Exam 3 Pulm/Rheum Flashcards
Which of these is NOT bacterial?
Pertussis
TB
Acute bronchiolitis
Community acquired pneumonia
Acute bronchiolitis - RSV virus
Which of these does NOT have a vaccine?
Pneumonia
Pertussis
RSV (bronchiolitis)
Influenza
RSV does not - has synagis for those with compromised immune systems
What is the time frame for administering antiviral for influenza?
24-48 hours from onset
Diagnostic test for influenza?
RT-PCR: it confirms whether it’s influenza A or B
It’s a viral culture of their respiratory secretions
What is Reye’s syndrome?
Aspirin + viral infections in kids. Leads to progressive hepatic failure and encephalopathy
Patient is coughing and it sounds like it’s “barking like a seal”
What other breathing findings might you hear?
Stridor
Kid has Croup
There are 3 phases of pertussis (whooping cough). What are they and what are their characteristics
Catarrhal phase: nasal congestion, sneezing low grade fever
Paroxysmal phase: episodes of intense coughing followed by “whoop”
Convalescent phase: chronic cough lasting weeks
What is the diagnostic test for pertussis (whooping cough)?
What stages does it need to be tested in?
Nasopharyngeal swab for Bordatea pertussis - must be taken in catarrhal or paroxysmal phase
Treatment for pertussis?
Azithromycin
And give it to the family as prophylaxis!!
Vaccine for whooping cough?
DTap
Tdap
What is progressive primary TB?
A caseating granuloma or TB lesion forms when organism escapes the macrophages and is able to spread
What is it called when a caseating granuloma along with Hilar lymphadenopathy is found in CXR of a person with TB?
Ghon complex
Which “disease” is confirmed by the presence of a steeple sign on X-ray?
Croup (acute laryngotracheitis)
Do we commonly hospitalize those with TB or treat as outpatient?
Mostly outpatient - with 6-9 month regimen or medication, monthly follow up and serial sputum cultures
Take new baseline CXR at end of treatment
What is the diagnostic test that confirms TB?
Interferon-gamma assay (IGRA) - blood test with TB specific antigens (more specific)
Is Community acquired pneumonia an upper or lower respiratory tract infection?
Lower
Most common pathogen for CAP? (Pneumonia)
Streptococcus pneumoniae
Describe the symptoms of someone with pneumonia
ACUTE ONSET fever, chills, diaphioresis, productive cough w/ purulent sputum
Pertinent lung exam findings in someone with CAP
Crackles, bronchial breath sounds, DULLNESS TO PERCUSSION
What labs do we order for diagnosing CAP? (Hint: 4 things)
CBC
Sputum
Blood culture
Nasal swab
(Sometimes urine sample)
Which “test” do we use to determine if someone with CAP needs to be hospitalized?
CURB 65. (Score of 2+ we hospitalize)
Confusion, urea BUN >30, RR >30, BP <60/90, 65+
Most common cause of hospital acquired pneumonia?
Staph aureus (MRSA)
In kids with pneumonia, their symptoms differ from adults; besides the fever, poor feeding, cough, what are some key exam findings you might notice?
Grunting, wheezing, GI symptoms (nausea, diarrhea)
True or false: infants <12 weeks we use the CURB 65 test for pneumonia treatment
False- all infants <12 weeks we HOSPITALIZE
What is the gold standard diagnostic test for a pulmonary embolism?
CT Angio
Virchows triad?
Venous stasis + vein damage + activation of coagulation
Risk factors of pulm embolism
Treatment for pulmonary embolism
Hospitalize!
Heparin + 3-6 months warfarin
Pulmonary hypertension is defined as systolic pressure > ____?
30 mmHg
Cor pulmonale is the result of which pulmonary disorder
Pulmonary hypertension
In assessing for pulmonary hypertension, you order an EKG. What might you find to help confirm your diagnosis?
Right axis deviation
Right bundle branch block
Peaked P waves (atrial enlargement)
Although EKG showed some promising signs to support pulmonary hypertension, what is the GOLD STANDARD test for diagnosis?
Right-sided cardiac cath
True or false: patient present to clinic with small, asymptomatic pneumothorax. You do not need to hospitalize them.
FALSE! every patient needs to be hospitalized, even if it’s just for overnight monitoring.
Patient present to clinic with a Pneumothorax, and no PHYSICAL symptoms. You get her vitals and notice an abnormal RR and BP. What treatment do you proceed with?
Simple aspiration - any sign of symptoms (INCLUDING abnormal vital signs) requires aspiration.
