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Internal Medicine > Pulmonology High Yield > Flashcards

Pulmonology High Yield Flashcards

1
Q

What is Asthma

A

Reversible Hyperirritability of tracheobronchial Tree
Trouble getting air OUT
FEV1/FVC

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2
Q

What causes Asthma

A

Airway Obstruction
Airway Hyperactivity
Chronic Airway Inflammation
Atopy is common: Wheezing, Eczema, Seasonal Rhinitis

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3
Q

Sx of Asthma

A

Dyspnea, Wheezing, Cough (especially at night)

Prolonged expiration with wheezing, hyperresonance, decreased breath sounds

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4
Q

What is the gold standard for dx of Asthma

A

PFT

Shows reversible Obstruction (increase RV, TLC, RV/TLC)

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5
Q

What are other ways to dx Asthma

A

Peak Expiratory Flow Rate
*PEFR>15% from initial attempt (response to treatment)
Pulse Oximetry

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6
Q

What are the steps in Bronchoprovocation to assess if Asthma is present

A

Metacholine Challenge Test (causes bronchospasms)
Bronchodilator Challenge Test (if >12% increase in FEV1 or >200cc)
Exercise Challenge Test (if >15% decrease in FEV1)

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7
Q

Dx and TX of intermittent Asthma

A

Day:

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8
Q

Dx and Tx of Mild Persistent Asthma

A 
Day: >2x/wk
Night: >2x/month
Tx: SABA + ICS
FEV >80%
ICS: Beclomethasone, Flunisolide, Triamcinolone
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9
Q

Dx and Tx of Moderate Persistent Asthma

A

Day: Daily
Night: >1x/wk
FEV: 60-80%
Tx: SABA + higher dose of ICS

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10
Q

Dx an Tx of Severe Persistent Asthma

A

Day: All day
Night: Nightly
FEV:

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11
Q

What are examples of SABA

A

Albuterol
Terbutaline
Epinephrine

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12
Q

What are examples of Anticholinergics

A

Ipratropium

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13
Q

What are examples of ICS

A

Beclomethasone, Flunisolide, Triamcinolone

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14
Q

What are examples of systemic steroids

A

Prednisone, Methylpredniosne, Prednisolone

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15
Q

What are examples of LABA

A

Salmeterol, Formoterol, Fluticasone/Salemetrol

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16
Q

What are examples of Mast Cell Modifiers

A

Cromyolyn

Nedocromil

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17
Q

What are examples of Leukotriene Modifiers/Receptor Antagonists

A

Montelukast, Zafirlukast, Zileuton

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18
Q

What is Pulmonary Hypertension

A

Increased pulmonary vascular resistance leads to RVH and high right sided HF

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19
Q

What are the different types of Pulmonary Hypertension

A

Primary: Idiopathic
Secondary: Due to Left Heart, Due to Lung Pathology (COPD), Due o Chroic Embolic disease, Misc.

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20
Q

Sx of Pulmonary Hypertension

A

Dyspnea, Chest Pain, Weakness, Fatigue, Cyanosis, Syncope, Edema
Increased JVP, signs of right sided HF, RV Heave

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21
Q

Dx of Pulmonary Hypertension

A

Definitive: Right sided Cath
EKG: Cor Pulmonale (RVH, RAE, RAD, RBB)
CXR

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22
Q

Tx of Pulmonary Hypertension

A 
Vasodilators
*CCB for primary
Phosphodiesterase 5-Inhibitors (Sildenafil/Viagra)
Prostacyclins
Endothelin Receptor Antagonists
O2, Anticoagulation
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23
Q

What is Bronchiectasis

A

This is when you get an obstruction further up the bronchial tree that leads to accumulation of sputum/mucus further down
Irreversible bronchial dilation secondary to transmural inflammation of bronchi
Destruction of muscular and elastic tissues, inflamed airways collapse easily
Obstruction of airflow and impaired clearance of mucous secretion leads to lung infections

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24
Q

What causes bronchiectasis

A

Chronic lung infections like H.Flu, Pseudomonas, Moraxella, CF

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25
Q

What is the most common cause of bronchiectasis

A

Cystic Fibrosis

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26
Q

Sx of Bronchiectasis

A

Daily chronic cough with thick, mucopurulent sputum
Hemoptysis
Persistent crackles at the base

