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Step 3 UW /FA > Pulm/crit > Flashcards

Pulm/crit Flashcards

1
Q

Which type of lung cancer causes SIADH? Which causes Hypercalcemia

A

SIADH = small cell carcinoma Hypercalcemia/parathyroid like hormone production = squamous cell carcinoma

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2
Q

Radiological descriptions of benign lung nodules

A

Popcorn calcifications, concentric calcifications, laminated calcifications, central or diffuse homogeneous calcifications

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3
Q

Radiological descriptions of malignant pulmonary nodules

A

Eccentric or asymmetric calcifications, reticular calcifications or punctuate calcifications, size> 2cm, usually located in the upper lobe, spiculated/ragged edges

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4
Q

Which has a normal diffusing capacity for carbon monoxide(DLco)? Asthma, COPD, restrictive, fibrotic lung disease or extra thoracic restriction?

A

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.

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5
Q

Asthma, COPD, fibrotic/restrictive lung disease FEV1/FVC? TLC? DLCO?

A

*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

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6
Q

What are the three most common cause of chronic cough?

A

Postnasal drip, GERD, asthma

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7
Q

What pulmonary function test are needed to make a definitive diagnosis of asthma?

A

An increase of 12% in FEV1 and or FVC with bronchodilators. *FEV1/FVC <0.7

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8
Q

For an acute asthma exacerbation what else can use besides beta agonist and inhaled corticosteroids? Dosage?

A

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

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9
Q

What pulmonary function testing is needed to diagnose CO PD?

A

Post bronchodilator FEV1/FVC is less than 0.7 and FEV1 is less than 80% of predictive value, TLC is usually increased

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10
Q

Lights criteria for exudative fluid

A

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.
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11
Q

Features of sarcoidosis

A

GRUELING-CC Granulomas, rheumatoid arthritis, uveitis, erythema do some, lymphadenitis, interstitial fibrosis, negative PPD, gamma globe anemia, increase calcium, cardiac problems

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12
Q

Guidelines for follow-up of pulmonary nodules

A

*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

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13
Q

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?

A

Acute Hypocalcemia due to chelation of Ca after blood(citrate) transfusion(can also chelate w/EDTA & Foscarnet). tx with IV Ca-gluconate/Chloride

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14
Q

CURB65 scoring

A

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

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15
Q

When is thoracentesis indicated?

A

>10 mm thickness on lateral decubitus

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16
Q

Lights criteria for transudative and exudative fluids

A

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

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17
Q

When is oxygen therapy indicated?

A

SaO2 <88%, PaO2<55 or PaO2 <60 w/ HF or erythrocytosis

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18
Q

What size long natural is the cut off for requiring pet scan?

A

8mm+ >6mm f/u CT 1yr 6-8 f/u CT 6m -12m

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19
Q

Cystic fibrosis Inheritance, gene, sx ?

A

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

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20
Q

Treatment of cystic fibrosis?

A

Bronchodilators and mucolytics. Supplementation of pancreatic enzymes and fat soluble vitamins along with stool softeners. Consider prophylactic anabiotic‘s with azithromycin or Tobramycin

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21
Q

Occupational lung disease associated with those who work in coal mines

A

Coal workers pneumoconiosis

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22
Q

Occupational long disease associated with those who work in shipyards, roofing and plumbing

A

Asbestosis

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23
Q

Occupational long disease associated with those who work in sandblasting or mining

A

Silicosis

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24
Q

Occupational long disease associated with those who work in aerospace or nuclear industry

A

Berylliosis

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25
Q

CF inheritance? mutation?

A

AR mut in CFTR gene

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26
Q

MC initial presentation of CF?

A

meconium ileus

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27
Q

Sx of CF

A

meconium ileus, FTT, Rectal Prolapse, Persistent cough, infertility(absent vas def), allergic bronchopulmonary aspergillosis, persistant cough, pancreatitis n shit like DM, hernia, amenorrhea, delayed puberty, RVH, portal HTN

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28
Q

Ivacaftor(VX-770)

A

first drug approved to tx CF = restores some function to the CF protein

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29
Q

3 things you can do for a CF patient that will IMPROVE SURVIVAL?

A

ibuprofen to reduce inflammation, Azithromycin to slow the rate of decline of FEV, abx during exacerbations

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30
Q

drugs that can worsen asthma?

A

ASA, NSAIDS, BB

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31
Q

+methacholine challenge test

A

>20% decrease in FEV1 after methacholine = dx of asthm

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32
Q

FEV, FVC, FEV/FVC, TLC & RV changes in asthma

A

decreased FEV(major), decreased FVC, FEV/FVC, Increased TLC & RV

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33
Q

what are the only 2 interventions that will decrease mortality and delay disease progression in COPD?

A

smoking cessation and long term home O2 use

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34
Q

when should a pt with COPD be put on home O2?

A

PO2 <55% or O2 sat is <90%

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35
Q

what type of pt would you see A1AT def in?

