USMLE Step 2 (Fach) / Respiratory (Lektion)
In dieser Lektion befinden sich 49 Karteikarten
Step 2 CK
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- Restrictive lung disease Characterized by loss of lung compliance. Result in ↑ lung stiffness and ↓ lung expansion. Etiology:- Alveolar (edema, hemorrhage, pus)- Interstitial lung disease (idiopathic interstitial pneumonias)- ...
- Interstitial lung disease A heterogenous group of disorders characterized by inflammation and/or fibrosis of the interstitium. - Advanced disease: Cystic spaces devlop in the lung periphery ("honey-combing"). Subgroups:(1) Exposure ...
- Antifibrotic agents - Pirfenidone - Nintedanib
- Hypersensitivity pneumonitis Alveolar thickening and noncaseating granulomas 2° to environmental exposure (eg, mold, hot tubs, cockatiels, down feather antigens). Presentation:- Acute: Dyspnea, fever, malaise, shivering, and cough ...
- Eosinophilic pulmonary syndromes A diverse group of disorders characterized by eosinophilic pulmonary infiltrates and abnormal peripheral blood eosinophilia. Includes:- Allergic bronchopulmonary aspergillosis- Löffler syndrome- Acute ...
- Chronic obstructive pulmonary disease (COPD) A chronic pulmonary disease that presents with progressive shortness of breath caused by airway inflammation. It is subdivided into chronic bronchitis and emphysema. - Chronic bronchitis: productive cough ...
- Acute exacerbation of chronic obstructive pulmonary ... Etiology- 80% of cases are caused by infection - Common causative agents: Haemophilus influenzae, Streptococcus pneumoniae, viruses- Other triggers: drugs (e.g., beta blockers), allergens, air pollution, ...
- Asthma Allergic asthma:- Cardinal risk factor: atopy- Environmental allergens: pollen (seasonal), dust mites, domestic animals, mold spores- Allergic occupational asthma: from exposure to allergens in the workplace ...
- Status asthmaticus Extreme asthma exacerbation that does not respond to initial treatment with bronchodilators Clinical features:- Initially: orthopnea, tachypnea, tachycardia, hypoxemia and cyanosis, hypercarbia- Signs ...
- Bronchiectasis Etiology:- Airway obstruction (eg, cancer)- Rheumatic disease (eg, RA, Sjögren), toxic inhalation- Chronic or prior infection (eg, aspergillosis, mycobacteria)- Immunodeficiency (eg, hypogammaglobulinemia)- ...
- Lung cancer Pathologic types are divided into two subgroups:- Small cell lung cancer (SCLC) – 25% of lung cancers- Nonsmall cell lung cancer (NSCLC) – 75% of lung cancers; includes squamous cell carcinoma, adenocarcinoma, ...
- Pleural effusion Transudative effusion: ↑ Capillary hydrostatic pressure and/or ↓ Capillary oncotic pressure- Congestive heart failure- Hepatic cirrhosis- Nephrotic syndrome Exudative effusion: ↑ Capillary permeability- ...
- Acute respiratory distress syndrome (ARDS) Definition:- Acute onset (<1 week)- Bilateral infiltrates on chest imaging- Pulmonary edema not explained by fluid overload or CHF- Abnormal PaO2/FiO2 ratio→ 200-300: Mild→ 100-200: Moderate→ < ...
- Pulmonary hypertension Mean pulmonary arterial pressure ≥ 25 mm Hg at rest Classification of pulmonary hypertension (WHO) by cause:Group 1: Pulmonary arterial hypertension (PAH)→ Idiopathic→ Hereditary (e.g., BMPR2 mutation)→ ...
- Pulmonary embolism Etiology:- Deep vein thrombosis: Typically popliteal or femoral veins→ Risk factors: obesity, immobility, malignancy, pregnancy, dehydration, hypercoagulability, use of contraceptives, previous DVT - ...
- Interstitial lung disease Etiology:- Idiopathic pulmonary fibrosis (most common)- Cryptogenic organizing pneumonia (COP)- Environmental lung disease: Coal worker's pneumoconiosis, silicosis, asbestosis, beryllosis- Drug-induced: ...
