Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PANCE review > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

steeple sign on XR of neck =

A

croup

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Lateral XR of neck with thumbprint sign =

A

epiglottitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Infection that causes acute bronchitis

A

most often viral - RSV, Rhinovirus, Influenza

5-10% bacterial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

I came in to see my physician assistant because of…

SOB, wheezing, cough 3+ weeks

A

acute bronchitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

XR findings of acute bronchitis

A

hyperinflation of lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Acute bronchitis treatment

A

H. flu vaccine

Supportive care including fluids, rest, use of humidifier

Antibiotics should play a small role here

Smoking cessation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What type of patient gets acute bronchiolitis?

A

children under 2 yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Acute bronchiolitis most commonly caused by what infection?

A

RSV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

PE findings of child with acute bronchiolitis

A

crackles, wheezing
elevated respiratory rate

signs of respiratory distress - chest wall retractions, accessory muscle use, nasal flaring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Acute bronchiolitis treatment

A

Supportive care: Humidifier, fluids, nebulized Albuterol or epinephrine

Self limiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

I came in to see my physician assistant because my child is…

Difficulty swallowing
Drooling
Hoarseness
Stridor

A

epiglottitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Most common cause of epiglottitis

A

H-flu (prevent with vaccine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Best abx to treat epiglottitis

A

2nd or 3rd gen cephalosporin (Cefuroxime or Ceftriaxone/Rocephin)

Clindamycin or Erythromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

I came in to see my PA because my child…

Low grade fever
Congestion
Cough
Stridor
Barking or seal-like cough
A

Croup

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Most common causes of croup

A

Parainfluenza, RSV, Rhinovirus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Croup treatment

A

Nebulized epinephrine for severe cases

Alway administer oral steroids

Supportive care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Treatment of influenza

A

Influenza vaccination
Supportive care
Ribavirin aerosolized
Zanamivir and oseltamivir (expensive, must be started within 48 hrs of infection)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Child with rapid consecutive coughs followed by a deep inspiration with characteristic high pitched whoop

A

pertussis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Pertussis treatment

A

Vaccination available as Tdap

Macrolides: Erythromycin or Azithromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

The most common cause of lower respiratory infection in children and in immunocompromised

A

RSV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Indications for Ribavirin

A

severe RSV infections in high risk patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Risk factors for TB

A

overcrowding, malnutrition, smoking, DM, HIV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

I came in to see my physician assistant because of…

Chronic productive cough with blood tinged sputum
Fever
Drenching night sweats
Weight loss

A

Tuberculosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are positive results of TB skin test?

A

Normal healthy low risk person positive test at 15 mm of induration

Healthcare worker or moderate risk patient positive at 10 mm

Immunocompromised patients considered positive at 5 mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How is TB diagnosed with labs and imaging?

A

TB skin test
Chest XR (apical/upper opacities)
Acid fast bacillus stain of sputum
Culture? (but slow growing, 2-6 wks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Medical therapy for TB

A

Initial 6 or 9 month course of four antibiotics

Isoniazid(INH)
Rifampin
Pyrazinamide
Ethambutol

Once antibiotic sensitivities are complete patients usually continue on isoniazid and rifampin for at least 4 more months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Side effects of TB medications

A

Isoniazid: peripheral neuropathy, hepatitis, rash

Rifampin: orange body fluids, flu like symptoms, hepatitis

Pyrazinamide: arthralgias, hepatitis

Ethambutol: optic neuritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

hot potato voice =

A

epiglottitis or peritonsillar abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Pulmonary disease associated with caves and bird or bat droppings

A

histoplasmosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

About half of CAP cases are caused by what? Other causes?

A

strep pneumo

H flu, staph aureus, Klebsiella, influenza, RSV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

PE findings of pneumonia

A

crackles
dullness to percussion
bronchial breath sounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Chest XR findings of pneumonia

A

lobar consolidation
air bronchograms
pleural effusions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Treatment of community-aquired pneumonia

A

macrolides (erythromycin) or doxycycline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is common name for atypical community acquired pneumonia?

A

walking pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

How does atypical CAP present differently?

A

Variable symptoms
Little or no finding on PE
Chest XR with diffuse infiltrates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Criteria to diagnose nosocomial pneumonia

A

pneumonia after 48 hrs in hospital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Most common cause of nosocomial pneumonia? Most common cause in ICU?

A

G- bacillus and staph aureus

ICU is Pseudomonas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Immunocompromised patients with SOB and cough, should be treated for what?

