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ER EOR > Regular Pulmonary--- > Flashcards

Regular Pulmonary--- Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

MCC of bronchiolitis

A

RSV

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2
Q

best predictor of dz for bronchiolitis

A

pulse ox

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3
Q

tx bronchiolitis

A

supportive
immunoprophylaxis for Pavilizumab

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4
Q

cardinal sx of acute bronchitis

A

cough

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5
Q

what is a rare sx in acute bronchitis

A

fever

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6
Q

tx bronchitis

A

supportive

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7
Q

another name for pertussis

A

whooping cough

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8
Q

different phases pertussis

A

catarrhal phase - URI sx

paroxysmal phase - severe coughing fits with high inspiratory whooping sound after cough; may have posttussive vomiting

convalescent phase – resolution of cough

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9
Q

tx pertussis

A

Macrolides
Doxy if allergy

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10
Q

where is inflammation in epiglottis

A

supraglottic structures

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11
Q

MCC epiglottitis

A

HIB

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12
Q

sx epiglottitis

A

3 D’s
drooling, dysphagia, distress

high fever
inspiratory stridor
tripoding

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13
Q

dx epiglottitis

A

lateral neck XR - thumbprint sign
laryngoscopy - definitive; cherry red epiglottis

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14
Q

tx epiglottitis

A

airway maintenance
supportive
abx - cephalosporin
can add dexamethasone for swelling

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15
Q

another name for croup

A

laryngotracheitits

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16
Q

inflammation in croup

A

subglottic region

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17
Q

MCC croup

A

parainfluenza

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18
Q

sx croup

A

seal like barking cough
inspiratory stridor
hoarseness

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19
Q

dx croup

A

frontal cervical XR - steep sign
Westley croup score - classifies severity of croup

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20
Q

tx croup

A

steroids in all stages of croup (IV or IM)
supportive
nebulizer epinephrine - for severe croup (if it doesn’t work, it’s likely bacterial tracheitis)

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21
Q

tx CAP

A

axocillin

or augmentin or cephalosporin + macrolide

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22
Q

sx pneumonia

A

sudden onset fever
productive cough + purulent sputum
pleuritic chest pain
rigors
tachycardia, tachypnea

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23
Q

PE for pneumonia

A

bronchial breath sounds
dullness to percussion
increased tactile fremitus
egophony

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24
Q

sx for PJP

A

triad - progressive DOE, fever, nonproductive cough

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25
Q

PE for PJP

A

nearly all patients with have either hypoxemia at rest or with exertion

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26
Q

where in the lungs is primary TB typically located

A

middle portion - Ghon focus

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27
Q

where in the lungs is secondary/reactive TB typically located

A

apices

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28
Q

sx TB

A

prolonged fever
cough
chest pain
dyspnea
hemoptysis
fever/chills/night sweats

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29
Q

dx TB

A

isolation of TB from a body secretion or fluid or tissue

place in respiratory isolation

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30
Q

how many sputum specimens should bobtailed for TB

A

3

31
Q

histology for TB

A

caseating granulomas

32
Q

any positive PPD for TB should be followed with

A

CXR

33
Q

people considered to have positive PPD test >/= 5 mm

A

HIV or immunosuppressed
close contacts of patients with active TB
CXR consistent with old/healed TB (calcified granuloma)

34
Q

people considered to have positive PPD test >/= 10 mm

A

People recently arriving (< 5 years) from high-prevalence countries
* People who use injection drugs
Mycobacteriology laboratory workers
* Residents/employees of high-risk congregate settings
* Those with comorbid conditions (e.g., diabetes, severe kidney disease,
Hodgkin disease, lymphoma, malnutrition)
People with < 90% ideal body weight
* Children < 4 years old
* Infants, children, and adolescents exposed to adults in high-risk categories
* Children born in high-prevalence regions of the world

35
Q

people considered to have positive PPD test >/= 15 mm

A

everyone else

36
Q

acute respiratory distress syndrome is characterized by

A

rapid onset of severe dyspnea
refractory hypoxemia
diffuse pulmonary infiltrates, leading to respiratory failure

37
Q

when should ARDS be suspected

A

acute onset of progressive sx of profound dyspnea
hypoxemia with increasing requirement for oxygen
alveolar infiltrates on chest imaging within 6-72 hours of inciting event

38
Q

CXR ARDS

A

bilateral diffuse pulmonary inflaters - classically spares the costophrenic angles

