Pulm and Critical Care III Flashcards
What bacteria is the most common cause of community-acquired pneumonia?
Streptococcus pneumoniae
What chest imaging finding is virtually pathognomonic for asbestosis?
Pleural plaques
What CXR finding is characteristic of epiglottitis?
“Thumbprint sign” (enlarged epiglottis)
What fungal infection typically occurs in patients exposed to soil contaminated by bird or bat droppings (e.g. caves)?
Histoplasma capsulatum
may manifest as subacute fever, malaise, dry cough; hilar lymphadenopathy seen on CXR (often mimics sarcoidosis) and granulomas with narrow-based budding yeast seen on biopsy
What imaging modality is typically used to diagnose pneumonia?
Chest X-ray
diagnosis requires presence of lobar, interstitial, or cavitary infiltrate on imaging; CXR should be acquired before administering empiric antibiotics
What is the best initial step in management for a stabilized patient with likely PE (modified Wells criteria) who has no absolute contraindications to anticoagulation?
Begin anticoagulation (e.g. IV heparin)
if there is no contraindication to anticoagulation, it should precede diagnostic imaging in patients with likely PE, especially when in moderate distress
What is the best initial step in management for a stabilized patient with suspected PE who has absolute contraindications to anticoagulation?
Obtain diagnostic test (e.g. CT angiography)
if CTA is positive, patients should receive appropriate treatment (e.g. IVC filter)
What is the best initial step in management for a stabilized patient with unlikely PE (modified Wells criteria) who has no absolute contraindications to anticoagulation?
Obtain diagnostic test (e.g. D-dimer assay)
What is the best test to differentiate asthma from COPD?
Spirometry before and after an inhaled bronchodilator
reversal of airway obstruction suggests asthma; partial or non-reversal suggests COPD
What is the best treatment for hypersensitivity pneumonitis?
Avoidance of the responsible antigen
What is the best treatment to minimize the development of life-threatening complications in patients with anaphylaxis (e.g. hypotension, upper airway edema)?
Intramuscular epinephrine
IV epinephrine is indicated for patients with anaphylaxis who do not respond to initial IM epinephrine
What is the diagnostic test for obstructive sleep apnea?
Nocturnal polysomnography
What is the first-line therapy for obesity hypoventilation syndrome?
Nocturnal positive-pressure ventilation
What is the first-line treatment for patients with exercise-induced bronchoconstriction who exercise a few times per week?
Short-acting β-agonists 10-20 minutes before exercise
use inhaled corticosteroids or anti-leukotriene if exercising daily
What is the first-line treatment for patients with exercise-induced bronchoconstriction who exercise daily?
Inhaled corticosteroids or anti-leukotriene agents 10-20 minutes before exercise
use short-acting β-agonists if only needed a few times per week
What is the general treatment for complicated parapneumonic effusion?
Antibiotics and drainage (e.g. chest tube)
What is the general treatment for uncomplicated parapneumonic effusion?
Antibiotics
What is the initial management for patients with non-allergic rhinitis?
intranasal antihistamine and/or glucocorticoids
What is the initial treatment for a child with severe respiratory distress and signs of epiglottitis?
Endotracheal intubation
broad-spectrum antibiotics should be administered after the patient is stabilized
What is the initial treatment of choice in asymptomatic or mildly symptomatic patients with SIADH?
Fluid restriction +/- salt tablets
What is the likely cause of dyspnea in patients with ankylosing spondylitis?
Limited chest and spinal mobility
causes a restrictive pattern on PFTs with an normal or increased FRC (due to fixation of rib cage in an inspiratory position)
What is the likely diagnosis given the flow-volume loop below?
Fixed upper airway obstruction (e.g. laryngeal edema)
What is the likely diagnosis in a euvolemic patient with low serum osmolality and high urine osmolality?
SIADH
commonly precipitated by pulmonary pathologies; hyponatremia may worsen with saline infusion
What is the likely diagnosis in a euvolemic patient with low serum osmolality and low urine osmolality?
Primary polydipsia
especially common in psychiatric patients; this presentation may also occur with beer potomania
What is the likely diagnosis in a patient on a ventilator who develops hypotension, tachycardia, and unilateral absence of breath sounds?
Pneumothorax
due to positive pressure ventilation; hypotension and tachycardia result from impaired right ventricular filling secondary to compression of the IVC
What is the likely diagnosis in a patient who develops respiratory failure, hypotension, and DIC immediately post-partum?
Amniotic fluid embolism
What is the likely diagnosis in a patient with a recent URI and a persistent productive cough without fever or significant CXR findings?
Acute bronchitis
may be associated with purulent and/or blood-tinged sputum production in up to half of patients
What is the likely diagnosis in a patient with COPD who develops sudden-onset dyspnea and chest pain with unilaterally decreased breath sounds (no tracheal deviation)?
Secondary spontaneous pneumothorax
chronic destruction of alveolar sacs leads to formation of large alveolar blebs, which can eventually rupture
What is the likely diagnosis in a patient with COPD who presents with JVD, hepatomegaly, and pitting edema?
Cor pulmonale
i.e. RHF from pulmonary hypertension
What is the likely diagnosis in a patient with mild hypoxemia, tachypnea, and CXR infiltrates hours after an episode of aspiration?
Aspiration pneumonitis
gastric acid induces a chemical burn with a consequent inflammatory response; resolves with supportive management
What is the likely diagnosis in a patient with PMHx of Hodgkin lymphoma status-post chemotherapy/radiation who presents with cough, dyspnea, and chest pain (imaging below)?
Secondary malignancy
there is an 18.5-fold increased risk for developing a second cancer in HL patients compared to the general population (likely related to chemo- and/or radiation therapy at a young age); most common sites are lung, breast, thyroid, bone, and GI
What is the likely diagnosis in a patient with pneumonia that presents with continued symptoms despite adequate antibiotic coverage and loculation on CXR?
Complicated parapneumonic effusion
What is the likely diagnosis in a patient with previous TB infection who presents with months of weight loss, fatigue, and hemoptysis without night sweats, fever, or chest pain (imaging below)?
Chronic pulmonary aspergillosis
What is the likely diagnosis in a patient with recurrent episodes of bacterial infection, purulent sputum, hemoptysis, and digital clubbing?
Bronchiectasis
may present similarly to chronic bronchitis, but bronchiectasis has more prominent sputum production and exacerbations are typically bacterial (viral in chronic bronchitis)
What is the likely diagnosis in a patient with recurrent sinusitis, bronchiectasis, and dextrocardia?
Kartagener syndrome (primary ciliary dyskinesia)
What is the likely diagnosis in a patient with respiratory distress, hypoxemia, and diffuse, bilateral alveolar infiltrates not due to CHF/fluid overload?
Acute respiratory distress syndrome
What is the likely diagnosis in a patient with significant smoking history that presents with shortness of breath, bilateral wheezing, high CO2 and respiratory acidosis?
COPD exacerbation
high CO2 and respiratory acidosis help differentiate from CHF exacerbation, which causes low CO2 and respiratory alkalosis
What is the likely diagnosis in a patient with significant smoking history who presents with shoulder pain, weight loss, and the imaging findings below?
Pancoast (superior sulcus) tumor
What is the likely diagnosis in a patient with sinusitis, lung nodules/cavitations, and elevated creatinine?
Granulomatosis with polyangiitis (formerly Wegener’s)
necrotizing vasculitis involving the upper and lower respiratory tract and kidneys; cutaneous manifestations are also common
