Pulmonology Flashcards
Which pneumoconiosis has diffuse infiltrates and hilar lymphadenopathy?
Berylliosis
Which pneumoconiosis has nodular opacities in the upper lung fields on chest X-ray?
Black lung from coal mining
Which pneumoconiosis has egg shell calcification on chest X-ray?
Silicosis
Lofgren’s syndrome may present like sarcoid. What major difference separates these diseases?
Lofgren’s syndrome is short term and spontaneously resolves - Sarcoid is chronic
A DVT in what location is the most common source of pulmonary embolism?
Lower extremity above the knee
What disorder should be considered in a young patient (20-30 years old) with severe emphysema?
Alpha 1 antitrypsin deficiency
What medication must all asthma patients have regardless of the severity of their disease?
All asthma patients must have a short acting beta agonist (albuterol) as a rescue medication
What should be considered with a diffuse ground glass appearance and no pulmonary nodules on chest X-ray?
Infiltrative lung disease
What should be considered with a localized ground glass appearance and a pulmonary nodule on chest X-ray?
Lung cancer
What should be considered in a patient with pneumonia who was exposed to bird or bat droppings in the Mississippi to the Ohio river area?
Histoplasma capsulatum
List three classes of antibiotics which may be used for Klebsiella pneumonia
Cephalosporins - Aminoglycosides - Fluoroquinolones
What two antibiotic classes may be considered to treat legionella pneumonia?
Macrolides and fluoroquinolones
What other bacterial pneumonia are patients who have pseudomonas pneumonia prone to get?
S. aureus pneumonia shares similar risk factors specifically nosocomial
What are the combinations of antibiotics which may be used for pseudomonas pneumonia?
Anti pseudomonal beta-lactam PLUS an anti- pseudomonal quinolone or aminoglycoside - Anti pseudomonal quinolone PLUS an aminoglycoside
At least how many antibiotics should be used at the same time for pseudomonas pneumonia?
Always treat with at least two antibiotics
What are the antibiotics which may be used for MRSA pneumonia?
Vancomycin or linezolid + Levofloxacin or ciprofloxacin
List the antibiotics classes for inpatient ICU treatment in a patient with a pneumonia caused by Strep pneumoniae or non MRSA staph.
Beta-lactam + macrolide or fluoroquinolone
List the antibiotics classes for inpatient non ICU treatment in a patient with a pneumonia caused by Strep pneumoniae or non MRSA staph.
Beta-lactam PLUS a macrolide
List the antibiotics classes for outpatient treatment in a patient with comorbidities and a pneumonia caused by Strep pneumoniae or non MRSA staph.
Fluoroquinolone doxycycline or macrolide PLUS a beta lactam
List the antibiotics classes for outpatient treatment in a healthy patient with pneumonia caused by S. pneumoniae or non MRSA staph.
Fluoroquinolone doxycycline or macrolide
What must be considered with a young patient who has been exposed to rodent feces and has a “CHF like” presentation?
Hanta virus
What situations predispose an infant to developing type 2 IRDS?
C-section or diabetic mother
What type of Infant respiratory distress syndrome (IRDS) occurs in a near or full term infant?
Type 2 IRDS
What type of Infant respiratory distress syndrome (IRDS) occurs in a pre-term infant? (usually born before 30 weeks)
Type 1 IRDS
Incomplete lung development due to congenital malformation?
Pulmonary hypoplasia
Long term inflammation and eventual scarring after episodes of severe respiratory distress and mechanical ventilation?
Broncho-pulmonary dysplasia
What antibiotic is most strongly associated with hypertrophic pyloric stenosis?
Clarithromycin (Note all macrolides can cause hypertrophic pyloric stenosis)
What is laryngotracheo-bronchitis also known as?
Croup
Where does the cancer associated with asbestosis tend to locate in the lung?
Mesothelioma locates to the pleural lining at the base of the lung
What is the Dx? Looks like CHF on chest X-ray but pulmonary wedge pressure in normal.
Acute respiratory distress syndrome (ARDS)
What is the Dx? Nuclear plant worker with shortness of breath?
Berylliosis
What lab is elevated in sarcoidosis?
Angiotensin converting enzyme levels 4x higher than normal - Elevated ESR
Bilateral hilar adenopathy?
Sarcoidosis
What is the most likely Dx? 1 week post partum has syncopal episode and is now tachycardic and short of breath.
Pulmonary embolism
What is the treatment for sarcoidosis?
Steroids
Class 5 pulmonary HTN cause?
