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PANCE/EOC > Pulm #2 > Flashcards

Pulm #2 Flashcards

1
Q

What is bronchiectasis?

A

Permanent and irreversible dilation of the bronchial airways

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2
Q

MCC of bronchiectasis in the US

A

Cystic Fibrosis

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3
Q

Recurrent lung infections cause bronchiectasis. What is the main cause if due to CF and what is the main cause if NOT due to CF?

A

CF: Pseudomonas

Non CF: H. Influenzae

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4
Q

What is the pathophysiology of bronchiectasis?

A

-Dilatation of the airways and impairment of mucociliary escalator leads to repeat infections, airway obstruction, and peribronchial fibrosis

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5
Q

Symptoms of bronchiectasis

A
  • Persistent productive cough with thick sputum
  • Hemoptysis
  • Crackles, wheezing, rhonchi
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6
Q

What is the preferred imaging of choice in bronchiectasis and what do you see?

A
  • High resolution CT scan

- -Thickened bronchial walls, airway dilation, lack of tapering of airway (tram-track appearance) and signet ring sign

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7
Q

However, what is the GOLD standard for imaging for bronchiectasis?

A

-Pulmonary function test: obstructive pattern (decreased FEV1, decreased FEV1/FVC <70%)

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8
Q

Treatment for bronchiectasis

A
  • Chest physiotherapy

- ABX often needed: Macrolides, Cephalosporins, Fluoroquinolones. Antibiotic cycling used (1 weekly each month)

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9
Q

Bronchogenic carcinoma is the leading cause of cancer deaths in the US. However, it is the ______most common cancer diagnosed in the US

A

Second (after prostate in men and breast in women

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10
Q

Where does bronchogenic carcinoma MC Met to?

A

-brain, bone, liver, lymph nodes, and adrenals

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11
Q

Risk factors for bronchogenic carcinoma

A
  • Smoking (MC)
  • Asbestosis
  • Radon exposure (miners)
  • TB
  • Genetic susceptibility
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12
Q

The US Preventative Services Task Force recommends annual low-dose CT screening for who?

A

55-80 who have no symptoms of lung cancer + 30 PPY smoking history who currently smoke or have quit within 15 years

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13
Q

What is the MC primary lung cancer in smokers, nonsmokers, women, and men?

A

Adenocarcinoma

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14
Q

Characteristics of adenocarcinoma

A
  • Typically peripheral

- Asymptomatic in early disease; hemoptysis, weight loss, cough, dyspnea

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15
Q

Treatment for adenocarcinoma of the lungs

A

Surgical resection

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16
Q

Symptoms of Squamous Cell Carcinoma

A
  • CCCP
  • -Centrally located
  • -HyperCalcemia
  • -Cavitary Lesions
  • -Pancoast Syndrome: shoulder pain, paresthesias, Horner’s Syndrome
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17
Q

Treatment for Squamous Cell Carcinoma

A

Chemotherapy but often metastatic at the time of presentation

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18
Q

What is chronic bronchitis defined as?

A

-Productive cough for at least 3 months a year for 2 consecutive years

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19
Q

Etiologies of chronic bronchitis

A

Smoking (MC), air pollution, hazardous dust

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20
Q

Pathophysiology of chronic bronchitis

A

Chronic inflammation leads to mucous gland hyperplasia, goblet cell mucus production, dysfunctional cilia

21
Q

Symptoms of chronic bronchitis

A
  • Chronic cough
  • Sputum production
  • Dyspnea
  • Cyanosis and obesity (blue bloaters)
  • Crackles, rhonchi, wheezing
22
Q

Diagnostics for chronic bronchitis

A
  • PFT: gold standard (decreased FEV1/FVC, decreased FEV1)
  • CXR: pulmonary hypertension
  • ECG: cor pulmonale
  • CBC: increased hemoglobin and hematocrit
  • ABG: respiratory acidosis
23
Q

Health Maintenance for chronic bronchitis

A

1) Quit smoking
2) vaccines (Pneumococcal and flu)
3) pulmonary rehab
4) Surgery
5) Azithromycin has been shown to have anti-inflammatory properties in the lungs

24
Q

Treatment for chronic bronchitis

A
  • Quit smoking
  • Combo therapy with anticholinergics + B2 agonists
  • ICS - never used alone. Add to LABA
  • O2
25
Q

What is the only therapy shown to decrease mortality in chronic bronchitis

A

Oxygen

26
Q

What is cystic fibrosis?

