2. Pulmonology Flashcards
Dyspnea + wheezing + cough at night
Name/Reversibility/Patho/Risk/PE/Admisison criteria/Dx/Tx
Name: Asthma
Reversibility: Reversible
Patho: 1. hyperactivity, 2. broncho constriction, 3. inflammation
Risk: Atopic dematitis
PE: wheezing, hyperresonance
Dx: PFT, PEFR (in ED)
Admission: PEFR less than 50% or doesn’t improve more than 15% (discharge 70% or improve more tha 15%)
Tx (step up process)
- Intermittent - SABA
- mild - SABA + LABA
- moderate - low or medium ICS + LABA
- Severe - high ICS + LABA (last resort - Omalizumab)
Asthma criteria explanation
- intermittent
- <2 sx/day/week
- SABA <2 days/week
- <2 sx night per month
- FEV >80%
- mild
- >2 sx/day/week
- SABA >2 days/week
- 3-4 night sx/month
- FEV >80%
- moderate
- daily sx
- SABA daily
- 1 night sx/week
- FEV 60-80
- Severe
- Throughout the day sx
- SABA several times a day
- More than 2 night sx/week
-
FEV less than 60
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Emphysema vs Chronic bronchitis sx
Emphysema
- Dyspnea
- Pink puffers
- Pursed lip (barrel chest)
- Respi-alkalosis
Chronic Bronchitis
- Productive cough x 3 month / 2 consecutive years
- Blue bloaters
- Respi-acid
COPD
Reversibility/Risk/Dx/Tx/Prevention
Reversibility: Irreversible
Risk: Smoking, alpha one antitrypsin deficiency, Multifocal atrial tacycardia
Dx: PFT
Tx: Bronchodilator + corticosteroids (may need O2 if severe)
Prevention: SMOKING CESSATION First
Pneumococcal + influenza
COPD Tx criteria
Mild - FEV >80% - SABA
Moderate - FEV 50-79% - SABA + LABA
Severe - FEV 30-50% - SABA + LABA + Pulmonary rehab
Very Severe - FEV less than 30% - SABA + LABA + Pulmonary rehab + O2 therapy
Daily chronic cough thick, mucopurulent, foul-smelling sputum + hemoptysis + hx cystic fibrosis
Name/Reversibility/Risk/Dx/Tx
Names: Bronchiectasis
Reversibility: Irreversible
Risk: Pseudomonas (CF), hx of cystic fibrosis
Dx: CT (tram-track)
Tx: Abx + chest physiotherapy
Pancreatic insufficiency + chronic sinusitis (cough wheezing)
Name/Reversibility/Risk/Classic Sx(3)/Dx/Tx
Name: Cystic Fibrosis
Reversibility: Irreversible
Risk: European (white)
Classic
- Gastro - Meconium ileus at birth, Pancreatic insufficiency (ADEK)
- Pulmo - Chronic sinusitis
- Inferitility
Dx: sweat chloride
Tx: Airway clear + Pancreatic enzyme replacement
Uveitis + dry cough + ACE increase
Name/Reversibility/Patho/Dx/Lab/Tx
Name: Sacroidosis
Reversibility: Irreversible
Patho: Noncaseating Granuloma formation
Dx: biopsy, CXR (hilar lymphadenopathy)
Lab: ACE increase, hypercalciuria/hypercalcemia, cutaneous anergy
Tx: Observation, Prednisone
clubbing finger + honeycombing CXR
Name/Reversibility/Risk/Patho/PE/Dx/Tx
Name: Idiopathic fibrosing interstitial pneumonia (pulmonary fibrosis)
Reversibility: Irreversible
Risk: Men + smoking
Patho: chronic inflammation -> fibrosis
PE: clubbing of the fingers
Dx: CXR (honeycombing), PFT
Tx: Lung transplant
- Mining quarry work with granite/slate/quartz/pottery/sandblasting (Name/DX)
- Electronic/aerospace/ceramic/dye (Name)
- Coal/carbon mine (Name/Dx)
- Cotton exposure (Name)
