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MEDI IM shelf > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

opacification, consolidation, air bronchograms on CXR

A

pneumonia***?

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2
Q

hyperlucent lung fields with flattened diaphragms

A

COPD emphysema

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3
Q

heart > 50% AP diameter, cephalization, Kerly B lines, interstitial edema

A

CHF***?

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4
Q

cavity containing air-fluid level on CXR

A

lung abscess***?

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5
Q

upper lobe cavitation, consolidation, +/- hilar adenopathy

A

pancoast tumor***?

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6
Q

thickened peritracheal stripe and splayed carina bifurcation on CXR

A

???

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7
Q

Pleural effusions see…

A

> 1 cm fluid on lateral decubitus

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8
Q

Px pleural effusion

A

thoracentesis

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9
Q

Transudative pleural effusion ddx

A 
CHF
nephrotic
cirrhotic
RA 
TB
Malignant
PE
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10
Q

Low pleural glucose on thoracentesis, think

A

RA

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11
Q

High lymphocytes in pleural fluid from thoracentesis, think

A

TB

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12
Q

Bloody pleural fluid from thoracentesis, think

A

Malignant
OR
PE

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13
Q

Exudative pleural effusion ddx

A

parapneumonic
malignancy
etc.

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14
Q

Complicated pleural effusion from thoracentesis… signs and tx

A

+ gram stain OR culture
pH < 7.2
glucose <60

tx: insert chest tube for drainage

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15
Q

Light’s criteria: transudative if…

A

LDH < 200
LDH eff/serum < 0.6
Protien eff/serum < 0.5

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16
Q

PE risks

A 
s/p surgery
long car ride/plane ride
hypercoagulable state (cancer, nephrotic)
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17
Q

PE sx

A 
tachycardia
tachypnea
decr pO2
pleuritic cp
hemoptysis
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18
Q

PE signs

A 
right heart strain on ECG
sinus tachy
decr vascular markings on CXR
wedge infarct
ABG with low CO2 and O2
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19
Q

If suspect PE, first give…then

A

heparin

THEN
work up with V/Q scan then spiral CT

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20
Q

Gold standard PE

A

pulmonary angiography

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21
Q

PE tx

A

heparin warfarin overlap
thrombolytics if severe, but NOT if s/p surgery or hemorrhagic stroke
if life threatening: surgical thrombectomy
IVC filter if contraind to chronic coagulation

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22
Q

ARDS pathophys

A

inflammation –> impaired gas exchange –> inflammation mediator release –> hypoxemia

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23
Q

ARDS etiology

A 
sepsis
gastric aspiration
trauma
low perfusion
pancreatitis
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24
Q

ARDS dx

A
  1. PaO2/FiO2 < 200
    ( < 300 means acute lung injury)
  2. Bilateral alveolar infiltrates on CXR
  3. PCWP is < 18 (means pul edema is non cardiogenic)
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25
Q

ARDS tx

A

mechanical ventilation with PEEP

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26
Q

FEV1/FVC < 80% predicted

A

obstructive

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27
Q

Improves > 12% with bronchodilator

A

asthma

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28
Q

Obstructive lung dz

A

asthma
chronic bronchitis
emphysema

29
Q

Restrictive lung dz

A

Interstitial lung dz (sarcoid, silicosis, asbestosis)

Structural (super obese/pickwickian, MG/ALS, phrenic nerve paralysis, scoliosis

30
Q

Obstructive PFTs

A 
FVC decr
FEV1 more decr
FEV1/FVC < 80%
TLC incr >120%
RV incr >120%
31
Q

DLCO reduced in obstructive lung dz

A

emphysema 2/2 alveolar destruction

32
Q

Restrictive PFTs

A 
FVC decr
FEV1 decr
FEV1/FVC normal
TLC decr
RV decr
Does not improve with bronchodilator
33
Q

DLCO reduced in restrictive lung dz

A

ILD due to fibrosis thickening distance

34
Q

COPD chronic bronchitis criteria dx

A

productiev cough > 3 mo for 2 y

35
Q

Chronic bronchitis tx

A

1st line: ipratropium, tiotropium
2nd line: beta agonists
3rd line: theophylline

36
Q

COPD indications to start O2

A

PaO2 < 55
SpO2 < 88%
or if
cor pulmonale, < 59

37
Q

Criteria for COPD exacerbation

A

change in sputum

increasing dyspnea

38
Q

Tx for COPD exacerbation

A
  1. quit smoking

2. cont O2 tx > 18 h/day

39
Q

Why is goal SpO2 94-95% instead of 100%?

