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Clinical Medicine > Test 2 - Pulmonary > Flashcards

Test 2 - Pulmonary Flashcards

1
Q

EOD Asthma

A
  1. Episodic/chronic Sx of airflow obstruction
  2. Reversibility of airflow obstruction, either spontaneously or following bronchodilator therapy
  3. Sx usually worse at night or in early morning
  4. Prolonged expiration & diffuse wheezes on physicals
  5. Limitation of airflow on PFT or +bronchoprovocation challenge
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2
Q

EOD COPD

A
  1. Hx of smoking
  2. Chronic cough, dyspnea & sputum production
  3. Rhonchi, dec. intensity of breath sounds & prolonged expiration on physical
  4. Airflow limitation on PFT that is not fully reversible & most often progressive
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3
Q

EOD Bronchiectasis

A
  1. Chronic productive cough w/ dyspnea & wheezing

2. Radiographic findings of dilated, thickened airways & scattered, irregular opacities

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4
Q

EOD Cystic Fibrosis

A
  1. Chronic or recurrent productive cough, dyspnea & wheezing
  2. Recurrent airway infections or chronic colonization w/ H influenza, P aeroginosa, S aureus or Burkholderia cepacia. Bronchiectasis & scarring on CXR
  3. Airflow obstruction on spirometry
  4. Pancreatic insufficiency, recurrent pancreatitis, distal intestinal obstruction syndrome, chronic hepatic disease, nutritional deficiencies, or male urogenital abnormalities
  5. Sweat Cl concentration >60 on two occasion or gene mutation
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5
Q

EOD Bronchiolitis

A
  1. Insidious onset of cough & dyspnea
  2. Irreversible airflow obstruction on PFT
  3. Minimal findings on CXR
  4. Relevant exposure or risk factor: toxic fumes, viral infections, organ transplantation, connective tissue disease
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6
Q

EOD Interstitial Lung Disease

A
  1. Insidious onset of progressive dyspnea & non-productive chronic cough
  2. Tachypnea, small lung volumes, bibasilar dry rales
  3. Digital clubbing & RHF w/ advanced disease
  4. CXR w/ low lung volumes & patchy distribution of ground glass, reticular, nodular, reticulonodular or cystic opacities
  5. Reduced lung volumes, pulmonary diffusing capacity & 6-min walk distance, hypoxemia w/ exercise
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7
Q

EOD Sarcoidosis

A
  1. Sx related to lung, skin, eyes, peripheral nerves, liver, kidney, heart & other issues
  2. Demonstration of noncaseating granulomas in a Bx
  3. Hepatosplenomegaly, hypercalcemia, inc. ACE
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8
Q

EOD Community Acquired Pneumonia

A
  1. Fever or hypothermia, tachypnea, cough w/ or w/o sputum, dyspnea, chest discomfort, sweats or rigors
  2. Bronchial breath sounds or inspiratory crackles
  3. Parenchymal opacity on CXR
  4. Occurs outside of the hospital or w/in 48 hrs of hospital admission in a Pt not residing in a long-term care facility
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9
Q

EOD Nosocomial pneumonia

A
  1. At least 2 of: fever, leukocytosis, purulent sputum
  2. New or progressive parenchymal opacity on CXR
  3. Especially common in Pts requiring intensive care or mechanical ventilation
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10
Q

EOD anaerobic pneumonia & lung abscess

A
  1. Hx or predisposition to aspiration
  2. Indolent Sx, including fever, wt loss, malaise
  3. Poor dentition
  4. Foul-smelling purulent sputum
  5. Infiltrate in dependent lung zone, w/ single or multiple areas of cavitation or pleural effusion
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11
Q

EOD Pulmonary Tuberculosis

A
  1. Fatigue, Wt loss, fever, night sweats & productive cough
  2. Risk factors for acquisition of infection: household exposure, incarceration, drug use, travel to an endemic area
  3. CXR - pulmonary opacities, most often apical
  4. Acid-fast bacilli on smear of sputum of sputum culture + for M tuberculosis
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12
Q

EOD Pulmonary Disease caused by Non-TB Mycobacteria

A
  1. Chronic cough, sputum production & fatigue; less commonly malaise, dyspnea, fever, hemoptysis & wt loss
  2. Parenchymal opacities on CXR, often w/ thin-walled cavities that spread contigously & often involve overlying pleura
  3. Isolation of non-TB mycobacteria in a sputum culture
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13
Q

