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Pediatrics Flashcards

1
Q

Nieman Pick enzyme deficiency?

A

sphingomyelinase

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2
Q

Nieman Pick H&P

A

cherry red macula
protruding abdomen
Lymphadenopathy
hepatosplenomegaly

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3
Q

Tay Sachs enzyme deficiency

A

hexoaminidase

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4
Q

Tay Sachs H&P

A

hyperacusis
mental retardation
seizures
cherry red macula

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5
Q

Gaucher’s disease enzyme deficiency

A

glucocerebrosidase

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6
Q

Gaucher’s H&P

A

hepatosplenomegaly
anemia
leukopenia
thrombocytopenia

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7
Q

Krabbes Disease enzyme deficiency

A

galactocebrosidase

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8
Q

Krabbes Disease H&P

A

hyperacusis, irritability, seizures

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9
Q

What is transient neonatal pustular melanosis and TX?

A

superficial pustules overlying hyperpigmented macules, spont resolves.
TX: tell parents to leave it alone

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10
Q

What is neonatal acne and what is the treatment

A

hormone stimulation of sebaceous glands occuring in 20% of infants 2-3wks of life

TX: resolves spontaneously, severe cases can be treated with benzoyl peroxide or topical retinoids

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11
Q

What is milia?

A

accumulation of sweat beneath sweat glands blocked by keratin, occurs in 1st week of life. Associated with increased temperature.

TX: possibly cool child

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12
Q

Mongolian Spot

A

bluish discoloration of butt and base of spine, benign

TX: document to prevent confusion with child abuse

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13
Q

Cutis marmorata

A

spider webbing/paleish marbling of neonates skin

tx: none, self resolving

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14
Q

Erythema toxicum

A

2-3mm yellow pustules with red base (look like white heads)
Arise first 24-72 hours, filled with eosinophils

tx: none, resolves by 3 weeks

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15
Q

Macular stains (stork bites)

A

permanent vascular malformations usually near nape of neck, upper eyelids, and middle of forehead
tx: none, but persist forever

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16
Q

Childhood immunization schedule

A

birth/1month = HEP B
2 months = Hep B, RV, DTAP, Hib, PCV, IPV
4 months = RV, DTAP, Hib, PCV, IPV
6 months = RV, DTAP, Hib, PCV, IPV, FLU
12 months = DTAP, HiB, PCV, IPV, FLU, MMR, Varicella

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17
Q

How many Hep B doses?

A

3 doses

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18
Q

How many MCV doses

A

2 doses

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19
Q

How many Hep A doses

A

2 doses

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20
Q

How many MMR doses?

A

2 doses

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21
Q

How many IPV doses

A

4 doses

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22
Q

How many PCV doses

A

4 doses

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23
Q

How many HiB doses

A

4 doses

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24
Q

How many DTAP doses

A

5 doses, and 4 years a TDap Booster

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25
Q

How many Rota Doses

A

3 doses

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26
Q

signs of diabetic ketoacidosis

A 
dehydraton (thrist, polydipsia, dry skin, dry mouth)
polyuria
nausea/vomiting
abdominal pain
altered mental status
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27
Q

Labs in diabetic ketoacidosis

A

increased glucose
elevated anion gap metabolic acidosis
ketones in urine and serum
hyperkalemia, hyponatremia

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28
Q

management of acute coronary syndrome

A

1st) get a submaximal (or maximal of patient can tolerate it) stress test
2) if stress is negative; patient discharged on aspirin, beta blocker, statin, ACEi
3) if stress test is positive; get coronary angiogram
4) if angiogram shows 1 or 2 vessel disease –> percutaneous coronary intervention is done
5) if angiogram shows 3+vessel disease –> cardiac bypass surgery

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29
Q

diagnostic modality for AAA in a symptomatic obese patient

A

CT with contrast

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30
Q

labs on autoimmune hepatitis:

A

anti-nuclear antibodies (anti-ANA), anti-smooth muscle antibodies (anti-ASMA), hypergammaglobulinemia
associated with other immune disorders

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31
Q

treatment for autoimmune hepatitis

A

low dose corticosteroids (prednisone)

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32
Q

dacryostenosis H&P/treatment

A

blocked tear duct, usually unilateral and painless
excessive tearing and mucoid material secretion
treated with nasolacrimal massage until 1 year old
nasal duct probing done after age 1 year

