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Pulmonology > Pulmo > Flashcards

Pulmo Flashcards

1
Q

2.2cm peripheral spicy later nodule with eccentric calcification - next best step?

A

Surgery

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2
Q

Features of spn- factors increasing malignant probability?

7 features

A 
Large size
Advance age
Female
Active or previous smoking
Family or personal history of lung ca 
Upper lobe location
Spiculated
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3
Q

Nodule- .8

A

Less than 6mm - no follow up

More than 8 mm- additional management or follow up

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4
Q

If nodule more than 8mm what will u do ?

A

Additional if any of 7 features present- intermediate or high probability category- requires biopsy or surgical excision
This has 5 % probability of malignancy

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5
Q

2cm Spiculated nodule, in smoker- >50 percent malignant probability- what to do?

A

Timely surgical excision, thoracotomy or VATS

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6
Q

Acute PTE- modified wells score

A

> 4 - high pretest probability

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7
Q

Drug for alcohol withdrawal

A

Benzodiazepines - lorazepam

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8
Q

Signs of alcohol withdrawal

A

History of heavy alcohol use
48-96 hours after hospital admission
Sympathetic nervous system activation- agitation, tachycardia , hypertension

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9
Q

Opioid poisonin- hydrocodone

A

Naloxone

Signs- hypoventilation leading to hypoxemia, somnolent with decreased respiratory rate and pinpoint pupils

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10
Q

Fever causes

A

> 101 is fever
Infection, rheumatologic , malignancy , medication

Acute PTE- cause fever- cause of tissue necrosis

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11
Q

Clostridium difficile colitis- features

A

Fever, abdominal tenderness, diahrroea, recent antibiotic use

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12
Q

Bronchiolitis features

A 
Nasal congestion
Rhinorrhoea
Coarse breath sounds
Wheezing with or without crackles
Low grade fever
Increase work of breathing - chest retra
Nasal flaring
Grunting
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13
Q

When to hospitalise RSV bronchiolitis child

A 
With respiratory distress
Apnea
Hypoxia  
Dehydration
Should follow contact and droplet precautions to prevent nosocomial spread
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14
Q

Treatment of bronchiolitis

A 
IVF
NASAL BULB SUCTIONING
HUMIDIFIED O2
No need of inhaled bronchodilator 
No antibiotics- use only in secondary pneumonia - fso - high fever , focal crackles, consolidation on x ray

For immunocompromise with severe disease- ribavarin.

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15
Q

Season for RSV bronchiolitis

A

Winter

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16
Q

When to give palivizumab for infants

A

Preterm <29 weeks
Chronic lung disease of prematurity
Hemodynamically sig CHD

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17
Q

Complications of RSV BRONCHIOLITIS

A

Apnea- infants less than 2 months

Respiratory failure

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18
Q

When to do antigen testing or NAAT in RSV

A

In patients receiving palivizumab prophylaxis - as RSV infection provides active immunity
- then pali should be discontinued

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19
Q

RSV complI in older patients

A

Recurrent wheezing in 30 percent

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20
Q

IVC filter indications

A

Complications of anticoagulant
Contraindication
Failure of anticoagulant

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21
Q

Laryngeal Edema features

A

Post extubation stridor
Resp failure
Occurs in 30 percent - 5 percent requires- reintubation

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22
Q

Risk factors for l. Edema

A

Female
Small tracheal diameter
Large et tube
Prolonged duration

How to prevent- give iv multiple dose steroids prior to extubation

If signs of Resp failure is there- consider reintubation

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23
Q

Features of extubation failure

A

Symptoms of impending failure-
Ph <7.35 or paco2- >45
Clinical signs of Resp failure
RR more than 25/min for 2 hours

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24
Q

Risk factors for extubation failure

A

Weak cough
Frequent SUCTIONING
Poor mental status
Positive fluid balance 24 hours prior ṭo extubation
Pneumonia as intial cause of respiratory failure
Age >65
Comorbid conditions

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25
Q

NI PPV FOR WHOM

A

Copd patients to prevent re intubation and decrease mortality

26
Q

Prior to extubation -

A

Give steriods to decrease the risk of failure

27
Q

OSA STOP BANG QUESTIONAIRE

A 
Snoring
Excessive daytime tiredness
Observed apnea or choking or gasping
High BP
BMI More than 35 ; 
Age more than 50
Neck size - men >17 inch ; female>16
Male gender

One point for each
0-2 low risk
3-4 - intermediate
>5- high risk

28
Q

OSA-

A

Do polysomnography
Due to nocturnal hypoxia- causes cognitive impairment in elderly- irritability, poor concentration, decreased short term memory

29
Q

Features of sepsis

A

Hypotension, hypothermia and leukocytosis- infection from undetermined source.

