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Clin Med II Disease Key Notes > Pulmonary (Exam #2) > Flashcards

Pulmonary (Exam #2) Flashcards

1
Q

What is always the initial study for pulmonary diagnostics, and what is the preferred view?

A

X-RAY (PA view)

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2
Q

What are the six anatomical landmarks that should be considered when reviewing pulmonary diagnostic imaging?

A
  • Airway
  • Bones
  • Cardiac silhouette/PA
  • Diaphragm
  • Edges
  • Fields
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3
Q

Why would you consider a high resolution CT (HRCT) over a low dose CT (LDCT), and vice versa?

A
  • HRCT: better detail

- LDCT: less detail but good for SCREENING

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4
Q

What is the primary risk associated with CT scans (compared to an x-ray), and in what population should this be most considered?

A

MORE RADIATION

- Pediatrics are more radiosensitive than adults

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5
Q

What are pediatrics at increased risk for with CT (2)?

A
  • Leukemia

- Brain tumors

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6
Q

What is there a link between with pregnant women and CT scans?

A

In utero exposure linked to pediatric CA mortality

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7
Q

What type of contrast is used for CT? What type of contrast is used for MRI?

A
  • CT: iodine

- MRI: Gadolinium

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8
Q

What three conditions should be evaluated with contrast on CT scan?

A
  • Vessels
  • Malignancy
  • Chest trauma
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9
Q

When using contrast with CT, which three complications/risks should be considered?

A
  • Allergic reaction to contrast
  • Contrast-induced nephropathy (CNI) = AKI
  • Development of lactic acidosis if taking Metformin
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10
Q

What two medications can be used to pre-treat an allergy to Iodine contrast?

A
  • Prednisone

- Benadryl

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11
Q

What two conditions (either or) must be met to be considered contrast-induced nephropathy (CNI)?

A
  • Serum Cr >0.5 mg/dL
    OR
  • > 25% from baseline
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12
Q

Before using CT WITH contrast, what five risk factors should be considered?

A
  • 60+ years old
  • History of renal disease
  • HTN with meds
  • DM
  • Taking Metformin
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13
Q

What is the preferred method for assessing pulmonary vasculature, and why?

A 
CTPA (CT Pulmonary Angiography)
- Less invasive 
- Less expensive
- Less time
(than Catheter-Directed Pulmonary Angiography (Direct PA))
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14
Q

What is the gold standard for PE evaluation?

A

Catheter-Directed Pulmonary Angiography (Direct PA)

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15
Q

What two exams should be considered if Catheter-Directed Pulmonary Angiography (Direct PA) is inconclusive, but there is still high suspicion for a PE?

A
  • CTPA

- V/Q scan

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16
Q

What is the primary risk associated with Magnetic Resonance Imaging (MRI/MRA)?

A

Nephrogenic systemic fibrosis

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17
Q

What are the two primary indications for using a V/Q scan?

A

Test of choice for…

  • Diagnosis of PE in pregnant women
  • Negative CR but high PE suspicion
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18
Q

How is a PET scan measured, and what finding is considered “possible malignancy”?

A

FDG via measurement of SUVs

- SUV >2.5 = possible malignancy

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19
Q

What finding is considered normal on US, and what finding is indicative of PTX on US?

A

Normal: seashore sign/motion lung beach

- PTX: barcode/stratosphere sign

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20
Q

What pulmonary diagnostic tool is commonly used in patients with obstruction of trachea or proximal bronchus?

A

Rigid Bronchoscopy

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21
Q

What two things can be determined using FEV-1/FVC ratio?

A
  • Determine obstructive vs. restrictive

- Define severity of obstruction

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22
Q

What position is preferred for spirometry testing, and why?

A

Sitting preferred

- Less likelihood of syncope

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23
Q

What is the technique for spirometry testing (5 steps)?

A
  1. TIGHT SEAL over mouthpiece
  2. Relax and breathe normally
  3. Take deep breath in
  4. Forcefully exhale all air
  5. Take another deep breath in, then STOP
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24
Q

What test is used to evaluate reversibility, and for what disease is this often used?

What two findings are indicative of reversibility?

A 
Bronchodilator Testing (specifically for asthma, which is reversible)
- Reversibility if FEV-1 increases by 12% AND 200 mL
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25
Q

What is the technique for bronchodilator testing (3 steps)?

A
  1. Perform spirometry to obtain a baseline value
  2. Using nebulizer or inhaler, 2-4 puffs of bronchodilator medication (hold for 5-10 seconds)
  3. Perform spirometry again, 15 minutes after medication inhaled
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26
Q

What is another name for the Methacholine Challenge Test, and for what disease is this often used? What is the technique for this test (2 steps)?

What finding is indicative of a positive test?

A

Bronchoprovocation (specifically to confirm diagnosis of asthma)

  1. Give Methacholine (vasoconstrictor) via nebulizer
  2. Perform spirometry at 30 seconds and 90 seconds → (Methacholine concentration increases during this time)
  • Positive test if FEV-1 decreases by 20%
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27
Q

What type of disease are these conditions classified as: Asthma, Asthmatic Bronchitis, COPD, Cystic Fibrosis, Emphysema, Upper Airway Obstruction? What does this mean?

A

Obstructive Disease

  • Trouble blowing OUT air
  • High lung volume
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28
Q

What type of disease are these conditions classified as: Pulmonary Fibrosis, infectious lung disease, thoracic deformities, Pleural Effusion, tumors, neuromuscular diseases, obesity? What does this mean?

A

Restrictive Disease

  • Trouble getting air IN
  • Reduced lung volume
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29
Q

What are these tests results indicative of: TLC and RV increased; FEV-1 and FEV-1/FVC decreased; FVC normal (hint: think GENERAL)?

A

Obstructive Disease

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30
Q

What are these tests results indicative of: TLC, FVC, RV and FEV-1 decreased; FEV-1/FVC normal or increased (hint: think GENERAL)?

A

Restrictive Disease

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31
Q

What is the technique for Diffusion Capacity (DLCO) testing (3 steps)?

What finding is indicative of a positive test?

