Pulmonary Geriatrics

Question 1

MCC CAP

Answer 1

strep pneumonia

Question 2

gram stain strep pneumo

Answer 2

gram positive diplococci

Question 3

second MCC CAP

Answer 3

haemophilus flu

Question 4

characteristics of klebsiella pneumo

Answer 4

occurs in alcoholics and DM

currant jelly sputum

cavitary lesions

Question 5

PE for pneumonia

Answer 5

bronchial breath sounds
dullness to percussion
increased tactile fremitus

Question 6

admission for pneumonia

Answer 6

CURB 65 - admit if 2

confusion
uremia > 30
RR >/= 30
BP low (SBP < 90 or DBP < 60)
age > 65

Question 7

sx PCP pneumonia

Answer 7

DOE on exertion
fever
nonproductive cough

Question 8

what type of bacteria is mycobacterium tuberculosis

Answer 8

acid-fast bacillus

Question 9

where in the lungs is primary TB located

Answer 9

middle portion of the lungs – ghon focus

Question 10

sx TB

Answer 10

prolonged fever
cough
chills
night sweats
fever

Question 11

dx TB

Answer 11

isolation of TB from a body secretion or fluid or tissue
CXR

Question 12

tx for TB plus ADE

Answer 12

RIPE

Rifampin - red/orange secretions
Isoniazid - peripheral neuropathy
Pyrazinamide - hyperuricemia
Ethambutol - optic neuritis

Question 13

what cancers are included in non-small cell lung CA

Answer 13

adenocarcinoma
large cell
squamous cell

Question 14

lung CA screening

Answer 14

annual low dose CT 55-80 if sx + 30 PPY smoking history who currently smoke or have quit within 15 years

Question 15

MC CA in nonsmokers

Answer 15

adenocarcinoma

Question 16

CXR and CT biopsy for adenocarcinoma

Answer 16

CXR - peripherally located
Bx - gland formation with mucin production

Question 17

characteristics of squamous cell lung CA

Answer 17

CCCP
centrally located
cavitary lesions
hypercalcemia
pan coast syndrome

Question 18

bx squamous cell CA

Answer 18

keratinization by tumor cells and/or intracellular desmosomes

Question 19

MC CA to present with paraneoplastic syndromes

Answer 19

small cell (oat cell) lung CA

Question 20

CXR and histology for small cell lung CA

Answer 20

CXR - centrally located
histology - sheets of small dark blue cells with rosette formation

Question 21

sx and PE for superior vena cava syndrome

Answer 21

facial, neck, or UE edema, chest pain
dyspnea = MC

dilated and prominent neck and chest veins

Question 22

what is Lambert-eaton myasthenic syndrome

Answer 22

antibodies against presynaptic voltage-gated calcium channels to prevent acetylcholine release –> muscle weakness

Question 23

sx and PE for lambert-eaton myasthenic syndrome

Answer 23

proximal muscle weakness that improves with repeated muscle use

dry mouth

hyporeflexia
sluggish pupillary response

Question 24

sx for superior sulcus (pan coast) tumors

Answer 24

shoulder and arm pain MC
Horner syndrome - ipsilateral ptosis, miosis, anhidrosis

weakness and atrophy of the muscles in the hand/arm

ulnar neuropathy

Question 25

what is emphysema

Answer 25

abnormal permanent enlargement of the terminal airspaces distal to the terminal bronchioles with no obvious fibrosis

Question 26

sx emphysema

Answer 26

dyspnea - hallmark chronic cough

Question 27

PE emphysema

Answer 27

hyperinflation - decreased/distant breath sounds, increased AP diameter (barrel chest), hyper resonance to percussion cachectic and non-cyanotic - pink puffer pursed lip expiration

Question 28

CXR emphysema

Answer 28

flattened diaphragms increased AP diameter decreased vascular markings bullae/blebs

Question 29

PFTs emphysema

Answer 29

normal or decreased FVC post bronchodilator decreased FEV1/FVC < 70% predicted decreased FEV1 decreased DLCO increased volumes - RV, TLC, RV/TLC, FRC

Question 30

chronic bronchitis

Answer 30

chronic productive cough for at least 3 months a year for 2 consecutive years

Question 31

sx chronic bronchitis

Answer 31

chronic cough sputum production DOE

Question 32

PE chronic bronchitis

Answer 32

crackles, rhonchi, wheezing cyanosis, peripheral edema, obesity = blue bloaters

Question 33

PFT chronic bronchitis

Answer 33

decreased FEV1 normal or decreased FVC postbronchodilator decreased FEV1/FVC < 70% increased volumes - RV, TLC, RV/TLC, FRC normal DLCO

Question 34

what is bronchiectasis

Answer 34

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

Question 35

MCC bronchiectasis

Answer 35

CF

Question 36

MC colonizer in bronchiectasis

Answer 36

if CF - pseudomonas if no CF - H flu

Question 37

sx bronchiectasis

Answer 37

productive cough + thick sputum hemoptysis

Question 38

dx bronchiectasis

Answer 38

CXR high resolution CT scan - preferred PFTs

Question 39

what is the preferred imaging for bronchiectasis

Answer 39

high resolution CT

Question 40

CT bronchiectasis

Answer 40

thickened bronchial walls airway dilation lack of tapering airways - tram-track appearance

Question 41

PFTs bronchiectasis

Answer 41

decreased FEV1 decreased FEV1/FVC < 70%

Question 42

causes of transudative pleural effusion

Answer 42

CHF MC nephrotic syndorme cirrhosis

Question 43

sx and PE for pleural effusion

Answer 43

asx dyspnea pleuritic chest pain cough dullness to percussion decreased fremitus decreased breath sounds

Question 44

dx pleural effusion

Answer 44

CXR - initial - blunting of costophrenic angles (positive menisci sign); lateral decubitus is the best film! thoracentesis - gold standard

Question 45

light’s criteria for pleural effusion

Answer 45

transudate: pleural: serum protein 0.5 pleural: serum LDH > 0.6 pleural fluid LDH > 2/3 ULN

Question 46

tx pleural effusion

Answer 46

treat underlying thoracentesis - diagnostic and therapeutic chest tube fluid drainage - if empyema