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Emergency EOR > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

DDX for hemoptysis

A 
Bronchiectasis
Acute bronchitis
Lung carcinoma
Tuberculosis
PE
Foreign body aspiration
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2
Q

DDX for pleuritic chest pain

A 
Bronchiectasis
Costochondritis
Pleural effusion
Pneumothorax
Pulmonary embolism
Pneumonia
Tuberculosis
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3
Q

Acute bronchitis often follows

A

URI

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4
Q

Acute bronchitis is most commonly caused by

A

Viruses
Adenovirus
Parainfluenza, influenza, coxsackie, rhinovirus

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5
Q

Diagnosis of acute bronchitis

A

Usually clinical w/o need for imaging
If suspect pneumonia - order CXR
CXR will be normal or nonspecific

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6
Q

Management of acute bronchitis

A

Symptomatic - fluids, rest, +/- bronchodilators, +/- antitussives
Antibiotics no statistical benefit in healthy pts

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7
Q

Lower respiratory tract infection of the small airways leading to mucus plugging and peripheral airway narrowing and variable obstruction

A

RSV - Acute bronchiolitis

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8
Q

Most common cause of acute bronchiolitis

A

RSV - respiratory syncytial virus

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9
Q

Most common age group affected by RSV

A

< 6 mo (esp ~ 2 mo)

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10
Q

Risk factors for RSV

A

Cigarette exposure
Lack of breastfeeding
Premature
Crowded conditions

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11
Q

Complications of RSV

A

Otitis media - most common acute

Asthma - most common later in life

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12
Q

Fever, URI symptoms for 1-2 days followed by respiratory distress (wheezing, tachypnea, nasal flaring, cyanosis, retractions)

A

RSV - acute bronchiolitis

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13
Q

Diagnosis of RSV/acute bronchiolitis

A

CXR - hyperinflation, peribronchial cuffing
Nasal washings using monoclonal Ab testing
Pulse ox

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14
Q

Best predictor of disease in children with RSV

A

Pulse ox

< 96% - admit

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15
Q

Management of RSV

A

Supportive: O2 mainstay
Albuterol, racemic epi if albuterol not effective
Ribavirin if severe

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16
Q

Prevention of RSV

A

Palivizumab prophylaxis in high risk groups

Hand washing preventative!

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17
Q

Mortality from acute epiglottitis is usually secondary to

A

Asphyxiation

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18
Q

Most common cause of acute epiglottitis

A

Haemophilus influenza type B
Reduced incidence due to Hib vaccination
Strept pneumonia, S. aureus, GABHS

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19
Q

Epidemiology of acute epiglottitis

A

3 mo - 6 years

Males 2X more common

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20
Q

3 D’s: dysphagia, drooling, distress

A

Acute epiglottitis

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21
Q

Inspiratory stridor, dyspnea, hoarseness, tripoding

A

Acute epiglottitis

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22
Q

Suspect in pt with rapidly developing pharyngitis, muffled voice and odynophagia out of proportion to physical findings

A

Acute epiglottitis

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23
Q

Diagnosis of acute epiglottitis

A
  1. Laryngoscopy - definitive diagnosis - cherry red epiglottis with swelling
  2. Lateral cervical radiograph - thumb sign
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24
Q

Management of acute epiglottitis

A
  1. Airway management - dexamethasone, intubation if severe
  2. Abx - ceftriaxone or cefotaxime
  3. +/- add penicillin, ampicillin
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25
Q

Inflammation most commonly secondary to acute viral infxn of the upper airway leading to subglottic larynx/trachea swelling

A

Laryngotracheitis (croup)

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26
Q

Signs/symptoms of Laryngotracheitis (croup)

A
  1. Barking cough (seal-like, harsh)
  2. Stridor (both inspiratory and expiratory)
  3. Hoarseness
  4. Dyspnea (especially worse at night)
  5. +/- preceding URI sx
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27
Q

Diagnosis of laryngotracheitis (croup)

A
  1. Clinical

2. Frontal cervical radiograph - steeple sign

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28
Q

Steeple Sign

A

Laryngotracheitis (croup)

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29
Q

Management of mild croup (no stridor at rest, no respiratory distress)

A

Cool humidified air mist, hydration
Dexamethasone
Supplemental O2 if < 92%

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30
Q

Management of moderate croup (stridor at rest with mild-mod retractions)

A

Dexamethasone PO or IM
+/- nebulized epinephrine
Should be observed 3-4 hrs

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31
Q

Management of severe croup (stridor at rest with marked retractions)

A

Dexamethasone + nebulized epinephrine and hospitalization

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32
Q

Highly contagious infection secondary to bordetella bacteria

A

Pertussis (Whooping Cough)

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33
Q

Signs/Symptoms of pertussis (whooping cough)