“if symptoms present, we TREAT”
what is the most common cause of ARDS?
sepsis
What is the condition that results from inflammation with increasing inflammatory cells, leading to a “leaky” capillary membranes?
ARDS
According to the Berlin Definition of classifying ARDS, what PaO2:FiO2 ratio is considered “severe” ?
ratio < 100 is considered severe
When assessing lung carcinomas, what is absolutely needed for diagnosis?
Tissue biopsy (for pathology)
Which of these pulmonary disorders is NOT characterized by hemoptysis?
TB, small cell lung carcinoma, squamous cell carcinoma, adenocarcinoma
Adenocarcinoma - this is located in the PERIPHERAL lung fields, where the others are in the central airways.
which disease is characterized by an “oat cell” appearance
small cell lung carcinoma
Which restrictive lung disease include granulomas
sarcoidosis, silicosis, berylliosis, hypersensitivity pneumonitis
of the restrictive lung diseases, which are characterized by symptoms (nodules) OUTSIDE OF THE LUNGS
Berylliosis & sarcoidosis.
Berylliosis - nodules will be located on point of contact with the irritant (hands)
Sarcoidosis - nodules/plaques will be everywhere
What are the 4 large cell vasculitities?
Polymyalgia Rheumatica
Giant Cell Arteritis
Takayasu arteritis
Behcet syndrome
What are some key differences that help decipher between polymyalgia rheumatic (PMR) and Giant Cell Arteritis GCA?
GCA - affects temporal arteries, commonly leading to blindness. Patient also complains of JAW CLAUDICATION
PMR - no blindness/jaw claudication; pain and stiffness in shoulders/hips
Treatment for vasculitis?
Prednisone
In primary Angiitis, a Brain biopsy is diagnostic. Another finding you might see on Angiogram (hint: what do the vessels look like?”
“string of beads” alternating narrowing/dilation of the vessels in the brain
Polyarteritis Nodosa is commonly associated (or looks like) what disease?
Hepatitis B…make sure you test for it in someone with possible polyarteritis nodosa
Wegeners syndrome is vasculitis of mainly which 2 organs?
lungs and kidneys
classic triad: upper, lower respiratory infection + glomerulonephritis
what is the classic triad of symptoms seen in patients with systemic Lupus Erythematosus (SLE)?
fever + joint pain (polyarticular and symmetric) + rash (“butterfly rash”)
Treatment for Lupus?
if non-life threatening - NSAIDs + antimalarials
life-threatening/severe: Prednisone + immunosuppresors
To diagnose SLE, there needs to be a positive ANA and what other antibody?
anti-dsDNA and/or anti-Sm antibody
what is the acronym used for diagnosing Lupus? (SLE)
SOAP BRAIN MD
need 4 of 11 for diagnosis
what is the syndrome characterized by hypercoagulability due to antibodies against phospholipid-binding plasma proteins?
antiphospholipid syndrome (APS)
chronic inflammatory disorder involving the SYNOVIUM of the joints
rheumatoid arthritis
Treatment for RA?
DMARDs + NSAIDs
never NSAIDs for monotherapy as they do not prevent erosion of joints
What are the diagnostic antibodies for Antiphospholipid syndrome?
Anticardiolipin + B2-glycoprotein + Lupus Anticoag.
Patient with hx pregnancy loss, DVT and evidence of hypercoagulability on Labs is likely to have what disease?
Antiphospholipid Syndrome (APS)
Treatment for someone with APS (antiphospholipid syndrome)?
lifelong anticoagulation (warfarin)
Raynaud’s phenomenon is commonly associated with which rheumatic disease?
Scleroderma
In which disease are you most likely to see sclerodactyly?
Scleroderma
sclerodactyly = tightening of skin in face and extremities, giving “claw-like” appearance in the hands
Sjogren’s syndrome is an autoimmune disease due to dysfunction of which organ/structures?
Lacrimal gland and salivary glands
will present with dry eyes and dry mouth
What are the specific antibodies positive in Sjogren’s syndrome?
SS-A (Ro) & SS-B (La)
Treatment of sjogrens?
artificial tears
lymphoma can occur in 6% of cases, so we want to monitor
What is the diagnostic test for dermatomyositis and polymyositis?
Muscle biopsy! (rule out malignancy)
Other Labs elevated: CK + aldolase
Diagnostic test for Giant Cell Arteritis?
biopsy of temporal artery
Jaw claudication and blindness are common symptoms that distinguish Giant cell arteritis from which other large vessel vasculitis?
