Pulmonology Flashcards
Bronchitis-common organisms
90% rhinovirus, Coronavirus, and RSV
Bronchitis-Tx
Supportive, B2 agonist, COPD: exacerbations-First line: 2nd gen cephalosporin, 2nd line: 2nd generation macrolide or bactrim;
Abx indicated: Elderly with cardiopulmonary dz and cough >7-10 days or immunocompromised
Epiglottitis: Most common organism & symptoms
Haemophilus Influenzae Tybe B–most common
S/S: Drooling (80%), Muffled voice, severe dysphagia, Tripod position
Epiglottitis Treatment
Secure Airway, Broad-spectrum 2nd or 3rd gen cephalosporin (Cefoaxime or ceftriaxone x 7-10 days)
Croup–AKA and Most common cause
AKA: viral laryngotracheobronchitis
Parainfluenza Virus 1 & 2
Croup Signs/Symptoms
Barking seal-like cough, Inspiratory stridor, “sounds worse than they look” opposite of Epiglottitis
Croup-Diagnostics
PA neck x ray: Steeple sign
lateral X ray: normal (diff Croup from epiglottitis)
Croup-Treatment and vaccination
Mild: supportive care
+ stridor (AT REST): active intervention, Steroids (dexamethasone), Nebulized epi, Humidified O2
Vaccination: kids-DTaP if incompletely immunized; Adults: booster Tdap
what is Reye’s syndrome?
Fatty liver with encephalopathy, May develop 2-3 weeks after onset of influenzae–esp. if ASA ingested
Influenzae-what treatment? And when is it C/I?
Neuraminidase Inhibitors: Zanamivir inhalation (relenza) and Oral oseltamivir (tamiflu)–will decrease severity if given within 48 hours of onset of symptoms (C/I in children <12 years)
C/I of the Influenza vaccination
Hypersensitivity to eggs, during febrile illness, thrombocytopenia
Pertussis: Cause?
Bordetella pertussis (gram negative bacteria)
Describe the 3 stages of Pertussis
Catarrhal Stage (1-2 weeks): Most infectious stage, URI symptoms
Paroxysmal stage (2-4 weeks): Spasms of rapid coughing; Deep, high pitched inspiration (the whoop)
Convalescent stage: (4 weeks after onset)
cough disappears, Decreased symptoms
Pertussis: Treatment of choice
Erythromycin (avoid in infants <1 y/o)
Most common Pneumonia Etiology of alcoholics and sputum
Klebsiella Pneumoniae; Sputum: Currant jelly
Most common Pneumonia etiology in cystic fibrosis patient:
Pseudomonas
Most common Pneumonia etiology in HIV/AIDs
Pneumocystic Jirovecii
Most common Pneumonia etiology in IV drug users
S. Aureus and Tuberculosis
Most common Nosocomial Pneumonia
Staph Aureus; Pseudomonas Aeruginosa (ICU)
Most common Cause of PNeumonia. (CAP); Gram stain?
Streptococcus Pneumoniae: Gram stain-Gram Positive Diplococci
CXR mycoplasma Pneumonia vs. Typical
Mycoplasma: Patchy Interstitial Infiltrates; Typical: Lobar infiltrates
Risk factors for the fungal Pneumonia Histoplasma Capsulatum
Ohio and Missippi river valleys, found in soil, Bat exposure, Cave explorers
Risk Factors for the Fungal Pneumonia: Coccidioides Immitis
Dimorphic fungus, Construction workers
Most common Oppurtunistic infection in HIV patients–Characteristics, CD4 counts, diagnostics, and TX
Pneumocystis Jiroveci
CXR: Butterfly pattern
CD4 count: 90% of patietns
Tx/Prophlyaxis: Bactrim
Symptoms of Carcinoid syndrome
Flushing, diarrhea, wheezing, hypotension
If given in a test scenario—Think carcinoid tumor
Type of lung cancer most likely to metastasize early and rarely amenable to surgery?
