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PANCE 2024 > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

What is the length of cough typically in Acute Bronchitis

A

1-3 weeks

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2
Q

Typical sxs associated with acute bronchitis (4)

A

Purulent sputum
Wheezing
Rhonchi
URI sxs

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3
Q

Management acute bronchitis

A

Supportive care; usually resolved in 1-3 weeks

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4
Q

What cells are effected in influenza ;; transmission?

A

Ciliated cells of the respiratory tract ; decreasing ciliary resistance ; infection spreads to lower respiratory tract

Transmission = respiratory droplets

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5
Q

3 sxs associated with the Flu

A

Myalgia
Fever
Cough

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6
Q

What are CXR findings in influenza

A

Bilateral
Or
Reticulonodular opacities

+/- consolidation

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7
Q

Flu management pearls

A

Osletamivir is drug of choice given with 48-72 hours of sxs onset
[protects agains flu A and flu B]

Rimantidine is another option
[protects only against flu A]

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8
Q

Who is at highest risk of complications from the flu? (3) ;; what bacterial infection can coincide

A

Pregnant
Less tha 2 years
Elderly > 65 yrs

Staph A and Strep P

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9
Q

Who should receive the flu vaccine

A

Everyone over the age of 6 months

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10
Q

The flu live vaccine should not be used in what populations (4)

A

-People age less than 2 or over 49
-Age 2-17 receiving ASA therapy
-Pregnant patients
-If received antivirals in the last 48 hours

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11
Q

5 typical bacteria involved in CAPNA

A

1 Strep Pneumo

Staph A
Haemophilios Influ.
Klebsiella
Pseudomonas Aerginosa

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12
Q

3 Atypical Bacteria in CAPNA

A

Mycoplasma pneumoniae
Legionella
chlamydiae pneumoniae

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13
Q

What is the difference in onset for atypical vs typical influenza ;; key sxs differences

A

Atypical = insidious ; non productive cough

Typical = sudden ;pleuritic chest pain

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14
Q

What is tactile fremitus in CAPNA and percussion does what?

A

Increased

Dull to percussion

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15
Q

3 positive lab findings in CAPNA

A

LEUKOCYTOSIS with a. LEFT SHIFT
Elevated procalcitonin
Could have positive blood culture

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16
Q

What does the gram stain look like in strep pnuemoniae

A

gram positive cocci in pairs ;; lancet shaped

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17
Q

What does the gram stain look like in atypical CAPNA

A

Not present. No stain.

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18
Q

4 things important about Legionella PNA

A

PNA sxs + Diarrhea

Hyponatremia

Urine antigen assay testing

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19
Q

Staph A can present with what CXR finding?

A

Cavitary legions

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20
Q

General management for CAPNA without and with comorbids

A

Without = Macrolide, Amoxicillin, Doxycycline

With = Augmentin, Cephalexin + Azithromycin
-Resp FQs

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21
Q

CURB 65 score criteria

A

0-1 HOME TREATMENT

2-3 CLOSE OP / OR ADMISSION

3-5 [30 day mortality 22%] SEVERE ADMISSION

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22
Q

What type of flu vaccine is recommend in sickle cell patients

A

PCV15 and PCV20

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23
Q

What is another name for pleural effusion

A

Parapnuemonic effusion

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24
Q

What is the definition of HAPNA ; and VAP?

A

Within 48 hrs of admission

VAPNA develops within 48-72 hours of intubation

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25
Q

What is the antibiotic of choice in positive abscess aspiration PNA

A

Ampicillin-Sulbactam or Augmentin

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26
Q

Most common cause of PNA in HIV with CD4 less than what?

A

PJP PNA ; also same in organ transplant folks

Less than 200

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27
Q

What will be present for PJP on CXR and CT Scan

A

CXR = Diffuse bilateral infiltrate

CT Scan = Ground Glass appearance

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28
Q

What is the management and prophylaxis for PJP PNA

A

Management = BACTRIM

Proph = BACTRIM ; if CD4 count less than 200

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29
Q

Management and Prophylaxis for PJP PNA

A

M = Bactrim

P = Bactrim

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30
Q

What are extra pulmonary diseases assoicated with TB (3)

A

Meningitis Osteomyelitis , Potts Disease

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31
Q

What is the gold standards dx of choice for TB

A

Acid Fast Bacilli Stain and Culture

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32
Q

Active TB management

A

RIPE x 2months
Rifampin Isonazid x 4months

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33
Q

What do we need to know about Side effects of RIPE therapy ?

