Pulmonology (Alice) Flashcards
definition of COPD
chronic productive cough lasting:
at least 3 months
x 2 at least 2 years
sharp pleuritic CP that worsens during breathing, f/c, cough w. purulent yellow sputum, PMH COPD
PNA
25 yo w. nonproductive cough x 2 weeks - 3 weeks ago she had a sore throat and runny nose
atypical PNA
SOB, fatigue, dry cough
COPD
SOB, fever, cough
PNA
SOB, nausea, epigastric pain
acid reflux
SOB, tachycardia, tachypnea, CP
PE
SOB, tachypnea, wt loss, chronic cough, fatigue
ILD
SOB, fatigue, edema, cough, dizziness, hypotn
pulmonary HTN
fatigue, conjunctivitis, skin rash, LAD, hilar LAD
sarcoidosis
SOB, pallor, brittle nails, tachycardia, lightheadedness, fatigue
anemia
SOB, fever, CP
pericarditis
ptosis, weak chewing, easily fatiguedm SOB, weakness w. every day activity
myasthenia gravis
definition of hempoptysis
bleeding into the bronchial tree
5 causes of hemptysis
bronchitis - mc
tumor
TB
bronchiectasis
trauma
definition of massive hemoptysis
> 600 cc x 24 hr
mcc of death from hemoptysis
asphyxia (hot hemorrhagic shock)
which arterial system is mc source of massive hemoptysis
bronchial
6 absolute contraindications to curative surgical resection of a lung tumor
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
2 s.e of bleomycin
pulmonary fibrosis
pulmonary infiltrates
mcc type of lung ca
small cell
lung ca w. the poorest prognosis
small cell
tx of choice for small cell lung carcinoma
combo chemo
3 paraneoplastic syndromes associated w. small cell lung carcinoma
lambert-eaton
cushing
SIADH
2 major categories of lung cancer
small cell (SCLC)
non small cell (NSCLC)
4 types of NSCLC, mc -> lc
adenocarcinoma
squamous cell
large cell
carcinoid
which type of lung ca is amenable to surgery
NSCLC
non smoker, incidental finding of small peripheral lesion
adenocarcinoma
smoker, hemoptysis, large central solitary tumor
squamous cell
SCLC almost always occurs in
smokers
what electrolyte abnl is SCLC associated w.
hyponatremia
hypercalcemia
most useful diagnostic tools for lung ca
bronchoscopy + bx
FNA
NSCLC: peripheral mass vs central mass
peripheral mass: adenocarcinoma
central mass: squamous cell
lung nodules > _ carry a higher rate of malignancy, esp in a smoker, and need bx
0.5 cm
carcinoid tumor that releases serotonin -> causes peristalsis/diarrhea, and asthma
carcinoid syndrome
SCLC is commonly associated w. _ secretion, which causes _ and _
ADH secretion
SIADH, hyponatremia
SCLC may secrete _, which causes Cushing syndrome
ACTH
masses in the upper region of the lung that compress nerves and BV
pancoast tumors
pancoast tumors are mc either (2)
squamous cell
adenocarcinoma
pancoast tumor that causes facial/arm swelling
superior vena cava syndrome
triad for pancoast syndrome
shoulder pain
horner’s syndrome
bony destruction
horner’s syndrome triad
ptosis
miosis
anhidrosis
what is this showing
centrally located mediastinal mass -> SCLC
tx for NSCLC
stage 1-2: surgery
stage 3: chemo then surgery
stage 4: palliative
tx for NSCLC
chemo
check this, not accurate
centrally located, hemoptysis, central bronchus solitary tumor
squamous cell carcinoma
low grade malignancy of neuroendocrine cells
bronchial carcinoid tumor
name the epidermal growth factor receptor (egfr) tyrosine kinase inhibitor used to tx NSCLC
erlotinib
mc primary lung ca in non smokers
adenocarcinoma
name the 3 lung tumors associated w. smoking
squamous cell
large cell
small cell
initial imaging findings of lung ca
CXR: coin lesion
CT: non calcified nodule
2 types of lung tumor found throughout the lungs
large cell
bronchial carcinoid
2 centrally located lung tumors
squamous cell
non small cell
peripherally located lung tumor
adenocarcinoma
2 types of pleural effusion
transudative
exudative
thin, watery fluid oozes into chest due to increase in pulmonary pressure
