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CPD > Week 7 > Flashcards

Week 7 Flashcards

1
Q

Etiology: COPD

A

smoking (primary), air pollution, second-hand smoke, Hx of childhood resp infxs, occupational pollutant exposure, autoimmunity, genetic (alpha-1-antitrypsin deficiency), ashthma

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2
Q

SSx (from history): COPD

A

dyspnea (exercise first, then rest), chronic productive cough (morning to all-day), wheezing, hemoptysis, lower extremity edema, small amount of clear sputum

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3
Q

PE: COPD

A

barrel chest, Hoover’s sign, pursed-lip breathing, cyanosis, yellowing of fingertips, nail clubbing, weight loss, tripod position

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4
Q

Findings (auscultation): COPD

A

decreased breath sounds, crackles at lung bases, distant heart sounds

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5
Q

Findings (percussion): COPD

A

hyperresonant, decreased diaphragmatic excursion

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6
Q

Dx: COPD

A

PFT, Pulse ox, arterial blood gases, chest CT, alpha-1-antitrypsin level, CXR

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7
Q

Findings (PFT): COPD

A

decreased FEV1 (decreased flow rate), TLC normal

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8
Q

When FEV1 falls below ___, the lungs are no longer normal.

A

85% of predicted values

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9
Q

Pathophysiology: emphysema

A

permanent enlargement of alveolar ducts and air spaces distal to terminal bronchioles; destruction of alveolar walls, elastic recoil, fibrosis, scarring

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10
Q

Etiology: emphysema

A

smoking, genetic (alpha-1-antitrypsin deficiency)

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11
Q

SSx: emphysema

A

dyspnea, cyanosis, exercise intolerance, cough (hard, spasmodic, tiring)

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12
Q

PE: emphysema

A

“pink puffers,” barrel chest, decreased breath sounds, hyperresonance, use of accessory resp. muscles, expiratory crackles/wheezing, PMI deviated toward sternum

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13
Q

SSx: chronic bronchitis

A

productive cough (worse in mornings, small amount colorless sputum), dyspnea (6th decade), wheezing, tachypnea, “blue bloaters,” anorexia

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14
Q

“Blue bloaters”

A

cyanosis and fluid retention, right CHF (seen in chronic bronchitis)

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15
Q

PE: chronic bronchitis

A

increased resp. rate (prop. to severity), use of accessory muscles; advanced dz (cyanosis, elevated JVP, peripheral edema); FET > 6 secs, barrel chest, wheezing, decreased breath sounds, hyperresonance, prolonged expiration, inspiratory crackles

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16
Q

Pathophysiology: chronic bronchitis

A

hyper-secretion of mucus secondary to hypertrophy of bronchial glands, leading to thickening of bronchial tubes

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17
Q

Primary difference between asthma and COPD

A

degree of reversibility

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18
Q

pathophysiology (3 main features): asthma

A

airway obstruction (reversible), inflammation, airway irritability (increased reactivity); manifests as episodes of wide-spread broncho-constriction

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19
Q

Etiology (infants): asthma

A

foods, emotional upset, atopy, bottle feeding, early weaning, parental smoking

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20
Q

Classifications: asthma

A

extrinsic (allergic) - d/t allergy to external factors, intrinsic (non-allergic) - d/t infx of upper/lower resp tract, irritants, emotions, exercise, cold weather

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21
Q

SSx: asthma

A

no sxs between asthmatic episodes, cough (worse at night, w/ exercise), wheezing, dyspnea, chest tightness, sputum

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22
Q

Common triggers: asthma

A

URIs, inhalant allergens, medications, food, exercise, irritants, weather, emotions, GERD

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23
Q

PE: asthma

A

tachypnea, tachycardia, diaphoresis, use of accessory muscles, anxiousness

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24
Q

In a patient with asthma, marked weight loss could be indicative of ____

A

development of severe emphysema

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25
Q

Pulsus paradoxus

A

exaggerated fall in systolic bp/slowing of pulse rate during inspiration; may occur during acute asthma exacerbation

