Term
| Pt with periodic breathing difficulty who is on ASA with no other respiratory risk factors: |
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Definition
- ASA sensitivity syndrome. This patient will have aspirin ingestion, persistent nasal blockage, adn episodes of bronchoconstriciton.
- The pathogenesis is 'pseudo-allergic reaction' which is an exaggerated release of vasoactive inflammatory mediators.
- leukotrienes accumulate because of the blockage of COX. These cause bronchoconstriction and polyp formation in susceptible individuals. |
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Term
| Dilated central bronhi which are larger than adjacent pulmonary arter branches, as well as thickened bronchial walls. |
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Definition
- Bronchiectasis.
- Usually presents with chronic productive cough and are often treated with repeated courses of antibiotics.
- Hemoptysis, sometimes massive, can occur. |
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Term
| Pt who has just been extubated after an acute exacerbation of asthma complains of muslce weakness: |
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Definition
- decreased serum potassium level
- beta 2 agonists like albuterol reduce serum potassium by driving K into cells.
- This can present with muscle weakness, arrhythmias, and EKG changes.
- Other common side effects include tremor, headache, adn palpitations. |
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Term
| How do you calculate the Alveolar O2? |
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Definition
| PAO2 = (FiO2 x [Patm - PH20]) - (PaCO2/R) |
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Term
| Who gets an elevated A-a gradient? |
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Definition
| any process that results in V/Q mismatching |
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Term
| Patient with atypical pneumonia and target shaped lesions on the extremities. |
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Definition
- Mycoplasma pneumonia
- Of note, Mycoplasma does not have a cell wall, and therefore does not Gram stain. |
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Term
| 3 criteria to classify an exudate instead of a transudate: |
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Definition
1. Pleural fluid protein:serum protein > 0.5
2. Pleural fluid LDH:serum LDH > 0.6
3. Pleural fluid LDH > 2/3 the upper limit of normal for serum LDH. |
|
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Term
|
Definition
1. infection
2. malignancy
3. PE (though may also produce transudate)
4. Connective tissue disease
5. iatrogenic |
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Term
| What is the next step in refractory allergic rhinitis? |
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Definition
| - Nasal smear for eosinophils to make sure that you're not dealing with something else. Unfortunately, once you have eosinophils, the differential is broad. |
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Term
| Pulmonary edema and a PCWP > 18 |
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Definition
Pulmonary edema 2/2 impaired LV function
- In this case, the pressure in the lungs is high because it is backed-up in the lungs because the LV is not able to move it out into the rest of the body. |
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Term
| Pulmonary edema and a PCWP < 18 |
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Definition
| Plumonary edema 2/2 a non-cardiac etiology |
|
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Term
| What pleural fluid test is most helpful in determining whether CT placement is needed? |
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Definition
- pleural fluid pH.
- low pH (< 7.2) is almost always indicative of an empyema and indicates removal by thoracostomy.
- Glu < 60 mg/dL is also an indication |
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Term
| First step in a child who presents with torticollis: |
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Definition
| Cervical spine radiographs to rule out C spine fracture or dislocation. |
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Term
| Pt c COPD presenting with catastrophic acute worsening of respiratory symptoms: |
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Definition
| - spontaneous pneumothorax. This is due to dilated alveolar blebs that rupture inot the pleural space. |
|
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Term
| What is a normal FEV1/FVC? |
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Definition
|
|
Term
| __________ pleural effusions are a/w a very high total protein concentration. |
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Definition
|
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Term
| What extra medication will help improve function and decrease length of hospitalization in patients with COPD exacerbation? |
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Definition
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