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Internal Medicine > Pulmonology Error List > Flashcards

Pulmonology Error List Flashcards

1
Q

What is Pneumonia

A

Inflammatory, Infectious process in lower airways (alveolar)

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2
Q

What are the typical pathogens

A

Strep. Pneumo is most common

H.Flu, Moraxella, Staph. Aureus, Klebsiella

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3
Q

What should you associated with pneumonia and Klebsiella

A

Alcoholics and Aspirators

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4
Q

Sx of pneumonia with Typical pathogens

A

Abrupt onset of fever and chills, productive cough, purulent sputum and pleuritic chest pain
Tachypnea, Tachycardia, Crackles, Dullness to Percussion, Consolidation or Effusion, Bronchial breath sounds, Increased Tactile Fremitus

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5
Q

What sputum do you see with Klebsiella

A

Currant Jelly

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6
Q

What sputum do you see with Pneumococcus

A

Rust Colored

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7
Q

What do you see on CXR with Typical Pneumonia

A

Lobar/Segmental Infiltrates

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8
Q

Tx for Typical Pneumonia

A

Outpatient: Macrolides (Clarithromycin, Azithormycin) or Doxycycline
Inpatient: Ceftriaxone + Azithromycin or Fluroquinolones

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9
Q

What are pneumococcal Vaccines

A

PCV13: Childhood Vaccine
PPV23: Polyvalent Pneumococcal for adults (elderly or immunocompromised)
Seasonal Flu for workers, elderly, immunocompromised

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10
Q

What are common pathogens for Atypical Pneumonia

A

Walking Pneumonia
Mycoplasm is most common
Influenza, Chlamydia, Legionella, RSV

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11
Q

Where do you find Legionella

A

Contaminated Water Sources

A/C Units, Cooling Towers

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12
Q

What other sx is Legionella associated with

A

GI and Neuro sx

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13
Q

Sx of Atypical Pneumonia

A

Low grade fever, mild pulmonary sx, myalgias, mild headaches, non-productive cough
Scattered rales/rhonchi, consolidation less common

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14
Q

Dx of Atypical Pneumonia

A

Clinical

RSV and Influenza have rapid antigen test

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15
Q

What do you see on CXR with Atypical Pneumonia

A

Diffuse patchy infiltrates

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16
Q

Tx of Atypical Pneumonia

A

Usually self-limited
Bacteria: Erythromycin for Mycoplasma and Legionella
Tetracycline for Chlamydia
If influenza: Antivirals, Tamiflu, Zanamivir

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17
Q

What is the most common pathogen for nosocomial: Health Care Acquired Pneumonia

A

Pseudomonas is most common

Staph. Aureus

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18
Q

Tx for Health Care Acquired

A

Cefepime, Imipenem, Meropenem, Piperacillin-Tazobactam, Piperacillin

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19
Q

What is a Pulmonary Embolism

A

Thrombus in pulmonary artery or branches, most are from DVT

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20
Q

What is Virchow’s Triad

A

Stasis, Hypercoagulability, Intimal Damage

All 3 must be present for PE to occur

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21
Q

Sx of Pulmonary Embolism

A

Dyspnea, Pleuritic Chest Pain, Hemoptysis, Syncope, Hypoxia, Cyanosis, Tachycardia, Tachypnea
Positive Homan Sign (calf pain with dorsiflexion)

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22
Q

What are the different tests for PE

A

CXR: Westermark’s Sign (avascular markings distal to emboli site)
Hampton’s Hump: Wedge shaped infiltrate on CXR
EKG: Sinus Tachycardia and non-specific ST/T Changes
ABG: At first Respiratory Alkalosis, but Respiratory Acidosis with time
Helical CT, Pulmonary Angiogram, V/Q Scan, Doppler Ultrasound

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23
Q

What is the Gold Standard for PE dx

A

Pulmonary Angiogram

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24
Q

What is the first initial screening test for PE

A

Helical CT scan

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25
Q

Tx of PE

A

Anticoagulation with Heparin, Warfarin for 3-6 months
IVC filter
Thrombectomy/Embolectomy

26
Q

What is the workup for PE

A

Low Suspicion: D-Dimer
If Negative: No PE
If Positive: Do Helical CT

High Suspicion: Helical CT
If Normal: No PE
Not sure: Pulmonary Angiogram or Lower Extremity Ultrasound
Positive: Treat

27
Q

How do you dx Lung Cancer

A

Bronchoscopy with Biopsy
CT Guided Biopsy
Cytology

28
Q

Where does Lung Cancer Mets

A

Brain, Bone, Liver, Lymph Nodes, Adrenals

29
Q

What are the categories for Lung Cancer

A 
Non-Small Cell
*Adenocarcinoma
*Large Cell
*Squamous Cell
Small Cell
30
Q

What is the deadliest lung cancer

A

Small Cell Carcinoma

31
Q

What is the most common lung cancer

A

Non-Small Cell Carcinoma (Adenocarcinoma)