A
  1. Inhale a single breath of gas (helium/CO)
  2. Expire
  3. Measure exhalation
  • Diseased lungs = higher CO levels measured in exhaled gas
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32
Q

What condition specifically involves cough (nocturnal) often longer than 3 weeks; wheezing?

A

Asthma

- Wheezing is HALLMARK

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33
Q

What condition specifically involves increased AP diameter from air trapping, wheezing with prolonged expiratory phase?

A

Asthma

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34
Q

Which two triads are associated with Asthma, and what are the three components of each?

A
  • ASA Triad/Samter’s Triad: sinus disease with nasal polyps, ASA sensitivity, severe asthma
  • Atopic Triad: atopic dermatitis, allergic rhinitis, asthma
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35
Q

What is the diagnostic test of choice for Asthma, and at what age range is it recommended?

A

Spirometry

- Recommended >5 years

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36
Q

What are the five components of Intermittent Asthma?

A
  • Symptoms less than/equal to 2 days/week
  • Nighttime awakenings less than/equal to 2 nights/month if 5+ years; none if 0-4 years
  • FEV-1 >80%
  • Normal activity
  • Less than/equal to 2 days/week SABA use to control sxs
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37
Q

What are the five components of Mild Persistent Asthma?

A
  • Symptoms 2+ days/week (NOT daily)
  • Nighttime awakenings 3-4 nights/month if 5+ years; 1-2 nights/month if 0-4 years
  • FEV-1 >80%
  • Minor limitations in activity
  • 2+ days/week SABA use to control sxs
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38
Q

What are the five components of Moderate Persistent Asthma?

A
  • Daily symptoms
  • Nighttime awakenings 1+ nights/week if 5+ years (not nightly); 3-4 nights/month if 0-4 years
  • FEV-1 60-80%
  • Some activity limitations
  • Daily SABA use to control sxs
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39
Q

What are the five components of Severe Persistent Asthma?

A
  • Symptoms throughout the day
  • Nighttime awakenings nightly if 5+ years; 1+ nights/week if 0-4 years
  • FEV-1 <60%
  • Extremely limited physical activity
  • SABA use several times/days to control sxs
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40
Q

What is the recommended treatment for Intermittent Asthma?

A

SABA as needed

- Note: used in all stages PRN

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41
Q

What is the recommended treatment Mild Persistent Asthma?

A

Daily low dose ICS (inhaled corticosteroid)

- Montelukast/Cromolyn if peds

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42
Q

What is the recommended treatment Moderate Persistent Asthma (2, consider age)?

A
  • Medium dose ICS + referral if 0-4 years

- Low dose ICS + LABA if 5+ years

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43
Q

What is the recommended treatment Severe Persistent Asthma (2)

A
  • Medium dose ICS + LABA

- Montelukast + referral

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44
Q

If Asthma is poor controlled, what are the treatment options for Step 5 and Step 6 (2 each)?

A

Step 5:

  • High dose ICS + LABA
  • Montelukast + referral

Step 6:

  • High dose ICS + LABA + OCS (oral corticosteroids)
  • Montelukast + OCS + referral
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45
Q

What is the recommended follow up for Asthma?

A

Follow up should occur 3 months initially

- Then every 3-12 months depending on severity

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46
Q

What are the three possible results of PEFR (Peak Expiratory Flow Rate), and what disease is it used to evaluate?

A

Asthma (Acute Asthma Exacerbation)

  • Green: >80% = good control
  • Yellow: 50-80% = caution, SABA + med
  • Red: <50% = medical emergency/ED
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47
Q

What condition involves inflammation → small airway disease AND/OR parenchymal destruction → airflow limitation?

A

COPD

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48
Q

What condition involves infiltration of submucosal layer by neutrophils; causes mucous gland enlargement → hypersecretion → loss of ciliary transport?

A

COPD

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49
Q

What component of COPD involves airway inflammation, airway remodeling = breathing through small straw?

A

Small airway disease

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50
Q

What component of COPD involves loss of alveolar attachments, decreased elastic recoil = balloon vs. brown bag?

A

Parenchymal destruction

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51
Q

What condition involves dyspnea, chronic cough, sputum production; DOE is early sxs?

A

COPD

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52
Q

What condition involves tobacco smoke, host factors (AATD, asthma, childhood URIs), occupation hazards, pollution?

A

COPD

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53
Q

Why is tobacco smoking a significant risk factor for COPD?

A
  • Smoking stimulates elastase → elastase creates degenerative changes in elastin, release of cytotoxic oxygen radicals from WBCs = further tissue damage
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54
Q

What is the most common cause of Cor Pulmonale, and what is this?

A

RHF due to lung etiology

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55
Q

What condition involves barrel chest (increased AP diameter), prolonged expiration, abnormal breath sounds (decreased, wheezing, rhonchi), pursed lip breathing, tripod positioning, cyanosis?

A

COPD

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56
Q

What condition involves pursed lip breathing, tripod positioning, cyanosis?

A

COPD

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57
Q

What is the required diagnosis for COPD?

A

Spirometry

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58
Q

What condition should be considered if sxs in young patient (less than 45 years), non-smoker, FH of emphysema? What disease is this a risk factor for?

A

Alpha-1 Antitrypsin (AAT)

- Risk factor for COPD

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59
Q

Which condition involves CXR showing signs of air trapping; blebs or bullae = emphysema?

A

COPD

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60
Q

What is the 1st line treatment for COPD? What two other treatment measures should also be considered?

A

Prevent progression
- Smoking cessation

Also, vaccinations (Influenza and Pneumococcal) and supplemental O2 (15+ hours/day → increased survival)

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61
Q

What is the treatment recommendation for Grade A COPD?

A

Bronchodilator

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62
Q

What is the treatment recommendation for Grade B COPD (2)?

A
  • LAMA
    OR
  • LABA
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63
Q

What is the treatment recommendation for Grade C COPD?

A

LAMA

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64
Q

What is the treatment recommendation for Grade D COPD (2)?

A
  • LAMA
    OR
  • LAMA-LABA
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65
Q

What are the two classifications of bronchodilators, and what is the name hint for each?

A
  • Beta2-Agonist (“-erol”)

- Anticholinergic (“-ium”)

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66
Q

What is the recommended short-acting Beta2-Agonist to treat COPD? Long-acting (2)?