- Sarcoidosis Bimodal distribution: 25-35 years old with a second peak for females 45-65 years oldSex: F > M (2:1)Prevalence: higher among African-Americans in the US Clinical features: - Constitutional symptoms: ...
- Histiocytosis X Chronic interstitial pneumonia caused by abnormal proliferation of histiocytes (related to Langerhans cells of the skin). - Most patients (90%) are cigarette smokers. - Variants of disease include eosinophilic ...
- Berylliosis Workers at risk:- Workers in high-tech fields, where alloys are often utilized (e.g., aerospace, nuclear, and electronics plants, ceramics industries, dental material production, and dye manufacturing) ...
- Silicosis Workers at risk:- Sandblasting, mining (e.g., coal mining), construction (e.g., tunnel construction), ceramics production, glass manufacturing, and working in foundries. Acute: short-term exposure to ...
- Asbestosis Risk factors:- Occupations involving the manufacture or demolition of ships, plumbing, roofing, insulators, heat-resistant clothing, and brake-lining- Smoking Clinical features:- Long latent period- Exertional ...
- Pneumococcal vaccination - Indication For all adults age ≥ 65, PCV13 vaccine is recommended followed by the PPSV23 vaccine 12 months later. For people age < 65 with certain high-risk conditions, sequential PCV13 and PPSV23 are also recommended.High-risk ...
- Pleural empyema Accumulation of pus in the pleural cavity Etiology: - Infected parapneumonic pleural effusion- Untreated hemothorax that becomes infected- Ruptured lung abscess- Thoracic trauma Clinical features:- Pleuritic ...
- Allergic rhinitis Etiology:- Type I hypersensitivity reaction- Genetic predisposition to atopy Clinical features:- Recurrent episodes of sneezing, nasal congestion, rhinorrhea, and post-nasal drip- Itchy nose and throat- ...
- Aspirin exacerbated respiratory disease (AERD) A chronic condition characterized by Samter's triad; exacerbated by a pseudoallergic sensitivity reaction to aspirin and other NSAIDs (NSAID intolerance). Clinical features: Samter's triad 1. Asthma2. ...
- Post-nasal drip syndrome (= Upper airway cough syndrome) ... Abnormally increased nasal mucus secretion that drips down the back of the throat and can lead to coughing, a feeling of obstruction in the throat, and throat clearing. Etiology:- Allergies- Cold temperatures- ...
- Ludwig's angina Etiology:- Mixed infection (Viridans streptococci and anaerobes)- Usually arising from an infected mandibular molar, an infection of the upper airways, or acute lingual tonsillitis- Predisposing factors: ...
- Retropharyngeal abscess Epidemiology:- Generally the most dangerous deep neck infection- Most common in children < 5 years of age Etiology:- Pathogen: Streptococci (viridans Streptococci, S. pneumoniae), Staphylococci (including MRSA), ...
- Aspergillosis Invasive aspergillosis:- Risk factors: Immunocompromise (neutropenia, glucocorticoids, HIV)- Triad of fever, chest pain, hemoptysis- Pulmonary nodules with halo sign (nodules with surrounding grown glass ...
- Predisposing conditions for aspiration pneumonia - Altered consciousness impairing cough reflex/glottic closure (eg, dementia, drug intoxication) - Dysphagia due to neurologic deficits (eg, stroke, neurodegenerative disease) - Upper gastrointestinal ...
- Solitary pulmonary nodules Factors increasing malignant probability:- Large size*- Advanced patient age- Female sex- Active or previous smoking- Family or personal history of lung cancer- Upper lobe location- Spiculated radiographic ...
- Empiric treatment of community-acquired pneumonia Outpatient:- Macrolide or doxycycline (healthy)- Fluoroquinolone* or beta-lactam + macrolide (comorbidities) Inpatient (non-ICU):- Fluoroquinolone* (IV)- Beta-lactam + macrolide (IV) Inpatient (ICU):- ...
