-
a virtual space between individual alveoli
interstitium
-
from inhalation of silica
silicosis
-
The chest film will reveal diffuse rounded opacities, Contraction of the lungs may occur, Upper lung zones are primarily affected
coal miner's lung
-
black lung
coal miner's lung
-
occupational lung disease caused by the inhalation of dust
pneumoconiosis
-
Most commonly associated with mining, insulation, shipbuilding, cement mixing and sandblasting related occupations
silicosis
-
Higher rate of pulmonary tuberculosis in ____ patients
silicosis
-
Hilar lymph nodes calcify forming “eggshell” calcifications on chest films
silicosis
-
may lead to pleural disease characterized by plaques, effusion and fibrosis
asbestosis
-
Mesothelioma, Bronchogenic Carcinoma are malignancies caused by
asbestosis
-
“Pleural Plaques” are seen on chest films
asbestosis
-
diagnosis is based largely on the history of exposure and latency period. 20-30 year exposure history
asbestosis
-
Allergic pulmonary condition caused by inhalation of organic materials
Hypersensitivity Pneumonitis
-
Known causative agents include bacteria, molds, human and animal proteins and resins
Hypersensitivity Pneumonitis
-
Abrupt onset of fever, cough & dyspnea within 4-8 hours of exposure Infiltrates in the mid-to-lower lung distribution Resolution within 24 hours, after removal from exposure Often mistaken for community-acquired pneumonia, treated with antibiotics
Hypersensitivity Pneumonitis
-
Characterized as lung injury caused by the inhalation of nitrogen dioxide gas
Silo-Filler’s Disease
-
Carbon monoxide and cyanide poisoning impairs oxygenation causing tissue hypoxia
smoke inhalation
-
Ensuing airway edema and mucosal sloughing occurs
smoke inhalation
-
Routine use of corticosteroids and antibiotics has not been proven to be effective in treatment of
smoke inhalation
-
Topical administration of epinephrine may be used to reduce airway edema
smoke inhalation
-
_____ cannot differentiate carboxyhemoglobin from oxyhemoglobin.
pulse oximetry
-
CO has a ____ higher affinity for hemoglobin than does oxygen
250 X
-
____ deposits in the alveoli and the interstitium results in irreversible fibrosis
Fibrin
-
Loss of functional alveolar-capillary units, Impaired gas exchange that leads to hypoxemia and hypercapnia, Impaired lung compliance (stiff lungs)Progresses into Restrictive Lung Disease: smaller lung volumes and capacities (TLC, Tidal Volumes)
interstitial lung disease
-
Patchy “Ground Glass” appearance, Reticular (network) pattern, Honeycombing (thick-walled cystic spaces) in the lung periphery
interstitial lung disease
-
A nodular inflammatory lesion that may contain epithelial cells, phagocytes or macrophages
granuloma
-
A form of coagulation necrosis
caseating
-
A systemic disease of unknown origin characterized by granulomatous inflammation of the lung
sarcoidosis
-
Systemic disorder involving multiple organ systems, Highest incidence in black women, Onset in the 3rd decade of life
sarcoidosis
-
Elevated ESR, Leukopenia, Elevated ACE levels (40-80% prevalence)
sarcoidosis
-
Requires tissue biopsy of a lymph node showing non-caseating granulomas
sarcoidosis
-
Long-term corticosteroid therapy, ACE levels will tend to drop
treatment for sarcoidosis
-
A condition characterized by the presence of vasculitis and granulomatous lesions affecting the respiratory tract and kidneys
Wegener’s Granulomatosis
-
Small vessel vasculitis, Granuloma formation inflammation, Necrosis
triad of symptoms for Wegener’s Granulomatosis
-
Nasal septum perforation, crusting and ulceration may present, Deep vein thrombosis and pulmonary emboli are common, “Saddle Nose” deformity is a late stage finding
Wegener’s Granulomatosis
-
Idiopathic condition involving alveolar (lung) hemorrhage and rapidly progressive glomerulonephritis
Goodpasture's syndrome
-
Most prevalent in men within the 3rd and 4th decade of life, Pathology is linked to glomerular antibodies
Goodpasture's syndrome
-
Immunosuppressive Therapy is treatment for
Goodpasture's syndrome
-
Most common acute cause of cough in non-smoker
Viral infections
-
Cough due to acute respiratory tract infections resolves within _______ weeks in the vast majority of patients.
