Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Internal Med EOR > Pulmonary 2 > Flashcards

Pulmonary 2 Flashcards

1
Q

what is bronchiectasis

A

chronic lung disease characterized by permanent and irreversible dilation of the bronchial airways with weakening of the function mucociliary transport mechanism

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

what is considered the common endpoint of various disorders that cause chronic airway inflammation

A

bronchiectasis

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

what is the most common cause of bronchiectasis in the US

A

cystic fibrosis

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

most common colonizers of bronchiectasis

A

pseudomonas aeruginosa in cystic fibrosis
haemophilus influenza if not due to cystic fibrosis

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

3 main components of bronchiectasis

A

recurrent infections
airway obstruction
peribronchial fibrosis

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

sx bronchiectasis

A

persistent productive cough with thick sputum (may be purulent)
dyspnea
pleuritic chest pain
hemoptysis due to bronchial artery erosion

nonspecific - fatigue, weight loss, recurrent infections

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

PE bronchiectasis

A

crackles (MC) & often bibasilar
wheezing
rhonchi

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

dx bronchiectasis

A

CXR - usually abnormal but nonspecific

High-resolution CT - preferred; thickened bronchial walls, airway dilation and lack of tapering of the airways (parallel or tram-track appearance), signet ring sign (increased airways diameter > adjacent vessel diameter)

PFT - criterion standard;
airway obstruction - decreased FEV1, decreased FEV1/FVC < 70% predicted, decreased FVC
hyperinflation - increased lung volumes (RV, TLC, RV/TLC, FRC)

test for cystic fibrosis

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

tx bronchiectasis

A

mucus clearance - chest physiotherapy, mucolytics (nebulizer hypertonic saline soln, acetylcysteine), postural drainage

vax against flu and pneumococcal

massive hemoptysis - bronchial artery embolization and/or surgery first line

aggressive abx

eventual lung transplant

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

abx for bronchiectasis

A

sputum culture unavailable - fluoroquinolone (moxifloxacin, levofloxacin)

sputum grown sensitive organisms but no H influenza or pseudomonas - amoxicillin or macrolide

beta lactamase-positive organism - augmentin, macrolide, cephalosporin, doxycycline, fluoroquinolone

pseudomonas - ciprofloxacin

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

what does a carcinoid tumor secrete

A

serotonin
histamine
bradykinin

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

most common mets for carcinoid tumor

A

liver

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

carcinoid syndrome

A

periodic episodes of diarrhea (serotonin), flushing, tachycardia, bronchoconstriction (histamine) and hemodynamic instability (hypotension)

may have heart murmur due to fibrosis

increased serotonin –> decreased niacin/B3 –> pellagra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

dx carcinoid syndrome

A

CT of chest - most useful; confirmed by bronchoscope biopsy for central lesions or transthoracic needle biopsy for peripheral lesions

bronchoscopy - pink to purple well-vascularized centrally-located tumor

tumor localization - CT scan and octreotide scintigraphy

UA - elevated 5-hydroxyindoleacetic acid (5-HIAA)

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

tx carcinoid tumor

A

tumor resection
niacin replacement
octreotide therapy to reduce sx

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

what is pneumoconiosis

A

chronic fibrotic lung disease secondary to inhalation of mineral dust

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

RF for silicosis

A

silica dust inhalation:
coal mining
quarry work with granite, slate, quartz
pottery makers
sandblasting
glass and cement manufacturing
masonry
hydraulic fracturing

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

sx pneumoconiosis

A

dyspnea on exertion, nonproductive cough
rales
weight loss
fatigue

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

dx silicosis

A

CXR - multiple small < 10 mm round nodular opacities (miliary pattern) primarily in the upper lobs
eggshell calcifications of hilarious and mediastinal nodes

Higher resolution CT

PFTs - restrictive

Lung biopsy - dust laden macrophages and loose reticulin fibers in the lung

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

tx silicosis

A

removal from exposure
corticosteroids, oxygen, rehab

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

what is Caplan syndrome

A

coal worker pneumoconiosis + rheumatoid arthritis

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

coal worker’s pneumoconiosis is also called

A

black lung disease

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

dx coal worker’s pneumoconiosis/black lung disease

A

CXR - small nodules predominantly in the upper lung with hyperinflation of the lobes in an obstructive pattern

PFTs - increased RV, TLC, RV/TLC - obstructive pattern

lung biopsy - black lungs - interstitial pigment deposition and an anthracitic macrophage

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

high risk occupations for berylliosis

A

aerospace
high tech electronics
ceramics
tool and dye manufacturing
alloy manufacturing (jewelry making)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
dx berylliosis
CXR - normal in 50%; hilar lymphadenopathy and increased interstitial lung markings the blood beryllium lymphocyte proliferation test is the most appropriate initial dx test for patients suspected of having berylliosis PFTs - similar to sarcoidosis - restrictive and/or obstructive bx - noncaseating granulomas
26
high risk occupations for asbestosis
destruction, repair, or renovation of old buildings insulators pipe-fitting boiler-makers ship building and shipyard workers
27
dx asbestosis
CXR - pleural plaques - bilatéral mid-lung zone parietal pleural thickening or calcification, especially along the lower lung fields and diaphragmatic pleura are hallmark shaggy heart sign - indistinct heart border, ground glass appearance PFTs - restrictive lung pattern - increased FEV1/FVC, decreased lung volumes (VC, RV, TLC) decreased DLCO and lung compliance bx - linear asbestos bodies in the lung tissue (ferruginous bodies)
28
what is the most common cause of bacterial pneumonia
streptococcus pneumonia
29
sx typical pneumonia
fever productive cough pleuritic chest pain dyspnea rigors
30
sx atypical pneumonia
low grade fever dry nonproductive cough extra pulmonary sx (myalgias, malaise, pharyngitis, nausea, vomiting, diarrhea)
31
PE typical pneumonia
tachypnea tachycardia bronchial breath sounds dullness to percussion increased tactile fremitus egophony inspiratory rales (crackles)
32
PE atypical pneumonia
exam often normal may have crackles
33
what type of bacteria is strep pneumoniae
gram positive diplococci
34
what type of bacteria is haemophilus influenzae
gram negative rod
35
what type of bacteria is klebsiella pneumoniae
gram negative rod
36
what type of bacteria is staph aureus
gram positive cocci in clusters
37
classic presentation strep pneumoniae pneumonia
blood-tinged rusty sputum
38
classic presentation of klebsiella pneumoniae
most often occurs in alcoholics, DM, severe COPD thick, mucoid, blood-tinged sputum (currant jelly)
39
classic presentation of mycoplasma pneumoniae
young and healthy, college students, military recruits MC cause of atypical/walking pneumonia cold agglutinin titers elevated in > 50%
40
classic presentation of legionella pneumiphila pneumonia
air conditions, potable water, cooling towers, ventilation systems, hot tubs in large facilities
41
dx pneumonia
CXR - patchy, segmental, lobar, or multilobar consolidation blood cultures x 2
42
Outpatient therapy (antibiotics) pneumonia
Low risk or no comorbidities and low risk for P. Aerugino aeruginosa or MRSA: Amoxicillin 1 g PO TID x 5 days Doxycycline 100 mg P BID x 5 days Azithromycin 500 PO once, then 250 mg PO daily x 4 days (if local pneumococcal resistance is < 25%) Significant comorbidities (chronic heart, lung, liver, or renal disease, diabetes, EtOH, active cancer, immunosuppression, asplenia) Amoxicillin/clavulanate (Augmentin) 875 BID or Cefuroxime 500 mg PO BID PLUS Azithromycin 500 PO once, then 250 mg PO daily x 4 days or Doxycycline 100 mg BID x 5 days Levofloxacin 750 mg PO daily x 5 days Moxifloxacin 400 mg PO daily x 5 days
43
inpatient tx pneumonia
Inpatient (hospitalize if > 50 with comorbidities, altered mental status, poor fluid status) Treatment regimens depend on various factors, which include severity, prior hospitalization, and prior abx use. Common options include: Ceftriaxone + Doxycycline or Azithromycin Levofloxacin, Moxifloxacin, Cefepime, Piperacillin/Tazobactam, Vancomycin, and Meropenem (alone and in various combinations)
44
when to admit for pneumonia
CURB65 Confusion Uremia > 30 mg/dL Respiratory rate >/= 30 BP low (SBP < 90 or DBP < 60) Age > 65
45
what is the most common cause of viral pneumonia in kids vs adults
kids - RSV adults - influenza
46
common causes of fungal pneumonia
Coccidioides (valley fever): Look for this in a patient with non-remitting cough/bronchitis non-responsive to conventional treatments; western states Pulmonary aspergillosis: The majority of cases occur in people with underlying illnesses such as tuberculosis or chronic obstructive pulmonary disease (COPD), but with otherwise healthy immune systems Cryptococcus: found in soil can disseminate and can cause meningitis Histoplasma capsulatum: Chronic cavitary histoplasmosis is characterized by pulmonary lesions that are often apical and resemble cavitary TB. Manifestations are worsening cough and dyspnea, progressing eventually to disabling respiratory dysfunction. Dissemination does not occur. Pneumocystis Jiroveci
47
dx fungal pneumonia
Chest X-Ray Findings: Cryptococcus: Cryptococcal antigen can be detected in CSF and serum. India ink stain or serology with latex agglutination assay or cryptococcal antigen assay (CRAG) is helpful. Histoplasma capsulatum causes mediastinal or hilar lymphadenopathy (looks like sarcoidosis)
48
tx fungal pneumonia
Cryptococcus and Histoplasma - Amphotericin B Coccidioides - Azoles - fluconazole or itraconazole Aspergillus - Triazoles - Triazole antifungal agents include voriconazole, posaconazole, itraconazole, and fluconazole
