ÃÑ·Ð ´ëÀå°æ Á¤¸®
1. hemoptysis mc cause: bronchitis, bronchogenic ca
¿ì¸®³ª¶ó¿¡¼ mc cause: Tb, bronchiectasis
2. °áÇÙȯÀÚ hemoptysis½Ã ¿øÀÎ
i) Tb bronchiectasis
ii) Tb reactivation
iii) fungal ball formation(aspergilloma)
iv) cavity formation(Rasmussen aneurysm rupture)
3. massive hemoptysis¶§ ¼ö¼úÀÌ ºÒ°¡´ÉÇÒ °æ¿ì ÃÖ¼±ÀÇ Ä¡·á? bronchial artery embolization
cf. BAE½Ã µå¹°°Ô spinal artery¸¦ ¸·¾Æ ÇϹݽЏ¶ºñ¸¦ ÀÏÀ¸Å³¼ö ÀÖ´Ù.
4. vocal fremitus°¡ °¨¼ÒÇϰí percussion dullness°¡ Áõ°¡Çϴ ȣÈí±â Áúȯ 2°¡Áö?
pleural effusion, atelectasis
cf. vocal fremitus°¡ Áõ°¡ÇÏ´Â °Í? atelectasis with patent bronchus
³ª¸ÓÁö´Â ¸ðµÎ °¨¼Ò(ÀϺδ Á¤»ó)
5. localized fixed lesion¿¡ Áö¼ÓÀûÀÎ wheezingÀÌ µé¸± ¶§ °í·ÁÇØ¾ß ÇÒ Áúȯ?
foreign body, neoplasm, bronchial stenosis
6. Àå±â°£ intubationÇÑ º´·ÂÀÌ ÀÖ´Â »ç¶÷¿¡¼ stridor°¡ µé¸± ¶§ °¡´É¼º ³ôÀº Áø´Ü?
post-intubation granuloma
7. ¸¶Ãë½Ã ±âµµ»ð°ü Á¦°ÅÈÄ stridor°¡ µé¸± ¶§ Áø´Ü ¹× Ä¡·á?
post-extubation laryngeal edema, heliumÄ¡·á
8. Èí¿¬ÀÌ Æó¿¡ ¹ÌÄ¡´Â ¿µÇâ
i) ciliary movementÀå¾Ö
ii) alveolar macrophage±â´É Àå¾Ö
iii) mucus secreting gland hypertrophy & hyperplasia
iv) antiprotease inhibition, proteolytic enzyme release¡è
v) airway resistance¡è(by vagally mediated smooth muscle constriction)
vi) ¥á1-ATȰ¼º °¨¼Ò
9. Èí¿¬
- mesothelioma¹ß»ý°ú´Â °ü°è°¡ ¾ø´Ù.
- ÁÖ·Î centriacinar emphysema¸¦ ÀÏÀ¸Å²´Ù.
cf. ¥á1-AT deficiency: panacinar emphysema
- sarcoidosis´Â ºñÈí¿¬ÀÚ¿¡¼ ´õ Àß »ý±ä´Ù.
10. Èí¿¬°ú °ü·Ã¼ºÀÌ ³ôÀº È£Èí±â Áúȯ(lung cancer, COPD¿Ü¿¡)
i) spontaneous pneumothorax
ii) eosinophilic granuloma
iii) Goodpasture's syndrome
11. ³ëÈ¿¡ µû¸¥ È£Èí±âÀÇ º¯È
- elastinÀÇ °¨¼Ò ¹× elastic recoil°¨¼Ò
- soluble collagenÀº °¨¼ÒÇϰí insoluble collagenÀº Áõ°¡
- FEV1Àº ¿¬°£ 25mL¾¿ °¨¼ÒÇÑ´Ù.
- PaCO2, TLC´Â º¯È¾ø´Ù. cf. PaO2, VC, diffusing capacity´Â °¨¼Ò
12. (A-a)DO2 = 713 ¡¿ FiO2 + 1.25PaCO2 - PaO2
room airÀ϶§´Â 150 + 1.25PaCO2 - PaO2
FiO2 100%À϶§´Â 713 + 1.25PaCO2 - PaO2
* normal < 15 mmHg
13. shunt fraction = (A-a)DO2/20
oxygen content(ml/dl) = 1.34 ¡¿ Hb ¡¿ SaO2 + 0.0031 ¡¿ PaO2
14. hypoxemia¿øÀÎ
i) alveolar hypoventilation
ii) V/Q mismatch
iii) shunt
(A-a)DO2°¡ Áõ°¡µÇ¾î ÀÖÀ¸¸é V/Q mismatch or shunt
À̶§ O2·Î ±³Á¤µÇ¸é V/Q mismatch, ±³Á¤µÇÁö ¾ÊÀ¸¸é shunt
15. shunt¸¦ ÀÏÀ¸Å°´Â »óȲ
i) alveolar collapse: atelectasis
ii) intraalveolar filling : pneumonia, pulmonary edema
iii) intracardiac shunt
iv) vascular shunt within lungs
16. V/Q mismatch¸¦ ÀÏÀ¸Å°´Â »óȲ
i) airway disease(asthma, COPD)
ii) ILD
iii) pulmonary vascular disease
iv) alveolar disease
17. Á¤»óÀο¡¼ (A-a)DO2°¡ 0ÀÌ»óÀÎ ÀÌÀ¯´Â?
