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PANCE study guide > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

Mc cause of acute bronchitis

A

Viral

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2
Q

Tx for acute bronchitis

A

Sx: Albuterol, antitussives No ABX usually needed d/t 80% viral

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3
Q

Sx. of Flu

A

Myalgias, sudden onset of fever and chills

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4
Q

Tx for Influenza A only

A

Amantidine/rimantidine

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5
Q

Tx for Flu A and B

A

Oseltamivir/Zanamivir

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6
Q

Define Catarrahl stage of pertussis

A

URI sx in first 1-2 wks

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7
Q

Define Paroxysmal stage of pertussis

A

Cough with post-tussive emesis

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8
Q

Define convalescent stage of pertussis

A

Sx lasting months after pertussis

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9
Q

Primary Tx of pertussis

A

Macrolides (azithromycin)

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10
Q

2ndary tx of pertussis

A

sulfa drugs

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11
Q

Viral PNA cxr

A

Perihilar markings

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12
Q

MC pathogen of CAP

A

S. pneumo

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13
Q

CXR of CAP

A

Lobar consolidation

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14
Q

Vocal fremitus is _______ in consolidation (bacterial) PNA

A

Increased

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15
Q

Percussion is ________ in consolidation (Bacterial) PnA

A

Dull

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16
Q

Whispered petroliloquy is ______ in consolidation (Bacterial) PNA

A

Present

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17
Q

diagnostic test of choice for bacterial PNA

A

CXR

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18
Q

CXR findings of consolidation PNA

A

Air bronchograms, Lobar consolidation, Atelectasis

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19
Q

MC cause of viral pna in infants/small children

A

RSV and Parainfluenza

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20
Q

MC cause of viral Pna in adults

A

Influenza

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21
Q

MC cause of VIRAL PNA in AIDS or transplant pt.

A

CMV

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22
Q

MC cause of atypical (walking) PNA esp in school aged college students or military recruits

A

Mycoplasma pneumoniae

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23
Q

Sx present in Mycoplasma pneumo

A

Pharyngitis Bullous myringitis URI sx.

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24
Q

PNA in ETOH’ics

A

Klebsiella pna

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25
Q

Legionella PNA is not transmitted through ________ instead through ______

A

person to person contact cooling towers, AC, contaminated water supply

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26
Q

Legionella PNA additional sx

A

N/V/D Inc LFT’s

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27
Q

HCAP mc pathogens

A

Gram negative rods (pseudomonas,)

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28
Q

Tx for Legionella PNA

A

fluoroquinolones

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29
Q

Out patient tx for CAP in pt w/o comorbidities

A

Macrolide (azithro), Tetracyclines (doxy)

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30
Q

Out pt tx for CAP in pt w/ CHF, old age, DM, lung dz.

A

Respiratory fluoroquinolones (Levofloxacin)

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31
Q

Out pt tx for CAP in Pediatric pt

A

Azithro, Amox/augmentin

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32
Q

Tx for psuedomonas HCAP

A

Tobramycin

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33
Q

Tx for MRSA HCAP

A

Vanco

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34
Q

When you hear HIV and PNA what opportunistic AIDS defining pathogen do you think.

A

Pneumocystis jiroveci

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35
Q

Tx. for pneumocystis jiroveci

A

BACTRIM prophylactically!

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36
Q

All fungal PNA present similarly with what Sx.

A

Fever, night sweats, malaise, and cough

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37
Q

Histoplasmosis is found in what part of the country

A

MS/OH river valley

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38
Q

Blastomycosis is found in what part of the country

A

Midwest

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39
Q

Coccidiomycosis is found in what part of the country

A

Desert Southwest

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40
Q

3 stages of TB

A

Infection, Latent, Reactivation

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41
Q

Are pt’s in the Latent stage of TB infective?

A

NO

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42
Q

Constitutional sx of TB

A

Fever, night sweats, anorexia, fatigue

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43
Q

Pulm Sx of TB

A

Chronic productive cough Hemoptysis

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44
Q

What is considered a positive TB test in an immuno-compromised, HIV, or close contact with confirmed TB pt?

