Mouth/Pulmonary Flashcards
Oral Candidiasis cause
Candida albicans; MCC immunocompromised, corticosteroid therapy, dentures
Oral Candidiasis S/S
creamy white patches on oral mucosa that can be scraped off to reveal underlying erythematous mucosa; mouth and throat pain; angular cheilitis
Oral Candidiasis Dx
clinical; wet prep; KOH (yeast and hyphae), biopsy (to r/o leukoplakia)
Oral Candidiasis TX
antifungals (ketoconazole, fluconazole, nystatin)
Oral Herpes Cause
HSV (type 1, 2, 6); transmitted during viral shedding
Oral Herpes S/S
painful, intraoral/lips, grouped vesicles after a prodrome of pain, burning, and tingling
Oral Herpes Dx
clinical; serology; Tzanck smear (multinucleated giant cells)
Oral Herpes Tx
antiviral (acyclovir)
Oral Leukoplakia Cause
tobacco, alcohol, denture use; dysplastic or squamous cell carcinoma
Oral Leukoplakia S/S
painless, white oral lesions that cannot be scraped off
Oral Leukoplakia Dx
biopsy (acanthosis)
Oral Leukoplakia Tx
surgical excision; cryotherapy or carbon dioxide laser ablation
Hypertensive Retinopathy cause
accelerated hypertension
Hypertensive Retinopathy S/S
floaters; blurred vision; distortion; progressive visual acuity loss
Hypertensive Retinopathy Dx
fundoscopic exam (arteriolar narrowing; copper or silver wiring; arteriovenous nicking)
Hypertensive Retinopathy Tx
regulate BP/HTN; laser photocoagulation; vitrectomy
Diabetes Retinopathy cause
hypoxia, neovascularization, and increased viscosity due to DM
Diabetes Retinopathy s/s
floaters; blurred vision; distortion, progressive visual acuity loss
Diabetes Retinopathy dx
fundoscopic exam (venous dilation, microaneurysms, retinal hemorrhages, retinal edema, hard exudates [nonproliferative]; neovascularization, vitreous hemorrhage [proliferative]), HA1C, fluorescein angiography
Diabetes Retinopathy tx
glucose control; laser photocoagulation; vitrectomy
Retinal Detachment (EMERGENCY) cause
congenital malformations, metabolic disorders, trauma, vascular disease, choroidal tumors, high myopia or vitreous disease, degeneration
Retinal Detachment (EMERGENCY) s/s
acute onset painless, blurred/blackened vision (curtain over eye); can progress to partial/complete blindness; photopsia (floaters/flashing lights); visual field defect
Retinal Detachment (EMERGENCY) dx
fundoscopic exam (ridges of displaced retinal flapping in the vitreous humor), normal IOP
Retinal Detachment (EMERGENCY) tx
emergency consult for laser surgery vs cryosurgery; remain supine with head turned towards the side of detachment
Retinal Venous Occlusion cause
atherosclerosis, glaucoma, macular edema, DM, HTN, high cholesterol, clotting disorders, age, smoking
Retinal Venous Occlusion s/s
acute onset of painfless unilateral blurring or loss of vision; gradually worsens; dark spots and floaters
Retinal Venous Occlusion dx
fundoscopic exam (blood and thunder); optical coherence tomography; ophthalmoscopy; fluorescein angiography
Retinal Venous Occlusion tx
laser therapy; corticosteroid injections; vitrectomy
Retinal Arterial Occlusion (EMERGENCY) cause
emboli, thrombotic phenomenon, vasculitides
Retinal Arterial Occlusion (EMERGENCY) s/s
acute, persistent, painless loss of vision in the range of counting fingers to light perception; worsening visual acuity; hx of jaw claudication, scalp tenderness, weight loss, fever, proximal muscle/joint aches (r/o temporal arteritis)
