Pulm -- 15% of EOR Flashcards
Describe some diagnostic findings associated with chronic bronchitis, including lab findings, PFT results, and gold std diagnostic test
3+ months of symptoms
PFT:
- FEV1/FVC ratio <0.7
- Both FEV1 and FVC are reduced
- Ratio does not improve with albuterol
Labs may show increased Hgb/Hct 2/2 chronic hypoxic state
Gold std diagnostic test is lung biopsy
Name the drugs used to treat acute COPD exacerbations
O2
B-agonists – albuterol, terbutaline
Steroids – PO prednisone > inhaled budesonide
Anticholinergics (ipatropium/tiotropium – cholinergic tone only reversible aspect of COPD)
Antibiotics if Gold’s criteria met – amoxicillin, doxy, bactrim for mild, augmentin, levaquin, cipro for severe)
Describe the cellular pathophys involved in chronic bronchitis
Enlargement of mucous glands
Hypertrophy of goblet cells in large airways
Describe CXR findings in a patient with bronchiectasis
Bronchi will be dilated and thickened, with ring-like markings; buzzword = “Tram tracks”
What are 3 indications to test for anti-1-antitrypsin deficiency?
- COPD in a patient <45 YO
- COPD with evidence of concurrent liver disease
- FHx of anti-1-antitrypsin deficiency
Pt with SLE, dry cough, DoE, clubbing of the fingers is suspicious for what?
Idiopathic pulmonary fibrosis – patients being treated with methotrexate are at higher risk for this, as are patients with autoimmune dz, connective tissue dz, and some occupational exposures.
Describe the CXR findings associated with idiopathic pulmonary fibrosis
Non-specific:
- reticular infiltrates
- spherical, nodular infiltrates
- or reticulonodular pattern
- Buzzword = honeycombing
How is idiopathic pulmonary fibrosis diagnosed?
HRCT is definitive
- CXR –> HRCT
What PFT findings are associated with idiopathic pulmonary fibrosis?
PFTs will show reduced TLC and reduced RV
What is the treatment for IPF?
Definitive = lung transplant
Pharmacotherapy include tyrosine kinase inhibitors (nintedanib) and TGF-beta regulars (pirfenidone)
What disease process and CXR findings are associated with pathological collagen deposition in the alveolar interstitium?
Idiopathic pulmonary fibrosis - will see honeycombing on CXR (thickened alveolar walls)
What is one drug ass’d with drug-induced pulmonary fibrosis, and what are the CXR findings?
Amiodarone, will look like ground glass infiltrates on CXR
Silicosis pneumoconiosis is associated with what kind of occupational exposures, and what are the characteristic CXR findings?
Sand, cement, stone, and fracking – eggshell calcifications are often seen on CXR
Asbestosis pneumoconiosis is associated with what kind of occupational exposures, and what are the characteristic CXR findings?
Asbestos/construction, shipbuilding, car repair, and textiles
Pleural plaques and pleural thickening is often found on CXR
Coal pneumoconiosis is associated with what CXR findings, and what eponymous syndrome?
Small nodules and hyperinflation in an obstructive pattern may be seen on CXR
Can manifest with symptoms of RA = Caplan syndrome
Talc pneumoconiosis is associated with what kind of occupational exposures, and what are the characteristic CXR findings?
Ceramic, paper, plastic, rubber, paint, and cosmetics – or hx of IV drug use, manigests as talc granulomatosis
Small, rounded opacities and micronodules may be seen on CXR, along with evidence of pulmonary hypertension
Berylliosis pneumoconiosis is associated with what kind of occupational exposures, and how does it manifest?
Dental, computer, nuclear, or aeorspace work. Causes a hypersensitivity reaction but can lay dormant for months - decades.
Hypersensitivity pneumoconiosis is associated with what kind of occupational exposures, and what are the characteristic CXR findings?
Birds and mold – also called extrinsic allergic alveolitis. Also associated with agricultural dusts, aerosolns, grain, hay, silage, sugar cane.
Non-fibrotic changes are seen, including mosaic attenuation and diffuse, multi-focal ground glass opacities on CXR.
In the setting of PNA, what do air-fluid levels on CXR indicate?
Pulmonary abscess
In the setting of PNA, what are cavitary lesions suspect for?
TB or fungal infection
You suspect your patient has PNA, but the CXR comes back clear. What is the likely dx?
Viral bronchitis
You suspect your patient has PNA, and the CXR comes back showing a reticular, lacy pattern. What is this concerning for?
Interstitial pneumonia, or an AIDS-related PNA (Pneumocystis jirovecii or MAC)
What is the treatment for uncomplicated CAP in a patient without any recent abx use?
Amoxicillin or cephalosporin
plus
Azithromycin, clarithromycin, or doxy
(AZ + cefpodoxime)
What is the treatment for HCAP PNA or sick as shit PNA?
Vanc + Zosyn
Vanc covers MRSA, zosyn covers pseudomonas
Alternatively linezolid + miropenem has same coverage
