Medicine - Pulm Flashcards
(152 cards)
1
Q
Name the Causes of ARDS (10)
A
ARDS
A= Aspiration vs. [Acute Pancreatitis] vs. [Air Fluid Embolus (amniotic)]
R= Radiation
D= Drugs vs. DIC vs. Drowning
S= Sepsis vs. Smoking vs. Shock
ARDS is a restrictive pattern that –> ⬇︎Lung Compliance, Pulm HTN and impaired gas exchange
2
Q
Tx for ARDS
A
PEEP (Positive End Expiratory Pressure)
3
Q
Based on GOLD Criteria, how should COPD pts be treated?
A
4
Q
What is the 4 Criteria for COPD Exacerbation
A
- SOB
- ⬆︎Cough
- Sputum ∆
- BL wheezing w/ respiratory acidosis
5
Q
Tx for COPD Exacerbation-4
Which improves survival? Which ⬇︎future events?
A
“I’m having COPD Exacerbation! Give me DOPA! (but not really)”
- Duoneb (albuterol + ipratropium)
- O2 PRN via BiPAP (goal: 90-94% O2 Sat) -only when desat
- [Prednisone 40 mg qd x 5]
- Abx (Azithro-⬇︎future events or Levoflox or Doxy)
6
Q
Criteria for Pulmonary HTN ; What are causes?-7
A
Pulm Arterial presure ≥25 (normal = 20);
- L Heart Dz = MOST COMMON
- Drugs (see image)
- [Limited CREST Scleroderma]
- SLE
- Recurrent VTE
- Idiopathic Primary
- Chronic Lung Dz
7
Q
Difference between [Dead Space Ventilation] and [Physiological shunting]; Which causes Hypoxemia?
A
[Dead Space Ventilation] = Area of Lung that has Good Ventilation but poor perfusion
vs.
[Physiological Shunting] = Area of Lung with POOR Ventilation but good perfusion which—> physiological shunting –> Hypoxemia (Think PNA) - “You’ll get Shunts when the [VP is PG” = Ventilation Poor but Perfusion is Good]
8
Q
What mediastinal masses are found in the…
A: Anterior mediastinum
B: Middle mediastinum
C: Posterior mediastinum
A
A: Anterior = Thymoma
B: Middle = Bronchogenic Cyst
C: Posterior = Neurogenic tumors (Meningocele/Lymphomas/Esophageal tumors)
9
Q
For pts on ventilators, what are the best ventilator setting changes for ⬆︎ oxygenation-2 and why
A
- INC PEEP ( prevents alveolar collapse/Reopens old ones/Reduces shunting) AND Reduces mortality in ARDS pts
- INC FiO2 (note: >60% for long time–>proinflammatory O2 free radicals!)
10
Q
Most common sx of Pulmonary Embolism-5
A
- Pleuritic Chest Pain
- SOB
- Cough
- Tachypnea
- Tachycardia
Physical Exam: Rales, low Fever, Hemoptysis
11
Q
(LTOT-Long Term Oxygen Therapy) improves survival in Stage 4 COPD pts
When is LTOT indicated-3 and how long/day is it used?
A
- [PaO2 LOE 55 mm Hg] OR
- [Pulse Ox SaO2 LOE 88] OR
- FEV1 < 30%
should be used GOE 15 hours/day!
In Cor Pulmonale pts, PaO2 LOE 59 or SaO2 LOE 89
12
Q
Describe the Approach to a PE pt
A
13
Q
Classic Sx of Sarcoidosis-8
A
CCUBBEDD
Cardiac (Restrictive Cardiomyopathy)
HYPERCalcemia
Uveitis –> Vision loss
Bilateral Hilar LAD!