- Long-term home oxygen therapy COPD patients with: 1. Resting PaO2 ≤ 55 mmHg or SaO2 ≤ 88% on room air 2. PaO2 ≤ 59 mmHg or SaO2 ≤ 89% in patients with cor pulmonale, evidence of right heart failure, or hematocrit > 55% The ...
- Atelectasis Etiology: - Obstructive atelectasis (most common): e.g., foreign body, mucous plug, malignancy- Compressive atelectasis: e.g., pleural effusion- Adhesive atelectasis: surfactant deficiency or dysfunction, ...
- Noninvasive positive-pressure ventilation Indications:- COPD- Cardiogenic pulmonary edema- Acute respiratory failure- Facilitate early extubation Contraindications:- Cardiac or respiratory arrest- Severe acidosis (pH < 7.10)- ARDS- Unstable cardiac ...
- Paraneoplastic syndromes All lung cancers:- General paraneoplastic manifestations: cachexia, increased risk of thrombosis (and lung embolism!)- Dermatomyositis- Acanthosis nigricans NSCLC:- Hypercalcemia of malignancy (squamous ...
- Lung cancer screening Annual low-dose CT scan Indications:- 55-80 years old- ≥ 30 pack years or quit < 15 years ago
- Extubation readiness criteria - pH > 7.25 - Fraction of inspired oxygen [FiO2] ≤ 40% - Positive end-expiratory pressure (PEEP) < 5 mmHg - Intact inspiratory effort and sufficient mental alertness to protect airway
- Tracheomalacia Collapsible intrathoracic airway Clinical features:- Respiratory distress- Expiratory stridor
- Pneumocystis pneumonia Interstitial pneumonia caused by the yeast-like fungal organism Pneumocystis jirovecii Risk factors:- HIV Infection: CD4 count: usually < 200/μL- History of PCP infection- Primary immunodeficiency disorders ...
- Peritonsillar abscess Epidemiology:- Most common deep neck infection- Most common in adolescents and young adults Etiology:- Pathogens: Streptococcus pyogenes (most common), Streptococcus anginosus, viridans streptococci, ...
- Acute bronchitis Etiology: Viruses (> 90% of cases): Influenza A and B, Parainfluenza, Adenovirus, RSV, Rhinovirus, Coronavirus Clinical features:- Cough > 5 days- Resolves in 2-3 weeks- Sputum (∼ 50% of cases), ...
- Influenza Seasonal pattern: Most infections occur during the fall and winter.Virus: Influenza virus A and B (and rarely influenza C) Clinical features:- Sudden onset of high fever, chills, headache, muscle/joint ...
- CMV pneumonia Interstitial pneumonitis Etiology: immunocompromised patients (e.g., following bone marrow transplant or in HIV/AIDS patients with CD4 ≤ 50 cells/mm3) Clinical findings: fever, nonproductive cough, ...
- Epistaxis Etiology :- Nose picking (common cause)- Fractures to the middle third of the face, base of the skull, or the nasal septum- Foreign body in the nose- Dry nose (rhinitis sicca)- Nasal septal defects (e.g., ...
- Pharyngeal cancer Pharyngeal cancers include all malignant tumors arising in the nasopharynx, oropharynx, or hypopharynx. Epidemiology:- Age: 50-60 years in nasopharyngeal cancer; approx. 55-70 years in oro- and hypopharyngeal ...
- Wells criteria Clinical symptoms of DVT – 3 PE more likely than other diagnoses – 3 Previous PE/DVT – 1.5 Tachycardia (heart rate > 100/min) – 1.5 Surgery or immobilization in the past four weeks – 1.5 ...
- Management of parapneumonic effusions Small effusion AND no respiratory distress or hypoxia → Oral antibiotics Moderate/large effusion OR Respiratory distress OR hypoxia → Ultrasound, IV antibiotics, drainage
- Air embolism Etiology:- Surgery: neurosurgical procedures (highest risk); laparoscopic surgery- Trauma- Barotrauma: mechanical ventilation ; decompression sickness- Accidental injection of air (infusion-related errors); ...