transudative pleural effusion
6 causes of transudative pleural effusion
chf - mc
cirrhosis
nephrosis
hypoalbuninemia
myxedema
doxorubicin
what is doxorubicin used to treat
breast/ovarian/lung ca
viscous/thick fluid in the lungs caused by infection
exudative pleural effusion
9 causes of exudative pleural effusion
pna - mc
TB
cancer
pericarditis
PE
xrt
RA
SE
pericarditis
light’s criteria for exudative pleural effusion dx
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
most important lab value when considering exudative pleural effusion
LDH
4 PE findings of pleural effusion
decreased tactile fremitus
decreased dullness to percussion
decreased breath sounds
unilateral lag on chest expansion
tx for hemorthorax
tube thoracostomy
first step in management of a new plaural effusion
diagnostic thoracentesis
dx for pleural effusion
- lateral decubitus CXR
- diagnostic thoracentesis
isolated left sided pleural effusion is likely _
right sided pleural effusion is likely _
left sided: exudative
right sided: transudative
think: “i left my ex”
tx for pleural effusion
thoracentesis
chronic/recurrent/symptomatic: pleurodesis vs indwelling catheter
infected pleural effusion
empyema
tx for empyema
chest tube
refractory: decortication
thoracotomy with removal of an infected fibrous rind from around the lung
decortication
think empyema
5 sx of PTX
acute onset of ipsilateral chest pain/dyspnea
decreased tactile fremitus
deviated trachea
hyperresonance
diminished breath sounds
2 types of PTX
spontaneous - primary
traumatic - secondary
what pt pop makes you think spontaneous PTX
tall, thin males btw 10-30 yo
4 causes of secondary PTX
asthma
COPD
CF
ILD
t/f: spontaneous PTX has a high rate of recurrence
t!
usually w.in 2 years
mediastinal shift to the contralateral side
impaired ventilation
CV compromise
tension PTX
what is this showing
pleural air
mediastinal shift
tension PTX
tx for PTX
small (<15% diameter): obs
small, mildly symptomatic: admit, high flow O2
large/symptomatic (>15% diameter): chest tube, serial CXR q 24 hr
tx for tension PTX
large bore needle thoracostomy
chest tube
sx of tension PTX
dyspnea
JVD
tachypnea
anxiety
pleuritic CP
unilateral decreased breath sounds
hyperresonance to percussion
where should thoracostomy be done for a tension PTX
second intercostal space
midclavicular line
where is a chest tube placed
fourth intercostal space
anterior/midaxillary line
nipple level
medical term for sucking chest wound
open PTX
what is a tube thoracostomy
chest tube
tx for open PTX
tube thoracostomy
occlusive dressing
CXR findings of PTX
loss of lung markings
rupture of subpleural apical blebs due to high negative intrapleural pressures
primary PTX
multiple broken ribs cause a separation of a segment of the rib cage -> part of the chest wall moves independently
flail chest
6 indications for early endotracheal intubtion and mechanical ventilation for flail chest
> 65 yo
comorbid lung dz
associated severe head trauma
shock
3 or more injuries
fx of eight or more ribs
2 types of post op PNA
hospital acquired (hap)
ventilator associated (vap)
definition of hap
develops 48-72 hr after admission
definition of vap
develops 48-72 hr after endotracheal intubation
5 most important pathogens associated w. hap/vap
pseudomonas
mssa
mrsa
enterobacter
klebsiela
what pathogens are associated w. pna that develops 4-7 days after admit (3)
mssa
strep pneumo
h flu
what pathogens are associated w. pna that develops > 7 days after admit (2)
p aeruginosa
mrsa
3 rf for hap
previous abx
elevated grastric pH - ppi/h2
cardiac/pulmonary/renal/liver dz
3 major rf for vap/post op pna
> 70 yo
abd/thoracic surgery
functional debilitation
dx for hap/vap
CXR vs CT
+/- bronchoscopy w. culture
abx for hap/vap (4)
pip/taz
cefepime
levoquin
imipenem/meropenem
if mrsa: add vanco vs linezolid
