p.2
Asthma Pathophysiology and Management
What are the most common side effects of β-agonists?
Muscle tremor and palpitations.
p.7
Acute Respiratory Distress Syndrome (ARDS) and Acute Respiratory Failure
What is the time frame for the acute onset of ARDS?
Within 1 week of a clinical insult or new/worsening respiratory symptoms.
p.2
Asthma Pathophysiology and Management
What is the physiological abnormality associated with asthma?
Airway hyperresponsiveness.
p.7
Acute Respiratory Distress Syndrome (ARDS) and Acute Respiratory Failure
What are the three phases of ARDS?
Exudative, Proliferative, and Fibrotic phases.
What is the first step in evaluating a mediastinal mass?
Place it in one of the three mediastinal compartments.
p.5
Pleural Effusion and Pneumothorax
What is the first step in the diagnostic approach to pleural effusion?
Determine whether the effusion is a transudate or exudate.
p.7
Acute Respiratory Distress Syndrome (ARDS) and Acute Respiratory Failure
What are the diagnostic criteria for ARDS?
Bilateral opacities consistent with pulmonary edema, absence of left atrial hypertension, and no primary hydrostatic edema.
p.4
Pneumonia and Pulmonary Infections
What is the most common etiology of community-acquired pneumonia?
Streptococcus pneumoniae.
p.7
Acute Respiratory Distress Syndrome (ARDS) and Acute Respiratory Failure
What are the types of respiratory failure?
Type 1: Alveolar flooding; Type 2: Alveolar hypoventilation; Type 3: Respiratory failure due to atelectasis; Type 4: Hypoperfusion of respiratory muscles.
p.2
Asthma Pathophysiology and Management
What indicates reversibility in asthma during spirometry?
>12% and 200 mL increase in FEV1 after an inhaled short-acting β-agonist.
p.7
Acute Respiratory Distress Syndrome (ARDS) and Acute Respiratory Failure
What is the primary cause of mortality in ARDS?
Nonpulmonary causes, with sepsis and nonpulmonary organ failure accounting for >80% of deaths.
p.1
Ventilation-Perfusion (V/Q) Relationships
What characterizes Zone 1 of the lung?
No blood flow since pulmonary capillary pressure is less than alveolar pressure.
What is the principal imaging test for the diagnosis of pulmonary embolism?
Chest CT Scan with IV contrast.
What characterizes massive pulmonary embolism?
Systemic arterial hypotension with usually anatomically widespread thromboembolism.
p.3
Chronic Obstructive Pulmonary Disease (COPD) Concepts
What does Reid's Index measure?
The ratio of mucus gland layer thickness to the thickness of the wall in the trachea and bronchi.
p.4
Pneumonia and Pulmonary Infections
What is the most common way microorganisms gain access to the lower respiratory tract in pneumonia?
Aspiration from the oropharynx.
p.4
Pneumonia and Pulmonary Infections
What is a major risk factor for anaerobic pneumonia?
Combination of an unprotected airway and significant gingivitis, especially in patients with alcohol or drug overdose or a seizure disorder.
p.4
Pneumonia and Pulmonary Infections
What is the main purpose of the sputum gram stain?
To ensure suitability of the sample for culture.
What are the hallmarks of massive pulmonary embolism?
Dyspnea, syncope, hypotension, and cyanosis.
What is a useful rule-out test for pulmonary embolism?
> 95% of patients with normal quantitative plasma D-dimer ELISA levels (<500 ng/mL) do not have PE.
p.1
Oxygen and Carbon Dioxide Transport in Blood
How is carbon dioxide primarily transported in the blood?
23% bound to hemoglobin (carbaminohemoglobin), 7% freely dissolved in plasma, and 70% converted to bicarbonate (HCO3-).
p.1
Asthma Pathophysiology and Management
What is the function of the pneumotaxic center?
It decreases the duration of inspiration and increases the respiratory rate.
p.2
Asthma Pathophysiology and Management
What are Charcot-Leyden crystals?
Eosinophilic, hexagonal, double-pointed crystals formed from breakdown of eosinophils in sputum.
p.4
Pneumonia and Pulmonary Infections
Which organisms are common etiologies of atypical pneumonia?
Respiratory viruses such as influenza viruses, adenoviruses, human metapneumovirus, and respiratory syncytial viruses.
p.3
Chronic Obstructive Pulmonary Disease (COPD) Concepts
What are the three interventions shown to influence the natural history of COPD?
Smoking cessation, oxygen therapy in chronically hypoxemic patients, and lung volume reduction surgery in selected patients with emphysema.
p.1
Pulmonary Volumes and Capacities
What is Residual Volume (RV)?
The remaining air in the lungs after maximal exhalation, which maintains oxygenation during breath-holding.
p.1
Pulmonary Volumes and Capacities
What is Vital Capacity (VC)?
