Pulmonology Flashcards
What is the most common patient complaint with emphysema?
Shortness of breath
What age should vaccinations for pneumococcal pneumonia begin?
65
Prolonged expiration (low FEV1) should make you think of what diagnosis?
Asthma or COPD
Hampton’s hump on CXR should make you think of what diagnosis?
PE
How long after administering a PPD should it be read?
48-72 hours
A patient without a functioning spleen is more susceptible to what type of organisms?
Encapsulated organisms most commonly strep pneumoniae and H. flu
What is the most common cause of pneumonia in children less than 1 year old?
RSV
What is the treatment for pneumocystitis jiroveci?
Bactrim
What occupations are the most associated with berylliosis?
Aerospace and nuclear plant workers
What CXR finding combined with patient history might make you think of berylliosis?
Diffuse infiltrates with hilar adenopathy
What is the gold standard diagnosis of a pleural effusion?
Thoracentesis
When performing a decompression for a tension pneumothorax where do you put the needle?
2nd ICS at the midclavicular line
Tamiflu can be given to children above what age?
1
Zanamavir (Relenza) may be given to children above what age?
7
HIV patients with ground glass appearance on CXR should make you think of what diagnosis?
Pneumocystitis jiroveci pneumonia (PJP used to known as PCP)
A noncaseating granuloma should make you think of what diagnosis?
Sarcoidosis
A pearl formation on CXR should make you think of what diagnosis?
Squamous lung cancer
Ghon or ranke complexes on CXR should make you think of what diagnosis?
TB
A Westermark sign on CXR should make you think of what diagnosis?
PE
Mesothelioma is most commonly found in what lung location?
80% found in pleural lining
What CXR finding might make you think of mesothelioma?
Pleural thickening, remember 80% are found in pleura lining
Hyperinflation on CXR as well as eosinophelia on CBC should lead you to what diagnosis?
Asthma
What organism is the most common cause of pneumonia in a patient with cystic fibrosis?
Pseudamonas
A college student presents with pneumonia. What two organisms should you be thinking of?
Chlamydia and mycoplasma
What size induration would a PPD be positive for in an HIV patient?
5mm
You suspect a pneumothorax. What instructions should go along with the order for a CXR?
It should be an end expiratory view in order to look for visceral pleural air
List the three most commonly used treatments for COPD?
Oxygen, ipatropium, and albuterol
List 4 medications which may cause asthma
Beta blockers, NSAIDS, ASA, ACE inibitors
Nobular opacities in the upper lung fields should make you think of what diagnosis?
Silicosis
What is the initial treatment for active TB?
RIPE
RIF + INH + PZA + EMB for several months followed by INH + RIF once sensitivities come back
Caseating granulomas should make you think of what diagnosis?
TB
“Blue bloater” refers to the characteristic physical exam findings of what disease?
Chronic bronchitis
A contralateral mediastinal shift should make you think of what diagnosis?
Tension pneumothorax
What is the best test to diagnose bronchiectasis?
CT
What are the main side effects of isoniazid (TB med INH)
Hepatitis and peripheral neuropathy
You are treating a patient for TB. He has noticed that this body fluids have an orange tint. What drug is causing this?
RIF (Rifampin)
Ethambutol has what major side effects?
Optic neuritis, red green vision loss
If you see a question that has anything to do with rats and the patient has pneumonia, what organism should you be thinking of?
Yersinia pestis
What is the most common organism causing pneumonia in COPD patients?
H. influenzae
Where is a pan coast tumor found on chest x-ray?
At the apex of either the right or left lung
Will evidence of TB be seen more frequently in the upper or lower lung lobes on CXR?
Upper
Patient with pneumonia has rust colored sputum. What diagnosis should you be thinking of?
Strep pneumonia
Coal miners lung often shows nodular opacities in what lung fields?
Upper lung fields
When you step up the diagnosis from intermittent asthma to mild persistent asthma what medication should you add?
Inhaled steroid like fluticasone
Any question about rabbits and pneumonia should make you think of what diagnosis?
