Pulmonology - Emma Holliday Review Flashcards
When do you perform a thoracentesis?
Fluid >1cm on lat decubitus
If fluid from thoracentesis is transudative?
CHF, nephrotic, cirrhotic
If fluid from thoracentesis is transudative and low pleural glucose?
Rheumatoid arthritis
If fluid from thoracentesis is transudative and high lymphocytes?
TB
If fluid from thoracentesis is transudative and bloody?
Malignant or PE
If fluid from thoracentesis is exudative?
Parapneumonic or cancer
How is fluid from a thoracentesis classified as complex?
+ gram or culture, pH <60
If fluid from thoracentesis is complex?
Insert chest tube for drainage
According to Light’s criteria fluid is transudative if?
LDH < 200
LDH eff/serum < 0.6
Protein eff/serum < 0.5
High risk for PE?
Post surgery, hyperCoAg state
PE symptoms?
Pleuritic chest pain, hemoptysis, tachypnea, Decrease pO2, tachycardia
PE signs?
Right heart strain on EKG, sinus tach, decrease vascular markings on CXR, wedge infarct, ABG w/ low CO2 and O2
If PE is suspected what needs to happen first?
Give heparin
Dx tools in the work up on PE (in order)?
V-Q scan then spiral C-T
Gold standard for PE work up?
Pulmonary Angiography
If severe what do you use in a patient with PE?
Thrombolytics
When is thrombolytics CI in patient with PE?
S/P surgery or hemorrhagic stroke
Tx of life threatening PE?
surgical thrombectomy
Chronic CoAg CI what do you give PE patient?
IVC filter
ARDS pathophys?
inflammation –> impaired gas exchange, inflam mediator release, hypoxemia
ARDS causes?
Sepsis, gastric aspiration, trauma, low perfusion, pancreatitis
Dx of ARDS?
- PaO2/FiO2 < 200
- BL alveolar infiltrates on CXR
- PCWP is < 18 ( pulmonary edema non cardiogenic)
Tx of ARDS?
Mechanical ventilation w/ PEEP
COPD criteria for dx?
Productive cough > 3 months for > 2 consecutive years
COPD tx?
1st line = Ipratropium, tiotropium
2nd line = Beta agonist
3rd line = Theophylline
Indications to start O2?
PaO2 < 55 or SpO2 < 88% If cor pulmonale <59
Criteria for COPD exacerbation?
change in sputum, increasing dyspnea
Tx for COPD exacerbation?
O2 to 90%. albuterol/ipratropium nebs, PO or IV corticosteroids, FQ or macrolide ABx
Best prognostic indicator for COPD?
FEV1
What is shown to decrease mortality associated with COPD?
- Quitting smoking
2. Continuous O2 therapy >18 hrs/day
What is the goal for SpO2 in COPD? Why?
94-95%, Hypoxia is the only drive for respiration
New clubbing in COPDer? Next best step? Most likely cause?
Hypertrophic osteoarthropathy
CXR
Underlying lung malignancy
Tx of asthma if patient has symptoms twice a week and PFTs are normal?
Albuterol only
Tx of asthma if patient has symptoms 4x a week, night cough 2x a month and PFTs are normal?
Albuterol + inhaled CS
Tx of asthma if patient has symptoms daily, night cough 2x a week FEV1 60-80%
Albuterol + inhaled CS + LABA (salmetrol)
Tx of asthma if patient has symptoms daily, night cough 4x a week FEV1 < 60%
Albuterol + inhaled CS + LABA (salmetrol) + montelukast + oral steroids
COPD Exacerbation tx?
Inhaled albuterol and PO/IV steroids
What to watch in COPD exacerbation? How should PCO2 be?
Peak flow rates and blood gas
Low
COPD exacerbation with normalizing PCO2 means? Do what?
Impending respiratory failure –> intubate
COPD complications?
Allergic bronchopulmonary aspergillus
1 cm nodules in upper lobe w/ eggshell calcifications? What test needs to be done?
Tx if nodule is >10 mm
Silicosis
TB test
INH for 9 months
Reticulonodular process in lower lobes with pleural plaques?
Asbestosis
Most common cancer associated with asbestosis? Increased risk for?
Bronchogenic carcinoma
mesothelioma
Patchy lower lobe infiltrates, thermophilic actinomyces?
Hypersensitivity pneumonitis = “farmer’s lung”
Hilar lymphadenopathy, Increase ACE, erythema nodosum? With hypercalcemia? Important referral? Dx? Tx?
Sarcoidosis
Secondary to increase macrophages making VitD
Ophtalmology –> uveitis conjunctivitis in 25%
Biopsy
Steroids
Found a pulmonary nodule… 1st test?
Look for an old CXR to compare
Characteristics of benign nodules?
Popcorn calcification
Concentric calcification
Pt < 40, < 3cm, well circumscribed
Popcorn calcification on CXR?
Hamartoma
Concentric calcification on CXR?
Old granuloma
Characteristic of malignant nodule?
Pt has risk factors -smoking -old >3cm Eccentric calcification --> Lung bx and remove nodule
A patient presents with weight loss, cough, dyspnea, hemoptysis, repearted pneumonia or lung collapse… most common cancer in non smoker?
Adenocarcinoma –> Scars of old pneumonia
Adenocarcinoma location and mets?
Peripheral cancer
Liver, bone, brain, and adrenals
Adenocarcinoma effusion characteristics?
Exudative with high hydralyronidase
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?
Squamous cell carcinoma –> Paraneoplastic syndrome secondary secretion of PTH + rP, Low PO4 High Ca2
A patient presents with weight loss, cough, dyspnea, hemoptysis, repearted pneumonia or lung collapse… with shoulder pain, ptosis, constricted pupil, and facial edema?
Superior sulcus syndrome from Small cell carcinoma (a Central Cancer)
A patient presents with weight loss, cough, dyspnea, hemoptysis, repearted pneumonia or lung collapse… with ptosis better after 1 minute of upward gaze?
Lambert eaton syndrome fomr small cell carcinoma
Pathophys of lambert eaton syndrome?
Antibodies against to pre-syn Ca channels
A patient presents with weight loss, cough, dyspnea, hemoptysis, repearted pneumonia or lung collapse… with Na = 125, MMM, no JVD?
SIADH from small cell carcinoma –> Euvolemic hyponatremia –> fluid restrict +/- 3% saline in <112
A patient presents with weight loss, cough, dyspnea, hemoptysis, repearted pneumonia or lung collapse… with CXR showing peripheral cavitation and CT showing distant mets?
Large cell carcinoma
