Pulmonology Flashcards
Patient with COPD <40 y/o even in non-smoker strongly indicates what?
Alpha-1-antitrypsin deficiency
Emphysema vs chronic bronchitis
Permanent enlargement of terminal airspaces seeing dyspnea most often with absent breath sounds and pursed lip breathing vs productive cough for at least 3 months a year for 2 consecutive years due to mucus gland hyperplasia and dysfunctional cilia with more wheezing
Cor pulmonale definition and ekg findings
Right sided heart failure brought on most often by increased pulmonary artery pressures, EGK findings would include RVH, right atrial enlargement, right axis deviation
What antibiotics are recommended for acute exacerbations of chronic bronchitis?
Azithromycin
LAMA and SAMA have what suffix
tropium
LABA and SABA have what suffix
terol
Most common cause of bronchiectasis in the US and what is bronchiectasis and what is the most common causative agent
Cystic fibrosis, permanent irreversible dilation of bronchial airways, pseudomonas (in CF patients)
Infant manifestations of cystic fibrosis
Meconium ileus
Examples of restrictive lung disorders (3)
Sarcoidosis
Pneumoconiosis
Idiopathic pulmonary fibrosis
Bronchiectasis diagnostic study (preferred and what is gold standard)
High resolution CT scan, PFT demonstrating obstructive pattern (decreased FEV1/FVC)
Diagnosis of asthma
PFT demonstrating reversible obstruction upon bronchoprovacation methacholine challenge test and then bronchodilator challenge
How to assess asthma exacerbation severity and patient response to treatment
Peak flow device
All but the most mild of asthma exacerbations should be discharged on a short course of…
…oral corticosteroids
Long term asthma maintenance
Inhaled corticosteroids are first line with only side effect being oral candidiasis, LABAs such as formoterol can be added as a step up but should be discontinued and should NEVER be monotherapy
Asthma classification system
Intermittent - symptoms <2x per day <2 days per week with night time awaking <2x/month
Mild persistent - symptoms >2 days per week but not daily with night time awakenings 3-4 x a month
Moderate persistent - symptoms daily, night time awaking >1x a week but not nightly
Severe persistent - Symptoms throughout the day, often awoken nightly
Lofgren syndrome
Triad of erythema nodosum, bilateral hilar lymphadenopathy, and polyarthralgias with fever often seen with sarcoidosis
Best initial test for diagnosis sarcoidosis, what is the most accurate test?
CXR for bilateral hilar lymphadenopathy, tissue biopsy is most accurate
1st line management of symptomatic sarcoidosis
Oral corticosteroids
Idopathic puomonary fibrosis cxr and ct findings
Honeycombing reticular opacities and focal ground glass opacification
Pneumoconiosis definition
Chronic fibrotic lung disease secondary to inhalation of mineral dust
Silicosis finding on cxr
Egg shell calcifications of hilar and mediastinal nodes
Berylliosis often occurs in what population
Metal workers such as aerospace or nickel/copper
Byssinosis often occurs in what population
Lung disease due to cotton exposure in those often working in textile industry
Parrot fever (psittacosis)
Infected bird exposure, chlamydophila psittaci, transmited via inhalation of dried feces and causes flu like symptoms
Chemoprophylaxis in long term care facilities
During influenza outbreak, all resients should receive oseltamivir regardless of immunization status
Contraindications to influenza vaccine (4)
- anaphylaxis reaction
- guillain barre syndrome within 6 weeks after previous influenza vaccination
- high fever
- patient <6 months of age
Acute bronchitis clinical presentation (4)
- hallmark is cough
- malaise
- uri symptoms
- may have hemoptysis
Pertussis clinical manifestations
- catarrhal phase - uri symptoms lasting 1-2 weeks
- paroxysmal phase - inspiratory “whoop” with paroxysmal coughing fit
- convalescent phase - resolution of cough
Pertussis management
-supportive care, antibiotics to decrease contagiousness (azithromycin)
Pertussis prevention
5 dose DTaP vaccine, 2, 4, 6, 12-15 months and 4-6 years of age, plus Tdap between 11-18
Bronchiolitis should make you think of what causative agent?
RSV
Bronchiolitis managemnet
Supportive care
Hot potato voice often occurs in these 2 conditions
peritonsilar abscess, acute epiglotitis
Acute epiglottitis diagnosis (definitive and supplemental finding)
Laryngoscopy performed when securing airway, cervical radiographs may show thumbprint sign
What should be given to all close contacts exposed to acute epiglottitis?
Rifampin
How is croup diagnosed and what supplemental finding is there?
Clinical diagnosis, frontal cervical radiograph can demonstrate steeple sign (subglottic narrowing of airway)
What drug provides significant relief and resolution of symptoms as well as decreased relapse in patients discharged home after being treated for croup?