3
-
Persistent cough accompanied by excessive mucus secretions increases the likelihood of _____
COPD
-
what is suspected when acute cough is accompanied by vital sign abnormalities (tachycardia, tachypnea, fever)
Pneumonia
-
Rales, decreased breath sounds, fremitus, and egophony are findings suggestive of what
air space consolidation
-
Rales, decreased breath sounds, fremitus, and egophony are findings suggestive of what
Community acquired pneumonia
-
Wheezing and rhonchi are suggestive of what in the absence of asthma
acute bronchitis
-
normal jugular venous pressure and negative hepatojugular reflux decrease the likelihood of what
biventricular CHF
-
Get a chest radiograph if you suspect what
pneumonia
-
The most likely causes of cough with a clear chest x-ray and the absence of ACEI's
postnasal drip, asthma, GERD
-
The perception of uncomfortable breathing
Dyspnea
-
Rapid onset, severe dyspnea in the absence of other clinical features should raise the suspicion for
pneumothorax, pulmonary embolism, or increased left ventricular end-diastolic pressure
-
Is accompanied by chest pain and occurs mainly in young, thin adult males
Spontaneous pneumothorax
-
Most patients with pleuritic chest pain in the outpatient clinic have pleurisy due to
acute viral respiratory tract infection
-
Most cases of dyspnea with wheezing are due to
Acute bronchitis
-
pursed lip breathing, use of extra respiratory muscles and barrel shaped chest are indicative of
obstructive airway disease
-
asymmetric excursion
pneumothorax
-
metabolic acidosis
Kussmaul respirations
-
breathing is first rapid and shallow but as acidosis worsens, breathing gradually becomes deep, slow, labored and gasping
Kussmaul respirations
-
Focal wheezing raises suspicion of
foreign body or other bronchial obstruction
-
Testing of ______ can help distinguish cardiac from non-cardiac causes of dyspnea in the ED.
BNP
-
Pulse ox values below ____% almost always represents clinically important hypoxemia.
94
-
Urgent and emergent conditions causing acute dyspnea include
pneumonia, COPD, asthma, pneumothorax, pulmonary embolism, cardiac disease, metabolic acidosis, cyanide toxicity, methemoglobinemia, CO poisoning
-
The expectoration of blood that originates from below the vocal chords
hemoptysis
-
Most cases of hemoptysis in the outpatient setting are due to
infection (bronchitis, pneumonia, tuberculosis)
-
Flexible bronchoscopy is indicated for which patients
smokers, over the age of 40, greater than 1 week history of hemoptysis
-
Characteristic findings in a patient with chronic obstruction of the upper airway
Inspiratory stridor, intercostal retractions on inspiration, palpable thrill over larynx, wheezing localized to the neck.
-
Local parenchymal collapse
atelectasis
-
the trachea bifurcates into the mainstem bronchi at which levels anteriorly and posteriorly
Sternal angle, T4 process
-
the lower border of the lung lies at T __ level posteriorly
10
-
the lower border of the lung lies at __th rib level in the midclavicular line.
6
-
the lower border of the lung lies at __th rib level in the midaxillary line.
8
-
sensation of tingling or "pins and needles" around lips or in the extremities sometimes brought on by shortness of breath
paresthesias
-
Musical respiratory sounds that may be audible to the patient or others
wheezes
-
A reflex response to stimuli that irritate receptors in the larynx, trachea, or large bronchi.
cough
-
hemoptysis is seen most often in those with
cystic fibrosis
-
Audible stridor is a sign of
airway obstruction in the larynx or trachea
-
decreased fremitus can be caused by
obstructed bronchus, COPD, pleural effusion/fibrosis, pneumothorax, infiltrating tumor, very thick chest wall, soft voice.
