Pulm Flashcards
Primary spontaneous pneumothorax
Tall, thin males who smoke.
Patients will present with sudden unprovoked chest pain and shortness of breath.
Lack of pleural movement with respirations on ultrasound
M mode on ultrasound will show barcode/ stratosphere sign indicating pneumothorax
Sickle-cell trait
Diagnosed by electrophoresis which displays an increased (but not predominant) HbS.
Have normal peripheral smears.
Benign carrier trait, with no decrease in life expectancy.
Patients are at an increased risk of hematuria, which is thought to be from renal papillary necrosis.
Mild intermittent Asthma
Symptoms <2days/week
Nighttime awakenings <2x/month
FEV1 >80%
No Limitations
Mild Persistent Asthma
Symptoms >2 days/ week BUT not daily
Nighttime awakenings 3-4x/ month
FEV1> 80%
Limitations Minor
Moderate persistent Asthma
Symptoms Daily
Nighttime awakenings >1 episode / Week but Not daily
FEV1 60-80%
Limitations Some
Severe Persistent Asthma
Symptoms throughout the day
Nighttime awakenings- Almost nightly
FEV1- <60%
Limitations- Extremely limited
Preferred test to confirm the diagnosis of pulmonary embolism
- CT pulmonary angiography
- Ventilation/perfusion scan can be obtained in patients unable to tolerate iodinated IV contrast.
Lung adenocarcinoma
Most common lung cancer to occur in never smokers
Peripheral spiculated lung mass
Arises from bronchial mucosal glands that secrete mucin.
Treatment of Lung adenocarcinoma
Mutations of the epidermal growth factor receptor (EGFR) that can be targeted by EGFR tyrosine kinase inhibitors such as erlotinib or gefitinib.
Wells criteria
1) Clinical signs/symptoms of deep venous thrombosis (3 points)
2) PE #1 diagnosis or equally likely (3 points)
3) Heart rate > 100/min (1.5 points)
4) Immobilization or recent surgery (1.5 points)
5) Previously diagnosed PE or deep venous thrombosis (1.5 points)
6) Hemoptysis (1.5 points)
7) Malignancy (1.5 points)
Wells criteria for PE likelihood
Low (< 2 points)
Moderate (2-6 points)
High (> 6 points)
MOST ACCURATE (gold standard) imaging modality to diagnosis pulmonary embolism
Pulmonary angiogram is MOST accurate
However, because it is invasive, slow, and expensive, CT angiogram with contrast is the preferred imaging modality
alpha-1 antitrypsin deficiency
Alpha-1-antitrypsin deficiency is inherited in an autosomal codominant pattern. Alpha-1 antitrypsin is a serine protease that normally functions to break down elastase. When levels of alpha-1-antitrypsin are abnormally low, the elevated levels of elastase cause breakdown of the pulmonary parenchyma, resulting in emphysema
Acute angle closure glaucoma
Acute angle closure glaucoma may present with abdominal pain, nausea, vomiting, a painful eye, and a fixed mid-dilated pupil that is nonreactive to light.
Tx: Decrease intraocular pressure with acetazolamide
Obstructive Lung disease:
Asthma
Decreased FEV1/FVC ratio
Value less than 0.80 is diagnostic for airflow obstruction
Diffusing capacity of the lungs for carbon monoxide (DLCO)
Measures the ability of the lungs to transfer gas from inhaled air to the red blood cells in pulmonary capillaries
DLCO decreases in patients with emphysema because of damage at the alveolar level
Wells criteria low risk (<4pts)
Get D dimer
Wells criteria High risk (>4pts)
CT angiography of pulmonary vasculature
Most common ECG finding of PE
sinus tachycardia
Diffuse ST elevation or PR segment depression
acute pericarditis
Low voltage on ECG
Obesity hypothyroidism Pericardial or pleural effusions COPD Amyloidosis
Massive PE
S1Q3T3 pattern (large S-wave in lead I, large Q-wave in lead III, inverted T-wave in lead III)
Right bundle branch block (RBBB)
Patients diagnosed with HIT
Discontinue heparin immediately and begin therapy with direct thrombin inhibitors.
