Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PA Clinical Year > Pulm PANCE review > Flashcards

Pulm PANCE review Flashcards

1
Q

Acute bronchitis= inflammation of _______

A

large and small airways

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Acute Bronchitis: Etiology?

A

MOSTLY viral!! 90% viruses; atypical bacterial infection (Mycoplasma, Chlamydia Pneumoniae, B. Pertussis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Acute Bronchitis:

S/Sx?

A

Cough, +/- Wheezing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Acute Bronchitis: CXR will show?

tx?

A

CXR: Neg for PNA

Tx: Antitussive, expectorants, albuterol, +/- abx to cover atypical infx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Acute Bronchiolitis is a major cause of ______ infections in which population?

A

lower respiratory infections of newborns and children -very contagious! Mostly occurs in kids <2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Acute Bronchiolitis: etiology is mostly _____

s/sx?

A

viral – mostly **RSV

S/Sx: Low-grade fever, cough, respiratory distress. Preceded by 1-3 days of URI sx (ie: nasal discharge)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Acute Bronchiolitis:
dx?
tx?

A

clinical

Tx: supportive
Humidified air, oxygen, nasal suction
+/- albuterol, fluids, ribavirin **(STEROIDS NOT BENEFICIAL)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

steeple sign is assoc with:

A

CROUP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Croup= inflammation of the _________

A

upper and lower respiratory tracts, mostly subglottic region

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Croup: age group?

etiology?

A

Typically 3 months-5 yrs old

Etiology: Viral (**Parainfluenza), adenovirus, RSV

paracrouper

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Croup: S/sx

A

Barking cough, inspiratory stridor, hoarseness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Croup: x-ray signs?

A

“Steeple sign” (subglottic narrowing)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Croup: Tx?

A

Palliative – Rest, hydration, calm child

  • Steroids – Single dose of dexamethasone (IM or PO)
  • Nebulized racemic epinephrine–> Reduces stridor and work of breathing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Influenza:

Etiology?

A

Viruses (A, B, C)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Influenza: S/sx

A

HA, F/C, myalgias, coryza, +/- sore throat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Influenza: dx

A

Rapid antigen test with nasal swab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Influenza: tx?

A 
Consider antivirals (oseltamivir, rimantadine, zanamivir) within 48 hours of sx onset
Supportive Care

Prevent: Annual vaccination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Pertussis aka _______

A

whooping cough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Pertussis: etiology?

-contagious- Y or N?

A

Bordetella pertussis

Highly contagious airborne disease that lasts ~6 weeks before subsiding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Pertussis: S/Sx (describe the 3 stages)

A

Catarrhal Stage: mild cough, sneezing, runny nose (similar to any URI)–> 1-2 weeks

Paroxysmal Stage: uncontrollable coughing spells. Inspiratory whoop. May have post-tussive vomiting–>2-6 weeks

Convalescent Stage: cough subsides over weeks to months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Pertussis: dx?

A

Clinical diagnosis, though nasopharyngeal cultures can confirm (PCR, bacterial cx, or serology)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Pertussis: tx?

A

Macrolides (erythromycin, azithromycin, clarithromycin) preferred or Bactrim (alternative for those who can’t take a macrolide)

Pertussis: vaccine-prevents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

A 14 yo male presents with exudative tonsillitis, fever, and adenopathy for the last 5 days. Her primary care provider placed her on amoxicillin when her rapid strep test was positive. She developed a non-pruritic rash maculopapular rash. What is the most likely cause?

A

Mononucleosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

CAP is a _______ infection

A

Parenchymal lung infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

CAP: risk factors?

A

Inc. Age, ETOH/Tobacco use, asthma/COPD, Immunosuppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

CAP: Etiology? typical vs atypical (list ex’s)

A

Bacteria > Viruses
Typicals: S. Pneumo > H. flu , M. Catarrhalis

Atypicals: Mycoplasma, Chlamydia, Legionella, Kleb, S. Aureus, Viruses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

CAP: S/Sx:

A

cough, sputum, dyspnea, tachycardia, pleuritic CP, +/-Fever/chills

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

CAP: labs

A

Leukocytosis with possible left shift

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

CAP: CXR?

A

Lobar or segmental infiltrates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

CAP: tx? outpatient?

A

Tx: oxygen, abx, neb tx
Outpatient: (usually 5-7 days )
<65 and otherwise healthy: amoxicillin + macrolide (azithromycin or clarithromycin) or doxycycline
If comorbidities, amoxicillin/clavulanate (Augmentin) instead of amoxicillin
If can’t take amox: cephalosporin + macrolide or doxy
Or respiratory fluoroquinolone (levofloxacin, moxifloxacin, or gemifloxacin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

CAP: in patient tx? (list ex meds)

A

Beta lactam (penicillins, cephalosporins, carbapenems, monobactams) + macrolide –or- monotherapy with a respiratory fluoroquinolone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

CAP–> pseudomonas infxn tx?

A

(currently or previously) or recent hospitalization with IV abx:
Pip/taz, or cefepime, or ceftazidime, or meropenem or imipenem + ciprofloxacin or levofloxacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

CAP: tx for MRSA positive or strongly suspected?

A

Add vancomycin or linezolid to the above regimens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Atypical Pneumonia: Sx? Pt population?

A

Milder sx’s in presentation ie low grade fever, nonproductive cough, myalgia, fatigue, mild pulmonary sx’s
vs CAP
–Usually occur in young healthy adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Atypical Pneumonia: etiology?

A

**Mycoplasma MC, Chlamydia, Legionella,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Atypical Pneumonia: labs

CXR?

A

Minimal Leukocytosis

-Not reliable with differentiating typical vs atypical findings – use clinical picture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Atypical Pneumonia: tx?

A

Macrolides (ie: azithromycin), fluoroquinolones (ie: Levaquin), tetracyclines (ie: doxycycline)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Hospital Acquired Pneumonia: occurs _____ hours after hospital admission

A

> 48

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Hospital Acquired Pneumonia: etiology

A

Organisms that colonize ill patients, staff and equipment

S. Aureus, P. Aeruginosa, Klebsiella, Enterobacter, Acinetobacter, E. coli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Hospital Acquired PNA: Dx?

A

New CXR opacity
-Fever, leukocytosis, purulent sputum

Lab: Sputum culture, blood cultures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Hospital Acquired Pneumonia: tx?

A

culture sensitive antibiotics (depends on local resistance rates, patient risk factors for MDR pathogens)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Viral Pneumonia: etiology?

A

Influenza A or B, RSV, adenovirus, Herpes (newborns), CMV (immune deficient)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Viral Pneumonia: S/Sx?

A

Fever, rhinitis, myalgia, HA, nonproductive cough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Viral Pneumonia: Tx?

A

RSV: Ribavirin
HSV: acyclovir
CMV: ganciclovir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Fungal Pneumonia: increased incidence in ______ PTs

A

immunocomp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Fungal Pneumonia: Etiology?

-Histoplasmosis?

A

Histoplasmosis: “Caves, Ohio Valley, & Lower Mississippi region”, grows in soil with bird/bat droppings.

tx: Itraconazole (mild-mod) or Amphotericin B (mod-severe)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Fungal Pneumonia: Etiology?

Coccidiomycosis?

A

“California desert, valley fever”, SW US

Tx: Fluconazole or itraconazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Fungal PNA:

PCP?

A

Pneumocystis jirovecii (PCP): ↑ HIV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Fungal Pneumonia: Blastomycosis?

