Pulmonology Flashcards
Opacification, consolidation, air bronchograms
lobar consolidation= PNA
hyperlucent lung fields with flattened diaphragms
COPD
heart > 50% AP diameter, cephalization, Kerly B lines & interstitial edema”
CHF
Cavity containing an airfluid level
abscess (staph or anaerobes)
“Upper lobe cavitation, consolidation +/- hilar adenopathy”
TB
transudative pleural effusion most likely?
CHF, nephrotic, Cirrhotic
if exudative pleural effusion w/ low pleural glucose?
Rheumatoid Arthritis
if exudative pleural effusion w/ high lymphocytes?
TB
if exudative pleural effusion that is bloody?
Malignant or PE
If exudative pleural effusion most likely?
parapneumonic effusion, TB, empyema, cancer, SLE, RA, Pancreatitis
Lights criteria Transduative if?
Pleural fluid protein: Serum Protein ratio = ≤ 0.5
Pleural Fluid LDH: serum LDH ratio = ≤ 0.6
Pleural Fluid LDH = < ⅔ the upper limit of normal serum LDH
Pleural fluid has ph 7.5, glucose 102, cholesterol 25, protein 4, specific gravity 1.003 what type of fluid is it?
Transudative Pleural effusion
Pleural fluid has ph 7.34, glucose 45, cholesterol 72, protein 53, specific gravity 1.020 what type of fluid is it?
Exudative Pleural effusion
Pleural fluid is clear, decreased cell count, low levels of protein, albumin and LDH what type is it?
Transudative pleural effusion
Pleural fluid is cloudy, increased cell count, high level of protein, albumin, and LDH, what type is it?
Exudative Pleural effusion
Pt. has SOB, tachypnea, Pleuritc chest pain with hemoptysis and is tachycardic and decreased PO2 what does this pt. have?
Pulmonary emoblism
tx: with heparin
pest diagnostic test is pulmonary angiography
what is the most common cause of ARDS?
Sepsis
other: gastric aspiration, trauma, low perfusion, pancreatitis
ARDS pathyphysiology?
Tissue damage (pulmonary or extrapulmonary) → release of inflammatory mediators (e.g., interleukin-1) → inflammatory reaction → injury to alveolar capillaries and endothelial cells leading to: Exudation of neutrophils and protein-rich fluid (hyaline membrane) into the alveolar space → diffuse alveolar damage (DAD) to type I and type II pneumocytes → decrease in surfactant → intrapulmonary shunting → late stage: proliferation of type II pneumocytes and infiltration of fibroblasts → progressive interstitial fibrosis
Diagnosis of ARDS
- ) PaO2/FiO2 < 200 (<300 means acute lung injury)
- ) Bilateral alveolar infiltrates on CXR
- ) PCWP is <18 (means pulmonary edema is noncardiogenic)
Tx of ARDS
Mechanical ventilation with PEEP
with high RR and low tidal volume
Obstructive lung disease
COPD (Emphysema, chronic bronchitis) Asthma
Restrictive lung disease
Interstitial lung dz (sarcoid, silicosis, asbestosis. Structural- super obese, MG/ALS, phrenic nerve paralysis, scoliosis
COPD dx?
postbronchodilator FEV1/FVC < 0.70
Productive cough >3mo for >2 consecutive yrs= Chronic bronchitis
Emphysema= permanent dilatation of pulmonary air spaces distal to the terminal bronchioles
COPD treatment?
1st line = ipratropium (SAMA), tiotropium (LAMA), budenside and or fluticasone, PDE4 inhibitor (roflumilast). 2nd line = Beta agonists salmeterol, formoterol (LABA) salbutamol, fenoterol(SABA). 3rd line= Theophylline
Indications to start O2 therapy and Why is our goal for SpO2 94-95% instead of 100%?
PaO2 <55 or SpO2<88% at rest. If cor pulmonale, <59
COPDers are chronic CO2 retainers. Hypoxia is
the only drive for respiration.
COPD exacerbation criteria?
Change in sputum, increasing dyspnea, increased cough
COPD exacerbation tx
O2 to 90%, albuterol/ipratropium nebs, PO or IV
corticosteroids, FQ or macrolide ABX,
show to improve COPD mortality
- ) Quitting smoking (can decr rate of FEV1 decline
2. ) Continuous O2 therapy >18hrs/day
Important vaccinations for COPD?
Influenza shot yearly
Pneumococcal: reduces the incidence of community-acquired pneumonia and invasive pneumococcal diseases
Age 19-64 years: Administer PPSV23.
Age ≥ 65 years
Vaccinated: Administer PPSV23 (should be at least 5 years after the previous PPSV23 dose and at least 1 year after PCV13).
Not vaccinated or unknown vaccination history: Administer PCV13 followed by PPSV23
Immunocompetent patients: Administer PPSV23 after 1 year.
Individuals with immunocompromising conditions, cerebrospinal leaks, or cochlear implants: Administer PPSV23 after 8 weeks.
new clubbing in finger and toes in COPDer and swelling and pain in joints and long bones, what is the next best step and what is it?
Next best step is CXR
most likely hypertrophic osteoarthropathy associated with NSCLC
Asthma exacerbation what do you do?
tx w/ inhaled albuterol and PO/IV
steroids.
Watch peak flow rates and blood gas. PCO2 should be low. (initially have ↓ PCO2 and respiratory alkalosis (↑ pH) due to tachypnea) Normalizing (rising) PCO2 means impending respiratory failure INTUBATE.
Asthma
If pt has sxs twice a week and PFTs are normal
Treatment?
Albuterol only
Asthma
If pt has sxs 4x a week, night cough 2x a month and
PFTs are normal
Treatment?
Albuterol + inhaled CS
Asthma
If pt has sxs daily, night cough 2x a week and FEV1 is
60-80%
Treatment?
Albuterol + inhaled CS + long-acting beta-ag (salmeterol)
Asthma
If pt has sxs daily, night cough 4x a week and FEV1 is <60%
Treatment?
Albuterol + inhaled CS + salmeterol + montelukast and oral steroids
1cm nodues in upper lobes w/
eggshell calcifications.
Silicosis. Get yearly TB test!.
Give INH for 9mo if >10mm
Reticulonodular process in
lower lobes w/ pleural
plaques.
Asbestosis. Most common cancer associated is
broncogenic carcinoma, but increases risk
for mesothelioma
• Patchy lower lobe infiltrates,
thermophilic actinomyces.
Hypersensitivity Pneumonitis =
“farmer’s lung”
Hilar lymphadenopathy, ↑ACE erythema nodosum. with hypercalcemia who to refer too? Dx? Tx?
Sarcoidosis
2/2 ↑ macrophages making vitD
Ophthalmology uveitis conjunctivitis in 25%
Dx by biopsy. Tx w/ steroids
pulmonary nodule with popcorn calcification
hamartoma (most common benign pulm nodule)
pulmonary nodule with concentric calcification
old granuloma
