IMC/FM/EMED Pulm Flashcards
(117 cards)
1
Q
Define Acute Bronchitis
What is an unusual Sx that makes the Dx shift to ?
95% of bronchitis is d/t ?
A
Cough persisting >5days
Fever- suspect pneumonia/influenza
Viral
2
Q
? three bacteria are the MCC of acute bronchitis
How is acute bronchitis Dx
How are these Pts Tx
A
M catarrhalis- MC
H influenza
Strep pneumo
CXR
Dextromethorphan
Guifenesin
B-agonist if wheeze w/ PulmDz
3
Q
How are acute exacerbation of chronic bronchitis d/t bacteria Tx empirically
MCC of acute and chronic sinusitis
How does acute sinusitis present in time frames
A
1st: 2ng Gen cephalosporin
2nd: 2nd gen macrolide or TMP-SMX
Acute: St. Pneumo viral respiratory infection
Chronic: Stah A
Worsens 5-7 days, fails to improves >10days
>12wks= chronic
4
Q
How is sinusitis Dx w/ imaging
What are the four indications for ABX to Tx sinusitis
What is used for first and second line ABX Tx
A
CT- gold standard
Waters view x-ray
Fever >102
Improve then worse
Purulent d/c
Sxs >10days
First :
Augmentin/Amox
Allergy: Doxy/Cephalosporin w/ Clinda
2nd: fail to improve w/ first line Tx in 7days Augmentin Levofloxacin Moxifloxacin Allergic: Doxy/Levo/Moxiflox
5
Q
How is Chronic Sinusitis Tx
How is Sinusitis in children Tx
When do Peds need f/u
A
Augmentin
Allergy: Clindamycin
45mg/kg/day w/ Augmentin
Allergy: 3rd-G Cephalosporin (One, Ten, Me)
72hrs; switch to second line agent
6
Q
? is the deadliest infectious dz in the USA
If Pt is not a resident of long term facility, ? time frame is applied for Dx
? is the MC microbe responsible
A
Pneumonia
CAP= <48hrs of admission
Strep pneumo
7
Q
What viruses can cause CAP
What do Pts present w/ on exam
? is needed for Dx
A
Corona Parainfluenza Adenovirus Influenza RSV
Desat O2
Tachy/Tachy
Fever
CXR/CT
8
Q
What lab result can help differentiate a bacterial from a viral pneumonia
What are the 4 MC causes of CAP in outpatients not needed admission
A
Procalcitonin- released by bacteria, inhibited by viral
SCM-pneumoniae
Influenza
9
Q
How is CAP Tx in previously healthy Pts w/ no ABX in past 90 days
How is Tx adjusted in areas w/ macrolide resistant Strep Pneumo
How are Pts w/ comorbidities or ABX use w/in past 90days Tx
A
Macrolide: Azith/Clarithromycin
Amoxicillin
Doxycycline
Beta-lactam and Macrolide or, Respiratory fluoroquinolone (GML-floxacin)
Macrolide or Doxy + Beta-lactam (Amox + Augmentin) or, Respiratory fluoroquinolone (GML-floxacin)
10
Q
What is first line Tx for ICU Pts w/ CAP
How is Tx adjusted for Pts w/ specific Pseudomonas RFs
How are Pts w/ MRSA risk Tx
A
Anti-pseudomonal Beta-lactam (Cefotax, Ceftriax, Ceftar, Amp-Sulbactam) and,
Either Azith or Resp Flqn (GML-floxacin)
Piper/Tazo or,
Imi/Meropenem or,
Cefepime with,
Azith or Resp Flqn (GML-floxacin)
Vancomycin
11
Q
What are the two pneumonia vaccines
Who is recommended to receive these
Adults w/ chronic illnesses that increase the risk for CAP should get ? vaccine regardless of age
A
Prevnar 13- first
Pneumovax 23
> 65y/o
ImmComp
Pneumovax 23
12
Q
ImmComp Pts or those at highest risk for fatal pneumonia need ? vaccine regiment
ImmCompe Pts 65y/o or > should receive a second dose of ? vaccine how often
A
Pneumovax 23 five years after first vaccine
Pneumovax 23 if first dose was 6/> years ago AND PT was <65y/o at time of first dose
13
Q
What PE finding suggest pneumonia d/t Strep Pneumo
This form of pneumonia is common in Pts w/ ? MedHx
What PE finding suggests Staph A pneumonia
A
Rust colored sputum
Splenectomy
Salmon colored sputum after influenza infection
14
Q
What causes Histoplasma capsulatum pneumonia
What other dz does this mimic on CXR
What type of pneumonia is associated w/ poor dental hygiene
A
Bat droppings
Sarcoidosis
Anaerobes
15
Q
Influenza pneumonia is characterized by ?
