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IM > pulm > Flashcards

pulm Flashcards

1
Q

3 types of lung cancers

A

small cell, squamous cell, adenocarcimoma

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2
Q

two lungs cancers associated with smoking

A

small cell and squamous cell

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3
Q

two centrally located lung cancers

A

small cell and squamous cell

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4
Q

two lung cancers with paraneoplastic syndromes

A

small cell and sqaumous cell

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5
Q

what do small cell and squamous cell lung cancer have in common?

A

smoking, centrally located, and paraneoplastic syndromes

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6
Q

small cell paraneoplastic syndrome

A

ACTH (cushing syndrome) and ADH (SIADH)

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7
Q

cancer with PTH-rp paraneoplastic syndrome

A

squamous cell

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8
Q

which cancer do you typically treat with resection?

A

adenocarcinoma, other two = chemo and radiation

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9
Q

what causes transudative pleural effusion

A

fluid leaking out of capillaries - CHF, nephrosis, cirrhosis

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10
Q

do oncotic and hydrostatic pressures lead to transudative pleural effusions?

A

yep

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11
Q

causes of exudative pleural effusions

A

malignancy, pneumonia, TB

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12
Q

what to do for pleural effusion in pt with CHF

A

diuresis - if fails, thoracentesis

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13
Q

Lights criteria

A

tells you if transudative pleural effusive

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14
Q

*** Lights criteria to be Transudative (T for Tiny, values must be LESS than in order to be Transudative)

A

LDH <200
LDH eff/serum <0.6
Protein eff/serou <0.5

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15
Q

*** white cells + lymphocytes in effusion

A

TB

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16
Q

do you tap in pt who has CHF, effusion < 1cm or effusion is loculated?

A

NO

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17
Q

*** what to do with effusion that has septations, lobes, is loculated

A

thoracostomy

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18
Q

Virchow’s triad

A

RISK OF COAGULATION - venous stasis, endothelial injury, hypercoagulable state (OCP, Factor V Leiden, malignancy)

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19
Q

*** OCP, Factor V leiden, malignancy = examples of

A

hypercoagulable state

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20
Q

> 2cm diameter between calves

A

suspect DVT = anti-coagulate

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21
Q

can a PE lead to pHTN?

A

YES, which would result in R heart strain

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22
Q

is pulmonary artery wedge pressure reflective of left atrial pressure?

A

YES

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23
Q

*** if PAWP is elevated, what can be cause?

A

something with left heart - left ventricular failure, MR, AR, MS, AS

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24
Q

*** PAWP > ? suggests HF

A

> 18 = CHF; when > 20 would expect to see resultant pulmonary edeuma

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25
Q

*** ABG of PE

A

hypoxemia, hypochloremia, met alkalosis

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26
Q

do you get a d-dimer when pre-test probability is high?

A

NO

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27
Q

definitive diagnosis of PE

A

CT scan with IV contrast, VQ scan

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28
Q

is VQ scan safe for bad kidneys?

A

YES, no contrast used

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29
Q

gold standard for PE diagnosis BUT is invasive, requires contrast

A

pulmonary angiogram

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30
Q

pt comes in with SOB, found to have discrepancy of calf diameter > 2cm - how to dx and tx?

A

with high clinical suspicion for PE, start anticoagulation; can firmly dx with CTA or VQ scan

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31
Q

how long to bridge warfarin for PE anticoagulation?

A

5 days or once INR is 2-3

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32
Q

types of anticoagulation for PE

A

Warfarin with heparin bridge OR NOAC

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33
Q

*** 4 progressive steps of COPD treatment?

A

SABA (albuterol)
LAMA (tiotropium, ipratropium)
LABA (salmeterol)
ICS (prednisone, methylprednisolone)

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34
Q

when O2 for COPD

A

sat < 88% or PaO2 < 55

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35
Q

goal O2 for COPD?

A

92-95

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36
Q

vaccines for COPD

A

Flu and pneumovac

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37
Q

COPD pt comes in with worsened SOB and increased sputum - what to do?

A

Abx treatment (macrolides), bronchodilators (ipratropium and albuterol) and steroids (PO prednisone or IV methylprednisolone)

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38
Q

if COPD pt is on salmeterol, what else are they likely on?

A

SABA (albuterol), LAMA (ipra/tio tropium)

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39
Q

*** eggshelll calcifications

A

silicosis, must get yearly Tb screens

40
Q

what does silicosis predispose you to?

A

TB, get yearly ppd

41
Q

reticulonodular process in lower lobes with pleural plaques

A

asbestosis

42
Q

*** patchy lower lobe infiltrates

A

hypersensitivity pneumonitis

43
Q

erythema nodosum, hilar LAD

A

sarcoidosis

44
Q

why hypercalcemia in sarcoid?

A

macrophages make vitamin D

45
Q

why optho referral in sarcoid?

A

uveitis

46
Q

*** how dx and treat sarcoid?

A

dx with biopsy and tx with steroids

47
Q

hypertrophic osteroarthropathy

A

acute new clubbing of fingers in patient with COPD, suspect malignancy and get CXR

48
Q

*** role of FEV1 in COPD

A

prognostic indicator

49
Q

adenocarcinoma metastasis

A

liver, bone, brain, adrenal glands

50
Q

*** low PO4 and high Ca in pt with lung cancer

A

squamous cell carcinoma with parathyroid hormone paraneoplastic syndrome

51
Q

shoulder pain, ptosis, constricted pupil and facial edema

A

superior sulcus syndrome from small cell carcinoma

52
Q

sx from IgE mediated disease

A

urticaria, pruritus, angioedema, anaphylaxis

53
Q

why SIADH in HIV?

