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2. Pulmonology Flashcards

1
Q

COPD

2type cause/Sx/Risk/Dx/Tx

A
  • Emphysema - Alpha 1 antitrypsin deficiency
    • Sx: pink, barrel chest, thin
  • Chronic bronchitis - cough x 3 month for 2 year
    • Sx: blue, obesity
  • Risk: Smoking
  • PE: Hyperresonance
  • Dx: PFT
  • Tx: Broncodilater + ICS
    • Mild FEV 80% - SABA
    • Moderate FEV 50-79% - SABA + LABA
    • Severe FEV 30-50% - SABA + LABA + pulmo rehab
    • Very severe FEV less than 30% - SABA + LABA + pulmo rehab + O2 therapy
  • Prevention: Stop smoke, Pnemo + influenza shot
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2
Q

Bronchiolitis

Cause/Patient/Sx/Dx/Admission/Tx

A
  • Cause: RSV
  • Patient: infant
  • Sx: expiratory wheezing
  • Dx: pulse Ox
  • Admission: if less than 96%
  • Tx: humidfied O2 therapy
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3
Q

Bronchitis

Cause/Hx/Dx/Tx

A
  • Cause: Virus
  • Hx: cough less than 1 weeks otherwise normal
  • Dx: Normal X-ray
  • Tx: Supportive
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4
Q

Epiglottitis

Cause/Patient/Sx/PE/Dx/Tx

A
  • Cause: H flu
  • Patient: unvaccinated person (Hib vaccination)
  • Sx: Rapid onset fever
  • PE: drooling, leaning forward
  • Dx: lateral X-ray (thumbprint sign)
  • Tx: IV abx
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5
Q

Laryngotrcheitis (croup)

Cause/Patient/Sx/Dx/Tx

A
  • Cause: parainfluenza
  • Patient: children
  • Sx: bark, seal like cough, LOW fever
  • Dx: X-ray (steeple sign - narrow trachea)
  • Tx
    • Mild - cool humidified air
    • Severe: Dexamethasone racemic epi
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6
Q

Baterial Tracheitis

Patient/Sx/Tx

A
  • Patient: children
  • Sx: HIGH fever, bark seal like cough
  • Tx: Airway management + IV abx
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7
Q

Influenza

2 type/Spread via/Sx/Dx/Tx

A
  • Type A (pandemic), Type B (epidemic)
  • Spread via droplet
  • Sx: sudden fever, non-productive cough
  • Dx: clinical, Confirm (RT-PCR)
  • Tx: Supportive
    • Oseltamivir (within 48 hr)
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8
Q

Pertussis (whooping cough)

Cause/Sx/3 stage/Tx

A
  • Cause: Bordetella pertussis
  • Sx: cough fit, post-tussive emesis, whoop
  • Stage
    • Cat (last 1-2 week)
    • Paroxy (last 2-6 week) - whooping cough
    • Conva (last 1-2 weeks) - recovery
  • Tx: AZA
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9
Q

PNA pathogen

  1. MC PNA
  2. ETOH PNA
  3. Water or GI sx PNA
  4. HIV related PNA
  5. Aspiration PNA
  6. Mississippi & ohio river valley
  7. Military PNA
  8. Sinusitis PNA
  9. Flu or MRSA PNA
  10. Typical vs Atypical
A
  1. Strep Pneumo
  2. Klebsiella
  3. Legionella
  4. PCP
  5. Anaerobes
  6. histoplasma
  7. mycoplasma
  8. Chlamydophila
  9. Staph A
  10. Typical vs atypical
    • Typical - Strep Pneumo, H flu, klebsiella, Staph A
    • Atypical - legionella, chlamydophila, mycoplasma
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10
Q

Typical vs Atypical PNA

Sx/PE/Dx/Tx/Prevention

A
  • Typical
    • Sx: Sudden onset of fever, Productive cough, dullness percuss, Egophony
    • PE: Egophoncy
    • Dx: X-ray (lobar consolidation)
  • Atypical
    • Sx: Low grade fever, dry cough, myalgias
    • PE: Ronchi, Rales
    • Dx: X-ray (patchy)
  • Tx
    • Outpatient: Macrolide (ACE) or Doxy (7-10 days) discharge
    • Inpatient: Ceftx + Macrolide or doxy
    • MRSA: Vanco + Ceftx
  • Prevention
    • PCV 13 - childhood (start at 12month)
    • PPSV23 - 65y older or 2-64 with chronic Dz
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11
Q

Histoplasmosis (fungal PNA)

Cause/Hx/Dx/Tx

A
  • Cause: Bird, bat droplet
  • Hx: travel to ohio, mississippi river
  • Dx: X-ray (Solitary pulmo calcification)
  • Tx: Itraconazole, amphotericin B
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12
Q

