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PANCE > 1) Pulmonology > Flashcards

1) Pulmonology Flashcards

1
Q

Abx for acute bronchitis

A

MOST = viral
But if: elderly, underlying cardiopulm dz, or cough >7-10 days, or immunocompromised
-2nd generation cephalosporin (cefuroxime, cefoxitine, cefotetan)

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2
Q

Acute Epiglottitis tx

A 
#1 Secure airway
#2 Broad spectrum 2nd or 3rd gen cephalosporin (cefotaxime or ceftriaxone 7-10 days)
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3
Q

Croup Tx

A 
Mild = supportive only
Severe = hospitalization

(corticosteroids, humidified air/oxygen, nebulized epi)

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4
Q

Stages of Pertussis

A

1) Catarrhal (insidious onset of coryza, HACKING cough, worse at night)
2) Paroxysmal (rapid coughing fits w/ WHOOP)
3) Convalescent sage (decrease in freq and paroxysms)

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5
Q

Treatment of Choice for Pertussis

A

Erythromycin
(treat close contacts too)
Prophylaxis: Dtap 7y/o

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6
Q

Most common cause of pneumonia

A

S. pneumo

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7
Q

Low grade fever
Cough
Bullous myringitis
**Cold Agglutins (confirm)

A

Manifestations of M. Pneumo pneumonia

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8
Q

Slower onset, immunosuppression
Increased LDH
More hypoxemic than appears on CXR
Interstitial infiltrates

A

Manifestations of pneumocysitis jiroveci

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9
Q

chronic cardiac or respiratory disease
hyponatremia
diarrhea or other system sump
longer prodrome

A

Legionella pneumoniae

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10
Q

Single rigor

rust colored sputum

A

s. pneumo

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11
Q

currant jelly sputum

Chronic illness, including alcohol abuse

A

k. pneumo

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12
Q

Pathogen most likely to cause pneumonia in: Alcohol abuse

A

Klebsiella pneumoniae

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13
Q

Pathogen most likely to cause pneumonia in: COPD

A

haemophilus pneumoniae

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14
Q

Pathogen most likely to cause pneumonia in: Cystic Fibrosis

A

Pseudomonas

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15
Q

Pathogen most likely to cause pneumonia in: Young adults, college settings

A
  • Mycoplasma pneumoniae

- Chlamydia penumoniae

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16
Q

Pathogen most likely to cause pneumonia in: Air conditioning/aerosolized water

A 
Legionella pneumoniae
(treatment of choice = levofloxacin alt = azithrom)
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17
Q

Pathogen most likely to cause pneumonia in: Post-splenectomy

A

Encapsulated Organisms:

  • s. pneumo
  • h. pneumo
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18
Q

Pathogen most likely to cause pneumonia in: Leukemia/Lymphoma

A

Fungus

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19
Q

Pathogen most likely to cause pneumonia in: children <1yr

A

RSV

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20
Q

Pathogen most likely to cause pneumonia in: Children <2yr

A

Parainfluenza

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21
Q

Healthcare associated pneumonia

A

Presents w/ symptoms > 48h after admission to hospital
-s. aureus, pseudomonas
(pseudomonas is most likely in ICU)

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22
Q

Tx of HAP

A
  • Cefepime
  • Ticarcillin/clavulanic acid
  • Piperacillin/tazobactam
  • Meropenem
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23
Q

Most common fungus in pneumonia

A

Aspergillus

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24
Q

Missisippi valley

A

histoplasmosis

also has worldwide distribution

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25
Q

Southwestern US

A

coccidiomycosis

26
Q

Southeast and midwest

A

blastomycosis

27
Q

CXR in pneumocysitis jiroveci

A

Diffuse or perihilar infiltrates w/ no effusion

CXR is the cornerstone of DX

28
Q

Tx of pneumocysitis jiroveci

A

TMP/SMX

29
Q

Primary TB

A
  • 10% of those infected
  • CXR: homogenous infilt, hilar/paratracheal lymph node enlargment, segmental atelectasis
  • TX: INH/RIF/PZA/EMB x 2 mo then INH/RIF for 4mo
30
Q

Progressive Primary TB

A
  • Def: 5% of those infected fail to contain the infection and progress to active TB in 2yrs
  • CXR: homogenous infilt, hilar/paratracheal lymph node enlargment, segmental atelectasis AND cavitary lesions
  • Tx: INH/RIF/PZA/EMB x 2 mo then INH/RIF for 4mo
31
Q

Latent TB

A
  • **95% of infected people contain the bacterial w/o becoming symptomatic
  • TX: INH for 9mo or RIF for 4mo OR RIF+PZA for 2mo
32
Q

Reactivation TB

A

Develops from latent TB in the setting of immune compromise

  • CXR:
  • fibrocavitary apical disease nodules, infiltrates posterior and apical segments of the Right upper lobe, apical posterior segments of the left upper lobe, superior segments of the lower lobes
33
Q

A TB skin test is positive if > or = 5mm in:

A

HIVpts, recent contacts of TBpt, people w/ TB on cxr, immunocomp pts on steroids

34
Q

A TB test is positive if > or = 10mm in:

A

recent immigrants, HIV neg inject drug users, mycobact lab workers, people in high congregate settings, people w/ chronic medical conditions like DM, silicosis, CRF

35
Q

A TB test is positive if > or = 15mm in:

