7 Lungs 2

Question 0

CBC results

Answer 0

Acute bronchitis: elevated lymphocytes

Bacterial pneumonia: elevated neutrophils

Question 1

Auscultation results for pt with emphysema vs chronic bronchitis

Answer 1

Emphysema: crackles upon expiration

Chronic bronchitis: crackles upon inspiration

Question 2

Klebsiella

Answer 2

affects alcoholics, malnourished, DM. necrotizing lobar pneumonia. Relative Bradycardia and current jelly sputum

Question 3

Abnormal breath sounds

Answer 3

Decreased (smoker, obese, emphysema, pleural effusion), absent (collapsed lung), bronchial (loud and harsh, areas of consolidation)

Question 4

Adventitious breath sounds

Answer 4

Ronchi, crackles, wheezing, stridor

Question 5

Auscultation findings over consolidation

Answer 5

Egophany, bronchophony, whispered pectoriloquy

Question 6

Stridor and SOB DDX

Answer 6

Epiglottitis–hot potato voice, high fever, drool, emergency
Foreign body–no hx of URI or fever, sudden
Retropharyngeal abscess–swelling back of throat, follow infxn
Diphtheria–grayish membrane over pharynx/larynx

Question 7

Laryngotracheobronchitis

Answer 7

Croup. Parainfluenza virus, adenovirus, RSV
Children 6mos to 3 years. Prodrome of URI w low fever, cough then hoarse voice, seal-like cough, respiratory stridor at night

Question 8

Acute bronchitis

Answer 8

Self limited inflammation of bronchus from viral infection. Ssx: cough > 5 days w sputum. PE: afebrile/low, wheezing, ronchi, normal percussion and transmission voice tests

Question 9

Productive cough DDX

Answer 9

Acute bronchitis, chronic bronchitis, pneumonia, post nasal drip, GERD, asthma

Question 10

Pathophysiology of typical lobar pneumonia

Answer 10

Stage 1: congestion
Stage 2: red hepatization
Stage 3: grey hepatization
Stage 4: resolving

Question 11

Community acquired pneumonia

Answer 11

Risks: level of consciousness, smoking, alcohol, lung disease, malnutrition, old age, immuno compromised
Organisms: RSV, parainfluenza virus, influenza, adenovirus, S pneumoniae, H flu, S aureus, group a strep, M catarrhalis, klebsiella, legionella, M pneumoniae, Chlamydophila, P aeruginosa

Question 12

Nosocomial pneumonia

Answer 12

Ventilator assoc, healthcare assoc (IV therapy, chemotherapy, dialysis, nursing home)

Question 13

Legionella pneumophila

Answer 13

concomitant GI symptoms of nausea and vomiting. Outbreaks from aerosolized organisms
Sx in elderly, smokers, immunocompromised, alcoholics, pts w pre existing condition

Question 14

Sputum in various bacterial pneumonias

Answer 14

Pneumococcus: bloody, rust colored
Pseudomonas, Haemophilus, pneumococcal: green
Anaerobic infxns: foul smelling
Klebsiella: viscid, currant jelly

Question 15

Bacterial pneumonia PE findings

Answer 15

Look sick/pallor, high fever, tachy/bradychardia, bronchial breath sounds, Egophany, dullness, tachypnea, cyanosis, wheezes/ronchi/crackles, tactile fremitus, pleural friction rub

Question 16

If bacterial pneumonia doesn’t resolve..

Answer 16

Comborbiites: alcoholism, COPD, CHF, CKD, malignancy, DM, HIV
Age >65 yrs, neoplastic disease
Klebsiella, legionella, S aureus, S pneumoniae, TB, fungi
Misdiagnosis of connective tissue disease, sarcoidosis, pulmonary embolism, pulmonary edema, drug induced lung disease

Question 17

Viral pneumoniae SSX

Answer 17

Malaise, headache, myalgia, cervical LA, chest pain, sore throat, cough w scant sputum

Question 18

Mycoplasma pneumonia

Answer 18

Walking pneumonia. Looks like URI. Don’t look sick, erythematous TM, no early findings on auscultation

Question 19

Friction rub on auscultation…

Answer 19

Hold breath and listen again! If +… Pericardial. If - pleural

Question 20

Histoplasmosis

Answer 20

Chronic cough, nodular lesions, crackles, wheezes, Ohio and Mississipii river valleys and Southeast, caves, PCR, calcified hilar lymph nodes

