pulm Flashcards
(196 cards)
1
Q
chronic bronchitis MCC
A
smoker
tobacco use
2
Q
chronic bronchitis sx
A
productive cough
cyanotic, wheezing
clubbing
cor pulmonale
3
Q
chronic bronchitis test
A
clinical: productive cough >3m/yr for 2y
PFT BIT: dec FEV`/FVC
ABG: chronic respiratory acidosis
4
Q
chronic bronchitis tx
A
1st: smoking cessation, home O2 if (<89%)
SABA/LABA, inhaled CS
surgical: lung resection/ transplant
5
Q
chronic bronchitis complications
A
lung infection
6
Q
emphysema MCC
A
tobacco use
smoking
7
Q
emphysema sx
A
pink puffer, cough is rare
dyspnea, pursed lip breathing, barrel chest
8
Q
emphysema test
A
CXR: inc AP diameter
PFT: dec FEV1/FVC
ABG: chronic respiratory acidosis
9
Q
emphysema tx
A
smoking cessation
vaccines: flu and pneumococcal
bronchodilators –> inhaled steroids
LABA: tiotropium
10
Q
COPD exacerbation MCC
A
S. pneumo
M. catorrhalis
H. flu
11
Q
COPD exacerbation test
A
CXR
ABG: acute respiratory acidosis
sputum culture
12
Q
COPD exacerbation tx
A
O2, systemic oral prednisone,
ipratropium, albuterol
abx if pseudomonas infx
13
Q
COPD exacerbation prevention
A
flu vaccine annually
pneumococcal vaccine
14
Q
acute bronchiolitis MCC
A
RSV
15
Q
acute bronchiolitis sx
A
cough, bilateral wheezing, clear rhinorrhea
prolonged expiratory phase, clubbing
F, dyspnea
16
Q
acute bronchiolitis test
A
clinical, O2 dec
CXR: atelectasis, air trapping
17
Q
acute bronchiolitis tx
A
supportive
severe: hospital
18
Q
acute bronchitis sx
A
cough hallmark
bilateral ronchi, wheezing
preceded by URI
19
Q
acute bronchitis test
A
clinical
sputum culture
CXR: thinking of bronchial walls (only when pneumonia suspected)
20
Q
acute bronchitis tx
A
supportive
dextromethorphan/guaifenesin
abx not indicated
21
Q
acute epiglottis MC organizm
A
Haemophilus influenza type B
22
Q
acute epiglottis tx
A
airway management
intubation, tracheostomy if needed
IV abx: ceftriaxone
23
Q
croup MCC
A
parainfluenza virus
24
Q
bacterial tracheitis vs croup
A
bacterial tracheitis: like croup but more toxic appearing. airway emergency
25
croup test
CXR: steeple sign
26
croup tx
severe: racemic nebulizer epi + PO/IM dexamethasone
27
influenza MC type
type A
28
influenza MCC
orthomycovirus
29
influenza complications
AOM, bronchiolitis
| croup, sinusitis, pneumonia
30
MCC viral pneumonia in adults
influenza
31
pertussis tx
macrolide (azithromycin) or bactrim
32
pertussis prevention
DTaP 5 doses before school age
4-6yo last dose
TDaP booster at 11-12 + pregnant (Q10y)
33
bacterial pneumonia sx
sudden onset productive cough
high fever, chills
dullness to percussion, inc TF, rales, ronchi
bronchophony/ ego phony
34
MCC community acquired pneumonia
S. pneumo
35
S. pneumo pneumonia sx
rust colored sputum
| bulbous myringitis
36
klebsiells pneumonia sx
currant jelly sputum
etoh abuse
cautery lesions
37
H. flu pneumonia sx
COPD
38
S. aureus pneumonia sx
IVDU
post flu
recent URI
39
pseudomonas pneumonia sx
CF, nursing homes
| immunocompromised
40
rusobacterium pneumonia sx
aspiration pneumonia
| foul smelling sputum
41
bacterial pneumonia test
CXR: patchy. areas or fluid localized to a single lobe
consolidation: S. pneumo
mycoplasma: cold agglutinin assay
legionella: urine antigen
42
mycoplasma pneumonia tx
macrolide
43
legionella pneumonia tx
doxy or macrolide
44
atypical bacterial pneumonia MCC
mycoplasma
45
atypical bacterial pneumonia sx
gradual onset
dry cough, low grade fever,
extra pulmonary sx: HA, myalgia, fatigue, GI
