Pulmonology Flashcards
What is the difference between carotid body and carotid sinus?
Carotid Body: Chemoreceptor
Carotid Sinus: Baroreceptor
What is the color of air on X-ray?
Black “radiolucent”
What is the color of fluid or a solid on X-ray?
White “radiopaque”
What disease has a steeple sign on neck films?
Croup (or Laryngotracheobronchitis)
What disease has a Thumb Sign on neck films?
Epiglottitis
What is a “Blue Bloater”?
Chronic Bronchitis
What is a “Pink Puffer”?
Emphysema
What are the pulmonary infiltrates with eosinophilia (PIE) syndromes?
Churg-Straus, Loeffler’s, allergic Bronchopulmonary Aspergillosis
What drugs cause Pulmonary Eosinophilia?
Nitrofurantoin and Sulfonamides
What are the risk factors for Lung CA?
Smoking, Radon, second hand smoke, pneumoconiosis (except Anthracosis)
What diseases have Hemoptysis?
Bronchiectasis, Bronchitis, Pneumonia, TB, Lung CA, Goodpasture’s, Wegener’s
Where is a Bochdalek Hernia?
Occur more commonly on the posterior left side (diaphragm), most common congenital Diaphragmatic Hernia (CDH)
Where is a Morgagni Hernia?
Anterior/middle of diaphragm, bowel sounds in thorax, seen on US in utero
surgery to fix immediately after birth
What diseases have Respiratory Alkalosis?
Restrictive Lung disease Anxiety Pregnancy Gram neg sepsis PE
What diseases have respiratory acidosis?
Obstructive lung diseases
What diseases have metabolic alkalosis?
Low volume state: vomiting, diuretics, GI blood loss
What diseases have metabolic acidosis?
“MUDPILES” and diarrhea
What does auscultation of stridor tell you?
Extrathoracic narrowing (seen on inspiration on X-Ray)
What does auscaltation of wheezing tell you?
Intrathoracic narrowing (seen on expiration on x-ray)
What does auscultation of rhonchi tell you?
Mucus in the airway (obstructive airway disease)
What does auscultation of crackles tell you?
Blowing collapsed alveoli open (restrictive lung disease)
What does dullness to percussion tell you?
Something between the airspace and chest wall absorbing sound, can be solid or fluid
What does hyperresonance tell you?
Air in that region of the lungs`
What does Tracheal deviation tell you?
Moves away from tension
Pneumothorax moves towards Atelectasis
What does Fremitus, Egophony and Bronchophony tell you?
Consolidation (pathognomonic for pneumonia)
What is Restrictive Lung disease?
small still lungs, can’t get air in
What is obstructive lung disease?
Mucus filled lungs, cannot get air out
What is epiglottitis?
inflammation of the epiglottis
thumb sign on x-ray
excessive drooling
What is Croup?
Respiratory condition that is usually triggered by an acute viral infection of the upper airway, steeple sign on x-ray, barking cough
What is Tracheitis?
“Acute URI”
Patients look toxic
Grey Pseudomembrane
Leukocytosis
What is asthma?
Chronic inflammatory disease of the airways
characterized by variable and recurring symptoms, wheezing on expiration, elevated IgE and Eosinophils
What is Bronchiolitis?
Athma in kids less than 2 years old
What is sinusitis?
Inflammation of the paranasal sinuses, tooth pain worsens upon bending forward
What is Bronchiectasis?
Bad breath, purulent sputum, and hemoptysis
What is Bronchitis?
Increased sputum production “Blue Bloater”
What is Emphysema?
Obstructive disease
Alpha-1-antitrypsin deficiency
What is Laryngomalacia?
Epiglottis rolls in from side to side
What is Pneumonia?
Consolidation of airway
What is Pneumothorax?
Absent breath sounds on one side
How do you detect a Pulmonary Embolus?
Tachypnea
increased V/Q scan
ECG may show signs of right heart strain or acute cor pulmonale in cases of Large Pes - large S wave in lead I, a large Q wave in lead III and an inverted T wave in lead III
S1Q3T3
What is a Tamponade?
Decreased breathe sounds and blood pressure,
distant muffled heart sounds
icnreased JVD
What is Tracheomalacia?
Soft cartilage and stridor since birth
What is Cystic Fibrosis?
Defective chloride transporter meconium ileus steatorrhea Bronchiectasis Chromosome 7
What is aspergillosis?
Mold, compost piles, associated with peanuts
What is Asbestosis?
Shipyard workers, pipe fitters, brake mechanics, insulation installers
What is Silicosis?
Sandblasters and glassblowers
What is Byssinosis?
Cotton workers, textile workers
What is Berylliosis?
Radio, TV repair, aerospace manufacturing, Beryllium mining, or manufacturing of fluorescent light bulbs
What is Anthracosis?
Coal workers, extensive fibrosis
What is Sarcoidosis?
Non-caseating granulomas, eggshell calcification around lymph nodes
What is Carcinoid syndrome?
Flushing, wheezing, diarrhea
What is Small Cell Cancer?
