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PNCE > pulm > Flashcards

pulm Flashcards

1
Q

chronic bronchitis MCC

A

smoker

tobacco use

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2
Q

chronic bronchitis sx

A

productive cough
cyanotic, wheezing
clubbing
cor pulmonale

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3
Q

chronic bronchitis test

A

clinical: productive cough >3m/yr for 2y
PFT BIT: dec FEV`/FVC
ABG: chronic respiratory acidosis

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4
Q

chronic bronchitis tx

A

1st: smoking cessation, home O2 if (<89%)
SABA/LABA, inhaled CS
surgical: lung resection/ transplant

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5
Q

chronic bronchitis complications

A

lung infection

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6
Q

emphysema MCC

A

tobacco use

smoking

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7
Q

emphysema sx

A

pink puffer, cough is rare

dyspnea, pursed lip breathing, barrel chest

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8
Q

emphysema test

A

CXR: inc AP diameter
PFT: dec FEV1/FVC
ABG: chronic respiratory acidosis

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9
Q

emphysema tx

A

smoking cessation
vaccines: flu and pneumococcal
bronchodilators –> inhaled steroids
LABA: tiotropium

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10
Q

COPD exacerbation MCC

A

S. pneumo
M. catorrhalis
H. flu

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11
Q

COPD exacerbation test

A

CXR
ABG: acute respiratory acidosis
sputum culture

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12
Q

COPD exacerbation tx

A

O2, systemic oral prednisone,
ipratropium, albuterol
abx if pseudomonas infx

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13
Q

COPD exacerbation prevention

A

flu vaccine annually

pneumococcal vaccine

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14
Q

acute bronchiolitis MCC

A

RSV

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15
Q

acute bronchiolitis sx

A

cough, bilateral wheezing, clear rhinorrhea
prolonged expiratory phase, clubbing
F, dyspnea

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16
Q

acute bronchiolitis test

A

clinical, O2 dec

CXR: atelectasis, air trapping

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17
Q

acute bronchiolitis tx

A

supportive

severe: hospital

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18
Q

acute bronchitis sx

A

cough hallmark
bilateral ronchi, wheezing
preceded by URI

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19
Q

acute bronchitis test

A

clinical
sputum culture
CXR: thinking of bronchial walls (only when pneumonia suspected)

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20
Q

acute bronchitis tx

A

supportive
dextromethorphan/guaifenesin
abx not indicated

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21
Q

acute epiglottis MC organizm

A

Haemophilus influenza type B

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22
Q

acute epiglottis tx

A

airway management
intubation, tracheostomy if needed
IV abx: ceftriaxone

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23
Q

croup MCC

A

parainfluenza virus

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24
Q

bacterial tracheitis vs croup

A

bacterial tracheitis: like croup but more toxic appearing. airway emergency

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25
Q

croup test

A

CXR: steeple sign

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26
Q

croup tx

A

severe: racemic nebulizer epi + PO/IM dexamethasone

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27
Q

influenza MC type

A

type A

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28
Q

influenza MCC

A

orthomycovirus

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29
Q

influenza complications

A

AOM, bronchiolitis

croup, sinusitis, pneumonia

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30
Q

MCC viral pneumonia in adults

A

influenza

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31
Q

pertussis tx

A

macrolide (azithromycin) or bactrim

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32
Q

pertussis prevention

A

DTaP 5 doses before school age
4-6yo last dose
TDaP booster at 11-12 + pregnant (Q10y)

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33
Q

bacterial pneumonia sx

A

sudden onset productive cough
high fever, chills
dullness to percussion, inc TF, rales, ronchi
bronchophony/ ego phony

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34
Q

MCC community acquired pneumonia

A

S. pneumo

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35
Q

S. pneumo pneumonia sx

A

rust colored sputum

bulbous myringitis

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36
Q

klebsiells pneumonia sx

A

currant jelly sputum
etoh abuse
cautery lesions

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37
Q

H. flu pneumonia sx

A

COPD

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38
Q

S. aureus pneumonia sx

A

IVDU
post flu
recent URI

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39
Q

pseudomonas pneumonia sx

A

CF, nursing homes

immunocompromised

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40
Q

rusobacterium pneumonia sx

A

aspiration pneumonia

foul smelling sputum

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41
Q

bacterial pneumonia test

A

CXR: patchy. areas or fluid localized to a single lobe

consolidation: S. pneumo
mycoplasma: cold agglutinin assay
legionella: urine antigen

