Pulmonary Review Flashcards
What is the most common patient complaint with emphysema?
Shortness of breath
At what age should vaccinations for pneumococcal pneumonia begin?
65 years old
Prolonged expiration (low FEV1) should make you think of what diagnosis?
Asthma or COPD
Hampton’s hump on CXR should make you think of what diagnosis?
Pulmonary embolism
How long after administering a PPD should it be read?
48-72 hours
A patient without a functioning spleen is more susceptible to what type of organisms?
Encapsulated organisms most commonly Strep pneumoniae and H. Flu.
What is the most common cause of pneumonia in children less than 1 year old?
Respiratory syncytial virus (RSV)
What is the treatment for pneumocystis jiroveci pneumonia?
Bactrim
What occupations are associated with berylliosis?
Aerospace and nuclear plant workers.
What CXR finding might make you think of berylliosis?
Diffuse infiltrates with hilar adenopathy.
What is the gold standard for diagnosis of a pleural effusion?
Thoracocentesis
When performing a decompression for a tension pneumothorax where do you put the needle?
2nd intercostal space at the midclavicular line.
Oseltamivir (Tamiflu) may be given to children above what age?
1 year old
Zanamivir (Relenza) may be give to children above what age?
7 years old
An HIV patient with ground glass appearance on CXR should make you think of what diagnosis?
Pneumocystis jiroveci pneumonia (PJP used tp be know as PCP).
A noncaseating granuloma should make you think of what diagnosis?
Sarcoidosis
A pearl formation on CXR should make you think of what diagnosis?
Squamous cell lung cancer
Ghon or Ranke complexes on CXR should make you think of what diagnosis?
TB
A Westermark sign on CXR should make you think of what diagnosis?
Pulmonary embolism
Mesothelioma is most commonly found in what lung location?
80% are found in the pleural lining
What CXR finding might make you think of mesothelioma?
Pleural thickening, remember 80% are found in the pleura lining.
Hyperinflation on a CXR as well as eosinophilia on CBC should make you think of what diagnosis?
Asthma
What organism is the most common cause of pneumonia in a patient with cystic fibrosis?
Pseudomonas
A college student presents with pneumonia. What two organisms should you be thinking of?
Chlamydia and Mycoplasma
At what size induration would a PPD be positive for an HIV patient?
5mm
You suspect a pneumothorax. What instructions should go along with the order for a chest x-ray?
It should be an end expiratory view in order to look for visceral pleural air.
List the three most commonly used medical treatments for COPD?
Oxygen, ipratropium and albuterol
List 4 medications which may cause asthma.
Beta blockers, NSAIDS, ACEI, ASA
Nodular opacities in the upper lung fields should make you think of what diagnosis?
Silicosis
What is the initial treatment for active TB?
INH+RIF+PZA+EMB x several months typically followed by INH+RIF once sensativities come back.
Caseating granulomas should make you think of what diagnosis?
TB
Blue bloater refers to the characteristic physical exam findings of what disease?
Chronic bronchitis
A contralateral mediastinal shift should make you think of what diagnosis?
Tension pneumothorax
What is the best test to diagnose bronchiectasis?
CT
What are the main side effects of isoniazid?
Hepatitis and peripheral neuropathy
You are treating a patient for TB. He has noticed that his body fluids now have an orange tint. What drug is most likely causing this?
Rifampin
Ethambutol has what two major side effects?
Optic neuritis, red green vision loss
If you see a question with anything to do with rats and the patient has pneumonia, what organism should you be thinking of?
Yersinia pestis
What is the most common organism causing pneumonia in COPD patients?
Haemophilus influenzae
Where is a Pancoast tumor found on chest x-ray?
At the apex of either the right or left lung.
Will evidence of TB be seen more frequently in the upper or lower lung lobes on CXR?
Upper
A patient has pneumonia with rust colored sputum. What is the most likely diagnosis?
Strep pneumonia
Coal miners lung often shows nodular opacities in what lung fields?
Upper lung fields
When you step up the diagnosis from intermittent asthma to mild persistent asthma what medication should you add?
An inhaled steroid like fluticasone
Any question about rabbits and pneumonia should make you think of what diagnosis?
