Pulmonology Flashcards by Amitav Rahman

Patient with COPD <40 y/o even in non-smoker strongly indicates what?

Alpha-1-antitrypsin deficiency

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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

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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

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What antibiotics are recommended for acute exacerbations of chronic bronchitis?

Azithromycin

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LAMA and SAMA have what suffix

tropium

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LABA and SABA have what suffix

terol

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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)

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Infant manifestations of cystic fibrosis

Meconium ileus

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Examples of restrictive lung disorders (3)

Sarcoidosis
Pneumoconiosis
Idiopathic pulmonary fibrosis

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Bronchiectasis diagnostic study (preferred and what is gold standard)

High resolution CT scan, PFT demonstrating obstructive pattern (decreased FEV1/FVC)

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Diagnosis of asthma

PFT demonstrating reversible obstruction upon bronchoprovacation methacholine challenge test and then bronchodilator challenge

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How to assess asthma exacerbation severity and patient response to treatment

Peak flow device

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All but the most mild of asthma exacerbations should be discharged on a short course of…

…oral corticosteroids

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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

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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

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Lofgren syndrome

Triad of erythema nodosum, bilateral hilar lymphadenopathy, and polyarthralgias with fever often seen with sarcoidosis

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Best initial test for diagnosis sarcoidosis, what is the most accurate test?

CXR for bilateral hilar lymphadenopathy, tissue biopsy is most accurate

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1st line management of symptomatic sarcoidosis

Oral corticosteroids

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Idopathic puomonary fibrosis cxr and ct findings

Honeycombing reticular opacities and focal ground glass opacification

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Pneumoconiosis definition

Chronic fibrotic lung disease secondary to inhalation of mineral dust

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Silicosis finding on cxr

Egg shell calcifications of hilar and mediastinal nodes

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Berylliosis often occurs in what population

Metal workers such as aerospace or nickel/copper

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Byssinosis often occurs in what population

Lung disease due to cotton exposure in those often working in textile industry

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Parrot fever (psittacosis)

Infected bird exposure, chlamydophila psittaci, transmited via inhalation of dried feces and causes flu like symptoms

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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?

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?

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)