46
atypical bacterial pneumonia test
CXR: reticulonodular infiltrates
mycoplasma: cold agglutinin assay
legionella: urine antigen
47
legionella pneumonia sx
from contaminated water
diarrhea + cough
hyponatremia
inc LFT
48
atypical bacterial pneumonia tx
azithromycin
mycoplasma: macrolide or doxy
legionella: doxy or macrolide
49
blastomycosis sx
immunocompetent men + outdoor activities
F, night sweats, WL, pulmonary sx
cutaneous papules: vemicus crusted/ ulcerated lesions
50
blastomycosis histology
round broad budding yeast w/ thick double walls
51
blastomycosis tx
```
amphotericin B (severe)
itraconazole (TOC)
```
52
coccidiomycosis sx
mild lung infx
bone granulomas or meningitis
erythema nodosum/multiforme
53
coccidiomycosis test
serologic
IgM + IgG
culture definitive
54
coccidiomycosis tx
amphotericin B
itraconazole
fluconazole if CNS sx
55
histoplasmosis sx
mild atypical pneumonia
| disseminated in immunocomp
56
histoplasmosis test
budding yeast w/in macrophages
CXR: solitary pulmonary calcifications
sputum culture definitive
57
histoplasmosis tx
amphotericin B
| itraconazole
58
MCC fungal meningitis
histoplasmosis
59
histoplasmosis sx
pneumonia
bone/ skin granulomas
dissemination causes cryptococcal meningitis
60
histoplasmosis test
india ink stain: encapsulated budding yeast
| CSF
61
histoplasmosis tx
amphotericin B
| fluconazole
62
histoplasmosis HIV prophylaxis
CD4 <100
| fluconazole
63
aspergillosis sx
mold grows in pulmonary cavities
64
aspergillosis tx
requires surgery
65
aspergillosis complication
aflatoxin B1 --> inc risk of hepatocellular carcinoma
66
pneumocystis pneumonia CD4
CD4 <200
67
pneumocystis pneumonia sx
MC opportunistic respiratory infx in acquired immunodeficiency syndrome
gradual F, dyspnea, dry cough, SOB, CP
68
pneumocystis pneumonia test
initial: sputum culture
CXR: bilateral diffuse infiltrates (batwing appearance)
CD4 <200, inc LDH
bronchoalveolar lavage definitive
69
pneumocystis pneumonia tx
bactrim
70
viral pneumonia MCC
influenza
71
viral pneumonia prevention
pneumococcal vax
| flu vax
72
viral pneumonia sx
insidious onset
dry cough, low grade F
wheezing
73
viral pneumonia CXR
diffuse infiltrates concentrated in perihilar region
| reticular line shaped opacities
74
viral pneumonia tx
supportive
75
SVC syndrome sx
facial fullness, face and arm edema
dilated veins over anterior chest, arms, and face
JVD
76
MC bronchogenic lung cancer
non- small cell
77
SVC syndrome
78
SVC syndrome patho
obstruction of SVC bu tumor
| impairs venous flow to RA
79
pancoast tumor patho
superior pulmonary sulcus tumor
| apical tumor at apex of lung compresses C8, T1 and T1 nerve roots
80
pancoast tumor sx
shoulder pain radiating down arm
| pain, UE weakness
81
pancoast tumor associated w/
horners syndrome
82
horners syndrome patho
invasion of cervical sympathetic chain by apical tumor
83
horners syndrome sx
unilateral facial anhidrosis, ptosis, miosis
84
nerve compressed to cause hoarseness
recurrent laryngeal nerve
85
nerve compressed to cause diaphragmatic elevation and SOB
phrenic nerve
86
most agressive lung cancer
small cell
87
small cell lung cancer location
central
88
eaton Lambert syndrome
autoantibodies destroy neurons
| proximal muscle weakness, dec DTR, paresthesia
89
small cell lung cancer sx
SIADH
cushings
eaton Lambert syndrome
90
small cell lung cancer tx
chemo rad
| surgery limited, usually not resectable
91
SCC lung cancer location
non small cell cancer
