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RS Flashcards

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1
Q 
Hounsfield units (HU) for CT thorax
Air
Fat
Water
Soft tissue
Ca ion
A 
Air: -1000 HU
Fat: -20 (Wiki: -100 to -50)
Water: 0 
Soft tissue: 30-50 (Wiki: 100 to 300)
Ca ion: >150
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2
Q

Ix for Pneumonia

A
  1. CBC
  2. L/RFT, Electrolytes (e.g. SIADH complicating pneumonia)
  3. ABG
  4. Atypical pneumonia serology
  5. NPA if suspect influenza
  6. Legionella urinary Ag test
  7. Sputum culture
  8. Blood cultures
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3
Q

CURB-65 for pneumonia

A 
C: Confusion
U: Urea >7mmol/L
R: RR>30
B: SBP<90 or DBP<60
Age >65
Any 3+ --> Hospitalization
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4
Q

CAP Tx

General therapy

A

Empirical ABX: Augmentin +/- Marcolide or Tetracycline

General therapy for pneumonia

  1. O2 for Type 1 RS failure; Mechanical ventilation for Type 2
  2. Chest physiotherapy
  3. Fluid rehydration
  4. Treat underlying COPD with bronchodilators
  5. Control cardiac arrhythmias (e.g. AF)
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5
Q

Cx of Pneumonia

A
  1. RS failure
  2. Septicemia
  3. Parapneumonic effusion
  4. Lung abscess
  5. Empyema thoracis
  6. SIADH
  7. AMI
  8. Cardiac arrhythmias, e.g. AF
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6
Q

Ix for Bronchiectasis

A
  1. CXR
  2. HRCT
  3. Igs
  4. Auto-Abs
  5. Barium studies, 24h esophageal monitoring for gastric reflux
  6. Ciliary and sperm analysis for ciliary dyskinesia
  7. Neutrophil fx
  8. Sweat test for CF
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7
Q

Tx for Bronchiectasis

A
  1. ICS +/- LABA

2. Long term Macrolide for immunomodulating effect

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8
Q

Sx of OSA

A
  1. Snoring
  2. Excessive daytime sleepiness
  3. Witness apneas
  4. Nocturnal choking
  5. Restless sleep
  6. Unrefreshing sleep, morning headache
  7. Irritability, intellectual deterioration, poor concentration
  8. ↓Libido
  9. Enuresis, nocturia
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9
Q

GINA symptom control (Global initiative for Asthma)

A 
In past 4 weeks,
1. Daytime asthma symptoms >2 per week
2. Night waking due to asthma
3. Reliever needed for symptoms >2 per week
4. Activity limitation due to asthma
Well controlled = 0
Partly controlled = 1-2
Uncontrolled = 3-4
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10
Q

Relievers for Asthma

A
  1. SABA (Salbutamol, Terbutaline)
  2. LABA (Salmeterol, Formoterol)
  3. Xanthines (PDE inhibitor)
  4. Anti-cholinergics
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11
Q

Preventers for Asthma

A
  1. ICS / Oral steroids
  2. Leukotriene receptor antagonist
  3. Anti-IgE Ab (Omalizumab)
    For pedi: Nedocromial sodium (mast cell stabilizer), Sodium cromoglycate
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12
Q

Pleural effusion causes

A 
Fluid overload
   1. CHF
   2. Renal failure
Hypoalbuminemia
   3. Cirrhosis
   4. Nephrotic syndrome
   5. Severe malnutrition
Pleural inflammation (--> Increase cap permeability)
   6. TB, Pneumonia
   7. SLE
   8. CA lung
   9. Pancreatitis / Liver abscess
Decreased lymphatic drainage
   10. Malignant infiltration
   11. Necrotizing infection
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13
Q

Ix for Pleural effusion

A 
Diagnostic thoracocentesis + pleural fluid analysis
   1. Appearance
   2. Chemistry (Light's criteria)
   3. Cell count, differential (PMN or Lymphocytes)
   4. Cytology (Malig)
   5. Microbiology (Smear, culture, AFB)
Treat organ failure if Transudative
Further Ix if Exudative, by
   -Percutaneous pleural biopsy
   -Thoracoscopy, Pleuroscopy
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14
Q

Top 3 DDx for Exudative

A

Infection
Malignancy
Systemic inflammation

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15
Q

Rivalta test

A

For pleural fluid
Disappear = Negative (Transudative)
Precipitates = Positive (Exudative)

