Pulmonology Flashcards
1
Q
definition of acute bronchitis
A
cough > 5 days w or w.o sputum x 2-3 weeks
2
Q
when would you suspect pna w. bronchitis sx
A
HR > 100
RR > 24
T > 38
3
Q
tx for acute bronchitis
A
symptomatic
abx not recommended
4
Q
pathophys of asthma
A
airway inflammation -> hyperresponsiveness -> reversible airflow obstruction
5
Q
dx for asthma
A
-FEV1:FVC ratio < 80%
-greater than 12% increase in FEV1 after bronchodilator therapy
6
Q
asthma classificaitons
A
-intermittent: daytime sx </= 2 days/week
-mild persistent: daytime sx > 2 days/week, nocturnal sx 3-4/month
-moderate persistent: daily sx, nighttime sx >1/week
-severe persistent: sx all day, nightly sx
7
Q
asthma step up therapy
A
step 1: SABA PRN
step 2: daily low dose ICS, SABA PRN
step 3: low dose ICS/LABA daily, SABA PRN
step 4: med dose ICS/LABA daily, SABA PRN
step 5: med dose ICS/LABA, SABA PRN, +/- biologics
step 6: high dose ICS/LABA, +/- LAMA, SABA PRN, oral steroids
8
Q
what are FEV and FVC
A
FEV: how much air a person can exhale during a forced breath
FVC: total amt of air exhaled during FEV test
9
Q
during PFT testing, you would expect _ to be the greatest amt of air, but this value is decreased in asthma
A
FEV 1
10
Q
25 yo CF pt w, chronic frequent coughing of yellow/green sputum and hemoptysis - HPI includes recent pseudomonas pna - she has foul breath - CXR shows “plate-like” atelectasis
A
bronchiectasis
11
Q
pathophys of bronchiectasis
A
lungs airways become dilated/damaged -> inadequate mucus clearance -> mucus builds up -> frequent infxns
12
Q
what conditions are associated w. bronchiectasis (5)
A
CF - 1/2 of cases
immune compromised
recurrent pna
aspiration
tumor
13
Q
what is this showing
A
plate like atelectasis -> bronchiectasis
14
Q
3 hallmark sx of bronchiectasis
A
daily cough
copious foul smelling sputum
frequent respiratory infxns
15
Q
2 CXR findings of bronchiectsis
A
tram track lung markings
plate-like atelectasis
16
Q
gs for bronchiectasis dx
A
CT
17
Q
lung sounds associated w. bronchiectasis
A
crackles
wheezes
18
Q
tx for bronchiectasis
A
ambulatory O2
abx for acute
CPT
lung transplant
19
Q
43 yo w. cutaneous flushing, diarrhea, wheezing - PMH HTN and T2DM - P 125, RR 30, BP 90/60 - diffuse wheezes in both lungs, diffuse “v” wave of jugular vein, 1/6 holosystolic murmur over LLSB, hyperactive bowel sounds
A
carcinoid tumor
20
Q
carcinoids tumors arise from _ cells leading to excessive secretion of _ (3)
A
neuroendocrine
serotonin, histamine, bradykinin
21
Q
common primary sites of carcinoid tumor (7)
A
GI (SI/LI)
stomach
pancreas
liver
lungs
ovaries
thymus
22
Q
mc site of neuroendocrine/carcinoid tumor metastasis
A
liver
23
Q
mcc of neuroendocrine tumor metastasis
A
carcinoid tumor of the appendix -> metastasizes to the liver
24
Q
hallmark sx of carcinoid syndrome
A
cutaneous flushing
diarrhea
wheezing
25
increased serotonin secretion w. carcinoid tumors leads to
collagen fiber thickening, fibrosis ->
-tricuspid regurgitation
-pulmonary stenosis
-bronchoconstriction
-wheezing
-pellagra
26
histamine release with carcinoid tumors leads to
vasodilation -> flushing
27
dx for carcinoid tumor
CT
octreoscan
UA
CXR
bronchoscopy
28
UA findings of carcinoid tumor
elevated f-HIAA (metabolite of serotonin)
29
CXR findings of carcinoid tumor
pedunculated sessile growth on the central bronchi
30
bronchoscopy findings of carcinoid tumor
well vascularized pink/purple cental lesion
31
tx for carcinoid tumor
surgical excision
octreotide (decreases serotonin)
niacin supplement
32
pathophys of COPD
chronic lung inflammation -> loss of elastic recoil and increasing airway resistance -> obstructed airflow