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33
Q

criteria for metabolic syndrome

A

BMI >30 (OBESITY) + 2 of the following:
fasting triglyceride level >150
HDL 130/85
fasting glucose >100

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34
Q

Atherosclerosis H&P:

A

asymptomatic for most of disease progression
later sequelae include; Angina, claudication, progressive hypertension, retinal changes, extra heart sounds, MI, stroke, renal damage

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35
Q

For stable angina

A

refer patient for cardiac stress test; if equivocal, refer patient for nuclear stress testing or exercise stress test with echocardiography; if these are positive possible angiography or PET scan

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36
Q

athersclerosis treatment

A

primarily minimize risk factors (tobacco use, HTN, hyperglycemia, hypercholesterolemia)
Diet low in fats and cholesterol and high in antioxidants is helpful in preventing disease.

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37
Q

When do you screen for hyperlipidemia?

A

Men >35 yrs

women > 45 yrs

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38
Q

hyperlipidemia H&P:

A 
usually asymptomatic
severe disease presents with:
1) xanthomas (lipids on tendons)
2) xanthalesmas (lipid deposits on medial eye)
3) cholesterol emboli in retina
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39
Q

hyperlipidemia TX:

A

1st line: tobacco cessation, exercise, dietary restrictions,
2nd line: cholesterol lowering agents (statins, niacin, fibric acids and bile acid sequestrants)

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40
Q

Goal LDL in humans

A

<100 in pts with CAD/PVD/AAA/carotid disease

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41
Q

Angina Pectoris H&P:

A

temporary myocardial ischemia causes substernal chest pain that may radiate to left shoulder, arm, jaw, or back, will usually occur during exertion

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42
Q

Angina Pectoris treatment

A

Primary: sublingual nitroglycerin and cessation of intense activity
Secondary: stress testing; followed by nuclear studies (nuclear stress test), and angiography if stress test is negative/positive

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43
Q

1st degree heart block

A

asymptomatic
PR interval > 0.2sec
No treatment

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44
Q

2nd Degree heart block MOBITZ I

A

caused by intranodal or his bundle conduction defect or drug side effects
asymptomatic
progressive PR lengthening until a QRS is skipped
tx: adjust medication doses; if there is symptomatic brady cardia you put in a pacemaker

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45
Q

2rd degree heart block MOBITZ II

A

Infranodal conduction problem (His, Purkinje)
usually asymptomatic
randomly skipped QRS without changes in PR interval
TX: ventricular pacemaker; because it can progress to 3rd degree heart block

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46
Q

3rd degree heart block

A

absence of conduction between atria and ventricles
syncope, dizziness, hypotension
no relationship between P waves and QRS
TX: ventricular pacemaker, avoid meds that affect AV conduction

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47
Q

What is PVST

A

tachy cardia (HR>100bpm) arising in atria or AV junction; usually in young patients with healthy hearts

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48
Q

H&P for PVST

A

sudden tachycardia, possible chest pain, shortness of breath, palpitations, syncope
P waves hidden in T waves, 150-250 BPM, normal QRS

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49
Q

TX for PVST

A

carotid massage, valsalva maneuver, IV adenosine
If hemodynamically unstable cardioversion or calcium channel blocker
sometimes catheter ablation of accessory conduction pathways is used for long term control

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50
Q

what is MAT (MFAT?)

A

tachycardia due to several ectopic foci in the atria that discharge automatic impulses, usually asymptomatic

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51
Q

What do you see on ECG for MFAT?

A

variable morphology of P waves (at least 3), and HR >100

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52
Q

What is the treatment of MFAT?

A

calcium channel blockers or beta blockers acutely

catheter ablation or surgery to eliminate abnormal pacemakers

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53
Q

define bradycardia

A

HR < 60 BPM
frequently asymptomatic, possible weakness, syncope
TX: pacemaker if severe, stop precipitating medications

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54
Q

risk factors for Atrial fibrillation

A

pulmonary disease, CAD, HTN, anemia, valvular disease, pericarditis, hyperthyroidism, rheumatic heart disease, sepsis, alcohol use

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55
Q

Afib H&P:

A

SOB, chest pain, palpitations, irregularly irregular pulse

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56
Q

ECG findings in Afib

A

no discernible P waves, irregular QRS rate

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57
Q

TX for Afib

A

anticoagulaton and rate control!
rate control with CA-channel blockers, beta blockers, digoxin.
Cardioversion if caught within 48hrs; or if after 48 hours but echo shows no thrombus.
If more than 48 hours or thrombus present; anticoagulate for 3-4 weeks and then cardiovert afterwards.
AV nodal ablation can be considered for recurrent cases.

