Term
| what is the GOLD STANDARD test for PE? |
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Definition
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Term
| indications for bronchoscopy... |
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Definition
| abnormal CXR, hemoptysis, opportunistic lung infections, retained secretions and mucous plugs, unexplained cough > 6 weeks, cancers |
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Term
| contraindications for bronchoscopy... |
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Definition
| uncooperative patient, unstable angina, uncontrolled cardiac arrhythmias and HTN, refractory hypoxemia, lack of bronchoscopy expertise, MI, tracheal stenosis |
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Term
| pleura fluid exudative examples... |
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Definition
| hemorrhage, infection, inflammation, malignancy, iatrogenic, connective tissue disorders, endocrine disorder |
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Term
| transudative pleural fluid examples.. |
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Definition
| CHF,nephrotic syndrome, hypoalbuminemia, cirrhosis, atelectasis, peritneal dialysis, SVC obstruction |
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Term
| 3 main categories of info in PFTs... |
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Definition
| lung volumes, flow rates, diffusing capacity |
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Term
| this measures the transfer of gas from the alveolus to the capillary... |
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Definition
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Term
| common causes of metabolic alkalosis... |
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Definition
| vomiting, nasogastric suctioning, loss of potassium, drugs (diuretics, corticosteroids) |
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Term
| some causes of metabolic acidosis... |
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Definition
| diarrhea, renal failure, accumulation of organic acids, drugs (salicylates, methanol) |
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Term
| helps determine causes of metabolic acidosis. calculated by AG=Na+ - (Cl- +HCO3-). Normal is 8-12 mmol/L |
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Definition
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Term
| the most common stimulus that evokes acute exacerbations of asthma... |
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Definition
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Term
| most potent and effective long term control therapy for asthmatics |
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Definition
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Term
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Definition
| mild intermittent symptoms. <2 days per week, asymptomatic. symptoms<2 nignts per month. PEF normal between episodes. |
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Term
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Definition
| >2 times per week, but <1 time per day: nocturnal >2 times per month. FEV1/PEF 60-80%. |
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Term
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Definition
| DAILY symptoms, daily short-acting agonsits; episodes > 2 times per week. FEV1/PEF< 60%-80% predicted |
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Term
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Definition
| severe persistent. constant daytime symptoms limiting physical activity; frequent nocturnal symptoms FEV1 <60% predicted. |
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Term
| this refers to severe bronchospasm that does not respond to aggressive therapies within 30-60 minutes |
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Definition
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Term
| triad of asthma, emphysema, and chronic bronchitis. these patients are usually over 40. have fied airflow obstruction on spirometry. |
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Definition
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Term
| what is the hallmark of COPD? |
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Definition
| EXPIRATORY FLOW LIMITAITON. ability to expel air is compromised, hyperinflation and air trapping, rib cage reconfigures over time, ventilatory muscles adapt temporarily. |
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Term
With this condition chronic/recurrent cough with EXCESS mucus production. you will also have a V/Q mismatch from bronchial narrowing and mucous plugging.