EOD Histoplasmosis

A
  1. Linked to bird droppings & bat exposure, common along river valleys
  2. Most asymptomatic, respiratory illness most common problem
  3. Widespread disease common in AIDs or other immunosuppressed states w/ poor prognosis
  4. Bx of affected organs w/ culture or urinary polysaccharide antigen
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14
Q

EOD Coccidiodomycosis

A
  1. Flu-like illness w/ malaise, fever, backache, HA & cough
  2. Erythem nodosum common w/ acute infection
  3. Dissemination may result in meningitis, bony lesions or skin & soft tissue abscesses
  4. CXR findings vary from pneumonitis to cavitation
  5. Serologic tests useful, spherules containing endospores demonstrable in sputum or tissues
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15
Q

EOD Pneumocystosis (PCP)

A
  1. Fever, dyspnea, nonproductive cough
  2. Bilateral diffuse interstitial disease w/o hilar adenopathy by CXR
  3. Bibasilar crackles on auscultation in many cases
  4. Reduced pO2
  5. P jiroveci in sputum, bronchoalveolar lavage fluid or lung tissue
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16
Q

EOD Aspergillosis

A
  1. MCC of non-candidal invasive fungal infection in stem cell or organ transplant Pts
  2. Predisposing factors: leukemia, bone marrow or organ transplant, late HIV infection
  3. Pulmonary, sinus & CNS are most common disease sites
  4. Demonstration of galactomannan or beta-D-glucan in serum or other body fluid samples is useful for early Dx & Tx
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17
Q

EOD Respiratory Syncytial Virus & Other Paramyxoviruses

A
  1. RSV is a major cause of morbidity & mortality at extremes of age
  2. Care is supportive
  3. A monoclonal antibody against RSV, palivizumab, is good but expensive prophylaxis among Pts w/ certain at-risk pulmonary conditions
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18
Q

EOD Seasonal Influenza

A
  1. Abrupt onset w/ fever, chills, malaise, cough, coryza & myalgias
  2. Aching, fever & prostration out of proportion to catarrhal Sx
  3. Leukopenia
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19
Q

EOD Avian Influenza (H5N1)

A
  1. Mostly from SE Asia & Egypt
  2. Clinically indistinguishable from influenza
  3. Rapid antigen assays to confirm Dx
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20
Q

EOD H1N1

A
  1. Flu-like illness w/ consistent epidemiologic background

2. Respiratory swab

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21
Q

EOD Severe Acute Respiratory Syndrome (SARS)

A
  1. Mild, moderate or severe respiratory illness
  2. Travel to endemic area w/in 10 days before Sx onset (Places in Asia)
  3. Persistent fever, dry cough, dyspnea
  4. Dx confirmed by antibody testing or isolation of virus
  5. No specific Tx
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22
Q

EOD Pulmonary Venous Thromboembolism

A
  1. Predisposition to venous thrombosis
  2. Dyspnea, CP, hemoptysis, syncope
  3. Tachypnea & widened alveolar-arterial pO2 difference
  4. Elevated rapid D-dimer & characteristic defects on CT arteriogram of chest, ventilation-perfusion scan or pulmonary angiogram
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23
Q

EOD Pulmonary HTN

A
  1. Dyspnea, fatigue, CP & syncope on exertion
  2. Narrow splitting of 2nd heart sound w/ loud pulmonary component, findings of RV hypertrophy & cardiac failure in advanced disease
  3. Hypoxemia & inc. wasted ventilation on PFTs
  4. EKG evidence of RV strain or hypertrophy & RA enlargement
  5. Enlarged central pulmonary arteries on CXR
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24
Q

EOD Obstructive Sleep Apnea

A
  1. Daytime somnolence or fatigue
  2. Hx of loud snoring w/ witnessed apneic events
  3. Overnight polysomnography demonstrating apneic episodes w/ hypoxemia
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25
Q

EOD Acute Respiratory Distress Syndrome

A
  1. Acute onset of respiratory failure
  2. Bilateral radiographic pulmonary opacities
  3. Absence of elevated LA pressure
  4. Ratio of pO2 in arterial blood to fraction conc. of inspired O2 (FIO2) <200, regardless of the level of PEEP
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26
Q

EOD Cor Pulmonale

A
  1. Sx & signs of chronic bronchitis & pulmonary emphysema
  2. Elevated JVP, parasternal lift, edema, hepatomegaly & ascites
  3. EKG tall peaked P waves, R axis dev & RVH
  4. CXR - enlarged RV & PA
  5. Echo or radionuclide angiography excludes primary LV dysfunction
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27
Q

EOD Pleural Effusion

A
  1. May be asymptomatic; CP common w/ pleuritis, trauma or infection, dyspnea w/ large effusions
  2. Dullness to percussion & dec. breath sounds over the effusion
  3. Radiographic evidence of pleural effusion
  4. Diagnostic findings on thoracentesis
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28
Q

EOD Spontaneous Pneumothorax

A
  1. Acute onset of unilateral CP & dyspnea
  2. Minimal physical findings in mild cases
  3. Unilateral chest expansion, dec. tactile fremitus, hyperresonance, diminished breath sounds, mediastinal shift, cyanosis & HOTN in tension pneumo
  4. Presence of pleural air on CXR
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29
Q

EOD Bronchogenic Carcinoma

A
  1. New cough or change in chronic cough
  2. Dyspnea, hemoptysis, anorexia & wt loss
  3. Enlarging nodule or mass, persistent opacity, atelectasis or pleural effusion on CXR or CT
  4. Cytologic or histologic findings of lung CA in sputum, pleural fluid or Bx
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30
Q

EOD Mesothelioma

A
  1. Unilateral, nonpleuritic CP & dyspnea
  2. Distant (>20 yrs) Hx of exposure to asbestos
  3. Pleural effusion or pleural thickening or both on CXR
  4. Malignant cells in pleural fluid or tissue Bx
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31
Q

COPD vs asthma pathophysiology

A

C - CD8 cells, macrophages & neutrophils

A - CD4, eosinophils, leukotrienes, IgE

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32
Q

Obstruction vs restriction

A

O - big lungs, dec. airflow, normal/inc. lung V, normal/dec. DLCO

R - Normal airflow, dec. lung V, normal/dec. DLCO

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33
Q

FEV1/FVC ratio

A

Amount of air exhaled in 1st sec compared to total amount of air exhaled

Above LLN - 70% = restrictive or normal
If FVC is below normal = obstructive

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34
Q

What diseases can cause a dec. DLCO?

A
  1. Emphysema
  2. Fibrosis
  3. Pulmonary vascular disease
  4. Anemia
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35
Q

What disease can cause an inc. DLCO?

A

Inc. pulmonary capillary blood volume

  1. Polycythemia
  2. Pulmonary hemorrhage
  3. L to R shunt
  4. Asthma
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36
Q

What are the obstructive diseases?

A
  1. Emphysema
  2. Chronic bronchitis
  3. Asthma
  4. Bronchiectasis
  5. Cystic Fibrosis
  6. Sarcoidosis (sometimes)
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37
Q

What are the restrictive diseases?

A
  1. Pleural disease - effusions, mass
  2. Alveolar disease - edema, infiltrates
  3. Interstitial disease - fibrosis, sarcoidosis
  4. Neuromuscular disease - ALS, Myasthenia Gravis, Guillan-Barre
  5. Diaphragmatic paralysis
  6. Thoracic cage abnormality - obesity, kyphoscoliosis
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38
Q

Common S/S w/ obstructive diseases?

A
  1. DOE, cough, wheeze
  2. Smoker/exsmoker
  3. Quiet lungs/wheeze
  4. FH
  5. Barrel chest
  6. Pursed lip breathing
  7. Clubbing in CF
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39
Q

Common S/S w/ restrictive diseases?

A
  1. DOE, cough, orthopnea
  2. Smoker/exsmoker
  3. Crackles/rales
  4. FH
  5. Abnormal chest wall
  6. Clubbing
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40
Q

What is emphysema?

A

permanent enlargement of the airspaces distal to the terminal bronchioles w/ destruction of their walls w/o obvious fibrosis
-T lymphocytes, macrophages release elastases leading to destruction of airspaces

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41
Q

What is chronic bronchitis?

A

chronic, productive cough for 3 months in 2 successive years

-CD8 T lymphocytes, neutrophils

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42
Q

S/S Emphysema

A

Pink Puffers

  1. Dyspnea
  2. Thin
  3. Accessory muscle use
  4. Quiet chest
  5. Presents after 50
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43
Q

S/S Chronic Bronchitis

A

Blue Bloaters

  1. Chronic cough
  2. Productive mucopurulent sputum
  3. DOE
  4. Overweight & cyanotic
  5. Peripheral edema
  6. Noisy chest - rhonchi & wheezes
  7. Presents in late 30s & 40s
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44
Q

Causes of COPD

A
  1. Smoking
  2. alpha-1 antitrypsin deficiency
  3. Chemicals/pollution
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45
Q

Chest exam findings in COPD

A
  1. Hyperinflation w/ inc. A/P
  2. Inc. resonance
  3. Dec. breath sounds & early inspiratory crackles
  4. Wheezing may not be present at rest but can be evoked w/ forced expiration/exertion
  5. Prolonged duration of expiration
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46
Q

CXR w/ COPD

A

Hyperinflation of lungs & flat diaphragms
if emphysema main - parenchymal bullae or subpleural blebs
bronchitis - nonspecific peribronchial & perivascular markings

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47
Q

Tx COPD

A

A. FEV1 >50%, 0-1 exacerbations/yr, low risk
- SABA PRN, Anticholinergic/beta-agonist
B. A w/ more Sx
- SABA w/ pulmonary rehab, LABA, anticholinergic
C. FEV1 2 exac/yr
- SABA w/ pulmonary rehab, LABA w/ corticosteroid or anticholinergic, consider surgery
D. C w/ more Sx
- LABA + corticosteroid or anticholinergic, LABA + corticosteroid + phosphodiesterase inhibitors, consider surgery

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48
Q

What can cause asthma symptoms?

A
  1. Extrinsic allergies
  2. Allergic bronchopulmonary aspergillosis
  3. Intrinsic asthma
  4. Extrinsic nonallergenic
  5. Aspirin sensitivity
  6. Exercise induced
  7. Asthma w/ COPD
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49
Q

What can cause bronchiectasis?

A
  1. Cystic Fibrosis
  2. Alpha-1 antitrypsin deficiency
  3. Hypogammaglobulinemia
  4. Common variable immunodeficiency
  5. Primary ciliary diskinesia
  6. Congenital anatomic defects
  7. Pulmonary infections -TB, pertussis
  8. Foreign body aspiration
  9. Tumors
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50
Q

What disease causes a ‘finger in glove’ appearance on a CXR?

A

Bronchiectasis

-thickened bronchial walls w/ ring shadows

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51
Q

Dx Bronchiectasis

A
  1. Crackles, esp in bases
  2. Clubbing
  3. Cachexia
  4. Lady Windmere Syndrome
  5. C&S - H influenza, Pseudomonas aeruginosa, S PNA
  6. PFTs normal at 1st, restrictive or obstructive later
  7. CXR - finger in glove appearance
  8. CT - dilated & thickened airways, cystic lesions
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52
Q

Tx Bronchiectasis

A
  1. Hydration
  2. O2
  3. Postural drainage w/ chest percussion or flutter valves
  4. Smoking cessation
  5. Flu & pneumovax vaccines
  6. Surgical resection maybe
  7. Abx
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53
Q

What is the most common fatal hereditary disorder in whites?

A

Cystic Fibrosis

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54
Q

What is the most common cause of severe chronic lung disease in the young?

A

Cystic Fibrosis

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55
Q

S/S Cystic Fibrosis

A
  1. Inc. AP diameter
  2. Basilar crackles
  3. Hyperresonance to percussion
  4. Clubbing
  5. Salty taste to skin
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56
Q

PFT & CXR in Cystic Fibrosis

A
  1. Dec. FEV1/FVC ratio
  2. Dec. FEV1
  3. Inc. TLC
  4. Dec. DLCO
  5. Diffuse interstitial disease w/ bronchiectasis & nodular densities of mucoid impactions
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57
Q

Causes of interstitial lung disease

A
  1. Hypersensitivity pneumonitis - birds, hottub, molds, fungus
  2. Idiopathic
  3. Drugs - chemo, radiation, amiodarone, methotrexate, macrodantin
  4. Occupations - foundry, mining, stoneworker, asbestos
  5. Connective tissue disorders - scleroderma, RA, polymyositis, lupus
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58
Q

Idiopathic Pulmonary Fibrosis

A
  1. Usually older people
  2. M>F
  3. Insidious onset
  4. Dyspnea, dry cough
  5. Asymptomatic, routine CXR finding
  6. FH
59
Q

Findings w/ ILD

A
  1. Non-specific
  2. Bilateral rales
  3. Connective tissue disease signs
  4. Clubbing
  5. Cor Pulmonale
60
Q

CXR ILD

A
  1. Reduced expansion

CT is key for diagnosis

61
Q

Which diseases have a lower lung zone predominance?

