Pulm Flashcards
70 yo M Smoker p/w 5cm nodule, gynecomastia
Large cell carcinoma may produce β- hCG resulting in gynecomastia
Nonsmoker F p/w peripheral lung mass, digital clubbing, hypertrophic pulmonary osteoarthropathy, thrombophlebitis, nonbacterial verrucous endocarditis, pleural involvement
Adenocarcinoma of the lungs
Nonsmoker p/w multiple nodules on imaging studies, interstitial infiltration, prolific sputum production.
Bronchoalveolar cell carcinoma (subtype of adenocarcinoma)
Smoker p/w central cavitary lung lesion and hypercalcemia, kidney stones
squamous cell carcinoma, w/ ectopic parathyroid hormone–related peptide (PTHrP)
Paraneoplastic sx a/w small cell lung carcinoma
SIADH (ADH), Cushingoid (ACTH), Eaton-Lambert sx (muscle weakness, ab-presynaptic ca ch.)
Child p/w high fever, pharyngitis, dyspnea, difficulty swallowing, keeping neck hyperextended; dx/rx?
Epiglottitis w/ cherry-red swollen epiglottis by laryngoscopy. X-ray: thumb sign with a swollen epiglottis. Rapid nasotracheal intubation.
Exacerbations of COPD rx?
Anticholinergic agent (ipratropium bromide) plus a β-agonist (short-acting, albuterol or a long-acting, salmeterol)
RDS and treatment with oxygen exposure and mechanical ventilation predisposes?
Retinopathy of prematurity, bronchopulmonary dysplasia, persistent PDA, interventricular hemorrhage, necrotizing enterocolitis.
Pt. p/w fever, nightsweats, pulm infiltrate w/ hilar adenopathy, rash on hands arms and joint pain, recent travel to south-west
Coccidioidomycosis, rx Amphotericin B, ketoconazole, fluconazole, or itraconazole
TB meds and SE
RIPE- 6mo- Rifampin (LFTs, orange) Isoniazide (LFTs) 2mo- Pyrazinamide (LFTs) Ethambutol (optic neuritis)
30 yoF p/w nonproductive cough, dyspnea, erythema nodosum, blurred vision (uveitis), bilateral hilar lymphadenopathy, hypercalcemia
Sarcoidosis; biopsy pulm lymphadenopathy- noncaseating granulomas; rx corticosteroid
Hx of stasis, tachypnea, dyspnea, tachycardia, hypotension, low-grade fever, JVD, accentuated pulmonic 2nd heart sound; dx?
PE w/ evated D- dimer on enzyme-linked immunosorbent assay, findings on CT angiogram
20yo cotton mill worker hx asthma p/w chest tightness that occurs toward the end of the first day of the work week
Byssinosis, cotton dust exposure, type of hypersensitivity pneumonitis
Acute respiratory distress syndrome (ARDS) definition
pulmonary edema in the absence of volume overload or depressed L ventricular function, with a PaO2:FiO2
PaO2:FiO2 < 300 in the setting of b/l cxr infiltrates and a pulmonary capillary wedge pressure of < 18 mm Hg define?
acute lung injury (ALI)
Newborn p/w tachypnea, cxr fluid in the fissures, prominent pulmonary vascular markings, flattening diaphragm
Transient tachypnea of the newborn (TTN); (pulmonary edema from delayed fetal fluid clearance from lungs)
FEV1:FVC ratio 0.7, FEV1 60% of normal with minimal (12%) improvement w bronchodilator
COPD
b/l patchy airspace disease, pulm cap wedge pressure
ARDS (interstitial pulmonary edema and bilateral perihilar alveolar edema,“butterfly” pattern)
Mild/ Moderate / Severe ARDS PaO2/FiO2 mmHg?
severe ≤ 100 < moderate < 200 < mild < 300 mmHg
Pt p/w low-grade fever, anorexia, weight loss, night sweats, productive cough. Cxr- hilar or mediastinal adenopathy, solitary pulmonary nodule or focal infiltrate.
TB
incidental solitary pulmonary nodule with a “popcorn” calcification, asymptomatic nonsmoker
Hamartoma, most common cause of benign tumors of the lung
Complications of chronic untreated Obesity related Obstructive Sleep Apnea?
Obesity hypoventilation sx w/ hypoxic/hypercapnic resp acidosis w/ compensation bicarb retention and decreased C, 2 erythrocytosis, pulmonary HTN, cor pulmonale
Pt. p/w dyspnea, tachypnea, tachycardia, chest pain w/ inspiration, hemoptysis, post flight, on OCP; dx?
Pulmonary infarct 2/2 PE occlusion of peripheral pulmonary artery
30yof p/w dyspnea on exersion, clear lungs, cxr prominent pulm arteries and enlarged Rt Ventricle w/ tricuspid regurge, Rt axis deviation
Primary Pulmonary HTN w/ rt ventricular strain and hypertrophy, possibly leading to RVHF and cor pulmonale
Smoker p/w wt loss, pulm nodule, urine Osm > 50–100 and sodium > 20 (euvolemic), w serum hyposmolality, hyponatremia; dx?