33
COPD includes
emphysema
chronic bronchitis
34
2 rf for COPD
smoking
alpha 1 antitrypsin deficiency
35
COPD in pt < 40 yo makes you think
alpha 1 antitrypsin deficiency
36
emphysema causes loss of _, permanently enlarged _, and difficulty _
loss of elastin
enlarged alveolar sacs
difficulty exhaling
37
hallmark sx of emphysema
DOE
38
6 PE findings of emphysema
hyperresonance to percussion
decreased/absent breath sounds
decreased tactile fremitus
barrell chest
pursed lip breathing
cachexia
39
what is this showing
loss of lung markings
hyperinflation
increased A/P diameter
**emphysema**
40
PFT findings of COPD
FEV1/FVC ratio < 0.7
increased TLC
41
ABG findings of COPD
respiratory acidosis
42
definition of chronic bronchitis
chronic productive cough on most days x 3 months of the year x 2 or more consecutive years
43
pathophys of chronic bronchitis
hypertrophy/hyperplasia of bronchial mucous glands/goblet cells in bronchioles -> cilia less mobile -> increased mucus production -> mucus plugs -> obstruction -> air trapping
44
5 PE findings associated w. chronic bronchitis
rales
ronchi
wheezing
cor pumonale (peripheral edema, cyanosis, JVD)
hepatomegaly
45
CXR findings of chronic bonchitis
perivascular markings
46
CBC findings of COPD
chronic hypoxic state leads to **increased Hgb/Hct**
47
gs dx for COPD
PFTs/spirometry
48
_ < 1L = increased mortality w. COPD
FEV1
49
CXR findings associated w. chronic bronchitis
increased AP diameter
increased vascular markings
enlarged right heart border
50
tx for COPD
LABA/LAMA combo
SAMA preferred over SABA
51
name a LAMA
tiotropium (spiriva)
52
name a SAMA
ipratropium (atrovent)
53
2 contraindications for SAMA/LAMA
glaucoma
bph
54
name a LABA
salmeterol (serevent)
55
s.e of SABA/LABA
tachycardia/arrhythmias
muscle tremor
CNS stimulation
hyperglycemia
56
contraindications for SABA/LABA
severe CAD
hyperthyroid
caution w. DM
57
adenosine antagonist that acts as a bronchodilator but is only used for refractory COPD/asthma due to narrow therapeutic index
theophylline
58
higher doses of theophylline are needed for what 2 pt pops
smokers
coffee drinkers
59
are ICS considered first line for COPD
no ma'am
60
indications for O2 therapy w. COPD
resting PaO2 < 55
OR
SpO2 < 89%
61
stages of COPD
I/mild: FEV1>80%
II/mod: FEV1 50-80%
III/severe: FEV1 30-50%
IV/very severe: FEV1 < 30%, e/o cor pulmonale
62
tx for COPD
I: SAMA
II: SAMA/LAMA
III: SAMA/LAMA, ICS, pulm rehab
IV: SAMA/LAMA, ICS, pulm rehab, O2
63
2 vaccines super important for COPD
influenza
pneumococcal
64
PE findings associated w. cor pulmonale
hepatojugular reflex
pulsus paradoxus
ventricular gallop
LE edema
JVD
hepatomegaly
parasternal lift
tricuspid.pulmonic insufficiency
loud S2
65
pathophys of cor pulmonale
RVH -> pulmonary HTN -> RV failure
66
6 causes of cor pulmonale
**COPD - mc**
PE
vasculitis
asthma
ILD
ARDS
67
dx for cor pulmonale
-echo: increased pressure in pulmonary a's and RV
-spirometry
-right heart cath
68
gs dx for cor pulmonale
right heart catheterization
69
what med used for CHF is not indicated for cor pulmonale and may be harmful
diuretics
70
tx for cor pulmonale
treat underlying cause
71
5 causes of hypoventilation syndrome
-central respiratory drive dpn - drugs, MS
-neuromuscular - ALS, MG
-chest wall abnl's
-obesity
-COPD
72
what is OHS/pickwickian syndrome
severe obesity -> failure to breathe rapidly/deeply enough -> low O2, high CO2
73
sx of OHS
daytime sleepy/sluggish
74
3 complications of OHS
pulmonary HTN
cor pulmonale
secondary erythrocytosis
75
dx for OHS
PFTs
sleep studies
CXR
ABGs
bicarb
76
t/f: sleep apnea falls into the category of OHS
t!
77
scarring/fibrosis of the lungs for an unknown reason
idiopathic pulmonary fibrosis
78
mc interstitial lung dz
IPF
79
non idiopathic causes of IPF
amiodarone
smoking
viral infxns
silica/hard metal dust
genetic
XRT
GERD
80
lung sound associated w. IPF
inspiratory crackles
81
what is this showing
diffuse patchy fibrosis -> pulmonary fibrosis
82
what is this showing
honeycombing -> pulmonary fibrosis
83
PFT findings of pulmonary fibrosis
normal vs increased FEV1/FVC ratio
84
tx for pulmonary fibrosis
antifibrotics: pirfenidone, nintedanimb
O2
lung transplant
85
53 yo M construction worker w. progressive dyspnea x a few years - afebrile, mild respiratory distress, inspiratory crackles - reticular linear pattern of opacities on CXR
pneumoconiosis
86
any fibrosis of the lung tissues w. a known cause
pneumoconiosis
87
mcc of pneumoconiosis
environmental/occupational exposure
*coal miners*
88
4 CXR findings of pneumoconiosis
small, nodular opacities in upper lung fields
eggshell calcifications
clacified plaques
hilar adenopathy
89
4 occupational exposures associated w. pneumoconiosis
coal
silicosis
asbestos
berylliosis
90
mining, sandblasting, stone, quarry work -> massive pulmonary fibrosis
silicosis
91
insulation, demolition, shipbuilding, construction
asbestos
92
what condition other than pneumoconiosis is associated w. asbestos
mesothelioma
93
high tech field, nuclear power, ceramics, aerospace, electrical plants, foundries -> pulmonary fibrosis
berylliosis
94
4 sx of pneumoconiosis
SOB
nonproductive cough
chronic hypoxia
cor pulmonale
95
dx for pneumoconiosis
CXR
96
tx for pneumoconiosis
supportive
O2
steroids
97
mcc cause of pna in adults vs peds
peds: RSV
adults: influenza
98
CXR findings of viral pna
bilat interstitial infiltrates
99
pna w. positive cold agglutinin titer
mycoplasma
100
sx of bacterial pna
fever
dyspnea
tachycardia
tachypnea
101
cxr findings of bacterial pna
patchy, segmental, lobar/multilobar consolidations
102
tx for bacterial pna, outpt vs inpt
outpt: doxycycline vs macrolides
inpt: ceftriaxone + azithromycin/resp fluoroquin
103
fungal pna makes you think what pt pop
immunocompromised (AIDS, steroids, organ transplant)
104
4 types of fungal pna to know
coccidioides (valley fever)
pulmonary aspergillosis
cryptococcus
histoplasma capsulatum
105
fungal pna found in western states
coccidioides (valley fever)
106
fungal pna found in non immunocompromised pt
pulmonary aspergillosis
107
fungal pna found in soil
cryptococcus
108
fungal pna that can be mistaken for TB due to cavitary lesions
histoplasma capsulatum
109
where is histoplasma found
bird/bat droppings
caves
zoos
mississippi ohio river valley
110
what fungal pna can cause meningitis
cryptococcus
111
tx for fungal pna
coccidioides: fluconazole/itraconazole
aspergillosis: fluconazole/itracontazole
cryptococcus: amphotericin B
histoplasma: ampthotericin B
112
what type of pna is associated w. HIV
pneumocystis jiroveci
113
PJP is common in HIV pt's w. CD4 count <
200
114
tx and prophlaxis for PJP
bactrim
115
CURB 65
confusion
urea > 7
RR > 30
SBP < 90 OR DBP < 60
age > 65
0-1 = low risk
2 = probs should admit
3-5 = admit
116
43 yo F w. COPD - cc worsening dyspnea at rest, retrosternal CP - has widened splitting of S2 - CXR shows pruning of the large pulmonary a's
pulmonary htn
117
normal pulmonary BP
15/5
118
pulmonary bp associated w. pulmonary HTN
> 20 at rest
119
mcc of pulmonary htn
mitral stenosis
120
4 causes of pulmonary htn
mitral stenosis
constrictive pericarditis
LV failure
mediastinal dz
121
5 PE findings of pulmonary htn
loud S2
JVD
ascites
hepatojugular reflex
lower limb edema
122
gs dx for pulmonary htn
right heart catheterization
123
what is this showing
enlarged pulmonary arteries
enlarged cardiac silhouette
**pulmonary htn**
124
ecg findings of pulmonary htn/right heart strain
t wave inversion in V1-V4, and inferior leads
125
tx for pulmonary htn
treat underlying cause
+/- diuretics
digoxin
anticoags
pde5 inhibitors
126
2 categories of ulng cancer
SCLC
NSCLC
127
lung cancer with the poorest prognosis
SCLC
128
4 subtypes of NSCLC
adenocarcinoma
squamous cell
large cell
carcinoid
129
masses w. SCLC are located
centrally
130
tx for SCLC
chemo
surgery is contraindicated
131
5 conditions associated w. lung carcinoma
cushing's
SIADH
superior vena cava syndrome
pancoast tumor
horner's syndrome
132
mc subtype of NSCLC
adenocarcinoma
133
masses w. adenocarcinoma are located
peripherally
134
central lung cancer masses make you think of (2)
SCLC
squamous cell carcinoma
135
2 rf for lung adenocarcinoma
smoking
asbestos
136
paraneoplastic syndrome associated w. adenocarcinoma of the lung
thrombophlebitis
137
paraneoplastic syndrome associated w. squamous cell lung ca
hypercalcemia
138
paraneoplastic syndrome associated w. large cell lung ca
gynecomastia
139
mc type of carcinoid tumor
adenocarcinoma
140
tx for NSCLC
stage 1-2: surgery
stage 3: chemo then surgery
stage 4: palliative
carcinoid: surgery
141
facial/arm edema and swollen chest wall veins
superior vena cava syndrome
142
shoulder pain, horner's syndrome, brachial plexus compression
pancoast tumor
143
unilateral miosis, ptosis, and anhidrosis
horner's syndrome
144
flushing, diarrhea, telangiectasia
carcinoid syndrome
145
chronic autoimmune inflammatory dz in which nodules/granulomas develop in the lungs, lympho nodes, and other organs
sarcoidosis
146
2 mc manifestations of sarcoidosis
1. lung
2. skin and lymph
147
5 sx of sarcoidosis
fever
wt loss
arthralgias
erythema nodosum
lupus pernio
148
what is this showing
lupus pernio - chronic, violaceous raised plaques/nodules on cheeks/nose/eyes -> **think sarcoidosis**
149
_ is pathognomonic and the most specific PE finding for sarcoidosis
lupus pernio
150
2 CXR finding of sarcoidosis
bilat hilar LAD
reticular infiltrates
151
lab findings of sarcoidosis
hypercalcemia
ACE 4x norml
152
dx for sarcoidosis
CXR
bx of peripheral lesions
bronchoscopy of central lesions
serial PFTs
153
bx findings of sarcoidosis
non-caseating granulomas
154
tx for sarcoidosis
**steroids**
MTX
ACEI for HTN
155
leading cause of death for sarcoidosis
pulmonary fibrosis
156
definition of pulmonary nodule vs mass
nodule: < 3 cm
mass: > 3 cm
157
management of pulmonary nodules/masses
CT if found on CXR
suspicious -> bx
not suspicious -> monitor q 3 mo, 6 mo, yearly x 2 yr
158
characteristics of suspicious lung nodule
ill defined or lobular border
spiculated
double from 21-40 days
diameter > 5.3 cm
159
characteristics of non suspicious lung nodule
< 1 cm
calcifications
smooth, well defined edges
no growth > 2 yr
diameter < 1.5 cm