A
  • SABA: Albuterol

- LABA: Salmeterol or Formoterol

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67
Q

What is the recommended short-acting Anticholinergic to treat COPD? Long-acting (2)?

A
  • SABA: Ipratropium bromide

- LABA Tiotropium bromide or Umeclidinium

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68
Q

When are corticosteroids recommended for treatment of COPD, and what are the two LABA-ICS we learned about?

A

Mostly used if COPD + Asthma

  • Advair
  • Symbicort
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69
Q

What is the recommended treatment for those with COPD + alpha-1 antitrypsin deficiency (AAT)?

A

Antiprotease Therapy

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70
Q

What condition involves acute changes in baseline dyspnea, cough, sputum to warrant a change in therapy?

A

Acute Exacerbations of COPD

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71
Q

What is the most common trigger associated with Acute Exacerbations of COPD?

A

Respiratory illness (viral vs. bacterial)

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72
Q

What is the recommended treatment for Acute Exacerbations of COPD (2)?

A
  • Increase frequency of SABA (Beta2 Agonist recommended)

- Oral steroids (Prednisone 40mg daily for 5 days)

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73
Q

What is the recommended oral steroid dose for Acute Exacerbations of COPD?

A

Prednisone 40mg daily for 5 days

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74
Q

How do you classify Acute Exacerbations of COPD (mild vs. moderate/severe)? What is the treatment for moderate/severe?

A
  • Mild: worsening of 1 of 3 cardinal sxs
  • Moderate/Severe: worsening of 2 OR 3 of 3 cardinal sxs = need abx (Macrolide or Fluoroquinolone); if severe, also hospitalization
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75
Q

What education/treatment is always considered for bronchitis AND pneumonia?

A
  • Smoking cessation

- Vaccinations

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76
Q

What is the most common etiology of Bronchitis?

A

VIRAL

- Influenza A & B

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77
Q

If Bronchitis is not viral, what is the second most common etiology (hint: pathogen)?

A

BACTERIAL 2nd

- Bordetella pertussis

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78
Q

What condition involves cough +/- sputum production for 5+ days for 1-3 weeks?

A

ACUTE Bronchitis

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79
Q

What does the presence of purulent sputum indicate?

A

NOTHING

- Certainly does not indicate bacterial infection

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80
Q

What condition involves at least 3 months of cough and sputum on most days of month for 2 consecutive years?

A

CHRONIC Bronchitis

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81
Q

What two PE findings are most commonly seen with Bronchitis? Which two findings should be negative?

A
  • Wheezing
  • Rhonchi that clears with coughing

Negative for crackles/rales or signs of consolidation

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82
Q

What is the recommended treatment for Bronchitis? Which four medications might be considered?

A

SUPPORTIVE

  • NSAIDs
  • Ipratropium
  • Antitussives
  • Albuterol/SVN
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83
Q

Which medication should always be avoided in the treatment of Bronchitis?

A

NO CODEINE

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84
Q

What specific condition involves prolonged progressive cough with whopping sound?

A

Bacterial Bronchitis

- Bordetella pertussis = “Whooping Cough”

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85
Q

What specific condition involves catarrhal (1-2 weeks) of URI/fever → paroxysmal (2-6 weeks) of cough and “whooping” → convalescent (weeks to months) where cough gradually resolves?

A

Bacterial Bronchitis

- Bordetella pertussis = “Whooping Cough”

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86
Q

What is the recommended diagnosis method for Bacterial Bronchitis (Bordetella pertussis = “Whooping Cough”)? What other two methods are often used, and in what time period?

A

Bacterial culture

  • PCR if first 4 weeks
  • Serology if 2-8 weeks
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87
Q

What is the treatment for Bacterial Bronchitis (Bordetella pertussis = “Whooping Cough”), and what is the primary goal?

A

Antibiotics

- Used to decrease transmission NOT resolve sxs

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88
Q

What are the two antibiotics that can be used to treat Bacterial Bronchitis (Bordetella pertussis = “Whooping Cough”)?

A
  • Macrolides (Azithromycin or Clarithromycin, Erythromycin)
    OR
  • Bactrim
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89
Q

What two conditions should ALWAYS be reported to the State Health Department?

A
  • Bacterial Bronchitis (Bordetella pertussis = “Whooping Cough”)
  • TB
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90
Q

Influenza (Viral Bronchitis) is typically considered self-limited, but what complication should always be considered?

A

PNA

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91
Q

What 7 populations are considered high-risk for Influenza (Viral Bronchitis)?

A
  • <2 years
  • 65+ years
  • Immunocompromised
  • Underlying chronic disease
  • Pregnant
  • Morbidly obese
  • Resident of nursing home/chronic care facility
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92
Q

What condition involves fever, HA, myalgia, malaise?

A

Influenza (Viral Bronchitis)

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93
Q

What two medications should be considered for treatment of Influenza (Viral Bronchitis), and within what time period?

A

Within 48 hours of sxs onset:

  • Tamiflu
  • Relenza
  • NOTE: reduces duration of sxs but not sxs themselves
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94
Q

What condition is an acute infection of pulmonary parenchyma?

A

Pneumonia

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95
Q

What specific condition involves aspiration from oropharynx?

A

Community-Acquired Pneumonia (CAP)

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96
Q

What specific condition involves inhaled contaminated droplets; via blood; infected pleura; pathogens proliferate faster/more than macrophages can handle → inflammatory response to increase defenses?

A

Community-Acquired Pneumonia (CAP)

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97
Q

What is the most common etiology of Community-Acquired Pneumonia (CAP), and what are the two most common etiologies?

A

BACTERIAL

  • Streptococcus pneumoniae for typical
  • Mycoplasma pneumonia for atypical
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98
Q

What specific condition involves acute onset fever and cough +/- sputum, hemoptysis, SOB, sweats, CP?

A

Community-Acquired Pneumonia (CAP)

- TYPICAL

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99
Q

What condition involves decreased/bronchial breath sounds, crackles/rales, signs of consolidation (dullness, increased tactile fremitus, bronchophony – spoken words louder/clearer, egophony – spoken “E” heard as “A”)?

A

Community-Acquired Pneumonia (CAP)

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100
Q

What condition involves infiltrate, consolidation, cavitation on CXR?

