Exam 3 Pulm/Rheum Flashcards by Jenner Jensen

Which of these is NOT bacterial?

Pertussis
TB
Acute bronchiolitis
Community acquired pneumonia

Acute bronchiolitis - RSV virus

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Which of these does NOT have a vaccine?

Pneumonia
Pertussis
RSV (bronchiolitis)
Influenza

RSV does not - has synagis for those with compromised immune systems

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What is the time frame for administering antiviral for influenza?

24-48 hours from onset

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Diagnostic test for influenza?

RT-PCR: it confirms whether it’s influenza A or B

It’s a viral culture of their respiratory secretions

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What is Reye’s syndrome?

Aspirin + viral infections in kids. Leads to progressive hepatic failure and encephalopathy

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Patient is coughing and it sounds like it’s “barking like a seal”

What other breathing findings might you hear?

Stridor

Kid has Croup

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There are 3 phases of pertussis (whooping cough). What are they and what are their characteristics

Catarrhal phase: nasal congestion, sneezing low grade fever

Paroxysmal phase: episodes of intense coughing followed by “whoop”

Convalescent phase: chronic cough lasting weeks

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What is the diagnostic test for pertussis (whooping cough)?

What stages does it need to be tested in?

Nasopharyngeal swab for Bordatea pertussis - must be taken in catarrhal or paroxysmal phase

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Treatment for pertussis?

Azithromycin

And give it to the family as prophylaxis!!

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Vaccine for whooping cough?

DTap

Tdap

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What is progressive primary TB?

A caseating granuloma or TB lesion forms when organism escapes the macrophages and is able to spread

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What is it called when a caseating granuloma along with Hilar lymphadenopathy is found in CXR of a person with TB?

Ghon complex

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Which “disease” is confirmed by the presence of a steeple sign on X-ray?

Croup (acute laryngotracheitis)

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Do we commonly hospitalize those with TB or treat as outpatient?

Mostly outpatient - with 6-9 month regimen or medication, monthly follow up and serial sputum cultures

Take new baseline CXR at end of treatment

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What is the diagnostic test that confirms TB?

Interferon-gamma assay (IGRA) - blood test with TB specific antigens (more specific)

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Is Community acquired pneumonia an upper or lower respiratory tract infection?

Lower

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Most common pathogen for CAP? (Pneumonia)

Streptococcus pneumoniae

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Describe the symptoms of someone with pneumonia

ACUTE ONSET fever, chills, diaphioresis, productive cough w/ purulent sputum

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Pertinent lung exam findings in someone with CAP

Crackles, bronchial breath sounds, DULLNESS TO PERCUSSION

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What labs do we order for diagnosing CAP? (Hint: 4 things)

CBC
Sputum
Blood culture
Nasal swab

(Sometimes urine sample)

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Which “test” do we use to determine if someone with CAP needs to be hospitalized?

CURB 65. (Score of 2+ we hospitalize)

Confusion, urea BUN >30, RR >30, BP <60/90, 65+

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Most common cause of hospital acquired pneumonia?

Staph aureus (MRSA)

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In kids with pneumonia, their symptoms differ from adults; besides the fever, poor feeding, cough, what are some key exam findings you might notice?

Grunting, wheezing, GI symptoms (nausea, diarrhea)

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True or false: infants <12 weeks we use the CURB 65 test for pneumonia treatment

False- all infants <12 weeks we HOSPITALIZE

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What is the gold standard diagnostic test for a pulmonary embolism?

CT Angio

Virchows triad?

Venous stasis + vein damage + activation of coagulation | Risk factors of pulm embolism

Treatment for pulmonary embolism

Hospitalize! | Heparin + 3-6 months warfarin

Pulmonary hypertension is defined as systolic pressure > ____?

30 mmHg

Cor pulmonale is the result of which pulmonary disorder

Pulmonary hypertension

In assessing for pulmonary hypertension, you order an EKG. What might you find to help confirm your diagnosis?

Right axis deviation Right bundle branch block Peaked P waves (atrial enlargement)

Although EKG showed some promising signs to support pulmonary hypertension, what is the GOLD STANDARD test for diagnosis?

Right-sided cardiac cath

True or false: patient present to clinic with small, asymptomatic pneumothorax. You do not need to hospitalize them.

FALSE! every patient needs to be hospitalized, even if it's just for overnight monitoring.

Patient present to clinic with a Pneumothorax, and no PHYSICAL symptoms. You get her vitals and notice an abnormal RR and BP. What treatment do you proceed with?

