Respiratory Flashcards
What is the presentation of tension pneumo
compression of mediastinum, absent breath stounds, hypotension
Presentation of GPA?
upper airway - bloody discharge, sinusitis, oral ulcers
lower airway - dyspnea, cough, hemoptysis
renal: hematuria, renal insufficiency,
What are the treatment modalities available for asthsma?
mild intermittent - SABA PRN mild persistent: SABA + ICS moderate persistent: SABA + ICS + LABA Severe: SABA + medium ICS + LABA controller - theophylline = leukotriene antagonist, can be used fluticasone - persistent
What are the causes of hilar lymphadenopathy?
CLL, lymphoma, sarcoidosis, mets, granulomatous infection
What are the causes of pulmonary hypertension?
Cardiac - congenital heart disease, acquired heart disease
Pulmonary - COPD, restrictive lung disease
Pulmonary vascular - chronic PE, vasculitis, primary pulmonary hypertension
What masses can be found in the anterior mediastinum?
thymoma, thymus lymphoma, teratomas, thyroid masses
What are the possibilities for posterior mediastinum masses?
Nerve - schwannoma, neurofibromas,
Bone - primary bone tumor ( osteosarcoma, myeloma, osteomyelitis)
What are the possibilities for a middle mediastinum mass?
Aorta- Aortic dissection, aortic aneurysm, esophagus - esophageal alchalasia, adenocarcinoma, cyst,
Heart - cysts
What is the most common pneumonia in post flu patients?
Staph
What lab finding is an indication of a worsening asthma attack?
Normal PCO2
What is the treatment protocol for COPD?
Bronchodilators (albuterol, ipatroprium = anti muscarininc)
Oxygen
Systemic steroids
Antibiotics (cover moxella, h flu and strep pneumo)
For persistent COPD - advisor (LABA + ICS)
Possibly NSAIDs
Run through the whole differential for pulmonary massess
See rads lecture Neoplasm - carcinoma, hamartoma, carcinoid, lymphoma, met Infection - TB, histo, coccidio, abscess Infarct Trauma - hematoma Other: Wegener's, rheumatoid, BOOP,
Run through differential for multiple pulmonary nodules
Mets -
Infection - Septic emboli, Miliary TB, fungal, invasive aspergillus
Inflammatory - AVM, Wegener’s, Rh nodules
Run through differential for chest wall lesions, pleural lesions, apical
Chest wall - abscess, hematoma, hamartoma, fibroma, lipoma, lymphoma
Pleural - fibroma, lipoma, loculated effusion, lymphoma, mets, mesothelioma,
Apical - TB, Abscess, pancoast tumor, TB mimics, PNA
What are the different causes of pulmonary effusions?
Unilateral - cirrhosis, PE, empyema, TB, mesothelioma, PNA, Dressler’s syndrome
Bilateral - CHF, nephrotic syndrome, mixed connective tissue disease, malnutrition, hypothyroid, viruses
Both - ascites, pancreatitis, trauma, pericarditis, chylous
What are the criteria for diagnosis of asthma?
airflow obstruction partially reversible with inhaled SABA as shown by
An increase in FEV1 of 12% from baseline, an increase of 10% points from baseline or increase of PEF of greater than 20% from baseline
What are the treatment options available for empyema?
streptokinase early - can help bust, but not if thick
antibiotics - helpful early
can do second chest tube if not too complex
otherwise, surgery
Describe the gram negative bacilli that can cause PNA
e coli, klebsiella, pseudomonas, proteus, enterobacter,
How does klebsiella mediated PNA often present?
currant jelly-like sputum with tissue necrosis, early abscess formation, often happens in alcoholics
produces mucoid colonies
A patient comes in with a complicated PNA. Treatment?
antibiotics +corticosteroids - minimizes pulmonary complications from inflammatory effects of dead organisms in tissue
What is peak airway pressure? What is plateau pressure?
peak = resistive + plateau plateau = elastic + PEEP
A patient presents with low grade fevers, lytic bone lesions, skin involvement from the Mississipi river valley. This is.. (and what is the treatment?)
