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IM EOR > Pulm -- 15% of EOR > Flashcards

Pulm -- 15% of EOR Flashcards

1
Q

Describe some diagnostic findings associated with chronic bronchitis, including lab findings, PFT results, and gold std diagnostic test

A

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

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2
Q

Name the drugs used to treat acute COPD exacerbations

A

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)

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3
Q

Describe the cellular pathophys involved in chronic bronchitis

A

Enlargement of mucous glands

Hypertrophy of goblet cells in large airways

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4
Q

Describe CXR findings in a patient with bronchiectasis

A

Bronchi will be dilated and thickened, with ring-like markings; buzzword = “Tram tracks”

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5
Q

What are 3 indications to test for anti-1-antitrypsin deficiency?

A
  • COPD in a patient <45 YO
  • COPD with evidence of concurrent liver disease
  • FHx of anti-1-antitrypsin deficiency
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6
Q

Pt with SLE, dry cough, DoE, clubbing of the fingers is suspicious for what?

A

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.

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7
Q

Describe the CXR findings associated with idiopathic pulmonary fibrosis

A

Non-specific:

  • reticular infiltrates
  • spherical, nodular infiltrates
  • or reticulonodular pattern
  • Buzzword = honeycombing
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8
Q

How is idiopathic pulmonary fibrosis diagnosed?

A

HRCT is definitive

- CXR –> HRCT

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9
Q

What PFT findings are associated with idiopathic pulmonary fibrosis?

A

PFTs will show reduced TLC and reduced RV

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10
Q

What is the treatment for IPF?

A

Definitive = lung transplant

Pharmacotherapy include tyrosine kinase inhibitors (nintedanib) and TGF-beta regulars (pirfenidone)

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11
Q

What disease process and CXR findings are associated with pathological collagen deposition in the alveolar interstitium?

A

Idiopathic pulmonary fibrosis - will see honeycombing on CXR (thickened alveolar walls)

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12
Q

What is one drug ass’d with drug-induced pulmonary fibrosis, and what are the CXR findings?

A

Amiodarone, will look like ground glass infiltrates on CXR

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13
Q

Silicosis pneumoconiosis is associated with what kind of occupational exposures, and what are the characteristic CXR findings?

A

Sand, cement, stone, and fracking – eggshell calcifications are often seen on CXR

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14
Q

Asbestosis pneumoconiosis is associated with what kind of occupational exposures, and what are the characteristic CXR findings?

A

Asbestos/construction, shipbuilding, car repair, and textiles
Pleural plaques and pleural thickening is often found on CXR

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15
Q

Coal pneumoconiosis is associated with what CXR findings, and what eponymous syndrome?

A

Small nodules and hyperinflation in an obstructive pattern may be seen on CXR

Can manifest with symptoms of RA = Caplan syndrome

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16
Q

Talc pneumoconiosis is associated with what kind of occupational exposures, and what are the characteristic CXR findings?

A

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

17
Q

Berylliosis pneumoconiosis is associated with what kind of occupational exposures, and how does it manifest?

A

Dental, computer, nuclear, or aeorspace work. Causes a hypersensitivity reaction but can lay dormant for months - decades.

18
Q

Hypersensitivity pneumoconiosis is associated with what kind of occupational exposures, and what are the characteristic CXR findings?

A

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.

19
Q

In the setting of PNA, what do air-fluid levels on CXR indicate?

A

Pulmonary abscess

20
Q

In the setting of PNA, what are cavitary lesions suspect for?

A

TB or fungal infection

21
Q

You suspect your patient has PNA, but the CXR comes back clear. What is the likely dx?

A

Viral bronchitis

22
Q

You suspect your patient has PNA, and the CXR comes back showing a reticular, lacy pattern. What is this concerning for?

A

Interstitial pneumonia, or an AIDS-related PNA (Pneumocystis jirovecii or MAC)

23
Q

What is the treatment for uncomplicated CAP in a patient without any recent abx use?

A

Amoxicillin or cephalosporin
plus
Azithromycin, clarithromycin, or doxy

(AZ + cefpodoxime)

24
Q

What is the treatment for HCAP PNA or sick as shit PNA?

A

Vanc + Zosyn

Vanc covers MRSA, zosyn covers pseudomonas

Alternatively linezolid + miropenem has same coverage

25
Q

What is the treatment for ventilator-associated PNA?

A

Vanc + Zosyn + Cipro

Vanc covers MRSA, zosyn covers pseudomonas

Alternatively linezolid + miropenem + cipro has same coverage

26
Q

What are the CURB-65 criteria?

A 
Confusion
Uremia (BUN 30+)
RR 30+
BP <90/50
65+ YO
27
Q

Pt with pharyngitis, HA, malaise, persistent dry cough, and (+) cold agglutinin titer is suspicious for what?

A

Mycoplasma PNA

Tx with AZ or doxy

28
Q

What Gram + diplococci pulmonary pathogen is associated with rusty/blood-tinged sputum, and what disease does it cause?

A

Strep pneumo – MC cause of PNA

29
Q

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?
A
  • S aureus
  • Causes PNA, usually HAP
  • Will see bilateral, multilobar infiltrates, abscesses, or cavitary lesions on CXR
30
Q

What is the tx for HAP?

A

Zosyn, cefepime/ceftazidime, or meropenem
— PLUS
Gentamicin or tobramycin

Add vanc if there is concern for MRSA

31
Q

Alcoholic patient with respiratory complaints coughing up bloody sputum - what is the likely etiologic agent? Describe the morphology

A

Klebsiella - Gram (-) rods

32
Q

What are some of the extrapulmonary findings associated with Legionella PNA?

A

Diarrhea, n/v

HA, confusion, AMS

33
Q

How is Legionella PNA dx’d?

A

PCR, urine antigen

34
Q

What are some heart sounds associated with pulmonary HTN?

A

Wide, split, loud S2

35
Q

Describe the pulmonary and cutaneous findings associated with sarcoidosis

A

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
36
Q

What is the treatment for sarcoidosis?

A

Corticosteroids and methotrexate

37
Q

What is the definition of a solitary pulmonary nodule, and what are concerning findings?

A 
By definition <3cm diameter
Suspicious characteristics:
- ill-defined
- lobular or spiculated
- >5.3 cm
38
Q

What are the screening recommendations for solitary pulmonary nodules?

A

If <1cm, monitor at:

  • 3 mo
  • 6 mo
  • then annually

If it doesn’t grow in 2+ years, it is likely benign

IM EOR (8 decks)

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