A

pts w/ no RF for tuberculosis

36
Q

Definitive dx of TB

A

Identification of m.tuberc on cultures or by DNA/RNA amp technicques

  • *demonstration of acid-fast bacilli on sputum supports but doesn’t confirm TB
  • Biposy revelaing CASEATING granulomas = histologic hallmark
37
Q

SE of INH

A

hepatitis, peripheral neuropathy (supplement w/ B6 to reduce the risk)

38
Q

SE of RIF

A

hepatitis, flu syndrome, orange-red bodily fluid

39
Q

SE of EMB

A

optic neuritis (red/green vision loss)

40
Q

SCLC

A

25-35% of all

  • originates at the central bronchi and mets to regional lymph nodes
  • early mets, aggressive course
  • Tx: Chemo
41
Q

NSCLC

A

1) Squamous Cell carcinoma (centrally located mass)
2) Adenocarcinoma (periphery of lungs) MOST COMMON
3) Large Cell Carcinoma
Tx: Surgery

42
Q

Lung Cancer Complications

A

SPHERE

  • SVC syndrome
  • Pancoasts Tumor
  • Horner Syndrome
  • Endocrine
  • Recurrent laryngeal nerve (hoarseness)
  • Effusions (exudative)
43
Q

SVC syndrome

A

Plethora, headache, mental status changes

44
Q

Pancoasts Tumor

A

Tumor of the lung apex

causes horner syndrome and shoulder pain, affects brachial plexus and cervical sympathetic nerve

45
Q

Horner’s syndrome

A

U/L facial anhidrosis, ptosis, myosis

46
Q

Endocrine

A

Carcinoid syndrome: flushing, diarrhea, telangiectasias

47
Q

Causes of exudates

A

Infection, Malignancy, Trauma

most common irritants are doxycycline and talc

48
Q

Causes of transudates

A

CHF, atelectasis, renal or liver dz/cirrhosis

49
Q

Light’s Criteria

A

EFFUSION if one of these is met:

  • pleural fluid protein to serum protein ration >0.5
  • pleural fluid LDH to serum LDH ration >0.6
  • pleural fluid LDH >2/3 the upper limit of normal for serum LDH
50
Q

Asbestosis

A
  • Occupation: Insulation, Demolition, Construction
  • Dx: linear opacities at bases and pleural plaques
  • Bx: Asbestos bodies
  • Complications: Increased risk of lung cancer and mesothelioma, especially if smoker
51
Q

Coal Workers’ Pneumoconiosis

A
  • Occupation: Coal Mining
  • Dx: Nodular opacities at upper lung fields
  • Complications: Progressive massive fibrosis
52
Q

Silicosis

A
  • Occupation: Mining, sand-blasting, quarry work, stone work
  • Dx: nodular opacities at upper lung fields
  • Complications: Increased risk of TB, progressive massive fibrosis
53
Q

Berryliosis

A
  • Occupation:high technology fields, aerospace, nuclear power, ceramics, foundries, tool and dye manufacturing
  • Dx: diffuse infiltrates and hilar adenopathy
  • Complications: requires chronic steroids
54
Q

Tx of pneumoconioses

A

Usually supportive because no effective tx is available

oxygen, vaccinations, rehab

55
Q

Sarcoidosis

A
  • Multiple organ disease of idiopathic cause (90% have lung involvement)
  • extrapulmonary findings are common and include erythema nodosum or enlargement of the parotids, lymphnodes, liver, or spleen
  • Blood Tests: leukopenia, eosinophilia, elevated ESR, hypercalcemia, hypercalciuria -Angiotensin-converting enzyme is elevated in 40-80% of patients
  • CXR: symettric bilateral hilar and right paratracheal adenopathy and b/l diffuse reticular infiltrates -Dx: via biopsy of lung or find needle biopsy that shows non-caseating granulomas
  • Tx: 90% are responsive to corticosteroids and maintained w/ modest doses
56
Q

Cause of ARDS

A
  • increased permeability of the alveolar capillary membranes which leads to development of protein rich pulmonary edema
  • 75% of ARDS = #1 Sepsis syndrome, severe multiple trauma, and aspiration of gastric contents
    (other: shock, toxic inhalation, near-drowning, multiple transfusions)
57
Q

Symp of ARDS

A
  • rapid onset of profound dyspnea 12-24h after the precipitating even
  • tachypnea, frothy pink-red sputum, diffuse crackles
  • cyanosis w/ increasingly severe hypoxemia refractory to administration of oxygen -CXR: may be normal at first, may have peripheral infiltrates, 80% = air broncograms
  • *pleural effusions may be small or absent -PCWP: normal
  • Multiorgan failure is common
58
Q

Tx of ARDS

A
  • Tx: identify and treat precipitating and secondary conditions
  • Oxygen via intubation (positive pressure ventilation and low levels of PEEP) -Mortality rate is high (1/3 die w/in first 3 days)
59
Q

Most common cause of respiratory distress in the preterm infant

A

Hyaline membrane dz
-caused by deficiency of surfactant
(air bronchograms, diffuse b/l atelectasis causing ground glass appearance)

60
Q

Tx of Hyaline membrane dz

A

-Tx: synchronized intermittent mandatory ventilation; exogenous surfactants as prophylaxis or as rescue

PANCE (18 decks)

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