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PANRE > Pulmonary 12% > Flashcards

Pulmonary 12% Flashcards

1
Q

Cough persist >5 days; 95% viral; in chronic lung patients consider H. influenzae, S. pneumoniae, M. catarrhalis; normal vital signs, no rales, no egophony.

A

Acute bronchitis

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2
Q

RSV first episode of wheezing in infants, young children, tachypnea, respiratory distress.

A

Acute bronchiolitis

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3
Q

Caused by Hib; CXR “Thumbprint Sign”; treat with Ceftriaxone (Rocephin)

A

Acute epiglottitis

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4
Q

Caused by Parainfluenza virus in the winter months; patients < 3 years old; CXR “Steeple Sign”; treatment is supportive (air humidifier), if severe IV fluids and racemic epinephrine

A

Croup

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5
Q

Fevers, chills, coryza, myalgia; diagnose with rapid antigen test; Zanamivir and Oseltamivir (Tamiflu) treat influenza A and B must be given within 48 hours. Amantadine and Rimantadine treat only influenza A. Annual vaccine for everyone 6 months and older unless contraindicated.

A

Influenza

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6
Q

Bordetella pertussis (gram negative capsule); patients < 2 years old; high-pitched “inspiratory whoop”; treat with Macrolide.

A

Pertussis (Whooping Cough)

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7
Q

Patients will present with fever, dyspnea, tachycardia, tachypnea, cough +/- sputum.

A

Bacterial pneumonia

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8
Q

Influenza pneumonia: Most common in adults, characterized by a more precipitous onset and fulminant course.
Adenovirus: Tends to cause symptoms fast, will present with GI symptoms and lasts about 1 week. May differentiate from bacterial mycoplasma pneumonia as mycoplasma is slow and insidious.
RSV: Children <1 year old
Parainfluenza: Children 2-5 years old.

A

Viral pneumonia

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9
Q

Apical infiltration

A

Tuberculosis

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10
Q

Lobar consolidation

A

Community-Acquired Pneumonia

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11
Q

COPD, smokers, postsplenectomy

A

Haemophilus influenzae

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12
Q

College kids, sore throat, long prodrome

A

Chlamydia pneumoniae

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13
Q

Young people living in dorms, (+) cold agglutinins, bullous myringitis, walking pneumonia, low temp

A

Mycoplasma

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14
Q

Ventilators, Cystic fibrosis, patients become sick fast - treat with 2 antibiotics

A

Pseudomonas

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15
Q

Air conditioning, aerosolized water, low NA+ (hyponatremia), GI symptoms (diarrhea) and high fever

A

Legionella

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16
Q

Rust colored sputum, common in patients with splenectomy

A

S. Pneumonia

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17
Q

Salmon colored sputum, lobar, after influenza, MRSA treat with vancomycin

A

S. Aureus

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18
Q

Histoplasma, Coccidioides (valley fever), Cryptococcus

A

Fungal pneumonia

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19
Q

Immunocompromised patients usually symptomatic, found in soil can disseminate and can cause meningitis

A

Cryptococcus

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20
Q

Bird or bat droppings (caves, zoo, bird), Mississippi or Ohio river valley causes mediastinal or hilar lymphadenopathy (looks like sarcoidosis)

A

Histoplasma capsulatum

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21
Q

Caused by fungal inhalation in western states. Look for this in a patient with non-remitting cough/bronchitis non-responsive to conventional treatments.

A

Coccidioides (valley fever)

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22
Q

HIV-related pneumonia

A

Pneumocystis jiroveci

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23
Q

Infants, young children, tachypnea, respiratory distress, wheezing. Diagnosed by nasal washing. Supportive measures include, albuterol via nebulizer, antipyretics and humidified oxygen admit if O2 sat < 95% and/or retractions

A

Respiratory syncytial virus infection (RSV)

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24
Q

Mycobacterium tuberculosis - transmitted by respiratory droplets. Classic findings include fever, night sweats, anorexia and weight loss.

A

Tuberculosis

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25
Q

PPD Rules: Area of induration = raised area (not the red area).

A

< 5 mm in HIV.
< 10 mm in high-risk area (healthcare worker or possible known exposure).
< 15 mm for non exposed.

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26
Q

Diagnose TB with _____

A

sputum for AFB smears and cultures.

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27
Q

Latent TB - treat with _____

A

Isoniazid for 9 months.