"blue bloaters" |
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Definition
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Term
| AIR TRAPPING AND LOSS OF ELASTICITY is a sign of this disease.... |
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Definition
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Term
| what kind of heart failure will you see in COPD patients? |
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Definition
| COR PULMONALE(due to RV hypertrophy due to pulmonary HTN) |
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Term
| what will a COPD pt look like on their PFT's? |
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Definition
| OBSTRUCTIVE PATTERN(decreased FVC, FEV1, FEV1/VC), HYPERINFLATION (increased TLC), AIR TRAPPING (increased RV) |
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Term
| For stage 1,2, and 3 COPD pt's...how do you treat them? |
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Definition
stage 1 (>50%)FEV1= short acting B2 agonist PRN (albuterol)
stage 2- (35-49%) add anticholinergic (atrovent)
stage 3- (<35%) add long acting B2 agonist (salmeterol) and theophyline (has side effects)- consider oral glucocorticoid |
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Term
| the most important intervention in disease modification in COPD patients.... |
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Definition
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Term
| the mainstay of drug therapy for COPD. there are three types- anticholinergics, beta2 agonists, and methylxanthines. |
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Definition
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Term
| use these bronchodilators for patients with MILD symptoms...(SOB on exertion) |
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Definition
| short acting bronchodilators |
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Term
| use these bronchodilators for patients who still have symtoms on short acting. for moderate disesase. |
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Definition
| long acting bronchodilators |
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Term
| consider these meds for pts who have maximal bronchodilator therapy. NOT recommended as firt line therapy in COPD. for mod-severe disease pts. |
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Definition
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Term
| productive cough >3months in 2 consec. years, in absence of any other disease to accout for symtoms... |
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Definition
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Term
| most common cause of community acquired pneumonia.... |
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Definition
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Term
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Definition
| mycoplasmal pneumoniae (50% military/students), chlamydia pneumoniae, legionella pneumonophila (in ICU patients) |
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Term
| when can you give quinolone in community acquired pneumonias? |
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Definition
| recommended if: failed therapy, allergy to recommended agents, highly resistant infection |
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Term
| what type of pneumonia would you suspect in a pt that presented with high fever, severe pneumonia in pts over 50? |
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Definition
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Term
| what lab work would you get on an admitted pneumonia patient? |
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Definition
| CXR, sputum gram stain, C and S, blood C&S x 2 different sites, CBC. |
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Term
| What is the empirical tx for CAP- out-patient> |
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Definition
| macrolides, doxycyline, fluroquinolones (for pts over 50) |
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Term
| in determining if a pt should be admitted to the hospital, what factors do you look at? |
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Definition
| Confusion, BUN >20, RR>30, BP <90/60, any age >65. with any three, admit (CURB 65 PREDICTION RULE) |
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Term
| if you have an alcoholic come in the ER that has pneumonia based on his xray, which type of pneumonia would you suspect? |
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Definition
| Klebsiella pneumonia (due to aspiration in alcoholics...often in upper lobes due to anaerobic bacteria) |
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Term
| if you have a pt that has been in the hospital for 3 days, and presents with cough, purulent sputum, fever, and CXR shows parenchymal infiltrate, and pt is on ventilator.,..what type of pneumonia do you suspect? |
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Definition
| hospital acquired pneumonia (nosocomial) |
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Term
| this is the most common cause of death in epidemics... |
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Definition
| complicating staphylococcal pneumonia |
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Term
| most common cause of bronchiolitis and pneumonia among infants and children under 1 yo.. |
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Definition
| RSV- single stranded RNA virus of the family paramyxoviridae. |
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Term
| if a pt presents to the ER with pneumonia and a hx of working with birds, what type of pneumonia do they probably have? |
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Definition
| psittacosis- caused by chlamydia psittaci (parrot fever) |
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Term
| on xray this shows thick wall opacity rounded or oval air-fluid line on dependent lung area... |
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Definition
| pulmonary abscess (complication of aspiration pneumonia, usually from oropharyngeal flora)give clindamycin |
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Term
| you know that a PPD test is positive if you have these results... |
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Definition
5mm or greater in HIV or immunocompromised pt
10mm or greater in high risk setting
15mm or greater in normal pt |
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Term
| this is an inflammatory disease/ chronic multisystem disorder with UNKNOWN etiology. requires 2+ systems for Dx. LUNG IS #1 organ involved. others are skin, eye, liver, lymph nodes. subacute, self-limiting, chronic, waxing and waning. an exaggerated cellular immune respone to an unknown antigen.blacks>white, women>men. |
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Definition
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Term
| what is the HALLMARK of sarcoidosis? |
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Definition
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Term
| this is a condition with hilar adenopathy in lungs, erythema nodosum, uveitis, fever, arthritis. good prognosis. |
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Definition
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Term
| what are some clinical symptoms of a pt with sarcoidosis? |
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Definition
| asymptomatic--> organ failure. cough and dyspnea are most common for approx 2-4 weeks, cutaneous and ocular, fatigue, fever, night sweats, wt loss, lymph nodes and other symptoms. |