Dexamethasone
Fremitus is increased in which of these conditions (pneumonia, pleural effusion, pneumothorax, obstructive lung disease)
Pneumonia
Egophony is positive in which of these conditions (pneumonia, pleural effusion, pneumothorax, obstructive lung disease)
Pneumonia
Hyperresonnace is found on percussion in which of these conditions (pneumonia, pleural effusion, pneumothorax, obstructive lung disease)
Pneumothorax and obstructive lung disease
Most common causative agent of community acquired pneumonia
Strep pneumoniae
Most common cause of atypical pneumonia
Mycoplasma pneumoniae
Diagnostic test of choice for mycoplasma pneumonia
PCR
Legionaire’s disease treatment options (2)
Macrolides (azithromycin, clarithromcin) or fluoroquinolones (levofloxacin)
Aspiration pneumonia treatment options (2)
Ampicillin sulbactam or augmentin
PCP pneumonia treatment (1)
Trimethoprim/sulfamethoxazole x21 days
Histoplasmosis
Yeast transmitted in soil containing bird and bat droppings in Mississippi and Ohio river valleys or in those who work as excavators or spelunkers, most patients asymptomatic but can be AIDS defining illness if CD4 <150. Treated with itraconazole and ampho B if needed
PCV13 vaccine schedule
2, 4, 6, 12-15 months of age
PPSV23 vaccine schedule
All adults age 65 and older, those younger at high risk,
Most common opportunistic HIV infection
PCP pneumonia, especially when when CD4 <200
What group of patients can have a blood reaction to sulfa drugs?
G6PD deficiency
HIV positives can see reactivation of what disease?
TB
Clinical manifestations of TB (7)
- cough
- hemoptysis
- fever
- chills
- nightsweats
- scrofula (ew its that neck thing)
- pott’s disease
Often initial test ordered in diagnosis of TB, what is the common screening for infection, what is the highest specificity test that isn’t impacted by BCG vaccination
Chest x ray, PPD, interferon gamma release assay (quantiferon TB gold assay)
Rifampin side effect (1)
Orange coloration of secretions
Isoniazid side effects (2)
- hepatitis
- peripheral neuropathy (prevented with vitamin b6 pyridoxine)
3 cirteria for latent TB diagnosis
- asymptomatic
- ppd +
- no evidence of active infection on CXR or CT
Imaging of choice to determine likelihood of malignancy of nodule found incidentally on chest radiograph?
CT of chest
Carcinoid tumors
Neuroendocrine tumors characterized by slow growth, low metastasis, most often in GI tract second most often found in lungs and secrete different hormones causing classic carcinoid syndrome - diarrhea, flushing, tachycardia, and bronchoconstriction
Cancer most common cause of cancer related death?
Lung cancer
Asbestos + smoking =
synergistic
Non-small cell lung cancer is usually treated how? What about small cell?
Surgical resection, chemotherapy
USPSTF guidelines for screening for lung cancer
Annual low dose ct for those 50-80 who have no symptoms of lung cancer + 30 ppy soking history who are currently smoking or have quit within the past 15 years
Small cell lung cancer often causes what additional condition?
Paraneoplastic syndromes such as SVC, SIADH, cushing, lambart eaton, etc
Proximal muscle weakness that improves with repeated muscle use, dry mouth, hyporeflexia. What condition is it and what is the treatment?
Lambert-eaton syndrome, tx is treat underlying malignancy and begin pyridostigmine
Horner syndrome is caused by what kind of tumor?
Non-small cell superior sulcus pancoast tumor
Most common foreign body aspiratin in children, most common age
Peanuts, age 2
Definitive diagnostic and therapeutic test for foreign body aspiration
Rigid bronchoscopy
Costochondritis vs tietze syndrome
Palpable edema is present alongside reproducable chest wall tenderness in tietze syndrome
Management of costocondritis
NSAIDS
Empyema
Direct infection of pleural space, grossly purulent
Most common cause of transudative pleural effusion
CHF
Most common cause of exudative pleural effusion
Infection or inflammation (think malignancy!!)
INITIAL test for pleural effusion
Chest radiograph demonstrating blunting of costophrenic angles
Diagnostic gold standard test for pleural effusion diagnosis
Thoracentesis
Treatment of a pneumothorax
Chest tube thoracostomy
Pulmonary hypertension is mean pulmonary arterial pressure >__. What symptoms does it cause?
20mmhg, dyspnea, fatigue, chest pain, cyanosis, edema
Definitive diagnosis of pulmonary hypertension
Right heart catheterization
Normal CXR in setting of hypoxia is suspicious for what?
PE
What is the imaging modality to confirm a PE when a patient doesn’t have normal kidney function, or is pregnant?
VQ scan
Best initial test to confirm presence of PE, what is the gold standard that is not usually performed? What is an alternative one that we use more often in real life?
Helical CT angiography, Pulmonary angiography, Venous doppler ultrasound of lower extremities
When is IVC filter used instead of anticoagulation in hemodynamicallys table PE management?
If anticoagulation is contraindicated
How is a PE treated in stable patients? What about unstable?
Anticoagulation, if unstable need thrombolysis or embolectomy
Lovenox vs unfractionated heparin
Lovenox is subQ and doesn’t need monitoring PTT, heparin is continuous iv drop and requires PTT 1.5-2.5x normal value**
Heparin antidote
Protamine sulfate
ARDS treatment
Noninvasive (cpap with full face mask) or mechanical ventilation
Cheyne stokes respiration
Cyclic breathing, smooth increases in respirations then gradual decrease with periods of apnea 15-60 seconds, due to decreased brain blood flow
Kussmaul respiration
Deep, rapid, continous respirations as a result of metabolic acidosis, no expieratory pause after expiration before next inspiration
Neonatal respiratory distress syndrome presents when? What about it is diferent from transient tachypnea of the newborn?
At birth or shortly after birth, it differs in that a CXR is done and demonstrates reticular (ground glass) opacities and generally a worsened presentation in neonatal distress syndrome vs TTN which might only show diffuse parenchymal infiltrates
How is a diagnosis of meconium aspiration made?
- Evidence of meconium stained amniotic fluid
- CXR demonstrating coarse irregular infiltrates with lung hyperinflation
How is meconium aspiration prevented?
-Prevention of post term delivery (>41 weeks)