A
  1. Idiopathic pulmonary fibrosis
  2. Connective tissue disease assoc. w/ ILD
  3. Asbestosis
62
Q

Which diseases have an upper lung zone predominance?

A
  1. Sarcoidosis
  2. Hypersensitivity pneumonitis
  3. Silicosis
  4. Langerhans Cell Histiocytosis
  5. Ankylosing spondylitis
63
Q

CT w/ idiopulmonary fibrosis

A
  1. Subpleural reticular changes inc. in bases
  2. Minimal ground glass
  3. Honeycombing
  4. Bronchiectasis

May need Bx to diagnose

64
Q

Tx idiopulmonary fibrosis

A

No real Tx

  1. O2
  2. Flu shot & pneumovax
  3. Pulmonary rehab
  4. Lung transplant
65
Q

S/S Asbestosis

A
  1. Inspiratory crackles
  2. Clubbing
  3. Pleural plaques
  4. Linear opacities in lower lungs
  5. Restrictive PFT
  6. Exertional dyspnea
  7. Dry cough
    Lung Bx for definitive Dx
    Supportive Tx
66
Q

S/S Silicosis

A

May be asymptomatic

  1. Hilar node calcification - egg shell pattern
  2. Small rounded opacities
  3. Tachypnea
  4. Prolonged expiration, wheezes, rhonchi, rales
  5. Cor pulmonale, cyanosis possible
  6. Restrictive PFT
67
Q

Diseases w/ caseating granulomas

A

central necrosis or dead cells

  1. TB
  2. Histoplasmosis
  3. Coccidiomycosis
  4. Bastomycosis
  5. Cat scratch fever
68
Q

Diseases w/ non-caseating granulomas

A

NOT related to infection

  1. Sarcoidosis
  2. Berylliosis
  3. Wegeners granulomatosis
  4. Crohns
69
Q

What is Lofgren’s syndrome?

A

Seen in sarcoidosis

fever, bilateral hilar adenopathy & erythema nodosum

70
Q

What is Heerdfordt Syndrome?

A

Seen in Sarcoidosis

Fever, uveitis & parotitis w/o VII nerve involvement

71
Q

What is the most common neurologic finding in Sarcoidosis?

A

CN VII Nerve palsy

Bell’s Palsy

72
Q

What are common findings w/ cardiac Sarcoidosis?

A
  1. CP
  2. Palpitations/Fluttering/skipping
  3. PVCs
  4. AV Blocks
  5. PSVT

Tx w/ steroids

73
Q

CXR scale in sarcoidosis

A

0 - Normal
1 - Bilateral hilar adenopathy
2 - BHA w/ parenchymal infiltrates (esp upper & middle lobes)
3 - Parenchymal infiltrates w/o BHA
4 - Fibrotic parenchymal disease w/ retraction of the hilar

74
Q

CURB-65 scoring

A 
Confusion
U BUN >20
RR >30 breaths/min
B SBP <60
65 or older

0-1 OutPt
2 short inPt
3 0 InPt
4-5 InPt/ICU

75
Q

What are the common causes of CAP?

A
  1. Strep pneumonia
  2. H influenza
  3. M Catarrhalis
  4. S aureus
  5. K pneumonia
  6. Viral
76
Q

Which PNA shows a current jelly sputum?

A

& hemoptysis

K pneumonia

Common in EtOH users

77
Q

Which PNA is linked to air conditioners?

A

Legionella
Diarrhea, hyponatremia
Elderly, smokers, IC

78
Q

Which PNA should you suspect w/ acute rigors?

A

S pneumonia

Rusty colored sputum

79
Q

What is required on CXR to Dx CAP?

A

Pulmonary opacity

80
Q

How can you differentiate btwn viral/bacterial CAP?

