Pulmonary Flashcards
(181 cards)
1
Q
What is the length of cough typically in Acute Bronchitis
A
1-3 weeks
2
Q
Typical sxs associated with acute bronchitis (4)
A
Purulent sputum
Wheezing
Rhonchi
URI sxs
3
Q
Management acute bronchitis
A
Supportive care; usually resolved in 1-3 weeks
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
5
Q
3 sxs associated with the Flu
A
Myalgia
Fever
Cough
6
Q
What are CXR findings in influenza
A
Bilateral
Or
Reticulonodular opacities
+/- consolidation
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]
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
9
Q
Who should receive the flu vaccine
A
Everyone over the age of 6 months
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
11
Q
5 typical bacteria involved in CAPNA
A
1 Strep Pneumo
Staph A
Haemophilios Influ.
Klebsiella
Pseudomonas Aerginosa
12
Q
3 Atypical Bacteria in CAPNA
A
Mycoplasma pneumoniae
Legionella
chlamydiae pneumoniae
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
14
Q
What is tactile fremitus in CAPNA and percussion does what?
A
Increased
Dull to percussion
15
Q
3 positive lab findings in CAPNA
A
LEUKOCYTOSIS with a. LEFT SHIFT
Elevated procalcitonin
Could have positive blood culture
16
Q
What does the gram stain look like in strep pnuemoniae
A
gram positive cocci in pairs ;; lancet shaped
17
Q
What does the gram stain look like in atypical CAPNA
A
Not present. No stain.
18
Q
4 things important about Legionella PNA
A
PNA sxs + Diarrhea
Hyponatremia
Urine antigen assay testing
19
Q
Staph A can present with what CXR finding?
A
Cavitary legions
20
Q
General management for CAPNA without and with comorbids
A
Without = Macrolide, Amoxicillin, Doxycycline
With = Augmentin, Cephalexin + Azithromycin
-Resp FQs
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
22
Q
What type of flu vaccine is recommend in sickle cell patients
A
PCV15 and PCV20
23
Q
What is another name for pleural effusion
A
Parapnuemonic effusion
24
Q
What is the definition of HAPNA ; and VAP?
A
Within 48 hrs of admission
VAPNA develops within 48-72 hours of intubation
25
What is the antibiotic of choice in positive abscess aspiration PNA
Ampicillin-Sulbactam or Augmentin
26
Most common cause of PNA in HIV with CD4 less than what?
PJP PNA ; also same in organ transplant folks
Less than 200
27
What will be present for PJP on CXR and CT Scan
CXR = Diffuse bilateral infiltrate
CT Scan = Ground Glass appearance
28
What is the management and prophylaxis for PJP PNA
Management = BACTRIM
Proph = BACTRIM ; if CD4 count less than 200
29
Management and Prophylaxis for PJP PNA
M = Bactrim
P = Bactrim
30
What are extra pulmonary diseases assoicated with TB (3)
Meningitis Osteomyelitis , Potts Disease
31
What is the gold standards dx of choice for TB
Acid Fast Bacilli Stain and Culture
32
Active TB management
RIPE x 2months
Rifampin Isonazid x 4months
33
What do we need to know about Side effects of RIPE therapy ?
R= red urine
I = peripheral neuropathies, give B6 pyridoxine
P = [mild joint pain]
E = can cause color blindness
34
How do you screen vs diagnose TB?
Screen - TST skin test, IGTA blood test
Dx - Positive screen + Positive CXR and Sputum
35
What do we need to know about TB positive skin testing
Measures transverse diameter of induration
[not erythema]
36
General positive values of TB based on risk
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
37
What is the most common malignant pulmonary nodule
Adenocarcinoma
38
What is the most common benign pulmonary nodule
Granuloma
39
What is the next step if you see a positive pulmonary nodule on CXR
Low dose CT without contrast; then Biopsy
40
What is the recommendation for low and high cancer risk patients with pulm nodule 6-8 mm ?
