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EOR Family Medicine > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

Most common cause of cancer death in the world

A

Lung carcinoma

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2
Q

90% of lung cancer cases are associated with

A

Smoking

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3
Q

25% of lung cancer is ___________, and 75% is ___________

A

Small-cell

Non small-cell

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4
Q

Most common type of non-small cell lung cancer, and second most common

A

Adenocarcinoma

Squamous cell carcinoma

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5
Q

Screening for lung cancer

A
  1. > 55 y/o
  2. 30 pack year smoker
  3. Must have smoked in last 15 years
    Screen annually w/ low dose chest CT
    Stop screening at 80 or if stopped smoking in 15 years
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6
Q

Signs/Symptoms of lung cancer

A

Persistent cough
Hemoptysis
Weight loss

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7
Q

Diagnosis of lung cancer

A
  1. CXR
  2. Chest CT
  3. Biopsy
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8
Q

Very aggressive type of lung cancer, where majority will have metastasis at time of diagnosis

A

Small cell carcinoma

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9
Q

Small cell carcinoma is associated with what diseases?

A
  1. SIADH
  2. Cushing’s syndrome
  3. Lambert Eaton’s syndrome
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10
Q

Risk factor for sleep apnea

A

Obesity

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11
Q

Physical airway obstruction (may be due to external airway compression, decreased pharyngeal muscle tone, increased tonsillar size or deviated septum)

A

Obstructive Sleep Apnea

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12
Q

Snoring, unrestful sleep, nocturnal choking, large neck circumference, crowded oropharynx

A

Obstructive Sleep Apnea

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13
Q

Diagnosis of sleep apnea

A

In laboratory polysomnography

Labs: polycythemia

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14
Q

Management of sleep apnea

A

CPAP is mainstay
Behavioral - weight loss, exercise, abstaining from alcohol
Oral appliances can be tried
Surgical correction

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15
Q

Complications of sleep apnea

A

Pulmonary hypertension

Arrhythmias

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16
Q

Reverse hyperirritability of the tracheobronchial tree, leading to airway inflammation and bronchoconstriction

A

Asthma

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17
Q

Most common chronic childhood disease

A

Asthma

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18
Q

Samter’s Triad

A
  1. Asthma
  2. Nasal polyps
  3. ASA/NSAID allergy
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19
Q

Classic triad of symptoms of asthma

A
  1. Dyspnea
  2. Wheezing
  3. Cough (esp at night)
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20
Q

Clues to severity of asthma

A

Steroid use
Previous intubations
ICU/hospital admissions

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21
Q

Prolonged expiration with wheezing, hyperresonance to percussion, decreased breath sounds, tachycardia

A

Asthma

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22
Q

Gold standard testing for asthma

A

Pulmonary Function Test showing reversible obstruction

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23
Q

Diagnosis for asthma

A
  1. PFTs
  2. Bronchoprovocation - bronchodilator challenge test (> 12% increase in FEV1)
  3. Peak Expiratory Flow Rate
  4. Pulse Oximetry
  5. ABG - hypoxia and hypercapnia
  6. CXR
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24
Q

S/E of short acting beta agonists (SABA)

