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Clin Med > Pulm > Flashcards

Pulm Flashcards

1
Q

What presents with signs/symptoms such as fever, chills, productive cough, dyspnea, pleuritic chest pain (on inhalation), generalized weakness, malaise, tachycardia, tachypnea, hypoxia, wheezes, rhonchi, crackles, increased tactile fremitus, bronchophony, egophony?

A

Pneumonia

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2
Q

What labs/imaging are you getting in a pneumonia work up?

A

Chest x-ray or chest CT
Sputum stain & culture
Blood cultures (inpatient)
Procalcitonin
C-reactive protein

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3
Q

How is pneumonia classified?

A

By source of infection; either community acquired or nosocomial (hospital acquired) or viral

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4
Q

How do you treat community acquired pneumonia?

A

Healthy patient w/stable vitals: treated at home with high dose amoxicillin, doxycycline, or macrolide (if local resistance <25%)
Patient with comorbidities & outpt treatment: combo amox-clav PLUS macrolide or doxy
Hospital admission: IV ABX; beta lactam or 3rd gen cephalosporin PLUS macrolide or doxy
ICU admit: 3rd gen cephalosporin PLUS macrolide

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5
Q

How do you treat nosocomial (hospital acquired) pneumonia?

A

Combo for gram negs, pseudomonas, & MRSA
4th gen cephalosporin PLUS vanc. PLUS fluoroquinolone

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6
Q

How do you treat pneumonia that is caused by a virus?

A

Rest, fluids, antipyretics
Influenza: neuraminidase inhibitors
COVID: Paxlovid or Molnupiravir

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7
Q

What is caused by strep pneumo and is common in pts with HIV?

A

Pneumocystis jirovecii (PCP)

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8
Q

What are the signs/symptoms of pneumocystis jirovecii (PCP)?

A

CD4 count < 200
Elevated LDH
Progressive SOB

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9
Q

How do you treat pneumocystis jirovecii (PCP)?

A

Bactrim (1st line)
Bactrim PLUS dapsone or clindamycin (2nd line)
Prednisone if PaO2 < 70

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10
Q

What is the leading cause of cancer-related deaths worldwide?

A

Pulmonary neoplasm

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11
Q

How are pulmonary neoplasms classified?

A

Small cell or non-small cell

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12
Q

What is the prognosis of small cell and non-small cell lung cancer?

A

Small cell: poor prognosis
Non-small cell: varies by stage

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13
Q

What are possible signs/symptoms of pulmonary neoplasm?

A

Can be asymptomatic, weight loss, cough, hemoptysis, pain
Local spread: Atelectasis, pneumonia, PE, SOB
Metastatic spread: pain that is non-specific or in bones, weight loss and weakness, neurologic symptoms

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14
Q

What is the treatment for a pulmonary neoplasm?

A

Varies by cell type and stage
Surgery, chemo., radiation, immunotherapy, radiofrequency ablation, palliative care

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15
Q

What condition is characterized by granulomas in the lungs and lymph nodes that can also be present in eyes, heart, kidneys, liver, and other organs that presents with signs/symptoms of hilar lymphadenopathy, cough, dyspnea, pulm. HTN?

A

Sarcoidosis

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16
Q

How do you stage sarcoidosis?

A

Stages based on chest x-ray:
0: normal
1: Bilateral hilar lymphadenopathy
2: Stage 1 PLUS parenchymal infiltrates
3: Parenchymal infiltrates alone
4: Pulmonary fibrosis

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17
Q

What is the treatment for sarcoidosis?

A

No cure
May spontaneously resolve
Systemic corticosteroids (1st line)

18
Q

What condition is caused by exposure to noxious particles/gases and characterized by airflow limitation resulting from airway/alveolar abnormalities?

A

COPD

19
Q

What are general signs/symptoms of COPD?

A

Chronic/daily cough
Chronic wheezing
Chronic sputum production
Dyspnea

20
Q

What might be noted during a physical exam in someone with COPD?

A

Pursed lips
Use of accessory muscles
Wheezes
Rhonchi
Diminished breath sounds
Perioral/peripheral cyanosis

21
Q

What test is required for diagnosing COPD?

A

Spirometry

22
Q

What FEV1/FVC is indicative of COPD?

