¼±Åà - È­»ìǥŰ/¿£ÅÍŰ ´Ý±â - ESC

 

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