-
When it comes to percussion normal lungs are
resonant
-
Dullness replaces resonance when
air is displaced by fluid or solid tissue
-
These breath sounds are soft and low pitched. They are heard throughout inspiration and continue without pause through expiration, and fade away 1/3 of the way through expiration
vesicular
-
These lung sounds are about equal in length in regards to inspiration and expiration. There may be a silent interval in-between
bronchovesicular
-
These breath sounds are loud and higher in pitch, with a short silence between inspiration and expiration. Expiratory lasts longer than inspiratory
bronchial
-
these sounds suggest secretions in large airways
rhonchi
-
Relatively low pitched with a snoring quality
rhonchi
-
relatively high pitched with a hissing or shrill quality
wheezing
-
increased transmission of voice through chest wall suggests
air-filled lung has become airless
-
Pain that is described as sharp or knife like is usually
pleural pain
-
pectus carinatum
pigeon chest
-
pectus excavatum
funnel chest
-
dyspnea that occurs in the supine position
orthopnea
-
Paroxysmal nocturnal dyspnea is associated with which condition
CHF
-
wheezing is generally associated with which condition
asthma
-
According to Cecil's the three most common causes of persistent cough are
postnasal drip, asthma, GERD
-
Massive hemoptysis is defined as more than ___ ml of blood in 24 hours
500
-
this pain is usually reproducible with movement or palpation over the affected area
musculoskeletal chest pain
-
fremitus is increased in areas of
underlying lung consolidation
-
fremitus is decreased in areas of
pleural effusion
-
What may cause hyporesonance to percussion
pnemothorax or hyperinflation
-
a course rattle or fine Velcro like sound
crackles
-
Heard in pulmonary edema, and interstitial fibrosis
crackles
-
A crunching sound timed with the cardiac cycle
Hamman's sign
-
Heard in patients with pneumomediastinum
Hamman's sign
-
Elasticity is usually measured as its inverse function ___________
compliance
-
The change in lung volume produced by a given chang in transpulmonary pressure
compliance
-
This is decreased in diseases such as pulmonary fibrosis, and pulmonary edema because of they restrict lung volume expansion
compliance
-
This is increased in emphysema because of the loss of elastic recoil
compliance
-
How does the body control the narrow range of normal pH
elimination or retention of carbon dioxide
-
The PaCo2 in blood is inversely proportional to the ______
minute ventilation
-
What is the strongest factor controlling ventilation
maintaining normal blood pH
-
The neuronal control of autonomic respiration resides in the _____
medullary reticular formation
-
The PaO2 versus ventilation curve is a mirror image of the ______ for hemoglobin
oxygen dissociation curve
-
the volume of air which can be inhaled or exhaled from a person's lungs in one minute
minute ventilation
-
defined as ventilation inadequate to keep PaCO2 from rising above normal
hypoventilation
-
the portion of blood that goes from the right side of the heart to the left without an opportunity for exchange of oxygen and carbon dioxide
shunt
-
When pulmonary capillary blood traverses unventilated lung units
physiologic shunt
-
the maximal amount of air that can be exhaled after maximum inhalation
forced vital capacity
-
"ee" sounds like "ay"
egophony
-
"99" sounds louder and clearer
bronchophony
-
Whispered sounds are clearer
whispered pectoriloquy
-
usually clears with coughing
rhonchi
-
does not clear with coughing
crackles
-
cough lasting <3 weeks
acute cough
-
cough lasting >3 weeks
persistent cough
-
most common cause of cough in smokers
low-grade chronic bronchitis
-
according to Pat the most common cause of acute cough in non-smokers
URI
-
Which ribs may be fractured due to cough
7-May
-
most common cause of hemoptysis in the US
airways disease
-
most common cause of hemoptysis in developing countries
tuberculosis
-
Enlargement and dilatation of the bronchioles
bronchiectasis
-
what does Amy Winehouse have
crack lung
-
FEV1
Forced Expiratory Volume in 1 second
-
Normal lungs can expire ____% of their vital capacity in 1 second
70
-
Patients with _______ have a low vital capacity but a normal FEV1
restriction
-
patients with _______ may have a normal vital capacity but a decreased FEV1
obstruction
-
________ is defined as a low FEV1/VC ratio
obstruction
-
________ is defined as a low vital capacity a low FEV1 but a normal FEV1/VC ratio
restriction
-
Hyperreactive airway state
asthma
-
episodic wheezing and shortness of breath
asthma
-
-
-
