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Surgery > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

_______ is the treatment of choice in patients with pulmonary embolism with normal ventricular function and no absolute contraindications.

A

Anticoagulation

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2
Q

_____ cancer is common in patients with a smoking history and presents with a central mass, hilar adenopathy, and mediastinal widening

A

Squamous cell lung cancer

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3
Q

Cavitation is seen with a _____ or primary TB.

A

Lung abscess

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4
Q

____ (type of lung cancer) is associated with the poorest prognosis.

A

Small cell lung cancer is the most common type of lung cancer that is metastatic at the time of discovery, and therefore has the poorest prognosis

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5
Q

A PE exam finding of DECREASED tactile fremitus and dullness to percussion would suggest ______.

A

Pleural effusion (PNA has increased tactile fremitus!)

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6
Q

_____ is the MC of cancer deaths in men and women 50-60 y

A

Lung cancer

*Cigarette smoking is MC

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7
Q

The primary sites of METS w/ lung cancer are:

A

brain, bone, liver, lymph nodes, and adrenals

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8
Q

MC type of lung cancer is _______.

A

A non-small cell carcinoma (85%)

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9
Q

What are the 3 types of non-small cell carcinoma?

A
  1. Adenocarcinoma
  2. Squamous cell
  3. Large cell (anaplastic) carcinoma
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10
Q

_____ is the most common type of non-small cell carcinoma in women.

A

Adenocarcinoma

*Bronchioalveolar is a rare low-grade subtype that has the best prognosis. Presents with voluminous sputum and an interstitial pattern on CXR.

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11
Q

______ (type of lung cancer) is typically centrally located and associated with cavitary lesions, HYPERcalcemia, and pancoast syndrome (Think CCCP).

A

Squamous cell

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12
Q

_______ (type of lung cancer) is VERY AGGRESSIVE.

A

Large Cell (Anaplastic)

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13
Q

Describe small cell carcinoma…

A

Typically METS early–> surgery usually not a treatment option

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14
Q

What are the S&S of Small Cell lung cancer?

A
  • dilated neck veins, prominent chest veins
  • SIADH/hyponatremia
  • Cushing’s syndrome
  • Lambert-Eaton syndrome- weakness (improves with movement)
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15
Q

What is pancoast syndrome?

A

Associated with squamous cell carcinoma. Atrophy of hand/arm muscles, tumors at superior sulcus, shoulder pain, Horner’s syndrome (miosis, ptosis, anhydrosis)

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16
Q

How is lung cancer diagnosed?

A

Found on CXR; CT for staging

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17
Q

How is Non small cell cancer treated? How is small cell treated?

A

Non small cell- surgery

Small cell- chemo

18
Q

Name 4 classifications of pleural effusion:

A
  1. Empyema- grossly purulent due to direct infxn of pleural space
  2. Parapneumonic- noninfected secondary to bacterial PNA
  3. Hemothorax- gross blood (think chest trauma and malignancy)
  4. Chylothorax- increased lymph involvement
19
Q

What is transudate and what causes it?

A

Transudate- circulatory system fluid due to increased hydrostatic pressure and/or decreased oncotic pressure

Etiologies- CHF is the MC cause (also nephrotic syndrome and cirrhosis)

20
Q

What is exudate and what causes it?

A

Exudate occurs when local factors increase vascular permeability (INFECTION, INFLAMMATION)
-contains plasma proteins, WBCs, platelets, RBCs

21
Q

What is Light’s Criteria?

A

Exclusive to EXUDATES. Presence of any 3 of the following= exudative.

  1. Pleural fluid protein
  2. Pleural fluid LDH
  3. Pleural fluid LDH (diff parameters than above, see study guide)
22
Q

What are the S&S of pleural effusion?

A

Usually asymptomatic. May complain of “pleuritic” chest pain, cough, dyspnea

23
Q

PE findings of Pleural Effusion-

A

DECREASED TACTILE FREMITUS

DECREASED BREATH SOUNDS

DULLNESS TO PERCUSSION

24
Q

How is a pleural effusion diagnosed?

A

CXR: PA/Lateral
-blunting of costophrenic angles

*LATERAL DECUBITUS films are the best

**Thoracentesis is the test of choice!!

25
Q

How do you treat a pleural effusion?