32
Q

What is the most common lung cancer in non-smokers

A

Adenocarcinoma

33
Q

Where is Adenocarcinoma

A

Peripheral

So tumor gets big before you start seeing sx

34
Q

Where is Large Cell Carcinoma

A

Peripheral, very aggressive

35
Q

Where is Squamous Cell

A

Central

36
Q

What are features of Squamous Cell Carcinoma in lungs

A

Cavitary Lesions
Hypercalcemia
Pancoast Syndrome (Shoulder Pain, Horner’s Syndrome due to compression of nerve, Atrophy of hands/arm Muscles)
Horners: Miosis, Ptosis, Anhydrosis

37
Q

What endocrine feature is seen with Squamous Cell Carcinoma in lungs

A

High Calcium due to PTHrp
Low PTH with High Calcium
Sx: Constipation, Irritable, Kidney Stones

38
Q

Where is Small Cell Carcinoma in lung

A

Central

39
Q

Sx of Small Cell Carcinoma of lung

A

Paraneoplastic: Lamber-Eaton, SIADH, Cushings Syndrome, Dermatomyositis, Clubbing, SVC Syndrome
Lambert-Eaton: Muscle Weakness but gets better with use
SVC Syndrome: Dilated Neck Veins, Facial Plethora, Prominent Chest Veins

40
Q

What is Sarcoidosis

A

A Chronic Multisystemic inflammatory granulomatous disorder of unknown etiology
Lung is most commonly affected
AA in 20’s-40’s

41
Q

Sx of Sarcoidosis

A

Dry, nonproductive cough, dyspnea, chest pain
Hilar Lymphadenopathy
Skin: Erythema Nodosum (tender, painful bumps under the skin, usually legs), Lupus Pernio, Maculopapular Rash
Visual: Uveitis, Conjunctivitis
Arrhythmias, Cardiomyopathies, Arthralgias, Fever, Malaise, Weight Loss

42
Q

Dx of Sarcoidosis

A 
Imaging: Non-Caseating Granulomas
Tissue Biopsy: Noncaseating Granulomas
CXR: Bilateral Hilar Lymphadenopathy
PFT: Restrictive Pattern
CT Scan: Hilar/Mediastinal Lymphadenopathy, Nodules, Ground Glass Opacities
43
Q

Tx of Sarcoidosis

A

Observation due to spontaneous remission
Oral Corticosteroids
Methotrexate, NSAIDS

44
Q

What is a Pleural Effusion

A

Abnormal accumulation of fluid in the pleural space

45
Q

What defines a Transudate in a Pleural Effusion

A

Not due to infection
Circulatory system fluid due to either increased hydrostatic and or decreased oncotic pressure
Usually due to CHF, Nephrotic Syndrome, Cirrhosis

46
Q

What defines an Exudate in a Pleural Effusion

A

Inflammation, has proteins, WBC, Platelets
Occurs when local factors increase vascular permeability
Lights Criteria
*Pleural fluid protein: Serum Protein >0.5
*Pleural fluid LDH: Serum LDH >0.6 or Pleural Fluid LDH >2/3 upper limit of LDH

47
Q

Sx of Pleural Effusion

A

Asymptomatic, Dyspnea, Pleuritic Chest Pain, Cough

Decreased Fremitis, Decreased breath sounds, Dullness to Percussion, Audible Pleural Friction Rub

48
Q

Dx of Pleural Effusion

A

CXR: Menisucs, Lateral Decubitus is best

CT need to confirm empymea: Loculations

49
Q

Tx of Pleural Effusion

A

Tx underlying Condition
Thoracentesis is gold standard
Fluid MUST be drained if empyema (pH

50
Q

What is COPD

A

Progressive, Irreversible Airflow Obstruction

Loss of elastic recoil and increased airway resistance

51
Q

RF for COPD

A

Smoking, Genetic (Alpha-1 Antitrypsin Deficiency)

52
Q

What are the 2 categories of COPD

A

Chronic Bronchitis

Emphysema

53
Q

What is Chronic Bronchitis

A

Increased airway resistance leads to airway obstruction, mucus plugging and mucociliary escalator destruction
Productive cough for > 3 month for 2 consecutive years

54
Q

Sx of Chronic Bronchitis

A

Rales, Rhonchi, Wheezing, Cor Pulmonale (peripheral edema, cyanosis)
Severe V/Q Mismatch
Blue Bloater

55
Q

What is Emphysema

A

Abnormal permanent enlargement of terminal airspace
Smoking leads to chronic inflammation which decreases protective enzymes
Loss of elastic recoil and increased compliance leads to airway trapping

56
Q

Sx of Emphysema

A

Accessory muscle use, tachypnea, prolonged expiration
Hyperinflation, Hyperressonance, Decreased breath sounds
Pink Puffers

57
Q

What is the gold standard for Dx of COPD

A

PFT/Spirometry

  • Decreased FEV1
  • Decreased FEV1/FVC
58
Q

What are other ways to dx COPD

A

CXR: Hyperinflation, Flat Diaphragm, Vascular Markings
EKG: Cor Pulmonale (RVH, RAE, RAD, Right sided HF)

59
Q

Tx of COPD

A

Stop Smoking
Oxygen is the only therapy to decrease mortality
Bronchodilators (Anticholinergics like Triotropium Ipratoprium)
SABA/LABA (Albuterol, Terbutaline, Salmetrol)
Theophylline (in refractory cases)
Corticosteroids

60
Q

What is the most important step in management of COPD

A

Stop Smoking!

Internal Medicine (16 decks)

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