HLK Week 4 Flashcards
What physiological response to pulmonary arterioles have to low oxygen?
Constriction (as opposed to systemic arterioles, which dilate)
What counts as a “submassive PE?”
Normotensive with acute PE and evidence of right ventricular dysfunction.
True or false: most patients with PE are normotensive with preserved RV function, and therefore have a good prognosis.
True
Explain the basic pathophysiological reason for the symptoms of pulmonary hypertension.
Loss of ability to increase cardiac output leads to SOB, dizziness, peripheral edema, fatigue, chest pain, etc.
Common sign of intrinsic lung disease:
- Bibasilar end-inspiratory crackles
- Clubbing (common in IPF)
- Erythema nodosum (common in sarcoidosis)
- Raynaud’s, telangiectasias, rash
- Evidence of cor pulmonale
- Wheezing NOT common
Describe the classic presentation for idiopathic pulmonary fibrosis (IPF):
- Progressive dyspnea
- Fine inspiratory bibasilar crackles
- Clubbing
- Systemic Sx uncommon but include: weight loss, fever, fatigue, arthralgia or myalgia.
Common imaging finding in late stage IPF:
Honeycombing
Typical sarcoidosis patient:
Middle aged, African American woman
Classic radiographic finding in sarcoidosis:
Bilateral hilar adenopathy
Classic radiographic finding in silicosis:
Hilar lymphadenopathy with “eggshell” calcifications
Classic radiographic finding in asbestosis:
Pleural thickening with plaques along the diaphragm and posterolateral chest wall.
What’s the most predictive symptom of pleural effusion?
Pleuritic chest pain (pain upon inspiration)
Type of non-inflammatory, non-painful pleural effusion:
Transudative
Type of inflammatory, painful pleural effusion::
Exudative
Why is a right sides pleural effusion commonly seen with ascites?
Positive intraperitoneal pressure and negative pleural pressure creates a pressure gradient, forcing fluid through diaphragmatic refts (seen in 30% of pts) and into the pleural space, especially when they breath.
Chylothorax:
- Milky effusion
- Sterile, painless
- TG > 110 is diagnostic
- Associated with lymphatic obstruction
Most common features of diffuse parenchymal lung disease:
Infiltration of the lung by inflammatory cells and fluid, leading to scarring, fibrosis and capillary obliteration
In addition to respiratory symptoms, the classic triad of coccidiomycosis is:
- Fever
- Joint pain
- Erythema nodosum
Histoplasmosis:
- MS, OH river valley
- Sx from mild flu to severe pneumonia
- Multiple organs if disseminated
- Serum polysaccharide antigen is Dx test
- Anemia, elevated LFTs
- Itraconazole, Amphotericin B
Coccidiomycosis:
- Mold spores in desert SW
- Disseminated in filipinos, blacks, pregnant, HIV
- Flu Sx, erythema nodosum
- Patchy nodular and upper lobe infiltrates on CXR
- Meningitis, skin, bone, mediastinum affected in disseminated
- Spherules with endospores on Bx
- Fluconazole, Amphotericin B, Itraconazonle
Psittacosis:
- Zoonotic disease in birds
- Flu like Sx with severe HA, T/P dissociation, culture negative endocarditis
- CXR looks like pneumonia
- Tetracyclines or erythromycin
Aspergillosis:
- Fungus ball
- Classic triad of fever, pleuritic pain, hemoptysis
- Halo sign
- Eosinophilia, high IgG/E, PCR and ELISA tests
- Itraconazole, voriconazole IV for severe
SARS:
- Horseshoe bats, travel to far east
- Presents as flu, pneumonia, CXR infiltrates
- Leukopenia, low-grade DIC
- Immunoassays after 3 weeks
- Antivirals, interferon, IgG, steroids, quarantine
Hantavirus:
- Desert SW
- Pulmonary syndrome or hemorrhagic fever
- Flu Sx with prominent cough and GI
- Pulmonary edema, kidney injury, myositis
- Plaque reduction neutralization test
- Supportive care + antivirals if hemorrhagic
Primary TB:
- Inhaled droplets
- Clinically and radiographically silent
- Infection usually contained in granulomas
- Risk factors include HIV, living in 3rd world or poor
- 5% go on to Sx of TB
Latent TB:
- Non-communicable
- 6% go on to re-activated TB, usually in first 2 years
Active TB:
- Dry cough turns productive with pus
- Night sweats and other Sx
- Apical, granulomatous lesions and effusions
Tx for active TB:
- RIPE (rifampin, isoniazid, pyrazinamide, ethambutol) for 2 months, followed by INH-RIF 2-3x/wk for 4 months.
- Continue for 3 months after clear CXR
What to order for a patients with suspected TB:
- CXR
- Sputum samples (3) for staining, culture and PCR
First line chemotherapy for NSCLC:
- A platinum drug: cisplatin, carboplatin
- Variable second drug: e.g., paclitaxel
What do most solitary pulmonary nodules turn out to be?
Infectious granulomas
