pulm Flashcards
chronic bronchitis MCC
smoker
tobacco use
chronic bronchitis sx
productive cough
cyanotic, wheezing
clubbing
cor pulmonale
chronic bronchitis test
clinical: productive cough >3m/yr for 2y
PFT BIT: dec FEV`/FVC
ABG: chronic respiratory acidosis
chronic bronchitis tx
1st: smoking cessation, home O2 if (<89%)
SABA/LABA, inhaled CS
surgical: lung resection/ transplant
chronic bronchitis complications
lung infection
emphysema MCC
tobacco use
smoking
emphysema sx
pink puffer, cough is rare
dyspnea, pursed lip breathing, barrel chest
emphysema test
CXR: inc AP diameter
PFT: dec FEV1/FVC
ABG: chronic respiratory acidosis
emphysema tx
smoking cessation
vaccines: flu and pneumococcal
bronchodilators –> inhaled steroids
LABA: tiotropium
COPD exacerbation MCC
S. pneumo
M. catorrhalis
H. flu
COPD exacerbation test
CXR
ABG: acute respiratory acidosis
sputum culture
COPD exacerbation tx
O2, systemic oral prednisone,
ipratropium, albuterol
abx if pseudomonas infx
COPD exacerbation prevention
flu vaccine annually
pneumococcal vaccine
acute bronchiolitis MCC
RSV
acute bronchiolitis sx
cough, bilateral wheezing, clear rhinorrhea
prolonged expiratory phase, clubbing
F, dyspnea
acute bronchiolitis test
clinical, O2 dec
CXR: atelectasis, air trapping
acute bronchiolitis tx
supportive
severe: hospital
acute bronchitis sx
cough hallmark
bilateral ronchi, wheezing
preceded by URI
acute bronchitis test
clinical
sputum culture
CXR: thinking of bronchial walls (only when pneumonia suspected)
acute bronchitis tx
supportive
dextromethorphan/guaifenesin
abx not indicated
acute epiglottis MC organizm
Haemophilus influenza type B
acute epiglottis tx
airway management
intubation, tracheostomy if needed
IV abx: ceftriaxone
croup MCC
parainfluenza virus
bacterial tracheitis vs croup
bacterial tracheitis: like croup but more toxic appearing. airway emergency
croup test
CXR: steeple sign
croup tx
severe: racemic nebulizer epi + PO/IM dexamethasone
influenza MC type
type A
influenza MCC
orthomycovirus
influenza complications
AOM, bronchiolitis
croup, sinusitis, pneumonia
MCC viral pneumonia in adults
influenza
pertussis tx
macrolide (azithromycin) or bactrim
pertussis prevention
DTaP 5 doses before school age
4-6yo last dose
TDaP booster at 11-12 + pregnant (Q10y)
bacterial pneumonia sx
sudden onset productive cough
high fever, chills
dullness to percussion, inc TF, rales, ronchi
bronchophony/ ego phony
MCC community acquired pneumonia
S. pneumo
S. pneumo pneumonia sx
rust colored sputum
bulbous myringitis
klebsiells pneumonia sx
currant jelly sputum
etoh abuse
cautery lesions
H. flu pneumonia sx
COPD
S. aureus pneumonia sx
IVDU
post flu
recent URI
pseudomonas pneumonia sx
CF, nursing homes
immunocompromised
rusobacterium pneumonia sx
aspiration pneumonia
foul smelling sputum
bacterial pneumonia test
CXR: patchy. areas or fluid localized to a single lobe
consolidation: S. pneumo
mycoplasma: cold agglutinin assay
legionella: urine antigen
mycoplasma pneumonia tx
macrolide
legionella pneumonia tx
doxy or macrolide
atypical bacterial pneumonia MCC
mycoplasma
atypical bacterial pneumonia sx
gradual onset
dry cough, low grade fever,
extra pulmonary sx: HA, myalgia, fatigue, GI
atypical bacterial pneumonia test
CXR: reticulonodular infiltrates
mycoplasma: cold agglutinin assay
legionella: urine antigen
legionella pneumonia sx
from contaminated water
diarrhea + cough
hyponatremia
inc LFT
atypical bacterial pneumonia tx
azithromycin
mycoplasma: macrolide or doxy
legionella: doxy or macrolide
blastomycosis sx
immunocompetent men + outdoor activities
F, night sweats, WL, pulmonary sx
cutaneous papules: vemicus crusted/ ulcerated lesions
blastomycosis histology
round broad budding yeast w/ thick double walls
blastomycosis tx
amphotericin B (severe) itraconazole (TOC)
coccidiomycosis sx
mild lung infx
bone granulomas or meningitis
erythema nodosum/multiforme
coccidiomycosis test