Located at the Carina, Malignant, Cushing’s syndrome, SIADH, and SVC syndrome
What is squamous cell CA?
Seen in smokers, high PTH and Ca2+
What is Bronchoalveolar CA?
Looks like pneumonia
due to pneumoconiosis, nonsmoker
Clues for Typical pneumonia?
Typical pneumonia: short illness, high fever, usually >40 y/o, X-ray: one lobe, Streptococcus Pneumonia
Clues for atypical pneumonia?
Atypical pneumonia: prolonged illness, low fever, usually >40 y/o
X-ray: diffuse, H. Influenza, Mycoplasma, Chlamydia
FEV1/FVC in Obstructive lung disease
Lower than normal (N: 0.75-0.80)
FEV1/FVC in Restrictive lung disease
Normal or elevated
What is the MOA of Isoproterenol?
Non-specific, Beta-agonists;
relates bronchial smooth muscle (B2)
What is the indication for Isoproterenol?
Bronchoconstriction due to sympathetic tone
What are the adverse effects of Isoproterenol?
Tachycardia (B1)
What is the MOA of albuterol?
B2 agonist; relaxes bronchial smooth muscle
What is the indication for Albuterol?
Acute exacerbation
What is the MOA of Salmeterol?
B2 agonist; relaxes bronchial smooth muscle
What is the indication for Salmeterol?
Long acting agent for prophylaxis
What are the adverse effects of Salmeterol?
Tremor and arrhythmia
What is the MOA of Methylxanthines?
Inhibit Phosphodiesterase -> decreases cAMP hydrolysis promoting bronchodilation
What is the indication for Methylxanthines?
Asthma
What are the adverse effects of methylxanthines?
Cardiotoxicity, Neurotoxicity
What are the methylxanthines?
Theophylline
What is the MOA of a muscarinic antagonist?
competitively block muscarinic receptors preventing bronchoconstriction
What is the indication for muscarinic antagonist?
Asthma, COPD
What is the muscarinic antagonist drug used for asthma?
Ipratropium
What is the MOA of cromolyn?
Prevents release of mediators from mast cells
What are the inidcations for Cromolyn?
Asthma prophylaxis
What is the MOA of coricosteroids?
Inhibits leukotriene synthesis -> reduces inflammation and leads to bronchodilation
What are the indications for corticosteroids?
Chronic asthma, COPD
What are the adverse effects of corticosteroids?
Osteoporosis, Cushingoid reaction, psychosis, glucose intolerance, infection, HTN, cataracts
What are the corticosteroid drugs?
Beclomethasone, Prednisone
What is the MOA of Antileukotriene?
5-lipoxygenase inhibitor -> inhibits conversion of arachidonic acid to leukotriene -> prevents bronchoconstriction and inflammatory cell infiltrate
What are the indications for antileukotriene?
Asthma, aspirin induced asthma
What are the antileukotriene drugs?
Zileuton, Zafirlukast, montelukast:
aspirin
induced asthma
What is the MOA of H1 Blockers?
Reversible inhibitors of H1 histamine receptors
What is the 1st generation H1 Blockers?
Diphenhydramine, Dimenhydrinate, Chlorpheniramine
What are the indications for 1st generation H1 blockers?
Allergy, motion sickness, sleep aid
What are the adverse effects of 1st generation H1 blockers?
Sedation, antimuscarinic, anti-alpha-adrenergic
What are the 2nd generation H1 Blockers?
Loratadine, fexofenadine, Desloratadine, Cetirizine
What are the indications for 2nd generation H1 Blockers?
Allergies
What are the effects of 2nd generation H1 Blockers?
Far less sedating than the 1st generation because of decreased entry into the CNS
What are the expectorants?
Guaifenesin, N-acetylcysteine
What is the MOA of Guaifenesin?
Removes excess sputum but does not suppress cough reflex
What are the indications for Guaifenesin?
Minor upper respiratory tract infections, common cold w/ cough
What is the MOA of N-acetylcysteine?
loosen mucus plugs by breaking disulfide bonds
What are the indications for N-acetylcysteine?
CF patients and antidote for Acetaminophen overdose
What is the MOA of Bosentan?
Competitively antagonizes endothelium-1 receptors decreasing pulmonary vascular resistance
What are the indications for Bosentan?
Pulmonary HTN
What is the MOA of Dextromethorphan?
Antitussive (antagonizes NMDA glutamate receptors)
What are the adverse effects of Dextromethorphan?
Mild opioid effect so mild abuse potential
What is the MOA of Pseudoephedrine, phenylephrine?
Sympathomimetic alpha-agonists
non-prescription nasal decongestants
What are the indications for Pseudoephedrine, Phenylephrine?
Reduces Hyperemesis, edema, nasal congestion, and opens obstructed Eustachian tubes
What are the adverse effects of Pseudoephedrine, phenylephrine?
HTN, CNS stimulation/ anxiety
What is the MOA of Methacholine?
Muscarinic receptor agonist
What are the indications for Methacholine?
Asthma challenge test