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Tanner Shared "pulm 2" - 21 Picmonics

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pulm 2

Pulmonary Hypertension Diagnosis and Management
Diagnosis
Echocardiogram
Right Heart Cathetherization
> 20 mmHg at Rest
Chest X-Ray
MANAGEMENT
Treat Underlying Disorder
Calcium Channel Blockers
Endothelin Receptor Antagonists
Prostacyclin Analogs
PDE-5 inhibitors
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2 mins
Pulmonary Hypertension Classification (WHO)
Group 1
Pulmonary Arterial Hypertension
Idiopathic
Hereditary
BMPR2 Mutation
Group 2
Left Heart Disease
Group 3
Lung Diseases or Hypoxia
COPD
Obstructive Sleep Apnea
Group 4
Chronic Pulmonary Emboli
Group 5
Multifactorial
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2 mins
Acute Respiratory Distress Syndrome (ARDS) Assessment
Cause
Damaged Alveolar-Capillary Membrane
Assessment
Restlessness
Dyspnea
Refractory Hypoxemia
Decreased PaO2
Diffuse Pulmonary Infiltrates
Atelectasis
Pulmonary Hypertension
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2 mins
Acute Respiratory Distress Syndrome (ARDS) Interventions
Interventions
Closely Monitor Patient
ABG's (Arterial Blood Gases)
Oxygen
Assess for O2 Toxicity
Mechanical Ventilation
PEEP
Assess for Pneumothorax
Permissive Hypercapnia
Considerations
High Mortality Rate
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2 mins
Pleural Effusion
Characteristics
Accumulation of Fluid in Pleural Space
Types
Transudative
Exudative
Chylothorax
Clinical Features
Dyspnea
Pleuritic Chest Pain
Decreased Breath Sounds
Diagnosis
Chest X-ray
Light Criteria
Management
Treat Underlying Disorder
Thoracentesis
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3 mins
Pneumothorax
Mechanism
Air Enters Pleural Space
Assessment
Sudden Dyspnea
Absent or Restricted Movement on Affected Side
Decreased or Absent Breath Sounds on Affected Side
Chest Pain
Tracheal Deviation
Vital Sign Changes
Crepitus
Considerations
High Fowler's Position With Oxygen
Prepare For Chest Tube Placement
Educate High Risk Patients
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2 mins
Pulmonary Embolism Causes
Causes
FAT BAT Mnemonic
Fat
Air
Deep Vein Thrombosis (DVT)
Bacteria
Amniotic Fluid
Tumor
Risk Factors
Hypercoagulable
Central Venous Lines
Immobilized
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1 min
Pulmonary Embolism Assessment
Assessment
Shortness of Breath (SOB)
Pleuritic Chest Pain
Tachypnea
Hemoptysis
Hypoxemia
Considerations
Sudden Death
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52 secs
Pulmonary Embolism Presentation and Diagnosis
Presentation
Sudden onset Shortness of Breath (S.O.B.)
Tachypnea
Pleuritic Chest Pain
Hemoptysis
Hypoxemia
Sudden Death
Diagnosis
Gold Standard: CT Pulmonary Angiography
X-Ray
D-Dimer
V/Q Scan
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1 min
Light's Criteria
Use
Determines Transudative vs. Exudative Source of Pleural Effusion
Exudate if (At Least One of the Following):
Effusion/Serum Protein Ratio > 0.5
Effusion/Serum LDH Ratio > 0.6
Effusion LDH > Two-thirds Upper Serum LDH Range
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2 mins
Spontaneous Pneumothorax
Mechanism
Accumulation of Air in Pleural Space
Tall and Thin Young Males
Bleb or Bulla Rupture
Underlying Disease
Signs and Symptoms
Hypoxemia
Chest Pain
Decreased Breath Sounds
Hyperresonance
Shortness of Breath (SOB)
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1 min
Tension Pneumothorax
Mechanism
Air Enters Pleural Space, but Can't Exit
Trauma or Infection
Signs and Symptoms
Decreased Breath Sounds
Trachea Deviates Away from Affected Side
Chest Pain
Tachycardia
Tachypnea
Hypotension
Hypoxemia
Hyperresonance
Emergency
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2 mins
Cystic Fibrosis Assessment
Thickened Mucus
Recurrent Pulmonary Infections
Pulmonary Congestion
Pancreatic Insufficiency
Steatorrhea
Fat-Soluble Vitamin Deficiencies
Salty Taste to Skin
Meconium Ileus
Delayed Growth and Poor Weight Gain
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2 mins
Cystic Fibrosis Interventions
Bronchodilators
N-Acetylcysteine (Mucolytics)
Inhaled Hypertonic Saline
Early Antibiotics
Dornase Alfa (Mucolytic Agent)
Postural Drainage with Percussion
Fat Soluble Vitamin Supplements
Pancreatic Enzymes with Every Meal
High Protein, High Calorie Diet
Added Dietary Salt
Glucose Monitoring
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2 mins
Bronchial Carcinoid Tumor
Characteristics
Excellent Prognosis
Signs and Symptoms
Symptoms of Bronchial Obstruction
Often Asymptomatic
Carcinoid Syndrome
Diarrhea
Wheezing
Flushing
Diagnosis
5-HIAA in Urine
Nests of Neuroendocrine Cells
Chromogranin A Positive
Treatment
Surgical Resection
Octreotide for Symptomatic Relief
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2 mins
Squamous Cell Carcinoma of the Lung
Characteristics
Strong Correlation with Smoking
More Common in Men
Central Location
Cavitating Lesion Extending to Hilum
PTHrP Causes Hypercalcemia
Diagnosis
Keratin Pearls
Intercellular Bridges
Treatment
Surgical Resection (if Early Stage)
Chemotherapy and Radiation (if Later Stage)
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2 mins
Adenocarcinoma of the Lung
Characteristics
Most Common Lung Cancer
Most Common in Nonsmokers
Peripheral Location
KRAS, EGFR, and ALK Mutations
Diagnosis
Glandular Pattern
Often Stains with Mucin
Clinical Features
Presents with Hemoptysis
Clubbing
Treatment
Surgical Resection
Chemotherapy and Radiation
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2 mins
Large Cell Carcinoma
Characteristics
Strong Correlation with Smoking
Poor Prognosis
Peripheral Lesions
Symptoms
Gynecomastia
Galactorrhea
Diagnosis
Anaplastic Cells
Pleomorphic Giant Cells
May Produce Beta hCG
Diagnosis of Exclusion
Treatment
Surgical Resection
Less Responsive to Chemotherapy and Radiation
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2 mins
Carcinoid Syndrome
Pathophysiology
Neuroendocrine Cells
Serotonin
Appendix
Diagnosis
Chromogranin A
Neuron Specific Enolase
Dense Core Bodies on EM
Signs and Symptoms
Symptoms When Metastasize to Liver
Flushing
Wheezing
Right Heart Murmur
Diarrhea
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4 mins
Mesothelioma
Characteristics
Malignant Pleural Tumor
Asbestos Exposure
Presentation
Dyspnea
Decreased Breath Sounds
Constitutional B Symptoms
Diagnosis 
Hemorrhagic Pleural Effusion
Pleural Thickening
Psammoma Bodies
Calretinin
Interventions
Surgery
Chemotherapy
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2 mins

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