A

Procalcitonin test

81
Q

Most common pathogens in Nosocomial PNA

A

HAP - MRSA, MSSA, Pseudomonas
VAP - Acineteobacter, Stenotrophomonas, MDROs
HCAP - S penumonia, H influenza
Anaerobic - Bacteroides, Fusobacterium

82
Q

What typically causes viral PNA?

A
  1. Influenza
  2. RSV
  3. Adenovirus
  4. Parainfluenza
  5. Metapneumovirus
83
Q

What are some complications of influenza?

A
  1. Secondary bacterial PNA
  2. Sinusitis, OM, purulent bronchitis
  3. Influenza PNA
  4. Inc. risk of MI
  5. Rhabdomyolysis
  6. Reye Syndrome
  7. Acute necrotizing encephalopathy
  8. Guillan Barre Syndrome
84
Q

Tx for influenza

A
  1. Balanced electrolyte fluids
  2. NSAIDS, APA
  3. Neuraminidase inhibitors
    -Zanamivir
    -Osetlamivir
    -Tamilflu
    …best if 48h after Sx onset
85
Q

What is the most common respiratory tract infection?

A

Human rhinovirus Type C

Triggers asthma & COPD
OM, croup, bronchiolitis, PNA

86
Q

What is the MCC of bronchiolitis?

A

RSV
seen in children <6mo
common cause of AOM

87
Q

What is the MCC of croup in kids?

A

Human parainfluenza virus

Tx - mild humidified air, neb epinephrine & steroids

88
Q

Who commonly gets Pertussis?

A

<2 yo
Transmitted via respiratory droplets
Prevent w/ Tdap

89
Q

Which PNA is seen more in COPD Pts?

A

H influenza

90
Q

Stages of Pertussis

A
  1. Catarrhal - sneezing, coryza, malaise, cough at night
  2. Paroxysmal - bursts of harsh coughing followed by high pitching inspiratory whoop
  3. Convalescent - 4 wks after illness onset, cont. cough w/ dec. frequency & severity
91
Q

S/S TB

A
  1. Slowly progressive constitutional
  2. Malaise, anorexial, unexplained wt loss, fever, night sweats
  3. Dry cough becoming purulent later
  4. Blood streaked sputum
  5. Post-tussive apical rales
92
Q

Extrapulmonary findings of TB

A
  1. Scofula Ptts
  2. Meningitis
  3. Pericarditis
  4. Pleuritis w/ effusion
  5. Osteomyelitis
  6. Hepatosplenomegaly
93
Q

ADRs Isoniazid

A

Tx for TB
used in pregnancy
1. Hepatotoxicity
2. Depletes B6 - give pyridoxine

94
Q

Which TB drug causes optic neuritis?

A

Ethambutol

Avoided in kids

95
Q

What labs should you monitor in TB Pts?

A
  1. LFTs
  2. BUN
  3. Serum Creatinine
  4. CBC
  5. Uric acid
  6. Baseline visual acuity & color vision testing
  7. ? monthly for signs of toxicity
  8. CXR baseline & final
96
Q

What can causes a PE?

A
  1. Air (from caths during surgery)
  2. Fat (long bone Fx)
  3. Septic (IE)
  4. Tumor cells (RCC)
  5. Foreign bodies (talc, drug users)
97
Q

S/S PE

A
  1. Dyspnea
  2. Pleuritic CP
  3. Cough, hemoptysis
  4. Palpitations, syncope
  5. Leg swelling & tenderness
  6. Tachycardia
  7. Tachypnea
  8. Inc. S2
  9. Presence of S4
  10. Crackles, wheezing
  11. Pleural friction rub
  12. RV heave
  13. Homan’s sign
98
Q

What is Homan’s sign & when can it be seen?

A

Pain upon dorsiflexion of foot

sign of PE

99
Q

Well’s criteria

A
  1. S/S of DVT
  2. Alternative Dx less likely than PE
  3. HR >100bpm
  4. Immobilization >3days or surgery in past 4 wks
  5. Previous PE/DVT
  6. Hemoptysis
  7. Cancer
    Score >4 PE likely
100
Q

What is Ortner’s syndrome?

