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First Aid Step 2 > Pulm > Flashcards

Pulm Flashcards

1
Q

Risk factors for DVT

A

Stasis, endothelial injury, hypercoagulability - Virchow’s triad

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2
Q

Criteria for exudative effusion

A

Pleural/serum protein >0.5
Pleural/serum LDH>0.6
PLeural fluid LDH >2/3 upper limit of nromal serum LDH

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3
Q

Causes exudative effusion

A

Leaky capillaries
-Malignancy, TB, bacterial or viral infection, PE with infarct, pancreatitis

THink inflammation

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4
Q

Causes transudative effusion

A

Intact capillaries
-CHF, liver or kidney disease, protein losing enteropathy

think changes in hydrostatic and oncotic P

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5
Q

Normalizing PCO2 in pt having an asthma exacerbation may indicate

A

Fatigue and impending respiratory failure

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6
Q

Sarcoidosis

A 
Dyspnea
Lateral hilar LNopathy on CXR
noncaseating granulomas
Inc ACE
Hypercalcemia
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7
Q

PFT obstructive disease

A

Dec FEV1/FVC (<80)

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8
Q

PFT restrictive disease

A

Inc FEV1/FVC, dec TLC (>110)

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9
Q

Honeycomb on CXR

Tx

A

Diffuse interstitial pulm fibrosis

Supportive care and steroids

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10
Q

Tx SVC syndrome

A

Rads

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11
Q

Tx mild persistent asthma

A

Inhaled beta agonists and inhaled corticosteroids

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12
Q

Tx COPD exacerbation

A

O2, bronchoD, abx, corticosteroids with taper, smoking cessation

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13
Q

Tx chronic COPD

A

Smoking cessation, home O2, Beta agonist, antichol, systemic or inhaled corticosteroids, flu and pneumo vaccines

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14
Q

Acid base disorder in PE

A

Resp alkalosis with hypoxia and hypocarbia

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15
Q

Non Small cel lung cancer associated with hypercalcemia

A

SCC

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16
Q

Lung cancer w/ SIADH

A

Small cell lung cancer

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17
Q

Lung cancer related to cigarette

A

Small cell lung cancer

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18
Q

Tall caucasion man witha cute SOB
Dx
Tx

A

Spontaneous pneumothorax

Spontaneous regression, supplemental O2 may help

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19
Q

Tx tension pneumo

A

Immediate needle thoracostaomy

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20
Q

Characteristics favoring carcinoma in isolated pulm nodule

A

Age >45-50
Lesions new ot larger compared to old films
Absence calcification or irregular calcification
Size >2 cm
Irregular margins

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21
Q

ARDS

A

Hypoxemia and pulm edema with normal PCWP

Resp alkalosis

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22
Q

Sequelae asbestos exposure

A

Pulmonary fibrosis–>pleural plaques–>bronchogenic carcinoma (mass in lung field)–>mesothelioma (pleural mass

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23
Q

Inc risk of what infection with silicosis

A

TB

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24
Q

Causes hypoxemia

A 
Right to left shunt
Hypoventilation
Low inspired O2
Diffusion defect
V/Q mismatch
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25
Q

Classic CXR findings for pulm edema

A

Cardiomegaly, prominent pulm vessels, Kerley B lines, bat’s wing appearance of hilar shadows, perivascular and peribronchial cuffing

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26
Q

Westermark’s sign and Hamptom’s hump

A

CXR findings suggesting PE

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27
Q

Etiologies of obstructive disease

A 
ABCT
Asthma
Bronchiectasis
CF/COPD
Tracheal or bronchial obstruction
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28
Q

Reversible airway obstruction 2/2 bronchial hyperreactivity, airway inflammation, mucous plugging, smooth mm hypertrophy

A

Asthma

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29
Q

pH imbalance asthma

A

Resp alkalosis with mild hypoxia

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30
Q

Dx asthma

A

Dec FEV1/FVC

Methacholine challenge- tests for bronchial hyper responsiveness

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31
Q

Meds for asthma exacerbations

A 
ASTHMA
Albuterol
Steroids
Theophylline
Humidified O2
Magnesium - severe
Antichol
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32
Q

