Semmelweis Pulmonology Flashcards
CXR indications
Chest pain, fever, cough, shortness of breath
1) Infection
2) Inhaled foreign body
3) Chest trauma
4) PTX
5) HF
6) Lung cancer
7) Monitor disease progression & ICU patients
8) Screening CXR with pos. tuberculin skin test
CXR contraindications
Absolute: None
Relative: Pregnancy, Children
HRCT indications
Normal CXR but symptoms/pulm. function test suggesting diffuse lung disease
Assess disease activity
Select optimal biopsy site
MRI indications
1) Chest wall/mediastinal structures (Pancoast tumor)
2) Info. about tissue composition
3) Hematomas
4) Lymph nodes
5) Cysts
6) Operability
7) PE (in case of contrast allergy)
8) Lung metastasis to the brain
US indications
PTX
Lesions of pleura
Pleural effusion
Bronchoscopy indications
Diagnostic:
1) Suspected lung cancer
2) Staging of lung cancer
3) ILD
4) Microbiological sampling
5) Broncho-esophageal fistula
Therapeutic:
1) Aspiration (airway secretions, foreign body)
2) Airway stenosis (heat, cryo, mechanical, balloon, stent)
Bronchoscopy contraindications (CUUSSHH)
Compliance (Non-compliant/cooperative patient)
Unstable angina/MI within 6 weeks
Unstable bronchial asthma
Severe respiratory failure
SVC syndrome
HTN pulmonary
Hemodynamic instability/Hemorrhagic diatheses (renal failure, cirrhosis, anticoag. th.)
Biopsy contraindications
Low PLT count
High INR
Renal failure
Anticoagulant treatment
TNB indications
Peripheral pulmonary mass not accessible by bronchoscopy
inoperable tumor, high risk patient
TNB contraindications
Mechanical ventilation Contralateral pneumonectomy Vascular lesions Hydatid cyst Pulmonary HTN Bullous lung disease Bleeding disorder
Thoracoscopy indications
Exudative effusion evaluation
Pleurodesis in recurrent malignant effusions & rec. PTX
Breaking up loculations in empyema
Dg. of malignant & tuberculous pleural diseases
Video-assisted thoracoscopic surgery indications
Correction of PTX Bullectomy, lung volume reduction surgery (emphysema) Wedge resection Lung parenchyma biopsy Lobectomy, pneumonectomy
Thoracentesis indications
Diagnostic: New/unknown etiology pleural fluid that is >10mm thick
Therapeutic: Relieve symptoms in pleural effusion
Thoracentesis contraindications
Bleeding disorder/anticoagulation
Minimal fluid volume
Severe pulmonary disease
Uncontrolled cough
Pleurodesis indications
Recurrent malignant pleural effusion & PTX
Dyspnea improves after thoracentesis
Good status after thoracentesis
Lung reexpansion after thoracentesis
Bronchodilator reversibility test
Indications:
Diagnosis/follow-up of asthma
Differentiaton of asthma vs. COPD
Contraindications: None
Bronchial provocation test
Indications:
Suspected asthma with normal spirometry & flow volume results
Contraindications: Severe airway obstruction Recent MI/stroke FEV1 <1L or <50% predicted value Hypertension severe Aortic aneurysm
Indications of ergospirometry
Determine origin of dyspnea (cardiac/pulmonary cause)
Select candidates for heart transplantation, lung resection
Prognosis in heart disease, pulmonary vascular disorder, CF
Preoperative assessment, post-op follow-up
Contraindications of ergospirometry
Contraindications: Acute coronary syndrome Resting O2 sat <85% Decompensated HF Acute renal failure Uncontrolled arrhythmias Acute myocarditis, pericarditis Untreated thyrotoxicosis
Indications to STOP examination: Syncope Abrupt decrease in BP HTN Pallor AMS
Allergy test indications
Asthma, eczema, allergic rhinitis
Urticaria, angioedema
Systemic symptoms following insect sting
Allergy test contraindications
Elderly Comorbidities Skin conditions Medications (antihistamines, TCAs, BZDs, antipsychotics) Anaphylaxis recently
ABG indications
1) Respiratory failure (acute/chronic)
2) Severe illness leading to met. acidosis (HF, LF, RF, hyperglycemic states in DM, MOF, sepsis, burns, poisons/toxins)
3) Ventilated patient
4) Sleep studies
PET-CT indications
Lung cancer staging & lymphatic spread
Distant metastases
Follow up of therapy
Check for recurrence
Inhaler indications
Asthma/COPD w/ w/o acute excerbations
Pt. who exhibit expiratory wheezing
O2 therapy indications
Acute emergency oxygen: Cardiac arrest Hypotension MI Low CO states (shock, HF) Respiratory failure Hypoxemia (pneumonia, COPD, asthma, IPF, PH, PE) CO poisoning / drug overdose
LTOT in COPD
O2 therapy contraindications
Absolute: Untreated PTX, Drugs
Relative: Asthma, COPD, Claustrophobia, Fever, Seizures
LTx indications
High risk of death due to lung disease within 2 years if LTx is not performed
Diseases: COPD IPF Bronchiectasis Emphysema (A1AT) iPAH LAM ILDs Sarcoidosis
LTx contraindications
Absolute: Smoking Other orgain failure Malignancy, chronic HBV/HCV, HIV Psychiatric disorder, non-compliance
Relative: Age>70 Ventilator-depedent respiratory failure CAD Previous thoracic surgery Obesity
NIV indications
Type I & Type II respiratory failure
OSAHS
CHF
Acidosis
NIV contraindications
CV instability AMS/Unconscious/Uncooperative Copious secretions/Emesis Craniofacial abnormalities Obesity Burns Foreign body in airways
