Pulmonology Flashcards
(116 cards)
1
Q
path in asthma
A
reversible inflammation and bronchoconstriction
2
Q
pt in asthma
A
SOB, wheezing, hyper resonant, prolonged expiration, exposure to trigger (cold air, allergens)
CBC = eosinophilia; ‘nasal polyps’
3
Q
dx of asthma
A
PFTs - FEV1/FVC decreased - reversible with bronchodilators - inducible with methacholine skin test = identify triggers
4
Q
tx of asthma
A
ß-agonists - short-acting, long-acting steroids - inhaled corticosteroids, oral prednisone stabilizers - nedocromil, cromolyn - leukotriene antagonists
5
Q
f/u asthma
A
avoid triggers
6
Q
chronic asthma treatment I
A
SABA
7
Q
chronic asthma treatment II
A
SABA + ICS (LTA = ICS)
8
Q
chronic asthma treatment III
A
SABA + ICS + LABA
9
Q
chronic asthma treatment IV
A
SABA + increase ICS + LABA
10
Q
refractory asthma treatment
A
oral prednisone
11
Q
asthma drugs - SABA
A
albuterol
12
Q
asthma drugs - LABA
A
formoterol, salmetrol
13
Q
asthma drugs - ICS
A
beclomethasone, budesonide, fluticasone, mometasone
14
Q
asthma drugs - steroids
A
prednisone (oral)
15
Q
asthma exacerbation path
A
exposure to trigger
16
Q
asthma exacerbation pt
A
exposure to trigger = wheezing, dyspnea, prolonged exhalation
CBC = eosinophilia
nasal polyps
17
Q
asthma exacerbation dx
A
clinical
peak flow
18
Q
asthma exacerbation tx
A
IV methylprednisolone
albuterol + ipratroprium
steroid taper
19
Q
asthma exacerbation f/u
A
racemic epinephrine
magnesium
stops wheezing or CO2 rising -> intubate
20
Q
lung cancer path
A
smoking, toxic exposure
21
Q
lung cancer pt
A
weight loss, hemoptysis, dyspnea, pleural effusion (tap effusion first)
22
Q
lung cancer dx
A
1st: cxr
then: CT
best: biopsy
- percutaneous if peripheral
- endoscopic ultrasound if proximal
- VATS if in the middle
- lobectomy okay too
23
Q
lung cancer tx
A
diagnose, stage
PFTs (can they tolerate surgerY?)
surgery vs. chemo
24
Q
lung cancer f/u
A
annual low-dose CT scan…cancer screen
- smoker within 15yrs
- 55-80y/o
- > 30 pack-year history
25
small cell lung cancer path
smoking
26
small cell lung cancer pt
```
sentral mass (central)
paraneoplastic syndromes
- SIADH = HypoNa
- ACTH = Cushing's
```
27
small cell lung cancer dx
bronch/EUS
28
small cell lung cancer tx
chemo
29
squamous cell lung cancer path
smoking
30
squamous cell lung cancer pt
```
sentral mass (central)
paraneoplastic syndromes
- PTH-rp = HyperCa
```
31
squamous cell lung cancer dx
bronch/EUS
32
squamous cell lung cancer tx
resection
| chemo, radiation
33
adenocarcinoma path
asbestosis
| cancer NON smokers get
34
adenocarcinoma pt
peripheral mass
| pleural plaques
35
adenocarcinoma dx
percutaneous biopsy
36
adenocarcinoma tx
chemo/rads
37
carcinoid tumor path
serotonin
38
carcinoid tumor pt
wheezing, flushing, diarrhea
39
carcinoid tumor dx
5-HIAA in the urine
40
carcinoid tumor tx
resection
41
pleural effusion path
transudate: 'fluid'
- increase hydrostatic = CHF
- decrease oncotic = cirrhosis, nephrosis
exudative: 'stuff'
- increase permeability = TB, cancer, PNA
42
pleural effusion pt
exertional dyspnea, orthopnea,
| incidentally found on xray
43
pleural effusion dx
1st: cxr
then: decubitus cxr (or ultrasound)
then: thoracentesis (not loculated)
OR
thoracotomy (loculated)
OR
thoracotomy (empyema)
Best: biopsy, gram stain, cytology
44
pleural effusion tx
if CHF, do NOT tap, just diuresis
| if no CHF, tap, then treat accordingly to the underlying diagnosis
45
thoracentesis
needle in the chest
46
thoracostomy
chest tube in chest
47
thoracotomy
hole cut in the chest
48
Light's Criteria
signifies exudate if:
- LDH > 200
- LDH fluid : LDH serum > 0.6 (high LDH)
- TP fluid : TP serum >0.5 (high protein)
49
pleural effusion work up: cell count with diff
infection
50
pleural effusion work up: gram stain
infection
51
pleural effusion work up: culture
infection
52
pleural effusion work up: AFB smear
TB
53
pleural effusion work up: adenosine deaminase
TB
54
pleural effusion work up: cytology
cancer
55
pleural effusion work up: Total protein (TP)
light's criteria
56
pleural effusion work up: LDH
light's
57
pleural effusion work up: RBC
hemothorax
58
pleural effusion work up: amylase
chylothorax
59
pleural effusion work up: pH, glucose
other
60
DVT path
virchow's triad:
- endothelial injury
- venous stasis
- hypercoaguability
61
DVT pt
unilateral leg swollen than the other >2cm
| pain, erythema, swelling
62
DVT dx
ultrasound
63
DVT tx
anticoagulation (LMWH->warfarin)
64
PE path
DVT embolisms to lung
65
PE pt
```
wedge infarct = hemoptysis, dyspnea
pulmonary HTN = heart strain
ischemia = pleuritic chest pain
