Pulm/crit Flashcards
Which type of lung cancer causes SIADH? Which causes Hypercalcemia
SIADH = small cell carcinoma Hypercalcemia/parathyroid like hormone production = squamous cell carcinoma
Radiological descriptions of benign lung nodules
Popcorn calcifications, concentric calcifications, laminated calcifications, central or diffuse homogeneous calcifications
Radiological descriptions of malignant pulmonary nodules
Eccentric or asymmetric calcifications, reticular calcifications or punctuate calcifications, size> 2cm, usually located in the upper lobe, spiculated/ragged edges
Which has a normal diffusing capacity for carbon monoxide(DLco)? Asthma, COPD, restrictive, fibrotic lung disease or extra thoracic restriction?
Asthma has a normal diffusing capacity of carbon monoxide because the alveoli are unaffected. By contrast COPD and restrictive/fibrotic lung diseases will have a decreased DLCO because of alveoli or destroyed and unable for gas exchange.
Asthma, COPD, fibrotic/restrictive lung disease FEV1/FVC? TLC? DLCO?
*Asthma: normal or increased TLC and DLCO, normal or decreased FEV1/FVC * COPD: decreased FEV1/FVC, increased TLC, decreased DLCO * restrictive/fibrotic lung disease: normal or increased FEV1/FVC, decreased TLC, decreased DLCO * extra thoracic long restriction: normal FEV1/FVC, decreased TLC, normal DLCO
What are the three most common cause of chronic cough?
Postnasal drip, GERD, asthma
What pulmonary function test are needed to make a definitive diagnosis of asthma?
An increase of 12% in FEV1 and or FVC with bronchodilators. *FEV1/FVC <0.7
For an acute asthma exacerbation what else can use besides beta agonist and inhaled corticosteroids? Dosage?
2 g of magnesium over 20 minutes IV. Magnesium has a bronchodilator affect however is of no use in COPD. *only indicated if <40% PEF despite >1hr of intestive tx with inhaled SABA & steroids
What pulmonary function testing is needed to diagnose CO PD?
Post bronchodilator FEV1/FVC is less than 0.7 and FEV1 is less than 80% of predictive value, TLC is usually increased
Lights criteria for exudative fluid
exudative fluid if:
- plural fluid protein/serum protein ratio >0.5
- plural fluid LDH/serum LDH ratio > 0.6
- plural fluid LDH level is greater than 2/3 the upper limit of the laboratories reference range.
Features of sarcoidosis
GRUELING-CC Granulomas, rheumatoid arthritis, uveitis, erythema do some, lymphadenitis, interstitial fibrosis, negative PPD, gamma globe anemia, increase calcium, cardiac problems
Guidelines for follow-up of pulmonary nodules
*Less than 6 mm: follow up CT and 12 months *6-8 mm follow up CT 6 to 12 months and again at 18 to 24 months * greater than 8 mm cereal CT/pet scan or excision based on radiographic characteristics
40 yo M s/p 6 units PRBC & 4 units FFP. Now has anxiety, perioral tingling and numbness for the last 2 hrs, muscle spasms of the hands and legs. CBC, CMP normal, vitals normal. dx? tx?
Acute Hypocalcemia due to chelation of Ca after blood(citrate) transfusion(can also chelate w/EDTA & Foscarnet). tx with IV Ca-gluconate/Chloride
CURB65 scoring
Confusion, urea >30, RR>30, BP<90/60 or age 65+ (each is 1 pt) 0 = outpatient treatment 1-2= inpatient treatment 3-4= urgent inpatient w/possible ICU
When is thoracentesis indicated?
>10 mm thickness on lateral decubitus
Lights criteria for transudative and exudative fluids
Transudative: 1. pleural fluid protein/serum protein <0.5 2. Pleural fluid LDH/serum LDH <0.6 3. Pleural fluid LDH <2/3 upper limit of labs normal Exudative: 1. pleural fluid protein/serum protein >0.5 2. Pleural fluid LDH/serum LDH >0.6 3. Pleural fluid LDH >2/3 upper limit of labs normal
When is oxygen therapy indicated?
SaO2 <88%, PaO2<55 or PaO2 <60 w/ HF or erythrocytosis
What size long natural is the cut off for requiring pet scan?
8mm+ >6mm f/u CT 1yr 6-8 f/u CT 6m -12m
Cystic fibrosis Inheritance, gene, sx ?
AR mut in CFTR gene lead to abnormal transfer sodium and chloride. Sx: recurrent pulmonary infections, sinusitis or bronchiectasis, infants may present with meconium ileus or interception. Pancreatic insufficiency most often presents with steatorrhea and poor weight gain along with decrease absorption of fat soluble vitamins. Adult men may present with infertility. Nasal polyps
Treatment of cystic fibrosis?
Bronchodilators and mucolytics. Supplementation of pancreatic enzymes and fat soluble vitamins along with stool softeners. Consider prophylactic anabiotic‘s with azithromycin or Tobramycin
Occupational lung disease associated with those who work in coal mines
Coal workers pneumoconiosis
Occupational long disease associated with those who work in shipyards, roofing and plumbing
Asbestosis
Occupational long disease associated with those who work in sandblasting or mining
Silicosis
Occupational long disease associated with those who work in aerospace or nuclear industry
Berylliosis