Pulmonology Flashcards
opacification, consolidation, air bronchograms on CXR
pneumonia***?
hyperlucent lung fields with flattened diaphragms
COPD emphysema
heart > 50% AP diameter, cephalization, Kerly B lines, interstitial edema
CHF***?
cavity containing air-fluid level on CXR
lung abscess***?
upper lobe cavitation, consolidation, +/- hilar adenopathy
pancoast tumor***?
thickened peritracheal stripe and splayed carina bifurcation on CXR
???
Pleural effusions see…
> 1 cm fluid on lateral decubitus
Px pleural effusion
thoracentesis
Transudative pleural effusion ddx
CHF nephrotic cirrhotic RA TB Malignant PE
Low pleural glucose on thoracentesis, think
RA
High lymphocytes in pleural fluid from thoracentesis, think
TB
Bloody pleural fluid from thoracentesis, think
Malignant
OR
PE
Exudative pleural effusion ddx
parapneumonic
malignancy
etc.
Complicated pleural effusion from thoracentesis… signs and tx
+ gram stain OR culture
pH < 7.2
glucose <60
tx: insert chest tube for drainage
Light’s criteria: transudative if…
LDH < 200
LDH eff/serum < 0.6
Protien eff/serum < 0.5
PE risks
s/p surgery long car ride/plane ride hypercoagulable state (cancer, nephrotic)
PE sx
tachycardia tachypnea decr pO2 pleuritic cp hemoptysis
PE signs
right heart strain on ECG sinus tachy decr vascular markings on CXR wedge infarct ABG with low CO2 and O2
If suspect PE, first give…then
heparin
THEN
work up with V/Q scan then spiral CT
Gold standard PE
pulmonary angiography
PE tx
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
ARDS pathophys
inflammation –> impaired gas exchange –> inflammation mediator release –> hypoxemia
ARDS etiology
sepsis gastric aspiration trauma low perfusion pancreatitis
ARDS dx
- PaO2/FiO2 < 200
( < 300 means acute lung injury) - Bilateral alveolar infiltrates on CXR
- PCWP is < 18 (means pul edema is non cardiogenic)
