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PANCE 2024 > Pulmonology Review FINAL > Flashcards

Pulmonology Review FINAL Flashcards

1
Q

What can be given as prevention of bronchiolitis?

A

Palivizmab during first year of life for children < 29 weeks or immunodeficiency

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2
Q

What antibiotics can be given for patients with epiglottitis?

What can be given as prevention to all close contacts?

A

-Ceftriaxone or Cefotaxime

-Rifampin and the Hib vaccine

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3
Q

What shape is Strep Pneumo?

A

Gram positive diplococci

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4
Q

What shape is Staph Aureus?

A

Gram positive cocci in clusters

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5
Q

Two common causes of hospital-acquired PNA?

A

Pseudomonas and MRSA (Staph Aureus)

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6
Q

Aspiration PNA Treatment

A

Ampicillin-Sulbactam or Amoxicillin-Clavulanate

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7
Q

Treatment for PNA
-CAP Outpatient
-CAP Inpatient

A

Outpatient: Macrolides (Azithromycin) or Doxycycline

Inpatient: Ceftriaxone + Macrolide or Doxycycline

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8
Q

HAP PNA (Pseudomonas Infection Risk) Treatment

A

-Piperacillin/Tazobactam or Cefepime + Aminoglycoside (Gentamicin) OR Fluoroquinolone (Levofloxacin, Moxifloxacin)

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9
Q

With HAP, what should you add if Legionella is suspected?

If MRSA is suspected?

A

Legionella: Levofloxacin or Azithromycin

MRSA: Vancomycin or Linezolid

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10
Q

Explain PNA vaccination rules

A

-PCV13: 4 doses (2, 4, 6, 12-15 months of age)
-PPSV23: adults 65 years or older

-If patient had no prior vaccination, give one dose of PCV13 then 8 weeks later one dose of PPSV23.

-Pregnancy is ok!

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11
Q

MCC of acute bronchiolitis?

A

RSV

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12
Q

Histoplasmosis is an AIDS-defining illness if CD4 <

A

CD4 < 150

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13
Q

PCP Pneumonia is the most common opportunistic infection in HIV, especially if CD4 <

A

CD4 < 200

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14
Q

Symptoms of PCP PNA

What labs are shown?

What does CXR show?

A

-Dyspnea on exertion, fever, nonproductive cough, oxygen desaturation on ambulation

Increased LDH and beta-D-glucan

diffuse bilateral interstitial infiltrates

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15
Q

PCP Treatment

A

Bactrim x 21 days
If HIV+, add Prednisone if hypoxic

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16
Q

What is the difference between Costochondritis and Tietze Syndrome?

A

Both have reproducible chest wall tenderness (MC involving 3rd, 4th, and 5th sternocostal joints)

-Tietze Syndrome has palpable edema, whereas Costochondritis does not.

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17
Q

Etiologies of a Pleural Effusion

-Transudate
-Exudate

A

-Transudate: CHF MCC, Nephrotic syndrome, Cirrhosis (due to increased hydrostatic pressure or decreased oncotic pressure)

-Exudate: any infection or inflammation. Pulmonary embolism, malignancy (due to increased vascular permeability)

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18
Q

What is the best XR view and what does it show for a pleural effusion?

A

Lateral decubitus films: blunting of the costophrenic angles (menisci sign)

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19
Q

Light’s Criteria for a pleural effusion

A

-An exudate is present if any of these 3 present:
–serum protein > 0.5
–serum LDH > 0.6
–LDH > 2/3 upper limit of normal LDH

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20
Q

With a primary spontaneous pneumothorax (PSP), who does it affect most commonly, and what is the pathophysiology behind it?

A

-No underlying lung disease, tall thin men 20-40 years old, smokers

-Apical sub pleural blebs rupture

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21
Q

Pneumothorax Types
-PSP
-SSP
-Traumatic
-Tension
-Catamenial

A

-PSP: atraumatic and idiopathic
-SSP: underlying lung disease
-Traumatic: iatrogenic (CPR, PEEP ventilation, MVA, subclavian line placement)
-Tension: positive air pressure pushes the trachea, great vessels, and heart to contralateral side
-Catamenial: occurs during menstruation

22
Q

Pneumothorax Treatments

-Small PSP < 3 cm from chest wall
-Large PSP > 3 cm from chest wall
-Stable SSP
-Tension

A

-Small: observation and supplemental oxygen
-Large: Needle or catheter aspiration vs. chest tube or catheter thoracostomy

-Stable SSP: Chest tube or catheter thoracostomy + hospitalization

-Tension: Needle aspiration followed by chest tube thoracostomy

23
Q

Where should the needle be placed for needle thoracostomy?

A

Between 2nd and 3rd rib, mid-clavicular line

24
Q

What is seen on exam in a patient with pulmonary hypertension and why?