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42
Q

mycoplasma pneumonia tx

A

macrolide

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43
Q

legionella pneumonia tx

A

doxy or macrolide

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44
Q

atypical bacterial pneumonia MCC

A

mycoplasma

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45
Q

atypical bacterial pneumonia sx

A

gradual onset
dry cough, low grade fever,
extra pulmonary sx: HA, myalgia, fatigue, GI

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46
Q

atypical bacterial pneumonia test

A

CXR: reticulonodular infiltrates

mycoplasma: cold agglutinin assay
legionella: urine antigen

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47
Q

legionella pneumonia sx

A

from contaminated water
diarrhea + cough
hyponatremia
inc LFT

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48
Q

atypical bacterial pneumonia tx

A

azithromycin

mycoplasma: macrolide or doxy
legionella: doxy or macrolide

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49
Q

blastomycosis sx

A

immunocompetent men + outdoor activities
F, night sweats, WL, pulmonary sx
cutaneous papules: vemicus crusted/ ulcerated lesions

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50
Q

blastomycosis histology

A

round broad budding yeast w/ thick double walls

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51
Q

blastomycosis tx

A 
amphotericin B (severe) 
 itraconazole (TOC)
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52
Q

coccidiomycosis sx

A

mild lung infx
bone granulomas or meningitis
erythema nodosum/multiforme

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53
Q

coccidiomycosis test

A

serologic
IgM + IgG
culture definitive

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54
Q

coccidiomycosis tx

A

amphotericin B
itraconazole
fluconazole if CNS sx

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55
Q

histoplasmosis sx

A

mild atypical pneumonia

disseminated in immunocomp

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56
Q

histoplasmosis test

A

budding yeast w/in macrophages
CXR: solitary pulmonary calcifications
sputum culture definitive

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57
Q

histoplasmosis tx

A

amphotericin B

itraconazole

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58
Q

MCC fungal meningitis

A

histoplasmosis

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59
Q

histoplasmosis sx

A

pneumonia
bone/ skin granulomas
dissemination causes cryptococcal meningitis

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60
Q

histoplasmosis test

A

india ink stain: encapsulated budding yeast

CSF

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61
Q

histoplasmosis tx

A

amphotericin B

fluconazole

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62
Q

histoplasmosis HIV prophylaxis

A

CD4 <100

fluconazole

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63
Q

aspergillosis sx

A

mold grows in pulmonary cavities

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64
Q

aspergillosis tx

A

requires surgery

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65
Q

aspergillosis complication

A

aflatoxin B1 –> inc risk of hepatocellular carcinoma

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66
Q

pneumocystis pneumonia CD4

A

CD4 <200

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67
Q

pneumocystis pneumonia sx

A

MC opportunistic respiratory infx in acquired immunodeficiency syndrome
gradual F, dyspnea, dry cough, SOB, CP

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68
Q

pneumocystis pneumonia test

A

initial: sputum culture
CXR: bilateral diffuse infiltrates (batwing appearance)
CD4 <200, inc LDH
bronchoalveolar lavage definitive

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69
Q

pneumocystis pneumonia tx

A

bactrim

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70
Q

viral pneumonia MCC

A

influenza

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71
Q

viral pneumonia prevention

A

pneumococcal vax

flu vax

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72
Q

viral pneumonia sx

A

insidious onset
dry cough, low grade F
wheezing

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73
Q

viral pneumonia CXR

A

diffuse infiltrates concentrated in perihilar region

reticular line shaped opacities

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74
Q

viral pneumonia tx

A

supportive

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75
Q

SVC syndrome sx

A

facial fullness, face and arm edema
dilated veins over anterior chest, arms, and face
JVD