blastomyces - treatment is amphotericin B
What are Light’s criteria?
fluid/serum protein > 0.5, fluid/serum LDH > 0.6,
What is the cause of transudative vs. exudative effusions?
exudative - infection, malignancy, autoimmune, PE
A patient presents with pneumonia and extrapulmonary symptoms such as elevated LFTs and loose stools. What test should you do?
legionella antigen test
What are the organisms that cause community aquired pneumonia?
strep pneumo, moraxella, H. Flu
What does decreased tactile fremitus mean?
pneumothorax or effusion
What are Well’s Criteria?
score 3+ (clinical signs of DVT, alternate diagnosis less likely)
score 1.5 (previous PE/DVT, Heart rate >100, recent surgery (in last 4 weeks),
Score 1 (hemopytisis, cancer)
if score greataer than 4, PE is likely
How does well’s criteria inform treatmetn?
if PE likely, give heparin before diagnostic studies
How do PPIs affect patients with asthsma?
improves peak expiratory flow, nocturnal respiratory symptoms
A patient comes in with an acute exacerbation of COPD with minimal air movement. What is the next step?
BIPAP unless hemodynamic unstability, worsening respiratory acidosis, etc.
What is the best prophy available for DVT?
sub q heparin
A patient presents with clubbing of the digits, periosteal bone formation and arthritis - what should be the next steps?
this is hypertrophic osteoarthropathy - associated with intrathoracic malignancy, so order an X ray
A patient presents with milky white pleural effusion. What is the likely cause?
lymphoma
What is the diagnostic method of choice for sarcoid?
fiberoptic bronchoscopy
What are frequent complications of cystic fibrosis?
chronic pulm infections, bronchiectasis, diabetes and GI problems (pancreatic insufficiency), infertility
A patient presents with bilateral lung fibrosis after starting an antiarrhythmic drug. This is likely caused by..
amiodarone
The presence of new onset clubbing in a patient with COPD is strongly suspicious for…
malignancy
What is the presentation of ABPA?
fever, malaise, cough, hemoptysis, eosinphilia
A patient with HIV presents with cough, fatigue, night sweats, lymphadenopathy and liver enlargement. reticulonodular opacities are seen. He has also palatal ulcers. how do you diagnose this dissem. fungal?
urine antigen for histoplasmosis
What is the tx for histoplasmosis?
itraconazole
Distinguish intermittent asthsma from mild persistent, moderate persistent, and severe persistent
intermittent - symptoms occur less than 2 days/week
nighttime awakenings - less than 2x per month
mild persisent - symptoms more than 2 days a week, but not daily- add corticosteroids
moderate persistent - daily symptoms, weekly nighttime prescribe long acting beta 2 agonist
severe persisent - symptoms throughout day- albuterol, long acting AND high dose corticosteroids
A patient presents with SOB, cough, hemoptysis and a non healing leg ulcer. What is the most likely explanation?
GPA
What are the causes of lung disease that present with low DLCO and obstructive pattern?
emphysema
What are the patterns of lung disease that present with low DLCO and restrictive patterN/
interstitial lung disease, sarcoid, asbestosis
What are the patterns of lung disease that present with obstructive pattern and normal DLCO?
chronic bronchitis
A patient presents with fever, malaise, chills, breathlessness and a dry cough and chest X ray shows generalized haziness in both lung fields. she breeds birds - what is this?
hypersensitivity pneumonitis
A smoking patient who works as a plumber presents with worsening dyspnea, fingernail clubbing. Chest X ray shows atelectasis and bilateral pleural plaques over the diaphragm. What is this?
bronchogenic carcinoma
A patient presents with headaches, insomnia, seizures, nausea, vomiting and heart palpitations. He is being treated with theophylline. What is this?
check serum theophylline levels
What is the pH of normal pleural fluid? How does it compare to the pH of transudative and exudative fluid?
7.6 is normal. transudative - 7.4 - 7.55. exudative 7.3