A

Catarrhal Phase - URI
Paroxysmal Phase
Convalescent Phase

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34
Q

Inspiratory whooping sounds after coughing fits

A

Paroxysmal Phase of pertussis (whooping cough)

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35
Q

The convalescent phase of pertussis may last for up to

A

6 weeks

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36
Q

Diagnosis of pertussis (whooping cough)

A

PCR of nasopharyngeal swab - gold standard

Lymphocytosis - elevated lymphocytes and WBC

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37
Q

Management of pertussis (whooping cough)

A
  1. Supportive (oxygen, nebulizers)

2. Erythromycin, Azithromycin (Bactrim if PCN allergic)

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38
Q

Complications of pertussis (whooping cough)

A 
Pneumonia
Encephalopathy
Otitis media
Sinusitis
Seizures
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39
Q

Most common cause of CAP

A

Streptococcus pneumoniae

Haemophilus influenzae

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40
Q

Klebsiella pneumonia is seen in ________ and is associated with _________

A

Alcoholics

Cavitary lesions

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41
Q

Most common viral cause of pneumonia in infants/small children

A

RSV

Parainfluenza

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42
Q

Most common viral cause of pneumonia in adults

A

Influenza

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43
Q

Most common causes of hospital acquired pneumonia

A

Pseudomonas
E coli
Klebsiella
S. aureus (MRSA)

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44
Q

When to hospitalize for pneumonia

A
  • Multilobar
  • Neutropenia
  • Comorbidities
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45
Q

Still considered community acquired if pt develops pneumonia within ___________ of initial hospital admission

46
Q

Physical exam signs of pneumonia

A

Dullness on percussion
Egophony
Increased tactile fremitus
Inspiratory rales (crackles)

47
Q

Mycoplasma pneumonia (atypical) is associated with:

A

bullous myringitis

48
Q

Legionella pneumonia is associated with

A

GI symptoms

Increased LFTs

49
Q

Diagnosis of pneumonia

A
  1. CXR/CT

2. Sputum (Gram stain/culture)

50
Q

Rusty (blood-tinged) sputum in pneumonia

A

Step pneumoniae

51
Q

Currant jelly sputum in pneumonia

A

Klebsiella

52
Q

Management of CAP outpatient

A

Macrolide or Doxycycline

53
Q

Management of CAP inpatient

A

B lactam + macrolide or doxycycline

OR fluoroquinolone

54
Q

Management of HAP

A

B lactam + AG or FQ

55
Q

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

56
Q

Most common chronic childhood disease

57
Q

Samter’s Triad

A
  1. Asthma
  2. Nasal polyps
  3. ASA/NSAID allergy
58
Q

Classic triad of asthma

A
  1. Dyspnea
  2. Wheezing
  3. Coughing (esp at night)
59
Q

Prolonged expiration with wheezing, hyperresonance to percussion

60
Q

Diagnosis of asthma

A
  1. PFT - gold standard (reversible obstruction)
  2. Bronchoprovocation - methacholine challenge
  3. Peak Flow Rate - best for assessing severity
  4. Pulse Ox
  5. ABG
  6. CXR
61
Q

Admission criteria for asthma

A 
PEFR < 50% predicted
Er visit within 3 days of exacerbation
Status asthmaticus
Post treatment failure
AMS
62
Q

Adjuncts for asthma management

A

IV magnesium - indicated in severe asthma

Omalizumab - used in severe, uncontrolled asthma

63
Q

Abnormal accumulation of fluid in the pleural space (not a disease itself but a sign of a disease)

A

Pleural effusion

64
Q

Grossly purulent/turbulent effusion (direct infection of the pleural space)

65
Q

Circulatory system fluid in pleural effusion due to either increased hydrostatic and/or decreased oncotic pressure

A

Transudative fluid

66
Q

Most common causes of transudative pleural effusion

A

CHF
Nephrotic syndrome
Cirrhosis

67
Q

Occurs when local factors within the lungs themselves cause a pleural effusion by increasing vascular permeability

A

Exudative fluid

68
Q

Signs/symptoms of pleural effusion

A

Typically asymptomatic

If symptomatic: dyspnea, pleuritic chest pain, cough

69
Q

Physical exam with pleural effusion

A

Decreased breath sounds
Decreased tactile fremitus
Dullness to percussion
+/- pleural friction rub

70
Q

Diagnosis of pleural effusion

A
  1. CXR - PA/lateral, lateral decubitus best
  2. Thoracentesis - test of choice - send fluid for culture, chemistry, cell count, cytology
  3. CT scan - used to determine empyema
71
Q

Light’s Criteria:

A

Pleural Effusion

Presence of any criteria determines exudative fluid

72
Q

Management of pleural effusion

A
  1. Treat underlying condition
  2. Thoracentesis - gold standard
  3. Chest tube pleural fluid drainage (if empyema)
  4. Pleurodesis - if malignant effusions or chronic
73
Q