The maximum amount of air that can be inhaled/exhaled, calculated as IRV + TV + ERV.
p.4
Bronchiectasis Overview
What is bronchiectasis?
Irreversible airway dilation that involves the lung in either a focal or diffuse manner.
p.5
Pleural Effusion and Pneumothorax
What is the treatment of choice for most cases of chylothorax?
Insertion of a chest tube plus administration of octreotide.
p.1
Oxygen and Carbon Dioxide Transport in Blood
How is oxygen primarily transported in the blood?
98% bound to hemoglobin (oxyhemoglobin) and 2% freely dissolved in plasma.
p.2
Asthma Pathophysiology and Management
What imbalance contributes to the pathogenesis of asthma?
Imbalance favoring TH2 production over TH1.
p.7
Acute Respiratory Distress Syndrome (ARDS) and Acute Respiratory Failure
What is the recommended tidal volume for ventilation in ARDS?
Low VT ventilation at 6 mL/kg of predicted body weight.
What are the most common masses in the posterior mediastinum?
Gastroenteric cysts, esophageal diverticula, hernia through foramen of Bochdalek, extramedullary hematopoiesis.
p.1
Pulmonary Volumes and Capacities
What is Total Lung Capacity (TLC)?
The total volume of gas present in the lungs after maximal aspiration, calculated as IRV + TV + ERV + RV.
p.1
Ventilation-Perfusion (V/Q) Relationships
What characterizes Zone 3 of the lung?
Continuous blood flow since pulmonary capillary pressure is greater than alveolar pressure.
p.1
Oxygen and Carbon Dioxide Transport in Blood
What does the mnemonic CADET represent?
Factors that cause a right shift in the O2-Hgb dissociation curve: Increased CO2, Acidosis, 2,3-BPG, Exercise, Temperature.
p.3
Chronic Obstructive Pulmonary Disease (COPD) Concepts
What is the most significant predictor of FEV1?
Pack-years of cigarette smoking.
p.2
Asthma Pathophysiology and Management
What is the most effective controller for asthma?
Inhaled corticosteroids (ICS).
What are the most common lesions in the anterior mediastinum?
Thymomas, teratomatous neoplasms, thyroid masses, terrible lymphomas.
What are the most common gas exchange abnormalities in pulmonary embolism?
Arterial hypoxemia and an increased alveolar-arterial O2 tension gradient.
p.6
Deep Vein Thrombosis (DVT)
What is the most common symptom of deep vein thrombosis (DVT)?
Cramp or 'charley horse' in the lower calf that persists and intensifies over several days.
What is the most frequently cited ECG abnormality in pulmonary embolism?
S1Q3T3 sign (in addition to sinus tachycardia).
p.2
Asthma Pathophysiology and Management
What are Curschmann's spirals?
Whorls of shed epithelium found in mucus plugs in asthma.
p.3
Chronic Obstructive Pulmonary Disease (COPD) Concepts
What characterizes Panlobular emphysema?
Abnormally large air spaces evenly distributed within and across acinar units, with a predilection for lower lobes.
p.1
Pulmonary Volumes and Capacities
What is Inspiratory Reserve Volume (IRV)?
The maximum amount of air that can be inhaled after a normal inhalation.
p.5
Pleural Effusion and Pneumothorax
What are the leading causes of transudative pleural effusion?
Left ventricular failure and cirrhosis.
p.5
Pleural Effusion and Pneumothorax
What are the leading causes of exudative pleural effusion?
Bacterial pneumonia, malignancy, viral infection, pulmonary embolism, and trauma.
p.4
Bronchiectasis Overview
What is the Vicious Cycle Hypothesis in bronchiectasis?
Susceptibility to infection and poor mucociliary clearance result in microbial colonization of the bronchial tree.
p.1
Ventilation-Perfusion (V/Q) Relationships
What is the V/Q ratio at the apex of the lung?
3, indicating wasted ventilation.
p.1
Oxygen and Carbon Dioxide Transport in Blood
What factors cause a left shift in the O2-Hgb dissociation curve?
Increased carbon monoxide, methemoglobin, fetal hemoglobin, decreased temperature, decreased 2,3-BPG, decreased CO2, and alkalosis.
p.3
Chronic Obstructive Pulmonary Disease (COPD) Concepts
What are the two hypotheses regarding the pathogenesis of asthma and COPD?
Dutch hypothesis (asthma as an allergic phenomenon) and British hypothesis (COPD as smoking-related inflammation).
p.7
Acute Respiratory Distress Syndrome (ARDS) and Acute Respiratory Failure
What are common causes of ARDS?
