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Online Med Ed > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

path in asthma

A

reversible inflammation and bronchoconstriction

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2
Q

pt in asthma

A

SOB, wheezing, hyper resonant, prolonged expiration, exposure to trigger (cold air, allergens)
CBC = eosinophilia; ‘nasal polyps’

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3
Q

dx of asthma

A 
PFTs
- FEV1/FVC decreased
- reversible with bronchodilators
- inducible with methacholine
skin test = identify triggers
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4
Q

tx of asthma

A 
ß-agonists
- short-acting, long-acting
steroids
- inhaled corticosteroids, oral prednisone
stabilizers
- nedocromil, cromolyn
- leukotriene antagonists
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5
Q

f/u asthma

A

avoid triggers

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6
Q

chronic asthma treatment I

A

SABA

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7
Q

chronic asthma treatment II

A

SABA + ICS (LTA = ICS)

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8
Q

chronic asthma treatment III

A

SABA + ICS + LABA

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9
Q

chronic asthma treatment IV

A

SABA + increase ICS + LABA

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10
Q

refractory asthma treatment

A

oral prednisone

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11
Q

asthma drugs - SABA

A

albuterol

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12
Q

asthma drugs - LABA

A

formoterol, salmetrol

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13
Q

asthma drugs - ICS

A

beclomethasone, budesonide, fluticasone, mometasone

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14
Q

asthma drugs - steroids

A

prednisone (oral)

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15
Q

asthma exacerbation path

A

exposure to trigger

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16
Q

asthma exacerbation pt

A

exposure to trigger = wheezing, dyspnea, prolonged exhalation
CBC = eosinophilia
nasal polyps

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17
Q

asthma exacerbation dx

A

clinical

peak flow

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18
Q

asthma exacerbation tx

A

IV methylprednisolone
albuterol + ipratroprium
steroid taper

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19
Q

asthma exacerbation f/u

A

racemic epinephrine
magnesium
stops wheezing or CO2 rising -> intubate

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20
Q

lung cancer path

A

smoking, toxic exposure

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21
Q

lung cancer pt

A

weight loss, hemoptysis, dyspnea, pleural effusion (tap effusion first)

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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

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23
Q

lung cancer tx

A

diagnose, stage
PFTs (can they tolerate surgerY?)
surgery vs. chemo

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24
Q

lung cancer f/u

A

annual low-dose CT scan…cancer screen

  • smoker within 15yrs
  • 55-80y/o
  • > 30 pack-year history
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25
Q

small cell lung cancer path

A

smoking

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26
Q

small cell lung cancer pt

A 
sentral mass (central)
paraneoplastic syndromes
- SIADH = HypoNa
- ACTH = Cushing's
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27
Q

small cell lung cancer dx

A

bronch/EUS

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28
Q

small cell lung cancer tx

A

chemo

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29
Q

squamous cell lung cancer path

A

smoking

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30
Q

squamous cell lung cancer pt

A 
sentral mass (central)
paraneoplastic syndromes 
- PTH-rp = HyperCa
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31
Q

squamous cell lung cancer dx

A

bronch/EUS

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32
Q

squamous cell lung cancer tx

A

resection

chemo, radiation

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33
Q

adenocarcinoma path

A

asbestosis

cancer NON smokers get

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34
Q

adenocarcinoma pt

A

peripheral mass

pleural plaques

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35
Q

adenocarcinoma dx

A

percutaneous biopsy

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36
Q

adenocarcinoma tx

A

chemo/rads

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37
Q

carcinoid tumor path

A

serotonin

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38
Q

carcinoid tumor pt

A

wheezing, flushing, diarrhea

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39
Q

carcinoid tumor dx

A

5-HIAA in the urine

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40
Q

carcinoid tumor tx

A

resection

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41
Q

pleural effusion path

A

transudate: ‘fluid’
- increase hydrostatic = CHF
- decrease oncotic = cirrhosis, nephrosis
exudative: ‘stuff’
- increase permeability = TB, cancer, PNA