Atypical/Mycoplasma pneumonia is characterized by
Lobar consolidations are seen in ? pneumonia while apical infiltration is seen in ?
A
Rapid onset, severe course
Less severe/rapid
Lobar: CAP
Apical: TB
16
Q
Pneumonia Pts will have ? 3 positive PE findings
HAP/VAP have ? time frame for Dx
HAP is the 2nd MCC of ?
A
Tactile fremitus
Egophony
Dull to percussion
> 48hrs since admission/intubation
Inpatient infections
17
Q
What 3 factors distinguish nosocomial pneumonia from CAP
? is the most important step in the pathogenesis of nosocomial pneumonia
? medication can help reduce incidences of VAP
A
1: cause
2: inc drug resistant microbes
3: poorer underlying health
Colonization of pharynx/stomach
Sucralfate
18
Q
? microbes are the MCC of HAP
? microbes are VAP more likely to have
TB is more likely to infect Pts in ? population
A
Gram neg rods
Pseudomonas
Staph A
Acinobacter
S maltophilia
HIV positive
19
Q
What are the classic findings of TB on PE
Define Drug Resistant TB
Define Multiple Drug Resistant TB
Define Extensively Drug Resistant TB
A
Fever
Anorexia
Weight loss
Night sweats
Resistant to one: I/R
Resistant to I and R
Resistant to R/I and Aminoglycosides and/or Careomycin
20
Q
? is the MC pulmonary Sx of TB
What is also a common complaint
What is an unusual Sx
A
Chronic cough
Bloody sputum
Dyspnea
21
Q
What are the PPD rules for TB
A
>5mm: CXR evidence of TB HIV/ImmSupp 15mg/day x 1mon or equivalent of Pred Close contact w/ infectious TB PT
>10mm: IVDA Immigrants Residents of high populations GI surgery
> 15mm:
No RFs
22
Q
How is TB Dx
What is seen on CXR
What is seen on biopsy results
A
Acid fast bacilli smears and cultures
Apical Ghon complexes
Caseating granulomas
23
Q
What are the two forms of miliary TB
How is TB Tx
A
Potts Dz: spine
Scrofula: cervical lymph nodes
+ PPD= CXR
Neg CXR: latent TB Tx w/ Isoniazid w/ Vit B6 x 9mon
Active CXR:
Baseline LFTs
RIPE x 8wks
RI x 16wks
24
Q
What are the s/e of RIPE therapy
What is used for prophylaxis for household members
When are Pts considered fully Tx
A
R: orange fluids
I: neuropaty
P: hyperuricemia
E: red-green blindness
Isoniazid x 12mon
Two negative AFBs and cultures
25
What part of RIPE needs to be adjusted if CrCl is <30
? RIPE adjustment is needed if Pt is also on HIV meds
What are the 4 indications to test for TB w/ NAAT
P/E- 3 x/wk
Raltegravir, double dose when used w/ Rifampin
Previously Tx for TB
Lived in endemic area
Contact w/ MDR TB
HIV seropositive
26
? is the traditional test for latent TB
Define Ranke Complex
How are pregnant Pts w/ TB Tx and w/ ? educational piece
TST via Mantoux method
Calcified hilar lymph node
R/I/E x 4-8wks
R/I x 7months
Breast feeding not c/i
27
# Define Asthma
Absence of ? Sx on PE indicates medical emergency
What are two odd precipitators to attacks
Chronic, reversible inflammatory airway dz
Lack of wheeze
NSAIDs/ASA
28
# Define FEV1
Define FEV
Define FVC
Amount exhaled in 1 second
Total amount exhaled during forced breath
Total amount exhaled during FEV test
29
How is asthma Dx
What result is Dx
What type of improvement result helps w/ Dx
Peak expiratory flow rate
FEV1/FVC 75-80%
>10% inc of FEV1
30
# Define Intermittent Asthma
Define Mild
Define Moderate
Define Severe
Sxs 2/< days/wk
