Pulmonology Flashcards
Asthma medication associated with arrhythmias and seizures
Theophylline
Classification of asthma severity
Intermittent: FEV1 >80%
Mild persistent: FEV1 >80%, SABA more than 2 times per week, minor limitation
Moderate: FEV1 60-80%
Severe: FEV1 <60%
COPD in a 30-40 year old makes you think of this diagnosis/work-up
alpha1- antitrypsin deficiency
Hyperinflation, flat diaphragm, trapped air, bullae/blebs on CXR
Emphysema
Enlarged right heart border, increase vascular marking on CXR
Chronic bronchitis
Stages of COPD management
GOLD I: FEV1 >80- SABA and/or anticholinergic II: FEV1 50-79 Add LABA III: FEV1 30-50 Add pulmonary rehab, ?steroids IV: FEV1 <30 Add O2 therapy
Most common causes of bronchiectasis
Cystic Fibrosis (pseudomonas) most common cause
H.Flu most common cause if not CF
Cystic Fibrosis patient with bronchiectasis, What is the likely microorganism? Treatment?
Pseudomonas; Fluoroquinolone
CT reveals airway dilation, tram-track appearance, lack of tapering bronchi. What is the diagnosis?
Bronchiectasis
Treatment for Mycobacterium Avian Complex
clarithromycin + ethambutol
Manifestations of Cystic Fibrosis
GI: Meconium ileus at birth, pancreatic insufficency (foul smelling stool)
Resp: recurrent respiratory infections
Most common extrapulmonary findings of sarcoidosis
Skin: erythema nodosum, lupus pernio
LN’s: intrathoracic hilar adenopathy
Optic: uveitis
Elevated ACE makes you think of what diagnosis?
Sarcoidosis (NCG secrete ACE)
CXR/CT finding of idiopathic pulmonary fibrosis
Diffuse reticular opacities (HONEYCOMBING!)
CXR reveals nodular opacities in upper lobes, eggshell calcifications of hilar LN’s. What is the exposure?
Mining and quarry work (Silicosis!)
Byssinosis is caused from?
Long-term cotton exposure
What condition would be seen with CXR showing pleural plaques, thickening, interstitial fibrosis in lower lobes
Asbestosis
Most common mediastinal tumor
Thymoma
Characteristics of malignant pulmonary nodule
irregular, spiculated, rapid growth, cavitary with thickened walls
Where does lung cancer usually METs to?
brain, bone, liver, LN and adrenals
What are the two central lung cancers?
Squamous cell carcinoma and small cell carcinoma
Characterstics of small cell lung cancer
aggressive, central, SVC syndrome, SIADH/hyponatremia, paraneoplastic (Cushings)
Pancoast syndrome
shoulder pain, Horners syndrome, atrophy of hand/arm
seen with squamous cell carcinoma
Lung cancer associated with cavitary lesions, hyperkalemia, pancoast tumor
squamous cell carcinoma (NSCLC)
Diagnosis of bronchial carcinoid tumor
pink to purple well vascularized central tumor
Where does mesothelioma originate from
Pleura (80%)
The term for palpable edema of the costal cartilage
Tietze syndrome
Most common cause of transudative pleural effusion
CHF
How do you determine cause of pleural effusion?
Lights Criteria:
pleural protein: serum protein >0.5
pleural LDH: Serum LDH >0.6
CXR shows blunting of costophrenic angles
Diagnosis?
Pleural effusion
CXR reveals companion lines, decreased peripheral lung markings and lungs, trachea and heart to the left. What is the next step?
Needle aspiration: 2nd ICS, midclavicular line on the right followed by chest thoracostomy
Hamptons Hump or Westermark’s sign on CXR are signs of?
PE (although most commonly CXR normal)
Patient with PE who is hemodynamically stable and has history of ICH, malignant HTN. What is treatment in this patient?
IVC Filter
Patient with PE who is hemodynamically unstable and has history of CVA 1 month ago. What is treatment in this patient?
Thrombectomy/embolectomy
2 contraindications for LMWH
Renal failure (Cr >2) Thrombocytopenia
Two most common causes of CAP?
S. Pneumo (MC) and H.Flu (CF, COPD)
Most common cause of CAP in young, school-aged, college students?
Mycoplasma Pneumoniae
What is a possible cause of pneumonia in an elderly patient in a home with N/V/D with hypnatremia and elevated LFTs?
Legionella
Most common cause of viral pneuomnia in adults? children?
Adults: Influenza
Children: RSV, Parainfluenza
Severe pneumonia seen with alcoholics, cavitary lesions on CXR
Klebsiella
Pneumonia/Cough associated with bird/rat droppings
Histoplasmosis
Currant jelly on sputum
Klebsiella
CXR showing upper lobe (RUL) bulging fissure, cavitations
Klebsiella
Physical exam findings of pleural effusion
Percussion: Dull
Fremitus: Decreased
Breath sounds: Decreased
Empiric treatment for CAP pneumonia
Outpt: Macrolide or Doxycycline
Inpt: Beta-Lactam + Macrolide OR FQ
ICU: Beta-Lactam + Macrolide OR Beta-Lactam + FQ
Empiric treatment for HAP
Anti-pseudomonal Beta-Lactam + AG or FQ
Empiric treatment for suspected PCP
Bactrim + steroids
Empiric treatment for aspiration pneumonia
Clindamycin or Augmentin +/- Metronidazole
Reaction size of PPD in health care worker to warrant positive for infection
10 mm or greater
CXR finding with primary TB
Middle/lower lobe consolidation
CXR finding with reactivation TB
Apical fibrocavitary lesion
Treatment for primary active TB
Rifampin Isoniazid Pyrazinamide Ethambutol (or streptomycin) for 2 months then d/c PZA and ETH (if sensitive to RIF and INH)
Main side effects of Isoniazid
Peripheral neuropathy and hepatitis
Patient being treated for TB has scotoma, color perception problems which medication is responsible?
Ethambutol
Most common cause (organism) for a premature 1 year old with fever, wheezing, tachypnea and nasal flaring?
RSV bronchiolitis
Most common cause of acute bronchitis
Adenovirus
1 year old with barking cough, stridor, dyspnea at night. What is the cause and what do you see on CXR?
Parainfluenza (Croup)
Steeple sign on CXR
3 year od with dysphagia, drooling and distress, thumbprint sign on CXR. What is treatment of choice
2nd/3rd generation cephalosporin (ceftriaxone or cefotaxime) and dexamethasone for treatment of epiglottitis (H. Flu)
Severe cough fits and post tussive emesis. What is the recommended treatment
Supportive care and macrolides/bactrim (B. Pertussis)
CXR of 5 day old with bilateral diffuse reticular ground glass opacities and air bronchograms is suggestive of what disease?
IRDS
Critically-ill patient PaO2/FI02 <200 not improving to 100% O2, bilateral pulmonary infiltrates that spares costophrenic angles on CXR and PCWP <18 has what condition?
ARDS
PaO2 on ventilation and PEEP must maintain above 55 (less than 60) to prevent oxygen toxicity. What will happen if it is greater than 60 for extended duration?
Irreversible pulmonary fibrosis
Causes of Metabolic Acidosis (Gap)
Methanol Uremia DKA Propylene glycol INH or infection Lactic acidosis Etheylene glycol Rhabdo/renal failure Salicylates
Most common cause of Primary pulmonary HTN? Secondary?
Primary: Idiopathic
Secondary: COPD
EKG reveals RVH, RAE, RAD, RBB, CBC reveals polycythemia and inc HCT. Likely diagnosis?
Pulmonary HTN
