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STEP 2 AG > Pulm > Flashcards

Pulm Flashcards

1
Q

CREST syndrome

A

CREST Assoc w/ systemic sclerosis, pulm HTN 2/2 arterial intimal hyperplasia

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2
Q

Survival benefit in COPD

A

Oxygen (O2 sat <88%, <89% if pt has Crit >55%

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3
Q

Pancoast tumor

A

Smoking, horners, superior vena cava syndrome (dx CXR), brachial plexus neuropathy

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4
Q

Etiology of pulmonary HTN

A

constriction of pulm vessels–>RVHF

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5
Q

SIADH causes

A 
Lung probs (HIV PCP)
NS makes it worse

Euvolemic hyponatremia sOsm<275, UOsm>100, UNa>40

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6
Q

Chronic cough

A

> 8 weeks, post nasal drip (gets better w antihistamines), asthma, GERD

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7
Q

Multifocal atrial tachycardia

A

Not a fib (no Ps in a fib), >=3 distinct P waveforms in V1
Causes=COPD exacerbation, catecholamine surge (sepsis), electrolytes
Tx underlying cause, IF PERSISTS after tx CCB

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8
Q

Bronchitis

A

Most viral, cough >5 days, may have blood-tinged sputum

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9
Q

Bronchiectasis

A

CF upper lobes, other causes lower, recurrent infections, CT dx
Ddx chronic bronchitis (=smokers, chronic cough vs infx)

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10
Q

Causes of hemithorax opacification on XR

A
  1. Atelectasis 2/2 Mucus plug mainstem bronchus (mediastinal shift TOWARD affected side, NO hemodynamic changes, bronchoscopy)
  2. Diaphragmatic hernia (partial opacity left lower, pt w trauma)
  3. Pleural effusion (med shift AWAY)
  4. PNA Multi lobular (slower onset)
  5. Pneumothorax (hemodynamic changes, radiolucent, med shift AWAY)
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11
Q

Drowning

A

Arrhythmia (immediate)
Cerebral edema (submersion >5 min)
ARDS (72 h, surfactant washed away by liquid, admit and monitor)

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12
Q

Complications of PEEP

A

Alveolar damage, pneumothorax, hypotension

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13
Q

Glucocorticoids

A

High PMNs

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14
Q

Asthma

A 
Steps:
1=PRN alb <2/wk, <2/mo
2=+low dose ICS 3-4/mo
3=+LABA OR +Med dose ICS daily, >1/wk
4=LABA AND med dose ICS >1/day
5=high dose ICS
6=+PO steroid

Exacerbation management
Mild-moderate=O2, SABA
Severe=O2, SABA+ipratropium, PO steroid, Mg if not improved in 1h, Look for signs of resp distress high PCO2, DECREASED wheezes
GERD can make sx worse 2/2 microaspiration! (Night + postprandial sx, hoarse in the AM)

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15
Q

Asbestos

A 
Bronchogenic carcinoma (cavitary mass on CXR, MC)
Pleural mesothelioma (less common, pleural effusion)
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16
Q

Anaphylaxis

A

1 organ system affected + hypotension, don’t need hives!! trigger can be food or abx in PT w asthma/atopy
Give IM epi

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17
Q

Mediastinal masses

A

lymphoma can be any
Anterior=G and the 3Ts thymoma(MYASTHENIA GRAVIS), retrosternal thyroid, teratoma, germ cell tumor (bHCG sem AND nonsem, nonseminomatous +AFP)
Middle=PA TrBL pericardial cyst, aortic aneurysm, tracheal tumor, bronchogenic cyst, lymph node
Posterior=ADEME (Adele’s diva alterego this time for ME) aortic aneurysm, diaphragmatic hernia, esophageal tumor, meningocele, enteric cyst

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18
Q

Congenital diaphragmatic hernia

A

Herniated gut compresses L lung, heart sounds louder on R, don’t do anything that will put air in the GI tract! ET intubation only, then NG decompression

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19
Q

Increased breath sounds

A

Consolidation (PNA)

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20
Q

Ventilators

A

ARDS—> avoid barotrauma low tidal volume <6mL/kg (ideal body weight), low FiO2 <0.6%, PEEP can be 15-20, goal O2 sat >88%

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21
Q

Pneumonia

A

V=0, severe V/Q mismatch, R—>L intrapulmonary shunting, NO IMPROVEMENT W INC FiO2

22
Q

PFTs

A

Obstructive: TLC ^ FEV1/FVC<80%, DLCO ^ in asthma, dec COPD
Restrictive: TLC dec, FEV1/FVC nl (both dec), DLCO dec ILD, nl restrictive chest wall dz

23
Q

Causes of cor pulmonale

A

COPD
ILD
Pulm vascular dz
OSA

24
Q

COPD exacerbation tx

A

O2
Neb albuterol + ipratropium (SABA + anticholinergjc)
PO steroid
+- abx
NO LABA FOR ACUTE EXACERBATION
In severe COPD, O2 can induce hypercapnea (VQ mismatch) May have sz

