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Prep Study > PULM PANCE > Flashcards

PULM PANCE Flashcards

1
Q

Tactile fremitus is what in pneumonia

A

increased

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2
Q

Tactile fremitus is what in pleural effusion

A

Decreased

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3
Q

Pneumonia and egophony

A

Consolidation would make an AY sound when you speak EE

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4
Q

Contraindications for lung resection in lung cancer

A

Distant metastasis

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5
Q

Klebsiella Pneumonia treatment

A

Cefotaxime

DM, Drinker

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6
Q

Mycoplasma pneumonia findings

A

Cold agglutinin Positive
Bilateral hilar infiltrates

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7
Q

When to give a Patient with COPD ABX

A

with an increase in sputum production
(indicates likely infection)

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8
Q

Immunocompromised patient with Legionella pneumonia Tx

A

First line Macrolide
If failed
Rifampin

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9
Q

Pneumo vax 23 Dosage Age

A

They get it at 65 once

If they received it prior to 65, must wait five years and get a second dose

i.e. if got it at 64, then they get second dose at 69

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10
Q

ABG’s How to

A

7.4
40

Use Ph and CO2

Down and down is Metabolic acidosis
Up and Up is Metabolic Alkalosis

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11
Q

Always test for TB prior to beginning what med

A

Enbrel
(Etanercept)

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12
Q

What can reduce theophylline Levels in the body

A

Smoking

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13
Q

What is a side effect of bleomycin

A

Pulmonary fibrosis

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14
Q

Physical exam finding of pleural effusion

A

Unilateral Chest lag on inspiration

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15
Q

What PFT is decreased in COPD chronic bronchitis

A

FEV1/FVC ratio

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16
Q

What is Ghon complex associated with

A

TB

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17
Q

Key bronchiectasis finding

A

Dilated thickened airways
Tram track

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18
Q

What is seen in hypersensitivity pneumonitis

A

Diffuse nodular densities

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19
Q

HIV positive TB patient treatment

A

If PPD positive and CXR negative
Latent
Isoniazid and Rifampin only

If PPD and CXR are both positive
Active
RIPE

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20
Q

Pertussis Contacts prophylaxis

A

Macrolides
Everyone

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21
Q

Next step when new pleural effusion with no cause appears

A

Diagnostic Thoracentesis

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22
Q

Spirometry findings in Obstructive lung disease

A

Increased TLC
Decreased Vital capacity
Prolonged FEV1
Decreased FEV1/FVC ratio
Increased residual volume

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23
Q

If received the BCG TB vax what screening test is used

A

Blood test

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24
Q

PJP pneumonia with HIV tx

A

Bactirm

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25
Q

Acute Bronchiolitis

A

MCC Viral (RSV),
Viral symptoms for 1-2 days followed by Respiratory distress
usually under 2 years of age

Expiratory wheeze
Inflamed Tubes = Air bronchograms

Supportive, humid O2, Fluids

Hand Washing is key prevention

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26
Q

Epiglottitis ABX Tx

A

3rd Gen Cef
or
Vanc

After airway management

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27
Q

Bronchiectasis

A

MC Cystic Fibrosis - Pseudomonas
Non CF is H Flu

Lots of mucous
Cough
Hemoptysis

Thickened and dilated bronchioles
Tram track sign
Signet sign (Compressed pulmonary artery nex tot dilated bronchus)

High Res CT is preferred

Chest Physiotherapy
ABX - Macrolides, Cef, Augmentin, Fluoroquinolones

Surg

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28
Q

Multi Lobular Emphysema marker

A

Alpha Anti Trypsin

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29
Q

Sarcoidosis

A

Black
Hypercalcemia
Elevated ACE
Bilateral Lymphadenopathy
Non Caseating Granulomas
Honeycombing, Ground Glass
Lupus Perino - Violaceous Nodules on face (Chronic)

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30
Q

Pulmonary HTN

A

Right Heart Strain
Pulm Artery Pressure normal is 12
Over 25 is Pulm HTN
Swanz Ganz
RVH on EKG
Leads to Cor Pulmonale
Lasix and Nitro (redistributes fluid)