A

Community-Acquired Pneumonia (CAP)

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101
Q

What might be seen on labs for Community-Acquired Pneumonia (CAP)?

A

Leukocytosis with left shift = bacterial

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102
Q

What newer diagnostic test is being used for Community-Acquired Pneumonia (CAP) (hint: can differentiate bacterial vs. viral)?

A

Procalcitonin and CRP

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103
Q

What is the #1 predictor of good outcome for Community-Acquired Pneumonia (CAP)?

A

Right site of care

- OP vs. IP vs. ICU

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104
Q

What is the specific recommended treatment for uncomplicated Community-Acquired Pneumonia (CAP) (2)?

A

ABX FOR 5 DAYS:
- Macrolide (Azithromycin)
OR
- Doxycycline

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105
Q

What is the specific recommended treatment for complicated Community-Acquired Pneumonia (CAP) (__ + __, OR __)?

A

ABX FOR 5 DAYS:
- Beta-Lactam (Augmentin) + Macrolide (Azithromycin)
OR
- Levaquin

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106
Q

What nine conditions classify as complicated Community-Acquired Pneumonia (CAP)?

A
  • Recent abx use
  • COPD
  • Liver/renal disease
  • CA
  • DM
  • CHF
  • Alcoholism
  • Immunocompromised
  • Asplenia
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107
Q

What condition is CURB-65 used for, and what are the conditions?

A

Pneumonia Risk Stratification:

  • Confusion
  • Urea/BUN HIGH
  • Respiratory rate high
  • BP high
  • 65+ years
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108
Q

What condition involves 48+ hours after admission; high risk if ICU or mechanical ventilation?

A

Hospital-Acquired Pneumonia (HAP)

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109
Q

What condition involves subtype of HAP that developed 48-72 hours after intubation?

A

Ventilator-Associated Pneumonia (VAP)

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110
Q

What condition involves altered upper respiratory tract flora (2)?

A
  • Hospital-Acquired Pneumonia (HAP)

- Ventilator-Associated Pneumonia (VAP)

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111
Q

What conditions indicate a diagnosis of Hospital-Acquired Pneumonia (HAP) or Ventilator-Associated Pneumonia (VAP) (__ AND __)?

A
  • New/progressive infiltrate on imaging
    AND
  • 2+ of fever, purulent sputum, leukocytosis
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112
Q

What is the recommended treatment for Hospital-Acquired Pneumonia (HAP)
and Ventilator-Associated Pneumonia (VAP)?

A

Abx PROMPTLY

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113
Q

What specific condition is associated with HIV/AIDS (low CD4 count)?

A

Pneumocystis jirovecii PNA (PCP)

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114
Q

What specific condition involves gradual onset fever, nonproductive cough, SOB?

A

Pneumocystis jirovecii PNA (PCP)

115
Q

What specific condition involves reticular/groundglass opacities on CXR?

A

Pneumocystis jirovecii PNA (PCP)

116
Q

What is the specific recommended treatment for Pneumocystis jirovecii PNA (PCP)?

A

BACTRIM

  • High mortality if NOT treated
  • Abx prophylaxis if high risk
117
Q

What specific condition involves displacement of gastric contents to lung → injury and infection?

A

Aspiration PNA

118
Q

What three conditions are considered risk factors for Aspiration PNA?

A
  • Post-op state
  • Neuro compromise
  • Anatomical defect
119
Q

What specific condition involves RLL infiltrate most common on CXR?

A

Aspiration PNA

120
Q

What is the recommended treatment for Aspiration PNA?

A

ABX

121
Q

What condition involves progressive scarring of lung tissue around alveoli?

A

Interstitial Lung Disease (ILD) = Diffuse Parenchymal Lung Disease (DPLD)

122
Q

What condition is considered irreversible?

A

Interstitial Lung Disease (ILD)

123
Q

What condition involves process of fibrosis and aberrant healing response?

A

Interstitial Lung Disease (ILD)

124
Q

What condition involves progressive DOE, persistent nonproductive cough +/- systemic sxs?

A

Interstitial Lung Disease (ILD)

125
Q

What condition involves crackles (“velcro-like”)?

A

Interstitial Lung Disease (ILD)

126
Q

What condition involves

A

Interstitial Lung Disease (ILD)

127
Q

What condition involves inspiratory squeaks/high-pitched rhonchi?

A

Interstitial Lung Disease (ILD)

128
Q

What is the recommended treatment for Interstitial Lung Disease (ILD)?

A

Lung tissue biopsy

129
Q

What condition involves groundglass appearance, reticular “netlike” CXR?

A

Interstitial Lung Disease (ILD)

130
Q

What finding is indicative of poor prognosis for Interstitial Lung Disease (ILD)?

A

Honeycombing on CXR

131
Q

What is the preferred imaging for Interstitial Lung Disease (ILD)?

A

HRCT

- Greater diagnostic accuracy

132
Q

What three labs should be ordered to rule out autoimmune associated with Interstitial Lung Disease (ILD)?

A
  • ANA
  • RF
  • CCP
133
Q

What finding on PFT is indicative of Interstitial Lung Disease (ILD)? What other diagnostic test can be seen with early disease?

A

RESTRICTIVE disease

  • Low TLC
  • Low FEV-1 and FVC
  • Normal FEV-1/FVC ratio

Reduced DLCO seen with early disease

134
Q

What is the most common type of Interstitial Lung Disease (ILD)?

A

Idiopathic Pulmonary Fibrosis (IPF)

135
Q

What specific condition involves gradual onset DOE and nonproductive cough (6+ months)?

A

Idiopathic Pulmonary Fibrosis (IPF)

136
Q

What specific condition involves velcro/coarse crackles (inspiratory); digital clubbing?

A

Idiopathic Pulmonary Fibrosis (IPF)

137
Q

What specific condition HCRT (reticular opacities, traction bronchiectasis, honeycombing); restrictive pattern on PFTs?

A

Idiopathic Pulmonary Fibrosis (IPF)

138
Q

What specific condition is associated with usual interstitial PNA (UIP) (seen on HRCT and lung biopsy)?

