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112 Cards in this Set
- Front
- Back
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panacinar emphysema
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alpha 1
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centrilobular emphysema
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smoking induced
central cmoking |
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decreased FEV1/FEV to <0.75
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COPD
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patient leans forward when sitting
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pink puffer (emphysema)
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definitive test for COPD
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PFTs
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Peak expiratory flow below 350
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Obstructive disease
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tx for COPD
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smoking cessation
albuterol or salmeterol (for longer acting) inhaled anticholinergic (ipratropium) inhaled steroids |
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criteria for home O2 in COPD
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PaO2 55 or
O2sat < 88 or PaO2 55-59 plus polycethemia or cor pulmonale |
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tx for nocturnal hypoxemia in COPD
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cpap
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secondary polychythemia
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COPD (due to chronic hypoxemia)
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chronic cough with large amounts of mucopurulent, foul-smelling sputum
dyspnea hemoptysis recurrent or persistent pneumonia |
bronchiectasis
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lung cancer that is not associated with smoking
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adeno
adeNO is NOt from sMOking |
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type(s) of lung cancer that is/are central
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SCLC is Sentral
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type(s) of lung cancer that is/are peripheral
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adeno and LCLC
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lung cancer with pleural involvement
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adeno (20% of cases)
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lung cancer
Eaton Lambert SIADH |
SCLC
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lung cancer
PTH-like hormone |
Squamous cell carcinoma
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sputum analysis useful only in diagnosis of what kind of cancers
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central ones
Sentral Sputum |
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stippled or eccentric versus central laminated pattern of calcifications on solitary pulmonary nodules
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stippled more likely malignant
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causes of pleural effusions
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CHF
Pneumo Malignancy (lung, breast, lymphomaI PE Viral Cirrhosis |
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Effusion:
percussion? fremitus? |
percussion dull
fremitus decreased |
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what to do with pleural effusion fluid
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Four Cs
hcemistry cytology cell count culture |
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elevated pleural fluid amylase
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esophageal rupture
pancreatitis malignancy |
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milky pleural fluid
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chylothorax
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frankly purulent pleural fluid
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empyema
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bloody effusion in pleural fluid
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malignancy
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exudative pleural effusion predominantly lymphocytic
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TB
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pH<7.2 in pleural fluid
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parapneumonic or empyema
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treatment for transudative pleural effusion
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diuretics and sodium restriction
thoracentesis if causing dyspnea |
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pleural fluid glucose <60
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r/o RA
(also possible in TB, esophageal rupture, malignancy, lupus) |
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panacinar emphysema
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alpha 1
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centrilobular emphysema
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smoking induced
central cmoking |
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decreased FEV1/FEV to <0.75
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COPD
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patient leans forward when sitting
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pink puffer (emphysema)
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definitive test for COPD
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PFTs
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Peak expiratory flow below 350
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Obstructive disease
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tx for COPD
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smoking cessation
albuterol or salmeterol (for longer acting) inhaled anticholinergic (ipratropium) inhaled steroids |
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criteria for home O2 in COPD
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PaO2 55 or
O2sat < 88 or PaO2 55-59 plus polycethemia or cor pulmonale |
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tx for nocturnal hypoxemia in COPD
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cpap
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secondary polychythemia
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COPD (due to chronic hypoxemia)
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chronic cough
large amoutns of mucopurulent, foul smelling sputum dyspnea hemoptysis recurrent or persistent pneumo |
bronchiectasis
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lung cancer NOT associated with smoking
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adeno
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central lung cancer
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SCLC
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least occuring lung cancer
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LCLC
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lung cancer with pleural involvement
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adeno
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lung cancer with eaton lambert and SIADH
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SCLC
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lung cancer with PTH-like hormone
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Squamous
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stppeled or eccentric pattern of calcificaiton in solitary pulmonary nodules
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likely malignant
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LDH in pleural effusion/serum in exudative
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>0.6
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Protein in pleural effusion/serum in exudate
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>0.5
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percussion, breath sounds and fremitus in pleural effusion
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dullness to percussion
decreased breath sounds decreased fremitus |
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check for these in pleural effusion
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four Cs
chemistry cytology cell count culture |
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amylase in pleural fluid
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esophageal rupture
pancreatitis malignancy |
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milky pleural fluid
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chylothorax
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purlent pleural fluid
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empyema
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bloody pleural effusion
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malignancy
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primarily lymphocytic exudative pleural effusions
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TB
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pH <7.2 in pleural fluid
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parapneumonic effusion or empyema
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tx for transudative effusions
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diuretics and Na restriciton
thoracentesis only for dyspnea |
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pleural fluid glucose <60
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r/o RA
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empyema
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associate with pneumonia
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hyperresonance to percussion
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on side of pneumothorax
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bloody effusion
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mesothelioma
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drugs that induce interstitial lung disease
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amiodarone
nitrofurantoin bleomycin phenytoin illicit drugs |
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non pulmonary diseases with clubbing
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congenital heart disease
bacterial endocarditis biliary cirhosis IBD PBC or.... IDIOPATHIC |
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erythema nodosum in context of a lung disease
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sarcoidosis
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bilateral hilar lymphadenopathy
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sarcoid I or II
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lung disease with elevated ACE
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sarcoid (60-80% of patients)
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cANCA
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Wegeners
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pANCA
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Churg strauss
Goodpastures |
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asbestosis causes this with smoking making it more likely
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bronchiogenic carcinoma
not mesothelioma |
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environmental lung disease in upper lobes
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silicosis
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lung diseases with hypercalcemia
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sarcoid
berylliosis |
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pleural plaques in an environmentally caused lung disease
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aspbestosis
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egg shell calcifications in an environmentally caused lung disease
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silicosis
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peripheral pulmonary infiltrates in a pneumonia
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eosinophilic
Churg Strauss |
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hemoptysis
dyspnea anti GBM and ABM igG |
Goodpastures
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ground glass
bilateral alveolar infiltrates resembling a bat surfactant accumulation |
Pulmonary alveolar proteinosis
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progressive dyspnea
non-productive cough ground glass honeycomb |
ILD
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level for hypercapnea
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PCO2 > 50
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levelo of PaO2 for hypoxia
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<60 with PaCOs >50
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what variable monitors ventilation
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PaCO2
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what variable monitors oxygenation
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O2 saturation and Pa)2
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how are ventilation and oxygenation related
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they're not!!
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hypoxia without hypercapnea
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VQ mismatch
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hypoxemia without hypercapnea
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diffusion impairment
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what can cause hypercapnea
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hypoventilation
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what can cause hypoxemia
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hypoventilation
VQ mismatch Shunt |
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key event in ARDS
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severe hypoxemia with no significant improvement on 100% oxygen
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atalectasis
alveolar collapse surfactant dysfunction |
ARDS
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two ways to get increased pulmonary fluid
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ARDS (with increased alveolar capillary permeability)
cardiogenic pulmonary edema with hydrostatic forces |
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dyspnea
tachypnea tachydcardia progressive hypoxemia not responsive to O2 stiff non-compliant lung |
ARDS
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PaO2/FiO2 <200
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ARDS
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PCWP <18 vs >18
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<18 is ARDS
>18 is cardiogenic pulmonary edema |
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value of PEEP
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peps up alveoli
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where should ET tube be
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3-5 cm above carina
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value of SIMV
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helps weaning bcause if patient initiates a breath then that determines tidal volume
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danger of high PEEP
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barotrauma/pneumothorax
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meds for people on ventilations
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benzos for breathers
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what to do if patient on a ventilator for 2 or more weeks
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tracheostomy to prevent tracheomalacia
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Loud S2
subtle sternal life |
Pulmonary HTN with RV dilatation
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young/middle aged woman
sudden pulmonary HTN |
young woman
prognosis is 2-3 yr survival |
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tx for primary pulmonary HTN
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transplant is only option
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RV hypertrophy with eventual RV failure from pulmonary HTN secondary to pulmonary disease
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cor pulmonale
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copd and polycythemia
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cor pulmonale
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peaked P waves
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cor pulmonale
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patient with long bone fracture develops dyspnea, mental status change, petechiae
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fat embolism
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PIOPED
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study that guides tx of PE if V/Q performed
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CHRISTOPHER study
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guides tx of PE if spiral CT performed
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tachypnea
rales tachycardia S4 P2 shock low grade fever |
PE
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PND
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Left sided HF
COPD!! |
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causes of hemoptysis
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bronchitis
lung cancer (bronchogenic carcinoma) TB Bronchiectasis Pneumonia Goodpastures PE with pulmonary infarction Aspergilloma within cavities Mitral stenosis (with increased PVP) |
