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Pulmonology And Special Topics > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

ABG-Atrial Blood Gas

A 
pH  7.35-7.45
PaCO2  35-45 mmHG
HCO3-  21-28 mEq/L
PaO2  80-100 mmHG
anion gap(Na+)-(CL-+HCO3-)=8-16 mEq/L
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2
Q

Acidosis

A

pH<7.35

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3
Q

Alkalosis

A

pH>7.45

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4
Q

Respiratory Acidosis

A

Decreased pH
increased PaCO2
Normal HCO3-

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5
Q

Respiratory Alkalosis

A

Increased pH
Decreased PaCO2
Normal HCO3-

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6
Q

Metabolic Acidosis

A

Decreased pH
Normal PaCO2
Decreased HCO3-

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7
Q

Metabolic Alkalosis

A

Increased pH
Normal PACO2
Increased HCO3-

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8
Q

Differential Diagnosis for Cough

A 
Asthma
COPD
Interstitial lung disease
Malignancy
Chronic pneumonia
Pleural effusion
GERD
Chronic allergic Rhinitis
Medication(ACEI-BB)
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9
Q

Differential Diagnosis for Dyspnea

A 
Flash pulmonary edema
PE
Anaphylaxis
Aspiration
Cardiac tamponade/effusion
COPD exacerbation vs chronic
Acute/chronic pneumonia
Respiratory muscle weakness 
Spontaneous/Tension Pneumonthorax
Metabolic Acidosis
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10
Q

Differential Diagnosis for Hypoxemia

A 
Asthma
COPD
CHF
PE
Pneumonia
Pneumothorax
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11
Q

Differential Diagnosis for Sputum Production

A 
Cardiogenic pulmonary edema
Acute Pneumonia
Bronchitis
Lung abscess
Bronchiectasis
Lung Cancer
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12
Q

Differential Diagnosis for Hemoptysis

A 
Bronchitis
Lung Cancer
Bronchiectasis
Cryptogenic
Pneumonia
Tuberculosis
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13
Q

Differential Diagnosis for Clubbing

A

Lung Cancer
Interstitial lung disease
Mesothelioma
Cystic fibrosis

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14
Q

Chest Xray Systematic approach

A 
A-Assess quality
B-Bones and soft tissue
C-Cardiac Silhouette 
D-Diaphragm 
E-Effusions
F-Fields and Fissures
G-Great vessels
H—Hilla and Mediastinum
I-Impression
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15
Q

Pleural Effusion

A

Fluid that accumulates between pleural layers(OUTSIDE lung tissue)

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16
Q

Pulmonary Infiltrate

A

Consolidation

Fluid or material fill the space within the lungs(INside the lungs)

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17
Q

Common Causes of pleural effusion

A

Lung cancer-Pneumonia-TB-Trauma-Drug RXN, abestosis, sarcoidosis

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18
Q

Common causes of pulmonary infiltrate

A

Pneumonia-pulmonary edema-cystic fibrosis-TB-trauma

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19
Q

IV contrast use for CT

A

Evaluate cancer in Liver, kidneys and brain

Better evaluate blood vessels, vascular soft tissues, organs and tumors

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20
Q

Iodine contrast dye adverse rxn

A

Vomiting, resp symptoms, pain, urticaria, burning, allergy

Ask about Hf of RXN, Iodine allergy, Diabetes, Vascular disease, RENAL DYSFUNCTION

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21
Q

VQ scan

A

Scan that uses radioactive material to examine airflow and blood flow-DIagnose PE especially for pregnant or before lobe resection in lung cancer

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22
Q

D-Dimer

A

HIgh sensitivity

Low Specificity

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23
Q

Pulmonary angiogram

A

Used to visualize large PE, aid in direct thrombosis, Identify sites of bleeding to place coils

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24
Q

Indications for pulmonary function tests

A

Pre-op veal
Evaluate sign/symptoms (cough, SOB, DOE, wheezing, hypoxemia, hypercapnea, crackles)
Abnormal CXR/CT
MOnitor-Occupational exposure-respirator use-pulmonary rehab
Screening at risk Pt

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25
Q

Obstructive lung disease causes

A 
Alph 1 anti trypsin deficiency
Asthma
Bronchiectasis
Bronchiolitis obliterans
COPD
Cystic fibrosis 
Early Silicosis
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26
Q

