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EOR - Emergency Medicine > Pulmonology > Flashcards

Pulmonology Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

pulmonary emergencies to know
(just to help my brain organize)

A

acute bronchiolitis
acute bronchitis
acute epiglottitis
acute respiratory distress syndrome (ARDS)
asthma
croup
foreign body aspiration
hemoptysis
influenza
lung ca
pertussis
pleural effusion
pleuritic chest pain
PNA
PTX
PE
RSV
TB
wheezing

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2
Q

mc cause of acute bronchiolitis

A

RSV

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3
Q

tachypnea, respiratory distress, wheezing in infants/young children

A

RSV/acute bronchiolitis

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4
Q

dx for acute bronchiolitis

A

nasal washing (RSV)
culture/antigen assay
CXR

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5
Q

CXR findings of acute bronchiolitis

A

normal

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6
Q

only tx that improves acute bronchiolitis

A

O2

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7
Q

indication for hospitalization for acute bronchiolitis (6)

A

O2 sat < 95-96%
< 3 months
RR < 70
nasal flaring
retractions
atelectasis on CXR

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8
Q

tx for bronchiolitis

A

+/- bronchodilators for sx relief

severe/immunocompromised: ribavarin, monoclonal abs (palivizumab)

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9
Q

what tx is not recommended for acute bronchiolitis for previously well infants

A

systemic steroids

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10
Q

definition of acute bronchitis

A

cough > 5 days

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11
Q

pathogens associated w. acute bronchitis

A

mc: viral
m. cat
h.flu
s.pneumo

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12
Q

mc bacterial cause of acute bronchitis

A

m.cat

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13
Q

t/f: fever is uncommon w. acute bronchitis

A

t!

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14
Q

2 lung sounds NOT associated w. acute bronchitis

A

rales
egophany

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15
Q

tx for acute bronchitis is mostly symptomatic, when should steroids/ribavirin/abx be used

A

-steroids: hx underlying RAD
-ribavirin: severe lung/heart dz, immunocompromised
-abx: elderly, underlying cardiopulm dz, cough 7-10 days, immunocompromised

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16
Q

indication for hospitalization for acute bronchitis

A

O2 < 96%

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17
Q

pathogen associated w. acute epiglottitis

A

h.flu type b (Hib)

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18
Q

acute epiglottitis mc affects what pt pop

A

unvaccinated kids

:(

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19
Q

Hib vaccination schedule

A

2, 4, 6, 12-15 months

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20
Q

3 d’s of epiglottitis

A

dysphagia
drooling
distress (respiratory)

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21
Q

imaging and classic finding for acute epiglottitis

A

lateral neck XR
thumbprint sign

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22
Q

what is this showing

A

thumbprint sign -> acute epiglottitis

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23
Q

management of acute epiglottitis

A

secure airway
culture
ceftriaxone
supportive

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24
Q

fluid collects in lungs -> respiratory failure -> organs deprived of O2

A

ARDS

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25
Q

hallmark of ARDS

A

non cardiogenic pulmonary edema

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26
Q

mc cause of ARDS

A

sepsis
also:
trauma
aspiration
near-drowning

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27
Q

rapid onset of dyspnea 12-24 hr after precipitating event

A

ARDS

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28
Q

3 PE findings of ARDS

A

tachypnea
pink, frothy sputum
crackles

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29
Q

CXR findings of ARDS

A

air bronchograms
bilaterally fluffy infiltrate

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30
Q

what is this showing

A

air bronchogram

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31
Q

intubation goals for ARDS

A

lowest level PEEP to maintain PaO2 > 60 mmHg OR SaO2 > 90

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32
Q

chronic, irreversible inflammatory airway dz w. recurrent attacks of breathlessness and wheezing

A

asthma

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33
Q

dx and monitoring of asthma

A

spirometry w. pre/post albuterol readings

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34
Q

spirometry findings of asthma

A

decreased FEV1/FVC < 80%
> 10% increase of FEV1 w. bronchodilator

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35
Q

what is FEV1

A

forced expiratory volume in the first second (should be greatest amt of air exhaled)

