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PANCE/EOC > Pulm #1 > Flashcards

Pulm #1 Flashcards

1
Q

Acute bronchitis is MCC by _____, but can also be caused by bacteria such as _____

A

Viruses (Adenovirus, Parainfluenza, Coronavirus, Rhinovirus)

-Bacterial: S. Pneumo, M. Cattarhalis, H. Influenzae

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2
Q

Symptoms of acute bronchitis

A
  • Cough (hallmark, and present for at least 5 days)
  • Malaise, dyspnea, may have hemoptysis
  • May have wheezing and rhonchi
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3
Q

Treatment for acute bronchitis

A
  • Symptomatic management

- ABX not indicated in most patients

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4
Q

What is acute bronchitis?

A

Inflammation of the bronchi

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5
Q

Risk factors for epiglottitis

A
  • DM
  • Children 3 mos - 6 years
  • Males
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6
Q

What are the causes of Epiglottitis?

A
  • H. Influenzae B in unvaccinated or foreign immigrants

- Group A Strep or Strep Pneumo if vaccinated, cocaine use

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7
Q

Symptoms of Epiglottitis

A
  • Dysphagia, Drooling, Distress

- Fever, inspiratory stridor, tripoding, hot potato voice

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8
Q

What is the definitive diagnostic for epiglottitis?

A

Laryngoscopy (cherry red epiglottis with swelling)

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9
Q

However, what other diagnostic can be done for epiglottitis and what do you see?

A

Lateral cervical radiographs: thumb or thumbprint sign

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10
Q

Treatment for epiglottitis

A
  • Maintain the airway (most important component) in the OR

- ABX: Ceftriaxone or Cefotaxime

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11
Q

How to prevent Epiglottitis in close contacts

A

-Rifampin

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12
Q

Acute Respiratory Distress Syndrome (ARDS) is MC in ______, such as _____

A

Critically ill patients

  • Gram negative sepsis (MC)
  • Severe pancreatitis
  • Near drowning
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13
Q

What are the three components of diagnosing ARDS

A
  • Severe hypoxemia refractory to supplemental oxygen (PaO2/FiO2 radio < 200 mm Hg)
  • Bilateral diffuse pulmonary infiltrates that spares costophrenic angles
  • Pulmonary capillary wedge pressure < 18 mm Hg with right heart catheterization (Swanz-Ganz)

-Symptoms developing within 1 week

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14
Q

Treatment for ARDS

Symptoms of ARDS

A
  • Noninvasive or mechanical ventilation + treat underlying cause
  • -PEEP improve hypoxemia

-Often fatal

  • Rapid onset of profound dyspnea 12-24 hours after precipitating event (car crash, etc.)
  • Pink frothy sputum
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15
Q

What is linked with COPD in younger adults (<40 y/o) associated with panlobar emphysema?

A

Alpha-1 Antitrypsin Deficiency

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16
Q

What should you do diagnostically in a patient who is under 40 with COPD?

A

Blood tests

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17
Q

What risk factors are associated with Asbestosis?

A
  • Destruction, repair or renovation of old buildings

- Insulation, ship building

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18
Q

Chest radiographs for Asbestosis shows

A
  • Pleural plaques/calcifications or thickening of parietal pleura of lower lobes
  • Interstitial fibrosis (honeycomb lungs) of the lower lobes
  • “Shaggy heart sign” –indistinct heart border
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19
Q

What gives a definitive diagnosis of Asbestosis?

A

Lung biopsy: shows linear asbestos bodies (ferruginous bodies)

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20
Q

What does a PFT show for asbestosis?

A

Restrictive lung pattern: increased FEV/FVC1, decreased lung volumes

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21
Q

Complications of Asbestosis

A
  • Bronchogenic carcinoma (most common)

- Malignant mesothelioma of the pleura (most specific)

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22
Q

What does a liver biopsy show in a patient with Alpha-1 Antritypsin Deficiency?

A

PAS-positive globules in hepatocytes

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23
Q

Treatment for Alpha-1 Antitrypsin Deficiency

A

IV pooled alpha-1 antitrypsin

24
Q

Aspergillosis is a fungus that most commonly affects the lungs, sinuses, and CNS. Where is it found?

A

In garden and houseplant soil and compost

25
Q

If Aspergillosis occurs in patients with asthma, bronchiectasis, or cystic fibrosis, it is considered allergic bronchopulmonary aspergillosis. What is one specific symptom that occurs with this type of aspergillosis?

A

Expectoration of brownish mucus plugs in the sputum

26
Q

If there is an aspergilloma, what happens and what symptoms occur?

A
  • Fungus colonizes a preexisting pulmonary cavitary lesion

- Hemoptysis

27
Q

With allergic aspergillosis, what diagnostic will be helpful?

A

Increased IgE, eosinophilia

28
Q

On a lung biopsy for aspergillosis, what will be seen?

