Pulmonary Flashcards
criteria for exudative effusion
light’s criteria:
- pleural/serum protein > 0.5
- pleural/serum LDH > 0.6
- pleural fluid LDH > 2/3 ULN of serum LDH
causes of exudative effusion
think of leak capillaries - malignancy, TB, bacterial or viral infections, pneumonia, PE w/ infarct, and pancreatitis
causes of transudative effusion
think of intact capillaries - CHF, liver or kidney dz, and protein losing enteropathy
normalizing pCO2 in a pt having an asthma exacerbation may indicate?
fatigue and impending respiratory failure
dyspnea, lateral hilar lymphadenopathy on CXR, non-caseating granulomas, increased ACE, and hypercalcemia. Dx?
sarcoidosis
PFTs of obstructive pulmonary disease
decreased FEV1/FVC
PFTs of restrictive pulmonary disease
increased FEV1/FVC and decreased TLC
honeycomb pattern on CXR. Tx?
diffuse interstitial pulmonary fibrosis - tx is supportive care; steroids may help
tx for SVC syndrome
radiation
tx for mild persistent asthma
inhaled beta-agonists and inhaled corticosteroids
tx for COPD exacerbation
O2 (target O2sat at 88-92%), bronchodilators (beta-2 agonists and anti-cholinergics), abx, systemic corticosteroids w/ taper, and smoking cessation
tx for chronic COPD
smoking cessation, home O2, beta-agonists, anti-cholinergic, systemic or inhaled corticosteroids, flu and pneumococcal vaccines
acid-base disorder in PE
respiratory alkalosis w/ hypoxia and hypocarbia
non-small cell lung cancer associated w/ hypercalcemia
squamous cell carcinoma
lung cancer highly related to cigarette exposure
small cell lung cancer
lung cancer associated w/ SIADH
small cell lung cancer
tall white male presents w/ acute shortness of breath. Dx? Tx?
spontaneous pneumothorax. spontaneous regression w/ supplemental O2 may be helpful
risk factors for DVT
stasis, endothelial injury, and hyper-coagulability (virchow’s triad)
tx of tension pneumothorax
immediate needle thoracostomy
characteristics favoring carcinoma in an isolated pulmonary nodule
age > 45-50; lesions new or larger in comparison to old films; absence of calcifications or irregular calcifications; size > 2 cm; irregular margins
hypoxemia and pulmonary edema w/ normal pulmonary capillary wedge pressure
ARDS
sequelae of asbestos exposure
pulmonary fibrosis, pleural plaques, bronchogenic carcinoma (mass in lung field), mesothelioma (pleural mass)
increased risk of what infection w/ silicosis?
mycobacterium tuberculosis
causes of hypoxemia
right-to-left shunt, hypoventilation, low inspired O2 tension, diffusion defect, V/Q mismatch
classic CXR findings for pulmonary edema
cardiomegaly, prominent pulmonary vessels, kerley b lines, bats wing appearance of hilar shadows, and perivascular and peribronchial cuffing
CXR findings suggestive of PE
westermark’s sign and hampton’s hump
fever + cough productive of foul-smelling sputum + hx concerning for aspiration pna. tx?
clindamycin
findings on CT of bronchial dilation, lack of airway trapping, and bronchial wall thickening are signs of?
bronchiectasis
two modalities shown to decreased mortality in COPD pts
home O2 and smoking cessation
most common adverse effect of inhaled corticosteroids
thrush (oral candida)
glucocorticoids cause neutrophilia how?
by increasing the BM release and mobilizing the marginated neutrophil pool
indicators of severe asthma
normal to increased pCO2 values, speech difficulty, diaphoresis, altered sensorium, cyanosis, and silent lungs
pts w/ impaired consciousness, advanced dementia, and other neuro disorders are predisposed to aspiration pna due to?
impaired epiglottic function
a mobile, cavitary mass in the lung which presents w/ intermittent hemoptysis. dx?
aspergilloma
pt presents w/ atypical CAP symptoms, concurrent GI and CNS symptoms. dx?
legionnaires
3 most common causes of chronic cough
postnasal drip (upper-airway cough syndrome), asthma, and GERD
hypoxia, hypocapnia, and respiratory alkalosis suggests?
CHF
exudative effusions w/ low glucose
empyemas - low glucose due to the high metabolic activity of leukocytes and bacteria w/in the pleural fluid
PE findings for pneumothorax…
percussion - ?
breath sounds - ?
fremitus - ?
percussion - hyperresonant
breath sounds - decreased or absent
fremitus - decreased or absent
PE findings for pleural effusion…
percussion - ?
breath sounds - ?
fremitus - ?
percussion - dull
breath sounds - decreased
fremitus - decreased
PE findings for emphysema…
percussion - ?
breath sounds - ?
fremitus - ?
percussion - diffusely hyperresonant
breath sounds - decreased
fremitus - decreased
