Pulmonary Flashcards
person has pleural effusion on CXR. what 3 requirements should be met if you decide to tap?
- > 1cm of fluid (otherwise too little to tap)
- nonloculated aka free flowing, not in septations or pouches (otherwise need surgical intervention, can’t tap)
- person definitely doesn’t have CHF or does and you tried diuresing but effusion still there
Light’s Criteria for thoracentesis transudate vs exudate
Transudate:
1. LDH < 2/3 upper limit of normal (~200)
AND
2. T protein effusion / T prot serum <0.5
AND
3. LDH effusion / LDH serum < 0.6
Exudate if ANY ONE of those are not met!
diagnostic thoracentesis shows inc WBCs with predominant PMNs. dx?
PNA
diagnostic thoracentesis shows inc WBCs with predominant lymphocytes. diff dx? (2)
TB or malignancy
diagnostic thoracentesis shows RBCs = hemothorax. can indicate cancer true or false
true
treatment for HIT besides stopping the heparin
argatroban (direct thrombin inhibitor)
for refractory persistent asthma that you’ve already used saba ics laba lama in the correct order, what other maintenance meds can you give them?
Leukotriene antagonist (montelukast, zafirlukast) are interchangeable with ICS but don’t use them together.
can also add oral steroids on top of ICS.
for refractory persistent copd that you’ve already used saba lama laba ics in the correct order, what other maintenance meds can you give them?
PDE 4 inhibitors (APREMILAST, roflumilast)
oral steroids
what very specific scenario would you give nedocromil or cromolyn sylfate for asthma?
these are IgE/histamine stabilizers.
if patient has very known triggers, they can take these before known exposure. very situational.
for acute asthma exacerbation, if you give them O2, duoneb (alb/ipratropium), and corticosteroids, and they’re refractory, what other rescue therapy can you use?
racemic epinephrine nebulizers, subcutaneous epi, IV Magnesium
if they still don’t respond you have to intubate them
well uworld said just intubate them bc subcu epi is not any more effective than aeorosl therapy like duoneb. only give subcut if their airway is so closed they cant even breath in nebulized treatment
if a lung nodule is unstable (changed from last imaging) what criteria do you use for if you just do serial CTs q1-2yrs (low suspicion for cancer) or need to do biopsy now (high suspicion for cancer)
NOT cancer: “small, smooth, nonSmoking” and young
<8mm, smooth/calcified, no smoking, <45 yrs old
CANCER: “not small, Spiculated, Smoker, Senile (old)”
>2cm, spicualted, >30 yr hx smoing, >70 yrs old
do bx now!
which 2 lung cancers are caused by smoking? how can u differentiate by vignette without biopsy? specific treatment?
Squamous cell and small cell carcinoma
they are both centrally located in lung on imaging, but:
for SCC look for hypercalcemia from PTH-rp
for small cell look for SIADH or cushings from ADH or ACTH (it’s a neuroendocrine tumor). TREAT WITH CHEMO NOT RESECTION.
what are the 2 cancers that ppl exposed to asbestosis get? which one is more common?
bronchiogenic carcinoma and mesothelioma adenocarcinoma. mesothelioma is RARE. if someone has it, they probably have asbestos exposure. but not everyoen that has exposure gets it. they more often get bronchiogenic carcinoma.
miner or aerospace worker with noncaseating granulomas in upper lobes and systemic organs
berylliosis. looks like sarcoidosis but look for that occupational exposure in the vignette (also sarcoidosis can have elvated
cancer of the lung that is in the periphery and has pleura involvolvement causing puckering. not related to smoking but environmental exposure.
paraneoplastic syndrome -> clubbing and hypertrophic osteoarthropathy
what is the exposure and what’s the cancer?
asbestosis. adenocarcinoma.
