pulm exam 2

Most bronchogenic carcinomas present between the ages ______, and few are less than ____ years old

what other factors can be potential carcinogens

What are the four major cell types of bronchogenic carcinomas

What are the most common carcinomas accounting for about 30 to 35% of primary tumors each

What are the carcinomas accounting for 20 to 25% and 15% respectively

Which type of carcinoma tends to originate in the central bronchi as intraluminal growth

Which carcinoma can be detected by sputum cytology

Where does squamous cell carcinoma tend to metastasize

This type of carcinoma also occurs centrally and tends to narrow bronchi by the extrinsic compression

Which type of carcinomas usually appear in the periphery and metastasize to distant organs

Where does adenocarcinoma and large cell carcinoma metastasize to

What are the non specific complaints for carcinomas

This is a tumor of the superior sulcus at the extreme apex of the lungs, it is characterized by severe unremitting pain in the lower part of the shoulder and inner aspect of the arm

Which tumor can progress to horner's syndrome (miosis, ptosis, enophthalmos, and loss of sweating on the affected side)

Which plexus does the Pancoast tumor affect

What are some examples of paraneoplastic syndromes

Which carcinoma can produce SIADH

If this is a obstructed by a tumor, it can cause progressive obstruction of venous drainage of the head, neck, and upper extremities

Under tumor complications, what results in hoarseness

What labs need to be ordered for all suspected lung cancer patients

What is the definitive diagnosis for the more centrally located carcinomas

What is essential in determining staging, treatment, and prognosis of carcinomas

If you see a suspicious legion on and xray what is your next choice of scan

If you want to see if the cancer has metastasized, what it is your choice of study

What is the treatment of choice for small cell carcinoma

What are the major factors for prognosis of carcinomas

This is a single round or oval sharply circumscribed pulmonary lesion, up to three centimeters, surrounded by normal lung tissue

What disrupts cell function and prevents tissue from taking up oxygen

What are the symptoms of cyanide poisoning

This is a precursor to vitamin B12, binds to cyanide and neutralizes it, is eliminated harmlessly from the body through urination, and is given intravenously and acts immediately

What are the side effects of hydroxocobalamin

This occurs from inhalation of hot gases injuring mucosal surfaces, complications become evident around 18 to 24 hours, complications include impaired ability to clear oral secretions and airway obstructions, producing inspiratory stridor

This results from the toxic gases produced by combustion, it can result in bronchorrhea and bronchospasm's, early with possible labored breathing and cyanosis, ARDS may follow in 1 to 2 days

with chemical injury, this can occur causing obstruction, atelectasis, and increasing hypoxemia, often pneumonia follows 5 to 7 days after exposure

Why does the treatment of smoke inhalation include

For patients that survive smoke inhalation follow-up is needed to monitor for what

This is caused by ingestion of petroleum distillates, lung injury mainly from vomiting and secondary aspiration, therapy as supportive, protect lungs from repeated aspiration with cuffed endotracheal tube if necessary

This is chronic fibrotic lung disease is caused by inhalation of coal dust and various inert, inorganic, or silicate dusts

This is caused from extensive or prolonged inhalation of free silica particles forming small rounded opacities through out the lung

On a chest xray, what strongly suggests silicosis

Asbestosis is a nodular interstitial fibrosis occurring in which occupations

This is an asthma like disorder in textile workers caused by inhalation of cotton dust, symptoms include chest tightness, cough, dyspnea and usually is worse on Mondays or the first day back to where, and subsides later in the week

This occurs in extremely obese individuals characterized by hypercapnia, hypoxemia, and elevated hematocrit

What it is the treatment for pickwickian syndrome

How is hypercapnia and hypoxemia corrected in pickwickian syndrome

What is the number one arrhythmia associated with pickwickian syndrome

what are the essentials to diagnosing a PE

what is the scan of choice for detection of a PE

where can PEs arise from

70% of PEs originate as clots in deep veins of ____, mostly in the _____

what is virchows triad

what is the most common cause of PEs in the Caucasian population

what causes factor V leiden thrombopenia

a thrombus in the pulmonary artery has hemodynamic effects that affect what

what are the pulmonary effects of a PE

what are the signs that a pt will present with for a PE

what are the symptoms of a PE

an ABG will usually note what for a PE

what is rarely seen on a CXR but is very suggestive of a PE

if you have an indeterminant study for a PE after doing a helical CT-PA what should be done next to r/o a PE

this study is reserved for pt's with a suspected emboli but other studies are inconclusive, it is expensive and invasive with potential for complications and is less than the "gold standard"

with any IV radio contrast-media, what do you need to worry about

this test measures the plasma level of a degradation product of a cross linked fibrin, is measured by ELISA, and takes about an hour to perform

what measurement difference between calves is highly indicative of a DVT

if a DVT is suspected and there are no CI, what should be started

this sign is said to be present when passive dorsiflexion of the ankle by the examiner elicits sharp pain in the calf

what is the diagnostic study if a DVT is suspected

what should be started on pts at risk to prevent DVTs before surgery or on hospital admission

extremely high risk pt's or surgeries may require what type of prevention

what is the timeframe to reach full therapeutic effect of coumadin

this anti-coag works by activating AT-III to slow or prevent the progression of DVT and to reduce the size and frequency of PE

what is the reversal of heparin

what are the medications used for lysis of pulmonary thromboembolia

what treatment is indicated when recurrent PEs are life threatening and major CIs for anticoag or failure or complications of anticoags or thrombolytic therapy are present

