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Pulmonology – Awesom
Random pulm associations
| Question | Answer |
|---|---|
| the only type of lung disease with decreased residual volume | intrathoracic restrictive |
| how to treat post-viral hypersensitivity | daily inhaled steroid (budesonide) |
| increased mortality in asthma is related to | their baseline airway lability - how constricted are their airways at baseline |
| oxygenation goal in asthma (PaO2 and SaO2) | PaO2 > 60 and SaO2 > 90 |
| what drug stabilizes mast cells | cromolyn |
| Brownish mucous plugs, dx, which pts get this, what is tx? What if hemoptysis? | Allergic Broncho Pulmonary Aspergillosis ABPA - colonization of upper airway with Aspergillus in asthma patients, tx with steroids; if hemoptysis then surgery. Type I immediate HSN IgE +skin reaction. |
| Pt with fever chills SOB after a day on a farm or has pet parakeet - what is this and what organism? | Hypersensitivity pneumonitis - Type 3 Immune Complex - Thermophilic Actinomycetes |
| Thermophilic Actinomycetes | Hypersensitivity pneumonitis |
| What are the findings on CXR with hypersensitivity pneumonitis? | ground glass appearance, interstitial or alveolar infiltrates |
| What are the findings on BAL with hypersensitivity pneumonitis? what is this the opposite of? | lymphocytosis with CD8 > CD4 (very specific), no eosinophils; opposite of sarcoidosis with CD4 > CD8 |
| pt with asthma, neuropathy, nasal polyps, found to have hypereosinophils | Churg Strauss - eosinophilic granulomatosis with polyangiitis - small to med vasculitis |
| medication for prevention of acute mountain sickness vs high altitude pulmonary edema, when to start | acetazolamide for AMS and nifedipine for HAPE; start 24-48 hrs prior to mountain ascent |
| sx's of acute mountain sickness vs high altitude pulmonary edema | AMS has HA n/v fatigue and dizziness; HAPE has all that plus SOB |
| symptoms of theophylline toxicity | tachycardia and tremors, EKG shows MAT |
| criteria for intubation | pH < 7.25, RR > 35, HR 120, or increased secretions or hemoptysis |
| Noninvasive ventilation for COPD vs CHF | COPD you give BiPap and CHF you give CPAP |
| tram lines | bronchiectasis, h/o PNA in the past |
| If you see pancreatitis in a young patient without known cause, what test must you do? | sweat chloride for CF |
| leading cause of mortality in CF? how do you treat it? | cepacia burkhdorferia, tx with Bactrim |
| honeycombing | idiopathic pulmonary fibrosis, lymphangio leiomyomatosis, langerhan cell granuloma / eosinophilic granuloma / histiocytosis X - proliferation of dendritic cells |
| plaques on the diaphragm | asbestosis plaques on your ass |
| egg shell calcifications | silicosis |
| hilar LNs | silicosis and sarcoidosis |
| non caseating granulomas | sarcoidosis and berylliosis |
| Lymphangioleiomyomatosis - whats the pathology? What are the sx's? who gets it? | proliferation of smooth muscle cells that invade all lung structures --> SOB, a lot of cystic changes, chylothorax, PTX. young girl |
| EKG changes for pulm embolism | S1Q3T3, TWI in v1 |
| mid-wall RV dyskinesia | PE |
| hypokinesis at apex on ECHO | RV infarct |
| pleural effusions with glucose of 80? 60? 30? | 80 - TB, 60 - cancer, 30 - RA |
| what diagnosis if you see lung field hyper resonant to percussion with decreased breath sounds and decrease vocal fremitus/resonance | PTX |
| what diagnosis if you hear bronchial breath sounds with lung exam dull to percussion and increased vocal fremitus/resonance | PNA |
| what diagnosis if you hear decreased breath sounds with lung exam dull to percussion and no vocal fremitus/resonance | pleural effusion |
| when to tap a pleural effusion | 1. >10mm on lateral decubitus CXR, 2. PNA not better with abx, 3. empyema, 4. loculated effusion (needs thoracostomy) |
| When to insert a chest tube | pH < 7.2, empyema, complicated parapneumonic effusion, malignancy |
| anterior mediastinum masses | thyroid tumors, thymic tumors, and lymphomas, teratoma |
| middle mediastinal masses | bronchogenic cysts, pericardial cysts, and lymphadenopathy |
| posterior mediastinal masses | Posterior mediastinal masses are generally limited to growths of neural tissue or esophageal tumors or cysts |
| when to do pulm rehab in COPD? | Current guidelines recommend pulmonary rehabilitation for patients with symptomatic COPD who have an FEV1 less than 50% of predicted. |
| who shouldn't get pulm rehab? | It is not recommended for patients who cannot walk or who have unstable angina or recent myocardial infarction. |
| who gets O2 in COPD | Oxygen therapy is indicated for patients who have hypoxemia, arterial PO2 of 55 mm Hg (7.3 kPa) or lower, or oxygen saturation of 88% or lower. |
| definition of COPD exacerbation | change in baseline dyspnea, cough, and/or sputum production beyond normal daily variation. Main sxs: inc SOB often w wheezing and chest tightness, increased cough and sputum production, change in the color and/or tenacity of sputum, and fever. |
| most appropriate tests to assess impending respiratory failure in patients with neuromuscular weakness | bedside vital capacity and maximal inspiratory pressure |
| what are the parameters that show a pt is at high risk for respiratory failure | Patients with vital capacity less than 20 mL/kg, patients who cannot generate more than 30 cm H2O of negative inspiratory force, or patients with declining values are at high risk for ventilatory failure |
| In victims of smoke inhalation, when should you think about cyanide poisoning? | blood lactic acid level of 90 mg/dL (10.0 mmol/L) or greater is sensitive and specific |
| How to tx cyanide poisoning | antidote is sodium thiosulfate |
Created by:
christinapham
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