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76
Q

MC bronchogenic lung cancer

A

non- small cell

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77
Q

SVC syndrome

A
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78
Q

SVC syndrome patho

A

obstruction of SVC bu tumor

impairs venous flow to RA

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79
Q

pancoast tumor patho

A

superior pulmonary sulcus tumor

apical tumor at apex of lung compresses C8, T1 and T1 nerve roots

80
Q

pancoast tumor sx

A

shoulder pain radiating down arm

pain, UE weakness

81
Q

pancoast tumor associated w/

A

horners syndrome

82
Q

horners syndrome patho

A

invasion of cervical sympathetic chain by apical tumor

83
Q

horners syndrome sx

A

unilateral facial anhidrosis, ptosis, miosis

84
Q

nerve compressed to cause hoarseness

A

recurrent laryngeal nerve

85
Q

nerve compressed to cause diaphragmatic elevation and SOB

A

phrenic nerve

86
Q

most agressive lung cancer

A

small cell

87
Q

small cell lung cancer location

A

central

88
Q

eaton Lambert syndrome

A

autoantibodies destroy neurons

proximal muscle weakness, dec DTR, paresthesia

89
Q

small cell lung cancer sx

A

SIADH
cushings
eaton Lambert syndrome

90
Q

small cell lung cancer tx

A

chemo rad

surgery limited, usually not resectable

91
Q

SCC lung cancer location

A

non small cell cancer

central lesion

92
Q

MC peripheral lesion lung cancer

A

adenocarcinoma

93
Q

non small cell lung cancer tx

A

surgery

94
Q

mesothelioma MC type

A

pleura tumor

95
Q

mesothelioma due to

A

asbestos exposure

talc

96
Q

mesothelioma sx

A

dyspnea, WL, cough, blood effusion,

pleural pain, CP, pneumothorax, hemoptysis

97
Q

mesothelioma test

A

CXR, CT: pleural thickening
bx definitive
immunostain w/ calretinin –> fried egg shape

98
Q

mesothelioma tx

A

local: pleurectomy

prognosis poor

99
Q

pulmonary carcinoid tumor patho

A

dysfx of neuroendocrine cells leading to tumor production

100
Q

pulmonary carcinoid tumor sx

A

bimodal distribution
serotonin synthesis
episodic diarrhea, skin flushing, wheezing (asthma like attacks)
hemoptysis, recurrent pneumonia, hypoTN

101
Q

pulmonary carcinoid tumor test

A

bronchoscopy: pink/purple end-bronchial lesion, well vascularized central tumor
Best: 24h urine w/ 5-HIAA –> inc serotonin levels

102
Q

pulmonary carcinoid tumor tx

A

surgical excision TOC

octreotide

103
Q

solitary pulmonary nodule (benign)

A

<6mm, no growth over 2y
circular and regular shape
central laminated calcification

104
Q

solitary pulmonary nodule (malignant)

A

> 50yo smoker or hx of size >3cm
steady growth
irregular in shape/margins, stippled/ eccentric calcification

105
Q

solitary pulmonary nodule RF granuloma

A

TB, histoplasmosis
coccidiomycosis
RA, sarcoidosis
thyoma

106
Q

solitary pulmonary nodule hamartoma sx

A

non smoker
asx
popcorn ball appearance

107
Q

solitary pulmonary nodule granuloma sx

A

non smoker
asx
bullseye nodule appearance

108
Q

solitary pulmonary nodule TB sx

A

immigrant, known exposure, + PPD
F, calcification <2cm
military pattern, apical, round

109
Q

solitary pulmonary nodule fungal.(MAC) infx sx

A

HIV + or low CD4

multiple sizes

110
Q

solitary pulmonary nodule sarcoidosis sx

A

bilateral caveating nodules w/ hilar lymphadenopathy

111
Q

solitary pulmonary nodule test

A

compare w/ previous CXR
low probability nodule –> CT
intermediate: (nodule >1cm) PET + PET then bx
high probability: bx

112
Q

pleural effusion MCC transudative

A

CHF

cirrhosis

113
Q

pleural effusion MCC exudative

A

bacterial pneumonia

malignancy

114
Q

pleural effusion sx

A

peripheral edema
dullness to percussion
dec BS, dec TF

115
Q

pleural effusion test

A

CXR: blunting of costophrenic angle (meniscus sign)
thoracentesis: gold standard

116
Q

pleural effusion tx

A

transudative: diuretics, Na restriction, thoracentesis
exudative: thoracentesis and tx underlying

117
Q

spontaneous pneumothorax sx

A

ipsilateral CP, sudden
dec BS, hyperrestonance
dec/absent TF

118
Q

spontaneous pneumothorax CXR

A

absence of lung markings
mediastinal shift to opposite side of pneumothorax
companion lines

119
Q

spontaneous pneumothorax tx

A

tube thoracotomy

120
Q

tension pneumothorax sx

A 
hypotension, JVD
shift trachea away from affected lung 
absent breath sounds
hyper resonance 
pulses paradoxus
121
Q

tension pneumothorax tx

A

needle thoracotomy

122
Q

tension pneumothorax complications

A

positive pressure ventilation increased accumulated air

exacerbates tension pneumothorax and causing cardiovascular collapse

123
Q

cor pulmonale patho

A

pulmonary HTN –> structural changes to right ventricle (dilation/ hypertrophy)
secondary to underlying pulmonary disease

124
Q

cor pulmonale MC form

A

chronic d/t COPD

acute typically d/t PE

125
Q

cor pulmonale sx

A

parasternal lift, loud S2, sx of RHF (hepatomegaly, edema, JVD)
tricuspid regurgitation