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26
Q

Findings (auscultation): asthma

A

end-expiratory high-pitched/polyphonic wheezing, prolonged expiratory phase, diminished breath sounds/chest hyperinflation during acute exacerbation

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27
Q

In a patient with asthma, the presence of inspiratory wheezing (usu expiratory) or stridor may prompt an evaluation of ___

A

upper airway obstruction (vocal cord dysfunction, vocal cord paralysis, thyroid enlargement, soft tissue mass)

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28
Q

RED FLAG symptoms: asthma

A

confusion, drowsiness, absent lung sounds, cannot speak, cyanosis, status asthmaticus

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29
Q

Status asthmaticus

A

unresponsive to routine therapy; severe, prolonged attack that can be suddenly fatal; unremitting attacks

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30
Q

PE (upper airway): asthma

A

signs of nasal obstruction (polyps, swollen mucosa) which can worsen asthma

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31
Q

PE (skin): asthma

A

atopic derm, eczema, or other signs of skin conditions (extrinsic asthma)

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32
Q

DDx: COPD

A

central airway stenosis, bronchiectasis, heart failure, TB, constrictive bronchiolitis

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33
Q

Pathophysiology: bronchiectasis

A

infx followed by airway obstruction and impaired drainage; permanent damage/dilation of bronchi

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34
Q

Etiology: bronchiectasis

A

infx (bac/virus/fungal), congenital obstruction, immunodeficiency (IgA, IgG, HIV), abnormal secretion clearance (CF), genetic (alpha-1-antitrypsin deficiency), extrapulmonary cause (RA, Crohn’s, Sjogren’s)

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35
Q

SSx: bronchiectasis

A

chronic daily cough, daily sputum (mucupurulent, thick), hemoptysis, dyspnea, rhinosinusitis, wheezing, pleuritic chest pain, fatigue

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36
Q

Age of presentation: bronchiectasis, COPD, asthma

A

bronchiectasis (45 - 60 yo)
COPD (> 60 yo)
asthma (2-20 yo; > 40 yo)

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37
Q

Sex bias: bronchiectasis, COPD, asthma

A

bronchiectasis (F)
COPD (M)
asthma (none)

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38
Q

Etiology: bronchiectasis, COPD, asthma

A

bronchiectasis (infx, genetic, immune defect) COPD (cigarette smoking)
asthma (FHx of allergies, following URI)

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39
Q

Role of infx: bronchiectasis, COPD, asthma

A

bronchiectasis (primary)
COPD (secondary)
asthma (exacerbations)

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40
Q

Predominant organism: bronchiectasis, COPD, asthma

A

bronchiectasis (H. influenzae, p aeruginosa)
COPD (S. pneumoniae, H. influenzae)
asthma (resp. syncytial virus, parainfluenza virus, rhinovirus, influenza virus)

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41
Q

Airflow obstruction and hyper-responsiveness: bronchiectasis, COPD, asthma

A

present in all

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42
Q

Quality of sputum: bronchiectasis, COPD, asthma

A

bronchiectasis (purulent)
COPD (mucoid, clear)
asthma (rare)

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43
Q

Pathophysiology: cystic fibrosis

A

gene defect (CFTR protein mutation) leading to abnormal production of thick mucus, primarily affecting respiratory and digestive systems

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44
Q

Sex bias: cystic fibrosis

A

M=F

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45
Q

Dx: cystic fibrosis

A

stool analysis (steatorrhea), trypsinogen blood test in newborns, sweat chloride test, chest x-rays, PFTs, genetic screen (CFTR mutation)

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46
Q

PE (nose): cystic fibrosis

A

rhinitis, nasal polyps

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47
Q

Sx (sinuses): cystic fibrosis

A

panopacification, polyps, chronic rhinosinusitis

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48
Q

Sx (kidney): cystic fibrosis

A

nephrolithiasis

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49
Q

Sx (musculoskeletal): cystic fibrosis

A

reduced bone density, clubbing of fingers/toes

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50
Q

Sx (reproductive tract): cystic fibrosis

A

spermatogenesis defects, amenorrhea, cervical mucus

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51
Q

Sx (liver): cystic fibrosis

A

cirrhosis, portal hypertension, cholelithiasis

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52
Q

Subtypes of COPD

A

emphysema, chronic bronchitis, obstructive asthma

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53
Q

COPD is the ___ leading cause of death in America.