A

>5mm of induration

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45
Q

What is the test time frame for PPD?

A

48-72 hours

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46
Q

What is considered a positive TB test in IVDA, Prisoners, Military, DM, or Hospital workers?

A

>10mm

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47
Q

What is considered a postive PPD in the general population?

A

>15mm

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48
Q

Diagnosis of TB requires what?

A

3 days of AM sputum culture

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49
Q

Tx of active TB?

A

Empiric “RIPE” Rifampin INH Pyrazinamide Ethambutol (Add B6 Pyridoxine-for prevention of peripheral neuropathy)

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50
Q

When is TB PT no longer considered infectious?

A

2 weeks after initiation of tx.

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51
Q

Total tx duration of TB

A

6ms (or 3 mos with neg. sputum culture)

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52
Q

Tx of non-contagious Latent TB?

A

INH + Pyridoxine (Vit B6) if INF resistant: Rifampin

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53
Q

What is the most common cause of cancer death worldwide?

A

Lung CA

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54
Q

Characteristics of a benign pulmonary nodule on CXR

A

<3cm Slow growing Smooth Central calcification (RARE cavitation)

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55
Q

Follow up for nodule <3cm on CXR

A

serial CXR watchful waiting q3m CT scan BX if concern for malignancy

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56
Q

Characteristics of Malignant pulmonary nodule o CXR

A

Irregular shape, spiculated Rapid growth (may double in 4mo) Cavitary w/ thickened walls

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57
Q

MC cause of brochogenic carcinoma

A

smoking

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58
Q

MC eiology of bronchogenic carcinoma

A

NSCLC

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59
Q

1st line tx for NSCLC

A

surgery

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60
Q

MC type of NSCLC

A

Adenocarcinoma

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61
Q

SCLC tx.

A

Chemo w/ or w/o radiotherapy, Surgery not usually tx of choice

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62
Q

presentation of SCLC

A

Usually has Mets by the time presents,

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63
Q

Define Horner’s syndrome

A

miosis, ptosis, anhydrosis

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64
Q

What percentage of sx secondary to sarcoid are pulmonary?

A

90%

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65
Q

What other systems besides pulmonary are affected by sarcoidosis

A

Lymph Skin Visual Myocardial Rhem Neuro

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66
Q

What sx are present in sarcoidosis w/ Lymph component?

A

Hilar notes, Painless intrathoracic lymphadenopathy

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67
Q

What sx are present in sarcoidosis w/ Skin component?

A

Erythema nodosum: bilat tender red nodules on ant legs Lupus Pernio: Violacsous, rased discolration of nose, ear cheek and chin (resembles frostbite)

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68
Q

What disorder is pathognomonic for sarcoidosis

A

Lupus Pernio

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69
Q

What sx are present in sarcoidosis w/ Visual component?

A

Uveitis: blurred vision, ocular discomfort, photophobia. Conjunctivitis

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70
Q

What sx are present in sarcoidosis w/ Myocardial component?

A

arrhythmias cmyops

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71
Q

What sx are present in sarcoidosis w/Rheum component?

A

arthralgias Splenomegaly

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72
Q

What sx are present in sarcoidosis w/ Neuro component?

A

CN palsies

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73
Q

CXR of sarcoidosis

A

Nodular lesions with hilar lymphadenopathy

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74
Q

Pt’s with sarcoidosis are (Hyper/Hypo)-Calcemic?

A

Hyper

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75
Q

Tx of sarcoidosis

A

Steroids for sx only

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76
Q

Where are pt’s with Asbestosis exposed?

A

Ships and insulation

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77
Q

Where are pt’s with silicosis exposed?

A

Sand blasting, foundry work

78
Q

Where are pt’s with “black lung” exposed

A

“miner’s lung” - coal

79
Q

50 year old man is seen c/o dyspnea and non-productive cough. Fine bibasilar inspiratory crackles are hears. Noted clubbing of fingers. What is suspected dx.? Also what would you expect to see on CXR?

