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ER EOR > Pulmonary Geriatrics > Flashcards

Pulmonary Geriatrics Flashcards

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1
Q

MCC CAP

A

strep pneumonia

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2
Q

gram stain strep pneumo

A

gram positive diplococci

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3
Q

second MCC CAP

A

haemophilus flu

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4
Q

characteristics of klebsiella pneumo

A

occurs in alcoholics and DM

currant jelly sputum

cavitary lesions

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5
Q

PE for pneumonia

A

bronchial breath sounds
dullness to percussion
increased tactile fremitus

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6
Q

admission for pneumonia

A

CURB 65 - admit if 2

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

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7
Q

sx PCP pneumonia

A

DOE on exertion
fever
nonproductive cough

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8
Q

what type of bacteria is mycobacterium tuberculosis

A

acid-fast bacillus

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9
Q

where in the lungs is primary TB located

A

middle portion of the lungs – ghon focus

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10
Q

sx TB

A

prolonged fever
cough
chills
night sweats
fever

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11
Q

dx TB

A

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

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12
Q

tx for TB plus ADE

A

RIPE

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

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13
Q

what cancers are included in non-small cell lung CA

A

adenocarcinoma
large cell
squamous cell

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14
Q

lung CA screening

A

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

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15
Q

MC CA in nonsmokers

A

adenocarcinoma

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16
Q

CXR and CT biopsy for adenocarcinoma

A

CXR - peripherally located
Bx - gland formation with mucin production

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17
Q

characteristics of squamous cell lung CA

A

CCCP
centrally located
cavitary lesions
hypercalcemia
pan coast syndrome

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18
Q

bx squamous cell CA

A

keratinization by tumor cells and/or intracellular desmosomes

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19
Q

MC CA to present with paraneoplastic syndromes

A

small cell (oat cell) lung CA

20
Q

CXR and histology for small cell lung CA

A

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

21
Q

sx and PE for superior vena cava syndrome

A

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

dilated and prominent neck and chest veins

22
Q

what is Lambert-eaton myasthenic syndrome

A

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

23
Q

sx and PE for lambert-eaton myasthenic syndrome

A

proximal muscle weakness that improves with repeated muscle use

dry mouth

hyporeflexia
sluggish pupillary response

24
Q

sx for superior sulcus (pan coast) tumors

A

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

weakness and atrophy of the muscles in the hand/arm

ulnar neuropathy

25
Q

what is emphysema

A

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

26
Q

sx emphysema

A

dyspnea - hallmark
chronic cough

27
Q

PE emphysema

A

hyperinflation - decreased/distant breath sounds, increased AP diameter (barrel chest), hyper resonance to percussion

cachectic and non-cyanotic - pink puffer

pursed lip expiration

28
Q

CXR emphysema

A

flattened diaphragms
increased AP diameter
decreased vascular markings
bullae/blebs

29
Q

PFTs emphysema

A

normal or decreased FVC
post bronchodilator decreased FEV1/FVC < 70% predicted
decreased FEV1
decreased DLCO

increased volumes - RV, TLC, RV/TLC, FRC

30
Q

chronic bronchitis

A

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

31
Q

sx chronic bronchitis

A

chronic cough
sputum production
DOE

32
Q

PE chronic bronchitis

A

crackles, rhonchi, wheezing

cyanosis, peripheral edema, obesity = blue bloaters

33
Q

PFT chronic bronchitis

A

decreased FEV1
normal or decreased FVC
postbronchodilator decreased FEV1/FVC < 70%

increased volumes - RV, TLC, RV/TLC, FRC

normal DLCO

34
Q

what is bronchiectasis

A

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

35
Q

MCC bronchiectasis

A

CF

36
Q

MC colonizer in bronchiectasis

A

if CF - pseudomonas
if no CF - H flu

37
Q

sx bronchiectasis

A

productive cough + thick sputum
hemoptysis

38
Q

dx bronchiectasis

A

CXR
high resolution CT scan - preferred
PFTs

39
Q

what is the preferred imaging for bronchiectasis

A

high resolution CT

40
Q

CT bronchiectasis

A

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

41
Q

PFTs bronchiectasis

A

decreased FEV1
decreased FEV1/FVC < 70%

42
Q

causes of transudative pleural effusion

A

CHF MC
nephrotic syndorme
cirrhosis

43
Q

sx and PE for pleural effusion

A

asx
dyspnea
pleuritic chest pain
cough

dullness to percussion
decreased fremitus
decreased breath sounds

44
Q

dx pleural effusion

A

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

45
Q

light’s criteria for pleural effusion

A

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

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

46
Q

tx pleural effusion

A

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

47
Q
A

ER EOR (28 decks)

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