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Family Medicine: Case Files > EH: Pulmonology > Flashcards

EH: Pulmonology Flashcards

1
Q

CXR: “Opacification, consolidation, air bronchograms”

A

Pneumonia

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2
Q

CXR: “hyperlucent lung fields with flattened diaphragms”

A

COPD

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3
Q

CXR: “heart > 50% AP diameter, cephalization, Kerly B lines & Fluffy interstitial edema”

A

CHF

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4
Q

CXR: “Cavity containing an air- fluid level”

A

Abcess - Caused by Staph and Aneorobics

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5
Q

CXR: “Upper lobe cavitation, consolidation +/- Hilar adenopathy”

A

TB

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6
Q

CXR: “Thickened peritracheal stripe and splayed carina bifurcation”

A

Left Atria Enlargement by Mitral Stenosis

or

Mediastinum Lymphadenopathy (cancer)

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7
Q

Pleural Effusions see fluid >1cm on lat decu

A

Thoracentesis

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8
Q

Transudative: If low pleural glucose?

A

Rheumatoid Arthritis

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9
Q

Transudative: If high lymphocytes?

A

Tuberculosis

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10
Q

Transudative: If bloody?

A

Malignant or Pulmonary Embolus

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11
Q

If exudative?

A

Likely Parapneumonic Effusion, cancer, etc

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12
Q

If Thoracentesis is complicated?

(+ gram or cx, pH < 7.2, glc < 60)

A

Insert chest tube for drainage

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13
Q

Light’s Criteria –> Ttransudative if?

A

LDH < 200

LDH eff/serum < 0.6

Protein eff/serum < 0.5

All three have to be positive to be Transudative

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14
Q

High risk after surgery, long car ride, hyper coagulable state

Pleuritic Chest pain

Tachypnea

Tachycardic

< SpO2

Wedge Infarct - Westermark Pulmonary vessel Blocked

(cancer, nephrotic syndrome)

A

PE

Heparin

VQ scan or Sprial CT

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15
Q

Pleuritic chest pain, Hemoptysis, Tachypnea, Decr SpO2, Tachycardia

A

PE

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16
Q

Right heart strain on EKG, Sinus Tach, Decr vascular markings on CXR, Wedge infarct, ABG w/ low CO2 and O2

A

PE

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17
Q

If suspected PE?

A

If suspected, give heparin 1st!

Then work up w/ V/Q scan

Then spiral CT.

Pulmonary angiography is gold standard.

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18
Q

Tx for PE?

A

Tx w/ Heparin warfarin overlap

Use thrombolytics if severe but NOT if s/p surgery or hemorrhagic stroke

Surgical thrombectomy if life threatening

IVC filter if contraindications to chronic coagulation

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19
Q

Inflammation

  • -> Impaired gas xchange
  • -> inflam mediator release
  • -> Hypoxemia

Bilateral Fluffy Infiltrates

A

ARDS

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20
Q

Causes of ARDS

A

Sepsis

Gastric Aspiration

Trauma

Low perfusion

Pancreatitis

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21
Q

Diagnosis of ARDS?

A
  1. ) PaO2/FiO2 < 200 (<300 means acute lung injury)
  2. ) Bilateral alveolar infiltrates on CXR
  3. ) PCWP is <18 mmHg (means pulmonary edema is non cardiogenic)
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22
Q

Tx for ARDS?

A

Oxygen; Mechanical ventilation w/ PEEP

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23
Q

Asthma:

Obstructive or Restrictive?

A

Obstructive

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24
Q

COPD:

Obstructive or Restrictive?

