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Panre > Lungs > Flashcards

Lungs Flashcards

0
Q

What are the s/s of acute bronchitis?

A

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.

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1
Q

What is an acute inflammation of the large airways? Risk factor?

A

Bronchitis, smoking

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2
Q

This is an infection and inflammation of the smaller airways. What is the most common cause?

A

Acute bronchiolitis. Caused by RSV.

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3
Q

Presentation of a child with bronchiolitis?

A

Diffuse wheezing, fever, cough, hyperinflation, crackles, nasal flaring. Child looks sick.

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4
Q

Treatment for bronchiolitis?

A

Supportive, bronchodilator, ribavirin.

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5
Q

Hallmark signs of influenza?

A

Toxic appearance but exam normal.

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6
Q

What medication do you avoid giving for flu and why?

A

ASA, Reye’s syndrome.

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7
Q

What are some predisposing factors for pneumonia?

A

Smoking, DM, alcoholism, malnutrition, cancer, immunosuppression

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8
Q

Pneumonia in smokers, COPD?

A

S. Pneumonaie, h. Flu.

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9
Q

Most common cause for CAP? Community acquired pneumonia.

A

Strep pneumonaie.

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10
Q

Pneumonia in nursing home resident?

A

S. Pneumonaie, h. Flu, TB.

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11
Q

Pneumonia and alcoholic?

A

S. Pneumonaie, klebsiella.

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12
Q

Pneumonia and bats?

A

Histoplasmosis

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13
Q

Pneumonia and birds?

A

Cryptococcus

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14
Q

Young healthy adult with pneumonia?

A

Mycoplasma.

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15
Q

Cystic fibrosis and pneumonia?

A

Pseudomonas

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16
Q

Pneumonia in IV drug user?

A

Staph aureus, TB.

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17
Q

Pneumonia in HIV?

A

Pneumocystis

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18
Q

Water source of pneumonia?

A

Legionella

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19
Q

Lobar pneumonia is caused by what?

A

Bacteria

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20
Q

Interstitial pneumonia is caused by?

A

Viral or mycoplasma.

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21
Q

Nodular pneumonia caused by?

A

Fungus. Or metastatic dz.

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22
Q

Describe an infiltrate on CXR.

A

Opaque consolidation that you can still see the landmarks.

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23
Q

Describe a pleural effusion on CXR.

A

Fluid in plural space. Loss of landmarks and borders. Caused by CHF, pneumonia, malignancy.

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24
Q

Treatment of CAP with no comorbidities?

A

Out patient tx with microlides (azithromycin) or fluroquinolones.

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25
Q

CAP with comorbidities?

A

Treat inpatient with ceftriaxone plus macrolide.

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26
Q

Pneumonia with altered mental status…. CVA or drugs think….

A

Aspiration pneumonia. Common on RLL. Treat wiTh amoxicillin, fluroquinolones.

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27
Q

Most common cause of HAP?

A

Gram negative rods.

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28
Q

What is RSV?

A

Common cause of bronchiolitis in kids.

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29
Q

Antiviral Amantadine.

A

Treats influenza A, can cause seizure.

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30
Q

Rimantadine?

A

Treats influenza A.

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31
Q

Zanamivir?

A

Influenza A and B treatment. Competes with neuraminidase. Bronchospasm side effect.

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32
Q

Oseltamivir or tamiflu.

A

Treats influenza A and B.

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33
Q

Ribavirin.

A

Treats influenza A, B, hepatitis A, B, C. No PREGNANCY

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34
Q

Gold standard for testing TB?

A

Acid fast bacillus culture.

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35
Q

PPD positive at >5 mm induration?

A

HIV, contact with active TB patients, organ transplants, immunosupressed.

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36
Q

PPD positive at > 10 mm induration?

A

High risk countries, IV drug users, prison/nurse/homeless shelter workers. High risk patients. Children over 4 in high risk setting.

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37
Q

Normal positive PPD size?

A

15 mm induration.

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38
Q

Positive PPD. What next?

A

CXR, if abnormal AFB smears and culture.

39
Q

Gohn complex?

A

Calcified lymph node on CXR in TB.

40
Q

Positive PPD but no active disease?

A

Treat with INH and vitamin B 6 x 9 months.

41
Q

Mechanism of action of INH, side effects.

A

Bactericidal, inhibits synthesis of mycolic acid. SE hepatitis, peripheral neuropathy.

42
Q

Mechanism of action and side effects of rifampin.

A

Bactericidal, inhibits RNA ploymerase. Hepatitis, orange body fluids, pseudomembranous colitis.

43
Q

The characteristics of asthma?

A

Obstruction of airflow, bronchial hyper reactivity, inflammation of airways.

44
Q

Mild intermittent asthma:

A

< 2 times per month

45
Q

Mild persistent asthma:

A

> 2 times per week and nocturnal sx > 2 times per month

46
Q

Moderate persistent asthma:

A

Daily, nocturnal > 6 per month

47
Q

Severe persistent asthma:

A

Continuous and nocturnal frequently

48
Q

Step 1 asthma treatment?

A

SABA prn

49
Q

Step 2 asthma tx?

A

sABA + low dose ICS

50
Q

Step 3 asthma tx?

A

Low dose ICS + long acting BA

51
Q

Step 4 asthma tx?

