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PANCE/EOC > Pulm #1 > Flashcards

Pulm #1 Flashcards

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1
Q

Acute bronchitis is MCC by _____, but can also be caused by bacteria such as _____

A

Viruses (Adenovirus, Parainfluenza, Coronavirus, Rhinovirus)

-Bacterial: S. Pneumo, M. Cattarhalis, H. Influenzae

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2
Q

Symptoms of acute bronchitis

A
  • Cough (hallmark, and present for at least 5 days)
  • Malaise, dyspnea, may have hemoptysis
  • May have wheezing and rhonchi
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3
Q

Treatment for acute bronchitis

A
  • Symptomatic management

- ABX not indicated in most patients

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4
Q

What is acute bronchitis?

A

Inflammation of the bronchi

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5
Q

Risk factors for epiglottitis

A
  • DM
  • Children 3 mos - 6 years
  • Males
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6
Q

What are the causes of Epiglottitis?

A
  • H. Influenzae B in unvaccinated or foreign immigrants

- Group A Strep or Strep Pneumo if vaccinated, cocaine use

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7
Q

Symptoms of Epiglottitis

A
  • Dysphagia, Drooling, Distress

- Fever, inspiratory stridor, tripoding, hot potato voice

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8
Q

What is the definitive diagnostic for epiglottitis?

A

Laryngoscopy (cherry red epiglottis with swelling)

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9
Q

However, what other diagnostic can be done for epiglottitis and what do you see?

A

Lateral cervical radiographs: thumb or thumbprint sign

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10
Q

Treatment for epiglottitis

A
  • Maintain the airway (most important component) in the OR

- ABX: Ceftriaxone or Cefotaxime

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11
Q

How to prevent Epiglottitis in close contacts

A

-Rifampin

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12
Q

Acute Respiratory Distress Syndrome (ARDS) is MC in ______, such as _____

A

Critically ill patients

  • Gram negative sepsis (MC)
  • Severe pancreatitis
  • Near drowning
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13
Q

What are the three components of diagnosing ARDS

A
  • Severe hypoxemia refractory to supplemental oxygen (PaO2/FiO2 radio < 200 mm Hg)
  • Bilateral diffuse pulmonary infiltrates that spares costophrenic angles
  • Pulmonary capillary wedge pressure < 18 mm Hg with right heart catheterization (Swanz-Ganz)

-Symptoms developing within 1 week

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14
Q

Treatment for ARDS

Symptoms of ARDS

A
  • Noninvasive or mechanical ventilation + treat underlying cause
  • -PEEP improve hypoxemia

-Often fatal

  • Rapid onset of profound dyspnea 12-24 hours after precipitating event (car crash, etc.)
  • Pink frothy sputum
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15
Q

What is linked with COPD in younger adults (<40 y/o) associated with panlobar emphysema?

A

Alpha-1 Antitrypsin Deficiency

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16
Q

What should you do diagnostically in a patient who is under 40 with COPD?

A

Blood tests

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17
Q

What risk factors are associated with Asbestosis?

A
  • Destruction, repair or renovation of old buildings

- Insulation, ship building

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18
Q

Chest radiographs for Asbestosis shows

A
  • Pleural plaques/calcifications or thickening of parietal pleura of lower lobes
  • Interstitial fibrosis (honeycomb lungs) of the lower lobes
  • “Shaggy heart sign” –indistinct heart border
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19
Q

What gives a definitive diagnosis of Asbestosis?

A

Lung biopsy: shows linear asbestos bodies (ferruginous bodies)

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20
Q

What does a PFT show for asbestosis?

A

Restrictive lung pattern: increased FEV/FVC1, decreased lung volumes

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21
Q

Complications of Asbestosis

A
  • Bronchogenic carcinoma (most common)

- Malignant mesothelioma of the pleura (most specific)

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22
Q

What does a liver biopsy show in a patient with Alpha-1 Antritypsin Deficiency?

A

PAS-positive globules in hepatocytes

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23
Q

Treatment for Alpha-1 Antitrypsin Deficiency

Study These Flashcards
A

IV pooled alpha-1 antitrypsin

24
Q

Aspergillosis is a fungus that most commonly affects the lungs, sinuses, and CNS. Where is it found?