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27
Q

Dx of Bronchiectasis

A

CT: Airway dilation, lack of tapering of bronchi, tram-track appearance (bronchial wall thickening)
See Signet Ring Sign (pulmonary artery coupled with dilated bronchus)
PFT: Obstructive Pattern (Low FEV1, Low FVC, Low FEV1/FVC

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28
Q

Tx of Bronchiectasis

A

Antibiotics
Empiric: Ampicillin, Amoxicillin, Bactrim
Pseudomonas: Fluoroquinolones, Zosyn, Aminoglycoside
Bronchodilators, Anti-inflammatory agents

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29
Q

What is Cystic Fibrosis

A

Autosomal recessive inherited disorder of defective CFTR protein
Prevents chloride transport (water movement out of cell), leads to buildup of thick, viscous mucus in lungs, pancreas, liver, intestines

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30
Q

Sx of Cystic Fibrosis

A

Young patient with bronchiectasis, pancreatic insufficiency, growth dealys and infertility
GI: Meconium Ileus at birth, Steatorrhea, Bulky pale/foul smelling stools, vitamin deficiency
Pulmonary: Recurrent URI, Dyspnea, Chest pain

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31
Q

Dx of Cystic Fibrosis

A

Elevated Sweat Chloride Test
CXR: Bronchiectasis, Hyperinflation of lungs
PFT: Obstructive pattern
Sputum Pattern

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32
Q

Tx of Cystic Fibrosis

A

Airway Clearance with bronchodilators, Mucolytics, Abx, decongestants
Pancreatic enzyme replacement
Vitamin Replacement: A, De, E, K

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33
Q

What is Acute Bronchitis

A

Inflammation of trachea/bronchi

34
Q

What causes Acute Bronchitis

A

Viral (adenovirus, parainfluenza, Influenza, Coxsackie)

35
Q

Sx of Acute Bronchitis

A

URI

Cough for more than 5 days

36
Q

Dx of Acute Bronchitis

A

Clinical

CXR non-specific

37
Q

Tx of Acute Bronchitis

A

Fluids, rest, antitussive agents, bronchodilators

Abx if immunocompromised, elderly, COPD

38
Q

What is Idiopathic Pulmonary Fibrosis

A

Chronic Progression of intersitital scarring (fibrosis) from persistent inflammation
Results from loss of pulmonary function and restrictive component

39
Q

What defines a restrictive disease such as Idiopathic Pulmonary Fibrosis

A

Decreased TLC, RV, Normal or Increased FEV1/FVC

40
Q

Sx of Idiopathic Pulmonary Fibrosis

A

Dyspnea, Nonproductive cough

Fine babasilar inspiratory crackles, clubbing of fingers

41
Q

Dx of Idiopathic Pulmonary Fibrosis

A

CXR/CT: Diffuse reticular opacities (Honeycombing), Ground Glass
Biopsy: Honeycombing (large cystic airspaces from CF alveolitis)

42
Q

Tx of Idiopathic Pulmonary Fibrosis

A

Stop Smoking
Oxygen
Lung transplant is only cure

43
Q

What is a Pneumoconiosis

A

Chronic fibrotic lung disease secondary to inhalation of mineral dust
Causes fibrosis and therefore restrictive lung disease

