Pulmonary - IM Quick Notes

arold001's version from 2015-12-30 19:37

Section 1

Question Answer
whats the step up therapy for COPD?SABA or anticholinergic --> LABA --> inhaled steroids --> may add theophylline, mucolytics
whats the first line tx for COPD exacerbation?ipratropium!
whats the tx for COPD exacerbation?ipratropium --> add beta2 agonist, IV methylprednisone or PO prednisone, antibiotics, oxygen, low threshold for intubation
what 2 things have been shown to decrease mortality in tx of COPD?1) smoking cessation
2) home oxygen (if SpO2 < 89% or PaO2 <55)
what are the 4 most common complications of COPD?1) acute exacerbations
2) cor pulmonale
3) chronic hypercapnia (respiratory acidosis with compensatory metabolic alkalosis),
4) polycythemia
if new onset CLUBBING in COPD patient...diagnosis?CANCER!
whats the atopic triad?allergic rhinitis, atopic dermatitis, asthma
whats the step up therapy for ASTHMA?SABA prn → +low-dose ICS → +LABA → +med/high dose ICS (or leukotriene antagonist or theophylline) → +oral steroids
whats the first line therapy for asthma exacerbation?albuterol (NOT ipratropium seen in COPD exacerbation)

Section 2

Question Answer
African American pt with dyspnea and chronic cough, CXR shows bilateral hilar adenopathysarcoidosis = biospy will show NONCASEASTING granulomas
how do you treat restrictive lung disease due to sarcoidosis?STEROIDS!
Elderly pt with chronic a-fib on RHYTHM CONTROL developing worsening dyspneaPulmonary fibrosis due to amiodarone
pt with lymphoma underwent radiation therapy and now presents with restrictive lung disease...why?radiation pnuemonitis!
pt with saddle nose deformity, restrictive lung disease and hematuria...diagnosis?wegeners granulomatosis +c-ANCA
pt with LOWER LOBE FIBROSIS, calcified pleural plaque...?asbestosis
whats the most common cancer a/w asbestosis?bronchogenic carcinoma >>mesothelioma
whats the most common cause of mesothelioma?asbestosis
pt with UPPER LOBE opacitis and EGG-SHELL calcifications of lymph nodes..?silicosis = mining, stone cutting, glass making
pt with silicosis has increased risk of what disease?TB!
silicosis is a/w what disease?TB
pt presents with restrictive lung disease and sarcoidosis (granulomas, skin lesions, hypercalcemia)...diagnosis?berylliosis!
how does CXR look in pt with PE??CXR is normal! need CTA
whats the first vital sign change in pts with PE?TACHYCARDIC!
pts with PE will show what on their EKG?ECG showing sinus tachycardia or right heart strain (S1Q3T3)
whats the tx for PE?HEPARIN followed by chronic anticoagulation for 3-6 months
what are 2 conditions when you tx PE with thrombolytics?1) massive PE
2) if hemodynamically unstable
name 3 causes of transudative pleural effusion?cirrhosis, CHF, nephrotic syndrome
name 8 causes of exudative pleural effusioninfection (parapneumonic effusion), malignancy, PE, collagen vascular disease, GI disease (eg, pancreatitis), hemothorax, chylothorax, Meigs’ syndrome (ovarian tumor)

Section 3

Question Answer
whats lights criteria for transudate versus exudate?pleural total protein/serum total protein > 0.5

pleural LDH/serum LDH >0.6

pleural LDH >2/3 upper limit of normal of serum LDH
whats the difference btw complicated vs. uncomplicated parapneumonic effusion? (3 findings)complicated if pleural fluid gram stain or culture (+), pH <7.2, or glucose <60
pleural fluid from thoracentesis shows: LOW glucose...think?rheumatiod arthritis, malignancy or infection
pleural fluid from thoracentesis shows: elevated lymphocytesTB
pleural fluid from thoracentesis shows: elevated amylase...think?pancreatitis or esophageal rupture
pleural fluid from thoracentesis shows: elevated TGchylothorax
pleural fluid from thoracentesis shows: elevated RBCs...thinkshemothorax, malignancy or PE
whats the tx for SYMPTOMATIC pleural effusion? versus uncomplicated pleural effusion?symptomatic: paracentesis.
uncomplicated: antiobiotics for pneumonia
whats the tx for COMPLICATED pleural effusion (if pleural fluid gram stain/culture positive, pH <7.2, glucose <60)tube thoracostomy or VATS if loculated emphyema
whats the tx for spontaneous pneumothroax due to bleb rupture?chest tube
whats the tx for tension pneumothroax?immediate needle thoracostomy in 2nd intercostal space followed by chest tube placement
tracheal deviation AWAY from affected side?tension pneumothroax

Section 4

Question Answer
Whats the definition of ARDS1) bilateral infiltrates on CXR
2) PaO2/FiO2 <200
3) PCWP <18
What ventilator settings would you choose for ARDS?high PEEP and low tidal volume
What the next best step for pts with ARDS?intubate!!
how do you work up a solitary nodule on CXR?1st step is to look at old imaging, 2nd step is to get CT; based on CT findings, either biopsy or repeat CT later (observation)
what are 2 BENIGN solitary pulmonary nodules on CXR?benign = granuloma or hamartoma
what are 2 MALIGNANT solitary pulmonary nodules on CXR?bronchogenic carcinoma or metastasis
small cell lung carcinoma causes ectopic release of what 3 things?ADH (SIADH), ACTH (cushings), Lambert-Eaton
squamous cell lung carcinoma is a/w what paraneoplastic syndromePTH-rP (hypercalcemia of malignancy)
Pt with face and arm erythema and swelling, distended veins of neck and chest wall, headache...due to tumor where? SVC syndrome = due to tumor compressing SVC
Pt with ptosis, miosis, anhidrosis, shoulder pain, atrophy of hand musclespancoast syndrome = superior sulcus tumor
younger pt with progressive dyspnea on exertion with elevated PA pressure and normal PCWPpulmonary HTN
whats the most common cause of trivial hemoptysis?acute bronchitis!
bronchiectasis is a/w disease?CF

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