Pulm Flashcards by Jennifer Hidinger

Obstructive lung disease:
(↓/↑) TLC
(↓/↑) FEV1/FVC
(↓/↑) compliance
(↓/↑) elasticity

↑TLC, ↓FEV1/FVC (<70%), ↑compliance, ↓elasticity

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Restrictive lung disease:
(↓/↑) TLC
(↓/↑) FEV1/FVC
(↓/↑) compliance
(↓/↑) elasticity

↓TLC, ↑FEV1/FVC, ↓compliance, ↑elasticity

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Emphysema:
smoking causes…
A1AT deficiency causes…

smoking causes centriacinar emphysema (upper lungs)

A1AT deficiency causes panacinar emphysema (lower lungs, pts <50 y/o)

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Defn and Tx of stage I-IV obstructive lung disease?

(FEV1 ≥80%) Tx short-acting bronchodilators (albuterol, ipratropium)
(FEV1 50-80%) add long-acting
bronchodilators (salmeterol, tiotropium)
(FEV1 30-50%) add inhaled steroids (fluticasone, triamcinolone)
(FEV1 <5o% w/ hypoxia) add O2 therapy for 18 hrs/day

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COPD exacerbation tx?

bronchodilators + abx + systemic steroids + O2 therapy

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Management of Asthma:
1-2 attacks/wk?
2+ attacks/wk?
daily attacks?
continuous attacks?

1-2 = prn albuterol

2+ = add low dose inhaled CS

daily = add LABA (salmeterol)

ct = add high dose inh CS

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Churg-Strauss syndrome:

asthma + eosinophilia + granulomatous vasculitis

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Infection a/w bronchiectasis?

Dx of bronchiectasis?

recurrent Pseudomonas pneumonia

high-res CT scan shows “signet rings”

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Etiology of bronchiectasis?

cystic fibrosis (MCC), Kartagener syndrome (∆dynein)

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MC lung cancer in women and nonsmokers?

tx?

Bronchial adenoma; lobectomy is curative

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Lambert-Eaton myasthenic syndrome =

SCLC → anti- VGCC antibodies → myasthenia gravis-like presentation

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Paraneoplastic syndromes a/w lung cancers?

squamous cell makes PTH-rP

SCLC makes ADH and ACTH (SIADH and cushings)

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tx Pleural effusion if:
transudative?
exudative?
paraneoplastic?

transudative → Tx diuretics + Na+ restriction
exudative → Tx underlying disease
parapneumonic → abx ± chest tube drainage

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Pleural fluid analysis:
amylase = 
milky fluid =
bloody fluid =
lymphocytic fluid = 
pH <60 =

amylase = esophageal rupture, pancreatitis, malignancy

milky fluid = chylothorax

bloody fluid = cancer

lymphocytic fluid = TB

pH <60 = r/o RA

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Empyema: MCC?

s aureus

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Presentation of tension pneumothorax?

mediastinal shift, hypOtension, JVD, absent breath sounds, hyperresonance to percussion

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ILD presentation?
Dx?
management?

dyspnea, nonproductive cough, fatigue

Dx spirometry (↓TLC, ↑FEV1/FVC) → get CXR (honeycomb lung) + tissue bx + UA if hematuria

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Causes of Drug-induced pulmonary fibrosis?

amiodarone, busulfan, bleomycin, MTX, or nitrofurantoin

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Presentation of Sarcoidosis?

tx?

young black female w/ respiratory complaints,
erythema nodosum, and blurry vision (anterior uveitis)

steroids

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dx of Sarcoidosis?

complications?

CXR shows bilateral hilar LN-opathy (pulmonary fibrosis is end-stage finding); tissue bx shows noncaseating granulomas w/ Schaumann and asteroid bodies

GRAINeD – ↑IgG, rheumatoid arthritis, ↑ACE, interstitial lung dz, noncaseating granulomas, ↑1α- hydroxylase → ↑vitamin D

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presents as classic ILD

CXR –> honeycomb lung
tissue bx shows eosinophilic granulomas

dx?
tx?

Histiocytosis X

steroids vs. lung txp (if not responding)

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triad of necrotizing vasculitis, necrotizing granulomas in lungs and upper respiratory tract, and
necrotizing glomerulonephritis → hematuria + hemoptysis

dx?
tx?

