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Pulmonology > Test #2 > Flashcards

Test #2 Flashcards

1
Q

Croup causative agent

A

Parainfluenza virus

Can also be caused by:

RSV

Influenza virus

Adenovirus

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2
Q

Croup hallmarks

A

Occurs between 6 months and 3 years most commonly

URI sx with barking cough and stridor on inspiration with absent/low grade fever

Triggered by circaidian rhythms (happens @ night)

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3
Q

Croup treatment

A

Stridor at rest: Racemix epi via nebulizer

Steroids - Decadron (liquid or powder)

Barking, no stridor at rest: mist therapy, cold air to dilate bronchioles

Worse on 3rd day

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4
Q

Epiglottitis causative agent

A

Most commonly H. flu Type B

Can also be cause by Group A Strep

Worry about asplenic kids - encapsulated bacteria

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5
Q

Epiglottotis hallmarks

A

Drooling, muffled “hot potato” voice

“Cherry red spot” epiglottis, stoic child

Can have grunting or soft stridor

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6
Q

Epiglottitis treatment

A

Be ready to intubate

Call in pediatric anesthesia

Get STAT soft-tissue lateral portable xray

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7
Q

Bronchiolitis (in peds)

A

Inflammatory process of smaller, lower airways

Can proceed to respiratory failure -> death

Preemies or infants with congenital heart/chronic lung/immunodeficiencies at risk for more severe disease and poorer outcomes

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8
Q

Bronchiolitis presentation

A

Fever, URI sx, tachypnea, wheezing

WBC normal

CXR clear

Mucopurulent sputum is possible, usually always viral

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9
Q

Bronchiolitis causative agents

A

RSV

can also be caused by Adenovirus and parainfluenza

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10
Q

Bronchiolitis Treatment

A

Only effective agents are oxygen and Ribavirin (reserved for immunocompromised/severly ill/premature infants

Palivizumab (Synagis) - IM monoclonal Ab providing passive immunity against RSV

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11
Q

Pneumonia in kids

A

Most cases are viral, but unable to predict so usually tx w/ Abx

Bacterial pneumonia presentation is more abrupt

Viral often with prodrome

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12
Q

Pneumonia in kids - causative agents

A

Varies with age

Newborns: group B Strep, Listeria, Gram negatives (E. coli, Klebsiella_

After 3 months of age: Strep pneumonae

Adolescent: Mycoplasma

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13
Q

Pneumonia in kids - presentation

A

Varies more, can be as little as tachypnea

Bacterial: Sudden, rapid onset with shaking chills, higher fevers

Viral: prodrome of rhinorrhea, cough, low-grade fever, pharyngitis

Newborns: poor feeding, irritable early on but become stoic later, cyanosis, hypoxic

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14
Q

Pneumonia in kids - labs

A

WBC elevated

CXR is more variable than adults, typically lacks classic lobar consolidation

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15
Q

Pertussis

A

“Whooping Cough”

Highly communicable, not all vaccinated seroconvert - can lose immunity over time

Dangerous for small infants - respiratory distress from coughing is what kills them

Lasts 4-12 weeks

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16
Q

Pertussis causative agent

A

Bordetella pertussis (Gram negative, aerobic, encapsulated coccobaccilus)

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17
Q

Pertussus presentation

A

Insidious onset with URI sx, +/- slight fever, cough but not paroxysmal

Cough for weeks, becomes paroxysmal with classic “whoop” after 2 weeks - this lasts 2-4 weeks

Cough so hard they vomit

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18
Q

Pertussis labs

A

Nasal swab for culture (Bordet-Gengou medium)

Or nasal swab for PCR - more sensitive, results in 3-7 days

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19
Q

Pertussis Treatment

A

Tx while awaiting labs - only shortens cough if tx in early phase

Tx prevents further transmission

Erythromycin for 14 days

Azithromycin for 5-7 days

Pt can cough for 3 months - educate!

