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Pulmonary Diseases > Cinical Sx > Flashcards

Cinical Sx Flashcards

1
Q

Most common otitis externa, usually s. aureus or p aeruginosa. Intense pain and tenderness. Local erythema, heat and tenderness over tragus. Adenopathy. Crusting otorrhea.

A

Acute localized otitis externa

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2
Q

Swimmers ear. P aeruginosa. Hot humid places. Canal erythematous, edematous and sometimes hemorrhagic. Crusty otorrhea and itching in ear canal.

A

Diffuse otitis externa

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3
Q

Complication of OM with resulting draining into EAC. Itching.

A

Chronic otitis externa

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4
Q

Severe necrotizing infection of EAC with invasion into the surrounding tissues including blood vessels, cartilage and none. Paerginosa most frequent. Erythematous, not, tender extern ear and pinn

A

Malignant otitis externa

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5
Q

Sore throat, exudative, scarlintinaform rash, fever, adenopathy

A

Corynebacterium haemolyticum pharyngitis

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6
Q

Sore throat, fever, lymphadenopathy, hepatosplenomegaly, maculopapular skin rash

A

Mononucleosis

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7
Q

Sore throat pathogen associated with conjunctivitis and flu like sx

A

Adenovirus

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8
Q

Sore throat with mucosal vesicles or ulcers

A

Coxsackie a, herpes simplex virus

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9
Q

Tonsillar exudates, tender anterior cervical adenopathy, fever, absence of cough (and hoarseness and rhinorrhea)

A

Streptococcal pneumonia

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10
Q

Strep throat tx

A

If exudates and adenopathy and temp greater tha. 100 Culture and tx. Exudates OR adenopathy and temp, culture and defer tx until confirmed. Tx all with hx of rheumatic fever. Preferred tx: Benzathine PCN given Im. Or pen vk 500mg PO qid x10d. Amox option. Macrolides in PCN allergies.

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11
Q

Strep complications

A

Nonsuppurative: rheumatic fever. Sppurative: pharyngeal abscess, OM , sinusitis.

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12
Q

Carditis, polyarthritis, chorea,subcutaneous nodules, erythema marginatum. Fever, arthralgia, hx. 2 major or 1 major, 2 minor

A

Jones criteria for rheumatic fever. Inflammatory lesions of heart, joints, and CNS following group a strep infection. 6-15yo
Tx: pcn x 10 d

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13
Q

Nasal congestion Ddx

A 
common cold
flu
acute sinusitis
allergic rhinitis
perennial rhinitis
rhinitis medicamentosa (rebound)
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14
Q

Sore throat Ddx

A 
common cold
flu
acute pharyngitis
allergic rhinitis
epiglottitis
acute sinusisits
mono
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15
Q

ear pain Ddx

A 
acute otitis media
otitis externa
cerumen impaction
foreign body in ear
common cold
flu
allergic rhinitis
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16
Q

cough Ddx

A 
common cold
flu syndrome
allergic rhinitis
acute bronchitis
acute sinusitis 
pneumonia
asthma COPD
GERD
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17
Q

chronic bilateral inflammation of lid margin, usually lower. string of whiteish pearls, benign. irritating.

A

blepharitis

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18
Q

uncomfortable infection of lacrimal apparatus

A

dacroysitis

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19
Q

meibomian gland abscess at lid margin. pus filled, feels like pudding

A

hordeloum

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20
Q

a granulomatous inflammation of meibomian gland.more hard and firm. usually not irritating, reoccurring.

A

chalazion

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21
Q

inward turning of the eyelid

A

entropion

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22
Q

outward turning of the eyelid. bad if causes irritation, can refer for surgery

A

ectropion

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23
Q

red eye, ocular discharge

A

acute conjuntivitis

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24
Q

usually s. auerus in adults, s. aur, s. pneumo, h. flu, m cattarhalis in kids. eye redness, purulent discharge, usually unilaterally, pus persists throughout the day

A

bacterial conjunctivitis

tx: antibiotic ocular ointment or drops QID x 7 days: erythromycin, sulfa, polymixin, fluroquinolones

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25
Q

usually caused by adenovirus. adenopathy, fever, pharyngitis, URI. redness, water/mucoid ocular discharge, morning crusting, irritation of the eyes. usually becomes bilateral is 24-48 hours

A

viral conjunctivitis

tx: self limited, keep home from school/work. can use eye drops, NSAID drops or antihistamine drops if helpful.

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26
Q

airborne allergens cause IgG mediate response, degradation of mast cells, iniltration of histamine and other inflammatory mediators in the eye. diffuse ocular injection, water discharge, itching usually bilateral. often other allergy sx will be present. PE shows cobblestoning of conjunctiva.

A

Allergic conjunctivitis

tx: ocular drops, antihistamine + decongestant; mast cell stabilizer + antihistamine.

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27
Q

benign yellowish dot?

A

pinguecula: conjunctivial nodule. benign. surgical removal.

28
Q

growth across the conjunctiva, could grow completely across eye. Once towards the iris, needs to be removed.

A

ptyergium

29
Q

acute onset of redness, irritation, watering of the eye, 70% female. No pain or vision changes. PE shows localized erythema.

A

episcleritis

no tx. self-limited. often associated with lupus. can use topical lubricants NSAIDS , steroids or oral NSAIDS

30
Q

Acute onset of intense PAIN and photophobia. deep red/purpilsh scleral hue. Dx confirmed with slit lamp

A

scleritis

31
Q

inflammation of cornea; associated with corneal ulcers. pain, photophobia, tearing, decreased vision. ocular erythema, predominately pericorneal injection, maybe discharge.

A

keratitis

tx: prompt referral

bacterial: hazy cornea
HSV keratitis: dendritic corneal ulcer

32
Q

lesions on tip of nose

A

herpes zoster ophthalmicus . needs referral

33
Q

intraocular inflammation. acute pain, erythema, photophobia, vision loss.

A

uveitis.

anterior: inflammatory cells in aqueous
psterior: more gradual onset, quiet eye

tx: steroids from ophlathlmo.

34
Q

insidious preogressive bilateral peripheral vision, resulting in tunnel vision. may be secondary to trauma.

A

glaucoma

acute angle closure: medical emergency, older agegroup, rapid onset, severe pain, profound visual loss, n/v, red eye, steamy cornea, dilated pupil, orbit hard to palpate

Tx: lower IOPacetazolamide 500mg IV, following by 250mg PO QUID. laser irdotomy.

35
Q

opacity of lens, usually bilateral. blurred vision, sensitivity to light, faded colors. white pupil reflection or white reflex.

A

cataract.

tx: surgery

36
Q

sudden visual loss, abrupt onset of floaters. eye not inflamed

A

vitreous hemorrhage.

multiple causes including DM retinopathy, retinal tears trauma, macular degeneration.

ophthalmoscopy shows clear lens but inability to see fundal details clearly.

urgent referral.

37
Q

leading cause of permanent visual loss >50yo. risks: caucasian, female, fhx, smoking

A

macular degeneration.
retinal drusen seen by ophthalmoscope.
atrophic (dry): degeneration of outer retina pigment epthelium; moderate severity, graudal
exudative (wet): choroidal new vessel growth leads to accumulation of serous fluid, hemorrhage, fibrosis; mroe rapid onset, more severe. diabetic reinopathy.

tx: laser therapy, vit e/antioxidants

38
Q

sudden monoculalr loss of vision, commonly upon waking. no paid or redness. widespread or sectoral retinal hemorrhages.

A

central and branch retinal vein occlusions.

screen all for DM, HTN, hyperlipidemia, glaucoma, peripfheral vvascular dz

39
Q

sudden profound monocular loss of vision. no pain or redness. widesprpaed of sectoral retinal pallid swlling.

A

central and branch retinal arter occlusions

excluse temporal arteritis in pts >55/ consider CV risks in all patients; evaluate carotids, cardiac sources of emboli.

40
Q

mild retinal hemorrhages, edema, exudates, dilation of veins, microaneurysms, without visual loss

A

diabetic retinopathy; background.

41
Q

macular edema, exudates ischemia of macula

A

diabetic retinopathy; maculopathy

42
Q

retinal new vessels

A

diabetic retinopathy; proliferative

43
Q

silver wiring and copper wiring due to tortuous and narrowed retinal arteries. AV nicking due to venous compression. flame shaped hemorrhages, edema, cotton wool spots, exudates from acute elevations of BP

A

Hypertensive retinopathy

44
Q

subacute, unilateral visual loss with papilledema, flame hemorrhages, central scotoma; pain exacerbated by eye movements.

A

optic neuritis

tx: corticosteroids

45
Q

ptosis with down and out eye, EOM restricted in all directions except lateral.

A

CN III oculomotor palsy.

medical causes: DM HTN, temporal arthritis.

46
Q

convergent squint with failure of abduction. horizontal diplopia.

