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Family Medicine EOR > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

Pt with a hx of eczema and seasonal rhinitis is at risk of developing?

A

asthma

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2
Q

T/F Asthma is reversible?

A

true

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3
Q

What is the mechanism of asthma?

A

inflammed airway

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4
Q

How should asthma be monitored?

A

peak flow

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5
Q

If you admin a inhaler in asthma what should go up with improvement?

A

FEV1 - forced expiratory volume in 1 sec

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6
Q

What two drugs can precipitate a acute asthma attack?

A

NSAIDS and aspirin

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7
Q

What is seen on peak flow in asthma?

A

decreased FEV1 and reduced FEV1 to FVC

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8
Q

Gold standard for diagnosing asthma?

A

Peak expiratory flow rate

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9
Q

Intermittent asthma?

A

symptoms < 2days/week, <2month

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10
Q

Mild persistent asthma?

A

symptoms > 2 days/wk, 3-4xmo, short b agonist use 2wk

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11
Q

Moderate persistent asthma?

A

daily symptoms, 1wk night, daily albuterol use, limits in normal acitivty

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12
Q

Severe persistent?

A

symptoms throughout day, 7x night, albuterol several times a day, extremely limited activity

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13
Q

Txt for intermittent asthma?

A

short acting beta 2 agonist (SABA)

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14
Q

Txt for mild persistent asthma?

A

lose dose inhaled corticosteroid + SABA

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15
Q

Txt for moderate persistent asthma?

A

Low ICS, LABA daily

Medium dose ICS + LABA

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16
Q

Txt for severe persistent asthma?

A

High dose ICS + LABA

+ oral steroids

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17
Q

What is the acute txt for asthma?

A

oxygen, nebulized SABA, ipratropium bromide and oral corticosteriods

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18
Q

What is the atopic triad of asthma?

A

wheeze, eczema, seasonal rhinitis

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19
Q

One week history of cough productive of whitish sptum, that was preceded by a URI?

A

Acute bronchitis

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20
Q

What is acute bronchitis?

A

a cough that persists over > 5 days

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21
Q

What symptom should not be seen in acute bronchitis?

A

fever (think pneumonia)

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22
Q

95% of acute bronchitis is?

A

viral

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23
Q

What is the most common bacterial cause of acute bronchitis?

A

M. Catarrhalis

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24
Q

What is the treatment of acute bronchitis?

A

supportive (analgesics, B2-agonist, cough suppressants)

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25
Q

In whom are antibiotics indicated for in acute bronchitis?

A

elderly pts
underlying cardiopulmonary disease and cough for > 7-10 days
immunocompromised

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26
Q

bacterial acute bronchitis txt?

A

1st- 2nd gen cephalosporin, 2nd- 2nd gen macrolide or Bactrim

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27
Q

Blue bloaters

A

Chronic bronchitis

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28
Q

Increased interstitial marking, thickening of bronchial walls, diaphragms are not flattend

A

chronic bronchitis

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29
Q

Gold standard Dx of chronic bronchitis?

A

lung biopsy

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30
Q

What is the FEV1/FVC ratio in chronic bronchitis?

A

< 0.7

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31
Q

What is a classic physiologic feature of chronic bronchitis?

A

airflow limitation that is irreversible or only partially reversible

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32
Q

What is the most contributory factor of COPD?

A

Smoking

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33
Q

What classifies as chronic bronchitis?

A

productive cough producing phlegm occurring on most days for 3 mo for 2 yrs

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34
Q

What is the txt for acute exacerbation bronchitis?

A 
O2
beta agonist
anticholinergics
Inhaled/IV steroids
abx
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35
Q

What is the txt for chronic exacerbation bronchitis?

A 
smoking cessation
ambulatory o2
bronchodilator
steroids
vaccines
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36
Q

What is the pathophysiology of chronic bronchitis?

A

enlargement of mucous glands and goblet cell hypertrophy in large airways

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37
Q

In pts with COPD, which of the following has been shown to decrease rate of malignancy and cardiovascular disease and improve survival?

A

smoking cessation

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38
Q

What has been shown to prolong life in pts with COPD and alter the natural history of the disease?

A

Home oxygen

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39
Q

CXR shows parenchymal bullae or subplueral blebs?

A

emphysema

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40
Q

Independently associated with an increased risk for all cause mortality in pts with COPD?

A

Bronchiectasis

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41
Q

What is the most significant symptom of COPD?

A

Breathlessness

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42
Q

What is emphysema?

A

airway inflammation and loss of elasticity of the alveoli over time, secondary to destruction of the walls of the alveoli

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43
Q

What is a genetic cause of emphysema?

A

alpha-1 antitrypsin (ATT) deficiency

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44
Q

Empysema that predominately affect the upper lobes?

