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Internal Medicine EOR > Pulm > Flashcards

Pulm Flashcards

(62 cards)

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1
Q

Obstructive diseases

A

Asthma
COPD
Bronchiectasis
CF

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2
Q

Restrictive Diseases

A

Sarcoidosis
IPF
Penumoconiosis

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3
Q

Asthma Samters Triad

A

Asthma
Nasal Polyps
NSAID allergy

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4
Q

Asthma Sx

A

dyspnea, wheezing, cough (worse at night)

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5
Q

Asthma PE

A

Prolonged expiration with wheezing
Hyperresonance to percussion
Decreased breath sounds

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6
Q

Status Asmaticus

A

Inability to speak in full sentences, AMS, pulsus paradoxis

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7
Q

Asthma Dx

A

Gold Standard: PFT
Methacholine challenge test
Bronchodilator challenge

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8
Q

PFT in asthma

A

decreased FEV1, decreased FEV1/FVC

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9
Q

Methacholine challenge in asthma

A

> /= 20% decrease in FEV1

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10
Q

Tx acute asthma

A
  1. SABA: albuterol (bronchodilators, nebs q20 min x3)
  2. Anticholinergics: Ipratropium
  3. Corticosteroids: Prednisone, prednisolone, methylprednisone (3-5d)
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11
Q

Tx chronic asthma

A

Start with SABA PRN then add an ICS (beclamthasone, Flunisolide) then add LABA (Salmeterol/fometerol)

Leuko Modifiers if allergies are causing asthma
IV mag if uncontrolled severe

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12
Q

Acute Bronchitis etiology

A

MC cause: ADENOVIRUS, parainfluenza

Inflam of trachea/bronchi often post URI

Hallmark is cough 1-3 weeks

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13
Q

Bronchitis dx/ tx

A

Clinical usually, CXR is nonspecific

Tx: TOC is sx tx

  • fluids
  • rest
  • antitussives
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14
Q

Bronchiectasis etiology

A

Recurrent/chronic lung infections: H. Flu (MC)

CF usually Pseudomonas

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15
Q

Bronchiectasis sx

A

Daily chronic cough with thick, mucopurulent, foul-smelling sputum

Hemoptysis

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16
Q

Bronchiectasis Dx

A

CT scan TOC: Dilated airway, bronchial wall thickening
TRAM TRACKS

PFT: obstructive pattern (decreased)

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17
Q

Signet Ring Sign

A

pulmonary artery coupled with dilated bronchus

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18
Q

Bronchiectasis Tx

A

Abx TOC

  • empiric ampicilin, amox, bactrim
  • pseudomonal fluoroquin, pip/tazo

Bronchodilators for mucus management

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19
Q

Bronchial Carcinoid tumors etiology

A

Enterochromaffin cells
MC in GI tract, lung is 2nd MC

Can secrete serotonin/ACTH/ADH/melanocyte stim hormone

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20
Q

Bronch Tumor sx

A

focal wheeze, cough, recurrent PNA, hemoptysis

SIADH, Cushing’s syndrome

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21
Q

Carcinoid syndrome

A

diarrhea d/t increased serotonin, increased bradykinin and histamine –> flushing, tachycardia, bronchoconstriction

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22
Q

Bronch Carcinoid tumor Dx/ Tx

A

Bronchoscopy

Tx: Surgical excision is definitive
Octreotide to reduce sx

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23
Q

COPD etiology

A

progressive, irreversible airflow obstruction d/t loss of elastic recoil and increased resistance