A

FEV1/FVC < or = 0.7

23
Q

What are the GOLD grades of COPD?

A

1: mild FEV1 > or = to 80% predicted
2: moderate FEV1 between 50-80% predicted
3: severe FEV1 between 30-50% predicted
4: very severe FEV1 < 30% predicted

24
Q

What is the treatment for COPD?

A

SABA (Albuterol), LABA (Formoterol, Salbutamol), SAMA (Ipratropium), LAMA (Tiotropium)
Supplemental O2 if O2 sat. of 88% or lower at rest

25
Q

What are the signs/symptoms of a COPD exacerbation?

A

Increase in chronic symptoms
Increase rescue inhaler use
Increase sputum/color change
Possible hypoxia

26
Q

What is the treatment for an acute COPD exacerbation?

A

ICS
Oral corticosteroids
Combo ICS/LABA
ABX

27
Q

Should you combine SAMA/LAMA treatment for COPD?

A

No, because they have increase risk of cardiovascular death, MI, or stroke

28
Q

What is a chronic inflammatory obstructive pulmonary disease w/reversible factors that can be triggered by behaviors (exercise, stress, cold) or environmental factors?

A

Asthma

29
Q

What are signs/symptoms of asthma?

A

Cough
Wheezing
SOB
Expiratory wheezes & rhonchi
Allergic shiners
Boggy nasal mucosa
Cyanosis if O2 sats are < 88%

30
Q

What diagnostic testing is done in asthma?

A

Asthma Control Test (ACT)
Spirometry

31
Q

What is the treatment for asthma?

A

General: SABA, SAMA, systemic corticosteroids, supplemental O2 & magnesium sulfate (in more severe cases)
Long term: ICS (fluticasone), Cromolyn sodium, immunomodulators, Leukotriene modifiers (Singulair), LABA (Advair, Symbicort), Methylxanthines (Uniphyl)

32
Q

What are the steps to asthma treatment?

A

Step 1: SABA PRN
Step 2: Low-dose ICS
Step 3: Low-dose ICS + LABA or medium-dose ICS
Step 4: Medium-dose ICS + LABA
Step 5: High-dose ICS + LABA AND Omalizumab for pts w/allergies
Step 6: High-dose ICS + LABA + oral corticosteroid AND Omalizumab for pts w/allergies

33
Q

What is Samter’s triad?

A

Pt w/history of asthma, inflammation of the sinuses, & recurrent nasal polyps (Aspirin induced asthma)

34
Q

What is the treatment for URI and acute (uncomplicated) bronchitis?

A

Supportive care
No ABX

35
Q

If you have a pt that presents with the following, what is your suspected diagnosis?

< 2 yo, fussy, not eating, low grade fever, rhinitis, congestion, wheezing, crackles, respiratory distress (intercostal retractions, nasal flaring, grunting)

A

Acute bronchiolitis (caused by RSV)

36
Q

What is the treatment for acute bronchiolitis?

A

Mild: supportive care
Severe: supportive care PLUS albuterol, steroids, and Ribavirin (confirmed RSV)
Hospitalize pts that are hypoxic, lethargic, increased RR, or resp. distress

37
Q

When can you give antivirals to a patient with confirmed influenza?

A

If it’s within 48 hrs of symptom onset

38
Q

What is a medical emergency that is characterized by drooling, dysphagia, distress, fever, stridor, and muffled voice?

A

Epiglottitis

39
Q

What is the treatment for epiglottitis?

A

Keep pt calm
Protect airway
Consult ENT or anesthesiologist
IV fluids
Rocephin + Vanc
Consult ID

40
Q

What are the stages of pertussis?

A

Catarrhal stage (7-14 days): URI symptoms
Paroxysmal stage: whooping cough, coughing so much it induces vomiting
Convalescent stage: symptoms diminish at approx. 4 weeks, average illness lasts 7 weeks

41
Q

What is the treatment for pertussis?

A

Macrolide (Azithromycin or Clarithromycin)
Bactrim (2nd line)
Prophylaxis treatment for close contacts
Treat cough

42
Q

What pulm diagnosis can be prevented with vaccines?

A

Pertussis: Tdap
Influenza
COVID
Pneumonia

Clin Med (15 decks)

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