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
41
2 common characteristics of squamous cell carcinoma of the lung
Starts centrally
Hypercalcemia common
42
What is the patho associated with superior vena cava syndrome and scc lung cancer
Obstruction of blood return to the heart by invasion compression or thrombosis of the superior vena cava
-Facial Plethora
-Distended Neck Veins
43
PNP syndromes associated with Small Cell Cancer
SIADH
Cushings
Carcinoid = flushing diarrhea
Eaton Lambert Syndrome
SVC Syndrome
44
PNP syndromes associated with Squamous Cell Cancer
High PTH - Hypercalcemia
Horner Syndrome
Pancoast Tumor
45
PNP syndromes associated with adenocarcinoma
Pulmonary osteoarthropathy
Marantic endocarditis
46
PNP syndromes associated with Large Cell Cancer
SVC Syndrome
Gynecomastia
47
Centrally located abnormal CXR concerning for cancer should be evaluated by? (3)
Sputum cytology
Bronchothoracic Bx
Transthoracic Bx
48
Peripherally located abnormal CXR concerning for cancer should be evaluated by? (3)
CT Transthoracic Bx
Thoracoscopy
Thoracotomy
49
USPTF for Lung Cancer Screening
20 pack year history and currently smoke or have quite in the last 15 years
Age 50-80
50
What cells are increased in chronic bronchitis
Goblet cells
51
Definition of chronic bronchitis
Chronic productive cough for longer the 3 months in at least 2 consecutive years
52
What type of wheeze is assoc with chronic bronchitis
Expiratory
53
Gold standard PFT findings associated with chronic bronchitis
Dec FEV1 and FEV1/FVC Ratio less 0.7
NML to increased TLC ; increased residual volume
NML diffusing capacity for carbon monoxide DLCO
54
What happens to alveoli in emphysema
Loss of elastic recoil and decreased surface area
55
4 risk factors for emphysema
Alpha 1 antitrypsin Def.
Asthma
Occupational exposure
Smoking
56
3 findings common in alpha 1 antitrypsin def.
Emphysema + Hepatitis + Vasculitis
57
Talk about what an emphysematic patient looks like
Pursed lips
Barrel chest [AP diameter increase]
Hyperrersonance
58
Gold standard PFTS found in emphysema
Reduced Ratio less than 0.7
NML to increased TLC, RV
REDUCED DLCO
59
Dont forget to prescribe your patients what for COPD?
Smoking cessation!!
60
When should you give antibiotics in COPD patients
Increased sputum ; Dyspnea or if mechanically ventilated
61
Pathophysiology and example of TRANSUDATIVE effusion
Imbalance of hydrostatic and oncotic pressures
-Heart Failure
-Cirrhosis
62
Pathophysiology and example of EXUDATIVE effusion
Increased capillary permeability, decreased lymphatic drainage
-Malignancy
-Infection
-Pulmonary Embolism
63
EXUDATIVE serum LDH is likely what
Elevated ; greater .6 and elevated 2/3 UPLN Serum LDH
64
What types of CXR are helpful with pleural effusion
Lateral decubitus
Upright
65
CXR best for pleural effusion imaging
Lateral decubitus
Upright
66
Thoracentesis insertion site for pleural effusion
1-2 intercostal spaces below the effusion
5-10 cm lateral to the spine
67
Definitive mangement of pleural effusion
Pleurodesis or indwelling pleural catheter
68
Management of pleural effusion less than 15% of chest diameter
Supplement O2 and monitor with serial chest X-ray
69
Management of PTX greater than 15% of chest diameter?
High concentration o2
Chest tube
Serial chest X-rays
70
What is virchows triad ; and for what>
Hypercoagable , stasis , endothelial injury
For PE
71
Remember what 4 factors for determining PE probability
HR > 100 bpm
Previous DVT
Immobilized 3 days or surgery in the last 4 weeks
Hemoptysis
++ malignancy [you know this]
72
What age folks can be PERCed out for PE? What can they not be taking?