A 
Tachycardia
Arrhythmias
Muscle tremors
CNS stimulation
Hypokalemia
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25
S/E of ipratropium (anticholinergic)
``` Thirst Blurred vision Dry mouth Urinary retention Dysphagia Acute glaucoma BPH ```
26
S/E of inhaled corticosteroids - beclomethasone, flunisolide, triamcinolone
thrush - using spacer and rinsing mouth after inhaler decreases risk
27
Adjuncts for asthma management
IV Magnesium - bronchodilator | Omalizumab - used in severe, uncontrolled asthma
28
Inflammation of trachea/bronchi (conducting airways). Often follows URI
Bronchitis
29
Bronchitis is mostly caused by:
Viruses Adenovirus Parainfluenza, influenza, etc.
30
Cough is hallmark, +/- productive, may last 1-3 weeks, symptoms similar to pneumonia sometimes
Bronchitis
31
Diagnosis of Bronchitis
1. Clinical w/o need for imaging | 2. Order CXR if pneumonia is suspected
32
Management of bronchitis
Symptomatic tx of choice - fluids, rest, antitussives, bronchodilators Abx not needed
33
Progressive, largely irreversible airflow obstruction due to loss of elastic recoil and increased airway resistance
Chronic obstructive pulmonary disease
34
Chronic bronchitis is usually ________, while emphysema usually has a __________
Episodic | Steady decline
35
Risk factors for COPD
Cigarette/smoking exposure (MC) | Alpha-1 antitrypsin deficiency
36
Abnormal, permanent enlargement of the terminal airspaces, leading to air trapping
Emphysema
37
Productive cough > 3 months x 2 consecutive years
Chronic bronchitis
38
Most common symptom of emphysema
Dyspnea
39
Hyperinflation on physical exam, hyperresonance to percussion, decreased/absent breath sounds, decreased fremitus, barrel chest. Pursed lip breathing
Emphysema
40
Appearance: cachectic, pursed lip breathing, pink puffers
Emphysema
41
Rales (crackles), rhonchi, wheezing on physical exam , with change in location with cough
Chronic bronchitis
42
Appearance: obese and cyanotic, blue bloaters
Chronic bronchitis
43
Diagnostic studies of COPD
1. PFT/spirometry - gold standard 2. CXR/CT scan 3. ECG - cor pulmonale
44
Most important step in management of COPD
Smoking cessation
45
Microaspiration of oropharyngeal secretions is most common route of nifection
Pneumonia
46
Most common cause of CAP
Streptococcus pneumoniae
47
2nd most common cause of CAP
Haemophilus influenzae
48
Most common cause of atypical (walking) pneumonia
Mycoplasma pneumoniae
49
Additional symptoms with atypical walking pneumonia caused by mycoplasma
Pharyngitis, ear (bullous myringitis), URI symptoms
50
Additional symptoms with legionella pneumonia
GI symptoms: anorexia, N/V/D | Increased LFTs, hyponatremia
51
Most common cause of pneumonia in severe EtOHics
Klebsiella pneumoniae
52
Most common viral cause of pneumonia in infants/small children
RSV and parainfluenza
53
Most common viral cause of pneumonia in adults
Influenza
54
Most common cause of pneumonia in the mississippi and ohio river valley - soil contaminated with bird/bat droppings
Histoplasma cpsulatum
55
When to hospitalize with pneumonia
1. Multilobar 2. Neutropenia 3. Patients have comorbidities that may complicate treatment
56
Sudden onset of fever, productive cough with purulent sputum, pleuritic chest pain, tachycardia, tachypnea
Pneumonia
57
Bronchial breath sounds, dullness on percussion, increased tactile fremitus, egophony, inspiratory rales (crackles) on physical exam
Pneumonia
58
Low grade fever, dry, nonproductive cough, extrapulmonary sx: myalgias, malaise, sore throat, HA, N/V/D
Atypical pneumonia
59
CXR with atypical pneumonia
diffuse, patchy interstitial or reticulonodular infiltrates
60
Diagnosis of pneumonia
1. CXR/CT scan | 2. Sputum (gram stain/culture)
61
Currant jelly sputum
Klebsiella
62
Green sputum
H. flu, pseudomonas
63
Rusty (blood tinged) sputum
Strep pneumoniae
64
Management of CAP outpatient pneumonia
Macrolide or Doxycycline | Fluoroquinolones only if comorbid conditions or recent abx use
65
Management of CAP inpatient pneumonia
Beta lactam + macrolide or broad spectrum fluoroquinolone
66
Management of hospital acquired pneumonia
B lactam + aminoglycoside or fluoroquinolone
67
Management of aspiration pneumonia
Clindamycin or Metronidazole or Augmentin
68
Chronic infection with Mycobacterium leading to granuloma formation
Tuberculosis
69
Chronic productive cough, chest pain, hemoptysis, night sweats, fever/chills, anorexia, weight loss
Tuberculosis
70
TB Screening for infection
PPD (purified protein derivative) | examine 48-72 hours for transverse induration (redness not considered positive)
71
For someone with no known risk factors, a positive PPD test is considered if:
> 15 mm
72
Diagnosis of tuberculosis
1. Acid-Fast Smear and Sputum culture x 3 days AFB cultures gold standard 2. CXR 3. Interferon Gamma Release Assay
73
Treatment of active TB infection
RIPE - Rifampin + INH + Pyrazinamide + Ethambutol
74
How long is the total treatment duration for active TB infection?
6 months
75
S/E of rifampin
Orange colored secretions (tears, urine)
76
Treatment of latent TB
INH + Pyridoxine x 9 months

EOR Family Medicine (14 decks)

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