Bell’s Palsy
Erythema Nodosum (SubQ Fat lesions)
[Dry cough & Dyspnea]
Diffuse interstitial fibrosis
- elevated ACE and 1-25VitD production –> HYPERCalcemia and HYPERCalciuria*
- Image showing b/l Hilar LAD*
14
Q
Sarcoidosis Etx-2 (Etiology)
A
[CD4 Helper T] inappropriately respond to environmental triggers + Suppressed TRegs –> Non-Caseating Granulomas in Lung
Image showing b/l Hilar LAD
15
Q
Sarcoidosis Tx-4
A
“Sarcoidosis is a SCAM”
Steroids
Cyclosporine
Azathioprine
MTX
Image showing b/l Hilar LAD
16
Q
How long does it take Malignant Pulm Nodules to double in size? How does this affect diagnostics?
A
1 month - 1 year; Pt with stable Pulm Nodule > 1 year = NO CA!
17
Q
Bronchiectasis Etx
A
Recurrent Cycle of
[Poor mucociliary clearance –> Bacterial infection –> Inflammation –> Bronchial Dilation and thickening–> Cough w/tenacious sputum and Hemoptysis]
Dx = High Res CT Chest
18
Q
Gold standard dx for Bronchiectasis
A
High Res CT chest scan (initial dx)
19
Q
List the Obstructive causes of Bronchiectasis (2)
A
A:
1) Tumor
2) Foreign Body
20
Q
List the Infectious causes of Bronchiectasis (2)
A
1) TB
2) [Aspergillus Fumigatus in ABPA]-Allergic BronchoPulmonary Aspergillosis] –> will be associated with [recurrent transient pulm infiltrates]
21
Q
List the Congenital causes of Bronchiectasis (3)
A
1) Immunodeficient Syndromes
2) cystic fibrosis
3) Kartagener (1° Ciliary Dyskinesia)
22
Q
List the Random causes of Bronchiectasis (3)
A
1) Rheumatoid Arthritis
2) Lupus
3) Graft
23
Q
What is the most common cause of Hemoptysis
A
Bronchitis (usually [acute s/p viral infection] but could be chronic also)
Tx = supportive
Also think about: Bronchiectsis/TB/CA/Trauma/PE
24
Q
Describe Bronchial Breath Sounds-2
A
[Loud short inspiration]
+
[Loud LONG EXPIRATION]
25
What does Bronchial breath sounds indicate?-3 Where in the body are Bronchial bs normal?
Alveoli are full of blood/pus/water= **Pulmonary Consolidation**--\> SHUNT;
THIS IS NORMAL OVER THE TRACHEA
26
Which **bacteria** cause Community Acquired PNA-8
1. Strep Pneumo
2. H. Flu
3. Moraxella
4. MRSA
5. Mycoplasma pneumoniae-*AT (ATypical)*
6. Chlamydophila pneumoniae-*AT*
7. Chlamydophila Psittaci-*AT*
8. Legionella-*AT*
27
Which **NON**-bacteria cause Community Acquired PNA-3
1. Flu
2. TB
3. Histoplasmosis
28
What determines whether or not Community Acquired PNA is admitted?
If pt has 1 of the **CURB 65**
**C**onfusion
B**U**N \> 19
**R**espiratory Rate \> 30
**B**P: Systolic \< 90
**65** y/o or older
29
Tx for Community Acquired PNA-4
1. CefTriaxone
2. CefTriaxone + Azithromycin
3. Levofloxacin (*For inpatient vs. Severe Outpatient*)
4. Vanc (*MRSA suspicion only*)
30
Name Drugs that cause Asthma exacerbation and why-4
1. NSAIDs (*pushes Arachodonic Acid pathway to leukotriene production*)
2. ASA (*pushes Arachodonic Acid pathway to leukotriene production*)
3. General B Blockers (*bronchospasms*)
4. MgSO4 (*⬆︎Histamine*)
31
What's the most significant finding in this CXR and what does it indicate?
Westermark Sign! = Pulmonary Embolus!
32
Formula for Alveolar-arterial oxygen gradient
33
Normal Alveolar-arterial oxygen difference is **Less than \_\_\_\_\_**. What does Higher difference indicate?