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58
Q

Aflutter risk factors

A

CAD, CHF, COPD, valvular disease, pericarditis

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59
Q

Aflutter H&P:

A

asymptomatic, or palpitations, syncope

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60
Q

Aflutter ECG changes:

A

regular tachycardia >150BPM with a sawtooth pattern of P waves

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61
Q

Aflutter TX:

A

rate control with Ca-channel blockers, beta blockers

electrical/chemical cardioversion

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62
Q

PVC causes

A 
common, frequently benign; can also be caused by:
hypoxia
abnormal serum electrolyte levels
hyperthyroidism
caffeine use
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63
Q

PVC H&P:

A

usually asymptomatic; possible palpitations, syncope

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64
Q

ECG in PVC

A

early and wide QRS without preceding P wave, followed by brief pause in conduction

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65
Q

PVC treatment

A

none in healthy patients, beta blockers in patients with CAD to prevent sudden death

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66
Q

Vtach H&P

A

series of 3+ PVCs with heart rate of 160-240 BPM,

possibly asymptomatic if brief, but can cause palpitations, syncope, hypotension

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67
Q

Vtach ECG

A

series of regular, wide QRS complexes independent of P waves.

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68
Q

Vtach treatment

A

electrical cardioversion followed by antiarrhythmic medications, may need internal defibrillator

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69
Q

Vfib H&P

A

lack of ordered ventricular contraction leads to loss of cardiac output; presents with syncope, hypotension, pulselessness

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70
Q

Vfib ECG findings

A

totallly erratic tracing, no P waves or QRS

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71
Q

Ffib treatment

A

CPR, immediate electric or chemical cardoversion

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72
Q

what causes systolic heart dysfunction

A

decreased contractility, increased preload, increased afterload, HR abnormalities, high output conditions

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73
Q

what causes diastolic heart dysfunction

A

decreased ventricular compliance with decreased ventricular filling, increased diastolic pressure decreased CO

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74
Q

CHF risk factors

A

CAD, HTN, valvular disease, cardiomyopathy, COPD, drug toxicity, alcohol use

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75
Q

systolic heart failure treatment

A

loop diuretics, ACE-I or ARBs, beta blockers, spironolactone, add digoxin to increase contractility for symptomatic relief

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76
Q

diastolic heart failure treatment

A

calcium channel blocker, ARB or ACE-I, beta blockers, aldosterone antagonists

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77
Q

aortic stenosis symptoms

A

chest pain, DOE, SYNCOPE

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78
Q

aortic stenosis murmur

A

crescendo-decrescendo systolic murmur radiating from right upper sternal border to carotids

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79
Q

aortic stenosis treatment

A

valve replacement

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80
Q

mitral regurgitation symptoms

A

palpitations, DOE, orthopnea, paroxysmal nocturnal dyspnea

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81
Q

mitral regurg murmur

A

harsh blowing holosystolic murmur radiating fro apex to axilla, widely split S2, midsystolic click

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82
Q

mitral regurg treatment

A

vasodilators, prophylactic antibiotics, prophylactic anticoagulation

83
Q

aortic regurgitation symptoms

A

chest pain, orthopnea, DOE

84
Q

aortic regurg murmur

A

bounding pulses
widened pulse pressure
diastolic decrescendo murmur at right second intercostal space
late diastolic rumble
capillary pulsations in nail beds when pressure is applied

85
Q

aortic regurg treatment

A

ACEI, CCB, valve replacement

86
Q

mitral stenosis symptoms

A

DOE, orthopnea, PND, peripheral edema, hepatomegaly

87
Q

mitral regurg murmur

A

opening snap after S2, diastolic rumble, loud S1

88
Q

mitral regurg treatment

A

diuretics, antiarry for Afib secondary to atrial enlargement

89
Q

hypertrophic cardiomyopathy causes

A

congential (autosomal dominant)