Example long and short acting beta 2 agonist

A

albuterol - short

Salmeterol- long

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33
Q

Function corticosteroids in asthma

A

Inhibit cytokine synthesis - beclomethasone/prednisone

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34
Q

Fcn muscarinic antagonist in asthma

A

block muscarinic receptors = prevent bronchoC

Ipratroprium

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35
Q

Fcn methylxanthines asthma

A

BronchoD by inhibiting PDE = inc cAMP levels

Theophylline- narrow therapeutic window (Cardio and neurotoxic)

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36
Q

Cromlyn fcn

A

Prevents release vasoactive mediators from mast cell

Use exercise induced bronchospasm = only good for prophy

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37
Q

AntiLT fcn

A

Zileuton: 5-lipoxygenase pathway inhibitor, blocks conversion of arachnidonic aci to LT
Montelukast, Zafirlukast: block LT receptors

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38
Q

Mild intermittent asthma
Howo often
Fev1
Tx

A

=80%

PRN short acting bronchoD

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39
Q

Mild persistent asthma
How often
FEV1
Tx

A

> 2/wk but 2 night/month
=80%
Daily low dose corticosteroid, PRN short acting bronchoD

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40
Q

Moderate persistent asthma
How often
FEV1
Tx

A

Daily
>1 night/wk
60-80%
Low to medium dose corticosteroid + long acting beta 2 and PRN short bronchoD

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41
Q

Severe persistent
How often
FEV1
Tx

A

Continual, frequent
<=60
High dose inhaled corticosteroid _ long acting beta 2; PO corticosteroid; PRN short acting bronchoD

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42
Q

Permanent dilation of bronchii 2/2 cycles of infection and inflammation
Chronic cough, yellow/green sputum, dysponea, hemoptysis, halitosis
CXR: inc bronchovascular marking and TRAM LINES (outline dilated bronchi)
CT: dilated airway and ballooned cyst
Spiro: dec FEV1/FVC

A

Bronchiectasis

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43
Q

If chronic hypercapnea, what can O2 do?

A

Suppress hypoxic respiratory drive

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44
Q

Chronic bronchitis - time criteria

A

productive cough >3 months in 2 consecutive yrs

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45
Q

Terminal airway destruction and dilation

A

Emphysema

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46
Q

Emphysema vs bronchitis S?S

A

E: pink puffer - dyspnea, pursed lips, minimal cough; thin appearance, late hypercarbia/hypoxia
B: blue bloater - cyanosis with mild dyspnea, productive cough, overweight, edema, rhonchi, early signs hypoxia

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47
Q

CXR of COPD

A

Hyperinflated lung, flat diaphragm, thin heart and mediastinum; bullae or blebs

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48
Q

pH status COPD

A

acute or chronic resp acidosis (inc pCO2) with hypoxemia

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49
Q

TX COPD

A 
COPD
Corticosteroids
Oxygen if PaO2 <=89%
Prevention - smoking, pneumo and flu vaccines
Dilators: Beta 2 ag and antichol
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50
Q

Inflammation or fibrosis of interalveolar septum
Honey combing
Shallow rapid breathing, DOE, nonproductive cough, fine crackles, RHF

A

Interstitial lung disease

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51
Q

PFT for interstitial lung dis

A

Dec TLC, FCV, DLCO

normal FEV1/FVC

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52
Q

Meds cause interstitial lung disease

A 
AMIODARONE
BLM
busulfan
Nitrofurantoin
Rads
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53
Q

Sarcoid S/S

A 
GRUELING
Granulomas
aRthritis
Uveitis
Erythema nodosum
LNopathy
Interstitial fibrosis
Negative TB
Gammaglobulinemia

Labs: Inc ACE, hyperCa, hypercalciuria, inc ALP

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54
Q

Sarcoid most common in

A

Afr Am females

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55
Q

Alveolar thickening and granulomas 2/2 environmental exposure

Acute within 4-6 hrs
Chronic - progressive dyspnea and rales

A

Hypersensitivity pneumonitis

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56
Q

Inhalation small inorganic dust particles

A

Pneumoconiosis

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57
Q

Manufacture tile or brake linings, insulation, construction, demolition, shipbuilding
Can see fibers on pleural biopsy
15-20 yrs after initial exposure
CXR shows/multinodular opacities and interstitial fibrosis; calcified pleural plaques, CT shows linear fibrosis
Complications?

A

Asbestosis

Complication: inc risk mesothelioma and other lung cancers

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58
Q

Coal mines
CXR small nodular opacities in upper lung
Spiro shows restrictive dis
Complicationn?