A

3rd

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54
Q

Hoover’s sign

A

costal margins move inwards w/ inspiration; seen in COPD

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55
Q

Chronic bronchitis cough

A

occurs most days of the month, 3 mos / year, for 2 years w/o other explanation

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56
Q

Etiology (10-30 yo): asthma

A

inhalants

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57
Q

Etiology (> 45 yo): asthma

A

infx

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58
Q

Dx: bronchiectasis

A

CBC (anemia), sputum culture, PFT (low FEV1), CXR, sweat test

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59
Q

Etiology: laryngotracheobronchitis

A

parainfluenza type I (60%) infx of upper/lower resp tracts; also parainfluenza II/III/IV, influenza A/B, adenovirus, coxsackie A/B, rhinovirus, measles, HSV, resp syncytial virus

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60
Q

Pathophysiology: laryngotracheobronchitis

A

resp distress caused by inflammatory response to infx, not infx itself

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61
Q

Population: laryngotracheobronchitis

A

M > F, 6 mos - 3ys

62
Q

SSx: laryngotracheobronchitis

A

prodrome (mild URI w/ coryza, nasal congestion, sore throat, cough, low-grade fever), followed by horse voice, barking cough, night stridor

63
Q

PE: laryngotracheobronchitis

A

mild (normal at rest, expiratory wheezing)

severe (inspiratory stridor, lethargy from hypoxemia, tachypnea, tachycardia)

64
Q

Lab: laryngotracheobronchitis

A

leukocytosis with left shift

65
Q

Dx: laryngotracheobronchitis

A

AP X-ray w/ “steeple sign”

66
Q

Prognosis: laryngotracheobronchitis

A

usu self-limited; death possible from airway obstruction

67
Q

DDX: laryngotracheobronchitis

A 
epiglottitis (hot potato voice)
foreign body (no URI/fever Hx)
retropharyngeal abscess (seen on lat x-ray)
diphtheria (grayish pseudomembrane)
68
Q

Etiology: acute bronchitis

A

influenza A/B, parainfluenza, coronavirus 1/2/3, rhinovirus, RSV

69
Q

SSx: acute bronchitis

A

cough > 5 days w/ purulent sputum

70
Q

PE: acute bronchitis

A

afebrile/low-grade fever, wheezing (bronchospasm), rhonchi (mucus in upper airways, clear w/ cough), normal percussion

71
Q

In patients with acute bronchitis, a CXR is only necessary when ___ (4)

A

> 75 yo, developing signs of pneumonia, abnormal vitals, presence of crackles

72
Q

DDx: acute bronchitis

A

chronic bronchitis, pneumonia, post-nasal drip, GERD, asthma

73
Q

4 Stages of Pneumonia

A

congestion phase, red hepatization, grey hepatization, resolving stage

74
Q

Extent of involvement: pneumonia

A

lobar (entire lobe), lobular (part of lobe), broncho-pneumonia (alveoli attached to particular bronchi)

75
Q

Etiology: pneumonia (3 main types)

A

virus (50%), bacteria MC < 30 yo, mycoplasma

76
Q

SSx: bacterial pneumonia

A

high fever, cough w/ thick/green/rust mucus, SOB, tachypnea, pleuritic pain w/ deep breaths, abdominal pain, severe fatigue, mb sweating and confusion