126
Q

cor pulmonale test

A

initial: echo (RV dilation)
confirm: R heart Cath
CXR: enlarged pulmonary arteries, prominent R heart border

127
Q

cor pulmonale tx

A

tx underlying
COPD: bronchodilators + INH steroid
OSA: CPAP
CHF: diuretics

128
Q

PE sx

A

dyspnea, tachycardia
dullness to percussion, dec BS
pleuritic CP

129
Q

PE test

A 
initial: CT
MAT: CTA gold 
if renal pt or contrast allergy: VQ scan
CXR: hamptons hump and westermark sign 
low suspicion: D dimer
130
Q

PE tx

A

acute anticoagulant: heparin (do not use if currently bleeding)
LMWH: stable pt w/ no renal problems, CA pts
unfractionated heparin: pts w/ renal failure
supplement O2
massive PE w/ RHF: thrombolytic (tPA)
long term anticoagulant: warfarin
IVC filter

131
Q

pulmonary HTN patho

A

pulmonary arterial pressure >25 at rest

RVH

132
Q

pulmonary HTN sx

A 
dyspnea on exertion, CP on exertion, 
syncope on exertion 
tricuspid regurgitation (holosystolic murmur) 
accentuated S2
RHF sx
133
Q

pulmonary HTN test

A

BIT: echo: dilated pulmonary artery, dilation of RA and RV
CXR: enlarged pulmonary arteries
gold: R heart Cath

134
Q

pulmonary HTN tx

A

1: NO, IV adenosine, CCB 1st line
2: tx underlying
3: tx underlying, oxygen
4: anticoagulant 1st line, tx underlying

135
Q

pulmonary HTN WHO classification

A

group 1: PAH (idiopathic, lupus, HIV, genetic mutation disorders)
group 2: PH d/t L heart disease
group 3: PH d/t chronic lung disease (COPD, OSA)
group 4: PH d/t chronic thromboembolic (PE)
group 5: PH d/t unclear mechanisms

136
Q

idiopathic pulmonary fibrosis causes and RF

A

meds: amiodarone, bleomycin, MTX
RF: old age, male, smoking, RA

137
Q

MCC interstitial lung dz

A

idiopathic pulmonary fibrosis

138
Q

idiopathic pulmonary fibrosis sx

A

gradual onset of nonproductive cough
bibasilar crackles, cyanosis
clubbing

139
Q

idiopathic pulmonary fibrosis test

A

CXR: honeycombing, reticular opacities
CT
PFT: restrictive

140
Q

idiopathic pulmonary fibrosis tx

A

no tx changes outcome
supplemental O2, chest PT
acute: IV CS
definitive: lung transplant

141
Q

coal worker pneumoconiosis test

A

CXR: small apical opacities in upper lobe. hyperinflation
PFT: obstructive

142
Q

coal worker pneumoconiosis tx

A

vaccination: flu, pneumococcal, minimize exposure

143
Q

Caplan syndrome

A

pneumoconiosis + rheumatoid arthritis

144
Q

asbestosis sx

A

SOB, dry cough, chronic CP, finger clubbing, pursed breathing
shipyard workers/ construction

145
Q

asbestosis test

A

initial: CXR (haze infiltrates, shaggy heart sign, bilateral linear opacities. calcified pleural plaques at lung bases (lower lung)
MAT: bx

146
Q

asbestosis tx

A

palliative

malignancy risk: non small cell lung cancer, malignant mesothelioma

147
Q

silicosis sx

A

dyspnea on exertion, cough w/ sputum

rhonchi, wheezing, tachyptic

148
Q

silicosis test

A

BIT: CXR (localized/ nodular in upper lung lobes, eggshell calcification of hilar nodes. round nodular opacities)

149
Q

silicosis tx

A

all pts need TB test
pneumococcal vaccine
flu vaccine
smoking cessation

150
Q

berylliosis RF

A

aerospace
fluorescent bulbs
computers

151
Q

berylliosis sx

A

acute: diffuse pneumonitis
skin lesions
hypercalcemia

152
Q

berylliosis test

A

beryllium lymphocyte proliferation/ transformation test
upper lobs, hilar lymphadenopathy
bx: noncaseating granulomas

153
Q

berylliosis tx

A

glucocorticoid therapy for both acute and chronic
MTX if dont respond
only ILD that responds to steroids

154
Q

byssinosis risk

A

cotton dust
yarn and rope making
textile

155
Q

byssinosis sx

A

early: asthma like sx
late: regular chest tightness at end of first day (Monday chest tightness)