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36
Q

asthma classifications

A

-mild intermittent: < 2x/week OR < 2/mo night sx
-mild persistent: > 2x/week OR 3-4/mo nightly sx
-moderate persistent: daily sx OR > 1 night/week nightly sx
-severe persistent: sx severeal times/day + nightly sx

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37
Q

asthma tx based on classification

A

-mild intermittent: SABA PRN
-mild persistent: daily low dose ICS, SABA PRN
-moderate persistent: daily low dose ICS + LABA, SABA PRN
-severe persistent: daily high dose ICS + LABA, SABA PRN, +/- oral steroids

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38
Q

tx for acute asthma attack

A

O2
nebulized SABA, ipratropium bromide
oral steroids

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39
Q

infxn of upper airway that obstructs breathing and causes characteristic barking cough

A

croup

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40
Q

what pathogen is associated w. croup

A

parainfluenza

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41
Q

croup is mc in what pt pop

A

3-6 mo

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42
Q

2 hallmark PE findings of croup

A

barking cough
stridor

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43
Q

what is this showing

A

steeple sign -> croup

narrowing of trachea in subglottic region

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44
Q

tx for croup: nonsevere vs severe

A

nonsevere: supportive -> humidifier, antipyretics
severe: IVF, nebulized racemic epi, steroids

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45
Q

foreign body aspiration mc occurs due to

A

food

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46
Q

mc location for foreign body aspiration

A

mainstem or lobar bronchus
r > l

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47
Q

5 rf for foreign body aspiration

A

institutionalization
advaned age
poor dentition
etoh
sedatives

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48
Q

lung sound clues based on location of aspiration

A

inspiratory stridor: high in airway
wheezing/decreased breath sounds: low in airway

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49
Q

imaging for foreign body aspiration plus hallmark finding

A

expirational CXR -> hyperinflation of affected side

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50
Q

labs for foreign body aspiration

A

ABG

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51
Q

tx for foreign body aspiration kids vs adults

A

kids: rigid bronchoscopy
adults: flexible bronchoscopy

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52
Q

3 complications of foreign body aspiration

A

PNA
ARDS
asphyxia

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53
Q

3 mc causes of hemoptysis

A
  1. bronchitis
  2. tumor
  3. TB

also bronchiectasis, smoking, pulmonary htn, pulmonary catheter, pulmonary hemorrhage

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54
Q

what does pulmonary vascular engorgement make you think of (2)

A

pulmonary htn
masses

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55
Q

hemoptysis, dry cough vs phlegm cough

A

bronchitis

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56
Q

hemoptysis, chest pain, rib pain, tobacco, wt loss, clubbing

A

tumor

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57
Q

hemoptysis, chest pain, night sweats

A

TB

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58
Q

work up for hemoptysis

A

culture
cytology
fiberoptic bronchoscopy
rigid bronchoscopy
CT

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59
Q

preferred work up for hemoptysis w. suspected ca

A

high res CT
cytology
fiberoptic bronchoscopy

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60
Q

preferred work up for hemoptysis w. massive bleeding

A

rigid bronchoscopy

greater suctioning/airway maintenance

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61
Q

primary cause of death w. hemoptysis

A

asphyxiation

not exsanguination

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62
Q

emergent tx for hemoptysis

A

ABCs

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63
Q

mc presentation of aute or mild hemoptysis

A

bronchitis

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64
Q

older smokers w. hemoptysis must get

A

high res CT

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65
Q

t/f: negative CXR rules out lung ca

A

f!
duh

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66
Q

influenza is caused by the _ virus

A

orthomyxovirus

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67
Q

how many strains of flu are there

A

a, b, c

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68
Q

what age should people start getting the flu shot

A

> 6 months

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69
Q

contraindications for the flu shot (4)

A

severe egg allergy
previous rxn
guillain-barre w.in 6 weeks of prev. vaccination
< 6 months old