77
Q

PE: bacterial pneumonia

A

fever, cyanosis, wheezes/rhonchi/crackles, increased tactile fremitus, tachycardia/bradycardia, bronchial breath sounds, +egophony, dullness to percussion, mb pleural friction rub

78
Q

Etiology: nosocomial pneumonia

A

E. coli, Klebsiella, enterobacter spp, P aeruginosa, MRSA, H. influenzae

79
Q

Streptococcus pneumoniae: bacterial pneumonia

A 
60-80% of bac pneumonia
usu unilateral
complications: meningitis, endocarditis
No abnormal lung sounds if dehydrated
RED FLAG: BUN >70, WBC <5000, underlying dz
80
Q

Klebsiella pneumoniae: bacterial pneumonia

A

gram-
aggressive lobar pneumonia
more gradual onset than pneumococcus, but spreads quickly
viscid exudates that can’t be expectorated - “currant jelly” sputum
risk factors: alcoholism, malnutrition, DM, antibiotics, COPD, >40, sick people
mortality: 30% (tx), 40-60% (w/o tx)
relative bradycardia (pulse rate doesn’t rise concurrently with fever)

81
Q

Haemophilus influenzae: bacterial pneumonia

A

MC winter/spring

risk factors: asthma, COPD, smoking, immunocompromised

82
Q

Legionella pneumophila: bacterial pneumonia

A

gram-
most asx
concomitant GI symptoms (n/v, diarrhea, anorexia)

83
Q

Dx: bacterial pneumonia

A

CXR (dense shadow/well-demarcated), CBC, CMP, CT, bronchoscopy, thoracentesis

84
Q

If symptoms aren’t resolving (pneumonia), consider (aggressive organisms).

A

klebsiella, legionella, staph aureus

85
Q

If symptoms aren’t resolving (pneumonia), consider (drug-resistant organisms).

A

strep pneumoniae, H. flu, P. aeruginosa, S aureus

86
Q

If symptoms aren’t resolving (pneumonia), consider (non-bacterial agents).

A

TB, fungi

87
Q

Complications: bacterial pneumonia

A

lung abscess, pleural effusion, empyema

88
Q

If symptoms aren’t resolving (pneumonia), consider (misdiagnoses).

A

neoplastic dz, pulmonary embolism, pulmonary edema

89
Q

Etiology: viral pneumonia

A

influenza virus, RSV, parainfluenza virus, adenovirus, paramyxovirus, CMV, VZV, HSV, EBV, Hantavirus, coronavirus

90
Q

SSx: viral pneumonia

A

fever, malaise, HA, cough w/ scant sputum, myalgia, neck LA, chest pain, sore throat

91
Q

PE: viral pneumonia

A

mild fever (mb no other sxs), tachypnea/dyspnea, wheezing/rhonchi/rales, dullness to percussion, tachycardia/bradycardia, sternal/intercostal retractions, decreased breath sounds, pleurisy

92
Q

Dx: viral pneumonia

A

CBC, CMP, CXR (fuzzy shadows/poor demarcation)

93
Q

Sx: SARS (coronavirus mutation)

A

high fever, dry cough, nasal congestion, dyspnea, localized chest pain, MS/joint pain, diarrhea, HA

94
Q

Dx: SARS

A

PCR, ELISA, CXR (patchy infiltrates)

95
Q

Sx: Hantavirus

A

initially resembles flu, progresses quickly to pulmonary edema

96
Q

Etiology: walking pneumonia

A

mycoplasma pneumoniae

97
Q

Prognosis: walking pneumonia

A

often benign, slow progression, resolves w/o tx

98
Q

SSx: walking pneumonia

A

violent dry coughing attacks w/ scant sputum, chills/fever, occ n/v,

99
Q

PE: walking pneumonia

A

pharyngeal erythema (no exudate), minimal cervical LA, bullous myringitis

100
Q

Dx: walking pneumonia

A

PCR (no bacteria found), CXR (normal/diffuse infiltrate)