A

Idiopathic Pulmonary Fibrosis (IPF)

139
Q

What are the three recommended treatments for Idiopathic Pulmonary Fibrosis (IPF)? What is the definitive cure for Idiopathic Pulmonary Fibrosis (IPF)?

A

Lung transplant = definitive

  • Treat for GERD
  • Nintedanib (TKI)
  • Pirfenidone
140
Q

What condition involves non-necrotizing granulomas?

A

Sarcoidosis

141
Q

What condition presents as female AAs 20-40 years, non-smoker?

A

Sarcoidosis

142
Q

What condition involves DOE, CP, cough; Erythema nodosum, Lupus pernio, Granulomatous uveitis, arthralgias?

A

Sarcoidosis

143
Q

What condition involves hilar adenopathy on CXR? What two findings will be seen on labs?

A

Sarcoidosis

  • Elevated serum ACE
  • Elevated serum calcium
144
Q

What type of tissue biopsy can be used for Sarcoidosis?

A

EBUS-TBLB tissue biopsy

145
Q

What is the 0, 2 and 4 staging on CXR for Sarcoidosis? At what staging level is treatment recommended?

A
  • 0 = normal
  • 2 = hilar adenopathy + diffuse infiltrates
  • 4 = fibrosis

No treatment until stage 2 OR symptomatic

146
Q

What is the recommended pharmacologic treatment for Sarcoidosis?

A

Steroids +/- immunosuppressants

147
Q

What condition involves inhalation of mineral dust, and what are the three types?

A

Pneumoconiosis

  • Silicosis
  • Coal Worker’s Pneumoconiosis (CWP)
  • Asbestosis
148
Q

What specific condition involves fibronodular lung disease due to inhalation of silica dust?

A

Silicosis

- Type of Pneumoconiosis

149
Q

What risk factor makes Silicosis (type of Pneumoconiosis) worse?

A

Smoking

150
Q

What condition is also called the “Black Lung”?

A

Coal Worker’s Pneumoconiosis (CWP)

- Type of Pneumoconiosis

151
Q

What condition involves inhalation of coal dust; black masses?

A

Coal Worker’s Pneumoconiosis (CWP)

- Type of Pneumoconiosis

152
Q

For Silicosis and Coal Worker’s Pneumoconiosis (CWP) (types of Pneumoconiosis), what two diagnostic tests are typically recommended? What finding will be seen with Silicosis?

A

CXR then HRCT

- “Crazy paving” pattern on HCRT for Silicosis

153
Q

For Silicosis and Coal Worker’s Pneumoconiosis (CWP) (types of Pneumoconiosis), if chronic SIMPLE, what finding will be seen on imaging?

A

Eggshell pattern

154
Q

What is the exposure time and expected progression for chronic SIMPLE Silicosis and Coal Worker’s Pneumoconiosis (CWP) (types of Pneumoconiosis)?

A
  • 10-12 years exposure

- Non-progressive once exposure eliminated

155
Q

For Silicosis and Coal Worker’s Pneumoconiosis (CWP) (types of Pneumoconiosis), if chronic COMPLICATED, what finding will be seen on imaging?

A

Angel-wing

156
Q

What is the exposure time and expected progression for chronic COMPLICATED Silicosis and Coal Worker’s Pneumoconiosis (CWP) (types of Pneumoconiosis)?

A
  • 20 years exposure

- Progressive even after no exposure

157
Q

For all three types of Pneumoconiosis, what is the recommended treatment?

If acute (not chronic), what additional treatment can be considered?

A

Supportive (tx will NOT change disease course)

If acute, consider steroids

158
Q

With Asbestosis (type of Pneumoconiosis), what does smoking put you at increased risk for?

A

Smoking increases risk for bronchogenic CA

159
Q

What specific condition involves lower lung opacities and pleural plaques on CXR?

A

Asbestosis

- Type of Pneumoconiosis

160
Q

For which specific condition is lung biopsy NOT recommended?

A

Asbestosis

- Type of Pneumoconiosis

161
Q

What form of CA most associated with Asbestosis

A

Mesothelioma

- Rare, poor prognosis

162
Q

What specific condition involves repetitive inhalation of antigens in susceptible host?

A

Hypersensitivity Pneumonitis

163
Q

Of al the Interstitial Lung Diseases (ILD), which type is considered reversible?

A

Hypersensitivity Pneumonitis

164
Q

Which specific condition involves etiology of causative agent – bacteria/fungi/mold; proteins/chemicals; environmental exposures (birds, hot tub)?

A

Hypersensitivity Pneumonitis

165
Q

What three medications are recommended treatment for Hypersensitivity Pneumonitis, and which is best for chronic stages?

A
  • Steroids (usually for chronic)
  • Bronchodilators
  • Antihistamines
166
Q

Which specific condition involves systemic vasculitis of small/medium vessels?

A

Granulomatosis with Polyangiitis (GPA)

167
Q

What specific condition involves necrotizing granulomas?

A

Granulomatosis with Polyangiitis (GPA)

168
Q

What specific condition involves infiltrates and cough; renal failure; skin (palpable purpura, ulcers); ocular, ENT, MSK, cardiac, PNS?

A

Granulomatosis with Polyangiitis (GPA)

169
Q

What specific condition involves stellate-shaped peripheral pulmonary aa. on CT Chest?

A

Granulomatosis with Polyangiitis (GPA)

170
Q

What specific condition involves elevated ESR/CRP and C-ANCA?

A

Granulomatosis with Polyangiitis (GPA)

171
Q

What specific condition involves proteinuria or RBC casts (glomerulonephritis)?

A

Granulomatosis with Polyangiitis (GPA)

172
Q

What two specialties should be consulted for Granulomatosis with Polyangiitis (GPA)?

A

Rheum AND Pulm

173
Q

What are the two recommended medications for treatment of Granulomatosis with Polyangiitis (GPA)?

A
  • Cyclophosphamide/Rituximab

- Steroids

174
Q

What are two possible causes of Treatment-Related ILD, and what is the recommended treatment?

A
  • Drug-induced
  • Radiation-induced

Discontinue drug and begin steroids

175
Q

Interstitial Lung Disease (ILD) can be associated with what group of diseases?

