Pulmonary Flashcards
What pneumonia presents with salmon pink sputum?
Staph
What are some buzzwords associated with gram negative pneumonia?
currant jelly sputum and bulging fissure sign (klebsiella)
What are some lab changes that you might see with legionella pneumophila?
hyponatremia, hypophosphatemia, thrombocytopenia, elevated LDH, elevated CRP
ILD: person presents with regular chest tightness toward the end of the 1st day of the workweek. What is causing this?
Monday chest tightness is caused by Byssinosis (organic dust that causes ILD)
What’s the most common manifestation of asbestos exposure in the first 10 years?
BAPE = benign asbestos pleural effusions
- vary from serous to bloody
- occur early in the exposure history (within 5 years)
- 1/3 of patients have eosinophils in the pleural fluid
Malignant mesothelioma is or is not associated with smoking?
Is not
Which part of the lung do asbestosis and silicosis involve?
Asbestosis is the lower lung and silicosis is the upper lung
All patients with silicosis have an increased risk for developing what 2 diseases?
Active TB and malignancy; also have a strong association with scleroderma and rheumatoid arthritis
What are some diseases that clubbing is almost always, commonly, and almost never seen in?
- Almost always = advanced IPF; asbestosis
- Commonly = bronchiectasis; CF; lung cancer
- Almost never = emphysema; sarcoidosis
What is Caplan syndrome?
Seropositive rheumatoid arthritis associated with massive CWP (call workers’ pneumoconiosis). This syndrome is notable for the development of peripheral lung nodules in addition to the upper lung nodules seen in CWP.
What are differences in BAL findings of helper/suppressor lymphocyte ratios in sarcoid vs hypersensitivity pneumonitis?
Sarcoid - helper/suppressor > 4:1
Hypersensitivity pneumonitis ratio
What are a couple of alternate diagnoses you can think of when assessing a progressively worsening asthmatic?
- churg-strauss syndrome
2. ABPA
What are 4 autoimmune diseases that cause pulmonary hemorrhage?
- Goodpasture syndrome
- SLE
- Granulomatosis with polyangiitis
- IPH (idiopathic pulmonary hemosiderosis)
What is the definition of pulmonary hypertension?
mean PAP >/= 25 at rest and >/= 30 with exercise
What conditions lead to a decrease in DLCO?
emphysema, ILD, pulmonary vascular disease, and anemia
What are classic signs of a fat embolus?
shortness of breath, confusion, and petechiae
What are the most common causes of a malignant pleural effusion?
Lung cancer (1/3), breast cancer (1/4), lymphoma (1/5)
A patient just had plastic surgery then went to the beach where she was exposed to sand and water and now has infected surgical wounds. What might me the causative organism?
Non tuberculosis mycobacteria
Is it significant if you find Aspergillus or cryptococcus in sputum?
No for Aspergillus but yes for cryptococcus; if you find cryptococcus you need to do a lumbar puncture to evaluate for CNS infection
What does the buzzword halo sign indicate?
It is the high resolution CT finding for a invasive pulmonary Aspergillus and it represents a pulmonary infarction
How does malignant mesothelioma present?
With pleuritic chest pain and a unilateral hemorrhagic pleural effusion
What lung cancers are associated with asbestos exposure?
malignant mesothelioma, squamous, and adenocarcinoma
Who should be screened for lung cancer with annual low dose CT scan?
- Aged 55-74
- smoked >/= 30 pack years
- current smoker or quit within the last 15 years
What can be the sole cause of a pulmonary infiltrate in a patient with AML? And what needs to be ruled out?
Sole cause - hemorrhage
Rule out - Aspergillus infection as the cause of the hemorrhage
(pleomorphic) Gram negative coccobacilli is a common buzz phrase for?
Haemophilus influenza (they may also be described as pleomorphic gram negative rods)
pneumonia + pharyngitis + hoarseness = ? type of PNA
chlamydophila pneumoniae
pneumonia + lots of extra pulmonary manifestations: hemolytic anemia, splenomegaly, erythema multiforme, SJS, arthritis, pharyngitis, tonsillitis, ear infection, neurological changes like confusion = ? type of PNA
mycoplasma pneumoniae
Intracellular lancet shaped gram positive diplococci describes what bacteria?
Strep pneumo
What presents with rust colored sputum?
strep pneumo
If a pneumonia bacteria is described as gram negative cocci, what should I be thinking?
Neisseria meningitidis or moraxella catarrhalis
What are 2 situations that lead to hypoxemia and a normal A-a gradient?
- breathing air with a reduced concentration of oxygen
2. hypoventilating
What should you think about in a pt with asthma or CF who has uncontrolled dz? They have recurrent exacerbations that improve with prednisone but then the patient has return of wheezing, coughing, and dyspnea shortly after stopping steroids?
ABPA
How do you screen for ABPA?
aspergillus antigen skin prick test; if positive then get IgE level
A patient gets worse as you are weaning their steroids. What might they have?
Churg-Strauss
Which fungal lung infection has erythema nodosum and erythema multiform as associated skin findings?
Coccidioidomycosis
What does the cxr of a histoplasmosis patient look like?
hilar adenopathy, focal alveolar infiltrates, multiple nodules
What are the DESAT causes that cause a patient to fail to wean off the vent?
D - drugs E - electrolyte imbalance and ET tube S - secretions A - alkalemia T - too high a pO2 and too low a pCO2
Describe the stages of pertussis in more detail
pertussis disease has 3 phases: catarrhal, paroxysmal, and convalescent. The catarrhal stage presents as a typical, uncomplicated upper respiratory infection lasting 5–12 days. Patients are most infectious during this stage.
It is not until the paroxysmal stage develops, with its characteristic paroxysms of coughing followed by a “whoop,” that pertussis becomes clinically apparent. After 1–2 weeks, this stage is followed by an often prolonged convalescent stage, lasting several weeks to months.
Which class of antibiotic interacts with theophylline and raises the level?
flouroquinolones (cipro)
What criteria must you meet for home O2?
1.Resting PaO2 ≤ 55 mmHg, or
2.O2 saturation ≤ 88%, or
3.PaO2 ≤ 59 mmHg (O2 sat ≤ 89%) with evidence of cor pulmonale
Evidence of cor pulmonale in these considerations is:
Clinical evidence of right heart failure
Pulmonale on ECG (P wave height > 2.5 mm in II, III, and AVF)
Hct > 56 (due to polycythemia from chronic hypoxia 2° cor pulmonale)
What should a finding of eggshell calcifications make you think of?
Silicosis
Sputum with a salty taste should make you think of what?
bronchoalveolar cell carcinoma, now called adenocarcinoma in situ (AIS),
The A-a gradient is increased in all causes of hypoxemia except which two causes?
hypoventilation and high altitude
What produces a Horner pupil?
pulmonary neoplasms of the superior sulcus