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28
Q

Active TB treatment: ______

A

quad therapy (RIPE): Rifampin (RIF); Isoniazid (INH); Pyrazinamide (PZA); Ethambutol (EMB)

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29
Q

Patients with active TB will need ____ for therapy cessation.

A

two negative AFB smears and TWO negative cultures in a row

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30
Q

TB prophylaxis for household members:

A

Isoniazid for 1 year.

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31
Q

GI tract cancer that has metastasized to the lungs.

A

Carcinoid tumors

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32
Q

Most common type of carcinoid tumor.

A

Adenoma - slow growing, rare metastasis

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33
Q

Carcinoid tumors present with ______

A

haemoptysis, cough, focal wheezing or recurrent pneumonia, carcinoid syndrome - cutaneous flushing, diarrhea, wheezing and low blood pressure (hallmark sign)

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34
Q

Carcinoid tumors on CXR are seen as ______

A

pedunculated sessile growth in the central bronchi

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35
Q

Lung CAs:

A

Small cell; non small cell: large cell, adenocarcinoma

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36
Q

99% smokers; does not respond to surgery; mets at presentation; central mass; very aggressive.

A

Small cell lung CA

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37
Q

85% of lung CA cases.

A

Non small cell lung CA

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38
Q

25-35% of lung CA cases; hemoptysis; central location; paraneoplastic syndrome: hypercalcemia; elevated PTH.

A

Squamous cell lung CA

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39
Q

5% of lung CA; fast doubling; rare response to surgery; paraneoplastic syndrome: gynecomastia; peripheral location 60%.

A

Large cell lung CA

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40
Q

Most common 45-50% of lung CA cases; peripheral location; associated with smoking and asbestos exposure; paraneoplastic syndrome: thrombophlebitis.

A

Adenocarcinoma

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41
Q

Ill defined, lobular or spiculated pulmonary nodule suggests ________

A

Cancer.

Biopsy.

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42
Q

Calcification, smooth well-defined edged pulmonary nodule suggests _________

A

Benign disease.

If not suspicious < 1 cm it should be monitored at 3 mo, 6 mo, and then yearly for 2 yr.

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43
Q

Obstructive pulmonary disease; greater than 12% increase in FEV1 after bronchodilator therapy monitor with peak flow meter; FEV1 to FVC ratio < 80%.

A

Asthma

44
Q

How much air a person can exhale during a forced breath; during the first forced breath.

A

Forced expiratory volume (FEV); FEV1

45
Q

Total amount of air exhaled during the FEV test.

A

Forced vital capacity (FVC)

46
Q

Asthma: Less than 2 times per week or 3 night symptoms per month; treatment.

A

Mild Intermittent;

Step 1: Short acting beta2 agonist (SABA) PRN

47
Q

Asthma: More than 2 times per week or 3-4 night symptoms per month; treatment.

A

Mild Persistent;

Step 2: Low-Dose inhaled corticosteroids (ICS) daily

48
Q

Asthma: Daily symptoms or more than 1 nightly episode per week; treatment.

A

Moderate Persistent;
Step 3: Low-Dose ICS + Long acting beta2 agonist (LABA) daily
Step 4: Medium-Dose ICS +LABA daily

49
Q

Asthma: Symptoms several times per day and nightly; treatment.

A

Severe Persistent:
Step 5: High-Dose ICS +LABA daily
Step 6: High-Dose ICS +LABA +oral steroids daily

50
Q

Foul breath, purulent sputum, hemoptysis and chronic cough along with a CXR demonstrating dilated and thickened airways with “tram tracks” and “plate-like” atelectasis (scarring)

A

Bronchiectasis

51
Q

½ of bronchiectasis cases are due to _________

A

Cystic fibrosis

52
Q

Gold standard for bronchiectasis diagnosis is ______

A

CT of the chest

53
Q

Bronchiectasis treatment.

A

Ambulatory oxygen, aggressive antibiotics, CPT (chest physiotherapy = bang on the back) and eventually lung transplant.

54
Q

Chronic cough that is productive of phlegm occurring on most days for 3 months of the year for 2 or more consecutive years without an otherwise-defined acute cause.

A

Chronic bronchitis

55
Q

“Blue Bloaters!” (due to chronic hypoxia); common in smokers (80% of COPD patients).