Retinal Arterial Occlusion (EMERGENCY) dx
fundoscopic exam (pallor of retina; arterial narrowing, separation of arterial flow, retinal edema, cherry red spot [perifoveal atrophy])
Retinal Arterial Occlusion (EMERGENCY) tx
recumbent position; gentle ocular massage to reduce damage; vessel dilation; paracentesis
cataracts cause
natural aging process, trauma, congenital causes, systemic disease, medication use (steroids/statins)
cataracts s/s
insidious onset of decreased vision; gradual diminution of vision loss; double vision; excess glare; fixed spots; reduced color perception; typically bilateral
cataracts dx
fundoscopic exam (translucent yellow discoloration on lens; dark against a yellow background)
cataracts tx
intracapsular or extracapsular extractions with lens placement
Open-Angle Glaucoma cause
increased IOP (less aqueous humor flows through canal of Schlemm); chronic
Open-Angle Glaucoma s/s
asymptomatic; blinding; loss of peripheral vision
Open-Angle Glaucoma dx
fundoscopic exam (increased IOP; increased cup-to-disk ratio)
Open-Angle Glaucoma tx
decrease aqueous production (b-blocker: timolol; carbonic anhydrase inhibitors: acetazolamide); increase flow (prostaglandin: latanoprost, bimatoprost; cholinergic: pilocarpine; epinephrine); Brimonidine (a-agonist) will do both
Acute-Angle Glaucoma (EMERGENCY) cause
increase IOP (narrows anterior chamber)
Acute-Angle Glaucoma (EMERGENCY) s/s
painful vision loss; nausea and vomiting; circumlimbal injection; steamy cornea; fixed mid-dilated pupil; decreased acuity; tearing
Acute-Angle Glaucoma (EMERGENCY) dx
fundoscopic exam (narrowed anterior chamber, IOP >55mmHg, firm globe); crescent shadow
Acute-Angle Glaucoma (EMERGENCY) tx
IV anhydrase inhibitor (acetazolamide); b-blocker (timolol); osmotic diuresis (mannitol); laser or surgical iridotomy; DO NOT GIVE mydriatics
Meniere’s Disease (endolymphatic hydrops) cause
unknown
Meniere’s Disease (endolymphatic hydrops) s/s
recurrent vertigo; lower range hearing loss; tinnitus; one-sided aural pressure
Meniere’s Disease (endolymphatic hydrops) dx
caloric testing (nystagmus is lost on impaired side)
Meniere’s Disease (endolymphatic hydrops) tx
low sodium diet; diuretics (acetazolamide); meclizine; intratympanic corticosteroid therapy; surgery
Labyrinthitis cause
bacterial or viral infection; vascular ischemia; autoimmune processes
Labyrinthitis s/s
acute to severe vertigo; hearing loss; aural fullness; nausea/vomiting; etc
Labyrinthitis dx
CBC and blood cultures to r/o infection
Labyrinthitis tx
antibiotics w/ fever or infection; vestibular suppressants (diazepam, lorazepam) during initial acute symptoms; hydration; antiemetics (prochloperazine)
Vertigo cause
labyrinthitis, BPPV, Meniere’s disease, vestibular neuritis, head injury (peripheral), vascular disease, arteriovenous malformation, tumor, multiple sclerosis, vertebrobasilar migraine (central)
Vertigo s/s
sudden onset dizziness, N/V, tinnitus, hearing loss, horizontal nystagmus, [peripheral]; gradual onset dizziness, vertical nystagmus (central)
vertigo dx
Hallpike maneuver will delay nystagmus (peripheral); audiometry; caloric stimulation; electronystagmography; MRI
vertigo tx
vestibular suppressants (diazepam, meclizine [antihistamine]); physical therapy; intervention/surgery
acute bronchitis cause