34
CXR findings for PE -4
1. Elevated hemidiaphragm
2. Atelectasis
3. Westermark sign
4. Hampton's Hump
35
Indications for IVC Filter -2
1. Anticoagulation ctx
2. Recurrent DVT/PE **despite** anticoag
36
*Family hx of Thrombosis is best indicator for inherited hypercoagulability*
Name the common inherited hypercoagulable diseases-5
1. Antiphospholipid Syndrome
2. Factor 5 Leiden
3. ⬆︎ Factor 8
4. Prothrombin 20210 mutation
5. Hyperhomocysteinemia
37
List 2 major signs of impending respiratory failure
1. Conversational Dyspnea
2. Abd paradoxus (abd moves **inward** during inspiration = diaphragmatic fatigue)
38
*Hospitalization, Nursing homes, abx use are common causes of healthcare-associated PNA*
Name UnCommon causes of healthcare-associated PNA-5
1. Hemodialysis
2. Family member w/MDR pathogen
3. Outpatient wound care
4. Gastric acid suppressants (PPI, H2 blocker)
5. Tube feedings
39
Which **bacteria** cause PNA in Immunodeficient pts -4
**NACS**
1. **N**eg gram rods (***N**EUTROPENIC PTS*)
2. **A**spergillus
3. **C**andida
4. **S**taph
40
Tx for Healthcare associated PNA 2/2 Pseudomonas -2
Zosyn vs. CefTazidime
## Footnote
"*Zoe* needs *Pipe* from *Tae*"*(Piperacillin / Tazobactam)*
41
Supplemental O2 should be given with what O2 Sat goal? Why is this?
90-94 %; below 90% --\> HUGE ⬇︎ Hb Saturation
42
How does Cirrhosis cause Hypoxia?
43
Dead Space % is represented in formulas by ____ and is defined as \_\_\_\_
VD/VT ; % of Tidal volume that is NOT partcipating in gas exchange (*anatomic vs physiologic*)
44
*\_\_\_% of Tidal Volume (VT) is normally Dead Space*
What conditions ⬆︎Dead space -3
Normally, **30% of VT is Dead Space**
45
Name the Conditions in which **Diffusion Capacity** is *INCREASED* (3)
A: [CHF vs. Polycythemia vs. Hemorrhage] --\> INC DLCO
## Footnote
*\*\*All others (PILEA) DEC diffusion capacity\*\**
46
Define [Solitary Pulmonary Nodule]
Single Lung nodule **1-6 cm** that does NOT invade
47
*Pt with hemoptysis comes in with [Coin lesion on CXR]*
What determines whether or not she needs w/u?
**1ST: LOCATE PREVIOUS (At least 1 year prior or older) CXR!** If lesion unchanged = NO CA
## Footnote
*Coin lesions = 80% chance malignancy*
48
3 characteristics of pulmonary nodules tht make them more likely to be **Malignant**
1. **Size**: Bigger is worst
2. **Border**: Spiculated / Retracted from surrounding tissue / irregular
3. **Location**: Endobronchial proximal extension/Local invasion/Satellite Nodules
49
DDx for Solitary Pulmonary Nodule -5
1. CA: hamartoma/metastasis/primary
2. Infectious: granulomatous/fungal (blasto,histo)
3. Pneumoconiosis
4. Vasculitis
5. Scar
50
What is FDG-PET? How are results interpreted?-3
*fluorodeoxyglucose (FDG)-positron emission tomography (PET)*
Pt is given radioactive sugar water --\> taken up my tumor as main source of energy--\> SUV (Standard uptake value)
\>3 SUV = Malignant
2 - 3 = Inderterminate
\<2 = benign
*not good for Brain/Liver/Kidney CA*
51
What are the Cons of FDG-PET?
NOT good for Brain/Liver/Kidney CA
52
What are the minimal PFT requirements before Lung CA resection - 2 ;
[PreOp FEV1 GOE 2L] or [Predicted PostOp FEV1 GOE 0.8L]
## Footnote
*If MD expects to resect 25% Lung volume and pt PreOp FEV1 is 1.5 L, then Predicted PostOp FEV1 will = 1.125 L*
53
Describe the system used to diagnose DVT
Wells Criteria!