25
Q

Chronic bronchitis vs emphysema

A

Chronic bronchitis—> productive cough 3 mo for 2 yrs, nl DLCO, CXR inc pulm vasc markings, flattened diaphragm
Emphysema—> dec DLCO, CXR dec pulm vasc markings, hyperinflation, a-1-antitrypsin (liver dz, panacinar, lower lobes) vs smoking (centriacinar, upper lobe)

26
Q

Cavitary lung lesions

A
  1. Abscess—> usually anaerobes indolent course, SIADH, systemic sx, putrid sputum, upper lobes/posterior (dependent while lying down), alcoholic/drug user/chronic renal dz, CT air fluid levels clindamycin
  2. Aspergillosis—> classic triad hemoptysis, pleuritic CP, fever, immunocomp, nodules w ground glass, chronic= >3 mo, systemic sx, cav lesion apical +/- aspergilloma
  3. TB—> no air-fluid level, disseminated spondylitis/fx arthritis osteo
  4. Bronchogenic carcinoma—> asbestos
  5. Granulomatosis w polyangiitis—> ulcers, multiple, kidney probs
  6. Squamous cell—> no leukocytosis or fever, slower onset (SMALL CELL DOES NOT FORM CAV)
27
Q

Solitary pulmonary nodule

A

Def=<3cm, round, surround nl
No change 2-3y r/o ca (ca x2 qmo-y)
+ changes—> CT
serial scans, PET/bx (central bronchoscopy periph CT guided percutaneous), or if likely malignant surg

28
Q

Secondary spontaneous pneumothorax

A

Ruptured apical bleb, COPD, Marfans, no tracheal shift

29
Q

Massive hemoptysis

A

> 600mL/24h or >1mL/h
Bronchoscopy (balloon tamp, cauterize), pulm arteriography (embolization), thoracotomy if can’t stop bleeding
Mild/mod can get a CT

30
Q

Nonallergic rhinitis

A

No eye sx, no trigger

Tx intranasal antihist OR steroid

31
Q

Croup

A

Barking cough, +-insp stridor ONLY WHEN CRYING
Steroid, racemic epi if no improvement
Ddx DROOLING=epiglottitis (Hib)

32
Q

Lung + kidney

A

Granulomatosis w polyangiitis—> tracheal narrowing, ulceration, multiple lung nodules w cavitation, anemia, dx ANCA or bx, tx steroid + rituximab OR cyclophosphamide
Goodpasture—> basement membrane

33
Q

COPD diaphragm flattening

A

INC wob (shortened muscle can’t contract as well during inspiration)
INC lung compliance
INC thoracic wall recoil

34
Q

Aspirin-exacerbated respiratory disease

A

Looks like asthma sx + allergic eyes, 30m-3h after NSAID, dec PGE, inc leukotrienes, polyps

35
Q

Sarcoidosis

A

Looks like mediastinal widening on XR, chronic granulomatous inflammation

36
Q

If it’s a euvolemic patient w lung stuff literally ANY lung stuff + hyponatremia

A

SIADH

37
Q

ARDs

A 
O2 doesn't help
Lung compliance IS LOW (fluid)
PaO2/FiO2 DEC
Aa gradient INC
PA pressure INC
38
Q

CAP

A

MC causes: strep pneumo, h flu, legionella, mycoplasma

CURB-65: Confusion, Urea nitrogen>20, RR>30, BP<90/60, age>65

1-2 maybe IP
3 def IP
5 ICU

Treatment:
OP —> azithro OR doxy
OP + comorbidities, IP —> +B-lactam (amox/cephalosporin) OR FQ
ICU —> Same as above but FQ + B-lactam

39
Q

Lots and lots of albuterol

A

Can cause hypoK

40
Q

PE

A

Acute a fib (2/2 RA strain), MC site of thrombus=proximal thigh iliac, femoral, popliteal

41
Q

Bronchiolitis

A

RSV, babies <2mo high risk of apnea

42
Q

COPD PFTs

A

DEC VITAL CAPACITY

43
Q

Nitrofurantoin side effect

A

Hypersensitivity pneumonitis, 3-9 d after, +/- rash

44
Q

CF

A

Lungs, pancreas, nasal polyps

45
Q

Weaning someone off a vent

A
  1. Alert enough to breathe on their own
  2. Minimal vent settings (Vt 7-8, PEEP<5, FiO2<40%
  3. pH > 7.25

Breathing trial turn vent off for a few hrs monitor ABGs before extubating

46
Q

small cell lung cancer

A

CHEMO

47
Q

Exudative pleural effusion

A

Empyema (acute, PNMs), TB (indolent, lymphs, prot>4, LDH>500, pt IC), cancer (lung breast), PE (blood, low prot)

48
Q

Blunt chest trauma

A

Hemothorax, intercostal vessels can bleed a lot, if >1,500mL blood emergency thoracotomy

49
Q

Management of tension pneumothorax

A

NEEDLE THORACOSTOMY BEFORE ALL ELSE (only time ignore ABCs)

50
Q

Non-small cell lung cancer

A

Brain mets, surgery

STEP 2 AG (16 decks)

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