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Pulmonology Flashcards

1
Q

Pneumovax indications

A

PCV13: 6wks-15mo

PPV23: 2-5 y/o, >65 y/o, chronic illness with increased CAP risk (sickle cell, splenectomy, liver dz, transplant, lung, heart)

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2
Q

COPD CAP organism

A

H. pneumo/flu

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3
Q

Children

A

RSV

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4
Q

Children >1y/o PNA cause

A

Parainfluenza virus

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5
Q

COPD CAP organism

A

H. pneumo

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6
Q

HAP (Nosocomial pneumonia) Tx

A

Vanco + Ceftazidime/Cefepime/Imipenem/(Zosyn) Piperacillin-Tazobactam/Cipro

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7
Q

Young, otherwise healthy, low-grade fever, mild pulm sx, nonproductive cough, myalgia, fatigue

A

Mycoplasma pneumo (MCC atypical pneumonia)

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8
Q

CAP Tx

A
  1. outpt: macrolide, doxy
  2. inpt: beta lactam/cephalosporin + macrolide, FQ
  3. ICU: beta lactam + macrolide/FQ
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9
Q

Nosocomial pneumonia (HAP) Tx

A

anti pseudomonal beta lactam + anti pseudomonal FQ/AG

Vanco + Ceftazidime/Cefepime/Imipenem/Piperacillin-Tazobactam/Cipro

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10
Q

Pharyngitis cause

A

GAS

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11
Q

Aspiration Pneumonia Tx

A

3rd gen cephalosporin + metronidazole/clindamycin

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12
Q

Tx Mycoplasma pneumo and Legionella CAP

A

erythromycin

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13
Q

Tx Chlamydia CAP

A

tetracycline

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14
Q

Influenza Tx

A

zanamivir or oseltamivir (Neuraminidase inhibitors)

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15
Q

PCP pneumonia Tx

A

Bactrim

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16
Q

CD4

A

Bactrim

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17
Q

Ghon and Ranke complexes mean?

A

healed/calcified primary infxn

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18
Q

Definitive Dx TB

A

M. tb in cultures, DNA, RNA amplification.

Acid fast bacilli does NOT confirm

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19
Q

Active TB Tx

A

INH/RIF/PZA/EMB x 2mo, INH/RIF x 4mo

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20
Q

Isoniazid ADRs

A

hepatitis, periph neuropathy

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21
Q

Add what to INH Tx?

A

B6 (pyridoxine)

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22
Q

Acute bronchitis MCC

A

virus (rhinovirus, coronavirus, RSV)

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23
Q

Tx acute exact chronic bronchitis- suspect bacterial cause

A

2nd gen cephalosporin

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24
Q

3rd gen ceph

A

cefdinir (Omnicef), ceftriaxone, cefotaxime, cefixime

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25
Q

2nd gen ceph

A

cefoxitin

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26
Q

1st gen ceph

A

cephalexin (Keflex), cefazolin (Ancef)

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27
Q

When to suspect bacterial bronchitis

A

elderly, cardiopulm dz, cough >7-10 days, immunocompromised

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28
Q

MCC Bronchiolitis

A

RSV (paramyxovirus)

seen after viral infxn

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29
Q

Epiglottitis Tx

A

2nd/3rd gen ceph

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30
Q

Tx Small cell lung CA

A

chemo.

REMEMBER: Small cell, Center, Chemo

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31
Q

Tx non-small cell lung CA (AdenoCA, SCC, large cell CA)

A

surgery

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32
Q

High suspicion for lung CA (lung nodule/mass)

A

> 45y/o, >2cm, indistinct margins, rapid growth, NO calcification

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33
Q

Monitoring lung nodule

A

CT Q3mo x 1yr -> Q2mo x 2yrs

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34
Q

Paraneoplastic syndromes

A

Cushings, SIADH, hypercalcemia, gynecomastia, periph neuropathy, Lambert-Eaton (myesthenia), anemia, DIC, eosinophilia, thrombocytosis.

  • Squamous cell: Hypercalcemia
  • Lg cell: gynecomastia
  • Small cell: Cushings, SIADH, Eaton-Lambert
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35
Q

Asthma: FEV1/FVC, methacholine challenge test

A

20%

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36
Q

ICS

A

Fluticasone, Flovent, Pulmicort, Budesonide

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37
Q

LABA

A

Formoterol, salmeterol.

