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IPAP > IMC/FM/EMED Pulm > Flashcards

IMC/FM/EMED Pulm Flashcards

1
Q

Define Acute Bronchitis

What is an unusual Sx that makes the Dx shift to ?

95% of bronchitis is d/t ?

A

Cough persisting >5days

Fever- suspect pneumonia/influenza

Viral

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2
Q

? three bacteria are the MCC of acute bronchitis

How is acute bronchitis Dx

How are these Pts Tx

A

M catarrhalis- MC
H influenza
Strep pneumo

CXR

Dextromethorphan
Guifenesin
B-agonist if wheeze w/ PulmDz

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3
Q

How are acute exacerbation of chronic bronchitis d/t bacteria Tx empirically

MCC of acute and chronic sinusitis

How does acute sinusitis present in time frames

A

1st: 2ng Gen cephalosporin
2nd: 2nd gen macrolide or TMP-SMX

Acute: St. Pneumo viral respiratory infection
Chronic: Stah A

Worsens 5-7 days, fails to improves >10days
>12wks= chronic

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4
Q

How is sinusitis Dx w/ imaging

What are the four indications for ABX to Tx sinusitis

What is used for first and second line ABX Tx

A

CT- gold standard
Waters view x-ray

Fever >102
Improve then worse
Purulent d/c
Sxs >10days

First :
Augmentin/Amox
Allergy: Doxy/Cephalosporin w/ Clinda

2nd: fail to improve w/ first line Tx in 7days
Augmentin 
Levofloxacin
Moxifloxacin
Allergic:
Doxy/Levo/Moxiflox
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5
Q

How is Chronic Sinusitis Tx

How is Sinusitis in children Tx

When do Peds need f/u

A

Augmentin
Allergy: Clindamycin

45mg/kg/day w/ Augmentin
Allergy: 3rd-G Cephalosporin (One, Ten, Me)

72hrs; switch to second line agent

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6
Q

? is the deadliest infectious dz in the USA

If Pt is not a resident of long term facility, ? time frame is applied for Dx

? is the MC microbe responsible

A

Pneumonia

CAP= <48hrs of admission

Strep pneumo

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7
Q

What viruses can cause CAP

What do Pts present w/ on exam

? is needed for Dx

A 
Corona
Parainfluenza
Adenovirus
Influenza
RSV

Desat O2
Tachy/Tachy
Fever

CXR/CT

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8
Q

What lab result can help differentiate a bacterial from a viral pneumonia

What are the 4 MC causes of CAP in outpatients not needed admission

A

Procalcitonin- released by bacteria, inhibited by viral

SCM-pneumoniae
Influenza

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9
Q

How is CAP Tx in previously healthy Pts w/ no ABX in past 90 days

How is Tx adjusted in areas w/ macrolide resistant Strep Pneumo

How are Pts w/ comorbidities or ABX use w/in past 90days Tx

A

Macrolide: Azith/Clarithromycin
Amoxicillin
Doxycycline

Beta-lactam and Macrolide or,
Respiratory fluoroquinolone (GML-floxacin)
Macrolide or Doxy + Beta-lactam (Amox + Augmentin) or,
Respiratory fluoroquinolone (GML-floxacin)
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10
Q

What is first line Tx for ICU Pts w/ CAP

How is Tx adjusted for Pts w/ specific Pseudomonas RFs

How are Pts w/ MRSA risk Tx

A

Anti-pseudomonal Beta-lactam (Cefotax, Ceftriax, Ceftar, Amp-Sulbactam) and,
Either Azith or Resp Flqn (GML-floxacin)

Piper/Tazo or,
Imi/Meropenem or,
Cefepime with,
Azith or Resp Flqn (GML-floxacin)

Vancomycin

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11
Q

What are the two pneumonia vaccines

Who is recommended to receive these

Adults w/ chronic illnesses that increase the risk for CAP should get ? vaccine regardless of age

A

Prevnar 13- first
Pneumovax 23

> 65y/o
ImmComp

Pneumovax 23

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12
Q

ImmComp Pts or those at highest risk for fatal pneumonia need ? vaccine regiment

ImmCompe Pts 65y/o or > should receive a second dose of ? vaccine how often

A

Pneumovax 23 five years after first vaccine

Pneumovax 23 if first dose was 6/> years ago AND PT was <65y/o at time of first dose

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13
Q

What PE finding suggest pneumonia d/t Strep Pneumo

This form of pneumonia is common in Pts w/ ? MedHx

What PE finding suggests Staph A pneumonia

A

Rust colored sputum

Splenectomy

Salmon colored sputum after influenza infection

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14
Q

What causes Histoplasma capsulatum pneumonia

What other dz does this mimic on CXR

What type of pneumonia is associated w/ poor dental hygiene

A

Bat droppings

Sarcoidosis

Anaerobes

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15
Q

Influenza pneumonia is characterized by ?

