(Masoomeh) Pulmonology p177 - 188 Flashcards
Best initial step in all lung nodule
compare the size of the nodule with an old chest X-ray
features of a malignant pulmonary nodule and its tx
enlarging, spiculated, sparse, eccentric calcifications, present in smokers and age greater than 40
resect the nodule
features of benign pulmonary nodule
small, dense central calcification, smooth border in non smokers and age less than 30
dx test for intermediate probability of malignant pulmonary lesion
intermediate probability of malignancy: transthoracic biopsy for peripheral lesions and bronchoscopic biopsy for central lesions
adverse effect of transthoracic biopsy
pneumothorax
How to tell whether the content of the lesion is malignant without a biopsy?
PET-positron emission tomography scan
which type of pneumoconioses.. 1--sand blasting, rock mining, tunneling 2--cotton 3--coal 4-shipyard workers, insulators 5--electronic manufacture 6--moldy sugar cane
1--silicosis 2--byssinosis 3--coal worker pneumoconiosis 4--asbestosis (associated with bronchogenic carcinoma) 5--berylliosis (granulomas on biopsy) 6--bagassossis
presentation of pulmonary fibrosis
dyspnea, fine rales or bibasilar crackles, loud P2 heart sound and finger clubbing,
dx tests of pulmonary fibrosis—initial and most accurate
initial is chest x-ray and most accurate is lung biopsy
PFT results in pulmonary fibrosis
decrease DLCO, FEV1, FVC, TLC, RV,
normal FEV1/FVC
tx of pulmonary fibrosis
steroids, prednisone
define sarcoidosis and its pulmonary sx
non caseating granulomatous disease common in African American, presents with dyspnea, bilateral hilar lymphadenopathy and pulmonary reticular infiltrates
dx–initial and accurate test of sarcoidosis
tx of sarcoidosis
initial is chest xray and accurate is lymph node biopsy
elevated ACE levels in 60% ,hypercalciuriain 20% and hypercalcemia in 5% of cases
tx=steroids
source of pulmonary embolism
DVT fom large vessels of legs in 70% and pelvic veins in 30%
what is pathogenesis and etiology of DVT
STASIS from immobility, surgery, trauma, joint replacement or thrombophilia(factor V leiden mutation), antiphospholipid syndrome, malignancy
sx of pulmonary embolism
dyspnea, SOB, tachypnea, tachycardia, pleuritic chest pain with clear lungs
most accurate dx test for pulmonary embolism
CTAngiography
dx test for DVT
lower extremity doppler study but accurate is angiography
tx of pulmonary embolism
Heparin and warfarin
when do we use IVC filter for DVT
when there is contraindication to anticoagulants
recurrent emboli on heparin
right ventricular dysfunction
when to give thrombolytics
hemodynamically unstable pts
acute right ventricle dysfunction
what to give if heparin induced thrombocytopenia develops
direct acting thrombin inhibitors
argatroban, lepirudin
define pulmonary HTN
systolic BP greater than 25mm hg, diastolic greater than 8mm hg
etiology of Pulmonary HTN
idiopathic, COPD, fibrosis, hypoxia
best initial and accurate test for PHTN
CXR,CT
swan ganz catheter
findings of EKG and echo in PHTN
EKG-Right axis deviation, RA and RV hypertrophy
Ech0=RA & RV hypertrophy
tx of phtn
Bosentan-endothelin antagonist
PDEinhibitor-sildanefil
prostacyclin analogue-epoprostenol
curative tx for idiopathic phtn
lung transplantation
sx of obstructive sleep apnea
snoring, daytime somnolence, nocturnal hypoventilation…common in obese pts.
dx and tx of osa
polysomnography
weight loss, avoid alcohol, CPAP(continuous positive airway pressure)
illness/injuries associated with ARDS
sepsis/aspiration
lung contusion
near drowning
burns or acute pancreatitis
dx for ARDS
cxr=bilateral infiltrates
air bronchograms
p02/fi02 rationbelow 300
normal PCWP
tx for ARDS
low tidal volume mechanical ventilation
positive end expiratory pressure