A

-Autosomal recessive defect that prevents chloride transport (water movement out of cell) –> build up of thick mucus in the lungs, pancreas, liver, intestines –> obstructive disease and exocrine gland dysfunction

27
Q

What gene is affected with cystic fibrosis?

A

Chromosome 7, CFTR gene

28
Q

Symptoms of cystic fibrosis

A
  • Meconium ileus
  • Failure to thrive
  • Bronchiectasis
  • Malabsoprtion of vitamins ADEK
  • Diarrhea
  • Infertility due to azoospermia
  • Pancreatitis
  • Sinusitis
29
Q

Most accurate diagnosis for Cystic Fibrosis

A
  • Elevated sweat chloride: 60 mmol/L or more on two occasions after Pilocarpine (induces sweating)
  • PFT: Obstructive pattern
30
Q

Treatment for CF

A
  • Airway clearance treatment: bronchodilators, decongestants
  • Pancreatic enzyme replacement: ADEK
  • ABX often needed: Macrolides, Cephalosporins, Augmentin
  • Lung and pancreatic transplant
  • Pneumococcal and Flu Vaccines
31
Q

Which type of Influenza is associated with more severe outbreaks?

A

Influenza A

32
Q

Risks for influenza

A
  • Age > 65
  • Pregnancy
  • Immunocompromised
  • Children are important vectors for the disease
33
Q

Symptoms of influenza

A
  • Abrupt onset of headache, fever, chills, malaise, URI symptoms, pharyngitis, PNA
  • Myalgias involving legs and lumbosacral areas
34
Q

Diagnostics for influenza

A
  • Usually clinical

- Rapid influenza test (nasal swab) or viral culture

35
Q

Treatment for Influenza

A
  • Supportive: Acetaminophen, Rest

- Antivirals only needed if > 65 or at high risk for complications (Oseltamivir) within 48 hours of symptom onset

36
Q

Who can get the inactivated influenza vaccination?

A

-All individuals 6 months or older (including pregnancy)

37
Q

Who can get the live attenuated vaccination and who cannot?

A

Can: ages 2-49
Cannot: immunocompromised, pregnancy, age 50 or older, if taken an antiviral within the last 48 hours, close caregivers of immunocompromised patient

38
Q

Pertussis (Whoopng cough) is a highly contagious infection secondary to ________, a gram ________

A

Bordatella Pertussis

Gram negative coccobacillus

39
Q

Three phases of Pertussis

A
  • Catarrhal: URI symptoms lasting 1-2 weeks
  • Paroxysmal: Severe coughing fits with inspiratory whooping after cough fits. Post-cough emesis. Lasts 2-4 weeks
  • Convalescent: resolution of the cough (lasts up to 6 weeks)
40
Q

Which stage of Pertussis is the most contagious?

A

Catarrhal

41
Q

Diagnostics for Pertussis

A
  • Clinical diagnosis

- However, when available, order throat culture and PCR nasal swab

42
Q

Treatment of Pertussis

A
  • Supportive is mainstay
  • Macrolides are DOC to reduce contagiousness
  • Bactrim second line
  • Azithromycin if patient < 1 month old
43
Q

When is the DTaP vaccination given?

A

2, 4, 6, 15-18 months
4-6 years old
11-18 years old booster

44
Q

What is the gold standard diagnostic for Pertussis?

A

PCR of nasopharyngeal swab

45
Q

MCC of Laryngotracheitis (Croup)

A

Parainfluenza Type I

46
Q

Symptoms of Croup

A
  • Upper airway involvement
  • Harsh, seal like barking cough
  • Inspiratory stridor, hoarseness
  • Coryza (inflammation of nasal cavity)
47
Q

Diagnostics for Croup

A
  • Clinical diagnosis

- Frontal cervical radiographs: Steeple sign (rarely done)

48
Q

Treatment for Croup (Mild, Moderate, Severe)

A

Mild (no stridor at rest, no respiratory distress): Supportive. Dexamethasone provides significant and quick relief. Discharged home

Moderate (stridor at rest with mild retractions): Dexamethasone PO or IM + supportive. Nebulized epinephrine. Observe for 3-4 hours.

Severe (stridor at rest with marked retractions): Dexamethasone + nebulizer Epinephrine and hospitalization

49
Q

What is the inhaler of choice for COPD?

A

Ipratropium Bromide

PANCE/EOC (63 decks)

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