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Emergency Medicine > Pulmonology > Flashcards

Pulmonology Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

What is Asthma

A

Reversible hyperirritability of tracheobronchial tree

Results from bronchoconstriction and inflammation

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2
Q

What is the Atopy Triad

A

Asthma, Nasal Polyps, ASA/NSAID allergies

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3
Q

Sx of Asthma

A

Dyspnea, Wheezing, Cough (especially at night)

Prolonged expiration with wheezing, hyperresonance, decreased breath sounds, tachycardia, pulsus paradoxus

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4
Q

Dx of Asthma

A

Gold Standard: PFT: Shows Reversible Obstruction
Peak Expiratory Flow Rate: Best objective way to assess severity of patient response in emergency department
O2 sat<90%
Bronchoprovocation: Metacholine Challenge Test
ABG
CXR

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5
Q

What does the Peak Expiratory Flow Rate tell you

A

If there’s an increase > 15% from the initial attempt after giving treatment, confirms dx of asthma
Shows it’s reversible

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6
Q

What does the Metacholine Challenge Test tell you

What does the Bronchodilator challenge Test tell you

A

Metacholine causes brochospasm: If >20% reduction in FEV1 = Asthma
If >12% increase in FEV1 or > 200cc = Asthma

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7
Q

What is admission/discharge criteria for Asthma

A

PEFR<50% predicted

To be discharged PEFR >70% predicted

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8
Q

Tx for Asthma

A

Beta-2 Agonists is 1st line for acute (Albuterol, Epinephrine)
Acute: Anticholinergics (Ipratropium), Systemic Corticosteroids (Prednisone, Methylprednisone)
Chronic: Inhaled Corticosteroids (Beclomethasone, Flunisolide), Long-Acting Beta2 Agonist (Salmeterol), Leukotriene Modifiers (Montelukast)

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9
Q

What is considered Intermittent Asthma

A

Sx <2x/day, <2x/week

Night sx <2x/month

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10
Q

What is considered Mild Persistent Asthma

A

> 2days/week

Night sx 3-4x/month

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11
Q

What is considered Moderate Persistent Asthma

A

Daily

Night: >1x/week

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12
Q

What is considered Severe Persistent Ashtma

A

Throughout the day

Night: 7x/week

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13
Q

What is COPD

A

Progressive, irreversible airflow obstruction
Loss of elastic recoil, Increased airway resistance
Includes Emphysema and Chronic Bronchitis

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14
Q

What are common risk factors for COPD

A

Smoking
Alpha-1 Antitrypsin deficiency (genetic disease linked to COPD, alpha-1 antitrypsin protects elastin in lungs from damage by WBC)

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15
Q

Sx of Emphysema

A

Accessory muscle use, tachypnea, prolonged expiration, mild cough
Hyperinflation, Hyperresonance to percussion, decreased breath sounds, decreased fremitus, barrel chest, pursed lips

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16
Q

Sx of Chronic Brochitis

A

Productive cough, Prolonged expiration

Rales (crackles), rhonchi, wheezing, peripheral edema, cyanosis

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17
Q

Dx of COPD

A

Pulmonary Function Test/Spirometry is Gold Standard
CXR/CT scan
EKG

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18
Q

What does a PFT tell you in COPD

A

FEV1 is the most important factor in determining mortality
Decreased FEV1, Decreased FVC = Obstruction
Hyperinflation: Increased lung volumes

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19
Q

Tx of COPD

A

Smoking Cessation is #1
Bronchodilators: Anticholinergics, Beta-2 Agonists
Corticosteroids
Oxygen

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20
Q

What is Pleural Effusion

A

Abnormal accumulation of fluid in the pleural space

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21
Q

What is a Transudate in a pleural effusion

A

Circulatory system fluid due to increased hydrostatic or decreased oncotic pressure
Not due to local pleural disease
Usually due to CHF, nephrotic syndrome, cirrhosis

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22
Q

What is an Exudate in a pleural effusion

A

Occurs when local factors increase vascular permeability (infectious process)
Contains plasma proteins, WBC, platelets

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23
Q

What criteria must be met for a Exudate (Light’s Criteria)

A

Pleural fluid protein: serum protein >0.5

Pleural fluid LDH: serum LDH >0.6 or Pleural fluid LDH >2/3 upper limit of normal LDH

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24
Q

Sx of Pleural Effusion

A

Asymptomatic
Dyspnea
Pleuritic chest pain
Decreased fremitus, decreased breath sounds, dullness to percussion, audible pleural friction rub

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25
Q

Dx of Pleural Effusion

A

CXR: Positive Menisci (blunting of costophrenic angles)
Lateral decubitus films are best
CT needed to cofirm empyema