A

Coal miners disease

Progressive massive fibrosis

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59
Q

Work in mines or quarries with glass, pottery or silica, sandblasting, cutting granite
CXR: small nodular opacities in upper lung zones, EGGSHELL CALCIFICATIONS, hilar adenopathy
Spiro: restrictive disease
Complication?

A

Silicosis

Increased risk TB, need annual TB test; progressive massive fibrosis

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60
Q

Work in high technology fields = aerospace, nuclear, electronic plants
Ceramics, foundries, plating facilities, dental material sites, dye manufacturing
CXR: diffuse infiltrates and BILATERAL hilar adenoathy, granulomas

Complications

A

Berylliosis

Requires chronic corticosteroids

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61
Q

Diverse group w/ eosinophilic pulm infiltrate and eosinophilia

A

Eosinophilic pulmonary syndromes

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62
Q

Decreased PO2

A

Hypoxemia

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63
Q

Tx hypercapnic pts

A

Inc ventilation to inc CO2 exchange

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64
Q

How to increase oxygenation on mechanical ventilator

A

Inc FiO2 or PEEP

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65
Q

How to increase ventilationon mechanical ventilator

A

Inc RR or Inc TV

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66
Q

Dx ARDS

A

Acute onset
Ratio PaO2/FiO2 <18

Hypoxemia, dec lung compliance, pulm edema

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67
Q

4 phases ARDS

A
  1. acute injury - normal PE and possible resp alkalosis
  2. 6-48 hrs: hyperventilation, hypocapnia, widening A-a gradient
  3. ARF, tachypnea, dyspnea, dec lung compliance, scattered rales, diffuse chest opacity on CXR
  4. Severe hypoxemia unresponsive to Tx, inc intrapulm shunting, metabolic and resp acidosis
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68
Q

Goal oxygenation ARDS

A

PaO2 > 60

SaO2>90% on FiO2 <=0.6

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69
Q

Mean pulm arterial P > 25 (normal 15)
5 classifications
1. Arterial pulm Htn
2. inc pulm venous P from L sided heart disease
3. Hypoxic vasoconstriction 2/2 chronic lung dis
4. chronic thromboembolic dis
5. Pulm Htn with unclear multifactorial etiology

A

Pulm HTN/Cor pulmonale

70
Q

Causes pulm HTn

A

LHF
MV disease
Inc resistance pulm VV

71
Q

S/S pulm HTN

A 
DOE 
Fatigue
Letharfy
Syncope with exertion
CP
RHF (edema, abdominal distention, JVD)'
Loud palpable S2, S4, parasternal heave
72
Q

Sudden onset dyspnea, pleuritic CP, low grade fever, cough, tachypnea, tachycardia, resp alkalosis, loud P2, RHF

A

Pulmonary thromboembolism

73
Q

Most common cause PE

74
Q

Dx of PE

A 
CXR: normal, possble Hapmtoms hump (wedge shaped infarct) or Westermarks sign (oligemia in affected lung zone)
EKG: sinus tach or S1Q3T3
Ct pulm ang with IV contrast - spiral CT
VQ scan- mismatch
D dimer: sensitive not specific
LE venous US: clot
75
Q

Lung nodules on CXR

  • Recent immigrant
  • SW US
  • Ohio River Vally
A
  • TB
  • Cocci
  • Histoplasmosis
76
Q

Benign vs malignant

  • age
  • smoking
  • films
  • appearance
  • margins
  • size
77
Q

Highly correlated with cigarette exposure, central location, neuroendocrine origin, paraneoplastic, mets on presentation (brain, liver, bone)

A

Small cell lung cancer

78
Q

3 types nonsmall cell lung ca

A

AdenoCA
SCC
Large cell/neuroendocrine

79
Q

Most common lung CA, peripheral location, broncheoalveolar carcinoma (single nodules, interstitial infiltration, prolific sputum), pleural effusion have increased hyaluronidase NOT ASSOCIATED WITH SMOKING