39
Q

PCWP ARDS vs pulmonary edema

A

ARDS - < 18
pulmonary edema > 18

40
Q

tx ARDS

A

PEEP
low tidal volume ventilation - 6ml/kg
supplemental oxygen

41
Q

MCC cancer related death in US

A

lung CA

42
Q

MCC lung CA

A

smoking

smoking and asbestosis are synergistic

43
Q

what lung CA are included in non-small cell

A

adenocarcinoma
large cell
squamous cell
lepidic pattern

44
Q

MCC cancer in smokers in nonsmokers

A

adenocarcinoma

45
Q

DX adenocarcinoma of the lung

A

CXR - peripherally located
biopsy - gland formation/glandular with mucin production

46
Q

second MCC lung CA

A

squamous cell

47
Q

characteristics of squamous cell lung CA

A

CCCP

centrally located
cavitary lesions
hypercalcemia
pan coast syndrome

48
Q

dx squamous cell lung CA

A

perform cytology and bronchoscopy

histology - keratinization by tumor cells and intracellular desmosomes - intercellular bridges

49
Q

large cell carcinoma characteristics

A

large peripheral mass with prominent necrosis

50
Q

histology large cell carcinoma

A

pleomorphic giant cells - sheets of round or polygonal cells with prominent nuclei

51
Q

which lung CA is most aggressive

A

small cell

52
Q

which lung CA is most likely to present with paraneoplastic syndromes

A

small cell

53
Q

dx small cell lung CA

A

CXR - centrally located
histology - sheets of small dark blue cells w rosette formation

54
Q

transudative effusions are due to

A

increased hydrostatic or decreased oncotic

55
Q

etiologies of transudative pleural effusions

A

HF
cirrhosis
nephrotic syndrome
pulmonary embolism

56
Q

etiologies of exudative pleural effusions

A

malignancy
pneumonia/TB
pulmonary embolism
pnacreatitis
esophageal rupture
hemothorax

57
Q

sx and PE for pleural effusion

A

dyspnea
pleuritic chest pain
cough

dullness to percussion
decreased fremitus
decreased breath sounds

58
Q

Dx pleural effusions

A

CXR - blunting of costophrenic angles
lateral decubitus films - best - detect smaller effusions

thoracentesis - gold standard; determine cause

59
Q

light’s criteria for pleural effusion

A

transudate:
pleural: serum protein </= 0.5
pleural:serum LDH </= 0.6
pleural fluid LDH <2/3 ULN

exudate:
pleural: serum protein > 0.5
pleural: serum LDH > 0.6
pleural fluid LDH > 2/3 ULN

60
Q

types of pneumothorax

A

primary spontaneous - atraumatic; no underlying cause

secondary spontaneous - underlying lung disease

traumatic - trauma or iatrogenic

tension - any type of pneumothorax where the air pressure pushes the trachea to the contralateral side

61
Q

sx pneumothorax

A

sudden onset dyspnea and chest pain - pleuritic, ipsilateral, unilateral

62
Q

PE pneumothorax

A

hyper resonance to percussion
decreased fremitus
decreased breath sounds

tension - increased JVD

63
Q

CXR pneumothorax

A

CXR - decreased peripheral markings; deep sulcus sign; visible visceral pleural sign

64
Q

tx pneumothorax

A

small - observe
large - needle or small bore catheter aspiration

secondary - chest tube

tension - needle aspiration –> chest tube

65
Q

sx pulmonary embolism

A

triad - dyspnea, pleuritic chest pain, hemoptysis

66
Q

what is highly suspicious for PE

A

normal CXR in the presence of hypoxia

67
Q

classic findings in CXR for PE

A

Westermark’s sign - start cut off of pulmonary vessels
Hampton’s hump - wedge-shaped opacification at the periphery of the lung

68
Q

EKG pulmonary embolism

A

S1Q3T3

deep S in lead I
isolated Q inversion in lead III
isolated T inversion in lead III

69
Q

what level for DDimer makes PE unlikely

A

< 500

70
Q

dx PE

A

CTPA - criterion standard
VQ scan - test of choice in pregnancy
Duplex US

71
Q

Tx PE

A

stable - anticoagulation - UFH, LMWH, fondaparinux

unstable (SBP < 90 or R HF) - thrombolysis; embolectomy if thrombolysis fails

72
Q

preferred anticoagulant in malignancy and pregnancy for PE

A

LMWH

73
Q
A

ER EOR (28 decks)

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