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26
Q

Tx of Pleural Effusion

A

Thoracentesis is gold standard
If empyema must do thoracentesis (pleural fluid pH<7.2, glucose <40, positive gram stain of pleural fluid)
Tx underlying condition

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27
Q

What is a pneumothorax

A

Air within the pleural space

Increasingly positive pleural pressure causes collapse of the lung

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28
Q

What is a spontaneous pneumothorax

Primary vs. Secondary

A

Thought to be a ruptured bleb
Primary: No underlying cause, usually tall, thin men 20-40yrs old, smokers, family hx
Secondary: Underlying lung disease without trauma (COPD, asthma, menstruation)

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29
Q

What is a Traumatic Pneumothorax

A

CPR, Thoracentesis, Subclavian lines, car accident

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30
Q

What is a Tension Pneumothorax

A

Positive air pressure pushes lungs, trachea, and heart to contralateral side
This is an emergency!

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31
Q

Sx of Pneumothorax

A

Chest pain, usually pleuritic, unilateral, Dyspnea

Increased hyperresonance, Decreased fremitus, decreased breath sounds, tachycardia, tachypnea, hypotension

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32
Q

Dx of Pneumothorax

A

CXR with expiratory view

See decreased peripheral lung markings and deep sulcus

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33
Q

Tx of Pneumothorax

A

Observation if small, they close spontaneously
Thoracostomy if large (chest tube)
Needle Aspiration if Tension followed by chest tube
Needle is placed in 2nd intercostal space at midclavicular line of the affected side
Avoid high altitudes, smoking, unpressurized aircraft, scuba diving

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34
Q

What is a PE

A

Thrombus in a pulmonary artery or branches

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35
Q

Sx of PE

A

Dyspea, Tachypnea
Pleuritic chest pain, hemoptysis
May see Homan’s Sign: Calf pain with dorsiflexion

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36
Q

Workup of PE

A

CXR: Westermark’s Sign, Hampton’s Hump
EKG: Sinus Tachycardia an non-specific ST/T changes
ABG: First Respiratory Alkalosis then Respiratory Acidosis
D-Dimer: If negative NO PE, If positive not very specific

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37
Q

Dx of PE

A

Helical CT is initial screening
Pulmonary Angiogram: Gold Standard
V/Q Scan
Doppler Ultrasoud

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38
Q

Tx of PE

A

Anticoagulation: Heparin, Warfarin
IVC Filter
Thrombolysis: tPA, STreptokinase, Urokinase
Thrombectomy

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39
Q

What is the most common pathogen in community acquired pneumonia and how does it look

A

Streptococcus Pneumonia

Gram Positive Cocci in pairs

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40
Q

What is the second most common pathogen in community acquired pneumonia and how does it look

A

H. Influenza

Gram Negative Rods (Bacilli)

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41
Q

What is the most common pathogen in Atypical pneumonia and what does it look like

A

Mycoplasma Pneumoniae

No cell wall so no response to beta-lactams

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42
Q

What pathogen is associated with pneumonia, cooling towers, A/C, and Contaminated water supplies

A

Legionella

Intracellular Gram Negative Rods

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43
Q

What pathogen is associated with pneumonia and alcoholics

A

Klebsiella Pneuoniae

Gram Negative Rods

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44
Q

What pathogen is associated with pneumonia and Immunocompromised

A

Psuedoonas Aeruginosa

Gram Negative Rods

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45
Q

What is the most common pathogen associated with viral pneumonia and infants/small children

A

RSV and Parainfluenza

46
Q

What is the most common pathogen associated with viral pneumonia in adults

A

Influenza

47
Q

What fungal pathogen is associated with pneumonia in immunocompromised host

A

Pneumocystis Jiroveci (PCP)

48
Q

List the 8 common pathogens associated with Community Acquired Pneumonia

A 
S. Pneumonia
Mycoplasma, Chlamydia
H. Influenza, M. Catarrhalis
Legionella
Klebsiella and GNR
S. Aureus
49
Q

What pathogens are associated with Hospital Acquired Pneumonia

A

Gram Negative Rods like Pseudomonas, Klebsiella, Enterobacter, Serratia

50
Q

What are pathogens associated with Typical Pneumonia

A

S. Pneumoniae
H. Influenza
Klebsiella
S. Aureus

51
Q

What are pathogens associated with Atypical Pneumonia

A

Mycoplasma
Chlamydia
Legionella
Viruses

52
Q

What does a CXR show with Typical vs Atypical Pneumonia

A

Lobar Pneumonia with Typical

Diffuse Patchy Infiltrates with Atypical

53
Q

Sx of Typical Pneumonia

A 
Sudden onset of fever
Productive cough with purulent sputum
Pleuritic Chest Pain
Tachycardia, Tachypnea
Bronchial breath sounds
Dullness to percussion
Increased Tactile Fremitus
Egophony
54
Q