A

Medium dose ICS + LABA

52
Q

Step 5 asthma tx?

A

High does ICS + LABA plus allergy Meds

53
Q

A patient presents with acute onset of chest toughness, SOB, cough. Tachycardia, tachypnea, cyanosis, accessory muscle use and NO wheezing. Dx? Tx?

A

Status asthmaticus. Tx with oxygen, bronchodilators every 2 hrs, IV corticosteroids, mechanical ventilation.

54
Q

Dx of chronic bronchitis.

A

Cough on most days for at least 3 months of the year for 2 consecutive years.

55
Q

Patient with chronic bronchitis is a…..

A

Blue bloater.

56
Q

Chronic bronchitis may have signs of?

A

Right heart failure or cor pulmonale.

57
Q

Treatment Of chronic bronchitis?

A

Stop smoking. Ipatropium bromide, albuterol, theophylline, steroids.

58
Q

What is emphysema?

A

Enlarged air space due to destruction of alveolar septa.

59
Q

Describe a pink puffer?

A

Thin, pursed lip breathing, barrel chest, tachypnea, decreased breath sounds. Hyperinflation of X-ray.

60
Q

This is abnormal and persistent dilation of major bronchi and bronchioles.

A

Bronchiectasis.

61
Q

Bronchiectasis is related to what in the history?

A

Destructive changes from infection. TB, fungal, CF, pneumonia.

62
Q

Patient presents to clinic with SOB, hemoptysis, and foul smelling sputum.

A

Bronchiectasis

63
Q

Signet sign on CT which is the test of choice?

A

Bronchiectasis

64
Q

90 % of this originate from DVT.

A

PE

65
Q

Risk factors for PE?

A

Hypercoag state, pregnancy, OCP, surgery, a fib, trauma.

66
Q

Patient presents with pleuritic chest pain, dyspnea and tachypnea?

A

Pulmonary embolism

67
Q

Common EKG finding in PE?

A

S1Q3T(inverted)3

68
Q

Gold standard for PE and test of choice?

A

Angiography, spiral or helical CT

69
Q

PE and hemodynamically stable. Ok for coag. Tx?

A

LMWH and warfarin x 7 days then warfarin x 6 months.

70
Q

PE and hemodynamically stable coag contraindicated?

A

Inferior vena cava filter

71
Q

PE and unstable? Tx?

A

Thrombolytics

72
Q

PE and unstable but coag contraindicated? Tx?

A

Pulmonary embolectomy

73
Q

Most common cause of pulmonary hypertension?

A

COPD

74
Q

What causes the leading number of cancer deaths?

A

Lung cancer

75
Q

No small cell cancer includes:

A

Adenocarcinoma, squamous cell, large cell.

76
Q

Risk factors for lung cancer?

A

Smoking, asbestos exposure, uranium arsenic chromium nickel exposure, hx of COPD,

77
Q

This starts in the central bronchi and mets to nodes. May have associated hypercalcemia.

A

Squamous cell carcinoma.

78
Q

Definitive dx test for carcinoma?

A

Biopsy

79
Q

Most common type of lung cancer?

A

Adenocarcinoma.

80
Q

This cancer appears at the periphery and mets to distant organs.

A

Adenocarcinoma

81
Q

Clinical sx of this lung cancer include lymphadenopathy, Hepatomegaly, clubbing.

A

Adenocarcinoma

82
Q

This is the most aggressive type of lung cancer. It arises in the peribronchial tissue located centrally.

A

Small cell carcinoma.

83
Q

What is paraneoplastic syndrome and which lung cancer is it related to?

A

Can cause SIADH, Cushing’s syndrome, etc. small cell carcinoma. No clubbing noted.

84
Q

This is a round oval, sharp lesion up to 3 cm in the lung.

A

Solitary pulmonary nodule. 25% are primary cancer, 10% are mets. Coin lesion.

85
Q

Benign solitary pulmonary nodule means….

A

Has not enlarged in 2 years.

86
Q

Treatment of solitary pulmonary nodule?

A

Exploratory thoractomy or thorascopy

87
Q

This is a low grade malignant neoplasm that is slow growing. Patient presents with hemoptasis, cough, wheezing, flushing and diarrhea. Dx? Tx?

A

Carcinoid tumor. CT for dx. Treatment is surgery. Resistant to chemo and radiation.

88
Q

Horner traveled to the coast with his lung cancer.

A

Yep

89
Q

This cancer invades other tissues leading to other sx. May present with mass in apex of lung, shoulder pain, and Horner syndrome.

A

Pancoast tumor.

90
Q

What is Horner syndrome?

A

Dropping of eyelids, decreased sweating, pupil contraction. Due to invasion of paraveterbral sympathetic chain.

91
Q

Treatment of pancoast tumor?

A

Surgery, RT and chemo may make it smaller prior to surgery.

92
Q

What is a transudate pleural effusion caused by?

A

Leaky vessels.

93
Q

What causes an exudate pleural effusion?

A

Inflammatory process.

94
Q

Three most common causes of pleural effusion?

A

CHF, infection, malignancy

95
Q

CXR findings and treatment of pleural effusion?

A

Blunting of the costophrenic angles, loss of land marks. Thoracentesis is treatment.

Panre (18 decks)

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