A

Chronic bronchitis

56
Q

Chronic bronchitis objective findings

A

Rales, rhonchi; CXR: peribronchial and perivascular markings; ↑ HGB and HCT common because of chronic hypoxic state; ↑ pulmonary HTN with RVH, distended neck veins, hepatomegaly.

57
Q

Chronic bronchitis AND Emphysema treatment.

A

Short acting bronchodilators for mild disease, long acting bronchodilators +/- inhaled corticosteroids for moderate to severe disease, Ipratropium bromide is inhaler of choice for COPD
Smoking cessation and supplemental O2 (O2 is single most important medication in long term)
Antibiotics for acute exacerbations.
Flu and pneumococcal vaccines are a must.

58
Q

A condition in which air spaces are enlarged as a consequence of destruction of alveolar septae.

A

Emphysema

59
Q

The body’s natural response to ↓ lung function is chronic hyperventilation = “Pink Puffers!” CO2 Retainers - the body must increase ventilation to blow off CO2.

A

Emphysema

60
Q

Emphysema objective findings

A 
Minimal cough (compared to chronic bronchitis), quite lungs, thin, barrel chest
CXR reveals loss of lung markings and hyperinflation - Parenchymal bullae and blebs are pathognomonic
Normal hematocrit (HCT)
61
Q

Young patient with a history of chronic lung disease, pancreatitis or infertility; Autosomal recessive mutation in CFTR gene; Recurrent respiratory infections (especially Pseudomonas)

A

Cystic fibrosis

62
Q

Cystic fibrosis objective findings.

A

CXR may reveal hyperinflation, mucus plugging and focal atelectasis; Labs will reveal an elevated quantitative sweat chloride test (gold standard)

63
Q

Cystic fibrosis treatment.

A

Chest physiotherapy, high fat diet, supplement fat soluble vitamins (A, D, E, K), antibiotics for acute exacerbations

64
Q

Pleural effusion symptoms

A

Dyspnea, and a vague discomfort or sharp pain that worsens during inspiration

65
Q

Differentiate pleural effusion exudate and transudate with pleurocentesis and Light’s Criteria.

A

Exudate: (local pleural disease) - protein ratio ↑, LDH ↑, infection, malignancy, trauma
Transudate: Congestive heart failure, atelectasis, cirrhosis

66
Q

Pleural effusion exam

A

Decreased tactile fremitus, dullness to percussion and and diminished breath sounds over the effusion

67
Q

Pleural effusion CXR

A

Lateral decubitus x-ray and upright films: Blunting of costophrenic angle. Mediastinal shift away from effusion

68
Q

Pleural effusion treatment

A

Thoracentesis is the gold standard

69
Q

Pneumothorax: Tall thin males 10-30 years old

A

Spontaneous pneumothorax

70
Q

Spontaneous pneumothorax treatment.

A

If > 15%, chest tube insertion with serial radiographs every 24 hours until resolved

71
Q

Pneumothorax: Etiology: Penetrating injury;

Physical exam: Hyperresonance to percussion and tracheal shift to contralateral side.

A

Tension pneumothorax

72
Q

Tension pneumothorax treatment.

A

Large bore needle decompression 2nd intercostal space midclavicular line.

73
Q

Right ventricular enlargement and eventually failure secondary to a lung disorder that causes pulmonary artery hypertension.
Lung disorders such as PE, vasculitis, ARDS, COPD (most common), Asthma, and ILD causes pulmonary artery hypertension.

A

Cor pulmonale

74
Q

Cor pulmonale symptoms

A

65-year-old man who presents with a chronic productive cough, dyspnea, and wheezing.

75
Q

Cor pulmonale exam

A

Cyanosis, distended neck veins, and a prominent epigastric pulsation. Findings include peripheral edema, neck vein distention, hepatomegaly, and a parasternal lift

76
Q

Patient recovering from a recent surgery presents with sudden onset of pleuritic CP, dyspnea, apprehension, cough, hemoptysis, and diaphoresis. P 120bpm with RRR. Lungs: tachypnea, crackles.

A

Pulmonary embolism

77
Q

Virchow’s triad.

A

Hypercoaguable state, venous stasis, vascular injury.

78
Q

PE risk factors.

A

CA, surgery, pregnancy, OCP, long bone fx (fat emboli)

79
Q

Homan’s sign

A

Dorsiflexion of the foot causes calf pain - indicative of DVT

80
Q

PE EKG and CXR findings.