80
Q

central location, 98% smokers

81
Q

least common, poor prognosis, peripheral location, early cavitation

A

Large cell/neuroendocrine CA

82
Q

Lung cancer mets

A 
LABB
Liver
Adrenals
Brain
Bone
83
Q

Horners

Associated tumor

A

Miosis, ptosis, anhidrosis

Pancoast tumor at apex

84
Q

Facial swelling and lung Ca

A

SVC syndrome - supraclavicular engorgement and facial swelling

85
Q

Hoarseness and lung CA

A

recurrent laryngeal n involvement

86
Q

Examples paraneoplastic syndromes of lung CA

A
  • Endocrine/metabolic
  • -Cushing - SCLC
  • -SIADH–SCLC
  • -Hypercalcemia–SCC
  • -Gynecomastia–Large cell
  • Skeletal
  • -Hypertrophic pulmoary osteoarthyopatyh- non small
  • -Digital clubbing - non small
  • Neuromuscular
  • -Peripheral neuropathy, subacute cerebellar degen, MG (Lambert-Eaton) - SCLC
  • -Dermatomyositis- All
  • CV
  • -Thrombophlebitis or nonbacterial venous endocarditis - Adeno
  • Heme
  • -Anemia, DIC, eosinophilia, thrombocytosis-All
  • -Hypercoagulability- Adeno
  • Cutaneous- acanthosis nigircans -All
87
Q

Tx SCLC

A

Unresectable, rads and chemo- low survival rate b/c returns

88
Q

Tx NSCLC

A

Surgical resection, rads or chemo

89
Q

Dyspnea, pleuritic CP, cough, dullness to percussion, dec breast sounds, possible rub

A

Pleural effusion

90
Q

Tx pleural effusion

A

Thoracentesis

91
Q

Acute onset unilat pleuritic CP and dyspnea; tachypnea, diminished or absent breat sounds, hyper resonance, dec tactile fremitus, JCD, decreased chest wall movement

A

Pneumothorax

Tension pneumo: tracheal deviation and hemodynamic instability

92
Q

Primary vs secondary pneumothorax

A

Primary: 2/2 rupture subpleural apical blebs - tall thin young adulte males
Secondary: COPD, trauma, infectious, iatrogenic

93
Q

1 way air valve causing air trapping in pleural space

A

Tension pneumothorax

94
Q

Presentation of pneumothorax

A 
P-THORAX
Pleuritic pain
Tracheal deviation
Hyperresonance
Onset sudden
Reduced breast sounds and dyspnea
Absent fremitus (asymmetric chest wall)
Xray shows collapse
95
Q

What does DLCO stand for

A

Diffusing capacity of lungs - ability to transfer gases from alveoli to pulm capillaries

96
Q

Inspiratory V during normal respiration

97
Q

Air V beyond normal tidal V that is filled during maximal inspiration

98
Q

Total inspiratory air volume considering both TV and IRV

99
Q

Air V beyond TV that can be expired during normal respiration

100
Q

Remaining air V left in lungs following max expiration

101
Q

RV + ERV = air remaining after expiration of TV

102
Q

Max air volume that can be expired and inspired IC + ERV

103
Q

Total air volume of lungs FVC + RV

104
Q

2 PFT decreased in obstructive, all others are increased

A

FVC and FEV1

105
Q

Normal A-a gradient

A

5-15 mmHg

Inc: PE, pulm edema, r-l shunt
False normal: may be seen in causes of hypoventilation or at high altitudes

106
Q

PAO2-PaO2 gradient

A

713 x 0.21 -(PaCO2/0.8)-PaO2

0.21 = FiO2 fraction of O2 in inspired air
PAo2: alveolar O2 content
PaO2 - arterial O2 (90-100)

107
Q

Nasal and throat irritation, sneezing, rhinorrhea, nonproductive cough, fever, no exudative or productive coug

A

Viral rhinitis/common cold

108
Q

Sore throat, LNopathy, fever, red swollen pharynx, tonsillar exudates
Causes?

A

Pharyngitis

Cause: GABS or common cold virus

109
Q

Tx GABS

A

Penicillin, amoxicillin, etc

110
Q

Complications GABS pharyngitis

A

PSGN- high antistreptolysin O
Rheumatic fever
Rheumatic heart disease

111
Q

Cause of tonsillar infections

A

Strep pharyngitis

112
Q

Arthralgias, myalgias, sore throat, nasal congestion, nonproductive cough, N/V, diarrhea, high fever, LNopathy

