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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
Q

S/E of ipratropium (anticholinergic)

A 
Thirst
Blurred vision
Dry mouth
Urinary retention
Dysphagia
Acute glaucoma
BPH
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26
Q

S/E of inhaled corticosteroids - beclomethasone, flunisolide, triamcinolone

A

thrush - using spacer and rinsing mouth after inhaler decreases risk

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27
Q

Adjuncts for asthma management

A

IV Magnesium - bronchodilator

Omalizumab - used in severe, uncontrolled asthma

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28
Q

Inflammation of trachea/bronchi (conducting airways). Often follows URI

A

Bronchitis

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29
Q

Bronchitis is mostly caused by:

A

Viruses
Adenovirus
Parainfluenza, influenza, etc.

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30
Q

Cough is hallmark, +/- productive, may last 1-3 weeks, symptoms similar to pneumonia sometimes

A

Bronchitis

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31
Q

Diagnosis of Bronchitis

A
  1. Clinical w/o need for imaging

2. Order CXR if pneumonia is suspected

32
Q

Management of bronchitis

A

Symptomatic tx of choice - fluids, rest, antitussives, bronchodilators
Abx not needed

33
Q

Progressive, largely irreversible airflow obstruction due to loss of elastic recoil and increased airway resistance

A

Chronic obstructive pulmonary disease

34
Q

Chronic bronchitis is usually ________, while emphysema usually has a __________

A

Episodic

Steady decline

35
Q

Risk factors for COPD

A

Cigarette/smoking exposure (MC)

Alpha-1 antitrypsin deficiency

36
Q

Abnormal, permanent enlargement of the terminal airspaces, leading to air trapping

37
Q

Productive cough > 3 months x 2 consecutive years

A

Chronic bronchitis

38
Q

Most common symptom of emphysema

39
Q

Hyperinflation on physical exam, hyperresonance to percussion, decreased/absent breath sounds, decreased fremitus, barrel chest. Pursed lip breathing

40
Q

Appearance: cachectic, pursed lip breathing, pink puffers

41
Q

Rales (crackles), rhonchi, wheezing on physical exam , with change in location with cough

A

Chronic bronchitis

42
Q

Appearance: obese and cyanotic, blue bloaters

A

Chronic bronchitis

43
Q

Diagnostic studies of COPD

A
  1. PFT/spirometry - gold standard
  2. CXR/CT scan
  3. ECG - cor pulmonale
44
Q

Most important step in management of COPD

A

Smoking cessation

45
Q

Microaspiration of oropharyngeal secretions is most common route of nifection

46
Q

Most common cause of CAP

A

Streptococcus pneumoniae

47
Q

2nd most common cause of CAP

A

Haemophilus influenzae

48
Q

Most common cause of atypical (walking) pneumonia

A

Mycoplasma pneumoniae

49
Q

Additional symptoms with atypical walking pneumonia caused by mycoplasma

A

Pharyngitis, ear (bullous myringitis), URI symptoms

50
Q

Additional symptoms with legionella pneumonia

A

GI symptoms: anorexia, N/V/D

Increased LFTs, hyponatremia

51
Q

Most common cause of pneumonia in severe EtOHics

A

Klebsiella pneumoniae

52
Q

Most common viral cause of pneumonia in infants/small children

A

RSV and parainfluenza

53
Q

Most common viral cause of pneumonia in adults

54
Q

Most common cause of pneumonia in the mississippi and ohio river valley - soil contaminated with bird/bat droppings

A

Histoplasma cpsulatum

55
Q

When to hospitalize with pneumonia

A
  1. Multilobar
  2. Neutropenia
  3. Patients have comorbidities that may complicate treatment
56
Q

Sudden onset of fever, productive cough with purulent sputum, pleuritic chest pain, tachycardia, tachypnea

57
Q

Bronchial breath sounds, dullness on percussion, increased tactile fremitus, egophony, inspiratory rales (crackles) on physical exam

58
Q

Low grade fever, dry, nonproductive cough, extrapulmonary sx: myalgias, malaise, sore throat, HA, N/V/D

A

Atypical pneumonia

59
Q

CXR with atypical pneumonia

A

diffuse, patchy interstitial or reticulonodular infiltrates

60
Q

Diagnosis of pneumonia

A
  1. CXR/CT scan

2. Sputum (gram stain/culture)

61
Q

Currant jelly sputum

A

Klebsiella

62
Q

Green sputum

A

H. flu, pseudomonas

63
Q

Rusty (blood tinged) sputum

A

Strep pneumoniae

64
Q

Management of CAP outpatient pneumonia

A

Macrolide or Doxycycline

Fluoroquinolones only if comorbid conditions or recent abx use

65
Q

Management of CAP inpatient pneumonia

A

Beta lactam + macrolide or broad spectrum fluoroquinolone

66
Q

Management of hospital acquired pneumonia

A

B lactam + aminoglycoside or fluoroquinolone

67
Q

Management of aspiration pneumonia

A

Clindamycin or Metronidazole or Augmentin

68
Q

Chronic infection with Mycobacterium leading to granuloma formation

A

Tuberculosis

69
Q

Chronic productive cough, chest pain, hemoptysis, night sweats, fever/chills, anorexia, weight loss

A

Tuberculosis

70
Q

TB Screening for infection

A

PPD (purified protein derivative)

examine 48-72 hours for transverse induration (redness not considered positive)

71
Q

For someone with no known risk factors, a positive PPD test is considered if:

72
Q

Diagnosis of tuberculosis

A
  1. Acid-Fast Smear and Sputum culture x 3 days
    AFB cultures gold standard
  2. CXR
  3. Interferon Gamma Release Assay
73
Q

Treatment of active TB infection

A

RIPE - Rifampin + INH + Pyrazinamide + Ethambutol

74
Q

How long is the total treatment duration for active TB infection?

75
Q

S/E of rifampin

A

Orange colored secretions (tears, urine)

76
Q

Treatment of latent TB

A

INH + Pyridoxine x 9 months

EOR Family Medicine (14 decks)

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