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Pulmonary
Internal Med
60
Science
Graduate
09/26/2015

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Cards

Term
Causes of for pulmonale
Definition

persistent pulmonary HTN

RVH

COPD

Remember, most frequent cause of right sided HF is LEFT sided HF

Term
Cor pulmonale presentation
Definition

1. RVH on EKG

2. exertional dyspnea

3. chronic productive cough

4. cyanosis

5. hepatomegaly

6. dependent edema

7. JVD

Term
treatment of for pulmonale
Definition
treat the underlying pulmonary cause
Term
abnormal enlargement of the right side of the heart as a result of disease of the lungs or the pulmonary blood vessels
Definition
cor pulmonale
Term
Etiology of lung cancer
Definition

smoking (90%)

environmental exposures 

Term
Screening : High risk for lung cancer
Definition

age 55-74, >= 30 pack yrs, smoking cessation < 15 

OR

age >= 50, >= 20 pack rys, 1 additional risk factor

Term
Screening moderate risk for lung cacner
Definition
Age >= 50, >=20 pack yrs, NO additional RF
Term
screening: low risk for lung cancer
Definition
< 50 yr, < 20 pack yrs
Term
Non-small cell lung carcinoma
Definition

adenocarcinoma (35-40%)

squamous cell (25-30%)

large cell (10-15%)

Term
types of lung carcionma
Definition

non-small cell (adeno, squamous, large cell)

small cell (10-15%)

carcinoid (<5%)

Term
Presentation of adenocarcinoma lung cancer
Definition

anorexia/weight loss/cough/hemoptysis

highest rates amoung non-smokers/women

#1 in smokers

peripherally located on CXR/CT

Term
presentation of squamous cell lung CA
Definition

anorexia/weight loss/cough/hemoptysis

95% occur in smokers

centrally located on CXR/CT

Paraneoplastic syndrome  - hypercalcemia, PTHrP production from tumor

Pancoast - SVC syndrome, horner syndrome

Term
large cell lung CA
Definition

anorexia/weight loss/cough/hemoptysis

diagnosis of exclusion

usually peripheral location 

Term
small cell lung CA
Definition

"oat cell" carcionma

paraneoplastic syndromes - SIADH, ATCH, lambert-easten myasthenic syndrome

Term
treatment of NSCLC (non-small cell lung cancer)
Definition
surgery is first line in stages Ia-IIIa
Term
treatment of small cell lung CA
Definition
chemotherapy
Term
etiology of carcinoid tumor
Definition
associated with MEN, type 1
Term
carcinoid tumor clinical presentation
Definition

slow growth

located in GI and lung

centrally located & proximal bronchi

Term
treatment of carcinoid tumor
Definition
surgery is first line (cut it out!)
Term
"single," spherical, well-circumscribed radiographic opacity <= 30mm that is completely surrounds by aerated lung and is not associated with atelectasis, hillier enlargement, or pleural effusions
Definition
pulmonary nodules
Term
New pulmonary nodule is usually >=
Definition
3 mm
Term
low dose CT findings of pulmonary nodules
Definition

shape 

  • irregular
  • smooth (type 1)
  • lobulated (type 2)
  • spiculated (type 3)
  • corona radiate (type 4)

location --> usually in upper lobes

Attenuation - ground glass opacity, semisolid, solid

Term
treatment of pulmonary nodules
Definition

<= 4 mm = annual CT x 3 yrs

> 4-6 mm = CT in 6 months

>6-8 mm = CT in 3 months

> 8mm = PET/CT, possible bx

 

follow growth - malignant usually double in size every 20-300 days, benign usually double in size either < 20 days (really fast) or >450 days (really slow)

Term
irreversible bronchial dilation 2ry to transmural inflammation of medium sized bronchi
Definition
bronchiectasis
Term
destruction of muscular & elastic tissues of the bronchial wall.
inflamed airways collapse easily
Definition
bronchiectasis
Term
OBSTRUCTION of airflow & impaired clearance of mucus secretions --> lung infections
Definition
bronchiectasis
Term
Etiology of bronchiectasis
Definition
  1.  recurrent/chronic lung infections. H. flu MC if not d/t CF; pseudomonas MC if d/t CF
  2. hereditary: CF MCC of bronchiectasis in US
  3. obstruction: FB aspiration, tumors, severe mucous 
Term
Clinical manifestations of bronchiectasis
Definition
  1. daily chronic cough w/ thick mucopurulent (foul smelling) sputum
  2. hemoptysis. d/t erosion into bronchial a.  
  3. persistent crackles @ bases common. 
Term
what is the MCC of massive hemoptysis?
Definition

bronchiectasis

 

acute bronchitis & lung Ca MCC of hemoptysis in general

Term
What is the study of choice for bronchiectasis?
Definition

high resolution CT scan

  • airway dilation
  • lack of tapering of bronchi
  • bronchial wall thickening (tram-track apperance)
  • mucopurulent plugs
  • consolidations
  • signet ring sign -pulm. a. coupled w/ dilated bronchus
Term
What would PFT's show in a patient with bronchiectasis?
Definition
obstructive - decreased FEV1, FVC, & FEV1/FVC < 70%
Term
Problematic pathogens for bronchiectasis
Definition
  1. pseudomonas: MC d/t CF
  2. mycobacterium avoid complex (MAC) clarithromycin + ethambutol 
  3. aspergillus: allergic bronchopneumonia. Thick, brown sputum.  Management: steroids + itraconazole. Sx if sxatic aspergilloma
Term
how do you treat bronchiectasis?
Definition
  1. abx: cornerstone. 
  • Empiric (Ampicillin, Amox, bactrim)
  • Pseudomonal (Fluoroquinolone, Zosyn, Aminoglycoside, Cephalosporin)
  • Azithromycin has anti-inflammatory properties