Small cell lung cancer (oat cell)
Where does Small cell lung cancer originate?
Central bronchi
Most common type of bronchogenic carcinoma and where does it appear?
Adenocarcinoma; Periphery of the lungs
Type of lung cancer most likely to present with Hemptysis. Location? How is it diagnosed?
Squamous cell carcinoma; More likely to be diagnosed via sputum cytology than the other types; Usually central
Type of non small cell lung cancer that metastasizes the earliest.
Large cell carcinoma
Symptoms of Horner’s syndrome
Constricted pupil, Partial Ptosis, and loss of sweating
Which type of lung cancer has the lowest association with Smoking?
Adenocarcinoma
Symptoms of Superior vena cava syndrome; What type of lung CA
Facial fullness, facial and arm edema, dilated veins over anterior chest, arms, face, JVD; Most common with Small cell Carcinoma
Symptoms of Pancoasts tumor; What type of Lung CA?
Causing shoulder pain radiating down to the arm; Usually Squamous celll cancers; Associated with Horner’s sydnrome 60% of the time; UE weakness 2 to brachial plexus invasion; C8 radiculopathy–> 5th digit numbness; Usually squamous cell cancer
Eaton Lambert syndrome: Type of lung CA most commonly associated, Symtoms
Most common in Small cell lung CA; Similar to Myasthenia Gravis with proximal muscle weakness/fatigability, diminished deep tendon reflexes, paresthesisas in LE.
Obstructive lung disease (COPD): PFT (Spirometry) Findings
Decreased FEV1 and Decreased FEV1/FVC ratio< 75%; Normal or increased TLC
Restrictive Lung Disease Spirometry results
Low TLC, Normal or high FEV1/FVC
Bronchiectasis: What is it? Diagnostic study of choice; CXR signs
Permanent, abnormal dilation of the bronchi and destruction of the bronchial walls; 50% associated with Cystic fibrosis
CT–>DOC
CXR: Dilated thickened airways, Tram-track lung markings, honeycombing; “Signet ring” sign; “tree-in-bud” opacities, atelectasis
First line agents of mild to mod COPD
Anticholinergic drugs or Beta agonists
Most common causes of Transudative Pleural effusion
CHF (most common); PE, cirrhosis, post-surgery (open heart)
Most common cause of Exudative Pleural effusion
Pneumonia (MCC)
Cancer, PE, kidney disease, or inflammatory disease
criteria for Exudative PLeural effusion
Pleural fluid protein-to-serum protein >0.5
Pleural fluid LDH to serum LDH >0.6
Pleural Fluid LDH >2/3 the normal upper limit for serum
Exudative: high protein
Transudative: low protein
Primary Spontaneous Pneumothorax: who does it typically occur in?
Typically Tall, Thin, Young Male smokers, (who are otherwise healthy)
When does Tension pneumothorax most commonly occur? How do you treat it?
During mechanical ventilation or pulmonary resuscitation; Post central line placement, trauma with resp. distress; mEdical emergency!Large bore needle into pleural space! Do not obtain CXR if tension pneumothorax is suspected!
Signs and symptoms of Pneumthorax
Symptoms: ipsilateral CP; Dyspnea
PE: Hyperresonance, decreased Tactile fremitus and breath sounds
What is Cor pulmonale and Most common cause
Failure of Right side of heart brought on by long term high blood pressure in pulmonary arteries and RV of the heart
Most commonly secondary to COPD
What is the gold standard diagnostic test for PE? What test is the most commonly used to diagnose PE?
Gold standard: Pulmonary Angiography
Best test: Spiral CT scan
Idiopathic Pulmonary Fibrosis: Most common among what type of patients? How is it characterizeD? Gold standard of diagnosis? CT findings? PFT findings? Mainstay of treatment?