serologic
IgM + IgG
culture definitive
coccidiomycosis tx
amphotericin B
itraconazole
fluconazole if CNS sx
histoplasmosis sx
mild atypical pneumonia
disseminated in immunocomp
histoplasmosis test
budding yeast w/in macrophages
CXR: solitary pulmonary calcifications
sputum culture definitive
histoplasmosis tx
amphotericin B
itraconazole
MCC fungal meningitis
histoplasmosis
histoplasmosis sx
pneumonia
bone/ skin granulomas
dissemination causes cryptococcal meningitis
histoplasmosis test
india ink stain: encapsulated budding yeast
CSF
histoplasmosis tx
amphotericin B
fluconazole
histoplasmosis HIV prophylaxis
CD4 <100
fluconazole
aspergillosis sx
mold grows in pulmonary cavities
aspergillosis tx
requires surgery
aspergillosis complication
aflatoxin B1 –> inc risk of hepatocellular carcinoma
pneumocystis pneumonia CD4
CD4 <200
pneumocystis pneumonia sx
MC opportunistic respiratory infx in acquired immunodeficiency syndrome
gradual F, dyspnea, dry cough, SOB, CP
pneumocystis pneumonia test
initial: sputum culture
CXR: bilateral diffuse infiltrates (batwing appearance)
CD4 <200, inc LDH
bronchoalveolar lavage definitive
pneumocystis pneumonia tx
bactrim
viral pneumonia MCC
influenza
viral pneumonia prevention
pneumococcal vax
flu vax
viral pneumonia sx
insidious onset
dry cough, low grade F
wheezing
viral pneumonia CXR
diffuse infiltrates concentrated in perihilar region
reticular line shaped opacities
viral pneumonia tx
supportive
SVC syndrome sx
facial fullness, face and arm edema
dilated veins over anterior chest, arms, and face
JVD
MC bronchogenic lung cancer
non- small cell
SVC syndrome
SVC syndrome patho
obstruction of SVC bu tumor
impairs venous flow to RA
pancoast tumor patho
superior pulmonary sulcus tumor
apical tumor at apex of lung compresses C8, T1 and T1 nerve roots
pancoast tumor sx
shoulder pain radiating down arm
pain, UE weakness
pancoast tumor associated w/
horners syndrome
horners syndrome patho
invasion of cervical sympathetic chain by apical tumor
horners syndrome sx
unilateral facial anhidrosis, ptosis, miosis
nerve compressed to cause hoarseness
recurrent laryngeal nerve
nerve compressed to cause diaphragmatic elevation and SOB
phrenic nerve
most agressive lung cancer
small cell
small cell lung cancer location
central
eaton Lambert syndrome
autoantibodies destroy neurons
proximal muscle weakness, dec DTR, paresthesia
small cell lung cancer sx
SIADH
cushings
eaton Lambert syndrome
small cell lung cancer tx
chemo rad
surgery limited, usually not resectable
SCC lung cancer location
non small cell cancer
central lesion
MC peripheral lesion lung cancer
adenocarcinoma
non small cell lung cancer tx
surgery
mesothelioma MC type
pleura tumor
mesothelioma due to
asbestos exposure
talc
mesothelioma sx
dyspnea, WL, cough, blood effusion,
pleural pain, CP, pneumothorax, hemoptysis
mesothelioma test
CXR, CT: pleural thickening
bx definitive
immunostain w/ calretinin –> fried egg shape
mesothelioma tx
local: pleurectomy
prognosis poor
pulmonary carcinoid tumor patho
dysfx of neuroendocrine cells leading to tumor production
pulmonary carcinoid tumor sx
bimodal distribution
serotonin synthesis
episodic diarrhea, skin flushing, wheezing (asthma like attacks)
hemoptysis, recurrent pneumonia, hypoTN
pulmonary carcinoid tumor test
bronchoscopy: pink/purple end-bronchial lesion, well vascularized central tumor
Best: 24h urine w/ 5-HIAA –> inc serotonin levels
pulmonary carcinoid tumor tx
surgical excision TOC
octreotide
solitary pulmonary nodule (benign)
<6mm, no growth over 2y
circular and regular shape
central laminated calcification
solitary pulmonary nodule (malignant)
> 50yo smoker or hx of size >3cm
steady growth
irregular in shape/margins, stippled/ eccentric calcification
solitary pulmonary nodule RF granuloma
TB, histoplasmosis
coccidiomycosis
RA, sarcoidosis
thyoma
solitary pulmonary nodule hamartoma sx
non smoker
asx
popcorn ball appearance
