Mouth/Pulmonary Flashcards
(161 cards)
1
Q
Oral Candidiasis cause
A
Candida albicans; MCC immunocompromised, corticosteroid therapy, dentures
2
Q
Oral Candidiasis S/S
A
creamy white patches on oral mucosa that can be scraped off to reveal underlying erythematous mucosa; mouth and throat pain; angular cheilitis
3
Q
Oral Candidiasis Dx
A
clinical; wet prep; KOH (yeast and hyphae), biopsy (to r/o leukoplakia)
4
Q
Oral Candidiasis TX
A
antifungals (ketoconazole, fluconazole, nystatin)
5
Q
Oral Herpes Cause
A
HSV (type 1, 2, 6); transmitted during viral shedding
6
Q
Oral Herpes S/S
A
painful, intraoral/lips, grouped vesicles after a prodrome of pain, burning, and tingling
7
Q
Oral Herpes Dx
A
clinical; serology; Tzanck smear (multinucleated giant cells)
8
Q
Oral Herpes Tx
A
antiviral (acyclovir)
9
Q
Oral Leukoplakia Cause
A
tobacco, alcohol, denture use; dysplastic or squamous cell carcinoma
10
Q
Oral Leukoplakia S/S
A
painless, white oral lesions that cannot be scraped off
11
Q
Oral Leukoplakia Dx
A
biopsy (acanthosis)
12
Q
Oral Leukoplakia Tx
A
surgical excision; cryotherapy or carbon dioxide laser ablation
13
Q
Hypertensive Retinopathy cause
A
accelerated hypertension
14
Q
Hypertensive Retinopathy S/S
A
floaters; blurred vision; distortion; progressive visual acuity loss
15
Q
Hypertensive Retinopathy Dx
A
fundoscopic exam (arteriolar narrowing; copper or silver wiring; arteriovenous nicking)
16
Q
Hypertensive Retinopathy Tx
A
regulate BP/HTN; laser photocoagulation; vitrectomy
17
Q
Diabetes Retinopathy cause
A
hypoxia, neovascularization, and increased viscosity due to DM
18
Q
Diabetes Retinopathy s/s
A
floaters; blurred vision; distortion, progressive visual acuity loss
19
Q
Diabetes Retinopathy dx
A
fundoscopic exam (venous dilation, microaneurysms, retinal hemorrhages, retinal edema, hard exudates [nonproliferative]; neovascularization, vitreous hemorrhage [proliferative]), HA1C, fluorescein angiography
20
Q
Diabetes Retinopathy tx
A
glucose control; laser photocoagulation; vitrectomy
21
Q
Retinal Detachment (EMERGENCY) cause
A
congenital malformations, metabolic disorders, trauma, vascular disease, choroidal tumors, high myopia or vitreous disease, degeneration
22
Q
Retinal Detachment (EMERGENCY) s/s
A
acute onset painless, blurred/blackened vision (curtain over eye); can progress to partial/complete blindness; photopsia (floaters/flashing lights); visual field defect
23
Q
Retinal Detachment (EMERGENCY) dx
A
fundoscopic exam (ridges of displaced retinal flapping in the vitreous humor), normal IOP
24
Q
Retinal Detachment (EMERGENCY) tx
A
emergency consult for laser surgery vs cryosurgery; remain supine with head turned towards the side of detachment
25
Retinal Venous Occlusion cause
atherosclerosis, glaucoma, macular edema, DM, HTN, high cholesterol, clotting disorders, age, smoking
26
Retinal Venous Occlusion s/s
acute onset of painfless unilateral blurring or loss of vision; gradually worsens; dark spots and floaters
27
Retinal Venous Occlusion dx
fundoscopic exam (blood and thunder); optical coherence tomography; ophthalmoscopy; fluorescein angiography
28
Retinal Venous Occlusion tx
laser therapy; corticosteroid injections; vitrectomy
29
Retinal Arterial Occlusion (EMERGENCY) cause
emboli, thrombotic phenomenon, vasculitides
30
Retinal Arterial Occlusion (EMERGENCY) s/s
acute, persistent, painless loss of vision in the range of counting fingers to light perception; worsening visual acuity; hx of jaw claudication, scalp tenderness, weight loss, fever, proximal muscle/joint aches (r/o temporal arteritis)