V/Q mismatch = hypoxemia and dyspnea
tachycardia, tachypnea, hypoxia, hypocapnia
```
66
PE dx
1st: D-dimer rules out disease (clinic)
Best: spiral CT (CT chest IV contrast)
Alt: V/Q scan if creatninine compromised
67
PE tx
IVF, O2, anticoagulation
- heparin to warfarin bridge
- 5d LMWH or therapeutic INR 2-3, whichever is longer
- tPa if massive
- IVC filter ONLY if anticoagulation is contraindicated
68
PE f/u
ABG: low O2, Low CO2, high pH
EKG: S1Q3T3
cxr: negative
Well's criteria
69
Well's Criteria
```
ZOMFG IDK = +3
DVT = +3
HR > 100 = +1.5
Immobilization (leg fx, travel) = +1.5
surgery within 4 weeks = +1.5
hx of DVT or PE = +1.5
hemoptysis = +1
malignancy = +1
```
70
Well's Criteria interpretation
If Score <2 & D-Dimer, VQ okay: low probability
if score 2-6 & VQ useless: med probability
if score >6 & V/Q ok: high probability
71
When to do a CT scan based on Well's criteria
Score = 4 -> don't do it
| score >4 -> do it
72
COPD time
emphysema and bronchitis
| genetics and smoking
73
COPD pt - pink puffer
pink puffer = emphysema = trapped air
- hyperresonant
- increase AP diameter, flattened diaphragm
- pursed lips, prolonged expiration
- CO2 retainer
74
COPD pt - blue bloater
blue boater = bronchitis = hypoxia
- cyanotic
- pulmonary HTN
- right heart failure
- hepatosplenomegaly
- peripheral edema
75
COPD dx
PFTs: decrease FEV1/FVC ... irreversible
| cxr can show flattened diaphragms
76
COPD tx
```
Corticosteroids = ICS -> oral prednisone
Oxygen = PaO2 <55 or SpO2 < 88%
Prevention = smoking cessation, vaccines
Dilators = bronchodilators, ipratropium
Experimental = don't worry bout it
Rehab = exercise capacity increases
```
77
Escalation of therapy for COPD
```
SABA
SABA + tiotropium
SABA + tiotropium + LABA
SABA + tiotropium + LABA/ICS
SABA + tiotropium + LABA/ICS + PDE-4i
...add oral steroids
```
78
COPD exacerbation path
infectious (viral or bacterial)
79
COPD exacerbation pt
cough, SOB, productive sputum
wheezing
CO2 retention
80
COPD exacerbation dx
1st: cxr (rule out pneumonia)
| ABG = CO2 retention
81
COPD exacerbation tx
CO2 = BiPAP
albuterol and ipratropium
oral or IV steroids
abx = doxycycline or azithromycin
82
COPD exacerbation f/u
intubate if CO2 rises
83
ARDS path
non-cariogenic pulmonary edema
84
ARDS pt
TRALI, gram negative rods, near-drowning
bilateral fluffy infiltrates on cxr
pulmonary edema
85
ARDS dx
ARDS criteria
- P/F ratio <200
- echo, BNP, PCWP normal
- pulmonary edema
86
ARDS tx
```
intubation
PEEP
low TV... 6cc/kg IBW
oxygenation
paralysis
```
87
ARDS f/u
fix underlying disease
88
CHF vs. ARDS: PCWP
```
ARDS = decreased
CHF = increased
```
89
CHF vs. ARDS: LV function
```
ARDS = increased
CHF = decreased
```
90
CHF vs. ARDS: cxr
```
ARDS = fluffy
CHF = fluffy
```
91
CHF vs. ARDS: 2d echo
```
ARDS = normal
CHF = LV dysfunction
```
92
CHF vs. ARDS: BNP
```
ARDS = decreased
CHF = increased
```
93
diffuse paranchymal lung disease (DPLD) or interstitial lung disease (ILD) path
variable
94
DPLD pt
```
chronic, insidious onset
dry cough
hypoxemia
restrictive picture
dry crackles
```
95
DPLD dx
cxr
high resolution CT
bx = VATS
96
DPLD tx
anti-inflammatories
- DMARDs
- biologics
- steroids
97
DPLD f/u
O2 supplementation if SpO2 <88%
98
sarcoid path
autoimmune, infiltrating disease
99
sarcoid pt
young, African American woman
bilateral hilar lymphadenopathy
Erythema nodosum
100
sarcoid dx
1st: cxr = bilateral hilar lymphadenopathy
then: PFTs = restrictive
best: biopsy = noncaseating granuloma
101
sarcoid tx
prednisone
102
sarcoid other
hypercalcemia .. vit D from granuloma
bradycardia/block = infiltrating heart
restrictive cardiomyopathy
103
asbestos path
inhaled, non-degradable material
104
asbestos pt
construction worker
shipyard industry
lung cancer or interstitial lung disease
105
asbestos dx
1st: cxr = pleural plaques
best: biopsy = barbell bodies
106
asbestos tx
smoking cessation
107
asbestos f/u
high risk for adenocarcinoma of lung
108
pneumoconiosis
heavy metal
| ground-glass opacities
109
asbestosis
shipyards, construction, demolition
| pleural plaque
110
silicosis
rock dust, sand blasting
111
coal miner's
coal
| Caplan Syndrome
112
hypersensitivity pneumonitis
noncaseating granulomas
pigeon feathers
actinomyces
113
special considerations: asbestosis
exposure: shipyards, construction
correlation: cancer
114
special considerations: berylliosis
exposure: aeronautics, nuclear
115
special considerations: silicosis
exposure: sand blasting, rock quarries
correlation: TB
116
special considerations: HE
histoplasmosis
exposure: birds, work only
correlation: get away from birds, get away from work
