pulmology Flashcards Preview

PANCE review > pulmology > Flashcards

Flashcards in pulmology Deck (172):
1

asthma is what type of disease

immunological (hyper-responsiveness to IgE that has been released from trigger)

2

asthma is what type of disease

immunological (hyper-responsiveness to IgE that has been released from trigger)

3

ABG with SEVERE asthma attack

respiratory low Pa02, respiratory acidosis

4

tests to asthma

FEVI, Peak Flow, lungs and symptoms reversible with bronchodilator

5

X-ray asthma attack, what if no attack?

big lung and flatten diagram, no attack it will be normal

6

asthma has what % FEVI/FVC

7

ABG with severe asthma attack

respiratory low Pa02

8

tests to asthma

Peak Flow, lungs

9

X-ray asthma attack, what if no attack?

big lung and flatten diagram, no attack it will be normal

10

the triad involving asthma

The triad: atopy, nasal polyps, NSAID allergy

11

acute tx for asthma

O2, Beta-agonists (inhaled albuterol) sc terbutaline,
IV epinephrine
can be added: inhaled ipratropium, Corticosteroids (po/IV)
Magnesium and BiPAP (non-invasive mechanical ventilation)

12

chronic tx for asthma

Mast cell stabilizers (cromolyn)
Leukotriene inhibitors (montelukast or zileuton
Long acting β2-agonists (salmeterol)

13

asthma symptoms everyday, every night

severe persistant asthma

14

intermittent asthma and tx

almost no symptoms, > 2 days a week, most likely only need albuterol

15

mild asthma tx

use albuterol + low dose inhaled steroids

16

moderate asthma tx

Short acting and LONG acting beta agonist and inhaled steroid

17

what if patient is already on short and long acting beta agonist, and inhaled steroid but having break through therapy?

increase inhaled steroid dose or for severe add oral steroids + immune suppressive agent Omalizumab (causes anaphylaxis) works by binding IgE.

18

majority of PE are caused by_____from where in the body_______

Emboli from the Lower extremities

19

hampton's hump and westermark on xray

HH: white lesion 1/2 circle attached to pleura, PE

20

EKG findings of PE

non-specific ST changes, tachycardia

21

what is Aa gradient

report card of how well body takes air from environment and shuttles it through alveoli to blood stream

22

the right heart is working hard with a PE, what are the EKG findings specific to this

S1Q3T3.
big wave p wave (p pulmonale).
Inverted Ts V1-V4.

23

you suspect PE, but d dimer is positive, what test is done next? (remember pt will be short of breath)

CT pulmonary angiogram and then VQscan (ventilation and perfussion scan)......US of chest will show a huge right ventricle

24

treatment for PE

HEPARIN, fibrinolysis (only in BAD cases) , mechanical thrombectomy, and IVC filter

25

signs of pulmonary HTN (right sided heart problem)

right ventricle heaving and prominent P2

26

what causes pulmonary HTN?

COPD and chronic PEs

27

tx for pulmonary HTN?

1. O2
2. vasodilator (sildenafil)
3. chronic anticoagulant
4. transplant

28

worst lung cancer

small cell

29

most common lung cancer

adenocarinoma (50% non-smokers)

30

where does small cell metastasize to

Iiver, bone, brain, adrenal

31

what is horner syndrome

pan coast tumor in the apex of the lung compresses the sympathetic nerve causing ptosis and mitosis of the eye

32

What is SVC obstruction

lung cancer tumors block drainage of vena cava and makes new routes

33

smoker with cancer symptoms and high calcium =

squamous cell carcinoma

34

tx lung ca

cut is to cure, then radiation...finally cancer

35

tx pulmonary nodule

CT guided biopsy (low risk people can follow just with imagining for first couple of months)

36

pulmonary carcinoid

cancer, pulmonary version grows in the bronchus and releases serotonin. This causes flushing, diarrhea, and bronchospasm

37

tx for pulmonary carcinoid

otreotide scintigraphy

38

what cell increases with asthma?

goblet cells

39

Bronchiectasis (most common cause)

CF

40

what organs does CF affect

lungs, pancreas, intestines

41

what organism causes infections in CF

pseudomonas

42

COPD, liver failure, but no smoking. what is the dx?

Alpha 1 antitypsin

43

how does the inflammation in asthma and COPD differ?

