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Clinical: Emergency Medicine > Pulmonology > Flashcards

Pulmonology Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

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?

A

Acute bronchiolitis

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2
Q

how is acute bronchiolitis diagnosed?

A

Nasal washing for RSV culture and antigen assay
CXR = normal

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3
Q

what is the treatment of bronchiolitis

A

supportive: bronchodilators sometimes relieve symptoms

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4
Q

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?

A

Acute bronchitis

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5
Q

how is acute bronchitis diagnosed?

A

CXR if dx is uncertain or symptoms persists despitre conservative treatment

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6
Q

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?

A

Acute epiglotitis

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7
Q

what is the most common etiology causing actue epiglotitis

A

Haemophilus influenzae type B (Hib)

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8
Q

what are the 3Ds of epiglottitis

A

Dysphagia
Drooling
respiratory Distress

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9
Q

how is epiglotitis diagnosed

A

lateral neck x-ray: thumbprint sign
CT scan: narrow airway from tissue swelling

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10
Q

what is the definitive diagnostic test for epiglotitis

A

laryngoscopy : edematous or “cheery red” epiglottitis

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11
Q

what is the treatment for epiglotitis

A

intubating if necessary
ceftriaxone

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12
Q

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

A

acute respiratory distress syndrome

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13
Q

how is ARDS characterized

A

fluid collecting in lungs, depriving organs of oxygen

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14
Q

what are the dignostic tests for ARDS

A

CXR shows air bronchograms and bilaterally fluffy infiltrate
normal BNP, pulmonary wedge pressure, LV function and echo

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15
Q

how is asthma diagnosed?

A

Peak flow spirometry
(FEV1 to FVC ratio <80%)

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16
Q

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?

A

Croup

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17
Q

What is see on XR with a patient with croup

A

AP CXR shows steeple sign

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18
Q

what is the treatment of severe croup

A

IV fluids
nebulized racemic epinepherine and steroids

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19
Q

how is FB aspiration treated

A

rigid bronchoscopy is preferred in children
flexibile bronchosocopy is diagnostic and therapeutic in adults

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20
Q

what are the most common causes of hemoptysis

A

bronchitis
tumor mass
TB

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21
Q

what are diagnostic tests for hemoptysis

A

cytology - when worried about lung cancer
fiberoptic bronchosocpy = preferred for CA
rigid bronchoscopy for cases of massive bleeding
high-resolution CT

22
Q

what are carcinoid tumors

A

GI tract cancer metastasized to the lung (CA of appendix = M/c; appendix -> liver -> lung)

23
Q

what type of cancer is the most common carcinoid tumor

A

adenoma

24
Q

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?

A

pertussis

25
Q

how is pertussis diagnosed

A

nasopharyngeal swab - culture

26
Q

what is the treatment of pertussis

A

macrolide (erythromycin/azithromycin)
supportive care with steroids / Beta2 agonists

27
Q

at what age are DTap vaccines given

A

5 doses: 2, 4, 6, 15-18 months, 4-6 years

28
Q

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?

A

pleural effusion

29
Q

how do you differentiate between exudative and transudative pleural effusion

A

pleurocentesis
Lights Criteria: increased protein, increased LDH.

30
Q

how are pleural effusions diagnosed

A

lateral decubitus CXR
Chest CT
ultrasound
Thoracentesis (gold standard)

31
Q

how is pleuritic chest pain characterized

A

sudden and intensely sharp, stabbing or burning pain in the chest when inhaling and exhaling.
exacerbated by deep breathing, cough, sneezing, or laughing

32
Q

what are common causes of pleuritic chest pain

A

pneumonia
pericarditis
pericardial effusion
pancreatitis

33
Q

how is pneumonia diagnosed

A

CXR - bilat insterstitial infiltrates
rapid antigen testing for flu, RSV nasal swab and cold agglutinin titer negative

34
Q

what is seen on CXR with bacterial pneumonia

A

patchy, segmental, lobar, multilobar consolidation

35
Q

what is outpatient treatment of bacterial pneumonia

A

doxycylcine or macrolides

36
Q

what is the inpatient treatment for bacterial pneumonia

A

ceftriaxone + azithromycin/respiratory FQs

37
Q

who is affected by PJP pnemonia

A

HIV patients with a CD4 count of <200

38
Q

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?

A

pneumothorax

39
Q

what is virchows triad

A

hypercoagulable state
trauma
venostasis

40
Q

how are pneumothorax’s diagnosed?

A

unstable: Ultrasound
stable: expiratory chest film
CT for those with uncertain diagnosis
and ABG shows hypoxemia

41
Q

what is homans sign

A

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

42
Q

what is seen on EKG with pulmonary embolism

A

TACHYCARDIA
S1Q3T3 (rare)

43
Q

what score is used for the diagnosis of PE

A

Well’s score

44
Q

what diagnostic tests are used for PE

A

spiral CT
Pulmonary angiography = gold standard definitive
CXR = westermarks/hamptoms hump
VQ scan
venous duplex ultrasound
ABG
D-dimer

45
Q

what is the treatment of PE

A

Heparin = anticoag of choice with factor Xa inhibitors (rivoroxaban, apixaban, edoxaban) or oral direct thrombin inhibitors (dabigatran) there after

46
Q

what is the most common cause of lower respiratory tract infection in children worldwide

A

RSV

47
Q

what are indications for hospitalization in patients with RSV

A

tachypnea with feeding difficulties
visible retractions
oxygen desaturation < 95-96%

48
Q

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

A

Tuberculosis

49
Q

what is the Mantoux test rules

A

for TB positive for induration:
>5mm at high risk
»10mm in pts age <4 or some risk factors
»>15 if no risk factors

50
Q

how is TB diagnosed

A

Sputum for AFB smears and mycobacterium TB cultures - have to be 3 AFB negative

51
Q

what is seen on CXR with a patient who is positive for TB

A

upper cavitary lesions, infiltrates, Ghon complexes in apex of lungs

52
Q

what is seen on lung biopsy with TB positive patients

A

caseating granulomas

Clinical: Emergency Medicine (13 decks)

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