Awake 2/< x/month
SABA 2/< days/wk
No activity interference
Sxs >2day/wk
Awake 3-4x/mon
SABA >2 days/wk
Minor limitations
Daily Sxs
Awake 1/>/wk
SABA daily
Some limitations
Daily Sxs
Nightly awakenings
SABA several x/day
Extreme limitations
31
Step 1 Asthma Tx
Step 2 Asthma Tx
Step 3 Asthma Tx
Step 4 Asthma Tx
Step 5 Asthma Tx
Step 6 Asthma Tx
1- Intermittent
SABA PRN
2- Mild
Low ICS daily
3- Moderate
Low ICS + LABA daily
4- Moderate
Med ICS + LABA daily
5- Persistent
High ICS + LABA daily
6- Persistent
High ICS + LABA + PO CCS daily
32
What is used for acute Tx of asthma exacerbation
MC inhaled precipitant
Define Samter Syndrome and Atopic Triad
O2
Nebulized SABA
Ipratropium bromide
PO CCS
Cigarette smoke
Samter:
Asthma ASA Polyps
Atopic:
Asthma Rhinitis Eczema
33
What defines Chronic Bronchitis
What defines Emphysema
Most smokers will be Dx w/ ? and be termed ?
Productive cough x 3mon/year x 2yrs
Structural changes
Chronic bronchitis, blue bloater
34
What is the single best variable for predicting which Pt will develop COPD
How is Chronic Bronchitis Dx
What is seen on CXR
Hx 40 pack/year smoker
Lung biopsy w/ inc Reid index (gland layer >50% of bronchial wall)
Inc interstitial markings and non-flat diaphragm
35
What will be seen on PFT in chronic bronchitis
What is the most effective therapy for Tx Pts w/ chronic bronchitis
When is supplemental O2 indicated
FEV/FVC ratio <0.7
Cessation
SaO2 <89% or,
Rest PaO2 <55mmH
36
How are COPD exacerbation Tx
If ABX are used, ? ones and w/ ? indication
What will probably develop in these Pts d/t chronic hypoxic vasoconstriction
O2 (goal 88-92%)
Nebulized albuteral and Ipratropium
PO Prednisone
Inc dyspnea, sputum/purlence;
Azith/Cefur/Doxy
Cor pulmonale
37
COPD Gold Categories
A: Less Sx, Low risk;
Breathless when hurrying on flat ground, 0-1 exacerbation, 0 hospitalizations
SABA/SAMA
B: more Sx, low risk;
Breathless when walking slower than peers, 0-1 exacerbations, 0 hospitalizations
LAMA/LABA
C: less Sx, High risk
Breathless when hurrying on flat ground, 2/> exacerbation, 1/> hospitalizations
LAMA and SABA
D: more Sxs, High risk;
Breathless when walking slower than peers, 2/> exacerbations, 1/> hospitalizations
LAMA+LABA w/ SABA
38
What causes structural changes seen in emphysema
What type of breathing habit do these Pts develop
What term is used for these Pts
Destruction of alveolar septae d/t lost elastin
Purse lip, keeps airway from collapsing
Pink puffer- retained CO2
39
What is different between Blue Bloaters and Pink Puffers on CBC results
? is the MC of all interstitial lung dzs
How is this MC Dx
BB- Inc H/H
PP- normal Hct
Idiopathic pulmonary fibrosis
CXR w/ diffuse, patchy fibrosis and pleural base honeycomb
40
What type of PFT results are seen in Idiopathic Pulmonary Fibrosis
How is this Tx
Define Pneumoconiosis
Restrictive pattern- dec volume, normal/inc FEV1/FVC
CCS O2 Transplant
Pulmonay fibrosis w/ known cause;
Exposure to mining/dust causing dec lung volume/FVC (restrictive dz)
41
Asbestosis CXR findings
Coal Workers CXR findings
Sillicosis CXR findings
Linear pattern w/ basilar predominance, opacities and honeycomb
Nodular opacities in upper fields and less prominent hilar adenopathy
