Pulmonary (New) Flashcards
Chronic hypoxemic vasoconstriction from chronic bronchitis can lead to:
Cor Pulmonale
What PFT values are noted in Emphysema?
↓ FEV1/FVC
↑ TLC
What findings in O2, age, RR and CXR would merit a hospitalization of a child with Bronchiolitis?
O2 < 95%
Age <3 mo
RR >70
Atelectasis on CXR
What is the definitive diagnostic tool used for Acute Epiglottitis?
Laryngoscopy
What is the MCC of Laryngotracheitis (Croup)?
Parainfluenza
What is the MCC and 2nd MCC of Acute Bronchiolitis?
RSV** > adenovirus
At what ages are the Pertussis DTaP and Tdap vaccines given?
DTaP- 2, 4, 6, 15 mo and 4 yo
Tdap- 12 yo and pregnant (>27 wks)
What is the treatment for Pertussis? Do we treat close contacts?
- Macrolide – Azithromycin or Clarithro
- Yes!
Shoulder pain + Horner’s + bone pain. Dx? In what d/o’s is this found?
Pancoast tumor
Adenocarcinoma and SCC
What is expected on ABG findings in Barbiturate overdose and COPD exacerbations (or any respiratory failure)? Why?
Respiratory acidosis d/t retention of CO2
What is the drug class and MOA of Cromolyn and Nedocromil?
- Mast cell modifiers
- Inhibit degranulation of mast cells
Gram (+) diplococci pairs is found in what pneumonia?
Strep pneumoniae
What is the MC lung cancer seen in nonsmokers and women?
Bronchogenic adenocarcinoma
High concentrations of inspired oxygen delivered through a ventilator may lead to what disorder?
Pulmonary fibrosis
What is the best test to diagnose a pulmonary embolism? What about in a patient with CKD?
Spiral CT (pulm angio) Ventilation perfusion scan
What type of pneumonia causes HIGH fever, confusion, hematuria and diarrhea?
Legionella
A patient presents with an asthma exacerbation. She is in Respiratory Alkalosis and is given nebulized beta-agonists, IV steroids, and oxygen. Her ABG normalizes but her lips are still cyanotic. What is the next best step in management?
Intubate (clinically, the patient is in respiratory failure).
What is the most effective treatment of hypoxia and acidosis in the setting of near drowning?
Positive pressure mechanical ventilation, CPAP or Bi-PAP
In COPD, should the patient receive high or low concentrations of oxygen? Why?
- Low
- With high, it causes hypoventilation d/t suppressed respiratory drive. Pt. becomes a CO2 container.
What is the treatment for Empyema Pleural Effusion?
Anti-staph antibiotics + chest tube (d/t thick fluid)
Low glucose, high protein, and high LDH levels would be significant for transudative or exudative effusion?
Exudative
What is expected on ABG findings in hyperventilation, seen in anxiety, pain, ASA use, pregnancy?
Respiratory alkalosis
In the treatment of hemothorax, where is the chest tube inserted? Why?
-At the base of lung since blood pulls
What is the MCC of pulmonary HTN?
Mitral Stenosis
What is the GOLD Dx for Pulmonary HTN?
Right heart cath
Steps in acute respiratory distress
A- Airway
B- Breathing
C- Circulation
What is the classic finding on CXR for lung abscess?
Consolidation air-FLUID level in thick-walled cavitary lesion
What is the major chronic morbidity following chronic inhalant hydrocarbons abuse?
Encephalopathy
What PNA is found to have ↑ cold agglutinins in 50% of patients?
Mycoplasma
-IgM
What is most likely found on CXR of an asthma patient?
Normal findings
Although risks vs. benefits must be weighed first, which BBs are more appropriate to use in asthma and COPD patients?
Beta-1 selective: Atenolol, Metoprolol
OR
Combo alpha / beta: Labetalol, Carvedilol
How are Cheyne-Stokes breathing characterized?
Cycling of crescendo-decrescendo tidal volumes separated by apneic or hypopneic pauses.
Low diffusion capacity of the lung for carbon monoxide (DLCO) is seen in ____ but normal in ____.
- Emphysema
- Chronic bronchitis
A newborn has a scaphoid (sunken) abdomen, respiratory distress, cyanosis and ↓ BS on his left side. What is the diagnosis?
Congenital Diaphragmatic Hernia (CDH)
CXR showing apical cavitary satellite lesions is evidence of:
Active or reactivation TB
IVD user presents with PNA. What is the best treatment for this patient?
IV Vanco»_space;
IV Cefuroxime or Ampicillin-Sulbactam
CXR in an infant showing air-bronchograms and ground-glass appearance would likely be found in:
Infant Respiratory Distress Syndrome (Hyaline Membrane Disease)
What 5 D/O’s are Obstructive Diseases?
Asthma Bronchiectasis Coal workers Pneumoconiosis COPD Cystic Fibrosis
The 3 common organisms causing pneumonias in patients with COPD and Cystic Fibrosis are:
H. flu**»_space; Strep pneumo, Moraxella
What is a SE of positive pressure ventilation?
Bullous rupture from barotrauma, leading to a pneumothorax
What are GI related findings in Cystic Fibrosis?
- Foul, greasy, fatty stools
- Vitamin deficiencies
Carbon monoxide poisoning has a _____ shift in oxygen-hemoglobin dissociation curve.
Left
What is the most common etiology of cancer in those exposed to asbestos?
Bronchogenic carcinoma
What makes up Horner’s syndrome? In what disorder is this found?
- Ipsilateral ptosis, anhidrosis, and miosis
- Lung CA
What is the next step in management in a stable patient with a suspected pneumonia? What is the best way to diagnose?
Initial: CXR
Best: sputum
What is the MCC disorder and cause of secondary spontaneous pneumothorax?
Rupture of bullae, MCC COPD
In an asplenic patient, what pneumonia pathogen is most likely?
S. pneumonia
When a patient has hemoptysis, what should you think of?
- PE
- FB
- Lung CA
What is the difference in presentation of a patient with epiglottitis vs tonsillitis or abscess?
In epiglottitis, the patient will be leaning forward with neck extended (tripod). The other two don’t make a difference with position.
What is the treatment for hospital acquired PNA?
Vanco + Piper + Tazo
What is the treatment for community acquired PNA?
Going home: PO Doxy or Clarithromycin
Admission: IV Ceph and Azithro