90
Q

hypertrophic cardiomyopathy symptoms

A

syncope, dyspnea, palpitations, chest pain, symptoms worsen with exertion

91
Q

hypertrophic cardiomyopathy exam findings

A

S4 sound, systolic murmur

92
Q

hypertrophic cardiomyopathy Xray findings

A

Boot-shaped heart on CXR

93
Q

hypertrophic cardiomyopathy treatment

A

beta blockers, CCB, pacemaker, partial septal excision

94
Q

Dilated cardiomyopathy causes

A

idiopathic, alcohol use, beri beri, coxsackievirus B, cocaine use, doxorubicin, HIV, pregnancy, hemochromatosis, chagas disease, ischemic heart disease

95
Q

Dilated cardiomyopathy symptoms

A

similar to CHF

96
Q

Dilated cardiomyopathy exam findings

A

S3, systolic and diastolic murmurs

97
Q

Dilated cardiomyopathy Xray findings

A

balloon-like heart on CXR

98
Q

Dilated cardiomyopathy treatment

A

stop alcohol or cocaine use, diuretics, ACEI, beta blockers, anticoagulation

99
Q

Restrictive cardiomyopathy causes

A

sarcoid, amyloid

100
Q

Restrictive cardiomyopathy symptoms

A

similar to CHF with right sided symptoms worse

101
Q

Restrictive cardiomyopathy exam findings

A

ascites, JVD

102
Q

What is becks triad?

A

hypotension, distended neck veins, distant heart sounds = cardiac tamponade

103
Q

Acute pericarditis causes

A

acute inflammation of pericardium along with pericardial effusion
caused by viral infection, tuberculosis, SLE, uremia, neoplasm, drug toxicity, post-MI inflammation, radiation, recent heart surgery

104
Q

acute pericarditis H&P

A

pleuritic chest pain, dyspnea, cough, chest pain decreased by leaning forward, fever, friction rub, pulsus paradoxus

105
Q

acute pericarditis ECG findings

A

global ST segment elevations, pr depression

106
Q

acute pericarditis treatment

A

NSAIDS for pain
colchicine to prevent recurrence
pericardiocentesis for large effusions

107
Q

chronic constrictive pericarditis H&P

A

diffuse thickening of pericardium with possible calcifications due to radiation or heart surgery
heart failure symptoms: JVD, DOE, afib common, increasing JVD with inspiration

108
Q

chronic constrictive pericarditis imaging

A

pericardial calcifications; echo/CT/MRI show pericardial thickening

109
Q

chronic constrictive pericarditis treatment

A

NSAIDS, colchicine, steroids, surgical excision of pericardium

110
Q

cardiac tamponade treatment

A

immediate pericardiocentesis

111
Q

cardiac tamponade symptoms

A

dyspnea, tachypnea, JVD, pulsus paradoxus

112
Q

myocarditis causes

A

coxsackie virus, parvovirus, HHV-6, adenovirus, echovirus, EBV, CMV, influenza
bacteria, rickettsiae, fungi, parasites
drug toxicity (cyclophosphamide, daunorubicin, doxorubicin), toxins

113
Q

myocarditis H&P

A 
recent history of URI
pleuritic chest pain
dyspnea
S3 or S4
friction rub
114
Q

acute rheumatic fever H&P

A

migratory arthritis, hot and swollen joints, fever, subcutaneous nodules, sydenham chorea, erythema marginatum

115
Q

acute rheumatic fever labs

A

increased ESR, CRP, and WBC + antistreptococcal antibodies

116
Q

acute rheumatic fever treatments

A

NSAIDS, steroids for severe carditis, antibiotics (penicillin) for infection

117
Q

JONES major criteria for RHD

A 
joints = polyarthritis, hot/swollen joints
heart = carditis, valve damage
Nodules = subcutaneous/extensor surfaces
Erythema marginatum
Sydenham chorea
118
Q

JONES minor criteria for RHD

A 
previous rheumatic fever
ECG with PR prolongation
Arthralgias
CRP and ESR elevated
increased temperature
119
Q

endocarditis H&P

A

fever, chills, night sweats, fatigue, arthralgias, possible new heart murmur
osler nodes = small, tender nodules on fingers and toes
Janeway lesions = peripheral petechaie
Roth spots = retinal hemorrhages
splinter hemorrhages under nails

120
Q

endocarditis treatment

A 
long term (4-6 wks) IV antibiotics; beta lactam plus aminoglycoside
antibiotic prophylaxis before surgical or dental work
121
Q

hypertensive emergency (malignant hypertension)

