Block 4 Flashcards
pulm hypoplasia vs bronchogenic cysts
poorly developed bronchial tree; assoc w/ congen diaphragmatic hernia & bil renal agenesis vs abnl foregut budding & dil bronchi -> airway compression, fluid/air filled; in middle mediastinum
asbestos vs beryl vs coal vs silicosis
supradiaphragm/pleural plaques; ferruginous dumbells w/ Prussian blue; pleural effusion/mesothel vs noncaseating gran vs black lung, carbon macs, anthracosis from urban sooty air vs fibrogenic, no phagolysosomes or macs -> inc TB, eggshell calc on hilum on CXR
sarcoid
noncaseating gran, bil hilar adenopathy, inc CD4 -> Th1, IL2; inc ACE. assoc w/ lupus pernio, RCM, erythema nodosum, hyperCa2+. tx w/ steroids
pulm arterial HTN. dx vs tx?
inactivating BMPR22 -> no vasc smooth mm prolif -> inc vasoconstrict/dec vasodil -> inc PVR -> RVH/RHF; assoc w/ scleroderma, amphet/cocaine, schistomasis. R heart cath, echo vs prevent RHF/cor pulm by endothel 1 antag, PDE5I, PGI2
Pancoast tumor
ca @ apex lung => sup sulcus tumor; assoc w/ recurrent laryngeal n -> hoarse, Horner, SVC syndrome, brachiocephalic v, brachial plexus -> shoulder pain, atrophy intrinsic mm, hemidiaphragm paralysis/elev
NSAID exac resp dz
COX inhib -> inc LT -> Samter 3ad: sinusitis, nasal polyps, asthma. tx w/ -kasts
pericarditis vs pericardial effusion vs cardiac tamponade
one leads to next. viral/constrictive, frxn rub, diffuse ST elev; tx w/ NSAIDs, colchicine, glucocorticoids, dialysis if uremic vs lg heart silhouette w/ clear lung fields vs Beck 3ad, low voltage EKG, electrical alternans, pulsus paradoxus (drop in SBP >10 on inspiration); dec RA size -> inc RAP -> inc central venous pressure -> obstructive shock
pneumothorax causes what type of percussion? which condition inc risk of pneumothorax? what causes inc fremitus?
hyperresonant. Marfan’s. lobar consolidation like pulm edema, PNA
details you forget for 3o AV block. how to tx afib vs aflutter vs vfib vs NSTEMI/unstable angina?
caused by Lyme, atrial rate > ventricular rate; tx w/ pacemaker. anticoag, rate & rhythm ctrl, cardioversion, cath ablation vs cath ablation @ tricuspid annulus & IVC vs CPR & defib vs anticoag, antiPLT, ADP inhib
which diuretic good for HF? other fxns of thiazides? amiloride?
ACE/ARB, BB x/ decompensated, spironolactone dec mortality; diltiazem inc mortality; loop = 1st line for sxs. nephro DI, 2nd line for HF, inc serum Li lvls. tx Liddle & nephro DI from Li
aging lungs. causes of SVC syndrome
inc lung compliance, V/Q mismatch, A-a grad, RV; dec chest wall compliance/stiff, resp strength, response to hypox/hypercap, FEV1-FVC. malig (mediastinal mass, Pancoast), thrombosis from indwelling cath
PE
inc RA/V & pulm a pressure, inc dead space, nml PCWP, V/Q mismatch to infinity -> tachy/pnea, resp alk, hypoxemia; dx CT pulm angio, S1Q3T3, sinus tach, Zahn in premortem; tx anticoag like hep/direct thrombin/Xa inhib, IVC filter
details you forget: transposition vs tet vs Ebstein. ASD vs PDA vs Eisen vs coarct. what 2 causes paradox emboli?
eggshell on string CXR, alprostadil PGE1 keep open, parallel vs tet spells, squat vs tricuspid regurg, accessory conduction, RHF. ostium 2o defect, Down/fixed split, paradox emboli vs PGE1/2 opens, indomethacin closes vs inc PAH/RA & RV pressure -> R/L, late cyanosis, clubbing, polycy vs inc risk Berry, aortic rupture, endocarditis. ASD & PFO
sick sinus syndrome. where’s Pancoast?
age-related degen of SA node -> sinus arrest/delayed P wave -> dec CO, brady. apex lung => sup sulcus tumor
When you see “pulm sten”, think…? what’s a nml A-a grad?
Tet, wide split S2, pulm a. 4-15mmHg; if hypoxic & abnl A-a -> impaired gas exchange or perfusion; if hypoxic & nml A-a -> alv hypovent or high altitude