A

Endemic around Great lakes, Ohio River Basin and Mississippi River.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Fungal PNA: Blastomycosis

  • Sx?
  • Tx?
A

Can have extrapulmonary lesions: skin (verrucous lesion with irregular borders), bone (osteomyelitis), prostatitis, CNS involvement

Tx: oral itraconazole (mild-mod), amphotericin B (mod-severe)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Fungal Pneumonia: Cryptococcus? is it fatal?
tx for mild mod?
tx for severe?

A

Potentially fatal, most patients immunocompromised. (OI in AIDS)

Mild-mod: fluconazole 6-12 months. Alternatives: itraconazole or voriconazole.

Severe: Amphotericin B + Oral Flucytosine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q 
HIV Pneumonia (PJP): etiology?
S/Sx?
A

PCP- Pneumocystis jiroveci pneumonia

S/Sx: fever, dry cough, fatigue, night sweats, hypoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

HIV Pneumonia (PJP):

  • PE:?
  • Labs?
A

50% normal exam

-Lab: **Sputum for silver stain is gold standard, but PCR testing replacing this. LDH increased in 90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

HIV Pneumonia (PJP)

  • CXR/CT classic finding?**
  • Tx?
A

Classic finding is bilateral diffuse hilar opacification.

Tx: Bactrim (for prophylaxis and treatment) KNOW that it’s bactrim!!!!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Aspiration Pneumonia is caused by ______

A

Exogenous substances or endogenous secretions end up in the lower airways

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Aspiration Pneumonia:

Requirements?

A

Compromise in usual defenses for lower airway
–Cough reflex, glottis closure

-Bacterial infection, obstruction (from uncleared fluid/particles), or irritant (ie: gastric fluid) in the lower airway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Aspiration Pneumonia: common bacteria?

A

Peptostreptococcus
Fusobacterium nucleatum
Prevotella
Bacteroides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Aspiration Pneumonia: clinical features?

A 
Cough
Fever
Dyspnea
Purulent sputum
***Putrid-smelling sputum considered diagnostic of anaerobic infection**
Crackles, wheezes, or rhonchi
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Aspiration PNA: dx?

A

CXR: Infiltrates

-If chemical pneumonitis
Bronchoscopy could show erythema of bronchi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Aspiration PNA: tx?

A

-If aspiration was observed: suction ASAP

Antibiotic Therapy:
–Parenteral: Pip/taz (Zosyn) or Ampicillin/sulbactam (Unasyn)
–PO: Augmentin –or-
Flagyl + amoxicillin (or pen G [IV])

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

TB= Pulmonary infx caused by_____

A

inhaling aerosol droplets containing Mycobacterium tuberculosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

TB: ___% form immune response to prevent progression of dz

A

95%

5% → Active TB within 2 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

TB: S/Sx

A

Cough, F/C, night sweats, anorexia, fatigue, wt. loss, hemoptysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Primary TB tx:

A

New TB infection. Fever most common (and often only sx)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

CXR finding: cavitary infiltrate in posterior apical segment of upper lobe, patchy or nodular infiltrates,

dx=?

A

TB**

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

TB skin test: is called?

A

Skin: Mantoux test (+PPD);

quantiferon gold Sputum: +/- acid-fast bacilli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

TB:

**calcified nodules=

A

active infection**

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Reactivation TB/LATENT TB is a previous focus of mycobacterial containment that was ______

A

seeded at the time of primary TB gets reactivated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Latent TB: ______ segments of the lung are MC involved

A

apical segments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Reactivation TB/LATENT TB:

S/Sx?

A

Insidious, vague symptoms: fatigue, weight loss, cough

–May develop CP, dyspnea, hemoptysis

71
Q

How to dx latent TB?

A

positive skin test, but no s/s or xray findings of disease. Not contagious.

72
Q

Latent TB w/ HIV negative:

tx?

