Lungs Flashcards
What are the s/s of acute bronchitis?
Cough preceded by URI sx, no findings of pneumonia. No consolidation on CXR. Treat with supportive therapy, rest, hydration, stop smoking. Abx only in elderly or immunocompromised.
What is an acute inflammation of the large airways? Risk factor?
Bronchitis, smoking
This is an infection and inflammation of the smaller airways. What is the most common cause?
Acute bronchiolitis. Caused by RSV.
Presentation of a child with bronchiolitis?
Diffuse wheezing, fever, cough, hyperinflation, crackles, nasal flaring. Child looks sick.
Treatment for bronchiolitis?
Supportive, bronchodilator, ribavirin.
Hallmark signs of influenza?
Toxic appearance but exam normal.
What medication do you avoid giving for flu and why?
ASA, Reye’s syndrome.
What are some predisposing factors for pneumonia?
Smoking, DM, alcoholism, malnutrition, cancer, immunosuppression
Pneumonia in smokers, COPD?
S. Pneumonaie, h. Flu.
Most common cause for CAP? Community acquired pneumonia.
Strep pneumonaie.
Pneumonia in nursing home resident?
S. Pneumonaie, h. Flu, TB.
Pneumonia and alcoholic?
S. Pneumonaie, klebsiella.
Pneumonia and bats?
Histoplasmosis
Pneumonia and birds?
Cryptococcus
Young healthy adult with pneumonia?
Mycoplasma.
Cystic fibrosis and pneumonia?
Pseudomonas
Pneumonia in IV drug user?
Staph aureus, TB.
Pneumonia in HIV?
Pneumocystis
Water source of pneumonia?
Legionella
Lobar pneumonia is caused by what?
Bacteria
Interstitial pneumonia is caused by?
Viral or mycoplasma.
Nodular pneumonia caused by?
Fungus. Or metastatic dz.
Describe an infiltrate on CXR.
Opaque consolidation that you can still see the landmarks.
Describe a pleural effusion on CXR.
Fluid in plural space. Loss of landmarks and borders. Caused by CHF, pneumonia, malignancy.
Treatment of CAP with no comorbidities?
Out patient tx with microlides (azithromycin) or fluroquinolones.
CAP with comorbidities?
Treat inpatient with ceftriaxone plus macrolide.
Pneumonia with altered mental status…. CVA or drugs think….
Aspiration pneumonia. Common on RLL. Treat wiTh amoxicillin, fluroquinolones.
Most common cause of HAP?
Gram negative rods.
What is RSV?
Common cause of bronchiolitis in kids.
Antiviral Amantadine.
Treats influenza A, can cause seizure.
Rimantadine?
Treats influenza A.
Zanamivir?
Influenza A and B treatment. Competes with neuraminidase. Bronchospasm side effect.
Oseltamivir or tamiflu.
Treats influenza A and B.
Ribavirin.
Treats influenza A, B, hepatitis A, B, C. No PREGNANCY
Gold standard for testing TB?
Acid fast bacillus culture.
PPD positive at >5 mm induration?
HIV, contact with active TB patients, organ transplants, immunosupressed.
PPD positive at > 10 mm induration?
High risk countries, IV drug users, prison/nurse/homeless shelter workers. High risk patients. Children over 4 in high risk setting.
Normal positive PPD size?
15 mm induration.
Positive PPD. What next?
CXR, if abnormal AFB smears and culture.
Gohn complex?
Calcified lymph node on CXR in TB.
Positive PPD but no active disease?
Treat with INH and vitamin B 6 x 9 months.
Mechanism of action of INH, side effects.
Bactericidal, inhibits synthesis of mycolic acid. SE hepatitis, peripheral neuropathy.
Mechanism of action and side effects of rifampin.
Bactericidal, inhibits RNA ploymerase. Hepatitis, orange body fluids, pseudomembranous colitis.
The characteristics of asthma?
Obstruction of airflow, bronchial hyper reactivity, inflammation of airways.
Mild intermittent asthma:
< 2 times per month
Mild persistent asthma:
> 2 times per week and nocturnal sx > 2 times per month
Moderate persistent asthma:
Daily, nocturnal > 6 per month
Severe persistent asthma:
Continuous and nocturnal frequently
Step 1 asthma treatment?
SABA prn
Step 2 asthma tx?
sABA + low dose ICS
Step 3 asthma tx?
Low dose ICS + long acting BA
Step 4 asthma tx?
Medium dose ICS + LABA
Step 5 asthma tx?
High does ICS + LABA plus allergy Meds
A patient presents with acute onset of chest toughness, SOB, cough. Tachycardia, tachypnea, cyanosis, accessory muscle use and NO wheezing. Dx? Tx?
Status asthmaticus. Tx with oxygen, bronchodilators every 2 hrs, IV corticosteroids, mechanical ventilation.
Dx of chronic bronchitis.
Cough on most days for at least 3 months of the year for 2 consecutive years.
Patient with chronic bronchitis is a…..
Blue bloater.
Chronic bronchitis may have signs of?
Right heart failure or cor pulmonale.
Treatment Of chronic bronchitis?
Stop smoking. Ipatropium bromide, albuterol, theophylline, steroids.
What is emphysema?
Enlarged air space due to destruction of alveolar septa.
Describe a pink puffer?
Thin, pursed lip breathing, barrel chest, tachypnea, decreased breath sounds. Hyperinflation of X-ray.
This is abnormal and persistent dilation of major bronchi and bronchioles.
Bronchiectasis.
Bronchiectasis is related to what in the history?
Destructive changes from infection. TB, fungal, CF, pneumonia.
Patient presents to clinic with SOB, hemoptysis, and foul smelling sputum.
Bronchiectasis
Signet sign on CT which is the test of choice?
Bronchiectasis
90 % of this originate from DVT.
PE
Risk factors for PE?
Hypercoag state, pregnancy, OCP, surgery, a fib, trauma.
Patient presents with pleuritic chest pain, dyspnea and tachypnea?
Pulmonary embolism
Common EKG finding in PE?
S1Q3T(inverted)3
Gold standard for PE and test of choice?
Angiography, spiral or helical CT
PE and hemodynamically stable. Ok for coag. Tx?
LMWH and warfarin x 7 days then warfarin x 6 months.
PE and hemodynamically stable coag contraindicated?
Inferior vena cava filter
PE and unstable? Tx?
Thrombolytics
PE and unstable but coag contraindicated? Tx?
Pulmonary embolectomy
Most common cause of pulmonary hypertension?
COPD
What causes the leading number of cancer deaths?
Lung cancer
No small cell cancer includes:
Adenocarcinoma, squamous cell, large cell.
Risk factors for lung cancer?
Smoking, asbestos exposure, uranium arsenic chromium nickel exposure, hx of COPD,
This starts in the central bronchi and mets to nodes. May have associated hypercalcemia.
Squamous cell carcinoma.
Definitive dx test for carcinoma?
Biopsy
Most common type of lung cancer?
Adenocarcinoma.
This cancer appears at the periphery and mets to distant organs.
Adenocarcinoma
Clinical sx of this lung cancer include lymphadenopathy, Hepatomegaly, clubbing.
Adenocarcinoma
This is the most aggressive type of lung cancer. It arises in the peribronchial tissue located centrally.
Small cell carcinoma.
What is paraneoplastic syndrome and which lung cancer is it related to?
Can cause SIADH, Cushing’s syndrome, etc. small cell carcinoma. No clubbing noted.
This is a round oval, sharp lesion up to 3 cm in the lung.
Solitary pulmonary nodule. 25% are primary cancer, 10% are mets. Coin lesion.
Benign solitary pulmonary nodule means….
Has not enlarged in 2 years.
Treatment of solitary pulmonary nodule?
Exploratory thoractomy or thorascopy
This is a low grade malignant neoplasm that is slow growing. Patient presents with hemoptasis, cough, wheezing, flushing and diarrhea. Dx? Tx?
Carcinoid tumor. CT for dx. Treatment is surgery. Resistant to chemo and radiation.
Horner traveled to the coast with his lung cancer.
Yep
This cancer invades other tissues leading to other sx. May present with mass in apex of lung, shoulder pain, and Horner syndrome.
Pancoast tumor.
What is Horner syndrome?
Dropping of eyelids, decreased sweating, pupil contraction. Due to invasion of paraveterbral sympathetic chain.
Treatment of pancoast tumor?
Surgery, RT and chemo may make it smaller prior to surgery.
What is a transudate pleural effusion caused by?
Leaky vessels.
What causes an exudate pleural effusion?
Inflammatory process.
Three most common causes of pleural effusion?
CHF, infection, malignancy
CXR findings and treatment of pleural effusion?
Blunting of the costophrenic angles, loss of land marks. Thoracentesis is treatment.