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42
Q

pleural effusion pt

A

exertional dyspnea, orthopnea,

incidentally found on xray

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43
Q

pleural effusion dx

A

1st: cxr
then: decubitus cxr (or ultrasound)
then: thoracentesis (not loculated)
OR
thoracotomy (loculated)
OR
thoracotomy (empyema)
Best: biopsy, gram stain, cytology

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44
Q

pleural effusion tx

A

if CHF, do NOT tap, just diuresis

if no CHF, tap, then treat accordingly to the underlying diagnosis

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45
Q

thoracentesis

A

needle in the chest

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46
Q

thoracostomy

A

chest tube in chest

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47
Q

thoracotomy

A

hole cut in the chest

48
Q

Light’s Criteria

A

signifies exudate if:

  • LDH > 200
  • LDH fluid : LDH serum > 0.6 (high LDH)
  • TP fluid : TP serum >0.5 (high protein)
49
Q

pleural effusion work up: cell count with diff

A

infection

50
Q

pleural effusion work up: gram stain

A

infection

51
Q

pleural effusion work up: culture

A

infection

52
Q

pleural effusion work up: AFB smear

A

TB

53
Q

pleural effusion work up: adenosine deaminase

A

TB

54
Q

pleural effusion work up: cytology

A

cancer

55
Q

pleural effusion work up: Total protein (TP)

A

light’s criteria

56
Q

pleural effusion work up: LDH

A

light’s

57
Q

pleural effusion work up: RBC

A

hemothorax

58
Q

pleural effusion work up: amylase

A

chylothorax

59
Q

pleural effusion work up: pH, glucose

A

other

60
Q

DVT path

A

virchow’s triad:

  • endothelial injury
  • venous stasis
  • hypercoaguability
61
Q

DVT pt

A

unilateral leg swollen than the other >2cm

pain, erythema, swelling

62
Q

DVT dx

A

ultrasound

63
Q

DVT tx

A

anticoagulation (LMWH->warfarin)

64
Q

PE path

A

DVT embolisms to lung

65
Q

PE pt

A 
wedge infarct = hemoptysis, dyspnea
pulmonary HTN = heart strain
ischemia = pleuritic chest pain
V/Q mismatch = hypoxemia and dyspnea
tachycardia, tachypnea, hypoxia, hypocapnia
66
Q

PE dx

A

1st: D-dimer rules out disease (clinic)
Best: spiral CT (CT chest IV contrast)
Alt: V/Q scan if creatninine compromised

67
Q

PE tx

A

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
Q

PE f/u

A

ABG: low O2, Low CO2, high pH
EKG: S1Q3T3
cxr: negative
Well’s criteria

69
Q

Well’s Criteria

A 
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
Q

Well’s Criteria interpretation

A

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
Q

When to do a CT scan based on Well’s criteria

A

Score = 4 -> don’t do it

score >4 -> do it

72
Q

COPD time

A

emphysema and bronchitis

genetics and smoking

73
Q

COPD pt - pink puffer

A

pink puffer = emphysema = trapped air

  • hyperresonant
  • increase AP diameter, flattened diaphragm
  • pursed lips, prolonged expiration
  • CO2 retainer
74
Q

COPD pt - blue bloater

A

blue boater = bronchitis = hypoxia

  • cyanotic
  • pulmonary HTN
  • right heart failure
  • hepatosplenomegaly
  • peripheral edema
75
Q

COPD dx

A

PFTs: decrease FEV1/FVC … irreversible

cxr can show flattened diaphragms

76
Q

COPD tx

A 
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
Q

Escalation of therapy for COPD

A 
SABA
SABA + tiotropium
SABA + tiotropium + LABA
SABA + tiotropium + LABA/ICS
SABA + tiotropium + LABA/ICS + PDE-4i
...add oral steroids
78
Q