Tularemia
Dullness to percussion should make you think of what diagnosis?
Lobular pneumonia
Young child presents to ER and you see him waiting in the tripod position. What diagnosis should you be thinking of?
Epiglottitis
At what size induration would a PPD be positive for a healthcare worker?
10mm
List 6 extrapulmonary complications of lung cancer
SPHERE SVC syndrome Pancoast tumor Horner's syndrome Endocrine problems Recurrent laryngeal symptoms Effusions (Exudative)
Currant jelly sputum should make you think of what diagnosis?
Klebsiella pneumoniae
What happens to TLC in sarcoidosis?
Decreases
What will the likely findings be on a CXR of a patient with asbestosis?
Linear opacities at the bases with pleural plaques
What are the most common cancers to metastasize to the lungs?
Breast, liver, colon
A thumbprint sign on X-ray should make you think of what diagnosis?
Later c-spine = epiglottitis
A barrel chest should make you think of what diagnosis?
Emphysema
Are the lungs noisy or quiet in COPD?
Quiet
List four indications for the flu vaccine
Child 6-59 months
Pregnant female
Healthcare worker
Age greater than 50
Post tussive rales should make you think of what diagnosis?
TB
Parenchymal metastasis and blebs on CXR should make you think of what diagnosis?
Emphysema
Rhonci or wheezes that clear after coughing suggest what diagnosis?
Bronchi or atelectasis
Does FEV1 go up or down with asthma?
Down
A very sick patient with diffuse infiltrates that spare the costophrenic angles should make you think of what diagnosis?
ARDS
What is the most common cause for bronchiectasis?
CF
What is the gold standard for the diagnosis of CF?
Sweat chloride test
An exudative pleural effusion should make you think of what diagnosis?
TB, lung cancer
What is the treatment for epiglottitis?
2nd or 3rd generation cephalosporins (ceftriaxone)
Erythromycin or clindamycin are other options
Transudative pleural effusions should make you think of what diagnosis?
CHF
What two lung cancers are typically found centrally on x-ray?
Small cell cancer and squamous cell cancer
What two lung cancers are typically found peripherally on x-ray?
Adenocarcinoma and large cell
Pertussis is most commonly treated with what antibiotic?
Erythromycin
List for most common places for metastasis from lung cancer?
Bone, brain, liver, adrenal glands
If you come across a question where the patient has erythema nodosum and an enlarged parotid gland what diagnosis should you be thinking of?
Sarcoidosis
What is erythema nodosum?
Tender red nodules found on the shins
A thin looking and flattened diaphragm on CXR should make you think of what diagnosis?
Emphysema
If you see a question with an alcoholic who has been diagnosed with pneumonia what is the most likely organism?
Klebsiella pneumoniae
Honeycombing and tram tracks on CXR should make you think of what diagnosis?
Bronchiectasis and idiopathic pulmonary fibrosis
Paradoxical pulses may be found in which pulmonary disorder?
Asthma
An older patient presents with pneumonia and diarrhea. What diagnosis are you thinking of?
Legionella pneumonia
Eggshell opacities on the CXR should make you think of what diagnosis?
Silicosis
List three causes of decreased tactile fremitus
COPD, asthma, pleural effuison, pneumothorax
Hyperresonance to percussion should make you think of what diagnosis?
Emphysema, pneumothorax, asthma
Tympany to percussion should make you think of what diagnosis?
Large pneumothorax
If you hear crackles in the lung fields list three pulmonary issues that should be in your differential
PNA, fibrosis, CHF, bronchitis
Does TLC go up or down in COPD
Up
List three differential diagnoses if you hear wheezes on lung exam?
Asthma, COPD, bronchitis
What is it called when a patient says “eeee” but on auscultation you hear “ay”
Egophony
A physical exam finding of egophany should make you think of what diagnosis?
Lobar pneumonia
CXR shows vascular redistribution and blurred vascular outlines. What diagnosis should you be thinking of?
CHF