A

Isoniazid 300 mg QD for 6-9 months

73
Q

Latent TB w/ HIV + tx:

A

Isoniazid 300mg QD for 12 months

74
Q

Active TB initial phase tx (2 months)

A

Isoniazid 5mg/kg/d
Rifampin 10mg/kg/d
Pyrazinamide 15-30 mg/kg/d
Ethambutol 5-25 mg/kg/d

75
Q

Active TB: continuation tx

A

**at least 4 months–> Isoniazid 300mg /d AND Rifampin 600mg/d

76
Q

Isoniazid S/E?

A

causes peripheral neuropathy. Coadminister Vitamin B6 to decrease risk

77
Q

Rifampin: S/E?

A

thrombocytopenia

78
Q

Ethambutol: S/E?

A

can cause color vision changes/ocular toxicity

79
Q

Before initiation of TB tx, must check the following labs:

A

LFTs, creatinine, platelet count, visual acuity and color vision tests

80
Q

Pneumothorax=

A

Accumulation of air in pleural space

81
Q

Pneumothorax:

etiology?

A

Spontaneous, traumatic, or iatrogenic

82
Q

Pneumothorax:
S/Sx?
PE?

A

Acute onset of ipsilateral CP with SOB

Exam: Decreased BS, unilateral chest expansion, **hyperresonance

83
Q

Pneumothorax:

Dx?

A

CXR – air in pleural space

84
Q

Pneumothorax: tx?

A

Small resolved spontaneously; Large +/- chest tube

85
Q

Tension Pneumothorax= air in pleural space causes ______

A

**mediastinal shift to contralateral side and impaired ventilation leading to CV compromise

86
Q

Tension Pneumothorax:

tx for unstable Pt?

A

Immediate insertion of large-bore needle to decompress

14-16g needle, 2nd ICS Space, mid clavicular line

87
Q

Tension Pneumothorax:

tx for stable Pt?

A

Chest tube placement

88
Q

Pleural effusion= accumulation of fluid in the ______

A

pleural space

89
Q

Pleural Effusion: etiology

transudative=

A

Transudative (thin): CHF, cirrhosis, nephrotic syndrome

90
Q

Pleural Effusion: etiology

exudative=

A

Exudative: Blood (Trauma), malignancy, infection, RA

91
Q

Pleural Effusion: s/sx

A

Dyspnea, +/- Fever

92
Q

Pleural effusion: PE?

A

Dullness to percussion lower lung, decreased breath sounds, decreased tactile fremitus

93
Q

Pleural effusion: dx
-CXR findings?
vs
U/S findings

A

CXR: White out in lower lung field blunting costophrenic angle

U/S: Localize effusion

94
Q

Pleural effusion: tx?

A
  • Thoracentesis

- Pleurodesis (Chronic effusions)

95
Q

Pleural Fluid Analysis:
Light’s criteria– Transudative vs Exudative
–exudative if at least 1 of the following is present: (list)

A
  • Effusion protein/serum protein >0.5
  • Effusion LDH/Serum LDH > 0.6
  • Effusion LDH > 2/3 UNL of lab’s serum LDH
96
Q

Asthma is a chronic inflammatory disorder with airway obstruction.

Triad=

A

**Triad: Airflow obstruction, Bronchial hyperreactivity, inflammation

97
Q

Asthma: etiology?

sx?

A

genetics, allergens, exercise, smoke, GERD

-Wheezing, dyspnea, dry cough, chest tightness

98
Q

Status Asthmaticus=

A

Prolonged, severe attack that does not respond to tx with pt at risk for ventilator failure

99
Q

Asthma: PE findings?

dx?