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16
Q

Sx of CA Lung

A

Constitutional symptoms: Malaise, LOA, LOW
Due to primary lesion (bronchial mucosa ulceration) –> Cough, sputum, hemoptysis
Due to primary lesion (obstructive) –> Wheeze, unresolved pneumonia, dyspnea
Due to intrathoracic spread
1. Lymphangitis carcinomatosis (spread along
lymphatics to both lungs) –> Cough, SOB
2. Pleura, Pleural effusion –> Chest pain, SOB
3. Pericardial effusion –> Cardiac tamponade –> SOB
4. SVCO –> Dyspnea, stridor, dysphagia, face swelling
5. L. recurrent laryngeal n. –> Hoarseness of voice
6. Brachial plexus (C8, T1, T2) and inferior cervical sym. ganglion (Horner’s) –> Pain in shoulder and arm; loss of sweating on 1 side of face
7. Esophagus –> Dysphagia
8. Chest wall and ribs –> Chest pain, swelling
*RLN can only be due to left lung cancer (no intrathoracic course of right RLN)

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17
Q

Horner syndrome

A
  1. Partial ptosis
  2. Miosis
  3. Anhidrosis
  4. Pseudo-enophthalmos
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18
Q

Signs of extra-thoracic manifestation of CA Lung

A
  1. Cachexia
  2. Finger clubbing
  3. Supraclavicular, Cervical LNs enlarged
  4. Liver, brain, bone, adrenal, spinal cord, skin, choroidal metastasis
    Liver –> Hepatomegaly, deranged LFT
    Brain –> Seizure, change in personality, vomiting
    Bone –> Pathological fractures, hyperCa, bone pain
    Adrenal –> Cortisol insufficiency (rare)
    Spinal cord –> Cord compression
    Choroidal –> Impaired visual acuity
  5. Unexplained anemia
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19
Q

Lambert–Eaton myasthenic syndrome

A

AI disease, Abs against presynaptic voltage-gated Ca channels
Muscle weakness, legs more affected
Underlying lung SCLC
Also asso w/ DM type 1, hypothyroidism

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20
Q

Cx of COPD

A
  1. Acute exacerbation
  2. Chronic RS failure
  3. Cor pulmonale
    • Chronic hypoxemia –> Pul HT –> RVH and RVF
  4. Pul thromboembolism
    • Blood: Sec polycythemia
    • Circulatory: Cor pulmonale, backlogging of blood, slow circulation
    • Bedrest
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21
Q

Ix for COPD

Study These Flashcards
A
  1. Lung function test
    • FEV1/FVC (<70% - airflow obs)
    • Increase RV, TLC
    • Decrease DLCO
  2. CBC
  3. CXR
  4. ABG (for RS failure)
  5. Sputum (for infection)
  6. ECG +/- Echo (for Cor pulmonale)
22
Q

Mx of COPD

Study These Flashcards
A
  1. Quit smoking
  2. Manage stable COPD
    • Bronchodilators, ICS
    • Long term O2 therapy
    • Rehabilitation + Flu / Pneumococcal vaccine
  3. Manage acute exacerbation
    • Controlled O2 therapy
    • ABX
    • Non-invasive ventilation (for type 2 RS failure)
  4. Manage exacerbation (Cor pulmonale)
    • Diuretics, fluid restriction
23
Q

