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Family Shelf > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

3 common presenting signs of asthma?

A

Cough, SOB and wheezing

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2
Q

2 things heard on auscultation for asthma?

A

Decreased lung sounds and hyper resonance

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3
Q

How do we diagnose asthma?

A

Do a pulmonary function test. If it shows obstructive with the ratio being reduced then this is an abnormal test. Then try to rescue them with broncho dilator and if they are reversed, they have asthma. If the PFT is normal, try to induce them with methyl choline. If you cause them to have asthma, they have it.

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4
Q

3 things to treat an asthma attack?

A

O2, nebulizer and oral steroids

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5
Q

When can someone be sent home vs. sent to ICU for an asthma attack?

A

Don’t need 02, are not wheezing and PEFR is over 70%

O2 need is rising, build up of co2, and PEFR is less than 50%

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6
Q

3 big dog treatments for acute asthma attack if it isn’t getting better?

A

Racemic epi, sub q epi, and mg

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7
Q

What is the only way to diagnose COPD and what will it show?

A

PFT, obstructive, FEV1/FVC down

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8
Q

What is the qualifier for giving o2?

What is the goal of

A

Spo2 less than 88 or PaO2 less than 55

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9
Q

Two things to prevent COPD?

A

Stop smoking

Flue and pneumonia vaccines

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10
Q

How to treat COPD exacerbation?

A

Antibiotics, doxy and azithromycin
Dilators, albuterol and ipratropium
Steroids

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11
Q

Why do we want to keep COPD folks at 88-92 oxygen?

A

Their Respiratory drive is driven by hypoxia and not hypercapnia, so we want their o2 a little lower to help with that.

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12
Q

3 symptoms to look for for an acute COPD exacerbation?

A

Cough, wheeze and sputum

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13
Q

Typical presenting patient with lung cancer?

First step when we think someone has lung cancer?

A

fever, weight loss, coughing up blood, old man who has smoked for a long time.
CXR

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14
Q

If you see a mass, what to do next?

A

CT to localize the cancer

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15
Q

How do you take a biopsy if the lesion is by the large proximal airways?
What about if the lesion is out in the periphery?
Middle of the lung?

A

EBUS, basically a broncoscopy with US
CT guided percutaneous needle bx
video assisted thorascopic surgery

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16
Q

What is another way we can get a diagnosis of lung cancer from another pulmonary conditon?

A

did a thorancentesis for effusion, sent the fluid to path and found out cancer. stage 4

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17
Q

How do we stage lung cancer?

A

PET CT

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18
Q

first thing to do with lung cancer?
2nd?
3rd?

A

stage
PFTs
treat

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19
Q

What is primary prevention of lung cancer all about?

A

NO SMOKING

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20
Q

How do we screen for lung cancer and who gets it?

A

55-80
30 pack year hx of smoking
quit less than 15 years
low dose ct

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21
Q

4 factors that lead us to think a lung nodule is not cancer?

A

less than 8 mm
smooth surface
no smoking
less than 45

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22
Q

4 factors that lead us to think a lung nodule is cancer?

A

bigger than 2 cm
spiculated surface
hx of smoking
greater than 70

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23
Q

first step when you find a pulmonary nodule?

A

look at old films because if it has not grown/changed for 2 years, its a stable nodule and you can stop

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24
Q

If it is new or has changed, what do we do?

A

unstable nodule.
low risk factor pt., serial CTs
high risk factor pt, biopsy

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25
Q

patho, location, 2 paraneoplastic syndromes, and treatment of small cell?

A

smoking, centrally (trachea and bronchi), ACTC and SIADH, chemo and radiation

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26
Q

patho, location, 1 paraneoplastic syndromes, and treatment of squamous cell?

A

smoking, central, Parathyroid hormone related peptide (hyoercalcemia), stage, chemo, rad, resection

27
Q

patho, location, and treatment of adenocarcinoma?

A

asbestos (people who dont smoke get this), peripheral, stage, chemo, rad, resection

28
Q

patho, location, 1 paraneoplastic syndromes, and treatment of carcinoid?

A

serotonin related, anywhere, serotonin syndrome (check 5HIAA in urine), stage, chemo, rad, resection

29
Q

2 forms of pleural effusion?

A

transudate and exudate

30
Q

4 causes of transudate?

