Pulm Flashcards
CXR with enlarged heart, interstitial edema, Kerly B lines indicates….
CHF
CXR with cavity containing air-fluid levels indicates….
abscess
CXR with thickened peritracheal stripe and splayed carina bifurcation indicates….
LA enlargement (e.g. MS via rheumatic fever, mediastinal lymphadenopathy)
define a pleural effusion on CXR
fluid >1cm on lateral decubitus XR (for small pleural effusions – sometimes more obvious on AP/PA if larger)
describe the type of pleural effusion seen with cancers and malignancies
1) Bloody Transudative
2) Exudative
describe pleural effusion seen in RA
transudative with low pleural glucose
transudative pleural effusion with low pleural glucose indicates….
RA
describe pleural effusion seen in TB
transudative with high lymphocytes
transudative pleural effusion with high lymphocytes indicates….
TB
Lights Criteria
Transudative Effusion if:
- LDH <200
- LDH eff / serum <0.6
- Protein eff / serum <0.5
Pt presents with pleuritic chest pain, hemoptysis, tachypnea, dec pO2, tachycardia should be evaluated for….
PE
Indicate Classic and Random presentation of PE based on the following tests:
- (1) EKG
- (2) CXR
- (3) ABG
1- sinus tachy (classic), R heart strain (submassive PE)
2- clear (classic), dec vascular markings (random), wedge infarct (random)
3- low CO2, low O2 (classic)
what is the first step if it is highly suspected someone has a PE
give heparin before any diagnostic imaging (CTA, V/Q scan)
describe the indications for the following in a PE:
- (1) thrombolytics
- (2) surgical thrombectomy
- (3) IVC filter
1- severe, massive or submassive PE
2- life-threatening
3- if Pt has contraindications to anticoagulation
describe some of the diagnostic findings in ARDS
1) PaO2/FiO2 <200 [<300 = acute lung injury]
2) bilateral alveolar infiltrates on CXR
3) PCWP <18 (= non-cardiogenic)
what are the indications to start O2 in COPD
PaO2 <55mmHg OR SpO2 <88%
if cor pulmonale, paO2 <59mmHg
what is the best prognostic factor for COPD
FEV1 (spirometry)
what can improve mortality in COPD
- stop smoking
- continuous O2 for 18hrs/day
what is the goal SpO2 in COPD
94-95% b/c chronic CO2 retainers –> hypoxia is only respiratory drive
COPDer with finger clubbing indicates….
(hypertrophic osteoarthropathy) possible lung malignancy
what sign may indicate need for lung malignancy workup, especially in a COPDer
hypertrophic osteoarthropathy (clubbing)
what is importantly monitored in an acute asthma exacerbation and why
PCO2
- should be low (tachypnea)
- if normalizing –> muscle fatigue –> impending respiratory failure –> intubate
what chronic infection is associated with Asthma
Allergic Bronchopulmonary Aspergillus
CXR with 1cm nodules in upper lobes and eggshell calcifications indicates….
silicosis
what must be monitored in patients with silicosis
yearly TB screening, PPD >10mm is positive (give INH for 9 mo)
Asbestosis imaging findings
reticulonodular process in lower lobes with pleural plaques
CXR with reticulonodular process in lower lobes with pleural plaques indicates….
asbestosis
describe ‘farmer’s lung’ CXR
Hypersensitivity Pneumonitis - patchy lower lobe infiltrates with thermophilic actinomyces
describe the the association with the following calcified nodules findings seen on CXR:
- (1) popcorn calcification
- (2) concentric calcification
- (3) eccentric calcification
1- hamartoma (most common)
2- old granuloma (benign)
3- possible malignancy (especially if large, >3cm)
____ is the most common lung cancer, non-smokers
adenocarcinoma
Adenocarcinoma of the lung:
- (1) location
- (2) common complication
- (3) common metastasis
1- periphery (may occur in old PNA scars)
2- exudative pleural effusion (with high hyaluronidase)
3- liver, bone (lytic), brain, adrenals
describe pleural effusion due to adenocarcinoma
exudative with high hyaluronidase
CXR with peripheral cavitation and CT showing distant metastasis indicates….
large cell carcinoma of the lung
indicate Tx for small cell lung CA and non-small cell lung CA
SCLC- chemo, radiation
NSCLC- resection