Sx of Atypical Pneumonia

A

Low grade fever
Dry, non-productive cough
Myalgias, malaise, sore throat, headache, N/V/D

55
Q

Dx of Pneumonia

A

CXR
CT
Sputum

56
Q

Tx of outpatient community acquired pneumonia

A

Macrolide or Dosxycycline

57
Q

Tx of inpatient community acquired pneumonia

A

Beta-Lactam + Macrolide

Broad Spectrum Fluoroquinolone (Levafloxacin, Gatifloxacin, Moxifloxacin, Gemifloxacin)

58
Q

Tx of Hospital Acquired Pnuemonia

A

Cefepime, Imipenem, Meropenem, Zosyn
+
Aminoglycoside (Getamicin) or Fluoroquinolone

59
Q

What pathogen causes Tuberculosis

A

Mycobacterium Tuberculosis

60
Q

Who are high risk populations for TB

A

Close contacts of patients with active TB, health care workers, immigrants from high prevalence areas, homeless, immunodeficiency (HIV, DM, Alcoholics)

61
Q

What is primary TB

A

Outcome of initial infection

These people are contagious

62
Q

What is chronic/Latent Infection TB

A

Carriers, have granulomas

Not Contagious

63
Q

What is Secondary/Reactivation TB

A

Reactivation of latent TB with waning imune defenses (elderly, HIV)
Usually seen in apex/uper lobes with cavitary lesions
These people are contagious

64
Q

Sx of Active TB

A

Chronic, Productive Cough, Chest Pain
Hemoptysis
Night sweats, fevers/chills, fatigue, anorexia, weight loss
Rales, rhocnhi near apices

65
Q

What does the reaction size of induration tell you about a TB test and its positivity

A

Considered positive if:
>5 in HIV or Immunosuppressed, Close contact with active TB
>10 High risk populations
>15 No known risk factors for TB

66
Q

Tx of TB

A 
RIPE: All 4 for first 2 months, then R&amp;I for 4 months
Rifampin
Isoniazid
Pyrazinamide
Ethambutol
67
Q

What are the side effects of TB meds

A

Rifampin: Thrombocytopenia, Orange colored secretions
Isoniazid: Hepatitis, Peripheral Neuropathy
Pyrazinamide: Hepatitis and Hyperuricemia
Ethambutol: Optic Neuritis (color perception problems, red-green visual changes)

68
Q

Tx of latent TB (positive skin test but clear CXR)

A

Isoniazid + Pyridoxine for 9 months

69
Q

What is Bronchiolitis

A

Inflammation of the bronchioles

70
Q

What is Acute Bronchiolitis

A

Seen in kids 2months-2yrs old after a viral infection like RSV, Adenovirus
Inflammatory process causes bronchiole narrowing
No fibrosis seen

71
Q

What is Bronchiolitis Obliterans (Constrictive)

A

Patchy chronic inflammation and fibrosis of bronchioles

Seen post-lung transplant rejection, inhalation injuries

72
Q

What is Acute Bronchiolitis

A

Lower respiratory tract infection of small airways

Leads to peripheral airway narrowing and variable obsruction

73
Q

What is the most common pathogen seen in Acute Bronchiolitis

A

RSV

74
Q

What are risk factors for Acute Bronchiolitis

A

Infants <2 yrs old

<6 months old if exposed to cigarettes, lack of breasfeeding, premature

75
Q

What are complications of Acute Bronchiolitis

A

Otitis Media with S. Pneumo

76
Q

Sx of Acute Bronchiolitis

A

Fever, URI

Wheezing, tachypnea, nasal flaring, cyanosis, retractions

77
Q

Dx of Acute Bronchiolitis

A

CXR: Hyperinflation, Peribronchial cuffing

Pulse Ox <96%

78
Q

Tx of Acute Brocnhiolitis

A

Supportive, humidified oxygen, IV fluid, Acetaminophen/ibuprofen for fever
Beta-Agonists, nebulized racemic epinephrine if albuterol is not effective

79
Q

What is Acute Bronchitis

A

Inflammation of trachea/bronchi (conducting airways)

80
Q

What is the most common pathogen seen in Acute Bronchitis

A

Adenovirus, Parainfluenza, Influenza Coxsackie, Rhinovirus, RSV
It usually follows a URI

81
Q

Sx of Acute Bronchitis

A

Cough, may be productive and last 1-3 weeks

82
Q

Dx of Acute Bronchitis

A

CXR usually normal

83
Q

Tx of Acute Bronchitis

A

Fluids, Rest, Antitussive Agents, Bronchodilators
No Abx for healthy people
Abx ok for elderly, COPD, or immunocompromised