A

Accentuated S2, signs of RHF (increased JVP, peripheral edema, ascites)

Increased pulmonary vascular resistance leads to RVH, increased RV pressure, and RHF eventually

25
Q

Regarding a PE, explain what S1Q3T3 means

A

Wide deep S in lead 1, both an isolated Q as well as T wave inversion in Lead III

26
Q

What is the best initial test to confirm a PE?

What should be done if the patient is pregnant or increased creatinine?

What is the gold standard diagnostic for a PE?

A

-Helical (spiral) CT angiography

-V/Q scan

-Pulmonary angiography

27
Q

What is the first-line treatment for a patient who is hemodynamically stable with a PE?

A

Anticoagulation: Heparin bridge + Warfarin or novel oral anticoagulant (Dabigatran, Rivaroxaban, Apixaban, Edoxaban)

28
Q

PE Prophylaxis
-Low risk, minor procedures, <40 years old

-Moderate Risk

-Patients undergoing orthopedic or neurosurgery, trauma

A

-Low risk: early ambulation

-Moderate: compression devices/stockings/venodyne boots

-Ortho/Trauma: LMWH

29
Q

What are two characteristic findings on CXR with a PE?

A

Hamptons Hump

Westermark Sign

30
Q

Who does ARDS occur in?

A

Critically ill patients, (Gram negative sepsis MC), severe trauma, near drowning, severe pancreatitis, etc.

31
Q

What is shown on a CXR in someone with ARDS?

A

-Bilateral diffuse pulmonary infiltrates but spares the costophrenic angles

32
Q

On right heart catheterization, what is seen with ARDS?

A

PCWP < 18 mm Hg (no cardiogenic pulmonary edema)

33
Q

Treatment for ARDS

A

-Noninvasive or mechanical ventilation + treat underlying cause (CPAP, PEEP, and low tidal volume)

34
Q

Normal Breath Sounds
-Bronchial:
-Bronchovesicular:
-Vesicular:

A

-Bronchial: Expiration (longer) > Inspiration

-Bronchovesicular: Expiration = Inspiration

-Vesicular: Inspiration > Expiration

35
Q

Pathophysiology of Neonatal Respiratory Distress Syndrome

A

-Insufficient surfactant production by an immature lung.
-Dysfunction of Type 2 Pneumocytes

36
Q

When are antenatal glucocorticoids given to prevent NRDS?

A

-If premature delivery expected (between 24-36 weeks)

-By 35 weeks, enough surfactant has been produced in the baby’s lungs

37
Q

What is the best treatment for meconium aspiration?

A

Prevention of post-term delivery. There is a high incidence of meconium aspiration if over 41 weeks

38
Q

What is the pathophysiology of emphysema?

A

-Alveolar capillary destruction + alveolar wall destruction due to chronic inflammation and decreased protective enzymes. Loss of elastic recoil and increased compliance leads to airway obstruction (air trapping)

39
Q

What type of emphysema is associated with smoking?

With alpha-1-antitrypsin deficiency?

A

-Centrilobar (proximal acinar)

-Panacinar (diffuse)

40
Q

What is unique about the PFT in emphysema vs Chronic Bronchitis?

A

-in Emphysema, the DLCO is decreased due to loss of elastic recoil

41
Q

What is shown on CXR in those with emphysema?

A

Hyperinflation: flattened diaphragms, increased AP diameter, decreased vascular markings, bullae

42
Q

What is the pathophysiology of chronic bronchitis?

A

-Chronic inflammation leads to mucus gland hyperplasia, goblet cell mucus production, dysfunctional cilia, and infiltration of neutrophils and CD8+ cells

43
Q

With chronic bronchitis, what is expected on:

-ECG:
-CBC:
-ABG:

A

-ECG: cor pulmonale (RVH, right atrial enlargement)

-CBC: increased hemoglobin and hematocrit

-ABG: respiratory acidosis

44
Q

Regarding symptoms, what is the main symptom of emphysema vs chronic bronchitis?

A

Emphysema: dyspnea

Chronic Bronchitis: productive cough (at least 3 months in the last 2 consecutive years)

45
Q

What is the MCC of Bronchiectasis in the US?

A

Cystic Fibrosis

46
Q

MC associated viruses related to viral COPD exacerbations?

A

Rhinovirus

47
Q

What are two factors that reduce mortality in COPD?

A

Smoking cessation**
Oxygen therapy

48
Q

COPD Treatment Categories

Category A:

Category B:

Category C:

Higher Burden:

A

Category A: SABA as needed

Category B: SABA + LAMA

Category C: LAMA + LABA

Higher Burden: LAMA + LABA or LAMA + LABA + glucocorticoid

49
Q

Name the Drugs

-SABA
-SAMA
-LABA
-LAMA

A

-SABA: Albuterol
-SAMA: Ipratropium
-LABA: Salmeterol, Formoterol
-LAMA: Tiotropium

50
Q

What are common side effects of LAMA and SAMAs?

A

Anticholingeric: dry mouth, thirst, blurry vision, urinary retention, difficulty swallowing

51
Q
A

PANCE 2024 (12 decks)

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