Pulmonology Flashcards
Which lung cancers are central vs peripheral?
AdenoCA (NSCLC) - peripheral, solitary nodule or mass
SCC (NSCLC) - central airways (smoking hx) post obstructive pna or lobar collapse
Large cell CA (NSCLC)- peripheral mass with prominent necrosis
SCLC - strongest assoc with cigarette smoking - adjacent to central airways with extensive lymphadenopathy and distant metastasis at dx
Treatment for eosinophilic type, mod-sev uncontrolled asthma?
Mepolizumab - monoclonal antibody to IL-5 (pro eosinophilic cytokines) use with eos count of 150-300/mcl or more
When is hyperbaric oxygen therapy indicated in CO poisoning?
When carboxyhemoglobin level above 25% (normal is 3%, smokers have 10-15%)
Treatment of central sleep apnea
- Fix underlying cause (ie. lasix if CHF and overloaded)
- Continuous CPAP may occasionally be useful
do NOT use adaptive servo-ventilation, it effectively suppresses CSA, but trial showed increase in mortality
What is light’s criteria?
Criteria for exudative pleural effusion (one of the following)
- Pleural to serum protein level >0.5
- Pleural to serum LDH >0.6
- Pleural LDH> 2/3rd upper limit of normal
Exudates = inflammation - infection, malignancy (PE, TB, autoimmune diseases, pancreatitis, post MI, drugs)
Transudate = imbalance between hydrostatic and oncotic pressures = heart failure, cirrhosis (nephrotic syndrome, trapped lung, atelectasis, constrictive pericarditis)
Should oxygen be prescribed to patients with neuromuscular diseases? Why/why not?
No. Their main issue is hypoventilation, and supplemental oxygen may further impair ventilation in patients with respiratory muscle weakness. They need BIPAP or AVAPS to support gas exchange when daytime hyper apnea is noted.
Anterior mediastinal masses
Terrible T’s”: thymoma, teratoma/germ cell tumor, “terrible” lymphoma, and thyroid. most common is (Thymic lesions - associated with various paraneoplastic syndromes, such as myasthenia gravis, dx with acetylcholine receptor antibody test)
When is pleurodesis indicated in pneumothorax?
After first occurrence if secondary spontaneous pneumothorax
If surgical candidate - should have VATS followed by mechanical pleurodesis.
If not surgical candidate - chemical pleurodesis or blood patch
How to treat cyanide poisoning? What lab findings are supportive? What if concomitant CO (house fire) poisoning?
Elevated lactate and methemoglobin. Usually concomitant with CO poisoning (ie. House fire)
Tx with hydroxycobalamin.
IF CO poisoning (smoke inhalation)sodium nitrite contraindicated bc it induces methemoglobinemia and decreases oxygen delivery. Although sodium nitrite is an antidote for cyanide poisoning alone.
Types of treatment for PAH
- CCB - IF have acute vasodilator response during RHC
- Prostanoids (epoprostenol, treprostinil, iloprost) - via CVL, 1st line for severe disease or progression despite oral treatment - vasodilator
- Endothelin-1 receptor antagosists (bosentatn, ambrisentan, macitenan) - 1st line oral therapies for mild-mod disease, blocks endogenous vasoconstructor and smooth muslce mitogen endothelin. Risk - liver injury, teratogenicity.
- PDE-5 inhibitors (sildenafil, tadalafil) - also 1st PO therapy for mild-mod disease.
Hypertensive urgency BP goals
Max of 25% in first hour, then, if stable to SBP 160 over next 2-6 hour, then normal over 24-48 hours
High altitude + confusion + ataxic gait. Dx and Tx
- high altitude cerebral edema
- Dexamethasone (and decent of course) + oxygen
Hypoxia + hypocapnia alter cerebral blood flow and O2 delivery to brain
What is actigraphy and it’s use?
wrist actigraphy measures quantity of sleep. Use it when you need to evaluate a pt with exessive daytime sleepiness and you don’t trust their self report/sleep diary. It diagnoses “insufficient sleep syndrome”
How do you treat CTEPH? What are diagnostic criteria ?
pulmonary thromboendarterectomy.
- Mean PAp of 25mmHG or more by RHC in absence of left heart pressure overload
- imaging - vascular webs, intimal irregularities, luminal narrowing (CT). ventilation-perfusion scan is more sensitive for dx (1st line)
CT finding of RB-ILD (respiratory bronchiolitis-associated interstitial lung disease).
disease in active smokers, seen on 5-25% of CA screening CT.
centrilobular micronodules
(Pathology - respiratory bronchiolitis and tan-pigmented macrophages on biopsy)
