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Internal Medicine > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

a 25-year-old cystic fibrosis patient complaining of chronic, frequent coughing productive of yellow and green sputum. She recently recovered from a Pseudomonas spp. pneumonia requiring hospitalization. On physical examination you notice foul breath, purulent sputum and hemoptysis along with a CXR demonstrating dilated and thickened airways with “plate-like” atelectasis (scarring).

A

Bronchiectasis

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2
Q

What is bronchiectasis? What are the most common causes?

A

Permanent dilation or destruction of bronchiole walls

Causes

  • cystic fibrosis
  • immune deficits
  • recurrent infections (pneumonia, bronchitis)
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3
Q

What are the chest x-ray findings of bronchiectasis?

A
  • linear “tram track” lung markings
  • plate-like atelectasis
  • dilated & thickened airways
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4
Q

Treatment of Bronchiectasis

A
  • oxygen
  • Aggressive ABX –> Pseudomonas (Zosyn, Fluoro.)
  • Chest physiotherapy
  • lung transplant
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5
Q

What is a carcinoid tumor? What are the common symptoms?

A

A tumor arising from neuroendocrine cells –> excess secretion of serotonin

Symptoms:

  • episodic flushing
  • diarrhea
  • wheezing & cough
  • itching
  • heart failure
  • Pellagra –> low niacin levels causing dementia, diarrhea, dermatitis
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6
Q

Where are carcinoid tumors most commonly found?

A
  1. GI (intestines, stomach, liver, pancreas)

2. Lungs

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7
Q

How do you diagnose a carcinoid tumor?

A

CT scan – definitive diagnosis

Urinalysis 5-HIAA – serotonin metabolite

Decreased Niacin

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8
Q

How do you treat a carcinoid tumor?

A

Surgery (lesions are immune to chemo and radiation)

Octreotide – decrease secretion of serotonin

Niacin supplementation

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9
Q

What is cor pulmonale & what are some common etiologies?

A

Right sided heart failure secondary to lung disorder that causes pulmonary hypertension

Etiologies:

  • COPD
  • pulmonary embolism
  • vasculitis
  • asthma
  • interstitial lung disease
  • ARDS (acute respiratory distress syndrome)
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10
Q

How do you diagnose cor pulmonale?

A

Echo – shows increased pressures in pulmonary arteries and right ventricle

Follow up tests done to diagnose exact etiology – ex: spirometry

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11
Q

How do you treat cor pulmonale?

A

Treat underlying conditions before permanent damage is done

Diuretics are not helpful! May be harmful!

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12
Q

What is idiopathic pulmonary fibrosis?

A

Fibrosis = scarring of the lungs

Idiopathic = unknown cause (must rule out common causes)

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13
Q

What is the MCC of interstitial lung disease?

A

Idiopathic pulmonary fibrosis

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14
Q

How do you treat idiopathic pulmonary fibrosis

A
  • oxygen
  • corticosteroids

Very few treatments…eventually need a lung transplant

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15
Q

What do you see on CXR and CT scan of a patient with idiopathic pulmonary fibrosis?

A
  • CXR = diffuse patchy infiltrates

- Ct = honeycombing

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16
Q

What is pneumoconiosis?

A

Any fibrosis of lung tissue with a known cause – typically from environmental or occupational hazards

  • coal workers
  • silicosis- mining, stone workers –> “eggshell” calcifications
  • asbestosis - insulation, demolition, construction
  • beryliosis - nuclear power & electric plants
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17
Q

Signs and symptoms of pneumoconiosis?

A
  • SOB
  • chronic dry cough
  • chronic hypoxia
  • cor pulmonale (LE edema, JVD, hepatoplenomegaly)
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18
Q

Signs & symptoms of cor pulmonale

A
  • Lower extremity edema
  • neck vein distention
  • hepatomegaly
  • parasternal lift
  • tricuspid/pulmonic insufficiency
  • loud S2
19
Q

How do you treat pneumoconiosis?