A

pneumocystis pneumonia (pneumocystis jirovecii)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Complication of pneumocystis pneumonia

A

pneumothorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Chest XR findings of pneumocystis pneumonia

A

diffuse interstitial infiltrates (ground glass appearance)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Best lab to eval severity of pneumonias

A

ABG (shows hypoxia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Pneumocystis pneumonia treatment

A

TMP-SMX (Bactrim)

+/- steroid for alveoli inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Histoplasmosis treatment

A

ANTI-FUNGAL

Oral Itraconazole or Amphotericin B for a few months and for prophylaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Tidal volume

A

volume of air moved into and out of lungs during normal resting respirations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Vital capacity

A

volume of air exhaled slowly after the deepest inspiration possible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What does spirometry measure?

A

volume and speed of exhalation and inspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

forced vital capacity (FVC)

A

volume of air forcefully exhaled after deepest breath possible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

FEV 1

A

volume of air forcefully exhaled in 1 second

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Peak expiratory flow rate (PEFR)

A

highest airflow rate during forced expiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Bronchospasm leading to airflow obstruction

A

asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is the atopic triad?

A

asthma, atopic dermatitis (eczema), allergic rhinitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What is a paradoxical pulse? Seen in what pulmonary pathology?

A

pulse that is weaker during inhalation and stronger during exhalations

seen during asthma exacerbation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Spirometry results of asthma

A

decreased FEV1 and PEFR (both improved with bronchodilator)

normal FVC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What other pulmonary function tests can be done if spirometry is not effective?

A

histamine or methacholine challenge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

How are severities of asthma classified?

A

Intermittent

  • Two or less episodes per week
  • Two or less nighttime episodes per month

Mild persistent

  • More than two episodes per week
  • Three to four nighttime episodes per month

Moderate persistent

  • Daily episodes
  • One nighttime episodes per week

Severe persistent

  • Symptoms continuous
  • Night time episodes almost every night
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Chronic treatment of intermittent and persistent asthma?

A

intermittent: SABA

mild persistent: SABA + daily low dose ICS

mod persistent: SABA + daily medium dose ICS + daily LABA

severe persistent: SABA + daily high dose ICS + daily LABA + systemic steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Most commonly used SABA, ICS, and LABA for asthma treatment

A

SABA - Albuterol
ICS - Beclomethasone
LABA - Salmeterol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Acute treatment of asthma exacerbation?

A

SABA
oxygen prn
consider upping steroid or using anticholinergic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What two conditions are under COPD umbrella?

A

chronic bronchitis

emphysema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Number one cause of COPD

A

smoking

61
Q

Differences between chronic bronchitis and emphysema

A

chronic bronchitis = “blue bloaters”
bronchi inflammation
productive cough, more hypoxic, larger air volume due to more trapped air

emphysema = “pink puffers”
alveoli collapse
dry cough, less hypoxic and more accessory muscle use, hyperventilation

62
Q

Diagnostic criteria of COPD cough

A

3 consecutive months per year in 2 consecutive years

63
Q

Pulmonary function test results of COPD

A

FEV1 decreased
FEV1/FVC decreased
Increased lung volume due to air trapping

64
Q

Pulm findings on PE of COPD

A

diminished breath sounds
+/- rhonchi in chronic bronchitis
wheezing

65
Q

Chest XR findings of COPD

A

hyperinflation with flat diaphragm

emphysema - parenchymal bullae, subpleural blebs

66
Q

COPD treatment

A

Stop smoking!

Antibiotics due to repeated infections

SABA (albuterol)

Anticholinergics (ipratropium)

Inhaled steroids (budesonide)

Oral steroid

Oxygen is only medication that changes course of severe COPD

67
Q

Best diagnostic test for cystic fibrosis

A

chloride sweat test showing elevated NaCl

68
Q

Pathophysiology and etiology of cystic fibrosis

A

Autosomal recessive disease caused by mutation of CFTR protein

This causes viscous mucus leading to recurrent pulm infections, pancreatic insufficiency (malabsorption), biliary obstruction, intestinal obstruction

69
Q

cystic fibrosis findings on lung exam

A

hyperresonance to percussion, apical crackles

70
Q

PFT results of cystic fibrosis

A

total lung capacity decreased

71
Q

Common complaints of patient with cystic fibrosis

A 
chronic lung issues
recurrent sinusitis
diarrhea, abd pain
poor growth and weight gain
infertility
72
Q

Cystic fibrosis treatment

A 
Chest and back percussion
DNAse enzyme to break down mucus
Bronchodilators
Inhaled hypertonic saline
Antibiotics for recurrent infection
Dietary supplements
Pancreatic enzyme replacement
73
Q

Irreversible dilation of the bronchial tubes caused by destruction of the tissue

A

Bronchiectasis

74
Q

50% of bronchiectasis cases are caused by ________.