Rx to shorten course

A

Viral influenza

Oseltamivir

113
Q

Major complication of sinusitis

A

Meningitis

114
Q

Causes acute sinusitis

A

Strep pneumo
H flu
Moraxella catarrhalis

115
Q

Cause chronic sinusitis

116
Q

DM and sinusitis

A

Mucormycosis

117
Q

Which sinuses usually affected in sinusitis

118
Q

Rx sinusitis

A

Amoxicillin

119
Q

Productive cough, sore throat, fever, wheezing tight breath sounds
Usual cause

A

Acute bronchitis

Viral
If inc risk bacterial infection give fluoroquinolones, tetracycline, erythromycin

120
Q

Infection broncheolaveolar tree by nasopharyngeal bugs–> prod or nonprod cough, dyspnea, chills, night sweats, pleuritic CP, decreased breast sound, dullness to percussion egophony, tachypnea
Labs: Inc WBC, positive sputum
CXR: lobar consolidation

A

Pneumonia

Bacterial or fungal- broad spectrum abx until cultures return

121
Q

Cough, hemoptysis, dyspnea, weight loss, night sweats, fever, rales

Dx?

A

TB

TB is screening for exposure

Acid fast stain, culture, bronchoscopy

122
Q

CXR reactived vs primary

A

Primary- lower lobe

Reactivated - apical

Also Ghon complexes- calcified granulomas/LN

123
Q

Most common pneumo in kids

124
Q

Most common pneumo adults

A

Strep pneumo - higher risk in pts w/ sickle cell

PRODUCTIVE COUGH

Tx: beta lactams and macrolides

125
Q

Pneumo common in COPD, slower onset than classic pneumo

A

H flu

Tx: Beta lactams or TMP-SNX

126
Q

Nosocomical pneumoa common in immunocompromised pts

Forms abscess

A

Staph auresu

Beta lactams

127
Q

Pneumo in alcoholics with high risk aspiration, currant jelly sputum

A

Kleb pneumo

Cephalosporin, aminoglycosides (gentamicin)

128
Q

Chronically ill and immunocompromised, CF, rapid onset pneumo

A

Pseudomonas

Tx: Fluroquinolones, aminoglycosides, 3rd gen cephalopsoring,

129
Q

Neonates and infants pneumo

A

GBS

Beta lactams

130
Q

Nosomical and elderly pts

A

Enterobacter

TMP SMX

131
Q

3 types atypical pneumo

A

Mycoplasma- young adults (college), positive cold agglutinin (macrolides)
Legionella: aerosolized water (macrolides, fluoroquinolones)
Chalmydophila - young and old (doxycyline and macrolides)

132
Q

Pneumo

Midwest and south central america

A

Blastomycosis

KOH prep
Verrucous or ulcerated skin lesions
Itraconazole

133
Q

Pneumo caves

A

Histoplasmosis

134
Q

Immunocompromised Pneumo + GI

A

PCP - inc LDH (or CMV if koilocytosis)

TMP SMX

135
Q

Paired gram + cocci pneumo

A

Strep pneumo

136
Q

PPD test positive at 5 mm

A

HIV, close contacts with TB, signs TB on CXR

137
Q

PPD test positive 10 mm

A

Homeless, immigrants, IVDU, health care, recent incarceration

138
Q

PPD test positive 15 mm

A

Always positive

139
Q

Causes ARDS

A

A- aspiration, acute pancreatitis, air or amniotic embolism
R - radiation
D- drug OD, diffuse lung disease, DIC, drowning
S -shock, sepsis, smoke inhalation

140
Q

Proonged, nonresponsive asthma attack that can be fatal

Tx

A

Status asthmaticus

Agressive bronchoD, corticosteroids, O2, possibly intubation

141
Q

Emphysema vs chronic bronchitis:

A

DLCO
Normal in bronchitis
Dec in ephysema (also asbestosis)

142
Q

Alpha 1 antitrypsin def induced emphysema vs not

A

Alpha 1: panlobular

Not: centrilobular

143
Q

Hoarseness worsens with time, dysphagia, hemoptysis, assocaited tob and alcohol

A

Laryngeal CA

Tx - remove lesions, rads with surg

144
Q

> 50 yrs, inflammatory lung disease, restrictive, inc PMN on lavage, CXT with honeycomb and CT ground glass

A

Idiopathic pulm fibrosis

Tx: steroids + azothioprine/cyclophosphamide

145
Q

Progressive AI disease of lungs and kidneys 2/2 antiglomerular basement membrane Ab (anit-GBM)
S/S: hemoptysis, dyspnea, resp infection
Labs: restrictive PFT, UA proteinuria and granular casts, renal biopsy crescenteric GMN and IgG in glomerular capillaries
Tx?

