Pulmonology 1

a virtual space between individual alveoli

from inhalation of silica

The chest film will reveal diffuse rounded opacities, Contraction of the lungs may occur, Upper lung zones are primarily affected

black lung

occupational lung disease caused by the inhalation of dust

Most commonly associated with mining, insulation, shipbuilding, cement mixing and sandblasting related occupations

Higher rate of pulmonary tuberculosis in ____ patients

Hilar lymph nodes calcify forming “eggshell” calcifications on chest films

may lead to pleural disease characterized by plaques, effusion and fibrosis

Mesothelioma, Bronchogenic Carcinoma are malignancies caused by

“Pleural Plaques” are seen on chest films

diagnosis is based largely on the history of exposure and latency period. 20-30 year exposure history

Allergic pulmonary condition caused by inhalation of organic materials

Known causative agents include bacteria, molds, human and animal proteins and resins

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

Characterized as lung injury caused by the inhalation of nitrogen dioxide gas

Carbon monoxide and cyanide poisoning impairs oxygenation causing tissue hypoxia

Ensuing airway edema and mucosal sloughing occurs

Routine use of corticosteroids and antibiotics has not been proven to be effective in treatment of

Topical administration of epinephrine may be used to reduce airway edema

_____ cannot differentiate carboxyhemoglobin from oxyhemoglobin.

CO has a ____ higher affinity for hemoglobin than does oxygen

____ deposits in the alveoli and the interstitium results in irreversible fibrosis

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)

Patchy “Ground Glass” appearance, Reticular (network) pattern, Honeycombing (thick-walled cystic spaces) in the lung periphery

A nodular inflammatory lesion that may contain epithelial cells, phagocytes or macrophages

A form of coagulation necrosis

A systemic disease of unknown origin characterized by granulomatous inflammation of the lung

Systemic disorder involving multiple organ systems, Highest incidence in black women, Onset in the 3rd decade of life

Elevated ESR, Leukopenia, Elevated ACE levels (40-80% prevalence)

Requires tissue biopsy of a lymph node showing non-caseating granulomas

Long-term corticosteroid therapy, ACE levels will tend to drop

A condition characterized by the presence of vasculitis and granulomatous lesions affecting the respiratory tract and kidneys

Small vessel vasculitis, Granuloma formation inflammation, Necrosis

Nasal septum perforation, crusting and ulceration may present, Deep vein thrombosis and pulmonary emboli are common, “Saddle Nose” deformity is a late stage finding

Idiopathic condition involving alveolar (lung) hemorrhage and rapidly progressive glomerulonephritis

Most prevalent in men within the 3rd and 4th decade of life, Pathology is linked to glomerular antibodies

Immunosuppressive Therapy is treatment for

Most common acute cause of cough in non-smoker

Cough due to acute respiratory tract infections resolves within _______ weeks in the vast majority of patients.

Persistent cough accompanied by excessive mucus secretions increases the likelihood of _____

what is suspected when acute cough is accompanied by vital sign abnormalities (tachycardia, tachypnea, fever)

Rales, decreased breath sounds, fremitus, and egophony are findings suggestive of what

Rales, decreased breath sounds, fremitus, and egophony are findings suggestive of what

Wheezing and rhonchi are suggestive of what in the absence of asthma

normal jugular venous pressure and negative hepatojugular reflux decrease the likelihood of what

Get a chest radiograph if you suspect what

The most likely causes of cough with a clear chest x-ray and the absence of ACEI's

The perception of uncomfortable breathing

Rapid onset, severe dyspnea in the absence of other clinical features should raise the suspicion for

Is accompanied by chest pain and occurs mainly in young, thin adult males

Most patients with pleuritic chest pain in the outpatient clinic have pleurisy due to

Most cases of dyspnea with wheezing are due to

pursed lip breathing, use of extra respiratory muscles and barrel shaped chest are indicative of

asymmetric excursion

metabolic acidosis

breathing is first rapid and shallow but as acidosis worsens, breathing gradually becomes deep, slow, labored and gasping

Focal wheezing raises suspicion of

Testing of ______ can help distinguish cardiac from non-cardiac causes of dyspnea in the ED.

Pulse ox values below ____% almost always represents clinically important hypoxemia.

Urgent and emergent conditions causing acute dyspnea include

The expectoration of blood that originates from below the vocal chords

Most cases of hemoptysis in the outpatient setting are due to

Flexible bronchoscopy is indicated for which patients

Characteristic findings in a patient with chronic obstruction of the upper airway

Local parenchymal collapse

the trachea bifurcates into the mainstem bronchi at which levels anteriorly and posteriorly

the lower border of the lung lies at T __ level posteriorly

the lower border of the lung lies at __th rib level in the midclavicular line.

the lower border of the lung lies at __th rib level in the midaxillary line.

sensation of tingling or "pins and needles" around lips or in the extremities sometimes brought on by shortness of breath

Musical respiratory sounds that may be audible to the patient or others

A reflex response to stimuli that irritate receptors in the larynx, trachea, or large bronchi.

hemoptysis is seen most often in those with

Audible stridor is a sign of

decreased fremitus can be caused by

When it comes to percussion normal lungs are

Dullness replaces resonance when

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

These lung sounds are about equal in length in regards to inspiration and expiration. There may be a silent interval in-between