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70
Q

contraindication for flumist vaccination

A

asthma

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71
Q

CXR findings of influenza PNA

A

bilateral diffuse infiltrates

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72
Q

when should antivirals be given for flu

A

< 48 hr after symptom onset

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73
Q

what are the influenza antivirals

A

oseltaivir
relenza - inhaled
rapivab - IV
baloxavir

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74
Q

which influenza antivirals treat A and B

A

olsetamivir
zanamivir

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75
Q

indications for antivirals w. influenza

A

hospitalized
outpt w. severe/progessive illness
outpt at high risk for complications

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76
Q

who is at high risk for complications w. influenza

A

immunocompromised
chronic conditions
> 65 yo
pregnant or 2 weeks postpartum

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77
Q

categories of lung ca

A

small cell (SCLC) - poor prognosis
non small cell (NSCLC) - mc

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78
Q

4 types of NSCLC

A

adenocarcinoma
squamous cell carcinoma
large cell carcinoma
carcinoid

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79
Q

99% of SCLC can be attributed to

A

smoking

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80
Q

which location of SCLC is very aggressive

A

central

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81
Q

SCLC is associated w. what conditions

A

paraneoplastic syndromes
cushing’s
SIADH
SVC syndrome
pancoast tumor
horner’s syndrome
carcinoid syndrome

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82
Q

tx for SCLC

A

chemo

can’t do surgery

83
Q

NSCLC adenocarcinoma is associated with a _ mass

A

peripheral

84
Q

causes of NSCLC adenocarcinoma

A

smoking
asbestos
thrombophlebitis

85
Q

squamous cell NSCLC presents with _
and is _ located

A

-hemoptysis, hypercalcemia, elevated PTHrP
-centrally

86
Q

large cell NSCLC presents with _
and is _ located

A

gynecomastia
peripherally

87
Q

NSCLC carcinoid tumors should make you think of

A

GI tract tumors metastasized to the lung
mc: appendix -> liver -> lung

88
Q

carcinoid NSCLC presents w.

A

carcinoid syndrome:
cutaneous flushing
diarrhea
wheezing
hypotn

89
Q

mc type of NSCLC carcinoid tumor

A

adenoma

90
Q

bronchoscopy findings of NSCLC carcinoid tumors

A

pink/purple central lesion
well vascularized

91
Q

lab finding of NSCLC carcinoid tumor

A

elevated 5-HIAA

92
Q

tx for NSCLC based on stage

A

1-2: surgery
3: chemo
4: palliative

93
Q

differentiation btw lung nodule vs mass

A

nodule: < 3 cm
mass: > 3 cm

94
Q

steps of pulmonary nodule management

A
  1. incidental finding on CXR
  2. CT
  3. if suspicious on CT -> bx
  4. if not suspicious on CT and < 1 cm -> monitor at 3 mo, 6 mo, and annually x 2 years
95
Q

characteristics of a suspicious pulmonary nodule

A

ill defined
lobular or spiculated

96
Q

characteristics of a benign pulmonary nodule

A

calcification
smooth/well defined edges

97
Q

highly contagious respiratory tract infxn marked by a severe hacking cough followed by a high pitched intake of breath

A

whooping cough/pertussis

98
Q

bordetella pertussis is a gram _ bacteria,
and should be suspected in what pt’s (2)

A

-negative
-adults with cough > 2 weeks, pt’s < 2 yo

99
Q

3 stages of pertussis

A

catarrhal: cold like sx, poor feeding/sleeping
paroxysmal: high pitched inspiratory “whoop”
convalescent: residual cough (up to 100 days)

100
Q

dx for pertussis

A

nasopharyngeal swab culture

101
Q

tx for pertussis

A

macrolides
steroids
beta 2 agonists

102
Q

vaccination schedule for pertussis

A

5 doses DTap: 2, 4, 6, 15-18 mo, 4-6 yr
1 dose Tdap: 11-18 yo
expecting moms: Tdap each pregnancy @ 27-36 weeks