COPD is mediated with neutrophil, which destroys the lungs. whereas Asthma is just hypertrophy

44

what is COR PULMONALE

chronic lung disease and hypoxia causes
pulmonary vasoconstriction (b/c lungs experience chronically low O2 level and become stenosis) which leads to pulmonary HTN and right-sided heart failure

45

why does home O2 work for COPD

reduces the narrowing and pressure in the lungs

46

how do you DX COPD

pulmonary function test

47

treatment for severe COPD

O2, steroid, beta 2 agonist, and BiPAP

48

what are blebs with COPD confused with on X-ray

pneumothorax

49

another name for small cell lung cancer

oat cells

50

syndrome that occurs with lung cancer

paraneoplastic syndromes

51

what do pulmonary function tests reveal for CF

mixed obstructive and restrictive pattern

52

finding for pulmonary function test and restrictive dz?

all get smaller

53

what do medication can cause restrictive lung disease

amiodarone and nitrofuratoin

54

patient has x ray that shows reticulonodular & honeycombing with clubbing or erythema nodosum. what category of restrictive diz

ldiopathic pulmonary fibrosis

55

Bilateral hilar adenopathy, with high ca+ what lung dz?

sarcoidosis

56

linear opacities at bases and pleural plaques worked in industrial environment

asbestosis

57

nodular opacities at upper lung field?

coal mining or silicosis

58

what do medication can cause restrictive lung disease

amiodarone and nitrofuratoin

59

acute respiratory distress syndrome =

noncardiogenic pulmonary edema (normal sized heart with kerly b-lines)

60

Hypoxia: pO2 0.5
Normal heart function: no evidence of CHF
Diffuse infiltrates: with normal heart size. BUT
X-ray shows pulmonary edema
what is the diagnosis?

ARDS

61

ARDS is caused by

sepsis, multiple trauma and aspiration of gastric contents

62

increased permeability of the alveolar capillary membranes which lead to protein rich edema, PE shows frothy pink or red sputum, diffuse crackles. what is this? tx?

ARDS (end point, lung failure due to sepsis)
Tx: supportive and low levels of positive end expiratory pressure.

63

what do you do with aspiration of foreign body?

bronchoscopy, remove FB and get cultures if post obstructive pneumo is suspected.

64

who gets hyaline membrane dz

preterm infants

65

hyaline membrane is caused by

membrane surfactant

66

X-ray shows ground glass appearance and domed diaphragm. what is the dx

hyaline membrane disease.

67

you suspect FB aspiration, what imagines do you order

expiratory film: expiratory view: failure of right lung to deflate on lateral decubitus film indicates a
foreign body in the right main stem bronchus. Right main stem usually lodges here due to anatomy

lateral soft tissue neck.

68

exam findings for pleural effusion

dullness to percussion, mediastinum usually shifted

69

x ray shows meniscus, blunting of costophrenic angle

pleural effusion

70

isolated left-sided pleural effusion

pneumonia, PE, cancers, Boerhaave syndrome
(esophageal rupture), aortic dissection. goes to Left b/c of weakness in wall on that side. CHF will not be isolated to the left side.

71

exudate effusion due to?

thick nasty fluid, infection, CA or trauma

72

transudate effusion

thin and watery. due to intake capillaries that are overloaded or low oncotic pressure. caused by medical conditions; CHF, renal or liver failure

73

is glucose low or high in exudate

low: infections the bugs are eating the sugars

74

how does treatment differ from exudate vs. transudate

exudate must be pulled out of lung. Transudate may be treated medically.

75

bilateral pleural effusions suggest

CHF (transudate)

76

right sided pleural effusion

CHF, pneumonia, PE, cancer

77

test to figure out effusion vs emphyema

X-ray on side (thick emphyema will not change position) effusion is more watery and will migrate

78

tx for emphyema

early on use chest tube, may need surgery

79

imagining that shows difference between parechymal and pleural densities

try x-ray, then go to CT

80

gold standard to diagnosis effusion

thoracentesis

81

what tests are sent with thoracentesis fluid?

protein, LDH, glucose, WBC,and gram stain

82

thoracentesis fluid shows: increased LDH and protein, decreased glucose. what type of effusion

exudative

83

thoracentesis fluid shows: low LDH, low protein and high glucose

transudative

84

tx for malignant effusions

drainage pleurodesis. using doxycycline and talc

85

tx for large pneumo (spontaneous)

Heimlich flutter valve:

86

x ray shows: collapsed lung, loss of vascular markings in the periphery, visible cupola

pneumothorax

87

primary cause of pneumo

spontaneous, manfans

88

secondary

trauma, pneumonia,

89

tension pneumo is tx with?

needle to chest, decompress and tube

90

small pneumo

resolved spontaneously, place on O2.

91

you are thinking a simple pneumo, but the patent's blood pressure drops and O2 sat drops =

tension pneumo

92

where to place needle to decompress

2nd mid-clavicular line 2 intercostal space, or 5-6th rib mid-axillary

93

when do you place Tube thoracostomy?

hemopneumothorax, persistent or recurrent
pneumothorax

94

tx sicker kids with bronchiolitis

hospitalization, steroids, Ribavirin for confirmed RSV

95

usually caused by RSV and during winter, wheezing in kids under 2 years old, usually viral. Fever, mild respiratory distress

Acute Bronchiolitis

96

steep sign

croup

97

Wheezes kid, you think acute bronchiolitis, all sudden wheezes stop...think

collasped airway

98

do you need labs with acute bronchiolitis?

no you can swab for RSV

99

tx sicker kids with bronchiolitis

hospitalization, steroids, Ribavirin for confirmed RSV

100

thumb print sign

epiglotitis

101

steep sign

croup

102

croup is most commonly caused by?

Parainfluenza virus type 1 in kids 3 months to 3 years
old in Fall and early Winter

103

tx for croup if patient comes to ER or office

humidified air or oxygen, nebulized epinephrine q15-20min,
oral/IM/IV dexamethasone (0.6mg/kg up to 10mg), IV fluids if necessary

104

The most common “complication” from a typical influenza

pneumonia

105

what do you use to treat pneumonia caused by influenza

antiviral---can move to be bacteria

106

best influenza test

Reverse transcription polymerase chain reaction (RT-PCR) is best

107

pertussis is caused by

Bordetella Pertussis is a Gram negative coccobacillus causing respiratory infection
● HIGHLY contagious

108

test to confirm pertussis

viral cultures, PCR and serology

109

tx for pertussis

supportive. if

110

if kids have not been vaccinated for pertussis give

DTaP. For adults give booster Tdap

111


x ray findings for reactivation TB

fibrocavitary apical disease and ghon complexes

112

does the TST skin test differentiate between active or latent forms

no

113

definitive dx requires the id of m. tuberculosis from?

cultures or DNA/RNA amplification

114

does acid fast bacilli on sputum confirm dx?

no, only supports dx

115

Hallmark histologic finding

caseting granulomas

116

isoniazid, rifampin, pyrazinamide, and ethambutol are

TB drugs

117

how is active TB treated

with all drugs for 2 month, followed by 4 months of additional drug therapy

118

SE effects of isoniazid

hepatitis, periperial neuropathy

119

SE effects of Rifampin

hepatitis, flu syndrome, orange body fluid

120

how are pt with HIV treated

therapy for a least 1 year

121

what is the bacilli Calmette guerin vaccine

TB vaccine given to individuals in high risk settings

122

typical pneumonia organisms

Strep pneumoniae, Haemophilus influenzae, Klebsiella, Moraxella

123

common most organisms overall

Strep pneumoniae, gram + dipplococci

124

typical pneumonia signs and symptoms

abrupt onset fever/chills, cough with sputum, abnormal vitals, abnormal lung exam, and an obvious lobar infiltrate on CXR

125

Atypical pneumonia organisms

Mycoplasma (MOST COMMON), chlamydophila, legionella, and viruses like influenza, RSV,
and parainfluenza

126

current colored sputum

Klebsiella

127

what is the difference between, pneuococcal polysaccharide vaccine and pneumococcal conjugate vaccine

PPSV: children 2-5 who have not been previously immunized and those over 65yo
PCV: four doses for children 6 weeks and 15 weeks

128

rust colored sputum

Strep pneumoniae

129

low grade fever, cough, bullous myringitis, cold agglutinins

mycoplasma pneumo

130

high procalcitonin levels suggest what type of pneumonia

bacteria

131

who not to give vaccine to?

egg allergy

132

what is the difference between, pneuococcal polysaccharide vaccine and pneumococcal conjugate vanccine

PPSV: children 2-5 who have not been previously immunized and those over 65yo
PCV: four doses for children 6 weeks and 15 weeks

133

treatment for typical pneumonia

marcolide (clarithromycin, azthromycin or doxycycline)