Restrictive Lung disease causes

A

CHest wall -ankylosing spondylitis
Kyphosis
Morbid obesity
Scoliosis
Drugs-Amiodarone, methotrexate, Nitrofurantin
Interstitial lung disease-asbestosis, berylliosis, eosinophilia pneumonia
Neuromuscular-ALS, Gillian Barre, Muscular dystrophy

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27
Q

Contraindications for PFT

A

Recent chest pain or MI
Recent or untreated pneumothorax
PE in last 3 month
Recent surgery-Eye, chest, lung

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28
Q

Pulmonary function test include

A

Spirometers, Lung volume determination(Body Plethysmography)Diffusion capacity
And frequently an ABG

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29
Q

Normal PFT values

A

Vary with age, sex, race and height

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30
Q

Tidal volume

A

Volume of air moved during a normal breath on quiet respiration

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31
Q

Inspirations reserve volume(IRV)

A

Maximum volume of air inhaled after normal inspiration

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32
Q

Expiratory reserve volume (ERV)

A

Maximum volume of air exhaled after normal exhalation

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33
Q

Residual volume(RV)

A

Volume of air left in lungs after maximal expiration(Calculated)

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34
Q

Functional residual capacity(FRC)

A

Volume of air in lungs at the end of a normal expiration

RV+ERV=FRC

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35
Q

Inspiratory capacity (IC)

A

Maximum volume of air that can be inhaled

TV + IRV= IC

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36
Q

Vital Capacity (VC)

A

Maximum volume of air traffic hat can be exhaled after maximal inspiration
IC+ERV=VC

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37
Q

Forced Vital Capacity(FVC)

A

Maximum volume of air that can forcibly exhaled after maximum inspiration
IC+ERV=FVC(forced)

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38
Q

Total Lung Capacity (TLC)

A

Volume of air in lungs after maximal inspiration
VC+RV=TLC
TV+IRV+ERV+RV=TLC

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39
Q

Forced Expiratory Volume in 1 second(FEV-1)

A

Amount of air forcefully exhaled in 1 second

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40
Q

FEV1/FVC ratio

A

FEV1 divided by FVC used to determine restrictive vs obstructive disease

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41
Q

Forced Expiratory Flow/Peak Flow(FEF)

A

Measure of how fast exhalation is

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42
Q

Pre and Post bronchodilator Spirometry

A

Evaluate for reversibility of obstructive disease(Asthma)

Considered reversible if FEV1 increase by 12 % or 200mL

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43
Q

Bronchoprovocation test

A

To determine if airway hyperreactivity is present-inducing an asthma attack(Methacholine challenge)

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44
Q

Normal FEV1/FVC

A

> 70%

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45
Q

Restrictive diseases-PFT findings

A

Reduced TLC, FRC ERV and RV

INcreased/Normal FEV1/FVC

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46
Q

Obstructive disease PFT findings

A

Increased TLC, ERV, RV

Reduced FEV1/FVC

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47
Q

Severity of Obstructive Lung disease

GOLD Criteria

A

Stage I-Mild-FEV1/FVC<70%, FEV1>80%
Stage II- Moderate- FEV1/FVC<70%, FEV1 50-80%
Stage III- Severe- FEV1/FVC <70%, FEV1 30-50%
Stage IV- Very Severe- FEV1/FVC <70%, FEV1 <30%

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48
Q

Decreased diffusion Capacity

A 
Obstructive(COPD, Cystic FIbrosis)
Parenchyma lung disease(sarcoidosis, asbestosis, interstitial lung disease)
Systemic Disease(Connective tissue disease, Scleroderma, rheumatoid arthritis, Lupus)
49
Q

Increased Diffusion Capacity

A

Exercise

Polycythemia

50
Q

Pulmonary rehab activities

A 
Social activity
Exercise
Nutritional support
Pharmacotherapy
Education on disease process
Smoking Cessation
Psychosocial support
Outcome assessment
51
Q

Pneumonia

A

Acute infection of the pulmonary parenchyma

52
Q

Types of pneumonia

A

Community acquired
Hospital/nosocomial/ventilator
Aspiration

53
Q

Virulence factors of pneumonia causing bacteria

A

Strep Pneumonia- produces pro teases that split IgA

Chlamydia Pneumonia- ciliostatic factor

54
Q

Viral pneumonia

A

Difficult to determine
RSV, parainfluenza, adenovirus
Flu Aand B- more likely to weaken lungs/immune system for secondary bacterial infection

