Pulmonary Flashcards
(127 cards)
1
Q
Small Cell Paraneoplastic syndromes
A
SIADH and ACTH
2
Q
Squamous Cell Paraneoplastic syndromes
A
PTH-like hormone secretion. Eaton-Lambert syndrome.
3
Q
NSCLC treatment
A
Surgery is the best option
4
Q
SCLC treatment
A
No surgery. Chemo and radiation
5
Q
Central lung tumors
A
Squamous cell and SCLC
6
Q
Peripheral lung tumors
A
Adenocarcinoma and Large cell carcinoma
7
Q
Tumor least association with smoking
A
Adenocarcinoma
8
Q
Exudate vs. Transudate
A
Exudate if any one is positive: 1. Protein (pleura)/Protein (serum) >0.5 2. LDH (p)/LDH(s) >0.6 3. LDH>2/3 the upper limit of normal serum LDH
9
Q
Serum total protein concentration
A
Upper limit of normal is 7 g/dL
10
Q
High adenosine deaminase is seen in
A
TB pleural and ascites fluid
11
Q
How to treat hypersensitivity pneumonitis
A
Avoid the antigen exposure
12
Q
Chemotherapy and radiation for Hodgkin’s complications
A
Secondary malignancy within 20 yrs
13
Q
ARDS is
A
A form of Non-cardiogenic pulmonary edema caused by leaky alveolar capillaries.
14
Q
Theophylline toxicity
A
CNS stimulation (HA, insomnia), N/V, Cardiac toxicity (arrhythmia)
15
Q
What affects theophylline metabolism
A
Ciprofloxacin and erythromycin decreases clearance and raises plasma concentration
16
Q
How does theophylline cause toxicity
A
Phosphodiesterase inhibition, adenosine antagonism, and stimulation of epinephrine release.
17
Q
Beta-agonists side effects
A
Arryhthmia, nervousness, tremor, but no CNS and GI effects
18
Q
parapneumonic effusions pH
A
<7.2 need chest tube aspiration to prevent empyema
19
Q
Normal pleural fluid pH
A
7.64, lower pH means pleural inflammation
20
Q
Transudative pleural effusion pH
A
7.35
21
Q
Parapneumonic effusions glucose
A
<60 mg/dL favors parapneumonic effusion, TB, or RA
22
Q
High amylase in pleural fluid?
A
Pancreatitis associated effusion and esophageal rupture
23
Q
Aspergilloma CXR
A
Cavitary lesions and fungus ball which can move around with position change
24
Q
When to use O2 in COPD patients
A
PaO2<88%, or with looser guidelines if there is cor pulmonale
25
Wegener's serum test
Antineurophilic cytoplasmic antibody (c-ANCA) positive in >90% of patients
26
Serum alpha fetoprotein use in
Hepatocellular carcinoma and testicular cancer
27
ESR used in
Temporal arteritis/polymyalgia rheumatica/Wegener's
28
Wegener's diagnosis
c-ANCA positivity and tissue biopsy
29
Wegener's treatment
High-dose steroids and cytotoxic agents
30
Inpatient treatment of CAP
levofloxacin or gatifloxacin (antipneumococcal)
31
Outpatient tx of CAP
azithromycin or doxycycline
32
PCP diagnosis
Bronchoalveolar lavage!!!
33
uses of bronchoalveolar lavage
Suspected malignancy and opportunistic infection
34
What is the A-a gradient
....
35
A-a gradient in PE
Increased
36
Most common EKG finding with PE
Normal, or non-specific ST segment elevations and T wave changes
37
PE EKG findings
S1,Q3T3. Right axis deviation, RBBB
38
Hampton's hump
Cone shaped area of opacification from atelectasis or infarction from PE on CXR
39
Westermark's sign
Dilated proximal pulm. artery with distal oligemia
40
Most common findings on PE ABG
Hypoxemia and hypocarbia
41
Bronchiectasis signs
Cough (90%) ,mucopurulent and tenacious sputum that is foul smelling, and hemoptysis.