31
Retinal Arterial Occlusion (EMERGENCY) dx
fundoscopic exam (pallor of retina; arterial narrowing, separation of arterial flow, retinal edema, cherry red spot [perifoveal atrophy])
32
Retinal Arterial Occlusion (EMERGENCY) tx
recumbent position; gentle ocular massage to reduce damage; vessel dilation; paracentesis
33
cataracts cause
natural aging process, trauma, congenital causes, systemic disease, medication use (steroids/statins)
34
cataracts s/s
insidious onset of decreased vision; gradual diminution of vision loss; double vision; excess glare; fixed spots; reduced color perception; typically bilateral
35
cataracts dx
fundoscopic exam (translucent yellow discoloration on lens; dark against a yellow background)
36
cataracts tx
intracapsular or extracapsular extractions with lens placement
37
Open-Angle Glaucoma cause
increased IOP (less aqueous humor flows through canal of Schlemm); chronic
38
Open-Angle Glaucoma s/s
asymptomatic; blinding; loss of peripheral vision
39
Open-Angle Glaucoma dx
fundoscopic exam (increased IOP; increased cup-to-disk ratio)
40
Open-Angle Glaucoma tx
decrease aqueous production (b-blocker: timolol; carbonic anhydrase inhibitors: acetazolamide); increase flow (prostaglandin: latanoprost, bimatoprost; cholinergic: pilocarpine; epinephrine); Brimonidine (a-agonist) will do both
41
Acute-Angle Glaucoma (EMERGENCY) cause
increase IOP (narrows anterior chamber)
42
Acute-Angle Glaucoma (EMERGENCY) s/s
painful vision loss; nausea and vomiting; circumlimbal injection; steamy cornea; fixed mid-dilated pupil; decreased acuity; tearing
43
Acute-Angle Glaucoma (EMERGENCY) dx
fundoscopic exam (narrowed anterior chamber, IOP >55mmHg, firm globe); crescent shadow
44
Acute-Angle Glaucoma (EMERGENCY) tx
IV anhydrase inhibitor (acetazolamide); b-blocker (timolol); osmotic diuresis (mannitol); laser or surgical iridotomy; DO NOT GIVE mydriatics
45
Meniere's Disease (endolymphatic hydrops) cause
unknown
46
Meniere's Disease (endolymphatic hydrops) s/s
recurrent vertigo; lower range hearing loss; tinnitus; one-sided aural pressure
47
Meniere's Disease (endolymphatic hydrops) dx
caloric testing (nystagmus is lost on impaired side)
48
Meniere's Disease (endolymphatic hydrops) tx
low sodium diet; diuretics (acetazolamide); meclizine; intratympanic corticosteroid therapy; surgery
49
Labyrinthitis cause
bacterial or viral infection; vascular ischemia; autoimmune processes
50
Labyrinthitis s/s
acute to severe vertigo; hearing loss; aural fullness; nausea/vomiting; etc
51
Labyrinthitis dx
CBC and blood cultures to r/o infection
52
Labyrinthitis tx
antibiotics w/ fever or infection; vestibular suppressants (diazepam, lorazepam) during initial acute symptoms; hydration; antiemetics (prochloperazine)
53
Vertigo cause
labyrinthitis, BPPV, Meniere's disease, vestibular neuritis, head injury (peripheral), vascular disease, arteriovenous malformation, tumor, multiple sclerosis, vertebrobasilar migraine (central)
54
Vertigo s/s
sudden onset dizziness, N/V, tinnitus, hearing loss, horizontal nystagmus, [peripheral]; gradual onset dizziness, vertical nystagmus (central)
55
vertigo dx
Hallpike maneuver will delay nystagmus (peripheral); audiometry; caloric stimulation; electronystagmography; MRI
56
vertigo tx
vestibular suppressants (diazepam, meclizine [antihistamine]); physical therapy; intervention/surgery
57
acute bronchitis cause