Emphysema + Bronchitis

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24
Q

COPD rsk fx

A

Sm MC

Alpha 1 antitrypsin deficiency: genetic <40yo

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25
Emphysema
abn, permanent enlargement of terminal airspaces Loss of elastic coil and increased compliance PINK PUFFER: cachectic, hypoxemia, CO2 normal
26
Chronic Bronchitis
Productive cough >3 months for 2 consecutive years | BLUE BLOATERS: obese, cyanotic
27
COPD PFT
GOLD STANDARD FEV1<1L = increased mortality Obstruction Hyperinflation
28
COPD CXR/CT
Hyperinflation, flat diaphragm, increased AP diameter
29
COPD EKG
Cor Pulmonale Chronic Pulm HTN Multifocal Atrial Tach
30
COPD Tx
1. Bronchodilators combo with anticholinergics and beta agonists - TOC for stable COPD 2. Corticosteroids NOT monotherapy 3. Oxygen (only therapy to reduce mortality)
31
Use oxygen in COPD if...
Cor Pulmonale O2 sat <88% PaO2<55mmHg
32
Anticholinergics
Tiotropium (preferred over beta 2 agonists) SE: dry mouth, thirst, blurred vision, urinary retention CI: BPH severe glaucoma
33
B2 agonists
Albuterol, terbutaline, salmeterol SE: B1 cross reactivity, tachycardia, tremor CI: severe CAD, caution in DM
34
Corticosteroids SE
osteoporosis thrush increased infections hyperglycemia
35
GOLD staging
Mild: FEV1/FVC <0.70, FEV1 >80% Moderate: FEV1/FVC <0.70, FEV1 50-79% Severe: FEV1/FVC <0.70, FEV1 30-49% Very Severe: FEV1/FVC <0.70, FEV1 <30%
36
Cor Pulmonale
Long standing pulm HTN -> R vent hypertrophy, R atrial enlargement, R axis deviation, R sided HF, seen especially with chronic bronchitis, multifocal atrial tach
37
``` Hypoventilation Syndrome (OHS) etiology ```
Awake alveolar hypoventilation in an OBESE individual which cannot be attributed to other conditions
38
OHS rsk fx
BMI >30 Central Obesity Severe OSA: daytime hypersomnolence, loud snoring, choking during sleep, fatigue, small oropharynx, tick neck
39
OHS labs
elevated serum bicarb Hypercapnea: pa CO2 >45mmHg Hypoxemia: PaO2 <70mmHg Polycythemia
40
OHS DX (DOE)
CXR: elevation of both hemidiaphragm and heart may be enlarged due to R vent hypertrophy
41
OHS Tx
1st line: CPAP/BiPAP, weight loss, lifestyle mods 2nd line: tracheostomy, bariatric surg
42
Idiopathic Pulm Fibrosis etiology
Chronic progressive interstitial scarring from persistent inflammation Dyspnea +/- nonproductive cough
43
IPF PE/Dx
Fine basilar INSPIRATORY crackles, clubbing, cyanosis Dx: CXR: diffuse opacities, honeycombinb, ground glass PFT: restrictive disease
44
IPF Tx
No effective treatment, smoking cessation, O2, corticosteroids maybe? Lung transplant is only cure
45
Pneumoconiosis etiology
chronic fibrotic lung disease 2/2 to inhalation of mineral dust
46
Silicosis
Mining/Pottery Dyspnea on exertion, nonproductive cough CXR: multiple small round nodular opacities, primary in the upper lobes, eggshell calcifications Tx: supportive
47
Coal Workers pneumoconiosis
Coal/Carbon mines CXR: small upper lobe nodules and hyperinflation, may have Obstructive PFT Caplan Syndrome: coal workers pneumoconiosis + RA SUPPORTIVE TX
48
Berylliosis
electronics, aerospace, ceramics, tool/dye manufacturing Sx: Dyspnea, cough, arthralgia, weight loss, fever CXR: increased interstitial lung markings Dx: + exposure, +beryllium proliferation test +noncaseating granulomas on biopsy Tx: corticosteroids, O2, Supportive
49
Asbestosis etiology
Seen in 15-20 years after long term sbestos Increased risk bronchogenic carcinoma, malignant mesothelioma of the pleura
50
Asbestosis dx/ tx
CXR: pleural plaques, interstitial fibrosis, primarily in LOWER lobes Shaggy Heart Sign: blurring of diaphragm/heart border Biopsy: linear asbestos bodies in lung tissue SUPPORTIVE
51
Pulm HTN etiology / pathophys
Pulm MAP >/= 25mmHg Increased vascular resistance / RVH
52
Pulm HTN Sx
Dyspnea, CP, weakness, fatigue, cyanosis, edema
53
Pulm HTN PE
Accentuated S2, fixed or paradoxically split P2 Signs of R heart failure (increased JVP, peripheral edema, ascites) Systolic ejection click, pulm regurg
54
Pulm HTN Dx
GOLD STANDARD: right side heart cath CBC: polycythemia, elevated Hct CXR: enlarged pulm arteries EKG: cor pulmonale, RVH, right axis deviation, RBBB Echo: large right ventricle, right atrial hypertrophy
55
Pulm HTN Tx
Primary: CCB | Type II / III: tx underlying disease
56
Pulm Nodules etiology
<3cm Mass >3cm Granulomatous infections: TB Tumors Inflamm: RA, sarcoidisis Mediastinal tumors: thymoma
57
Pulm Nodules Dx
Obs if low malignant probability Needle Aspiration or bronchoscopy for peripheral lesions Resection w/ biopsy if malignancy
58
Sarcoidosis etiology
Chronic multisystem, inflammatory, granulomatous, disorder of unknown etiology Exaggerated T cell response
59
Sarcoidosis Sx
``` 50% asx Dry cg, dyspnea, cp Anterior Uveitis: blurred vision, photophobia, floaters Arrythmias Arthralgias Cranial Nerve Palsies ```
60
Sarcoidosis skin sx
2nd MC organ involved - Erythema nodosum anterior legs - Lupus pernio: nose, ears, cheeks, chin - Maculopapular rash: MC rash of sarcoidosis - Parotid gland enlargement
61
Sarcoidosis Dx
Compatible clinical radiologic findings Noncaseating granulomas Exclusion of other diseases CXR: bilateral hilar LDA
62
Sarcoidosis Tx
Obs, oral corticosteroids

Internal Medicine EOR (8 decks)

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