Hypercapnia = Hypercarbia

24
Q

Hypoventilation

Study These Flashcards
A
  1. Depressed CNS in Barbiturate overdose

2. Neuromuscular or skeletal deformity with restriction of chestwall movement (MG, Kyphoscoliosis)

25
Examples of Type 1 RS failure
Oxygenation failure (only decrease PO2) ``` V-Q imbalance 1. COPD 2. Asthma 3. ILD (IPF) Shunting 4. Pul edema 5. ARDS 6. Major lung collapse ```
26
Examples of Type 2 RS failure
Hypoventilation (with early elevated pCO2) 1. CNS disease, Barbiturate overdose 2. MG, Kyphoscoliosis V-Q imbalance 3. Severe COPD or acute exacerbation of COPD
27
Pathophysio of COPD causing RS failure
1. V-Q mismatch 2. Alveolar hypoventilation 3. Shunting
28
Dx of Cor pulmonale
1. Clinical features of Pul HT, RVH, RVF 2. Underlying COPD 3. RHF where there is AE of chronic RS problem 4. RS failure (Type 1 or 2) 5. CXR showing dilated pulmonary trunks at hila, RV dilatation 6. ECG shows P pulmonale (spiky P), RAD, RVH 7. Echo (usu not done)
29
SE of Salbutamol
(Wiki) Fine tremor, anxiety, headache, muscle cramps, dry mouth, and palpitation. Tachycardia, arrhythmia, flushing of the skin, myocardial ischemia (rare), and disturbances of sleep and behaviour
30
Haemophilus influenzae | 流感嗜血桿菌
Gram negative Coccobacilli Facultative anaerobe
31
Mycoplasma pneumoniae | 肺炎支原體/黴漿菌性肺炎
Absence of a peptidoglycan cell wall | Asso w/ Cold agglutinin disease
32
Chlamydophila pneumoniae
Obligate intracellular bacterium
33
Atypical pneumonia
1. Mycoplasma pneumoniae 2. Chlamydophila pneumoniae 3. Legionella pneumophila
34
Paraneoplastic for CA Lung
1. Connective tissue – clubbing, hypertrophic pulmonary osteoarthropathy --> Arthralgia, pain, tenderness of extremities 2. Ectopic hormones - ADH --> ↓Na --> Confusion, weakness - ACTH --> ↓K --> Weakness - PTH like peptide --> ↑Ca --> Polyuria, thirst, confusion 3. Neuromuscular - Encephalopathy --> Dementia, confusion - Cerebellar degeneration -> Ataxia, clumsiness - Peripheral neuropathy --> Paresthesia, weakness - Myasthenia-like (Eaton-Lambert) - Dermatomyositis
35
EGFR inhibitors for CA lung
TKI - Erlotinib (Tarceva) - Gefitinib (Iressa) Monoclonal Ab against EGFR - Cetuximab
36
VEGF inhibitors for CA lung
Anti-VEGF (vascular endothelial growth factor) | - Bevacizumab
37
SE of Isoniazid (H)
1. Hepatotoxicity 2. Peripheral neuropathy 3. Psychosis, epilepsy
38
SE of Rifampicin (R)
1. Red-orange discoloration of urine 2. Hepatotoxicity 3. Flu syndrome
39
SE of Pyrazinamide (Z)
1. Gout 2. Frozen shoulder 3. Hepatotoxicity 4. Rash
40
SE of Ethambutol (E)
1. Optic neuritis (aka retrobulbar neuritis) | 2. Gout
41
SE of Streptomycin (S)
1. Ototoxicity 2. Avoid in preg 3. Nephrotoxicity
42
MDR-TB
Resistant to at least Isoniazid and Rifampicin
43
XDR-TB
Resistant to at least Isoniazid + Rifampicin + any quinolones + at least 1 of 2nd line injectables (Kanamycin, Capreomycin, Amikacin)
44
Chemotherapy for NSCLC (30-40% response rate)
- Cyclical combination chemo - Add Platinum based drug (Cisplatin, Carboplatin) to increase efficacy - Tgt with newer generation of cytotoxic drug (Paclitaxel, Gemcitabine, Vinorelbine, Pemetrexed) - SE: Myelosuppression
45
Targeted therapy for CA lung: Ind, choice
Indications 1. Primary tx for tumor with oncogenic molecular targets 2. For patients not tolerating or accepting risk of chemo EGFR-TKI (Gefitinib, Erlotinib) - Especially for adenoCA, women, non-smoker, with activating EGFR mutations - Distinct SE = Acneiform skin rash - New targets with new therapy: EML4-ALK rearrangement gene with ALK inhibitor (Crizotinib) and ROS1 rearrangement (use when TKI resistance) - Use chemo if no EGFR mutation
46
SOCRATES
``` Site Onset Character Radiation Association Time Exa/Relieving Severity ```
47
Churg-Strauss syndrome
``` aka Eosinophilic granulomatosis with polyangiitis Asthma/AR Eosinophilia Vasculitis ANCA ```
48
Nikolsky's sign
Present when slight rubbing of the skin results in exfoliation of the outermost layer - Stevens-Johnson Syndrome/toxic epidermal necrolysis - Staphylococcal scalded skin syndrome - Pemphigus vulgaris
49
Azathioprine and Allopurinol
Cannot be used tgt
50
Allergic contact dermatitis test
Skin patch test | Type 4 HS
51
Atopic dermatitis
aka Atopic eczema Skin prick test Type 1 HS

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