solitary pulmonary nodule granuloma sx
non smoker
asx
bullseye nodule appearance
solitary pulmonary nodule TB sx
immigrant, known exposure, + PPD
F, calcification <2cm
military pattern, apical, round
solitary pulmonary nodule fungal.(MAC) infx sx
HIV + or low CD4
multiple sizes
solitary pulmonary nodule sarcoidosis sx
bilateral caveating nodules w/ hilar lymphadenopathy
solitary pulmonary nodule test
compare w/ previous CXR
low probability nodule –> CT
intermediate: (nodule >1cm) PET + PET then bx
high probability: bx
pleural effusion MCC transudative
CHF
cirrhosis
pleural effusion MCC exudative
bacterial pneumonia
malignancy
pleural effusion sx
peripheral edema
dullness to percussion
dec BS, dec TF
pleural effusion test
CXR: blunting of costophrenic angle (meniscus sign)
thoracentesis: gold standard
pleural effusion tx
transudative: diuretics, Na restriction, thoracentesis
exudative: thoracentesis and tx underlying
spontaneous pneumothorax sx
ipsilateral CP, sudden
dec BS, hyperrestonance
dec/absent TF
spontaneous pneumothorax CXR
absence of lung markings
mediastinal shift to opposite side of pneumothorax
companion lines
spontaneous pneumothorax tx
tube thoracotomy
tension pneumothorax sx
hypotension, JVD shift trachea away from affected lung absent breath sounds hyper resonance pulses paradoxus
tension pneumothorax tx
needle thoracotomy
tension pneumothorax complications
positive pressure ventilation increased accumulated air
exacerbates tension pneumothorax and causing cardiovascular collapse
cor pulmonale patho
pulmonary HTN –> structural changes to right ventricle (dilation/ hypertrophy)
secondary to underlying pulmonary disease
cor pulmonale MC form
chronic d/t COPD
acute typically d/t PE
cor pulmonale sx
parasternal lift, loud S2, sx of RHF (hepatomegaly, edema, JVD)
tricuspid regurgitation
cor pulmonale test
initial: echo (RV dilation)
confirm: R heart Cath
CXR: enlarged pulmonary arteries, prominent R heart border
cor pulmonale tx
tx underlying
COPD: bronchodilators + INH steroid
OSA: CPAP
CHF: diuretics
PE sx
dyspnea, tachycardia
dullness to percussion, dec BS
pleuritic CP
PE test
initial: CT MAT: CTA gold if renal pt or contrast allergy: VQ scan CXR: hamptons hump and westermark sign low suspicion: D dimer
PE tx
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
pulmonary HTN patho
pulmonary arterial pressure >25 at rest
RVH
pulmonary HTN sx
dyspnea on exertion, CP on exertion, syncope on exertion tricuspid regurgitation (holosystolic murmur) accentuated S2 RHF sx
pulmonary HTN test
BIT: echo: dilated pulmonary artery, dilation of RA and RV
CXR: enlarged pulmonary arteries
gold: R heart Cath
pulmonary HTN tx
1: NO, IV adenosine, CCB 1st line
2: tx underlying
3: tx underlying, oxygen
4: anticoagulant 1st line, tx underlying
pulmonary HTN WHO classification
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
idiopathic pulmonary fibrosis causes and RF
meds: amiodarone, bleomycin, MTX
RF: old age, male, smoking, RA
MCC interstitial lung dz
idiopathic pulmonary fibrosis
idiopathic pulmonary fibrosis sx
gradual onset of nonproductive cough
bibasilar crackles, cyanosis
clubbing
idiopathic pulmonary fibrosis test
CXR: honeycombing, reticular opacities
CT
PFT: restrictive
idiopathic pulmonary fibrosis tx
no tx changes outcome
supplemental O2, chest PT
acute: IV CS
definitive: lung transplant
coal worker pneumoconiosis test
CXR: small apical opacities in upper lobe. hyperinflation
PFT: obstructive
coal worker pneumoconiosis tx
vaccination: flu, pneumococcal, minimize exposure
Caplan syndrome
pneumoconiosis + rheumatoid arthritis
asbestosis sx
SOB, dry cough, chronic CP, finger clubbing, pursed breathing
shipyard workers/ construction
asbestosis test
initial: CXR (haze infiltrates, shaggy heart sign, bilateral linear opacities. calcified pleural plaques at lung bases (lower lung)
MAT: bx
asbestosis tx
palliative
malignancy risk: non small cell lung cancer, malignant mesothelioma
