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GK PANCE > Pulm > Flashcards

Pulm Flashcards

1
Q

MCC of bronchitis

A

adenovirus

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2
Q

pathophys of bronchitis

A

inflamed trachea and bronchii produce mucus

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3
Q

sx of bronchitis

A

Hx of URI followed by productive cough lasting 1-3 wks

+/- Fever

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4
Q

How can you differentiate between bronchitis and pneumonia?

A

Pneumonia = dyspnea

NO DYSPNEA in bronchitis

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5
Q

What does CXR show for bronchitis?

A

Nothing

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6
Q

how is dx for bronchitis made

A

clinical

CXR shows nothing

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7
Q

Tx for bronchitis

A

supportive, bronchodilators (SABA) may help

DO NOT GIVE antibiotics

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8
Q

MCC of bronchiolitis

A

RSV (respiratory synctial virus)

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9
Q

Lower respiratory tract infection that affects the small airways

A

bronchiolitis

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10
Q

What age group is most affected by bronchiolitis?

A

2mos-2y/o

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11
Q

pathophys of bronchiolitis

A

proliferation/necrosis of bronchiolar epithelium

↓

produces obstruction from sloughed epithelium

↓

increased mucus plugging

↓

submucosal edema

↓

peripheral airway narrowing + obstruction

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12
Q

Risk Factors for Bronchiolitis

A
  1. cig smoking
  2. lack of breastfeeding
  3. premature infant <37 weeks gestation
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13
Q

What symptoms indicate respiratory distress?

A
  1. wheezing
  2. tachypnea
  3. nasal flaring
  4. cyanosis
  5. retractions
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14
Q

What is polyphonic wheezing and what medical state do you hear it in?

A

Polyphonic wheezes are loud, musical and continuous. These breath sounds occur in expiration and inspiration and are heard over anterior, posterior and lateral chest walls.

*Bronchiolitis*

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15
Q

What is the best dx test for bronchiolitis?

A

Pulse Ox

if < 96%, pt must be admitted

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16
Q

What is another diagnostic tool that can be used in bronchiolitis in addition to pulse Ox?

A

CXR: hyperinflation and peribronchial cuffing (border around the bronchials that make a bold border around the edge)

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17
Q

mild bronchiolitis tx

A

supportive: IVF + nebulizers (racemic epinephrine) if needed

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18
Q

What can you trial in a pt with bronchiolitis?

A

aerosolized albuterol

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19
Q

Are corticosteroids indicated in tx of bronchiolitis?

A

NO

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20
Q

What medication can you use in pts w/ bronchiolitis who have underlying heart, lung or immune disease?

A

Ribavirin

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21
Q

Tx for severe bronchiolitis

A

high flow nasal cannula humidified O2 + IVF + nebulized epinephrine/albuterol

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22
Q

What are the main complications of bronchiolitis?

A
  1. Respiratory failure
  2. Otitis Media (acute)
  3. Asthma (chronic)
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23
Q

What population is RSV prophylaxis in relation to preventing bronchiolitis recommended for?

A

Recommended in winter for high-risk pts <2y/o w/ hx of prematurity, chronic lung dz or congential heart dz.

Palivizumab (injectable poly or monoclonal antibodies)

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24
Q

MCC of epiglottitis

A

HiB (Bacteria)

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25
Q

Sx of epiglottitis

A

Dysphagia

Droooling

Distress

+

inspiratory stridor

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26
Q

How will a patient with epiglottits look when you walk into the room?

A

neck hyperextended + chin protruding (sniffing dog position)

Lean forward in a “tripod” position

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27
Q

Dx for epiglottitis

A

clinical impression

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28
Q

What do you want to absolutely avoid in patients with possible epiglottitis?

A

the airway must be secured before a definitive dx can be made: DO NOT USE TONGUE DEPRESSOR

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29
Q

thumbprint sign

A

lateral cervical CXR for epiglottitis

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30
Q

Definitive dx for epiglottitis

A

Laryngoscopy

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31
Q

Tx for epiglottitis

A

secure airway, check ABCs

2nd or 3rd gen cephalosporins: Ceftriaxone or cefotaxine

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32
Q

swelling of the subglottic/larynx

A

croup

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33
Q

barking cough

A

croup

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34
Q

seal like cough

A

croup

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35
Q

harsh cough

A

croup

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36
Q

MCC of croup

A

parainfluenza virus type 1

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37
Q

sx of croup

A

Secondary to viral infection

low grade fever, mild dyspnea, inspiratory stridor, hoarse voice, barking cough

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38
Q

steeple sign

A

croup

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39
Q

subglottic narrowing

A

steeple sign

seen on AP neck film for croup patient

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40
Q

mild croup tx

A

OP mgmt w/ cool mist therapy and fluids

dexamethasone

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41
Q

moderate croup tx

A

Supplemental O2

IM Corticosteroids

nebulized racemic epinephrine

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42
Q

Severe croup tx (respiratory distress at rest, inspiratory stridor)

A

hospitalize + nebulized racemic epinephrine

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43
Q

What is the MCC of epiglottitis post vaccination for HiB?