-ICS + LABA = Advair, Symbicort

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38
Q

Cystic fibrosis inheritance pattern

A

autosomal recessive

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39
Q

Light’s criteria for exudates

A
  1. fluid:serum protein >0.5
  2. fluid:serum LDH >0.6
  3. fluid LDH >2/3 UNL of serum LDH
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40
Q

Homan’s sign

A

PE, DVT

pain with dorsiflexion

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41
Q

PE Tx

A

stable: heparin in acute phase, LMWH (Lovenox) or warfarin continued x 6mo
unstable: thrombolytics
- anticoag CI: IVC filter, embolectomy

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42
Q

honeycomb lung

A

idiopathic pulmonary fibrosis / interstitial fibrosis, bronchiectasis

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43
Q

insulation, demolition, construction

A

asbestosis

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44
Q

mining, stone work

A

silicosis

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45
Q

high technology (aerospace, nuclear, manufacturing)

A

berryliosis

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46
Q

erythema nodosum associated with what?

A

sarcoidosis.
(also: enlarged parotids/lymph nodes/liver/spleen, uveitis)

erythema nodosum= red, tender shins

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47
Q

Sarcoidosis labs/CXR

A

leukopenia, eosinophilia, incr ESR, hypercalcemia/uria, incr ACE, b/l hilar adenopathy, cutaneous anergy (decr rxn)

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48
Q

Sarcoidosis Tx

A

NONE

PO corticosteroids: worsening

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49
Q

3 MCC of ARDS

A

sepsis**, trauma, aspiration gastric contents

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50
Q

frothy pink/red sputum

A

ARDS

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51
Q

MCC respiratory dz in preterm infant

A

Hyaline membrane dz

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52
Q

Ground glass appearance

A

PCP, Hyaline membrane dz

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53
Q

pulmonary cap wedge pressure

A

ARDS

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54
Q

pulmonary cap wedge pressure >15

A

cardiogenic

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55
Q

what to use to distinguish true transudate vs pseduoexudate?

A

cholesterol

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56
Q

Hampton’s hump

A

PE

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57
Q

Squamous cell lung CA extrapulm sx

A

hypercalcemia

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58
Q

small cell lung CA extrapulm sx

A

Lambert Eaton, SIADH

59
Q

Dx of active TB infxn (3)

A
  1. clinical
  2. CXR
  3. sputum (stain AND culture)
60
Q

timing of HAP, VAP, HCAP

A

HAP >48hrs
VAP >48-72hrs
HCAP contact extensive

61
Q

Tx pertussis

A

erythromycin

62
Q

MCC and Dx bronchiectasis

A

cystic fibrosis, CT

63
Q

extrapulm complications of lung CA (6)

A

SVC syndr, Pancoast tumor, Horner’s, endocrine, recurrent laryngeal sx, exudative effusions

64
Q

PNA and rats

A

Yersinia pestis

65
Q

indications for flu vaccine (4)

A

> 50y/o, underlying chronic med condition, 6-59 mo, preg, HCW, NH residents

66
Q

MC location mesothelioma

A

pleural lining (pleural thickening on CXR)

67
Q

eggshell opacities

68
Q

splenectomy vaccines given

A

H. flu, seasonal flu, N. gonorrhea, Pneumovax

69
Q

very sick, lung infiltrates spare costophrenic angles

70
Q

Westermark sign

71
Q

Laryngotracheitis: sx

A

croup

stridor, barking, seal like cough, hoarse, fever

steeple sign

72
Q

barking cough? whooping cough?

Tx

A

barking cough: croup (laryngotracheitis)
6mo-6y/o
Tx: cool humidified air, PO steroids, epi

whooping cough: pertussis

73
Q

chemoreceptors location

A

central: medulla
periph: carotid bodies, CN IX, aortic bodies, CN X

74
Q

gold std test to Dx asthma

75
Q

assess asthma severity/response in ED

A

peak exp flow rate (PEFR)

76
Q

Tx asthma

A

SABA for acute
+ICS +LABA +PO steroids

send all home on short course PO steroids (unless super tiny exac)

77
Q

ICS ADR

78
Q

asthma FEV1: >80%, 60-80%,

A

> 80% mild, 60-80% mod,

79
Q

Tx allergic rhinitis, ASA-induced asthma

A

Leukotrienes

montelukast

80
Q

genetic dz linked with COPD,

A

alpha1-antitrypsin def

81
Q

COPD, resp acidosis/alk

A

resp acidosis, incr CO2, hypoxic: chronic bronchitis

resp alk: emphysema

82
Q

arrhythmia with COPD

83
Q

COPD: FEV1/FVC

84
Q

COPD: DLCO

A

decr in emphysema

85
Q

COPD Dx gold std test

A

PFT/spirometry

86
Q

Tx COPD

A

anticholinergics (ipratropium, atrovent) preferred

O2- for cor pulmonale (>90% at rest)

pneumo and flu vaccines

87
Q

inhaled anticholinergic ADR (ipratropium)

88
Q

bronchiectasis MCC

A 
cystic fibrosis (in US)
Pseudomonas

H. flu (if not CF)

89
Q

bronchiectasis test of choice

90
Q

Signet ring sign

A

bronchiectasis

pulm A. with dilated bronchus

91
Q

pseudomonas abx

A

fluoroquinolone, Zosyn (piperacillin-tazobactam), aminoglycoside (gentamicin), cephalosporin (cefepime), imipenem

