Hubbard DSAs Flashcards
describe grades 1-5 on the MRC dyspnea scale
1: not troubled by breathlessness except on strenuous exercise
2: SOB when hurrying on the level or when walking up slight hill
3: walks slower than most people on the level, stops after a mile, stops after 15 mins walking at own page
4: stops for breath after walking 100 yards or after few minutes on level ground
5: too breathless to leave the house or breathless when undressing
in TNM staging for tumors, what does T1 mean
tumor <2cm w/o extraparenchymal extension
T2 in TNM staging
tumor >2cm but not more than 4cm w/o extraparenchymal extension
T3 in TNM staging
tumor >4cm and/or having extraparenchymal extension
T4a in TNM staging
tumor invades skin, mandible, ear canal, and or fascial nerve
T4b in TNM staging
tumor invades skull base and/or pterygoid plates and/or encases carotid artery
N0 in TNM staging
no regional LN mets
N1 in TNM staging
mets in a single, ipsilateral LN <3cm
N2a in TNM staging
mets in a single ipsilateral LN >3 but less than 6cm
N2b in TNM staging
mets in multiple ipsilateral LN >6cm
N2c in TNM staging
mets in bilateral or contralateral LN, none >6cm
N3 in TNM staging
mets in LN >cm
stage 1 non-small cell lung CA:
- definition
- tx
- prognosis
tumor surrounded by lung or pleura, <2cm from carina
- surgery, adjuvant chemotharpy if needed
- 60-70% survival
stage 2 non-small cell lung CA:
- definition
- tx
- prognosis
locally advanced dz w/o mediastinal involvement
- surgery and adjuvant chemotherapy
- 40-50% survival
stage 3 non-small cell lung CA:
- definition
- tx
- prognosis
mediastinal involvement, or 2 separate tumor nodules in same lobe w/o involvement
- combine modalities of chemo, radiation, surgery
- 5-20% survival
stage 4 non-small cell lung CA:
- definition
- tx
- prognosis
metastatic
- chemo
- median survival 7 months
GOLD staging 1
Mild
- FEV1/FVC <70%
- FEV1 >80% of predicted
- w/ or w/o chronic sx (cough, sputum)
GOLD staging 2
Moderate
- FEV1/FVC <70%
- FEV1 b/w 50%-80% of predicted
- w/ or w/o chronic sx (cough, sputum)
GOLD staging 3
Severe
- FEV1/FVC <70%
- FEV1 b/w 30%-50% of predicted
- w/ or w/o chronic sx (couch, sputum)
GOLD staging 4
Very Severe
- FEV1/FVC <70%
- FEV1 <30% of predicted
- chronic respiratory failure
Tx for GOLD staging 1
short acting bronchodilator
Tx for GOLD staging 2
add regular tx w/ one or more long-acting bronchodilators, add pulmonary rehab
Tx for GOLD staging 3
add inhaled corticosteroid if repeated exacerbations
Tx for GOLD staging 4
add long-term oxygen therapy if chronic respiratory failure, consider surgical tx
ddx for predominantly basal infiltrates on CXR
IPF, asbestosis, NSIP
ddx for predominantly upper lobe infiltrates on CXR
hypersensitivity pneumonitis, sarvoidosis, silicosis
ddx for peripheral infiltrates on CXR
IPF, chronic eosinophilic pneumonia, cryptogenic organizing pneumonia
ddx for central infiltrates on CXR
sarcoidosis, pulmonary alveolar proteinosis
ddx for mosaic attenuation on CXR
small airway disease (hypersensitivity pneumonitis, respiratory bronchiolitis-associated interstitial lung dz)
what does the epworth sleepiness scale measure
assesses the level of somnolence during daytime activity to help determine the need for diagnostic testing for sleep disorders.
purpose of STOP-BANG questionnaire
high sensitivity and negative predictive value, par ticularly for moderate or severe sleep apnea
AHI > 5 confirms what
OSA
ratio of pleural fluid to serum protein <0.5
transudative pleural effusion
ratio of pleural fluid to serum protein >0.5
exudative pleural effusion
ratio of pleural fluid LDH to serum LDH <0.6
transudative pleural effusion
ratio of pleural fluid LDH to serum LDH >0.6
exudative pleural effusion
pleural fluid LDH <2/3 upper limit of normal for serum
transudative pleural effusion
pleural fluid LDH >2/3 upper limit normal for serum
exudative pleural effusion
borders, contents, and lesions of anterior mediastinum
- sternum –> anteriorly to pericardium and posteriorly to brachiocephalic vessels
- thymus gland, anterior mediastinal LNs, internal mammary a. and v.
- thymomas
- lymphomas
- teratomas
- thyroid masses
contents and lesions of middle mediastinum
- heart, aorta, venae cavae, brachiocephalic a. and vs, phrenic nerves, trachea
- vascular masses, LN enlargement, pleuropericardial and bronchogenic cysts
contents and lesions of posterior mediastinum
- descending thoracic aorta, esophagus, thoracic duct, azygos and hemiazygos veins. mediastinal LNs
- neurogenic tumors
- meningocele, meningomyelocele
- gastroenteric cysts
- esophageal diverticula
what bacteria are the following patients most likely to get in community acquired pneumonia:
- pts in extended care facilities or w/ comorbidities
- alcoholics
- pts w/ structural lung dzs
- aspiration
extended care/comorbidities: gram negative
alcoholics: klebsiella
structural lung dzs: pseudomonas aeruginosa
aspiration: gram negative and anaerobic
what is the CURB-65 criteria
used to identify high risk patients w/ pneumonia
- Confusion
- blood urea nitrogen
- respiration rate
- systolic blood pressure
- age > 65
- *pts who meet two criteria are admitted to the hospital
- **3 criteria –> ICU
antibiotic therapy for Inpatient PNA pts w/ aspiration
clindamycin
b-lactam/b-lactamase inhibitor
antibiotic therapy for inpatient PNA pts w/o aspiration
quinolone or combo of B-lactam + macrolide or doxy
antibiotic therapy for outpatient PNA pts w/o chronic dz
macrolide or doxy
antibiotic therapy to outpatient PNA pts w/ cardiopulm dz
quinolone or combo B-lactam + macrolide or doxy
empiric outpatient antibiotc therapy for PNA in previously healthy patient
macrolid
antibiotic therapy for suspected ventilator acquired pneumonia in pts w/o risk
ceftriaxone or levofloxacin
antibiotic therapy for suspected ventilator acquired pneumonia in pts w/ risk factors
antipseudomonal agent + vanco
group 1 pulmonary hypertension
pulmonary arterial hypertension (PAH)
- idiopathic
- resting mPAP > 25mmHg
- PCWP <15
- drug and toxin-induced
- associated w/ CT disease, HIV, portal HTN, etc
group 2 pulmonary hypertension
secondary left heart disease
- resting mPAP > 25mmHg w/ underlying lung dz
- systolic and diastolic dysfunction
- valvular dz
group 3 pulmonary hypertension
secondary lung disease and/or hypoxia
- mPAP >25 mmHg
- COPD
- interstitial lung dz
- sleep disordered breathing
group 4 pulmonary hypertension
chronic thromboembolic pulmonary HTN
group 5 pulmonary hypertension
secondary unclear or multifactorial causes
- hematologic disorders
- systemic disorders
- metabolic disorders
CXR of TB patient
lesions in apical posterior segments of upper lung and superior segments of lower lobe
can IGRA distinguish b/w latent and active forms of TB
no
clinical triad of fat embolism
hypoxemia
neurologic abnormalities
petechial rash
tx for fat embolism
supportive care
organisms causing adult supraglottitis
- h. influenzae
- pneumococci
- group a strep
- s. aureus
- s. viridans
most important approach to evaluate airway obstruction
CT
virchow’s triad
hypercoagulability of blood
vessel wall injury
stasis of blood
homan sign
pain in calf on forced dorsiflexion of the foot (DVT pts, although it is a nonspecific and nonsensitive test for DVT)
wells criteria for DVT
- active cancer +1
- bedridden recently or recent major surgery +1
- calf swelling >3cm +1
- collateral superficial veins +1
- entire leg swollen +1
- pitting edema, confined to symptomatic leg +1
- paralysis, paresis, or recent plaster immobilization of LE +1
- previous DVT +1
- alternative dx more likely -2
wells criteria PE
- sx of DVT +3
- alternative dx less likely +3
- HR > 100 +1.5
- immobilization > 3 days or surgery in last 4 weeks +1.5
- previous PE or DVT +1.5
- hemoptysis +1
- active cancer +1
assessment of wells score for PE
high: >6
moderate: 2-6
low: <2
PE likely: >4
PE unlikely < or = 4
process after getting a wells score of 0
proceed to d-dimer
- negative: rule out DVT
- positive: go to US
- –negative: rule out DVT
- –positive: strongly consider anticoags
process after getting a wells score of 1-2
proceed to high-sensitivity d-dimer
- negative: rule out DVT
- positive: go to US
- –negative: rule out DVT
- –positive: strongly consider anticoags
wells score of 3 or higher means
DVT is likely (17-35% chance)
westermark sign
seen on CXR in PE patients
- lack of vascularity distal to an embolus
positive D-dimer means
high likelihood for DVT
in patients with low probability of a PE, a normal d-dimer means
rules out DVT
in what PE patients is thrombolytic therapy considered
pts w/ extensive thrombosis
- MAY be effective in pts w/ circulatory shock due to PE
