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2 Pulm: Pleura, ILD
Step Up to Medicine, Chap 2: Diseases of Pleura and ILD
| Question | Answer |
|---|---|
| Which type of effusion: pathophys either from elevated capillary pressure in pleura (CHF) or decreased plasma oncotic pressure (hypoalbuminemia) | Transudative effusions (protein poor) |
| Which type of effusion: pathophys from increased permeability of pleural surfaces or decreased lymphatic flow from pleural surface from damage to pleural membranes or vasculature | Exudative effusions (protein rich) |
| Which tests should be performed if exudative effusion is suspected? | Differential cell ct, glucose, pH, amylase, triglycerides, micro, and cytology |
| Protein and LDH parameters for exudative effusions? | Pleural protein/serum protein >0.5. Pleural LDH/serum LDH >0.6. LDH >2/3 the upper limit of normal serum LDH. |
| MCC of pleural effusion? | CHF (transudative; elevated capillary pressure) |
| Most reliable test for detecting pleural effusions? | CT |
| What testing to do on pleural effusion fluid? | 4 Cs: chemistry (glucose, protein), cytology, cell ct (CBC w/differential), and culture |
| What does the pleural tap indicate?: elevated amylase | esophageal rupture (ouch!), pancreatitis, malignancy |
| What does the pleural tap indicate?: frankly purulent fluid | empyema (pus in pleural space) |
| What does the pleural tap indicate?: bloody effusion | malignancy |
| What does the pleural tap indicate?: exudative with predominant lymphocytes | TB |
| What does the pleural tap indicate?: pH <7.2 | parapneumonic effusion or empyema |
| Glucose level <60 can be used to rule out which cause of pleural effusion? | Rheumatoid arthritis. Can also be low with TB, esophageal rupture, malignancy, and lupus |
| Noninfected pleural effusion secondary to bacterial pneumonia? | Parapneumonic effusion |
| Complicated parapneumonic effusion that becomes infected. | Empyema |
| Which procedures (3) should be followed by CXR to make sure no traumatic pneumothoraces occurred? | Transthoracic needle aspiration, throacentesis, and central line placement |
| Mediastinal shift is in which direction in relation to the spontaneous pneumothorax? | Shift is TOWARD the side of the pneumothorax |
| Mediastinal shift is in which direction in relation to the tension pneumothorax? | Shift is AWAY from the side of the pneumothorax (pressure collapses ipsilateral lung) |
| Management for suspected tension pneumothorax? | Do NOT obtain a CXR. Immediately decompress the pleural space via large-bore needle or chest tube! |
| Causes of tension pneumothorax? | Mechanical ventilation, CPR, trauma |
| Hypotension, distended neck vv, shift of trachea away from midline on CXR. | Tension pneumothorax |
| A history of which medications might suggest interstitial lung disease? | Chemo, gold, amiodarone, penicillamine, and nitrofurantoin. Also bleomycin, phenytoin. |
| Which nail finding is associated with idiopathic pulmonary fibrosis? | Digital clubbing (if pt has this, get CXR); typically caused by chronic hypoxia |
| FEV1/FVC ratio in ILD? Obstructive or restrictive? | Ratio is increased (both are low, but FVC is lower). Restrictive. |
| What diagnostic testing is typically required in pts with ILD? | Tissue biopsy |
| Systemic granulomatous disease characterized by non-caseating granulomas. Typically seen in AA women <40yo. Anterior uveitis is common. | Sarcoidosis |
| MCC death in sarcoidosis? | Cardiac disease (uncommon though) |
| How do serum ACE levels help support diagnosis of sarcoidosis? | Elevated in abt 50% of pts. Note it is also elevated in other diseases. |
| Stage I sarcoidosis? | Bilateral lymphadenopathy |
| Stage II sarcoidosis? | Lymphadenopathy and ILD |
| Stage III sarcoidosis? | ILD ONLY |
| Langerhans cells proliferation (abnormal); assoc'd with cigarette smoking; honeycomb appearance on chest radiograph and cystic lesions on CT scan; possible spontaneous pneumothorax, lytic bone lesions, and diabetes insipidus | Histiocytosis X |
| Necrotizing granulomatous vasculitis; c-ANCA. Diagnosis? Gold std test for dx? Tx? | Dx: Wegener's granulomatosis Test: Tissue biopsy Tx: immunosuppressants and glucocorticoids |
| Granulomatous vasculitis in pts with asthma? | Churg-Strauss; assoc'd with p-ANCA adn eosinophilia inblood Tx: systemic glucocorticoids |
| Increased risk of which malignancies in asbestosis? | Bronchogenic carcinoma and malignant mesothelioma |
| Which disease associated with mining, stone cutting, and glass manufacturing is linked with increased risk of TB? | Silicosis |
| Hallmark serum finding in hypersensitivity pneumonitis (extrinsic allergic alveolitis)? | Presence of serum IgG and IgA to the inhaled antigen |
| Autoimmune disease caused by IgG antibodies directed against glomerular and alveolar basement membranes (type II hypersensitivity reaction) | Goodpasture's syndrome |
| Tx for Goodpasture's? | Plasmapheresis, cyclophosphamide, and corticosteroids |
| Rare condition caused by accumulation of surfactant-like protein and phospholipids in the alveoli | Pulmonary alveolar proteinois |
| What is the chest radiograph appearance in pulmonary alveolar proteinosis? | Ground glass appearance with bilateral alveolar infiltrates that resemble a bat shape |
| Why should steroids not be given to treat pulmonary alveolar proteinosis? | B/c they are already at increased risk of infection. Instead use lung lavage or GCSF (new tx). |
Created by:
sarah3148
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