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PANCE > 2. Pulmonology > Flashcards

2. Pulmonology Flashcards

1
Q

Dyspnea + wheezing + cough at night

Name/Reversibility/Patho/Risk/PE/Admisison criteria/Dx/Tx

A

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)

  1. Intermittent - SABA
  2. mild - SABA + LABA
  3. moderate - low or medium ICS + LABA
  4. Severe - high ICS + LABA (last resort - Omalizumab)
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2
Q

Asthma criteria explanation

A
  • 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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3
Q

Emphysema vs Chronic bronchitis sx

A

Emphysema

  • Dyspnea
  • Pink puffers
  • Pursed lip (barrel chest)
  • Respi-alkalosis

Chronic Bronchitis

  • Productive cough x 3 month / 2 consecutive years
  • Blue bloaters
  • Respi-acid
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4
Q

COPD

Reversibility/Risk/Dx/Tx/Prevention

A

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

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5
Q

COPD Tx criteria

A

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

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6
Q

Daily chronic cough thick, mucopurulent, foul-smelling sputum + hemoptysis + hx cystic fibrosis

Name/Reversibility/Risk/Dx/Tx

A

Names: Bronchiectasis

Reversibility: Irreversible

Risk: Pseudomonas (CF), hx of cystic fibrosis

Dx: CT (tram-track)

Tx: Abx + chest physiotherapy

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7
Q

Pancreatic insufficiency + chronic sinusitis (cough wheezing)

Name/Reversibility/Risk/Classic Sx(3)/Dx/Tx

A

Name: Cystic Fibrosis

Reversibility: Irreversible

Risk: European (white)

Classic

  1. Gastro - Meconium ileus at birth, Pancreatic insufficiency (ADEK)
  2. Pulmo - Chronic sinusitis
  3. Inferitility

Dx: sweat chloride

Tx: Airway clear + Pancreatic enzyme replacement

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8
Q

Uveitis + dry cough + ACE increase

Name/Reversibility/Patho/Dx/Lab/Tx

A

Name: Sacroidosis

Reversibility: Irreversible

Patho: Noncaseating Granuloma formation

Dx: biopsy, CXR (hilar lymphadenopathy)

Lab: ACE increase, hypercalciuria/hypercalcemia, cutaneous anergy

Tx: Observation, Prednisone

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9
Q

clubbing finger + honeycombing CXR

Name/Reversibility/Risk/Patho/PE/Dx/Tx

A

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

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10
Q
  1. Mining quarry work with granite/slate/quartz/pottery/sandblasting (Name/DX)
  2. Electronic/aerospace/ceramic/dye (Name)
  3. Coal/carbon mine (Name/Dx)
  4. Cotton exposure (Name)
  5. Old building/ship building/destruction (Name/Relate/Dx)
A
  1. Silicosis/CXR - egg shell calcification
  2. Berylliosis
  3. Coal worker (black lung)/CXR - upper lobe nodule
  4. Byssinosis (brown lung)
  5. Asbestosis/Mesothelioma/CXR - plaque @ lower lobe
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11
Q

Pleuritic chest pain + localized pain and tenderness @ costochondral

Name/PE

A

Name: Costochondritis

PE: localized tenderness @ 2-5th costochondral junctions

  • Tenderness + edema = Tietze syndrome
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12
Q

Blunting of costophrenic angles + friction rub

Name/Patho/Dx/Tx

A

Name: Pleural effusion

Patho: accumulation of fluid

Dx: CXR - PA/lateral (lateral decubitus films), Thoracentesis (fluid analyze)

Tx: Thoracentesis (chest tube)

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13
Q

Light criteria (list of Dz)

A

Exudative (tranduative opposite)

  1. Protein >0.5
  2. LDH >0.6
  3. LDH >2/3 upper limit of normal LDH

Tranduative Dz - CHF, Nephrotic, Cirrhosis, PE

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14
Q

Unilateral Pleuritic + hyperresonance + companion line

Name/3 type/Dx/Tx

A

Name: Pneumothorax

3 type

  1. Spontaneous
    • primary - bleb rubture (tall thin smoker 20-40)
    • secondary - lung dz
  2. Traumatic - iatrogenic - subclavian line placement
  3. 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)
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15
Q

