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IPAP > Pulm: Block 1 > Flashcards

Pulm: Block 1 Flashcards

1
Q

What is the pathophysiology of COPD

How does it present and what is seen on PE?

A

Abnormal and permanent enlargement of airspace due to wall destruction

Older PT w/ smoking Hx w/ Dyspnea
Dec sounds
Hyperresonance

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2
Q

What will be seen on diagnostic studies of COPD?

What are two complications that can arise from emphysema?

A

Dec FEV, Inc TLC

Pneumothorax from bullae
Weight loss due to breathing efforts

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3
Q

What mechanism allows us to breathe?

A

TP: 4mmHg, inflate
TTP: -4mmHg, deflate
TRP: air flow to/from atmosphere and to/from lungs
-4mmHg in interstitial space pulls lungs during inspiration

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4
Q

What is the criteria to receive the term ‘blue bloater’?

What will be seen/heard on exam and PFT?

A

Productive cough x3mon for two consecutive years

Inc resonance
Dec sounds
Accessory muscle use
FEv/FVC ratio <0.7
FEV <80%
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5
Q

What are the two causes of the Cor Pulmonale showing in Blue Bloaters?

What is the most common and four less common causes of bronchiolitis?

A

RV failure
PHTN

MC= RSV
LC= Parainfluenza, Rhino, Influenza, Metapneumo
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6
Q

How is bronchiolitis Dx and Tx

What are three potential complications?

What is the most common cause of Acute Bronchitis and how does it present?

A

Child under 2yrs w/polyphonic wheezes and ralesafter 1-3 day URI; Tx w/ Support

Dehydration, Apnea, Aspiration pneumo

Viruses- productive cough <1wk
Tx: support, dilators

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7
Q

How does acute bronchitis present?

What are the 6 viruses that can cause acute bronchitis?

What 3 bacteria could cause acute bronchitis?

A

Cough x 5days or more
Non/purulent sputum
URI prodrome

RPM RIC
Rhino Parainfluenza Metap
RSV Influenza Corona

Bordatella pertussis
Mycoplasma pneumo
Chlamydia pneumo

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8
Q

How does bronchiectasis present?

What will be seen on imaging of bronchiectasis

How is the Dx confirmed?

A

Large amount of sputum
Crackles and wheezing

Tram tracks- dilated and thickened airway

CT: Signet ring sign (wall thickening and plugs_ and
Tree-in-bud (trapped debris)

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9
Q

What is the most common cause of bronchiectasis

How is it Tx?

A

CF

Therapy Hydrate ABD Dilator

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10
Q

Define Bronchiectasis

What type of airway dz is it?

What vaccine has significantly reduced the prevalence of epiglottitis?

A

Dilation w/ decreased airway clearance causing mucus pooling

Obstructive

HIB

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11
Q

What are the top three the most common causes of URIs?

How do these PTs present?

How is it Tx?

A

Strep Pneumo- MC, in carriers
HIB- unvaccinated Peds PT
Moraxella- smokers

Rapid onset fever/dysphagia
Stridor, Tripod, drooling
Thumb sign on x-ray

ABX (Cephtriaxone, Vanc)- safe for young, old, pregnant

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12
Q

What is the full term of Croup

Croup is most commonly caused by ? and in ? age PT

How is Croup Tx?

A

Laryngotracheitis

Parainfluenza virus, 6mon-3yrs

Cool temps
Dexameth, Racemic Epi

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13
Q

What respiratory sound is made in Croup PTs and what Sx is rarely seen?

What hallmark image is seen on x-ray for these PTs?

What is the difference between this fever and epiglottitis fever?

A

Inspiratory stridor
Rare= hypoxia

Steeple sign on PA view

Croup: low, non toxic PT
Epiglottitis: high, toxic PT

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14
Q

Who and how does Bacterial Tracheitis present?

How is this one different?

What meds are used to Tx Bacterial Tracheitis

What is different about these PTs Tx process?

A

3-5y/o w/ high fever (+102), barky cough, stridor

Toxic appearing
Pseudomembrane development

IV Ceftriaxone/Vanc
IV fluids

Sedate, Intubate, Bronchoscope

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15
Q

How does influenza appear in clinic?

How is Influenza Dx

How are they Tx and what med can be given to high risk PTs if Dx is made within 48hrs

A 
HA
Myalgia
Fevers
Sudden onset fever
Non-productive cough

Reverse PCR, rarely culture

Support- PO fluids
Oseltamivir- don’t use w/ statin due to liver damage

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16
Q

What is the most common cause of viral pneumonia in adults?

What are the differences between the three types of this microbe

How is this microbe spread?

A

Influenza

A: pandemic (PT more sick)
B: epidemic
C: sporadic

Respiratory droplet

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17
Q

What microbe causes Whooping Cough?

How does this present?

A

Bordetella Pertussis

Hx of nasal congestion, Cough
Low fever
Repetitive cough, whoop, post-cough emesis

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18
Q

What med is used to Tx Pertussis?

What are the three stages of pertussis?

A

Azith. preferred <1mon
Alt: TMP/SMX if macrolide c/i

Catarrhal- 1-2wks; fever, non-productive cough, rhinorrhea
Paroxysma- 2-6wks; whooping, stridor
Convalescent- 1-2wks; reduced Sxs

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19
Q

What microbe is the most common cause of bacterial pneumonia?

What can be seen on PE to ID this?

A

Strep Pneumo

Rust colored sputum, Gram Pos

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20
Q

What microbe is the most common cause of pneumonia in alcoholics?

What is the most common cause of pneumonia in drug users?

A

Klebsiella- currant jelly sputum, bulging fissures

Staph A: gram pos cocci in clusters seen post influenza, most dangerous

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21
Q

What is the most common cause of pneumonia in CF, nursing homes and cyanosis?

What microbe is most common cause in COPD PTs and is usually post-URI?

A

Pseudomonas

H Infleunza, gram NEG pleomorphic rods

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22
Q

What are the two microbes most likely to cause health care associated pneumonia?

How are pneumonias Tx?

A

Pseudomonas
MRSA

Outpatient, healthy: Macrolide or Doxy*- few s/e, no QTc lengthening

OutPT w/ comorbidity/Inpatient: respiratory flouroquinolone

ICU: Ceftriaxone/Cefotaxime and Azith or Respiratory fluoroquinolone

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23
Q

What comorbidities in a pneumonia PT change the Tx protocol?

“Walking Pneumonia” can be from what six microbes?

A

DM, HTN, Obese, Apnea

CCC FML
Chlamydia Pneumo(mild)
Chlamydia Psitt.
Cox Burnetti
F. Tularemia
Mycoplasma pneumo (young PTs)
Legionella Pneumo
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24
Q

Most common cause of Typical CAP, follows URI/influenza and has acute onset

May follow influenza, cavitary and possible MRSA

Present in DM, ImmComp, long term care facilities and aspiration pneumonia

Chronic lung Dz PTs or PTs on mechanical vents

A

Strep Pneumo- rust color sputum

Staph A

Klebsiella

Pseudomonas

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25
Q

What are the five atypical organisms that can cause

atypical pneumonia?