A

tachycardia, tachypnea, prolonged expiration, expiratory wheezing

Dx:
PFT: ↓FEV1, ↓ FEV1/FVC, ↑RV, TLC
ABG: Hypoxemia & hypocarbia (initially)

100
Q

Intermittent asthma definition

A

Sx: < or equal to 2 days/week

FEV1: >80%
FEV1/FVC: normal

  • 1 exacerbation per year
    tx: step 1= SABA PRN
101
Q

Persistent-mild asthma definition

A

> 2 days/week

FEV1 >80%

FEV1/FVC: normal

2 or more exacerbations per year

tx: step 2= low dose ICS + SABa

102
Q

Persistent-moderate asthma definition

A

daily Sx

FEV1 60-80%

FEV1/FVC: reduced 5%

2 or more exacerbations per year

tx: step 3= medium dose ICS + SABA PRN
OR
low dose ICS + LABA

103
Q

Persistent-severe asthma definition

A

Sx throughout the day

FEV1: <60%

FEV1/FVC: reduced > 5%

2 or more exacerbations per year

tx: step 4= medium dose ICS+ LABA

104
Q

Asthma Treatment – Quick Relief
-SABA- ex’s

-anticholinergic: Ex’s

Systemic corticosteroids: Ex’s

A

SABA: Albuterol, Levalbuterol, etc.–Most effective bronchodilators w/ rapid onset and few S/E. Scheduled daily use NOT recommended.

Anticholinergics: Ipratroprium bromide (Atrovent)

Systemic Corticosteroids: Methylprednisolone, prednisone, prednisolone

105
Q

Asthma Treatment – Long Term

  • ICS?
  • Combo of ICS + LABA? (Ex’s)
A

ICS- QVAR, Pulmicort, Aerobid, Flovent, Asmanex, Azmacort

Combinations of ICS + LABA:
Symbicort= Budesonide + Formoterol

Advair= Fluticasone + Salmeterol

Dulera=Mometasone + Formoterol

*Preferred, 1st Line Agents for all patients with persistent asthma

Adverse Effects: cough, dysphonia, oropharyngeal candidiasis

106
Q

Asthma Treatment: Long Term

LABA: ex’s?

Leukotriene modifiers: ex’s?

Mast cell stabilizers?

A

Salmeterol & Formoterol
–>Bronchodilation up to 12 hours. NOT monotherapy – NO Anti-inflammatory effects

-Leukotriene Modifiers: Montelukast, zileuton, zafirlukast–> Alternatives to low-dose ICS with mild persistent asthma

Cromolyn sodium–> Useful if taken before exposure or exercise

107
Q

Asthma Treatment: Long Term

Phosphodiesterase inhibitors (methylxanthines): Ex’s?

Immunomodulators?

Vaccinations?

A

-Theophylline – narrow therapeutic-toxic range

Immunomodulators:Omalizumab (Xolair)=>Recombinant Ab that binds Ig

**Pneumococcal & Influenza vaccines recommended

108
Q

Theophylline S/E?

A

Insomnia, GERD, HA, N/V, Seizures, hyperglycemia, hypokalemia, arrhythmias
**narrow therapeutic-toxic range

109
Q

COPD:

Emphysema?

A

pink puffers

*Destruction of alveolar walls produces widely dilated air spaces

110
Q

COPD:Emphysema
etiology?
S/Sx?

A

Smoking, α-1 antitrypsin deficiency

S/Sx: Exertional dyspnea, wt. loss, minimal cough

111
Q

Risk factors for COPD:

and PE findings?

A

Risks: Smoking, pollution, infections, occupational dusts/chemicals

–α-1 Antitrypsin Deficiency (genetic)

Sx: Dyspnea, pursed lip breathing, grunting expirations, asthma

Exam: ↑ AP dimension, decreased BS, may have crackles or rhonchi, +/-wheezing, prolonged expiratory phase

112
Q

COPD:Chronic bronchitis
describe?
-s/sx?

A

=Excessive mucus secretion in bronchial tree causing mucus plugging and inflammation

  • *Productive cough for at least 3 months during each of 2 successive years
  • S/Sx: Chronic cough, sputum production, episodic dyspnea, wheezing, wt. gain

Aka: “Blue Bloaters”
etiology: smoking!!