Pulmonary nodule Malignancy vs Benign

A

Mass - 3 cm more, Nodule - 3 cm less

Benign - slow, well round

Malignancy - Fast, irregular, cavity with thickened wall

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16
Q

Flushing + tachycardia + diarrhea + high serotonin

Name/DX/Tx

A

Name: Bronchial carcinoid tumors

Dx: Bronchoscopy (pink to purple well-vascularized central tumor)

Tx: surgical excision

17
Q

hx of smoking + hemoptysis + weight loss

Name/4 type/MET spots/Lab/Dx/Tx

A

Name: bronchogenic carcinoma

Type

  1. Non small cell
    • Adeno - MC, Peripheral located
    • Squamous - central located + cavitary lesion
    • Large - very agressive
  2. Small cell - met early

Lab: hypercalcemia (squamous)

MET spots: Brain, bone, liver, lymph node

Dx: CT

Tx: Nonsmall - surgical, small - chemo

18
Q

Sudden dyspnea + hx of DVT & post OP + chest pain + tacypnea

Name/Risk/Dx/Tx

A

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)

  1. PE possible low - D-dimer
  2. 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
19
Q

dyspnea + RVH + Right Axis deviation

Name/PE/Dx/Tx

A

Name: Pulmonary HTN

PE: S2 + Right side HF

Dx: Right side catheterization (definitive), ECG - RVH, right axis deviation

Tx: CCB

20
Q

Pathogen for PNA

  1. MC CAP
  2. 2nd MC CAP (COPD)
  3. CAP with sinusitis
  4. AC or water supply with CAP
  5. flu with CAP
  6. ETOH with CAP
  7. HIV with CAP
  8. Mississippi & Ohio river valley
  9. Aspiration PNA
  10. military + CAP
A
  1. Strep PNA
  2. H flu
  3. Chlamydophila
  4. Legionella
  5. Staphy A
  6. Klebsiella
  7. PCP
  8. histoplasma
  9. Anaerobes
  10. Mycoplasma
21
Q

Typical vs atypical PNA

A

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

22
Q

PNA Tx/Prevention

A

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
23
Q

Night sweat + weight loss + fever/chill + cough

Name/3 Type/Dx/Tx

A

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)
24
Q

Normal chest x-ray + cough

Name/Dx/Tx

A

Name: Bronchitis

Dx: Normal CXR

Tx: Fluid, rest, NO ABX

25
Q

Coughing fit

Name/Pathogen/3 stage/Dx/Tx

A

Name: Pertussis

Pathogen: Bordetella pertussis

Stage

  1. catarrhal - most contagious (1-2week)
  2. Paroxymal - inspiration whooping sound after cough fits (post cough emesis)
  3. convalescent - resolution of cough (up to 6 weeks)

Dx: PCR of NasoSwab

Tx: Macrolide (AZA, erytho), alternative - septra (TMX-SMX)

26
Q

Expiratory wheezing + young children + hx of URI

Name/Pathogen/Dx/Admission/Tx

A

Name: Acute bronchiolitis

Pathogen: RSV

Dx: Pulse OX

Admission: if less than 96%

Tx: Humidified O2 therapy

27
Q

Dysphagia + drooling + distress

Name/Pathogen/Dx/Tx

A

Name: Acute epiglottitis

Pathogen: H flu

Dx: Laryngoscopy (definitive), CXR - Later neck (Thumb sign)

Tx: Airway + IV Ceftx or cefotaxime (may use IV Vanco)

28
Q

Barking cough + stridor

Name/Pathogen/Dx/Tx

A

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
29
Q

Sudden onset fever + cough + chill + malaise + X-ray no abnormality

Name/type/Dx/Tx/Prevention

A

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)
30
Q

Sudden drooling + coughing

Name/MC site/Dx/Tx

A

Name: Foregin body aspiration

MC site: Right side

Dx: Rigid bronchoscopy

Tx: Rigid bronchoscopy to remove

31
Q

Acute hypoxemia + orgain failling + sepsis

Name/Patho/Dx/Tx

A

Name: Acute respiratory distress syndrome

Patho: injury leads to increase prermeability of ablveolar -> pulmonary edema

Dx

  1. ABG (200<) - not responsible with 100% O2
  2. CXR - whiteout pattern
  3. Cadiac cath (PCWP) <18mmHg

Tx: CPAP, Positive end expiratory pressure

32
Q

Snoring + always tired + large neck

Name/Risk/PE/Dx/Tx

A

Name: sleep apnea

Risk: obesity

PE: Large neck, micrognathia (jaw is undersized)

Dx: Polysomnography

Tx: CPAP

PANCE (12 decks)

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