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Term
| with a pt with sarcoidosis, what are the 4 stages that occurs in the lungs? |
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Definition
1= hilar adenopathy
2= adenopathy and infiltrates
3= infiltrates
4= fibrosis |
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Term
| diagnosis is based on this for sarcoidosis... |
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Definition
| based on clinical, radiographic and histologic findings. need to biopsy! |
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Term
| what drugs to you give pts with active inflammation from sarcoidosis? |
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Definition
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Term
| this is a condition where diffuse interstitial disease of the lung that is directly related to intensity and duration of exposure. usually exposed for a min of 10 years before disease manifests. end result if fibrotic lesions. hx of mining, milling, mineral silicates, building trades. |
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Definition
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Term
| how would a pt with asbestosis present? |
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Definition
| progressive dyspnea, non-productive cough, fatigue, clubbing, crackles, rales or if severe Cor Pulmonale. x ray findings- start in LOWER lobes with indistinct heart border. may show pleural effusion, ground-glass appearance, "honeycombing" (more advanced disease) |
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Term
| this condition will present 30-35 years after exposure. pt may complain of pain, hoarseness, dysphagia, horner's syndrome, brachial plexopathy, ascites. extrathoracic spread in over 90% of patients. xray will show UNILATERAL PLEURAL EFFUSIONS. POOR prognosis. |
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Definition
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Term
| if patient has progressive pulm fibrosis and has hx of working with cement, mining, stone cutting. inhaled silica. acute will show "CRAZY PAVING" and chronic will show "EGGSHELL" calcifications. predominance in UPPER LOBES. |
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Definition
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Term
| If pt presents with diffuse, small, rounded opacities or nodules on xray, and has hx of working in coal mine... |
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Definition
| coal worker's pneumoconiosis |
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Term
| if pt presents with SEVERE dyspnea, rapid onset, diffuse infiltrates, hypoxemia, resp failure.... |
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Definition
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Term
| These are some examples of ARDS due to DIRECT injury... |
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Definition
| pneumonia, aspiration, near-drowing |
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Term
| These are some examples of indirect injury with ARDS... |
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Definition
| sepsis, severe trauma, drug overdose, post cardiopulmonary bypass |
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Term
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Definition
exudative phase (days 1-7)
proliferative phase (days 7-21)
fibrotic phase (>21 days) |
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Term
| these lung changes occur in the exudative phase in ARDS... |
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Definition
| atelectasis, reduced compliance, shunting, V/Q mismatch, hypoxemia |
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Term
| day 7-21 proliferative phase in ARDS... |
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Definition
| either improvement, weaning from vent or progressive injury, interstitial inflammation, early fibrosis |
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Term
| lung changes in fibrotic phase in ARDS...(>21 days) |
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Definition
| if no recovery, extensive fibrosis, long term ventilatory support, oxygen, emphysematous changes |
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Term
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Definition
| mechanical ventilation, corticosteroids, fluid management (dry lung= happy lung) |
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Term
| autosomal recessive disorder with a mutation on chromosome 7 that is usally diagnosed in childhood. multisystem disease. median survival is in 30's |
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Definition
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Term
| in this condition the lung tissue becomes thick, stiff or scarred |
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Definition
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Term
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Definition
| vessel injury, venous stasis, hypercoaggable state |
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Term
| patient's common complaints with PE... |
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Definition
| tachycardia, pulse >100, tachypnea, pulse ox <95% RA |
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Term
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Definition
| apex-central, pleural-based, wedge-shaped area of infiltrate |
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Term
| What is WESTERMARK'S SIGN? |
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Definition
| unilateral lung oligemia that is a rare sign of a very LARGE pulm embolism |
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Term
| this drug has anti-inflammatory properties, and it helps with pulmonary vasculitis caused by the PE |
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Definition
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Term
| this drug is good for reversing PE FASTER than standard antithrombolytic pathways alone, but RISK OF HEMORRHAGE is the main problem. |
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Definition
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Term
| Most common form of lung cancer |
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Definition
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Term
| this is a tumor in the apex of the lung with involvement of the 8th cervical and 1st and 2nd thoracic nerves, with shoulder pain. |
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Definition
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Term
| treatment for pancoast tumor.. |
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Definition
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Term
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Definition
| most are bronchial adenomas and hamartomas. primary tx is SURGERY |
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Term
80% central, slow growinng endobronchial lesions, 50% of all benign neoplasms
80-90% of them are carcinoids
Avg age 45(range 15-60)
Symtomatic for years, chronic cough, hemoptysis, atelectasis, lobar collapse, pneumonitis, abscess? |
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Definition
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Term
| this is characterized by "POPCORN" calcifications... |
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Definition
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Term
| this resembles white, turbid, milky color- FAT. "chylomicrons" in the pleural fluid. |
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Definition
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