84
Q

What is Laryngotracheitis (Croup)

A

Inflammation secondary to acute viral infection of upper airway (larynx, subglottis, trachea)

85
Q

What is the most common pathogen seen in Croup

A

Parainfluenza, Adenovirus

86
Q

What age group is Croup typically seen in

A

6 months-6 yrs

87
Q

Sx of Croup

A

Barking Cough, Seal-Like Cough
Stridor
Hoarseness
Dyspnea

88
Q

Dx of Croup

A

Cervical Xray: Steele Sign (Subglottic narrowing of trachea)

89
Q

Tx of Croup

A

Cool, humidified air mist

Oral Steroids, Nebulized Epinephrine in severe cases

90
Q

What is Acute Epiglottitis (Supraglottitis)

A

Inflammation of the epiglottis

91
Q

What is the most common pathogen associated with Acute Epiglottitis

A

H. Influenza type B (Hib)

92
Q

Sx of Epiglottitis

A

Dysphagia, Drooling, Distress

Fevers, Odynophagia, Inspiratory stridor, Dyspnea, Hoarseness, Tripoding

93
Q

Dx of Epiglottitis

A

Laryngoscopy

Lateral Cervical Xray: Thumb’s Sign (Swollen, Enlarged Epiglottis)

94
Q

Tx of Epiglottitis

A

Supportive: Place child in comfortable position and keep calm
Dexamethasone to reduce airway edema
Antibiotics: 2nd/3rd Generation Cephalosporins

95
Q

What is Pertussis (Whopping Cough)

A

Highly contagious infection secondary to Bordetella Pertussis

96
Q

Sx of Pertussis

A

Catarrhal Phase: URI sx for 1-2 wks
Paroxysmal Phase: Severe paroxysmal coughing fits (with inspiratory whooping sound after cough fit). Post-coughint emesis
Convalescent Phase: Resolving of cough and emesis, coughing fits may continue with yawning, laughing

97
Q

Dx of Pertussis

A

Nasopharyngeal Swab

Severe Lymphocytosis

98
Q

Tx of Pertussis

A

Supportive
Abx only stop the spread, don’t do anything for patient
Macrolides are drug of choice (Erythromycin, Azithromycin), Bactrim second line

99
Q

What is Infant Respiratory Distress Syndrome

A

Disease of premature infants secondary to insufficiency of surfactant production and lung structural immaturity
Leads to atelectasis and perfusion pafter ventilation
Decreased lung compliance

100
Q

What are risk factors for Respiratory Distress Syndrome

A

Caucasian Males, C-Section, Perinatal infections, Multiple Births

101
Q

Sx of Infant Respiratory Distress Syndrome

A

Tachypnea, nasal flaring, cyanosis, chest wall retractions

102
Q

Dx of Infant Respiratory Distress Syndrome

A

CXR: Bilateral diffuse reticular ground-glass opacities and air bronchograms
Domed diaphragms

103
Q

Tx of Infant Respiratory Distress Syndrome

A

Exogenous surfactant given to open alveoli

104
Q

What is Acute Respiratory Distress Syndrome

A

Life threatening acute hypoxemic respiratory failure
Usually develops in critically ill patients
Severe refractory hypoxemia is a hallmark of ARDS, it doesn’t respond to 100% O2, Bilateral pulmonary infiltrates on CXR

105
Q

Sx of Acute Respiratory Distress Syndrome

A

Acute dyspnea and hypoxemia with multi-organ failure if severe

106
Q

Dx of ARDS

A

ABG
CXR: White out pattern
Cardiac Catheterization of pulmonary artery (Swan-Ganz): Pulmonary capillary wedge pressure <18mmHg

107
Q

Tx of ARDS

A

Noninvasive or mechanical ventilation

CPAP with full face mask

108
Q

What is Influenza

A

Acute respiratory illness caused by Influenza A or B with outbreaks mainly in the fall or winter
A is more severe

109
Q

Sx of Influenza

A

Abrupt onset of headache, fever, chills, malaise

110
Q

What are contraindications to Influenza Vaccine

A

Eggs, Gelatin or Thimerosal Allergies

111
Q

Who gets the Influenza Vaccine

A

Elderly, Chronic illness (asthma, sickle cell disease, COPD), nursing home people, healthcare workers, pregnant women

112
Q

Tx of Influenza

A

Antivirals: Oseltamivir (Tamiflu), Zaamivir (Relenza). Best if given within 48 hours of onset of symptoms

Emergency Medicine (6 decks)

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