viruses (rhinovirus, coronavirus, RSV); bacterial (HIB, S. pneumo, M. cat) for chronic lung diseases
acute bronchitis s/s
cough with or without sputum, dyspnea, fever, sore throat, headache, myalgias, substernal discomfort, expiratory rhonchi or wheezes
acute bronchitis dx
clinical, CXR (to r/o pneumonia)
acute bronchitis tx
supportive (hydration, expectorants, analgesics, b2 agonists, cough suppressants), cephalosporin, macrolide, bactrim (bacterial/chronic)
influenza cause
orthomyxovirus (A, B, C); transmitted through droplet nuclei
influenza s/s
abrupt fever, chills, malaise, muscle aches, substernal chest pain, headache, nasal stuffiness, nausea (w/in 18-72 hrs); fever (1-7 days) w/ coryza, nonproductive cough, photophobia, eye pain, sore throat, pharyngeal injection, flushed faces, wheezes/ronchi
influenza dx
clinical; rapid flu and cultures; CXR w/ bilateral diffuse infiltrates (pneumonia, S. aureus)
influenza tx
supportive care (rest, analgesics, cough suppressants), tamiflu (oseltamivir) given w/in 48 hrs; influenza shot
bacterial pneumonia cause
streptococcus pneumoniae, haemophilus influenzae, moraxella catarrhalis, staphylococcus aureus, klebsiella pneumonia, mycoplasma pneumonia, chlamydia, legionella
bacterial pneumonia dx
CXR (lobar infiltrates); sputum culture
bacterial pneumonia tx
antibiotics (macrolide, doxycycline, fluoroquinolone, broad spectrum beta-lactam)
Viral Pneumonia causes
influenza, RSV, adenovirus, parainfluenza, cytomegalovirus
Viral Pneumonia dx
CXR (bilateral patchy infiltrates); sputum culture
Viral Pneumonia tx
supportive, antiviral (oseltamivir)
Fungal Pneumonia cause
Histoplasma capsulatum, Coccidioides immitis, Blastomyces dermatitidis, Paracoccidioides brasiliensis, Sporothrix schenckii, Cryptococcus neoformans, Candida species, Aspergillus species, Mucor species
Fungal Pneumonia dx
CXR (patchy infiltrate, mediastinal adenopathy, pulmonary nodules w/ ground-glass opacity); sputum cultures (caseating/necrotizing granulomas inside macrophages; fungal hyphae; intracellular yeast)
Fungal Pneumonia tx
amphotericin B (histoplasmosis); fluconazole (coccidioides, etc)
Community Acquired Pneumonia cause
Strep pneumo, HIB, M. Cat, Staph aureus, Klebsiella, (bacterial); influenza, RSV, adenovirus, parainfluenza (viral)
Community Acquired Pneumonia s/s
cough, purulent sputum, SOB, tachycardia, chest pain, fever, sweats, rigors, crackles and dullness to percussion; rust colored sputum w/ single rigor (strep); currant-jelly sputum, ETOH related, comorbid related (klebsiella)
Community Acquired Pneumonia dx
CXR (infiltrate), gram stain/sputum culture, elevated procalcitonin
Community Acquired Pneumonia tx
macrolide (Azithromycin), doxycycline (healthy); fluoroquinolone, macrolide + beta-lactam (chronic disease); pneumovax or PPSV
Atypical Community Acquired Pneumonia cause
Mycoplasma, chlamydia, legionella, M. cat
Atypical Community Acquired Pneumonia s/s
low grade fever, nonproductive cough, myalgia, fatigue; reddened TM or bullous myringitis (mycoplasma); high fever, dry cough, dyspnea (legionella [contaminated water droplets])
Atypical Community Acquired Pneumonia dx
CXR (infiltrates); sputum culture
Atypical Community Acquired Pneumonia tx
macrolide (azithromycin); doxycycline (chlamydia); supportive (viral)
Hospital Acquired Pneumonia cause
staph, pseudomonas
Hospital Acquired Pneumonia s/s