Polymyalgia rheumatica (PMR)
What are some main large-vessel vasculitidies?
Polymyalgia rheumatica, Giant cell arteritis, Takayasu Arteritis
to diagnose Obstructive sleep apnea, what epworth sleepiness score do you need?
> 9
what is another word for the sleep study?
polysomnography
Is the first line treatment for OSA in adults and kids CPAP?
No- CPAP is the first line choice for adults, but in kids we’re more likely to do surgery (due to noncompliance)
What 3 characteristics do we see on imaging that describe interstitial lung disease?
reticular changes, honeycombing, traction bronchioectasis
What needs to be ordered to CONFIRM and diagnose idiopathic pulmonary fibrosis?
Need a tissue biopsy to confirm by pathology that it is idiopathic.
Sarcoidosis looks a lot like TB on an XRAY. What is the main characteristic that distinguishes the two?
Sarcoidosis is NONcaseating granuloma; TB is CASEATING. If you suspect sarcoidosis, do TB test to rule out
In which restrictive lung disease would you most likely find pleural plaques on CXray?
asbestosis
What makes the cutaneous nodules of Berylliosis different from those in Sarcoidosis?
The skin nodules in berryliosis are located on areas of skin that were exposed to the toxin.
Silo-fillers restrictive lung disease is due to inhalation of what?
Nitrogen dioxide
Characterized by cough lasting >5 days and up to 3-4 weeks. 90% viral
Acute bronchitis
What is the vaccine for Acute bronchiolitis?
NONE - RSV does not have a vaccine
Which virus has the risk of persistent airway resistance later in life?
RSV
Diagnostic test for RSV?
RSV Rapid viral antigen testing (nasopharyngeal swab)
Hypoxemia is defined as pO2 < ?
60
Hypercapnia is defined as pCO2 > ?
50
How do we calculate what the A-a gradient should be?
(Age/4) + 4
Asthma will have a reversible airflow post-bronch…which spirometry value do we look for and what change do we need to diagnose reversibility/asthma?
FEV1 should have a change of > 12% expected
Which disease can be linked to Alpha-1 antitrypsin deficiency?
COPD
What determines a COPD Exacerbation?
the change of sputum to purulent + rr >30
ADD antibiotics to normal med regimen
RSV (acute bronchiolitis) is common in what age?
< 2 years
treatment for pertussis “whooping cough”
Azithromycin
What type of lung carcinoma looks like a pedunculated “floating finger” in the central airway?
Carcinoid Tumor
What is carcinoid syndrome?
Flushing + diarrhea + wheezing + hypotension
lung carcinoma characterized by NO tobacco association, unilateral chest pain, occupational hx of mining
mesothelioma (the tumor has invaded the lung pleura, causing the unilateral pain)
Horner syndrome?
myosis + partial ptosis + anhidrosis (seen in mesothelioma)
Treatment for mesothelioma
chemotherapy
which type of nonsquamous cell lung carcinoma is most related to NONSMOKERS
adenocarcinoma
what is paraneoplastic syndrome?
the hormones secreted by the tumor cell can have different effects: thrombophlebitis, hypercalcemia, gynecomastia
which non small cell lung carcinoma happens to have a rapid doubling time?
Large cell carcinoma (double rapidly, metastasize early)
What type of imaging do you order to determine metastasis/staging in lung carcinoma?
PET scan - lights up w/ metabolism (cancer cells)
Do you perform a pre-op biopsy in non small cell lung carcinoma?
NO - higher risk for damaging the lung tissue if there is disease present
disorder in which inflammation in the lung leads to leaky capillaries
ARDS
what is the diagnostic test for Gout?
getting the joint fluid - shows needle-like negative befringence
diagnostic for Takayasu Arteritis?
CT angio - shows stenosis, occlusion, dilation of aorta and branches
Which organ system is typically left unaffected by Polyarteritis Nodosa?
Lungs
In primary angiitis, patients will have no systemic symptoms, however, which organ system is affected?
Nervous system - primary angiitis is limited to the brain and spinal cord (brain biopsy is diagnostic)
In what type of Vasculitis is ANCA positive for PR-3?
Wegners (granulomatosis with polyangitis)
Berlin Definition of ARDS: onset of respiratory distress, progressing to respiratory failure, within ____ days of a clinical insult
7
Bilateral Infiltrates on CXR, pulmonary infiltrates without signs of fluid overload or heart failure, AND a PaO2: FIO2 < 100 can be diagnosed as???
ARDS