113
Q

COPD: dx

  • CXR findings?
  • labs?
  • late PFT findings?
A
  • CXR: +/- hyperinflation, flat diaphragms
  • CBC: polycythemia from hypoxemia

PFT: (later findings)
↓ FEV1 and ↓ Ratio of FEV1/FVC–> Ratio is <70% of that predicted for matched control
-RV and TLC are increased

114
Q

COPD: complications?

A

Cor pulmonale, polycythemia, infx, resp failure, bronchogenic carcinoma, disability and PUD

115
Q

COPD: list main treatments

A

Stop Smoking
Anticholinergics: Ipratropium (Atrovent), tiotropium (Spiriva)
B-Adrenergic Agents: Albuterol, formoterol, salmeterol
Corticosteroids
Oral Theophylline

116
Q

When is supplemental O2 indicated with COPD pts?

A

Oxygen: PaO2<55mm or SaO2 <88% RA

117
Q

COPD exacerbations:

Uncomplicated: Abx tx?

A

Doxy, Macrolides, Cephalosporins

118
Q

COPD exacerbations:
complicated: abx tx?

Surgery?

A

Quinolone, Amox/clav

  • Steroids for exacerbations
  • Vaccination against influenza/pneumococcal

Surgery: Lung Transplant, lung volume reduction surgery

119
Q

Bronchiectasis is abnormal dilation of the bronchi.
Etiology?
S/Sx?

A

**irreversible
E: Bronchial Injury (often from infx), CF 50%
Sx: Chronic purulent sputum, +/- hemoptysis

120
Q

Bronchiectasis:
PE findings?
Dx?

A

Exam: Crackles, clubbing

Dx: CXR/CT – Tortuous airways

121
Q

Bronchiectasis: tx?

A

Bronchodilators, +/- abx, O2, chest physiotherapy

122
Q

Upper lobe findings ddx:

A

cystic fibrosis and TB

123
Q

Lower lobe ddx:

A

aspirations, PNA,

124
Q

Cystic fibrosis is an ________ recessive dz with dysfxn of exocrine glands

A

autosomal

Lungs: ↑ Mucus, Airway obstruction

125
Q

Cystic fibrosis:

  • MC pathogens?
  • pancreas ?
  • GI tract issues?
A

P. aeruginosa or S. Aureus

Pancreas: Pancreatic insufficiency

GI Tract: malabsorption

126
Q

Cystic fibrosis:

dx lab test?

A

+Sweat Chloride Test > 60 mEq/L**

127
Q

Cystic fibrosis:

tx?

A

Hydration, Humidification, O2, abx, chest physiotherapy, possible lung transplantation

128
Q

Idiopathic Pulmonary Fibrosis= inflammation & fibrosis of alveolar walls and air spaces w/o known cause

s/sx?

A

Exertional dyspnea and dry
non-prod cough

Crackles on exam

Digital clubbing

Fever, fatigue, anorexia, wt. loss

129
Q

Idiopathic Pulmonary Fibrosis:
dx CXR ?
PFT?

A

CXR: Diffuse ground-glass, nodular or reticular infiltrates

PFT: Restrictive pattern with ↓ FVC & ↓ FEV1

130
Q

Idiopathic Pulmonary Fibrosis:

tx?

A

+/- Steroid, Immunosuppressive agents

131
Q

Pneumoconioses=

A

Group of interstitial lung disease caused by inhalation of certain dusts and lung tissue reaction

Environmental lung dz**

132
Q

Pneumoconioses:
etiology dusts: ?

noxious gases?

A 
Silicosis
Asbestos
Coal Mine Dust (“black lung”)
Berylliosis
Byssinosis (Cotton)
Talcosis
Siderosis

Nitrogen oxides
Chlorine
Sulfur oxides
Metal fumes

133
Q 
Pneumoconioses: 
-MUST get occupational hx
-Dx:
--PFTs?
CXR?
CT scan?
A

PFTs (Multiple measurements over time)

CXR – Not sensitive or specific
CT Scan – Helps earlier dx

134
Q

Pneumoconioses: tx?