A

Mycoplasma- young adult, NOT visible on x-ray

Legionella- hot tub, GI, Neuro, effusions

Chlamydia Pneumo- young adult after pharyngitis

Cox Burnetti- livestock, inc LFTs

Chlamydia psittaci- parrott exposure, temp/pulse dissociation

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26
Q

What microbe cause pneumonia after exposure to birds, NOT parrot?

Define Bullous Myringitis

A

Birds: Crypto Neoformans, H Capsulatum

Hemorrhagic bleb on TM during Mycoplasma Pneumonia
Tx w/ macrolide

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27
Q

What is the presenting cough Sx of atypical pneumonia?

How are Atypical Pneumonias Tx and what classes are avoided?

A

Non-productive cough
Rales
Interstitial infiltrate (CXR)

Tetracyclines- D/T
Macrolides- A/C
Fluoroquinolones
NO: B-Lactam/Sulfonamides

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28
Q

PT w/ Histoplasmosis probably has ? travel Hx and exposure?

How does this appear on CXR?

How is it Dx and Tx?

A

Fungal infection from Ohio-Mississippi valley, bird/bat droppings

Solitary pulmonary calcification
Hilar/mediastinal adenopathy

Sputum culture
Itraconazole/Amphotericin B

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29
Q

What causes Pneumocystitis Pneumonia

How do these PTs present?

What will be seen on lab work and imaging of PCP?

How is it Tx?

A

HIV Hx, most commonly from Pneumocystitis jirovecii

Gradual onset of non-productive cough

CD4 <200
Inc LDH
Bat wing pattern CXR

TMP-SMX
Steroids if PaO2 <70% or A-gradient >35

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30
Q

What will be seen on CXR of TB?

How are these Dx?

A

Primary/Latent: Ghon focus
Reactivation: cavitary in upper lobes

Primary/Latent: PPD
Reactivated: sputum smear for acid fast bacilli or, culture for AFB

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31
Q

What causes carcinoid syndrome?

How do these PTs?

How is Carcinoid Syndrome Dx?

A

Neuroendocrine tumor secreting histamine, , prostaglandins peptides catecholamine serotonin

Skin flush, wheezing, diarrhea

5-HIAA collection x 24hrs

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32
Q

What are non-pulmonary Sxs indicative of metastases?

What lab results will be seen in PTs w/ Carcinoid Syndrome?

What is this the leader of?

A

Hip/back pain
Horners (Pancoast)
Neuro Sxs
Tachy w/ HOTN

HyperCa

Cancer related death among men and women

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33
Q

What type of lung nodule is most likely benign and malignant?

A

Benign:
Fast/no growth on Q2yr images
Popcorn pattern,
Multiple nodules <5mm Lifelong non-smoker, <30y/o w/ no CaHx

Malignant: >2.5cm, Spiculated
Upper lobe
Multiple pulmonary nodules +1cm in diameter
PT >30y/o w/ smoking or CaHx

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34
Q

What is the most common cause of the two type of pleural diseases?

What will be seen on PE for these PTs?

How are these Dx?

A

Transudative: CHF
Exudative: infection (bacterial pneumonia)

Dec sounds
Dec tactile fremitus
Dull percussion

CXR w/ costophrenic and cardiophrenic angles, loss of diaphragm/apex silhouette

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35
Q

How are pleural Dzs Tx?

How are Transudative and Exudative differentiated?

A

Thoracentesis

```
Light’s Criteria-
Transudate:
Protein <0.5
Serum LDH <0.6
LDH <2/3 upper limit
HF PE Cirrhosis Nephrotic
~~~

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36
Q

What will be seen on PE of a Spot Pneumo?

What will be seen on CXR?

How are they Tx?

A

Dec sounds
Dec fremitus
Hyper resonance

Absence of lung markings

<20%= observation w/ O2
>20%= chest tube
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37
Q

What type of BP is seen in Tension Pneumos?

What is the most common chronic and acute cause of compromised pulmonary circulation

How doe they present?

How is it Tx?

A

HOTN w/ JVD

Chronic: COPD
Acute: PE

R side HF
Edema
Dyspnea

R heart cath

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38
Q

What is the most common presenting Sx and Sign of VTEs?

What would be seen on EKG?

A

Sx: dyspnea
S: tachypnea

Sinus tachy, S1Q3T3

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39
Q

What is Virchow’s Triad

What would be seen on CXR of VTE?

What is the TOC in mod/high probability cases?

A

Stasis, Trauma, Hypercoag

Hampton hump- pleural based wedge infarct
Westermak sign- vascular cutoff sign

CT pulmonary angiography
Alt Test= VQ if bad kidneys

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40
Q

What is Well’s Criteria

A

PE Risk Score

S/Sxs of DVT= 3
DDx less likely than DVT= 3
HR >100= 1.5
Imm/Surgery in 3 days/4wks= 1.5
DVT/PE Hx= 1.5 
Hemoptysis= 1 
Malignancy w/ Tx in past 6mon= 1
0-2= low
3-6= mod
>6= high
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41
Q

How do restrictive pulmonary Dzs present?

How do Restrictive Pulmonary Dz appear on diagnostic studies?

How is it managed?

A

Male w/ Hx of smoking and chronic dry cough w/ dyspnea (smoking, dust exposure, GERD)

Dec FVC and FEV
Near normal FEV/FVC ratio
CXR w/ honey comb

O2, Pulm rehab

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42
Q

What two findings are seen in in PHTN?

What are the origins of each type of Pneumoconiosis: Beryillosis, Silcosis, Siderosis, Stannosis, Byssinosis

A

RVH, elevated Pulm Pressure +25mmHg

Asbestos: ship, roof, plumbing
Bery: aerospace/fluorescent
Sill: miner, sandblasting
Side: arc welder, iron
Stann: tin
Byss: cotton
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43
Q

What is the key highlight for pneumoconiosis?

Which origins of pneumoconiosis affects the upper/lower lobes of the lungs?

How do pneumoconiosis PTs present

A

Dec lung volume

Up: Silica, Coal, Bery, Talc
Low: Cobalt/hard metals, asbestosis

Dyspnea
Non-productive cough
Chronic hypoxia

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44
Q

How does pneumoconiosis appear on Dx studies?

Define Lupus Pernio and where is it seen?

A

CXR shows interstitial fibrosis
Dec volume

Raised plaques and nodules on face, pathognomonic for Sarcoidosis

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45
Q

What is seen on lab work and CXR of PTs w/ Sarcoidosis

How are these PTs managed?

A

HyperCa
Elevated serum ACE
CXR= hilar adenopathy
Mediastinal node biopsy= noncaseating granuloma is Dx

Steroids

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46
Q

What are S/Sxs that can be seen in Sarcoidosis?

What can obstructive sleep apnea lead to?

How are these PTs managed?

A

LUB pH
Lupus Uveitis Bells Polyarthritis Hemoptysis

PHTN, Cor Pulmonale (RVH)

CPAP, Life style changes

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47
Q

What is the pathphysiology of ARDS?

What is the most common cause of ARDS?

How do PTs present during PE?

A

Aveolar damage increasing permeability causing pulmonary edema

Sepsis

Hypoxemia refractory to O2

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48
Q

What is seen on Dx studies of ARDS PTs?

What can cause ARDS?

How is ARDS managed?

A

Bilateral infiltrates
PA wedge pressure <18
PaO2 <300mmHg
Inc A-gradient

Neurogenic pulm edema
Transfusion injury
High altitude
Opioid OD
PE
Eclampsia

Ventilation w/ PEEP

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49
Q

Neonatal/Infant Respiratory Distress Dz is AKA ?

What causes Hyaline Membrane Dz

How does this look on CXR?

How is it Tx?

A

Hyaline Membrane Dz

Surfactant deficiency in premature as respiratory difficulty hrs after birth

Dec lung volume, Ground glass

Intubate, O2, CPAP, Surfactant

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50
Q

What is used for Step 1-6 of Asthma Tx?

A

1: SABA
2: Low dose CCS
3: Low dose CCS + LABA or Medium dose CCS
4: Med dose + LABA
5: High dose + LABA (Allergies= +Omalizumab)
6: High dose + LABA + PO CCS (Allergies= +Omalizumab)

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51
Q

How do PTs w/ HyperK present?

How does it look on EKG?

A

Brady, HOTN, dysrhythmia
Lethargy, paralysis

Peaked T
Prolonged PR
Wide QRS

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52
Q

How is hyperkalemia Tx?

If a PT is acidic, they are ?

A

Ca gluconate to stabilize cell membrane
Insulin/albuteral/BiCarb to redistribute K

HyperK

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53
Q

How do HypoK PTs present?

What will be seen on EKG?

A

Weak, Hyporeflexia, Cramps

U waves
Flat T
QT prolongation
ST depression

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54
Q

What will happen if HypoNa is Tx too fast?

What is the most common cause of HyperCa

A

Central Pontine Myelinolysis

Malignancy, Squamous Cell CA (inpatient)
Primary hyperparathyroidism (outpatient)
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55
Q

Finding cervical/supraclavicular adenopathy can be the first PE finding indicating what two issues?

What issue can cause vessel engorgement of the head and neck?

A

Thoracic malignancy
Mycobacterial infection

Superior vena cava syndrome

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56
Q

What is the initial test for any PT presenting w/ hemoptysis?

Oxygen content in arterial blood depends on what two things and tissue perfusion needs what 3rd factor?

A

CXR

PO2
Hg level
CO

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57
Q

Ventilation is affected by what 3 factors?

What factor increases or decreases alveolar surface tension?

A

Airway resistance
Alveolar surface tension
Lung compliance

Water/fluid- inc
Surfactant- dec

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58
Q

What causes a left shift/increased affinity?

What causes a right shift/decreased affinity?

A

Inc pH (alkaline)
Dec PCO2
Dec temp

Dec pH (acid)
Inc PC02
Inc temp

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59
Q

Define DLCO

What med can be used to stimulate someone to hyperventilate?

Orthopnea is most commonly caused by ? but also could be from ?

A

Diffusing capacity of lungs for carbon monoxide

Epi

CHF
Secretions (pulonary dz)
Diaphragm weakness

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60
Q

Since there are no pain fibers in the lungs, PTs w/ pulmonary chest pain is indicative of an issue where?

What types of pain are indicative of CA?

A

Pleura Diaphragm Mediastinum

Diaphragm pain referring to shoulder
Pleural pain localized to chest wall
Both inc pain w/ inspiration

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61
Q

Define Tachypnea

Define Kussmaul breaths

A

Breathing due to dec tidal volume
>20/min

Rapid, large volume breaths due to metabolic acidosis

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62
Q

Define Cheyne Stokes

What breathing pattern is a precursor to respiratory failure?

A

Rhythmic waxing/waning tidal volume w/ apenic periods (high altitude, LV failure, Neuro dz)

Rapid, shallow breaths

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63
Q

Where and why do we palpate during a pulmonary PE?

What findings on percussion mean ?

A

Trachea- mediastinal shift
Posterior wall- fremitus, egophony
Anterior wall- cardiac impulse

Dull= consolidation, effusion (pneumonia)
Hyper= emphysema, pneumothorax
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64
Q

Central bronchial lung sounds normally have what 4 characteristics?

What do wheezes sound like and what are they associated w/?

A

Louder High pitch, Hollow, Louder on expiration

High pitched, musical, whistling
Bronchospasm, edema/secretions

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65
Q

What do rhonchi sound like and what are they associated w/?

What do crackles sound like and what are they associated w/?

A

Low pitch, gurgling
Origin of large airway, cleared w/ cough; due to secretion, collapse

Brief, popping
Fine= Fibrosis, early pulmonary edema
Course= pneumonia, obstructive dz, CHF

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66
Q

What are four groups of PTs that can have clubbing?

What are two populations clubbing is not common in?

A

Chronic infections
AV malformation
Malignancy
Interstitial dz

Asthma COPD

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67
Q

PHTN is mPAP +_ and measured via ?

A

+25mmHg
R heart cath
Severe= +35 or
+25 w/ high RA pressure Cardiac index is <2L/min

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68
Q

What are the five classification s of PHTN?

What contrast is used in perfusion/ventilation scans when looking for PEs?

A

1: pulmonary arterial HTN
2: left side Heart Dz
3: chronic lung dz/hypoxemia (Cor Pulmonale)
4: chronic thromboembolic dz
5: unidentified mechanisms

Radioactive albumin- perfusion
Radioactive gas- ventilation

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69
Q

What are PET scans used for?

What Dzs are located in the basal lung?

A

ID and staging of CA

SAID PAB
Scleroderma
Aspiration
Intersitial fibrosis
Drug reaction
Panlobar emphysema
Asbestosis
Bronchiectasis
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70
Q

What is the imaging modality of choice for assessing lung cancer or malignant mesothelioma?

When are VQ scans preferred?

A

MRI

RF PE Pregnancy

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71
Q

What are two ways lung function is evaluated?

What is the “sixth” VS?

What 3 pieces of info are required for pulmonary function tests?

What two pieces are sometimes used?

A

PFTs ABGs

Pulse Ox

Height Age Gender

Race Weight

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72
Q

What are the c/i to conducting a pulmonary function test?

What is the most available and useful PFT?

A 
Severe asthma
Hemoptysis
Angina
Active TB
Respiratory distress
Pneumothorax

Spirometry- measures volume exhaled in time

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73
Q

What does the Flow-Volume Loop do for testing?

What are the two parts?

A

Graphs max inspiratory and exhalation efforts
Flow vs volume

FEV1- effort dependent
Latter- effort independent and accurately reflect properties of lungs and resistance to flow

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74
Q

What does Forced Vital Capacity indicate?

What does it measure and indicate?

A

Degree of expansion
Measures total amount of air blow, out as fast as possible after inhaling as deeply as possible.

Good indicator of effort
Measures volume

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75
Q

What does an FEV1 measurement indicate?

What does this measurement indicate and measure?

A

Effort dependent
Patency of large airways

Indicates large and small airway function
Measures volume

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76
Q

What is the FEV1/FVC ratio

What does a low or high ratio indicate?

A

% of FVC in 1st second of effort based on Height/Age

Low: Obstruction
High: Restriction

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77
Q

FEF 25-75 is AKA and indicates ?

What does it measure?

A

MMEF rate
Patency of small airways, more sensitive for early obstruction

Measures FLOW of forced expiration

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78
Q

What part of the pFT is the least effort dependent?

What does this part of the test measure?

A

FEF25-75

Flow

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79
Q

What are the 4 things that can cause a “scoop” pattern on a spirometry test?

What are 4 things that can show a restrictive pattern?

A

Asthma
Bronchiectasis
COPD/CF

SAID OK
Scoliosis ALS Interstitial Dystrophy Obese Kyphosis

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80
Q

Obstruction and Restriction category %s

A 
O-
Mild: >80%
Mod: 50-80%
Sev: 30-50%
VSev:<30%
R-
M: 65-80%
Mod: 50-65%
Sev: 30-50%
VSev: <30%
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81
Q

Lung volume measurements are useful when ?

What test is the gold standard for assessing PTs w/ obstructive sleep apnea?

Define Diffusing Capacity and when is it useful

A

Spirometry shows dec FVC but not normal ordered PFT

Body Plethysmography using Boyle’s Law

Measures rate of alveolar/capillary gas transfer
Infiltrative dz, Emphysema

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82
Q

Diffusing capacity is useful in differentiating between ?

These test results are dependent on what two factors?

A

Emphysema (Low) vs Chronic Bronchitis

Alveolar surface area
Pulmonary blood flow
Measure HgB first if PT is anemic

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83
Q

What can cause the Diffusing Capacity to be elevated?

What would cause it to be decreased?

When would these results be seen as normal?

A

Pulmonary hemorrhage
Acute HF
Asthma

Emphysema
Interstitial lung dz
Pulmonary vascular dz

Asthma
Chronic bronchitis

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84
Q

What is deemed as one of the most clinically valuable tests of lung function?

SpO2 measurements take what 3 physiological factors into assumption?

A

Transfer Factor for Carbon Monoxide (TLCO)

pH, PCO2, Hgb

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85
Q

SpO2 is useful for what two things?

What is the 40-50-60 SpO2 assumption rule?
Today Britanie taught something cool- Minus 30 rule

A

Tracking trends
Detecting Hgb saturation changes

SpO2 / PaO2
70%/40mmHg
80%/50mmHg
90%/60mmHg

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86
Q

What are the 3 categories of cough?

What is the MC cause of an acute cough?

A

Acute: <3wks
Subacute: 3-8wks
Chronic: > 8wks

Viral respiratory tract infection (acute bronchitis)
Others: Pneumonia, PE

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87
Q

When is a CXR needed in a PT w/ a cough?

Elderly PTs may not present w/ S/Sxs of pneumonia, what VS need to be assessed?

A

Pulse >100
Resp >24
Temp >100.4
Crackles/consolidation

Mental status
Respiration
SpO2

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88
Q

What is the most common cause of sub-acute coughs?

What are the most common causes of chronic coughs?

A

Post-infectious

Post nasal drainage- AKA Upper Airway Cough Syndrome
Asthma
GERD

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89
Q

What is the most common cause of chronic cough in non-smokers?

What are other causes?

A

Post Nasal Drainage

Non/Allergic rhinitis
Vasomotor rhinitis (hot to cold)
Chronic sinusitis

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90
Q

What etiology of chronic cough usually presents w/ more severe S/Sxs?

What part of the PE findings are irrelevant for this issue

A

Sinusitis

Color of sputum

91
Q

When are ABX given to a chronic cough?

What meds are given to chronic cough (PND) PTs?

A

PND w/ proven sinusitis on imaging, can be clinically silent

Intranasal CCS
PO Montelukasts Antihistamines Decongestants

92
Q

What is the second most common cause of chronic cough?

What is the work up process for chronic cough due to asthma?

A

Asthma- cough variant asthma- wheeze, tight chest, exertional dyspnea

Methacholine/Histamine challenge w/ response
Spirometry shows reversible obstruction

93
Q

What meds are used for Chronic Cough from asthma?

What meds are given to PTs w/ Chronic Cough due to GERD?

What is the last resort/last Tx option for Chronic Cough due to GERD?

A

ICS w/ SABA
PO montelukast if ICS isn’t available

PPIs- Ome/Lansoprazle
Should improve in 3mon

Nissen Fundoplication

94
Q

What will be seen on PE/CXR of chronic bronchitis

What imaging is used if CXR is not Dx?

A

Base crackles
Tracks/Rings in dilated mucus filled bronchi

CT- TOC

95
Q

What is the imaging definition of Bronchiectasis?

What meds are used for this Dz?

A

Bronchus larger than adjacent pulmonary artery and bronchi visible w/in 1cm of pleura

ABX for exacerbation
Respiratory physical therapy
Inhaled bronchodilators
NO antitussives

96
Q

What are the most common sites CF mucus plugs up and blocks?

CF lung issues will cause what sound to be audible on PE?

A

Exocrine ducts leading to inflammation: Lung, Pancreas, Testes

Crackles at apex

97
Q

What will be seen on ABGs of a CF PT?

What will be seen on a PFT?

A

Hypoxemia
Compensated resp acidosis in advanced Dz

Obstructive > Restrictive
Dec FVC, FEV1, TLC, DLCO
Inc RV:TLC

98
Q

What is the name of the sweat test needed to Dx CF?

What med can be used for these PTs?

A

Pilocarpine Ionotophoresis
2 tests on different days

rhDNAse- dec sputum viscosity and improves FEV1
Inhaled hypertonic saline
SABA

99
Q

What is the only definitive Tx of CF

What med is given to CF PTs due to the gene mutation?

A

Lung transplant- 3yr survival rate 55%

Ivacaftor

100
Q

What vaccines can CF PTs get?

Bronchiolitis is a generic term for ?