54
DVT tx - 2
1st: Therapeutic Heparin vs Lovenox
2nd: [Warfarin px vs NOAC] x at least 3 months
55
Advantages of Lovenox over Unfractionated Heparin - 4
Lovenox...
1. Longer half life = administered SubQ only 1-2/day (but note: this also means it takes longer to reverse if surgery is needed)
2. No Lab monitoring
3. FIXED Dosing
4. ⬇︎probability of HIT Thrombocytopenia
56
*You hear Stridor in a patient*
What is your DDx?-4 ; How can you differeniate between them?
Biphasic = Inspiratory AND Expiratory (Vascular Ring)
*LaryngoMalcia: Laying down is Malicious (Supine worsens Stridor)*
57
Tx for Croup
Nebulized Racemic Epi breathing tx
58
Laryngomalacia Etx
Collapse of supraglottic structures during inspiration --\> *Laying down is Malicious (LaryngoMalacia) = Supine worsens Stridor*
59
**Asthma** Etx
Excess TH2 cells *(recruited by hypersensitive APC to inhaled allergens)* secrete **IL4** --\>activates [B-lymphocyte class switching for IgE Ab]--\> IgE binds to Mast cells which will then secrete **IL5** --\> Recruits Eosinophils--\>which release mediators like Leukotrienes.
60
List the 5 Step Asthma action plan based on
SABA use
and
Nighttime Awakenings
61
Describe Kerley B lines and what they represent
Interstitial fluid in lung tissue appearing as 3 cm linear densities in lung periphery = CHF
62
*Orthopnea differs from Paroxysmal Nocturnal Dyspnea in that it occurs **while pt is awake** EVERY time they lie down*
Which conditions are associated with Orthopnea? - 6
1. CHF which can --\> Pulmonary Edema
2. Pulmonary edema
3. Asthma
4. Chronic Bronchitis
5. OSA
6. Panic Disorder
63
Why is an inspiratory hold maneuver performed?
To measure the pulmonary compliance (sum of the elastic pressure) so that the PEEP can be matched with that
64
Common side effects for Beta 2 agonist - 4
1. **hypOkalemia** --\> muscle weakness, arrhythmias
2. Palpitations
3. Tremor
4. HA
65
Imaging findings for Bronchogenic Carcinoma - 4
## Footnote
*Asbestos --\> Bronchogenic carcinoma \> mesothelioma*
1. **BL** Pleural Plaques (pleural mesothelioma will have uL pleural abnormality)
2. BL Pleural thickening
3. Honeycoming (cystic areas surrounded by interstitial infiltrates)
4. BL CENTRAL reticulonodular infiltrates
## Footnote
*smoking enhances asbestos damage. SOB comes from fibrosis, NOT the pleural calcifications*
66
Which pulmonry process targets the bilateral lower lobes of the lung?
AAT-Alpha 1 antitrypsin deficiency --\> Panacinar Basilar predominant emphysema --\> **⬇︎Bilateral Breath Sounds** *Smoking --\> Upper lobe centriacinar emphysema*
67
Alpha 1 Antitrypsin Dx? ; Tx?
Dx=serum AAT levels ; Tx = Pooled AAT
## Footnote
*This is a Panacinar Basilar predominant disease*
68
What is the difference between Aspiration Pneumonitis and Aspiration PNA?
A Pneumonitis = Lung inflammation from gastric acid
A PNA = Lung INFECTION from oropharygeal secretions
69
How do you diagnose Asthma - 2
1. FEV1/FVC ⬆︎ ≥12% with Bronchodilator OR
2. FEV1/FVC ⬇︎ ≥20% with Methacholine
70
How can you tell if a pt has GERD-induced or ASA-induced asthma, or true asthma?
True asthma will be REVERSIBLE with bronchoDilator. Others will NOT!
71
Somter's Triad describes \_\_\_\_
What is the triad? ; Tx?
