Pulmonology Flashcards
1
Q
definition of COPD
A
chronic productive cough lasting:
at least 3 months
x 2 at least 2 years
2
Q
sharp pleuritic CP that worsens during breathing, f/c, cough w. purulent yellow sputum, PMH COPD
A
PNA
3
Q
25 yo w. nonproductive cough x 2 weeks - 3 weeks ago she had a sore throat and runny nose
A
atypical PNA
4
Q
SOB, fatigue, dry cough
A
COPD
5
Q
SOB, fever, cough
A
PNA
6
Q
SOB, nausea, epigastric pain
A
acid reflux
7
Q
SOB, tachycardia, tachypnea, CP
A
PE
8
Q
SOB, tachypnea, wt loss, chronic cough, fatigue
A
ILD
9
Q
SOB, fatigue, edema, cough, dizziness, hypotn
A
pulmonary HTN
10
Q
fatigue, conjunctivitis, skin rash, LAD, hilar LAD
A
sarcoidosis
11
Q
SOB, pallor, brittle nails, tachycardia, lightheadedness, fatigue
A
anemia
12
Q
SOB, fever, CP
A
pericarditis
13
Q
ptosis, weak chewing, easily fatiguedm SOB, weakness w. every day activity
A
myasthenia gravis
14
Q
definition of hempoptysis
A
bleeding into the bronchial tree
15
Q
5 causes of hemptysis
A
bronchitis - mc
tumor
TB
bronchiectasis
trauma
16
Q
definition of massive hemoptysis
A
> 600 cc x 24 hr
17
Q
mcc of death from hemoptysis
A
asphyxia (hot hemorrhagic shock)
18
Q
which arterial system is mc source of massive hemoptysis
A
bronchial
19
Q
6 absolute contraindications to curative surgical resection of a lung tumor
A
distant metastases (except solitary brain/adrenal)
MI w.in past 3 mos
SVC syndrome due to metastatic tumor
bilat endobronchial tumor
contralateral lymph node metastases
malignant pleural effusion
20
Q
2 s.e of bleomycin
A
pulmonary fibrosis
pulmonary infiltrates
21
Q
mcc type of lung ca
A
small cell
22
Q
lung ca w. the poorest prognosis
A
small cell
23
Q
tx of choice for small cell lung carcinoma
A
combo chemo
24
Q
3 paraneoplastic syndromes associated w. small cell lung carcinoma
A
lambert-eaton
cushing
SIADH
25
2 major categories of lung cancer
small cell (SCLC)
non small cell (NSCLC)
26
4 types of NSCLC, mc -> lc
adenocarcinoma
squamous cell
large cell
carcinoid
27
which type of lung ca is amenable to surgery
NSCLC
28
non smoker, incidental finding of small peripheral lesion
adenocarcinoma
29
smoker, hemoptysis, large central solitary tumor
squamous cell
30
SCLC almost always occurs in
smokers
31
what electrolyte abnl is SCLC associated w.
hyponatremia
hypercalcemia
32
most useful diagnostic tools for lung ca
bronchoscopy + bx
FNA
33
NSCLC: peripheral mass vs central mass
peripheral mass: adenocarcinoma
central mass: squamous cell
34
lung nodules > _ carry a higher rate of malignancy, esp in a smoker, and need bx
0.5 cm
35
carcinoid tumor that releases serotonin -> causes peristalsis/diarrhea, and asthma
carcinoid syndrome
36
SCLC is commonly associated w. _ secretion, which causes _ and _
ADH secretion
SIADH, hyponatremia
37
SCLC may secrete _, which causes Cushing syndrome
ACTH
38
masses in the upper region of the lung that compress nerves and BV
pancoast tumors
39
pancoast tumors are mc either (2)
squamous cell
adenocarcinoma
40
pancoast tumor that causes facial/arm swelling
superior vena cava syndrome
41
triad for pancoast syndrome
shoulder pain
horner's syndrome
bony destruction
42
horner's syndrome triad
ptosis
miosis
anhidrosis
43
what is this showing
centrally located mediastinal mass -> SCLC
44
tx for NSCLC
stage 1-2: surgery
stage 3: chemo then surgery
stage 4: palliative
45
tx for NSCLC
chemo
46
centrally located, hemoptysis, central bronchus solitary tumor
squamous cell carcinoma
47
low grade malignancy of neuroendocrine cells
bronchial carcinoid tumor
48
name the epidermal growth factor receptor (egfr) tyrosine kinase inhibitor used to tx NSCLC
erlotinib
49
mc primary lung ca in non smokers
adenocarcinoma
50
name the 3 lung tumors associated w. smoking
squamous cell
large cell
small cell
51
initial imaging findings of lung ca
CXR: coin lesion
CT: non calcified nodule
52
2 types of lung tumor found throughout the lungs
large cell
bronchial carcinoid
53
2 centrally located lung tumors
squamous cell
non small cell
54
peripherally located lung tumor
adenocarcinoma
55
2 types of pleural effusion
transudative
exudative
56
thin, watery fluid oozes into chest due to increase in pulmonary pressure