A

Pneumococcal
Influenza

Inflammation of bronchioles <2mm, usually RSV in Peds

101
Q

What is a constrictive type of bronchiolitis seen in adults?

What type os exposure hx makes PT susceptible to Bronchiolitis

A

Bronchiolitis Obliterans

Ammonia/Diacetyl- obliterans
Viral
Organ transplant- obliterans, proliferative
CT d/o- follicular type (RA, Sjogren)

102
Q

How does bronchiolitis present?

What would be seen on a PFT?

A

Insidious onset w/ Tachy, Crackles, Wheezing

Irreversible obstructive

103
Q

What is a better imaging modality for bronchiolitis and what is seen?

How is it definitively Dx?

A

Chest CT, trapped air similar to asthma

Lung biopsy

104
Q

How is bronchiolitis Tx?

Epiglottitis forms a boundary wall of ?

A

PO CCS for proliferative
Inhaled dilators
Cough suppressant
O2 to maintain SPO2 >88

Back wall of vallecular space below base of tongue

105
Q

What labs are ordered for epiglottitis?

What ABX are used for epiglottitis?

A

CBC w/ Diff
Blood culture
Intubated PT- epiglottis culture

3rd Gen (Ceftriax/Cefotax) and Vanc

106
Q

What is the common triad of FBA?

How do Sxs change by location of obstruction?

A

Wheeze, Cough, Diminished breath sounds

Laryngotracheal: uncommon, most life threatening: stridor, wheeze, dyspnea

Large Bronchi: cough, wheeze

Lower Airway: little distress after initial choking episode

107
Q

How are objects stuck in throats recommended to be removed?

What is the next step for suspected aspirations if there is a mod/high or low suspicion?

A

<1yr= back blows, chest compression
Heimlich, Intubate, O2

Mod/High: PE, Chest/Neck xray, rigid bronchoscopy
Low: PE w/ normal x-rays

108
Q

What is the 4th leading cause of death in the US?

What is the two of effects smoking causes in airways?

A

COPD + Asthma

Hypertrophy/proliferated mucus glands
Cilia paralysis

109
Q

What part of the airway is most effected by smoking?

What are the effects of smoking on the lung parenchyma?

A

Bronchioles

Destruction of CT in alveolar walls

110
Q

Smoking on the airways lead to ? while effects on parenchyma lead to ?

What is the protector of the lungs that prevent enzymes of inflammatory cells?

A

Airway: bronchitis
Parenchyma: emphysema

a1-antitrypsin- lack of this allows elastin degredation

111
Q

When does a1-antitrypsin deficiency COPD develop?

What PTs are screened for this deficiency?

A

30-40yrs

All w/ FamHx of COPD

112
Q

Chronic bronchitis as a sole Dx indicated ?

What are the two types of emphysema?

A

Mild COPD

Panacinar: involvement of acinus, mostly in lower lung and most common in AAT deficiency

Centrilobular: proximal acinus/bronchiole; irregular destruction sparing areas
MC in smokers

113
Q

What is considered a high PaCO2 measurement?

What is the issue in the lungs during emphysema?

What is the Triad of presenting Sxs for the first decade?

A

> 40

Stretched, less recoil and loss of exhalation drive

SoB, inc cough, sputum

114
Q

What are late S/Sxs of COPD

What is the hallmark of this Dz?

A

Pneumonia
PHTN
Cor Pulmonale
Chronic resp failure

Periodic exacerbation precipitated by infection or environmental cause

115
Q

What two microbes are most likely to cause pneumonia in COPD PTs?

What is the common cause of death in COPD PTs?

A

Strep Pneumo
Moraxella Catt.

Mulitple/yearly lung infections

116
Q

What is the chief complaint of PTs w/ emphysema?

What Sx is rare in these PTs?

A

Dyspnea

No cough, barely any sputum due to destroyed cilia

117
Q

What PFT results will be seen in early, mid and late staged COPD?

A

Early: FEV 25-75%
Mid: dec FEV1 and ratio
Late: dec FVC, inc TLC (especially in emphysema)

118
Q

What lung dz is DLCO low?

What are the 4 GOLD guidelines?

A

Emphysema

1 Mild: FEV +80%
2 Mod: 50-79%
3 Sev: 30-49%
4 Very Sev: <30%

119
Q

Although rarely obtained, what results would be expected from an ABG draw in a COPD PT?

What work up studies are done?

A

Compensated Resp Acid

Sputum analysis/culture

120
Q

What 3 arrhythmias could be seen on EKG in a COPD PT?

Why is a CXR ordered if it’s not diagnostic?

A

MAT- never shock
A-Fib/Flutter

R/o alternatives or comorbidities

121
Q

What are the expected CXR results for chronic bronchitis and emphysema?

What would be the benefit of ordering a CT for COPD work up?

A

CB: cardiomegaly
E: small cardiac silhouette

Extent of damage for TPs considered for lobectomy

122
Q

What does it mean if COPD PT has clubbing?

What is the single most important intervention in COPD PTs?

A

CA
Normally seen in bronchiectasis w/ pneumonia and hemoptysis

Smoking cessation w/ Buproprion or Carenicline

123
Q

When is O2 given to COPD PTs?

What is the only therapy w/ evidence of improving COPD progression?

A

Resting hypoxemia <90%

O2 via cannula x 15hrs/day @ 1-3L/min
No mortality benefit

124
Q

COPD PTs that start therapeutic O2 see an improvement in ? Sxs?

A 
PHTN
Impaired cognitive funtion
Erythrocytosis
Cor Pulmonale
Morning MA
125
Q

Short acting dilators:
Ipratropium

Albuteral, metaproterenol

A

Preferred for longer duration and fewer s/e w/ daily use

SABAs
Rapid onset w/ more s/e
Combined w/ Ipratropium

126
Q

Long acting dilators:
Tiotropium

Formoterol, Salmeterol

A

LAMA
More expensive but fewer exacerbations
Improved Sxs, no mortality benefit

LABA
Combined w/ ICS
Monotherapy has no mortality risk

127
Q

CCS:
ICS

PD4 Inhibitors
Roflumilast

A

Mod/Sev COPD but no mortality benefit
LABA + ICS= fewer exacerbations, improved status, fewer admits

Dec inflammation and promotes dilation

128
Q

What drug combo is given for acute COPD exacerbation?

Giving ABX to these PTs is most beneficial when ? 2 of 3 are present?

A

10-14 day PO steroids

Inc sputum (purulence/quantity)
Dyspnea
129
Q

ABX for COPD PTs is considered in what 4 circumstances?

A

> 65y/o
FEV1 <50%
3+ exacerbations/yr
Comorbidities present

130
Q

What ABX are even options for COPD?

Which ones are usually used on outpatient basis?