Atypical/Mycoplasma pneumonia is characterized by

Lobar consolidations are seen in ? pneumonia while apical infiltration is seen in ?

A

Rapid onset, severe course

Less severe/rapid

Lobar: CAP
Apical: TB

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16
Q

Pneumonia Pts will have ? 3 positive PE findings

HAP/VAP have ? time frame for Dx

HAP is the 2nd MCC of ?

A

Tactile fremitus
Egophony
Dull to percussion

> 48hrs since admission/intubation

Inpatient infections

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17
Q

What 3 factors distinguish nosocomial pneumonia from CAP

? is the most important step in the pathogenesis of nosocomial pneumonia

? medication can help reduce incidences of VAP

A

1: cause
2: inc drug resistant microbes
3: poorer underlying health

Colonization of pharynx/stomach

Sucralfate

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18
Q

? microbes are the MCC of HAP

? microbes are VAP more likely to have

TB is more likely to infect Pts in ? population

A

Gram neg rods
Pseudomonas
Staph A

Acinobacter
S maltophilia

HIV positive

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19
Q

What are the classic findings of TB on PE

Define Drug Resistant TB

Define Multiple Drug Resistant TB

Define Extensively Drug Resistant TB

A

Fever
Anorexia
Weight loss
Night sweats

Resistant to one: I/R

Resistant to I and R

Resistant to R/I and Aminoglycosides and/or Careomycin

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20
Q

? is the MC pulmonary Sx of TB

What is also a common complaint

What is an unusual Sx

A

Chronic cough

Bloody sputum

Dyspnea

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21
Q

What are the PPD rules for TB

A 
>5mm:
CXR evidence of TB
HIV/ImmSupp
15mg/day x 1mon or equivalent of Pred
Close contact w/ infectious TB PT
>10mm:
IVDA
Immigrants
Residents of high populations
GI surgery