viruses (rhinovirus, coronavirus, RSV); bacterial (HIB, S. pneumo, M. cat) for chronic lung diseases
58
acute bronchitis s/s
cough with or without sputum, dyspnea, fever, sore throat, headache, myalgias, substernal discomfort, expiratory rhonchi or wheezes
59
acute bronchitis dx
clinical, CXR (to r/o pneumonia)
60
acute bronchitis tx
supportive (hydration, expectorants, analgesics, b2 agonists, cough suppressants), cephalosporin, macrolide, bactrim (bacterial/chronic)
61
influenza cause
orthomyxovirus (A, B, C); transmitted through droplet nuclei
62
influenza s/s
abrupt fever, chills, malaise, muscle aches, substernal chest pain, headache, nasal stuffiness, nausea (w/in 18-72 hrs); fever (1-7 days) w/ coryza, nonproductive cough, photophobia, eye pain, sore throat, pharyngeal injection, flushed faces, wheezes/ronchi
63
influenza dx
clinical; rapid flu and cultures; CXR w/ bilateral diffuse infiltrates (pneumonia, S. aureus)
64
influenza tx
supportive care (rest, analgesics, cough suppressants), tamiflu (oseltamivir) given w/in 48 hrs; influenza shot
65
bacterial pneumonia cause
streptococcus pneumoniae, haemophilus influenzae, moraxella catarrhalis, staphylococcus aureus, klebsiella pneumonia, mycoplasma pneumonia, chlamydia, legionella
66
bacterial pneumonia dx
CXR (lobar infiltrates); sputum culture
67
bacterial pneumonia tx
antibiotics (macrolide, doxycycline, fluoroquinolone, broad spectrum beta-lactam)
68
Viral Pneumonia causes
influenza, RSV, adenovirus, parainfluenza, cytomegalovirus
69
Viral Pneumonia dx
CXR (bilateral patchy infiltrates); sputum culture
70
Viral Pneumonia tx
supportive, antiviral (oseltamivir)
71
Fungal Pneumonia cause
Histoplasma capsulatum, Coccidioides immitis, Blastomyces dermatitidis, Paracoccidioides brasiliensis, Sporothrix schenckii, Cryptococcus neoformans, Candida species, Aspergillus species, Mucor species
72
Fungal Pneumonia dx
CXR (patchy infiltrate, mediastinal adenopathy, pulmonary nodules w/ ground-glass opacity); sputum cultures (caseating/necrotizing granulomas inside macrophages; fungal hyphae; intracellular yeast)
73
Fungal Pneumonia tx
amphotericin B (histoplasmosis); fluconazole (coccidioides, etc)
74
Community Acquired Pneumonia cause
Strep pneumo, HIB, M. Cat, Staph aureus, Klebsiella, (bacterial); influenza, RSV, adenovirus, parainfluenza (viral)
75
Community Acquired Pneumonia s/s
cough, purulent sputum, SOB, tachycardia, chest pain, fever, sweats, rigors, crackles and dullness to percussion; rust colored sputum w/ single rigor (strep); currant-jelly sputum, ETOH related, comorbid related (klebsiella)
76
Community Acquired Pneumonia dx
CXR (infiltrate), gram stain/sputum culture, elevated procalcitonin
77
Community Acquired Pneumonia tx
macrolide (Azithromycin), doxycycline (healthy); fluoroquinolone, macrolide + beta-lactam (chronic disease); pneumovax or PPSV
78
Atypical Community Acquired Pneumonia cause
Mycoplasma, chlamydia, legionella, M. cat
79
Atypical Community Acquired Pneumonia s/s
low grade fever, nonproductive cough, myalgia, fatigue; reddened TM or bullous myringitis (mycoplasma); high fever, dry cough, dyspnea (legionella [contaminated water droplets])
80
Atypical Community Acquired Pneumonia dx
CXR (infiltrates); sputum culture
81
Atypical Community Acquired Pneumonia tx
macrolide (azithromycin); doxycycline (chlamydia); supportive (viral)
82
Hospital Acquired Pneumonia cause
staph, pseudomonas
83
Hospital Acquired Pneumonia s/s