cough, purulent sputum, SOB, tachycardia, chest pain, fever, sweats, rigors, crackles and dullness to percussion
Hospital Acquired Pneumonia dx
CXR (infiltrates); sputum culture
Hospital Acquired Pneumonia tx
ceftriaxone, fluoroquinolone, broad spectrum beta-lactam, imipenem, cefepime
Tuberculosis cause
mycobacterium tuberculosis; inhaled droplets
Tuberculosis s/s
cough w/ sputum >3 weeks, fever, night sweats, anorexia, weight loss, chest pain, dyspnea, hemoptysis, post-tussive rales
Tuberculosis dx
CXR (infiltrates, hilar/paratracheal LAD, segmental atelectasis, cavitations [primary TB]; posterior segments of upper lobes and super segments of lower lobes [reactivation]; ghon complexes/calcified primary focus [healed primary infection]; calcified primary and hilar LAD [Ranke complex]); TB skin test, cultures (DNA/RNA amplification tests); biopsy (caseating/necrotizing granulomas)
Tuberculosis tx
isoniazid (hepatitis, neuropathy -> give B6), rifampin (orange fluid), pyrazinamide, ethambutol (optic neuritis)
■ LTBI: INH x9mo; RIF x4mo; RIF + PZA x2mo
■ Active TB: INH + RIF + PZA + EMB x2mo
Bronchogenic Carcinoma cause
smoking #1 risk factor
■ Squamous cell - centrally located; slow growing; hemoptysis
■ Adenocarcinoma (MC) - peripherally located; slow growing; distant metastasis
■ Large cell - peripherally located; slow growing; early metastasis
■ Small cell (oat cell) - central bronchi; early metastasis; poor prognosis
Bronchogenic Carcinoma s/s
cough, hemoptysis, pain, anorexia, weight loss, asthenia, LAD, hepatomegaly, clubbing of fingers, paraneoplastic syndrome (Cushing’s, gynecomastia, cerebellar degeneration, thrombophlebitis, anemia, acanthosis nigricans)
■ Super vena cava syndrome - dyspnea, headache, cough, arm swelling, etc
■ Pancoast tumor (lung apex tumor) - horner syndrome (unilateral facial anhidrosis, ptosis, miosis, shoulder pain)
■ Carcinoid syndrome - flushing, diarrhea, telangiectasias (endocrine); hoarseness (recurrent laryngeal nerve); exudate (effusions)
Bronchogenic Carcinoma dx
CXR, CT chest, bronchoscopy w/ biopsy/cytology, PET scan
Bronchogenic Carcinoma tx
surgery (non-small cell); combo chemo/surgery (small cell)
carcinoid tumor cause
neuroendocrine tumor; grow slow; rarely metastasize; common in GI tract
carcinoid tumor s/s
hemoptysis, cough, wheezing, recurrent pneumonia, carcinoid syndrome
carcinoid tumor dx
bronchoscopy and biopsy (pink/purple vascularized lesion); CT scan
carcinoid tumor tx
surgical excision, radiation, chemotherapy, ocreotide
Pulmonary Nodules (coin lesion) cause
TB, fungal infection, foreign body, malignancy
Pulmonary Nodules (coin lesion) s/s
asymptomatic
Pulmonary Nodules (coin lesion)
biopsy (definite diagnosis); CT scan
Pulmonary Nodules (coin lesion)
watchful waiting for size increase; CT q3mo (low probability); excision (high probability)
Metastatic Tumors cause
bladder cancer, colon cancer, breast cancer, prostate cancer, sarcoma, Wilms tumor, neuroblastoma
Metastatic Tumors s/s
new onset cough, shortness of breath at rest, symptoms of primary tumor
Metastatic Tumors dx
CT or PET scan, biopsy
Metastatic Tumors tx
excision, chemo/radiation, etc
Asthma cause
allergens, exercise, URIs, GERD, drugs (ASA), stress, weather changes; obstruction of airflow, bronchial hyperreactivity, inflammation of airway
Asthma s/s
cough, chest tightness, breathlessness, wheezing
Asthma dx