103
Q

accumulation of excess fluid btw the layers of the leura outside the lungs

A

pleural effusion

104
Q

describe pain w. pleural effusion

A

vague discomfort/sharp pain that worsens during inspiration

105
Q

work up for pleural effusion includes pleurocentesis so that you can differentiate btw (2)

A

exudate
transudate

106
Q

what criteria is used for exudative pleural fluid

A

light’s criteria:
-pleural fluid protein/serum protein > 0.5
-pleural fluid LDH/serum LDH > 0.6
-pleural fluid LDH > 2/3

107
Q

causes of transudate pleural fluid (6)

A

transient:
-changes in hydrostatic pressure
-cirrhosis
-CHF
-nephrotic syndrome
-ascites
-hypoalbuminemia

108
Q

causes of exudative pleural fluid (6)

A

PNA - mc
infxn
malignancy
cancer
PE
TB

109
Q

what view is this, what is it showing

A

lateral decubitus
pleural effusion

110
Q

gs dx for pleural effusion

A

thoracentesis

111
Q

2 PE findings of pleural effusion

A

decreased tactile fremitus
dullness to percussion

112
Q

isolated left sided pleural effusion is likely

A

exudative

113
Q

right sided pleural effusion is likely

A

transudative

114
Q

tx for pleural effusion

A

thoracentesis

115
Q

tx for recurrent/chronic pleural effusions (2)

A

-pleurodesis
-indwelling catheter

116
Q

mc causes of pleuritic CP (4)

A

**inflammation of tissues lining pleura **:
-PNA
-pericarditis
-pericardial effusion
-pancreatitis

117
Q

describe pleuritic CP

A

intensely sharp/stabbing
burning
pain w. inhaling and exhaling

118
Q

pleuritic CP is exacerbated by (2)

A

deep breathing
coughing/sneezing/laughing

119
Q

4 types of PNA

A

bacterial
viral
fungal
HIV

120
Q

mc cause of PNA in adults vs kids

A

adults: flu
kids: RSV

121
Q

dx of viral PNA (3)

A

CXR
rapid flu/RSV
cold agglutinin titer negative

122
Q

CXR findings of viral PNA

A

bilateral interstitial infiltrates

123
Q

tx for viral PNA

A

tamiflu
beta 2 agonists
fluids

124
Q

sx of bacterial PNA

A

fever
dyspnea
tachycardia/tachypnea
cough
+/- sputum

125
Q

CXR findings of bacterial PNA

A

patchy, segmental lobar/multilobar consolidation

126
Q

dx for bacterial PNA

A

CXR
blood cultures x 2
sputum gram stain

127
Q

tx for bacterial PNA, inpt vs outpt

A

outpt: doxy, macrolides (based on local resistance)

inpt: ceftriaxone + azithromycin/respiratory FQ’s

128
Q

what are the respiratory FQs

A

moxifloxacin
gemifloxacin
levofloxacin

129
Q

fungal PNA is mc in what pt pops

A

immunocompromised:
HIV
steroids
organ transplant

130
Q

5 types of fungal PNA

A

coccidioides (valley fever)
aspergillosis
cryptococcus
histoplasma capsulatum
pneumocystis jiroveci

131
Q

which 2 fungal PNA’s are treated with fluconazole/itraconazole

A

coccidioides
aspergillosis

132
Q

which 2 fungal PNAs are treated w. amphotericin B

A

cryptococcus
histoplasma capsulatum

133
Q

tx for PJP

A

bactrim
sulfa allergy: ptenamidine
steroids

134
Q

which fungal PNA is mc in western states

A

coccidoides (valley fever)

135
Q

which fungal PNA affects pt’s w. healthy immune systems

A

aspergillosis

136
Q

which fungal PNA is found in soil and can be complicated by meningitis

A

cryptococcus

137
Q

which fungal PNA is characterized by apical pulmonary lesions that resemble TB

A

histoplasma capsulatum

138
Q

where is histoplasma capsulatum typically found

A

misssissippi ohio river valley
zoos: bird/cat droppings

139
Q

CXR findings of histoplasma capsulatum

A

apical lesions
mediastinal/hilar LAD

140
Q

PJP is common in HIV pt’s w. CD4 count <

A

200

141
Q

CXR findings of PJP

A

diffuse interstitial or bilateral perihilar infiltrates

142
Q

dx for PJP

A

bronchoalveolar lavage PCR
HIV test

143
Q

hallmark PE finding of PJP

A

low O2 despite supplemental O2

144
Q

pharm/indication for prophylaxis for PJP

A

daily bactrim if CD4 < 200

145
Q

what tool is used to estimate mortality of CAP to help determine inpt vs outpt tx

A

CURB 65:
confusion
urea >7
RR > 30
BP: SBP </= 90, DBP </= 60
>65 yo

0-1 = low risk -> outpt
2 = mod risk -> probs admit, maybe outpt
3-5 = severe risk -> admit

146
Q

collapsed lung caused by accumulation of air in pleural space

A

PTX

147
Q

PE findings of PTX (5)

A

acute onset ipsilateral CP
dyspnea
decreased tactile fremitus
hyperresonance
diminished breath sounds

148
Q

2 types of PTX

A

spontaneous
traumatic

149
Q

spontaneous PTX makes you think of what pt pop

A

tall, thin males age 10-30

150
Q

4 common causes of secondary PTX

A

COPD
asthma
cystic fibrosis
ILD

151
Q

air in pleural space from PTX increases and is unable to escape

A

tension PTX

152
Q

what is this showing

A

mediastinal shift to the contralateral side, pleural air
-> tension PTX

153
Q

tx for PTX based on size

A

< 15% diameter = small -> supportive

> 15% diameter or symptomatic = large -> CT placement

tension: large bore needles, CT placement

for all: serial CXR q 24 hr

154
Q

blockage of one of the pulmonary arteries in the lungs

A

PE

155
Q

90% of PE’s originate from cots in

A

deep veins of the LE

156
Q

mc sx of PE

A
  1. dyspnea
  2. pleuritic CP
157
Q

what is virchow’s triad

A

hypercoagulable state
trauma
venostasis

158
Q

5 hypercoagulable states

A

surgery
cancer
OCP
pregnancy
smoking

159
Q

what is homan’s sign

A

dorsiflexion of the foot causes pain in the calf -> DVT

160
Q

ekg findings of PE

A

tachycardia - mc
S1Q3T3
non specific ST changes

161
Q

what tool is used to assess probability of PE

A

wells score

162
Q

initial and gs dx for PE

A

initial: spiral CT
gs: CTA

163
Q

CXR findings of PE

A

westermark sign
hamptom hump

164
Q

what is this showing

A

triangular pleural infiltrate adjacent to hilum -> hampton’s hump

165
Q

what is this showing

A

focal oligemia (decreased vascularization)
-> westermark sign ->PE

166
Q

ABG suggestive of PE

A

respiratory alkalosis 2/2 to hyperventilation

167
Q

anticoagulation recs for PE

A

acute: heparin
maintenance: Xa inhibitors and DOACs
severe renal insufficiency: Warfarin

168
Q

minimum duration of anticoagulation post PE

A

provoked: 3 months
unprovoked: 6 months
2 unprovoked: long term

169
Q

leading cause of PNA and bronchiolitis in kiddos

A

RSV

170
Q

PE findings of RSV

A

wheezing/coughing x months
low grade fever
nasal flaring/retractions
nail bed cyanosis