A

cystic fibrosis

75
Q

Chest XR findings of bronchiectasis

A

Tram tracks or ring like markings – dilated thickened bronchi

Atelectasis

76
Q

Bronchiectasis treatment

A

Prophylactic antibiotics may be necessary

Surgical resection if disease is found all in one area

77
Q

Chest XR with parenchymal bullae, subpleural blebs

A

emphysema

78
Q

Types of obstructive pulmonary diseases

A

Asthma
COPD (chronic bronchitis, emphysema)
Cystic fibrosis
Bronchiectasis

79
Q

All obstructive pulmonary diseases have what finding on chest XR?

A

hyperinflation of lung fields

80
Q

Types of restrictive pulmonary diseases

A

Idiopathic pulmonary fibrosis
Pneumoconiosis
Sarcoidosis
Pleural diseases

81
Q

Dry cough
Dyspnea
Fine crackles at bases may be present
Lung volumes are reduced

A

Idiopathic pulmonary fibrosis

82
Q

Idiopathic pulmonary fibrosis treatment

A

Prednisone may help

Oxygen improves symptoms

Lung transplant

83
Q

Group of diseases which are restrictive and caused by inhalation of specific types of dust.

A

Pneumoconiosis

84
Q

nodules in middle and upper lung fields with eggshell calcifications

A

Silicosis or asbestosis

85
Q

This is the development of scar tissue within the lungs

A

Idiopathic pulmonary fibrosis

86
Q

nodular opacities in upper lung fields. Eggshell calcifications

A

coal miners lung

87
Q

Pulmonary function test results of restrictive pulmonary diseases

A

FEV1 is reduced
FVC is reduced
Lung volumes are reduced

88
Q

Treatment of any pneumoconiosis

A

Oxygen will alleviate symptoms

Do not smoke!

Avoid dust of any type

89
Q

inflammatory disease which is characterized by granulomas throughout the body

A

Sarcoidosis

90
Q

Chest XR of sarcoidosis

A

Hilar adenopathy

Nodules or infiltrates in the parenchyma as in later disease

91
Q

Pathophysiology of pleural effusion

A

Excess fluid between the pleural layers which limits breathing by limiting the ability of the lungs to expand

92
Q

How is US guided thoracentesis useful in evaluating pleural effusion?

A

Find out the cause of effusion

exudative fluid (inflammation) = pneumonia
transudative fluid = CHF, cirrhosis
93
Q

Sarcoidosis treatment

A

In most cases observation is first step

Corticosteroids

94
Q

What is egophony? When is it positive?

A

on auscultation an E sounds like an A, indicating consolidation

Pleural effusion, pneumonia, idiopathic pulmonary fibrosis

95
Q

What does dullness to percussion and diminished breath sounds indicate?

A

fluid in lungs

96
Q

What do you hear on auscultation of pleural effusion?

A

diminished breath sounds

pleural friction rub

97
Q

Pleural effusion treatment

A

Antibiotics if appropriate

Therapeutic thoracentesis

Chest tube placement

Pleurodesis – obliteration of the pleural space

98
Q

What is a pneumothorax?

A

air or gas in the pleural space which will limit the lungs ability to expand

99
Q

Biopsy showing non-caseating granulomas? Caseating granulomas?

A

Noncaseating = Sarcoidosis

Caseating = TB

100
Q

What type of person is at risk for primary pneumothorax (no underlying lung disease)?

A

Smokers

Young, tall, thin males

101
Q

Causes of secondary pneumothorax

A

Underlying lung disease - COPD, asthma, cystic fibrosis, TB, etc.

102
Q

Hallmark CXR finding of tension pneumothorax

A

contralateral mediastinal shift

103
Q

Visceral pleural line on CXR is diagnostic of ______.

A

pneumothorax

104
Q

Pneumothorax treatment

A

A small primary pneumothorax (10-15% of hemithorax involvement) may be watched and will likely resolve on its own

Chest tube is definitive therapy for larger pneumothorax or tension pneumothorax

Pleurodesis - obliteration of the pleural space

105
Q

What is Cor Pulmonale?

A

Right-sided heart failure secondary to severe pulmonary disease

106
Q

EKG and CXR findings of cor pulmonale

A

EKG: tall peaked T waves, right axis deviation

XR: enlarged R ventricle, enlarged pulm artery

107
Q

PE signs of right sided heart failure

A

cyanosis, peripheral edema, ascites, increased JVD

108
Q

Treatment of right sided heart failure and cor pulmonale?

A
  • Treat the underlying lung disease
  • Oxygen
  • Diuretics as well as salt and fluid restriction
109
Q

___________ is a blockage of a main artery into the lungs by something that has traveled from somewhere else in the circulatory system.

A

Pulmonary embolism

110
Q

What is Virchow’s triad?

A

risk factors of pulmonary embolism

  1. Immobility
  2. Hypercoagable state
  3. Vessel injury
111
Q

How should pulmonary embolism be imaged?