A

<40, nonsmoker

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36
Q

sx of A1AT def

A

COPD on CXR, Low albumin, elevated prothombin due to liver cirrhosis, low A1AT

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37
Q

tx of A1AT def?

A

infusion with A1AT

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38
Q

Bronchiectasis presentation/

A

anatomic defect resulting in profound dilation of bronchi = often due to multiple infections or CF. sx: episodes of lung infections + HIGH(cups) volume of sputum, hemoptysis and fever, Tram tracking on CXR,

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39
Q

tx of bronchiectasis

A

chest physiotherapy = cupping and clapping, rotation abx to avoid resistance

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40
Q

Allergic bronchopulomonary aspergillosis(ABPA) SX?

A

HSR to fungal antigens that colonize the bronchial tree sx: cough up brownish mucous plugs with recurrent infections, peripheral eosinophilia, elevated IgE, cough, wheezing, hemoptysis and bronchiectasis

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41
Q

tx of Allergic bronchopulomonary aspergillosis(ABPA)

A

ORAL corticosteroids + Itraconazole *cant use inhaled wont get past mucous plugs T.T

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42
Q

MCC of bronchiectasis?

A

CF

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43
Q

MCC of CAP

A

pneumococcus

44
Q

MCC of HAP

A

gram - bacilli

45
Q

when should you think pneumonia over bronchiectasis?

A

pneumo: tachycardia, tachypenia, hypotension

46
Q

Empyema + criteria

A

infected pleural effusion that acts like abscess and only improves wiht drainage. - LDH >60% of serum - Protein >50% of serum - pH <7.2, +gram stain or culture

47
Q

which has a productive cough? lobar or intersitial pneumo?

A

lobar

48
Q

name the pneumonia associated with… diarrhea, HA, confusion

A

legionella

49
Q

name the pneumonia associated with… Bacteremia

A

Strep. Pneumo

50
Q

name the pneumonia associated with… current jelly sputumm hemoptysis

A

klebsiella

51
Q

name the pneumonia associated with… rotten egg smell

A

anaerobes

52
Q

name the pneumonia associated with… dry cough, bullous myringitis

A

mycoplasma pneumo

53
Q

name the pneumonia associated with… CD4<200

A

PCP

54
Q

tx of outpatient pneumonia

A

azithromycin, or clarithromycin OR moxifloxacin

55
Q

tx of HAP

A

Vanc + pip/tazo; or ceftazidine, cefipime, TMP/SMX = point being u need pseudomonas coverage

56
Q

TX of inpatient pneumonia

A

ceftriaxone + azithromycin or moxifloxacin

57
Q

bug that causes pneumo that presents with… recent viral illness

A

staph

58
Q

bug that causes pneumo that presents with… alcoholic/DM

A

klebsiella

59
Q

bug that causes pneumo that presents with… young healthy patients

A

mycoplasma or chalymidia pneumo

60
Q

bug that causes pneumo that presents with… persons present at the birth of an animla, vets, farmers

A

coxiella burnetii

61
Q

bug that causes pneumo that presents with… arizona construction workers

A

coccidioidomycosis

62
Q

bug that causes pneumo that presents with… COPD

A

H. influenza

63
Q

bug that causes pneumo that presents with… poor dentition

A

anaerobes

64
Q

bug that causes pneumo that presents with… ppl who fucking love birds

A

chalymdia psittaci

65
Q

What is interstitial lung disease(ILD)

A

inflammation or fibrosis of interalveolar septum causing impaired gas exchange and increase in lung stiffness(restritive lung dz)

66
Q

Dz associated with…. ship yard workers, insulators and pipe fitters

A

asbestosis

67
Q

Dz associated with…. glass workers, mining, sandblasting, brickyards

A

silicosis

68
Q

Dz associated with…. coal worker

A

coal works pneumonoconiosis

69
Q

Dz associated with…. cotton

A

byssinosis

70
Q

Dz associated with…. electronics, ceramics, fluorescent lights

A

berylliosis **has granulomas!!!!

71
Q

Dz associated with…. mercury

A

pulmonary fibrosis

72
Q

drugs that can cause interstital lung dz?

A

bleomycin, busulfan, amiodarone, methylsergide, nitrofuratonin, cyclophosphamide, etc

73
Q

Classic presentation of ILD?

A

SOB with Dry nonproductive cough and chronic hypoxia PE: dry, rales, loud P2(sx of pulmonary HTN), clubbing

74
Q

Hypersensitivity Pneumonitis cause? tx?

A

fever, dyspnea, severe cough within 4-6 hr of exposure to antigen! cause: feathers, MAI, hay, compost, A/C tx: avoid + steroids

75
Q

DX of ILD?

A
  1. CXR 2. CT, PFT or Bx **need to do EKG to look for RV hypertrophy due to pulmonary HTN
76
Q

PFT in ILD? FEV, FVC, FEV/FVC, TLC, RV, DLCO

A

FEV, FVC, TLC, RV, DLCO = decrease FEV/FVC = increased

77
Q

why do an EKG for ILD?

A

looking for RV hypertrophy due to pulmonary hypertrophy

78
Q

TX of ILD?

A
  1. steroids 2. Azathioprine 3. cyclophosphamide
79
Q

whats Sarcoidosis

A

idiopathic inflammatory condition involving infiltration of non-caseating granulomas thought out the body. MC in AA women

80
Q

sx of sarcoidosis

A

Eye: uveitis(burning, itching, tearing) neural: 7th CN probs Skin: lupus pernio(purple rash of face), Erythema Nodosum(itchy, painful on legs and ankles) Cardiac: restrictive cardiomyopathy RENAL & HEPATIC: OFTEN ASYMPTOMATIC (lean more tword amyloidosis if you see this) Hypercalcemia: excess VitD from granulomas causes this Bilateral hilar lymphadenopathy, Liver & spleen enlargement,

81
Q

best initial test for sarcoidosis? most accurate test?

A

initial CXR, accurate = bx of lymph node

82
Q

tx of sarcoidosis

A

steroids ONLY IF SYMPTOMATIC = if hilar lymphadenpathy but not symptomatic leave alone

83
Q

Normal pulmonary vascular values: systolic, diastolic and MAP

A

Systolic: 25mmHg Diastolic: 8mmHg MAP: 15mmHg

84
Q

sx of pulmonary HTN

A

Loud P2, Tricuspid reguritation, RV heave, raynauds phenomenon, wide split S2

85
Q

SAAG calculations & meaning…

A

(SAAG = serum albumin - ascites albumin); SAAG = albumin concentration of serum - albumin concentration of ascitic fluid. SAAG > 1.1; Ascites is due to an imbalance between hydrostatic and oncotic pressures;(portal HTN) • Chronic liver disease. • Massive hepatic metastases. • CHF. • Portal-vein Thrombosis. SAAG < 1.1; Ascites is due to protein leakage; • Nephrotic syndrome. • Tuberculosis. • Malignancy, (e.g., ovarian cancer). • Pancreatic ascites. • Biliary ascites. • Serositis. • Bowel obstruction or infarction. • Peritoneal Carcinomatosis.

86
Q

Allergic Bronchopulmonary Aspergillosis(ABPA) sx?

A

*asthmatic pt with worsening asthma(cough, wheezing) w/brown mucous plugs(hemoptysis), peripheral eosinophila and elevated IgE and central bronchiectasis,

87
Q

Allergic Bronchopulmonary Aspergillosis(ABPA) dx?

A

aspergillus skin testing, meansing IgE, ABPA ab’s

88
Q

Allergic Bronchopulmonary Aspergillosis(ABPA) tx?

A

ORAL steroids and if refractory Itraconazole

89
Q

dx of Acute Respiratory Distress Syndrome?

A

CXR shows white out, normal wedge pressure, pO2/FiO2 <200.

90
Q

tx of ARDS

A

ventilation w/low tidal volume of <6mL/kg(reduces barotrauma), PEEP, prone, diruetics, positive inotropes(doubutamine), ICU

91
Q

TX of TB

A

4 for 2: INH, Rifamp, pyrazina, etham for 2 months THEN 2 for 4: INH + Rifampin for an additonal 4 months

92
Q

PPD + but CXR - ?

A

9m of INH

93
Q

side fx of INH

A

hepatotoxic, peripheral neuropathy = pyridoxine

94
Q

side fx of Rifampin

A

red/orange colored body fluids = benign

95
Q

side fx of pyrazinamide

A

hyperuricemia = NSAID + Colchine

96
Q

side fx of Ethambutol

A

optic neuritis = decrease dose

97
Q

how do you check someon for TB who has had the BCG vaccine?

A

INF y release assay = IGRA

98
Q

Acute Bronchitis sx?

A

*nonsmoking patient with recent URI & persistant cough + production of yellow, blood tinged sputum. SX: - >5 days w/cough yellow/bloody sputum - No fever, chill or pneumona on CXR present(lungs clear) - Wheezing or rhonchi

99
Q

Acute Bronchitis tx?

A

NSAIDs + Bronchodilators

100
Q

Why do you get yellow/purulent sputum and blood with acute bronchitis?

A

*Yellow/purulent Sputum = epithelium sloathing not infection *Blood = inflammation due to epithelial damage

101
Q

Three common causes of chronic cough?

A

GERD, Post nasal drip & Asthma

102
Q

Abx should cover for what bugs with COPD exacerbation?

A

Streptococcus, H.influenza, Moraxella

*tx for 5-7d

103
Q

Tx for loculated pleural effusion?

A

Video-assisted thorascopy(VATS) or surgical decortication +/- chest tube

104
Q

Symptoms of Pulmonary Embolism?

Tx?

A

Chest pain, SOB, syncope, Hemoptysis or low grade fevers, tachypnea, tachycardia, +/- cyanosis, S1Q3T3(S wave in lead 1 Q wave in lead 3, T wave inversion in lead 3)

TX: anticoagulate: Provoked or 1st time PE 3-6m of anticoagulation

105
Q
A

Step 3 UW /FA (19 decks)

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