101
Q

Sputum: bacterial/viral/mycoplasma pneumonia

A

bacterial - copius, rusty, purulent, many PMNs
viral - scant, thin, mb bloody, no bacteria
mycoplasma - scant, thin, PMNs/macrophages/resp epithelial cells

102
Q

Fever: bacterial/viral/mycoplasma pneumonia

A

bacterial - high
viral - low/absent
mycoplasma - varies

103
Q

Onset: bacterial/viral/mycoplasma pneumonia

A

bacterial - sudden
viral - gradual
mycoplasma - gradual

104
Q

Myalgia: bacterial/viral/mycoplasma pneumonia

A

bacterial - absent
viral - present
mycoplasma - varies

105
Q

WBC: bacterial/viral/mycoplasma pneumonia

A

bacterial - 15,000+
viral - low, WNL
mycoplasma - WNL

106
Q

Etiology: fungal pneumonia

A

pneumocysis jirovecii

107
Q

Population: fungal pneumonia

A

immunocompromised, esp. patients w/ AIDS

108
Q

SSx: fungal pneumonia

A

gradual onset (malaise, night sweats, weight loss, low-grade fever), dry cough w/o expectoration; when severe, dyspnea/cyanosis/resp failure/chest pain/productive cough

109
Q

Complications: fungal pneumonia

A

spontaneous pneumothorax and hypoxemia secondary to ARDS-like syndrome

110
Q

Etiology: coccidioidomycosis

A

coccidoides immitis (SW US, Mex, S America)

111
Q

SSx: coccidioidomycosis

A

Hx of C. immitis infx, usu subclinical/asx, triad of fever/erythema nodosum/arthralgias; common complaints (fever, cough, dyspnea, HA, chest pain)

112
Q

Dx: coccidioidomycosis

A

CBC, CXR, skin testing, serology (IgM)

113
Q

Prognosis: coccidioidomycosis

A

usu self-limited, can be disseminated

114
Q

Sx: allergic bronchopulmonary aspergillosis

A

patients usu have asthma; cough, wheezing, dyspnea, low-grade fever, sticky plug-forming sputum

115
Q

Dx: allergic bronchopulmonary aspergillosis

A

CBC differential (E >50%), increased IgE, +RAST, CXR (bronchiectasis, infiltrate)

116
Q

Prognosis: pneumonia d/t aspiration

A

very severe, high mortality

117
Q

SSx: lipoid aspiration

A

acute, fever, cough, oil droplets in sputum, chronic weight loss, night sweats

118
Q

Etiology: lung abscess

A

anaerobic bacteria are sequestered -> necrosis of lung parenchyma; usu complication of aspiration pneumonia or severe bacterial pneumonia

119
Q

SSx: lung abscess

A

fever, cough, sour-tasting sputum > 2 wks, night sweats, weight loss, hemoptysis, pleurisy

120
Q

Dx: lung abscess

A

seen as cavitation on CXR and CT

121
Q

Etiology: TB

A

inhalation of mycobacterium tuberculosis

122
Q

Population (higher prevalence): TB

A

homeless, prisoners, health care workers w/ high-risk communities, children w/ high-risk adults, foreign-born, travelers, elderly, low income

123
Q

Population (higher risk of progression): TB

A

infected within previous 2 years, < 4 yrs, untreated TB, HIV/CA/organ transplant/corticosteroid use, DM/CKD/gastrectomy/underweight

124
Q

Age / Sex: TB

A

22-44; M>F

125
Q

4 broad syndromes of TB

A

1) similar to atypical pneumonia (fever, non-productive cough), CXR (unilateral infiltrates, hilar adenopathy)
2) TB pleurisy w/ effusion (high fever, pleuritic pain, dyspnea)
3) progression to upper lobes
4) extra-pulmonary TB (14% - kidneys, bones, meninges, peritoneum)

126
Q

What is miliary TB?