A

BP > 180/120 with evidence of end organ damage:

renal damage, pulmonary edema, aortic dissection, encephalopathy, papilledema

122
Q

hypertensive emergency (malignant hypertension) treatment

A

hospitalization to rapidly reduce diastolic blood pressure to 100mm Hg with IV nitroprusside, labetalol, nicardipine or fenoldopam
then beta blockers and ACEI to gradually reduce mean diastolic pressure to 100 to 105 over 2 hours
diuretics for pulmonary edema

123
Q

cardiogenic shock treatment

A

dobutamine, intraortic balloon pump, PTCA for MI

124
Q

septic shock treatment

A

treat underlying infection, norepinephrine, IV fluids

125
Q

hypovolemic shock treatment

A

IV fluids, transfusions, surgery to stop cause of volume loss, skin grafts for severe burns

126
Q

anaphylactic shock treatment

A

maintain airway, epinephrine, bendaryl, IV fluids

127
Q

neurogenic shock treatment

A

IV fluids, pressor agents, atropine for bradycardia

128
Q

abdominal aortic aneurysm H&P

A

localized dilation of aorta inferior to the renal arteries

lower back pain, pulsating abdominal mass, abdominal bruits, hypotension and severe pain with rupture

129
Q

AAA screening

A

one time screening US for men age 65-75 with a history of smoking

130
Q

AAA diagnosis

A

ultrasound followed by CT or MRI for more accurate information

131
Q

AAA treatment

A

monitor with periodic US if 5.5cm

132
Q

Aortic dissection H&P:

A

intimal tear causes formation of false lumen, Type A ascending aorta, type B descending aorta
acute “ripping” chest pain, syncope, decreased peripheral pulses, HTN may be present

133
Q

aortic dissection radiology

A

widening of aorta and superior mediastinum on CXR

CT w/ contrast, echo, MRI, or MRA good for definite diagnosis

134
Q

aortic dissection treatment

A

nitropursside, beta blockers if unstable

standford A need emergency surgery, stanford B can be medically managed

135
Q

peripheral vascular disease H&P

A

occlusion of peripheral blood supply secondary to atherosclerosis
presents with: leg claudication that improves with rest, resting leg pain in severe disease, dry skin, skin ulcers, decreased air growth in affected area, male impotence

136
Q

PVD labs

A

ABI <0.4 indicates severe disease

137
Q

PVD radiology

A

US useful for locating stenosis, angiography will map narrowing in the arterial distribution

138
Q

PVD treatment

A

exercise, foot examinations
asparin, pentoxifylline or cilostazol to help slow occlusion
percutaneous transluminal angioplasty indicated for medical management failure
amputation if necrosis/neurosensory loss/vascular death occurs to prevent gangrene

139
Q

What is virchows triad?

A

blood stasis, hypercoagulability, endothelial damage

140
Q

venous varicosities H&P

A

pain and fatigue that lessens with leg elevation; possible visible or palpable veins, increased local pigmentation, edema, or ulceration

141
Q

venous varicosities treatment

A

exercise, compression hosiery, leg elevation

surgical removal or injection sclerotherapy for cosmetic improvement or symptomatic varicosities

142
Q

arteriovenous malformations H&P

A

abnormal communications between arteries and veins

palpable, warm, pulsating masses, painful if mass compresses adjacent structures

143
Q

AVM treatment

A

surgical removal or sclerosis if symptomatic or located in the bowel/brain

144
Q

DVT H&P

A

deep leg pain, swelling, warmth

145
Q

DVT labs

A

D-dimer will be elevated, more useful to rule out DVT if negative

146
Q

DVT radiologic anaylsis test

A

compressive venous ultrasound and contrast venography

147
Q

DVT treatment

A

leg elevation, LMW heparin, warfarin for long term management, IVC filters placed in patients with recurrent DVTs or anticoagulation contraindications

148
Q

polyarteritis nodosa H&P

A

inflammation of small/medium arteries
ASSOCIATED WITH HEP B/C
presents as: fever, HTN, hematuria, anemia, neuropathy, weight loss, joint pain, palpable purpura, or ulcers on skin

149
Q

polyarteritis nodosa Labs

A 
increased WBC
decreased H&H
increased ESR
proteinuria
hematuria
150
Q

polyarteritis nodosa treatment

A

corticosteroids, immunosuppressive agents

151
Q

Temporal Arteritis (giant cell) H&P

A

subacute granulomatous inflammation of carotid and vertebral arteries
associated with polymyalgia rheumatica
new onset of headache, temporal region pain, jaw claudication, transient or permanent monocular blindness, myalgias, arthralgias, fever