Wegener granulomatosis:

↑c-ANCA; tissue bx shows necrotizing granulomas

cyclophosphamide

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asthma + eosinophilia + necrotizing vasculitis

dx?
tx?

Churg-Strauss syndrome:

incr p-ANCA

steroids

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rheumatoid nodules + pneumoconiosis

Caplan syndrome (a/w coal workers pneumoconiosis)

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cancer a/w Asbestosis?

bronchogenic carcinoma >> mesothelioma

inhalation of silicon → fibrosis of upper lungs Dx CXR shows upper lung fibrosis + “egg shell” calcifications Tx?

Silicosis: | Tx supportive care

(classic ILD sx) + fever + eosinophilia Dx CXR shows peripheral infiltrates, dx? tx?

Eosinophilic pneumonia: get p-ANCA to r/o Churg-Strauss Tx steroids

Goodpasture's: dx? tx?

Dx tissue bx shows linear staining get c-ANCA to r/o Wegener Tx steroids + cyclophosphamide + • plasmapheresis

accumulation of surfactant-like protein and phospholipids in alveoli → (classic ILD sx) CXR = ground glass appearance w/ bat-shaped bilateral alveolar infiltrates dx? tx?

Pulmonary alveolar proteinosis: *tissue bx (definitive) Tx lung lavage vs. GM-CSF

CXR shows honeycomb lungs w/ temporal heterogeneity; tissue bx shows UIP (usual interstitial pneumonia) dx? tx?

Idiopathic pulmonary fibrosis: steroids (temporizing), lung txp

infectious pneumonia-like presentation (cough, dyspnea, flu-like sx) but unresponsive to abx CXR shows bilateral patchy infiltrates dx? tx?

Cryptogenic organizing infectious pneumonitis: presentation? steroids

Physical exam findings a/w pulmonary htn?

loud P2 + subtle sternal lift on auscultation

Tx pulmonary htn vs primary pulmonary htn?

PH --> underlying cause + bosentan 1' --> pulmonary vasodilators (CCB) + lung transplant

Cor pulmonale: presentation? physical exam? tx?

pulmonary HTN + RVH loud P2 + subtle sternal lift on auscultation Tx underlying cause + bosentan

``` destruction of bronchial walls → permanent bronchiolar dilation → chronic cough w/ “cupfuls” of sputum, dyspnea, hemoptysis, recurrent pneumonia ```

bronchiectasis

``` airway inflammation → reversible airflow obstruction → wheezing, shortness of breath, cough, chest tightness ```

asthma attack

``` chronic productive cough of 3 months/year for 2 years → “blue bloaters”, overweight and cyanotic, may have signs of cor pulmonale ```

chronic bronchitis

destruction of alveolar walls → permanent alveolar dilation → “pink puffers”, thin w/ barrel chest, expiration w/ pursed lips

emphasema

CXR finding more specific to emphysema

hyperinflated lungs and increased AP diameter

cough, hemoptysis, dyspnea, wheezing, recurrent PNA in same lobe

think lung cancer

work up for suspected lung cancer

CXR, sputum cytology and CT scan --> bronchoscopy and mediastinoscopy with BIOPSY

Staging and treatment for NSCLC

* NSCLC stage I (local) → pneumonectomy vs. sleeve lobectomy * NSCLC stage II (hilar LN) → pneumonectomy vs. sleeve lobectomy * NSCLC stage III (distal LN) → chemo/radiation * NSCLC stage IV (mets) → chemo/radiation

treatment for pancost tumor

irradiation for 6 weeks to shrink tumor, then surgical resection

Complications assc with lung cancer