| central lesion
92
MC peripheral lesion lung cancer
adenocarcinoma
93
non small cell lung cancer tx
surgery
94
mesothelioma MC type
pleura tumor
95
mesothelioma due to
asbestos exposure
| talc
96
mesothelioma sx
dyspnea, WL, cough, blood effusion,
| pleural pain, CP, pneumothorax, hemoptysis
97
mesothelioma test
CXR, CT: pleural thickening
bx definitive
immunostain w/ calretinin --> fried egg shape
98
mesothelioma tx
local: pleurectomy
| prognosis poor
99
pulmonary carcinoid tumor patho
dysfx of neuroendocrine cells leading to tumor production
100
pulmonary carcinoid tumor sx
bimodal distribution
serotonin synthesis
episodic diarrhea, skin flushing, wheezing (asthma like attacks)
hemoptysis, recurrent pneumonia, hypoTN
101
pulmonary carcinoid tumor test
bronchoscopy: pink/purple end-bronchial lesion, well vascularized central tumor
Best: 24h urine w/ 5-HIAA --> inc serotonin levels
102
pulmonary carcinoid tumor tx
surgical excision TOC
| octreotide
103
solitary pulmonary nodule (benign)
<6mm, no growth over 2y
circular and regular shape
central laminated calcification
104
solitary pulmonary nodule (malignant)
>50yo smoker or hx of size >3cm
steady growth
irregular in shape/margins, stippled/ eccentric calcification
105
solitary pulmonary nodule RF granuloma
TB, histoplasmosis
coccidiomycosis
RA, sarcoidosis
thyoma
106
solitary pulmonary nodule hamartoma sx
non smoker
asx
popcorn ball appearance
107
solitary pulmonary nodule granuloma sx
non smoker
asx
bullseye nodule appearance
108
solitary pulmonary nodule TB sx
immigrant, known exposure, + PPD
F, calcification <2cm
military pattern, apical, round
109
solitary pulmonary nodule fungal.(MAC) infx sx
HIV + or low CD4
| multiple sizes
110
solitary pulmonary nodule sarcoidosis sx
bilateral caveating nodules w/ hilar lymphadenopathy
111
solitary pulmonary nodule test
compare w/ previous CXR
low probability nodule --> CT
intermediate: (nodule >1cm) PET + PET then bx
high probability: bx
112
pleural effusion MCC transudative
CHF
| cirrhosis
113
pleural effusion MCC exudative
bacterial pneumonia
| malignancy
114
pleural effusion sx
peripheral edema
dullness to percussion
dec BS, dec TF
115
pleural effusion test
CXR: blunting of costophrenic angle (meniscus sign)
thoracentesis: gold standard
116
pleural effusion tx
transudative: diuretics, Na restriction, thoracentesis
exudative: thoracentesis and tx underlying
117
spontaneous pneumothorax sx
ipsilateral CP, sudden
dec BS, hyperrestonance
dec/absent TF
118
spontaneous pneumothorax CXR
absence of lung markings
mediastinal shift to opposite side of pneumothorax
companion lines
119
spontaneous pneumothorax tx
tube thoracotomy
120
tension pneumothorax sx
```
hypotension, JVD
shift trachea away from affected lung
absent breath sounds
hyper resonance
pulses paradoxus
```
121
tension pneumothorax tx
needle thoracotomy
122
tension pneumothorax complications
positive pressure ventilation increased accumulated air
| exacerbates tension pneumothorax and causing cardiovascular collapse
123
cor pulmonale patho
pulmonary HTN --> structural changes to right ventricle (dilation/ hypertrophy)
secondary to underlying pulmonary disease
124
cor pulmonale MC form
chronic d/t COPD
| acute typically d/t PE
125
cor pulmonale sx
parasternal lift, loud S2, sx of RHF (hepatomegaly, edema, JVD)
tricuspid regurgitation
126
cor pulmonale test
initial: echo (RV dilation)
confirm: R heart Cath
CXR: enlarged pulmonary arteries, prominent R heart border