A

pulmonary pathology like PCP, leads to hyponatremia

54
Q

*** how to improve oxygenation with ventilator settings?

A

increase FiO2 or PEEP

55
Q

role of PEEP

A

prevents alveolar collapse and may reopen already collapsed alveoli; life-saving in ARDS

56
Q

what is the risk of prolonged high FiO2

A

oxygen toxicity with formation of free radicals

57
Q

what do you expect of RR and blood gas acid status in asthma exacerbation

A

hyperventilation with hypocarbia since blowing off

58
Q

1st step of asthma tx

A

SABA

59
Q

2nd step of asthma tx

A

low dose ICS

60
Q

3rd step of asthma tx

A

medium-dose ICS

61
Q

4th step of asthma tx

A

medium-dose ICS + LABA

62
Q

5th step of asthma tx

A

high-dose ICS + LABA

63
Q

when do you add oral corticosteroids to asthma tx?

A

Step 6 (high-dose ICS + LABA + oral corticosteroids)

64
Q

SABA a couple times a week and nighttime awakenings a couple times a month

A

step 1 - SABA prn

65
Q

SABA 3 times a week and 3-4 nightly awakenings per month

A

step 2 - SABA + low-dose ICS

66
Q

SABA daily and night awakenings weekly

A

step 3 - SABA + medium-dose ICS

67
Q

SABA multiple times a day and night awakenings most nights during a week

A

step 4 or 5 - SABA + medium/high-dose ICS + LABA

68
Q

*** must you be on a ICS before you start a LABA with asthma tx?

A

YES

69
Q

tachypnea, low-grade fever, tachycardia, chest pain worse with coughing

A

PE

70
Q

irregular RR intervals, absent P waves, narrow QRS complexes

A

a fib

71
Q

is a fib associated with PE

A

yes

72
Q

are the manifestations of PE variable and non-specfici?

A

yes

73
Q

what oxygen information do we get from ABG?

A

PaO2

74
Q

*** how do you calculate PAO2 to determine A-a gradient?

A

PAO2 = 150 - (PaCO2/.8)

75
Q

*** what is age appropriate A-a gradient?

A

(patient age/4) + 4

76
Q

what to do for an asthmatic pt with impending resp failure (absent wheezing, retention of CO2, decreased mental status)

A

intubate

77
Q

severe asthma exacerbation tx

A

SABA, ipratropium, systemic corticosteroids

78
Q

upper and lower respiratory tract disease and glomerulonephritis

A

granulomatosis with polyangiitis, vasculitis of small and medium sized vessel

79
Q

*** how do you diagnose granulomatosis with polyangiitis?

A

ANCA antibody test, then tissue biopsy (may need to rule out HIV as + can muck up ANCA results)

80
Q

*** otitis, sinusitis, dyspnea, hemoptysis, weight loss, fatigue, mild anemia

A

granulomatosis with polyangiitis

81
Q

*** young adult male with kidney and lung pathology

A

Goodpasture’s disease, Ab against protein of glomerular and alveolar basement membranes

82
Q

*** how to dx Goodpasture’s disease?

A

renal biopsy demonstrating linear IgG deposition along membrane

83
Q

HIV with CD4 < 200, dyspnea and non-productive cough

A

PCP

84
Q

Osler’s nodes, Roth’s spots, Janeway lesions, splinter hemorrhages, new onset heart murmur

A

endocarditis

85
Q

can people who had pulmonary TB develop a chronic pulmonary aspergillosis in the future?

A

YES

86
Q

Aspergillus is a ______ and thus is treated with _____

A

Aspergillus is a fungus and treated with azoles!

87
Q

how does pneumonia cause hypoxemia

A

right-to-left intrapulmonary shunting and V/Q mismatch

88
Q

pulsus paradoxus

A

cardiac tamponade; > 20mg blood pressure change with inspiration

89
Q

cancer and SOB

A

think PE!! cancer is part of Virchow’s triangle (hypercoagulability of malignancy)

90
Q

low arterial perfusion (hypotension, syncope), acute dyspnea, pleuritic chest pain, tachycardia

A

massive PE - leads to RV dysfuction and resultant hypotension

91
Q

*** a pt has a suspect effusion/mass in lung, what to do?

A

TAP, if negative but still suspect mass then do bronchoscopy BUT if + then proceed with further imaging etc to qualify but no need for bronchoscopy

92
Q

you identify a coin lesion in the lungs by XR, but it is stable when compared to previous XR 2 years ago - malignant? workup?

A

benign if stable for 2-3 years, no work-up required

93
Q

increased lung compliance, air-trapping, functional residenual and total lung capacities

A

COPD

94
Q

*** immunocompromised + pulmonary nodules with surrounding ground-glass opacities + thick sputum

A

acute aspergillosis

95
Q

pt has acute exacerbation of COPD, what to do?

A

SABA, ICS, antibiotics – and if doesn’t improve start non-invasive ventilatory support

IM (17 decks)

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