Pulmonary Flashcards
MVA pt comes in with trouble breathing, tachycardia, and trachea deviated to the right?
left pneumothorax
shove a needle in the 2nd intercostal on the left side. Dont bother with at CXR. Don’t intubate yet b/c PEEP will make the pneumothorax worse!
Insert a chest tube only if the needle doesn’t work.
SIRS criteria?
Temp >101.3 or 90
RR >20
WBC >12000 or
Where are bronchogenic cysts found?
The middle mediastinum
FEV1 and RV for Obstructive disease?
FEV1 will be 120% predicted
I.E. more air is in and it is trapped
FVC, RV and FEV1 or Restrictive disease?
FVC 75% predicted
RV = normal until the disease gets severe, then it starts to drop.
I.E. - the lung space is smaller and able to push the little air that it has out easier
A kid with asthma who is on daily fluticasone has to use his albuterol inhaler 1x per day. What is the next treatment?
Switch the albuterol to a long term B agonist (salmeterol.()
How does ipratropium work in asthma?
Theophylline?
Ipa = AcH R blocker - prevents bronchoconstriction
Theophylline = a methylxanthine that blocks PGE - causing less cAMP breakdown. Bronchodilates. Has a narrow T.I. so its use is limited
Mild Intermittent Asthma?
symptoms
How many symptoms before pt needs to use salmeterol?
Daily symptoms + >1 night per week symptoms
tx = albuterol, fluticasone, and salmeterol
What are the only 2 interventions proven to improve survival in patients with COPD?
Supplemental O2 >90% for >15h per day
Smoking Cessation
What kind of lung diseases do myasthenia and sarcoid cause?
Restrictive!
What kind of lung disease does amiodarone cause?
Interstitial Lung Disease
Lab markers in sarcoidosis?
Hi ACE levels, Hypercalcemia, hypercalcuria
Hi alk phos
What will lung pathology look like in Hypersensitivity Pneumonitis?
Alveolar thickening and granulomas
CXR = upper lobe fibrosis
Characteristic lung finding in silicosis?
What annual screening do they need?
Eggshell calcifications - will cause a restrictive disease
Need to screen for TB annually
What 3 things could an increased Aa gradient suggest?
Shunt
VQ mismatch
Diffusion impairment
Algorythm for “Is low PO2 correctable with O2?
Yes = VQ mismatch has occured No = Shunt has occured
ARDS criteria
Acute onset
PaO2/FiO2 ratio
What should PO2 and PCO2 be to indicate it is ok to stop mechanical ventialtion?
PO2 should be > 70 (on 40% FiO2)
PCO2 should be
What will the heart exam of a pt with a pulmonary embolism sound like?
A loud P2, prominent jugular A waves
25 yo black female w/ painful bumps on her shins, weight loss, cough. Exam shows 1cm right axillary lymph node. What is the next best step for dx?
Take a bx of the axillary lymph node. She likely has sarcoidosis, and this is less invasive than a lung bx
What is the only lung cancer to not be associated with smoking?
Bronchoalveolar carcinoma
What extra symptoms to look for with: Small Cell Lung Cancer Squamous Cell Lung Cancer Large Cell lung cancer AdenoCA
Small = hi ACTH, SIADH, Lambert Eatooon, peripheral neuropathy SqCC = hi PTHrP Large = Gynecomastia Adeno = thrombophlebitis, nonbacterial verrucous endocarditis
All can cause anemia, acanthosis nigricans, dermatomyositis!
What are the causes of transudative and exudative pleural effusions?
Transudative - increased PCWP or decreased oncotic pressure (CHF, cirrhosis, nephrotic)
Exudative - increased pleural vascular permeability (infection, malignancy, pancreatitis, RA/SLE, trauma)