A

CXR, Helical CT, pulmonary angiography

112
Q

EKG of pulmonary embolism

A

sinus tachycardia most common finding

S1Q3T3 pattern in 10%

113
Q

How to treat pulmonary embolism?

A

Anticoagulation x 6-12 months; Heparin immediately, Warfarin long term

Thrombolytics

Inferior vena cava filter

Embolectomy

114
Q

CXR showing Westermark sign and Hampton hump

A

pulmonary embolism

115
Q

What test can rule out pulmonary embolism?

A

Normal VQ scan

116
Q

right sided heart failure with splitting of S2 and exertional syncope

A

pulmonary HTN

117
Q

Gold Standard for pulmonary HTN diagnosis

A

right heart catheterizations

118
Q

Pulmonary HTN management

A

Treat underlying cause

Anticoagulants – warfarin

Diuretics and salt restriction

Oxygen

Calcium channel blockers

Lung transplant

119
Q

Types of non-small cell lung cancers (NSCLC)

A

adenocarcinoma, squamous cell carcinoma, large cell

120
Q

Labs and diagnostic studies to eval for lung tumor

A 
biopsy
cytology of sputum
CT to look for nodules
PET to look for metastasis
Thoracocentesis
Video assisted thoracic surgery (VATS)
121
Q

Pulmonary neoplasm most commonly found in large central bronchi

A

squamous cell carcinoma

122
Q

Most common lung cancer in non smokers

A

adenocarcinoma

123
Q

Most aggressive lung cancer with early metastasis

A

small cell carcinoma (oat cell)

124
Q

Definition of pulmonary nodule

A

less than 3 cm consolidation w/o other lung findings

125
Q

How should pulmonary nodule be managed?

A

watchful waiting with serial CT

126
Q

Acute onset of dyspnea and tachypnea in baby that does not respond to oxygen therapy

A

ARDS

127
Q

ARDS treatment

A

Typically mechanical ventilation
Treat underlying causes
Oxygen supplementation does NOT help

128
Q

Symptoms of respiratory distress in premature infant with diffuse ground glass appearance on CXR

A

Hyaline membrane disease

129
Q

Pathophysiology of hyaline membrane disease

A

insufficient surfactant production in premature infant

130
Q

Hyaline membrane disease treatment

A

Oxygen
CPAP
Intubation
Surfactant spray

131
Q

How can hyaline membrane disease be prevented?

A

Give steroids if risk of delivery before 34 weeks gestation

132
Q

I came in to see my physician assistant because of…

Wheezing
Drooling
Dyspnea
Foul smell

A

Foreign body aspiration

133
Q

CXR findings if foreign body aspiration

A

air trapping

134
Q

FEV1/FVC ratio in PFTs of obstructive and restrictive lung disease

A

decreased in obstructive (low FEV1)

same or increased in restrictive (low FVC)

135
Q

How are asthma and COPD differentiated?

A

asthma is reversible bronchoconstriction and PFT’s will improve with treatment

COPD is irreversible with chronic decrease in PFT’s

136
Q

How does the sympathetic and parasympathetic nervous system affect airways?

A

sympathetic dilates airways

parasympathetic constricts airways

137
Q

MOA of beta agonists in lungs

A

stimulates the sympathetic nervous system and dilates bronchioles

138
Q

Which drug class treats obstructive pulmonary diseases by inhibiting parasympathetic nervous system to open airways?

A

anticholinergics (ex. ipratropium)

139
Q

When would you not want to use a beta agonist to open airways?

A

if patient is on beta blocker or who needs beta blocker for angina or arrhythmias

140
Q

What are crackles heard on lung exam?

A

sound of stiff alveoli popping open

141
Q

A decreased _______ is hallmark of pulmonary fibrotic disease.

A

DLCO (diffusion defect)

142
Q

3 causes of pulmonary HTN

A

Resistance in lungs
Backup from left heart
Increased flow into right heart (eg. VSD)

143
Q

_________ is most common cause of pneumonia.

A

strep pneumo

144
Q

What is Light’s Criteria for pleural effusion?

A

fluid is exudative if any of following:
pleural fluid protein/serum protein ratio >0.5
pleural fluid LDH/serum LDH ratio >0.6
pleural fluid LDH level >2/3 upper limit for serum LDH

145
Q

empyema

A

pus in pleural space; complication of pneumonia or caused by penetrating chest trauma

146
Q

Hallmark of pleural effusion on XR

A

blunting of costophrenic angles

147
Q

What does hyper-resonance on percussion indicate?

A

more air than usual; seen in asthma, COPD, and pneumothorax

148
Q

tactile fremitus

A

feel vibrations on patient’s back as patient speaks

increased vibration if lung filled with something other than air

PANCE review (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions