Lung cancer and more Flashcards
Pulm nodule workup?
Prior CXR to compare, if new or changed do CT for location and size
Benign: less than 35 years old, less than 2 cm, uniform, no lymphadenopathy
F/U in 3-6 months
Cancer risk: smoker, 45 or older, irregular, bigger than 2 cm, new or progressing
FDG-PET, biopsy, resection depednign on likelihood of malignancy
Lung cancer that is cavitary?
Squamous and direct extension
Adenocarciumo
Asbestos has high hyalurodinase (means wants to move)
Squamous cell paraneoplastic?
PTH related peptide
Hypercalcemia
Dermatomyositsi (in all lung cancer)
Superior vena cava syndroma?
Head swelling, CNS symptoms and headache and vision changes
Need endogenous stunting, then radition therapy
COMES WITH CANCER
What are non small cell lung cancers?
Tx
Squamous, adenocarcinoma and large cell cancer
CAN RESECT them and add chemoradiation
Idiopathic pulmonary fibrosis history?
Lavage shows what?
Tx?
Progressive intolerance
Dyspnea, crackles, JVD, tachypnea, Clubbing
Lavage shows neutrophils
It is a restrictive lung disease
CT on lung fibrosis?
Honeycomb (or ground glass)
Lung fibrosis serum markers?
SP-A SP-B MCP-1 and KL-6
LUNG BIOPSY needed for dx and staging
Tx of idiopathic pulmonary fibrosis?
Pirfenidone (prevents collagen synth)
Nintedanib blocks fibrogenic growth factors
glucocorticoid exacerbation
PULMONARY NOTgood (Pirfect Nintendos)
LUNG TRANSPLANT (5 year survival)
Sarcoid lab? KNOW!
Increase ACE (angiotensin converting enzyme)
Hyper calcium (b/c macrophage making more vit d)
more WBC, sed rate, alk phos
Sarcoid treatment?
Unique finding of sarcoid?
STEROIDs, usually self limiting
ANERGY (no reaction to skin test like PPD)
Arhtritis, chest pain, erythema nodulous, lymphadenopathy, vision loss, nerve palsy?
Sarcoid. Steroids!
Asbestosis complications?
bronchogenic carcinoma, mesothelioma
What exposure increases risk of TB or progressive fibrosis?
Silicosis (sand mining)
Does coal increase risk of cancer?
NO, just progressive fibrosis (which is terrible!) Need Pirfendion or nintenib (perfect nintendos)
Berylliosis?
Increased risk of cancer
Goodpasture syndrome?
antiglomerular basement membranes
Hemoptysis,d yspnea, recent infection
ANTI GBM
Proteinura and granular cast
Crescentric glomerulonephritis
IgG along glomerular capillaries
Tx of good pasture?
Plasmapheresis, glucocorticoids and immunosppressive
Granulomatosis with polyangitis has nasal saddle.
Tx?
C disease! Cyclophosphamide and corticosteroids
heart issues with each of the following?
Chromosome 22q11 Trisomy 21 Congen rubella Turner Marfan
22q11: truncus and tet 21 is endocardial defects, tet, PDA Rubella: PDA Turner is Coarct Marfan is aortic regurg
PE 4 star topic!
H and P?
Tachypnea and tachycardia
Altered mental status. Boring physical exam
think of cause for it
acid base in PE?
resp alkalosis b/c lots of breathing, but low O2!!
PE findings on EKG?
KNOW
S1Q3T3 (wide S in lead 1, q and inverted T in 3)
Dx for PE?
CT with contrast
PE tx?
O2, fluids or pressors
LMWH initially then warfarin for 3 to 6 months
IVC filter if contraindication to chronic anticoag (high fall risk)
THROMBOLYTICS if unstable (usually don’t need it, because dead already if so severe)
Pulm HTN is 2 or 3 star
Cauess?
PE, vale disease, L to R shunt, COPD (most common cause), Idiopathic pulm htn
Dx of pulm htn?
Echo is sufficient.
Tx of idiopathic pulm htn
Vasodilators
Prostoglandins
Endothelia antagonists (__sentans)
Cyclic GMP inhibitors: sildenafil
Nifedipine
Diuretics can help reduce congestion
Pulmonary edema and wedge pressure less than 18 is what?
ARDS (if higher, think cariogenic cause)
Cant do CT angio if history of renal failure or on metformin but you suspect PE, what do you do?
VQ
Tx of pulm htn is best with what?
Prostagladins Pro at Pulm htn
other vasodilators
Sentans (endothelin blockers)
Phosph inhib
Dihydropyridine