Egg shell classifications of hilar nodes
42
Berylliosis CXR findings
? restrictive lung dz makes Pts at increased risk for TB
? restrictive lung dz needs tobacco cessation more than others
Difuse infiltrates w/ hilar adenopathy
Sillicosis- need serial TST/CXRs
Asbestosis
43
? tissue finding indicates significant exposure to asbestos
? size lung mass is a nodule or a mass
How are incidental CXR findings of pulmonary nodules managed
Ferruginous body
<3cm- coin lesion, nodule (<30mm)
>3cm- mass
CT w/out contrast-
Ill defined, lobular, spiculated= biopsy
<1cm, calcified, smooth/defined border= f/u 3mon, 6mon, annual x 2yrs
44
What are the two categories of lung cancer
What are the 4 subtypes of one of these categories
Small cell
Non-Small cell:
Adeno: non-smoker w/ small peripheral lesion; MC bronchogenic Ca
SCC: central, solitary mass in smokers w/ hemoptysis
Large: fast growth that rarely responds to surgery
Carcinoid- lack differentiation
45
How does Small Cell Lung Ca present
What lab results would be seen
What syndrome can this Ca cause
Aggressive and almost always in smokers;
more likely to spread early
ACTH/ADH: HypoNa/HyperCa
Lamber Eaton- limb weakness
46
How are lung Ca Dx
Pancoast tumors are more likely to be ? types
What makes up the Pancoast Syndrome
Bronchoscopy w/ biopsy if central or,
Fine Needle Transthoracic aspiration (most useful)
Adeno/SCC
Shoulder pain
Horners
Bone destruction
47
How is Non-Small Cell lung Ca Tx
How is Small Cell Ca Tx
? measurement means PHTN
Stage 1-2: surgery
Stage 3: chemo then surgery
Stage 4: palliative
Chemo, no surgery option
>25mmHg at rest
48
? is the MCC of PHTN
How is this Dx
How is this Tx depending on the origin
MS
Right sided catheterization
LVF: diuretic, digoxin, anticoagulate
Cardiogenic: prostanoids, PD5 inhibitors, endothlin antagonists
Pulm Artery HTN: endothelin antagonists, prostanoids
49
MCC of anaphylaxis
? type of reaction is the usually
What does this reaction cause to happen
Ingested foods
MC a Type 1 IgE mediated reaction
Mast cells/basophils cause HOTN, shock, angioedema from fluid shift from intravascular space
50
What is usually the first sign of anaphylaxis
? is first line Tx
Acronym for acute asthmatic exacerbation Tx
Cutaneous pruritus/urticaria/angioedema
IM Epi
```
BIOMES
Beta agonist
Ipratropium
O2
Mg sulfate
Epi/Terbutaline
Steroids
```
51
? medication can cause Pts to be resistant to Epi
? is the MC sleep-related breathing d/o
What are the 2 presenting c/c and what are the two most specific Sxs
BBs
OSA
Snoring
Wake time sleepiness;
Nocturnal choking, Gasping
52
Polysomnography is the preferred Dx test for OSA, when are at home tests considered
? is the best Dx study to dx malignant pleural mesothelioma
? finding is nearly always present when malignant pleural mesothelioma is Dx
No other comorbidities
VATS Biopsy
Pleural effusion
53
MC type/location of malignant mesothelioma
What is commonly seen on PE for Croup
What virus causes this
Pleura
Hoarseness
Inspiratory stridor
Seal-barking cough
Parainfluenza type 1-3
54
What CXR finding is Dx for croup
How is this Tx
What causes membranous croup
Steeple sign
Warm/humid air
Dexamethasone Sxs <24hr
Nebulized epi if +wheeze
Diphtheria
55
? is the MC EKG finding in PEs