cough, purulent sputum, SOB, tachycardia, chest pain, fever, sweats, rigors, crackles and dullness to percussion
84
Hospital Acquired Pneumonia dx
CXR (infiltrates); sputum culture
85
Hospital Acquired Pneumonia tx
ceftriaxone, fluoroquinolone, broad spectrum beta-lactam, imipenem, cefepime
86
Tuberculosis cause
mycobacterium tuberculosis; inhaled droplets
87
Tuberculosis s/s
cough w/ sputum >3 weeks, fever, night sweats, anorexia, weight loss, chest pain, dyspnea, hemoptysis, post-tussive rales
88
Tuberculosis dx
CXR (infiltrates, hilar/paratracheal LAD, segmental atelectasis, cavitations [primary TB]; posterior segments of upper lobes and super segments of lower lobes [reactivation]; ghon complexes/calcified primary focus [healed primary infection]; calcified primary and hilar LAD [Ranke complex]); TB skin test, cultures (DNA/RNA amplification tests); biopsy (caseating/necrotizing granulomas)
89
Tuberculosis tx
isoniazid (hepatitis, neuropathy -> give B6), rifampin (orange fluid), pyrazinamide, ethambutol (optic neuritis)
■ LTBI: INH x9mo; RIF x4mo; RIF + PZA x2mo
■ Active TB: INH + RIF + PZA + EMB x2mo
90
Bronchogenic Carcinoma cause
smoking #1 risk factor
■ Squamous cell - centrally located; slow growing; hemoptysis
■ Adenocarcinoma (MC) - peripherally located; slow growing; distant metastasis
■ Large cell - peripherally located; slow growing; early metastasis
■ Small cell (oat cell) - central bronchi; early metastasis; poor prognosis
91
Bronchogenic Carcinoma s/s
cough, hemoptysis, pain, anorexia, weight loss, asthenia, LAD, hepatomegaly, clubbing of fingers, paraneoplastic syndrome (Cushing's, gynecomastia, cerebellar degeneration, thrombophlebitis, anemia, acanthosis nigricans)
■ Super vena cava syndrome - dyspnea, headache, cough, arm swelling, etc
■ Pancoast tumor (lung apex tumor) - horner syndrome (unilateral facial anhidrosis, ptosis, miosis, shoulder pain)
■ Carcinoid syndrome - flushing, diarrhea, telangiectasias (endocrine); hoarseness (recurrent laryngeal nerve); exudate (effusions)
92
Bronchogenic Carcinoma dx
CXR, CT chest, bronchoscopy w/ biopsy/cytology, PET scan
93
Bronchogenic Carcinoma tx
surgery (non-small cell); combo chemo/surgery (small cell)
94
carcinoid tumor cause
neuroendocrine tumor; grow slow; rarely metastasize; common in GI tract
95
carcinoid tumor s/s
hemoptysis, cough, wheezing, recurrent pneumonia, carcinoid syndrome
96
carcinoid tumor dx
bronchoscopy and biopsy (pink/purple vascularized lesion); CT scan
97
carcinoid tumor tx
surgical excision, radiation, chemotherapy, ocreotide
98
Pulmonary Nodules (coin lesion) cause
TB, fungal infection, foreign body, malignancy
99
Pulmonary Nodules (coin lesion) s/s
asymptomatic
100
Pulmonary Nodules (coin lesion)
biopsy (definite diagnosis); CT scan
101
Pulmonary Nodules (coin lesion)
watchful waiting for size increase; CT q3mo (low probability); excision (high probability)
102
Metastatic Tumors cause
bladder cancer, colon cancer, breast cancer, prostate cancer, sarcoma, Wilms tumor, neuroblastoma
103
Metastatic Tumors s/s
new onset cough, shortness of breath at rest, symptoms of primary tumor
104
Metastatic Tumors dx
CT or PET scan, biopsy
105
Metastatic Tumors tx
excision, chemo/radiation, etc
106
Asthma cause
allergens, exercise, URIs, GERD, drugs (ASA), stress, weather changes; obstruction of airflow, bronchial hyperreactivity, inflammation of airway
107
Asthma s/s
cough, chest tightness, breathlessness, wheezing
108
Asthma dx