A

idiopathic pulmonary fibrosis CXR-“honeycombing”, ground glass opacities

80
Q

Managment of idiopathic pumonary fibrosis

A

smoking cessation and O2. Lung transplant only cure

81
Q

Where are pt’s with Berylliosis exposed?

A

Flourescent light bulb factories, aerospace, electronics

82
Q

CXR of Asbestosis

A

Pleural plaques, interstitial fibrosis (honeycomb of lungs), primarily in lower lungs!!!

83
Q

Chronic exposure to _____ leads to 80% of Mesothelioma cases.

84
Q

Define pleural effusion

A

Abnormal accumulation of fluid in the pleural space

85
Q

MC cause of transudative pelural effusion

86
Q

Transudate pleural effusion occurs d/t

A

Circulatory system fluid

87
Q

Exudate pleural effusion occurs d/t

A

local pulmonary factors inc vascular permeability

88
Q

sx of pleural effusion

A

asymptomatic dyspnea “pleuritic cp” cough

89
Q

In pleural effusion tactile fremitus is ______ ?

90
Q

In pleural effusion breath sounds are ______?

A

Diminished

91
Q

In pleural effusion Percussion is _____?

92
Q

What CXR is best for assumed pleural effusion

A

Lat Decub.

93
Q

Gold standard tx for pelural effusion

A

Thoracentesis (Dx and therapeutic)

94
Q

Do not remove greater than ____ during 1 thoracentesis?

95
Q

What are the 3 types of PTX?

A

Spontaneous Traumatic Tension

96
Q

Managment of tension pneumothorax

A

Immediate needle aspiration followed by chest tube thoracostomy

97
Q

Where do you place the needle for aspiration of tension PTX

A

2nd ICS MCL just above the third rib in order to avoid the NAV that rides under the 2nd rib

98
Q

Placement of chest tube for tube thoracostomy in PTX

A

5th ICS Anterior to midaxiallary line

99
Q

Virchow’s Triad

A
  1. Stasis
  2. Hypercoaluability
  3. Intimal Damage
100
Q

Classic Triad of Sx for PE

A
  1. dyspnea
  2. Pleuritic cp
  3. Hemoptysis
101
Q

CXR finding of Westermark Sign or Hamptons’ Hump Is an uncommon finding suggestive of

102
Q

Describe

Diagnose

A

Westermarks Sign

Avascular markings distal to area of embolus

PE

103
Q

Describe

Diagnose

A

Hampton’s Hump:

Wedge shaped infiltrate

PE

104
Q

Describe

Diagnose

A

Tension Pneumo

105
Q

Define

Diagnose

A

Lobar pneumonia

CAP

106
Q

Define

Diagnose

A

Perihilar markings

Viral Pna

107
Q

Define

Diagnose

A

Fluid seen in R lower lung. Dull CVA

Pleural effusion

108
Q

Most common CXR findings of PE

A

None

Most CXR in PE will be normal

109
Q

ECG finding in PE

A

Sinus tach and non specific ST/T changes are MC

Also S1Q3T3 (more likely to be seen w/ massive PE

110
Q

Initial screening test for PE

A

Helical CT scan

111
Q

Gold standard for PE testing

A

Pulmonary angiography: usually only done if high suspicion and neg CT or VQ scan

112
Q

Tx for pt with PE who is hemodynamically stable

A

UFH or SQ LMWH followed by PO warfarin once therapeutic

113
Q

Tx for PE in hemodynamically unstable

A

Thrombolytic tx or embolectomy if anticoag is contraindicated

114
Q

How long must you tx a pt with PE after intiial DVT

115
Q

What is the reversal agent for LMWH and UFH

A

Protamine sulfate

116
Q

Define heparin Induced thrombocytopenia

A

Suspect HIT if drop in platelet count by 50% of baseline after initiation of Heparin tx.