What is the most specific finding
Obstructive lung dzs and spirometry results
Sins tach
S1Q3T3- McGinn White Sign
```
Dec FEV1/ration <0.8:
Emphysema
Chronic bronchitis
Bronchiectasis
Asthma
```
56
What is seen on biopsy results of sarcoidosis
? organs are involved 90% of the time
What two derm manifestations may be seen
Non-caseating granuloma
Lungs
Erythema multiform- tender nodules on anterior lower legs, nonspecific
Lupus pernio- violaceous raised discoloration on face (pathognemonic); resembles frostbite
57
What lab results support Dx of Sarcoidosis
What sing may be seen on gallidium scans
If needed, how is sarcoidosis Tx
Inc ACE
HyperCa
Lambda sign- uptake by hilar nodes
Pred
Methotrexate- progressive/refractory
58
? triad is used for DVTs/PE
What type of birth control do women who smoke/>35y/o need to be on to reduce DVT risk
Virchows:
Trauma Stasis Hypercoag
Progestin only
59
How are DVTs Dx
How can a DVT be ruled out in Pts w/ low risks
If DVT is found, how are they Tx
Fist: Venous US
Gold: venography
D-dimer
LMWH
Fondaparinux
Factor 10a inhibitors
60
Most PEs arise from where in the body
What are the 4 specific RFs
What triad would be seen if a fat emboli is the cause
Iliofemoral DVTs
Cancer
OCPs
Pregnancy
Surgery
Hypoxemia
Neuro abnormals
Petechial rash
61
Pregnant Pts w/ amniotic fluid emboli can lead to ? complication
What risk stratification method is used for PEs
? is the initial method for Dx
DIC
Wells:
>4: PE likely
4/
62
What will be seen on ABGs during PEs
What two findings may be seen on CXR
? is the gold standard or imaging modalities for Dx
Respiratory alkalosis
Westermarks
Hampton Hump
Pulmonary angiography
63
How are PEs Tx
How long is medical therapy used for
OSA usually presents d/t obstruction at ? level
Acute phase: Heparin
Then: ARE-aban and Dabigatran
3mon minimum
Oropharynx
64
What are the 5 RFs for OSA
For a Dx, ? sleep study results are needed
```
Obesity
Anatomical
FamHx
ETOH/Sedative
Hypothyroidism
```
5/> events/hr w/ Tired/Waking/Snoring/HTN
15/> events/hr regardless of other Sxs
65
How is mild/mod OSA Tx
How is severe OSA Tx
How can Pulmonic Sarcoidosis preesent
Mild/Mod: CPAP, PO piece
Sev:
CPAP Uvulo-plasty
Tracheostomy- life threatening
Fever
Arthralgia
Weight loss
ENodosum
66
What is the hallmark CXR finding for almost all pulmonary sarcoidosis
What other 3 DDx need to be considered though if this hallmark is seen
Mediastinal lymphadenopathy
Young female: sarcoidosis
Kid from Ohio/zookeeper: histo
60y/o ceremics: berylliosis
67
How is pulmonary sarcoidosis Dx
? is needed to assess dz progression and guide Tx
How is this form of sarcoidosis Tx
Blood test: HyperCa
Inc ACE 4x
Serial PFTs
CCS
ACEI
Methotrexate
68
? is the leading cause of death in Pts w/ pulmonary sarcoidosis
Define Transudative Effusion
What are the MCC
Pulmonary fibrosis
Transient fluid d/t hydrostatic pressure
CHF
Cirrhosis w/ ascite
Hypoalbumin d/t nephrotic synd.
69
# Define Exudative Effusion
What are the MCCs
What criteria is used to dx an exudate
Fluid d/t infection/Ca/Immune
Pneumonia
PE
TB
```
Lights; 1 of 3= Dx
High protein, LDH
Protein >0.5
LDH >0.6
LDH >2/3 upper limit
```
70
Left sided effusions are more than likely ? while right sided are probably ?