> 15mm:
No RFs

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22
Q

How is TB Dx

What is seen on CXR

What is seen on biopsy results

A

Acid fast bacilli smears and cultures

Apical Ghon complexes

Caseating granulomas

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23
Q

What are the two forms of miliary TB

How is TB Tx

A

Potts Dz: spine
Scrofula: cervical lymph nodes

+ PPD= CXR
Neg CXR: latent TB Tx w/ Isoniazid w/ Vit B6 x 9mon

Active CXR:
Baseline LFTs
RIPE x 8wks
RI x 16wks

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24
Q

What are the s/e of RIPE therapy

What is used for prophylaxis for household members

When are Pts considered fully Tx

A

R: orange fluids
I: neuropaty
P: hyperuricemia
E: red-green blindness

Isoniazid x 12mon

Two negative AFBs and cultures

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25
Q

What part of RIPE needs to be adjusted if CrCl is <30

? RIPE adjustment is needed if Pt is also on HIV meds

What are the 4 indications to test for TB w/ NAAT

A

P/E- 3 x/wk

Raltegravir, double dose when used w/ Rifampin

Previously Tx for TB
Lived in endemic area
Contact w/ MDR TB
HIV seropositive

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26
Q

? is the traditional test for latent TB

Define Ranke Complex

How are pregnant Pts w/ TB Tx and w/ ? educational piece

A

TST via Mantoux method

Calcified hilar lymph node

R/I/E x 4-8wks
R/I x 7months
Breast feeding not c/i

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27
Q

Define Asthma

Absence of ? Sx on PE indicates medical emergency

What are two odd precipitators to attacks

A

Chronic, reversible inflammatory airway dz

Lack of wheeze

NSAIDs/ASA

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28
Q

Define FEV1

Define FEV

Define FVC

A

Amount exhaled in 1 second

Total amount exhaled during forced breath

Total amount exhaled during FEV test

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29
Q

How is asthma Dx

What result is Dx

What type of improvement result helps w/ Dx

A

Peak expiratory flow rate

FEV1/FVC 75-80%

> 10% inc of FEV1

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30
Q

Define Intermittent Asthma

Define Mild

Define Moderate

Define Severe

A

Sxs 2/< days/wk
Awake 2/< x/month
SABA 2/< days/wk
No activity interference

Sxs >2day/wk
Awake 3-4x/mon
SABA >2 days/wk
Minor limitations

Daily Sxs
Awake 1/>/wk
SABA daily
Some limitations

Daily Sxs
Nightly awakenings
SABA several x/day
Extreme limitations

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31
Q

Step 1 Asthma Tx

Step 2 Asthma Tx

Step 3 Asthma Tx

Step 4 Asthma Tx

Step 5 Asthma Tx

Step 6 Asthma Tx

A

1- Intermittent
SABA PRN

2- Mild
Low ICS daily

3- Moderate
Low ICS + LABA daily

4- Moderate
Med ICS + LABA daily

5- Persistent
High ICS + LABA daily

6- Persistent
High ICS + LABA + PO CCS daily

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32
Q

What is used for acute Tx of asthma exacerbation

MC inhaled precipitant

Define Samter Syndrome and Atopic Triad

A

O2
Nebulized SABA
Ipratropium bromide
PO CCS

Cigarette smoke

Samter:
Asthma ASA Polyps
Atopic:
Asthma Rhinitis Eczema

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33
Q

What defines Chronic Bronchitis

What defines Emphysema

Most smokers will be Dx w/ ? and be termed ?

A

Productive cough x 3mon/year x 2yrs

Structural changes

Chronic bronchitis, blue bloater

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34
Q

What is the single best variable for predicting which Pt will develop COPD

How is Chronic Bronchitis Dx

What is seen on CXR

A

Hx 40 pack/year smoker

Lung biopsy w/ inc Reid index (gland layer >50% of bronchial wall)

Inc interstitial markings and non-flat diaphragm

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35
Q

What will be seen on PFT in chronic bronchitis

What is the most effective therapy for Tx Pts w/ chronic bronchitis

When is supplemental O2 indicated

A

FEV/FVC ratio <0.7

Cessation

SaO2 <89% or,
Rest PaO2 <55mmH

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36
Q

How are COPD exacerbation Tx

If ABX are used, ? ones and w/ ? indication

What will probably develop in these Pts d/t chronic hypoxic vasoconstriction

A

O2 (goal 88-92%)
Nebulized albuteral and Ipratropium
PO Prednisone

Inc dyspnea, sputum/purlence;
Azith/Cefur/Doxy

Cor pulmonale

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37
Q

COPD Gold Categories

A

A: Less Sx, Low risk;
Breathless when hurrying on flat ground, 0-1 exacerbation, 0 hospitalizations
SABA/SAMA

B: more Sx, low risk;
Breathless when walking slower than peers, 0-1 exacerbations, 0 hospitalizations
LAMA/LABA

C: less Sx, High risk
Breathless when hurrying on flat ground, 2/> exacerbation, 1/> hospitalizations
LAMA and SABA

D: more Sxs, High risk;
Breathless when walking slower than peers, 2/> exacerbations, 1/> hospitalizations
LAMA+LABA w/ SABA

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38
Q

What causes structural changes seen in emphysema

What type of breathing habit do these Pts develop

What term is used for these Pts

A

Destruction of alveolar septae d/t lost elastin

Purse lip, keeps airway from collapsing

Pink puffer- retained CO2

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39
Q

What is different between Blue Bloaters and Pink Puffers on CBC results

? is the MC of all interstitial lung dzs

How is this MC Dx

A

BB- Inc H/H
PP- normal Hct

Idiopathic pulmonary fibrosis

CXR w/ diffuse, patchy fibrosis and pleural base honeycomb

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40
Q

What type of PFT results are seen in Idiopathic Pulmonary Fibrosis

How is this Tx

Define Pneumoconiosis

A

Restrictive pattern- dec volume, normal/inc FEV1/FVC

CCS O2 Transplant

Pulmonay fibrosis w/ known cause;
Exposure to mining/dust causing dec lung volume/FVC (restrictive dz)

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41
Q

Asbestosis CXR findings

Coal Workers CXR findings

Sillicosis CXR findings

A

Linear pattern w/ basilar predominance, opacities and honeycomb

Nodular opacities in upper fields and less prominent hilar adenopathy

Egg shell classifications of hilar nodes

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42
Q

Berylliosis CXR findings

? restrictive lung dz makes Pts at increased risk for TB

? restrictive lung dz needs tobacco cessation more than others

A

Difuse infiltrates w/ hilar adenopathy

Sillicosis- need serial TST/CXRs

Asbestosis

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43
Q

? tissue finding indicates significant exposure to asbestos

? size lung mass is a nodule or a mass

How are incidental CXR findings of pulmonary nodules managed

A

Ferruginous body

<3cm- coin lesion, nodule (<30mm)
>3cm- mass

CT w/out contrast-
Ill defined, lobular, spiculated= biopsy
<1cm, calcified, smooth/defined border= f/u 3mon, 6mon, annual x 2yrs

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44
Q

What are the two categories of lung cancer

What are the 4 subtypes of one of these categories

A

Small cell
Non-Small cell:

Adeno: non-smoker w/ small peripheral lesion; MC bronchogenic Ca

SCC: central, solitary mass in smokers w/ hemoptysis

Large: fast growth that rarely responds to surgery

Carcinoid- lack differentiation

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45
Q

How does Small Cell Lung Ca present

What lab results would be seen

What syndrome can this Ca cause

A

Aggressive and almost always in smokers;
more likely to spread early

ACTH/ADH: HypoNa/HyperCa

Lamber Eaton- limb weakness

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46
Q

How are lung Ca Dx

Pancoast tumors are more likely to be ? types

What makes up the Pancoast Syndrome

A

Bronchoscopy w/ biopsy if central or,
Fine Needle Transthoracic aspiration (most useful)

Adeno/SCC

Shoulder pain
Horners
Bone destruction

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47
Q

How is Non-Small Cell lung Ca Tx

How is Small Cell Ca Tx

? measurement means PHTN

A

Stage 1-2: surgery
Stage 3: chemo then surgery
Stage 4: palliative

Chemo, no surgery option

> 25mmHg at rest

48
Q

? is the MCC of PHTN

How is this Dx

How is this Tx depending on the origin

A

MS

Right sided catheterization

LVF: diuretic, digoxin, anticoagulate

Cardiogenic: prostanoids, PD5 inhibitors, endothlin antagonists

Pulm Artery HTN: endothelin antagonists, prostanoids

49
Q

MCC of anaphylaxis

? type of reaction is the usually

What does this reaction cause to happen

A

Ingested foods

MC a Type 1 IgE mediated reaction

Mast cells/basophils cause HOTN, shock, angioedema from fluid shift from intravascular space

50
Q

What is usually the first sign of anaphylaxis

? is first line Tx

Acronym for acute asthmatic exacerbation Tx

A

Cutaneous pruritus/urticaria/angioedema

IM Epi

BIOMES
Beta agonist
Ipratropium
O2
Mg sulfate
Epi/Terbutaline
Steroids
51
Q

? medication can cause Pts to be resistant to Epi

? is the MC sleep-related breathing d/o

What are the 2 presenting c/c and what are the two most specific Sxs

A

BBs

OSA

Snoring
Wake time sleepiness;
Nocturnal choking, Gasping

52
Q

Polysomnography is the preferred Dx test for OSA, when are at home tests considered

? is the best Dx study to dx malignant pleural mesothelioma

? finding is nearly always present when malignant pleural mesothelioma is Dx

A

No other comorbidities

VATS Biopsy

Pleural effusion

53
Q

MC type/location of malignant mesothelioma

What is commonly seen on PE for Croup

What virus causes this

A

Pleura

Hoarseness
Inspiratory stridor
Seal-barking cough

Parainfluenza type 1-3

54
Q

What CXR finding is Dx for croup

How is this Tx

What causes membranous croup

A

Steeple sign

Warm/humid air
Dexamethasone Sxs <24hr
Nebulized epi if +wheeze

Diphtheria

55
Q

? is the MC EKG finding in PEs

What is the most specific finding

Obstructive lung dzs and spirometry results

A

Sins tach

S1Q3T3- McGinn White Sign

Dec FEV1/ration <0.8:
Emphysema
Chronic bronchitis
Bronchiectasis
Asthma
56
Q

What is seen on biopsy results of sarcoidosis

? organs are involved 90% of the time

What two derm manifestations may be seen

A

Non-caseating granuloma

Lungs

Erythema multiform- tender nodules on anterior lower legs, nonspecific
Lupus pernio- violaceous raised discoloration on face (pathognemonic); resembles frostbite

57
Q

What lab results support Dx of Sarcoidosis

What sing may be seen on gallidium scans

If needed, how is sarcoidosis Tx

A

Inc ACE
HyperCa

Lambda sign- uptake by hilar nodes

Pred
Methotrexate- progressive/refractory

58
Q

? triad is used for DVTs/PE

What type of birth control do women who smoke/>35y/o need to be on to reduce DVT risk

A

Virchows:
Trauma Stasis Hypercoag

Progestin only

59
Q

How are DVTs Dx

How can a DVT be ruled out in Pts w/ low risks

If DVT is found, how are they Tx

A

Fist: Venous US
Gold: venography

D-dimer

LMWH
Fondaparinux
Factor 10a inhibitors

60
Q

Most PEs arise from where in the body

What are the 4 specific RFs

What triad would be seen if a fat emboli is the cause

A

Iliofemoral DVTs

Cancer
OCPs
Pregnancy
Surgery

Hypoxemia
Neuro abnormals
Petechial rash

61
Q

Pregnant Pts w/ amniotic fluid emboli can lead to ? complication

What risk stratification method is used for PEs

? is the initial method for Dx

A

DIC

Wells:
>4: PE likely
4/

62
Q

What will be seen on ABGs during PEs

What two findings may be seen on CXR

? is the gold standard or imaging modalities for Dx

A

Respiratory alkalosis

Westermarks
Hampton Hump

Pulmonary angiography

63
Q

How are PEs Tx

How long is medical therapy used for

OSA usually presents d/t obstruction at ? level

A

Acute phase: Heparin
Then: ARE-aban and Dabigatran

3mon minimum

Oropharynx

64
Q

What are the 5 RFs for OSA

For a Dx, ? sleep study results are needed

A 
Obesity
Anatomical
FamHx
ETOH/Sedative
Hypothyroidism

5/> events/hr w/ Tired/Waking/Snoring/HTN
15/> events/hr regardless of other Sxs

65
Q

How is mild/mod OSA Tx

How is severe OSA Tx

How can Pulmonic Sarcoidosis preesent

A

Mild/Mod: CPAP, PO piece
Sev:
CPAP Uvulo-plasty
Tracheostomy- life threatening

Fever
Arthralgia
Weight loss
ENodosum

66
Q

What is the hallmark CXR finding for almost all pulmonary sarcoidosis

What other 3 DDx need to be considered though if this hallmark is seen

A

Mediastinal lymphadenopathy

Young female: sarcoidosis

Kid from Ohio/zookeeper: histo

60y/o ceremics: berylliosis

67
Q

How is pulmonary sarcoidosis Dx

? is needed to assess dz progression and guide Tx

How is this form of sarcoidosis Tx

A

Blood test: HyperCa
Inc ACE 4x

Serial PFTs

CCS
ACEI
Methotrexate

68
Q

? is the leading cause of death in Pts w/ pulmonary sarcoidosis

Define Transudative Effusion

What are the MCC

A

Pulmonary fibrosis

Transient fluid d/t hydrostatic pressure

CHF
Cirrhosis w/ ascite
Hypoalbumin d/t nephrotic synd.

69
Q

Define Exudative Effusion

What are the MCCs

What criteria is used to dx an exudate

A

Fluid d/t infection/Ca/Immune

Pneumonia
PE
TB

Lights; 1 of 3= Dx
High protein, LDH
Protein >0.5
LDH >0.6
LDH >2/3 upper limit
70
Q

Left sided effusions are more than likely ? while right sided are probably ?