Sarcoidosis
Class 4 pulmonary HTN cause?
Pulmonary embolism
Class 3 pulmonary HTN cause?
COPD
Class 2 pulmonary HTN causes?
Mitral stenosis - Aortic stenosis -Left ventricular hypertrophy - Left heart failure
Class 1 pulmonary HTN causes?
Ventricular septal defect -Atrial septal defect -Patent ductus arteriosus
Patients with Virchows triad have an increased risk for what pulmonary disorder?
Pulmonary embolism
Virchow triad?
Stasis - Hypercoagulable - Trauma
Right heart failure caused by long term COPD history?
Cor pulmonale
Is chronic bronchitis or emphysema associated with an elevated hemoglobin?
Chronic bronchitis
Pink Puffer?
Emphysema
Blue bloater?
Chronic bronchitis
Only medication that improves morbidity and mortality in COPD?
Oxygen
Agent of choice for COPD exacerbation?
Ipratropium
First line agent of choice for acute asthma attack?
Albuterol
What is the likely Dx? Solitary pulmonary nodule of 2 cm in size found on chest X-ray incidentally
Lung cancer
What is a bloody pleural effusion concerning for?
Malignancy
What criteria determine transudate from exudate?
Light’s criteria
What is the most common type of lung cancer in smokers?
Squamous cell
Most aggressive lung cancer?
Small cell
What is the most common type of lung cancer in non-smokers?
Adenocarcinoma
What does a positive whisper pectoriloquy represent?
Pulmonary consolidation
How many millimeters of induration is considered positive when reading a PPD result in an HIV positive patient?
> 5 mm
What is the most likely Dx? Smoker with hemoptysis weight loss and new DVT?
Lung cancer
A “cinnamon breath smell” is associated with what pulmonary infection?”
Tuberculosis
Red orange urine occurs with which tuberculosis medication?
Rifampin
Ethambutol side effect?
Optic neuritis
What is given to prevent neuropathy in a patient receiving isoniazid (INH) therapy?
B6 (pyridoxine)
Where will older pulmonary lesions from tuberculosis be found?
Lower lobes
Where will newer pulmonary lesions from tuberculosis be found?
Upper lobe cavitary lesion
What lab is elevated in PJP pneumonia?
LDH
What is the most likely Dx? Young IV drug user with fever severe hypoxia and diffuse infiltrates on X-ray?
PJP pneumonia
What pneumonia is associated with air conditioning vents and spas?
Legionella
Most common ventilator associated bacterial infection?
Pseudomonas
Bacterial pneumonia which occurs in a young patient after flu is most likely caused by what organism?
Staph aureus
Rusty sputum?
Strep pneumoniae pneumonia
What pneumonia associated with diarrhea and low sodium levels?
Legionella
Flu + aspirin in children can cause what condition?
Reye syndrome
Flu can be treated with oseltamivir within how many hours of onset of symptoms?
48 hours
Wet cough and foul smelling sputum in a child?
Bronchiectasis
First episode of wheezing in child?
Bronchiolitis
Chronic aspiration in kids leads to plate like atelectasis on X-ray and what condition?
Bronchiectasis
Salty baby?
Cystic fibrosis
Treatment for Berylliosis?
Chronic steroids
How high does pulmonary pressure need to be to diagnose pulmonary HTN?
25 mmHg at rest
What cancer is a patient with asbestos exposure at increased risk for.
Mesothelioma
What is the Dx? Patient worked with insulation. Chest X-ray shows thickened pleura and basilar lesions.
Asbestosis
What is the Dx? Pulmonary fibrosis in a patient who was a sandblaster. Chest X-ray shows egg shell calcifications.
Silicosis
What is the Dx? Chronic dry cough dyspnea fatigue and clubbing. Chest X-ray shows fibrosis and CT chest shows honeycombing.
Idiopathic pulmonary fibrosis
Does patient with sarcoidosis tend to have high or low serum calcium levels?
High (hypercalcemia)
What is the Dx? Chest X-ray shows bilateral hilar adenopathy and non caseating granulomas?
Sarcoidosis
Gold standard test used to diagnose Pulmonary HTN?
Right heart cardiac catheterization
Treatment for acute respiratory distress syndrome (ARDS)?
Supportive care/ventilatory support - Find and treat underlying cause
Right sided heart failure due to pulmonary HTN?
Cor Pulmonale
Initial Treatment for pulmonary embolism?
Heparin
What is the Dx? Young healthy female smoker on oral contraception with acute chest pain and SOB?