55
Q

Fungal Pneumonia

A

Think immunocompromised
Histoplasmosis- Midwest-US travel Hx
Coccidioides app-AZ, CA,NM, TX
Cryptococcus-Found in soil

56
Q

Pneumonia S and Symptoms

A 
Cough +/- sputum
Fever
Dyspnea
\+/- Pleuritic chest pain
\+/- chills
\+/-rigor
\+/- hemoptysis
57
Q

Pneumonia Physical exam

A 
Febrile
RR>24
Tachycardia
Lung SOunds-Crackles
\+/- egophony 
\+/- tactile fremitis
58
Q

Pneumonia Diagnostic findings

A

CBC- Leukocytosis with a left shift
CXR-Lobar consolidation, interstitial infiltrates,+/-cavitation(based on pathogen) if non-diagnostic consider CT Chest
+/- blood cultures(hospitalized)
Sputum with gram stain and culture
Urinary antigen(ICU-testing legionella and Strep pneumoniae)
Procalcitonin-Distinguish between viral/bacterial

59
Q

Treating CAP outpatient/inpatient

A 
Severity(CURB65/PSI)
ABility to maintain oral intake
Compliance
Hx Substance abuse
Mental illness
Cognitive impairments
Living situation
Functional status
60
Q

Curb 65

A 
Point for
-Confusion
-BUN>20mg/dL
-RR>30
-BP<90/60
-Age>/=65
2 or more points hospitalization
61
Q

PSI(Pneumonia Severity Index)

A

More than 70 points =hospitalization

62
Q

Outpatient Treatment of CAP with otherwise healthy Pt

A

Macrolide(Azithromycin 500mg, then 4 days of 250mg daily)

Or Doxycycline

63
Q

Outpatient treatment of CAP with Pt with commorbidities

A

Commorbidities(Chronic Heart, lung, renal disease, DM, ETOH abuse, malignancy, asplenia or immunosupressed)
Respiratory Fluoroquinolone(Levofloxacin Oral/IV 750 mg qday for 5-7 days or afebrile for 48-72 hrs whichever is longer)
Or
Macrolide and a betalactam
(Azythromycin 500mg and 250mg q day x 4 days)
(Amoxicillin clavulanate ER 2 g q 12 hrs for min of 5 days

64
Q

Treatment of CAP inpatient nonICU

A 
Respiratory Fluoroquinolone(Levofloxacin 750 mg qday PO/IV min of 5 days)
Or Anti-pneumoncoccal beta lactate(Ceftriaxone)plus a macrolide(Azyrthomycin 500mg qday x 3 days PO/IV)
65
Q

CAP in hospital treatment with concern for MRSA

A

Add Vancomycin or Linezolid

66
Q

Pneumonia prevention

A

2 vaccines
Prevnar 13-for Pts>6weeks-can have injection site RXN,fever, decrease appetite, irritability, diarrhea, rash
Pneumovax 23-Age>2yrs, can cause-fever, myalgia, severe local and systemic RXN

67
Q

Who should get pneumonia vaccinations

A

> 65
19-64 with-smoker, Nursing home, heart dis, asthma, COPD, liver dis, DM alcoholic, immunocompromised, CSF leaks, Cochlear implants

68
Q

Bronchitis

A

Self limiting inflammation of bronchi-Cough>5days(1-3weeks)

69
Q

Bronchitis S and S

A

Cough>5days up to 3 weeks
+/-sputum
Virus
Rarely Bacterial

70
Q

Viral Causes of Bronchitis

A 
Flu A and B
Parainfluenza
Coronavirus(1-3)
Rhinovirus
RSV
Human metapneumovirus
71
Q

Rare Bacterial causes of Bronchitis

A

Mycoplasma pneumonia -kids cough 4-6 weeks
Chlamydia pneumonia-college students Pharyngitis, laryngitis, hoarse voice, low grade fevers
Bordetella pertussis(include if long term cough)-whooping cough, posttussive emesis

72
Q

Bronchitis exam and labs

A 
Normal exam
May have wheezes or honcho-clear with cough
CXR-normal
No egophony or vocal fremitus
CBC-normal WBC(may have slight elevation in Lymphocytes)
Rapid flu/PCR/culture
Pertussis PCR
Procalcitonin
73
Q

Bronchitis treatment

A 
Symptomatic 
-NSAIDs, ASA, APAP, Ipratropium
-Cough suppressants
-OTC decongestants/antihistamines/guaifenesin
AVOID ANTIBIOTICS
74
Q

