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Internal Medicine Shelf > Pulmonology - Emma Holliday Review > Flashcards

Pulmonology - Emma Holliday Review Flashcards

1
Q

When do you perform a thoracentesis?

A

Fluid >1cm on lat decubitus

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2
Q

If fluid from thoracentesis is transudative?

A

CHF, nephrotic, cirrhotic

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3
Q

If fluid from thoracentesis is transudative and low pleural glucose?

A

Rheumatoid arthritis

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4
Q

If fluid from thoracentesis is transudative and high lymphocytes?

A

TB

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5
Q

If fluid from thoracentesis is transudative and bloody?

A

Malignant or PE

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6
Q

If fluid from thoracentesis is exudative?

A

Parapneumonic or cancer

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7
Q

How is fluid from a thoracentesis classified as complex?

A

+ gram or culture, pH <60

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8
Q

If fluid from thoracentesis is complex?

A

Insert chest tube for drainage

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9
Q

According to Light’s criteria fluid is transudative if?

A

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

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10
Q

High risk for PE?

A

Post surgery, hyperCoAg state

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11
Q

PE symptoms?

A

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

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12
Q

PE signs?

A

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

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13
Q

If PE is suspected what needs to happen first?

A

Give heparin

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14
Q

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

A

V-Q scan then spiral C-T

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15
Q

Gold standard for PE work up?

A

Pulmonary Angiography

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16
Q

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

A

Thrombolytics

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17
Q

When is thrombolytics CI in patient with PE?

A

S/P surgery or hemorrhagic stroke

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18
Q

Tx of life threatening PE?

A

surgical thrombectomy

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19
Q

Chronic CoAg CI what do you give PE patient?

A

IVC filter

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20
Q

ARDS pathophys?

A

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

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21
Q

ARDS causes?

A

Sepsis, gastric aspiration, trauma, low perfusion, pancreatitis

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22
Q

Dx of ARDS?

A
  1. PaO2/FiO2 < 200
  2. BL alveolar infiltrates on CXR
  3. PCWP is < 18 ( pulmonary edema non cardiogenic)
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23
Q

Tx of ARDS?

A

Mechanical ventilation w/ PEEP

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24
Q

COPD criteria for dx?

A

Productive cough > 3 months for > 2 consecutive years

25
Q

COPD tx?

A

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

26
Q

Indications to start O2?

A

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

27
Q

Criteria for COPD exacerbation?

A

change in sputum, increasing dyspnea

28
Q

Tx for COPD exacerbation?

A

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

29
Q

Best prognostic indicator for COPD?

A

FEV1

30
Q

What is shown to decrease mortality associated with COPD?

A
  1. Quitting smoking

2. Continuous O2 therapy >18 hrs/day

31
Q

What is the goal for SpO2 in COPD? Why?

A

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

32
Q

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

A

Hypertrophic osteoarthropathy
CXR
Underlying lung malignancy

33
Q

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

A

Albuterol only

34
Q

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

A

Albuterol + inhaled CS

35
Q

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

A

Albuterol + inhaled CS + LABA (salmetrol)

36
Q

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

A

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

37
Q

COPD Exacerbation tx?

A

Inhaled albuterol and PO/IV steroids

38
Q

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

A

Peak flow rates and blood gas

Low

39
Q

COPD exacerbation with normalizing PCO2 means? Do what?

A

Impending respiratory failure –> intubate

40
Q

COPD complications?

A

Allergic bronchopulmonary aspergillus

41
Q

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

A

Silicosis
TB test
INH for 9 months

42
Q

Reticulonodular process in lower lobes with pleural plaques?

A

Asbestosis

43
Q

Most common cancer associated with asbestosis? Increased risk for?

A

Bronchogenic carcinoma

mesothelioma

44
Q

Patchy lower lobe infiltrates, thermophilic actinomyces?

A

Hypersensitivity pneumonitis = “farmer’s lung”

45
Q

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

A

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

46
Q

Found a pulmonary nodule… 1st test?

A

Look for an old CXR to compare

47
Q

Characteristics of benign nodules?

A

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

48
Q

Popcorn calcification on CXR?

A

Hamartoma

49
Q

Concentric calcification on CXR?

A

Old granuloma

50
Q

Characteristic of malignant nodule?

A 
Pt has risk factors
-smoking
-old
>3cm
Eccentric calcification --> Lung bx and remove nodule
51
Q

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

A

Adenocarcinoma –> Scars of old pneumonia

52
Q

Adenocarcinoma location and mets?

A

Peripheral cancer

Liver, bone, brain, and adrenals

53
Q

Adenocarcinoma effusion characteristics?

A

Exudative with high hydralyronidase

54
Q

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?

A

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

55
Q

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

A

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

56
Q

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

A

Lambert eaton syndrome fomr small cell carcinoma

57
Q

Pathophys of lambert eaton syndrome?

A

Antibodies against to pre-syn Ca channels

58
Q

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

A

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

59
Q

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

A

Large cell carcinoma

Internal Medicine Shelf (4 decks)

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