spirometry of FEV1/FVC <75%; increase of 10% after bronchodilator therapy (histamine, methacholine challenge test, decline in FEV1>20%)
Asthma tx
SABA -> low dose ICS + SABA -> low dose ICS + LABA -> medium dose ICS + LABA -> leukotriene modifiers
Bronchiectasis cause
congenital (cystic fibrosis); infection (TB, fungal, lung abscess); obstruction (tumor)
Bronchiectasis s/s
chronic purulent sputum (foul smelling), hemoptysis, chronic cough, recurrent pneumonia
Bronchiectasis dx
CT chest (high resolution); CXR (bronchial markings, basal cystic spaces, honeycombing)
Bronchiectasis tx
antibiotics x 10-14 days (amoxicillin, augmentin, bactrim, cipro); bronchodilators
Chronic Bronchitis cause
smoking
Chronic Bronchitis s/s
“blue bloaters”; mild dyspnea, chronic productive cough x 3mos/2yrs; rhonchi/wheeze, peripheral edema, overweight, cyanotic
Chronic Bronchitis dx
CXR (increased interstitial markings at bases, normal diaphragms)
Chronic Bronchitis tx
anticholinergics (ipratropium); SABA; antibiotics and steroids prn
emphysema cause
smoking
emphysema s/s
“pink puffers”; exertional dyspnea, mild nonproductive cough, normal lung sounds, no peripheral edema, thin, weight loss, barrel chest, hyperventilation, pursed-lip breathing
emphysema dx
CXR (decreased lung markings at apices, flattened diaphragms, hyperinflation, small/thin heart, bullae/blebs)
emphysema tx
anticholinergics (ipratropium); SABA; antibiotics and steroids prn
Chronic Obstructive Pulmonary Disease cause
emphysema (destruction of alveolar space); chronic bronchitis (chronic productive cough); smoking, recurrent URIs, pollutants, a1-antitrypsin deficiency
Chronic Obstructive Pulmonary Disease s/s
progressive SOB, excessive cough with or w/o sputum, increased AP diameter, resonance on percussion, decreased breath sounds, inspiratory crackles, prolonged expiration
Chronic Obstructive Pulmonary Disease dx
decreased spirometry (FEV/FVC) w/o improvement with bronchodilators; CXR (hyperinflation, flat diaphragms, blebs, increased markings)
Chronic Obstructive Pulmonary Disease tx
stop smoking; anticholinergics (ipratropium); SABA; corticosteroids; antibiotics prn
Pleural Effusion cause
pulmonary infection, malignancy, trauma (exudates); CHF, atelectasis, cirrhosis/renal disease (transudates); infection in pleural space (empyema); trauma, aortic dissection, and malignancy (hemothorax)
Pleural Effusion s/s
gradual onset, asymptomatic; dyspnea, pleuritic chest pain, cough; decreased breath sounds, dullness to percussion, occasional friction rub
Pleural Effusion dx
PA CXR (blunted costophrenic angle); thoracentesis (gold standard) w culture/LDH; CBC, CMP, BUN/Cr, pulse ox
Pleural Effusion tx
oxygenation/ventilation, thoracentesis/chest tube; antibiotics prn
Pneumothorax cause
massive, sudden accumulation of air in pleural cavity (tension)
Pneumothorax s/s
sudden, sharp, unilateral, pleuritic chest pain, SOB, tracheal deviation, decreased unilateral breath sounds
Pneumothorax dx
PE (diminished breath sounds, deviated trachea, chest hypertympanic), upright/expiratory CXR, ultrasound chest [Tension: clinical (does not require xray)]
Pneumothorax tx
support airway/oxygenation; needle aspiration (thoracotomy)/ “pigtail” catheter/chest tube
Pulmonary Embolism cause
virchow’s triad [venous stasis, hypercoagulable, vessel wall damage], age, recent surgery, previous DVT, hormone use, cancer, long travel, smoker