COPD exacerbation path

A

infectious (viral or bacterial)

79
Q

COPD exacerbation pt

A

cough, SOB, productive sputum
wheezing
CO2 retention

80
Q

COPD exacerbation dx

A

1st: cxr (rule out pneumonia)

ABG = CO2 retention

81
Q

COPD exacerbation tx

A

CO2 = BiPAP
albuterol and ipratropium
oral or IV steroids
abx = doxycycline or azithromycin

82
Q

COPD exacerbation f/u

A

intubate if CO2 rises

83
Q

ARDS path

A

non-cariogenic pulmonary edema

84
Q

ARDS pt

A

TRALI, gram negative rods, near-drowning
bilateral fluffy infiltrates on cxr
pulmonary edema

85
Q

ARDS dx

A

ARDS criteria

  • P/F ratio <200
  • echo, BNP, PCWP normal
  • pulmonary edema
86
Q

ARDS tx

A 
intubation
PEEP
low TV... 6cc/kg IBW
oxygenation
paralysis
87
Q

ARDS f/u

A

fix underlying disease

88
Q

CHF vs. ARDS: PCWP

A 
ARDS = decreased
CHF = increased
89
Q

CHF vs. ARDS: LV function

A 
ARDS = increased
CHF = decreased
90
Q

CHF vs. ARDS: cxr

A 
ARDS = fluffy
CHF = fluffy
91
Q

CHF vs. ARDS: 2d echo

A 
ARDS = normal
CHF = LV dysfunction
92
Q

CHF vs. ARDS: BNP

A 
ARDS = decreased
CHF = increased
93
Q

diffuse paranchymal lung disease (DPLD) or interstitial lung disease (ILD) path

A

variable

94
Q

DPLD pt

A 
chronic, insidious onset
dry cough
hypoxemia
restrictive picture
dry crackles
95
Q

DPLD dx

A

cxr
high resolution CT
bx = VATS

96
Q

DPLD tx

A

anti-inflammatories

  • DMARDs
  • biologics
  • steroids
97
Q

DPLD f/u

A

O2 supplementation if SpO2 <88%

98
Q

sarcoid path

A

autoimmune, infiltrating disease

99
Q

sarcoid pt

A

young, African American woman
bilateral hilar lymphadenopathy
Erythema nodosum

100
Q

sarcoid dx

A

1st: cxr = bilateral hilar lymphadenopathy
then: PFTs = restrictive
best: biopsy = noncaseating granuloma

101
Q

sarcoid tx

A

prednisone

102
Q

sarcoid other

A

hypercalcemia .. vit D from granuloma
bradycardia/block = infiltrating heart
restrictive cardiomyopathy

103
Q

asbestos path

A

inhaled, non-degradable material

104
Q

asbestos pt

A

construction worker
shipyard industry
lung cancer or interstitial lung disease

105
Q

asbestos dx

A

1st: cxr = pleural plaques
best: biopsy = barbell bodies

106
Q

asbestos tx

A

smoking cessation

107
Q

asbestos f/u

A

high risk for adenocarcinoma of lung

108
Q

pneumoconiosis

A

heavy metal

ground-glass opacities

109
Q

asbestosis

A

shipyards, construction, demolition

pleural plaque

110
Q

silicosis

A

rock dust, sand blasting

111
Q

coal miner’s

A

coal

Caplan Syndrome

112
Q

hypersensitivity pneumonitis

A

noncaseating granulomas
pigeon feathers
actinomyces

113
Q

special considerations: asbestosis

A

exposure: shipyards, construction
correlation: cancer

114
Q

special considerations: berylliosis

A

exposure: aeronautics, nuclear

115
Q

special considerations: silicosis

A

exposure: sand blasting, rock quarries
correlation: TB

116
Q

special considerations: HE

A

histoplasmosis

exposure: birds, work only
correlation: get away from birds, get away from work

Online Med Ed (18 decks)

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