A

Connective Tissue diseases

- Absence of extrapulmonary symptoms does NOT exclude CT disease

176
Q

What three subtypes of Interstitial Lung Disease (ILD) are most associated with smoking? If smoking cessation is achieved, what will be the result?

A
  • RB-ILD (Respiratory Bronchiolitis-Associated ILD)
  • DIP (Desquamative Interstitial Pneumonitis)
  • PLCH (Pulmonary Langerhans Cell Histiocytosis)

Most patients have significant improvement/complete remittance with smoking cessation

177
Q

What is a possible complication of Interstitial Lung Disease (ILD), and how does this occur?

A

Cor Pulmonale

- As lungs stiffen, pulmonary aa. dilate → blood backs up into heart and causes RV dysfunction

178
Q

What is the most significant risk factor associated with lung CA?

A

SMOKING

179
Q

For lung CA, what is small, smooth, well-defined lesion (“coin lesion”); often benign?

A

Solitary Pulmonary Nodule (SPN)

180
Q

What is the most common type of Solitary Pulmonary Nodule (SPN) if benign?

A

Infectious granulomas

181
Q

What is the diagnostic process for Solitary Pulmonary Nodule (SPN) (hint: what is the recommended radiography)?

A
  1. Review old films

2. Helical CT without contrast

182
Q

Diagnostically, what three findings are more indicative of a BENIGN Solitary Pulmonary Nodule (SPN)?

A
  • Minimal growth in 2 years
  • Calcification
  • Small/smooth/well-defined
183
Q

Diagnostically, what four findings are more indicative of a MALIGNANT Solitary Pulmonary Nodule (SPN)?

A
  • Rapid growth
  • NO calcification
  • Poorly defined or irregular
  • Larger size (5+ cm)
184
Q

If solid SPN is 8+ mm with LOW probability of malignancy, what is the recommended diagnostic plan?

A

CT at 3 months

- If no growth, f/u CT at 9-12 and 18-24 months

185
Q

If solid SPN is 8+ mm with INTERMEDIATE probability of malignancy, what is the recommended diagnostic plan?

A

FDG PET scan/CT +/- biopsy

186
Q

If solid SPN is 8+ mm with HIGH probability of malignancy, what is the recommended diagnostic plan?

A

Biopsy or excision

187
Q

If solid SPN is 6-8 mm, what is the recommended diagnostic plan?

A

CT at 6-12 months

188
Q

If solid SPN is <6 mm, what is the recommended diagnostic plan?

A

No follow up required

- Optional CT at 12 months

189
Q

What are the three types of Non-Small Cell Carcinoma (NSCLC)?

A
  • Adenocarcinoma
  • Squamous Cell Carcinoma
  • Large Cell Carcinoma
190
Q

What type of lung CA arises centrally and is aggressive with poor prognosis?

A

Oat Cell Carcinoma

- Type of Small Cell Lung Cancer (SCLC)

191
Q

What type of lung CA is strongly associated with smoking?

A

Oat Cell Carcinoma

- Type of Small Cell Lung Cancer (SCLC)

192
Q

What type of lung CA involves hilar mass, mediastinal LAD; cough?

A

Oat Cell Carcinoma

- Type of Small Cell Lung Cancer (SCLC)

193
Q

What type of lung CA commonly involves brain metastasis?

A

Oat Cell Carcinoma

- Type of Small Cell Lung Cancer (SCLC)

194
Q

What three types of paraneoplastic syndromes are associated with Oat Cell Carcinoma (type of SCLC)?

A
  • SIADH
  • Cushing’s
  • Eaton-Lambert
195
Q

What two syndromes are associated with Oat Cell Carcinoma (type of SCLC)?

A
  • Paraneoplastic syndromes (SIADH, Cushing’s, Eaton-Lambert)

- SVC syndrome

196
Q

What is the most common type of Non-Small Cell Lung Cancer (NSCLC)?

A

Adenocarcinoma

197
Q

What type of lung CA arises peripherally and is often due to smoking?

A

Adenocarcinoma

- Type of Non-Small Cell Lung Cancer (NSCLC)

198
Q

What two types of lung CA metastasize to distant organs?

A
  • Adenocarcinoma
  • Large Cell Carcinoma

Both types of Non-Small Cell Lung Cancer (NSCLC)

199
Q

What type of lung CA is more associated with SVC Syndrome?

A

NSCLC > SCLC

200
Q

What type of lung CA is associated with thrombophlebitis, clubbing?

A

Adenocarcinoma

- Type of Non-Small Cell Lung Cancer (NSCLC)

201
Q

What type of lung CA can arise centrally OR peripherally?

A

Large Cell Carcinoma

- Type of Non-Small Cell Lung Cancer (NSCLC)

202
Q

What type of lung CA extends into hilum/mediastinum; slow growth?

A

Squamous Cell Carcinoma

- Type of Non-Small Cell Lung Cancer (NSCLC)

203
Q

What type of lung CA involves cough/hemoptysis?

A

Squamous Cell Carcinoma

- Type of Non-Small Cell Lung Cancer (NSCLC)

204
Q

What type of lung CA can be associated with PTH (hypercalcemia)?

A

Squamous Cell Carcinoma

- Type of Non-Small Cell Lung Cancer (NSCLC)

205
Q

What type of lung CA can cavitate; may be able to detect via sputum cytology?

A

Squamous Cell Carcinoma

- Type of Non-Small Cell Lung Cancer (NSCLC)

206
Q

What type of lung CA can be associated with excess hCG production?

A

Large Cell Carcinoma

- Type of Non-Small Cell Lung Cancer (NSCLC)

207
Q

What is the most common symptom associated with a primary lesion lung CA?

A

COUGH

208
Q

While hemoptysis may be indicative of CA, what condition is it most associated with?

A

Bronchitis

209
Q

If lung CA presents as pleural effusion, pericardial effusion, hoarseness, what type of etiology should be considered?

A

Intrathoracic spread

210
Q

What two syndromes are associated with intrathoracic spread of lung CA?

A
  • SVC Syndrome

- Pancoast Syndrome

211
Q

What is the gold standard diagnosis for SVC Syndrome?

A

Superior vena cavogram

212
Q

What specific condition involves SOB, facial swelling, dilated neck veins? What condition is this associated with?

A

SVC Syndrome

- Associated with intrathoracic spread of lung CA

213
Q

What specific condition involves tumor involving superior sulcus that compresses brachial plexus/cervical SNS?

A

Pancoast Syndrome

- Associated with intrathoracic spread of lung CA

214
Q

What specific condition involves ipsilateral side of tumor, if pain: proximal → distal (closer to tumor)?

A

Pancoast Syndrome

- Associated with intrathoracic spread of lung CA

215
Q

What specific condition may involve Horner’s syndrome (injury to SNS of face = miosis, anhidrosis, ptosis)?

A

Pancoast Syndrome

- Associated with intrathoracic spread of lung CA

216
Q

What specific conditions are triggered by altered immune response to neoplasm?

A

Paraneoplastic syndromes

- Associated with lung CA, specifically Oat Cell Carcinoma (SCLC)

217
Q

What specific conditions can involve hematologic findings like hypercalcemia (bone destruction), anemia, leukocytosis, thrombocytosis, hypercoagulation?

A

Paraneoplastic syndromes

- Associated with lung CA, specifically Oat Cell Carcinoma (SCLC)

218
Q

What specific conditions can involve endocrine findings like PTH-like substance (hypercalcemia); excess HCG production (gynecomastia, milky nipple discharge); SIADH (irritable, restless, personality changes, AMS); Cushing’s Syndrome (muscle weakness, weight loss, HTN, hirsutism) = worse prognosis?

A

Paraneoplastic syndromes

- Associated with lung CA, specifically Oat Cell Carcinoma (SCLC)

219
Q

What specific conditions can involve endocrine findings like Eaton-Lambert Syndrome (low ACh → muscle weakness, hyporeflexia)?

A

Paraneoplastic syndromes

- Associated with lung CA, specifically Oat Cell Carcinoma (SCLC)

220
Q

What is the most common site of metastasis for lung CA? What other three sites should be considered?

A

LIVER MOST COMMON

- Also bone, adrenal glands, brain

221
Q

What is the GOLD STANDARD diagnostic tool for lung CA? What other diagnostic tool should also be utilized?

A

TISSUE BIOPSY

- Also, PET with FDG

222
Q

What staging system is used for SCLC? Describe it.

A

Limited vs. Extensive

  • Limited: ipsilateral hemithorax
  • Extensive: extends beyond hemithorax + pleural effusions
223
Q

What staging system is used for NSCLC? Describe it.

A

TNM system

  • T (primary tumor)
  • N (nodal involvement)
  • M (distant metastases)
224
Q

What PFT finding is the strongest indicator of post-op complications with lung CA?

A

FEV-1 <60%

225
Q

What is the recommended treatment for SCLC? How well does this typically work?

A

Chemotherapy regardless of stage

- Initially responds well but aggressive so relapse common

226
Q

What is the recommended treatment for NSCLC?

A

Surgical resection

227
Q

What stage of NSCLC has the best prognosis?

A

Stage 1 has best prognosis with surgery (75% 5-year survival)

228
Q

If a patient is in late stages of NSCLC (late = IIIB-IV), what treatment is recommended?

A

Radiation or combination chemo

229
Q

Generally, is SCLC or NSCLC more aggressive? Which has the worse prognosis?

A

SCLC is more aggressive = worse prognosis

230
Q

What diagnostic tool is used for screen for lung CA in high-risk patients? What is considered high risk?

A

LDCT

  • Current smokers
  • Quit within 15 years
  • 20 pack-year hx with 1 RF
231
Q

What three medications can be considered for smoking cessation?

A
  • Wellbutrin (Zyban)
  • Chantix
  • Nicotine replacement (prescription or OTC)
232
Q

If prescribing Wellbutrin (Zyban), what risk in children should be considered? What other two side effects should be considered?

A

Increased risk of suicide in children/young adults

- AE of seizures, weight loss

233
Q

What condition requires prolonged exposure; MUST be active to spread?

A

TB

234
Q

What condition involves fever; cough (dry, 3+ weeks); pleuritic CP; weight loss; primarily affects lungs?

A

TB

235
Q

What is the most common form of TB, and how does it typically present?

A

Latent TB (LTBI) = most common

  • NO symptoms
  • CANNOT to be transmitted
236
Q

Why would TB go from latent to active?

A

Active if immune system unable to fight infection (esp. HIV or DM)

237
Q

What condition involves risk factors of immunocompromised (HIV, DM, children, silicosis); immigrants from areas of high exposure; IVDU; close living quarters?

A

TB

238
Q

What condition involves posttussive crackles; dull/decreased fremitus?

A

TB

239
Q

Under what two conditions would a CXR be indicated to test for TB?

A
  • Positive infection

- Symptomatic

240
Q

Which test involves intradermal forearm; read in 2-3 days; measure induration? What disease is it evaluating for?

A

TST (Mantoux Tuberculin Skin Test)

- Evaluating for TB

241
Q

In what population would a TST test result of 15+ mm be seen?

A

Positive in anyone (even without TB risk factors)

242
Q

In what seven populations would a TST test result of 10+ mm be seen?

A
  • Recent immigrants from countries with high TB rates
  • HIV-negative IVDU
  • Lab personnel
  • Residents/employees of prisons, HC facilities, etc.
  • Persons with certain high-risk medical conditions
  • Children <4 years
  • Children exposed to adults at high risk
243
Q

In what five population would a TST test result of 5+ mm be seen?

A
  • HIV+
  • Recent contact with active TB
  • Evidence of TB on CXR
  • Immunosuppressed patients
  • Organ transplant patients
244
Q

What test should be considered for evaluation of TB that can be used in place of TST if non-compliance concerns or received BCG?

A

IGRA

- Blood TB test

245
Q

What condition involves CXR findings of the apical/posterior upper lobes?

A

TB

246
Q

What is Ghon lesion (calcified parenchymal granuloma), ipsilateral calcified hilar lymph node? What disease is this associated with?

A

Ranke Complex

- Associated with TB

247
Q

What three tests can be done using sputum collection? How is sputum collected performed?

A

Sputum: 3 specimens 8-24 hours apart

  • Smear = Acid Fast Bacilli (AFB)
  • Cytology = Nucleic Acid Amplification Test (NAA)
  • Culture = gold standard
248
Q

If AFB and NAA both positive, what does this indicate, and what is the next treatment step?