A

Obstructive

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25
Emphysema : Obstructive or Restrictive?
Obstructive
26
Interstitial lung dz (sarcoid, silicosis, asbestosis): Obstructive or Restrictive?
Restrictive
27
Structural- super obese : Obstructive or Restrictive?
Restrictive
28
MG/ALS, phrenic nerve paralysis, scoliosis : Obstructive or Restrictive?
Restrictive
29
Obstructive FEV1/FVC?
\< 80% Predicted
30
Restrictive FEV1/FVC?
Normal
31
Obstructive TLC and RV?
↑ \>120% predicted
32
Restrictive TLC and RV?
↓ \<80% predicted
33
Obstructive / Restrictive? Improves \>12% with bronchodilator
Obstructive: Asthma does, COPD and Emphysema don’t Restrictive: Nope
34
Obstructive / Restrictive? DLCO reduced?
Obstructive: Reduced in Emphysema 2/2 alveolar destruction. Restrictive: Reduced in ILD due to fibrosis thickening distance
35
Criteria for diagnosis of COPD?
Productive cough \>3mo for \>2 consecutive yrs
36
Treatment of COPD?
1st line = Ipratropium, Tiotropium. 2nd Beta agonists. 3rd Theophylline (Narrow therapeutic window, Arrhythmias)
37
COPD Indications to start O2?
PaO2 \<55 or SpO2\<88%. If cor pulmonale, \<59
38
COPD: Criteria for exacerbation?
Change in sputum, increasing dyspnea
39
Treatment for COPD Exacerbation?
ABX (Macrolide) and Steroids O2 to 90% Albuterol / Ipratropium nebs PO or IV corticosteroids FQ or macrolide ABX
40
Best prognostic indicator for COPD?
FEV1 (Spirometry)
41
Shown to improve mortality in COPD?
1. ) Quitting smoking (can decr rate of FEV1 decline 2. ) Continuous O2 therapy \>18hrs/day
42
Why is our goal of SpO2 94 - 95% instead of 100% in COPD?
COPDers are chronic CO2 retainers. Hypoxia is the only drive for respiration.
43
Important vaccinations for COPDers?
Pneumococcus Vaccine w/ a 5yr booster and Yearly influenza vaccine
44
New Clubbing in a COPDer?
**Hypertrophic Osteoarthropathy** (Cancer) Acute Onset of Clubbing --\> Lung Cancer Next best step... get a **CXR** Most likely cause is underlying lung malignancy
45
Asthma: If pt has sxs twice a week and PFTs are normal?
Mild Intermitant Albuterol only
46
Asthma: If pt has sxs 4x a week, night cough 2x a month and PFTs are normal?
Moderate-Intermittant Albuterol and Inhaled CS
47
Asthma: If pt has sxs daily, night cough 2x a week and FEV1 is 60-80% predicted value?
Moderate-Consistant Albuterol + inhaled CS + Long-acting beta-ag (salmeterol)
48
Asthma: If pt has sxs daily, night cough 4x a week and FEV1 is \<60%?
Severe Albuterol + inhaled CS + Salmeterol + Montelukast and Oral steroids
49
Asthma Exacerbation?
Tx w/ inhaled albuterol and PO/IV steroids. Watch peak flow rates and blood gas. PCO2 should be low. Normalizing PCO2 means impending respiratory failure --\> INTUBATE!
50
Asthma Complication?
Allergic Brochopulmonary Aspergillus Ab in Blood
51
CXR Popcorn calcification?
Hamartoma
52
CXR Concentric calcification?
Old granuloma
53
Pulmonary Nodule: If pt has risk factors (smoker, old), If \>3cm, if eccentric calcification
Do open lung bx and remove the nodule
54
Most common cancer in non-smokers?
Adenocarcinoma. Occurs in scars of old pnia
55
Location and mets from lung?
Adeno Carcinoma Peripheral cancer. Mets to Liver, Bone, Brain and Adrenals
56
Characteristics Adenocarcinoma of Lung effusion?
Exudative with high Hyaluronidase
57
Patient with kidney stones, constipation and malaise low PTH and central lung mass?
Squamous cell carcinoma. Paraneoplastic syndrome 2/2 secretion of **PTH-rP**. Low PO4, High Ca
58
Patient with shoulder pain, ptosis, constricted pupil, and facial edema?
Superior Sulcus Syndrome from Small Cell Cancer Central Cancer Pancoast Tumor from Small Cell Cancer
59
Patient with ptosis better after 1 minute of upward gaze?
Lambert Eaton Syndrome from Small Cell Carcinoma Ab to pre-syn Ca channel
60
Old smoker presenting w/ Na = 125, moist mucus membranes, no JVD?
SIADH from Small Cell Carcinoma Produces Euvolemic Hyponatremia Fluid Restrict +/- 3% Saline in \<112
61
CXR shows peripheral cavitation and CT showing Distant METS?
Large Cell Carcinoma Peripheral Cancer Causes Cavitation Very Metastatic
62
"1cm nodues in upper lobes w/ eggshell calcifications"
Silicosis Get yearly TB test!. Give INH for 9mo if \>10mm
63
"Reticulonodular process in lower lobes w/ pleural plaques"
Asbestosis. Most common cancer is broncogenic carcinoma, but incr risk for mesothelioma
64
"Patchy lower lobe infiltrates, thermophilic actinomyces. "
Hypersensitivity Pneumonitis = “farmer’s lung”
65
"Hilar lymphadenopathy, ↑ACE erythema nodosum"
Sarcoidosis

Family Medicine: Case Files (21 decks)

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