A

R= red urine
I = peripheral neuropathies, give B6 pyridoxine
P = [mild joint pain]
E = can cause color blindness

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34
Q

How do you screen vs diagnose TB?

A

Screen - TST skin test, IGTA blood test

Dx - Positive screen + Positive CXR and Sputum

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35
Q

What do we need to know about TB positive skin testing

A

Measures transverse diameter of induration

[not erythema]

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36
Q

General positive values of TB based on risk

A

5 = HIV, Recent Contact, Immune suppressed

10 = High prevalence country in the last 5 years , less 90% ideal body weight, compromised, IV Drug users

15 = Healthy folks

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37
Q

What is the most common malignant pulmonary nodule

A

Adenocarcinoma

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38
Q

What is the most common benign pulmonary nodule

A

Granuloma

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39
Q

What is the next step if you see a positive pulmonary nodule on CXR

A

Low dose CT without contrast; then Biopsy

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40
Q

What is the recommendation for low and high cancer risk patients with pulm nodule 6-8 mm ?

A

Low < 5% = CT at 6-12 mo’s then 18-24 mo’s

High >65% = CT at 6-12 mo’s then 18-24 mo’s

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41
Q

2 common characteristics of squamous cell carcinoma of the lung

A

Starts centrally

Hypercalcemia common

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42
Q

What is the patho associated with superior vena cava syndrome and scc lung cancer

A

Obstruction of blood return to the heart by invasion compression or thrombosis of the superior vena cava

-Facial Plethora
-Distended Neck Veins

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43
Q

PNP syndromes associated with Small Cell Cancer

A

SIADH
Cushings
Carcinoid = flushing diarrhea
Eaton Lambert Syndrome
SVC Syndrome

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44
Q

PNP syndromes associated with Squamous Cell Cancer

A

High PTH - Hypercalcemia
Horner Syndrome
Pancoast Tumor

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45
Q

PNP syndromes associated with adenocarcinoma

A

Pulmonary osteoarthropathy
Marantic endocarditis

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46
Q

PNP syndromes associated with Large Cell Cancer

A

SVC Syndrome
Gynecomastia

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47
Q

Centrally located abnormal CXR concerning for cancer should be evaluated by? (3)

A

Sputum cytology

Bronchothoracic Bx

Transthoracic Bx

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48
Q

Peripherally located abnormal CXR concerning for cancer should be evaluated by? (3)

A

CT Transthoracic Bx

Thoracoscopy

Thoracotomy

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49
Q

USPTF for Lung Cancer Screening

A

20 pack year history and currently smoke or have quite in the last 15 years

Age 50-80

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50
Q

What cells are increased in chronic bronchitis

A

Goblet cells

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51
Q

Definition of chronic bronchitis

A

Chronic productive cough for longer the 3 months in at least 2 consecutive years

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52
Q

What type of wheeze is assoc with chronic bronchitis

A

Expiratory

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53
Q

Gold standard PFT findings associated with chronic bronchitis

A

Dec FEV1 and FEV1/FVC Ratio less 0.7
NML to increased TLC ; increased residual volume
NML diffusing capacity for carbon monoxide DLCO

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54
Q

What happens to alveoli in emphysema

A

Loss of elastic recoil and decreased surface area

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55
Q

4 risk factors for emphysema

A

Alpha 1 antitrypsin Def.
Asthma
Occupational exposure
Smoking

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56
Q

3 findings common in alpha 1 antitrypsin def.

A

Emphysema + Hepatitis + Vasculitis

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57
Q

Talk about what an emphysematic patient looks like

A

Pursed lips
Barrel chest [AP diameter increase]
Hyperrersonance

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58
Q

Gold standard PFTS found in emphysema

A

Reduced Ratio less than 0.7
NML to increased TLC, RV
REDUCED DLCO

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59
Q

Dont forget to prescribe your patients what for COPD?

A

Smoking cessation!!

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60
Q

When should you give antibiotics in COPD patients

A

Increased sputum ; Dyspnea or if mechanically ventilated

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61
Q

Pathophysiology and example of TRANSUDATIVE effusion

A

Imbalance of hydrostatic and oncotic pressures

-Heart Failure
-Cirrhosis

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62
Q

Pathophysiology and example of EXUDATIVE effusion

A

Increased capillary permeability, decreased lymphatic drainage

-Malignancy
-Infection
-Pulmonary Embolism

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63
Q

EXUDATIVE serum LDH is likely what

A

Elevated ; greater .6 and elevated 2/3 UPLN Serum LDH

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64
Q

What types of CXR are helpful with pleural effusion

A

Lateral decubitus
Upright

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65
Q

CXR best for pleural effusion imaging

A

Lateral decubitus
Upright

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66
Q

Thoracentesis insertion site for pleural effusion

A

1-2 intercostal spaces below the effusion
5-10 cm lateral to the spine

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67
Q

Definitive mangement of pleural effusion

A

Pleurodesis or indwelling pleural catheter

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68
Q

Management of pleural effusion less than 15% of chest diameter

A

Supplement O2 and monitor with serial chest X-ray

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69
Q

Management of PTX greater than 15% of chest diameter?