How are these Tx
Define ARDS
L: exudative
R: transudative
Centesis
Chronic: pleuroesis or indwelling cath
Resp failure d/t fluid in lungs from inc alveolar capillary permeability
71
What 3 events account for 75% of all ARDS cases
What 3 things can be seen on PE
What would be seen on CXR
Sepsis sydrome- MC
Sev/mulitple trauma
Aspiration/inhalation
Tachypnea
Pink sputum
Crackles
Bronchograms
BIlateral fluffy infiltrates
72
How is ARDS Tx
What score system is used to predict the mortality of Sepsis
? is an indirect marker of tissue perfusion used in sepsis Tx
Intubate w/ lowest level of PEEP to maintain PaO2 >60mm/SaO2 >90
qSOFA:
New/worse mentation
RR >22/min
SBP 100/<
Lactate
73
HOTN is a late finding in sepsis w/ ? event occurring before HOTN sets in
? is the MCC of sepsis and ? is the MC manifestation
What are the 4 components of the SIRS criteria no longer used
Hypoperfusion
Pneumonia;
Fever
Temp <36/>38
HR >90bpm
RR >20
WBC <4K/>12K/>10% bands
74
Gram-Pos shock is d/t ? microbes
Gram-Neg shock is d/t ? microbes
? are the sepsis biomarkers
Staph/Strep exotoxin
EColi, Klebsiella, Proteus, Pseudomonas endotoxins
Procalcitonin: peak 12-48hrs
Lactate: >18 are Dx of septic shock
75
How are septic Pts Tx
Fluid resuscitation w/ IV crystalloid 30mL/kg in first 3hrs
Empiric ABX w/in 1hr
NorEpi if MAP is not maintained >65mm
76
# Define Cafe Coronary Syndrome
What microbe causes pertussis
What are the 3 phases of pertussis
Near/Fatal asphyxiation from airway obstruction d/t poorly chewed meat
Bordatella
Catarrhal- lacrimation, infective
Paroxysmal- staccato whoop
Convalescent- dec Sxs
77
How is pertussis Tx
What is used to predict death/hospitalizations in Pts w/ COPD
What are the two preferred ABX for Tx of Legionella Pneumonia
Azithromycin
TMP-SMX
```
BODE Index:
BMI
Obstructed airway
Dyspnea
Exercise capacity
```
Azithromycin
Levofloxacin
78
MCC of bacterial CAP
Pts w/ stable VS and pneumothorax need needle decompression when?
? antifibrinotic agent can be used to Tx idiopathic pulmonary fibrosis
Strep pneumo
>3cm pneumo or Sxs
Pirfenidone
Nintedanib
79
Emphysema affects structures past ? point
Distal to terminal bronchiole- acinus
80
What is the MCC of proximal acinar emphysema
? is the MCC of diffuse panacinar emphysema
What is the MCC of distal acinar emphysema
Cigarette smoking, less commonly in coal worker's pneumoconiosis
Alpha-1 antitrypsin deficiency
Spot pneumo
81
What are the only two interventions used to decrease mortality in emphysema
? genotype is associated w/ the highest risk for alpha-1 antitrypsin deficiency
? drugs are the MCC of drug reactions and cause ? MC manifestation
Cessation, O2 therapy
ZZ, MM is normal
```
Derm eruptions:
ASA
NSAID
B-lactam ABX
Sulfas
```
82
What are the 4 types of hypersensitivity reactions
1: anaphylactic, immediate;
IgE mediated degranulation of mast cells; anapnylaxis, urticaria, angioedema
2: cytotoxic;
IgG/IgM Abs react to Ags causing complement activation;
hemolytic anemia, E. fatalis, Goodpsture
3: immune complex;
IgG/IgM complex deposition and complement activation;
Serum sickness, SLE, PostStrep glomeruloneph.
4: cell mediates, delayed;
activated T-cells against surface Ags
Contact dermatitis, TST, transplant rejection
83
? screening questionnaire is used for OSA
MC presenting Sx of PE
MC presenting sign of PE
MC EKG finding
STOP-Bang
Dyspnea at rest/exertion
Tachypnea
Tachycardia
84
? is the gold standard for Dx PE but is rarely used d/t invasive method
MC Sx of acute bronchitis
When are x-rays indicated for acute bronchitis work ups
Catheter based pulmonary angiography
Cough
Fever
Sxs x 14days
85
? strains of influenza can be detected on rapid test
COPD Pts <65y/o need ? vaccines
COPD Pts >65y/o need ? vaccines
A and B
PPSV-23 and Influenza
PPSV-23, PCV-12 and Influenza
86
? microbe is MC isolated from COPD Pts
BMI over ? amount indicates Obesity Hypoventilation Syndrome
What would be seen on VS
H Influenza
>30kg/m2
SpO2 <94% on room air
87
? is MCC of chronic Cor Pulmonale
? are the two MCC of acute Cor Pulmonale
? type of axis deviation would be seen on EKG
COPD
PE, Acute RDS
RAD
88
What are the 5 groups of Cor Pulmonale by etiology
What distinguishes Sarcoidosis
What bronchoscopy biopsy result means a Dx
1: Pulm arterial HTN
2: left HDz (MC)
3: lung dz/hypoxemia
4: chronic thromboemoblism
5: unclear, multifocal mechanisms
T-cell/mononuclear phagocyte accumulation
Noncaseating granuloma
Sarcoid granuloma: noncaseating epitheloid granuloma surrounded by fibroblasts/lymphocytes
89
What test do Sarcoidosis Pts need annually
When is surfactant production started in utero
The lack of surfactant is the primary cause of ?