134

X-ray chest for atypical infection

fluffier infiltrate

135

college student has what type of pneumonia

chlamydia and mycoplasma

136

Alcohols have what type of pneumonia

klebsiella

137

most common cause of bacterial pneumonia in HIV

streptococcus

138

COPD + pneumonia

H. flu

139

air condition + pneumonia

legionella

140

bird dropping + pneumonia

histo or chlamydia

141

tx: CAP but person is sick enough to be admitted

3rd gen cephalosporin+macrolide, or a FQ by itself

142

tx CAP with co-morbidities

fluoroquinolone (FQ) OR Augmentin + a macrolide

143

tx CAP

macrolide like azithromycin, or maybe doxycycline

144

influenza can cause pneumonia do antivirals help

yes. zanamivir and oseltamivir

145

Hospital acciqured bugs include

s. aureus, gram negative bacilli

146

what bug causes ICU pneumo

pseudomonas

147

tx hospital /ICU pneumo with?

ceftriaxone, cefepime and imipenem

148

_____ is the most common cause of opportunistic infections in HIV

pneumocystis jiroveci

149

pneumocystis jiroveci occurs when CD4 counts drop below what number

150

how do you dx pneumocystis pneumonia

sputum spain via induced sputum or bronchalveloar lavage

151

tx for HIV with pneumocystis infections

Bactrim (trimethoprim-sulfamethoazole) . Also, used prophylactic when CD4 counts are below 200 cells

152

what type of pneumo with Cystic fibrosis

pseudomonas

153

what type of pneu if you are under one

RSV

154

pneum associated with post viral infection

staph. aureus

155

what physical exam finding are consistent with chronic silicosis.

Diffuse rhonchi and low pitched rales

156

Idiopathic pulmonary fibrosis findings

honeycombing and restrictive

157

What is the therapy of choice for a patient diagnosed with Coccidioidomycosis?
A.

The first line drug of choice for Valley Fever is fluconazole. Patient may remain on therapy up to 6 months to prevent relapse while recovery is monitored via serum complement fixation titers.

158

Which acid-base abnormality is most commonly associated with chronic obstructive pulmonary disease?

respiratory acidosis

159

name the 3 stages of pertussis

The three phases of pertussis that have been described are catarrhal, paroxysmal, and convalescent. The catarrhal phase is characterized by upper respiratory symptoms such as nasal congestion, rhinorrhea, and sneezing and this phase is when the patient is most infectious. The paroxysmal phase is the phase of intense episodes of coughing with post-tussive vomiting. The convalescent phase is the phase in which symptoms begin to resolve, but the patient may have a lingering cough for weeks.

160

ou suspect that he has a partial obstruction of the trachea due to a foreign body. What is the most appropriate next step in the care of this patient?

Bronchoscopy is the definitive test to confirm the diagnosis of tracheal foreign body, and removal can be accomplished at the same time.

161

young women with cough for 3 months and obstructive lung symptoms, she does not have asthma, what might she have?

Alpha-1-antitrypsin deficiency This deficiency allows the natural proteases produced in the lungs to break down the alveolar walls resulting in the emphysema-like symptoms.

162

You have recently diagnosed a patient with a pulmonary embolism. While beginning anticoagulation therapy with heparin and warfarin, at what point can you discontinue heparin?

When the INR is greater than 2.0 (for 24 hours) heparin therapy can be discontinued. Warfarin therapy should be continued with an INR goal of between 2.0 and 3.0.

163

Which of the following organisms is likely to cause a lobar pneumonia

Streptococcus pneumoniae

164

fungal pneumonia, which of the following drugs would be contraindicated?

steroids

165

A common complication in placing a subclavian central venous catheter is which of the following?

Pneumothorax

166

gold standard to dx TB

putum cultures revealing Mycobacterium tuberculosis are the gold standard in diagnosis of pulmonary TB. Typically sputum samples are obtained in the morning on three consecutive days.

167

what are the lung cancer screen recommendations for smokers and what imaging is used?

recommend low-dose chest CT scan annually for high-risk individuals (age 55-74 years with 30-pack year smoking history)

168

On physical exam you note clubbing of the fingers and inspiratory crackles diffusely throughout both lungs. Chest x-ray reveals pleural plaques with a reticular pattern through both lung bases. What is the most likely diagnosis for this patient?

Asbestosis

169

ou suspect she may have pulmonary hypertension. What is the next best step in the diagnostic workup of this patient?

Trans-thoracic echocardiogram

170

By what mechanism do inhaled corticosteroids enhance the overall effectiveness of other pharmacologic agents used in the treatment of asthma?

The preservation of beta-2 receptors in the lungs allows medicines such as albuterol to remain tolerance free over time.

171

In the treatment of pulmonary tuberculosis, what should be coadministered with isoniazid to reduce the risk of peripheral neuropathy?

b6

172

x-ray findings of foreign body in the lungs

Ipsilateral hyperlucency and hyperexpansion of the ipsilateral hemithorax