, once diagnosis is established variconazole and caspofungin |
| Normal pulmonary defense | mucociliary clearance, cough and gag reflex, innate flora of oropharynx |
| Pneumonia pathophysiology | inhalation of pathogen, macrophages overwhelmed, inflammatory mediators |
| Phases of pneumonia | edema, red hepatization, gray hepatization, resolution |
| CAP pathogen | strep pneumo (most common) H flu, M cat, M pneumo, RSV |
| MRSA risk factors (pneumonia) | recent illness, flu, esrd, pleural effusion, multifocal infiltration, recent antibiotics, IVDA |
| Pneumonia typical | acute, thick brown yellow sputum, productive cough, high fever shaking chills, consolidation on cxr |
| Pneumonia atypical | gradual, clear sputum, low grade fever, no infiltrates |
| Pneumonia physical exam | inspiration crackles, bronchial breath sounds, dull to percussion, e to a changes |
| CURB 65 | confusion, uremia, rr (>30), bp (<90/<60), 65yo |
| Acute bronchitis | inflammation of tracheobronchial tree, cough 1-3 weeks duration, usually viral |
| DVT | thrombus usually found in the lower extremities, pelvic veins, and upper extremities |
| PE | obstruction of the pulmonary artery or its branches by material (fat, air, tumor, or thrombus) |
| Virchows triad (DVT) | venous stasis, venous injury, hyper-coagulability |
| Cause of death for PE | r ventricle after load increases, rv dilates, rv dysfunction, rv ischemia, rv failure |
| PE "the great masquerader" | non-specific symptoms, tachy, elevated neck veins, loud p2, pleural rub, humans sign (swollen, warm, erythematous) |
| PE EKG | sinus tach, RBBB, right axis deviation, P wave pulmonale, new a fib, rt ventricle strain |
| Wells criteria | clinical prediction model for PE |
| Gold standard for PE diagnosis | pulmonary angiogram |
| Massive PE | PE with systolic BP less than 90mmHg |
| Submassive PE | PE with RHF with normal BP |
| Small Cell carcinoma | extremely rapid growth, central location, almost always smokers, crush artifact |
| Non-small cell carcinoma | squamous cell carcinoma, adenocarcinoma, large cell |
| Squamous cell carcinoma | most common with hemoptysis, central location, exfoliates, aggressive |
| Adenocarcinoma | Most common lung cancer, slow growing, peripheral location, "scar" tumor, more common in non smokers |
| Large cell carcinoma | Poorly differentiated, peripheral, rapid growth |
| Cancer clinical presentation | constitutional symptoms most common, other symptoms related to local tumor growth, local spread, metastasis |
| Pancoast tumor | superior sulcus tumor, compresses brachial and cervical nerve roots, manifests as horners syndrome, anhydrosis, or arm pain |
| Paraneoplastic syndrome | endocrine hormone secretion, clubbing, anorexia, weigh loss/ cachexia, fever |
| Gold standard for cancer diagnosis | Surgical lung biopsy |
| TNM system | Tumor size and invasion, lymph Nodes, Metastasis |
| Stage 1 | no lymph nose involvement, surgical removal |
| Stage 2 and 3 | lymph nodes involved, larger tumor, multiple lung tumors, surgery radiation and chemo |
| Small cell carcinoma staging | limited or extensive both bad |
| Visceral pleura | adheres to lung, covers each lobe, gets blood from the brachial artery, limited lymphatic drainage, no innervation |
| Parietal pleura | adheres to chest wall, blood from systemic capillary, lymphatic drainage, innervated |
| Pleural effusion cause | excess production of fluid, decreased drainage |
| Pleural effusion classification | transudative, exudative |
| Transudative pleural effusion | disorder of hydrostatic or oncontic or hydrostatic forces, fluid seeps from vessels |
| Exudative pleural effusion | Disorder of inflammation, fluid exudes through wide gaps between cells, rich in cells and protein |
| Lights criteria | protein/serum protein ratio >0.5 LDH/serum LDH ratio >0.6 LDH> 2/3 the upper limit of normal serum |
| Treatment of exudative pleural effusion | bacterial infections (empyema) and malignancy need chest tube, chronic can lead to fibrosis, the rest of pts you drain or do surgically debride |
| Treatment of transudative pleural effusion | no chest tube needed, treat underlying cause, can do a thoracentesis to help with dyspnea |
| Pneumothorax physical exam | chest pain, dyspnea, hyperresonant, diminished tactile fremitis, decreased breath sounds |
| Pneumothorax Xray | peripheral absence of lung markings and the presence of a pleural stripe |
| Pneumothorax classifications | spontaneous, traumatic, tension |
| Primary Spontaneous | no underlying lung disease, peak incidence in the 3rd decade of life |
| Blebs | physical stress can cause small patches of irregular architecture which can rupture spontaneously |
| Secondary spontaneous | pneumothorax in a lung with underlying disease |
| Traumatic pneumothorax | penetrating chest injury, blunt chest injury, iatrogenic (healthcare on purpose or an oops) |
| Tension pneumothorax | Rapid accumulation of air in the pleural space, rise in pleural pressure, pressure can reduce blood flow, decrease CO, shock and death |
| Tension pneumothorax exam | low bp, absent/decreased breath sounds, hyperresonant, tracheal deviation |
| Tension pneumothorax treatment | needle decompression, chest tube |
| Pleuritis | pleural inflammation |
| Restriction causes | P (pleural) A (alveolar) I (interstitial) N (Neuromuscular) T(thoracic cage abnormalities) |
| Interstitial lung disease | diseases of the alveoli and interstitum |
| Usual Interstitial Pneumonia | most common idiopathic interstitial pneumonia, worst prognosis, does not respond to anti-inflammatory tx |
| Idiopathic Granulomatous | Sarcoidosis, second most common ILD, frequently a multi system disease |
| Sarcoidosis diagnosis and treatment | transbronchial biopsy to find granulomas, treat with corticosteroids |
| ILD Granulomatous | Chronic beryllium disease, hypersensitivity pneumonitis |
| ILD non-granulomatous | autoimmune disease, occupational exposure, drugs, radiation |
Created by:
duanea00
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