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36 Cards in this Set
- Front
- Back
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What is and when do you see radiation pneumonitis?
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. Insidious onset of SOB + CP
. Fever . Leukocytosis . Increased ESR . Sharply demarcated infiltrate with a ground glass appearance . Seen in 10% of pts following tx . 2-3 months after exposure |
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What's the MCC of superior vena cava syndrome?
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. Lung CA in which 38% are small cell CA
. Squamous in 2nd |
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How do you proceed with pulmonary nodules are found on Xrays?
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. If solitary (<3 cm), check old films
. If no old film, do CT . Do PET scan for indeterminates, X-rays + CT scan . If PET is +, do biopsy . If PET is -, do CT every 2 years |
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What's a parapneumonic effusion?
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. Caused by bacterial pneumonias
. Do thoracocentesis . Chest tube insertion for drainage if: - <7.2 pH - pus - Gram + |
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What is superficial thromboplhebitis and how do you tx?
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. Erythema, tenderness, edema, palpable clot or cord in a superficial vein
. Not a risk factor for PE . TX with NSAIDs or aspirin |
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What are the steps in diagnosing PE?
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. X-ray
. ABG - hypoxemia (decreased [O2]) + hypocapnia (decreased [CO2]) . EKG (S1Q3T3) . V/Q scan |
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How is the diagnosis of pneumonia made?
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. Clinical findings + increased WBCs + X-ray abnormalities
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What are some characteristics of typical X atypical pneumonia?
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. Typical - short prodrome (<2 days), high fever (>102), age (>40), X-ray (1 lobe), agent (S. pneumo), Meds (3rd cephalosporing or quinilones)
. Atypical - long prodrome (>3 days), low fever (<102), age (<40), X-rays (bunch of lobes), Agent (many), Meds (azythromycin) |
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What will you find on PE of restrictive ling disease?
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. Fine inspiratory crackles at the bases on auscultation of the chest
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What's the FEV1/FEV ration in restrictive lung disease?
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. normal
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What causes sinusitis and how do you TX?
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. S. pneumo or
. Hemophilus . TX: amoxicillin or 2nd generation cephalosporin X 10-14 days |
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What's the proper placement of the needle for thoracocentesis?
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. Superior edge of the seventh rib between te tip of the scapula and the post. axillary line
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What causes transudative effusions and what's the TX?
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. Any factor that alters the formation or absorption of pleural fluid:
- CHF (right sided pleural effusions) - Increased hydrostatic pressure - Decreased oncotic pressure - Cirrhosis, nephrotic syndrome . TX: Tx the primary cause |
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How do you diagnose acute bronchitis?
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. Cough
. Fever . yellow sputum . otherwise healthy young man |
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What are some complications of neonatal RDS?
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. pneumothorax
. bronchopulmonary dysplasia . intraventricular hemorrhages |
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What are the physical findings in pneumonia?
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. Increased fremitus
. Dullness . bronchial breathing . bronchophony . pectoriloqui . crackles |
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What are some conditions associated with hemoptysis?
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. Mitral stenosis
. Pneumonia . Bronchiectasis . Bronchogenic carcinoma |
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How do you confirm the diagnosis of CF?
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. Abnormal sweat electrolytes
. Immunoreactive trypsinogen assay . Confirmatory DNA probe test |
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How do you TX traumatic pneumothorax and what's the presentation?
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. Distended neck veins
. diminished breath sounds on affected side . Tracheal deviation to the opposite side . TX: needle thoracostomy at 2nd intercostal space then chest tube insertion at fifth intercostal |
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What are the physical findings in pulmonary effusions?
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. Decreased fremitus
. no breath sounds . dullness or flatness to percussion . tracheal deviation away from the affected side |
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What are the physical findings in atelectasis?
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. Decreased fremitus
. No breath sounds . Dullness or flatness to percussion . Tracheal deviation towards the affected side |
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How do you TX emphysema?
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. Smoking cessation (slows progression)
. Bronchodilators (B2 agonists) . Anticholinergics (ipatropium) . ABX for infection . O2 if pulse Ox is <90% on room air . shots for pneumo and influenza |
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How do you check for bronchiectasis?
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. CT
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How do you guide therapy with heparin in PE?
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. Increase in PTT time to 1.5-2x normal
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How do you guide therapy with Warfarin in PE?
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. Increase in PT to 1.3-1.5X for 6 months
. follow INR (goal = 2-3) . If INR <5 - omit next dose . If INR 5-9 - stop warfarin temporarily . If INR >9 - stop warfarin, give oral vitamin K |
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What are the EKG changes associated with PE?
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. Deep S in lead I
. Q wave in lead III . Inverted T in III . S1Q3T3 |
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If a pt is having heparin induced thrombocytopenia, what is the management?
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. Lepirudin, an anticoagulant not related to the heparins
. Enoxaparin could also induce thrombocytopenia |
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What are the physical findings in asthma?
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. Prolonged expiration
. Diffuse wheezing . Impaired expansion . decreased fremitus . Hyperresonnance . Low diaphragm |
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What's the FEV1/FEV ratio in COPD?
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. <0.75 ( less than normal)
. decreased DLCO in emphysema . normal DLCO in chronic bronchitis |
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What CA medication can cause pneumonitis, which progresses to pulmonary fibrosis?
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. Bleomycin
. suspect when cough and SOB appears |
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What's a common lung finding in pts with ARDS?
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. decreased lung compliance
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What's the TX for sarcoidosis?
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. Prednisone 30-40 mg/day
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What causes exudatives effusions?
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. When local factors produce an inflammatory process
. Pneumonia (empyema, RA) . CA . TBC (100% lymphocytes) |
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When should you start thinking about intubation?
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. CO2 >50
. O2 <50 . especially if pH is <7.30 . Give O2 first for both cases if no response then intubate |
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What are the physical findings in pneumothorax?
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. no fremitus
. no breath sounds . hyperresonance or tympany |
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How do you diagnose a pleural effusion and how to differentiate between exudative and transudative?
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. Do thoracocentesis
- LDH effusion: Trans- <200, Exu- >200 - LDH pleural/serum: Trans- <0.6, Exu- >0.6 - Protein pleural/serum: Trans- <0.5, Exu- >0.5 |
