Term
| How will pH, HCO3 and PCO2 change with Metabolic acidosis/alkalosis and Respiratory acidosis/alkalosis? |
|
Definition
Metabolic = HCO3 and PCO2 go in the opposite direction of pH.
Respiratory = HCO3 and PCO2 go in the same direction as pH. |
|
|
Term
| What is the Gold Standard for diagnosing a PE? |
|
Definition
|
|
Term
| What is rusty colored sputum usually indicative of? |
|
Definition
|
|
Term
| What is the most common study in the evaluation of pleural effusions? |
|
Definition
|
|
Term
|
Definition
| the amount of air breathed in (inspired) or out (expired) during normal respiration (spontaneous breath) |
|
|
Term
| What is Inspiratory Reserve Volume (IRV)? |
|
Definition
| The additional air that can be inhaled after a normal tidal breath in. |
|
|
Term
| What is the Functional Residual Capacity (FRC)? |
|
Definition
| the amount of air left in the lung at end of normal breathing exhalation |
|
|
Term
| What is Vital Capacity (VC)? |
|
Definition
| the amount of air that can be forced out of the lungs after a maximal inspiration |
|
|
Term
| What is Residual Volume (RV)? |
|
Definition
| the amount of air left in the lung after a maximal exhalation (never expired) |
|
|
Term
| What is Inspiratory Capacity (IC)? |
|
Definition
| the volume that can be inhaled after a tidal breathe – out |
|
|
Term
| What is Expiratory Reserve Volume (ERV)? |
|
Definition
| the amount of additional air that can be breathed out after normal expiration |
|
|
Term
| What kind of pulmonary diseases will have a decreased FEV1? Decreased TLC? |
|
Definition
| Dec FEV1 = Obstructive. Dec TLC = Restrictive. |
|
|
Term
| What is the anion gap formula? |
|
Definition
|
|
Term
| Which type of asthma is intrinsic and extrinsic? |
|
Definition
Extrinsic = Allergic, IgE type.
Intrinsic = unrelated to allergens. |
|
|
Term
| What is the most common stimulus that evokes acute exacerbations of asthma? |
|
Definition
| Infection (viral more than bacterial). |
|
|
Term
| What is the most potent and effective long term control therapy for asthma? |
|
Definition
|
|
Term
| What is the role of Ipatropium Bromide in asthma therapy? |
|
Definition
| It is an anticholinergic used for quick relief in the treatment of asthma. |
|
|
Term
| Describe the 4 stages of asthma. |
|
Definition
1. symptoms less than 2 days/week with noctural symptoms less than 2 nights/month.
2. symptoms greater than 2 days/week but less than 1 time/day and nocturnal symptoms greater than 2x/month.
3. daily symptoms that affect activity and may last days.
4. Constant daytime symptoms that are extremely limiting and frequent nocturnal symptoms. |
|
|
Term
| How many short acting Beta2 canisters used per month is a risk factor for death from asthma? |
|
Definition
|
|
Term
| When is Magnesium Sulfate used in asthma treatment? |
|
Definition
|
|
Term
| What is status asthmaticus? |
|
Definition
| Status asthmaticus refers to severe bronchospasm that does not respond to aggressive therapies within 30 to 60 minutes |
|
|
Term
| Explain the "Rule of Twos" for controller therapy with asthma. |
|
Definition
Two beta-agonist canisters/year
Two doses of beta-agonists/week
Two nocturnal awakenings/month
Two unscheduled visits/year
Two prednisone bursts/year |
|
|
Term
| :inflammation of the nasal membranes with a symptom complex of any the following: sneezing, nasal congestion, nasal itching, and rhinorrhea. |
|
Definition
|
|
Term
| 2 common clinical features with Allergic Rhinitis? |
|
Definition
| Allergic shiners and the allergic salute with crease on nose. |
|
|
Term
| What are the treatment options for Allergic Rhinitis? |
|
Definition
| Antihistamines, decongestants, Leukotriene Inhibitors, mast cell stabilizers, anticholinergics and nasal/inhaled corticosteroids. |
|
|
Term
| Describe the criteria for acute, subacute and chronic sinusitis. |
|
Definition
Acute = Less than 4 weeks.
Subacute = 4-12 weeks.