44
Q

Where do people who get Silicosis work

A

Mining, Quarry, Granite

45
Q

What do you see on CXR with Silicosis

A

Round nodular opacities in UPPER LOBES

Eggshell Calcifications of hilar and mediastinal nodes

46
Q

Tx for Silicosis

A

Supportive, Steroids, Oxygen

47
Q

What is the Black Lung

A

Coal Workers Pneumoconiosis

48
Q

What do you see with Black Lung

A

Small upper lobe nodules with hyperinflation of lower lobes

49
Q

What is associated with Asbestosis

A

Mesothelioma

50
Q

What do you see on CXR with Asbestosis

A 
Pleural Plaques
Interstitial Fibrosis (honeycombing) in LOWER LOBES
51
Q

Tx for Asbestosis

A

Steroids, Oxygen, Stop Smoking

52
Q

What is Mesothelioma

A

Originates from pleura, associated with Asbestos

53
Q

Sx of Mesothelioma

A

Pleuritic chest pain, dyspnea, fever, night sweats, weight loss, hemoptysis

54
Q

Dx of Mesothelioma

A

Pleural Biopsy via video assisted thorascopy

55
Q

Tx of Mesothelioma

A

Pleurectomy, Resection, Radiation and/or Chemo

56
Q

What is Bronchial Carcinoid Tumor

A

Rare neuroendocrine tumors characterized by slow growth, low METS

57
Q

What neuroendorcrine abnormalities are seen with Bronchial Carcinoid Tumor

A

ACTH, ADH, MSH

58
Q

Sx of Bronchial Carcinoid Tumors

A

SIADH, Cushings Syndrome, Hemoptysis
Carcinoid Syndrome: Makes serotonin, increased bradykinin and histamine leading to FLUSHING, tachycardia, bronchoconstriction, hemodynamic, Diarrhea

59
Q

Dx of Bronchial Carcinoid Tumor

A

Otreotide

Pink to purple well-vascularized central tumor

60
Q

Tx of Bronchial Carcinoid Tumor

A

Tumor Excision

61
Q

What is a pneumothorax

A

Air within the pleural space

It increases positive pleural pressure which causes collapse of the lung

62
Q

Who is more likely to get a Spontaneous Pnemothorax

A

Primary: Tall men in their 20’s
Secondary: Underlying lung disease without trauma (COPD, Asthma)

63
Q

What causes traumatic pneumothorax

A

CPR, Thoracentesis, PEEP, Sublclavian Lines, MVA

64
Q

What is a Tension Pneumothorax

A

Positive air pressure pushes the lungs, trachea and heart to the contralateral side
Life Threatening

65
Q

Sx of a Tension Pneumothorax

A

Increased JVP, Pulsus Paradoxus, Shift of trachea or heart to contralateral side

66
Q

Tx of Tension Pneumothorax

A

Needle Aspiration first

Followed by Chest tube thoracostomy

67
Q

Sx of a Spontaneous Pneumothorax

A

Chest pain, usually pleuritic and unilateral, Dyspnea

Increased Hyperresonance, decreased fremitius, decreased breath sounds, unequal respiratory expasion, Hypotension

68
Q

Dx of Spontaneous Pneumothorax

A

CXR with Expiratory view

Decreased peripheral lung markings, may have copnanion lines, deep sulcus

69
Q

Tx of Spontaneous Pneumothorax

A

Observation if small, will close spontaneously

Chest tube placement if large

70
Q

Sx of TB

A

Gradual onset of fever, cough, weight loss, night sweats, dyspnea, blood tinged sputum

71
Q

What pathogen causes TB

A

Mycobacterium Tuberculosis

72
Q

Who are high risk populations for TB

A

Health Care Workers, Immigrants, Homeless, HIV

73
Q

What is primary TB

A

Contagious

Active initial infectin with clinical progression, usually self-limited

74
Q

What is Chronic (latent) TB

A

Patients who had primary TB that are controlled due to granuloma formation
Usually are PPD positive in 2-4 weeks after infection
Not Contagious

75
Q

What is secondary (Reactivation) TB

A

Localized in apex/upper lobes with cavitary lesions

Patients are contagious

76
Q

Dx of TB

A 
PPD skin test
If positive CXR to confirm
>5mm if HIV Positive or immunosuppressed
>10mm in high risk populations (immigrants)
>15mm everyone else (no known RF)
77
Q

What is the gold standard for Dx TB

A

Acid-Fast Smear and Sputum Cultures

Need 3 cultures

78
Q

What are CXR findings with TB

A

Primary: Middle/Lower Lobes
Reactivation: Apical
Miliary: Millet-Seed

79
Q

Tx of TB

A

RIPE
Rifampin, Isoniazid, Pyrazinamide, Ethambutol
RIPE for 2 months, followed by RI for 4 months

80
Q

What are side effects of TB Drugs

A

Rifampin: Orange colored secretions
Isoniazid: Peripheral neuropathies, Hepatotoxicity
Pyrazinamide: Hyperuricemia
Ethambutol: Optic Neuropathy (red/green colorblindness)

81
Q

How do you treat latent TB

A

Isoniazid and Pyridozinomide for 9 months

Internal Medicine (16 decks)

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