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Physician Assistant > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

Leading cause of morbidity and mortality worldwide

A

pneumonia

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2
Q

Common bacterial etiologies of typical pneumonia

A

Streptococcus pneumoniae

H. influenzae

Moraxella catarrhalis

Staphylococcus aureus

Klebsiella pneumoniae

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3
Q

Common bacterial etiologies of atypical pneumonia

A

Mycoplasma

Legionella

Chlamydia

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4
Q

Viral etiologies of pneumonia

A

Influenza virus

Respiratory syncytial virus (RSV)

Adenovirus

Parainfluenza virus

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5
Q

Pneumonia most commonly seen in alcohol abuse

A

Klebsiella pneumonia

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6
Q

Pneumonia associated with air conditioning/ aerosolized water

A

Legionella pneumonia

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7
Q

Pneumonia most commonly associated with COPD

A

Haemophilus pneumoniae

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8
Q

Patient presents with

  • productive cough
  • purulent sputum
  • ill/toxic appearance
  • rigors, fevers, rales
  • pleuritic CP
  • tachypnea

What do you suspect?

A

Typical pneumonia

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9
Q

Patient presents with

  • Dry cough
  • Clear sputum
  • Acutely ill
  • PE > CXR
  • HA, sore throat, earrache, wheeze, malaise

What do you suspect?

A

Atypical pneumonia

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10
Q
A

Typical pneumonia

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11
Q
A

Atypical pneumonia (MC mycoplasma)

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12
Q

Empirical abx tx of CAP for previously healthy patients with no use of antimicrobials within the previous 3 months

A

Macrolide

Azithromycin 250 mg
2 PO tbas today and 1 tab PO daily x 4 days

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13
Q

Empirical abx tx of CAP in the presence of comorbidities such as chronic heart, lung or renal disease; DM; alcoholism; cancer; asplenia; immunosuppression; or use of antimicrobials within the previous 3 months

A

Fluoroquinolone OR beta-lactam

Levofloxacin 750 mg PO Q 24 hours x 5 days

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14
Q

CURB-65 admission criteria?

A

Confusion- AMS

Uremia (BUN >20 mg/dL)

Respiratory rate (>30 breaths per min)

Blood pressure (<90 sys or <60 diastolic)

>65 yo

Score
0-1 = outpatient
2 = admission to medical ward
3 or higher = admssion to ICU

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15
Q

Tuberculosis etiology

A

Mycobacterium tuberculosis

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16
Q

True or False

Latent TB infection (LTBI) is considered infectious

A

False

These patients are not considered to be infectious nor can they spread the disease

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17
Q

Patient presents with fever, drenching night sweats, anorexia, and weight loss. He also complains of pleuritic chest pain, dyspnes, and hemoptysis. Patient appears malnourished. What do you suspect?

A

TB

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18
Q

CXR shows cavitations with progressive disease, homogeneous infiltrates, hilar/paratracheal lymph node enlargement

A

primary TB

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19
Q

Caseating granulomas (aka necrotizing granulomas) is the histologic hallmark for…

A

TB

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20
Q

List 4 antituberculous drugs

A

Isoniazid (INH)

Rifampin (RIF)

Pyrazinamide (PZA)

Ethambutol (EMB)

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21
Q

LTBI tx

A

INH x 9 months

OR

RIF x 4 months

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22
Q

Active TB tx

A

INH/RIF/PZA/EMB x 2 months

followed by 4 months of additional multidrug tx

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23
Q

INH side effects

A

hepatitis

peripheral neuropathy (coadmin Vit B6 to reduce risk)

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24
Q

RIF side effects

A

hepatitis

flu syndrome

orange bodily fluid (urine)

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25
Q

EMB side effects

A

optic neuritis (red-green vision loss)

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26
Q

Acute Bronchitis tx

A
  1. Cough supressant (codeine)
  2. Short acting beta-agonists
  3. NSAIDs
  4. NOT antibiotics
  5. Decongestants
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27
Q

Patient presents with cough, dyspnea, headache, and expiratory rhonchi or wheezes. CXR is negative. What do you suspect?