``` SPHERE – > SVC syndrome > Pancoast tumor →Horner syndrome > Endocrine(paraneoplastic), > Recurrent laryngeal nerve (hoarseness), > Effusions (pleural or pericardial) ```

differentail for coin lesion

primary lung cancer granuloma (TB or fungal) hamatoma metastatic cancer

characteristic a/w benign coin lesion

> calcification = granuloma, > bull’s-eye shape, popcorn shape = hamartoma, > air-crescent or halo sign = aspergilloma, > Southwest region = coccidioidomycosis > Ohio river valley = histoplasmosis) → leave alone

how to diagnose pleural effusion/type

``` thoracentesis + 4 Cs – chemistry (glucose,protein), cytology CBC+diff culture ```

lights criteria

pleural fluid is exudative if any of the following: | > p/s protein p/s LDH p LDH at upper 2/3 of normal

Dx tissue bx shows noncaseating granulomas | w/ Schaumann and asteroid bodies

Sarcoidosis

Dx CXR shows lower lung fibrosis + pleural plaques Dx tissue bx shows ferruginous bodies

asbestosis

intersitital lung dz with Etiology: mining, stone cutting, glass manufacturing

silicosis

ILD that presents similar to sarcoid

berylliosis * Dx beryllium lymphocyte proliferation test * Tx steroids

What is hypersensitivity pneumonitis? How to Dx and tx?

Acute form: inhalation of antigenic agent (e.g. bird droppings) → type III and IV hypersensitivity → flu-like sx Chronic form: (classic ILD sx) * Dx CXR shows pulmonary infiltrates (acute form), interstitial fibrosis (chronic form) * Tx steroids + avoid birds

goodpastures is type __ HS rxn

II (anti-GBM antibodies attack alveolar and glomerular basement membrane)

prognosis of idiopathic pulm fibrosis

death in 3-7 years

lung changes with radiation pneumonitis CXR and CT findings?

alveolar thickening and pulm fibrosis CT shows diffuse infiltrates (CRX is usually normal)

2 types of respiratory failure

hypoxia (PaO2 < 60) | hypercapnia (PaCO2 > 50)

what can cuase inc A-a gradient with elevated to nml CO2

V/Q mismatch to shunting

how to distinguish between V/Q mismatch and shunting

V/Q mismatch: responds to supplmental O2; imbalance between lung perfusion and ventilation, presents as ↓O2 but nl CO2 Shunting: lack of ventilation in well-perfused areas (e.g. PNA, atelectasis); not responsive to supplemental O2

nml A-a gradient with normal Co2 and dec PaO2

high altitudes

pathophys of ARDS

``` diffuse inflammatory response → neutrophil activation → interstitial damage and alveolar collapse → massive shunting → dyspnea + respiratory distress ```

How to Dx and Tx ARDS

* Dx CXR shows diffuse bilateral pulmonary infiltrates (white-out of lungs) * Dx ABG shows hypoxia (PaO2 <60) not responsive to O2 therapy * Dx PCWP shows no evidence of CHF * Tx ventilation w/ ↓FiO2, ↑PEEP

etiologies of ARDS

septic shock (MCC), aspiration pneumonia, trauma

goals of ventialtion

maintian alveolar ventialtion and correct hypoxia

``` Distinguish between the following ventilator settings AC SIMV CPAP PSV ```

1. AC (assisted control) – has backup RR, gives preset VT per attempted breath 2. SIMV (synchronous intermittent mandatory ventilation) – has backup RR, does not have preset VT per breath 3. CPAP (continuous positive airway pressure) – no backup RR, continuous PEEP support 4. PSV (pressure support ventilation) – PEEP support only with attempted breath

What ventiator settings control CO2? O2?

CO2 with EE and TV | O2 with FiO2 and PEEP

softening of tracheal cartilage w/ prolonged ventilation; PPx tracheostomy if ventilator-dependent for 2+ wks

tracheomalacia

PA pressure >25 mmHg (rest) or>30 mmHg (exercise) → | presents as exertional dyspnea, fatigue, chest pain, ±syncope

Pulm HTN

etiology of primary pukm HTN Prognosis ?

∆BMPR2 → uninhibited smooth muscle growth → ↑pulmonary resistance Px: mean survival 2-3 yrs

Etiologies of cor pulmonale

COPD (MCC), recurrent PE, ILD, asthma, sleep apnea, CF, pneumoconioses

acute onset chest pain, dyspnea, hyperventilation, hemoptysis, right-sided heart failure → death Dx and Tx

PE * Dx D-dimer to r/o, spiral CT or V/Q scan to r/in * Tx heparin + warfarin * Tx tPA to speed up clot resolution (massive * PE, unstable, right heart failure, no c/i) * recurrent PE → Tx IVC filter

Pulm Flashcards

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