A

High concentration o2
Chest tube
Serial chest X-rays

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70
Q

What is virchows triad ; and for what>

A

Hypercoagable , stasis , endothelial injury

For PE

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71
Q

Remember what 4 factors for determining PE probability

A

HR > 100 bpm
Previous DVT
Immobilized 3 days or surgery in the last 4 weeks
Hemoptysis

++ malignancy [you know this]

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72
Q

What age folks can be PERCed out for PE? What can they not be taking?

A

Age less than 50

Exogenous estrogen

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73
Q

What D-dimmer level excludes PE

A

Less then 500

74
Q

What is localized oligemia? Also associated with what for PE

A

Assoc with PE, reference to decreased lung markings surrounding pulm vessel

Wetsermarks Sign and Hampton’s Hump

75
Q

What type of bundle branch is associated with PE?

A

RBB

76
Q

Management in order for PE based on severity :

A

Hemodynamically stable
>Anticoagulation
Hemodynamically unstable:
>Thrombolytic therapy
>Surgical thrombectomy or embolectomy
>Inferior vena cava filter [contra or previous PEs]

77
Q

Who should get LMWH after previous PE

A

If undergoing surgery

78
Q

Pulmonary hypertension is defined as an arterial pressure of what

A

Over 20

79
Q

What 3 things can cause increased resistance in pulmonary hypertension

A

Sleep Apnea
Fibrosis
Thromboemboli

80
Q

What two things can cause increased pressure in Pulm hypertension

A

Left to Right Shunt
Heart Failure

81
Q

What 3 diseases are associated with vascular thickening and worsening of pulm hypertension

A

Pulmonary fibrosis
Scleroderma
Sarcoidosis

82
Q

WHO Pulm hypertension by number, 1-5

A

1 =Arterial
2=Left heart disease
3=CLDz
4=Thromboembolic
5=Multifactorial

83
Q

Abnormal sxs of pulm hypertension and why?

A

Anorexia

Right ventricular heart failure

84
Q

What is the definitive diagnosis for Pulm hypertension

A

Right heart catheterization with arterial pressure greater than 20

85
Q

What is a chronic vs. acute cause of cor pormonale

A

Chronic : COPD
Acute : Large PE

86
Q

What is an interesting findings in idiopathic pulmonary fibrosis

A

Nail clubbing and Bibisilar crackles

87
Q

Two common findings when diagnosing idiopathic pulmonary fibrosis

A

Honeycombing and Normal FEV1/FVC ratio

88
Q

What two anti fibrotic medications can be used in IPFibrosis ; definitive

A

Nintedanib
Pirfenidone

Definitive treatment = Lung Transplant

89
Q

What can cause

Silicosis
Siderosis
Asbestosis

Which are all types of :

A

Silicosis = mining
Siderosis = arc welding
Asbestosis = shipyard ; building demolition

PNEUMOCONIOSIS

90
Q

PTS WITH rheumatoid arthritis can develop what lung syndrome?