152
Q

Temporal Arteritis (giant cell) labs

A

increased ESR, temporal artery biopsy shows inflammation in media with lymphocytes, plasma cells or giant cells

153
Q

Temporal Arteritis (giant cell) treatment

A

prednisone for 1-2months followed by taper; low dose ASA, vitamin D and calcium supplementation to reduce osteoporosis risk from chronic steroids

154
Q

Takayasu Arteritis H&P

A

inflammation of aorta and its branches, asian heritage, usually women 10-40
malaise, vertigo, syncope, fever, decreased carotid and limb pulses

155
Q

Takayasu Arteritis radiology

A

arteriography may detect abnormal vessels or stenoses; CT or MRI useful for detecting vessel wall abnormalities

156
Q

Takayasu Arteritis treatment

A

corticosteroids, immunosuppressive agents, bypass grafting of obstructed vessels

157
Q

Churg Strauss (allergic granulomatosis with angiitis) H&P

A 
inflammation of small or medium arteries
ASTHMA SYMPTOMS (a kid usually), fatigue, malaise, mononeuropathy, erythematous or papular rash
158
Q

Churg Strauss (allergic granulomatosis with angiitis) labs

A

increased eosinophils, increased ESR, p-ANCA positive, eosinophilic granulomas in lungs

159
Q

Churg Strauss (allergic granulomatosis with angiitis) treatment

A

corticosteroids, immunosuppressive agents

160
Q

Henoch-Schonlein purpura H&P

A

IgA immune complex mediated vasculitis, usually in children

recurrent upper respiratory tract infections, abdominal pain, fever, hemorrhagic urticaria, ass w/ intussuception

161
Q

Henoch-Schonlein purpura treatment

A

frequently self limited, steroids for severe G symptoms

162
Q

Kawasaki disease treatment

A

high dose ASA, IVIG, frequently self limited

163
Q

What is the normal A-a gradient?

A

5-15mm Hg

164
Q

Increased A-a gradient indicates what diseases?

A

PE, pulmonary edema, right to left vascular shunts

165
Q

signs of a peritonsillar abscess

A

difficulty opening mouth, asymetric tonsils, displacement of the uvula away from the abscess

166
Q

tuberculosis treatment

A

isoniazid, rifampin, pyrazinamide, and ethambutol initially
followed by INH and rifampin for 6 months
vitamin B6 supplement

167
Q

PPD test cutoffs

A 
5mm = immunocompromised patients, close contact with TB infected patient, signs of TB on CXR
10mm = homeless patients, immigrants, IVDA users, chronically ill patients, health care workers, patients from jail
15mm = always positive if greater
168
Q

ARDS H&P

A

acute dyspnea and pulmonary decompensation; cyanosis, tachypnea, wheezing, rales, rhonchi

caused by sepsis, trauma, pancreatitis, aspiration, near drowning, drug overdose, shock, lung infection

169
Q

ARDS labs

A

ABG shows respiratory alkalosis, decreased O2, decreased CO2, wedge pressure <18mm Hg

170
Q

ARDS radiology

A

bilateral pulmonary edema and infiltrates

171
Q

ARDS treatment

A

ICU admission with mechanical ventilation
PEEP, increased insipratory times
treat underlying cause

172
Q

status asthmaticus treatment

A

aggressive bronchodilator therapy, supplemental O2, possibly intubation

173
Q

chronic bronchitis H&P

A

productive cough, recurrent respiratory infections, dyspnea, wheezing, rhonchi
history of productive cough for 3 months of the year >2 yrs

174
Q

chronic bronchitis treatment

A

smoking cessation, antibiotics given for URI, bronchodilators during exacerbations

175
Q

Emphysema H&P

A

dyspnea, possible productive cough, morning headache, barrel chested, pursed-lip breathing, prolonged expiratory duration, decreased heart sounds, decreased breath sounds, wheezing, rhonchi, accessory muscle use, JVD, exacerbations present with worsening of symptoms

176
Q

emphysema radiology

A

CXR shows flat diaphragm, hyperinflated lungs, subpleural blebs and bullae, decreased vascular markings

177
Q

emphysema treatment

A

smoking cessation, supplemental O2, inhaled corticosteroids and long acting beta 2 agonists
pneumococcal and influenza vaccines important
enzyme replacement in alpha 1 antitripsin, lung transplant in severe disease