Pneumonia, sepsis, aspiration of gastric contents, trauma, multiple transfusions, and drug overdose.
p.2
Asthma Pathophysiology and Management
What is the most common reason for poor control of asthma?
Noncompliance with medications, usually ICS.
p.4
Pneumonia and Pulmonary Infections
What is the most frequently isolated pathogen in blood cultures for community-acquired pneumonia?
Streptococcus pneumoniae.
What is the most common symptom of pulmonary embolism?
Unexplained breathlessness.
p.5
Obstructive Sleep Apnea Diagnosis and Criteria
What are the symptoms of Obstructive Sleep Apnea/Hypopnea syndrome?
Nocturnal breathing disturbances or daytime sleepiness despite sufficient sleep opportunities.
p.1
Asthma Pathophysiology and Management
What is the main respiratory center in the brain?
The medulla, which sends inspiratory ramp signals to the diaphragm.
p.3
Chronic Obstructive Pulmonary Disease (COPD) Concepts
What is the most typical finding in COPD?
Persistent reduction in forced expiratory flow rates.
What are the most common masses in the middle mediastinum?
Lymphoma, metastatic lymph node enlargement, masses of vascular origin, neurogenic tumors.
p.4
Pneumonia and Pulmonary Infections
What criteria must a sputum sample meet to be adequate for culture?
>25 neutrophils and <10 squamous cells per low power field.
What is the definite diagnostic test for pulmonary embolism?
Pulmonary Angiography, which visualizes an intraluminal filling defect in more than one projection.
What characterizes small to moderate pulmonary embolism?
Normal RV function and normal systemic arterial pressure (excellent prognosis with adequate anticoagulation).
p.7
Acute Respiratory Distress Syndrome (ARDS) and Acute Respiratory Failure
What are the classifications of hypoxemia severity in ARDS?
Mild: Pao2/Fio2 200-300 mmHg; Moderate: Pao2/Fio2 100-200 mmHg; Severe: Pao2/Fio2 < 100 mmHg.
p.2
Asthma Pathophysiology and Management
What is the primary action of β-agonists in asthma treatment?
Relax smooth-muscle cells of all airways.
p.7
Acute Respiratory Distress Syndrome (ARDS) and Acute Respiratory Failure
What characterizes acute hypoxemic respiratory failure?
Occurs with alveolar flooding and subsequent intrapulmonary shunt physiology.
p.1
Pulmonary Volumes and Capacities
What is Tidal Volume (TV)?
The amount of air inhaled/exhaled during a relaxed state, approximately 500 mL.
p.2
Asthma Pathophysiology and Management
What drugs are considered safe for asthma in pregnancy?
Inhaled corticosteroids (ICS) and theophylline.
p.1
Ventilation-Perfusion (V/Q) Relationships
What characterizes Zone 2 of the lung?
Intermittent blood flow since pulmonary capillary pressure is greater than alveolar pressure only during systole.
p.5
Obstructive Sleep Apnea Diagnosis and Criteria
What is the apnea-hypopnea index (AHI)?
The number of episodes of obstructive apnea or hypopnea per hour of sleep.
What characterizes moderate to large pulmonary embolism?
RV hypokinesis with normal systemic arterial pressure.
p.2
Asthma Pathophysiology and Management
What are the most common allergens that trigger asthma?
Dermatophagoides (house dust mites).
p.2
Asthma Pathophysiology and Management
What is the typical presentation of exercise-induced asthma?
Worse in cold, dry climates than in hot, humid conditions.
p.5
Obstructive Sleep Apnea Diagnosis and Criteria
What defines an apnea episode?
Cessation of airflow for 10 seconds or more during sleep.
p.1
Asthma Pathophysiology and Management
What is the role of the apneustic center?
It increases the duration of inspiration and decreases the respiratory rate.
p.1
Pulmonary Volumes and Capacities
What is Functional Residual Capacity (FRC)?
The volume of gas in the lungs after normal expiration, calculated as ERV + RV.
p.4
Bronchiectasis Overview
What is the most common clinical presentation of bronchiectasis?
Persistent productive cough with ongoing production of thick, tenacious sputum.
What is the best-known indirect sign of pulmonary embolism on transthoracic echo?
McConnell's sign: hypokinesis of the RV free wall with normal motion of the RV apex.
p.5
Pleural Effusion and Pneumothorax
Which three tumors account for approximately 75% of all malignant pleural effusions?
Breast carcinoma, lymphoma, and lung carcinoma.
p.5
Pleural Effusion and Pneumothorax
What tracheal deviation occurs in tension pneumothorax?
Contralateral tracheal deviation.
p.5
Obstructive Sleep Apnea Diagnosis and Criteria
What is hypopnea?
A ~30% reduction in airflow for at least 10 seconds during sleep, accompanied by either a ~3% desaturation or an arousal.
