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pance-flashcards > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

Bronchitis-common organisms

A

90% rhinovirus, Coronavirus, and RSV

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2
Q

Bronchitis-Tx

A

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

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3
Q

Epiglottitis: Most common organism & symptoms

A

Haemophilus Influenzae Tybe B–most common

S/S: Drooling (80%), Muffled voice, severe dysphagia, Tripod position

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4
Q

Epiglottitis Treatment

A

Secure Airway, Broad-spectrum 2nd or 3rd gen cephalosporin (Cefoaxime or ceftriaxone x 7-10 days)

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5
Q

Croup–AKA and Most common cause

A

AKA: viral laryngotracheobronchitis

Parainfluenza Virus 1 & 2

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6
Q

Croup Signs/Symptoms

A

Barking seal-like cough, Inspiratory stridor, “sounds worse than they look” opposite of Epiglottitis

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7
Q

Croup-Diagnostics

A

PA neck x ray: Steeple sign

lateral X ray: normal (diff Croup from epiglottitis)

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8
Q

Croup-Treatment and vaccination

A

Mild: supportive care
+ stridor (AT REST): active intervention, Steroids (dexamethasone), Nebulized epi, Humidified O2
Vaccination: kids-DTaP if incompletely immunized; Adults: booster Tdap

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9
Q

what is Reye’s syndrome?

A

Fatty liver with encephalopathy, May develop 2-3 weeks after onset of influenzae–esp. if ASA ingested

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10
Q

Influenzae-what treatment? And when is it C/I?

A

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)

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11
Q

C/I of the Influenza vaccination

A

Hypersensitivity to eggs, during febrile illness, thrombocytopenia

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12
Q

Pertussis: Cause?

A

Bordetella pertussis (gram negative bacteria)

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13
Q

Describe the 3 stages of Pertussis

A

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

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14
Q

Pertussis: Treatment of choice

A

Erythromycin (avoid in infants <1 y/o)

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15
Q

Most common Pneumonia Etiology of alcoholics and sputum

A

Klebsiella Pneumoniae; Sputum: Currant jelly

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16
Q

Most common Pneumonia etiology in cystic fibrosis patient:

A

Pseudomonas

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17
Q

Most common Pneumonia etiology in HIV/AIDs

A

Pneumocystic Jirovecii

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18
Q

Most common Pneumonia etiology in IV drug users

A

S. Aureus and Tuberculosis

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19
Q

Most common Nosocomial Pneumonia

A

Staph Aureus; Pseudomonas Aeruginosa (ICU)

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20
Q

Most common Cause of PNeumonia. (CAP); Gram stain?

A

Streptococcus Pneumoniae: Gram stain-Gram Positive Diplococci

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21
Q

CXR mycoplasma Pneumonia vs. Typical

A

Mycoplasma: Patchy Interstitial Infiltrates; Typical: Lobar infiltrates

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22
Q

Risk factors for the fungal Pneumonia Histoplasma Capsulatum

A

Ohio and Missippi river valleys, found in soil, Bat exposure, Cave explorers

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23
Q

Risk Factors for the Fungal Pneumonia: Coccidioides Immitis

A

Dimorphic fungus, Construction workers

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24
Q

Most common Oppurtunistic infection in HIV patients–Characteristics, CD4 counts, diagnostics, and TX

A

Pneumocystis Jiroveci
CXR: Butterfly pattern
CD4 count: 90% of patietns
Tx/Prophlyaxis: Bactrim

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25
Q

Symptoms of Carcinoid syndrome

A

Flushing, diarrhea, wheezing, hypotension

If given in a test scenario—Think carcinoid tumor

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26
Q

Type of lung cancer most likely to metastasize early and rarely amenable to surgery?

A

Small cell lung cancer (oat cell)

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27
Q

Where does Small cell lung cancer originate?

A

Central bronchi

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28
Q

Most common type of bronchogenic carcinoma and where does it appear?

A

Adenocarcinoma; Periphery of the lungs

29
Q

Type of lung cancer most likely to present with Hemptysis. Location? How is it diagnosed?

A

Squamous cell carcinoma; More likely to be diagnosed via sputum cytology than the other types; Usually central

30
Q

Type of non small cell lung cancer that metastasizes the earliest.

A

Large cell carcinoma

31
Q

Symptoms of Horner’s syndrome

A

Constricted pupil, Partial Ptosis, and loss of sweating

32
Q

Which type of lung cancer has the lowest association with Smoking?

A

Adenocarcinoma

33
Q

Symptoms of Superior vena cava syndrome; What type of lung CA

A

Facial fullness, facial and arm edema, dilated veins over anterior chest, arms, face, JVD; Most common with Small cell Carcinoma

34
Q

Symptoms of Pancoasts tumor; What type of Lung CA?