A

Caplan syndrome

Rheumatoid nodules in the lungs

91
Q

CXR findings sig for pneumoconiosis

A

Small round nodular opacities in the upper lobes

92
Q

4 silicosis hazardous jobs

A

Rock mining
Sand blasting
Masonry work
Stone cutting

93
Q

What does silicosis look like on CXR

A

Eggshell calcifications

94
Q

4 jobs associated with asbestosis

A

Mining
Ship building
Construction
Pipe fitting

95
Q

CXR and CT findings for asbestosis

A

Lower lobe reticular opacities with honeycombing

CT = parenchymal pleural plaques

96
Q

1 complication of pneumoconiosis

A

2 = bronchogenic carcinoma

Mesothelioma - asbestosis

97
Q

3 places possible for mesothelioma spread

A

Pleural

Pericardial

Peritoneal

98
Q

What are two things to remember about sarcoidosis

A

NOn caseating granulomas with T cell and inflammatory cell overgrowth

Produces increased ACE levels

99
Q

what is lofgrens syndrome

A

Hilar LAD
Erythema nodosum
Arthritis

100
Q

CXR for sarcoidosis usually has what

A

Bilateral hilar adenopathy

101
Q

PFTs will be what for sarcoidosis

A

Restrictive

102
Q

First line and alternative treatment for sarcoidosis

A

Low dose prednisone

Methotrexate = alternative

103
Q

What is the Samter triad

A

ASA sensitivity
Nasal Polyps
Asthma

104
Q

What is the atopic triad

A

Allergic rhinitis
asthma
Atopic dermatitis

105
Q

What is the #1 etiology of ARDS

A

Sepsis

106
Q

What type of sputum is common in ARDS

A

Frothy pink-red sputum

107
Q

CXR findings in ARDS

A

Bilateral diffuse opacities

108
Q

What is the FVC

A

Measure of forced expire volume until full exhalation

109
Q

When would you perform the 6 minute walk test

A

To quantify exercise tolerance and effectiveness of interventions

110
Q

Hemoptysis ; stridor ; DOB retrieval ; staging of cancer think what diagnostic

A

Bronchoscopy

111
Q

Catemenial asthma is what

A

Only present with menses

112
Q

Anticholinergic work how for asthma

A

Lead to bronchial smooth muscle dilation to relieve constriction

113
Q

When can you step down asthma therapy

A

After 3 months of control

114
Q

A1 Anti trypsin think early onset COPD + what else

A

Hepatic dysfunction

115
Q

Elongated lungs with diaphragmatic flattening think what on CXR

A

COPD

116
Q

COPD therapy that can help ; only proven one

A

O2 supplementation if hypoxic

117
Q

What is the step up course for COPD ABCD

A

BD SABA / SAMA
LABA or LAMA
LAMA
LAMA + LABA

CC are not proven to be helpful

118
Q

What electrolyte can be helpful in COPD exacerbations

A

Magnesium

119
Q

Think what drugs for inducing interstitial lung disease

A

Amiodarone

Methotrexate

120
Q

2 complications of IPFibrosis

A

RVH Dz

Pulmonic HTN

121
Q

IPFibrosis has what nail changes

A

Clubbing ;; DRY INSPIRATORY CRACKLES

122
Q

Pneumoconiosis treatment

A

Inhaled BD
Supplemental O2
Consider Lung TXPLT

123
Q

Coal workers pneumo [4]

A

Ingestion of coal dist leading to coal Macules in the lungs

+RF or +CCP for Rheumatoid arthritis

Pts initially asxs at first

CXR : diffuse small opacities prominent in the upper lung fields

124
Q

Silicosis [4]

A

Inhalation of silica particles = glass workers; sand blasters ; miners

UPPER LOBES ; egg shell calcifications

Higher incidence of TB

CXR : small rounded opacities in the upper lobes along with peri hilar node calcifications

125
Q

Asbestosis [4]

A

Exposure to SHIPYARDS, construction workers ; piper filters; insulators

Progressive dyspnea resulting in mesothelioma and lung cancer

Cancer of the pleural lining

CXR = linear streaking honey combing pleural plaques

126
Q

Non caseating granulomatous lung disease

A

Sarcoidosis

elevated ACE Hypercalcemia elevated ESR

127
Q

What organs are involved in sarcoidosis [4]

A

Cardiac restrictive cardiomyopathy

Skin : erythema nodusum ; arthritis

Constitutional : malaise ; fever ; dyspnea

Organomegaly

128
Q

CXR of sarcoidosis

A

Mediastinal and hilar LAD

129
Q

Pulmonary nodules vs masses

A

Less than 3 cm - nodules

Mass = greater 3cm

130
Q

MC malignant pulmonary nodule

A

Adenocarcinoma

131
Q

Small cell lung cancer are usually where

A

Central discrete NO discrete intraluminal mass

132
Q

If central mass with intraluminal mass think what lung cancer

A

Squamous cell

133
Q

Where do lung Adenocarcinoma often arise from

A

Mucous glands

134
Q

Complications of lung cancer SPHERE ; that can be a pts first presentation

A

SVC syndrome

Pancoast tumors

Horners syndrome

Endocrine Tumores / carcinoid SIADH=small cell

Recurrent laryngeal symptoms

Effusions

135
Q

Should you recommend surgery for small cell lung cancer

A

No ROLE , just chemo and radiation

136
Q

MC location for carcinoid tumor

A

GI tract

137
Q

Why is there flushing diarrhea and bronchospasms in carcinoid tumors

A

Serotonin release

138
Q

PE percussion causes what ; tactile fremitus

A

Dullness

Decreased

139
Q

TRANSUDATIVE effusion think about

A

Hypoalbuminemia [cirrhosis, nephrotic syndrome]
Malnutrition’
CHF
Constrictive pericarditis