49
what is the most common opportunistic infection in HIV
pneumocystis pneumonia esp if CD+
50
what can clue you in that your pt has PCP
nearly all patients w PCP will have either hypoxemia at rest or with exertion (oxygen desaturation w ambulation is highly suggestive)
51
dx PCP
CXR is the cornerstone of diagnosis. The radiograph shows diffuse interstitial or bilateral perihilar infiltrates Diagnose with bronchoalveolar lavage (PCR), labs, and an HIV test Methenamine silver stain is used to stain Pneumocystis. Samples of affected tissue, such as lung tissue from biopsy, can be stained to reveal the pathogen Will often have very low O2 saturation despite supplemental O2
52
tx PJP
Treat with Trimethoprim-sulfamethoxazole (BACTRIM) and steroids If allergic treat with Pentamidine Prophylaxis for high-risk patients with a CD4 count of less than 200 or with a history of PJP infection. Daily Bactrim is the prophylaxis antibiotic of choice.
53
what is pulmonary HTN
elevated mean pulmonary arterial pressure > 20 mmHg or > 25 mm Hg on resting cardiac cauterization
54
what can pulmonary HTN lead to
RVH, increased RV pressure, and eventually right sided HF
55
what are the different classifications of pulmonary HTN
group 1 - idiopathic pulmonary arterial HTN group 2 - pulmonary HTN due to left heart disease group 3 - pulmonary HTN due to hypoxemia or chronic lung disease group 4 - pulmonary HTN due to chronic thromboembolic dz
56
sx pulmonary HTN
dyspnea on exertion lethargy fatigue
57
PE for pulmonary HTN
accentuated ST signs of right sided HF tricuspid regurgitation (holosystolic murmur)
58
dx pulmonary HTN
CXR EKG Echocardiograph with bubble study is most important Right heart Cath - definitive/gold standard CBC
59
what will CXR show for pulmonary HTN
enlarged pulmonary arteries right sided HF
60
what will EKG show for pulmonary HTN
cor pulmonale - RVH, RAD, right atrial enlargement, RBBB may have LVH
61
what will echo with bubble study show for pulmonary HTN
elevated right ventricular systolic pressure hypertrophied and dilated right ventricle right ventricular dysfunction
62
what will CBC show for pulmonary HTN
polycythemia with increased hematocrit
63
tx for group 1 pulmonary HTN
oral CCB endothelin receptor antagonists + PDE5 inhibitor - Ambrisentan + Tadalafil
64
tx for group 2 pulmonary HTN
treating HF and volume overload w diuretics
65
tx for group 3 pulmonary HTN
supplemental oxygen if hypoxemia at rest or with physical activity
66
tx group 4 pulmonary HTN
long-term anticoagulation
67
what is the MC cardiac cause of pulmonary HTN
mitral stenosis
68
what are the 4 subtypes of non small cell lung CA
adenocarcinoma large cell squamous cell carcinoid
69
lung CA screening
annual low dose CT for those 55-80 who have no sx of lung CA + a 30 PPY smoking hx who currently smoke or who have quit within 15 years
70
MC lung CA
adenocarcinoma
71
common gene mutations in adenocarcinoma of the lung
KRAS EGFR ALK
72
dx adenocarcinoma of the lung
CXR - peripherally located CT guided biopsy - gland formation (glandular appearance) with mucin production
73
second most common cause of lung CA after adenocarcinoma
squamous cell
74
characteristics of squamous cell lung CA
CCCP centrally located; associated w wide mediastinum Cavitary lesions (central necrosis with cavitation) hyperCalcemia Pancoast syndrome
75
dx squamous cell lung CA
sputum cytology fiberoptic bronchoscopy biopsy - keratinization by tumor cells and/or intracellular desmosomes (intercellular bridges)
76
what paraneoplastic syndromes are associated w small cell (oat cell) lung CA
SVC syndrome SIADH (hyponatremia) Cushing syndrome (ectopic ACTH production) Lambert Eaton syndrome
77
dx small cell lung CA
CXR - centrally located mass Biopsy - usually CT guided (peripherally located) or via bronchoscopy (centrally located) Histology - sheets of small dark blue cells w rosette formation (about 2x the size of resting lymphocytes)
78
tx for small cell vs other lung CA
small cell - chemo others - surgery
79
where is large cell lung CA typically located
large peripheral mass with prominent necrosis
80
histology of large cell lung CA
pleomorphic giant cells (sheets of round to polygonal cells w prominent nucleoli and abundant pale staining cytoplasm w differentiating features)
81
Superior vena cava syndrome sx
facial, neck, and upper extremity edema facial plethora chest pain respiratory sx neurologic sx dyspnea is MC presenting sx
82
tx SVC syndrome
stabilization immediate endogenous intervention (thrombus removal or stent placement)
83
Lambert-eaten syndroome
antibodies against presynaptic voltage gated CALCIUM channels proximal muscle weakness that improves w repeated use autonomic sx - dry mouth, postural hypoTN, erectile dysfunction hyporeflexia
84
superior sulcus (Pancoast) tumors
shoulder and arm pain most common initial sx ; pain can progress and radiate to head and neck Horner syndrome - triad of ipsilateral ptosis, miosis, anhidrosis weakness atrophy of the muscles of the hand and/or arm may have ulnar neuropathy
85

Internal Med EOR (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions