Pulmonology 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
2
Q
mc cause of acute bronchiolitis
A
RSV
3
Q
tachypnea, respiratory distress, wheezing in infants/young children
A
RSV/acute bronchiolitis
4
Q
dx for acute bronchiolitis
A
nasal washing (RSV)
culture/antigen assay
CXR
5
Q
CXR findings of acute bronchiolitis
A
normal
6
Q
only tx that improves acute bronchiolitis
A
O2
7
Q
indication for hospitalization for acute bronchiolitis (6)
A
O2 sat < 95-96%
< 3 months
RR < 70
nasal flaring
retractions
atelectasis on CXR
8
Q
tx for bronchiolitis
A
+/- bronchodilators for sx relief
severe/immunocompromised: ribavarin, monoclonal abs (palivizumab)
9
Q
what tx is not recommended for acute bronchiolitis for previously well infants
A
systemic steroids
10
Q
definition of acute bronchitis
A
cough > 5 days
11
Q
pathogens associated w. acute bronchitis
A
mc: viral
m. cat
h.flu
s.pneumo
12
Q
mc bacterial cause of acute bronchitis
A
m.cat
13
Q
t/f: fever is uncommon w. acute bronchitis
A
t!
14
Q
2 lung sounds NOT associated w. acute bronchitis
A
rales
egophany
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
16
Q
indication for hospitalization for acute bronchitis
A
O2 < 96%
17
Q
pathogen associated w. acute epiglottitis
A
h.flu type b (Hib)
18
Q
acute epiglottitis mc affects what pt pop
A
unvaccinated kids
:(
19
Q
Hib vaccination schedule
A
2, 4, 6, 12-15 months
20
Q
3 d’s of epiglottitis
A
dysphagia
drooling
distress (respiratory)
21
Q
imaging and classic finding for acute epiglottitis
A
lateral neck XR
thumbprint sign
22
Q
what is this showing
A
thumbprint sign -> acute epiglottitis
23
Q
management of acute epiglottitis
A
secure airway
culture
ceftriaxone
supportive
24
Q
fluid collects in lungs -> respiratory failure -> organs deprived of O2
A
ARDS
25
hallmark of ARDS
non cardiogenic pulmonary edema
26
mc cause of ARDS
**sepsis**
also:
trauma
aspiration
near-drowning
27
rapid onset of dyspnea 12-24 hr after precipitating event
ARDS
28
3 PE findings of ARDS
tachypnea
pink, frothy sputum
crackles
29
CXR findings of ARDS
air bronchograms
bilaterally fluffy infiltrate
30
what is this showing
air bronchogram
31
intubation goals for ARDS
lowest level PEEP to maintain PaO2 > 60 mmHg OR SaO2 > 90
32
chronic, irreversible inflammatory airway dz w. recurrent attacks of breathlessness and wheezing
asthma
33
dx and monitoring of asthma
spirometry w. pre/post albuterol readings
34
spirometry findings of asthma
decreased FEV1/FVC < 80%
> 10% increase of FEV1 w. bronchodilator
35
what is FEV1
forced expiratory volume in the first second (should be greatest amt of air exhaled)
36
asthma classifications
-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
37
asthma tx based on classification
-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
38
tx for acute asthma attack
O2
nebulized SABA, ipratropium bromide
oral steroids
39
infxn of upper airway that obstructs breathing and causes characteristic barking cough
croup
40
what pathogen is associated w. croup
parainfluenza
41
croup is mc in what pt pop
3-6 mo
42
2 hallmark PE findings of croup
barking cough
stridor
43
what is this showing
steeple sign -> croup
*narrowing of trachea in subglottic region*
44
tx for croup: nonsevere vs severe
nonsevere: supportive -> humidifier, antipyretics
severe: IVF, nebulized racemic epi, steroids
45
foreign body aspiration mc occurs due to
food
46
mc location for foreign body aspiration
mainstem or lobar bronchus
**r > l**
47
5 rf for foreign body aspiration
institutionalization
advaned age
poor dentition
etoh
sedatives
48
lung sound clues based on location of aspiration
inspiratory stridor: high in airway
wheezing/decreased breath sounds: low in airway
49
imaging for foreign body aspiration plus hallmark finding
expirational CXR -> hyperinflation of affected side
50
labs for foreign body aspiration
ABG
51
tx for foreign body aspiration kids vs adults
kids: rigid bronchoscopy
adults: flexible bronchoscopy
52
3 complications of foreign body aspiration
PNA
ARDS
asphyxia
53
3 mc causes of hemoptysis
1. bronchitis
2. tumor
3. TB
*also bronchiectasis, smoking, pulmonary htn, pulmonary catheter, pulmonary hemorrhage*
54
what does pulmonary vascular engorgement make you think of (2)
pulmonary htn
masses
55
hemoptysis, dry cough vs phlegm cough
bronchitis
56
hemoptysis, chest pain, rib pain, tobacco, wt loss, clubbing
tumor
57
hemoptysis, chest pain, night sweats
TB
58
work up for hemoptysis
culture
cytology
fiberoptic bronchoscopy
rigid bronchoscopy
CT
59
preferred work up for hemoptysis w. suspected ca
high res CT
cytology
fiberoptic bronchoscopy
60
preferred work up for hemoptysis w. massive bleeding
rigid bronchoscopy
*greater suctioning/airway maintenance*
61
primary cause of death w. hemoptysis
asphyxiation
*not exsanguination*
62
emergent tx for hemoptysis
ABCs
63
mc presentation of aute or mild hemoptysis
bronchitis
64
older smokers w. hemoptysis must get
high res CT
65
t/f: negative CXR rules out lung ca
f!
duh
66
influenza is caused by the _ virus
orthomyxovirus
67
how many strains of flu are there
a, b, c
68
what age should people start getting the flu shot
> 6 months
69
contraindications for the flu shot (4)
severe egg allergy
previous rxn
guillain-barre w.in 6 weeks of prev. vaccination
< 6 months old
70
contraindication for flumist vaccination
asthma
71
CXR findings of influenza PNA
bilateral diffuse infiltrates
72
when should antivirals be given for flu
< 48 hr after symptom onset
73
what are the influenza antivirals
oseltaivir
relenza - inhaled
rapivab - IV
baloxavir
74
which influenza antivirals treat A and B
olsetamivir
zanamivir
75
indications for antivirals w. influenza
hospitalized
outpt w. severe/progessive illness
outpt at high risk for complications
76
who is at high risk for complications w. influenza
immunocompromised
chronic conditions
> 65 yo
pregnant or 2 weeks postpartum
77
categories of lung ca
small cell (SCLC) - **poor prognosis**
non small cell (NSCLC) - **mc**
78
4 types of NSCLC
adenocarcinoma
squamous cell carcinoma
large cell carcinoma
carcinoid
79
99% of SCLC can be attributed to
smoking
80
which location of SCLC is very aggressive
central
81
SCLC is associated w. what conditions
**paraneoplastic syndromes**
cushing's
SIADH
SVC syndrome
pancoast tumor
horner's syndrome
carcinoid syndrome
82
tx for SCLC
chemo
*can't do surgery*
83
NSCLC adenocarcinoma is associated with a _ mass
peripheral
84
causes of NSCLC adenocarcinoma
smoking
asbestos
thrombophlebitis
85
squamous cell NSCLC presents with _
and is _ located
-hemoptysis, hypercalcemia, elevated PTHrP
-centrally
86
large cell NSCLC presents with _
and is _ located
gynecomastia
peripherally
87
NSCLC carcinoid tumors should make you think of
GI tract tumors metastasized to the lung
**mc: appendix -> liver -> lung**
88
carcinoid NSCLC presents w.
**carcinoid syndrome:**
cutaneous flushing
diarrhea
wheezing
**hypotn**
89
mc type of NSCLC carcinoid tumor
adenoma
90
bronchoscopy findings of NSCLC carcinoid tumors
pink/purple central lesion
well vascularized
91
lab finding of NSCLC carcinoid tumor
elevated 5-HIAA
92
tx for NSCLC based on stage
1-2: surgery
3: chemo
4: palliative
93
differentiation btw lung nodule vs mass
nodule: < 3 cm
mass: > 3 cm
94
steps of pulmonary nodule management
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
characteristics of a suspicious pulmonary nodule
ill defined
lobular or spiculated
96
characteristics of a benign pulmonary nodule
calcification
smooth/well defined edges
97
highly contagious respiratory tract infxn marked by a severe hacking cough followed by a high pitched intake of breath
whooping cough/pertussis
98
bordetella pertussis is a gram _ bacteria,
and should be suspected in what pt's (2)
-negative
-adults with cough > 2 weeks, pt's < 2 yo
99
3 stages of pertussis
**catarrhal:** cold like sx, poor feeding/sleeping
**paroxysmal:** high pitched inspiratory "whoop"
**convalescent:** residual cough (up to 100 days)
100
dx for pertussis
nasopharyngeal swab culture
101
tx for pertussis
macrolides
steroids
beta 2 agonists
102
vaccination schedule for pertussis
**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
accumulation of excess fluid btw the layers of the leura outside the lungs
pleural effusion
104
describe pain w. pleural effusion
vague discomfort/sharp pain that worsens during inspiration
105
work up for pleural effusion includes pleurocentesis so that you can differentiate btw (2)
exudate
transudate
106
what criteria is used for exudative pleural fluid
**light's criteria:**
-pleural fluid protein/serum protein > 0.5
-pleural fluid LDH/serum LDH > 0.6
-pleural fluid LDH > 2/3
107
causes of transudate pleural fluid (6)
transient:
-changes in hydrostatic pressure
-cirrhosis
-CHF
-nephrotic syndrome
-ascites
-hypoalbuminemia
108
causes of exudative pleural fluid (6)
**PNA - mc**
infxn
malignancy
cancer
PE
TB
109
what view is this, what is it showing
lateral decubitus
pleural effusion
110
gs dx for pleural effusion
thoracentesis
111
2 PE findings of pleural effusion
decreased tactile fremitus
dullness to percussion
112
isolated left sided pleural effusion is likely
exudative
113
right sided pleural effusion is likely
transudative
114
tx for pleural effusion
thoracentesis
115
tx for recurrent/chronic pleural effusions (2)
-pleurodesis
-indwelling catheter
116
mc causes of pleuritic CP (4)
**inflammation of tissues lining pleura **:
-PNA
-pericarditis
-pericardial effusion
-pancreatitis
117
describe pleuritic CP
intensely sharp/stabbing
burning
pain w. inhaling and exhaling
118
pleuritic CP is exacerbated by (2)
deep breathing
coughing/sneezing/laughing
119
4 types of PNA
bacterial
viral
fungal
HIV
120
mc cause of PNA in adults vs kids
adults: flu
kids: RSV
121
dx of viral PNA (3)
CXR
rapid flu/RSV
cold agglutinin titer negative
122
CXR findings of viral PNA
bilateral interstitial infiltrates
123
tx for viral PNA
tamiflu
beta 2 agonists
fluids
124
sx of bacterial PNA
fever
dyspnea
tachycardia/tachypnea
cough
+/- sputum
125
CXR findings of bacterial PNA
patchy, segmental lobar/multilobar consolidation
126
dx for bacterial PNA
CXR
blood cultures x 2
sputum gram stain
127
tx for bacterial PNA, inpt vs outpt
outpt: doxy, macrolides (based on local resistance)
inpt: ceftriaxone + azithromycin/respiratory FQ's
128
what are the respiratory FQs
moxifloxacin
gemifloxacin
levofloxacin
129
fungal PNA is mc in what pt pops
immunocompromised:
HIV
steroids
organ transplant
130
5 types of fungal PNA
coccidioides (valley fever)
aspergillosis
cryptococcus
histoplasma capsulatum
pneumocystis jiroveci
131
which 2 fungal PNA's are treated with fluconazole/itraconazole
coccidioides
aspergillosis
132
which 2 fungal PNAs are treated w. amphotericin B
cryptococcus
histoplasma capsulatum
133
tx for PJP
bactrim
sulfa allergy: ptenamidine
steroids
134
which fungal PNA is mc in western states
coccidoides (valley fever)
135
which fungal PNA affects pt's w. healthy immune systems
aspergillosis
136
which fungal PNA is found in soil and can be complicated by meningitis
cryptococcus
137
which fungal PNA is characterized by apical pulmonary lesions that resemble TB
histoplasma capsulatum
138
where is histoplasma capsulatum typically found
misssissippi ohio river valley
zoos: bird/cat droppings
139
CXR findings of histoplasma capsulatum
apical lesions
mediastinal/hilar LAD
140
PJP is common in HIV pt's w. CD4 count <
200
141
CXR findings of PJP
diffuse interstitial or bilateral perihilar infiltrates
142
dx for PJP
bronchoalveolar lavage PCR
HIV test
143
hallmark PE finding of PJP
low O2 despite supplemental O2
144
pharm/indication for prophylaxis for PJP
daily bactrim if CD4 < 200
145
what tool is used to estimate mortality of CAP to help determine inpt vs outpt tx
**CURB 65:**
confusion
urea >7
RR > 30
BP: SBP 65 yo
0-1 = low risk -> outpt
2 = mod risk -> probs admit, maybe outpt
3-5 = severe risk -> admit
146
collapsed lung caused by accumulation of air in pleural space
PTX
147
PE findings of PTX (5)
acute onset ipsilateral CP
dyspnea
decreased tactile fremitus
hyperresonance
diminished breath sounds
148
2 types of PTX
spontaneous
traumatic
149
spontaneous PTX makes you think of what pt pop
tall, thin males age 10-30
150
4 common causes of secondary PTX
COPD
asthma
cystic fibrosis
ILD
151
air in pleural space from PTX increases and is unable to escape
tension PTX
152
what is this showing
mediastinal shift to the contralateral side, pleural air
-> tension PTX
153
tx for PTX based on size
< 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
blockage of one of the pulmonary arteries in the lungs
PE
155
90% of PE's originate from cots in
deep veins of the LE
156
mc sx of PE
1. dyspnea
2. pleuritic CP
157
what is virchow's triad
hypercoagulable state
trauma
venostasis
158
5 hypercoagulable states
surgery
cancer
OCP
pregnancy
smoking
159
what is homan's sign
dorsiflexion of the foot causes pain in the calf -> DVT
160
ekg findings of PE
**tachycardia - mc**
S1Q3T3
non specific ST changes
161
what tool is used to assess probability of PE
wells score
162
initial and gs dx for PE
initial: spiral CT
gs: CTA
163
CXR findings of PE
westermark sign
hamptom hump
164
what is this showing
triangular pleural infiltrate adjacent to hilum -> hampton's hump
165
what is this showing
focal oligemia (decreased vascularization)
-> westermark sign ->PE
166
ABG suggestive of PE
respiratory alkalosis 2/2 to hyperventilation
167
anticoagulation recs for PE
acute: heparin
maintenance: Xa inhibitors and DOACs
severe renal insufficiency: Warfarin
168
minimum duration of anticoagulation post PE
provoked: 3 months
unprovoked: 6 months
2 unprovoked: long term
169
leading cause of PNA and bronchiolitis in kiddos
RSV
170
PE findings of RSV
wheezing/coughing x months
low grade fever
nasal flaring/retractions
nail bed cyanosis
171
indications for RSV vaccination/prophylaxis
what is used for RSV prophylaxis
-kids w. lung issues
-kids born premature/immunocompromised
prophylaxis: synagis (palivizumab) once monthly x 4-5 months beginning in Nov
172
parameters for SOB
RR > 25 OR < 10
SpO2 < 92 on RA
SpO2 < 95% on high flow O2
173
3 mc causes of SOB
asthma
COPD
CHF
174
non respiratory causes of SOB
pegnancy
ASA poisoning
renal failure
anemia
pericarditis
epiglottitis
GAD
myasthenia gravis
rib fx
175
ABG finding of SOB
elevated CO2
176
tx for SOB
O2 duh (high flow vs rebreathing)
BiPAP
intubation
asthma/COPD: albuterol
CHF: lasix
177
all pt's w. SOB should get what work up
CXR
CBC
CMP
BNP
troponin
EKG
178
what does acid fast bacilli make you think of
myobacterium tuberculosis
179
sx of TB
fatigue
productive cough
night sweats
wt loss
post tussive rales
180
rf for TB
endemic area/recent immigration
immunocompromised
prisoners
healthcare workers
181
how is TB transmitted
aerosolized droplets
182
2 types of TB screening
TST
interferon-gamma release assays (IGRAs)
183
mantoux test rules for TST
**>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
dx for TB
guidelines for negative
-sputum for AFB and myobacterium TB cultures
*at least 3 consecutive negatives*
-NAAT = faster/more reliable
185
CXR findings of TB
cavitary lesions
ghon complexes in apex
infiltrates
186
CXR findings of TB
cavitary lesions
ghon complexes in apex
infiltrates
187
what is this showing
ghon complexes in apex -> TB
188
bx findings of TB
caseating granulomas
189
what is miliary TB
TB spread outside the lungs
190
what are pott dz and scrofula
pott: TB spread to vertebral column
scrofula: TB spread to cervical lymph nodes
191
what is this showing
Pott Dz -> TB in vertebral column
192
what might this be in pt w. TB
scrofula -> TB spread to cervical lymph nodes
193
work up for TB if PPD/IGRA is positive
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
tx for latent TB
**4R: rifamycin x 3-4 months -> preferred**
vs
3HP rifapentine PLUS isoniazid x 3 months
vs
3HR: rifampin PLUS isoniazid x 3 months
195
tx for active TB
**4 month:** rifapentine (RPT) + moxifloxacin (MOX) + isoniazid (INH) + pyrazinamide (PZA)
**6-9 month:** RIPE
196
what TB med causes QT prolongation
moxifloxacin (MOX)
197
s.e of RIPE
**rifampin:** red/orange body fluids
**isoniazid:** peripheral neuropathy -> give w. B6 (pyridoxine)
**pyrazinamide:** hyperuricemia -> gout
**ethambutol:** optic neuritis/red-green blindness
198
which TB med needs to be given w. pyridoxine
isoniazid
199
all TB meds are _toxic
hepato
*get baseline labs*
200
indications for tx cessation for pt's w. active TB
negative AFB smears/cultures x 2
201
prophylactic tx for household members of active TB pt
isoniazid x 1 year
202
lab indication that you need to stop TB tx
LFTs < 3-5 x ULN
203
3 considerations for pt on TB tx
monitor SCr and LFTs
take meds on empty stomach
lots of ddi - esp HIV meds