A

Prevent Respiratory Protection (Masks i.e. N95 Respirator)

STOP SMOKING!!!!

Closely monitor pathologic findings (Abnormal PFTs/CT Scans)

Treat airway inflammation (ICS, trial of bronchodilators)

Always Document thoroughly (Disability/Compensation)

135
Q

Sarcoidosis is a multi-organ disease of unknown cause

__________ granulomatous inflammation in affected organs

A

**noncaseating

136
Q

Sarcoidosis:
s/sx?

associated with?

A

Nonproductive cough, dyspnea of insidious onset, chest discomfort, +/- fever, malaise

Assoc: erythema nodosum, parotid gland enlargement, HSM, LAD, arthritis, cardiomyopathy, uveitis

137
Q

Sarcoidosis: KEY CXR finding?

A

***Bilateral hilar and right paratracheal adenopathy

138
Q

Sarcoidosis:
dx?
tx?

A

Dx: Transbronchial bx confirms
Tx: 90% respond to corticosteroids

139
Q

Pulmonary Embolism:
etiology?
S/Sx?

A

E: Thrombi from venous circulation or tumors (90% from DVTs)

S/Sx: Dyspnea, cough, CP, hemoptysis, diaphoresis

140
Q

Pulmonary Embolism:
PE?
RF: ?

A

tachycardia, tachypnea, crackles, low grad fever

RF: ↑ Age, Surgery/Trauma/ Immobility, OCP use, malignancy, hypercoagulable States

141
Q

Pul. Embolism:

Virchow’s triad**

A

Venous Stasis, hypercoagulability, endothelial damage

142
Q 
PE: dx? 
-ABG?
EKG?
CXR? 
VQ scan?
A

ABG: Resp alkalosis, hypoxia

EKG: Tachycardia, Ant ST-Seg changes/TWI, RBBB, RAD, S1Q3T3

CXR: Usually Normal;
Hampton’s hump, Westermark’s sign

VQ Scan: Shows defects–Normal exam r/o clinically significant thromboembolism

143
Q

PE: first choice diagnostic test** ?

A

CT**

144
Q

Pulmonary Embolism - Tx?

A

-O2 if needed

-Anticoagulants:
Heparin
Warfarin
INR goal 2-3
NOAC

-Thrombolytics

-Surgery:
IVC filter
Thromboembolectomy

145
Q

Cor Pulmonale=

A

Failure of right ventricle resulting from pulmonary disease

R ventricular dilatation, hypertrophy and eventual right sided HF

146
Q

Cor pulmonale:

Acute vs chronic?

A

Acute (PE, ARDS)

Chronic (COPD, Restrictive Lung Dz)

147
Q

Cor Pulmonale:
CXR findings?
-tx?

A

Widening of pulmonary arteries

Tx:
Medical: Correct hypoxemia/acidosis, O2, diuretics, vasodilators

Surgical: VAD, biventricular pacing, transplan

148
Q

Pulm. HTN= ________ effects in pulmonary arteries

A

vasoconstrictive

149
Q

Pulm. HTN:
Etiology?
Dx?

A

E: Hypoxia, acidosis, Lung resection, emphysema, PE, sickle cell, Mitral stenosis, LV failure

Dx: Right heart cath > ECHO

150
Q

Pulm HTN:

Tx?

A
  • O2, diuretics, anticoagulants, exercise

- Epoprostenol, prostacyclin, CCB, NO, sildenafil

151
Q

Acute Respiratory Distress Syndrome (ARDS)= acute onset of resp failure due to _______

A

↑ permeability of alveolar capillary membranes → Pulm Edema, hypoxia and dyspnea

-High Mortality (30-40%)

152
Q

ARDS: Criteria (list)

A
  • PaO2: FIO2 Ratio <200
  • B/L pulm infiltrates
  • PCWP (≤18 mmHg)
153
Q

ARDS: etiology and Sx

A

Sepsis, multiple trauma, DIC, aspiration, shock, pancreatitis

-Sx: tachypnea, frothy pink or red sputum, diffuse rales, dyspnea, severe hypoxemia

154
Q

ARDS: CXR?