A

Hoarseness/cough from compression of L recurrent laryngeal nerve by dilated main PA

Could be caused by Pulmonary HTN

101
Q

S/S Pulmonary HTN

A
  1. Loud P2
  2. Pansystolic murmur of tricuspid regurg
  3. RV heave
  4. JVD
  5. Peripheral edema
  6. Hepatomegaly
    Lungs usually clear
102
Q

EKG changes w/ pulmonary HTN

A
  1. RVH
  2. Rt axis dev
  3. RBBB
    or normal
103
Q

What is normal RV systolic P & when is wrong when it’s raised?

A

28 mmHg

Raised >35 in pulmonary HTN

104
Q

Tx of Pulmonary HTN

A
  1. Anticoagulants
  2. CCBs to lower systemic arterial P
  3. Prostacyclin - pulm vasodilator
  4. Heart-lung transplant usually needed
105
Q

Causes of Cor Pulmonale

A
  1. Anatomic reduction of pulmonary vascular bead
    - Emphysema, ILD, PE
  2. Inc. blood viscosity
    - Polycythemia
  3. Inc. Pulmonary blood flow
    - Congenital heart disease w/ L to R shunts
106
Q

Causes of ARDS

A
  1. Sepsis
  2. Aspiration of gastric contents
  3. PNA
  4. Burns
  5. Chest trauma
  6. Fat embolism from long bone Fx
  7. Near drowning
  8. Pancreatitis
107
Q

Signs of ARDS

A
  1. S3, S4
  2. JVD
  3. LE edema
  4. Cardiomegaly
  5. Effusions
  6. Kerley B lines
108
Q

Tx of ARDS

A

Supportive

  1. Fluid mgmt
  2. DVT prophylaxis
  3. Stress ulcer prophylaxis - PPI
  4. Nutritional support
  5. Sedation/analgesia
  6. PEEP if necessary
  7. Prone ventilation
109
Q

Obstructive vs. Restrictive sleep apnea

A

O - chest & abdomen move but no airflow due to position or anatomy

R - no signal to make you breathe

110
Q

Influenza vaccinations

A

Recommended for everyone >6 mo unless egg allergy, febrile illness, guillan barre

  1. Trivalent inactivated vaccine - Fluzone, more Ag for elderly
  2. Trivalent live attenuated vaccine - contraindication in pregnancy
  3. Tamiful
111
Q

TB CXR

A
  1. Primary Progressive Disease - unilateral lower or middle lobe infiltrates, pleural effusion, hilar adenopathy
  2. Reactivation - cavitary apical disease
  3. Elderly - often lower lobe
  4. Miliary - all over
  5. HIV/Immunocompromised - variable
  6. Resolution - hilar nodules + calcification, pleural scarring, Ranke complexes, bronchiectasis
112
Q

What are Ranke Complexes & when are they seen?

A

calcified primary foci & lymph nodes seen in TB

113
Q

What is the MCC of respiratory disease in premies?

A

Hyaline membrane disease

Deficiency of surfactant

114
Q

Causes of Pulmonary HTN

A
  1. Idiopathic
  2. Heritable - mutation in BMPR2, ALK-1 or ENG
  3. Drug & toxins
  4. Connective tissue disease (scleroderma)
  5. HIV
  6. Portal HTN
  7. Congenital heart disease
  8. Schistomiasis
  9. Chronic hemolytic anemia
  10. Newborns
  11. L heart disease
115
Q

Risk factors for obstructive sleep apnea

A
  1. Middle-aged over wt male
  2. > 18 size neck
  3. Loud snoring w/ sudden awakenings
  4. Morning HA
  5. Not rested in AM
  6. Daytime fatigue
  7. BMI >30
  8. Retrognathia/micronathia
  9. Crowded oropharynx
  10. Tonsillar & adenoid hypertrophy
  11. Pendulous uvula
  12. Nasal obstruction
116
Q

Tx Sleep apnea

A
  1. CPAP
  2. Surgery
  3. Weight loss
    - sleep on side, avoid EtOH, avoid meds
117
Q

Transudate Causes

A
  1. CHF
  2. Cirrhosis
  3. Nephrotic syndrome
  4. Hypoalbuminemia
  5. Peritoneal dialysis
  6. Early atelectasis
  7. Central venous cath in pleural space
  8. Urinothorax
118
Q

Exudate Causes

A
  1. Malignancy
  2. Infections
  3. PE
  4. Connective tissue diseases
  5. GI disease (pancreatitis, esophageal rupture)
  6. Asbestosis
  7. Drugs
  8. Post-cardic syndrome
  9. Hemothorax
  10. Chylothorax
  11. Uremia
119
Q

What is Light’s Criteria?