Simple aspiration - any sign of symptoms (INCLUDING abnormal vital signs) requires aspiration. "if symptoms present, we TREAT"

what is the most common cause of ARDS?

sepsis

What is the condition that results from inflammation with increasing inflammatory cells, leading to a "leaky" capillary membranes?

ARDS

According to the Berlin Definition of classifying ARDS, what PaO2:FiO2 ratio is considered "severe" ?

ratio < 100 is considered severe

When assessing lung carcinomas, what is absolutely needed for diagnosis?

Tissue biopsy (for pathology)

Which of these pulmonary disorders is NOT characterized by hemoptysis? TB, small cell lung carcinoma, squamous cell carcinoma, adenocarcinoma

Adenocarcinoma - this is located in the PERIPHERAL lung fields, where the others are in the central airways.

which disease is characterized by an "oat cell" appearance

small cell lung carcinoma

Which restrictive lung disease include granulomas

sarcoidosis, silicosis, berylliosis, hypersensitivity pneumonitis

of the restrictive lung diseases, which are characterized by symptoms (nodules) OUTSIDE OF THE LUNGS

Berylliosis & sarcoidosis. Berylliosis - nodules will be located on point of contact with the irritant (hands) Sarcoidosis - nodules/plaques will be everywhere

What are the 4 large cell vasculitities?

Polymyalgia Rheumatica Giant Cell Arteritis Takayasu arteritis Behcet syndrome

What are some key differences that help decipher between polymyalgia rheumatic (PMR) and Giant Cell Arteritis GCA?

GCA - affects temporal arteries, commonly leading to blindness. Patient also complains of JAW CLAUDICATION PMR - no blindness/jaw claudication; pain and stiffness in shoulders/hips

Treatment for vasculitis?

Prednisone

In primary Angiitis, a Brain biopsy is diagnostic. Another finding you might see on Angiogram (hint: what do the vessels look like?"

"string of beads" alternating narrowing/dilation of the vessels in the brain

Polyarteritis Nodosa is commonly associated (or looks like) what disease?

Hepatitis B...make sure you test for it in someone with possible polyarteritis nodosa

Wegeners syndrome is vasculitis of mainly which 2 organs?

lungs and kidneys | classic triad: upper, lower respiratory infection + glomerulonephritis

what is the classic triad of symptoms seen in patients with systemic Lupus Erythematosus (SLE)?

fever + joint pain (polyarticular and symmetric) + rash ("butterfly rash")

Treatment for Lupus?

if non-life threatening - NSAIDs + antimalarials life-threatening/severe: Prednisone + immunosuppresors

To diagnose SLE, there needs to be a positive ANA and what other antibody?

anti-dsDNA and/or anti-Sm antibody

what is the acronym used for diagnosing Lupus? (SLE)

SOAP BRAIN MD | need 4 of 11 for diagnosis

what is the syndrome characterized by hypercoagulability due to antibodies against phospholipid-binding plasma proteins?

antiphospholipid syndrome (APS)

chronic inflammatory disorder involving the SYNOVIUM of the joints

rheumatoid arthritis

Treatment for RA?

DMARDs + NSAIDs never NSAIDs for monotherapy as they do not prevent erosion of joints

What are the diagnostic antibodies for Antiphospholipid syndrome?

Anticardiolipin + B2-glycoprotein + Lupus Anticoag.

Patient with hx pregnancy loss, DVT and evidence of hypercoagulability on Labs is likely to have what disease?

Antiphospholipid Syndrome (APS)

Treatment for someone with APS (antiphospholipid syndrome)?

lifelong anticoagulation (warfarin)

Raynaud's phenomenon is commonly associated with which rheumatic disease?

Scleroderma

In which disease are you most likely to see sclerodactyly?

Scleroderma | sclerodactyly = tightening of skin in face and extremities, giving "claw-like" appearance in the hands

Sjogren's syndrome is an autoimmune disease due to dysfunction of which organ/structures?

Lacrimal gland and salivary glands will present with dry eyes and dry mouth

What are the specific antibodies positive in Sjogren's syndrome?

SS-A (Ro) & SS-B (La)

Treatment of sjogrens?

artificial tears | lymphoma can occur in 6% of cases, so we want to monitor

What is the diagnostic test for dermatomyositis and polymyositis?

Muscle biopsy! (rule out malignancy) Other Labs elevated: CK + aldolase

Diagnostic test for Giant Cell Arteritis?

biopsy of temporal artery

Jaw claudication and blindness are common symptoms that distinguish Giant cell arteritis from which other large vessel vasculitis?

