Comprehensive: Pulm

Absence of O2 and accumulation of CO2

Asphyxia

Region of the lungs where gas exchange with the blood occurs

Respiratory zone

The trachea divides at the _______ at the T4 vertebrae

Carina

The trachea divides at the carina at the ____ vertebrae

T4

Increase surface area for gas diffusion

Alveoli

Voluntary breathing is controlled by the _______

Cerebral cortex

Involuntary breathing is controlled by the _______

Medulla oblongata and pons

Innervation of diaphragm

Phrenic nerve (C3-C5)

Majority of oxygen is transported via ______

Hemoglobin

Majority of CO2 is transported via ______

Bicarb in plasma

_______ is important to keep alveoli open for gas exchange

Surfactant

True or False: V/Q shunting IS a normal variant

False

Normal pulse ox

96-100%

Pulse ox requiring supplemental oxygen

< 88%

A thoracentesis should NOT be performed below the ____ rib due to risk of peritoneal perforation

8th

Direct visualization of the airways

Bronchoscopy

Where is a needle decompression done?

2nd ICS/MCL on side of PTX

Indication for a needle decompression

Tension PTX

Nasal cannula flow rate

1-6 L/min

Simple face mask flow rate

6-8 L/min

Non-rebreather flow rate

8-12 L/min

Do NOT perform PFTs if SABA within _____

6 hours

Do NOT perform PFTs if LABA within _____

12 hours

Do NOT perform PFTs if currently taking _____

Steroids

Volume of gas in the lungs at the end of maximum inspiration (VC + RV)

Total lung capacity (TLC)

Amount of air breathed in or out during normal respiration, spontaneous breath

Tidal volume (TV)

Additional air that can be inhaled after a normal tidal breath in

Inspiratory reserve volume (IRV)

Amount of air left in the lung at the end of normal breathing exhalation (ERV + RV)

Functional residual capacity (FRC)

Amount of air that can be forced out of the lungs after a maximal inspiration (IRV + TV + ERV)

Vital capacity

Amount of air left in the lung after a maximal expiration

Residual volume

Volume that can be inhaled after a tidal breath out (TV + IRV)

Inspiratory capacity

Amount of additional air that can be breathed out after normal expiration

Expiratory reserve volume

Obstructive or Restrictive:

- Decrease in FEV1

- Increase in RV & TLC

Obstructive

Obstructive or Restrictive:

- Decrease in TLC & RV

- FEV1/FVC can remain normal

Restrictive

FEV1/FVC seen in Obstructive disease

Decreased (< 80%)

Bicarb reabsorption occurs in the ________

Proximal and distal renal tubule

__________ are sensitive to pCO2 and pH

Chemoreceptors in the medulla

________ are sensitive to arterial pO2

Carotid bodies and aortic arch

Effect on potassium seen with respiratory & metabolic acidosis

Hyperkalemia

Effect on potassium seen with respiratory & metabolic alkalosis

Hypokalemia

Metabolic acidosis HIGH anion gap differentials

MUDPILES

Methanol, Uremia, DKA, Propylene glycol, Iron, Lactic acidosis, Ethanol, Salicylates & Starvation

Metabolic acidosis NORMAL anion gap differentials

HARDUPS

Hyperalimentation, Acetazolamide, Renal tubular acidosis, Diarrhea, Uretero-pelvic shunt, Post-hypocapnia, Spironolactone

Most common cause of metabolic acidosis with a NORMAL anion gap

Diarrhea

True or False: FDA does NOT recommend cough medication for children < 2 y/o

True

Most likely CAP:
College aged student

Mycoplasma PNA

Most likely CAP:
Bullous myringitis/Severe ear pain

Mycoplasma PNA

Most likely CAP:
Hotel AC system

Legionella PNA

Most likely CAP:
Sore throat, hoarseness

Chlamydia PNA

Most likely CAP:
Rust colored sputum

Streptococcus PNA

Most likely CAP:
Currant jelly sputum- thick, mucoid blood-tinged sputum

Klebsiella PNA

Most likely CAP:
COPD patient

H. Influenzae

Most likely CAP:
Alcoholic patient

Klebsiella PNA

Most likely CAP:
Peds patient < 1 y/o

RSV

Most likely CAP:
Peds patient > 2 y/o

Parainfluenza

Chest CT shows "tree in bud" and "ground glass"

CAP

What is the CURB-65 method used for?

Whether to admit a patient with CAP

CURB-65

Confusion
Uremia (BUN > 20)
Respiration ( RR > 30)
BP (< 90/60)
> 65 y/o

Tx for peds typical CAP

Amoxicillin

Tx for peds atypical CAP

Azithromycin

Tx for typical/atypical CAP

Azithromycin, Clarithromycin, or Doxycycline

Tx for inpatient non-ICU CAP

Ceftriaxone/Ceftaroline IV + Azithromycin IV

Causes of Viral PNA

Influenza A & B

Cause of HIV associated PNA

Pneumocystic jirovecii (PJP/PCP)

HIV: CD4 count

< 200

Tx for HIV associated PNA

Bactrim DS (+ corticosteroids)

Most likely PNA:
Foul smelling purulent sputum

Anaerobic PNA

Tx for anaerobic PNA

Beta-lactam/Beta-lactamase inhibitor (ex. ampicillin/sulbactam)

Chronic bronchitis is most commonly _____

Viral

Most common cause of lower respiratory tract infections in children < 1 y/o

RSV

Proliferation and necrosis of bronchiolar epithelium and increased mucus secretion

RSV

3 Ds of epiglottitis

Dysphagia, Drooling, Distress

MCC of epiglottitis in children

H. influenza type b

MCC of epiglottitis in adults

S. pneumo

MCC of epiglottitis in immunocompromised

Pseudomonas

Thumbprint sign on XR

Epiglottitis

Most infectious stage of pertussis

Catarrhal stage

Stage of pertussis with high pitched "whoop"

Paroxysmal stage

Final stage of pertussis

Convalescent stage

Abx are most effective in what stage of pertussis? What Abx?

Catarrhal stage- Macrolides (Bactrim 2nd line)

Cause of croup

Parainfluenza virus type 1 & 2

Barking "seal-like" cough

Croup

Tx for Tuberculosis

RIPE:
Rifampin, INH (Isoniazid), Pyrazinamide, Ethambutol

Tb tx side effect:

Peripheral neuropathy, must administer vitamin B6

INH

Tb tx side effect:
Orange body fluids

Rifampin

Tb tx side effect:
Red-green vision loss

Ethambutol

Endemic mycosis associated with river valleys and inhalation of contaminated soil (bird/bat droppings)

Histoplasmosis

Fungal infection associated with the Ohio and Mississippi Rivers, Great Lakes, and Southeast US

Blastomycosis

Cause of Aspergillosis

A. fumigatus

A chronic lung condition characterized by airway narrowing due to inflammation and tightening of the muscles around the small airway

Asthma

Defining feature of asthma

Bronchial/Airway hyperresponsiveness

In asthma, bronchodilator use should improve FEV1 by ____%

12%

SABA used for exercise induced asthma

Levalbuterol

Formoterol & Salmeterol

LABA

Albuterol & Levalbuterol

SABA

Severe bronchospasm that does NOT respond to aggressive therapies within 30-60 minutes

Status asthmaticus

Chronic productive cough occurring for > 3 months in 2 successive years

Chronic bronchitis

Abnormal permanent enlargement of air sacs with destruction of alveolar walls that causes airway narrowing and increased airway resistance, AIR TRAPPING

Emphysema

What subtype of emphysema is the MOST common?

Centriacinar

What subtype of emphysema: Focal destruction of the bronchioles and central portion of the acinus (proximal alveoli)

Centriacinar

What subtype of emphysema: Typically affects the upper lobes

Centriacinar