2. Mucus management / chest physiotherapy : bronchodilators, anti-inflammatory; surgery, embolization for bleeding

 

3. Surgery resection (or transplantation) in severe

Term
chronic progressiev interstitial scarring (fibrosis) from persistent inflammation --> loss of pulm. function w/ restrictive component of unknown cause
Definition

idiopathic pulmonary fibrosis (fibrosing interstitial pneumonia)

Term
Clinical manifestations of idiopathic pulmonary fibrosis (fibrosing interstitial pneumonia)
Definition

dyspnea and/or nonproductive cough 

usually gradual onset

Term
How do you diagnose idiopathic pulmonary fibrosis (fibrosing interstitial pneumonia)
Definition

CXR/CT scan: diffuse reticular opacities (honeycombing)

ground glass opacities 

 

BX: honeycombing - large cystic airspaces from cystic fibrotic alveolitis

Term
What do PFT's show in idiopathic pulmonary fibrosis (fibrosing interstitial pneumonia)
Definition

restrictive dz: decreased lung volumes (decreased TLC, RV)

 

normal/increased FEV1/FVC

 

decreased DCLO

Term
how do you treat idiopathic pulmonary fibrosis (fibrosing interstitial pneumonia)?
Definition

smoking cessation, O2 therapy

lung transplant only cure

Term
air within the pleural space. increasingly positive pleural pressure causes collapse of the lung
Definition
pneumothorax
Term
types of pneumothorax
Definition
  1. spontaneous pneumo: (atraumatic & idiopathic) believed to be ruptured bleb
  2. traumatic
  3. tension: + air pressure pushes lungs, trachea, & heart to contralateral side. needle aspiration 2nd ICS MCL followed by chest tube thoracostomy
Term
Types of spontaneous pneumothorax
Definition

Primary: no underlying lung dz: mainly affects tall, thin men 20-40y, smokers, fam hx


Secondary: underlying lung dz w/o trauma (ex COPD, asthma), menstruation (catamenial)

Term
Clinical manifestations of pneumothorax
Definition
chest pain (usually pleuritic, unilateral) non exertional in onset; dyspnea
Term
PE : pneumothorax
Definition
  1. increased hyperresonance
  2. decreased fremitus
  3. decreased breath sounds
  4. unequal respiratory expansion
  5. tachycardia & tachypnea
  6. hypotension
  7. Tension PTX: increased JVP, pulsus paradoxus
Term
Diagnosis of pneumothorax?
Definition

CXR w/ expiratory view preferred

+- companion lines

decreased peripheral lung markings

deep sulcus

Term
how do you treat pneumothorax
Definition
  1. observation if small <20% often closes spontaneously
  2. chest tube placement (thoracostomy); if large PTX
  3. needle aspiration if tension PTX followed by chest tube placement. Needle placed in 2nd ICS @MCL of affected side
  4. Avoid high altitudes, smoking, unpressurized aircraft, and scuba diving 
Term
inflammation of trachea/bronchi (conducting airways)
Definition
acute bronchitis
Term
acute bronchitis is MCC by...
Definition

viruses

(adenovirus, parainfluenza, influenza, coxsackie)

bacteria 

(S. pneumoniae, H. influ, M. cat, Mycoplasma)

Term
Acute bronchitis often follows....
Definition
URI
Term
Clinical manifestations of acute bronchitis
Definition

similar to pneumonia

Hallmark is cough (+- productive & may last 1-3 wks)

Diagnosis is usually clinical

Term
how do you diagnose acute bronchitis?
Definition
CXR usually nonspecific/normal
Term
How do you treat acute bronchitis?
Definition
  1. symptomatic tx of choice: fluids, rest, antitussive agents +- bronchodilators
  2. abx no statistical benefit in healthy pts (abx +- beneficial in elderly, COPD, IC or who don't respond to conservative tx)
Term
chronic fibrotic lung diseases caused by the inhalation of coal dust or various inert, inorganic or silicate dusts
Definition
pneumoconioses
Term
clinically important pneumoconiosis include:
Definition

coal workers' pneumoconioses

silicosis

asbestosis

Term
Clinical features of pneumoconioses
Definition

simple - pneumoconioses usually asxatic

 

severe - dyspnea, inspiratory crackles, clubbing of fingers, cyanosis

Term
What are the diagnostic studies for pneumoconioses
Definition

PFT - restrictive dsyfunction & reduced diffusing capacity 

CXR 

Term
CXR : coal worker's pneumoconioses
Definition
small opacities are prominent in the upper lung fields
Term
CXR: silicosis
Definition
small rounded opacities are seen throughout the lung, and hilar lymph nodes may be calcified
Term
CXR: asbestosis
Definition
interstitial fibrosis, thickened pleura, and calcified plaques appear on the diaphragms or lateral chest wall
Term
Management of pneumoconioses
Definition
  1. primarily supportive as no efective tx is available.  O2, vaccinations (pneumococcal, influenza), rehab
  2. steroids may relieve the chronic alveolitis in silicosis
  3. smoking cessation especially important w/ asbestosis because somking interfers w/ short asbestos fiber clearance from the lung.  Smoking and asbestos are synergistically linked to lung cancer, especially mesothelioma
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