Small cell carcinoma w/ SIADH
Light’s criteria for pleural effusion as exudate (capillary leakage) vs transudate (elevated hydrostatic ie CHF, low oncotic P)? at least 1 of 3 criteria
Pleural Fluid protein:serum > 0.5, LDH PF:serum > 0.6, PF LDH>2/3 upper normal limit of serum LDH (>60); exudates from inf, autoimmune, neoplasm, PE, CT dz
Complicated parapneumonia
Exudative effusion w/ glu
Pleural fluid with pH
Criteria for tube thoracostomy, chest tube to drain likely empyema
Decreased breathsounds, decreased tactile fremetus, dullness to percussion?
Pleural Effusion
Full inspiratory and expiratory phases (Bronchial breath sounds), dullness to percussion, increased tactile fremitus, bronchophony, egophonay, whisper pectoriloquy?
Lung consolidation (eg. Community acquire pneumonia)
Pleural Plaques, fingernail clubbing, bibasilar end expiratory crackles
Bronchogenic carcinoma or Asbestosis from asbestos exposure
Pt. w/ Panacinar emphysema, hepatomegaly, p/w malaise, elevated LFTs, dx? Bx?
Alpha1-antitrypsin deficiency with panacinar emphysema and liver cirrhosis (bx: hepatocyte inclusions stain with PAS resist Diastase digestion)
PE w/ GFR< 30, rx?
Unfractioned heparin; enoxaparin, rivaroxaban, fondaparinux are contraindicated in renal failure w/ decreased clearance
Carbon monoxide poisoning labs?
In severe poisoning, tissue hypoxia may cause an increased anion gap metabolic acidosis secondary to increased lactic acid production.
Most common source of PE?
Proximal leg veins (popliteal, femoral, iliac)
Smoker p/w shoulder pain, ipsilateral ptosis, myosis, anhydrosis, enophthalmus, weakness in hand, pain paresthesia 4,5th digits, medial arm; dx?
Pancoast tumor involving sympathetic chain (horner’s sx) and brachial plexus
Digital clubbing; a/w?
Intrathoracic neoplasia (brochogenic lung cx), CF, empyema, bronchiectasis, lung cavitary lesions and abscess, fibrosis, asbestosis, mesothelioma, congenital cyanotic heart dz (not hypoxemia/ copd)
Peak Airway Pressure = Restrictive Pressure + Plateau Pressure
Increased PAP w/ normal Plateau = Airway obstruction (mucous plug, blonchospasm, ET block)
Plateau Pressure = Elastic Pressure + PEEP (Positive End Expiratory Pressure)
Increased PAP w/ increased Plateau P = decreased pulm compliance (pneumothorax, edema, pneumonia, atelectasis)
Normal or increased FEV1/FVC >70%; decreased FVC<80%, DLCO (carbon monoxide diffusion capacity), RV and TLC; dx?
Restrictive lung dz from interstitial lung dz, sarcoidosis, asbestosis, heart failure, wegner’s granulomatosis; Honeycombing, fibrosis or traction bronchiectasis on CT
Normal FEV1/FVC >70%, decreased FVC<80%, normal DLCO (carbon monoxide diffusion capacity); dx?
Restrictive lung dz from MSK deformity, neuromuscular dz
Decreased FEV1/FVC <70%, decreased DLCO (carbon monoxide diffusion capacity); dx?
COPD from emphysema
Decreased FEV1/FVC <70%, normal DLCO (carbon monoxide diffusion capacity); dx?
COPD from chronic bronchitis, Asthma
Asthma w 2 or less attacks/wk, 2 or less nighttime events/month, normal PFTs, no limitations in activity; dx/rx?
Mild intermittent asthma, rx: PRN albuterol
Asthma w/ 2-6 attacks/wk, 3-4 nighttime events/month, normal PFTs, minor limitations in activity; dx/rx?
Moderate intermittent asthma, rx: PRN albuterol and low dose inhaled corticosteroids
Asthma w/ daily attacks, weekly nighttime events, FEV1 60-80%, limitations in activity; dx/rx?
Moderate Persistent asthma; rx PRN albuterol, low dose inhaled corticosteroid, and inhaled Solmedurol (long acting inhaled beta agonist)
Asthma w/ multiple daily attacks, frequent nighttime events, FEV1<60%, significant limitations in activity; dx/rx?
Severe Persistent asthma; rx PRN albuterol, high dose inhaled corticosteroid, inhaled Solmedurol, can add oral prednisone
Recurrent nose bleads, hemoptysis, w/ chronic hypoxemia and reactive polycythemia; dx?
Osler-Weber-Rendu (hereditary telangiectasia) w/ pulmonary AVM causing R to L shunt (hypoxemia, increased Hct)
PE likelihood via Wells Criteria? >4 likely do CT angio, 4 or less unlikely so do D-dimer first (<500 excludes PE)
3pts: clinical signs of DVT, other diagnosis less likely than PE; 1.5pts: HR>100, previous PE or DVT, recent surgery or immobilization; 1pt: hemoptysis, cancer
A-a gradient calculation? (PAO2 - PaO2) normal <14, abnormal >30
PAO2=FiO2x(Patm-PH2O)-(PaCO2/R)=0.21x(760-47)-(PaCO2/0.8) = 150 - (PaCO2/0.8)
Nocturnal wheezing, chest tightness, cough that’s worst at night or after eating, hoarsenss, sore throat, adult hx of asthma, obese, erythematous post pharynx and larynx; dx/rx?
GERD inducing asthma; rx Omeprazole (PPI)
