Pulmonary Flashcards
what’s the MC cause of lung cancer?
smoking
where are METS MC in lung cancer?
brain, bone, liver, LNs, & adrenals
what are the 2 types of lung cancer?
Non-Small Cell Carcinoma (NSCC) & Small Cell Carcinoma (SCC)
who is adenocarcinoma lung cancer MC in?
smokers, women, & nonsmokers
where does adenocarcinoma lung cancer occur in the lungs?
peripherally
where does SCC lung cancer occur in the lungs?
centrally
what is squamous cell lung cancer a/w?
cavitary lesions (central necrosis), hypercalcemia, & pancoast syndrome
what are the types of NSCC lung cancer?
- Adenocarcinoma
- Squamous Cell
- Large Cell (Anaplastic) Carcinoma
what’s the s/s of lung cancer?
cough, hemoptysis, dyspnea
SVC syndrome
Hypercalcemia (esp. with Squamous Cell)
SIADH/Hyponatremia (MC w/ small cell)
Cushing’s syndrome (ectopic ACTH - MC w/ small cell)
Pancoast Syndrome (shoulder pain, Horner’s syndrome, atrophy of hand/arm muscles)
what’s the dx of lung cancer?
- CXR & CT scan (often seen on CXR but not used for screening; CT used for staging)
- Sputum cytology (good for central lesions)
- Bronchoscopy - for central lesions
what’s the tx of NSCC lung cancer?
surgical resection = TOC
what’s the tx of small cell lung cancer?
chemotherapy = TOC
what’s transudative pleural effusion?
d/t either incr. hydrostatic &/or decr. oncotic pressure
what’s the MC cause of transudative pleural effusion? other causes?
CHF = MC cause
nephrotic syndrome, cirrhosis = other causes
what is exudative pleural effusion? causes?
increase vascular permeability
causes: infection/inflammation
what are the s/s of pleural effusion?
MC asx
if symptomatic -> dyspnea, “pleuritic” chest pain, cough
what’s the PE like for pleural effusion?
decr. tactile fremitus, decr. breath sounds, dullness to percussion
what’s the dx test of choice for pleural effusion?
thoracentesis (dx and therapeutic)
how do you dx pleural effusion?
CXR: PA/lateral -> blunting of costophrenic angles
Thoracentesis (test of choice, dx and therapeutic)
CT scan (to confirm empyema)
what’s the light’s criteria?
criteria exclusive to exudates -> presence of ANY of the 3 = exudative pleural effusion:
- pleural fluid protein: serum protein >0.5
- pleural fluid LDG: serum LDH >0.6
- pleural fluid LDH > 2/3 ULN LDH
what’s the tx for pleural effusion?
- Treat the underlying condition
- Thoracentesis: GOLD STANDARD
- Chest tube pleural fluid drainage: if empyema (pleural fluid pH <7.2, glucose <40, pos. gram stain of pleura fluid)
- Pleurodesis (if malignant effusions or chronic - use talc (MC), doxycycline)
what’s the criteria for empyema pleural effusion?
pleural fluid pH <7.2, glucose <40, pos. gram stain of pleura fluid
what’s the GOLD STANDARD tx for pleural effusion?
Thoracentesis
who is primary spontaneous pneumothorax MC in?
NO underlying lung disease
Mainly affects tall, thin men 20-40 y/o, smokers, + family h/o pneumothorax
who is secondary spontaneous pneumothorax MC in?
d/t UNDERLYING lung disease w/out trauma (ex. COPD, asthma)
what is spontaneous pneumothorax d/t?
bleb rupture
what are the s/s of pneumothorax?
pleuritic unilateral chest pain that’s non-exertional and sudden in onset
dyspnea
what’s the PE like for pneumothorax?
increased hyper-resonance to percussion, decreased remits, decreased breath sounds (over the affected side)
what’s the PE like for a tension pneumothorax?
increased hyper-resonance to percussion, decreased remits, absent breath sounds (over the affected side)
incr. JVP, pulses paradoxus, hypotension
what’s the dx for pneumothorax (except tension pneumothorax)?
CXR with expiratory view
-decr. peripheral lung markings
what’s the tx for small (<15-20%) primary spontaneous pneumothorax?
observation for 6 hr with repeat CXR to confirm no press ion and 24-48 hr f/u
usu. resolve itself w/in 10 days
***give O2 to help with air resorption
what’s the tx for pneumothorax if large or severe symptoms?
chest tube placement (thoracotomy)
what’s the tx for a tension pneumothorax?
Needle aspiration in 2nd ICS mid-clavicular line
what pneumonia’s commonly present post-op?
Hospital acquired pneumonia
OR
Ventilator acquired pneumonia
when is HAP acquired post-op? onset timing (early/late)?
after >48 hrs after hospital admission
(can follow atelectasis)
early onset -> < 5 days
late onset -> >5 days
when is VAP acquires post-op?
48-72 hrs after ET intubation
what’s the s/s of post-op pneumonia?
cough, dyspnea, chest pain, AMS, malaise, fever
what’s the PE like for post-op pneumonia?
Vitals: Dec O2 sat, inc HR/RR, fever
Bronchial breath sounds, dullness on percussion, incr. tactile fremitus, egophony
what will the CXR of post-op pneumonia?
CXR will show consolidation (serial CXR to determine response to tx)
what are the common bacteria in HAP pneumonia?
S. pneumonia
Mycoplasma pneumonia
what’s the tx of HAP/VAP early onset < 5 days?
Ceftriaxone IV
OR
Levo IV/PO
OR
Ampicillin/Sulbactam *Unasyn) IV or Amox/Clav (Augmentin)
what’s the tx of HAP/VAP late onset >5 days?
Cefepime IV OR Ceftazadime OR Meropenem IV OR Zosyn OR Levo
PLUS
Vanco IV
how do you prevent post-op pneumonia?
Early mobilization after surgery
If patient is immobile chest physiotherapy can be performed to improve lung ventilation and dec accumulation of secretions
what is seen on x-ray for for small cell lung cancer?
central hilar mass, mediastinal widening