A

TB disease is presumed = start treatment

249
Q

If TB culture is positive, what does this indicate, and what is the next treatment step?

A

TB disease confirmed = treatment + Drug Susceptibility Testing (DST)

250
Q

If TB culture is negative but TB suspected still, what is the next treatment step?

A

Treatment and monitor response

251
Q

What test can be used to identify M. tuberculosis and Rifampin resistance for TB?

A

Xpert MTB/RIF Assay

252
Q

When treating a patient for TB, what should always be utilized?

A

Direct Observed Treatment (DOT) for ALL patients with TB disease

253
Q

If ACTIVE TB, what is the treatment (2)?

A
  • INITIALLY, RIPE (Rifampin, Isoniazid, Pyrazinamide, Ethambutol) daily for 2 months then repeat CXR, AFB smear and culture
  • CONTINUATION: RIF and INH daily for 4 months
254
Q

What medication involves the side effect of orange-red compounds, and what disease is it used to treat?

A

RIF (Rifampin)

- Treats TB

255
Q

What medication involves the side effect of hepatotoxicity, peripheral neuropathy, and what disease is it used to treat?

A

INH (Isoniazid)

- Treats TB

256
Q

What medication involves the side effect of hepatotoxicity, and what disease is it used to treat?

A

PZA (Pyrazinamide)

- Treats TB

257
Q

What medication involves the side effect of optic neuritis, and what disease is it used to treat?

A

EMB (Ethambutol)

- Treats TB

258
Q

If LATENT TB, what is the treatment (2)? What if pregnant or children 2-11 years?

A

INH and Rifapentine for 12 weekly doses if 12+ years

- INH ONLY if pregnant or children 2-11 years

259
Q

Under what three conditions is someone considered NOT infectious with TB and can go home?

A
  • 2 weeks of treatment regimen
  • 3 negative sputum smears
  • Sxs improve
260
Q

Under what four conditions would someone who is STILL infectious with TB be allowed to go home?

A
  • Strict follow-up
  • DOT arranged
  • No children <5 or immunocompromised in home
  • Restricted travel except health-care visits
261
Q

If a patient has MDR-TB, what does this mean?

A

Does not respond to at least RIF and INH

262
Q

If a patient has XDR-TB, what does this mean?

A

Extensively drug resistant (responds to fewer drugs, including Fluoroquinolones)

263
Q

What is the purpose of the BCG Vaccine, and in to who is it recommended?

A

Decrease risk of severe complications due to TB

- Single dose at birth recommended in developing countries unless IC or pregnant

264
Q

What condition involves common in OH and Mississippi River valleys; more common if HIV/AIDS or IC?

A

Histoplasmosis

265
Q

What condition involves etiology of soil contaminated with bird/bat droppings; spelunking?

A

Histoplasmosis

266
Q

What type of Histoplasmosis occurs in healthy people; CXR can show residual granulomas?

A

Asymptomatic Primary Histoplasmosis

267
Q

What type of Histoplasmosis involves mild fever, fatigue, few resp. sxs for 1 week-6 months?

A

Acute Symptomatic Pulmonary Histoplasmosis

268
Q

What type of Histoplasmosis occurs in IC; fever, fatigue, cough, SOB + multiple organ involvement; can be fatal?

A

Progressive Disseminated Histoplasmosis

269
Q

What type of Histoplasmosis occurs in older COPD patients; progressive lung changes (apical cavities)?

A

Chronic Pulmonary Histoplasmosis

270
Q

Which three diagnostic tests are recommended for both Histoplasmosis and Coccidioidomycosis (Valley Fever)?

A
  • ID test (Immunodiffusion)
  • CF (Complement Fixation)
  • Antigen detection (EIA test)
271
Q

How can you differentiate Histoplasmosis from TB on CXR?

A

Histoplasmosis: hilar LAD, patchy/nodular infiltrates in LOWER lobes
- TB occurs in UPPER lobes

272
Q

What is the recommended treatment for Acute Symptomatic Pulmonary Histo if mild/moderate (2)?

A
  • <4 weeks = NO treatment

- >4 weeks = Itraconazole

273
Q

What is the recommended treatment for Acute Symptomatic Pulmonary Histo if moderate/severe?

A

Amphotericin B

- Then Itraconazole

274
Q

What is the recommended treatment for Progressive Disseminated Histo?

A

Amphotericin B

- Then Itraconazole

275
Q

What condition involves etiology of contaminated soil; endemic to desert/Western hemisphere?

A

Coccidioidomycosis (Valley Fever)

276
Q

What condition is worse if IC, pregnant, DM, African or Filipino ethnicity?

A

Coccidioidomycosis (Valley Fever)

277
Q

What condition is often asymptomatic; primary infection involves fever, cough, pleuritic CP, fatigue, erythema nodosum, CAP 1-3 week post-exposure?

A

Coccidioidomycosis (Valley Fever)

278
Q

What three areas of the body are affected by Coccidioidomycosis (Valley Fever) Disseminated Disease?

A
  • Lungs
  • Bones
  • Brain
279
Q

What is the recommended treatment for Coccidioidomycosis (Valley Fever)?

A

NONE

280
Q

What is the recommended treatment for Coccidioidomycosis (Valley Fever) if high-risk/Disseminated?

What if the patient is pregnant, and why?

A

“-azole” (Fluconazole, Itraconazole)

- Amphotericin B if severe or pregnant because -azole are teratogenic

281
Q

What conditions should indicate consideration of Cocci (__ AND __or__or__)?

A 
- Pulmonary complaints
AND
(1+ of 3 E’s)
- Erythema nodosum
- Erythema multiforme
- Eosinophilia
282
Q

What type of lung CA arises centrally (main bronchus)?

A

Squamous Cell Carcinoma

- Type of Non-Small Cell Lung Cancer (NSCLC)

283
Q

What is the recommended treatment for Chronic Pulmonary Histo?

A

Itraconazole for 1 year

284
Q

What is the recommended treatment for HIV/AIDS and Histo?

A

Amphotericin B + Itraconazole

Clin Med II Disease Key Notes (4 decks)

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