A

Acute bronchitis

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28
Q

Illness of infants and young children- inflammation of the bronchioles

A

Acute bronchiolitis

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29
Q

“Thumb sign” on lateral neck XR makes you think…

A

Epiglottits

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30
Q

“Steeple sign” on PA neck film makes you think…

A

Croup

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31
Q

Croup etiology

A

Parainfluenza virus types 1 and 2

RSV

adenovirus

influenza

rhinovirus

32
Q

Croup tx

A

Usually self-limiting
-stay hydrated

Corticosteroids, humidified air/oxygen

nebulized epinephrine

33
Q

Bronchogenic carcinoma is divided into what 2 major categories

A
  • Small Cell Lung Cancer (SCLC)
  • Non-Small Cell Lung Cancer (NSCLC)
    • squamous cell carcinoma
    • adenocarcinoma
    • large cell carcinoma
34
Q

SCLC vs NSCLC

Which one is more common and which one is more aggressive?

A

NSCLC is more common (SCLC is 13-15% cases)

SCLC prone to early metastasis and aggressive course

** Small cell lung cancer is a smaller percentage of cases, but is typically more severe**

35
Q

Where does SCLC tend to originate

A

central bronchi

tends to metastasize to regional lymph nodes

36
Q

What are the 3 subgroups of NSCLC? And which is most common?

A

squamous cell carcinoma (25-35%)

adenocarcinoma (35-40%)

large cell carcinoma

37
Q

Lung cancer that is bronchial in orgin, centrally located mass, and pt is more likely to present with hemoptysis (therefore sputum cytology dx)

A

Squamous cell carcinoma

38
Q

This lung cancer usually appears in the periphery of the lung and is not amenable to early detection through sputum examination

A

adenocarcinoma

39
Q

SCLC vs NSCLC Tx

A
  • SCLC
    • combination chemotherapy
    • patients rarely live >5 years after dx
  • NSCLC
    • surgery
    • adjuvant chemotherapy may be considered
40
Q

If a lesion is >___ in size it is referred to as a mass

41
Q

Characteristics of benign solitary pulmonary nodules

A

<30 yo

round, oval

sharp margins

calcified

up to 3 cm

surrounded by normal tissue

42
Q

Strongest predisposing factor to asthma is atopy. The atopic triad consists of…

A

wheeze

eczema

seasonal rhinitis

43
Q

3 pathophys components of asthma

A

obstruction of airflow

bronchial hyperreactivity

inflammation of the airway

44
Q

Asthma dx indicated by FEV1/FVC

A

FEV1/FVC <75%

A >12% incr in FEV1 after bronchodilator therapy is supportive of dx

45
Q

Asthma tx

A
  • Step 1
    • SABA PRN
  • Step 2
    • low-dose ICS
  • Step 3
    • low-dose ICS + LABA
    • medium-dose ICS
  • Step 4 and above
    • consult specialist
46
Q

2 diseases of COPD

A

emphysema

chronic bronchitis

47
Q

Condition in which the air spaces are enlarged as a consequence of destruction of alveolar septa

A

Emphysema

“pink puffers”

48
Q

Disease characterized by a chronic cough that is productive of phlegm occurring on most days for 3 months of the year for 2 or more consecutive years

A

Chronic bronchitis

“blue bloaters”

49
Q

Dx studies for COPD

A
  • CXR
    • hyperinflation and flat diaphragms
  • Pulmonary
    • decr FEV1/FVC
  • CBC
    • may show polycythemia caused by chronic hypoxemia
50
Q

COPD management

A

SMOKING CESSATION

anticholinergic inhalers (ipratropium or tiotropium)

SABA

supplemental oxygen (SaO2 <88%)

51
Q

Autosomal recessive disorder that results in the abnormal production of mucus by almost all exocrine glands, causing obstruction of those glands and ducts.

A

Cystic fibrosis

52
Q

What are the 4 types of pleural effusions?

A
  1. Exudative
    • Infection, Malignancy, Trauma
  2. Transudative
    • ​​CHF, renal disease, cirrhosis
  3. Empyema
    • ​​Infection
  4. Hemothorax
    • ​​Trauma
53
Q

Pleural Fluid Analysis

  • Protein to serum protein ratio >0.5
  • LDH to serum LDH >0.6
  • OR LDH >2/3 upper limit of normal serum LDH

What type of pleural effusion is this?

54
Q

Pleural Fluid Analysis

  • Protein to serum protein ratio <0.5
  • LDH to serum LDH ratio <0.6

What type of pleural effusion is this?

A

Transudative

55
Q

Pleural Fluid Analysis

  • WBCs

What type of pleural effusion is this?

56
Q

Risk factors for PE- Virchow’s triad

A

Hypercoagulable state

Venous stasis

Vascular intimal inflammation or injury

57
Q

Approximately ____ % of patients with DVT will experience a PE

58
Q

Patient presents with sudden onset of pleuritic chest pain and dyspnea. Pt is tachycardic and tachypnic. Capnography shows low ETCO2 and pt has low saO2. What do you suspect?

