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Pulmonary And rheum > Exam 3 Pulm/Rheum > Flashcards

Exam 3 Pulm/Rheum Flashcards

1
Q

Which of these is NOT bacterial?

Pertussis
TB
Acute bronchiolitis
Community acquired pneumonia

A

Acute bronchiolitis - RSV virus

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2
Q

Which of these does NOT have a vaccine?

Pneumonia
Pertussis
RSV (bronchiolitis)
Influenza

A

RSV does not - has synagis for those with compromised immune systems

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3
Q

What is the time frame for administering antiviral for influenza?

A

24-48 hours from onset

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4
Q

Diagnostic test for influenza?

A

RT-PCR: it confirms whether it’s influenza A or B

It’s a viral culture of their respiratory secretions

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5
Q

What is Reye’s syndrome?

A

Aspirin + viral infections in kids. Leads to progressive hepatic failure and encephalopathy

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6
Q

Patient is coughing and it sounds like it’s “barking like a seal”

What other breathing findings might you hear?

A

Stridor

Kid has Croup

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7
Q

There are 3 phases of pertussis (whooping cough). What are they and what are their characteristics

A

Catarrhal phase: nasal congestion, sneezing low grade fever

Paroxysmal phase: episodes of intense coughing followed by “whoop”

Convalescent phase: chronic cough lasting weeks

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8
Q

What is the diagnostic test for pertussis (whooping cough)?

What stages does it need to be tested in?

A

Nasopharyngeal swab for Bordatea pertussis - must be taken in catarrhal or paroxysmal phase

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9
Q

Treatment for pertussis?

A

Azithromycin

And give it to the family as prophylaxis!!

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10
Q

Vaccine for whooping cough?

A

DTap

Tdap

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11
Q

What is progressive primary TB?

A

A caseating granuloma or TB lesion forms when organism escapes the macrophages and is able to spread

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12
Q

What is it called when a caseating granuloma along with Hilar lymphadenopathy is found in CXR of a person with TB?

A

Ghon complex

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13
Q

Which “disease” is confirmed by the presence of a steeple sign on X-ray?

A

Croup (acute laryngotracheitis)

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14
Q

Do we commonly hospitalize those with TB or treat as outpatient?

A

Mostly outpatient - with 6-9 month regimen or medication, monthly follow up and serial sputum cultures

Take new baseline CXR at end of treatment

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15
Q

What is the diagnostic test that confirms TB?

A

Interferon-gamma assay (IGRA) - blood test with TB specific antigens (more specific)

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16
Q

Is Community acquired pneumonia an upper or lower respiratory tract infection?

A

Lower

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17
Q

Most common pathogen for CAP? (Pneumonia)

A

Streptococcus pneumoniae

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18
Q

Describe the symptoms of someone with pneumonia

A

ACUTE ONSET fever, chills, diaphioresis, productive cough w/ purulent sputum

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19
Q

Pertinent lung exam findings in someone with CAP

A

Crackles, bronchial breath sounds, DULLNESS TO PERCUSSION

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20
Q

What labs do we order for diagnosing CAP? (Hint: 4 things)

A

CBC
Sputum
Blood culture
Nasal swab

(Sometimes urine sample)

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21
Q

Which “test” do we use to determine if someone with CAP needs to be hospitalized?

A

CURB 65. (Score of 2+ we hospitalize)

Confusion, urea BUN >30, RR >30, BP <60/90, 65+

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22
Q

Most common cause of hospital acquired pneumonia?

A

Staph aureus (MRSA)

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23
Q

In kids with pneumonia, their symptoms differ from adults; besides the fever, poor feeding, cough, what are some key exam findings you might notice?

A

Grunting, wheezing, GI symptoms (nausea, diarrhea)

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24
Q

True or false: infants <12 weeks we use the CURB 65 test for pneumonia treatment

A

False- all infants <12 weeks we HOSPITALIZE

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25
Q

What is the gold standard diagnostic test for a pulmonary embolism?

A

CT Angio

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26
Q

Virchows triad?

A

Venous stasis + vein damage + activation of coagulation

Risk factors of pulm embolism

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27
Q

Treatment for pulmonary embolism

A

Hospitalize!

Heparin + 3-6 months warfarin

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28
Q

Pulmonary hypertension is defined as systolic pressure > ____?

A

30 mmHg

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29
Q

Cor pulmonale is the result of which pulmonary disorder

A

Pulmonary hypertension

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30
Q

In assessing for pulmonary hypertension, you order an EKG. What might you find to help confirm your diagnosis?

A

Right axis deviation
Right bundle branch block
Peaked P waves (atrial enlargement)

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31
Q

Although EKG showed some promising signs to support pulmonary hypertension, what is the GOLD STANDARD test for diagnosis?

A

Right-sided cardiac cath

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32
Q

True or false: patient present to clinic with small, asymptomatic pneumothorax. You do not need to hospitalize them.

A

FALSE! every patient needs to be hospitalized, even if it’s just for overnight monitoring.

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33
Q

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?