Chronic = More than 12 weeks. |
|
|
Term
| What is the etiology of acute sinusitis with the 4 most common organisms? |
|
Definition
| Upper Respiratory infection (URI) generally of viral origin secondarily colonized by most commonly Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis and Staphylococcus aureus. |
|
|
Term
| What are the treatment options for Sinusitis? |
|
Definition
| Decongestants, antihistamines, nasal corticosteroids, and antibiotics. |
|
|
Term
| What Triad is commonly seen with COPD? |
|
Definition
| Triad of asthma, emphysema & chronic bronchitis |
|
|
Term
| What is the hallmark of COPD? |
|
Definition
| EXPIRATORY FLOW LIMITATION |
|
|
Term
| Describe the 3 stages of COPD based on predicted FEV1 values. |
|
Definition
1 - FEV1 greater than 50%.
2 - FEV1 between 35-49%.
3 - FEV1 less than 35%. |
|
|
Term
| Describe COPD (Chronic Bronchitis). |
|
Definition
| Blue Bloater, Chronic/recurrent cough with excess mucus production (at least 3 months during 2 consecutive years). |
|
|
Term
| What pulmonary conditions will present with purulent foul smelling phlegm? |
|
Definition
|
|
Term
| What is the standard first line treatment for COPD? What can also be given? |
|
Definition
| Short/Long term beta agonist is first line. Can also give anticholinergics, corticosteroids, theophyllines, oxygen and mucolytics. |
|
|
Term
| Which 3 classes of drugs are bronchodilators and are mainstays of drug therapy for COPD? |
|
Definition
| Beta 2 agonists, Anticholinergics and Methylxanthines (Theophylline). |
|
|
Term
| :A shrunken, airless state affecting all or part of a lung. |
|
Definition
|
|
Term
| :Chronic dilatation of bronchi or bronchioles as a sequel of inflammatory disease or obstruction. |
|
Definition
|
|
Term
| :Inflammation of the bronchioles. |
|
Definition
|
|
Term
| :Inflammation of the mucous membrane of the bronchial tubes. |
|
Definition
|
|
Term
| Most common cause of acute bronchitis? |
|
Definition
|
|
Term
| :An acute infection of lung parenchyma including alveolar spaces & interstitial tissue. |
|
Definition
|
|
Term
| Most common cause of CAP? |
|
Definition
|
|
Term
| Which type of pneumonia is seen most commonly in the military or in dorms? |
|
Definition
|
|
Term
| What is the most common cause of pneumonia that leads to the ICU? |
|
Definition
|
|
Term
| Most common viral cause of pneumonia in adults? Peds? |
|
Definition
Adults = Influenza.
Peds = RSV. |
|
|
Term
| 3 most common organisms for typical CAP? |
|
Definition
| Strep pneumo, H. flu and Staph aureus |
|
|
Term
| What are the 4 critical elements for pneumonia diagnosis? |
|
Definition
| CXR, Sputum culture, blood culture and CBC |
|
|
Term
| Most common first line antibiotic treatment for CAP? |
|
Definition
|
|
Term
| What drug class is used to treat CAP if it is resistant to PCN and Macrolides? |
|
Definition
|
|
Term
| Define the CURB-65 prediction rule of when to hospitalize a pneumonia patient. |
|
Definition
| Confusion, BUN over 20, RR over 30, BP under 90/60 and age over 65 with any 3 of the above. |
|
|
Term
| Which CAP vaccine is given to children? Adults? |
|
Definition
Children = Pneumococcal Conjugate Vaccine (PCV).
Adult = Pneumococcal Polysaccharide Vaccine (PPV) or Polyvalent Vaccine. |
|
|
Term
| Which kind of pneumonia is frequently a result of aspiration in alcoholics? |
|
Definition
|
|
Term
| Describe the sputum seen with Klebsiella pneumonia. |
|
Definition
| abundant, thick, tenacious, and blood-tinged sputum sometimes called currant jelly sputum. |
|
|
Term
| When will HAP typically develop after admission? |
|
Definition
| Greater than 48 hours after admission. |
|
|
Term
| What are the most common organisms of HAP? |
|
Definition
| Enteric Gram negative GI flora and MRSA |
|
|
Term
| What is the drug treatment of choice for MRSA? |
|
Definition
|
|
Term
| Which strain of Influenza only infects humans? |
|
Definition
|
|
Term
| Most common cause of bronchiolitis and pneumonia among infants and children under 1 year of age? |
|
Definition
|
|
Term
| What is the treatment of choice for PCP? |
|
Definition
| TMP/SMX (Bactrim and Septra) |
|
|
Term
| What is a pulmonary abscess and what will it look like on CXR? |
|
Definition
| It is pus inside the lung and it will appear on CXR as a rounded opacity. |
|
|
Term
| Describe the sputum seen with a pulmonary abscess. |
|
Definition
|
|
Term
| What is the typical etiology of a pulmonary abscess? |
|
Definition
| Aspiration of oropharyngeal flora. |
|
|
Term
| :TB that spreads to whole body through blood |
|
Definition
|
|
Term
| What is the Tx regimen for TB? |
|
Definition
| Isoniazid (INH) + (Rifampin, Ethambutol, Pyradinamide or Streptomycin). |
|
|
Term
| Most common bacteria causing epiglottitis? |
|
Definition
|
|
Term
| What are some clinical signs of epiglottitis? |
|
Definition
| Muffled voice and drooling. |
|
|
Term
| What is the most common method of diagnosing epiglottitis? |
|
Definition
| Lateral soft tissue of the neck x-ray |
|
|
Term
| :Viral, upper airway, inflammation with, dyspnea, barking cough, inspiratory stridor, hoarseness |
|
Definition
| Croup or (Laryngotracheobronchitis) |
|
|
Term
|
Definition
| Parainfluenza type 1 virus |
|
|
Term
| 3 most common secondary bacterial pathogens seen with CF? |
|
Definition
| Psuedomonas, Staph aureus and H. flu |
|
|
Term
| What are the 2 most common organs involved in sarcoidosis? What are 2 common skin manifestations of Sarcoidosis? |
|
Definition
| Lungs and lymph nodes. Skin manifestations include Erythema nodosum and lupus pernio. |
|
|
Term
| What is Lofren's syndrome? |
|
Definition
| A type of sarcoidosis characterized by hilar LAD, erythema nodosum and uveitis. |
|
|
Term
| Describe the 4 stages of sarcoidosis in the lungs. |
|
Definition
1. Hilar LAD.
2. LAD + infiltrates.
3. Just infiltrates.
4. Fibrosis. |
|
|
Term
| What is the most sensitive test for interstitial lung disease? |
|
Definition
|
|
Term
| What are the most common neurological manifestations of Sarcoidosis? |
|
Definition
| Cn 7 and 8 neuropathies. (facial paralysis and hearing loss). |
|
|
Term
| How is Sarcoidosis diagnosed? |
|
Definition
| Clinical, radiographic and biopsy findings. |
|
|
Term
| What is the standard treatment for an active inflammation of sarcoidosis? |
|
Definition
|
|
Term
| What part of the lungs does Sarcoidosis like to go to? Asbestosis? Silicosis? |
|
Definition
Sarcoidosis = Upper lungs.
Asbestosis = Lower lungs.
Silicosis = Upper lungs. |
|
|
Term
| What do pleural plaques indicate? |
|
Definition
| Past exposure to Asbestos. |
|
|
Term
| How will Asbestosis typically appear on CXR? |
|
Definition
| Typically in the lower borders that obstruct the diaphragm and cardiac borders. It will have a "ground glass" appearance and "honeycombing" with a more advanced state. |
|
|
Term
| How long does it typically take Asbestosis to appear post exposure? Mesothelioma? |
|
Definition
Asbestosis = 10 years.
Mesothelioma = 30-35 years. |
|
|
Term
| :Progressive pulmonary fibrosis commonly due to occupational exposure in Mining, stone cutting, cement. Foundry, glass making, making abrasive soapes, stone quarrying (granite), sandblasting (silica, quartz) |
|
Definition
|
|
Term
| Describe the nodules that form around the bronchioles in Silicosis. |
|
Definition
| They resemble "onion skin". |
|
|
Term
| What is the major conditions that Silicosis increased a patients risk for? |
|
Definition
|
|
Term
| How will Silicosis appear on CXR? |
|
Definition
Acute = "crazy paving".
Chronic = "eggshell" calcifications around lymph nodes. |
|
|
Term
| What are the most common disorders associated with ARDS? |
|
Definition
| Pneumonia, FB Aspiration, Pulmonary contusion, Sepsis, Severe trauma and Drug overdose. |
|
|
Term
| Describe the Exudative, Proliferative and Fibrotic phases of ARDS. |
|
Definition
Exudative phase (days 1-7).
Proliferative phase (days 7-21).
Fibrotic phase (>21 days). |
|
|
Term
|
Definition
| Keep lungs dry and give corticosteroids. |
|
|
Term
|
Definition
| Clinical criteria + sweat test |
|
|
Term
| 2 most common causes of hemoptysis? |
|
Definition
| Bronchitis and bronchogenic cancer |
|
|
Term
| 2 most common causes of massive hemoptysis? |
|
Definition
|
|
Term
| Most common form of lung cancer? |
|
Definition
|
|
Term
| What is the percentage of METS for small cell, large cell, adenocarcinoma and squamous cell lung cancer? |
|
Definition
Squam = greater than 50%.
Large and Adeno = 80%.
Small = 95%. |
|
|
Term
| Which kind of lung cancer is most sensitive to chemotherapy? |
|
Definition
|
|
Term
| What are the two most common benign lung neoplasms? |
|
Definition
| Bronchial adenomas and hamartomas |
|
|
Term
| What is the 5 year survival rate for typical carcinoids? Atypical? |
|
Definition
Typical = 90%.
Atypical = 65%. |
|
|
Term
| How will Hamartomas be seen on CXR? |
|
Definition
| peripheral "popcorn" calcifications |
|
|
Term
| In the TNM staging system describe what T0, TX and T4 stand for. |
|
Definition
T0 = No evidence of tumor.
TX = Positive cytology but no evidence of tumor on CXR or bronchoscopy.
T4 = Tumor invades mediastinum. |
|
|
Term
| In the TNM staging system describe what N0, NX and N3 stand for. |
|
Definition
N0 = No regional node involvement.
NX = Nodes cannot be assessed.
N3 = Contralateral mediastinal node involvement. |
|
|
Term
| In the TNM staging system describe what M0, MX and M1 stand for. |
|
Definition
M0 = No distant METS.
MX = Distant METS cannot be assessed.
M1 = Distant METS present. |
|
|
Term
| How will a pulmonary infarction appear on CXR? How about a very large PE? |
|
Definition
| "Hamptons Hump". A large PE may show "Westermark's sign". |
|
|
Term
| What percentage of patients with a PE die within the first 30 days of diagnosis, even with treatment? |
|
Definition
|
|
Term
| What is the PERC (Pulmonary Embolism Rule out Criteria) Rule? |
|
Definition
| Low pre-test probability PLUS: Less than 50, HR less than 100, O2 sat greater than 94%, no hormone use, no hemoptysis, no unilateral leg swelling, no recent major surgery/trauma and no prior PE or DVT. |
|
|
Term
| What is the most common EKG finding with a PE? |
|
Definition
| PEA - pulseless electical activity |
|
|
Term
|
Definition
| HIV - Hypercoagubility, Intimal vessel injury and Venous stasis. Risk factors for PE. |
|
|
Term
| What blood test is used to check for a PE? |
|
Definition
|
|
Term
| What is the treatment for PE? |
|
Definition
| Stat anticoagulants (Heparin and then LMWH or Lovenox). |
|
|
Term
| When would you use a thrombolytic instead of an anticoagulant for PE treatment? |
|
Definition
| If they have a high risk of dying if anticoagulation isnt done fast, bc thrombolytics work faster but also increase risk of hemorrhage. |
|
|
Term
| What is the standard diagnosis for DVT? |
|
Definition
|
|
Term
| What is the most common cause of pleural effusions? |
|
Definition
|
|
Term
| What are the causes of Transudative pleural effusions? |
|
Definition
| CHF, or other non-infectious disease processes. |
|
|
Term
| What are the causes of Exudative pleural effusions? |
|
Definition
| Infection, cancer or autoimmune |
|
|
Term
| Most common form of exudative pleural effusion? |
|
Definition
|
|
Term
| What volume would it take for a pleural effusion to present with dyspnea on exertion? |
|
Definition
|
|
Term
| What are the typical characteristics of a Chylothorax? What should you check? |
|
Definition
| White, turbid, milky colored pleural effusion. Need to check triglycerides, cholesterol and total lipid content. |
|
|
Term
| What should you suspect with a black pleural effusion? Brown (chocolate)? Yellow-green? Highly viscous? Putrid odor? Ammonia odor? |
|
Definition
Black = think aspergillus.
Brown(chocolate) = think rupture of amebic liver abscess.
Yellow-green = think rheumatoid pleurisy.
“highly viscous” = think cancer, malignant mesothelioma.
Putrid odor = think anaerobes.
Ammonia odor = think urinothorax. |
|
|
Term
| What condition is most commonly associated with a secondary pneumothorax? |
|
Definition
|
|
Term
| What is the most common PE finding with a spontaneous pneumothorax? |
|
Definition
|
|
Term
| What is the gold standard for diagnosing pneumothoraces? What is actually used? |
|
Definition
| GS = CT. CXR is used more though. |
|
|
Term
| What is the etiology of Hyaline Membrane Disease (HMD)? |
|
Definition
| Also called Respiratory Distress Syndrome and is most common in premature infants due to the lack of surfactant production. |
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