Pulmonary embolus
Initial treatment for all pneumothorax patients?
100% oxygen
What is the Dx? Thin young healthy male runner who develops acute onset of chest pain and dyspnea?
Spontaneous pneumothorax
What are the chest X-ray findings with acute respiratory distress syndrome (ARDS)?
Bilateral infiltrates/white out (may look like CHF)
What type of COPD is associated with hyperventilation flat diaphragm on CXR and a normal Hgb/HCT?
Emphysema
What are the two types of COPD?
Chronic bronchitis and emphysema
Most common cause of acute bronchitis?
Viral
Types of asthma classifications?
Intermittent - Mild persistent - Moderate persistent - Severe persistent
In a patients with asthma the FEV1 to FVC will be
FEV1 to FVC < 75% = diagnosis of asthma in pt with chronic wheezing/cough
In a patient with malignancy is the pleural effusion transudative or exudative?
Exudative
In a patient with CHF is the pleural effusion transudative or exudative?
Transudative
What conditions is a right sided pleural effusion often associated with?
CHF or cirrhosis
What is the main treatment for a pleural effusion?
Thoracentesis
Name 3 types of non small cell (bronchogenic) cancers.
Squamous cell - Adenocarcinoma - Large cell
What is a Hallmark sign seen with carcinoid tumors?
Cutaneous Flushing
Name the commonly used meds to treat active tuberculosis infection.
RIPE: Rifampin - isoniazid (INH) - Pyrazinamide - Ethambutol
Which vitamin should be given along with isoniazid (INH) therapy?
Vitamin B6 (pyridoxine)
What is the recommended treatment for a healthcare worker with a first time positive PPD?
Isoniazid (INH) for 6 months
What is the sputum test for tuberculosis?
AFB smear and cultures
What is the Dx? Recent international travel now with fever night sweats cough hemoptysis SOB and weight loss.
Tuberculosis
Treatment for PJC pneumonia?
Trimethoprim-sulfamethoxazole or pentamidine
Pneumonia seen in HIV patients with low CD4 counts?
PJC= Pneumocystis jiroveci (formerly called PCP)
Treatment for Histoplasma pneumonia?
Amphotericin B
Pneumonia associated with inhalation of bat or bird droppings?
Histoplasma
Treatment for immunocompromised patient with fungal pneumonia?
Itraconazole or fluconazole
Chest X-ray shows RUL abscess. Most likely organism?
Klebsiella (often associated with aspiration)
Pt with suspected pneumonia has “currant jelly colored” sputum. Most likely organism?
Klebsiella
What organism os associated with positive cold agglutinins?
Mycoplasma
What is the preferred treatment for atypical or “walking pneumonia”?
Macrolides
Name 2 antibiotics you can use to treat Legionella.
Macrolide or Fluoroquinolone
Chest X-ray shows lobar pneumonia. Most likely organism?
Strep pneumoniae
What medications are recommended for MRSA pneumonia?
Vancomycin or linezolid + levofloxacin or ciprofloxacin
Organism causing pneumonia spread by contaminated water?
Legionella pneumonia
Pneumonia often related to post intubation, ventilator or hospital?
Pseudomonas pneumonia
Pt with suspected pneumonia/URI has salmon/pink colored sputum. Most likely organism?
Staph aureus
Pt with suspected pneumonia/URI has rusty colored sputum. Most likely organism?
Strep pneumoniae
Which virus can lead to pneumonia after URI and also often causes diarrheal illness/GI symptoms?
Adenovirus
Virus causing pneumonia after exposure to rodent feces (Western states)?
Hanta Virus
Most common cause of viral pneumonia in adults?
Influenza
Name the organisms that cause typical pneumonia
Strep pneumoniae - Staph aureus - Group A Strep
Organisms responsible for atypical pneumonia?
Mycoplasma pneumoniae- Chlamydia pneumoniae- Legionella
Organism usually causing pneumonia after aspiration?
Klebsiella
Should normal percussion over the lung fields sound dull or resonant?
Resonant
What does positive egophony on auscultation in a patient with pneumonia mean?
When listening over the area of consolidation, patient will say “eee” and it sounds like “aaa”
What is the Dx? Previously healthy patient with abrupt onset of fever headache malaise occurring in the winter months.
Influenza
What condition is bronchiectasis often associated with?
Cystic fibrosis
Child with chronic persistent productive cough foul smelling sputum?