transudative pleural effusion
57
6 causes of transudative pleural effusion
**chf - mc**
cirrhosis
nephrosis
hypoalbuninemia
myxedema
doxorubicin
58
what is doxorubicin used to treat
breast/ovarian/lung ca
59
viscous/thick fluid in the lungs caused by infection
exudative pleural effusion
60
9 causes of exudative pleural effusion
**pna - mc**
TB
cancer
pericarditis
PE
xrt
RA
SE
pericarditis
61
light's criteria for exudative pleural effusion dx
**at least one is present:**
pleural fluid protein/serum ratio > 0.5
pleural fluid LDH/serum LDH ratio > 0.6
pleural fluid LDH > 2/3 upper limit of normal
**basically: increased pro and increased LDH = exudative pleural effusion**
62
most important lab value when considering exudative pleural effusion
LDH
63
4 PE findings of pleural effusion
decreased tactile fremitus
decreased dullness to percussion
decreased breath sounds
unilateral lag on chest expansion
64
tx for hemorthorax
tube thoracostomy
65
first step in management of a new plaural effusion
diagnostic thoracentesis
66
dx for pleural effusion
1. lateral decubitus CXR
2. diagnostic thoracentesis
67
isolated left sided pleural effusion is likely _
right sided pleural effusion is likely _
left sided: exudative
right sided: transudative
*think: "i left my ex"*
68
tx for pleural effusion
**thoracentesis**
chronic/recurrent/symptomatic: pleurodesis vs indwelling catheter
69
infected pleural effusion
empyema
70
tx for empyema
chest tube
refractory: decortication
71
thoracotomy with removal of an infected fibrous rind from around the lung
decortication
*think empyema*
72
5 sx of PTX
acute onset of ipsilateral chest pain/dyspnea
decreased tactile fremitus
deviated trachea
hyperresonance
diminished breath sounds
73
2 types of PTX
spontaneous - primary
traumatic - secondary
74
what pt pop makes you think spontaneous PTX
tall, thin males btw 10-30 yo
75
4 causes of secondary PTX
asthma
COPD
CF
ILD
76
t/f: spontaneous PTX has a high rate of recurrence
t!
*usually w.in 2 years*
77
mediastinal shift to the contralateral side
impaired ventilation
CV compromise
tension PTX
78
what is this showing
pleural air
mediastinal shift
**tension PTX**
79
tx for PTX
small (<15% diameter): obs
small, mildly symptomatic: admit, high flow O2
large/symptomatic (>15% diameter): chest tube, serial CXR q 24 hr
80
tx for tension PTX
large bore needle thoracostomy
chest tube
81
sx of tension PTX
dyspnea
JVD
tachypnea
anxiety
pleuritic CP
unilateral decreased breath sounds
hyperresonance to percussion
82
where should thoracostomy be done for a tension PTX
second intercostal space
midclavicular line
83
where is a chest tube placed
fourth intercostal space
anterior/midaxillary line
*nipple level*
84
medical term for sucking chest wound
open PTX
85
what is a tube thoracostomy
chest tube
86
tx for open PTX
tube thoracostomy
occlusive dressing
87
CXR findings of PTX
loss of lung markings
88
rupture of subpleural apical blebs due to high negative intrapleural pressures
primary PTX
89
multiple broken ribs cause a separation of a segment of the rib cage -> part of the chest wall moves independently
flail chest
90
6 indications for early endotracheal intubtion and mechanical ventilation for flail chest
> 65 yo
comorbid lung dz
associated severe head trauma
shock
3 or more injuries
fx of eight or more ribs
91
2 types of post op PNA
hospital acquired (hap)
ventilator associated (vap)
92
definition of hap
develops 48-72 hr after admission
93
definition of vap
develops 48-72 hr after endotracheal intubation
94
5 most important pathogens associated w. hap/vap
**pseudomonas**
**mssa**
**mrsa**
enterobacter
klebsiela
95
what pathogens are associated w. pna that develops 4-7 days after admit (3)
mssa
strep pneumo
h flu
96
what pathogens are associated w. pna that develops > 7 days after admit (2)
p aeruginosa
mrsa
97
3 rf for hap
previous abx
elevated grastric pH - ppi/h2
cardiac/pulmonary/renal/liver dz
98
3 major rf for vap/post op pna
> 70 yo
abd/thoracic surgery
functional debilitation
99
dx for hap/vap
CXR vs CT
+/- bronchoscopy w. culture
100
abx for hap/vap (4)
pip/taz
cefepime
levoquin
imipenem/meropenem
if mrsa: add vanco vs linezolid