Viral PNA

Cause/Hx/Tx

A
  • Cause: MC RSV
  • Hx: Bronchiolitis
  • Tx: Supportive care, proper hygiene
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13
Q

PCP

Cause/Patient/Sx/Dx/Tx

A
  • Cause: Penumocystic jirovecii
  • Patient: hx of HIV
  • Sx: Gradual onset of nonproductive cough
  • Dx: X-ray (bilateral interstitial infiltrates = bat wing)
    • CD4 less than 200, increased LDH
  • Tx: TMP-SMX (bactram)
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14
Q

TB

3 Type/Sx/Dx/Tx

A
  • 3 Type
    • Primary - Rapid contagious
    • Reactivation (secondary) - Contagious
    • Latent - NOT contagious
  • Sx: fever, night sweat, weight loss
  • Dx
    • PPD first
      • Normal 15mm
      • homeless, health care, drug user 10mm
      • immunocompromised 5mm
    • X-ray
      • Primary or latent: Ghon focus
      • Reactivation: cavitation upper lobe
      • Milet seed: military TB
    • AFB (gold)
  • Tx: RIPE (Rifamfin, INH, pyrazinamide, ethambutol) x 2 month
    • INH + PZA x 9 month (latent)
    • INH + PZA x 12 month (latent with HIV)
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15
Q

Carcinoid syndrome

Cause/Sx/Dx/Tx

A
  • Cause: Carcinoid tumor
  • Sx: Dyspnea + Flushing or diarrhea
  • Dx: Broncoscopy (pink purple well vascularized central tumor), 24 hr collection for (5-HIAA)
  • Tx: Surgical remove (Octreotide)
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16
Q

Bronchogenic carcinoma

2 type/Hx/Sx/Lab/Dx/Tx

A
  • 2 type
    • Non small cell
      • Adeno MC
    • Small cell - MET
  • Hx: long Smoking
  • Sx: Cough, hemoptysis, weight loss
  • Lab: Hypercalcemia
  • Dx: CT, bx confirms
  • Tx: Non small - surgical, small - chemo
17
Q

Lung nodule

Malignancy vs benign

Mass vs Nodule

Dx/Tx

A
  • Benign - Slow, well round
  • Malignancy - Fast, irregular
  • Mass - 3 cm more
  • Nodule - 3 cm less
  • Dx: CT, Bx
  • Tx: Referral to pulmonology
18
Q

Pleural effusion

Cause/PE/Dx/Tx

A
  • Cause: accumulation fluid by dz
    • Transduative: CHF (MC), Nephro, Cirrhosis, PE
    • Exudative: Infection (MC), Malignancy
  • PE: Decrease breath sound, decreased tactile fremitus
  • Dx: X-ray (blunting of costophrenic angle)
  • Tx: Thoracentesis
19
Q

Light Criteria

Explain with disease

A
  • Exudative: Infection, Malignant
    • Serum Protein 0.5<
    • Serum LDH 0.6<
    • Fluid LDH 2/3 <
  • Transduative
    • Serum protein 0.5>
    • Serum LDH 0.6>
    • Fluid LDH 2/3>
20
Q

Pneumothorax

3 type/Sx/Dx/Tx

A
  • 3 type
    • Spontaneous
      • Primary - bleb rupture (tall thin smoker 20-40)
      • Secondary - lung dz
    • Iatrogenic - subclavian line place
    • Tension - Positive air pressure push trachea to one side (traumatic)
  • Sx: Unilateral pleuritic
  • Dx: CXR - companion line
  • Tx
    • Spontaneous - observe
    • large - Thoracostomy
    • Tension - needle aspiration (2nd ICS + MCL)
21
Q

Pulmo HTN

Sx/Dx/Tx

A
  • Sx: Dyspnea
  • Dx: X-ray (RVH, prominent pulmonary artery)
    • swan-ganz (definitive), ECG - right axis deviation
  • Tx: CCB
22
Q

Cor pulmonale

Cause/Sx/PE/Tx

A
  • Cause: MC COPD, MC acute PE
  • Sx: Right side HF sx
  • PE: RVH sign
  • Tx: Right heart catheterization
23
Q

Pulmonary embolism

Cause/Sx/Hx/Dx/Tx

A
  • Cause: virchow’s triad - stasis, hypercoagulation, trauma
  • Sx: Sudden dyspnea
  • Hx: DVT or Post op
  • Dx
    • D-dimer vs CT initial
      • PE possible low - D-dimer
      • PE possible high - CT
    • Pulmo angio - definitive
    • X-ray shows - hampton (wedge), westermark (vascular cutoff sign)
    • ECG - tachy, S1Q3T3
  • Tx
    • hemodynamic ok - LMWH or IV UFH, if contra - IVC filter
    • hemodynamic not ok - Thromboytic, if contra - embolectomy
24
Q