Drug-induced Asthma
1. Asthma or chronic rhinosinusitis
2. Nasal Polyps
3. ASA sensitivity is the cause
Tx = Montelukast Leukotriene inhibitor
72
Most lung conditions cause a respiratory \_\_\_\_\_[acidosis/alkalosis]. Why is this?
Which lung condition causes the opposite of this?
Respiratory **Alkalosis**; PE, atelectasis, pleural effusion, pulm edema --\> V/Q mismatch --\> compensatory tachypnea
alveolar hypOventilation --\> respiratory acidosis
73
What is the mainstay tx for COPD
Muscarinic R Blockers
74
Name the conditions associated with Granulomas - 6
1. TB
2. Tertiary syphillis gummas
3. Blastomycosis
4. Histoplasma
5. Sarcoidosis
6. Churg Strauss Eosinophilic Granulomatosis with Polyangiitis
75
How do pts with ____ minimize their [Work of Breathing]
A: ***Obstructive*** Disorders
B: ***Restrictive*** Disorders
A: ***O**bstructive*= [sl**OO**w + Deep] Breaths
B: *Restrictive*= [fast + shallow] Breaths
76
*Based on the image:*
Is the pathology **Obstructive** vs. **Restrictive** vs. **Tracheal Stenosis**
**Obstructive - *Emphysema*** *(intraAlveolar wall destruction)*
78
What is **Bronchiectasis**
[Chronic Necrotizing Inflammation of Bronchi & Bronchioles]---\> [Permanent **Dilatation** of Bronchi & Bronchioles] ---\> [Daily Copious Mucus production]
79
Is ARDS an obstructive, restrictive or normal breathing pattern?
**RESTRICTIVE**
So is Laryngeal Edema
80
What is normal Jugular Venous Pressure? - 2
\<4cmH20
OR
\<7mmHg
81
Name the diseases that are
Obstructive but with a Low Diffusion Capacity
82
Name the diseases that are
Obstructive but with a Normal Diffusion Capacity - 2
83
Name the diseases that are
Obstructive but with a HIGH Diffusion Capacity
84
Name the diseases that are
Restrictive but with a low Diffusion Capacity - 4
85
Name the diseases that are
Restrictive but with a Normal Diffusion Capacity - 2
86
Name the diseases that are
Restrictive but with a HIGH Diffusion Capacity
87
Name the diseases that are
Normal Spirometry but with a low Diffusion Capacity - 3
88
Name the diseases that are
Normal Spirometry but with a HIGH Diffusion Capacity - 2
89
A diagnostic pleuracentesis is performed
What are the diagnostic measurement values for EXUDATIVE pleural fluid - 5
*Usually caused by ⬆︎capillary or pleural membrane permeability*
1. **Pleural:Serum protein \>0.5**
2. **Pleural:Serum LDH \>0.6**
3. Pleural LDH \> 2/3 of the upper limit of normal serum LDH
4. pH\<2
5. Glucose\<60
90
A diagnostic pleuracentesis is performed
What are the diagnostic measurement values for Transudative pleural fluid - 2
pH = 7.40-7.55
*normal pleural pH = 7.6*
91
A diagnostic pleuracentesis is performed
There are high levels of amylase present
Dx?-2
1. pancreas-associated
2. esophageal rupture
92
A diagnostic pleuracentesis is performed
There is a Pleural fluid glucose\<60
Dx?-4
1. Empyema (complicated parapneumonic effusion)
2. CA
3. RA
4. TB
## Footnote
*Glucose is low in Empyema because of the high metabolic activity of leukocytes and/or bacteria*
93
Would you expect CHF to cause respiratory Alkalosis or Acidosis? Why?
Respiratory Alkalosis ; CHF pulm edema --\> tachypnea
94
What should the goal O2 sat be when placing a COPD pt on supplemental Oxygen? ; Why is this?