A

minute foci of infx in many organs

127
Q

DDx: TB

A

pneumonia, lung abscess, pulmonary mycosis, CA, non-TB mycobacterium

128
Q

Only __% of people infected with TB will develop active dz.

A

10

129
Q

PPD test interpretation

A

> 5mm + in HIV, known TB contact, TB Hx, organ transplants, immunocompromised
10mm + in recent immigrants, IV drug users, < 4 yrs, children exposed to high-risk adults
15mm + in any person

130
Q

SSx: active TB

A

chronic cough MC (>3wks), yellow/green sputum (AM), hemopytsis, malaise/fatigue, anorexia/wt loss, low grade fever (late afternoon), night sweats, pleuritic pain

131
Q

PE: active TB

A

fever, cachexia, hypoxia, LA, abnormal lung sounds

132
Q

Dx: active TB

A

mantoux test, acid-fast stain of sputum, WBC - normal, CXR (ipsilateral hilar adenopathy/atelectasis)

133
Q

DDx: pleurisy

A

acute abdomen (n/v, abd. pain)
intercostal neuritis (no friction rub)
costo-chondritis (trauma hx, localized pain)
herpes (eruptions)
MI (location, concomitant, risk hx, cardiac enzymes)
pneumothorax (tracheal deviation, r/o by CXR)
pericarditis (friction rub w/ ht beat, pain radiating to neck/shoulders, resp cough, ht sounds muffled)

134
Q

Dx: pleurisy

A 
CXR (normal, fluid blunting of costo-phrenic angle)
Ultrasound (pleural fluid)
CT (trapped pockets of fluid)
CBC
ABGs
135
Q

PE: pleurisy

A

fever if infx, tachycardia, limited chest motion, decreased breath sounds, pleural friction rub (crackles/grating/creaking on insp/expiration)

136
Q

PE: pleurisy vs pericarditis

A

pleurisy - pleural friction rub

pericarditis - pericardial friction rub (present when pt holds breath)

137
Q

PE: pleurisy w/ effusion

A

decreased/absent breath sounds, percussion dullness, decreased tactile fremitus, egophony at upper border of fluid

138
Q

SSx: pleurisy

A

sudden onset of pleuritic chest pain, pain w/ coughing/deep breathing -> tachypnea, shallow breathing, dyspnea; referred pain to shoulder/diaphragm; w/ effusion, pain subsides

139
Q

Etiology: pleurisy

A

infx (virus MC), inhalants, SLE, RA, lung/breast CA, mesothelioma, CHF, PE, lymph obstruction, trauma

140
Q

Pleurisy

A

inflammation of the pleura w/ possible effusion

141
Q

Etiology: histoplasmosis

A

histoplasma capsulatum, fungus found in OH/MS river valleys and SE

142
Q

SSx: histoplasmosis

A

most asx
acute (fatigue, fever, chest pain, dry cough)
chronic (similar to TB)
disseminated (various, multiple organs)

143
Q

PE: histoplasmosis (chronic)

A

crackles, wheezes

144
Q

PE: histoplasmosis (disseminated)

A

ulcers (buccal mucosa, tongue, gingiva, larynx), mb vision loss, mb hepatosplenomegaly

145
Q

Dx: histoplasmosis

A

sputum culture, +skin test, PCR, CXR (calcified hilar lymph nodes, lung scarring in chronic forms)

146
Q

Reactivation risk: latent TB

A

3-5%

147
Q

Location: latent TB lesions

A

post. segment of RUL, apicoposterior segment of LLL, apical segment of lower lobes

148
Q

QuantiFERON-TB Gold interpretation

A

patients infected with M. tuberculosis will have increased IFN-gamma

149
Q

Tx: multi-drug resistant TB (MDR-TB)

A

4 different antibiotics over 18-24 mos

150
Q

Vaccine: TB

A

BCG; immunity decreases after 10 years

CPD (8 decks)

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