How are these Tx

Define ARDS

A

L: exudative
R: transudative

Centesis
Chronic: pleuroesis or indwelling cath

Resp failure d/t fluid in lungs from inc alveolar capillary permeability

71
Q

What 3 events account for 75% of all ARDS cases

What 3 things can be seen on PE

What would be seen on CXR

A

Sepsis sydrome- MC
Sev/mulitple trauma
Aspiration/inhalation

Tachypnea
Pink sputum
Crackles

Bronchograms
BIlateral fluffy infiltrates

72
Q

How is ARDS Tx

What score system is used to predict the mortality of Sepsis

? is an indirect marker of tissue perfusion used in sepsis Tx

A

Intubate w/ lowest level of PEEP to maintain PaO2 >60mm/SaO2 >90

qSOFA:
New/worse mentation
RR >22/min
SBP 100/<

Lactate

73
Q

HOTN is a late finding in sepsis w/ ? event occurring before HOTN sets in

? is the MCC of sepsis and ? is the MC manifestation

What are the 4 components of the SIRS criteria no longer used

A

Hypoperfusion

Pneumonia;
Fever

Temp <36/>38
HR >90bpm
RR >20
WBC <4K/>12K/>10% bands

74
Q

Gram-Pos shock is d/t ? microbes

Gram-Neg shock is d/t ? microbes

? are the sepsis biomarkers

A

Staph/Strep exotoxin

EColi, Klebsiella, Proteus, Pseudomonas endotoxins

Procalcitonin: peak 12-48hrs
Lactate: >18 are Dx of septic shock

75
Q

How are septic Pts Tx

A

Fluid resuscitation w/ IV crystalloid 30mL/kg in first 3hrs

Empiric ABX w/in 1hr

NorEpi if MAP is not maintained >65mm

76
Q

Define Cafe Coronary Syndrome

What microbe causes pertussis

What are the 3 phases of pertussis

A

Near/Fatal asphyxiation from airway obstruction d/t poorly chewed meat

Bordatella

Catarrhal- lacrimation, infective
Paroxysmal- staccato whoop
Convalescent- dec Sxs

77
Q

How is pertussis Tx

What is used to predict death/hospitalizations in Pts w/ COPD

What are the two preferred ABX for Tx of Legionella Pneumonia

A

Azithromycin
TMP-SMX

BODE Index: 
BMI 
Obstructed airway
Dyspnea
Exercise capacity

Azithromycin
Levofloxacin

78
Q

MCC of bacterial CAP

Pts w/ stable VS and pneumothorax need needle decompression when?

? antifibrinotic agent can be used to Tx idiopathic pulmonary fibrosis

A

Strep pneumo

> 3cm pneumo or Sxs

Pirfenidone
Nintedanib

79
Q

Emphysema affects structures past ? point

A

Distal to terminal bronchiole- acinus

80
Q

What is the MCC of proximal acinar emphysema

? is the MCC of diffuse panacinar emphysema

What is the MCC of distal acinar emphysema

A

Cigarette smoking, less commonly in coal worker’s pneumoconiosis

Alpha-1 antitrypsin deficiency

Spot pneumo

81
Q

What are the only two interventions used to decrease mortality in emphysema

? genotype is associated w/ the highest risk for alpha-1 antitrypsin deficiency

? drugs are the MCC of drug reactions and cause ? MC manifestation

A

Cessation, O2 therapy

ZZ, MM is normal

Derm eruptions:
ASA
NSAID
B-lactam ABX
Sulfas
82
Q

What are the 4 types of hypersensitivity reactions

A

1: anaphylactic, immediate;
IgE mediated degranulation of mast cells; anapnylaxis, urticaria, angioedema

2: cytotoxic;
IgG/IgM Abs react to Ags causing complement activation;
hemolytic anemia, E. fatalis, Goodpsture

3: immune complex;
IgG/IgM complex deposition and complement activation;
Serum sickness, SLE, PostStrep glomeruloneph.

4: cell mediates, delayed;
activated T-cells against surface Ags
Contact dermatitis, TST, transplant rejection

83
Q

? screening questionnaire is used for OSA

MC presenting Sx of PE

MC presenting sign of PE

MC EKG finding

A

STOP-Bang

Dyspnea at rest/exertion

Tachypnea

Tachycardia

84
Q

? is the gold standard for Dx PE but is rarely used d/t invasive method

MC Sx of acute bronchitis

When are x-rays indicated for acute bronchitis work ups

A

Catheter based pulmonary angiography

Cough

Fever
Sxs x 14days

85
Q

? strains of influenza can be detected on rapid test

COPD Pts <65y/o need ? vaccines

COPD Pts >65y/o need ? vaccines

A

A and B

PPSV-23 and Influenza

PPSV-23, PCV-12 and Influenza

86
Q

? microbe is MC isolated from COPD Pts

BMI over ? amount indicates Obesity Hypoventilation Syndrome

What would be seen on VS

A

H Influenza

> 30kg/m2

SpO2 <94% on room air

87
Q

? is MCC of chronic Cor Pulmonale

? are the two MCC of acute Cor Pulmonale

? type of axis deviation would be seen on EKG

A

COPD

PE, Acute RDS

RAD

88
Q

What are the 5 groups of Cor Pulmonale by etiology

What distinguishes Sarcoidosis

What bronchoscopy biopsy result means a Dx

A

1: Pulm arterial HTN
2: left HDz (MC)
3: lung dz/hypoxemia
4: chronic thromboemoblism
5: unclear, multifocal mechanisms

T-cell/mononuclear phagocyte accumulation
Noncaseating granuloma

Sarcoid granuloma: noncaseating epitheloid granuloma surrounded by fibroblasts/lymphocytes

89
Q

What test do Sarcoidosis Pts need annually

When is surfactant production started in utero

The lack of surfactant is the primary cause of ?

A

EKG d/t blocks/V-tach

Starts: 20wks
Gradual: 33-36wks
Surges: >36wks

RDS- AKA Hyaline Membrane dz

90
Q

? is the leading RF for surfactant deficiency

What is surfactant made of and what function does it do

What would be seen on CXR of RDS

A

Prematurity

Phospholipid, proteins- dec alveolar surface tension to increase expansion

Ground glass appearance w/ air bronchograms

91
Q

What are 3 RFs for RDS

What are infants that required prolonged ventilator support at risk for

What lab result is used as marker for fetal lung maturity and more mature surfactant levels

A

Maternal DM
Asphyxia
C-section

Bronchopulmonary dysplasia

Phophatidyglycerol

92
Q

? is a common complication to arise from aspiration pneumonia

? microbe is MC involved

How are these complications Tx

A

Lung abscess

Anaerobe (Peptostrepto, Fuso, Bacteroides)

1st: PO Clindamycin
2nd: Augmentin
Amp-sulbactam
Carbapenem

93
Q

What two c/c indicate a Dx of influenza

When can antiviral therapies be considered for use

What can be used

A

Rapid onset fever/arthralgia

Old/young Pt
Respiratory Dz

Oselta: PO w/ food; s/e N/V/Dizzy

Zana: inhaled; s/e wheeze/bronchospasm

Amantadine: PO; s/e in
elderly/renal impairment

Rimantadine: PO; less s/e potential than Rimantadine

94
Q

? is used for influenza prophylaxis for close family members

Croup is AKA ?

? vaccine prevents the croup

A

Oseltamivir

Laryngotrachobronchitis

HIB

95
Q

? medication is given to mothers who are expected to deliver early

What is the time frame for this medication to be given

What is the c/i to using antenatal CCS

A

Betamethasone

Delivering before 34wks

Maternal systemic infection- chorioamnionitis

96
Q

? FEV1 level indicates a mod/sev COPD exacerbation

? level indicates a mild exacerbation

What does P jirovecii look like on CXR

A

<50%

> 50%

Batman: Ground glass opacification

97
Q

How is P jirovecci Tx and when is steroid use indicated

What are 4 c/c seen in Idiopathic Pulm Fibrosis

What will lab results show of the lung washings obtained

A

TMP-SMX
Steroid- PaO2 <70 or A-gradient >35mmHg

Dry cough
Exertional dyspnea
Velcro crackles
Finger clubbing

Interstitial pneumonia

98
Q

? type of precaution does TB need

How is carcinoid syndrome Dx

What are the 3 parts to the carcinoid trifecta

A

Airborne NOT DROPLET

24hr excretion of 5-hydroxyindoleacetic acid

Flushing
Wheezing
Diarrhea

99
Q

Where do carcinoid tumors most frequently mets to

What are expected CXR findings in CF Pts

? Pt population is most likely to develop bronchiectasis

A

Liver

Dilated, thick bronchi w/ tram track signs d/t thickened walls

Secondary to CF

100
Q

CF PTs are most likely to have bronchiectasis exacerbation d/t ? microbe and Tx w/

Time frame for PE to appear after surgery/immobilization/central instrumentation

Where does a saddle PE form

A

Pseudomonas: inhaled aminoglycosides

3mon

Bifurcation of main PA and R/L PA

101
Q

Why is nebulized racemic epi used for Croup Tx

? Dx has to be considered during unexplained, isolated pleural effusions found on CXR

How much of an effusion is needed to be seen on AP/PA films

A

A-agonist causing vasoconstriction in upper airway vessels to decrease swelling

PE w/ blunted angles

250-500mL

102
Q

MCC of pleural effusions in US

Dx test of choice for Pertussis

What class of ABX is most effective for Tx

A

HF

Nasal swab

Macrolides

103
Q

How often are IM RSV monoclonal Abs administered in high risk PTs during RSV season

What 3 bacteria can cause bronchitis

When is Pertussis most infective

A

Monthly

Bordatella
Mycoplasma
Chlamydia

Catarrhal stage

104
Q

MCC of epiglottitis

What PE finding can aid w/ Dx

How are these PTs Tx

A

HIB

Pain over hyoid bone

Admit
Intubate if needed
IV Ceftriax/Amp-Sulbactam

105
Q

What meds are used for Sx control of carcinoid tumors

What are the RFs that predict poor outcome for RSV induced bronchiolitis

What two clinical situations can lead to a false-negative D-dimer

A

Somatostatin analogues:
Ianreotide
Octerotide
Pasireotide

<3mon old
<34wks gestation
Tachy >70bpm
Ill appearance
Inability to hydrate

Recent anticoagulation
Subacute thrombosis <7d

106
Q

Top three areas in sequence for aspirated foreign bodies to become lodged in kids

All aspirated bodies need ? examination

Retained foreign bodies can lead to ? issue

A

R main bronchus
L main bronchus
Trachea

Rigid bronchoscopy

Bronchiectasis

107
Q

What is seen on CXR for aspirated foreign body

What is the physiological response to applying noninvasive PPV to COPD PTs

? is the gold standard for Dx P Jirovecci pneumonia

A

Obstructed lung: more hypodense d/t air not exiting
Unobstructed: less dense

Increased tidal volume d/t elimination of dead space

Fluoroscein staining

108
Q

Define Cor Pulmonale

What is the MCC in the USA

Preferred Tx for CAP in Pts w/ no comorbidity

What is used for Tx if insidious onset, low fever, and diffuse infiltrates

A

Aletered structure and function of RV

COPD

Amoxicillin

Doxy

109
Q

Cardiac output equation

Why do Pts w/ sarcoidosis have HyperCa

Post-influenza pneumonia is d/t ? microbe causing ? and mediated by ?

A

CO= SV x HR

Granulomas secrete calcitriol (active Vit D) causing inc intestinal absorption of Ca

Staph A;
Necrotizing pneumonia;
Panton-Valentine Leukocidin

110
Q

Pneumonia w/ bullous myringitis is d/t ?

MCC of pleural effusions in developed countries

MCC transudates

MCC exudates

A

Strep pneumo

HF

HF Cirrhosis Nephrotic PE

Malignancy 
Bacterial pneumonia
TB
PE
Pancreatitis
111
Q

Siderosis is d/t ?

Stannosis is d/t ?

Define Caplan Syndrome

A

Arc welding

Tin welding

Miner w/ RA who acquires any pneumoconioses

112
Q

PE findings of acute bronchiolitis

? is the MCC of neonatal respiratory distress

What causes this MC

A

Exspiratory wheeze
Tachypnea

Transient tachypnea of newborn

Residual fluid in lungs from delivery; seen as diffuse parenchymal infiltrates/interlobar fluid accumulation

113
Q

? Rx is recommended for all Pts admitted for asthma exacerbation

? trifecta suspects Sarcoidosis Dx

Superior Vena Cava syndrome is associated w/ ? and present w/ ?

A

Pred

Uveitis
Bilat hilar adenopathy
Dry cough

Lung Ca;
Facial/arm swelling
Dyspnea, cough

114
Q

What are the 4 Sxs associated w/ Pancoast Syndrome

How are small pleural effusions best seen on CXR

? position makes effusions most difficult to detect

A

Arm swelling
Shoulder pain
Horners
Atrophy in hand/arm muscles

Lateral decubitus w/ affected side down

Supine

115
Q

? is the most important non-pharmacological component to asthma management

Mnemonic for causes of hemoptysis

A

Trigger avoidance

BATTLE CAMP:
Bronchitis/ectiasis
Asperiglloma
Tumore
TB
Lung abscess
Emboli, pulm
Coagulopathy
Autoimmune
AV malformation
Alveolar hemorrhage
MS
Pneumonia
116
Q

Chlamydia pneumonia often follows ? Dx

Cox Burnetti (Q-fever) is passed by ? and will have ? abnormal lab result

What dissociation is seen in Chlamydia psittaci

A

Prolonged pharyngitis

Livestock;
Inc LFTs

Temp-pulse dissociation- Faget Sign; brady cardia w/ fever

117
Q

Potential neuro complication induced by pertussis

Stopped

A

Seizures

75

IPAP (212 decks)

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