Accumulation of air in the pleural space

A

Pneumothorax

74
Q

Risk factors for spontaneous pneumothorax

A
  1. Family history
  2. Smoking
  3. Males
75
Q

Diagnosis of pneumothorax

76
Q

Treatment for spontaneous pneumothorax

A

Small - oxygenation and observation - repeat CXR after 6 hours
Large - pleural aspiration, chest tube
Unstable - chest tube

77
Q

Treatment for tension pneumothorax

A

Immediate needle decompression and chest tube

78
Q

Thrombus in the pulmonary artery or its branches - not a disease itself but a complication of a DVT

A

Pulmonary embolism

79
Q

Most people who die from PE die from:

A

Subsequent PEs (not initial one)

80
Q

Most common signs/symptoms of PE

A

Dyspnea, tachypnea

Pleuritic chest pain

81
Q

Most common predisposing condition for PE

A

Factor V Leiden

82
Q

Diagnosis for PE

A
  1. Helical CT scan - best initial test
  2. V/Q scan
  3. Pulmonary angiography - gold standard
  4. Doppler US - 70% of pts with PE will be positive for lower extremity DVT
83
Q

A normal CXR in the setting of hypoxia is highly suspicious for

A

Pulmonary embolism

84
Q

Westermark’s Sign

A

Pulmonary embolism on CXR

85
Q

Hampton’s Hump

A

Pulmonary embolism on CXR

86
Q

Most specific result for PE on EKG

87
Q

Simple lab test to r/o PE if low

88
Q

Management of Pulmonary embolism

A 
LMWH - low risk pts
Warfarin for at least 3 mo
May use dabigatran or apixaban instead
IVC filter if anticoag CI or failed
Thrombolysis of clot - streptokinase
Thrombectomy/Embolectomy - unstable/massive PE if thrombolysis ineffective
89
Q

Life threatening acute hypoxemic respiratory failure (organ failure from prolonged hypoxemia)

A

Acute respiratory distress syndrome

90
Q

Most common cause of ARDS

A

Sepsis
Severe trauma
Aspiration of gastric contents

91
Q

Signs/Symptoms of ARDS

A

acute dyspnea and hypoxemia

Multi-organ failure if severe

92
Q

Diagnosis of ARDS

A
  1. Severe refractory hypoxemia (HALLMARK)
  2. Bilateral pulmonary infiltrates on CXR
  3. Absence of cardiogenic pulmonary edema/CHF
93
Q

Pulmonary Capillary Wedge Pressure that is < _________ is indicative of ARDS as opposed to cardiogenic pulmonary edema

A

18 mmHg

If > 18 mmHg, points towards cardiogenic pulmonary edema

94
Q

Management of ARDS

A

Noninvasive or mechanical ventilation and treat underlying cause

95
Q

Diagnosis of foreign body aspiration

A
  1. Bronchoscopy - allows for removal

2. CXR

96
Q

Chronic infection leading to granuloma formation

A

Tuberculosis

97
Q

High risk populations for TB

A 
Healthcare workers
Homeless
Immigrants
Immunodeficiency
Incarcerated
98
Q

Diagnosis of tuberculosis

A
  1. Acid-Fast Smear and Sputum Culture x 3 days
  2. CXR
  3. Interferon Gamma Release Asay
99
Q

Treatment for Active TB infection

A 
RIPE
Rifampin
INH
Pyrazinamide
Ethambutol
100
Q

S/E of rifampin

A

Thrombocytopenia, orange colored secretions

101
Q

S/E of isoniazid

A

Hepatitis
Peripheral neuropathy
Drug-induced lupus

102
Q

S/E of pyrazinamide

A

Hepatitis
Hyperuricemia
Photosensitive dermatologic rash

103
Q

S/E of ethambutol

A

Optic neuritis, peripheral neuropathy

104
Q

Treatment of latent TB infection

A

INH + pyridoxine x 9 mo

105
Q

Most common cause of cancer death in the world

A

Lung cancer

106
Q

90% of lung cancer cases are associated with

A

Cigarette smoking

107
Q

Most common type of lung cancer

A

Non-small cell carcinoma (75%)

108
Q

Most common type of non-small cell carcinoma

A

Adenocarcinoma

109
Q

Screening for lung cancer

A

> 55 y/o
30 pack year smoker
Must have smoked in last 15 years
Screen annually until 80 or if person has not smoked in 15 years

110
Q

Diagnosis of lung cancer

A
  1. CXR
  2. Chest CT
  3. Biopsy
111
Q

Treatment for small cell carcinoma lung cancer

A

Chemo and radiation

Very poor prognosis

112
Q

Treatment for non-small cell carcinoma lung cancer

A

Surgical resection with or without chemo

If mass is resectable but pt has poor pulmonary fxn, not a candidate for surgery

Emergency EOR (12 decks)

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