Bronchiectasis

A

Inflamed, easily collapsible airway obstruction resulting in chronic daily cough with viscous sputum

75
Q

Bronchiectasis Epi/patho

A 
INcreased risk with increased age
Women>men
Cystic Fibrosis
Infectious insult
Impaired drainage, airway obstruction or defect in host defense
76
Q

Pathogen most likely to cause chest cavitation on a CXR

A

Pseudomonas aerguginosa

77
Q

Significant risk factor for Pseudomonas aeruginosa caused pneumonia

A

Hx of structural lung disease

78
Q

Significant risk factor for MRSA

A

Use of H-2 blocker

Also pneumonia after Recent completion of antibiotics think MRSA

79
Q

Bronchiectasis Etiology

A 
Foreign body aspiration/airway obstruction
Defective host defense
Cystic fibrosis
Rheumatic diseases
Dyskinesia cilia
Pulmonary infections
Smoking
80
Q

Bronchiectasis Clinical features

A 
A daily cough
Productive mucopurulent sputum
Lasts months to years
Dyspnea
Wheezing
Pleuritic chest pain
81
Q

Bronchiectasis physical exam

A

Crackles
Wheezing
+/- clubbing

82
Q

Bronchiectasis Diagnostic findings

A

Chest CT-Diagnostic study of choice
CXR-linear atelectasis with dilated thickened airways
CBC
Immunoglobulin quantitation
Swear chloride test/mutation analysis for CF
Sputum smear
PFT-Obstructive impairment, decreased or normal FVC, Low FEV1, Low FEV1/FVC

83
Q

Treatment of Bronchiectasis

A

Treat underlying cause(rare)
Acute exacerbation-Oral antibiotics(no sputum start Fluoroquinolone otherwise treatbased on culture) x 14 days
Hospitalize if RR>25, Hypotensive, Temp>38, Hypoxemia
Chronic-Mucolytic agents, airway clearance(chest physiotherapy), suppressive antibiotics, SUrgery(lung resection), Lung transplant

84
Q

Lung abscess

A

Necrosis of the pulmonary parenchyma caused by microbial infection(Necrotizing Pneumonia)

85
Q

Acute Lung Abscess

A

Less than1 month

86
Q

Chronic Lung abscess

A

Greater than 1 month

87
Q

Lung Abscess Primary Cause

A

ASpiration

88
Q

Lung abscess secondary cause

A

Neoplasm

Systemic Disease that compromises immune defenses(HIV, Organ transplant)

89
Q

Lung abscess Patho

A

Often anaerobic
ASpiration- typical source is gingiva(poor dentition)
Bacteria not cleared normally(substance abuse or anesthesia)
Pneumonia develops
Tissue necrosis starts 7-14days later

90
Q

Lung abscess bacteria

A 
Anaerobes
-Peptostreptoccus
-prevotella
-Bacteroides
-Fusobacterium
Nonanerobes
-Strep milleri
-Staph Aureus
-Klebsiella
-Gram neg bacilli
-Strep Pyogenes
-H influenza
-Legionella
-Pseudomonas aeruginosa(immunocompromised)
91
Q

Lung abscess clinical features

A 
Indolent over weeks to months
Fever
Cough+/- sputum
Putrid/sour tasting sputum
NIght sweats
WEight loss
Anemia
Hemoptysis
Pleurisy
92
Q

Lung ABscess clinical features

A

Chest X-ray-Infiltrate with cavity

Chest CT- determine location

93
Q

Lung abscess treatment

A

Anaerobic
Beta lactam-beta-lactamase inhibitor(Ampicillin-sulbactam 3 g IV q 6hrs
Carbapenem(Imipenem)
Typically 3 weeks or until CXR shows small stable residual lesion

94
Q

Pertussis aka Whooping cough eti/patho

A

INfants less than 12 months(can be fatal)
Gram negative coccobacillus-Bordetella pertussis
Transmitted by respiratory droplets
HUman reservoir
INcubation 1-3 weeks(10 days)
Adheres to ciliated epithelium then proliferates and disseminates, localized to epithelium only

95
Q

3 stages of pertussis

A

Catarrhal
Paroxysmal
Convalescent

96
Q

Catarrhal Phase

A

7-10 days
Indistinguishable from a viral URI
Gradually becomes more severe as it enters paroxysmal phase