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20
Q

Pediatric Infectious Disease Pearls

A

Bronchiolitis - RSV w/ wide spectrum -> peaks ~6 months old

Difficult to distinguish bronchitis from pneumonia or bacterial from viral -> tx with Abx

Pertussis -> Tx w/ confirmed exposure, dont wait for labs

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21
Q

Cystic fibrosis pneumonia treatment

A

Aminoglycoside (cover pseudomonas)

Piperacillin/Ticarcillin (antipseudomonal PCN)

bronchodilators, O2 as needed, myolytics, possible steroids

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22
Q

Cystic fibrosis diagnostic tests

A

Sweat chloride testing

DNA Assay

IRT Assay

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23
Q

Cystic fibrosis

A

Autosomal recessive

Exocrine gland system disease

defective chloride channels -> highly viscous secretions

Causes both respiratory and pancreatic insufficieny

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24
Q

Cystic fibrosis treatment

A

Pulmonary: bronchodilators, mucolytics, steroids, Abx

Pancreatic: enzyme and vitamin supplements, high-caloric high-protein diet

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25
Q

Cystic fibrosis morbidity

A

Progressive obstructive lung disease

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26
Q

Cystic fibrosis presentations

A

Meconium ileus (not passed w/in 24 hrs of birth)

abdominal distention with thick, sticky meconium

infantile failure to thrive, respiratory compromise, or both

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27
Q

Fetal lung development

A

Cannalicular stage - 16-25th week -> lungs transition to viable

Sacular stage - 24th week -> gas exchange is now possible

Surfactant delivered during 3rd trimester

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28
Q

Respiratory Distress Syndrome of Newborn

A

Commonly in preterm infants

Due to pulmonary surfactant deficiency

Inflammation, pulmonary edema, and hypoxemia also contribute

28 weeks and less at greatest risk

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29
Q

Respiratory Distess Syndrome of the Newborn Clinical manifestations

A

Tachypnea

Nasal flaring

Expiratory grunting

Accessory muscle breathing

Cyanosis

Abnormal pulmonary function w/in 48 hrs post-birth

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30
Q

Respiratory Distress Syndrome of Newborns Treatment

A

Surfactant

CPAP

O2

Antinatal glucocorticoids

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31
Q

Acute bronchitis common causes

A

Viral (80-90% all cases) - usually influenza A and B

Bacteria - strep pneumo, h-flu, Chlamydia and Mycoplasma

Have to r/o Bordatela pertussis cause

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32
Q

Whooping cough organism and treatment

A

Bordatella pertussis

Tx w/ a macrolide

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33
Q

Acute bronchitis Abx for <65 yo, no cardiac disease, FEV1> 50%, or <3 exacerbations per year

