Pulmonology Flashcards
What is the most common complaint in a patient with emphysema?
Shortness of breath
At what age should vaccinations for pneumonococcal pneumonia begin?
65 yo
Prolonged expiration (low FEV1) should make your think of what diagnosis?
Asthma or COPD
Hampton’s hum on CXR should make you think of what diagnosis?
Pulmonary embolism
How long after administering a PPD should it be read?
48-72 hours
A patient without a functioning spleen is more susceptible to what type of organism?
Encaspulated organisms - like Strep pneumonia and H flu
What is the most common cause of pneumonia in a child less than 1 year old?
RSV
What is the treatment for pneumocystis jiroveci pneumonia?
bactrim
What occupations are associated with berylliosis?
Aerospace and nuclear plant workers
Was CxR finding might make you think of berylliosis?
diffuse infiltrates with hilarious adenopathy
What it the gold standard for diagnosis of a pleural effusion?
thoracocentiesis
What performing a decompression for a tension pneumonia thorax, where do yo put the needle?
2nd intercostal space at the mid clavicular line
Oseltamirvir (Tamiflu) may be given to children above what age?
1 year
ZANAMIVIR (Relenza) may be given to children above what age?
7
An HIV patient has a ground glass appearance on his CXR - what should be your diagnosis?
Pneumocystits jiroveci ( used to be carinii)
A non-caveating granuloma found on a chest Xray should make you think of what disease?
Sarcoid
A pearl formation of the CXR should make you think of …
Squamous cell lung CA
Ghon of Ranke complexes should make you think of …
TB
A westermark sign on CXR should make you think of…
Pulmonary Embolism
Mesothelioma is most commonly found in what lung location?
80% are found in the pleural lining
What chest CXR should make you think of mesothelioma
Pleural thickening - remember 80% are found in the pleural lining
Hyperinflation as well as eosinophilia on a CBC should make you think of what diagnosis?
Asthma
What organism is the most common cause of pneumonia in a patient with cycstic fibriosis
Pseudomonas
A college student present with pneumonia. what 2 organisms should you be thinking of??
Chlamydia and mycoplasma
At what induration would a PPD be positive in an HIV patient?
5mm
‘you suspect a patient has a pneumothorax. What instructions should go along with the order for CXR?
It should ben and end expiratory view in order to look for visceral pleural air.
List the 3 most commonly used medical treatments which for COPD?
O2, ipratropium, and albuterol
List 4 medications which may cause asthm
BETABLOCKERS, NSAIDS, ACEI AND ASS
Nodular opacities in the uppeerlung fields should make you think of what diagnosis?
Silicosis
What is the initial treatment for TB?
INH + RIF + PZ + EMB x several months (until cultures are back) and they typically followed by INH + RIF once sensitivities come back
Caseating granulomas should make you think of what diagnosis?
TB
Blue bloater refers to the characteristic presentation with physical exam findings of what disease?
Chronic Bronchitis
A contralateral mediastinal shift should make you think of what diagnosis?
Tension pneumothorax
What is the best way to diagnosis bronchiectasis?
CT scan
What are the main sideffects of Isoniazid (INH)
Hepatitis a nd peripheral neuropathy
You are treating a patient for TB. He has noticed that his body fluids now have an orange tint. What is the drug that is most likely causing this?
Rifampin
Ethambutol has what 2 major side effects?
optic neuritis and red green vision loss
If you see a question that has anything to do with rats and the patient has pneumonia - what organism should you be thinking of?
Yersinia Pestis
What is the most common organism causing pneumonia in COPD patients?
Haemophilus influenza
Where is a pan coast tumor found on CXR?
at the apex of the wither the right of left lungs
Will evidence of TB be seen more frequently on the upper of lower lobes on CXR?
Upper
A patient has pneumonia with rust color sputum. What is the most likely diagnosis?
Strep pneumo
Coal miniers often show n ocular opacities in what lung fields?
upper
When you stop up the diagnosis from intermittent asthma to mild persistent asthma - what medication are you adding?
Inhaled steroid like fluticasone
Any question about rabbits and pneumonia shod make you think of what diagnosis?
Tularemia
Dullness to percussion should make you think of what diagnosis
Lobar pneumonia
A young child presents to the ED and you see him waiting in the “tripod” position. What is the most likely diagnosis?
Epiglotitis
What size induration would a PPD be positive for a healthcare worker?
10mm
List 6 extra pulmonary complications of lung cancer?
SPHERE - SVC syndrome, Pancoast tumor, Horner’s syndrome, Endocrine problems, Recurrent laryngeal symptoms, Effusions (exudative)
Currant jelly sputum should make you think of what diagnosis?
Klebsiella pneumonia
What happens to a total lung capacity in sarcoidosis?
It goes down
What will the likely findings be on CXR of a patient with asbestosis?
Linear opacities at the bases with pleural plaques
Tyomany to percussion should make you think of what diagnosis?
Large pneumothorax
What are the 3 most common cancers to metastasize to the lungs?