A 
TAD CAC
Docy
TMP/SMT
Cefpodoxime
Azithromycin
Cipro/Levo
Amox/Clavulonic

Doxy/Azith

131
Q

What is the DOC for HIV Pts w/ Pneumonia Jerivici

What is a SABA/ABX combo that can be used for COPD

A

TMP/SMT

Albuterol + Ipratropium

132
Q

What 3 drugs are not given for COPD exacerbation?

O2 therapy for 24hrs per day is recommended when PTs have resting hypoxemia which is ?

A

Suppressants
Expectorants
Mucolytics

<88%
PaO2 <56mmHg

133
Q

When are COPD PTs admitted?

A 
Severe/worsening Sxs despite Tx
Acute/worsening hypoxemia, hypercapnia, peripheral edema, change in mental status
Poor home care
Inability to sleep
Inability to hydrate/nutrition
High risk comorbid condition
134
Q

How are COPD PTs managed on an inpatient status?

A 
O2 @ 90-94%
Iprotropium  + SABA
CCS
Broad ABX
Chest physiotherapy
135
Q

How are COPD Pts w/ Cor Pulmonale managed inpatient?

A 
O2
Bed rest
Acidemia correction
Na/Fluid restriciton
Diuretics
136
Q

65y/o male w/ PCO2 at 60 and breathing at 35 resp/min. What is the only way to correct the PCO2 and fix the respiratory acidosis?

What is the BODE index?

A

Intubate and Ventilate
Only option for high PCO2 (>50)

BMI- lower is worse
Obstruction: FEV1 after dilator
Dyspnea: based on exertion
Exercise: based on 6min walk

137
Q

When are COPD PTs referred?

A

Any PT under 40y/o
>2 exacerbation/year on max therapy (LABA+ long anticholinergic +ICS)
Severe/rapid progression
Disproportionate Sxs
Long term O2 therapy
Onset of comorbidity (CHF, Bronchiectasis, CA)

138
Q

What vaccine follows Prevnar 13/when is the next one given?

PT w/ COPD exacerbation and multiple comorbidities is started on ? ABX?

A

PPSV23 one year later

Levofloxocin

139
Q

To a certain extent, all asthmatics have what five pathophysiological issues?

A 
Edema, infiltrates in bronchial walls
Epithelial damage
Hypertrophy/plasia of smooth muscles
Inc collagen beneath epithelium
Hypertrophy of glands and goblet cells
140
Q

Why do asthmatics have airway remodeling?

What is the name of the asthma precipitant that occurs during a menstrual cycle?

A

GF induced tissue changes

Catamenial

141
Q

What is the sequence of events of allergen exposure induced asthma?

What drugs are used to stop the two end products?

A

Allergen IgE Mast cells Mediators Constriction/Permeability

Constriction= B agonist
Inflammation= inhaled CCS
142
Q

What are the four common precipitants to asthma?

Why can asthma PTs be sensitive to ASA?

A

Allergen exposure
Inhaled irritant- smoking
RTI- viral are most common
Exercise- loss of heat/moisture= rapid cooling

Leukotriene production from arachidonic acid

143
Q

What causes the obstruction of asthma?

What would be an ominous late finding of an asthma attack?

A

Bronchoconstriction

Rising PCO2

144
Q

What are the 3 red flag questions of an asthma attack?

Abnormal coughing during what part of the day is indicative of asthma?

A

Ever been hospitalized, intubated, or on PO steroids?

Night

145
Q

What sound is hear on PE of asthma and what makes it worse?

What finding is bad?

A

Wheeze, inc w/ expiration

No wheeze= dec airflow

146
Q

What four findings are indicative an asthma PT is having a severe attack?

What finding can they develop?

A

No wheezing
Hunched shoulders
Accessory muscle use
Unable to be recumbent

Pulsus paradoxus

147
Q

What are S/Sxs of an impending arrest of an asthma PT?

A 
Drowsy/confused
Paradoxical abdomen motion
No wheeze
Bradycardia
Absent Pulsus Paradoxus (often in sev cases)
148
Q

What would be seen on ABG in a mild, severe or impending asthma failure attack?

What will be seen on PFT in asthma?

A

Mild: alkalosis
Sev: hypoxemia
Impending: acidosis

PEFR, FEV1, Max mid-expiration all decreased

149
Q

What is a severe asthma FEV1 level

What test is done if asthma is suspected and spirometry is nondiagnostic?

A

<50%
Mod: 50-70
Mild: +70%

Bronchial provocation test: Inhaled histamine or Methacholine challenge
+= FEV dec >20%

150
Q

What is the difference between neg/pos Bronchial provocation test?

When is peak expiratory flow highest and lowest?

A

Pos is not pos for asthma
Neg is neg for asthma

Low: upon waking
High: hrs before mid-day

151
Q

What would be seen on CXR of asthma?

Chart on Slide42

A

Normal or hyperinflated

Of Asthma lecture

152
Q

Asthma PTs can step down their Tx if they’re stable for ?

What drug class is a preferred 1st line therapy for persistent asthma?

A

3mon

Inhaled CCS

153
Q

What can be added to PTs taking inhaled CCS or what needs to be monitored?

What are the long acting dilator B-agonists?

A

Ca, Vit D
DEXA

Salmeterol
Formoterol
Tiotropium
Theophylline

154
Q

What mediator inhibitors are used for asthma?

When is Tiotropium added to asthma Tx?

A

Cromolyn, Nedocromil
Mild persistent/exercise induced prior to exposure

Uncontrolled asthma while on ICS and LABA, usually in COPD

155
Q

When is Theophylline added on to asthma Tx?

What asthma med needs to have LFT monitoring?

A

Persistent nocturnal Sxs

Leukotrienes

156
Q

What is the MOA of Omalizumab for asthma?

What is done for mild asthma exacerbation?

A

Recombinent Ab that binds to IgE w/o activating mast cells

> 80% peak flow w/ full response to SABA
If not on ICS, start
If on ICS, give 7 day PO steroid dose (don’t double dose)

157
Q

What is done for moderate asthma exacerbation

A 
O2 for hypoxemia
Continuous SABA 
Systemic CCS
Serial PFTs
PT education
158
Q

What is done for severe asthma exacerbation?

A

SpO2 >90% (asphyxia is common cause of death)
Systemic CCS
Continuous high dose SABA
Avoid anxiolytics, hyponitcs and mucolytics

159
Q

How are asthma exacerbations managed in the ER?

What type of recovery findings are the only ones for discharging a PT?

A

Repeat assessments after Initial bronchodilator and
after 3 doses of inhaler

FEV >70%
Sustained for 60min
No distress
Normal exam

160
Q

When do asthma PTs need to be referred?

A 
Atypical presentation
Complicated comorbidity
Suboptimal response
High dose ICS
2+ systemic steroids in 12mon
Any life threatening hospitalization in 12mon
Social/psych d/o
161
Q

What ABX can be used for epiglottitis, is safe on Peds kidneys and safe in pregnancy?