A
  1. Treat underlying condition- diuretics, sodium restriction
  2. Thoracentesis: gold standard! DON’T remove more than 1.5L during any one procedure
  3. Chest tube pleural fluid drainage: if empyema may inject with streptokinase to facilitate drainage
26
Q

What is the primary cause of a pulmonary embolism?

A

95% originate from DVTs in the LE above the knee or pelvis

*other= fat emboli from long bone fracture and air emboli from central lines

27
Q

What are the S&S of a PE?

A

Dyspnea MC symptom

Tachypnea MC sign

28
Q

What is the classic triad of a pulmonary embolism?

A

Dyspnea, pleuritic chest pain, hemoptysis

29
Q

What is the classic presentation of a pulmonary embolism?

A

Post-op patient with sudden tachypnea, tachycardia, +/- cough, hemoptysis

*Factor V Leiden in the MC predisposing condition

30
Q

How is a pulmonary embolism diagnosed?

A

Helical CT scan best initial test!

(pulmonary angiography is gold standard)

CXR: Westermarks sign, Hampton’s hump
ECG: sinus tach

31
Q

How is a pulmonary embolism managed?

A
  1. Anticoagulation with Heparin
    - Then warfarin x 3mos or
    - Dabigitran or edoxaban
  2. IVC filter: if pt CI for anticoagulate
  3. Thrombolysis: if massive PE and hemodynamically unstable
  4. Thrombectomy/Embolectomy: if thrombolysis is CI
32
Q

Prophylactic options for PE?

A

Early ambulation, elastic stockings/SCDs, LMWH

33
Q

Name and describe the different types of PTX…

A
  1. Spontaneous
    - Atraumatic & idiopathic. Due to bleb rupture.
    a. Primary- NO underlying lung dz, mainly affects tall and thin men 20-40y, smokers, ppl w/ family hx of PTX
    b. Secondary- + underlying lung dz w/o trauma (COPD, asthma)
  2. Traumatic
    - Iatrogenic- during CPR, thoracentesis, PEEP, subclavian line placement, accidents (MVAs)
  3. Tension
    - Any type of PTX in which the positive air pressure pushes lungs, trachea, great vessels & heart to the CONTRALATERAL SIDE. Immediately life threatening! MC seen during TRAUMA, mechanical ventilation, resuscitation efforts
    - Have increased JVP, pulsus paradoxus, hypotension
34
Q

Describing chest pain and PE findings with PTX…

A

Chest pain usually pleuritic, unilateral, non exertional, and sudden onset, dyspnea

  • Hyperresonance to percussion, decreased fremitus, decreased breath sounds
  • Unequal respiratory expansion, tachycardia, tachypnea
35
Q

How is a PTX diagnosed?

A

CXR with EXPIRATORY VIEW

*may see companion lines

36
Q

How is a PTX treated?

A
  1. Observation in primary spontaneous if small (often resolves within 10 days on its own)
  2. Chest tube placement (thoracostomy) if large or severe symptoms
  3. Needle Aspiration: if tension PTX followed by chest tube placement. Needle placed in 2nd intercostal space at midclavicular line of the affected side.
37
Q

What are the associated CXR findings for aspiration PNA?

A

Early-fluffy infiltrate or normal CXR

Late- pneumonia, ARDS

38
Q

What lobes are commonly involved in aspiration PNA?

A

Supine-RUL

Sitting- RLL

39
Q

Which organisms are commonly involved in aspiration PNA?

A

Community acquired- gram positive, mixed

Hospital/ICU- gram negative rods

40
Q

What diagnostic studies are indicated for aspiration PNA?

A

CXR, sputum culture, gram stain

41
Q

What is the treatment for aspiration PNA?

A

Bronchoscopy with antibiotics if PNA develops, intubation if respiratory failure occurs, ventilation with PEEP if ARDS develops

Abx- Zosyn or Cefepime + Cipro
(add Vanc if MRSA suspected or Linezolid if Legionella suspected)

42
Q

What is Mendelson’s syndrome?

A

Chemical pneumonitis secondary to aspiration of stomach contents.

Surgery (11 decks)

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