Polymyalgia rheumatica (PMR)

What are some main large-vessel vasculitidies?

Polymyalgia rheumatica, Giant cell arteritis, Takayasu Arteritis

to diagnose Obstructive sleep apnea, what epworth sleepiness score do you need?

what is another word for the sleep study?

polysomnography

Is the first line treatment for OSA in adults and kids CPAP?

No- CPAP is the first line choice for adults, but in kids we're more likely to do surgery (due to noncompliance)

What 3 characteristics do we see on imaging that describe interstitial lung disease?

reticular changes, honeycombing, traction bronchioectasis

What needs to be ordered to CONFIRM and diagnose idiopathic pulmonary fibrosis?

Need a tissue biopsy to confirm by pathology that it is idiopathic.

Sarcoidosis looks a lot like TB on an XRAY. What is the main characteristic that distinguishes the two?

Sarcoidosis is NONcaseating granuloma; TB is CASEATING. If you suspect sarcoidosis, do TB test to rule out

In which restrictive lung disease would you most likely find pleural plaques on CXray?

asbestosis

What makes the cutaneous nodules of Berylliosis different from those in Sarcoidosis?

The skin nodules in berryliosis are located on areas of skin that were exposed to the toxin.

Silo-fillers restrictive lung disease is due to inhalation of what?

Nitrogen dioxide

Characterized by cough lasting >5 days and up to 3-4 weeks. 90% viral

Acute bronchitis

What is the vaccine for Acute bronchiolitis?

NONE - RSV does not have a vaccine

Which virus has the risk of persistent airway resistance later in life?

RSV

Diagnostic test for RSV?

RSV Rapid viral antigen testing (nasopharyngeal swab)

Hypoxemia is defined as pO2 < ?

Hypercapnia is defined as pCO2 > ?

How do we calculate what the A-a gradient should be?

(Age/4) + 4

Asthma will have a reversible airflow post-bronch...which spirometry value do we look for and what change do we need to diagnose reversibility/asthma?

FEV1 should have a change of > 12% expected

Which disease can be linked to Alpha-1 antitrypsin deficiency?

COPD

What determines a COPD Exacerbation?

the change of sputum to purulent + rr >30 ADD antibiotics to normal med regimen

RSV (acute bronchiolitis) is common in what age?

< 2 years

treatment for pertussis "whooping cough"

Azithromycin

What type of lung carcinoma looks like a pedunculated "floating finger" in the central airway?

Carcinoid Tumor

What is carcinoid syndrome?

Flushing + diarrhea + wheezing + hypotension

lung carcinoma characterized by NO tobacco association, unilateral chest pain, occupational hx of mining

mesothelioma (the tumor has invaded the lung pleura, causing the unilateral pain)

Horner syndrome?

myosis + partial ptosis + anhidrosis (seen in mesothelioma)

Treatment for mesothelioma

chemotherapy

which type of nonsquamous cell lung carcinoma is most related to NONSMOKERS

adenocarcinoma

what is paraneoplastic syndrome?

the hormones secreted by the tumor cell can have different effects: thrombophlebitis, hypercalcemia, gynecomastia

which non small cell lung carcinoma happens to have a rapid doubling time?

Large cell carcinoma (double rapidly, metastasize early)

What type of imaging do you order to determine metastasis/staging in lung carcinoma?

PET scan - lights up w/ metabolism (cancer cells)

Do you perform a pre-op biopsy in non small cell lung carcinoma?

NO - higher risk for damaging the lung tissue if there is disease present

disorder in which inflammation in the lung leads to leaky capillaries

ARDS

what is the diagnostic test for Gout?

getting the joint fluid - shows needle-like negative befringence

diagnostic for Takayasu Arteritis?

CT angio - shows stenosis, occlusion, dilation of aorta and branches

Which organ system is typically left unaffected by Polyarteritis Nodosa?

Lungs

In primary angiitis, patients will have no systemic symptoms, however, which organ system is affected?

Nervous system - primary angiitis is limited to the brain and spinal cord (brain biopsy is diagnostic)

In what type of Vasculitis is ANCA positive for PR-3?

Wegners (granulomatosis with polyangitis)

Berlin Definition of ARDS: onset of respiratory distress, progressing to respiratory failure, within ____ days of a clinical insult

Bilateral Infiltrates on CXR, pulmonary infiltrates without signs of fluid overload or heart failure, AND a PaO2: FIO2 < 100 can be diagnosed as???

ARDS

Exam 3 Pulm/Rheum Flashcards

(105 cards)