A

PE

PE = v/q mismatch and gas exchange cannot occur at that area –> low saO2 and ETCO2

59
Q

Dx studies for PE

A
  • spiral CT
  • pulmonary angiography
  • V/Q scan
60
Q

EKG changes indicating PE/cor pulmonale

(seen in <20% of patients)

61
Q

D-dimer test- is it useful for dx PE?

A

D-dimer = saying “I love you” on the first date… once you say it you cant take it back.

D-dimer can be useful especially to rule out PE if clinical suspicion is low and d-dimer is negative

62
Q

PE tx

A
  • Anticoagulation therapy
    • heparin
    • factor Xa inhibitors (rivaroxaban, apixaban)
    • minimum of 3 months
  • Vena cava interruption (filter)
  • PREVENTION
    • ambulation
    • compression stockings
    • heparin
63
Q

____ is the most important and potent stimulus of pulmonary arterial vasoconstriction. Other causes include acidosis and veno-occlusive conditions.

64
Q

Pt presents with dyspnea, retrosternal chest pain, weakness,edema, and fatigue. Physical exam shoes narrow splitting and accentuation of S2 and a systolic ejection click.

EKG may show right ventricular hypertrophy and/or atrial hypertrophy.

CXR may show enlarged pulmonary arteries.

What do you suspect?

A

Pulmonary hypertension

65
Q

Mean pulmonary arterial pressure >_____ mmHg is dx of pulmonary hypertension.

66
Q

Pulmonary hypertension Dx studies

A

CXR

EKG

Echocardiography - estimate pulm arterial pressure

Right heart catherization- more precise

67
Q

Pulmonary HTN Tx

A
  • Oral anticoagulancts
  • CCB (decr systemic arterial pres)
  • Prostacyclin (potent pulm vasodilator)
  • Heart-lung transplantation
  • Tx of underlying disorders
68
Q

Examples of Restrictive Pulmonary Diseases

A
  • Idiopathic pulmonary fibrosis/ fibrosing interstitial pneumonia
  • Pneumoconioses
    • Asbestosis
    • silicosis
    • berylliosis
  • Sarcoidosis
  • Berylliosis
69
Q
  • MC dx among pts with interstitial lung disease
  • more common in men aged 50-75 years
  • Sx include dry cough, DOE, fatigue
  • PE may show clubbing of the fingers and inspiratory crackles
  • CT shows diffuse, patchy fibrosis with pleural-based honeycombing
  • normal to increased FEV1/FVC ratio

What do you syspect?

A

Idiopathic pulmonary fibrosis (IPF)

70
Q

Term for chronic fibrotic lung diseases caused by the inhalation of coal dust or various inert, inorganic, or silicate dusts.

A

Pneumoconioses

71
Q

Pneumoconioses disease most commonly found in those who work in insulation, demolition, and contruction.

What are these patients at an increased risk for?

A

Asbestosis

Incr risk of lung cancer, meothelioma (espicially if a smoker)

72
Q

Multiorgan disease characterized by noncaseating granulomatous inflammation. Approx 90% of pts have lung involvment

A

Sarcoidosis

73
Q

Clinical features of this disease include…

  • respiratory sx- cough, dyspnea, chest discomfort
  • Extrapulmonary findings
    • erythema nodosum
    • enlargement of parotid glands, lymph noides, liver, spleen
A

Sarcoidosis

74
Q

Sarcoidosis dx studies

A
  • Serum blood tests
    • leukopenia
    • eosinophilia
    • elevated ESR
    • hypercalcemia
    • hypercalciuria
  • ACE levels are elevated in 40-80% of pts
  • Radiographic findings
    • symmetric bilateral hilar adenopathy
    • right paratracheal adenopathy
    • bilateral diffuse reticular infiltrates
  • Transbronchial biopsy of the lung or fine-needle node biopsy confirms dx
75
Q

Lung injury marked by acute onset of respiratory insufficiency with hypoxemia and bilateral radiographic infiltrates

76
Q

3 clinical settings account for 75% of ARDS cases: what are those 3 causes?

A
  • Sepsis syndrome (single most important)
  • Severe multiple trauma
  • Aspiration of gastric contents

other causes include shock, toxic inhalation, near-drowning, and multiple transfusion

Physician Assistant (11 decks)

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