Most common diagnosis among pts with interstitial lung dz; Characterized by progressive parenchymal scarring and loss of pulmonary function; Gold standard: Lung biopsy; CT: diffuse, patchy fibrosis with pleural based honeycombing
PFT: restrictive pattern
Tx: Corticosteroids in combo with immunosuppressive agents
Alpha- 1 antitrypsin deficiency
Think in any nonsmoker under age of 30 with Emphysema
Classic CXR findings in environmental Lung dz: Asbestosis and Silicosis
RESTRICTIVE PATTERN!
Asbestosis: Pleural Plaques-Reticular linear pattern with basilar predominance, opacities, and honeycombing; Associated with increased risk of lung cancer and malignant mesothelioma
Silicosis: egg shell calcificiation; Nodular pattern with upper lobe predominance Sources: Mining, stone cutting, and glass manufacturing
Sarcoidosis: Characteristics, Population
Noncaseating granulomatous inflammation
90% with lung involvement
Population: More common in young (<40 y/o) black females
Sarcoidosis: Symptoms, Diagnostics, and tx
S/S: dry cough, dyspnea, fatigue
Extramanifestations: Uveitis (blurred vision with tearing), Erythema Nodosom-Maculopapular lesions;
CXR: Bilateral hilar and right paratracheal adenopathy
Elevated ACE
Bx: Noncaseating gransulomas
Tx: Prednisone
Hyaline Membrane disease: What is it? What population is it commonly seen? Tx?
Caused by deficiency of pulmonary surfactant
Most commonly seen in premature infants
Tx: steroids to mom 48 hours pre-delivery to help fetal lung maturity;
Exogenous surfactant in the delivery room
Tx for CAP, CAP + comorbidities, CAP + Hospitalization?
CAP: Azithromycin
CAP + Comorbidities: Fluoroquinolone
CAP + hospitalization: Ceftriaxone + Azithromycin
Tx of Nosocomial Pneumonia
3 drug regimen: (4th gen ceph + Floroquinolone + Vanco)
Cefepime, Pipercillin/Taxobactam, or Meropenem
(need to cover Gram -, Pseudomonas, and MRSA)
Tuberculin Skin Test
5 mm for HIV patients, Close contacts, immunosuppressed
10 mm: Healthcare workers
15 mm: Healthy individuals with low likelihood of TB
TX of TB
Initial phase: 2 months with 4 drug Regimen-RIPE: Rifampin, Isoniazid, Pyrazinamide, ethambutol
Continuation phase: 4 months with 2 drug regimen: Rifampin and Isoniazid
Which type of lung cancer is associated with Hypercalcemia?
Squamous cell carcinoma
What is the most common important stimulant of pulmonary artery vasoconstriction (as seen in secondary Pulmonary HTN)?
Hypoxia
Legionella: Risk Factors; TOC for immunocompromised pts
INdoor (exposure to Air conditioning), TOC for immunocompromised pts: Azithromycin, or a fluoroquinolone (Levofloxacin)
What imaging modality is most sensitive to detect a small Amount of pleural fluid?
Chest CT
Pleural findings consistent with a transudative pleural effusion? (think LDH, WBC, glucose, and protein
Glucose >60 mg/dL; Protein <3g/dL
Pleural findings associated with Exudative pleural effusion?
Glucose 3.0 g/dL, LDH>200 IU/L
Pleural serum:protein >0.5, pleural serum LDH ratio >0.6, total pleural protein >3g/dL
Chest examination findings in a pt with a PNEUMOTHORAX
Decreased tactile fremitus on the affected side and Percussion will be hyperresonant
What kind of chest film will best demonstrate a small pneumothorax?
Expiratory; Other findings: visceral pleural line on a chest film and a “deep sulcus sign” on a supine film
What is the drug of choice for treating apnea in the preterm infant?
Methylxanthines in the form of caffeine citrate
Define APhonia
The inability to vocalize; Sign of complete obstruction of the airway.
First line agents for the treatment of acute exacerbations of chronic bronchitis
Macrolides, Fluorquinolones, and Augmentin
