pulmology Flashcards
1
Q
asthma is what type of disease
A
immunological (hyper-responsiveness to IgE that has been released from trigger)
2
Q
asthma is what type of disease
A
immunological (hyper-responsiveness to IgE that has been released from trigger)
3
Q
ABG with SEVERE asthma attack
A
respiratory low Pa02, respiratory acidosis
4
Q
tests to asthma
A
FEVI, Peak Flow, lungs and symptoms reversible with bronchodilator
5
Q
X-ray asthma attack, what if no attack?
A
big lung and flatten diagram, no attack it will be normal
6
Q
asthma has what % FEVI/FVC
A
7
Q
ABG with severe asthma attack
A
respiratory low Pa02
8
Q
tests to asthma
A
Peak Flow, lungs
9
Q
X-ray asthma attack, what if no attack?
A
big lung and flatten diagram, no attack it will be normal
10
Q
the triad involving asthma
A
The triad: atopy, nasal polyps, NSAID allergy
11
Q
acute tx for asthma
A
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
Q
chronic tx for asthma
A
Mast cell stabilizers (cromolyn)
Leukotriene inhibitors (montelukast or zileuton
Long acting β2-agonists (salmeterol)
13
Q
asthma symptoms everyday, every night
A
severe persistant asthma
14
Q
intermittent asthma and tx
A
almost no symptoms, > 2 days a week, most likely only need albuterol
15
Q
mild asthma tx
A
use albuterol + low dose inhaled steroids
16
Q
moderate asthma tx
A
Short acting and LONG acting beta agonist and inhaled steroid
17
Q
what if patient is already on short and long acting beta agonist, and inhaled steroid but having break through therapy?
A
increase inhaled steroid dose or for severe add oral steroids + immune suppressive agent Omalizumab (causes anaphylaxis) works by binding IgE.
18
Q
majority of PE are caused by_____from where in the body_______
A
Emboli from the Lower extremities
19
Q
hampton’s hump and westermark on xray
A
HH: white lesion 1/2 circle attached to pleura, PE
20
Q
EKG findings of PE
A
non-specific ST changes, tachycardia
21
Q
what is Aa gradient
A
report card of how well body takes air from environment and shuttles it through alveoli to blood stream
22
Q
the right heart is working hard with a PE, what are the EKG findings specific to this
A
S1Q3T3.
big wave p wave (p pulmonale).
Inverted Ts V1-V4.
23
Q
you suspect PE, but d dimer is positive, what test is done next? (remember pt will be short of breath)
A
CT pulmonary angiogram and then VQscan (ventilation and perfussion scan)……US of chest will show a huge right ventricle
24
Q
treatment for PE
A
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