A

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

35
Q

Eaton Lambert syndrome: Type of lung CA most commonly associated, Symtoms

A

Most common in Small cell lung CA; Similar to Myasthenia Gravis with proximal muscle weakness/fatigability, diminished deep tendon reflexes, paresthesisas in LE.

36
Q

Obstructive lung disease (COPD): PFT (Spirometry) Findings

A

Decreased FEV1 and Decreased FEV1/FVC ratio< 75%; Normal or increased TLC

37
Q

Restrictive Lung Disease Spirometry results

A

Low TLC, Normal or high FEV1/FVC

38
Q

Bronchiectasis: What is it? Diagnostic study of choice; CXR signs

A

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

39
Q

First line agents of mild to mod COPD

A

Anticholinergic drugs or Beta agonists

40
Q

Most common causes of Transudative Pleural effusion

A

CHF (most common); PE, cirrhosis, post-surgery (open heart)

41
Q

Most common cause of Exudative Pleural effusion

A

Pneumonia (MCC)

Cancer, PE, kidney disease, or inflammatory disease

42
Q

criteria for Exudative PLeural effusion

A

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

43
Q

Primary Spontaneous Pneumothorax: who does it typically occur in?

A

Typically Tall, Thin, Young Male smokers, (who are otherwise healthy)

44
Q

When does Tension pneumothorax most commonly occur? How do you treat it?

A

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!

45
Q

Signs and symptoms of Pneumthorax

A

Symptoms: ipsilateral CP; Dyspnea
PE: Hyperresonance, decreased Tactile fremitus and breath sounds

46
Q

What is Cor pulmonale and Most common cause

A

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

47
Q

What is the gold standard diagnostic test for PE? What test is the most commonly used to diagnose PE?

A

Gold standard: Pulmonary Angiography

Best test: Spiral CT scan

48
Q

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?

A

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

49
Q

Alpha- 1 antitrypsin deficiency

A

Think in any nonsmoker under age of 30 with Emphysema

50
Q

Classic CXR findings in environmental Lung dz: Asbestosis and Silicosis

A

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

51
Q

Sarcoidosis: Characteristics, Population

A

Noncaseating granulomatous inflammation
90% with lung involvement
Population: More common in young (<40 y/o) black females

52
Q

Sarcoidosis: Symptoms, Diagnostics, and tx

A

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

53
Q

Hyaline Membrane disease: What is it? What population is it commonly seen? Tx?

A

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

54
Q

Tx for CAP, CAP + comorbidities, CAP + Hospitalization?

A

CAP: Azithromycin
CAP + Comorbidities: Fluoroquinolone
CAP + hospitalization: Ceftriaxone + Azithromycin

55
Q

Tx of Nosocomial Pneumonia

A

3 drug regimen: (4th gen ceph + Floroquinolone + Vanco)
Cefepime, Pipercillin/Taxobactam, or Meropenem
(need to cover Gram -, Pseudomonas, and MRSA)

56
Q

Tuberculin Skin Test

A

5 mm for HIV patients, Close contacts, immunosuppressed
10 mm: Healthcare workers
15 mm: Healthy individuals with low likelihood of TB

57
Q

TX of TB

A

Initial phase: 2 months with 4 drug Regimen-RIPE: Rifampin, Isoniazid, Pyrazinamide, ethambutol
Continuation phase: 4 months with 2 drug regimen: Rifampin and Isoniazid

58
Q

Which type of lung cancer is associated with Hypercalcemia?

A

Squamous cell carcinoma

59
Q

What is the most common important stimulant of pulmonary artery vasoconstriction (as seen in secondary Pulmonary HTN)?

A

Hypoxia

60
Q

Legionella: Risk Factors; TOC for immunocompromised pts

A

INdoor (exposure to Air conditioning), TOC for immunocompromised pts: Azithromycin, or a fluoroquinolone (Levofloxacin)

61
Q

What imaging modality is most sensitive to detect a small Amount of pleural fluid?

A

Chest CT

62
Q

Pleural findings consistent with a transudative pleural effusion? (think LDH, WBC, glucose, and protein

A

Glucose >60 mg/dL; Protein <3g/dL

63
Q

Pleural findings associated with Exudative pleural effusion?

A

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

64
Q

Chest examination findings in a pt with a PNEUMOTHORAX

A

Decreased tactile fremitus on the affected side and Percussion will be hyperresonant

65
Q

What kind of chest film will best demonstrate a small pneumothorax?

A

Expiratory; Other findings: visceral pleural line on a chest film and a “deep sulcus sign” on a supine film

66
Q

What is the drug of choice for treating apnea in the preterm infant?

A

Methylxanthines in the form of caffeine citrate

67
Q

Define APhonia

A

The inability to vocalize; Sign of complete obstruction of the airway.

68
Q

First line agents for the treatment of acute exacerbations of chronic bronchitis

A

Macrolides, Fluorquinolones, and Augmentin

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