Pulm Flashcards
1
Q
MCC of bronchitis
A
adenovirus
2
Q
pathophys of bronchitis
A
inflamed trachea and bronchii produce mucus
3
Q
sx of bronchitis
A
Hx of URI followed by productive cough lasting 1-3 wks
+/- Fever
4
Q
How can you differentiate between bronchitis and pneumonia?
A
Pneumonia = dyspnea
NO DYSPNEA in bronchitis
5
Q
What does CXR show for bronchitis?
A
Nothing
6
Q
how is dx for bronchitis made
A
clinical
CXR shows nothing
7
Q
Tx for bronchitis
A
supportive, bronchodilators (SABA) may help
DO NOT GIVE antibiotics
8
Q
MCC of bronchiolitis
A
RSV (respiratory synctial virus)
9
Q
Lower respiratory tract infection that affects the small airways
A
bronchiolitis
10
Q
What age group is most affected by bronchiolitis?
A
2mos-2y/o
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
12
Q
Risk Factors for Bronchiolitis
A
- cig smoking
- lack of breastfeeding
- premature infant <37 weeks gestation
13
Q
What symptoms indicate respiratory distress?
A
- wheezing
- tachypnea
- nasal flaring
- cyanosis
- retractions
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*
15
Q
What is the best dx test for bronchiolitis?
A
Pulse Ox
if < 96%, pt must be admitted
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)
17
Q
mild bronchiolitis tx
A
supportive: IVF + nebulizers (racemic epinephrine) if needed
18
Q
What can you trial in a pt with bronchiolitis?
A
aerosolized albuterol
19
Q
Are corticosteroids indicated in tx of bronchiolitis?
A
NO
20
Q
What medication can you use in pts w/ bronchiolitis who have underlying heart, lung or immune disease?
A
Ribavirin
21
Q
Tx for severe bronchiolitis
A
high flow nasal cannula humidified O2 + IVF + nebulized epinephrine/albuterol
22
Q
What are the main complications of bronchiolitis?
A
- Respiratory failure
- Otitis Media (acute)
- Asthma (chronic)
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)
24
Q
MCC of epiglottitis
A
HiB (Bacteria)
25
Sx of epiglottitis
**D**ysphagia
**D**roooling
**D**istress
+
inspiratory stridor
26
How will a patient with epiglottits look when you walk into the room?
**neck hyperextended + chin protruding** (sniffing dog position)
**Lean forward in a "tripod" position**
27
Dx for epiglottitis
clinical impression
28
What do you want to absolutely avoid in patients with possible epiglottitis?
the _airway must be secured_ before a definitive dx can be made: **DO NOT USE TONGUE DEPRESSOR**
29
**thumbprint sign**
lateral cervical CXR for **epiglottitis**
30
Definitive dx for epiglottitis
Laryngoscopy
31
Tx for epiglottitis
secure airway, check ABCs
2nd or 3rd gen cephalosporins: **Ceftriaxone or cefotaxine**
32
swelling of the **subglottic/larynx**
croup
33
barking cough
croup
34
seal like cough
croup
35
harsh cough
croup
36
MCC of croup
parainfluenza virus type 1
37
sx of croup
Secondary to viral infection
low grade fever, mild dyspnea, inspiratory stridor, hoarse voice, **barking cough**
38
steeple sign
croup
39
subglottic narrowing
steeple sign
seen on AP neck film for croup patient
40
mild croup tx
OP mgmt w/ cool mist therapy and fluids
**dexamethasone**
41
moderate croup tx
Supplemental **O2**
**IM Corticosteroids**
**nebulized racemic epinephrine**
42
Severe croup tx (respiratory distress at rest, inspiratory stridor)
**hospitalize + nebulized racemic epinephrine**
43
What is the **MCC of epiglottitis post vaccination for HiB**?
**strep** and **staph** species
44
life threatening **acute hypoxemic respiratory failure**
acute respiratory distress syndrome
45
this disease develops in pts already critically ill
ARDS
46
what is the MCC of ARDS?
**sepsis**
47
**hypoxemia**
↓ **lung compliance**
**non-cardiogenic pulmonary edema**
ARDS
48
PaCO2/FiO2 ratio \<200
ARDS
49
pathogenesis of ARDS
endothelial injury
50
sx of ARDS in phase 1 acute injury
normal PE
+/- respiratory alkalosis
51
sx of ARDS Phase 2 (6-48 hrs)
hyperventilation, hypocapnia
52
sx of ARDS Phase 3&4
acute resp failure, tachypnea, dyspnea, ↓ lung compliance, **scattered rales**, **difficuse chest opacity on CXR**
↓
**severe hypoxemia unresponsive to therapy**
↓
**metabolic + respiratory acidosis**
53
Dx for ARDS
**acute onset of respiratory distress**
**PaO2/FiO2** ratio of **\<200**
54
**diffuse alveolar filling pattern** on **CXR**
ARDS
55
**bilateral pulmonary infiltrates** on **CXR**
ARDS
56
capillary wedge pressure **\<18mmHg**
ARDS
57
Tx for ARDS
**mechanical ventilation**, +/- CPAP
**PEEP** (Positive end expiratory pressure): recruits collapsed alveoli
58
What CXR looks similar to an ARDS CXR?
How can you differentiate in diagnosis?
_Cardiogenic Pulmonary Edema_: **PCWP \>18**
_ARDS_: **PCWP \<18**
59
3 criteria to dx ARDS
1. **refractory hypoxemia**
2. **B/L pulm infiltrates** on CXR
3. **absence of cardiogenic pulm edema/CHF**
60
wheezing is louder during
**expiration**
61
What is wheezing?
a high-pitched **whistling, continuous**, musical sound produced by **narrowed/obstructed airways**.
62
low pitched sounds that may clear with cough
rhonchi
63
crackles/rales are heard during
**inspiration**
64
Samter's triad
1. asthma
2. nasal polyps
3. ASA/NSAID allergy
65
3 main pathophys components of asthma
1. airway hyperreactivity
2. bronchoconstriction
3. inflammation
66
**decreased expiratory airflow** & **increased airway resistance**
obstructive
67
classic triad of asthma
1. **dyspnea**
2. **wheezing**
3. **coughing esp @ night**
68
What will PE show for asthmatic patients?
**prolonged expiration with wheezing, hyperresonance to percussion**
69
PE for severe asthma & status asthmaticus
**AMS**
**pulsus paradoxus** (Inspiratory decrease in SBP \> 10)
**silent chest (**no air exchange)
70
Gold standard Dx test for asthma
PFT: reversible obstruction
71
What should you do next if PFT testing doesn't show asthma?
bronchoprovocation: methacholine challenge test
72
What are the **3 classes of rescue drugs** for Asthma exacerbations?
1. SABA: 1st line, most effective & fastest working. **(Albuterol, Terbutaline, Epi)**
2. Anticholinergics **(ipatropium)**
3. Corticosteroids **(Prednisone)**
73
MC S/E of SABAs
tachycardia, arrhythmias, muscle tremors, CNS stimulation
74
S/E of ipratropium
**thirst, blurred vision, dry mouth, urinary retention, dysphagia, acute glaucoma, BPH**
75
What medication decreases relapse of asthma?
Prednisone
76
5 classes of medications used for long term mgmt of asthma
1. **ICS** (Flunisolide, Triamcinolone)
2. **LABA** (Salmeterol, Formoterol)
3. **Mast Cell Modifiers** (Cromolyn, Nedocromil)
4. **Leukotriene Modifiers/Receptor Antagonists** (LTRA) (Montelukast, Zafirlukast)
77
What is the drug of choice for long term, persistent chronic maintenance of asthma?
ICS
78
Main S/E w/ ICS
thrush
79
which medication targets nocturnal asthma?
LABAs
80
When would you add a LABA to the tx regimen for asthma?
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
Which asthma med inhibits acute phase response to **cold air, exercise and sulfites?**
Mast cell modifiers (Cromolyn, Nedocromil)
82
Which asthma med is useful in pts w/ **allergic rhinitis/ ASA induced asthma**?
LTRA (montelukast)
83
bronchodilator that improves resp muscle endurance
Theophylline
84
S/E of theophylline
nervousness, N/V, anorexia, HA
85
**postinfluenza** or **postviral pneumonia** causative agent
**staph aureus**
86
Post-Viral Pneumonia
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
What will CXR for postviral pneumonia show?
multiple cavitary lesions
88
Tx for postviral Pnuemonia
staph aureus
Tx: **vancomycin, linezolid, Piper-Taco**
89
**skin flushing**
**wheezing**
**diarrhea**
Bronchial carcinoid tumor
90
Dx for broncial carcinoid tumors
24-hour excretion of **5-hydroxyindoleacetic acid (5-HIAA)** in the patient’s urine
91
classic triad for Pulm Embolism
1. dyspnea
2. pleuritic chest pain
3. hemoptysis
92
Best initial test for pulm Embolism
Helical CT scan
93
gold standard test for Pulm Embolism
Pulm angiography
94
CXR will show what in a pt w/ PE
1. **Westermark's sign**: avascular markings distal to area of embolism
2. **Hampton's Hump:** wedge shaped infiltrate (infarction)
95
ECG for PE
S1Q3T3
96
When would you do a pulm angio in a PE?
ordered if **high suspicion & negative CT or VQ scan**
97
fever
diarrhea
confusion
hyponatremia
**Legionella Pneumonia**
98
Tx **when stridor is present at rest in a croup** pt
**epi + dexamethasone**
99
What does CXR show for sarcoidosis
**bilateral hilar lymphadenopathy**
100
MCC of transudate effusion
CHF
101
Causes of **transudate Pleural effusion**
* CHF
* Nephrotic syndrome
* Cirrhosis
* PE
all "failures" are transudate: renal/liver/heart
102
Causes of exudate
**pus-related:**
* **Bacterial/viral pneumonia**
* TB
* Pancreatitis
* **Malignancy**
103
What are the 3 types of **non-small cell carcinomas**?
1. **Adenocarcinoma**
2. **Squamous Cell**
3. **Large Cell (anaplastic) carcinoma**
104
MC type of lung cancer
adenocarcinoma
105
Bronchogenic Carcinoma -Adenocarcinoma
**peripheral**
**metastasizes to distant areas**
106
Lung nodule Cpx: **nonsmoker, incidental finding**
**non small cell carcinoma (adenocarcinoma)**
107
Lung Nodule findings:
## Footnote
**voluminous sputum**
**interstitial lung pattern on CXR**
**bronchioalveolar lung nodule** (subtype of non small cell carcinoma adenocarcinoma)
108
**"CCCP"**
**C**entrally Located
**C**avitary lesions
hyper**C**alcemia
**P**ancoast Syndrome
squamous cell lung cancer
109
Pancoast Syndrome
* associated w/squamous cell cancer (CCCP)
* tumor @ superior sulcus
* shoulder pain
* horner's syndrome
* atrophy of hand/arm muscles
110
what is a very aggressive lung cancer?
large cell anaplastic carcinoma
111
these **lung nodules metastasize early** and **surgery is not the tx of choice**
small cell (oat cell) carcinoma
112
**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?
small cell (oat cell) lung CA
113
Which 2 lung nodules are found centrally?
**squamous cell**
**small cell/oat cell**
114
Which 3 lung nodules are found peripherally?
adenocarcinoma (NSCC)
Large cell Carcinoma
115
Dx workup for lung CA
**CXR & CT SCAN**
**Sputum Cytology and bronchoscopy** useful for central lesions
116
Non Small Cell Lung Nodule Mgmt
surgical resection
117
Small Cell Lung Nodule Mgmt
chemo
118
Cor Pulmonale
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
Pulm HTN
Mean pulm arterial pressure \>25mmHg at rest
120
What will EKG show in pulm HTN
RVH, right axis deviation
121
What will CBC in pt with pulm HTN show?
**Polycythemia w/ increased Hematocrit**
122
What electrolyte imbalance can excessive use of albuterol cause?
Hypokalemia
123
What is the most specific PE finding in sarcoidosis?
**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
What will Pleural Effusion show on PE?
PE will show **↓ breath sounds + dull percussion + ↓ tactile fremitus**
125
What finding on high resolution computed tomographic imaging of the chest is most consistent with **idiopathic pulmonary fibrosis**?
**honeycombing**
126