92
Q

H flu: bacteria type

A

gram neg, coccobacillus, facultative anaerobe

93
Q

CF lung dz

A

bronchiectasis

94
Q

young, bronchiectasis, pancreatic insuff, growth delays, infertility, vit ADEK def, DM

95
Q

meconium ileus at birth

96
Q

elev sweat chloride test

97
Q

obstructive lung dz

A

BRONCHIECTASIS, CF…

98
Q

sarcoidosis: what exam in ALL pts

A

ophthalmic

99
Q

lupus pernia assoc with what?

A

sarcoidosis.

violaceous, raised discoloration- face

100
Q

cornerstone of COPD Tx

A

anticholinergics- ipratropium

101
Q

sarcoidosis: lung findings

A

b/l hilar lymphadenopathy

102
Q

Tx sarcoidosis

A 
none
PO corticosteroids (if worsening)
103
Q

exposure: silicosis, byssinosis

A

silicosis: quarry, pottery, sandblasting
byssinosis: cotton, textile

104
Q

reduce asbestosis -> CA risk how?

A

smoking cessation

105
Q

lung location: silicosis, CWL, asbestosis

A

upper: silicosis, CWL
lower: asbestosis

106
Q

benign pulm nodule

A

calcifications, cavitary

107
Q

Small cell carcinoma: Tx

A

oat cell, SCLC
central
Tx chemo

108
Q

NSCLC: Tx

A

Tx surgery (more cancers, cut it out)
Adenocarcinoma: nonsmokers
Squamous: central
Large cell

109
Q

Squamous cell: extrapulm

A

hypercalcemia, Pancoast, Horner’s

110
Q

Small cell: extrapulm

A

SIADH, Eaton-Lambert, SVC syndr

111
Q

MCC CA deaths

112
Q

Tietze syndr

A

tenderness at costochondral/sternal junction + PALPABLE EDEMA

113
Q

amt fluid seen on CXR

114
Q

pulsus paradoxus + lung condition- tachypnea

A

tension PTX

115
Q

PE initial screening test, gold std

A

initial: CT

gold std: pulm angiography

116
Q

heparin antidote

A

protamine sulfate

117
Q

pneumonia- hypoNa, incr LFTs

A

Legionella

118
Q

pneumonia- cavitary lesions

A

Klebsiella

119
Q

pneumonia- after viral illness/flu

120
Q

viral pneumonia in adults, kids

A

adults: influenza
kids: RSV

121
Q

consolidation sx

A

bronchial BS, incr tactile fremitus

122
Q

INH ADR, prevention of ADR

A

peripheral neuropathy, hep

prevent: B6 (pyridoxine)

123
Q

Pyrazinamide ADR

A

hyperuricemia, photosensitivity, hep

124
Q

ethambutol ADR

A

peripheral neuropathy, optic neuritis

125
Q

RIF ADR

A

thrombocytopenia, orange

126
Q

latent TB Tx

A 
INH x 9mo
plus pyridoxine (B6)
127
Q

URI sx -> 1-2days later resp distress, wheezing

young child

A

bronchiolitis

128
Q

RF bronchiolitis

A

cigarette exposure, no breastfeed, premature

129
Q

Tx bronchiolitis

A

humidified O2

130
Q

MCC acute bronchitis (vs bronchiolitis)

A

bronchitis: adenovirus
bronchiolitis: RSV

both after URI

131
Q

definitive Dx epiglottitis

A

laryngoscopy

132
Q

pertussis phases

A

catarrhal: URI
paroxysmal: coughing fits, whoop after, emesis
convalescent: resolving

133
Q

MCC death in 1st mo of life

A 
infant RDS (hyaline membrane dz)
Tx: exogenous surfactant, steroids to fetus
134
Q

severe refractory hypoxemia, not responsive to 100% O2

135
Q

Dx, Tx ARDS

A

cardiac cath of pulm artery: PCWP

136
Q

flu vaccine CI

A

eggs, gelatin, thimerosal allergy

137
Q

normal BS

A

bronchial: trachea, larynx
bronchovesicular: primary bronchus
vesicular: all areas

138
Q

Cheyne Stokes causes

A

hypercapnia, decr brain blood flow

139
Q

Biot’s breathing causes

A

opioid use, medulla oblongata damage

140
Q

MCC pulm HTN

A

idiopathic

141
Q

pulm HTN sx

A

middle aged/young female

cor pulmanale, R HF, RVH, RAE, RAD, RBB

142
Q

definitive Dx pulm HTN

A

R sided cath (pulm artery pressure >25)

143
Q

pulm HTN TX

PANCE (9 decks)

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