pain due to acute pleural inflammation is known as what

explain pleuritis

how is pleuritis treated

what is another cause for pain that is pleuritic but is not pleuritis

in a rib fracture or pleuritis, lack of proper ventilation can lead to this

this may be asymptomatic, may be pleuritic, may cause dyspnea, will notice decreased tactile fremitus on physical exam along with dullness to percussion, distant breath sounds and egophony if large

how much fluid must be present in the lateral decubitus to be considered effusion

what should be done to yield fluid for a diagnosis of the etiology of effusion

what accounts for most transudates and is the most common cause of pleural effusion

what are the most common causes of exudative effusion

TG readings of what can detect a chylothorax

what labs are used to detect an esophageal perforation

one treatment option for palliative pain control in a pleural effusion is what

what is the treatment for effusion secondary to pneumonia

what is required for frank pus

primary spontaneous pneumothorax usually affects what types of people

why do spontaneous pneumos occur in tall thin males

what are some causes for secondary pneumos

this type of pneumothorax is associated with menstruation

what are some clinical finds for a pneumo

what are some clinical findings for a pneumo

if there is severe tachycardia, HoTN, and a mediastinal or tracheal shift what needs to be suspected

a pneumo is usually revealed on a CXR by noting what

most congenital bleb pneumos occur where

a tension pneumo will result in what

what can be associated with a rupture of the esophagus or bronchus

what is the treatment for a pneumo is <15%

what is the treatment for a pneumo that is > 15%

this is a primary tumor arising from the surface lining of the pleura or peritoneum, symptoms include insidious onset of SOB, non pleuritic CP, weight loss

what will a CXR show with mesothelioma

what are common features of interstitial and mycotic lung diseases

these diseases will have a decrease in DLCO and ventilator function, usually present with exertional dyspnea and dry cough of insidious onset, and chest exam is notable for fine inspiratory crackles at bases

this disease has a CXR that notes ground-glass, nodular, reticular or reticulonodular infiltrates that may progress to honeycomb lung

what is very good for diagnosis of interstitial diseases

what is used for pathological diagnosis of interstitial diseases

what is the most common diagnosis presenting with interstitial lung disease

what is the treatment for cryptogenic fibrosing alveolitis

what is the prognosis of cryptogenic fibrosing alveolitis

pts with cryptogenic fibrosing alveolitis have an increased risk of what

this is a systemic disease of unknown cause with granulomatous inflammation of the lung in 90% of pts, pt may have malaise, fever, and dyspnea of insidious onset

physical findings of this disease include skin rashes, erythema nodosum, parotid gland enlargement, hepatosplenomegaly, lymphadenopathy

the first signs of sarcoidosis is noted on a routine CXR how

what is the treatment for sarcoidosis

if a patient has asymptomatic sarcoidosis, how are they treated

this is an idiopathic disease hitting a combination of glomerulonephritis, necrotizing granulomatous vasculitis of upper and lower respiratory tracts, and varying degrees of small vessel vasculitis , it usually affects young and middle aged adults

this is an idiopathic multisystem vasculitis of small and medium-sized arteries that occurs in pts with asthma

how is pulmonary angiitis and granulomatosis treated

this causes an idiopathic recurrent alveolar hemorrhage and rapidly progressive glomerulonephritis, occurs mainly is men who are in their 30's and 40's, and hemoptysis is the presenting symptom

who is goodpastures syndrome diagnosed

what is the current treatment of goodpasture syndrome

this disease is linked to bird droppings and bat exposure, is very common along river valleys

what is the treatment for histoplasmosis

this is endemic in the soil in many arid regions of the southwestern USA, mexico, and south and central America, is a very common opportunistic infection in HIV-infected pts and symptoms include flu-like with malaise, fever, backache, and cough

this disease occurs most often in men of the south central and Midwestern USA and Canada, may often see skin lesions with verrucous cutaneous lesions with abrupt down-sloping border, and can also affect the bone and urogenital system

this can colonize the tracheobronchial tree and is usually asymptomatic unless there is marked immunodeficiency

what unique condition can aspergillosis cause that leads to wheezing and transient infiltrates

when should allergic bronchopulmonary aspergillosis be considered in a pt

how is allergic brochopulmonary aspergillosis treated

what is the rough definition of acute respiratory failure by ABGs in a non-COPD pt

what are some chief signs of hypoxemia

what are some cardinal symptoms of hypercapnia

what are some chief sign of hypercapnia

for non ventilator support, what is the goal in acute hypoxemic respiratory failure

what is the only mask that will give you an exact FiO2 % up to 40-50% of O2

which mask do you never run <5L/min

which mask has the highest FiO2 on a mask

how high should a nasal cannula run

what determines how long a cylinder will last

what is indicated for hypoxemia not quickly reversible, for upper airway obstruction, impaired airway protection, poor handling of secretions, and facilitation of mechanical ventilation

how far in an ET tube inserted

this is great for urgent airway management

the tip of the tube once intubated should be at the level of what

what are some indications for mechanical ventilation

this can occur in pts whose lungs are over distended by too great a volume or pressure

what are some signs of barotrauma

what is a common ventilator complication

what are labs are ordered to check the patients general health while ventilated

this is a special type of respiratory failure, it occurs after a systemic or pulmonary insult, is characterized by respiratory distress, bilateral infiltrates, hypoxemia, noncompliant lungs, and normal pulmonary capillary wedge pressure

what are the common risk factors for ARDS

what are the clinical findings of ARDS

what is the treatment for ARDS

what is the major cause of death in ARDS