i) V/Q heterogeneity or inequality
ii) physiologic shunt
18. O2 dissociation curve¸¦ Rt shift½ÃŰ´Â Á¶°Ç
acidosis: pH¡é, ü¿Â¡è, 2.3-DPG¡è, CO2¡è
19. pulse oxymetry
- hemoglobinÀÇ °¢ ÇüŸ¦ ±¸º°ÇÏÁö ¸øÇÑ´Ù.
Áï, carboxyhemoglobin, methemoglobin°ú oxyhemoglobinÀ» ±¸º°ÇÏÁö ¸øÇÑ´Ù.
¿¹> óÀ½¿¡ SaO2°¡ ³·¾Ò´ø AMIȯÀÚ°¡ long acting nitrate infusionÇÏ´øÁß
methemoglobinemia°¡ »ý°Ü SaO2°¡ »ó½ÂÇÒ¼ö ÀÖ´Ù.
Áï, methemoglobinemia¶§ SaO2¸¦ overestimateÇÒ¼ö ÀÖ´Ù.
20. CXR¿¡¼ Á¤»óÀ¸·Î º¸Àϼö ÀÖ´Â ¼Ò°ßµé
SPN<6mm, acute pulmonary thromboembolism without infarction
diffuse granulomatous disease(¿¹, miliary Tb), interstitial disease
bronchiectasis, mild emphysema, partially obstructing airway disease
neuromuscular disease
21. cavity Çü¼ºÁúȯ
1) °¨¿°¼º: Legionella, P. aeruginosa, S. aureus, type III S. pneumoniae
M. tuberculosis, Norcardia, ±× ¿Ü fungus
2) ºñ°¨¿°¼º: neoplasm, Wegener's granulomatosis, infarction, infected bullae & cyst,
sequestration
22. ÆóÁúȯ¿¡¼ MRIÀÇ ¿ªÇÒ
- spacial resolutionÀº CTº¸´Ù ÁÁÁö ¸øÇÏ´Ù.
- lung apex, spine, thoracoabdominal junctionÀ» º¸´Âµ¥´Â CTº¸´Ù ¿ì¼öÇÏ´Ù.
23. Ga scan»ó º´º¯ºÎÀ§¿¡ Ä§ÂøÇÏ´Â °æ¿ì
i) lung cancer
ii) sarcoidosis
iii) P. carini pneumonia
iv) diffuse ILD
v) hypersensitivity pneumonitis
24. BAL
- lavage½ÃÇà Ç¥ÁØÀå¼Ò´Â Rt middle lobe³ª lingula segment
- Èí¿¬ÀÚ¿¡¼ poly°¡ Áõ°¡
- hypersensitivity pneumonitis: CD4/CD8¡é
- sarcoidosis´Â CD4/CD8 > 3.5
25. therapeutic bronchoscopyÀûÀÀÁõ
i) foreign bodyÁ¦°Å
ii) pulmonary alveolar proteinosis¿¡¼ whole lung lavage
iii) endoscopic laser therapy
iv) bronchial toilet: secretion, hemoptysisÁ¦°Å
v) intratumoral injection
26. hemoptysis½Ã bronchoscopyÀûÀÀÁõ
i) 40¼¼ ÀÌ»ó smoker
ii) localized CXR abnormality
iii) 1ÁÖÀÌ»ó Áö¼ÓµÇ´Â hemoptysis
27. ÆóÀÇ »ý¸®Àû ±â´É
°¡½º±³È¯, surfactant »ý»ê, angiotension I -> angiotensin II·ÎÀÇ Àüȯ¿Ü¿¡
¼øÈ¯Ç÷¾×³» serotonin, bradykininÀÇ ºñȰ¼ºÈ¿¡ °ü¿©ÇÑ´Ù.
28. neuropeptideÁ¾·ù
1) ±â°üÁö ¼öÃà & vasodilatation : substance P, neurokinin A
2) ±â°üÁö ¼öÃà & vasoconstriction: bombesin
3) ±â°üÁö È®Àå & vasodilatation : VIP