42
Most feared complication of bronchiectasis
Life-threatening hemoptysis and lung abscesses
43
How to diagnose bronchiectasis
High resolution chest CT
44
Pancoast syndrome
When a superior sulcus tumor of the right lung presses on the brachial plexus
45
Hypertrophic osteoarthropathy
Clubbing, and sudden onset joint arthropathy in chronic smoker. Often associated with lung cancer, CXR needed to rule out malignancy or other lung pathology.
46
What happens if you get pneumonia in the same place over and over
Red flag for lung cancer
47
COPD and functional residual capacity
Increased, and TLC increased as well
48
Sounds in fluid filled regions
Bronchial breath sounds, louder with more prominent expiratory component
49
Egophony
Sounds bleating, E sounds like A with nasal or sheep like quality
50
Pleural effusion
Decreased breath sounds
51
Vesicular vs. bronchial breath sounds
Vesicular are quiet insp. and exp. Bronchial are louder exp. sounds.
52
Mucuous plugging sounds
No breath sounds over affected areas because no air is getting there
53
Emphysema breath sounds
Vesicular, decreased breath sounds
54
Interstitial lung disease breath sounds
Vesicular with crackles at the end of inspiration
55
Atypical PNA etiologies
Mycoplasma, Chlamydia, legionella, coxiella, influenza
56
Mycoplasma presentation
Non-productive cough, more indolent course, erythema multiforme
57
How to diagnose legionella
Urine test
58
Skin finding in Mycoplasma PNA
Look for Erythema Multiforme
59
Most common cause of atypical PNA
Mycoplasma pneumoniae
60
CXR in atypical PNA
Out of proportion to findings on physical exam
61
Chronic bronchitis and hemoptysis
Frequent cause of mild hemoptysis in patients with significant smoking hx
62
Chronic bronchitis presentation
Chronic productive cough for at least 3 months over 2 years with PFTs c/w COPD, prominent bronchovascular marking, mild flattening of the diaphgram, and normal DLCO.
63
Difference between emphysema and chronic bronchitis
DLCO decreased in emphysema, decreased vascular markings in emphysema
64
Restrictive lung disease FEV1/FVC
Normal ratio, but both are decreased
65
Alveolar consolidation on PE
Decreased breath sounds, dullness to percussion, tactile fremitus, egophony, whispered pectoriloquy, and bronchophony
66
tx for Cor pulmonale
Tx underlying cause + bosentan
67
Bosentan is
endothelin receptor antagonist that is used to treat PAH
68
Pulmonary HTN prez
PA pressure >25 mmHG rest or >30 mmHg exercise, exerional dyspnea, fatigue, CP +/- syncope
69
Dx pulm htn
Loud P2+, CXR, pfts, abg, ekg, echo, catherization
70
Synchronous intermittent mandatory ventilation
Backup RR< does not have present tidal volume per breath
71
When is the A-a nl
If you are hypoventilating or not enough PaO2 (like high elevation)
72
What happens when the A-a is elevated
V/Q mismatch vs. shunting
73
ARDS CXR
Diffuse b/l pulmonary infiltrates (lung white-out)
74
ARDS PCWP
low PCWP, NO CHF
75
ARDS tx
decrease FiO2, increase PEEP
76
Dx of pleural effusion
Thoracentesis + 4 Cs: chemistry (glucose, protein), cytology, CBC+diff, culture
77
Effusion with amylase
Esophageal rupture, pancreatitis, malignancy
78
effusion with milky fluid
chylothorax
79
effusion with pururlence
empyema
80
bloody effusion
cancer
81
lymphocytic fluid effusion
TB
82
pH<7.2 in effusion
empyema or parapneumonic effusion
83
glucose <60 in effusion
r/o RA!
84
MCC of empyema in effusion
Staph aureus
85
mesothelioma surgery
Extrapleural pneumonectomy (high morbidity/mortality)
86
Asbestos exposure hotspots
shipyards, rooftops
87
Most common lung cancer in nonsmokers
Adenocarcinoma
88
Pancoast tumor tx
xrt for 6 wks to shrink tumor
89
Lung cancer complications
SPHERE: SVC syndrome, pancoast tumor, endocrine (paraneoplastic), recurrent laryngeal nerve, effusions
90
Small cell paraneoplastic
ADH, ACTH, anti-VGCC antibodies (Lambert-Eaton myasthenic syndrome)
91
Squamous cell paraneoplastic
PTH-rP ....