117
Q

What are the PERC criteria

A

Age <50

Pulse <100

O2 sat >95%

No prior PE

No trauma

No Hemoptysis

No estrogens

No unilateral leg swelling

118
Q

Scoring for Well’s Criteria

A

<4 = Low probability

4.5-6 = Mod Probability

>6 = High probability

119
Q

Pathogensis of Pulmonary HTN

A

Inc. Pulmonary vascular resistance –> RVH –> R sided HF

120
Q

Primary Pulm HTN Mc cause

A

Idiopathic

121
Q

Secondary Pulm HTN mc cause

A

Pulm dz (COPD MC)

122
Q

Physical exam of Pulm HTN pt

A

Signs of R sided HF:

Inc. JVP

Peripheral edema

Ascities

123
Q

Definitive diagnosis of Pulm HTN

A

R sided cath: Pulm art pressure >25mmHg at rest

124
Q

Managment of Pulm HTN

A

Calcium Channel Blockers are 1st line tx

Vasodilators

O2

Anticoags

125
Q

thumbprint sign on XRay indicative of what?

A

Epiglottitis

126
Q

MC pathogen of acute epiglottitis

A

Group A strep (used to be Hflu)

127
Q

Tx of Epiglottitis

A

Immediate intubation

3rd Gen cephalosporins

128
Q

Steeple sign on Xray indicative of

129
Q

What is heard on exam for pt with Croup

A

Inspiriatory stridor

130
Q

MC cause of croup

A

Parainfluenza

131
Q

Tx of croup

A

Hydration, humidity, steroids

Racemic epi if struggling

132
Q

What is the most common cause of respiratory distress in an infant?

A

Hyaline Membrane Dz

133
Q

Cause of Hyaline Membrane Dz

A

Deficiency of surfactant

134
Q

Describe

Diagnose

A

Gilateral atelectasis and “ground glass appearance”

Hyaline Membrane Dz

135
Q

Tx of Hyaline membrane dz

A

O2, early intubation, Ventilation, Surfactant replacement

136
Q

What is the most common lower respiratory illness in infants and children < 2 yo

A

Acute Bronchiolitis

137
Q

MC pathogen of Bronchiolitis

138
Q

Tx for Bronchiolitis

A

Supportive

Hospitalize if severe

Bronchodilators, corticosteroids are controversial use

139
Q

Sx of Foreign body aspiration

A

Sudden onset cough, choking, wheezing or resp disterss

140
Q

Tx of Foreign body aspirant

A

Rigid bronchoscopy if lower airway

Heimlich if in upper airway

141
Q

What is the “hallmark of ARDS”

A

Severe refractory hypoxemia not responsive to 100% O2

142
Q

What is the genetic makeup of CF

A

Autosomal Recessive

143
Q

What is the most common pathogen of lower respiratory tract infection in a pt with CF?

A

Pseudomonas

144
Q

Pathognomonic for CF

A

Meconium ileus

145
Q

W/u for CF?

A

Sweat chloride test is definitive

146
Q

Define bronchiectasis

A

Irreversable bronchial dilation 2ndary to inflammation of the bronchi leading to obstruction of airflow and mucus clearance. leading then to lung infections

147
Q

MC cause of bronchiectasis in the US

148
Q

If not due to CF what is the mc cause of recurrent lung infections leading to bronchiectasis in the US

149
Q

Sx of bronchiectasis

A

Daily chronic cough w/ mucopurulent sputum

150
Q

What is the MC cause of massive hemoptysis

A

Bronchiectasis

151
Q

What is the MC cause of hemoptysis in general

152
Q

Lung exam of Bronchiectasis

A

persistent crackles at bases is common

153
Q

Preferred imaging for Bronchiectasis

A

High res CT scan

154
Q

Describe

Diagnose

A

Tram track appearance: thickening of of bronchial wall on CT

Bronchiectasis

155
Q

Describe

Diagnose

A

Signet Ring sign: Pulm artery coupled w/ dilated bronchus

Bronchiectasis

156
Q

Tx for Bronchiectasis

A

ABX cornerstone,

Empiric: Ampicillin

Psuedomonas (CF): FQ

157
Q

COPD encompases 2 diagnoses. What are they?