Bronchiectasis
Treatment for infant with Hyaline membrane disease (AKA: infant respiratory distress syndrome - IRDS)?
Respiratory support - Ventilatory support - Exogenous surfactant
Treatment to prevent Hyaline membrane disease in the newborn?
Give antenatal corticosteroids
What is the cause of hyaline membrane disease in infants?
Surfactant deficiency
What childhood vaccine protects children from pertussis?
DTaP
Preferred treatment for pertussis?
Clarithromycin or azithromycin
Organism that causes whooping cough?
Bordetella pertussis
Steeple sign on a frontal chest X-ray showing tracheal narrowing?
Croup
Virus that causes croup?
Parainfluenza virus type 1
Child has barking cough and stridor?
Croup
What is the Dx? Child presents with dysphagia, drooling and respiratory distress. Lateral neck X-ray shows “thumbprint sign”.
Acute Epiglottitis
How is RSV diagnosed?
Analysis/culture of Respiratory secretions
Most common cause of acute bronchiolitis in an infant?
Respiratory syncytial virus (RSV)
What dermatologic condition is associated with sarcoidosis?
Erythema nodosum
A 30 year old female presents with a dry cough. Her chest X-ray shows bilateral hilar adenopathy with non-caseating granulomas. What is your suspected diagnosis?
Sarcoidosis
How will idiopathic pulmonary fibrosis present on CT scan?
Diffuse patchy fibrosis with pleural-based honeycombing
Which of the pneumoconiosis have an increased risk of contracting tuberculosis?
Silicosis
What is the diagnosis if a patient presents with pulmonary fibrosis and an extensive history and workup does not reveal a cause?
Idiopathic pulmonary fibrosis
Which pneumoconiosis has an eggshell calcification look on chest x-ray?
Silicosis
`What pneumoconiosis presents like sarcoidosis and is due to a work environment in ceramics, nuclear power or as a tool maker?
Berylliosis
Where does mesothelioma appear in the lung?
It appears at the pleural base
What lung cancer is associated with asbestosis?
Mesothelioma
What is a normal blood pressure in the lungs?
15/5 mmHg - Compared to systemic arterial blood pressure of 120/80
What two classes of pulmonary hypertension are treated with warfarin?
Group 1 and group 4
What medication is the mainstay of long-term treatment for group 4 pulmonary hypertension or pulmonary embolus?
Warfarin
What is the recommended treatment for preventing pulmonary hypertension due to severe Mitral Stenosis?
Early surgical repair or replacement of the valve
A 42 year old female develops severe pulmonary hypertension due to an unrepaired ASD and subsequent right heart failure. What syndrome has she acquired?
Cor pulmonale - Since it is due to a congenital unrepaired ASD it is called Eisenmenger syndrome
Acute respiratory distress syndrome will have what x-ray findings?
Findings similar to congestive heart failure due to the leaky capillaries but the patient is not volume overloaded
A patient in a car accident presents with a tension pneumothorax. Which way will the trachea deviate?
Toward the good lung
What is the diagnostic test of choice to evaluate cor pulmonale?
Right heart catheterization
What is Cor Pulmonale?
Right heart failure due to severe pulmonary hypertension
What is the diagnostic modality of choice for suspected pulmonary embolus in a pregnant woman?
VQ scan
What treatment of choice do all sizes of pneumothorax have in common?
Oxygen
Tall thin males, patients with cystic fibrosis and emphysema patients all have what potential complication in common?
Spontaneous pneumothorax
What is the most common cause of acute respiratory distress syndrome?
Sepsis
Can salmeterol ,a long acting beta agonist, be used as solo therapy in a patient with asthma?
Never - At minimum, a short acting beta agonist is required is required as a rescue inhaler. LABAs may only be used in combination with inhaled corticosteroids
Deficiency in what enzyme can lead to early emphysema-like condition in young non-smokers?
Alpha-1 antitrypsin deficiency
Which of the COPD disease states will be found to have an elevated hematocrit on CBC, due to chronic hypoxic state
Chronic bronchitis
A child has daily asthma attacks and two to three night time attacks per week. What is the recommended addition to his albuterol inhaler therapy?
Inhaled corticosteroids
A patient presents to your office afebrile with a nonproductive cough for five days. What is the suspected disease process?
Bronchitis
In addition to steroids, albuterol plus ipratropium treatment and oxygen, what additional medication should be given to all acute COPD exacerbations?
Antibiotics
Which COPD is considered reversible?
Asthma is considered reversible
What are the three types of COPD?