Breast liver and colon
A thumbprint sign on Xray should make you think of what 2 diagnosis’s?
Lateral C-spine + epiglottis
Abdominal + intestinal ischemia
A barrel chest should make you think of what diagnosis:
quietEmphysema
List 4 indications for the flu vaccineAre the lungs quiet or noisy in COPD?
Child 6-59 months
pregnant femlare;
healthcare worker
age greater than 50 yo.
Posttussive rales should make you think of what diagnosis?
TB
Bullae and blebs on CXR should make you think of what diagnosis?
Emphysema
Rhonchi or wheezes that clear after coughing suggest what diagnosis?
Bronchitis or atelectasis
Does FEV1 go up or down with asthma?
IT goes down
A very sick patient with diffuse infiltrates that spare the costophrenic angles should make you think of what diagnosis?
ARDS (acute respiratory distress syndrome
What is the most common cause of bronchiectasis
Cystic Fibrosis
What is the gold standard for the diagnosis of cystic fibrosis
Chloride sweat test
An exudative pleural effusion should make you think of what?
TB
Lung cancer
What is the first line antibiotic for epiglottis
3rd gen cephalosporin - Ceftriaxone
Transudative pleural effusions should make you think of what diagnosis?
CHF
What 2 lung cancers are typically found centrally on CXR
Small cell and squamous cell
What 2 lung cancers are typically found peripherally on CXR??
Adenocarcinoma and large cell
Pertussis is most commonly treated with what antibiotic?
Erythromycin
List the 4 most common places lung cancer will metastaze to?
Bone
brain
adrenals
liver
If you clomacross a question where the patient has erythema nodosum and an enlarged parotid gland - what is the most likely diagnosis?
Sarcoidosis
What is erythemal nodosum?
Tender red nodules usually found on the shins
A thin looking hear and flattened diaphragm on CXR should make you think of what diagnosis?
Emphysema
If you see a question with an alcoholic who has been diagnosied with pneumonia - what is the most likely organism?
Klebsiella
Honeycombing and tram tracks on the CXR should make you think of what diagnosis?
Bronchiectasis and idiopathic pulmonary fibrosis
Prasocial pulses may be found in what pulmonary disorder?
Asthma
A older patient present with pneumonia and diarrhea. What is the most likely diagnosis?
Legionella pneumonia
Eggshell opacities on the CXR should make you think of what diagnosis?
Silicosis
List 3 cause of decreased tactile fremitus
COPD, Asthma, Pleural effusion, pneumothorax
Hyperrsonance to percussion should make you think of what diagnosis?
Emphysema, pneumothorax, asthma
If you hear crackles in the lung fields list 3 pulmonary issues that should be in your differential
Pneumonia, fibrosis, CHF, Bronchitis
Does total lung capacity go u or down in COPD?
It goes up
List 3 things that should be in your differential when you hear wheezes on a lung exam
Asthma, COPD, Bronchitis
What is it called when a patient says “EEE” but on auscultation you hear “ayyy”
egophony
A physical exam ringing of egophony should make you think of what diagnosis?
Lobar pneumonia
A CXR shows vascular redistribution and blurred vascular outlines what is the most likely diagnosis>
CHF
What are the stages of Pertussis?
Catarrhal - coryza, snezzing
Paroxysmal - onset of cough
Convalescent - decreasing symptoms
What is an ominous sign for a child with a foreign body aspiration?
Aphonia - indicates a complete airway obstruction
Describe the physiology of Emphysema
Abnormal permanent enlargement of the air
What is the definitive study for a foreign body aspiration?
Bronchoscopy - as you can identify and retrieve.
If you were to see peripheral pruning of the large pulmonary arteries - you should immediately think of what diagnosis
Pulmonary hypertension as in Emphysema
Egg shell calcification of hilarious or mediastinal lymph nodes are characteristic of what disease state?
Silicosis
Which type of lunge cancer has the worst prognosis?
small cell
What is the antibiotic treatment of choice in an HIV patient with Legionella?
Azithromycin/Clarithromycin or a Fluoroquinolone such as Levaquin.
What is the gold standard for diagnosing DVT?
Contrast venography
What is the gold statndard for diagnosing a Pulmonary Embolism?
Pulmonary arteriogram
If a patient has a found smelling sputum - this should make you think of …
Bronchiectasis - which is likely found in Cystic fibrosis
What is the pathophysiology of bronchiectasis?
Permanent abnormal dilation and destruction of the bronchial walls
What is the physiologic make up of a transudate?
Found in CHF - a transudate has
Glucose>60
Protein <3 WBC ,1000
LDJH > 200
What is the physiologic make up of an EXUDATE?
found in cancer, etc Glucose <60 Protein >3 WBC<1000 LDH <200
What is the method of transmission of the influenza virus?
droplet particles
What is the method of transmission of RSV?
Fomite/ large particle spread
What medications could be given to a preterm infant after delivery with respiratory issues?
Methylxanthines