Question 21

Loud sounds on inspiration DDX

Answer 21

Laryngotracheobronchitis, epiglottitis, retropharyngeal abscess

Question 22

Pneumocystis jirovecii pneumonia

Answer 22

rare in general pop, affects immunocompromised. gradual onset malaise, weight loss, night sweats, dry cough

Question 23

Coccidiomycosis

Answer 23

Deserts of SW. “sometimes it’s ripe, and the wind blows, and you get it”. Self-limited, most cases subclinical.
in immunocompromised, may disseminate–>erythema nodosum, meningitis, endocarditis, osteomyelitis

Question 24

Allergic Bronchopulmonary Aspergillosis

Answer 24

when pts with asthma get worse. Eosinophilic pneumonia. Sputum with brown flecks

Question 25

Acute pulmonary histoplasmosis PE

Answer 25

crackles or wheezes, pericardial friction rub, erythema multiforme/nodosum

Question 26

Chronic Pulmonary Histoplasmosis PE

Answer 26

crackles, wheezes

Question 27

Chronic Progressive Disseminated Histoplasmosis

Answer 27

ulcers on buccal mucosa, tongue, gingiva, larynx; vision loss; hepatosplenomegaly

Question 28

Aspiration caused pneumonia

Answer 28

sudden onset, severe symptoms, high mortality

Question 29

Lipoid aspiration

Answer 29

oil causes inflammation and secondary infection. CXR reveals infiltrates throughout lung--difficult to recover

Question 30

Pulmonary Tuberculosis Groups with Higher Prevalence

Answer 30

homeless/marginally housed, correctional facilities/shelters, health care workers serving at risk pop, children exposed to at risk, foreigners/travel to endemic area, elderly

Question 31

TB etiology

Answer 31

Mycobacterium tuberculosis. person-to-person inhalation of airborne droplet nuclei, must be constant exposure

Question 32

primary TB infection

Answer 32

inflammatory reaction holds organisms back. Only 10% of affected develop active. If not active, not contagious!

Question 33

Active TB SSx

Answer 33

chronic productive cough (yellow/green, am), hemoptysis, malaise, fatigue, anorexia/wt loss, low grade fever, night sweats

Question 34

Active TB PE

Answer 34

fever, hypoxia, cachexia, tachycardia, LA, decreased breath sounds, crackles

Question 35

TB Imaging

Answer 35

ipsilateral hilar adenopathy often w atelectasis in upper lobes. Normal CXR does NOT r/o TB

Question 36

Miliary TB

Answer 36

Hematogenous and lymphatic spread to target organs

Question 37

Latent TB Infection and reactivation

Answer 37

Asymptomatic, bacteria alive and inactive, walled off. Lesions in posterior segment of RUL

Question 38

TB Tests

Answer 38

Purified Protein Derivative--Mantoux Test QuantiFERON Gold--IFN gamma release assay

Question 39

Multi-Drug Resistant TB

Answer 39

develops in the course of TB treatment with inappropriate doses/incomplete dosing

Question 40

TB DDX

Answer 40

pneumonia, lung abscess, pulmonary mycosis, CA, non-TB mycobacterium, histoplasmosis, coccidiomycosis, silicosis, sarcoidosis

Question 41

Pleurisy SSx

Answer 41

sudden onset of pain, rapid/shallow breaths, splinting of chest, SOB, painful cough

Question 42

Pleurisy PE

Answer 42

fever if infectious cause, limited chest motion, decreased breath sounds, pleural friction rub, dullness to percussion, decreased tactile fremitus

Question 43

Pleurisy DDX

Answer 43

acute abdomen, intercosta neuritis, costo-chondritis, herpes, MI, pneumothorax, pericarditis

Question 44

Pleural Effusion Liquid Types

Answer 44

lymph: chylothorax pyogenic: empyema blood: hemothorax serous: hydrothorax

Question 45

Pleural Empyema SSx

Answer 45

fever, cough, fatigure, SOB, chest pain, bad breath | if severe-->dehydrated, bloody/brown sputum, high fever, coma

Question 46

Pneumothorax

Answer 46

air/gas in pleural cavity between visceral and parietal pleura-->collapse of lung on affected side Spontaneous or traumatic