178
Q

bronchiectasis H&P

A

permanent dilation of bronchi

persistent, productive cough, hemoptysis, frequent respiratory infections, copious sputum, wheezing, rales, hypoxemia

179
Q

bronchiectasis treatment

A

hydration/sputum removal, chest PT, antibiotics when sputum increased, inhaled B2 agonists and corticosteroids may reduce symptoms; resection of severely diseased portion of lungs

180
Q

squamous cell lung cancer paraneoplastic syndromes

A

hypercalcemia, dermatomyositis

181
Q

adenocarcinoma of the lung paraneoplastic syndromes

A

DIC, thrombophlebitis, microangiopathic hemolytic anemia, dermatomyositis

182
Q

small cell lung cancer paraneoplastic syndromes

A

cushings, SIADH, GH/ACTH secretion, eaton-lambert syndrome, dermatomyositis

183
Q

large cell lung cancer paraneoplastic syndromes

A

gynecomastia, dermatomyositis

184
Q

laryngeal cancer H&P

A

ass with tobacco and alcohol use

hoarsness that worsens with times, dysphagia, ear pain, hemoptysis

185
Q

laryngeal cancer treatment

A

partial or total laryngectomy used to remove lesions in larynx; radiation therapy can be used with surgery for extensive lesions

186
Q

idiopathic pulmonary fibrosis H&P

A

progressive exercise intolerance, dyspnea, dry crackles, JVD, tachypnea, possible digital clubbing

187
Q

idiopathic pulmonary fibrosis labs

A

PFTs show restrictive lung disease, decreased TLC, decreased compliance
bronchioalveolar lavage shows PMNs
lung biopsy shows extensive fibrosis and loss of parenchymal architecture

188
Q

idiopathic pulmonary fibrosis imaging

A

reticulonodular pattern and “honeycomb lung”

CT shows ground glass appearance

189
Q

idiopathic pulmonary fibrosis treatment

A

corticosteroids + azathioprine or cyclophosphamide

lung transplant usually indicated, most die before they receive a lung transplants

190
Q

Sarcoidosis H&P

A

noncaseating granulomas, hilar adenopathy, pulmonary infiltrates
cough, malaise, weight loss, dyspnea, hypercalcemia, arthritis, chest pain, fever, erythema nodosum, lymphadenopathy, vision loss

191
Q

Sarcoidosis labs

A

increased serum ACE, increased calcium hypercalcuria, increased ALP, decreased WBC, increased ESR, decreased DLCO

192
Q

Sarcoidosis imaging

A

CXR shows bilateral hilar lymphadeopathy and ground grass pulmonary infiltrates

193
Q

Sarcoidosis treatment

A

occasionally self resolving
corticosteroids in chronic cases
cytotoxic drugs if steroids fail

194
Q

asbestosis

A

insulation/construction/demolition/building maintenance/car making

radiology: multinodular opacities, pleural effusions, pleural/parenchymal fibrosis

increased risk of malignant mesothelioma and lung cancer

195
Q

silicosis

A

mining, pottery, sandblasting, granite cutting

radiology = small apical nodular opacities; hilar adenopathy

increased risk of TB infection, progressive fibrosis

196
Q

coal worker disease

A

coal mining
restrictive lung pattern
radiology: small apical nodular opacities
progressive fibrosis

197
Q

berylliosis

A

electronics, ceramics, die manufacturing
pulmonary edema, diffuse granuloma formation
radiology: diffuse infiltrates, hilar adenopathy
increased risk of lung cancer; may need steroids

198
Q

goodpasture syndrome H&P

A

antiglomerular basement membrane antibodies, intra-alveolar hemorrhage and glomerulonephritis
hemoptysis, dyspnea, recent respiratory infection

199
Q

goodpasture syndrome imaging

A

bilateral alveolar infiltration

200
Q

goodpasture syndrome treatment

A

plasmapheresis and corticosteroids and immunosuppressive agents

201
Q

granulomatosis with polyangitis (wegeners) H&P

A

hemoptysis, dyspnea, myalgias, chronic sinusitis, ulcertations of nasopharynx, fever, renal symptoms, CNS problems, opthalmologic and cardiac involvement

202
Q

granulomatosis with polyangitis (wegeners) labs

A

noncaseating granulomas

+ c-ANCA

203
Q

granulomatosis with polyangitis (wegeners) treatment

A

cytotoxic therapy (cyclophosphamide) and corticosteroids

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