A

Simple aspiration - any sign of symptoms (INCLUDING abnormal vital signs) requires aspiration.

“if symptoms present, we TREAT”

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34
Q

what is the most common cause of ARDS?

A

sepsis

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35
Q

What is the condition that results from inflammation with increasing inflammatory cells, leading to a “leaky” capillary membranes?

A

ARDS

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36
Q

According to the Berlin Definition of classifying ARDS, what PaO2:FiO2 ratio is considered “severe” ?

A

ratio < 100 is considered severe

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37
Q

When assessing lung carcinomas, what is absolutely needed for diagnosis?

A

Tissue biopsy (for pathology)

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38
Q

Which of these pulmonary disorders is NOT characterized by hemoptysis?

TB, small cell lung carcinoma, squamous cell carcinoma, adenocarcinoma

A

Adenocarcinoma - this is located in the PERIPHERAL lung fields, where the others are in the central airways.

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39
Q

which disease is characterized by an “oat cell” appearance

A

small cell lung carcinoma

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40
Q

Which restrictive lung disease include granulomas

A

sarcoidosis, silicosis, berylliosis, hypersensitivity pneumonitis

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41
Q

of the restrictive lung diseases, which are characterized by symptoms (nodules) OUTSIDE OF THE LUNGS

A

Berylliosis & sarcoidosis.

Berylliosis - nodules will be located on point of contact with the irritant (hands)

Sarcoidosis - nodules/plaques will be everywhere

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42
Q

What are the 4 large cell vasculitities?

A

Polymyalgia Rheumatica
Giant Cell Arteritis
Takayasu arteritis
Behcet syndrome

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43
Q

What are some key differences that help decipher between polymyalgia rheumatic (PMR) and Giant Cell Arteritis GCA?

A

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

44
Q

Treatment for vasculitis?

A

Prednisone

45
Q

In primary Angiitis, a Brain biopsy is diagnostic. Another finding you might see on Angiogram (hint: what do the vessels look like?”

A

“string of beads” alternating narrowing/dilation of the vessels in the brain

46
Q

Polyarteritis Nodosa is commonly associated (or looks like) what disease?

A

Hepatitis B…make sure you test for it in someone with possible polyarteritis nodosa

47
Q

Wegeners syndrome is vasculitis of mainly which 2 organs?

A

lungs and kidneys

classic triad: upper, lower respiratory infection + glomerulonephritis

48
Q

what is the classic triad of symptoms seen in patients with systemic Lupus Erythematosus (SLE)?

A

fever + joint pain (polyarticular and symmetric) + rash (“butterfly rash”)

49
Q

Treatment for Lupus?

A

if non-life threatening - NSAIDs + antimalarials

life-threatening/severe: Prednisone + immunosuppresors

50
Q

To diagnose SLE, there needs to be a positive ANA and what other antibody?

A

anti-dsDNA and/or anti-Sm antibody

51
Q

what is the acronym used for diagnosing Lupus? (SLE)

A

SOAP BRAIN MD

need 4 of 11 for diagnosis

52
Q

what is the syndrome characterized by hypercoagulability due to antibodies against phospholipid-binding plasma proteins?

A

antiphospholipid syndrome (APS)

53
Q

chronic inflammatory disorder involving the SYNOVIUM of the joints

A

rheumatoid arthritis

54
Q

Treatment for RA?

A

DMARDs + NSAIDs

never NSAIDs for monotherapy as they do not prevent erosion of joints

55
Q

What are the diagnostic antibodies for Antiphospholipid syndrome?

A

Anticardiolipin + B2-glycoprotein + Lupus Anticoag.

56
Q

Patient with hx pregnancy loss, DVT and evidence of hypercoagulability on Labs is likely to have what disease?

A

Antiphospholipid Syndrome (APS)

57
Q

Treatment for someone with APS (antiphospholipid syndrome)?

A

lifelong anticoagulation (warfarin)

58
Q

Raynaud’s phenomenon is commonly associated with which rheumatic disease?

A

Scleroderma

59
Q

In which disease are you most likely to see sclerodactyly?

A

Scleroderma

sclerodactyly = tightening of skin in face and extremities, giving “claw-like” appearance in the hands

60
Q

Sjogren’s syndrome is an autoimmune disease due to dysfunction of which organ/structures?

A

Lacrimal gland and salivary glands

will present with dry eyes and dry mouth

61
Q

What are the specific antibodies positive in Sjogren’s syndrome?

A

SS-A (Ro) & SS-B (La)

62
Q

Treatment of sjogrens?

A

artificial tears

lymphoma can occur in 6% of cases, so we want to monitor

63
Q

What is the diagnostic test for dermatomyositis and polymyositis?

A

Muscle biopsy! (rule out malignancy)

Other Labs elevated: CK + aldolase

64
Q

Diagnostic test for Giant Cell Arteritis?

A

biopsy of temporal artery

65
Q

Jaw claudication and blindness are common symptoms that distinguish Giant cell arteritis from which other large vessel vasculitis?

A

Polymyalgia rheumatica (PMR)

66
Q

What are some main large-vessel vasculitidies?

A

Polymyalgia rheumatica, Giant cell arteritis, Takayasu Arteritis

67
Q

to diagnose Obstructive sleep apnea, what epworth sleepiness score do you need?

A

> 9

68
Q

what is another word for the sleep study?

A

polysomnography

69
Q

Is the first line treatment for OSA in adults and kids CPAP?

A

No- CPAP is the first line choice for adults, but in kids we’re more likely to do surgery (due to noncompliance)

70
Q

What 3 characteristics do we see on imaging that describe interstitial lung disease?

A

reticular changes, honeycombing, traction bronchioectasis

71
Q

What needs to be ordered to CONFIRM and diagnose idiopathic pulmonary fibrosis?

A

Need a tissue biopsy to confirm by pathology that it is idiopathic.

72
Q

Sarcoidosis looks a lot like TB on an XRAY. What is the main characteristic that distinguishes the two?

A

Sarcoidosis is NONcaseating granuloma; TB is CASEATING. If you suspect sarcoidosis, do TB test to rule out

73
Q

In which restrictive lung disease would you most likely find pleural plaques on CXray?

A

asbestosis

74
Q

What makes the cutaneous nodules of Berylliosis different from those in Sarcoidosis?

A

The skin nodules in berryliosis are located on areas of skin that were exposed to the toxin.

75
Q

Silo-fillers restrictive lung disease is due to inhalation of what?

A

Nitrogen dioxide

76
Q

Characterized by cough lasting >5 days and up to 3-4 weeks. 90% viral

A

Acute bronchitis

77
Q

What is the vaccine for Acute bronchiolitis?

A

NONE - RSV does not have a vaccine

78
Q

Which virus has the risk of persistent airway resistance later in life?

A

RSV

79
Q

Diagnostic test for RSV?

A

RSV Rapid viral antigen testing (nasopharyngeal swab)

80
Q

Hypoxemia is defined as pO2 < ?

A

60

81
Q

Hypercapnia is defined as pCO2 > ?

A

50

82
Q

How do we calculate what the A-a gradient should be?

A

(Age/4) + 4

83
Q

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?

A

FEV1 should have a change of > 12% expected

84
Q

Which disease can be linked to Alpha-1 antitrypsin deficiency?

A

COPD

85
Q

What determines a COPD Exacerbation?

A

the change of sputum to purulent + rr >30

ADD antibiotics to normal med regimen

86
Q

RSV (acute bronchiolitis) is common in what age?

A

< 2 years

87
Q

treatment for pertussis “whooping cough”

A

Azithromycin

88
Q

What type of lung carcinoma looks like a pedunculated “floating finger” in the central airway?

A

Carcinoid Tumor

89
Q

What is carcinoid syndrome?

A

Flushing + diarrhea + wheezing + hypotension

90
Q

lung carcinoma characterized by NO tobacco association, unilateral chest pain, occupational hx of mining

A

mesothelioma (the tumor has invaded the lung pleura, causing the unilateral pain)

91
Q

Horner syndrome?

A

myosis + partial ptosis + anhidrosis (seen in mesothelioma)

92
Q

Treatment for mesothelioma

A

chemotherapy

93
Q

which type of nonsquamous cell lung carcinoma is most related to NONSMOKERS

A

adenocarcinoma

94
Q

what is paraneoplastic syndrome?

A

the hormones secreted by the tumor cell can have different effects: thrombophlebitis, hypercalcemia, gynecomastia

95
Q

which non small cell lung carcinoma happens to have a rapid doubling time?

A

Large cell carcinoma (double rapidly, metastasize early)

96
Q

What type of imaging do you order to determine metastasis/staging in lung carcinoma?

A

PET scan - lights up w/ metabolism (cancer cells)

97
Q

Do you perform a pre-op biopsy in non small cell lung carcinoma?

A

NO - higher risk for damaging the lung tissue if there is disease present

98
Q

disorder in which inflammation in the lung leads to leaky capillaries

A

ARDS

99
Q

what is the diagnostic test for Gout?

A

getting the joint fluid - shows needle-like negative befringence

100
Q

diagnostic for Takayasu Arteritis?

A

CT angio - shows stenosis, occlusion, dilation of aorta and branches

101
Q

Which organ system is typically left unaffected by Polyarteritis Nodosa?

A

Lungs

102
Q

In primary angiitis, patients will have no systemic symptoms, however, which organ system is affected?

A

Nervous system - primary angiitis is limited to the brain and spinal cord (brain biopsy is diagnostic)

103
Q

In what type of Vasculitis is ANCA positive for PR-3?

A

Wegners (granulomatosis with polyangitis)

104
Q

Berlin Definition of ARDS: onset of respiratory distress, progressing to respiratory failure, within ____ days of a clinical insult

A

7

105
Q

Bilateral Infiltrates on CXR, pulmonary infiltrates without signs of fluid overload or heart failure, AND a PaO2: FIO2 < 100 can be diagnosed as???

A

ARDS

Pulmonary And rheum (1 decks)

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