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INTERNAL MED IP/OP > PULMONOLOGY > Flashcards

PULMONOLOGY Flashcards

1
Q

How would you treat a patient’s cough/dyspnea/sore throat x 7-10 days?

A

For Bronchitis: Tessalan pearls, guaifenesin, acetaminophen/ibu
Start to think about chest xray and abx for pneumonia
Abx: 1stDoxy 2ndMacrolide (Bactrim)

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2
Q

What should you always check when you suspect bronchitis?

A

Check for hypoxemia, crackles, check for dyspnea or wheezing

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3
Q

How long can the cough persist form bronchitis?

A

Can last 2-3 weeks

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4
Q

What are the most common viral causes of pneumonia?

A

RSV, adenovirus, influenza virus, and parainfluenza

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5
Q

If we have an elderly pt with pneumonia, what scoring system would we use to determine if they need to be hospitalized or not?

A

CURB 65

Confusion, Urea greater than 20, RR greater than 30, Low systolic BP less than 90, and age greater than 65

If 3 or more of the above present – consider hospitalizaiton

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6
Q

Common causes of pneumonia?

A

Strep pneumoniae (community) or H influ; Pseudomonas & MRSA (hospital)

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7
Q

How do you treat pneumonias?

A 
Community – Doxy or Macrolide
 
Hospital – Floro or ceph + macrolide. Vanc for MRSA
 
Peds – Amoxicillin
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8
Q

Rust colored sputum – cause?

A

pneumococcus

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9
Q

An alcoholic with pneumonia or Currant jelly sputum – cause?

A

Klebsiella

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10
Q

How is mycoplasma pneumonia diagnosed?

A

PCR

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11
Q

If a patient has pneumonia + GI symptoms and confusion – cause?

A

Legionella

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12
Q

What’s the cause of bacterial influenza?

A

Staph aureus

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13
Q

Although also most commonly occurs in HIV patients, what other lung disorder should we keep in the back of our minds?

A

Pneumocystis (fungus)

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14
Q

When does pneumocystits jiroveci present (CD4 count), how does a CXR look, how do you treat?

A

CD4 under 200 – Tx imperically with TMP-SMX

CXR – diffuse bilateral patchy interstitial infiltrates (ground glass)

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15
Q

In a pt with COPD what type of pneumonia do they get?

A

H influ

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16
Q

In an IVD user what type of pneumonia do they get?

A

Staph aureus

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17
Q

Aspiration pneumonia is often what bug?

A

Klebsiella

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18
Q

What type of pneumonia do cystic fibrosis pts get?

A

Pseudomonas

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19
Q

When would symptoms have to develop in order to be diagnosed with a nosocomial pneumonia?

A

Within 48 hours after leaving a hospital

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20
Q

Who should definitely get a yearly flu vaccination?

A

Those over 65 and all people who work in nursing homes

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21
Q

How do we dx and tx influenza?

A

Rapid Viral nose swab

Tx with Oseltamivir within 48hours

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22
Q

A patient with CF has a chronic daily cough, with thick, foul smelling sputum – dx? Tx?

A

Acute bronchiectasis

Tx – culture sputum, floroquinolones, long term azith, chest physiotherapy

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23
Q

What is bronchiectasis?

A

Abnormal/persistent dilatation of bronchii (CF pts) caused by destruction and recurrent infections

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24
Q

How do you treat pertussis?

A

Azithro

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25
Q

A vitamin A deficiency is also associated with what other disease?

A

CF

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26
Q

If on Chest XR you see bilateral hilar adenopathy, what do you think? What do you do next?

A

Sarcoidosis Get a biopsy – see noncaseating granulomas

27
Q

erythema nodosum of the LE’s should make you think of what?

A

Sarcoid

28
Q

How do we treat sarcoid?

A

symptomatic pts get corticosteroids

29
Q

if you see honeycombing on chest CT – dx?

A

Asbestosis (idiopathic pulmonary fibrosis)

30
Q

How does a pt present with idiopathic interstitial lung disease?

A

insidious dry cough, dyspnea, crackles, clubbing

PFTs = restrictive

Diagnosis of exclusion – unless with lung biopsy

31
Q

How do we classify mildly intermittent asthma?

A 
FEV1 = 80%+  
Symptoms less 2x/week  
Night less than 2x/month
 
FEV1/FVC = decreased
32
Q

How do we classify mild persistent asthma?

A

FEV1 = 80%+
Symptoms more than 2x/week
Night more than 2x/month

FEV1/FVC = decreased

33
Q

How do we classify moderate persistent asthma?

A

FEV1 = 60-80%
Symptoms Daily
Night more than 6x/month

34
Q

How do we classify severe asthma?

