PULM and Allergy/Immuno Flashcards
Types of CA
Small Cell
Squamous Adeno Large Carcinoid Mesothelioma
Small Cell - ACTH, ADH, Lambert E, L myc, Kulchitsky cell. Bombesi, chromogranin+. Poorly diff neuroendocrine>
Squamous- PTHrp _ Central cavitation, Keratin, pearls, intercellular bridges
Adeno - Peripheral - most common overal - K-Ras - Short plump microvilli
Large
Carcinoid - polyp like mass in the bronchus - Well diff neuroendocirne - Nonsmoking, related. Chromogranin +
mesothelioma - recurrent hemorrhagic pleural effusion - Long villi. Psamomma body.
Sarcoid finding
What to not confuse this with?
Sarcoid - noncaseating granulomas - ICN ACE, Ca, can mimic sjogrens. E nodosum.
dont confuse w/ berylliosis! Which is also noncaseating granulomas!
Asbestos - findings?
Pleural plaques - ferruginous bodies - Fe
Sililicosis findings -
M! dysfunction - INC risk of TB - pper lobe eggschell calcifications of hilar LAD
Anthracosis
Asx - urban dweller
Nasopharyngeal CA findings
monitoring?
Epistaxis, otitis media.
Monitor EBV titers for tx responsiveness
Obsturctive PFT fidigns
Emphysema vs Chronic Bronchitis?
FEV1/FVC is LESS THAN 80% predicted.
Emyphsema - DEC DLCO (destroyed alveoli)
Chronic Bronhchitis - DLCO is normal
Tx COPD exacerbation vs Asthma?
COPD - O2, Ipra, Steroids, ABX! -»PPV, Intubate.
Asthma - similar - O2, Ipra, steroids. NO ABX.
Pharm causes of Restrictive Diseaes and PFT?
Restrictive - FEv/FVC > 8-%.
Drug - Bleomycin, busulfan, amiodarone, methotrexate.
Solitary mass - algorithm?
Past X ray.
Neg -> Ct
Okay looking - serieal CT
Suspicious - Surgical excision
PE pressure measurements?
What ABG findings?
S1Q3T3
INC RA, pulm artery pressure.
NORMAL WEDGE.
ABG - INC A-a gradient . (Normal alveoli, DEC arterioles)
Empyema - most convincing finding?
pH > Gluocse
Lights criteria
Tranduse -Low - CHF, Cirrhosis
Exudate - INC - PE, CA, Infection
Bronchial rupture
vs
Diaphgramatic rupture
Both are post traumatic
Bronchial rupture - persistent PTX
Diaphgramatic rupture - NG in pulm space
Neonatal RDS - Tx?
Steroids, T4, Prolactin
Longstanding complciatiosn of neonatal ARDS?
Tx?
N! dmg -> T2 stem cell dmg -> fibrosis
Protein rich, pink/fibrin. NORMAL pulm wedge! BUT INC poulm artery .
Tx - low tidal, INC PEEP. But INC PTX risk
Bronchogenic cyst location?
Middle mediastnial mass.
Tx for aspirin induced athma?
Montelukast
LTR antagonist
TB exudate findings
HIGH PROTEIN CONTENT (Greater than 4),LYMPHOCYTIC leukocytosis. No gross purulence! (compared to other infectious exudates.
Pulmonary contusion
– after trauma – delayed in development – up to within first 24 hours. Tx- conservative w/ pain control and maintnence of pulm toilet until bloody fluid cleared./
Angioedema (hereditary tx) - c1 esterase inhbitor def.
Intubate (if needed)
Acute:ECALLANTIDE or FFP
Long term - androgens (Danazole, Stanazole)
When Asx, best way to test for asthma?
> 20% def in FEV1 w/ methacholine use . WHEN ASX
Best test for dx Bronchiectasis?
High res CT scan
Major cuase of death in CF?
lung pathology
Most accurate test to dx CF/
Sweat test
Not genotyping - so many genes that can cause CF
TB ppx
TB tx?
TB PPx - INH + B6 for NINE months
Or Rifampin + Pyrazidamine
Tx - RIPE for 6 mo - after 2 mo, can remove Ethambutol and pyrazinamide and just o Rifampin and INH
PE - treatment
Role of thrombolytics?
PE - Heparin (LMWH)
tpa ONLY in hypotensive/tachycardic patients.
Stroke (within 4)
STEMI - within 30 min. Up to 12 hr)
PE test in preg?
VQ first only in pregnancy.
most acurate test for OSA?
Polysomnography (aka sleep study)
ARDS formulat defnition?
PO2/Fio2 below 300./
Tacile fremitus, what findigns in consolidation vs pleural effusion.
Effusion, DEC; consolidation INC
PE CT findigns other than staghorn?
Wedge shaped infarction pathognomonic
What are 2 things that INC Aa gradident?
What does not change Aa grdient?
ARDS, PE both INC A-a gradient, pleural effusion.
Basically every.
The only things that dont change Aa gradient and you see hypoxia are breathing shitty low O2 oxygen basically.
When to sputum stain pneumo?
Optional in outpatient setting due ot low yield and poor culture results, usu tx with empiric therapy. May or may not perform inpatient? BUT ALWAYS CXR.
If intubated, always collect sputum.
Massive hemoptysis (over 600ml) with unstable vitals
bronchoscopy first, even if you think field will be obstructed (use suction etc) Thoracotomy is not indicated unless bronch fails.
COPD exacerbation, Noninvasive PPV vs Intubate?
Try NPPV first for 2 hours, unless they have severe pH less than 7.1, somnolence. If fail 2 hr, intubate.
MYasthinia gravis crisis tx algorithm –
Intubate frist. Thetn Steroid s+IVIG OR pphx
Ventilator assoc Pneumo
within 48 hr of intubation fever etc. LOEWR RESPITRORY TRACT SAMPLE (GRAM STAIN AND CULTURE and empiric abx before narrowing
Nonallergic rhinitis vs Allergic rhinitis sx + tx?
Nonallergic has no eye symptoms and no triggers. Tx both with Antihistamines/intranasal steroids.
Laryngomalacia time of appearance and time course
peaks 4-8 mo, usus reseolves by 12-18 mo. Dx clinical but confirmed by direct visualized with laryngoscopy. Omega shaped epiglottis with collapse of supraglottic structures during inspiration.
Platuea pressure in intubated patient w/ inspiratory hold
sum of PEEP and Elastc pressure (lung compliance)
Muscle weakness in likely lung CA patient?
dermatomyosisits!!! (Grotton papuels etc) , Or ACTH, or PThRP)
Solitary pulm nodule
if suspicion for malignancy, SURGICAL EXCISION, NOT FLEX BRONCH. Inermediate risk can undergo FDG-PET + bronch biopsy.
High risk: irregular, smoker, weight changes etc
Solitary pulm nodule definition
– lesion elss than 3cm completedly surrolunded by pulm parenchyma with NO LAD.
