Pulm -- 15% of EOR Flashcards
Describe some diagnostic findings associated with chronic bronchitis, including lab findings, PFT results, and gold std diagnostic test
3+ months of symptoms
PFT:
- FEV1/FVC ratio <0.7
- Both FEV1 and FVC are reduced
- Ratio does not improve with albuterol
Labs may show increased Hgb/Hct 2/2 chronic hypoxic state
Gold std diagnostic test is lung biopsy
Name the drugs used to treat acute COPD exacerbations
O2
B-agonists – albuterol, terbutaline
Steroids – PO prednisone > inhaled budesonide
Anticholinergics (ipatropium/tiotropium – cholinergic tone only reversible aspect of COPD)
Antibiotics if Gold’s criteria met – amoxicillin, doxy, bactrim for mild, augmentin, levaquin, cipro for severe)
Describe the cellular pathophys involved in chronic bronchitis
Enlargement of mucous glands
Hypertrophy of goblet cells in large airways
Describe CXR findings in a patient with bronchiectasis
Bronchi will be dilated and thickened, with ring-like markings; buzzword = “Tram tracks”
What are 3 indications to test for anti-1-antitrypsin deficiency?
- COPD in a patient <45 YO
- COPD with evidence of concurrent liver disease
- FHx of anti-1-antitrypsin deficiency
Pt with SLE, dry cough, DoE, clubbing of the fingers is suspicious for what?
Idiopathic pulmonary fibrosis – patients being treated with methotrexate are at higher risk for this, as are patients with autoimmune dz, connective tissue dz, and some occupational exposures.
Describe the CXR findings associated with idiopathic pulmonary fibrosis
Non-specific:
- reticular infiltrates
- spherical, nodular infiltrates
- or reticulonodular pattern
- Buzzword = honeycombing
How is idiopathic pulmonary fibrosis diagnosed?
HRCT is definitive
- CXR –> HRCT
What PFT findings are associated with idiopathic pulmonary fibrosis?
PFTs will show reduced TLC and reduced RV
What is the treatment for IPF?
Definitive = lung transplant
Pharmacotherapy include tyrosine kinase inhibitors (nintedanib) and TGF-beta regulars (pirfenidone)
What disease process and CXR findings are associated with pathological collagen deposition in the alveolar interstitium?
Idiopathic pulmonary fibrosis - will see honeycombing on CXR (thickened alveolar walls)
What is one drug ass’d with drug-induced pulmonary fibrosis, and what are the CXR findings?
Amiodarone, will look like ground glass infiltrates on CXR
Silicosis pneumoconiosis is associated with what kind of occupational exposures, and what are the characteristic CXR findings?
Sand, cement, stone, and fracking – eggshell calcifications are often seen on CXR
Asbestosis pneumoconiosis is associated with what kind of occupational exposures, and what are the characteristic CXR findings?
Asbestos/construction, shipbuilding, car repair, and textiles
Pleural plaques and pleural thickening is often found on CXR
Coal pneumoconiosis is associated with what CXR findings, and what eponymous syndrome?
Small nodules and hyperinflation in an obstructive pattern may be seen on CXR
Can manifest with symptoms of RA = Caplan syndrome
Talc pneumoconiosis is associated with what kind of occupational exposures, and what are the characteristic CXR findings?
Ceramic, paper, plastic, rubber, paint, and cosmetics – or hx of IV drug use, manigests as talc granulomatosis
Small, rounded opacities and micronodules may be seen on CXR, along with evidence of pulmonary hypertension
Berylliosis pneumoconiosis is associated with what kind of occupational exposures, and how does it manifest?
Dental, computer, nuclear, or aeorspace work. Causes a hypersensitivity reaction but can lay dormant for months - decades.
Hypersensitivity pneumoconiosis is associated with what kind of occupational exposures, and what are the characteristic CXR findings?
Birds and mold – also called extrinsic allergic alveolitis. Also associated with agricultural dusts, aerosolns, grain, hay, silage, sugar cane.
Non-fibrotic changes are seen, including mosaic attenuation and diffuse, multi-focal ground glass opacities on CXR.
In the setting of PNA, what do air-fluid levels on CXR indicate?
Pulmonary abscess
In the setting of PNA, what are cavitary lesions suspect for?
TB or fungal infection
You suspect your patient has PNA, but the CXR comes back clear. What is the likely dx?
Viral bronchitis
You suspect your patient has PNA, and the CXR comes back showing a reticular, lacy pattern. What is this concerning for?
Interstitial pneumonia, or an AIDS-related PNA (Pneumocystis jirovecii or MAC)
What is the treatment for uncomplicated CAP in a patient without any recent abx use?
Amoxicillin or cephalosporin
plus
Azithromycin, clarithromycin, or doxy
(AZ + cefpodoxime)
What is the treatment for HCAP PNA or sick as shit PNA?
Vanc + Zosyn
Vanc covers MRSA, zosyn covers pseudomonas
Alternatively linezolid + miropenem has same coverage
What is the treatment for ventilator-associated PNA?
Vanc + Zosyn + Cipro
Vanc covers MRSA, zosyn covers pseudomonas
Alternatively linezolid + miropenem + cipro has same coverage
What are the CURB-65 criteria?
Confusion Uremia (BUN 30+) RR 30+ BP <90/50 65+ YO
Pt with pharyngitis, HA, malaise, persistent dry cough, and (+) cold agglutinin titer is suspicious for what?
Mycoplasma PNA
Tx with AZ or doxy
What Gram + diplococci pulmonary pathogen is associated with rusty/blood-tinged sputum, and what disease does it cause?
Strep pneumo – MC cause of PNA
Pulmonary pathogen, Gram + cocci, found arranged in clusters associated with salmon-colored sputum:
- What is the organism?
- What disease does this cause?
- What will be seen on CXR?
- S aureus
- Causes PNA, usually HAP
- Will see bilateral, multilobar infiltrates, abscesses, or cavitary lesions on CXR
What is the tx for HAP?
Zosyn, cefepime/ceftazidime, or meropenem
— PLUS
Gentamicin or tobramycin
Add vanc if there is concern for MRSA
Alcoholic patient with respiratory complaints coughing up bloody sputum - what is the likely etiologic agent? Describe the morphology
Klebsiella - Gram (-) rods
What are some of the extrapulmonary findings associated with Legionella PNA?
Diarrhea, n/v
HA, confusion, AMS
How is Legionella PNA dx’d?
PCR, urine antigen
What are some heart sounds associated with pulmonary HTN?
Wide, split, loud S2
Describe the pulmonary and cutaneous findings associated with sarcoidosis
Pulmonary:
- Often incidental findings on CXR:
- – Bilateral hilar adenopathy
- – Reticular opacities
- Pneumothorax, pleural thickening, pulmonary HTN
- Cough, dyspnea, CP
Cutaneous:
- Papules of nares, lips, eyelids, forehead, nape of neck, and along scars/tattoos
- Nodular lesions on face, trunk, extensor surfaces
- Plaques on shoulders, arms, back, buttocks
- Lupus pernio: violaceous or erythematous, indurated lesions on nose, cheeks, chin, ears
- Erythema nodosum and subcutaneous nodules, both painful
What is the treatment for sarcoidosis?
Corticosteroids and methotrexate
What is the definition of a solitary pulmonary nodule, and what are concerning findings?
By definition <3cm diameter Suspicious characteristics: - ill-defined - lobular or spiculated - >5.3 cm
What are the screening recommendations for solitary pulmonary nodules?
If <1cm, monitor at:
- 3 mo
- 6 mo
- then annually
If it doesn’t grow in 2+ years, it is likely benign