A

FEV1 = Less than 60%
Symptoms continuous
Frequent night

35
Q

If a patient has intermittent asthma, what is the tx?

A

SABA prn (Albuterol, levalbuterol)

**If used more than 2 days/week need to step-up

36
Q

If symptoms are more than 2 days/week (but not daily) and nighttime symptoms occur 3-4x/month – what levels of asthma? How do we treat?

A

Mild Persistent asthma

**ADD a low-dose ICS (fluticasone, budesonide)

If that doesn’t control symptoms enough consider a medium dose ICS OR add a LABA

(Salmeterol, formoterol – short time ONLY)

37
Q

If asthma symptoms are daily with nighttime symptoms occurring 1+/week – what level? How do we treat?

A

Moderate persistent asthma - Consult with pulmonologist

Medium ICS + LABA

38
Q

Emphysema is what? Chronic bronchitis is what?

A

Emphysema = Loss of lung elasticity, enlarged air spaces

Chronic bronchitis = inflammation, excessive sputum production

Cough present for more than 3 months

39
Q

If a patient has moderate COPD, what is their FEV1 & FEV1/FVC?

A

FEV1/FVC less than 70%

FEV1 = 60-80%

40
Q

What is considered mild COPD?

A

FEV1/FVC greater than 70%

FEV1 greater than 80%

41
Q

What’s the treatment progression for COPD?

A

AlbuterolTiotropriumICS (symbicort)

42
Q

What’s the leading cause of cancer death?

A

Lung cancer

43
Q

What form of lung cancer is common in nonsmokers?

A

Bronchogenic adenocarcinoma

44
Q

What form of lung cancer is common in smokers and is very aggressive?

A

Small cell

45
Q

What form of lung cancer develops centrally?

A

Squamous cell

46
Q

What are the sxs of lung cancer?

A

Cough, chest pain, weight loss, dyspnea

Hemoptysis is lung cancer until proven otherwise

47
Q

Is there any screening for lung cancer?

A

Not really – anyone who is ages 55-80 with a 30 pack year hx and currently smokes or quit within the past 15 years needs a Low-Dose CT until quit x 15 years

48
Q

What are the different types of pleural effusions?

A

Exudates (infection), Transudates (CHF), Empyema, and Hemothorax

49
Q

How do we Dx and Tx a pleural effusion?

A

Dx = CXR (blunting) or U/S

Tx = Thoracentesis

50
Q

Thoarcentesis comes back with a large amount of protein – cause?

A

Exudate (Light’s Criteria)

51
Q

Thoracentesis comes back with minimal protein and minimal LDH – cause?

A

Transudate

52
Q

Thoracentesis comes back with pus – cause?

A

Empyema

53
Q

What are the two types of sleep apnea?

A

Cental and *Obstructive

54
Q

What are the characteristic sxs of sleep apnea?

A

loud snoring, disrupted sleep, nocturnal gasping/choking, witnessed apnea, daytime sleepiness/fatigue

55
Q

What’s a PE finding in sleep apnea?

A

Neck circumference in women greater than 16in; 17in in men

56
Q

Your patient is hypoxic, tachy, and complaining of pleuritic CP – what do you think of?

A

PE!!

57
Q

If you are highly suspicious of a PE – what do you do?

A

get the CT

58
Q

If there is low risk of a PE what should you do?

A

Go through PERC =Age <50; HR <100; O2 sat on room air >94%; No prior history of DVT/PE; No recent surgery or trauma; No hemoptysis; no exogenous estrogen; no clinical signs suggesting DVT?
*MUST be able to say “correct” to all of them in order to pass all of them - Pass = do nothing

59
Q

What happens if you fail PREC?

A

Go through WELLS criteria

60
Q

What are the componenets of the WELLS criteria?

A 
Sxs of DVT
 
PE judged most likely diagnosis
 
Surgery or bedridden more than 3 days in the past 4 weeks
 
Previous DVT or PE
 
HR greater than 100
 
Active cancer treatment
61
Q

If you fail WELLS – then what?

A

If low = D-Dimer

If mod-high = do imaging

62
Q

If your pt actually has a PE – tx?

A

FULL ANTICOAG x 3-6 months

Unless unprovoked = lifetime☹

63
Q

What are some fun facts/PE findings of a PE?

A

ECG = S1Q3T3 (S wave in 1, Q wave inversion in 3)

CXR = Hampton hump (peripheral wedge of airspace) and westermark’s sign

64
Q

If a patient is not responding to 100% oxygen – what do you think about?

A

ARDS

INTERNAL MED IP/OP (9 decks)

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