SaO2: 90-93% only
HIGH O2 will knock out COPDers drive to breath --\> hypOventilation --\> Respiratory acidosis --\> cerebral vasoDilation --\> seizures and AMS
95
What are the 2 key things to remember when manging ARDS
1. Prevent SpO2 \< 88% (may need to use high PEEP\> 5)
2. Prevent alveolar overdistension with low tidal volumes ≤6cc/kg
3. Prevent Hyperventilation (RR x TV) as this --\> Respiratory Alkalosis
## Footnote
*ARDS etx = Lung injury --\> fluid and cytokine leakage into the alveoli --\> refractory hypoxia and Pulm HTN*
96
Hypersenstivity Pneumonitis etx ; mngmt?
Lung parenchyma inflammation from antigen exposure (usually from bird droppings or molds a/w farming ; Avoidance
episodes last 4-6 hrs after exposure and chronically can --\> pulm fibrosis
97
What is the most common side effects for long term inhaled Corticosteroids?
Oral Candidasis (Thrush) for **INHALED CTS**
98
What's the most sensitive indicator for a pt who's Hypovolemic/Dehydrated?
⬇︎Urine Na+
## Footnote
Urine Na:Urine Creatinine \< 1%
99
In pts with PE, what is the mechanism for why they have symptoms?
**Pulmonary Infarction** from the embolus --\> sx
100
In Asbestos Interstitial Lung Disease, what is the mechanism for why pts become SOB?
Pulmonary Fibrosis (restrictive lung disease)
## Footnote
*Image: Pleural Plaques = pathopgnomonic*
101
What are the major causes of Interstitial Lung Disease - 4
1. Dust inhalation (Asbestos, Beryllium, Silicon)
2. Drugs (Amiodarone, Bleomycin, Macrobid)
3. Radiation
4. Connective tissue disease (RA, Scleroderma)
102
Alveolar bleb rupture is the most common cause of spontaneous ptx in pts with ___ disease
COPD
103
Risk factors for Aspiration PNA - 4
1. Altered consciousness due to EtOH
2. Vomiting due to EtOH
3. Neurologic dysphagia (stroke)
4. Mechanical disruption of glottic closure (ET or NG tube)
104
cp for MASSIVE Pulmonary Embolism - 3
1. hypOtension
2. JVD
3. RBBB acutely from severe R Heart Strain
105
Chronic smokers who present with suddent joint pains is suggestive of \_\_\_\_\_, which can indicate what underlying disease?
hypertrophic osteoarthropathy ; LUNG CA
106
What is the purpose of Chest Physiotherapy? ; Indication?
Loosens and promotes expectoration of secretions ; Bronchiectasis
107
A diagnostic pleuracentesis is performed
There are high levels of Triglycerides present
Dx
Chylothorax exudate
from lymph leaking out of the thoracic duct (milky white fluid)
108
List the 5 Step Asthma action plan Treatment
109
Any pt with Decreased Breath Sounds Bilaterally should be suspected for \_\_\_\_\_\_
AAT - Alpha 1 Antitrypsin Deficiency Panacinar Emphysema
## Footnote
*Look for fam hx (NonAlcoholic Liver cirrhosis) or slight transaminitis*
110
Alpha 1 Antitrypsin deficiency cp - 3
1. **⬇︎breath sounds bilaterally** (from panacinar basilar predominant emphysema)
2. transaminitis (could be slight)
3. +/- Skin panniculitis
## Footnote
*NonAlcoholic Liver Cirrhosis is 2nd most common cause of death in these pts*
111
Chronic Bronchitis diagnostic criteria
3 consectuve months of productive cough within a 2 year period
112
In Idiopathic Pulmonary Fibrosis interstitial lung disease, would you expect Alveolar-arterial gradient to be High or low? ; Why?
HIGH (A-a gradient = difference between oxygen content in Alveoli and artery)
IPF (collage deposition in peri-alveolar tissue) ILD --\> impaired gas exchange
113
How does Lung Consolidations present? - 3
1. ⬆︎breath sounds
2. ⬆︎tactile fremitus
3. Dullness to percussion
114
Kartagener Syndrome cp triad ; etx?