decreased respiratory drive
COPD
-
a change in structure and function of the right ventricle of the heart as a result of a respiratory disorder
cor pulmonale
-
low respiratory drive
COPD
-
exercise limiting organ of the body
heart
-
#1 cause of COPD in developed countries
tobacco smoke
-
steroids are added early in the treatment of this disease
asthma
-
steroids are added late in the treatment of this disease
COPD
-
removes overdistended regions to allow more normal regions to re-expand
Lung volume reduction surgery
-
progressive worsening over 1-3 days can lead to
potentially fatal asthma
-
lower respiratory tract starts below what anatomic structure
vocal chords
-
diagnosed by new infiltrate on exam or x-ray
pneumonia
-
#1 cause of death from infectious disease in the US is from
pneumonia
-
hospital acquired pneumonia is defined as symptom onset >___ hours after hospital admission
48
-
most common bacterium associated with pneumonia world wide
Streptococcus pneumoniae
-
pneumococcus colonizes ____% of healthy adults
10-May
-
May have associated non-respiratory syndromes (CNS, immune hemolytic anemia)
Mycoplasma pneumoniae
-
the original atypical pneumonia organism, although it is present in up to 1/3 of cases
Mycoplasma pneumoniae
-
‘Discovered’ in 1976 during an outbreak of pneumonia. Found in aquatic environments
Legionella pneumophila
-
50% of 20 year olds have serologic evidence of past infection. Organism is associated with chronic inflammatory diseases (atherosclerosis)
Chlamydia pneumonia
-
may cause necrotizing infiltrates or pneumatoceles
Staphylococcal pneumonia
-
may cause necrotizing infiltrates or pneumatoceles
gram negative
-
Inhalation of oropharyngeal or gastric contents (volume-dependent)
aspiration pneumonia
-
may cause necrotizing infiltrates or pneumatoceles
aspiration pneumonia
-
what is a factor that increases risk of infection with a drug resistant-pneumococci
recent beta lactam therapy (within the past 3 months)
-
what is a factor that increases risk of infection with a drug resistant-pneumococci
>65 years of age
-
factor that increases the risk for gram negative infection
residence in a nursing home
-
factor that increases the risk for enteric gram negative infection
underlying cardiopulmonary disease
-
factor that increases the risk for infection with pseudomonas aeruginosa
Corticosteroid therapy (> 10 mg/d of prednisone)
-
factor that increases the risk for infection with pseudomonas aeruginosa
Structural lung disease (bronchiectasis)
-
factor that increases the risk for infection with pseudomonas aeruginosa
Broad-spectrum antibiotics (> 7 d in past month)
-
Advanced generation macrolide
azithromycin or clarithromycin
-
Respiratory quinolone
Moxifloxacin, gatifloxacin, levofloxacin, or gemifloxacin
-
Outpatient therapy for pneumonia in otherwise healthy patients
Advanced generation macrolide
-
Outpatient therapy for pneumonia in otherwise healthy patients
azithromycin or clarithromycin
-
Outpatient therapy for pneumonia in otherwise healthy patients if patient is allergic to macrolides
doxycycline
-
Outpatient therapy for pneumonia in patients with cardiopulmonary disease and/or other modifying factors
Anti-pneumococcal fluoroquinolone
-
Outpatient therapy for pneumonia in patients with cardiopulmonary disease and/or other modifying factors
macrolide PLUS b-Lactam (oral cefpodoxime, cefuroxime, high-dose amoxicillin, amox/clavulanate; or parenteral ceftriaxone followed by oral cefpodoxime
-
rates of influenza has _____ compared to previous decade, possibly due to aging population and/or change in predominating viral strains (H3N2)
doubled
-
influenza has an incubation period of ___ days
4-Jan
-
Fever, myalgia, headache, malaise, nonproductive cough, sore throat, rhinitis are all symptoms of
influenza
-
Resolution in ___ days, though cough and malaise can persist for over 2 weeks
7-Mar
-
Children with influenza may present with
otitis media, nausea, vomiting
-
Viral cultures are optimal from ______ specimens and require specific viral culture media
nasopharyngeal
-
Only _______ effective against both Influenza A and B
ostelmavir and zanamivir
-
Who needs annual influenza vaccinations
Long term aspirin therapy
-
Who needs annual influenza vaccinations
pregnancy
-
Who needs annual influenza vaccinations
Chronic medical conditions (pulmonary, cardiac, metabolic, renal, neurologic, immunodeficiency, hemoglobinopathy)
-
Who needs annual influenza vaccinations
nursing home residents
-
Who needs annual influenza vaccinations
Age 6 months-18 years or >50 yr
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