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Surgery EOR > Pulmonology (Alice) > Flashcards

Pulmonology (Alice) Flashcards

1
Q

definition of COPD

A

chronic productive cough lasting:
at least 3 months
x 2 at least 2 years

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2
Q

sharp pleuritic CP that worsens during breathing, f/c, cough w. purulent yellow sputum, PMH COPD

A

PNA

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3
Q

25 yo w. nonproductive cough x 2 weeks - 3 weeks ago she had a sore throat and runny nose

A

atypical PNA

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4
Q

SOB, fatigue, dry cough

A

COPD

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5
Q

SOB, fever, cough

A

PNA

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6
Q

SOB, nausea, epigastric pain

A

acid reflux

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7
Q

SOB, tachycardia, tachypnea, CP

A

PE

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8
Q

SOB, tachypnea, wt loss, chronic cough, fatigue

A

ILD

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9
Q

SOB, fatigue, edema, cough, dizziness, hypotn

A

pulmonary HTN

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10
Q

fatigue, conjunctivitis, skin rash, LAD, hilar LAD

A

sarcoidosis

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11
Q

SOB, pallor, brittle nails, tachycardia, lightheadedness, fatigue

A

anemia

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12
Q

SOB, fever, CP

A

pericarditis

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13
Q

ptosis, weak chewing, easily fatiguedm SOB, weakness w. every day activity

A

myasthenia gravis

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14
Q

definition of hempoptysis

A

bleeding into the bronchial tree

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15
Q

5 causes of hemptysis

A

bronchitis - mc
tumor
TB
bronchiectasis
trauma

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16
Q

definition of massive hemoptysis

A

> 600 cc x 24 hr

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17
Q

mcc of death from hemoptysis

A

asphyxia (hot hemorrhagic shock)

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18
Q

which arterial system is mc source of massive hemoptysis

A

bronchial

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19
Q

6 absolute contraindications to curative surgical resection of a lung tumor

A

distant metastases (except solitary brain/adrenal)
MI w.in past 3 mos
SVC syndrome due to metastatic tumor
bilat endobronchial tumor
contralateral lymph node metastases
malignant pleural effusion

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20
Q

2 s.e of bleomycin

A

pulmonary fibrosis
pulmonary infiltrates

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21
Q

mcc type of lung ca

A

small cell

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22
Q

lung ca w. the poorest prognosis

A

small cell

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23
Q

tx of choice for small cell lung carcinoma

A

combo chemo

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24
Q

3 paraneoplastic syndromes associated w. small cell lung carcinoma

A

lambert-eaton
cushing
SIADH

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25
Q

2 major categories of lung cancer

A

small cell (SCLC)
non small cell (NSCLC)

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26
Q

4 types of NSCLC, mc -> lc

A

adenocarcinoma
squamous cell
large cell
carcinoid

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27
Q

which type of lung ca is amenable to surgery

A

NSCLC

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28
Q

non smoker, incidental finding of small peripheral lesion

A

adenocarcinoma

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29
Q

smoker, hemoptysis, large central solitary tumor

A

squamous cell

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30
Q

SCLC almost always occurs in

A

smokers

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31
Q

what electrolyte abnl is SCLC associated w.

A

hyponatremia
hypercalcemia

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32
Q

most useful diagnostic tools for lung ca

A

bronchoscopy + bx
FNA

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33
Q

NSCLC: peripheral mass vs central mass

A

peripheral mass: adenocarcinoma
central mass: squamous cell

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34
Q

lung nodules > _ carry a higher rate of malignancy, esp in a smoker, and need bx

A

0.5 cm

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35
Q

carcinoid tumor that releases serotonin -> causes peristalsis/diarrhea, and asthma

A

carcinoid syndrome

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36
Q

SCLC is commonly associated w. _ secretion, which causes _ and _

A

ADH secretion
SIADH, hyponatremia

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37
Q

SCLC may secrete _, which causes Cushing syndrome

A

ACTH

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38
Q

masses in the upper region of the lung that compress nerves and BV

A

pancoast tumors

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39
Q

pancoast tumors are mc either (2)

A

squamous cell
adenocarcinoma

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40
Q

pancoast tumor that causes facial/arm swelling

A

superior vena cava syndrome

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41
Q

triad for pancoast syndrome

A

shoulder pain
horner’s syndrome
bony destruction

42
Q

horner’s syndrome triad

A

ptosis
miosis
anhidrosis

43
Q

what is this showing

A

centrally located mediastinal mass -> SCLC

44
Q

tx for NSCLC

A

stage 1-2: surgery
stage 3: chemo then surgery
stage 4: palliative

45
Q

tx for NSCLC

A

chemo

check this, not accurate

46
Q

centrally located, hemoptysis, central bronchus solitary tumor

A

squamous cell carcinoma

47
Q

low grade malignancy of neuroendocrine cells

A

bronchial carcinoid tumor

48
Q

name the epidermal growth factor receptor (egfr) tyrosine kinase inhibitor used to tx NSCLC

A

erlotinib

49
Q

mc primary lung ca in non smokers

A

adenocarcinoma

50
Q

name the 3 lung tumors associated w. smoking

A

squamous cell
large cell
small cell

51
Q

initial imaging findings of lung ca

A

CXR: coin lesion
CT: non calcified nodule

52
Q

2 types of lung tumor found throughout the lungs

A

large cell
bronchial carcinoid

53
Q

2 centrally located lung tumors

A

squamous cell
non small cell

54
Q

peripherally located lung tumor

A

adenocarcinoma

55
Q

2 types of pleural effusion

A

transudative
exudative

56
Q

thin, watery fluid oozes into chest due to increase in pulmonary pressure

A

transudative pleural effusion

57
Q

6 causes of transudative pleural effusion

A

chf - mc
cirrhosis
nephrosis
hypoalbuninemia
myxedema
doxorubicin

58
Q

what is doxorubicin used to treat

A

breast/ovarian/lung ca

59
Q

viscous/thick fluid in the lungs caused by infection

A

exudative pleural effusion

60
Q

9 causes of exudative pleural effusion

A

pna - mc
TB
cancer
pericarditis
PE
xrt
RA
SE
pericarditis

61
Q

light’s criteria for exudative pleural effusion dx

A

at least one is present:
pleural fluid protein/serum ratio > 0.5
pleural fluid LDH/serum LDH ratio > 0.6
pleural fluid LDH > 2/3 upper limit of normal

basically: increased pro and increased LDH = exudative pleural effusion

62
Q

most important lab value when considering exudative pleural effusion

A

LDH

63
Q

4 PE findings of pleural effusion

A

decreased tactile fremitus
decreased dullness to percussion
decreased breath sounds
unilateral lag on chest expansion

64
Q

tx for hemorthorax

A

tube thoracostomy

65
Q

first step in management of a new plaural effusion

A

diagnostic thoracentesis

66
Q

dx for pleural effusion

A
  1. lateral decubitus CXR
  2. diagnostic thoracentesis
67
Q

isolated left sided pleural effusion is likely _
right sided pleural effusion is likely _

A

left sided: exudative
right sided: transudative

think: “i left my ex”

68
Q

tx for pleural effusion

A

thoracentesis

chronic/recurrent/symptomatic: pleurodesis vs indwelling catheter

69
Q

infected pleural effusion

A

empyema

70
Q

tx for empyema

A

chest tube
refractory: decortication

71
Q

thoracotomy with removal of an infected fibrous rind from around the lung

A

decortication

think empyema

72
Q

5 sx of PTX

A

acute onset of ipsilateral chest pain/dyspnea
decreased tactile fremitus
deviated trachea
hyperresonance
diminished breath sounds

73
Q

2 types of PTX

A

spontaneous - primary
traumatic - secondary

74
Q

what pt pop makes you think spontaneous PTX

A

tall, thin males btw 10-30 yo

75
Q

4 causes of secondary PTX

A

asthma
COPD
CF
ILD

76
Q

t/f: spontaneous PTX has a high rate of recurrence

A

t!

usually w.in 2 years

77
Q

mediastinal shift to the contralateral side
impaired ventilation
CV compromise

A

tension PTX

78
Q

what is this showing

A

pleural air
mediastinal shift

tension PTX

79
Q

tx for PTX

A

small (<15% diameter): obs
small, mildly symptomatic: admit, high flow O2
large/symptomatic (>15% diameter): chest tube, serial CXR q 24 hr

80
Q

tx for tension PTX

A

large bore needle thoracostomy
chest tube

81
Q

sx of tension PTX

A

dyspnea
JVD
tachypnea
anxiety
pleuritic CP
unilateral decreased breath sounds
hyperresonance to percussion

82
Q

where should thoracostomy be done for a tension PTX

A

second intercostal space
midclavicular line

83
Q

where is a chest tube placed

A

fourth intercostal space
anterior/midaxillary line

nipple level

84
Q

medical term for sucking chest wound

A

open PTX

85
Q

what is a tube thoracostomy

A

chest tube

86
Q

tx for open PTX

A

tube thoracostomy
occlusive dressing

87
Q

CXR findings of PTX

A

loss of lung markings

88
Q

rupture of subpleural apical blebs due to high negative intrapleural pressures

A

primary PTX

89
Q

multiple broken ribs cause a separation of a segment of the rib cage -> part of the chest wall moves independently

A

flail chest

90
Q

6 indications for early endotracheal intubtion and mechanical ventilation for flail chest

A

> 65 yo
comorbid lung dz
associated severe head trauma
shock
3 or more injuries
fx of eight or more ribs

91
Q

2 types of post op PNA

A

hospital acquired (hap)
ventilator associated (vap)

92
Q

definition of hap

A

develops 48-72 hr after admission

93
Q

definition of vap

A

develops 48-72 hr after endotracheal intubation

94
Q

5 most important pathogens associated w. hap/vap

A

pseudomonas
mssa
mrsa
enterobacter
klebsiela

95
Q

what pathogens are associated w. pna that develops 4-7 days after admit (3)

A

mssa
strep pneumo
h flu

96
Q

what pathogens are associated w. pna that develops > 7 days after admit (2)

A

p aeruginosa
mrsa

97
Q

3 rf for hap

A

previous abx
elevated grastric pH - ppi/h2
cardiac/pulmonary/renal/liver dz

98
Q

3 major rf for vap/post op pna

A

> 70 yo
abd/thoracic surgery
functional debilitation

99
Q

dx for hap/vap

A

CXR vs CT
+/- bronchoscopy w. culture

100
Q

abx for hap/vap (4)

A

pip/taz
cefepime
levoquin
imipenem/meropenem

if mrsa: add vanco vs linezolid

Surgery EOR (17 decks)

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