A

strep and staph species

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44
Q

life threatening acute hypoxemic respiratory failure

A

acute respiratory distress syndrome

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45
Q

this disease develops in pts already critically ill

A

ARDS

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46
Q

what is the MCC of ARDS?

A

sepsis

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47
Q

hypoxemia

↓ lung compliance

non-cardiogenic pulmonary edema

A

ARDS

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48
Q

PaCO2/FiO2 ratio <200

A

ARDS

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49
Q

pathogenesis of ARDS

A

endothelial injury

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50
Q

sx of ARDS in phase 1 acute injury

A

normal PE

+/- respiratory alkalosis

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51
Q

sx of ARDS Phase 2 (6-48 hrs)

A

hyperventilation, hypocapnia

52
Q

sx of ARDS Phase 3&4

A

acute resp failure, tachypnea, dyspnea, ↓ lung compliance, scattered rales, difficuse chest opacity on CXR

↓

severe hypoxemia unresponsive to therapy

↓

metabolic + respiratory acidosis

53
Q

Dx for ARDS

A

acute onset of respiratory distress

PaO2/FiO2 ratio of <200

54
Q

diffuse alveolar filling pattern on CXR

A

ARDS

55
Q

bilateral pulmonary infiltrates on CXR

A

ARDS

56
Q

capillary wedge pressure <18mmHg

A

ARDS

57
Q

Tx for ARDS

A

mechanical ventilation, +/- CPAP

PEEP (Positive end expiratory pressure): recruits collapsed alveoli

58
Q

What CXR looks similar to an ARDS CXR?

How can you differentiate in diagnosis?

A

Cardiogenic Pulmonary Edema: PCWP >18

ARDS: PCWP <18

59
Q

3 criteria to dx ARDS

A
  1. refractory hypoxemia
  2. B/L pulm infiltrates on CXR
  3. absence of cardiogenic pulm edema/CHF
60
Q

wheezing is louder during

A

expiration

61
Q

What is wheezing?

A

a high-pitched whistling, continuous, musical sound produced by narrowed/obstructed airways.

62
Q

low pitched sounds that may clear with cough

A

rhonchi

63
Q

crackles/rales are heard during

A

inspiration

64
Q

Samter’s triad

A
  1. asthma
  2. nasal polyps
  3. ASA/NSAID allergy
65
Q

3 main pathophys components of asthma

A
  1. airway hyperreactivity
  2. bronchoconstriction
  3. inflammation
66
Q

decreased expiratory airflow & increased airway resistance

A

obstructive

67
Q

classic triad of asthma

A
  1. dyspnea
  2. wheezing
  3. coughing esp @ night
68
Q

What will PE show for asthmatic patients?

A

prolonged expiration with wheezing, hyperresonance to percussion

69
Q

PE for severe asthma & status asthmaticus

A

AMS

pulsus paradoxus (Inspiratory decrease in SBP > 10)

silent chest (no air exchange)

70
Q

Gold standard Dx test for asthma

A

PFT: reversible obstruction

71
Q

What should you do next if PFT testing doesn’t show asthma?

A

bronchoprovocation: methacholine challenge test

72
Q

What are the 3 classes of rescue drugs for Asthma exacerbations?

A
  1. SABA: 1st line, most effective & fastest working. (Albuterol, Terbutaline, Epi)
  2. Anticholinergics (ipatropium)
  3. Corticosteroids (Prednisone)
73
Q

MC S/E of SABAs

A

tachycardia, arrhythmias, muscle tremors, CNS stimulation

74
Q

S/E of ipratropium

A

thirst, blurred vision, dry mouth, urinary retention, dysphagia, acute glaucoma, BPH

75
Q

What medication decreases relapse of asthma?

A

Prednisone

76
Q

5 classes of medications used for long term mgmt of asthma

A
  1. ICS (Flunisolide, Triamcinolone)
  2. LABA (Salmeterol, Formoterol)
  3. Mast Cell Modifiers (Cromolyn, Nedocromil)
  4. Leukotriene Modifiers/Receptor Antagonists (LTRA) (Montelukast, Zafirlukast)
77
Q

What is the drug of choice for long term, persistent chronic maintenance of asthma?

A

ICS

78
Q

Main S/E w/ ICS

A

thrush

79
Q

which medication targets nocturnal asthma?

A

LABAs

80
Q

When would you add a LABA to the tx regimen for asthma?

A

added to steroids ONLY if persistent asthma is not controlled with ICS alone

Once asthma control maintained > 3 mos, step down off LABA recommended

81
Q

Which asthma med inhibits acute phase response to cold air, exercise and sulfites?

A

Mast cell modifiers (Cromolyn, Nedocromil)

82
Q

Which asthma med is useful in pts w/ allergic rhinitis/ ASA induced asthma?

A

LTRA (montelukast)

83
Q

bronchodilator that improves resp muscle endurance

A

Theophylline

84
Q

S/E of theophylline

A

nervousness, N/V, anorexia, HA

85
Q

postinfluenza or postviral pneumonia causative agent

A

staph aureus

86
Q

Post-Viral Pneumonia

A

Patient with a history of influenza

Complaining of fever, productive cough with bloody sputum and shortness of breath

CXR will show multiple cavitary lesions

Most commonly caused by Staphylococcus aureus

87
Q

What will CXR for postviral pneumonia show?