A

Used to distinguish btwn exudative/transudative pleural effusion

  1. PF to serum protein ratio >0.05
  2. PF to serum LDH ratio >0.06
  3. PF LDH ?2/3 ULN serum LDH
120
Q

What is a tension pneumothorax?

A

P intrapleural exceeds Patm

emergency

121
Q

Tx of pneumothorax

A
  1. O2
  2. Observation for small iatrogenic or primary spontaneous pneumo
  3. Aspiration - if >4L, admit & chest tube
  4. Chest tubes
122
Q

Risk factors for Bronchiogenic carcinoma

A
  1. Tobacco
  2. Asbestos
  3. Radon
  4. Radiation
  5. Arsenic, Cr, Ni, benzene
  6. Air pollution
  7. Age ~71
  8. Hx of CA
  9. Hx of COPD or lung disease
  10. M>F
  11. Poor Blacks
123
Q

If calcium is seen in a lung nodule what does this usually mean?

A

benign

small, round, solid are good

ground glass or sub-solid is bad

124
Q

What is a hamartoma?

A

Fat density tumor
Benign
May have popcorn calcification

125
Q

What is a cardinoid nodule?

A 
Slow growers
Low malignant potential
Assoc/ w/ an airway
May have Ca2+
seen in younger Pts
-pink/purple central lesion that is well vascularized 
Cut it out!!!
126
Q

What are ground glass nodules

A

Hazy appearance
Slow growers
can represent early adenocarcinoma

127
Q

What can intense shoulder pain be caused from?

A

Pancoast syndrome

Superior sulcus tumor

128
Q

What is the most common lung CA?

A

adenocarcinoma

More common in young women & never smokers

129
Q

Which CA has the strongest assoc to smoking?

A

Squamous cell carcinoma

assoc. w/ hypercalcemia

130
Q

What is carcinoid syndrome?

A
  1. Wheezing
  2. Flushing
  3. Diarrhea
    rarely seen w/ carcinoid tumors
131
Q

Tx of NSCLC

A

IA-IIB - surgical resection, chemo w/ IIA&B
IIIA - Trimodality therapy
IIIA/B - chemoradiation
IV - Chemo w/ palliative care

132
Q

How often to get CT w/ lesions?

A

Low risk - q 3mo for a year then q 6 mo for next 2 years

high risk - cut that shit out!

intermediate risk - Bx & CT

133
Q

1st line test to Dx PE?

A

Spiral CT

134
Q

What is the underlying abnormality in ARDS?

A

inc. permeability of the alveolar capillary membranes that leads to development of protein rich pulmonary edema

135
Q

What is pulmonary alveolar proteinosis?

A

rare disease where phospholipids accumulate w/in alveolar spaces
Dx by bronchoalveolar lavage - milky appearance & PAS-positive lipoproteinaceous material

136
Q

What is Loffler syndrome?

A

acute eosinphilic pulmonary infiltrates in response to transpulmonary passage of helminth larvae

137
Q

Granulomatosis w/ polyangiitis

A

Idiopathic
combination of glomerulonephritis, necrotizing granulomatous vasculitis, small vessel vasculitis
Chronic sunusitis, arthralgias, fevers, skin rach & wt loss

138
Q

What is bronchopleural fistula & when is it seen?

A

Large bronchus involved in lung injury

Complication w/ pneumothorax

139
Q

How long does it take to see a normal CXR after PNA Tx?

A

up to 6 weeks

may show signs before CXR shows anything

140
Q

What should you suspect with bullous myringitis?

A

Atypical CAP

seen in healthy young adults

MCC Mycoplasma PNA

141
Q

What commonly infects neutropenic IC Pts?

A

Aspergillus, GNB & Candida

often have neg cultures

142
Q

Causes of OM?

A
  1. Mycoplasma PNA
  2. Influenza
  3. Human rhinovirus Group C
  4. RSV
143
Q

How do you treat human parainfluenza virus?

A

Steroids +
Mild - humidified air
Mod - Nebulized epinephrine

Clinical Medicine (11 decks)

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