A

centrilobular emphysema

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45
Q

Empysema that causes changes in the lower lobes and commonly occurs with alpha-1 antitrypsin deficiency?

A

Panacinar emphysema

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46
Q

A young age person with elevated liver function tests or liver failure and worsening emphysema what do they have?

A

Alpha 1 antitrypsin deficiency emphysema

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47
Q

What’s the txt for alpha 1 antitrypsin deficiency?

A

alpha 1 antitrypsin protein

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48
Q

Diagnosis of COPD?

A

pulmonary function tests

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49
Q

In acute COPD exacerbation what ABG is seen?

A

acute respiratory acidosis (low pH and elevated pCO2)

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50
Q

Pink puffer

A

emphysema

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51
Q

Thin, barrel chest, hyperventilation, pursed lip breathing

A

emphysema

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52
Q

chronic productive cough, peripheral edema, overweight and cyanotic?

A

bronchitis

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53
Q

Parenchymal bullae and blebs, flattened diaphragm, decreased lung markings at apices, small thin appearing heart

A

emphysema

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54
Q

increased interstitial markings at bases, diaphragms are not flattened

A

bronchitis

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55
Q

Patho for emphysema?

A

alveolar enlargement and loss of septal wall integrity without any evidence of fibrosis

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56
Q

What is the worst type of lung cancer?

A

small cell

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57
Q

Lung cancer associated with smoking, aggressive, and has already metastasized?

A

small cell

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58
Q

What is lung cancer associated with?

A

paraneoplastic phenomena

59
Q

What is paraneoplastic phenomena?

A

ACTH secretion
SIADH
Lambert- Eaton syndrome

60
Q

Most common type of non-small cell lung cancer?

A

Adenocarcinoma

61
Q

Someone who develops lung cancer but has no smoking history

A

Adenocarcinoma

62
Q

What is the common paraneoplastic syndrome associated with squamous cell carcinoma?

A

hypercalcemia

63
Q

What is the primary treatment of squamous cell lung cancer?

A

surgery

64
Q

It primarily affects women and is the only lung malignancy not associated with tobacco use?

A

Bronchoalvelar cancer

65
Q

Triad of Horner Syndrome?

A

miosis (constricted pupil), ptosis, and anhidrosis

66
Q

Patient presents a a smoker w/ hemoptysis and an abnormal chest x ray showing a large central solitary tumor?

A

squamous cell carcinoma

67
Q

Treatment of non-small cell lung cancer?

A

surgery, chemo, rads

68
Q

Txt for small cell lung cancer?

A

CHEMO

69
Q

The most common cause of acute bronchiolitis?

A

Respiratory syncytial virus (RSV)

70
Q

Dx of bronchiolitis?

A

nasal washing for RSV culture and antigen assay

71
Q

What circumstances is Ribavirin admin for bronchiolitis?

A

infants born premature
O2< 95%
respiratory rate > 70
or atelectasis

72
Q

Txt for bronchiolitis?

A

supportive: oxygenation and hydration

73
Q

Bronchiolitis is seen in whom?

A

infants and young children < 2years

74
Q

Precedes a URI prodrome, with rhinorrhea, nasal flaring, tachypnea, and retractions, expiratory wheezes

A

bronchiolitis

75
Q

What is the MC cause of croup?

A

parainfluenza virus

76
Q

What is seen on CXR for croup?

A

steeple sign

77
Q

Whom does croup occur?

A

6 months and 3 years

78
Q

What is the characteristic symptom of croup?

A

barking cough and noisy breathing inspiratory stridor

79
Q

What is the txt for severe croup?

A

humidified oxygen racemic epinephrine

80
Q

What is the txt for mild croup?

A

oral corticosteroids (dexamethasone)

81
Q

Symptom associated with laryngotracheobronchitis (viral coup)?

A

barking cough

82
Q

Thumb print on CXR?

A

epiglottis

83
Q

Dx of croup?

A

Posterioranterior (PA) neck film showing subglottic narrowing (steeple sign)

84
Q

Rust colored sputum, common in pts with splenectomy?

A

S. pneumoniae

85
Q

Salmon colored sputum

A

S. aureus

86
Q

Organism causing Infection seen in pts on ventilators, cystic fibrosis

A

Pseudomonas

87
Q

Hyponatremia, GI symptoms (diarrhea), and high fever, air conditioning, aerosolized water

A

Legionella

88
Q

Young people living in dorms, + cold agglutinins, bullous myringitis, walking pneumonia, low temp

A

Mycoplasma

89
Q

currant jelly sputum, DRINKERS, aspiration

A

Klebsiella

90
Q

Organism responsible for viral pneumonia in adults?

A

flu

91
Q

Organsim responsible for viral pneumonia in kids?