A

multiple cavitary lesions

88
Q

Tx for postviral Pnuemonia

A

staph aureus

Tx: vancomycin, linezolid, Piper-Taco

89
Q

skin flushing

wheezing

diarrhea

A

Bronchial carcinoid tumor

90
Q

Dx for broncial carcinoid tumors

A

24-hour excretion of 5-hydroxyindoleacetic acid (5-HIAA) in the patient’s urine

91
Q

classic triad for Pulm Embolism

A
  1. dyspnea
  2. pleuritic chest pain
  3. hemoptysis
92
Q

Best initial test for pulm Embolism

A

Helical CT scan

93
Q

gold standard test for Pulm Embolism

A

Pulm angiography

94
Q

CXR will show what in a pt w/ PE

A
  1. Westermark’s sign: avascular markings distal to area of embolism
  2. Hampton’s Hump: wedge shaped infiltrate (infarction)
95
Q

ECG for PE

A

S1Q3T3

96
Q

When would you do a pulm angio in a PE?

A

ordered if high suspicion & negative CT or VQ scan

97
Q

fever

diarrhea

confusion

hyponatremia

A

Legionella Pneumonia

98
Q

Tx when stridor is present at rest in a croup pt

A

epi + dexamethasone

99
Q

What does CXR show for sarcoidosis

A

bilateral hilar lymphadenopathy

100
Q

MCC of transudate effusion

A

CHF

101
Q

Causes of transudate Pleural effusion

A
  • CHF
  • Nephrotic syndrome
  • Cirrhosis
  • PE

all “failures” are transudate: renal/liver/heart

102
Q

Causes of exudate

A

pus-related:

  • Bacterial/viral pneumonia
  • TB
  • Pancreatitis
  • Malignancy
103
Q

What are the 3 types of non-small cell carcinomas?

A
  1. Adenocarcinoma
  2. Squamous Cell
  3. Large Cell (anaplastic) carcinoma
104
Q

MC type of lung cancer

A

adenocarcinoma

105
Q

Bronchogenic Carcinoma -Adenocarcinoma

A

peripheral

metastasizes to distant areas

106
Q

Lung nodule Cpx: nonsmoker, incidental finding

A

non small cell carcinoma (adenocarcinoma)

107
Q

Lung Nodule findings:

voluminous sputum

interstitial lung pattern on CXR

A

bronchioalveolar lung nodule (subtype of non small cell carcinoma adenocarcinoma)

108
Q

“CCCP”

Centrally Located

Cavitary lesions

hyperCalcemia

Pancoast Syndrome

A

squamous cell lung cancer

109
Q

Pancoast Syndrome

A
  • associated w/squamous cell cancer (CCCP)
  • tumor @ superior sulcus
  • shoulder pain
  • horner’s syndrome
  • atrophy of hand/arm muscles
110
Q

what is a very aggressive lung cancer?

A

large cell anaplastic carcinoma

111
Q

these lung nodules metastasize early and surgery is not the tx of choice

A

small cell (oat cell) carcinoma

112
Q

SIADH/Hyponatremia

SVC syndrome: dilated neck veins, facial plethora, prominent chest veins

Cushing’s syndrome

Lambert Eaton Syndrome

All of these associated with which type of lung CA?

A

small cell (oat cell) lung CA

113
Q

Which 2 lung nodules are found centrally?

A

squamous cell

small cell/oat cell

114
Q

Which 3 lung nodules are found peripherally?

A

adenocarcinoma (NSCC)

Large cell Carcinoma

115
Q

Dx workup for lung CA

A

CXR & CT SCAN

Sputum Cytology and bronchoscopy useful for central lesions

116
Q

Non Small Cell Lung Nodule Mgmt

A

surgical resection

117
Q

Small Cell Lung Nodule Mgmt

A

chemo

118
Q

Cor Pulmonale

A

an alteration in the structure and function of the right ventricle caused by a primary disorder of the respiratory system.

R heart dysfunction due to a lung problem NOT heart problem

119
Q

Pulm HTN

A

Mean pulm arterial pressure >25mmHg at rest

120
Q

What will EKG show in pulm HTN

A

RVH, right axis deviation

121
Q

What will CBC in pt with pulm HTN show?

A

Polycythemia w/ increased Hematocrit

122
Q

What electrolyte imbalance can excessive use of albuterol cause?

A

Hypokalemia

123
Q

What is the most specific PE finding in sarcoidosis?

A

Lupus pernio (chronic, violaceous, raised plaques and nodules commonly found on the cheeks, nose, and around the eyes) is pathognomonic for sarcoidosis and is the most specific physical exam finding in this disease

124
Q

What will Pleural Effusion show on PE?

A

PE will show ↓ breath sounds + dull percussion + ↓ tactile fremitus

125
Q

What finding on high resolution computed tomographic imaging of the chest is most consistent with idiopathic pulmonary fibrosis?

A

honeycombing

126
Q
A

GK PANCE (26 decks)

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