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31
Q

Bronchial Carcinoid Tumors

A

Flushing
Wheezing
Diarrhea

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32
Q

Cystic Fibrosis

A

Steatorrhea
ADEK Fat solubles (Not absorbed)
Chloride sweat test
Meconium ileus
Growth delays, lots of illness, sinusitis
Bronchiectasis
Pseudomonas

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33
Q

Pulmonary Fibrosis

A

Clubbing
Inspiratory crackles
Honeycombing
Ground Glass

Ventilators
Bleomycin
Amiodarone

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34
Q

Atypical Pneumonia

A

Legionella
Mycoplasma
Chlamydia
Coxiella
Psittoci

Slow Onset

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35
Q

Typical Pneumonia

A

MCAT
Strep Pneumo
Hemophilus Influenza B (HIB)
Staph A

Acute onset

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36
Q

Legionella

A

Atypical pneumonia
Hyponatremia
Diahrrea

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37
Q

Coxiella

A

Atypical Pneumonia
Q Fever
Livestock
Elevated LFTs’

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38
Q

MC Smoker pneumonia

A

Hemophilus Influenza B (HIB)

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39
Q

Urine tests for pneumonia

A

Legionella
Strep Pneumo

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40
Q

Curb 65

A

Confusion
Uremia (BUN >19mg/dl, >7mmol)
Resp >30
SBP <90, DBP <60
over 65

2 points iffy
3 is admitted

1 point for each

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41
Q

CAP ABX

A

No comorbidities
single treatment
Outpatient is Amoxicillin
can use doxy or macrolide

High risk or comorbidities ie DM
Dual treatment
Amoxicillin and macrolide (both)

Inpatient ABX is CEF

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42
Q

PJP Pneumonia Treatment

A

Bactrim
21 days

If CD4 count is low, can use prophylactically (<200)

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43
Q

Fungal Pneumonias

A

Coccidiomycosis Southwest
Blastomycosis NE Great lakes
Histoplasmosis Mississippi South east

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44
Q

Coccidiomycosis Location

A

Southwest

Erythema Nodosum

Fluconazole
Itraconazole

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45
Q

Blastomycosis Location

A

NE Great lakes

Skin verrucous lesions
Osteomyelitis

Itraconazole
Ampho B

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46
Q

Histoplasmosis Location

A

Mississippi South east

Bird/Bats

Can mimic Tuberculosis

Itraconazole
Ampho B

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47
Q

Pneumonia vaccine for peds

A

PCV 13

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48
Q

Pulmonary nodules under 3 cm

A

Usually Benign

(Can be Cx, if Cx MCC is adeno)

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49
Q

Small cell lung cancer

A

Central, Oat cell, paraneoplastic, Neuroendocrine
Can cause SIADH and Lambert Eaton
Hemoptysis

Tx
Radiation chemo combo
no surg

50
Q

Non small cell cancers

A

MC is adeno
Squamous cell, large cell
SVC syndrome, Horner syndrome (both are large cell)
Pancoast

Smoking (squamous cell)

51
Q

Lung cancer marker

A

CEA

52
Q

Paraneoplastic

A

Lung nodule
endocrine problems

53
Q

Carcinoid Syndrome

A

Flushing
Diarrhea
Lung nodule

54
Q

Pan coast

A

Pain in shoulder
Mass in upper lobe

55
Q

Lights criteria tranudative

A

Clear (transparent=transudative)

Protein under 0.5
LDH under 0.6

MCC’s HF, Cirrhosis, Nephrotic, PE

56
Q

Lights Criteria Exudative

A

Cloudy (WBC)