Asthma - Chronic bronchitis - Emphysema
What is the only medicine that will improve mortality and morbidity of a COPD patient?
Oxygen
What is the preferred inhaled agent for emphysema?
Ipratropium bromide inhaler
What is the preferred inhaled agent for an acute asthma exacerbation?
Albuterol inhaler
Which of the lung cancers is nonsurgical and is only treated with chemotherapy?
Small cell carcinoma
When performing a lung exam, you have the patient whisper and the sound is heard clearly. What do you suspect?
Consolidation
A patient undergoes thoracentesis for a large right pleural effusion. The fluid is noted to be bloody. What is the suspected etiology?
Malignancy or pulmonary infarct
A 60 year smoker presents to your office with hemoptysis. On chest X-ray you see a large central solitary tumor. What type of lung cancer do you suspect?
Squamous cell carcinoma
What is the most common cause of a transudative pleural effusion?
Congestive heart failure
Which lung cancer is commonly found incidentally in non-smokers in the peripheral lung fields?
Adenocarcinoma
What are two types of lung cancer commonly associated with smoking?
Squamous cell carcinoma and small cell carcinoma
What type of cancer is suspected in a patient who has cutaneous flushing, diarrhea, wheezing and low blood pressure?
Carcinoid tumor with metastasis
You note an isolated 1 cm pulmonary nodule with a ground glass appearance on a chest X-ray. What do you suspect?
Lung cancer
What is considered a positive PPD result in patient with HIV?
5 mm or greater (Note: measure the wheal not the redness)
What vitamin supplement can help prevent peripheral neuropathy in a patient taking isoniazid?
Pyridoxine (Vitamin B6)
Which tuberculosis medication can cause red orange urine?
Rifampin
Which tuberculosis medication can cause optic neuritis?
Ethambutol
Which tuberculosis medication can lead to peripheral neuropathy?
Isoniazid (INH)
What is the recommended treatment for PJP if the patient is allergic to sulfa drugs?
Pentamidine
Which of the fungal pneumonias is most likely to lead to meningitis in an immunocompromised patient?
Cryptococcus
What medication is used to treat Histoplasma capsulatum pneumonia?
Amphotericin B
While living in the Mississippi River Valley, you treat a 15 year old boy with a cough. Chest X-ray reveals bilateral hilar adenopathy. What is the suspected etiology?
Histoplasma capsulatum
Hantavirus is acquired through what vector?
Dried rodent feces
What pneumonia is associated with positive cold agglutinins?
Mycoplasma pneumonia (aka walking pneumonia)
Aspiration pneumonia in alcoholics and nursing home patients is most commonly caused by what organism?
Klebsiella pneumonia
A patient in the ICU on a ventilator develops hypotension and rapidly goes into septic shock. What is the suspected etiology?
Pseudomonas aeruginosa
Which pneumonia is associated with diarrhea, very high fevers, and hyponatremia?
Legionella pneumonia
An 18 year old post flu returns to your office with fever and productive sputum. Chest x-ray demonstrates a large infiltrate. What is the suspected etiology?
Staphylococcus aureus
An outbreak of flu like symptoms associated with nausea and diarrhea occurs in a group of military recruits in boot camp. You suspect what etiology?
Adenovirus
What pneumonia is commonly associated with patients that are post splenectomy?
Streptococcus pneumonia
What is the most common cause of viral pneumonia?
Influenza
What x-ray findings are expected in a patient with cystic fibrosis?
Dilated thickened airways or plate like atelectasis
Bronchiectasis is commonly associated with what genetic disease?
Cystic fibrosis
A “steeple sign” seen on chest x-ray is associated with what condition?
Croup
A premature delivery of an infant before 30 weeks gestation is treated with corticosteroids and exogenous surfactant to prevent what complication?
Infant respiratory distress syndrome
A child presents to the hospital with pertussis and is placed on a macrolide antibiotic. What is the gold standard testing used to diagnose the pertussis?
Nasopharyngeal secretions remains the current
A school age child presents with a cough and is suspected of having croup. What is the etiology of the disease?
Parainfluenza virus
What is the most likely causative organism in a patient with epiglottitis?
Haemophilus influenza type B
A child in the ER is in acute respiratory distress, he is leaning forward and drooling. What is the expected finding on the lateral x-ray of the neck?
Thumb print sign
A 14 month old has a runny nose, fever and wheezing. She states she thought it was a cold but now the child is short of breath. What is the suspected etiology?
Respiratory Syncytial Virus (RSV)