A
  • oxygen
  • steroids
  • smoking cessation
  • *vaccines**
  • rehab
20
Q

What is the most common cause of community-acquired pneumonia?

A

Streptococcus pneumoniae

Gram - cocci

21
Q

What is the most common cause of hospital acquired pneumonia?

A

Pseudomonas

Gram - rods

22
Q

Other causes of community acquired pneumoia

A
  • strep pneumoniae
  • Mycloplasma pneumonia
  • H. influenzae
  • Viral –> influenza (adults), RSV (kids)
  • M. catarrhalis
23
Q

What causes “walking pneumonia” and who does it typically affect?

A

Mycloplasma pneumoniae

School aged kids, college students, military recruits

24
Q

Which pneumonia is caused by outbreaks related to contaminated water? What symptoms do they have?

A

Legionella pneumophila – gram-negative rod

contaminated water supplies –> air conditioners, cooling towers

GI symptoms = anorexia, N/V/D, increased LFTs, hyponatremia

Increased incidence in elderly, smokers, immunodeficient

25
Q

Which pneumonia is commonly seen after a viral illness like the flu?

A

Staphylococcus aureus – gram + cocci

HAP, IV drug users, immunocompromised, elderly

bilateral with multilobar infiltrates

26
Q

Which pneumonia is seen in ETOHics?

A

Klebsiella pneumoniae – gram-negative rods

Cavitary lesions

27
Q

Which pneumonia is associated with aspiration & where is it most commonly seen?

A

Anaerobes

MC in right lower lobe

28
Q

which pneumonia is associated with HIV pts?

A

Pneumocystis jirovecci – fungus

compromised host

dry cough, dyspnea on exertion, pleuritic chest pain

29
Q

Where is Histoplasma capsulatum most commonly found? What kind of an organism is this?

A

Mississippi & Ohio river valley soil contaminated with bird / bat droppings

Fungus

30
Q

Where is Coccidioides found and what kind of organism is this?

A

Soil of southwest Uninted States in desert areas

Fungus

31
Q

What are common types of hospital acquired pneumonia?

A
  • Pseudomonas
  • E. coli
  • Klebsiella
  • Enterobacter
  • Staph aureus
32
Q

Describe community acquired pneumonia?

A

Acquired OUTSIDE of a hospital & pt is not a member of a long-term care facility OR develops within 48 hours of initial hospital admission

33
Q

Describe hospital acquired pneumonia?

A

> 48 hours after hospitalization

34
Q

Signs & Symptoms of typical pneumonia

A
  • sudden onset fever
  • productive cough w/ purulent sputum
  • pleuritic chest pain
  • rigors = chills
  • tachycardia & tachypnea

(S. pneumonia, H. influenza, Klebsiella, S. Aureus)

35
Q

Physical Exam of typical pneumonia

A

-bonchial breath sounds
-dullness on percussion
-incrased tactile fremitus
+ egophony
-inspiratory rales & crackles

36
Q

Chest XR findings of typical pneumonia vs. atypical pneumonia

A

typical= lobar

atypical = diffuse, patchy, interstitial

37
Q

Atypical pneumonia signs & symptoms

A
  • low-grade fever
  • dry, nonproductive cough
  • extrapulmonary symptoms = myalgias, malaise, sore throat, headache, N/V/D

(mycoplasma pneumoniae, chlamydophila, legionella, viruses)

38
Q

rusty-blood tinged sputum

A

strep pneumoniae

39
Q

green sputum

A
  • H flu

- Pseudomonas

40
Q

currant jelly sputum

A

Klebsiella

41
Q

Foul smelling sputum

A

Anaerobes

42
Q

PCV13 (Prevnar) vaccine is given when?

A

childhood – kids <24 months old are given 4 doses

43
Q

PPSC23 (Pneumovax) is given when?

A

age >/= 65

age 2-65 yo with chronic disease

  • cardiac
  • pulmonary
  • diabetes
  • liver disease
  • chronic care facility
  • immunocompromised

Internal Medicine (3 decks)

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