Protein over 0.5
LDH over 0.6

Infection, cancer, PE, TB

57
Q

Empyema imaging

A

CT

Usually post op day 4

58
Q

Glucose number in pleural fluid likely autoimmune

A

under 60
under 0.5

59
Q

Cor pulmonale

A

Lung problem causing right heart failure

RVH

60
Q

PPD positive with Positive CXR

A

Active TB
RIPE 4 months
then R and I for 6 months

61
Q

Active TB that is aymptomatic

A

Ghon complex

62
Q

Secondary (reactivated) TB

A

Upper cavitary lesions
Night Sweats
Fever

63
Q

Latent TB

A

Asymptomatic
Positive PPD
Negative CXR

R - 4 months
I - 3months

64
Q

RIPE SIde effects

A

R - Orange secretions
I - Peripheral neuropathy (give B6)
P - Liver
E - Eyes

65
Q

COPD exacerbation with worsening mucous

A

Give ABX
Macrolide

66
Q

BB acceptable for asthma patients

A

B1

Esmolol
Atenolol
Metoprolol

67
Q

Acute bronchitis

A

MCC Viral
5 days of cough
supportive care ( no steroids or abx)
Self limiting

MCC Adenovirus

68
Q

Pertussis Phases

A

Catarrhal Phase 1-2 weeks (night cough)

Paroxysmal phase (cough,cough,cough, vomit) (whoop)

Convalescent

69
Q

Pertussis diagnosis

A

PCR nasal pharyngeal wash swab

70
Q

Pertussis peds under 4

A

Admit

71
Q

Pertussis Peds over 4

A

Isolate until 5 days of abx
or
21 days of symptoms

72
Q

Pertussis ABX

A

Azithromycin

can use bactrim if allergic

73
Q

Pertussis contact prophylaxis

A

Azithromycin for all household contacts

74
Q

CPAP/BIPAP containdication

A

Cannot protect airway
Cannot cooperate

75
Q

RSV typical age

A

Under 5

76
Q

Smoker Screening age

A

ages 50-80

with 20 pack history

currently smoke or quit with 15 years

Low dose CT annually

77
Q

Basic asthma tx first 3 lines

A

Albuterol
ICS
LABA (salmeterol)

78
Q

Squamous cell lung cx location

A

central
Often involves bronchus
Associated with smokers

79
Q

Loeffler syndrome

A

Pulmonary symptoms
Low grade fever
Sputum
Wheezing
Cough

Increased IGE and eosinophilia

Seen in hookworm
(recent Travel to endemic countries)

80
Q

Churg Strauss

A

Eosinophilic Granulomatous Polyangitis

Males over 40
Necrotizing granulomatous
Upper airway, Asthma

Eosinophils
Asthma

P-ANCA

Tx Steroids
Cyclophosphamide
AZA

81
Q

Wegeners

A

Granulomatous Polyangitis

Upper airway Necrotic
AGN

C-ANCA
elevated CRP, ESR, Anemia

Tx Steroids
Cyclophosphamide

82
Q

Emphysema is destuction of what

A

Alveoli

83
Q

DLCO and empysema

A

used to distinguish between Chronic Bronchitis and emphysema
decreased in emphysema

84
Q
A

number of exacerbations in year
gold spirometry score
MMRC
Cat score

85
Q

COPD Class A

A

1 exacerbation in year
Cat score minimal
Gold spirometry Mild

SABA albuterol
or Ipratropium SAMA

86
Q

COPD Class B

A

1 exacerbation in year

High symptoms
low exacerbation

Gets LAMA (tiotropium)
or LABA with ICS (Salmeterol +ICS or Formoterol +ICS)
(ICS - Mometasone, Budesonide, Fluticasone)

Should already be on
SABA
ICS

87
Q

COPD Class C

A

Low daily symptoms
Severe exacerbations

Gets LAMA (tiotropium)
or LABA with ICS (Salmeterol +ICS or Formoterol +ICS)
(ICS - Mometasone, Budesonide, Fluticasone)

Should already be on
SABA
ICS

88
Q

COPD Class D

A

2 or more exacerbation in year
high symptoms = CAT >10
Severe = Gold score of 4

Class D Gets LAMA (tiotropium)
or LABA with ICS (Salmeterol +ICS or Formoterol +ICS)
(ICS - Mometasone, Budesonide, Fluticasone)

