Pulmonology - Emma Holliday Review

Question 1

When do you perform a thoracentesis?

Answer 1

Fluid >1cm on lat decubitus

Question 2

If fluid from thoracentesis is transudative?

Answer 2

CHF, nephrotic, cirrhotic

Question 3

If fluid from thoracentesis is transudative and low pleural glucose?

Answer 3

Rheumatoid arthritis

Question 4

If fluid from thoracentesis is transudative and high lymphocytes?

Answer 4

TB

Question 5

If fluid from thoracentesis is transudative and bloody?

Answer 5

Malignant or PE

Question 6

If fluid from thoracentesis is exudative?

Answer 6

Parapneumonic or cancer

Question 7

How is fluid from a thoracentesis classified as complex?

Answer 7

+ gram or culture, pH <60

Question 8

If fluid from thoracentesis is complex?

Answer 8

Insert chest tube for drainage

Question 9

According to Light’s criteria fluid is transudative if?

Answer 9

LDH < 200
LDH eff/serum < 0.6
Protein eff/serum < 0.5

Question 10

High risk for PE?

Answer 10

Post surgery, hyperCoAg state

Question 11

PE symptoms?

Answer 11

Pleuritic chest pain, hemoptysis, tachypnea, Decrease pO2, tachycardia

Question 12

PE signs?

Answer 12

Right heart strain on EKG, sinus tach, decrease vascular markings on CXR, wedge infarct, ABG w/ low CO2 and O2

Question 13

If PE is suspected what needs to happen first?

Answer 13

Give heparin

Question 14

Dx tools in the work up on PE (in order)?

Answer 14

V-Q scan then spiral C-T

Question 15

Gold standard for PE work up?

Answer 15

Pulmonary Angiography

Question 16

If severe what do you use in a patient with PE?

Answer 16

Thrombolytics

Question 17

When is thrombolytics CI in patient with PE?

Answer 17

S/P surgery or hemorrhagic stroke

Question 18

Tx of life threatening PE?

Answer 18

surgical thrombectomy

Question 19

Chronic CoAg CI what do you give PE patient?

Answer 19

IVC filter

Question 20

ARDS pathophys?

Answer 20

inflammation –> impaired gas exchange, inflam mediator release, hypoxemia

Question 21

ARDS causes?

Answer 21

Sepsis, gastric aspiration, trauma, low perfusion, pancreatitis

Question 22

Dx of ARDS?

Answer 22

1. PaO2/FiO2 < 200
2. BL alveolar infiltrates on CXR
3. PCWP is < 18 ( pulmonary edema non cardiogenic)

Question 23

Tx of ARDS?

Answer 23

Mechanical ventilation w/ PEEP

Question 24

COPD criteria for dx?

Answer 24

Productive cough > 3 months for > 2 consecutive years

Question 25

COPD tx?

Answer 25

1st line = Ipratropium, tiotropium 2nd line = Beta agonist 3rd line = Theophylline

Question 26

Indications to start O2?

Answer 26

PaO2 < 55 or SpO2 < 88% If cor pulmonale <59

Question 27

Criteria for COPD exacerbation?

Answer 27

change in sputum, increasing dyspnea

Question 28

Tx for COPD exacerbation?

Answer 28

O2 to 90%. albuterol/ipratropium nebs, PO or IV corticosteroids, FQ or macrolide ABx

Question 29

Best prognostic indicator for COPD?

Answer 29

FEV1

Question 30

What is shown to decrease mortality associated with COPD?

Answer 30

1. Quitting smoking | 2. Continuous O2 therapy >18 hrs/day

Question 31

What is the goal for SpO2 in COPD? Why?

Answer 31

94-95%, Hypoxia is the only drive for respiration

Question 32

New clubbing in COPDer? Next best step? Most likely cause?

Answer 32

Hypertrophic osteoarthropathy CXR Underlying lung malignancy

Question 33

Tx of asthma if patient has symptoms twice a week and PFTs are normal?

Answer 33

Albuterol only

Question 34

Tx of asthma if patient has symptoms 4x a week, night cough 2x a month and PFTs are normal?

Answer 34

Albuterol + inhaled CS

Question 35

Tx of asthma if patient has symptoms daily, night cough 2x a week FEV1 60-80%

Answer 35

Albuterol + inhaled CS + LABA (salmetrol)

Question 36

Tx of asthma if patient has symptoms daily, night cough 4x a week FEV1 < 60%

Answer 36

Albuterol + inhaled CS + LABA (salmetrol) + montelukast + oral steroids

Question 37

COPD Exacerbation tx?

Answer 37

Inhaled albuterol and PO/IV steroids

Question 38

What to watch in COPD exacerbation? How should PCO2 be?

Answer 38

Peak flow rates and blood gas | Low

Question 39

COPD exacerbation with normalizing PCO2 means? Do what?

Answer 39

Impending respiratory failure --> intubate

Question 40

COPD complications?

Answer 40

Allergic bronchopulmonary aspergillus

Question 41

1 cm nodules in upper lobe w/ eggshell calcifications? What test needs to be done? Tx if nodule is >10 mm

Answer 41

Silicosis TB test INH for 9 months

Question 42

Reticulonodular process in lower lobes with pleural plaques?

Answer 42

Asbestosis

Question 43

Most common cancer associated with asbestosis? Increased risk for?

Answer 43

Bronchogenic carcinoma | mesothelioma

Question 44

Patchy lower lobe infiltrates, thermophilic actinomyces?

Answer 44

Hypersensitivity pneumonitis = "farmer's lung"

Question 45

Hilar lymphadenopathy, Increase ACE, erythema nodosum? With hypercalcemia? Important referral? Dx? Tx?

Answer 45

Sarcoidosis Secondary to increase macrophages making VitD Ophtalmology --> uveitis conjunctivitis in 25% Biopsy Steroids

Question 46

Found a pulmonary nodule... 1st test?

Answer 46

Look for an old CXR to compare

Question 47

Characteristics of benign nodules?

Answer 47

Popcorn calcification Concentric calcification Pt < 40, < 3cm, well circumscribed

Question 48

Popcorn calcification on CXR?

Answer 48

Hamartoma

Question 49

Concentric calcification on CXR?

Answer 49

Old granuloma

Question 50

Characteristic of malignant nodule?

Answer 50

``` Pt has risk factors -smoking -old >3cm Eccentric calcification --> Lung bx and remove nodule ```

Question 51

A patient presents with weight loss, cough, dyspnea, hemoptysis, repearted pneumonia or lung collapse... most common cancer in non smoker?

Answer 51

Adenocarcinoma --> Scars of old pneumonia

Question 52

Adenocarcinoma location and mets?

Answer 52

Peripheral cancer | Liver, bone, brain, and adrenals

Question 53

Adenocarcinoma effusion characteristics?

Answer 53

Exudative with high hydralyronidase

Question 54

A patient presents with weight loss, cough, dyspnea, hemoptysis, repearted pneumonia or lung collapse... with kidney stones, constipation and malaise, low PTH + central lung mass?

Answer 54

Squamous cell carcinoma --> Paraneoplastic syndrome secondary secretion of PTH + rP, Low PO4 High Ca2

Question 55

A patient presents with weight loss, cough, dyspnea, hemoptysis, repearted pneumonia or lung collapse... with shoulder pain, ptosis, constricted pupil, and facial edema?

Answer 55

Superior sulcus syndrome from Small cell carcinoma (a Central Cancer)

Question 56

A patient presents with weight loss, cough, dyspnea, hemoptysis, repearted pneumonia or lung collapse... with ptosis better after 1 minute of upward gaze?

Answer 56

Lambert eaton syndrome fomr small cell carcinoma

Question 57

Pathophys of lambert eaton syndrome?

Answer 57

Antibodies against to pre-syn Ca channels

Question 58

A patient presents with weight loss, cough, dyspnea, hemoptysis, repearted pneumonia or lung collapse... with Na = 125, MMM, no JVD?

Answer 58

SIADH from small cell carcinoma --> Euvolemic hyponatremia --> fluid restrict +/- 3% saline in <112

Question 59

A patient presents with weight loss, cough, dyspnea, hemoptysis, repearted pneumonia or lung collapse... with CXR showing peripheral cavitation and CT showing distant mets?

Answer 59

Large cell carcinoma