1. Situs Inversus
2. Recurrent Sinusitis (impaired mucociliary clearance)
3. Bronchiectasis (impaired mucociliary clearance)
etx = primary ciliary dyskinesia
115
What are the main complications of positive pressure ventilation - 2
1. tension PTX --\> hypOtension
2. alveoalar damage
116
How do you work up a Solitary Pulmonary Nodule
## Footnote
*Round, \<3cm, no LAD*
117
Why is it alarming when a pt who clearly has ⬆︎Work of Breathing has a normal pH and normal PaCO2?
If they visually have ⬆︎WOB than you expect their PaCO2 to be low and pH to be low but if these values are normal, the pt is likely going into **RESPIRATORY COLLAPSE** and can no longer maintain adequate ventilation due to fatigue
118
How do these parameters change in COPD pts
Elasticity
Compliance
alveolar Elasticity (how well tissue snaps back) **DECREASES** --\> ⬇︎ability to expel air
alveolar Compliance **INCREASES** --\> making it easier for incoming air to fill alveoli
BOTH of these --\> diaphragm flattening, difficulty expanding thoracic cavity --\> ⬆︎WOB
119
Tx for Upper Airway Cough Syndrome
1st Gen Antihistamine +/- Decongestant
120
How do Anaerobic lung infections present on imaging?
**CAVITARY** **LESIONS** (not lobar infiltrate) in lower lobes
## Footnote
(*lobar infiltrates more likely represent typical PNA*)
121
Describe the following values for PNA:
breath sounds
tactile fremitus
percussion
⬆︎bs / ⬆︎TF / Dullness to percussion
122
Describe the following values for Pleural Effusion:
breath sounds
tactile fremitus
percussion
⬇︎bs / ⬇︎TF / Dullness to percussion
123
Describe the following values for PTX or emphysema:
breath sounds
tactile fremitus
percussion
⬇︎bs / ⬇︎TF / Hyperresonance to percussion
124
What are the txs for SIADH - 1st/2nd/3rd line?
1st: FLUID RESTRICTION
2nd: Hypertonic saline
3rd: ADH R Blocker (Demeclocycline)
125
What paraneoplastic syndromes are Small Oat Cell Lung carcinoma (SOLC) associated with? - 2
1. SIADH
2. ACTH (Cushings Syndrome)
126
What paraneoplastic syndromes is Squamous cell lung carcinoma associated with?
s**Ca****++**mous cell carcinoma!
⬆︎⬆︎PTHrelatedProtein --\> **HYPERCALCEMIA**
127
Pts with underlying lung disease like ____ are at risk for develoing chronic pulmonary aspergillosis
Diagnostic criteria for this?
cavitary TB;
Dx = ALL 3 must be present
1. \>3 mo sx (fever, wt loss, hemoptysis)
2. Cavitary lesions contains aspergilloma fungal balls
3. IgG serology positive for Aspergillus
128
Where is lung ADC located? ; what's the most important prognostic factor?
peripherally ; Stage at diagnosis since survival is determiend by resectability
129
Main clinical characteristic of Microscopic Polyangiitis ; Which antibody?
Hemoptysis; p-ANCA
130
Main clinical characteristic of Wegener Granulomatosis with polyangiitis-2 ; Which antibody?
Hemoptysis and ELK; **C**-ANCA
131
Main clinical characteristic of Churg Strauss Eosinophilic Granulomatosis with polyangiitis-4 ; Which antibody?
1. **A**sthma
2. **G**ranulomas
3. **E**osinophilia
4. Nasal polyps with rhinitis
; p-ANCA
132
DDx for Hemoptysis - 5
**BBcTT**
1. \*\*\* **B**ronchitis - MOST COMMON! \*\*\*
2. **B**ronchiectasis
3. **C**ancer
4. **T**B
5. **T**rauma (PE)
133
What are the common causes of clubbing? - 2
1. Lung ADC
2. Cystic Fibrosis
134
Silicosis ⬆︎risk for developing _____ and causes _____ lesions on imaging
Which demographics are mostly affected?-2
TB ; cavitary lung lesions
1. Stone Workers
2. Miners
***Stone Miners*** *are **Sili** and they're going to get **TB**!*
135
Physiologically, what causes hypoxemia in pts with Pneumonia?
