Pulmonology Flashcards
What are the most common causes of hemoptysis?
- bronchitis (50%): hemopthysis, dry cough, cough with phlegm
- tumor mass (20%): hemoptysis, chest pain, rib pain, tobacco history, weight loss, clubbing
- tuberculosis (8%): hemoptysis, chest pain, sweating
- other causes: bronchiectasis, pulmonary catheters, trauma, pulmonary hemorrhage
What is small cell lung carcinoma?
(15% of cases) (central mass) - 99% smokers, does not respond to surgery and metastases at presentation
- location: central, very aggressive
- treatment: combination chemotherapy needed
- paraneoplastic syndromes: Cushing’s, SIADH
What percentage of lung carcinoma is non small cell?
85 percent of lung cancer cases
What is squamous cell?
(central mass) with hemoptysis, 25-35% of lung cancer cases
- location: central
- may cause hemoptysis
- paraneoplastic syndrome: hypercalcemia
- elevated PTHrp
What is large cell?
fast doubling rates - responds to surgery rare (5%)
- location: periphery 60%
- paraneoplastic syndrome: gynecomastis
What is adenocarcinoma?
most common (peripheral mass), 35-40% of cases of lung cancer
- most common
- associated with smoking and asbestos exposure
- location: periphery
- paraneoplastic syndrome: thrombophlebitis
What is the tx for non small cell lung carcinoma?
can be treated with surgery
- treatment depends on staging
- stage 1-2 surgery
- stage 3 chemo then surgery
- stage 4 palliative
What is the tx for small cell lung carcinoma?
CAN NOT be treated with surgery will need chemotherapy
What are the assoacited manifestions with lung carcinoma?
- Superior vena cava syndrome (facial/arm edema and swollen chest wall veins)
- Pancoast tumor (shoulder pain, Horner’s syndrome, brachial plexus compression)
- Horner’s syndrome (unilateral miosis, ptosis and anhidrosis)
- Carcinoid syndrome (flushing, diarrhea, and telangiectasia)
What is a pleural effusion?
Dyspnea, and a vague discomfort or sharp pain that worsens during inspiration
- differentiate exudate and transudate with pleurocentesis and Light’s criteria
- Ecudate: (local pleural disease) - protein ration increases, LDH increased, infection, malignancy, trauma
- Transudate: congestive heart failure, atelectasis, cirrhosis
- decreased tactile fremitus, dullness to percussion and diminished breath sounds over the effusion
- lateral decubitus x-ray and upright films: blunting of costophrenic angle, mediastinal shift away from effusion
- thoracentesis is the gold standard
What is pneumonia (postoperative)?
currently, postoperative pneumonia is the third most common complication for all surgical procedures and is associated with increased patietn morbidity and mortality
- prolongs the length of stay by a mean of 7-9 days as well as increases medical costs ranging from $12,000 to $40,000
- hosptial-acquired pneumonia (pneumonia developign 48-72 hours after admission)
- Ventilator-associated pneumonia (VAP, pneumonia developing 48-72 h after endotrachel intubation) occurign in the post-surgical patient
What are the most important pathogens with postoperative pneumonia?
- pseudomonas aeruginosa
- methicillin-sensitive staphylococcus aureus
- methicillin-resistant s. aureus (MRSA)
How is postoperative pneumonia dx?
- chest x-ray or chest computed tomography
- sometimes bronchoscopy or blood cultures
What is the tx for postopertive pneumonia?
treatment includes empirically chosen antibiotics active against resistant organisms
-piperacillin/taxobactam
-cefepime
-lebofloxacin
-imipenem
-meropenem
In treatment settings where MRSA rates are >20%, vancomycin or linezolid should be added
What is a pneumothorax?
an absence of breath sounds and hyperresonance to percussion with tracheal deviation
What is a spontaneous pneumothorax?
- primary spontaneous pneumothorax occurs in the absence of underlying disease - tall, thin males between 10 and 30 years of age are at the greatest risk of primary pneumothorax
- secondary spontaneous pneumothorax occurs in the prescence of underlying disease - asthma, COPD, cystic fibrosis, interstitial lung disease
What is a tension pneumothorax?
- etilogy: penetrating trauma
- physical exam: hyperresonance to percussion and tracheal shift to the contralateral side
What is the tx for a pneumothorax?
small pneumothoraces <15% of the diameter of the hemithorax will resolve spontaneously without the need for chest tube placement
- for lare, >15% of the diameter of hemithorax, and symptomatic pneumothoraces, chest tube placement is performed
- patients should be followed with serial CXR every 24 hours until resolved
What is shortness of breath?
can have causes that aren’t due to underlying disease
-examples include exercise, altitude, tight clothing, a prolonged period of bed rest, or a sedentary lifestyle
What are the symptoms of asthma?
SOB, flare-ups, wheezing
What are the symptoms of COPD?
SOB, fatigue, dry cough
What are the symptoms of pneumonia?
SOB, fever, coughing