EKG d/t blocks/V-tach
Starts: 20wks
Gradual: 33-36wks
Surges: >36wks
RDS- AKA Hyaline Membrane dz
90
? is the leading RF for surfactant deficiency
What is surfactant made of and what function does it do
What would be seen on CXR of RDS
Prematurity
Phospholipid, proteins- dec alveolar surface tension to increase expansion
Ground glass appearance w/ air bronchograms
91
What are 3 RFs for RDS
What are infants that required prolonged ventilator support at risk for
What lab result is used as marker for fetal lung maturity and more mature surfactant levels
Maternal DM
Asphyxia
C-section
Bronchopulmonary dysplasia
Phophatidyglycerol
92
? is a common complication to arise from aspiration pneumonia
? microbe is MC involved
How are these complications Tx
Lung abscess
Anaerobe (Peptostrepto, Fuso, Bacteroides)
1st: PO Clindamycin
2nd: Augmentin
Amp-sulbactam
Carbapenem
93
What two c/c indicate a Dx of influenza
When can antiviral therapies be considered for use
What can be used
Rapid onset fever/arthralgia
Old/young Pt
Respiratory Dz
Oselta: PO w/ food; s/e N/V/Dizzy
Zana: inhaled; s/e wheeze/bronchospasm
Amantadine: PO; s/e in
elderly/renal impairment
Rimantadine: PO; less s/e potential than Rimantadine
94
? is used for influenza prophylaxis for close family members
Croup is AKA ?
? vaccine prevents the croup
Oseltamivir
Laryngotrachobronchitis
HIB
95
? medication is given to mothers who are expected to deliver early
What is the time frame for this medication to be given
What is the c/i to using antenatal CCS
Betamethasone
Delivering before 34wks
Maternal systemic infection- chorioamnionitis
96
? FEV1 level indicates a mod/sev COPD exacerbation
? level indicates a mild exacerbation
What does P jirovecii look like on CXR
<50%
>50%
Batman: Ground glass opacification
97
How is P jirovecci Tx and when is steroid use indicated
What are 4 c/c seen in Idiopathic Pulm Fibrosis
What will lab results show of the lung washings obtained
TMP-SMX
Steroid- PaO2 <70 or A-gradient >35mmHg
Dry cough
Exertional dyspnea
Velcro crackles
Finger clubbing
Interstitial pneumonia
98
? type of precaution does TB need
How is carcinoid syndrome Dx
What are the 3 parts to the carcinoid trifecta
Airborne NOT DROPLET
24hr excretion of 5-hydroxyindoleacetic acid
Flushing
Wheezing
Diarrhea
99
Where do carcinoid tumors most frequently mets to
What are expected CXR findings in CF Pts
? Pt population is most likely to develop bronchiectasis
Liver
Dilated, thick bronchi w/ tram track signs d/t thickened walls
Secondary to CF
100
CF PTs are most likely to have bronchiectasis exacerbation d/t ? microbe and Tx w/
Time frame for PE to appear after surgery/immobilization/central instrumentation
Where does a saddle PE form
Pseudomonas: inhaled aminoglycosides
3mon
Bifurcation of main PA and R/L PA
101
Why is nebulized racemic epi used for Croup Tx
? Dx has to be considered during unexplained, isolated pleural effusions found on CXR
How much of an effusion is needed to be seen on AP/PA films
A-agonist causing vasoconstriction in upper airway vessels to decrease swelling
PE w/ blunted angles
250-500mL
102
MCC of pleural effusions in US
Dx test of choice for Pertussis
What class of ABX is most effective for Tx
HF
Nasal swab
Macrolides
103
How often are IM RSV monoclonal Abs administered in high risk PTs during RSV season
What 3 bacteria can cause bronchitis
When is Pertussis most infective
Monthly
Bordatella
Mycoplasma
Chlamydia