Pulmonary Embolism s/s
pleuritic chest pain, fatigue, dyspnea, syncope, hemoptysis, cardiac arrest
Pulmonary Embolism dx
CT pulmonary angiogram; Wells score, PERC criteria; (PE, EKG, and CXR normal), elevated D-dimer, VQ scan if CT unable or low creatinine/Glomerular filt
Pulmonary Embolism tx
airway/hemodynamic support, anticoagulation (heparin -> LMWH, enoxaparin); thrombosis for “massive” PEs; IVC filter
Pulmonary HTN cause
hypoxia, acidosis, veno-occlusive conditions (secondary); idiopathic (rare)
Pulmonary HTN s/s
dyspnea, angina-like retrosternal chest pain, weakness, fatigue, edema, ascites, cyanosis, effort syncope; narrow splitting S2 and systolic ejection click
Pulmonary HTN dx
heart catheterization w/ echo; CXR (enlarged pulmonary arteries); EKG (RVH, atrial hypertrophy, RV strain)
Pulmonary HTN tx
chronic oral anticoagulants, CCB, prostacyclin (iloprost, epoprostenol, pulmonary vasodilator); transplant
Cor Pulmonale cause
pulmonary HTN, RV hypertrophy, pulmonary embolism, ARDS
Cor Pulmonale s/s
fatigue, tachypnea, exertional dyspnea, cough, anginal chest pain, hemoptysis, syncope
Cor Pulmonale dx
right heart catheterization; CXR, EKG (RV failure); ABG, BNP
Cor Pulmonale tx
diuretics, CCB (nifedipine, diltiazem), B-agonists, prostacyclin, warfarin
Idiopathic Pulmonary Fibrosis cause
unknown
Idiopathic Pulmonary Fibrosis s/s
insidious dry cough, exertional dyspnea, constitutional symptoms (malaise, fatigue, etc); clubbing of fingers, inspiratory crackles
Idiopathic Pulmonary Fibrosis dx
PFTs (decreased lung volume, normal/increased FEV1/FVC); CXR/CT (diffuse, patchy fibrosis w/ honeycombing); bronchoalveolar lavage, biopsy
Idiopathic Pulmonary Fibrosis tx
supportive, no evidence of benefit
Pneumoconiosis cause
inhalation of coal dust or various inert, inorganic, silicate dusts
Pneumoconiosis s/s
asymptomatic; dyspnea, inspiratory crackles, clubbing of the fingers, cyanosis
Pneumoconiosis dx
PFTs (decreased lung volume, normal/increased FEV1/FVC); CXR (small opacities in upper lung fields [coal]; small rounded opacities throughout, hilar lymph node calcifications [silicosis]; linear opacities, interstitial fibrosis, thickened pleura, calcified plaques on diaphragms or lateral chest wall [asbestos])
Pneumoconiosis tx
supportive (oxygenation, vaccinations, rehab), corticosteroids, smoking cessation
Sarcoidosis causes
idiopathic
Sarcoidosis s/s
cough, insidious dyspnea, chest discomfort, malaise, fever, organ-specific involvement symptoms; erythema nodosum, enlarged parotid glands, LAD, liver, spleen
Sarcoidosis dx
transbronchial biopsy/fine needle biopsy (noncaseating granulomas); CXR (symmetric bilateral hilar LAD, right paratracheal LAD, bilateral diffuse reticular infiltrates); serum blood work (leukopenia, eosinophilia, ESR, hypercalcemia, ACE levels elevated)
Sarcoidosis tx
corticosteroids
ARDS cause
previous clinical insult; MCC sepsis, inhalation of irritants, severe pneumonia, head/chest trauma
ARDS s/s
acute onset of shortness of breath/labored/rapid breathing within 1 week of known clinical insult, low blood pressure, confusion/extreme tiredness
ARDS dx
acute onset of respiratory failure with PaO2/FiO2 <300mmHg; bilateral infiltrates on CXR; pulmonary artery wedge pressure <18mmHg (CBC, CT vs echo vs EKG)
ARDS tx
oxygen/ET tube, IV fluids, blood thinners/antibiotics/sedate prn