A 
CHF
nephrotic syndrome
gastrosis
cirrhosis
essentially fluid coming out of capillaries
31
Q

3 causes of exudate?

A

malignancy, pneumonia, TB

32
Q

What to start with when trying to diagnose effusion?

A

CXR to see that there is fluid

33
Q

3 image modalities to see if the effusion is loculated?

If it is, how to manage loculated?

A

US, CT, lateral cxr (best because cheapest)

thoracostomy, if fails, thoracotomy

34
Q

How do you treat effusion in CHF?

A

lasix, if that fails, thoracentesis

35
Q

what is the lights criteria to determine if it is transudate or eudate?

A

LDH of fluid (greater than 2/3 upper limit of normal)
LDH of fluid/LDH of serum - greater than .6
Total protein of fluid/Total protein of serum - greater than .5
any one is positive it is exudate. All need to be negative

36
Q

virchows triad?

A

venous stasis, hypercoagulable state, endothelial injury

37
Q

big time clinical sign of DVT?
Diagnose?
Treatment?

A

unilateral leg/limb swelling distal to clot
US
anticoagulate

38
Q

4 clinical symptoms to remember about PE?

A

cough up blood, chest pain, right heart strain due to increased pulmonary htn, hypoxia.

39
Q

what if the wells criteria for PE is less than 2, what do you do?

A

d dimer to confirm no PE

40
Q

what is the wells criteria is over 4 in CT and over 6 in VQ, what do you do?

A 
CT angiogram (spiral CT) with contrast 
VQ scan if they have bad kidneys
41
Q

How do you treat PE?

A

heparin to warfarin bridge for 5 days or INR is between 2 and 3, whichever is longer

42
Q

What is the only indication for IVC filter and PE?

A

they are bleeding and next PE would kill them

43
Q

When to use TPA?

A

BIG FREAKING CLOT

44
Q

What is the underlying issue with ARDS?

A

the diffusion barrier is thicker because of the fluid that has leaked out leading to edema. remember, oxygen is diffusion limited.

45
Q

What does the patient look like with ARDS?

A

sick as crap, short of breath, hypoxic, probably ICU on ventilator.

46
Q

How do we diagnose ARDS?

A

pulmonary edema on CXR and seeing them in respiratory failure basically

47
Q

What will the PCWP and LV function be in cardiogenic pulmonary edema from CHF and Pulmonary edema in ARDS?

A

PCWP in CHF up and LV fxn down

PCWP in ARDS normal or down and LV up or normal

48
Q

how to treat ARDS?

A

intubate keeping TV down and RR up to keep CO2 under control

PEEP

49
Q

What is the underlying, big picture problem of DPLD?

A

restricted fibrotic lung that does not oxygenate

50
Q

2 clinical symptoms of DPLD?

What will the PFT show?

A

hypoxic and dry cough

FEV1/FVC will go up

51
Q

best image modality for DPLD?

best way to diagnose?

A

high res CT

biopsy

52
Q

most common treatment for DPLD?

A

steroids

53
Q

3 rheumatoid diseases causing pulmonary fibrosis?

A

lupus, RA, and Systemic sclerosis

54
Q

buzz words for sarcroid?

A

black, female, bilateral hilar LA,

55
Q

what will high res CT show for DPLD?

A

ground glass opacities

56
Q

What is the thing that will help you make the diagnoses of sarcoidosis from others?

A

noncaseating granulomas.

57
Q

3 extra pulmonary manifestations of sarcoidosis?

A

heart block, bells palsy, E nodosum

58
Q

4 step process to diagnose DPLD?

A

xray, high res ct, PFT and biopsy

59
Q

two patient populations getting asbestos?
x ray finding for asbestos?
biopsy finding for asbestos?

A

shipyard and construction workers
pleural plaques
barbell bodies

60
Q

two patient populations getting sillicosis?

Look like on xray?

A

rock quarry and sand blastingfibrotic nodules in upper lobes, TB

61
Q

what lung exposure is associated with RA?

A

coal miners lung

62
Q

what is the main difference to remember about hypersensitivity pneumonitis?

A

this is antigen mediated. fever, cough, sob hours after exposure, but remove the antigen and symptoms go away. dont use steroids just take away antigen

63
Q

treat sarcoidosis?

A

steroids

64
Q

Tb and malignancy will look similar clincially and the exudate will differ if there is an effusion by what?

A

TB will have leukocytes with ADA positive

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