Catarrhal stage
104
MCC of epiglottitis
What PE finding can aid w/ Dx
How are these PTs Tx
HIB
Pain over hyoid bone
Admit
Intubate if needed
IV Ceftriax/Amp-Sulbactam
105
What meds are used for Sx control of carcinoid tumors
What are the RFs that predict poor outcome for RSV induced bronchiolitis
What two clinical situations can lead to a false-negative D-dimer
Somatostatin analogues:
Ianreotide
Octerotide
Pasireotide
```
<3mon old
<34wks gestation
Tachy >70bpm
Ill appearance
Inability to hydrate
```
Recent anticoagulation
Subacute thrombosis <7d
106
Top three areas in sequence for aspirated foreign bodies to become lodged in kids
All aspirated bodies need ? examination
Retained foreign bodies can lead to ? issue
R main bronchus
L main bronchus
Trachea
Rigid bronchoscopy
Bronchiectasis
107
What is seen on CXR for aspirated foreign body
What is the physiological response to applying noninvasive PPV to COPD PTs
? is the gold standard for Dx P Jirovecci pneumonia
Obstructed lung: more hypodense d/t air not exiting
Unobstructed: less dense
Increased tidal volume d/t elimination of dead space
Fluoroscein staining
108
# Define Cor Pulmonale
What is the MCC in the USA
Preferred Tx for CAP in Pts w/ no comorbidity
What is used for Tx if insidious onset, low fever, and diffuse infiltrates
Aletered structure and function of RV
COPD
Amoxicillin
Doxy
109
Cardiac output equation
Why do Pts w/ sarcoidosis have HyperCa
Post-influenza pneumonia is d/t ? microbe causing ? and mediated by ?
CO= SV x HR
Granulomas secrete calcitriol (active Vit D) causing inc intestinal absorption of Ca
Staph A;
Necrotizing pneumonia;
Panton-Valentine Leukocidin
110
Pneumonia w/ bullous myringitis is d/t ?
MCC of pleural effusions in developed countries
MCC transudates
MCC exudates
Strep pneumo
HF
HF Cirrhosis Nephrotic PE
```
Malignancy
Bacterial pneumonia
TB
PE
Pancreatitis
```
111
Siderosis is d/t ?
Stannosis is d/t ?
Define Caplan Syndrome
Arc welding
Tin welding
Miner w/ RA who acquires any pneumoconioses
112
PE findings of acute bronchiolitis
? is the MCC of neonatal respiratory distress
What causes this MC
Exspiratory wheeze
Tachypnea
Transient tachypnea of newborn
Residual fluid in lungs from delivery; seen as diffuse parenchymal infiltrates/interlobar fluid accumulation
113
? Rx is recommended for all Pts admitted for asthma exacerbation
? trifecta suspects Sarcoidosis Dx
Superior Vena Cava syndrome is associated w/ ? and present w/ ?
Pred
Uveitis
Bilat hilar adenopathy
Dry cough
Lung Ca;
Facial/arm swelling
Dyspnea, cough
114
What are the 4 Sxs associated w/ Pancoast Syndrome
How are small pleural effusions best seen on CXR
? position makes effusions most difficult to detect
Arm swelling
Shoulder pain
Horners
Atrophy in hand/arm muscles
Lateral decubitus w/ affected side down
Supine
115
? is the most important non-pharmacological component to asthma management
Mnemonic for causes of hemoptysis
Trigger avoidance
```
BATTLE CAMP:
Bronchitis/ectiasis
Asperiglloma
Tumore
TB
Lung abscess
Emboli, pulm
Coagulopathy
Autoimmune
AV malformation
Alveolar hemorrhage
MS
Pneumonia
```
116
Chlamydia pneumonia often follows ? Dx
Cox Burnetti (Q-fever) is passed by ? and will have ? abnormal lab result
What dissociation is seen in Chlamydia psittaci
Prolonged pharyngitis
Livestock;
Inc LFTs
Temp-pulse dissociation- Faget Sign; brady cardia w/ fever
117
Potential neuro complication induced by pertussis
Stopped
Seizures
75