127
cor pulmonale tx
tx underlying
COPD: bronchodilators + INH steroid
OSA: CPAP
CHF: diuretics
128
PE sx
dyspnea, tachycardia
dullness to percussion, dec BS
pleuritic CP
129
PE test
```
initial: CT
MAT: CTA gold
if renal pt or contrast allergy: VQ scan
CXR: hamptons hump and westermark sign
low suspicion: D dimer
```
130
PE tx
acute anticoagulant: heparin (do not use if currently bleeding)
LMWH: stable pt w/ no renal problems, CA pts
unfractionated heparin: pts w/ renal failure
supplement O2
massive PE w/ RHF: thrombolytic (tPA)
long term anticoagulant: warfarin
IVC filter
131
pulmonary HTN patho
pulmonary arterial pressure >25 at rest
| RVH
132
pulmonary HTN sx
```
dyspnea on exertion, CP on exertion,
syncope on exertion
tricuspid regurgitation (holosystolic murmur)
accentuated S2
RHF sx
```
133
pulmonary HTN test
BIT: echo: dilated pulmonary artery, dilation of RA and RV
CXR: enlarged pulmonary arteries
gold: R heart Cath
134
pulmonary HTN tx
1: NO, IV adenosine, CCB 1st line
2: tx underlying
3: tx underlying, oxygen
4: anticoagulant 1st line, tx underlying
135
pulmonary HTN WHO classification
group 1: PAH (idiopathic, lupus, HIV, genetic mutation disorders)
group 2: PH d/t L heart disease
group 3: PH d/t chronic lung disease (COPD, OSA)
group 4: PH d/t chronic thromboembolic (PE)
group 5: PH d/t unclear mechanisms
136
idiopathic pulmonary fibrosis causes and RF
meds: amiodarone, bleomycin, MTX
RF: old age, male, smoking, RA
137
MCC interstitial lung dz
idiopathic pulmonary fibrosis
138
idiopathic pulmonary fibrosis sx
gradual onset of nonproductive cough
bibasilar crackles, cyanosis
clubbing
139
idiopathic pulmonary fibrosis test
CXR: honeycombing, reticular opacities
CT
PFT: restrictive
140
idiopathic pulmonary fibrosis tx
no tx changes outcome
supplemental O2, chest PT
acute: IV CS
definitive: lung transplant
141
coal worker pneumoconiosis test
CXR: small apical opacities in upper lobe. hyperinflation
PFT: obstructive
142
coal worker pneumoconiosis tx
vaccination: flu, pneumococcal, minimize exposure
143
Caplan syndrome
pneumoconiosis + rheumatoid arthritis
144
asbestosis sx
SOB, dry cough, chronic CP, finger clubbing, pursed breathing
shipyard workers/ construction
145
asbestosis test
initial: CXR (haze infiltrates, shaggy heart sign, bilateral linear opacities. calcified pleural plaques at lung bases (lower lung)
MAT: bx
146
asbestosis tx
palliative
| malignancy risk: non small cell lung cancer, malignant mesothelioma
147
silicosis sx
dyspnea on exertion, cough w/ sputum
| rhonchi, wheezing, tachyptic
148
silicosis test
BIT: CXR (localized/ nodular in upper lung lobes, eggshell calcification of hilar nodes. round nodular opacities)
149
silicosis tx
all pts need TB test
pneumococcal vaccine
flu vaccine
smoking cessation
150
berylliosis RF
aerospace
fluorescent bulbs
computers
151
berylliosis sx
acute: diffuse pneumonitis
skin lesions
hypercalcemia
152
berylliosis test
beryllium lymphocyte proliferation/ transformation test
upper lobs, hilar lymphadenopathy
bx: noncaseating granulomas
153
berylliosis tx
glucocorticoid therapy for both acute and chronic
MTX if dont respond
only ILD that responds to steroids
154
byssinosis risk
cotton dust
yarn and rope making
textile
155
byssinosis sx
early: asthma like sx
late: regular chest tightness at end of first day (Monday chest tightness)
156
byssinosis test
routine PFT: OSHA requirement
157
byssinosis tx
exhaust hoods
158