ABG?

A

CXR: bilateral patchy, diffuse infiltrates
ABG: Resp acidosis

155
Q

ARDS: tx?

A

-Tx etiology (if possible)
Sepsis: Broad spectrum abx

O2: High flow with positive pressure

Diuretics

156
Q

Hyaline Membrane Disease occurs 2/2 ______

A

surfactant deficiency, minutes to hours after birth

Incidence: Weeks gestation

157
Q

Hyaline Membrane Disease: Incidence weeks gestation
<28 weeks= ___%
32-36 weeks- ___%
>37 weeks= ___%

A

<28 weeks – 70%, 32-36 weeks – 20%, >37 weeks – 5%

158
Q

Hyaline Membrane Disease

S/Sx?

A

Tachypnea, nasal flaring, grunting, retractions

159
Q

Hyaline Membrane Disease: tx?

A

Dexamethasone given to mom prior to delivery, O2, ventilation, exogenous surfactant

160
Q

Foreign Body Aspiration:
-MC age?
Sx?
Exam findings?

A

Typically <4y/o

Sx: Coughing, wheezing, choking, dyspnea

Exam: decreased breath sounds on FB side, localized wheezing, or normal exam (40%)

161
Q

Foreign body aspiration:
Dx?
tx?

A
  • Get CXR, but only ~15% are radiopaque

- **Definitive Dx and Tx is direct laryngoscopy and rigid bronchoscopy

162
Q

Solitary Pulmonary Nodule=

  • % benign=
  • % malignant=
A

Round, oval, sharply circumscribed pulmonary lesion (up to 5cm)

90% benign: usu <2 cm, distinct margins and may be calcified–>Most are infectious granulomas – chronic inflammatory lesion

-10% malignant: >45y/o, >2cm, indistinct margins, rarely calcified

163
Q

Solitary Pulmonary Nodule: tx?

A

Observation vs thorascopy or thoracotomy w/ bx

164
Q

Bronchogenic Carcinoma:

  • etiology?
  • MC one?
A

E: Smoking, asbestos, radon gas, metals

-**Adenocarcinoma (MC)–> Typically found in lung periphery

165
Q

Bronchogenic Carcinoma:

-SCC originates?

A

Squamous Cell Carcinoma (metastasizes)–> Typically originates in central bronchi → regional LN

166
Q

Bronchogenic Carcinoma:

LCC occurs?

A

Large Cell Carcinom–>Large peripheral mass with central necrosis

167
Q

Bronchogenic Carcinoma:
SCC mets ______
-SCC can cause _____

A

**Very aggressive, fast growing and mets quickly

-Cause SIADH and paraneoplastic syndromes

168
Q

Bronchogenic Carcinoma: S/Sx

A

Cough, dyspnea, LAD, clubbing, hemoptysis, hepatomegaly, clubbing

169
Q

Bronchogenic Carcinoma: CXR findings

A

Hilar or peripheral mass with cavitation, +/- pleural effusion
-CT helpful in differentiating malignant features

170
Q

Bronchogenic Carcinoma: Dx?

tx?

A

Bronchoscopy with bx and cytology

Tx: Surgery, Radiation therapy, Chemotherapy

171
Q

Mesothelioma= a primary tumor of _______

-risk factor?

A

pleural surfaces
~75% malignant

-RF= asbestos**

172
Q

Mesothelioma:
S/Sx?
Dx?

A

S/Sx: Dyspnea, CP, fevers, wt. loss, pleural effusions

Dx: Bx and cytology

173
Q

Mesothelioma:

tx?

A

Tx: radiation and chemotherapy

Prognosis is very poor, 75% die in 1-2 years

PA Clinical Year (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions