Pulmonology Flashcards
a pt is a 9 month old infant presents with a three day history of a mild respiratory tract infection with serious nasal discharge, fever of 101.4 and decreased appetite. PE reveals a tachypneic infant wtih audible wheezing and a respiratory rate of 65. Flaring of the alae nasi, use of excessory muscles and subcostal and intercostal retractions are noted. Expiratory wheezes are present.
what is the most likely diagnosis?
Acute bronchiolitis
how is acute bronchiolitis diagnosed?
Nasal washing for RSV culture and antigen assay
CXR = normal
what is the treatment of bronchiolitis
supportive: bronchodilators sometimes relieve symptoms
23yo female with a one week history of cough productive of whitish sputum. this was preceded one week prior by URI. she denies chills, night sweats, SOB or wheezing. temp is 99.9. what is the most likely diagnosis?
Acute bronchitis
how is acute bronchitis diagnosed?
CXR if dx is uncertain or symptoms persists despitre conservative treatment
3yo boy who is brought to the ER with sudden onset fever (104), respiratory distress and stridor. on exam the boy appears acutely ill. he is sitting, learning forward with his mouth open. He has a muffled voice and is drooling. When asked, paretns report “we dont believe in vaccinations”.
What is the most likely diagnosis?
Acute epiglotitis
what is the most common etiology causing actue epiglotitis
Haemophilus influenzae type B (Hib)
what are the 3Ds of epiglottitis
Dysphagia
Drooling
respiratory Distress
how is epiglotitis diagnosed
lateral neck x-ray: thumbprint sign
CT scan: narrow airway from tissue swelling
what is the definitive diagnostic test for epiglotitis
laryngoscopy : edematous or “cheery red” epiglottitis
what is the treatment for epiglotitis
intubating if necessary
ceftriaxone
pt brought to the ED with acute onset of dyspnea and tachypena. he has a long hx of alcoholism and was involved in a motor vehicle accident two days ago. he is hypoxic wtih crackles auscultated bilaterally and frothy pink sputum. chest XR reveals diffuse bilateral infiltrates, which spare the costophrenic angle and air bronchospasm. No cardiomegaly or pleural effusion noted. O2 sat of 70%.
What is the most likely diagnosis
acute respiratory distress syndrome
how is ARDS characterized
fluid collecting in lungs, depriving organs of oxygen
what are the dignostic tests for ARDS
CXR shows air bronchograms and bilaterally fluffy infiltrate
normal BNP, pulmonary wedge pressure, LV function and echo
how is asthma diagnosed?
Peak flow spirometry
(FEV1 to FVC ratio <80%)
a 2yo boy brought in by his father, who is concerned for a “barking cough”, mild fever, and a hoarse voice. he reports that he had a runny nose last week that since resolved. PE reveals inspiratory stridor.
What is the most liekly diagnosis?
Croup
What is see on XR with a patient with croup
AP CXR shows steeple sign
what is the treatment of severe croup
IV fluids
nebulized racemic epinepherine and steroids
how is FB aspiration treated
rigid bronchoscopy is preferred in children
flexibile bronchosocopy is diagnostic and therapeutic in adults
what are the most common causes of hemoptysis
bronchitis
tumor mass
TB
what are diagnostic tests for hemoptysis
cytology - when worried about lung cancer
fiberoptic bronchosocpy = preferred for CA
rigid bronchoscopy for cases of massive bleeding
high-resolution CT
what are carcinoid tumors
GI tract cancer metastasized to the lung (CA of appendix = M/c; appendix -> liver -> lung)
what type of cancer is the most common carcinoid tumor
adenoma
4yo boy with a severe cough followin gon week of cold symptoms, inclduing sneezing, conjunctivitis, and nocturnal cough. He presents with paroxysms of cough followed by a deep inspiration and occasional post-tussive emesis.
what is the most likely diagnosis?
pertussis
how is pertussis diagnosed
nasopharyngeal swab - culture
what is the treatment of pertussis
macrolide (erythromycin/azithromycin)
supportive care with steroids / Beta2 agonists
at what age are DTap vaccines given
5 doses: 2, 4, 6, 15-18 months, 4-6 years
58yo female who returns to the hospital with chest pain and difficulty breathing several weeks after being discharged following MI requiring immediate cardiac catheterization. she has been coughing up frotthy sputum for the past three days. pt complains of sharp pain that worsens during inspiration. PE reveals decreased tactile fremitus, dullness to percussion and diminshed breath sounds on the left side. CXR demonstrates blutning of the left constophrenic angle, meniscus sign, obliteration of left hemidiaphragm and medistinal shift.
What is the most likely diagnosis?
pleural effusion
how do you differentiate between exudative and transudative pleural effusion
pleurocentesis
Lights Criteria: increased protein, increased LDH.
how are pleural effusions diagnosed
lateral decubitus CXR
Chest CT
ultrasound
Thoracentesis (gold standard)
how is pleuritic chest pain characterized
sudden and intensely sharp, stabbing or burning pain in the chest when inhaling and exhaling.
exacerbated by deep breathing, cough, sneezing, or laughing
what are common causes of pleuritic chest pain
pneumonia
pericarditis
pericardial effusion
pancreatitis
how is pneumonia diagnosed
CXR - bilat insterstitial infiltrates
rapid antigen testing for flu, RSV nasal swab and cold agglutinin titer negative
what is seen on CXR with bacterial pneumonia
patchy, segmental, lobar, multilobar consolidation
what is outpatient treatment of bacterial pneumonia
doxycylcine or macrolides
what is the inpatient treatment for bacterial pneumonia
ceftriaxone + azithromycin/respiratory FQs
who is affected by PJP pnemonia
HIV patients with a CD4 count of <200
19yo male transported to the ED following a car crash. upon arrival, he is alert and anxious and appears to be in respiratory distress. quick assessment reveals that she sustained a trauma to his face, neck and chest. his left hemithorax appears to be expanding more than the right. He is receiving oxygen via a nonrebreathing mask. vitals are: RR 36 and labored. SPO2 is 85%. PE shows decreased tactile fremitus, deviated trachea, hyperresonance and diminisehd breath sounds
what is the most likely diagnosis?
pneumothorax
what is virchows triad
hypercoagulable state
trauma
venostasis
how are pneumothorax’s diagnosed?
unstable: Ultrasound
stable: expiratory chest film
CT for those with uncertain diagnosis
and ABG shows hypoxemia
what is homans sign
dorsiflexion of the foot causes pain in the calf - indicative of DVT
what is seen on EKG with pulmonary embolism
TACHYCARDIA
S1Q3T3 (rare)
what score is used for the diagnosis of PE
Well’s score
what diagnostic tests are used for PE
spiral CT
Pulmonary angiography = gold standard definitive
CXR = westermarks/hamptoms hump
VQ scan
venous duplex ultrasound
ABG
D-dimer
what is the treatment of PE
Heparin = anticoag of choice with factor Xa inhibitors (rivoroxaban, apixaban, edoxaban) or oral direct thrombin inhibitors (dabigatran) there after
what is the most common cause of lower respiratory tract infection in children worldwide
RSV
what are indications for hospitalization in patients with RSV
tachypnea with feeding difficulties
visible retractions
oxygen desaturation < 95-96%
34yo female nurse presents with worsening cough for 6 weeks duration together with weight loss, fatigue, night sweats and fever. recent HIV tets was negative. Chest CT reveals a 3cm lesion of upper lobe of left lung and calcification around left lung hilus. sputum smear is positive for acid-fast organisms
what is the diagnosis
Tuberculosis
what is the Mantoux test rules
for TB positive for induration:
>5mm at high risk
»10mm in pts age <4 or some risk factors
»>15 if no risk factors
how is TB diagnosed
Sputum for AFB smears and mycobacterium TB cultures - have to be 3 AFB negative
what is seen on CXR with a patient who is positive for TB
upper cavitary lesions, infiltrates, Ghon complexes in apex of lungs
what is seen on lung biopsy with TB positive patients
caseating granulomas
