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Internal Medicine EOR > Pulm > Flashcards

Pulm Flashcards

1
Q

Obstructive diseases

A

Asthma
COPD
Bronchiectasis
CF

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2
Q

Restrictive Diseases

A

Sarcoidosis
IPF
Penumoconiosis

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3
Q

Asthma Samters Triad

A

Asthma
Nasal Polyps
NSAID allergy

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4
Q

Asthma Sx

A

dyspnea, wheezing, cough (worse at night)

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5
Q

Asthma PE

A

Prolonged expiration with wheezing
Hyperresonance to percussion
Decreased breath sounds

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6
Q

Status Asmaticus

A

Inability to speak in full sentences, AMS, pulsus paradoxis

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7
Q

Asthma Dx

A

Gold Standard: PFT
Methacholine challenge test
Bronchodilator challenge

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8
Q

PFT in asthma

A

decreased FEV1, decreased FEV1/FVC

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9
Q

Methacholine challenge in asthma

A

> /= 20% decrease in FEV1

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10
Q

Tx acute asthma

A
  1. SABA: albuterol (bronchodilators, nebs q20 min x3)
  2. Anticholinergics: Ipratropium
  3. Corticosteroids: Prednisone, prednisolone, methylprednisone (3-5d)
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11
Q

Tx chronic asthma

A

Start with SABA PRN then add an ICS (beclamthasone, Flunisolide) then add LABA (Salmeterol/fometerol)

Leuko Modifiers if allergies are causing asthma
IV mag if uncontrolled severe

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12
Q

Acute Bronchitis etiology

A

MC cause: ADENOVIRUS, parainfluenza

Inflam of trachea/bronchi often post URI

Hallmark is cough 1-3 weeks

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13
Q

Bronchitis dx/ tx

A

Clinical usually, CXR is nonspecific

Tx: TOC is sx tx

  • fluids
  • rest
  • antitussives
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14
Q

Bronchiectasis etiology

A

Recurrent/chronic lung infections: H. Flu (MC)

CF usually Pseudomonas

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15
Q

Bronchiectasis sx

A

Daily chronic cough with thick, mucopurulent, foul-smelling sputum

Hemoptysis

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16
Q

Bronchiectasis Dx

A

CT scan TOC: Dilated airway, bronchial wall thickening
TRAM TRACKS

PFT: obstructive pattern (decreased)

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17
Q

Signet Ring Sign

A

pulmonary artery coupled with dilated bronchus

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18
Q

Bronchiectasis Tx

A

Abx TOC

  • empiric ampicilin, amox, bactrim
  • pseudomonal fluoroquin, pip/tazo

Bronchodilators for mucus management

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19
Q

Bronchial Carcinoid tumors etiology

A

Enterochromaffin cells
MC in GI tract, lung is 2nd MC

Can secrete serotonin/ACTH/ADH/melanocyte stim hormone

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20
Q

Bronch Tumor sx

A

focal wheeze, cough, recurrent PNA, hemoptysis

SIADH, Cushing’s syndrome

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21
Q

Carcinoid syndrome

A

diarrhea d/t increased serotonin, increased bradykinin and histamine –> flushing, tachycardia, bronchoconstriction

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22
Q

Bronch Carcinoid tumor Dx/ Tx

A

Bronchoscopy

Tx: Surgical excision is definitive
Octreotide to reduce sx

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23
Q

COPD etiology

A

progressive, irreversible airflow obstruction d/t loss of elastic recoil and increased resistance

Emphysema + Bronchitis

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24
Q

COPD rsk fx

A

Sm MC

Alpha 1 antitrypsin deficiency: genetic <40yo

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25
Q

Emphysema

A

abn, permanent enlargement of terminal airspaces

Loss of elastic coil and increased compliance
PINK PUFFER: cachectic, hypoxemia, CO2 normal

26
Q

Chronic Bronchitis

A

Productive cough >3 months for 2 consecutive years

BLUE BLOATERS: obese, cyanotic

27
Q

COPD PFT

A

GOLD STANDARD
FEV1<1L = increased mortality
Obstruction
Hyperinflation

28
Q

COPD CXR/CT

A

Hyperinflation, flat diaphragm, increased AP diameter

29
Q

COPD EKG

A

Cor Pulmonale
Chronic Pulm HTN
Multifocal Atrial Tach

30
Q

COPD Tx

A
  1. Bronchodilators combo with anticholinergics and beta agonists
    - TOC for stable COPD
  2. Corticosteroids NOT monotherapy
  3. Oxygen (only therapy to reduce mortality)
31
Q

Use oxygen in COPD if…

A

Cor Pulmonale
O2 sat <88%
PaO2<55mmHg

32
Q

Anticholinergics

A

Tiotropium (preferred over beta 2 agonists)

SE: dry mouth, thirst, blurred vision, urinary retention

CI: BPH severe glaucoma

33
Q

B2 agonists

A

Albuterol, terbutaline, salmeterol

SE: B1 cross reactivity, tachycardia, tremor

CI: severe CAD, caution in DM

34
Q

Corticosteroids SE

A

osteoporosis
thrush
increased infections
hyperglycemia

35
Q

GOLD staging

A

Mild: FEV1/FVC <0.70, FEV1 >80%

Moderate: FEV1/FVC <0.70, FEV1 50-79%

Severe: FEV1/FVC <0.70, FEV1 30-49%

Very Severe: FEV1/FVC <0.70, FEV1 <30%

36
Q

Cor Pulmonale

A

Long standing pulm HTN -> R vent hypertrophy, R atrial enlargement, R axis deviation, R sided HF, seen especially with chronic bronchitis, multifocal atrial tach

37
Q 
Hypoventilation Syndrome (OHS)
etiology
A

Awake alveolar hypoventilation in an OBESE individual which cannot be attributed to other conditions

38
Q

OHS rsk fx

A

BMI >30
Central Obesity
Severe OSA: daytime hypersomnolence, loud snoring, choking during sleep, fatigue, small oropharynx, tick neck

39
Q

OHS labs

A

elevated serum bicarb
Hypercapnea: pa CO2 >45mmHg
Hypoxemia: PaO2 <70mmHg
Polycythemia

40
Q

OHS DX (DOE)

A

CXR: elevation of both hemidiaphragm and heart may be enlarged due to R vent hypertrophy

41
Q

OHS Tx

A

1st line: CPAP/BiPAP, weight loss, lifestyle mods

2nd line: tracheostomy, bariatric surg

42
Q

Idiopathic Pulm Fibrosis etiology

A

Chronic progressive interstitial scarring from persistent inflammation

Dyspnea +/- nonproductive cough

43
Q

IPF PE/Dx

A

Fine basilar INSPIRATORY crackles, clubbing, cyanosis

Dx:
CXR: diffuse opacities, honeycombinb, ground glass

PFT: restrictive disease

44
Q

IPF Tx

A

No effective treatment, smoking cessation, O2, corticosteroids maybe?

Lung transplant is only cure

45
Q

Pneumoconiosis etiology

A

chronic fibrotic lung disease 2/2 to inhalation of mineral dust

46
Q

Silicosis

A

Mining/Pottery
Dyspnea on exertion, nonproductive cough

CXR: multiple small round nodular opacities, primary in the upper lobes, eggshell calcifications

Tx: supportive

47
Q

Coal Workers pneumoconiosis

A

Coal/Carbon mines

CXR: small upper lobe nodules and hyperinflation, may have Obstructive PFT

Caplan Syndrome: coal workers pneumoconiosis + RA

SUPPORTIVE TX

48
Q

Berylliosis

A

electronics, aerospace, ceramics, tool/dye manufacturing

Sx: Dyspnea, cough, arthralgia, weight loss, fever

CXR: increased interstitial lung markings

Dx: + exposure, +beryllium proliferation test
+noncaseating granulomas on biopsy

Tx: corticosteroids, O2, Supportive

49
Q

Asbestosis etiology

A

Seen in 15-20 years after long term sbestos

Increased risk bronchogenic carcinoma, malignant mesothelioma of the pleura

50
Q

Asbestosis dx/ tx

A

CXR: pleural plaques, interstitial fibrosis, primarily in LOWER lobes
Shaggy Heart Sign: blurring of diaphragm/heart border

Biopsy: linear asbestos bodies in lung tissue

SUPPORTIVE

51
Q

Pulm HTN etiology / pathophys

A

Pulm MAP >/= 25mmHg

Increased vascular resistance / RVH

52
Q

Pulm HTN Sx

A

Dyspnea, CP, weakness, fatigue, cyanosis, edema

53
Q

Pulm HTN PE

A

Accentuated S2, fixed or paradoxically split P2
Signs of R heart failure (increased JVP, peripheral edema, ascites)

Systolic ejection click, pulm regurg

54
Q

Pulm HTN Dx

A

GOLD STANDARD: right side heart cath

CBC: polycythemia, elevated Hct
CXR: enlarged pulm arteries
EKG: cor pulmonale, RVH, right axis deviation, RBBB
Echo: large right ventricle, right atrial hypertrophy

55
Q

Pulm HTN Tx

A

Primary: CCB

Type II / III: tx underlying disease

56
Q

Pulm Nodules etiology

A

<3cm
Mass >3cm

Granulomatous infections: TB
Tumors
Inflamm: RA, sarcoidisis
Mediastinal tumors: thymoma

57
Q

Pulm Nodules Dx

A

Obs if low malignant probability

Needle Aspiration or bronchoscopy for peripheral lesions

Resection w/ biopsy if malignancy

58
Q

Sarcoidosis etiology

A

Chronic multisystem, inflammatory, granulomatous, disorder of unknown etiology

Exaggerated T cell response

59
Q

Sarcoidosis Sx

A 
50% asx
Dry cg, dyspnea, cp
Anterior Uveitis: blurred vision, photophobia, floaters
Arrythmias
Arthralgias
Cranial Nerve Palsies
60
Q

Sarcoidosis skin sx

A

2nd MC organ involved

  • Erythema nodosum anterior legs
  • Lupus pernio: nose, ears, cheeks, chin
  • Maculopapular rash: MC rash of sarcoidosis
  • Parotid gland enlargement
61
Q

Sarcoidosis Dx

A

Compatible clinical radiologic findings
Noncaseating granulomas
Exclusion of other diseases

CXR: bilateral hilar LDA

62
Q

Sarcoidosis Tx

A

Obs, oral corticosteroids

Internal Medicine EOR (8 decks)

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