These breath sounds are loud and higher in pitch, with a short silence between inspiration and expiration. Expiratory lasts longer than inspiratory

these sounds suggest secretions in large airways

Relatively low pitched with a snoring quality

relatively high pitched with a hissing or shrill quality

increased transmission of voice through chest wall suggests

Pain that is described as sharp or knife like is usually

pectus carinatum

pectus excavatum

dyspnea that occurs in the supine position

Paroxysmal nocturnal dyspnea is associated with which condition

wheezing is generally associated with which condition

According to Cecil's the three most common causes of persistent cough are

Massive hemoptysis is defined as more than ___ ml of blood in 24 hours

this pain is usually reproducible with movement or palpation over the affected area

fremitus is increased in areas of

fremitus is decreased in areas of

What may cause hyporesonance to percussion

a course rattle or fine Velcro like sound

Heard in pulmonary edema, and interstitial fibrosis

A crunching sound timed with the cardiac cycle

Heard in patients with pneumomediastinum

Elasticity is usually measured as its inverse function ___________

The change in lung volume produced by a given chang in transpulmonary pressure

This is decreased in diseases such as pulmonary fibrosis, and pulmonary edema because of they restrict lung volume expansion

This is increased in emphysema because of the loss of elastic recoil

How does the body control the narrow range of normal pH

The PaCo2 in blood is inversely proportional to the ______

What is the strongest factor controlling ventilation

The neuronal control of autonomic respiration resides in the _____

The PaO2 versus ventilation curve is a mirror image of the ______ for hemoglobin

the volume of air which can be inhaled or exhaled from a person's lungs in one minute

defined as ventilation inadequate to keep PaCO2 from rising above normal

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

When pulmonary capillary blood traverses unventilated lung units

the maximal amount of air that can be exhaled after maximum inhalation

"ee" sounds like "ay"

"99" sounds louder and clearer

Whispered sounds are clearer

usually clears with coughing

does not clear with coughing

cough lasting <3 weeks

cough lasting >3 weeks

most common cause of cough in smokers

according to Pat the most common cause of acute cough in non-smokers

Which ribs may be fractured due to cough

most common cause of hemoptysis in the US

most common cause of hemoptysis in developing countries

Enlargement and dilatation of the bronchioles

what does Amy Winehouse have

FEV1

Normal lungs can expire ____% of their vital capacity in 1 second

Patients with _______ have a low vital capacity but a normal FEV1

patients with _______ may have a normal vital capacity but a decreased FEV1

________ is defined as a low FEV1/VC ratio

________ is defined as a low vital capacity a low FEV1 but a normal FEV1/VC ratio

Hyperreactive airway state

episodic wheezing and shortness of breath

blue bloater

pink puffer

decreased respiratory drive

a change in structure and function of the right ventricle of the heart as a result of a respiratory disorder

low respiratory drive

exercise limiting organ of the body

#1 cause of COPD in developed countries

steroids are added early in the treatment of this disease

steroids are added late in the treatment of this disease

removes overdistended regions to allow more normal regions to re-expand

progressive worsening over 1-3 days can lead to

lower respiratory tract starts below what anatomic structure

diagnosed by new infiltrate on exam or x-ray

#1 cause of death from infectious disease in the US is from

hospital acquired pneumonia is defined as symptom onset >___ hours after hospital admission

most common bacterium associated with pneumonia world wide

pneumococcus colonizes ____% of healthy adults

May have associated non-respiratory syndromes (CNS, immune hemolytic anemia)

the original atypical pneumonia organism, although it is present in up to 1/3 of cases

‘Discovered’ in 1976 during an outbreak of pneumonia. Found in aquatic environments

50% of 20 year olds have serologic evidence of past infection. Organism is associated with chronic inflammatory diseases (atherosclerosis)

may cause necrotizing infiltrates or pneumatoceles

may cause necrotizing infiltrates or pneumatoceles

Inhalation of oropharyngeal or gastric contents (volume-dependent)

may cause necrotizing infiltrates or pneumatoceles

what is a factor that increases risk of infection with a drug resistant-pneumococci

what is a factor that increases risk of infection with a drug resistant-pneumococci

factor that increases the risk for gram negative infection

factor that increases the risk for enteric gram negative infection

factor that increases the risk for infection with pseudomonas aeruginosa

factor that increases the risk for infection with pseudomonas aeruginosa

factor that increases the risk for infection with pseudomonas aeruginosa

Advanced generation macrolide

Respiratory quinolone

Outpatient therapy for pneumonia in otherwise healthy patients

Outpatient therapy for pneumonia in otherwise healthy patients

Outpatient therapy for pneumonia in otherwise healthy patients if patient is allergic to macrolides

Outpatient therapy for pneumonia in patients with cardiopulmonary disease and/or other modifying factors

Outpatient therapy for pneumonia in patients with cardiopulmonary disease and/or other modifying factors

rates of influenza has _____ compared to previous decade, possibly due to aging population and/or change in predominating viral strains (H3N2)

influenza has an incubation period of ___ days

Fever, myalgia, headache, malaise, nonproductive cough, sore throat, rhinitis are all symptoms of

Resolution in ___ days, though cough and malaise can persist for over 2 weeks

Children with influenza may present with

Viral cultures are optimal from ______ specimens and require specific viral culture media

Only _______ effective against both Influenza A and B

Who needs annual influenza vaccinations

Who needs annual influenza vaccinations

Who needs annual influenza vaccinations

Who needs annual influenza vaccinations

Who needs annual influenza vaccinations