- Old building/ship building/destruction (Name/Relate/Dx)
- Silicosis/CXR - egg shell calcification
- Berylliosis
- Coal worker (black lung)/CXR - upper lobe nodule
- Byssinosis (brown lung)
- Asbestosis/Mesothelioma/CXR - plaque @ lower lobe
Pleuritic chest pain + localized pain and tenderness @ costochondral
Name/PE
Name: Costochondritis
PE: localized tenderness @ 2-5th costochondral junctions
- Tenderness + edema = Tietze syndrome
Blunting of costophrenic angles + friction rub
Name/Patho/Dx/Tx
Name: Pleural effusion
Patho: accumulation of fluid
Dx: CXR - PA/lateral (lateral decubitus films), Thoracentesis (fluid analyze)
Tx: Thoracentesis (chest tube)
Light criteria (list of Dz)
Exudative (tranduative opposite)
- Protein >0.5
- LDH >0.6
- LDH >2/3 upper limit of normal LDH
Tranduative Dz - CHF, Nephrotic, Cirrhosis, PE
Unilateral Pleuritic + hyperresonance + companion line
Name/3 type/Dx/Tx
Name: Pneumothorax
3 type
- Spontaneous
- primary - bleb rubture (tall thin smoker 20-40)
- secondary - lung dz
- Traumatic - iatrogenic - subclavian line placement
- Tension - Positive air pressure push trachea (contralateral side)
Dx: CXR - companion line
Tx
- if small - observe
- if large - chest tube (thoracostomy)
- if tension - needle aspitation (2nd ICS + MCL)
Pulmonary nodule Malignancy vs Benign
Mass - 3 cm more, Nodule - 3 cm less
Benign - slow, well round
Malignancy - Fast, irregular, cavity with thickened wall
Flushing + tachycardia + diarrhea + high serotonin
Name/DX/Tx
Name: Bronchial carcinoid tumors
Dx: Bronchoscopy (pink to purple well-vascularized central tumor)
Tx: surgical excision
hx of smoking + hemoptysis + weight loss
Name/4 type/MET spots/Lab/Dx/Tx
Name: bronchogenic carcinoma
Type
- Non small cell
- Adeno - MC, Peripheral located
- Squamous - central located + cavitary lesion
- Large - very agressive
- Small cell - met early
Lab: hypercalcemia (squamous)
MET spots: Brain, bone, liver, lymph node
Dx: CT
Tx: Nonsmall - surgical, small - chemo
Sudden dyspnea + hx of DVT & post OP + chest pain + tacypnea
Name/Risk/Dx/Tx
Name: pulmonary embolism
Risk: post op, hx of DVT
Dx: CT, Angiography (Gold), V/Q (pt with kidney issue unable to use CT with contrast)
- PE possible low - D-dimer
- PE possible high - CT
ECG: Sinus tachycardia MC, S1Q3T3
Tx
- hemodynamic stable - LMWH or IV UFH -> contraindicated then use IVC filter
- hemodynamic unstable - Thrombolytic -> contraindicated than use embolectomy
dyspnea + RVH + Right Axis deviation
Name/PE/Dx/Tx
Name: Pulmonary HTN
PE: S2 + Right side HF
Dx: Right side catheterization (definitive), ECG - RVH, right axis deviation
Tx: CCB
Pathogen for PNA
- MC CAP
- 2nd MC CAP (COPD)
- CAP with sinusitis
- AC or water supply with CAP
- flu with CAP
- ETOH with CAP
- HIV with CAP
- Mississippi & Ohio river valley
- Aspiration PNA
- military + CAP
- Strep PNA
- H flu
- Chlamydophila
- Legionella
- Staphy A
- Klebsiella
- PCP
- histoplasma
- Anaerobes
- Mycoplasma
Typical vs atypical PNA
Typical
- Strep pneumo
- H flu
- Klebs
- Staphy A
Sx: Sudden onset fever, productive cough, dullness percuss, Egophony