97
Q

Paroxysmal Phase

A

1-6 weeks up to 10
Cough increases over 1-2 weeks, plateaus for 2-3 and gradually decreases
Paroxysmal cough(burst of numerous coughs with one inspiration)
Long inspiratory gap with High pitched Whoop
Posttussive emesis
Sputum +/- purple to

98
Q

Convalescent Phase

A

Paroxysms less common

Cough resolves over 2-3 weeks

99
Q

Atypical presentation of pertussis in young infants

A

Feeding difficulties
Apnea
Cyanosis

100
Q

Pertussis complications

A

Bacterial pneumonia MC in kids, MC cause of death

101
Q

Diagnostic tests for Pertussis

A

CBC w/diff-Leukocytosis with lymphocytosis(degree of lymphocytosis parallels severity) Lymphocytosis even though bacterial cause due to only infecting epithelium
CXR-may have subtle changes
Have high index of suspicion
Clinical case definition
Confirmatory tests(Culture, PCR, serology)

102
Q

CLinical case def of pertussis

A 
Cough illness >2 weeks
Plus one of
-Paroxysms of cough
-Inspiratory whoop
-posttussive emesis w/o other causes
103
Q

Pertussis bacterial culture

A

Gold standard-nasopharyngeal secretion swab x 10 sec

104
Q

Pertussis PCR

A

Vary results

Posterior nasopharyngeal swab

105
Q

Pertussis Serology

A

Anti bodies detected in 1-2 weeks of symptoms
Most reliable to compare acute to convalescent-not practical clinically
Better to test single time 2 weeks post onset for IgG, high tiger.2 years after vaccine supports infection

106
Q

Diagnosing Pertussis

A 
Clinical case def
Confirm with tests
<2 weeks:culture and PCR
>2 weeks: PCR and serology
>4 weeks:serology only
107
Q

Pertussis treatment

A

Best to treat during catarrhal phase up to 3 weeks of cough
-most contagious
-decreases severity
Treat if symptoms <3-4 weeks
INfants and pregnant treat <6 weeks
Health care workers treat <8 weeks
Macrolides(azythromycin 500 mgx1 then 250 mg qday x 4 days)
TMP-SMX(Bactrim)DS BID x 14 days(not for pregnant or nursing)

108
Q

Pertussis Pt education

A

Describe disease
Pharmacotherapy
Fluids, rest Isolation
Public health(prophylaxis and reportable)

109
Q

Pertussis prophylaxis

A

Close contacts
High risks of severe complications
Use full course of ABx
Watch for 21 days

110
Q

Pertussis isolation

A

No school or healthcare work for 5 days of treatment or 21 days of symptoms
Public health will determine

111
Q

Seasonal influenza transmission

A

Large droplets-coughing or talking
Shedding highest 1/2-1 day after exposure
INcubation 1-4 days

112
Q

Influenza CLinical presentation

A

Systemic-Fever myalgias, headache, malaise
Upper resp-Sore throat, nose congestion
Lower resp-Cough
Will have both upper and lower resp tracts involved
Physical exam-Hyperemia, +/-cervical adenopathy
Abrupt onset of systemic and resp symptoms
Gradual improvement over 2-5 days to a week

113
Q

Influenza complications

A

MC- Pneumonia-(Primary viral pneumonia, more severe persistence high Fever and other s and s)(Secondary-bacterial pneumonia MC, Strep and then staph)

114
Q

INfluenza Clinical def

A

Influenza like illness(ILI)
-Affects both upper and lower resp tracts
-Signs of systemic illness(fever>100, headache, myalgia, weakness)
-Not attributed to other causes
Confirmation needed for high risk Pt

115
Q

Influenza confirmation

A

Needed for High risk Pt and severe case/complications

116
Q

Diagnostic testing for Influenza

A

Rapid antigen testing(In clinic)
Reverse transcriptase PCR(send out)
VIral culture(not useful in clinic)

117
Q

Influenza treatment

A

Neuraminidase inhibitors
-Oseltamivir-tamiflu 75 mg BID x 5 days-
-Side effects- N/V/D
Shortens duration of influenza symptoms 1-3 days if given with in 24-36 hrs

118
Q

Influenza prophylaxis treatment

A

Oseltamivir 75 mg x7 days for high risk Pts who have been vaccinated
X 14 days for high risk Pt who have not been vaccinated prior

Pulmonology And Special Topics (3 decks)

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