A

CN VI Abducens palsy

may be dute to trauma, neoplasm, brainstem lesions

47
Q

Ddx: Red Eye

A 
acute conjunctivitis: bacterial, viral, allergic, mechanical
episcleritis
scleritis
acute angle glaucoma
herpes keratitis
iritis (uveitis)
subconjuntival hemorrhage
hypema (pus)
hypopyon
48
Q

DDx: eye pain

A 
forein body, corneal abrasion
acute angle closure glaucoma
optic neuritis
scleritis
keratitis
optic neuritis
49
Q

Ddx: ocular discharge

A

conjuntivitis
keratitis
dacrocytitis

50
Q

Ddx visual loss

A 
refractive errors
retinopahty
macular degeneration
optic neuritis
keratitis, uveitis
glaucoma
cataract
vitreous hemorrhage
retinal vessel occlusions
51
Q

Red flags of the eye

A

reduction of visual acuity, ciliar flush: a pattern of injection i which the redness is most pronounced in a ring at the limbus; photopobia, severe foreighn body sensation that prevents pt from ekeping eye open; corneal opacity; fixed pupil; sesvere headache with nausea

52
Q

COPD cor pulmonale

A

JVD, hepatomegaly, peripheral edema

53
Q

most common causes of acute cough

A 
URIs
acute bacerial sinusitis
bordetlla pertussis infection
excerbation of COPD
allergic rhinitis
environmental irritant rhinitis
54
Q

most common causes of subacute cough following URI

A

post infectious cough
bordetella pertussis
bacterial sinusitis
asthma

55
Q

the 3 most common causes of cough in children above the age of 1 and adults

A

Post nasal drip
asthma
GERD

56
Q

Chronic cough is most often due to one or more of the following

A 
PND
Asthma
GERD
chronic bronchitis
bronchiesctasis
non-asthmatic eosinophilic bronchitis
57
Q

chronic cough in pt that is non-smoker, not taking ACE I, normal chest xray:

A

PND
Asthma
GERD
eosinophillic bronchitis

58
Q

combination of primary lung lesion (granuloma) with paratracheal lymph node granulomas.

A

Ghon complex in TB

59
Q

fever, cough, weight loss, sputum production, hemopysis. pe may be normal or may show adenopathy or chest signs (sonsolidation, percussion dullness) or be normal

A

TB.

60
Q

TB Treatment

A

Isoniazid
Rifampin
Pyrazinamide
Ethambutol

For latent/recent conversion: INH daily for 6-9mo or RIF is INH resistant. Any positive PPD age 35

61
Q

minimal fever, rhinorrhea, anorexia, mild cough. cough can last 100 days

A

pertussis. whooping cough in kids.

62
Q

cough fever, sputum production, chest pain, dyspnea, usually productive cough all day. may have abrupt onset with shaking chills, fever, tachypnea

A

CAP.

pneumococcal / s. pneumoniae = rusty sputum

lung abscess tx: clindamycin, flagyl plus cephalosporin. tx needs to be prolonged.

63
Q

modifying factors that increase the risk of infection with specific pathogens

A

PCN resistant and drug resistant pneumococci: age >65, B-lactam therapy within 3 mo, alcoholism, immunosuppresive illness, multiple medical comorbidities, exposure to a child in a daycare center.

enteric gram-neg organisms: residence in a nursing home, underlying cardiopulmonary disease, multiple medical comorbidities, recent anitbiotic therapy

p. aeuruginosa: structural lung disease (bronchiectasis), corticosteroid therapy >10mg prednisode/day, broad-spectrum antibiotic therapy >7days/last mo, malnutrition

64
Q

Tx for outpatient CAP with no cardiopulmonary dz or modifying factors

A

probable organisms: s. pneumoniae, c. pneumonia, m pneumonia (usually young people), h. flu, viruses, misc.

tx: macrolide (asithromycin or clarithroycin OR doxycycline.

65
Q

Outpaitnet CAP with cardiopulmonary disease and/or modifying factors

A

s. pneumoniae, atypical pathogens such as m. pneumonaie or c. pneumonia, h. flu, viruses, ENTERIC GRAM NEG BACILLI, misc.

Tx: NOT cipro. Selected B-lactam (cefpodxime, cefuroxime, high dose ampicillin, amoxicillin/clauvaunate) PLUS macrolide/doxyclcine OR levofloxin alone (1pill/day easier).

66
Q

Hospitalized patients with CAP

A

s. pneumoniae, h. flu, m.pnue or c. pne, aerobic gram neg bacilli, legionella spp, respiratory viruses, misc.

TX: selected b-lactam with antipneumococcal activity (ceftriaxone, cefotaxime, ampicillin/sulbactam, high dose amp.) IV. PLUS macrolie or doxyclicne. OR antipenumoccal quinolone alone, IV.

67
Q

Patients with CAP pseudomonal risk factors

A 
Tx: Cipro PLUS antipseudomonal, antipneumococcal B lactam (imipenem, meropenem, cefepime, piperacillin/tazobactam) 
OR 
nonpseudomonal quinolone (levofloxacin) or macrolide PLUS antipseudomonal B lactam PLUS aminoglycoside

Pulmonary Diseases (3 decks)

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