A

Azithromycin - 500 mg PO day 1 - 250 mg PO x4 days

Clarithromycin - 250-500 PO BID x7-14 days

Doxycycline - 100 mg PO BID x7 days

Bactrim (160/800) - 1 tab PO BID x10-14 days

Cefuroxime - 250-500 PO q12 hrs x10 days

Cefdinir - 300 PO BID x5-10 days

Cefpodoxime - 200 PO q12 hrs x10 days

Make sure to tx w/ alternative class if Abx use w/in 3 months

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34
Q

Acute bronchitis Abx for pts w/ COPD exacerbation, >65 y/o

A

Consider hospitalization

Augmentin - 1 tab PO BID x7-10

Fluroquinalones - Cipro if Pseudomonas risk

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35
Q

Latent TB treatment

A

Isonazid for 6-9 months ->9 if HIV+

OR isonizaid + rifapentine for 3 months if HIV-

OR isonizaid + rifampin for 3 months if HIV+

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36
Q

Active TB treatment

A

Isonazid + Rifampin + Ethambutol + Pyrazinamide for 2 months

THEN Isonazid + rifampin for 4 months

Increase tx to 9 months if sputum culture is not negative at 8 weeks

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37
Q

Aspergillosis

A

Commonly affect immunosuppressed

Fungal spores found in soil/dead matter

Hemopytsis, cough, fever, malasie, wheezing, weight loss

CXR nonspecific

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38
Q

Aspergillosis treatment

A

Voriconazole

Ampho B - watch for dizziness, N/V/D, SOB, fever, weight loss

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39
Q

Abx effective against bactera lacking a cell wall

A

Macrolides

Imipenim

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40
Q

Pneumonias with a non-productive cough

A

Mycoplasma

Chlamydia

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41
Q

CXR shows cavitary lesion and pleural effusions

A

H-flu

Staph aureus

Anaerobic

TB

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42
Q

Legionella in lung

A

lower lobes

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43
Q

Klebsiella in lungs

A

upper lobes

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44
Q

HAP common bacteria

A

Pseudomonas

Staph aureus

Enterobacter

Klebsiella

E. coli

45
Q

leukopenia sign of

A

sepsis

46
Q

Intrapulmonary pressure

A

pressure w/in the alveoli

becomes more negative with chest expansion to suck air into lungs

47
Q

Intrapleural pressure

A

Negative pressure in the pleural space

Keeps lungs flush against chest wall and eases chest wall expansion

May be lost if fluid collects in pleural space -> lung cannot fully expand

48
Q

Light’s criteria

A

Has to meet any one => exudative

  1. Pleural fluid protein/serum protein ratio > 0.5
  2. Pleural fluid LDH/serum LDH > 0.6
  3. Pleural fluid LDH > 2/3 lab normal serum LDH (~ >200)
49
Q

Benign pulmonary neoplasms

A

grow in fairly ordered manner

stick together w/out migration

encapsulated with smooth borders

Hamartomas and granulomas

50
Q

Hamartoma

A

local tissue grows in disorganized manner

often have bronchial tissue and calcifications

51
Q

Granuloma

A

chronic inflammatory lesions with macrophages

TB, sarcoidosis, histoplasmosis, cryptococcosis

52
Q

Most common metastatic to lungs

A

Breast

Colon

Prostate

Bladder

53
Q

Malignant cells

A

Tumors

rapid growth w/ continuous division

Little/no differentiation with most normal function lost

Irregular, invasive borders that metastasize

54
Q

Malignant cell spread routes

A

Transcoelomic

Lymphatic

Hematogenous

Iatrogenic

55
Q

Transcoelomic spread

A

Along the surface of an organ

Mesothelioma

56
Q

Lymphatic spread

A

Most common route for carcinomas

57
Q

Hematogenous spread

A

Most common route for sarcoidosis

58
Q

Iatrogenic spread

A

Transplantation or implantation

59
Q

Small cell lung cancer (SCLC)

A

Primitive neuroendocrine cells

Metstasizes early, commonly to brain (90%)

Aggressive, rapidly fatal, few curable

Highly prevelant among smokers

60
Q

SCLC hormone production

A

Adrenocorticotrophic hormone (ACTH)

Arginine vasopressin (AVP)

Atrial natriuretic factor (ANF)

Gastrin-releasing peptide (GRP)

61
Q

Types of non small cell lung carcinomas

A

80% all lung cancers

Adenocarcinoma

Squamous cell carcinoma

Large cell carcinoma

Adenocarcinoma most common

All have similar prognosis and treatment, but different locations and spread patterns

62
Q

Adenocarcinoma

A

Associated w/ smoking, but also most common lung CA in never-smokers

Peripheral -> arises from epithelium

May see metastatic dx before primary symptoms

63
Q

Bronchoalveolar adenocarcinoma

A

subtype of adenocarcinoma

More aggressive, rapidly progressive

Occurs in young (2nd decade) - non-resolving focal/bilateral “pneumonia”

64
Q

Squamous cell carcinoma

A

“Epidermoid carcinoma”

Occurs in proximal bronchi - tends to obstruct

local, infiltrating nest of tumor cells w/ central necrosis -> cavitation

late metastasis

65
Q

Large cell carcinoma

A

Lest common, Dx of exclusion

Large, poorly differentiated cellular mass w/ prominent necrosis

Occurs peripherally

Syncytial (multinucleate cytoplasmic mass) groups and single cells

66
Q

Lung cancer commonly metastasizes to:

A

Brain

Adrenals (50%)

Liver(30-50%)

Lymph node

Bone

67
Q

Routine lab test indicitave of metastatic disease

A

Hematocrit: <40% men, <35% women

Elevated alkaline phosphatase, GGT, SGOT, and calcium levels

68
Q

Horner’s Syndrome

A

Miosis (smaller pupil), eyelid droop, and loss of sweating on one side of face

Due to superior cervical ganglion lesion

OR inflammatory involvement of cervical lymph nodes and proximal brachial plexus

69
Q

Pancoast’s Syndrome

A

Shoulder pain radiaing in the ulnar distribution

Due to apex tumor extension to C8, T1, T2 nerves

Rib destruction possible

70
Q

Superior vena cava syndrome (SVCS)

A

Venous dilation

90% due to bronchogenic cancer

Swelling of face/tongue/neck/arms, SOB, hoarseness, nasal congestion

HA, syncopy, lethargy from cerebral edema

71
Q

Pediatric Respiratory rate

A

Newborn: 30-50

Infant-12yo: 20-30

Adolescent (13+): 12-20

72
Q

Pediatric Heart rate

A

Newborn: 120-160

Infant-5yo: 80-140 (120 5yo)

6-12 yo: 70-110

13+: 55-105

73
Q

Pediatric Systolic BP

A

Newborn: 50-70

Infant (1-12mo): 70-100

1-12 yrs: 80-120

74
Q

Paraneoplastic syndromes

A

Cachexia - common w/ NSCLC

Hypercalcemia - common w/ squamous cell CA

Hypertropic pulmonary osteoarthropathy - clubbing of fingers and toes

75
Q

Eaton-lambert syndrome

A

Autoimmune response -> proximal muscle weakness w/ depressed deep tendon reflexes

usually occurs in lower extremities

r/o Myasthenia gravis: strength should improve w/ serial effort

76
Q

Solitary pulmonary nodule

A

Likely benign if <5mm

Likely malignant if >3cm

If likely benign - serial CT over 2 years - shouldnt grow

If likely malignant - tissue bx & resect

77
Q

Multiple pulmonary nodules

A

Usually malignant if >1cm - usually mets

If benign - infection, wegners, AV malformation, pneumoconiosis

Pattern matters

78
Q

Lung cancer workup

A

CBC, CMP, CXR, PFT

Bronchoscopy or fine needle bx (for peripheral)

Stage: CT, PET, MRI

79
Q

TNM Staging

A

T = primary tumor, get location and size

N = regional lymph node metastasis

M = distant metastasis

80
Q

Small cell lung cancer stages

A
  1. Limited = confined to single hemi-thorax
  2. Extensive = malignant pleural effusion or metastatic disease
81
Q

Non small cell lung cancer stages

A

Stage 1 = confined to lung

Stage 2 = spread to lung lymph nodes

Stage 3 = spread to mediastinal lymph nodes

  • IIIA = lymph nodes on same side as lung
  • IIIB = wider spread

Stage 4 = spread to other lobes or distal metastasis

82
Q

Surgical lung cancer treatment

A

limited disease w/ resectable lesion

lobectomy most effective w/ NSCLC

83
Q

Chemotherapy lung cancer treatment

A

4-6 cycles recommended

Drug combinations to kill cancer cells

May lessen symptoms with widespread disease

84
Q

Radiation lung cancer treatment

A

Mediastinum, node positive-limited stage disease

High energy X-rays to kill cells

Significant side effect - radiation pneumonitis in 15%

Get PFTs first to ensure sufficient function

85
Q

Targeted lung cancer treatment

A

Stop action of abnormal proteins that promote growth

Avastin - prevents new blood vessel formation

Tarceva - helps in NSCLC

86
Q

Adjucant lung cancer treatment

A

Treatment w/ chemo/radiation/target therapy before or after surgery to prevent reoccurance

87
Q

SCLC treatment

A

Limited stage: 4-6 cycles chemo w/ simultaneous radiation

Extensive stage: chemo, consider radiation w/ painful bone mets or SVC syndrome

Cranial mets are common - consider prophylactic radiation

88
Q

NSCLC treatment

A

Stage 1: resect, consider adjucant tx

Stage 2: resect w/ nodes, chemo +/- radiation

Stage 3 - IIIA: radiation + chemo, consider resection

IIIB: chemo +/- radiation

Stage 4: chemo

89
Q

Types of Respiratory failure

A

Type 1 - Hypoxia (pO2 <60)

Type 2 - Hypercapneia (pCO2 >50)

90
Q

Type 1 Respiratory failure reasons

A
  1. low PiO2 - high altitute
  2. Hypoventilation
  3. Diffusion - pneumonia, fibrosis
  4. Shunt - blood not getting oxygenated
  5. V/Q mismatch - treat w/ O2 to differentiate from shunt - will respond
91
Q

Type 2 respiratory failure reasons

A

Increased CO2 production (sepsis, fever, burn)

Alveolar hypoventilation

  • reduced minute volume
  • increased dead space
92
Q

Hypoxemia signs

A

Cyanosis

Restlessness

Confusion

Anxiety

Tachypnea

93
Q

Signs of Hypercapnia

A

Dyspnea

HA

HTN

Tachycardia w/ Tachypnea

AMS

94
Q

BiPAP good for what pts in emergency cases?

A

COPD and CHF

95
Q

Danger signs of impending respiratory failure

A

Deteriorating mental status

silent chest

pulsus paradoxus

CO2 retention

Acidosis/Cyanosis/Hypoxemia

96
Q

Acute asthma medical therapy

A

Albuterol - 4-8 puff MDI q20 mins for up to 4 hours

Ipratropium bromide - 8 puffs MDI q20mins up to 3 hrs

Methylprednisolone - 60-125 g IV

Epinephrine - .3-.5 mg IM

Terbutaline - .25 mg SQ q20 mins x3 doses

DO NOT GIVE BOTH EPI AND TERBUTALINE

97
Q

Emphysema predominant COPD exacerbation first complaint

A

Dyspnea

appear uncomfortable, accessory muscle use

98
Q

COPD Chronic bronchitis pts exacerbation first complaint

A

Chronic, productive cough

Overweight and cyanotic, can appear comfortable

99
Q

COPD Exacerbation treatment

A

Ipretropium MDI 4-8 puggs q1-2 hrs

Albuterol 4-8 puffs q1-2hrs

Corticosteroids - 30-40 prednisome, 125 methylprednisone

May need NIPPV if severe, hypercapnic, acidemia

100
Q

High altitude illness parameters

A

Moderate altitude - 8000-10000ft

High altitude - 10,000-18,000 ft

101
Q

High altitude sickness pathophysiology

A

Hypobaric hypoxic condition

  • fluid retention
  • vasoconstriction
  • pulmonary artery HTN
  • increased endothelial permeability
  • edema
102
Q

High altitude illness management

A

Stop ascent/descend

Supplemental O2

Axetazolamide (250 BID/TID)

Dexamethasone (8mg loading, 4 mg q6hrs)

Antiemetics

103
Q

High altitude pulmonary edema (HAPE)

A

Most common fatal high-altitude ilness

-occurs above 8,000 ft, usually 2-4 days after activity

Dyspnea @ rest, cough, fatigue, HA

104
Q

HAPE treatment

A

Hyperbaric tx

2,000 ft descent

O2/CPAP

Rest/warth

Acetazolamide/dexamethasone

Ascend no more than 2,000 ft/night

105
Q

Carbon monoxide treatment

A

100% O2 for 4 hours

Hyperbaric if severe/underlying illness/pregnant

106
Q

Cyanide poisoning

A

Hard to confirm

Consider in all pts w/ smoke inhalation and CNS/CV findings

Can cause immediate respiratory arrest

Increased lactate production with anion gap metabolic acidosis

107
Q

Cyanide poisoning treatment

A

Inhaled and injected nitrites, injected sodium thiosulfate

-promotes cyanide binding/excretion via kidneys

3-step kit

CI w/ concomitant CO poisoning

supplemental O2

108
Q

Pneumothorax treatment

A

Needle decompression

16 G needle mid-clavicular line over 2nd rib

Pulmonology (2 decks)

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