30
Q

qSOFA score

A

RR - > 22 /min
Altered mentation
Systolic BP less than 100

One point each
More than 2 means septic

31
Q

Two major intial interventions to reduce mortality

A

1) aggressive IVF - 30 ml per kg is given over the first 3 hours
2) early broad spectrum antibiotics - within one hour eg- vancomycin plus cefepime.

32
Q

Supplemental O2 in copd does what?

A

It improves oxygenation of a lung unit that has a low ventilation perfusion ratio.

33
Q

How is hypoxia caused in copd?

A

By v/q mismatch
Emphysematous component of COPD causes air flow limitation - which is due to destruction of elastic tissue and bronchiolar collapse. - second component is bronchitis limiting air flow.

Copd exacerbation- causes mucus plugging and bronchospasm - which limits air flow

Lot of vq mismatch areas- reason for hypoxemia in copd- low vq will cause vasoconstricton - so air is directed to good vq areas.

Supplement O2- reach alveoli - increase in q - as it removes vasoconstricton - improves gas exchange to blood- hypoxemia improves.

Emphysema- dead space ventilation increase - leading to high vq in these areas- which is due destruction of alveolar- capillary interface- this mechanism is responsible for hypercapnia. Here 02 improves v . But q doesn’t significantly improve- so less effective mechanism

34
Q

SPN features

A

Rounded opacity
Surrounded by lung parenchyma
<3 cm diameter
No LN

If stable for 2-3 years- leave it.

35
Q

Large size spn

A

More than 2cm - independently correlates with more than 50 percent malignant probability

36
Q

Surveillance for more than 8mm lesions

A

Repeat ct in 3 months - this is only for nodules with low malignant probability - eg- 1cm nodule in 50 yo man- non smoker

37
Q

IVC filter indications

A

Complications of anticoagulant
Contraindication
Failure of anticoagulant

38
Q

How is snoring caused?

A

Respiration induced soft tissue vibration in the setting of a relaxed upper airway during sleep.
Can be isolated or a part of OSA.
More than 50 percent don’t have OSA

STOP Bang questionnaire - has high negative predictive value

39
Q

Smoking and alcohol in snoring

A

Both increases snoring
Alcohol- causes relaxation. Of pharyngeal muscles

Stop these first
If not respond- do oral appliance - physical manipulation of airway- mandible advancement, tongue retraction
Surgical - uvulopalatopharyngoplasty

40
Q

Prelimi test for OSA

A

Nocturnal O2 saturation

Gold std- polysomnography

41
Q

Septic Shock features

A

Hypothermia, hypotension, leukocytosis - has an ongoing infection from an undetermined site. See if there is sepsis- qSOFA score-

RR more than 22
Altered mentation
Systolic BP less than 100

More than 2 - septic

42
Q

TB in HIV

A

New or reactivation can occur
No cavitation occurs
Lobar , pleural or disseminated infection occurs
Features- fever, cough, pleurisy and weight loss
Thoracocentesis- lymphocyte predominant exudative effusion.
Elevated adenosine deaminase- occurs both in malignancy and tb

Pleural effusion occurs due to hypersensitivity to m. Tubercular antigen, pleural fluid is aseptic
So do pleural biopsy - to confirm

43
Q

ART in Tb

A

Att started first - then ART after 1-2 weeks delay- to reduce IRIS- immune reconstitution inflammatory syndrome

44
Q

PCP

A

Indolent fever, dyspnea, dry cough and bilateral interstitial infiltrates.