spirometry of FEV1/FVC <75%; increase of 10% after bronchodilator therapy (histamine, methacholine challenge test, decline in FEV1>20%)
109
Asthma tx
SABA -> low dose ICS + SABA -> low dose ICS + LABA -> medium dose ICS + LABA -> leukotriene modifiers
110
Bronchiectasis cause
congenital (cystic fibrosis); infection (TB, fungal, lung abscess); obstruction (tumor)
111
Bronchiectasis s/s
chronic purulent sputum (foul smelling), hemoptysis, chronic cough, recurrent pneumonia
112
Bronchiectasis dx
CT chest (high resolution); CXR (bronchial markings, basal cystic spaces, honeycombing)
113
Bronchiectasis tx
antibiotics x 10-14 days (amoxicillin, augmentin, bactrim, cipro); bronchodilators
114
Chronic Bronchitis cause
smoking
115
Chronic Bronchitis s/s
"blue bloaters"; mild dyspnea, chronic productive cough x 3mos/2yrs; rhonchi/wheeze, peripheral edema, overweight, cyanotic
116
Chronic Bronchitis dx
CXR (increased interstitial markings at bases, normal diaphragms)
117
Chronic Bronchitis tx
anticholinergics (ipratropium); SABA; antibiotics and steroids prn
118
emphysema cause
smoking
119
emphysema s/s
"pink puffers"; exertional dyspnea, mild nonproductive cough, normal lung sounds, no peripheral edema, thin, weight loss, barrel chest, hyperventilation, pursed-lip breathing
120
emphysema dx
CXR (decreased lung markings at apices, flattened diaphragms, hyperinflation, small/thin heart, bullae/blebs)
121
emphysema tx
anticholinergics (ipratropium); SABA; antibiotics and steroids prn
122
Chronic Obstructive Pulmonary Disease cause
emphysema (destruction of alveolar space); chronic bronchitis (chronic productive cough); smoking, recurrent URIs, pollutants, a1-antitrypsin deficiency
123
Chronic Obstructive Pulmonary Disease s/s
progressive SOB, excessive cough with or w/o sputum, increased AP diameter, resonance on percussion, decreased breath sounds, inspiratory crackles, prolonged expiration
124
Chronic Obstructive Pulmonary Disease dx
decreased spirometry (FEV/FVC) w/o improvement with bronchodilators; CXR (hyperinflation, flat diaphragms, blebs, increased markings)
125
Chronic Obstructive Pulmonary Disease tx
stop smoking; anticholinergics (ipratropium); SABA; corticosteroids; antibiotics prn
126
Pleural Effusion cause
pulmonary infection, malignancy, trauma (exudates); CHF, atelectasis, cirrhosis/renal disease (transudates); infection in pleural space (empyema); trauma, aortic dissection, and malignancy (hemothorax)
127
Pleural Effusion s/s
gradual onset, asymptomatic; dyspnea, pleuritic chest pain, cough; decreased breath sounds, dullness to percussion, occasional friction rub
128
Pleural Effusion dx
PA CXR (blunted costophrenic angle); thoracentesis (gold standard) w culture/LDH; CBC, CMP, BUN/Cr, pulse ox
129
Pleural Effusion tx
oxygenation/ventilation, thoracentesis/chest tube; antibiotics prn
130
Pneumothorax cause
massive, sudden accumulation of air in pleural cavity (tension)
131
Pneumothorax s/s
sudden, sharp, unilateral, pleuritic chest pain, SOB, tracheal deviation, decreased unilateral breath sounds
132
Pneumothorax dx
PE (diminished breath sounds, deviated trachea, chest hypertympanic), upright/expiratory CXR, ultrasound chest [Tension: clinical (does not require xray)]
133
Pneumothorax tx
support airway/oxygenation; needle aspiration (thoracotomy)/ “pigtail” catheter/chest tube
134
Pulmonary Embolism cause
virchow’s triad [venous stasis, hypercoagulable, vessel wall damage], age, recent surgery, previous DVT, hormone use, cancer, long travel, smoker