A

COPDers are chronic CO2 retainers, hypoxia is the only drive for respiration, so if relieve hypoxia, lose oxygen drive completely

40
Q

Important vaccinations for COPD

A

pneumococcus
w/ 5 y booster
yearly influenza

41
Q

Your COPD patient comes with a 6 week history of clubbing… dx, next step, underlying cause

A

hypertrophic osteoarthropathy

get CXR

most likely cause is underlying lung malignancy

42
Q

asthma: if pt has sxs twice a week and PFTs are normal

A

albuterol only

43
Q

asthma: if pt has sxs 4x a week, night cough 2x a month, and nL PFTs

A

albuterol + ICS

44
Q

asthma: if pt has sxs daily, night cough 2x a week, and FEV1 is 60-80%

A

albuterol + ICS + salmeterol

45
Q

asthma: pt has sxs daily, night cough 4x a week, and FEV1 is < 60%

A

albuterol + ICS + salmeterol + montelukast + oral steroids

46
Q

Asthma exacerbation tx

A

albuterol neb
PO/IV steroids
watch peak blow rates and blood gas
PCo2 should be low

47
Q

Normalizing PCO2 in asthma exacerbation means …

A

impeding respiratory failure

INTUBATE

48
Q

Asthma exacerbation complications

A

allergic bronchopulmonary aspergillus

49
Q

1 cm lung nodules in upper lobes w/ eggshell calcifications

A

silicosis

get yearly TB test!
give INH for 9 mo if > 1 cm

50
Q

reticulonodular process in lower lobes with pleural plaques

A

asbestosis

MC cancer is bronchogenic carcinoma
but incr risk for mesothelioma

51
Q

patchy lower lobe infiltrates, thermophilic actinomyces

A

hypersensitivity pneumonitis “farmer’s lung”

52
Q

hilar lymphadenopathy, incr ACE, erythema nodosum

A

sarcoidosis

53
Q

hilar lymphadenopathy, incr ACE, erythema nodosum with hypercalcemia

A

2/2 incr mphages making vit D

54
Q

important referral in sarcoidosis dx/tx

A

ophthalmology –> uveitis conjunctivitis in 25%

55
Q

sarcoidosis dx/tx

A

dx with biopsy

tx with steroids

56
Q

So you found a pulmonary nodule…1st step

A

look for an old CXR to compare!

57
Q

Characteristics of benign lung nodules

A
  • popcorn calcification (hamartoma)
  • concentric calcification (old granuloma)
  • pt < 40 yo
  • < 3 cm, well circumscribed
58
Q

Characteristics malignant lung nodules

A
  • RF: smoker, old
  • > 3 cm
  • eccentric calcification
59
Q

Tx malignant lung nodules

A

open lung bx

remove nodule

60
Q

A patient presents with weight loss, cough, dyspnea, hemoptysis, repeated pnia or lung collapse…think

A

lung cancer

61
Q

MC cancer in non-smokers

A

adenocarcinoma

occurs in scars of old pneumonia

62
Q

lung adenocarcinoma location and mets

A

peripheral cancer

mets to liver, bone, brain, and adrenals

63
Q

lung adenocarcinoma effusion characteristics

A

exudative with high hyaluronidase

64
Q

pt with kidney stones, constipation, malaise, low PTH, and central lung mass

A

squamous cell carcinoma
paraneoplastic syndrome 2/2 secretion of PTH-rP
low PO4
high Ca2+

65
Q

pt with shoulder pain, ptosis, constricted pupil, and facial edema in setting concerned for lung cancer

A

Superior sulcus syndrome
2/2 small cell carcinoma
central cancer also

66
Q

pt with ptosis better after 1 minute of upward gaze

A

Lambert Eaton Syndrome
2/2 small cell carcinoma
antibody to pre-synaptic Ca2+ channel

67
Q

old smoker presenting with Na+ 125, moist mucus membranes, no JVD?

A

SIADH
2/2 small cell carcinoma
produces euvolemic hyponatremia

68
Q

tx SIADH

A

fluid restriction

+/- hypertonic (3%) saline in < 112

69
Q

CXR showing peripheral cavitation and CT showing distant mets (setting suspected lung cancer)

A

large cell carcinoma

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