Should already be on
SABA
ICS

Trelegy

89
Q

COPD Medications
-SABA

A

Albuterol

Not for peds under 4

90
Q

COPD Medications
-SAMA

A

Ipratropium

91
Q

COPD Medications
-LABA

A

Formoterol (quicker)
Salmeterol

Must have ICS also

92
Q

COPD Medications
- ICS

A

Mometasone
Budesonide
Fluticasone

93
Q

COPD Medications
-LAMA

A

Tiotropium

94
Q

COPD Medications
-Combivent

A

Albuterol (SABA)
Ipratropium (SAMA)

95
Q

COPD Medications
-Advair diskus

A

Fluticasone (ICS)
Salmeterol (LABA)

96
Q

COPD Medications
-Symbicort

A

Budesonide (ICS)
Formoterol (LABA)

97
Q

COPD Acute exacerbation

A

Quick - SAMA, SABA, or combivent (together)
Albuterol, Ipratropium
Oral prednisone
BIPAP
ABX if increased sputum production

98
Q

Theophylline contraindication

A

don’t use for Acute exacerbation

99
Q

O2 for COPD

A

under 88%
PAO2 under 55

Long term O2

100
Q

Gold standard for COPD

A

PFT (FEV1 or ratio)

PFT FEV Under 70 methacholine challenge
then give albuterol
if increase by 12 or more
not COPD

101
Q

COPD Exacerbation ABX

A

> 65
Looks sick
Increased sputum

gets azithromycin and prednisone

102
Q

Metabolic disorder associated with Chronic emphysema

A

Respiratory Alkalosis

103
Q

ARDS

A

Diffuse inflammation of lung
Trauma, Drowning, Aspiration, Pancreatitis, Sepsis (gram neg)

Can lead to Multi system organ failure and death

Severe hypoxia refractory to O2

CXR Diffuse bilateral Pulmonary infiltrates
(similar to CHF but Spares costophrenic angles)

PCWP <18 = ARDS
PCWP >18 Cardiac pulmonary edema (CHF)

CPAP/BIPAP (low tidal volume)

104
Q

Hospital Acquired Pneumonia treatment

A

Cover pseudomonas
Piper taz
or Fluoroquinolone

105
Q

Cryptococcus

A

Pacific Northwest
India Ink Stain
HIV positive
Bird droppings

Meningoencephalitis MCC fungal meningitis

Ampho B + Fluconazole

106
Q

SVC syndrome

A

Fat face (plethora)
JVD
Lump obstruction SVC

CT

Diuretics to reduce fluid in SVC
Surgery, Radiation Etc

107
Q

Paraneoplastic syndorme

A

Cancer plus endocrine problems
Small cell
SIADH, Clubbing, Hypercalcemia, Cushings

Treat underlying cause

108
Q

Lambert Eaton

A

Lung cancer plus neuromuscular dysfunction
Bad DTR’s get better with exercise

Treat underlying cause

109
Q

Pancoast

A

Shoulder pain
Upper lobe mass (Superior sulcus of lung)
Horner (ptosis)
weakness and atrophy of hand and arm
Non Small Cell

110
Q

What is 5 HIAA used to diagnose

A

Carcinoid syndrome

111
Q

2 most common causes of hempotysis

A

Acute bronchitis
Bronchogenic Carcinoma

112
Q

C ANCA is associated with what Vasculitis

A

Wegeners
Granulomatous with poly angitis

113
Q

P ANCA is associated with what Vasculitis

A

Churg Struass
Eosinophils

114
Q

Endospores are associated with what fungal pneumonia

A

Coccidomicies

115
Q

Paramyxovirus - disease

A

Measles

116
Q

Togavirus - disease

A

German measles

117
Q

Herpes virus - Disease

A

Roseola

118
Q

Parvovirus - Disease

A

Fifth disease

118
Q

Parvovirus - Disease

A

Fifth disease

119
Q

Ziehl Neelson Positive

A

MAC
Mycoplasma avian complex

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