135
Pulmonary Embolism s/s
pleuritic chest pain, fatigue, dyspnea, syncope, hemoptysis, cardiac arrest
136
Pulmonary Embolism dx
CT pulmonary angiogram; Wells score, PERC criteria; (PE, EKG, and CXR normal), elevated D-dimer, VQ scan if CT unable or low creatinine/Glomerular filt
137
Pulmonary Embolism tx
airway/hemodynamic support, anticoagulation (heparin -> LMWH, enoxaparin); thrombosis for “massive” PEs; IVC filter
138
Pulmonary HTN cause
hypoxia, acidosis, veno-occlusive conditions (secondary); idiopathic (rare)
139
Pulmonary HTN s/s
dyspnea, angina-like retrosternal chest pain, weakness, fatigue, edema, ascites, cyanosis, effort syncope; narrow splitting S2 and systolic ejection click
140
Pulmonary HTN dx
heart catheterization w/ echo; CXR (enlarged pulmonary arteries); EKG (RVH, atrial hypertrophy, RV strain)
141
Pulmonary HTN tx
chronic oral anticoagulants, CCB, prostacyclin (iloprost, epoprostenol, pulmonary vasodilator); transplant
142
Cor Pulmonale cause
pulmonary HTN, RV hypertrophy, pulmonary embolism, ARDS
143
Cor Pulmonale s/s
fatigue, tachypnea, exertional dyspnea, cough, anginal chest pain, hemoptysis, syncope
144
Cor Pulmonale dx
right heart catheterization; CXR, EKG (RV failure); ABG, BNP
145
Cor Pulmonale tx
diuretics, CCB (nifedipine, diltiazem), B-agonists, prostacyclin, warfarin
146
Idiopathic Pulmonary Fibrosis cause
unknown
147
Idiopathic Pulmonary Fibrosis s/s
insidious dry cough, exertional dyspnea, constitutional symptoms (malaise, fatigue, etc); clubbing of fingers, inspiratory crackles
148
Idiopathic Pulmonary Fibrosis dx
PFTs (decreased lung volume, normal/increased FEV1/FVC); CXR/CT (diffuse, patchy fibrosis w/ honeycombing); bronchoalveolar lavage, biopsy
149
Idiopathic Pulmonary Fibrosis tx
supportive, no evidence of benefit
150
Pneumoconiosis cause
inhalation of coal dust or various inert, inorganic, silicate dusts
151
Pneumoconiosis s/s
asymptomatic; dyspnea, inspiratory crackles, clubbing of the fingers, cyanosis
152
Pneumoconiosis dx
PFTs (decreased lung volume, normal/increased FEV1/FVC); CXR (small opacities in upper lung fields [coal]; small rounded opacities throughout, hilar lymph node calcifications [silicosis]; linear opacities, interstitial fibrosis, thickened pleura, calcified plaques on diaphragms or lateral chest wall [asbestos])
153
Pneumoconiosis tx
supportive (oxygenation, vaccinations, rehab), corticosteroids, smoking cessation
154
Sarcoidosis causes
idiopathic
155
Sarcoidosis s/s
cough, insidious dyspnea, chest discomfort, malaise, fever, organ-specific involvement symptoms; erythema nodosum, enlarged parotid glands, LAD, liver, spleen
156
Sarcoidosis dx
transbronchial biopsy/fine needle biopsy (noncaseating granulomas); CXR (symmetric bilateral hilar LAD, right paratracheal LAD, bilateral diffuse reticular infiltrates); serum blood work (leukopenia, eosinophilia, ESR, hypercalcemia, ACE levels elevated)
157
Sarcoidosis tx
corticosteroids
158
ARDS cause
previous clinical insult; MCC sepsis, inhalation of irritants, severe pneumonia, head/chest trauma
159
ARDS s/s
acute onset of shortness of breath/labored/rapid breathing within 1 week of known clinical insult, low blood pressure, confusion/extreme tiredness
160
ARDS dx
acute onset of respiratory failure with PaO2/FiO2 <300mmHg; bilateral infiltrates on CXR; pulmonary artery wedge pressure <18mmHg (CBC, CT vs echo vs EKG)
161
ARDS tx
oxygen/ET tube, IV fluids, blood thinners/antibiotics/sedate prn