Study These Flashcards
A

In garden and houseplant soil and compost

25
If Aspergillosis occurs in patients with asthma, bronchiectasis, or cystic fibrosis, it is considered allergic bronchopulmonary aspergillosis. What is one specific symptom that occurs with this type of aspergillosis?
Expectoration of brownish mucus plugs in the sputum
26
If there is an aspergilloma, what happens and what symptoms occur?
- Fungus colonizes a preexisting pulmonary cavitary lesion | - Hemoptysis
27
With allergic aspergillosis, what diagnostic will be helpful?
Increased IgE, eosinophilia
28
On a lung biopsy for aspergillosis, what will be seen?
Tissue appears dusky and necrotic | -Septate hyphae with regular branching at acute (45 degree) angles
29
True or False: Aspergillosis is associated with increased risk of hepatocellular carcinoma
True
30
Treatment for both types of Aspergillosis
- Allergic: tapered oral corticosteroids + Chest physiotherapy (add Itraconazole in some cases) - Aspergilloma: Surgical resection vs observation if asymptomatic
31
Aspiration PNA is MCC by ______ and has increased incidence in _____.
Anaerobes -Peridontal disease
32
Aspiration PNA is most commonly in what location and why?
Right lower lobe -Due to vertical angle of right mainstem bronchus
33
Symptoms of Aspiration PNA
Foul-smelling "rotten egg" sputum
34
Treatment for aspiration PNA
- Ampicillin-Sulbactam or Amoxicillin-Clavulanate | - Metro + either Amoxicillin or Penicillin G as alternatives
35
What bacteria with PNA is associated with sever alcoholics?
Klebsiella -current jelly sputum and cavitary lesions
36
What is the gold standard in diagnosing Asthma?
Pulmonary function testing (PFT) shows reversible obstruction
37
3 components of Asthma pathophysiology
- Airway hyperreactivity - Bronchoconstriction - Inflammation
38
Risk factors for Asthma
- Atopy (strongest) - Family history - Air pollution - Male gender - Tobacco Smoke
39
What are the three components of Samter's Triad?
Asthma + chronic rhino sinusitis + sensitivity to Aspirin or NSAIDs
40
Symptoms of Asthma
- Dyspnea - Wheezing - Cough (at night) - Chest tightness - Fatigue
41
What are some exam findings of a patient with asthma
- Prolonged expiratory wheeze - Hyperresonance to percussion - Decreased breath sounds - Tachypnea - Tachycardia - Use of accessory muscles
42
How else can you diagnose Asthma?
-Bronchoprovocation: Methacholine challenge (> 20% decrease on FEV1) followed by bronchodilator challenge (Increase of FEV1 > 12 is expected)
43
What is the best and most objective way to assess exacerbation severity and patient response to treatment in asthma?
Peak expiratory flow rate
44
In an acute asthma exacerbation, what are three discharge criteria?
- PEFR > 70% predicted - PEFR > 15% initial attempt - Subjective improvement
45
On ABG with asthma, what is expected?
Respiratory alkalosis (from tachypnea)
46
Treatment for acute asthma
- SABA (Albuterol, Terbutaline, Epinephrine) - Antimuscarinics (Ipatropium) - Corticosteroids (Prednisone, Methylprednisone, Prednisolone)
47
What are some common side effects of SABA?
Tachycardia/arrhythmias Muscle tremors CNS stimulation Hypokalemia
48
Treatment for chronic asthma
- inhaled corticosteroids - LABA - ICS/LABA combo (Symbicort, Advair Diskus)
49
What are some examples of LABA?
- Sameterol - Formoterol - Budesonide
50
MCC of post-op fever day 1
Atelectasis
51
How to prevent asthma exacerbations?
- Reduce risk factors such as tobacco smoke, air pollution, chemical irritants (including perfume), reduce # of lower respiratory infections - Use spacers for inhalers
52
Intermittent asthma
- Symptoms: < 2 x/day - SABA use: < 2 x/week - Nighttime awakenings: < 2/month - Interference with activities: None - Lung function: Normal FEV1/FVC - Treatment: SABA
53
Mild Persistent Asthma
- Symptoms: > 2 days/week, but not daily - SABA use: > 2 days/week, but not more than 1x/day - Nighttime awakenings: 3-4 x/month - Interference with activities: Minor - Lung function: Normal FEV1 > 80% - Treatment: SABA + low-dose ICS
54
Moderate Persistent Asthma
- Symptoms: Daily - SABA use: Daily - Nighttime awakenings: > 1x/week, not nightly - Interference with activities: Some - Lung function: Normal FEV1 60-80% - Treatment: Low ICS + LABA or Medium ICS
55
Severe Persistent Asthma
- Symptoms: Throughout the day - SABA use: Several times a day - Nighttime awakenings: Nightly - Interference with activities: Extremely limited - Lung function: FEV1 < 60% - Treatment: High dose ICS + LABA +/- Omalizumab

PANCE/EOC (63 decks)

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