PULM 4 Flashcards
What is the best initial test to DX PNEUMOTHORAX in..
ACUTE setting/trauma bay?
Non acute setting?
Acute/trauma bay –> Bedside US (bc need faster dx bc increased risk of tension physiology)
Non/acute setting –> Upright CXR (takes longer so only do if you are not concerned about tension physiology)
Which two lung cancers are CENTRALLY located?
Central:
- SCC
- Small cell
Peripheral :
- Adenocarcinoma
- Large cell
What percentage of lung cancers are Small Cell Lung CA?
Small cell lung CA is known for early metastasis AND associated with what 3 paraneoplastic syndromes?
25 %
- Cushings (ACTH secretion)
- Eaton- Lambert (auto Ab to presynaptic Ca2+ channels, increased strength with increased use)
- SIADH (hyponatremia)
Patient is presenting with a lung mass and hyponatremia….what should you think on the differential?
Small cell with paraneoplastic SIADH
What paraneoplastic syndromes are associated with:
- SCC
- Small cell
- Hypercalcemia (tumor secretes PTrP parathyroid like hormone)
- SIADH, Eaton Lambert, Cushings
What is the preferred TRX for mild hyponatremia due to SIADH?
What rate do you want to correct the sodium?
FREE water restriction.
correct at 0.5mEQ/hr
What is the definition of COPD exacerbation?
What are the two indications for ABX in COPD exacerbation?
COPD exacerbation = change in sputum, cough or dyspnea.
START ABX if:
1. Increased sputum purulence, volume or dyspnea
- Requires Mechanical ventilation
Who should you screen with yearly low dose CT?
In what three scenarios can you stop surveillance?
Ages 55-80 with 30 pack year and currently smoking/quit < 15 years ago.
STOP IF:
- > 80 yo
- Life expectancy limited
- Quit smoking for 15 years.
Which 2 Ventilator settings regulate PO2?
Which 2 ventilatory setting regulate CO2?
PO2
- FiO2
- PEEP
PCO2
- Resp Rate
- Tidal volume
Pulmonary barotrauma is a risk of mechanical ventilation and can lead to pneumothorax.
What S/S would make you concerned that there is Tension physiology?
How do you DX?
What is the trx of ICU patient with Tension Pneumothorax?
What is the treatment of intubated patient with pneumothorax without tension physiology?
Tension physiology:
- Tachypnea
- Tachycardia
- HypoTN (from mediastinal compression) ****
- Unilateral decreased breath sounds
DX = bedside US (best for trauma bay or ICU)
TRX of tension Pneumothorax (HYPOTN present) = Needle decompression, then chest tube.
TRX of Pneumothorax without tension physiology = Chest tube.
Pulmonary contusion can occur due to blunt force trauma to chest…it can present with tender chest wall/bruising, and delayed (up to 24 hours) respiratory distress…
What is the classic CXR finding?
TRX?
CXR = irregularly shaped, localized, lung opacification.
TRX = hospitalize, O2, pain control (prevent hypoventilation) and pulmonary hygiene.
How do you manage a choking patient depending on their age?
< 1 yo –> alternating 5 blows to back while turned over and 5 chest trust while suppine.
> 1 yo –> Abdominal thrusts only.
What is the pathophysiology of hyperparathyroidism due to CKD?
TWO MECHANISMS:
- CKD –> Decreased conversion of 1,25 Vit D –> decreased intestinal absorption of Ca –> decreased Ca –> PTH release due to decreased calcium.
- CKD –> Phosphate retention –> Phosphate binds serum Ca –> PH release due to decrease calcium.
(Secondary Hyperparathyroidism).
What is are the characteristic Ca, PTH, and 1,25 Vit D levels found in secondary hyperparathyroidism due to CKD?
- Low Ca
- High PTH
- Low 1,25 Vit D
If you have secondary hyperparathyroidism due to CKD for long enough…what do you develop?
What does Ca and PTH levels look like?
What are the 3 indications of parathyroidectomy in tertiary hyperparathyroidism?
Tertiary Hyperthyroidism…autonomous PTH secretion regardless of Ca level due to hypertrophy.
Ca - High
PTH - High
Parathyroidectomy if:
- Bone pain
- Soft tissue calcifications
- Persistently increased Ca, PTH and Phos