A

Emphysema

Chronic Bronchitis

158
Q

Greatest RF for COPD

159
Q

In patients under 40 with positive fam hx with COPD RF possible

A

A1-antitrypsin deficiency

160
Q

Define Emphysema

A

Abnormal permanent elargement of terminal airspaces

161
Q

Define Chronic Bronchitis

A

Prod cough > 3mos x 2 y consecutively

162
Q

Hallmark Sx of Emphysema

163
Q

Hallmark sx of COPD

A

Prod cough

164
Q

Physical exam of Ephysema

A

Hyperinfalation of lungs

Hyperresonance

decreased breath souds

Barrel Chested

Pursed lip breathing (Pink puffer)

165
Q

Physical exam of chronic bronchitis

A

Rales (crackles), Rhonchi, wheezing

Signs of Cor Pulmonale: peripheral edema and cyanosis

166
Q

Gold standard test in COPD

A

PFT’s/Spirometery

167
Q

FEV1<____? is indicative of increased mortality

168
Q

Primary tx for COPD

A

Quit smoking

169
Q

Pharmocological tx for COPD

A

Combo tx w/ B2agonists + anticholinergics greatest response

Ach: Tiotropium/Ipratropium

B2A: albuterol, terbutaline, salmeterol

170
Q

When should you avoid using Ach in a patient with COPD

A

Patients with BPH and Glaucoma may worsen with ach

171
Q

When should you not use B2agonist in a pt with COPD

A

severe CAD

172
Q

Gold Criteria Stage 1 Predicted PFT with Tx

A

FEV1>80%: Bronchodilators (prn short acting)

173
Q

Gold criteria stage II PFT% predicted and tx

A

FEV1 50-79%: Bronchodilators (prin short acting), + Long acting dilator

174
Q

GOLD stage 3 PFT % predicted and tx.

A

FEV1 30-50%; Bronchodilators (prn short acting) + Long acting dilator (salmeterol) + Pulm rehab and steroids when exacerbations

175
Q

Gold stage 4 PFT% predicted and tx.

A

FEV1 <30: Bronchodilators (prn short acting) + Long acting (salmeterol) + pulm rehab & steroids when exacerbations + O2 therapy

176
Q

Atopic traid

A
  1. Asthma
  2. Nasal Polyps
  3. ASA/NSAID allergy
177
Q

Gold standard of asthma diagnosis

178
Q

Define Intermittent Asthma severity

A

Sx < 2x week

SABA use < 2x/week

Night time awakenings: < 2x/mo

No interference w/ aodl

179
Q

PFT’s of Intermittent Asthma severity

A

Normal FEV1 between exacerbations

FEV1>80 predicted

FEV1/FVC normal

180
Q

TX for Intermittent asthma exacerbations

A

inhaled SABA PRN

181
Q

Define Milkd persistent asthma

A

sx: >2d/wk (but not daily)

Saba use: > 2d/wk (but not >1x/day)

Nighttime awakenings: 3-4x/mo

AODL: Minor limitation

182
Q

PFT’s of Persistent Mild Asthma

A

FEV1>80% predicted

FEV1/FVC Normal

183
Q

Tx of persistent Mild Asthma

A

Inhaled SABA (Albeterol)

Low dose ICS (beclemethasone, Flunisolide, Triamcinolone)

184
Q

Define Moderate persistent Asthma

A

sx: Daily

SABA use: Daily

Nighttime awakenings: >1x/week (but not nightly)

AODL: Some limitation

185
Q

PFT’s of Moderate persistent Asthma

A

FEV1 60-80% predicted

FEV1/FVC reducted by 5%

186
Q

TX of moderate persistent asthma

A

Low ICS (beclemethasone, flunisolide, triamcinolone) + Laba (Salmeterol, advair)

OR

Inc ICS to medium

OR

Add LTRA (Montelukast, Zafirlukast)

187
Q

Define Severe Persistent Asthma

A

Sx: throughout the day

SABA: several times throughout the day

Nighttime awakenings: Often 7x/week

AODL: Extremely limited

188
Q

PFT’s of Severe persistent Asthma

A

FEV1 <60 predicted

FEV1/FVC reduced by > 5%

189
Q

TX of Severe persistent asthma

A

High dose ICS + LABA

+/- Omalizumab (Anti-IgE drug)

PANCE study guide (14 decks)

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