Tularemia
Dullness to percusion should make you think of what diagonsis?
Lobar pneumonia
A young child presents to ER and you see him waiting in tripod position. What is the most likely diagnosis?
Epiglottitis
At what size induration would a PPD be positive for a healthcare worker?
10mm
List six extrapulmonary complications of lung cancer.
SPHERE - SVC syndrome, Pancoast tumor, Horner’s syndrome, Endocrine problems, Recurrent laryngeal symptoms, Effusions (exudative).
Currant jelly sputum should make you think of what diagnosis?
Klebsiella pneumoniae
What happens to total lung capacity in sarcoidosis?
It goes down
What will the likely findings be on a CXR of a patient with asbestosis?
Linear opacities at the bases with pleural plaques.
Tympany to percussion should make you think of what diagonsis?
Large pneuomthorax
What are the three most common cancers to metastasize to the lungs?
Breast, liver and colon
A thumbprint sign on x-ray should make you think of what two diagnoses?
Lateral C-spine = epiglottitis, abdominal = intestinal ischemia.
A barrel chest should make you think of what diagnosis?
Emphysema
Are the lungs noisy or quiet in COPD?
Quiet
List four indications for the flu vaccine.
Child 6-59 months, pregnant female, healthcare worker, age greater than 50.
Post tussive rales should make you think of what diagnosis?
TB
Parenchymal metastasis and blebs on CXR should make you think of what diagnosis?
Emphysema
Rhonci or wheezes that clear after coughing suggest what diagnosis?
Bronchitis or atelectasis
Does FEV1 go up or down with asthma?
It goes down
A very sick patient with diffuse infiltrates that spare the costophrenic angles should make you think of what diagnosis?
Capatilise acute respiratory distress syndrome (ARDS).
What is the most common cause of bronchiectasis?
Cystic Fibrosis
What is the gold standard for the diagnosis of cystic fibrosis?
Sweat chloride test
An exudative pleural effusion should make you think of what diagnosis?
TB, Lung cancer
What is the treatment for epiglottitis?
2nd or 3rd generation cephalosporin (Ceftriaxone). Macrolides may also be used (clindamycin).
Transudative pleural effusions should make you think of what diagnosis?
Congestive heart failure
What two lung cancers are typically found centrally on chest x-ray?
Small cell lung cancer and squamous cell
What two lung cancers are typically found peripherally on chest x-ray?
Adenocarcinoma and Large cell
Pertussis is most commonly treated with what antibiotic?
Erythromycin
List the four most common lung cancer will metastasize to.
Bone, brain, adrenals and liver
If you come across a question where the patient has erythema nodosum and an enlarged parotid gland what is the most likely diagnosis?
Sarcoidosis
What is erythema nodosum?
Tender red nodules usually found on the shins.
A thin looking heart and flattened diaphragm on CXR should make you think of what diagnosis?
Emphysema
If you see a question with an alcoholic who has been diagnosed with pneumonia what is the most likely organism?
Klebsiella pneumoniae
Honeycombing and tram tracks on the CXR should make you think of what diagnosis?
Bronchiectasis and idopathic pulmonary fibrosis
Paradoxical pulses may be found in what pulmonary disorder?
Asthma
An older patient presents with pneumonia and diarrhea. What is the most likely diagnosis?
Legionella pneumonia
Eggshell opacities on the CXR should make you think of what diagnosis?
Silicosis
List three causes of decreased tactile fremitus.
COPD, Asthma, pleural effusion, pneumothorax
Hyperresonance to percusion should make you think of what diagnosis?
Emphysem, pneumothorax, asthma
If you hear crackles in the lung fields list three pulmonary issues that should be in your differential.
Pneumonia, fibrosis, CHF, Bronchitis
Does total lung capacity go up or down in COPD?
It goes up.
List three things that should be in your differential if you hear wheezes on a lung exam?
Asthma, COPD, Bronchitis
What is it called when a patient says “ee” but on auscultion you here “ay”?
Egophony
A physical exam finding of egophony should make you think of what diagonsis?
Lobar pneumonia
CXR shows vascular redistribution and blurred vascular outlines. What is the most likely diagnosis?
CHF
