OME - Day 4 Flashcards
Biopsy of a lung cancer adjacent to the trachea, what test do you use?
Endoscopic Ultrasound / Bronchoscopy (EUS is better)
Biopsy of a lung cancer in the middle of the lung parenchyma, what test do you use?
VATS
Biopsy of a lung cancer on the periphery, what test do you use?
Percutaneous, CT guided
Cushing’s Syndrome and lung cancer = ?
Small cell, ACTH
How do you screen lung cancer?
CT scan
Hyponatremia and lung cancer = ?
Small cell, SIADH
Lung Cancer and Hypercalcemia
Metastatic disease OR PTH-rp from Squamous cell carcinoma
Ship-yards, construction, and lung cancer =?
Asbestosis, pleural plaques, adenocarcinoma (don’t forget mesothelioma)
What do you get to evaluate a lung cancer?
CT scan
Wheezing, flushing, diarrhea, lung cancer, what’s the diagnosis?
Carcinoid, 5-HIAA in the urine
Adenosine Deaminase is high in the pleural fluid, what does that means?
TB
Pleural effusion has malignant cells in it, what does that mean?
Metastatic cancer
The pleural effusion fluid is loculated, what do you do?
Thoracostomy (chest tube)
The pleural effusion is an empyema, what do you do?
Thoracotomy (surgery)
There are a lot of red blood cells in the pleural effusion, what does that mean?
Hemothorax
You find an effusion on CXR, no heart failure, what do you do?
Lateral Decubitus OR ultrasound
You find an effusion on CXR, they have heart failure, what do you do?
Diuresis
How do you diagnose PE with abnormal chest x-ray?
CT scan with IV Contrast
How do you diagnose PE with bad kidneys?
V/Q scan
How do you diagnose PE with good kidneys?
CT Scan with IV Contrast
How long do you bridge someone with heparin to Coumadin?
INR 2-3 or 5 days, whichever is longer
One leg is more swollen than the other, what do you do?
DVT, Ultrasound
PE and IVC filter?
Contraindication to anticoagulation, remove filter as soon as anticoagulation is over
PE and metastatic cancer tx?
Low Molecular Weight Heparin only (no bridge)
PE and tPA?
Massive pe (hypotension)
What does the ABG look like in a PE (that you’ll see on the USMLE)?
low pO2, low pCO2, Respiratory Alkalosis
Bilaterally fluffy infiltrates and hypoxemia
CHF, ARDS, PCP pneumonia
PCWP in ARDS?
Normal or low
What is the ARDS protocol?
Low tidal volume, high respiratory rate, PEEP
What is the definition of ARDS?
Noncardiogenic (BNP, Echo, PCWP normal) pulmonary edema (CXR), P/F ratio < 200
Lung disease and working in construction or shipyards - dx?
Asbestosis
Lung disease and pleural plaques - dx?
Asbestosis/Mesothelioma
Lung disease and mesothelioma - dx?
Asbestosis
Lung disease and sand blasting - dx?
Silicosis
Lung disease and aeronauticals - dx?
Berylliosis
Lung disease and bilateral hilar lymphadenopathy suggests ___?
Sarcoidosis
Lung disease in an African American woman suggests ___?
Sarcoidosis
Diagnose sarcoidosis
NON-caseating granulomas on biopsy (NOT ace levels, NOT vit levels)
No allergies at home on the weekends, but lots of allergies at work suggests ___
hypersensitivity pneumonitis
What imaging helps the most with DPLD / ILD?
High Resolution CT