A

Tachycardia, ST changes; Westermark’s sign and Hampton’s Hump (triangular infiltrate secondary to intraparenchymal hemorrhage).

81
Q

PE testing.

A

Spiral CT; pulmonary arteriography (gold standard)

82
Q

PE treatment

A

Heparin > Coumadin (INR 2.5) x 3-6 months

83
Q

Usually caused by an underlying disorder such as constrictive pericarditis, mitral stenosis, LV failure, mediastinal disease compressing the pulmonary veins.

A

Pulmonary hypertension

84
Q

Pulmonary hypertension history

A

History of underlying disorder (such as COPD) with worsening dyspnea, especially at rest and retrosternal chest pain.

85
Q

Pulmonary hypertension exam

A

Narrow splitting of S1, loud P2, systolic ejection click, and parasternal lift

86
Q

Pulmonary hypertension diagnostics

A

Pulmonary artery pressure >25 mmHg - diagnose with right heart catheterization

87
Q

The most common of all interstitial lung diseases.

Be sure to rule out other common causes such as drugs, and environmental or occupational exposures.

A

Idiopathic pulmonary fibrosis

88
Q

Idiopathic pulmonary fibrosis diagnostics

A

CT chest: diffuse patchy fibrosis with pleural based honeycombing.
PFTs will demonstrate a restrictive pattern - opposite of what you would see with asthma.
Decreased lung volume with a normal to increased FEV1/FVC ratio.

89
Q

Pneumoconiosus types. (Restrictive Pulmonary Disease)

A

Asbestosis, silicosis, berylliosis, coal worker’s pneumoconiosis

90
Q

Pneumoconiosus type: ship building, demolition, construction; CXR: interstitial fibrosis and pleural thickening; mesothelioma

A

Asbestosis

91
Q

Pneumoconiosus type: mining, sandblasting, stone or quarry work; CXR: nodular opacities of upper lung fields, “eggshell” calcification of hilar lymph nodes.

A

Silicosis

92
Q

Pneumoconiosus type: high tech fields, nuclear power, ceramics, foundries; CXR: diffuse infiltrates, hilar adenopathy.

A

Berylliosis

93
Q

Pneumoconiosus type: coal miners; CXR: nodular opacities.

A

Coal worker’s pneumoconiosis

94
Q

Restrictive Pulmonary Disease - Pulmonary manifestations (most common), erythema nodosum, parotid gland enlargement.

A

Sarcoidosis

95
Q

Sarcoidosis CXR findings.

A

Bilateral hilar lymphadenopathy seen on chest radiograph is the hallmark finding in 90% of cases.

96
Q

Sarcoidosis diagnosis and treatment.

A

Biopsy: non-caseating granulomas and ↑ ACE levels
Treatment: 90% of cases are responsive to steroids and can be controlled with a maintenance note.

97
Q

Rapid onset of profound dyspnea occurring 12-24 hours after the precipitating event.

A

Acute respiratory distress syndrome

98
Q

Acute respiratory distress syndrome exam

A

Tachypnea, frothy pink or red sputum and diffuse crackles.

99
Q

Acute respiratory distress syndrome CXR findings

A

Air bronchograms and bilaterally fluffy infiltrate

100
Q

Acute respiratory distress syndrome treatment

A

Tracheal intubation with lowest level of PEEP

101
Q

Affects premature infants. It occurs when infants are born before the lungs are producing adequate amounts of surfactant. Surfactant helps to prevent the lungs from collapsing. As the airways collapse, infants will struggle more and more to breath until they become acidotic and multisystem organ failure begins.

A

Hyaline membrane disease

102
Q

Hyaline membrane disease CXR findings

A

Diffuse bilateral atelectasis causing a “ground glass appearance” and air bronchograms

103
Q

Hyaline membrane disease treatment and prophylaxis.

A

Antenatal corticosteroids to mother and exogenous surfactant as both treatment and prophylaxis

104
Q

Foreign body aspiration - presentation (depends on location of obstruction) high vs. low

A

High in the airway - Inspiratory stridor.

Low in the airway - Wheezing and decreased breath sounds.

105
Q

Foreign body aspiration location

A

80% in mainstem or lobar bronchus, 20% in upper airway, right > left

106
Q

Foreign body aspiration treatment

A

Remove foreign body with bronchoscope

PANRE (9 decks)

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