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24 Cards in this Set
- Front
- Back
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what is the management of a solitary pulmonary nodule?
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hi-res CT if benign features
biopsy / surgical excision if malignant features: >50y patient, >2 cm, lack of calcification, cavitation with thick walls, rapidly increasing in size |
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pathology found in each compartment:
anterior mediastinum middle mediastinum posterior mediastinum |
anterior mediastinum: thymoma, retrosternal thyroid, teratoma, lymphoma
middle mediastinum: bronchogenic cyst, tracheal tumor, pericardial cyst, lymphoma, enlarged lymph node, aortic arch aneurysm posterior mediastinum: all neurogenic tumors, meningocele, enteric cyst, lymphoma, diaphragmatic hernia, esophageal tumor, aortic aneurysm |
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what type of infection in patients with foul-smelling sputum after instrumentation of airway or esophagus?
what treatment? |
anaerobic lung infection
clindamycin |
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what is the consequence of chronic destruction of alveolar sacs, e.g. as in a smoker with COPD?
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formation of large alveolar blebs, which may rupture and leak air into pleural space
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what is the preferred treatment for acute thrombogenic emboli?
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combination heparin/warfarin, d/c heparin in ~5 days if patient's INR is therapeutic
important to start warfarin with supplemental heparin because warfarin may initially be thrombogenic due to inhibition of proteins C and S |
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most common cancer caused by asbetos exposure
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bronchogenic carcinoma
(mesothelioma is second) |
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criteria for initiating home O2 therapy
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all COPD patients with PaO2 <55 mmHg or SaO2 <88% on room air
patients with cor pulmonale, evidence of pulmonary HTN or hematocrit >55% even if PaO2 >55 mmHg or SaO2 >89% patients who become hypoxic during exercise or sleep goal is SaO2 >90%; use 15 hours per day |
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describe composition of nasal secretions in:
infectious rhinitis allergic rhinitis nasal polyposis (e.g. aspirin sensitivity) non-allergic rhinitis (e.g. vasomotor rhinitis) |
infectious rhinitis: high neutrophils
allergic rhinitis: high eosinophils nasal polyposis (e.g. aspirin sensitivity): high eosinophils non-allergic rhinitis (e.g. vasomotor rhinitis: *absence* of nasal eosinophilia |
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imaging modality of choice to diagnose superior vena cava (SVC) syndrome
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chest X-ray
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what are the acute hematologic consequences of high-dose glucocorticoid administration?
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decrease eosinophils
decrease lymphocytes increase neutrophils by increasing bone marrow release and mobilizing marginated neutrophil pool |
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what is suggested by recurrent pneumonias in the same anatomic lung region, and how should they be worked up?
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bronchial obstruction
worked up with chest CT concerning for bronchogenic carcinoma |
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what pulmonary capillary wedge pressures differentiate ARDS from cardiogenic pulmonary edema?
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PCWP <18 mmHg suggests ARDS
PCWP >18 mmHg suggests cardiogenic pulmonary edema |
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what cardiac structural changes may be seen in the setting of pulmonary embolism?
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right heart dilatation and failure secondary to obstructed outflow
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what electrolyte abnormalities may be caused by asthma medications?
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beta-2 agonists (e.g. albuterol) drive K+ into cells
possible result is clinically significant hypokalemia with muscle weakness, arrhythmias, and EKG changes |
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tumor markers:
seminoma non-seminomatous GCT |
seminoma: beta-HCG
non-seminomatous GCT: beta-HCG and AFP |
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what are indications for noninvasive positive pressure ventilation?
what are contraindications? |
indications: low pH, high CO2, high RR in a COPD exacerbation
contraindications: sepsis, hypotension, dysrhythmia |
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what skin rash is associated with Mycoplasma?
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erythema multiforme, target-shaped skin lesions over all four extremities
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what is the negative predictive value of D-dimer for pulmonary embolism?
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95%
it is also 95-97% sensitive -- a good test for ruling out PE! |
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symptoms of theophylline toxicity
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CNS stimulation
GI disturbances cardiac arrhythmias |
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repiratory complications of mitral stenosis
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enlargement of left atrium can cause persistent cough and elevation of left main stem bronchus
dilated atrium may also lead to a-fib |
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features of idiopathic pulmonary fibrosis
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chronic inflammation of alveolar walls leading to progressive fibrosis and destruction
presents with progressive dyspnea, nonproductive cough and digital clubbing exam shows dry end-inspiratory crackles |
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mechanism of hypoxia in pneumonia
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alveolar and interstitial inflammation leading to V/Q mismatch and increase in alveolar-arterial O2 gradient
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normal right atrial pressure
normal pulmonary artery pressure |
4-6 mmHg
25/15 mmHg |
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indications for draining pleural fluid
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pH <7.2
glucose <60 mg/dL |