sarcoidosis sx
pulmonary sx: nonproductive cough, SOB, F, WL
lupus pernio: chronic violaveous raised plaques/ nodules on face
uveitis, arthralgas, erythema nodosum (tender red nodules anterior leg)
159
sarcoidosis test
```
initial: CXR (noncaseating granulomas, bilateral hilar central lymphadenopathy or bat wing)
hypercalcemia, inc serum ACE levels
MAT: bx (noncaseating granulomas)
bronchoalveolar lavage: inc CD4
PFT: restrictive
```
160
sarcoidosis tx
resolve spontaneously
mainstay: PO prednisone
MTX if refractory
annual EKG, PFT, and ophthalmology exam
161
lofgrens syndrome sx
triad: erythema nodosum, bilateral hilar lymphadenopathy, polyarthrialgia
fever
162
obstructive sleep apnea test
polysomnogram sleep study
163
obstructive sleep apnea tx
CPAP, weight loss
sleep on side
surgery to realign jaw
164
central sleep apnea due to
CNS mediated
| neurological malfunction
165
central sleep apnea test
polysomnogram
166
central sleep apnea tx
CPAP
| tracheostomy definitive
167
pickwickian syndrome patho
hypoventilation in overweight patients
| low O2 levels, high CO2
168
pickwickian syndrome sx
overweight/obese
daytime sleepiness
lower limb swelling, snoring
169
pickwickian syndrome test
diagnosis of exclusion
170
pickwickian syndrome tx
CPAP
| tracheostomy
171
pickwickian syndrome complication
pulmonary HTN
| RHF
172
ARDS MCC
sepsis
| near drowning
173
ARDS sx
severe refractory hypoxemia hallmark
doesn't respond to O2
cyanosis, tachycardia
174
ARDS test
CXR: bilateral infiltrates, spares costophrenic angles
175
ARDS tx
oxygen
intubate
fluid management
tx underlying
176
IRDS RF
caucasian, male, C section delivery
perinatal infections, multiple births (esp premature)
maternal diabetes
177
IRDS test
CXR: reticular ground glass opacities + air bronchograms
178
IRDS tx
exogenous surfactant
| CPAP
179
IRDS prevention
CS to mature lungs if premature (24-36w)
180
asthma attack tx
Best initial: SABA + O2
2nd line: IV methylprednisolone
severe: inhale SABA, inhaled ipratropium and systemic steroids
181
bronchiectasis patho
permanent abnormal dilation of bronchi walls
| impaired clearance of secretions
182
bronchiectasis MCC
CF
183
bronchiectasis sx
chronic cough w/ large amount of mucopurulent foul smelling sputum, hemoptysis
184
bronchiectasis test
BIT/MAT: HR chest CT (tram track, signet ring sign)
185
bronchiectasis tx
```
prophylactic abx (amoxicillin, azithromycin, bactrim)
pseudomonas/mycoplasma: zosyn
aspergillosis (thick brown sputum: CS + itraconazole
```
186
cystic fibrosis patho
autosomal recessive
| CFTR gene, chromosome 7, F508 mutation
187
cystic fibrosis sx
meconium ileus in newborn
recurrent chronic URI
thick sticky mucus
steatorrhea, infertility
188
cystic fibrosis test
newborn screen
sweat chloride test
PFT: obstructive
189
cystic fibrosis tx
ADEK replacement
chest PT
abx for infections
surgery for meconium ileus
190
cystic fibrosis complications
respiratory
GI
infertility
191
cystic fibrosis MC pathogen
pseudomonas
192
MC location for foreign body lung
right main bronchus
193
FB lung tx
rigid bronchoscopy gold
194
hyaline membrane disease patho
deficiency of surfactant (type 2 alveolar cells) in premature infants
195
SIDS RF
infants sleeping in prone position (strongest modifiable RF)
sleeping on soft surface or w/ accessories
overheating, low birthweight, premature
bed sharing
196
SIDS reduced risk
supine position for sleep
firm mattress, room sharing w/o bed sharing
pacifier use