Usually with sputum
BAL is second line

45
Q

Histo in HIV

A

Febrile wasting illness- fever, fatigue, weight loss, vomiting and dyspnea
X-ray - diffuse infiltrates

46
Q

Lung cancer Screening recommendation

A

Yearly with low dose CT
55-80 years

Eligibility for screening based on smoking history- pt with more than 30 pac year history and who is a current smoker or quit smoking with last 15 years

Termination- above 80 years, quit more than 15 years ago , less life expectancy

Smokers have 10-30 fold increase risk . Cumulative risk- 30 percent in heavy smokers to 1 percent in non smokers

47
Q

Smoking cessation

A

Reduce COPD , copd exacerbations and luṅG ca

Lung ca by 80-90 % if left more than 15 years ago in comparison with current smokers

48
Q

Rapid sequence intubation

A

Rapidly acting sedative- etomidate, propofol, midazolam
Paralytic agent- succinylcholine , rocuronium

No benzodiazepines - decrease respiratory drive

Nippv- for copd exacerbation

49
Q

New Rbbb in PE

A

Means RV strain- bedside echo - RV DYSFUNCTION, decreased contractility and RV thrombus
Massive embolism- pul HT leading to dilatation of tricuspid valve annulus and moderate TR

INFERIOR AND POSTERIOR WALL HYPOKINESIA - in MI

50
Q

Capnography- quantitative waveform or calorimetric analysis

A

Normal rectangular waveform- all waves are present - measures end tidal co2
If flat- et is in esophagus

Calorimetric test- paper changes from purple to yellow

51
Q

Pertussis

A 
Lethal 
Relentless coughing fits
Post tussiv emesis
Apnea 
Lymphocyte predominant leukocytosis 
Sick contacts with cough paroxysms
52
Q

Mycoplasma pneumonia

A

School age and young adults
Malaise, headache and fever
Rhinorrhoea and sore throat
Progress to atypical pneumonia - walking pneumonia - doesn’t cause bronchiolitis

53
Q

Croup- laryngotracheitis

A

Hoarseness
Barky cough
Inspiratory stridor

Parainfluenza

Fall or early Winter month- 6months to 3 years

Rx- mild- no stridor- humidified ( to soften the secretions and prevent drying)air-+ steroids (single dose oral or im)
Moderate or severe- stridor at rest- corticosteroids plus nebulized epinephrine

Prevention- hand washing , decontamination of surfaces, proper ventilation

Pa neck - steeple sign- subglottic Edema

Self limited- resolves within a week

54
Q

Cough variant asthma

A

Non productive cough
Due to exertion or cold air exposure- bronchospasm

Allergens- dust and mites are triggers

Wheezing and rhochi are absent

Treatment is same as asthma

55
Q

Treatment of asthma

A 
Intermittent(<2/2)- SABA 
Mild persistent(more than 2/ 3-4 times a month) Low dose ICS

MODERATE( daily/more than once weekly)- low dose ICS and LABA or medium dose ICS

SEVERE PERSISTENT- ( throughout the day/ 4-7 times a week) - step 4- medium dose ICS and LABA

STEP 5- high dose ICS and LABA and consider omalizumab for allergics

Step 6- step 5 + oral steroids

56
Q

Trachea alavida

A

Coughing
Sob
Stridor

Weakness of tracheal walls - expiratiory air way collapse

Chest tightness - present in asthma

57
Q

Transient tachypnea of new born

A

TTN- due to retained Fetal lung fluid - decreased clearance

Cesarean, prematurity, maternal diabetes

Cf- tachypnea, increase work of breathing
Clear breath sounds
Cxr- hyperinflation, fluid In fissures, cardiomegaly, prominent vascular markings and small effusion

Rx- supportive care- O2 , nutrition
Resolves in 1-3 days

58
Q

RDS

A

in premature infants - lack of surfactant
Persistent wheezing and steriod dependence- have chronic lung disease

Cxr- GGO with air bronchograms

59
Q

Vsd murmur

A

Holosystolic

60
Q

Calcification in spn

A

Popcorn, laminated, central and diffuse homogenous- benign

Eccentric, reticular or punctate- malignant

61
Q

Acute bronchitis

A

With copd- give antibiotics

For those with increased dyspnea, sputum volume and purulence

62
Q

Mitral stenosis

A

Recurrent laryngeal nerve compression- due to LAE- ortners syndrome

Mitral facies- pink purplish patches on cheeks

Loud S1 , loud s2 if pulmonary ht

Opening snap - high frequency early diastolic sound

Mid diastolic rumble- best at apex

Cxr- pbf to upper lobes , dilated pulm vessels, LAE, flattened left heart border

Ecg- p mitrale, broad and notched p waves, atrial tachyarrhthmias, RVH ( tall R waves in v1 and v2 )

TTE- MV thickening / calcification / decreased mobility , coexisting MR

Pulmonology (2 decks)

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