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Emergency Medicine > Pulmonology > Flashcards

Pulmonology 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
Dx of Pleural Effusion
CXR: Positive Menisci (blunting of costophrenic angles) Lateral decubitus films are best CT needed to cofirm empyema
26
Tx of Pleural Effusion
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
27
What is a pneumothorax
Air within the pleural space | Increasingly positive pleural pressure causes collapse of the lung
28
What is a spontaneous pneumothorax | Primary vs. Secondary
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)
29
What is a Traumatic Pneumothorax
CPR, Thoracentesis, Subclavian lines, car accident
30
What is a Tension Pneumothorax
Positive air pressure pushes lungs, trachea, and heart to contralateral side This is an emergency!
31
Sx of Pneumothorax
Chest pain, usually pleuritic, unilateral, Dyspnea | Increased hyperresonance, Decreased fremitus, decreased breath sounds, tachycardia, tachypnea, hypotension
32
Dx of Pneumothorax
CXR with expiratory view | See decreased peripheral lung markings and deep sulcus
33
Tx of Pneumothorax
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
34
What is a PE
Thrombus in a pulmonary artery or branches
35
Sx of PE
Dyspea, Tachypnea Pleuritic chest pain, hemoptysis May see Homan's Sign: Calf pain with dorsiflexion
36
Workup of PE
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
37
Dx of PE
Helical CT is initial screening Pulmonary Angiogram: Gold Standard V/Q Scan Doppler Ultrasoud
38
Tx of PE
Anticoagulation: Heparin, Warfarin IVC Filter Thrombolysis: tPA, STreptokinase, Urokinase Thrombectomy
39
What is the most common pathogen in community acquired pneumonia and how does it look
Streptococcus Pneumonia | Gram Positive Cocci in pairs
40
What is the second most common pathogen in community acquired pneumonia and how does it look
H. Influenza | Gram Negative Rods (Bacilli)
41
What is the most common pathogen in Atypical pneumonia and what does it look like
Mycoplasma Pneumoniae | No cell wall so no response to beta-lactams
42
What pathogen is associated with pneumonia, cooling towers, A/C, and Contaminated water supplies
Legionella | Intracellular Gram Negative Rods
43
What pathogen is associated with pneumonia and alcoholics
Klebsiella Pneuoniae | Gram Negative Rods
44
What pathogen is associated with pneumonia and Immunocompromised
Psuedoonas Aeruginosa | Gram Negative Rods
45
What is the most common pathogen associated with viral pneumonia and infants/small children
RSV and Parainfluenza
46
What is the most common pathogen associated with viral pneumonia in adults
Influenza
47
What fungal pathogen is associated with pneumonia in immunocompromised host
Pneumocystis Jiroveci (PCP)
48
List the 8 common pathogens associated with Community Acquired Pneumonia
``` S. Pneumonia Mycoplasma, Chlamydia H. Influenza, M. Catarrhalis Legionella Klebsiella and GNR S. Aureus ```
49
What pathogens are associated with Hospital Acquired Pneumonia
Gram Negative Rods like Pseudomonas, Klebsiella, Enterobacter, Serratia
50
What are pathogens associated with Typical Pneumonia
S. Pneumoniae H. Influenza Klebsiella S. Aureus
51
What are pathogens associated with Atypical Pneumonia
Mycoplasma Chlamydia Legionella Viruses
52
What does a CXR show with Typical vs Atypical Pneumonia
Lobar Pneumonia with Typical | Diffuse Patchy Infiltrates with Atypical
53
Sx of Typical Pneumonia
``` 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
Sx of Atypical Pneumonia
Low grade fever Dry, non-productive cough Myalgias, malaise, sore throat, headache, N/V/D
55
Dx of Pneumonia
CXR CT Sputum
56
Tx of outpatient community acquired pneumonia
Macrolide or Dosxycycline
57
Tx of inpatient community acquired pneumonia
Beta-Lactam + Macrolide | Broad Spectrum Fluoroquinolone (Levafloxacin, Gatifloxacin, Moxifloxacin, Gemifloxacin)
58
Tx of Hospital Acquired Pnuemonia
Cefepime, Imipenem, Meropenem, Zosyn + Aminoglycoside (Getamicin) or Fluoroquinolone
59
What pathogen causes Tuberculosis
Mycobacterium Tuberculosis
60
Who are high risk populations for TB
Close contacts of patients with active TB, health care workers, immigrants from high prevalence areas, homeless, immunodeficiency (HIV, DM, Alcoholics)
61
What is primary TB
Outcome of initial infection | These people are contagious
62
What is chronic/Latent Infection TB
Carriers, have granulomas | Not Contagious
63
What is Secondary/Reactivation TB
Reactivation of latent TB with waning imune defenses (elderly, HIV) Usually seen in apex/uper lobes with cavitary lesions These people are contagious
64
Sx of Active TB
Chronic, Productive Cough, Chest Pain Hemoptysis Night sweats, fevers/chills, fatigue, anorexia, weight loss Rales, rhocnhi near apices
65
What does the reaction size of induration tell you about a TB test and its positivity
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
Tx of TB
``` RIPE: All 4 for first 2 months, then R&I for 4 months Rifampin Isoniazid Pyrazinamide Ethambutol ```
67
What are the side effects of TB meds
