UWORLD PULMONARY MEDICINE

What are the s/s for aspiration pneumonia?
foul smelling sputum
right lower lobe

What are the risk factors for aspiration pneumonia?
1. Altered Conciousness d/t seizures, ETOH, drug OD, CVA
2. Dysphagia d.t esophageal reflux, diverticula, obstruction
3. Neuro disorder d/t advanced dementia, Parkinsonism, myasthenia gravis
4. Sedation to procedures d/t bronchoscopy, intubation, endoscopy

What is hypersensitivity pneumonitis?
alveolar inflammation d/t repeated exposure to Ag
-most commonly birds droppings or molds w/farmers

What are s/s of acute hypersensitivity penumonitis?
cough
breathlessness
fever
malaise
4-6 hours after Ag exposure

Chronic exposure to Ags with HP can cause what with the lungs?
Pulmonary fibrosis and a restrictive lung pattern on spirometry

What are typical CXR findings in HP?
ground glass opacity or “haziness” in lower lung fields

What is tx for HP?
avoidance of exposure to Ags

What is the role of systemic corticosteroids in HP?
help speed recovery from acute sxs of HP
and are critical to severe episodes
but do not slow or reverse effects –> AVOID EXPOSURE

What is a common finding in association with asthma?
GERD

What is the most common primary trigger for asthma?
GERD

What s/s should be elicited during interview in adult-onset asthma sxs?
worst after meals
worst after exercise
worse when laying down

What should be started in adult-onset asthma which worsens after meals or at night when laying down?
PO PPI

When is Inhaled Fluticasone used?
pts with persistent asthma -sxs more than twice weekly

When is inhaled albuterol used?
acute asthma attacks for immediate relief

When are oral steroids used in asthma?
severe persistent asthma
emergency tx of asthma attacks

What are pulmonary embolism findings on ECG?
Right Axis Deviation

How is intermittent asthma dx’d?
daytime sx < 2/wk B-Agonist use<2/wk nighttime awakenings < 2/month Nl FEV1 Nl FEV1/FVC no limitations of daily activity

How is Mild Persistent Asthma dx’d?
sx > 2/wk but not daily
nighttime awakenings 3-4/month
Nl PFTs
minor limitations on daily activities

How to dx Moderate Persistent Asthma?
daily sx
weekly nighttime awakenings
FEV1: 60-80% predicted value
moderate limitations on daily activities

How to dx severe persistent asthma?
sx throughout day
frequent nighttime awakenings
FEV1<60% extreme daily activity limitations

What is therapy to intermittent asthma?
beta-agonist

What is tx for mild persistent asthma?
PRN B-agonist
Inhaled Corticosteroids

What is tx for Moderate persistent asthma?
PRN B-agonist
Inhaled corticosteroids
long acting B-agonist

What is tx for severe persistent asthma?
PRN B-agonist
Inhaled corticosteroids
long-acting B-agonist
PO Corticosteroids

What is tx for pulmonary thromboembolism?
IV unfractionated Heparin
OR
subcu LWMH
*for 5-6 days*
+
PO Warfarin

then d/c Heparin when INR reaches 2-3

How is digital clubbing described on exam?
pain in wrists
thickening of distal fingers
convex nail beds

What is Hypertrophic Osteoarthropathy?
digital clubbing
sudden onset arthropathy of wrists, hands, and joints

What is Hypertrophic Pulmonary Osteoarthropathy?
clubbing and srthropathy are attributable to underlying dz: Lung CA, TB, Bronchiectasis, or emphysema

How is compliance affected in COPD?
loss of alveolar and elastic tissue increases compliance

What are the effects of barrel chest and flattening of diaphragm?
harder to decrease intra thoracic pressure during inhalation
increased work of breathing

What s/s favor obstructive lung dz?
cough, SOB, significant smoking Hx
Bilateral wheezes, respiratory distress, accessory muscles for respiration, and prolonged expiratory time

What ABG is consistent with COPD?
Respiratory acidosis
hypercapnia
hypoxia

Nl serum pH?
7.34-7.43

What is nl serum O2?
75-100

What is nl serum C02?
35-45

What is normal serum bicarb?
22-26

What are the light criteria for defining whether pulmonary effusion is exudative?
1. pe protein/serum protein > 0.5
2. pe LDH/serumLDH>0.6
3. PE LDH > 2/3 upper limit for nl serum LDH

What are common causes of PE that are exudative?
Pulmonary embolism
malignancy
infection (pneumonia/TB)
CT dz
Iatrogenic

Transudative effusions are characterized by?
few WBCs
few RBCs
Glucose near serum levels

What causes hypoxemia in pts with pneumonia?
alveolar and interstitial inflammation
areas of V/Q mismatch
increases the alveolar-arterial oxygen gradient

What is the dx test of choice for recurrent pneumonia?
Chest CT

What are causes of recurrent pneumonia involving same region of lung?
LOCAL ANATOMIC OBSTRUCTION
-bonchial compression from CA, mediastinal adenopathy, or vascular anomaly
-Intrinsic Bronchial Obstruction-bronchiectasis, retained foreing body, bronchial stenosis

RECURRENT ASPIRATION
seizures, ETOH, drugs, GERD, dysphagia, achalasia

What are some causes of recurrent pneumonia involving different regions of lung?
Sinopulmonary dz (CF, immotile cilia)
Noninfectious (vascultis, bronchiolitis obliterans w/organizaing pneumonia)
Immunodeficiency (HIV, leukemia, decreased IGs)

Respiratory – Obstructive Pulmonary diseases

Difference between restrictive and Obstructive disorders: Restrictive disorders are altered chest and lung COMPLIANCE (affect inhalation only), Obstructive disorders are altered airway resistance (affect inspiration and expiration) Restrictive Lung Disorder Decreased expansion of the lungs due to alterations in the …

Chapt 7: Pulmonary

which describes the exchange of gases within the cells of the blood and tissues? internal respiration aka cell respiration which condition is the temporary absence of spontaneous respiration? apnea WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY …

Module 12: Alterations of Pulmonary Function

Which respiratory structure regulates lung ventilation by constricting and dilating? A) Pores of Kohn B) Diaphragm C) Bronchus D) Alveolus C) Bronchus Air is expelled from the alveoli during exhalation due to the effects of: A) surfactant. B) elastin. C) …

Pathophysiology 26 – Pulmonary – Objectives 9-11

Pneumonia infection of the lower respiratory tract caused by bacteria, viruse, fungi, protozoa, or parasites (anything that gets into lungs can cause pneumonia); 1) community-acquired pneumonia (streptococcus pneumonia primarily); 2) Hospital acquired (nosocomial) pneumonia; 3) Pneumococcal pneumonia; 4) viral pneumonia …

Aspiration pneumonitis

Define aspiration pneumonitis Acute lung injury d/t inhaled chemical irritants (acidic stomach contents, hydrocarbons, water – fresh or salt) What factors impact the magnitude of injury? pH (severe if pH 2.4) volume of aspiration osmolality presence of non-sterile particulate matter …

29) Classification of pulmonary infections, lobar pneumonia

What is a pulmonary infection? Pneumonia – infection of lung parencyhma How do we classify pneumonia? + Transmission + Anatomical location (patterns on x-ray) + Primary vs secondary + Causative agent WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY …

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