171
Q

indications for RSV vaccination/prophylaxis

what is used for RSV prophylaxis

A

-kids w. lung issues
-kids born premature/immunocompromised

prophylaxis: synagis (palivizumab) once monthly x 4-5 months beginning in Nov

172
Q

parameters for SOB

A

RR > 25 OR < 10
SpO2 < 92 on RA
SpO2 < 95% on high flow O2

173
Q

3 mc causes of SOB

A

asthma
COPD
CHF

174
Q

non respiratory causes of SOB

A

pegnancy
ASA poisoning
renal failure
anemia
pericarditis
epiglottitis
GAD
myasthenia gravis
rib fx

175
Q

ABG finding of SOB

A

elevated CO2

176
Q

tx for SOB

A

O2 duh (high flow vs rebreathing)
BiPAP
intubation
asthma/COPD: albuterol
CHF: lasix

177
Q

all pt’s w. SOB should get what work up

A

CXR
CBC
CMP
BNP
troponin
EKG

178
Q

what does acid fast bacilli make you think of

A

myobacterium tuberculosis

179
Q

sx of TB

A

fatigue
productive cough
night sweats
wt loss
post tussive rales

180
Q

rf for TB

A

endemic area/recent immigration
immunocompromised
prisoners
healthcare workers

181
Q

how is TB transmitted

A

aerosolized droplets

182
Q

2 types of TB screening

A

TST
interferon-gamma release assays (IGRAs)

183
Q

mantoux test rules for TST

A

>5 mm = positive: HIV (+), recent contact w. (+) TB, CXR findings, organ transplant

>10 mm = positive: recent antivirals, IVDU, healthcare setting/employee, myobacteriology lab personell, comorbidities, <4 yo, kids exposed to high risk categories

>15 mm: no known rf for TB

184
Q

dx for TB

guidelines for negative

A

-sputum for AFB and myobacterium TB cultures
at least 3 consecutive negatives
-NAAT = faster/more reliable

185
Q

CXR findings of TB

A

cavitary lesions
ghon complexes in apex
infiltrates

186
Q

CXR findings of TB

A

cavitary lesions
ghon complexes in apex
infiltrates

187
Q

what is this showing

A

ghon complexes in apex -> TB

188
Q

bx findings of TB

A

caseating granulomas

189
Q

what is miliary TB

A

TB spread outside the lungs

190
Q

what are pott dz and scrofula

A

pott: TB spread to vertebral column
scrofula: TB spread to cervical lymph nodes

191
Q

what is this showing

A

Pott Dz -> TB in vertebral column

192
Q

what might this be in pt w. TB

A

scrofula -> TB spread to cervical lymph nodes

193
Q

work up for TB if PPD/IGRA is positive

A
  1. CXR
  2. start empiric tx if dx is likely
  3. if CXR is negative -> latent TB
  4. if CXR is positive -> active TB
194
Q

tx for latent TB

A

4R: rifamycin x 3-4 months -> preferred
vs
3HP rifapentine PLUS isoniazid x 3 months
vs
3HR: rifampin PLUS isoniazid x 3 months

195
Q

tx for active TB

A

4 month: rifapentine (RPT) + moxifloxacin (MOX) + isoniazid (INH) + pyrazinamide (PZA)
6-9 month: RIPE

196
Q

what TB med causes QT prolongation

A

moxifloxacin (MOX)

197
Q

s.e of RIPE

A

rifampin: red/orange body fluids
isoniazid: peripheral neuropathy -> give w. B6 (pyridoxine)
pyrazinamide: hyperuricemia -> gout
ethambutol: optic neuritis/red-green blindness

198
Q

which TB med needs to be given w. pyridoxine

A

isoniazid

199
Q

all TB meds are _toxic

A

hepato

get baseline labs

200
Q

indications for tx cessation for pt’s w. active TB

A

negative AFB smears/cultures x 2

201
Q

prophylactic tx for household members of active TB pt

A

isoniazid x 1 year

202
Q

lab indication that you need to stop TB tx

A

LFTs < 3-5 x ULN

203
Q

3 considerations for pt on TB tx

A

monitor SCr and LFTs
take meds on empty stomach
lots of ddi - esp HIV meds

EOR - Emergency Medicine (13 decks)

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