Rifampin: Thrombocytopenia, Orange colored secretions Isoniazid: Hepatitis, Peripheral Neuropathy Pyrazinamide: Hepatitis and Hyperuricemia Ethambutol: Optic Neuritis (color perception problems, red-green visual changes)
68
Tx of latent TB (positive skin test but clear CXR)
Isoniazid + Pyridoxine for 9 months
69
What is Bronchiolitis
Inflammation of the bronchioles
70
What is Acute Bronchiolitis
Seen in kids 2months-2yrs old after a viral infection like RSV, Adenovirus Inflammatory process causes bronchiole narrowing No fibrosis seen
71
What is Bronchiolitis Obliterans (Constrictive)
Patchy chronic inflammation and fibrosis of bronchioles | Seen post-lung transplant rejection, inhalation injuries
72
What is Acute Bronchiolitis
Lower respiratory tract infection of small airways | Leads to peripheral airway narrowing and variable obsruction
73
What is the most common pathogen seen in Acute Bronchiolitis
RSV
74
What are risk factors for Acute Bronchiolitis
Infants <2 yrs old | <6 months old if exposed to cigarettes, lack of breasfeeding, premature
75
What are complications of Acute Bronchiolitis
Otitis Media with S. Pneumo
76
Sx of Acute Bronchiolitis
Fever, URI | Wheezing, tachypnea, nasal flaring, cyanosis, retractions
77
Dx of Acute Bronchiolitis
CXR: Hyperinflation, Peribronchial cuffing | Pulse Ox <96%
78
Tx of Acute Brocnhiolitis
Supportive, humidified oxygen, IV fluid, Acetaminophen/ibuprofen for fever Beta-Agonists, nebulized racemic epinephrine if albuterol is not effective
79
What is Acute Bronchitis
Inflammation of trachea/bronchi (conducting airways)
80
What is the most common pathogen seen in Acute Bronchitis
Adenovirus, Parainfluenza, Influenza Coxsackie, Rhinovirus, RSV It usually follows a URI
81
Sx of Acute Bronchitis
Cough, may be productive and last 1-3 weeks
82
Dx of Acute Bronchitis
CXR usually normal
83
Tx of Acute Bronchitis
Fluids, Rest, Antitussive Agents, Bronchodilators No Abx for healthy people Abx ok for elderly, COPD, or immunocompromised
84
What is Laryngotracheitis (Croup)
Inflammation secondary to acute viral infection of upper airway (larynx, subglottis, trachea)
85
What is the most common pathogen seen in Croup
Parainfluenza, Adenovirus
86
What age group is Croup typically seen in
6 months-6 yrs
87
Sx of Croup
Barking Cough, Seal-Like Cough Stridor Hoarseness Dyspnea
88
Dx of Croup
Cervical Xray: Steele Sign (Subglottic narrowing of trachea)
89
Tx of Croup
Cool, humidified air mist | Oral Steroids, Nebulized Epinephrine in severe cases
90
What is Acute Epiglottitis (Supraglottitis)
Inflammation of the epiglottis
91
What is the most common pathogen associated with Acute Epiglottitis
H. Influenza type B (Hib)
92
Sx of Epiglottitis
Dysphagia, Drooling, Distress | Fevers, Odynophagia, Inspiratory stridor, Dyspnea, Hoarseness, Tripoding
93
Dx of Epiglottitis
Laryngoscopy | Lateral Cervical Xray: Thumb's Sign (Swollen, Enlarged Epiglottis)
94
Tx of Epiglottitis
Supportive: Place child in comfortable position and keep calm Dexamethasone to reduce airway edema Antibiotics: 2nd/3rd Generation Cephalosporins
95
What is Pertussis (Whopping Cough)
Highly contagious infection secondary to Bordetella Pertussis
96
Sx of Pertussis
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
Dx of Pertussis
Nasopharyngeal Swab | Severe Lymphocytosis
98
Tx of Pertussis
Supportive Abx only stop the spread, don't do anything for patient Macrolides are drug of choice (Erythromycin, Azithromycin), Bactrim second line
99
What is Infant Respiratory Distress Syndrome
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
What are risk factors for Respiratory Distress Syndrome
Caucasian Males, C-Section, Perinatal infections, Multiple Births
101
Sx of Infant Respiratory Distress Syndrome
Tachypnea, nasal flaring, cyanosis, chest wall retractions
102
Dx of Infant Respiratory Distress Syndrome
CXR: Bilateral diffuse reticular ground-glass opacities and air bronchograms Domed diaphragms
103
Tx of Infant Respiratory Distress Syndrome
Exogenous surfactant given to open alveoli
104
What is Acute Respiratory Distress Syndrome
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
Sx of Acute Respiratory Distress Syndrome
Acute dyspnea and hypoxemia with multi-organ failure if severe
106
Dx of ARDS
ABG CXR: White out pattern Cardiac Catheterization of pulmonary artery (Swan-Ganz): Pulmonary capillary wedge pressure <18mmHg
107
Tx of ARDS
Noninvasive or mechanical ventilation | CPAP with full face mask
108
What is Influenza
Acute respiratory illness caused by Influenza A or B with outbreaks mainly in the fall or winter A is more severe
109
Sx of Influenza
Abrupt onset of headache, fever, chills, malaise
110
What are contraindications to Influenza Vaccine
Eggs, Gelatin or Thimerosal Allergies
111
Who gets the Influenza Vaccine
Elderly, Chronic illness (asthma, sickle cell disease, COPD), nursing home people, healthcare workers, pregnant women
112
Tx of Influenza
Antivirals: Oseltamivir (Tamiflu), Zaamivir (Relenza). Best if given within 48 hours of onset of symptoms

Emergency Medicine (6 decks)

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