silicosis sx
dyspnea on exertion, cough w/ sputum
rhonchi, wheezing, tachyptic
silicosis test
BIT: CXR (localized/ nodular in upper lung lobes, eggshell calcification of hilar nodes. round nodular opacities)
silicosis tx
all pts need TB test
pneumococcal vaccine
flu vaccine
smoking cessation
berylliosis RF
aerospace
fluorescent bulbs
computers
berylliosis sx
acute: diffuse pneumonitis
skin lesions
hypercalcemia
berylliosis test
beryllium lymphocyte proliferation/ transformation test
upper lobs, hilar lymphadenopathy
bx: noncaseating granulomas
berylliosis tx
glucocorticoid therapy for both acute and chronic
MTX if dont respond
only ILD that responds to steroids
byssinosis risk
cotton dust
yarn and rope making
textile
byssinosis sx
early: asthma like sx
late: regular chest tightness at end of first day (Monday chest tightness)
byssinosis test
routine PFT: OSHA requirement
byssinosis tx
exhaust hoods
sarcoidosis sx
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)
sarcoidosis test
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
sarcoidosis tx
resolve spontaneously
mainstay: PO prednisone
MTX if refractory
annual EKG, PFT, and ophthalmology exam
lofgrens syndrome sx
triad: erythema nodosum, bilateral hilar lymphadenopathy, polyarthrialgia
fever
obstructive sleep apnea test
polysomnogram sleep study
obstructive sleep apnea tx
CPAP, weight loss
sleep on side
surgery to realign jaw
central sleep apnea due to
CNS mediated
neurological malfunction
central sleep apnea test
polysomnogram
central sleep apnea tx
CPAP
tracheostomy definitive
pickwickian syndrome patho
hypoventilation in overweight patients
low O2 levels, high CO2
pickwickian syndrome sx
overweight/obese
daytime sleepiness
lower limb swelling, snoring
pickwickian syndrome test
diagnosis of exclusion
pickwickian syndrome tx
CPAP
tracheostomy
pickwickian syndrome complication
pulmonary HTN
RHF
ARDS MCC
sepsis
near drowning
ARDS sx
severe refractory hypoxemia hallmark
doesn’t respond to O2
cyanosis, tachycardia
ARDS test
CXR: bilateral infiltrates, spares costophrenic angles
ARDS tx
oxygen
intubate
fluid management
tx underlying
IRDS RF
caucasian, male, C section delivery
perinatal infections, multiple births (esp premature)
maternal diabetes
IRDS test
CXR: reticular ground glass opacities + air bronchograms
IRDS tx
exogenous surfactant
CPAP
IRDS prevention
CS to mature lungs if premature (24-36w)
asthma attack tx
Best initial: SABA + O2
2nd line: IV methylprednisolone
severe: inhale SABA, inhaled ipratropium and systemic steroids
bronchiectasis patho
permanent abnormal dilation of bronchi walls
impaired clearance of secretions
bronchiectasis MCC
CF
bronchiectasis sx
chronic cough w/ large amount of mucopurulent foul smelling sputum, hemoptysis
bronchiectasis test
BIT/MAT: HR chest CT (tram track, signet ring sign)
bronchiectasis tx
prophylactic abx (amoxicillin, azithromycin, bactrim) pseudomonas/mycoplasma: zosyn aspergillosis (thick brown sputum: CS + itraconazole
cystic fibrosis patho
autosomal recessive
CFTR gene, chromosome 7, F508 mutation
cystic fibrosis sx
meconium ileus in newborn
recurrent chronic URI
thick sticky mucus
steatorrhea, infertility
cystic fibrosis test
newborn screen
sweat chloride test
PFT: obstructive
cystic fibrosis tx
ADEK replacement
chest PT
abx for infections
surgery for meconium ileus
cystic fibrosis complications
respiratory
GI
infertility
cystic fibrosis MC pathogen
pseudomonas
MC location for foreign body lung
right main bronchus
FB lung tx
rigid bronchoscopy gold
hyaline membrane disease patho
deficiency of surfactant (type 2 alveolar cells) in premature infants
SIDS RF
infants sleeping in prone position (strongest modifiable RF)
sleeping on soft surface or w/ accessories
overheating, low birthweight, premature
bed sharing
SIDS reduced risk
supine position for sleep
firm mattress, room sharing w/o bed sharing
pacifier use