What are cold agglutants?

A

Ceftriaxone, Vancomycin

IgM Abs indicating where a Dz is in process, Mycoplasma

162
Q

What microbe is most common in PTs w/ aspiration/poor dentition related pneumonia?

What microbe predominates infections of PTs that have traveled to SW US?

A

Staph

C. Imitis

163
Q

What are the two major and one minor pathways for pneumonia?

MC cause of bacterial pneumonia?

A

Major: inhalation, aspiration
Minor: blood borne

Strep Pneumo- 2/3 of all CAP cases

164
Q

When is Staph A pneumonia common?

What microbe is most likely to cause pneumonia in PTs in a nosocomial/recent ABX population?

A

After influenza through hematogenous spread

Pseudomonas

165
Q

What is the most deadly infectious Dz in the US?

What are the RFs for CAP in order?

A

CAP

Inc age
ETOH
Tobacco

166
Q

What pathological process allows a CAP infection to grow?

What 3 tests can be used to differentiate the microbes of CAP?

A

Normal defenses prevent lower respiration infections:
Cough reflex
Immunity
Mucociliary clearance

PCR, UA, Agglutinin

167
Q

How do atypical microbe CAP appear differently than typical?

What is usually the microbe and what drug classes are used for T?

A

Gradual onset of dry cough, HA, malaise, N/V, low fever

Mycoplasma
Macrolide, Doxy

168
Q

What does a CXR of a PT w/ atypical pneumonia show?

How is CAP Dx?

A

Worse than PT appearance

Culture

169
Q

What microbe causes cavitation seen on CXR?

A

Staph

TB if in apex

170
Q

Viral pneumonia is usually seen as ? on CXR

What education piece needs to go w/ CAP Tx?

A

Bilateral

Clearing CXR takes longer, f/u imaging not needed if clinical response is present
Re-image if high risk to r/o malignancy (Smokers >40, Geriatrics >65)

171
Q

What is Procalcitonin’s response to a bacterial or viral CAP infection?

What two microbes can be detected through urine antigen testing?

A

Bacteria: released
Viral: inhibited

Legionella
Strep Pneumo

172
Q

Since Macrolide(A/C)/Doxy are used for CAP outpatient Tx, what are used if PT has used ABX in past 90 days, is >65, ImmSupp or has child daycare exposure?

What ABX are used for CAP outpatient in areas w/ high macrolide resistance?

A

Respiratory Fluoroquinolone
Macrolide + B-Lactam (Amox/Clavu)

Same as above

173
Q

What two ABX are used for atypical pneumo Tx?

What two ABX can be used for CAP in an admitted PT?

A

Azithromycin
Doxy

Ceftriaxone and Macrolide (A/C) or,
Quinolone (Levo, Moxi, Gatifloxacin)

174
Q

If influenza is complicated by a secondary bacteria pneumo infection, what ABX are used?

What anti-pseudomonas B-Lactam is used for inpatient CAP PTs?

A

Oseltamivir and
Ceftriax/Ceftaroline and
Vanc/Ilnezolid

Piper/Tazo, Cefepime

175
Q

CAP outpt microbes

CAP hospitalized microbes

ICU admitted microbes

Nosocomial pneumonia microbe

A

Strep Pneumo
Mycoplasma
Chlamydia

Strep Pneumo
Mycoplasma
Chlamydia

Strep Penumo
H influena
Legionella

Staph A
Pseudomonas
Gran Neg rods: Enterobacter, Klebsiella, E Coli

176
Q

How are ICU PTs w/ CAP Tx?

What is the CURB-65 criteria

A

Respiratory fluoroquinolone or Azithromycin and
Cefota/Ceftria/Amp (anti-pseudomonal B-lactams)

Confused
Urea >20mg
Resp Rate 30 or higher
BP systloic <90, 60 or less D
65 or older
0-1: low
2: mod, consider admit
3: high, admit
4-5: ICU admit
177
Q

Define HAP

Define HCAP

Define VAP

A

> 48hrs after admit w/out infection at admit

Non-hopitalized PT w/ extensive healthcare contact

> 48hr after intubation development

178
Q

What meds are used as a prophylactic for admitted PTs to prevent nosocomial pneumonia

What would be S/Sxs of nosocomial pneumonia?

A

PPI, H2 blocker, Antacid

Fever, Leukocytosis, Purulent sputum
Opacity on imaging

179
Q

What labs are drawn on PTs w/ nosocomial pneumonia

A 
Blood culture
CBC w/ diff
CMP
ABG
Thoracentesis (Staph)
180
Q

What may be seen on imaging in PTs w/ anaerobic pneumonia?

How are these PTs Tx?

A

Abscess: + air/fluid level
Necrotizing pneumonia- +air/fluid level
Empyema- do not have air/fluid level

Amxo/Clavu
Amox or PCN and Metron
No more Clindamycin

181
Q

What microbe causes lung abscesses and empyemas?

Outpt pneumo Tx

Inpatient pneumo Tx w/ DM

A

Staph

Macrolide/Doxy

Resp Fluoroquinolone

182
Q

What is the 2nd most common infectious cause of death in adults?

How is TB spread

A

TB (1st was CAP)

Droplet, ingest by macrophage in alveoli

183
Q

What does primary TB develop

What is the only S/Sx seen in PTs w/ latent TB?

A

Infection escapes alveoli, lymph/hematogenous spread, contained by granulomas-> latent
No containment= Progressive TB

Crackles in apex
+ PPD

184
Q

What is different about Miliary TB compared to Primary/Latent

What are the constitutional Sxs of an active TB dz?

A

Miliary= hematogenous spread and is primary progressive or reactivated

Malaise, Anorexia, Weight loss, Fever, Night sweats

185
Q

What is the MC Sxs of TB and what is a rare Sx?

Primary TB is usually ? and ? silent

A

Chronic cough, progression from dry to purulent w/ blood
Rarely: dyspnea

Clinically, Radiograph

186
Q

How is TB ID’d w/ labs?

A

3 sputum specimens Q8hrs induced w/ hypertonic saline for Acid Fast Bacilli

Blood culture: rarely + unless CD4 is low

Pleura biopsy: 50% chance of + test

187
Q

When is imaging of TB recommended?

What is seen on CXR of Primary, Reactivated and Miliary TB?

A

+ PPD
+ clinical Sxs

Primary: hilar adenopathy, atelectasis, pleural effusion, granuloma/Ghon complex

Reactive: Cavitation in posterior upper lobe/superior lower lobe

Milliary: small opaque nodules across chest

188
Q

Reactivated TB in lower lobes may be confused as ?

PTs that received a BCG vaccine are protected from ? but not ?

A

CA, Pneumonia

Protected: TB meningitis, Disseminated TB
Not: Primary, Latent

189
Q

What is the Gold Standard for testing for TB?