Ventilation/Perfusion mismatch - a shunt occurs direct blood away from alveoli and this is why O2 supplement barely help
136
pt presents with pulmonary nodules surrounded by ground glass opacities
Dx? ; Tx?-2
Aspergillosis
tx:
1. Voriconazole AND
2. Caspfungin
Image shows "halo sign"
137
Brutons X linked agammaglobulinemia etx
**low B lymphocytes** --\> low Ig --\> sinopulmary and GI infections
## Footnote
*puts pt at risk for infections like Giardia*
138
Cyclosporine and Tacrolimus have the same MOA
Side Effects for these two are similar as well. List side effects for Cyclosporine - 4 ; which 2 does Tacrolimus share?
1. Gum Hypertrophy - Cyclosporine
2. Hirsuitsm - Cyclosporine
3. Nephrotoxicity with HyperKalemia
4. Tremor
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Side effects of Azathioprine - 3
1. Diarrhea
2. Hepatotoxicity
3. Leukopenia
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Side effect of Mycophenolate
Marrow Suppression
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A neonate is born with absent T cells and dysfunctional B cells
Diagnosis? ; Tx?
Severe Combined ImmunoDeficiency (SCID) ; Stem Cell Transplant
Absent T causing fucked up B
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In pts with chronic granulomatous disease, there is an impaired _______ which leads to ⬆︎infection with which organisms? ; Dx?-2
oxidative burst ; catalase positive (Staph A, Serratia, Burkholderia)
1. nitroblue tetrazolium OR
2. dihydrorhodamine
Both of these are neutrophil function test
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What is Leukocyte Adhesion Deficiency associated with? - 3
1. Delayed umbilical cord separation
2. periOdontal disease
3. recurrent sinopulmonary infection
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After transplant, when does Acute Cellular Rejection occur? ; How does it present? - 3
\<90 days ;
1. RUQ pain
2. Transaminitis
3. Fever
*HYPERacute occurs in \< 7 days*
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Hereditary Angioedema etx
deficiency or dysfunction of C1 inhibitor --\> ⬆︎bradykinin and C2b
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pts with pharyngeal cobblestoning likely have _____ and need to be treated with \_\_\_\_\_\_
allergic rhinitis ; nasal corticosteroids
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MOD for Severe Combined Immunodeficiency (SCID) ; tx?
Defective T cell maturation --\>dysfunctional B cells --\> recurrent **viral, fungal, bacterial** infections
"Absent T causing fucked up B"
Tx = stem cell transplant
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MOD for Common Variable Immunodeficiency
**hypOgammaglobulinemia** --\> recurrent Sinopulmonary and GI bacterial infections
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Wiskott Aldrich Syndrome presents at what stage of life? ; cp?-3
infancy;
1. eczema
2. bleeding
3. sinopulmonary infections
MOD = disables cytoskeleton remodeling
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Why should a pt with recurrent sinopulmonary and GI infections be **thoroughly** screened before receiving blood transfusions?
They could have Selective IgA Deficiency which --\> production of Anti-IgA in their blood. After receiving blood transfusion those Anti-IgA would --\> anaphylaxis
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MOD for Hyper IgM Syndrome ; What would the laboratory values show? -4
CD40 ligand defect --\> **severe sinopulmonary infections** ;
1. Hyper IgM
2. low IgG
3. low IgA
4. normal lymphocyte (CD4/CD8) populations
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Guidelines for Lung CA screening - 3
**low dose annual CT** if fits all 3 criteria:
1. [55-80 yo]
2. smoked for 30 pack years
3. still smoking or quit within last 15 years
* Pack Year = [# of packs/day x # of years smoking]*
* ex: [4 packs/ day x 30 years smoking = 120 pack years]*
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