A

Tissue appears dusky and necrotic

-Septate hyphae with regular branching at acute (45 degree) angles

29
Q

True or False: Aspergillosis is associated with increased risk of hepatocellular carcinoma

A

True

30
Q

Treatment for both types of Aspergillosis

A
  • Allergic: tapered oral corticosteroids + Chest physiotherapy (add Itraconazole in some cases)
  • Aspergilloma: Surgical resection vs observation if asymptomatic
31
Q

Aspiration PNA is MCC by ______ and has increased incidence in _____.

A

Anaerobes

-Peridontal disease

32
Q

Aspiration PNA is most commonly in what location and why?

A

Right lower lobe

-Due to vertical angle of right mainstem bronchus

33
Q

Symptoms of Aspiration PNA

A

Foul-smelling “rotten egg” sputum

34
Q

Treatment for aspiration PNA

A
  • Ampicillin-Sulbactam or Amoxicillin-Clavulanate

- Metro + either Amoxicillin or Penicillin G as alternatives

35
Q

What bacteria with PNA is associated with sever alcoholics?

A

Klebsiella

-current jelly sputum and cavitary lesions

36
Q

What is the gold standard in diagnosing Asthma?

A

Pulmonary function testing (PFT) shows reversible obstruction

37
Q

3 components of Asthma pathophysiology

A
  • Airway hyperreactivity
  • Bronchoconstriction
  • Inflammation
38
Q

Risk factors for Asthma

A
  • Atopy (strongest)
  • Family history
  • Air pollution
  • Male gender
  • Tobacco Smoke
39
Q

What are the three components of Samter’s Triad?

A

Asthma + chronic rhino sinusitis + sensitivity to Aspirin or NSAIDs

40
Q

Symptoms of Asthma

A
  • Dyspnea
  • Wheezing
  • Cough (at night)
  • Chest tightness
  • Fatigue
41
Q

What are some exam findings of a patient with asthma

A
  • Prolonged expiratory wheeze
  • Hyperresonance to percussion
  • Decreased breath sounds
  • Tachypnea
  • Tachycardia
  • Use of accessory muscles
42
Q

How else can you diagnose Asthma?

A

-Bronchoprovocation: Methacholine challenge (> 20% decrease on FEV1) followed by bronchodilator challenge (Increase of FEV1 > 12 is expected)

43
Q

What is the best and most objective way to assess exacerbation severity and patient response to treatment in asthma?

A

Peak expiratory flow rate

44
Q

In an acute asthma exacerbation, what are three discharge criteria?

A
  • PEFR > 70% predicted
  • PEFR > 15% initial attempt
  • Subjective improvement
45
Q

On ABG with asthma, what is expected?

A

Respiratory alkalosis (from tachypnea)

46
Q

Treatment for acute asthma

A
  • SABA (Albuterol, Terbutaline, Epinephrine)
  • Antimuscarinics (Ipatropium)
  • Corticosteroids (Prednisone, Methylprednisone, Prednisolone)
47
Q

What are some common side effects of SABA?

A

Tachycardia/arrhythmias
Muscle tremors
CNS stimulation
Hypokalemia

48
Q

Treatment for chronic asthma

A
  • inhaled corticosteroids
  • LABA
  • ICS/LABA combo (Symbicort, Advair Diskus)
49
Q

What are some examples of LABA?

A
  • Sameterol
  • Formoterol
  • Budesonide
50
Q

MCC of post-op fever day 1

A

Atelectasis

51
Q

How to prevent asthma exacerbations?

A
  • Reduce risk factors such as tobacco smoke, air pollution, chemical irritants (including perfume), reduce # of lower respiratory infections
  • Use spacers for inhalers
52
Q

Intermittent asthma

A
  • Symptoms: < 2 x/day
  • SABA use: < 2 x/week
  • Nighttime awakenings: < 2/month
  • Interference with activities: None
  • Lung function: Normal FEV1/FVC
  • Treatment: SABA
53
Q

Mild Persistent Asthma

A
  • Symptoms: > 2 days/week, but not daily
  • SABA use: > 2 days/week, but not more than 1x/day
  • Nighttime awakenings: 3-4 x/month
  • Interference with activities: Minor
  • Lung function: Normal FEV1 > 80%
  • Treatment: SABA + low-dose ICS
54
Q

Moderate Persistent Asthma

A
  • Symptoms: Daily
  • SABA use: Daily
  • Nighttime awakenings: > 1x/week, not nightly
  • Interference with activities: Some
  • Lung function: Normal FEV1 60-80%
  • Treatment: Low ICS + LABA or Medium ICS
55
Q

Severe Persistent Asthma

A
  • Symptoms: Throughout the day
  • SABA use: Several times a day
  • Nighttime awakenings: Nightly
  • Interference with activities: Extremely limited
  • Lung function: FEV1 < 60%
  • Treatment: High dose ICS + LABA +/- Omalizumab

PANCE/EOC (63 decks)

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