156
Q

byssinosis test

A

routine PFT: OSHA requirement

157
Q

byssinosis tx

A

exhaust hoods

158
Q

sarcoidosis sx

A

pulmonary sx: nonproductive cough, SOB, F, WL
lupus pernio: chronic violaveous raised plaques/ nodules on face
uveitis, arthralgas, erythema nodosum (tender red nodules anterior leg)

159
Q

sarcoidosis test

A 
initial: CXR (noncaseating granulomas, bilateral hilar central lymphadenopathy or bat wing) 
hypercalcemia, inc serum ACE levels 
MAT: bx (noncaseating granulomas) 
bronchoalveolar lavage: inc CD4 
PFT: restrictive
160
Q

sarcoidosis tx

A

resolve spontaneously
mainstay: PO prednisone
MTX if refractory
annual EKG, PFT, and ophthalmology exam

161
Q

lofgrens syndrome sx

A

triad: erythema nodosum, bilateral hilar lymphadenopathy, polyarthrialgia
fever

162
Q

obstructive sleep apnea test

A

polysomnogram sleep study

163
Q

obstructive sleep apnea tx

A

CPAP, weight loss
sleep on side
surgery to realign jaw

164
Q

central sleep apnea due to

A

CNS mediated

neurological malfunction

165
Q

central sleep apnea test

A

polysomnogram

166
Q

central sleep apnea tx

A

CPAP

tracheostomy definitive

167
Q

pickwickian syndrome patho

A

hypoventilation in overweight patients

low O2 levels, high CO2

168
Q

pickwickian syndrome sx

A

overweight/obese
daytime sleepiness
lower limb swelling, snoring

169
Q

pickwickian syndrome test

A

diagnosis of exclusion

170
Q

pickwickian syndrome tx

A

CPAP

tracheostomy

171
Q

pickwickian syndrome complication

A

pulmonary HTN

RHF

172
Q

ARDS MCC

A

sepsis

near drowning

173
Q

ARDS sx

A

severe refractory hypoxemia hallmark
doesn’t respond to O2
cyanosis, tachycardia

174
Q

ARDS test

A

CXR: bilateral infiltrates, spares costophrenic angles

175
Q

ARDS tx

A

oxygen
intubate
fluid management
tx underlying

176
Q

IRDS RF

A

caucasian, male, C section delivery
perinatal infections, multiple births (esp premature)
maternal diabetes

177
Q

IRDS test

A

CXR: reticular ground glass opacities + air bronchograms

178
Q

IRDS tx

A

exogenous surfactant

CPAP

179
Q

IRDS prevention

A

CS to mature lungs if premature (24-36w)

180
Q

asthma attack tx

A

Best initial: SABA + O2
2nd line: IV methylprednisolone
severe: inhale SABA, inhaled ipratropium and systemic steroids

181
Q

bronchiectasis patho

A

permanent abnormal dilation of bronchi walls

impaired clearance of secretions

182
Q

bronchiectasis MCC

A

CF

183
Q

bronchiectasis sx

A

chronic cough w/ large amount of mucopurulent foul smelling sputum, hemoptysis

184
Q

bronchiectasis test

A

BIT/MAT: HR chest CT (tram track, signet ring sign)

185
Q

bronchiectasis tx

A 
prophylactic abx (amoxicillin, azithromycin, bactrim)
pseudomonas/mycoplasma: zosyn 
aspergillosis (thick brown sputum: CS + itraconazole
186
Q

cystic fibrosis patho

A

autosomal recessive

CFTR gene, chromosome 7, F508 mutation

187
Q

cystic fibrosis sx

A

meconium ileus in newborn
recurrent chronic URI
thick sticky mucus
steatorrhea, infertility

188
Q

cystic fibrosis test

A

newborn screen
sweat chloride test
PFT: obstructive

189
Q

cystic fibrosis tx

A

ADEK replacement
chest PT
abx for infections
surgery for meconium ileus

190
Q

cystic fibrosis complications

A

respiratory
GI
infertility

191
Q

cystic fibrosis MC pathogen

A

pseudomonas

192
Q

MC location for foreign body lung

A

right main bronchus

193
Q

FB lung tx

A

rigid bronchoscopy gold

194
Q

hyaline membrane disease patho

A

deficiency of surfactant (type 2 alveolar cells) in premature infants

195
Q

SIDS RF

A

infants sleeping in prone position (strongest modifiable RF)
sleeping on soft surface or w/ accessories
overheating, low birthweight, premature
bed sharing

196
Q

SIDS reduced risk

A

supine position for sleep
firm mattress, room sharing w/o bed sharing
pacifier use

PNCE (33 decks)

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