A

Quantiferon Gold/T-spot- blood test measuring reaction w/ M Tuberculosis Ag

190
Q

What test is ordered to confirm a TB Dx if TST is pos but there’s a low likelihood of TB infection?

What test is ordered in place of, not in addition to, a TST?

A

Quantiferon Gold

Interferon Gamma Release Assay

191
Q

S/e, monitoring and comments on INH

A

Peripheral neuropathy, Hepatitis, Rash

AST/ALT, Neuro

Pyridoxine as prophylaxis

192
Q

S/e, monitoring and comments on Rifampin

A

Hepatitis, Fever, GI, Bleeding, Renal failure

CBC, PLT, AST/ALT

Fluids turn orange

193
Q

S/e, monitoring and comments on Pyrazinamide

A

Hyper uricemia, Hepatotoxic

Uric acid, AST/ALT
-cidal to intracellular organisms

194
Q

S/e, monitoring and comments on Ethambutol

A

Optic neuritis, rash

Red/green discrimination

-static, inhibits resistance

195
Q

S/e, monitoring and comments on Streptomycin

A

CN8 damage, nephrotoxicity

Audiogram, BUN/Creatinine

196
Q

What baseline labs are ordered when starting TB Tx?

What is done each month as monitoring?

A

CBC, CMP, Visual acuity, Audiogram, Serum uric acid, HcG

Sputum culture until negative

197
Q

What med combo is used for latent TB Tx?

How is RSV Dx?

A

INH w/ pyridoxine x 9mon

Nasal wash for PCR
Nasopharyngeal/throat swab

198
Q

How is Pertussis Dx?

A

Culture and PCR

If more than 4wks, serology

199
Q

Exposure to Pertussis can get prophylaxis when?

What causes Croup?

A

Within 21 days of onset of cough

Parainfluenza Type 1

200
Q

Mild, Mod and Sev Croup Txs

A

Mild: no stridor at rest, no respiratory distress= Dexameth or non-pharm Tx

Mod: Stridor at rest, retractions

Sev: stridor at rest w/ marked retractions and distress
Mod/Sev= Nebulized Epi and Dexameth

201
Q

How much of an PFT improvement needs to be seen for the Dx of asthma to be given?

What is heard on PE of pneumonia?

A

12%, 200mL

Crackles
Bronchial breath sound
Dull percussion
Egophony= lobar effusion

202
Q

PHTN work up can include ? test

What type of CA causes hypercalcemia?

A

TTE

Squamous cell lung carcinoma

203
Q

What microbe is most likely to cause lobar pneumonia?

What is the most important drug agent for mod-persistant asthma?

A

Strep Pneumo- encapsulated, Gram Pos, Tx w/ Azith/Doxy

Inhaled fluticansone

204
Q

PTs w/ mod/sev asthma must be on ? drug?

Fungal causes of epiglottitis

Viral causes

A

Inhaled CCS

Candidia

PHIVE
Parainflu HSV Influ VZoster EBV

205
Q

What type of non-cell CA is the most common worldwide and leading cause of CA death?

What is the most common risk factor for this type of CA?

A

Bronchiogenic carcionoma

Smoking

206
Q

Non-small cell CA includes ? 4 types?

What CA are central?

A

SLAB
Squamous Large Adeno Bronchoalveolar/Adeno in situ

Small cell carcinoma
Squamous cell
Large Cell

207
Q

Small Cell Carcinoma

A

Central
Hilar/Mediastinal on imaging
Associated w/ SIAD, Paraneoplastic Syndrome
Early hematogenous spread, common, poor prognosis

208
Q

Adenocarcinoma

A

Peripheral in women/non-smoker
Grows from mucus gland
MC Primary Lung CA

209
Q

Squamous Cell CA

A

Central from bronchial epithelium- 2/3 bronchus
More likely to show w/ hemoptysis
Dx w/ Sputum Cytology
Local spread
Hilar adenopathy and widened mediastinum, caviation

210
Q

Large Cell CA

A 
Hetergenous of undifferentiated
Central or Peripheral (MC)
Rapid double time
Cavitary lesion w/ air/fluid level
Rarer than Adenocarcinoma
211
Q

What type of CA is a slow spreader?

CA in liver equates to ? BUN

A

Non-Small Cell CA

Low or none

212
Q

Pancoast tumor

A 
Superior sulcus of lung apex
Shoulder*/arm pain following ulnar C8/T1 
Horner's
Weak/atrophy hand
Progression to SVC Syndrome if on R side
213
Q

What type of CA can cause SIADH

What type can cause HyperCA?

A

SIADH w/ Small Cell- water retention, HypoNA, concentrated urine

HyperCA w/ Squamous

214
Q

? form of pneumonia will trigger a positive Cold Agglutin Test?

What causes exercise induced asthma?

A

Mycoplasma- Tx w/ Azith

Bronchospasm

215
Q

What version of paraneoplastic syndrome is seen in Myasthenia Gravis PTs?
How is Myasthenia Gravis Dx?

A

Thymoma

Acetylcholine receptor AB test

216
Q

All suspected lung CA PTs get w/ Labs

How are each types of tumors Dx

A

CBC CMP

FNA if palpable (cervicle/supraclavicular)
Bronchoscopy biopsy if central
Transthoracic aspiration for peripheral

217
Q

When is surgery the TOC for CA?

Prior to surgery all PTs have ? test

A

Early non-small cell Stages 1 and 2

PFTs

218
Q

When is Chemo/Radiation the TOC for CA

Difference between node and mass?

A

Small cell CA
Adv non-small stage 3-4

Nodule= <3cm
Mass= >3cm
219
Q

Most common cause of benign solitary pulmonary nodules?

Most common cause of malignant nodules?

A

Infectious granulomas

Adenocarcinoma

220
Q

What is the most common type of benign tumor?

Hemoptysis + CKDz= ?

A

Hamartomas

Granulomatosis w/ polyangitis (Wegners)

221
Q

Features of a nodule making the likelihood of malignancy greater

A 
<30y/o
Smokers
CAHx
Larger size at discovery
Eccentric calcification
Spiculated
Corona Radiata margin
222
Q

Features of a nodule making it more likely to be benign

A 
<30y/o
Smooth/defined borders
Dense central/diffuse calcification
Small and stable on repeat image
<8mm
223
Q

4 buzz words for benign patterns

2 buzz words for malignant patterns

A

Dense Laminated Popcorn Diffuse

Stippled Ecentric

224
Q

What is the image TOC for monitoring nodules?

What is the f/u schedule for nodule size for low/high risk PTs

A

Chest CT

4mm or less- none/CT Q12mon
>4-6mm- CT Q12mon/CT Q 6-12 and 18-24mon
>6-8mm: CT Q6-12mon/CT Q3-6mon, 9-12 and 24mon

IPAP (212 decks)

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