92
benign coin lesions
calcification = granuloma, bull's eye shape, popcorn chape = hamartoma, air-crescent or halo sign= aspergilloma, southwest region=coccidio, ohio river valley = histolasmosis) LEAVE ALONE
93
malignant coin lesions
spiculations or 20+ pack year smoking = primary lung cancer, multiple lesions = metastatic cancer leading to resection indication
94
Chronic Bronchitis
Chronic cough for 3 months/yr for 2 yrs
95
Panacinar emphysema caused by
A1AT deficiency, pts <50 y/o
96
Centriacinar emphysema in upper lungs caused by
Smoking
97
Emphysema in patient <50 y/o
Dx A1AT levels
98
COPD exacerbation tx
Bronchodilators + abx + systemic steroids + O2 therapy
99
bronchiectasis gets what infection
Pseudomonas PNA recurrently
100
Bronchiectasis high res CT
Signet rings
101
Bronchiectasis tx
Bronchodilators + abx for acute exacerbations
102
Causes of bronchiectasis
MCC is cystic fibrosis, kartagener syndrome (dynein mutation)
103
Atopy
asthma +allergic rhinitis + atopic dermatitis
104
triad asthma
asthma +aspirin sensitivity + nasal polyps
105
ABPA (allergic bronchopulmonary aspergillosis)
asthma + pulm. infiltrates + aspergillus allergy
106
Churg-Strauss syndrome
Asthma + eosinophilia + granulomatous vasculitis
107
Stages for COPD
Stage 1 FEV1>80% predicted, Stage 2 50-80, stage 3 30-50, Stage 4 <50% with hypoxia
108
Tx for COPD
Stage 1: SABA, ipratropium Stage 2: LABA, tiotropium, Stage 3: Add inhaled steroids, Stage 4: Add O2 therapy for 18 hrs/day
109
Lung volumes
VC: the most you can breathe in, FRC: end tidal ..asdfa.sdf.asd.fa.sdf
110
ILD presentation
dyspnea, nonproductive cough, fatigue
111
Drug-induced pulmonary prez
classic ILD sx s/p amiodarone, bufulfan, bleomycin, MTX< or nitrofurantoin
112
Sarcoidosis prez
young black female w/ respiratory complaints, erythema nodosum, and blurry vision (ant. uveitis)
113
Sarcoid histology
Schaumann and asteroid bodies
114
Sarcoid tx
steroids
115
Sarcoid complications
GRAINeD: Inc. IgG, RA, increased ACE, ILD, noncaseating granulomas, increased vitamin D from increased 1alpha-hydroxylase
116
Histiocytosis X can cause ILD?
Yes
117
Histiocytosis X dx
Honeycomb lung on CXR, histology eosinophilic granulmas, tx with steroids vs. lung txp
118
Wegener grenulomatosis (granulomatosis with polyangiitis)
Triad of necrotizing vasculitis, necrotizing granulomas in lungs and upper respiratory tract, and necrotizing glomerulomephritis leading to hematuria and hemoptysis
119
Wegeners dx
Inc. c-ANCA, tissue bx shows necrotizing granulomas
120
Wegeners tx
cyclophosphamide
121
Churg-Strauss syndrome
Triad of asthma, eosinophilia, necrotizing vasculitis with elevated p-ANCA tx with steroids
122
caplan syndrome
Rheumatoid nodules + pneumoconiosis
123
Asbestosis
dx CXR shows LOWER lung fibrosis +oleural plaques, tissue bx shows ferruginous bodies, tx supportive care
124
Most common cancer from asbestosis
Bronchogenic carcinoma>>mesothelioma
125
Silicosis
Fibrosis of UPPER LUNGS, "egg shell" calcifications, mining, stone cutting, glass manufacturing
126
berylliosis
Sarcoid-like presentation, dx beryllium lymphocyte proliferation test, tx steroids
127
Goodpasture syndrome
anti-GBM antibodies attack alveolar and glomerular BM leading to hematuria and hemoptysis, tissue bx shows linear staining, get c-ANCA to r/o Wegener tx steroids+cyclophosphamide+plasmapharesis