A

Goodpasture

Plasmapheresis, steroid and immunosuppressive Rx

146
Q

Granulomatous inflammation and necrosis of lung and other organs 2/2 systemic vasculitis affecting lung and kidneys - noncaseeating granulomas and destruction of lung parenchyma
S/S: ulceration of nasopharynx, CNS Sx
Lab: + cytoplasmic antineutrophil Ab (c-ANCA)
Tx

A

Granulomatosis with polyangitis -Wegner

Cytotoxic Tx - cyclophosphamide and steroids

147
Q

Risk factors PE

A 
7H
Hereditary hypercoagulability
History- prior DVT or PE
Hypomobility
Hypovolemia- heydration
Hypercoagulability
Hormones
Hyperhomocysteinemia
148
Q

Time line to anticoagulate after PE

A

3-6 months

149
Q

3 types pneumothorax

A

Closed - chest wall intact (COPD, spontaneous, TB, blunt trauma)

Open- air through opening in chest wall (penetrating trauma, iatrogenic)

Tension- air enters but does not leave (trauma)

150
Q

Dyspnea, pleuritic CP, weakness, decreased BS, dullness to percussion, decreased tactile fremitus

A

Hemothorax

151
Q

Tumor on visceral pleura or peritoneum with poor prognosis

Asbestos (20 yrs later)

A

Mesothelioma

Extrapleural pneumonectomy w/ chemo and rads - Tx

152
Q

Tx central sleep apnea

A

respiratory stimulants

phrenic n pacemaking

153
Q

Localized alveolar collapse, common after surgery and anesthesia, also asthmatics/FB aspiration/ mass effect
CXR: fluffy infiltrates and lobar collapse
Preventive Tx?

A

Atelectasis

Incentive spiro, ambulate, PT

154
Q

How to check proper placement of ET tube?

A

end tidal CO2 - rise following expiration

155
Q

What can be adjusted with mechanical ventilation?

A

TV
RR
FiO2
inspirator P

PEEP prevent alveolar collapse

156
Q

Predictors of weaning success

A

Max ins P < 30 cm H2O
VC > 10mL/Kg
minute vent 200
frequency: TV ratio <100 breaths/min/L

157
Q

Determines and automatically delivers set TV and rate

Pt provides no effort

158
Q

Determines and automatically devliers set TV and rate

Pt can breathe spontaneously between mechanical breaths

159
Q

Machines tries to synch rate with pt initiated breaths, automatically delivers TC and rate
Pt can breathe spontaneously between mechanical breaths

160
Q

Machines senses pt’s attempt to breathe and delivers full preset TV, backup rate if no spont breathing
Pt driven unless no attempts to breath

161
Q

Acute inflammation of larynx, 3 mo - 5 yrs, barking cough, inspiratory stridor, subglottic narrowing/steeple sign
Causes?

A

Croup

Parainfluenza 1 and 2 (RSV, influenza, rubeola, adenovirus, Myco pneumo)

162
Q

Cause epiglottitis

Major S/S

A

HiB, strep or the H flu
Dysphagia, drooling, muffled voice, high fever, lean forward to breath, THUMBPRINT SIGN (opacified epiglottis obscures airways)

163
Q

Cause bronchiolitis

A

RSV or parainfluenza 3 (not common)

S/S - wheezing and resp distress
CXR - hyperinflation lungs

Tx- monitor airway

164
Q

Caused by surfactant def; presents within 2 d of birth, inc RR, ABG shows inc CO2, dec O2, ground glass on CXR

A

RDS of newborn

Increased risk of developing asthma

165
Q

complication meconium aspiration

166
Q

Tx CF

A

DNase - decrease viscosity of phlegm
NSAIDS
BRonchD
abx

167
Q

Common pulm infection

A

Pseudomonas

Staph

168
Q

Top 3 causes cough in outpt

A

Asthma
GERD
postnasal drip

169
Q

Pneumo in TB and pulm cavitation

A

Aspergillus

170
Q

Popcorn calcifcations

A

Granulomas - bening

171
Q

NBulls eye calcifications

A

Hamartomas- benign

172
Q

Gold standard PE

A

pulm angiography

First Aid Step 2 (22 decks)

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