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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
Q

Emphysema :

Obstructive or Restrictive?

A

Obstructive

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26
Q

Interstitial lung dz (sarcoid, silicosis, asbestosis):

Obstructive or Restrictive?

A

Restrictive

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27
Q

Structural- super obese :

Obstructive or Restrictive?

A

Restrictive

28
Q

MG/ALS, phrenic nerve paralysis, scoliosis :

Obstructive or Restrictive?

A

Restrictive

29
Q

Obstructive FEV1/FVC?

A

< 80% Predicted

30
Q

Restrictive FEV1/FVC?

A

Normal

31
Q

Obstructive TLC and RV?

A

↑ >120% predicted

32
Q

Restrictive TLC and RV?

A

↓ <80% predicted

33
Q

Obstructive / Restrictive?

Improves >12% with bronchodilator

A

Obstructive: Asthma does, COPD and Emphysema don’t

Restrictive: Nope

34
Q

Obstructive / Restrictive?

DLCO reduced?

A

Obstructive: Reduced in Emphysema 2/2 alveolar destruction.

Restrictive: Reduced in ILD due to fibrosis thickening distance

35
Q

Criteria for diagnosis of COPD?

A

Productive cough >3mo for >2 consecutive yrs

36
Q

Treatment of COPD?

A

1st line = Ipratropium, Tiotropium.

2nd Beta agonists.

3rd Theophylline (Narrow therapeutic window, Arrhythmias)

37
Q

COPD Indications to start O2?

A

PaO2 <55 or SpO2<88%. If cor pulmonale, <59

38
Q

COPD: Criteria for exacerbation?

A

Change in sputum, increasing dyspnea

39
Q

Treatment for COPD Exacerbation?

A

ABX (Macrolide) and Steroids

O2 to 90%

Albuterol / Ipratropium nebs

PO or IV corticosteroids

FQ or macrolide ABX

40
Q

Best prognostic indicator for COPD?

A

FEV1 (Spirometry)

41
Q

Shown to improve mortality in COPD?

A
  1. ) Quitting smoking (can decr rate of FEV1 decline
  2. ) Continuous O2 therapy >18hrs/day
42
Q

Why is our goal of SpO2 94 - 95% instead of 100% in COPD?

A

COPDers are chronic CO2 retainers.

Hypoxia is the only drive for respiration.

43
Q

Important vaccinations for COPDers?

A

Pneumococcus Vaccine w/ a 5yr booster

and

Yearly influenza vaccine

44
Q

New Clubbing in a COPDer?

A

Hypertrophic Osteoarthropathy (Cancer)

Acute Onset of Clubbing –> Lung Cancer

Next best step… get a CXR

Most likely cause is underlying lung malignancy

45
Q

Asthma:

If pt has sxs twice a week and PFTs are normal?

A

Mild Intermitant

Albuterol only

46
Q

Asthma:

If pt has sxs 4x a week, night cough 2x a month and

PFTs are normal?

A

Moderate-Intermittant

Albuterol and Inhaled CS

47
Q

Asthma:

If pt has sxs daily, night cough 2x a week and FEV1 is

60-80% predicted value?

A

Moderate-Consistant

Albuterol + inhaled CS + Long-acting beta-ag (salmeterol)

48
Q

Asthma:

If pt has sxs daily, night cough 4x a week and FEV1 is

<60%?

A

Severe

Albuterol + inhaled CS + Salmeterol + Montelukast and
Oral steroids

49
Q

Asthma Exacerbation?

A

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
Q

Asthma Complication?

A

Allergic Brochopulmonary Aspergillus

Ab in Blood

51
Q

CXR Popcorn calcification?

A

Hamartoma

52
Q

CXR Concentric calcification?

A

Old granuloma

53
Q

Pulmonary Nodule:

If pt has risk factors (smoker, old), If >3cm, if eccentric calcification

A

Do open lung bx and remove the nodule

54
Q

Most common cancer in non-smokers?

A

Adenocarcinoma.

Occurs in scars of old pnia

55
Q

Location and mets from lung?

A

Adeno Carcinoma Peripheral cancer.

Mets to Liver, Bone, Brain and Adrenals

56
Q

Characteristics Adenocarcinoma of Lung effusion?

A

Exudative with high Hyaluronidase

57
Q

Patient with kidney stones, constipation and malaise low PTH and central lung mass?

A

Squamous cell carcinoma.

Paraneoplastic syndrome 2/2 secretion of
PTH-rP. Low PO4, High Ca

58
Q

Patient with shoulder pain, ptosis,
constricted pupil, and facial edema?

A

Superior Sulcus Syndrome from Small Cell Cancer

Central Cancer

Pancoast Tumor from Small Cell Cancer

59
Q

Patient with ptosis better after 1
minute of upward gaze?

A

Lambert Eaton Syndrome from Small Cell Carcinoma

Ab to pre-syn Ca channel

60
Q

Old smoker presenting w/ Na = 125,
moist mucus membranes, no JVD?

A

SIADH from Small Cell Carcinoma

Produces Euvolemic Hyponatremia

Fluid Restrict +/- 3% Saline in <112

61
Q

CXR shows peripheral cavitation and CT showing Distant METS?

A

Large Cell Carcinoma

Peripheral Cancer

Causes Cavitation

Very Metastatic

62
Q

“1cm nodues in upper lobes w/ eggshell calcifications”

A

Silicosis

Get yearly TB test!.

Give INH for 9mo if >10mm

63
Q

“Reticulonodular process in lower lobes w/ pleural plaques”

A

Asbestosis.

Most common cancer is broncogenic carcinoma, but incr risk for mesothelioma

64
Q

“Patchy lower lobe infiltrates, thermophilic actinomyces. “

A

Hypersensitivity Pneumonitis = “farmer’s lung”

65
Q

“Hilar lymphadenopathy, ↑ACE erythema nodosum”

A

Sarcoidosis

Family Medicine: Case Files (21 decks)

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