Idiopathic pulmonary fibrosis

Cause/Patient/Sx/Dx/Tx

A
  • Cause: lung tissue become thick and stiff -> forming scar
  • Patient: smoker
  • Sx: dyspnea
  • PE: Clubbing finger
  • Dx: X-ray - honeycombing,
  • Tx: O2 and pulmo rehab
25
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)
  6. Inital Dx for Pneumoconiosis
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
  6. PFT then use X-ray
26
Q

Sarcoidosis

Patient/PE/Dx/Tx

A
  • Patient: AA Female
  • PE: Lupus pernio (chronic plaque or nodule on cheek), Uveitis
  • Dx
    • Serum ace level high
    • Hypercalcemia
    • X-ray - bilateral hilar adenopathy
    • Bx - noncaseating granulomas
  • Tx: Predisone
27
Q

Sleep apnea

Patient/Sx/PE/Dx/Tx

A
  • Patient: obese
  • Sx: Snoring
  • PE: Enlarge neck and tonsil
  • Dx: Polysomnography
  • Tx: CPAP
28
Q

ARDS (acute respiratory distress syndrome)

Cause/Leading Cause/Dx/Tx

A
  • Cause: aveolar damage -> increased capillary permeability -> edema
  • Leading cause: Sepsis
  • Dx
    • ABG (200<)
    • Cardiac cath (PCWP) <18mmHg
  • Tx: Mechanical ventilation, CPAP
29
Q

Asthma

Cause/Triad/Sx/Dx/Tx

A
  • Cause
    • Inflammation
    • Secretion
    • muscle spasm (Constriction)
  • Samter triad: Nasal polyp, Allergic (ASA, NSAID), Asthma
  • Sx: Wheezing
  • Dx: PFT, or PEFR (in ED)
    • Mild intermittent - sx <2d/wk, night sx<2d/Month
    • Mild persistent - sx>2d/wk, night sx 3-4d/Month
    • Moderate persistent - daily sx, night sx >5d /month
    • Severe persistent - Throughout all day sx, Night daily
  • Admission PEFR less than 50% or does not improve by 15% after tx
  • Tx
    • level 1 - SABA
    • level 2 - SABA + low ICS
    • level 3 - low ICS + LABA + SABA
    • level 4 - medium ICS + LABA + SABA
    • level 5 - high ICS + LABA + SABA
    • Last resort - Omalizumab
30
Q

Asthma Meds

  1. SABA - Onset/MOA/SE
  2. Anticolinergic - Onset/MOA/SE
  3. Corticosteriod - Onset/MOA/SE
  4. LABA - Onset/MOA
  5. ICS - Onset/MOA/SE
  6. Mast cell stabilizer - Onset/MOA/Prevention for
  7. Leukotrient - Onset/MOA/Best for
A
  1. Albuterol (Quick)
    • MOA: Beta agonist
    • SE: Beta 1 cross activity
  2. Ipratropium (Quick)
    • MOA: Bronchodilator
    • SE: dry mouth
  3. Prednisone (Quick)
    • MOA: Anti-inflammatory
    • SE: Osteoprosis, growth delay
  4. Salmeterol (long term)
    • MOA: Bronchoilater
  5. Baclomethasone, Triamcinolone
    • MOA: Anti-inflammatory
    • SE: Thrush
  6. Cromolyn
    • MOA: inhibit Mastcell
    • Prevention for kid: excercise
  7. Monelukast
    • MOA: blocks leukotrience receptor
    • Best for NSAID/ASA allergy and rhinitis patient
31
Q

Cystic Fibrosis

Cause/Patient/Hx/Dx/Tx

A
  • Cause: Autosomal recessive
  • Patient: European (white)
  • Hx: Meconium ileus at birth, Pancreatic insufficiency (ADEK)
  • Dx: Sweat chloride elevated
  • Tx: Airway clear (broncodilator) + Pancreatic enzyme replacement
32
Q

Bronchetasis

Cause/Sx/Dx/Tx

A
  • Cause: Cystic fibrosis
  • Sx: Cough with larger amount Foul smell of sputum
  • Dx: CT scan (tramtrak like)
  • Tx: Abx + chest physiotherapy
33
Q

Foreign body aspiration

Cause/Patient/Sx/Dx/Tx

A
  • MC site: Right main bronchus (left has heart slighly higher then right)
  • Patient: child
  • Sx: Sudden wheezing, drooling
  • Dx: Rigid bronchoscopy
  • Tx: Rigid bronchoscopy to remove
34
Q

Hyline membrane disease

Cause/Patient/Dx/Tx

A
  • Cause: lack of surfactant
  • Patient: preterm babt
  • Dx: X-ray (ground glass)
  • Tx: Surfactant (baclometasone)

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