A

RSV

92
Q

A non- remitting cough/bronchitis non responsive to conventional txt

A

Coccidioides

93
Q

bird or bat droppings (caves, zoo, bird), looks like sarcoidosis on CXR

A

Histoplasma capsulatum

94
Q

Found in soil in dry states can disseminate and can cause meningitis?

A

cryptococcus

95
Q

HIV related pneumonia?

A

Pneumocystis jiroveci (PJP)

96
Q

Walking pneumonia is cause by?

A

atypical pneumonia

97
Q

Poor dental hygiene is associated with pneumonia caused by?

A

anaerobes

98
Q

characterized by a more precipitous onset and fulminant course?

A

influenza pneumonia

99
Q

Seen in community acquired pneumonia

A

lobar consolidation

100
Q

apical infiltration is seen in?

A

TB

101
Q

Transmission of vocal sounds through consolidation leads to the changes heard with _______________ .

A

Ephony

102
Q

Consolidation would increase the transmission of vocal vibrations and manifest as increased ____________ .

A

Tactile fremitus

103
Q

COPD, smokers, post-splenectomy?

A

Haemophilus influeza

104
Q

College kids, sore throat, long prodrome

A

Chlamydia pneumoniae

105
Q

Lobar consolidation is seen in ?

A

Community acquired pneumonia

106
Q

What 3 things will a pt with pneumonia have on physical exam?

A

+ egophony
+ tactile fremitus
+ dullness to percussion

107
Q

Txt for outpt therapy?

A

Doxycycline, Marcolides

108
Q

Txt for inpt therapy?

A

Ceftriaxone + azithromycin, fluq

109
Q

Why are macrolides used to txt mycoplasma pneumonia?

A

bc mycoplasma lacks a cell wall

110
Q

Dx of viral pneumonia?

A

CXR bilateral interstitial infiltrates

111
Q

Txt for viral pneumonia?

A

symptomatic oseltamivir (Tamiflu)

112
Q

When must Tamiflu be given to treat influenza?

A

within 48hrs

113
Q

Amantadine and Rimantadine treat only

A

influenza A

114
Q

Txt for coccidioides?

A

flucanazole or itraconazole

115
Q

Txt for cryptococcus?

A

Amp B

116
Q

Mississippi or Ohio river valley

A

Histoplasma capsulatum

117
Q

Txt for histoplasma?

A

Amp B

118
Q

Txt for Pneumocystis Jiroveci?

A

Bactrim and steriods

119
Q

Diffue intersitial or bilateral perihilar infiltrates?

A

Pneumocystis jiroveci

120
Q

Txt for pneumocystis jiroveci?

A

Bactrim (Pentamidine if allergic)

121
Q

Daily prophylaxis of choice for PJP?

A

Bactrim

122
Q

DX for sleep apnea?

A

polysomnography in lab or home

123
Q

Txt for sleep apnea?

A

CPAP
Oral appliance
Uvulopalatopharyngoplasty
Tracheostomy

124
Q

Fever, night sweats, anorexia and weight loss

A

TB

125
Q

> 5mm PPD?

A

cxr of past TB, immunocompromisted ex HIV, close contacts w/ infectous TB

126
Q

> 10mm PPD?

A

IV drug users, recent immigrants, prisons, homeless shelters, pt with DM, or those with gastro surgery

127
Q

> 15mm PPD?

A

Pts w/ no risk

128
Q

Dx of TB?

A

3 sputum specimens for acid fast bacilli (AFB smears), and TB cultures

129
Q

What does the cxr for TB look like?

A

cavitary lesions, infiltrates, ghon complexes in apex of lungs, caseating granulomas

130
Q

What is miliary TB?

A

Tb spread outside the lungs

131
Q

What is Potts dz?

A

Tb to spine

132
Q

What is Scrofula?

A

Tb to cervical lymph nodes

133
Q

What’s next after a + TB test?

A

CXR

134
Q

Txt for a neg TB cxr?

A

latent Tb- Isoniazid for 9 mo

135
Q

What should a pt taking Isoniazid also take?

A

Supplemental Vit B6 (Pyridoxine)

136
Q

What does Pyridoxine prevent in TB?

A

Neuropathy

137
Q

sde of Isoniazid?

A

peripheral neuropathy

138
Q

Txt for active TB?

A

RIPE

Rifampin, Isoniazide, Pyrazinamide, Ethambutol

139
Q

Sde of TB drugs?

A

hepatotoxic

140
Q

Orange body fluids, hepatitis

A

Rifampin

141
Q

Hyperuricemia (gout)

A

Pyrazinamide

142
Q

Optic neuritis, red-green blindness

A

Ethambutol

143
Q

What drug can cause reactivation of TB?

A

Etanercept

144
Q

How long are TB pts treated?

A

Four drugs x 8 weeks

2 drugs x 16 weeks

Family Medicine EOR (15 decks)

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