Dx: lobar consolidation
Atypical
- Legion
- Chlamydophila
- Mycoplasma
Sx: low grade fever, dry cough, Ronchi, myalgias, malaise
Dx: X-ray - Patchy interstitial
PNA Tx/Prevention
Tx
- Outpatient: Macrolide or Doxy (7-10 days) discharge
- Inpatient: Ceftx + Macrolide or Doxy
- MRSA (hospital accquire): Vanco + Ceftx
Prevention
- PCV13 - childhood Vac
- PPSV23 - 65<, or 2-64 with chronic dz
Night sweat + weight loss + fever/chill + cough
Name/3 Type/Dx/Tx
Name: Tuberculosis
Type
- Primary TB - Rapid + contagious
- Latent TB - granuloma (caseating) + not contagious
- Secondary (reactive) TB - upper lobe cavitation + contagious
Dx: Acid/fast smear & sputum culture x 3 days (gold)
- CXR
- upper lobe - reactivation
- middle/lower lobe - primary TB
- milet-seed - military TB
Tx: RIPE - Rifampin, INH, Pyrazinamide, Ethambutol (ACUTE X 2 month)
- INH + PZA x 9 month (latent)
- INH + PZA x 12 month (latent with HIV)
Normal chest x-ray + cough
Name/Dx/Tx
Name: Bronchitis
Dx: Normal CXR
Tx: Fluid, rest, NO ABX
Coughing fit
Name/Pathogen/3 stage/Dx/Tx
Name: Pertussis
Pathogen: Bordetella pertussis
Stage
- catarrhal - most contagious (1-2week)
- Paroxymal - inspiration whooping sound after cough fits (post cough emesis)
- convalescent - resolution of cough (up to 6 weeks)
Dx: PCR of NasoSwab
Tx: Macrolide (AZA, erytho), alternative - septra (TMX-SMX)
Expiratory wheezing + young children + hx of URI
Name/Pathogen/Dx/Admission/Tx
Name: Acute bronchiolitis
Pathogen: RSV
Dx: Pulse OX
Admission: if less than 96%
Tx: Humidified O2 therapy
Dysphagia + drooling + distress
Name/Pathogen/Dx/Tx
Name: Acute epiglottitis
Pathogen: H flu
Dx: Laryngoscopy (definitive), CXR - Later neck (Thumb sign)
Tx: Airway + IV Ceftx or cefotaxime (may use IV Vanco)
Barking cough + stridor
Name/Pathogen/Dx/Tx
Name: laryngotracheitis (croup)
Pathogen: parainfluenza
Dx: fontral neck X-ray (steeple sign - narrowing of trachea)
Tx
- Mild - cool humidified air
- Moderate - Dexamethasone PO or IM
- Severe - Dexamethasone + nebulized EPI and hospitalization
Sudden onset fever + cough + chill + malaise + X-ray no abnormality
Name/type/Dx/Tx/Prevention
Name: Influenza
Type: A is extensive outbreak (severe) than B
Dx: clinical
Tx: supportive tx
- Oseltamivir (tamiflu) - Good for A and B
- Must use within 48 hours of sx
Prevention: Annually flu shot (CI: eggs, gelatin, or fever)
- Nasal type - healthy individual 2-49 year old (CI - pregnancy, 50y older)
Sudden drooling + coughing
Name/MC site/Dx/Tx
Name: Foregin body aspiration
MC site: Right side
Dx: Rigid bronchoscopy
Tx: Rigid bronchoscopy to remove
Acute hypoxemia + orgain failling + sepsis
Name/Patho/Dx/Tx
Name: Acute respiratory distress syndrome
Patho: injury leads to increase prermeability of ablveolar -> pulmonary edema
Dx
- ABG (200<) - not responsible with 100% O2
- CXR - whiteout pattern
- Cadiac cath (PCWP) <18mmHg
Tx: CPAP, Positive end expiratory pressure
Snoring + always tired + large neck
Name/Risk/PE/Dx/Tx
Name: sleep apnea
Risk: obesity
PE: Large neck, micrognathia (jaw is undersized)
Dx: Polysomnography
Tx: CPAP