140
Q

EXUDATIVE effusions think

A

Malignancy
Pancreatitis
Post cardiac surgery

141
Q

PTX think what physical exam

A

Hyperresonance to percussion
Diminished breathe sound
Reduced lung expansion

142
Q

Location for ND / Chest tube

A

2-3 Mid clavicular = acute unstable, ND

4-5 mid axillary = stable, chest tube

143
Q

Recurrent PTX treatment

A

VATS or pleurodesis

144
Q

U/S for PTX +

A

Barcode sign
= no lung sliding

145
Q

Age of croup infection commonly

A

6 mo - 5 years

146
Q

Does croup usually have fever

A

NO

147
Q

MC pathogen in epiglottis

A

HIB

Strep

148
Q

Good abx for epiglottis

A

Ceftriaxone

149
Q

What is an example of gram negative PNA

A

Klebsiella = ETOH

Pseudomonas = cystic fibrosis

150
Q

HAP vs VAP Mc pathogens

A

HAP = Staph A

VAP = Acinobacter

151
Q

Greater than what age for flu vaccine

A

6 months

152
Q

Paramyxovirus think [3]

A

Rsv

Parainfulenza —> croup

153
Q

TB risk factors

A

Incarcerated

Drug use

Homeless

Droplets —> alveoli —> macrophages engulf infection [becomes active or latent]

154
Q

Chronic cough w rusty sputum hemoptysis

A

TB

155
Q

Does TB screening decide active vs latent disease

A

NO!

156
Q

Definitive test for TB diagnosis

A

Culture of sputum

157
Q

What does CSF look like in TB meningitis

A

Lymphocytic pleocytosis
Elevated protein
Decreased glucose

158
Q

What does pleural fluid have in pleural TB

A

Elevated adenosine deaminase levels

159
Q

Spinal TB is defined as

A

POTTS dz

160
Q

Military TB is defined as what on CXR

A

Small nodular densities that are in a diffuse machine gun like pattern

161
Q

Active TB treatment

A

6 month of TXM :

Initial 2 months RIPE

Last 4 months IR

162
Q

Latent TB TXM options [3]

A

9 months of I
3 moths of IR
4 months of R

163
Q

Rifampin ADR

A

Hepatitis ; rash

Interferes with retroviral agents

164
Q

Pyrazinimide ADRs

A

Hyperuricemia ; monitor uric acid levels

165
Q

Pertussis transmitted by

A

Droplets - respiratory

Cataraall ; paraxysmsal ; convalascent [STAGES]

166
Q

CXR of PCP PNA

A

Diffuse interstitial or alveolar infiltrates

Elevated LDH

167
Q

PCP PNA first line

A

Bactrim

168
Q

CD4 count below what is risk for fungal PNA

A

200

169
Q

Normal PA pressure

A

8- 20 mmHg

HTN = greater than 25

170
Q

Pulmonary HTN findings [3]

A

Split S2 with Loud pulmonic component ; tricuspid regurgitation

Hepatosplenomegaly JVD peripheral edema

Palpable RVHeave

Get a right sided cath to eval pressures

171
Q

Cor pulmonale is what

A

Right sided HF with no Left sided HF

massive PE ; ARDS = acute

COPD ILS = chronic

EKG Echo

TXM = 02 ; decrease pulm vascular resistance

172
Q

4 RF for OSA

A

Macroglossia
Micrognathia
Tonsillar hypertrophy
Obesity

173
Q

High risk OSA STOP BANG

A

5-8

174
Q

What does psmn test in OSA

A

Apnea hypopnea index [5-15] is mild

175
Q

Obesity hypoventilation syndrome has what

A

Day time hypercapnia

176
Q

What is a good ratio to get to mange ARDS

A

Pa o2 / Fi o2

177
Q

When should a patient be placed in prone position for ARDS

A

P/F ratio less than 150

178
Q

Cystic fibrosis is what genetic disorder

A

Autosomal recessive

179
Q

CF would be what to percussion

A

Hyper-resonant

180
Q

MC cause of respiratory distress in preterm infants

A

Hyaline membrane disease
Lack of surfactant

181
Q

What medication should be administered to pre term infants to accelerate lung maturation

A

Betamethasone

PANCE 2024 (15 decks)

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