Age less than 50
Exogenous estrogen
73
What D-dimmer level excludes PE
Less then 500
74
What is localized oligemia? Also associated with what for PE
Assoc with PE, reference to decreased lung markings surrounding pulm vessel
Wetsermarks Sign and Hampton’s Hump
75
What type of bundle branch is associated with PE?
RBB
76
Management in order for PE based on severity :
Hemodynamically stable
>Anticoagulation
Hemodynamically unstable:
>Thrombolytic therapy
>Surgical thrombectomy or embolectomy
>Inferior vena cava filter [contra or previous PEs]
77
Who should get LMWH after previous PE
If undergoing surgery
78
Pulmonary hypertension is defined as an arterial pressure of what
Over 20
79
What 3 things can cause increased resistance in pulmonary hypertension
Sleep Apnea
Fibrosis
Thromboemboli
80
What two things can cause increased pressure in Pulm hypertension
Left to Right Shunt
Heart Failure
81
What 3 diseases are associated with vascular thickening and worsening of pulm hypertension
Pulmonary fibrosis
Scleroderma
Sarcoidosis
82
WHO Pulm hypertension by number, 1-5
1 =Arterial
2=Left heart disease
3=CLDz
4=Thromboembolic
5=Multifactorial
83
Abnormal sxs of pulm hypertension and why?
Anorexia
Right ventricular heart failure
84
What is the definitive diagnosis for Pulm hypertension
Right heart catheterization with arterial pressure greater than 20
85
What is a chronic vs. acute cause of cor pormonale
Chronic : COPD
Acute : Large PE
86
What is an interesting findings in idiopathic pulmonary fibrosis
Nail clubbing and Bibisilar crackles
87
Two common findings when diagnosing idiopathic pulmonary fibrosis
Honeycombing and Normal FEV1/FVC ratio
88
What two anti fibrotic medications can be used in IPFibrosis ; definitive
Nintedanib
Pirfenidone
Definitive treatment = Lung Transplant
89
What can cause
Silicosis
Siderosis
Asbestosis
Which are all types of :
Silicosis = mining
Siderosis = arc welding
Asbestosis = shipyard ; building demolition
PNEUMOCONIOSIS
90
PTS WITH rheumatoid arthritis can develop what lung syndrome?
Caplan syndrome
Rheumatoid nodules in the lungs
91
CXR findings sig for pneumoconiosis
Small round nodular opacities in the upper lobes
92
4 silicosis hazardous jobs
Rock mining
Sand blasting
Masonry work
Stone cutting
93
What does silicosis look like on CXR
Eggshell calcifications
94
4 jobs associated with asbestosis
Mining
Ship building
Construction
Pipe fitting
95
CXR and CT findings for asbestosis
Lower lobe reticular opacities with honeycombing
CT = parenchymal pleural plaques
96
#1 complication of pneumoconiosis
Mesothelioma - asbestosis
#2 = bronchogenic carcinoma
97
3 places possible for mesothelioma spread
Pleural
Pericardial
Peritoneal
98
What are two things to remember about sarcoidosis
NOn caseating granulomas with T cell and inflammatory cell overgrowth
Produces increased ACE levels
99
what is lofgrens syndrome
Hilar LAD
Erythema nodosum
Arthritis
100
CXR for sarcoidosis usually has what
Bilateral hilar adenopathy
101
PFTs will be what for sarcoidosis
Restrictive
102
First line and alternative treatment for sarcoidosis
Low dose prednisone
Methotrexate = alternative
103
What is the Samter triad
ASA sensitivity
Nasal Polyps
Asthma
104
What is the atopic triad
Allergic rhinitis
asthma
Atopic dermatitis
105
What is the #1 etiology of ARDS
Sepsis
106
What type of sputum is common in ARDS
Frothy pink-red sputum
107
CXR findings in ARDS
Bilateral diffuse opacities
108
What is the FVC
Measure of forced expire volume until full exhalation
109
When would you perform the 6 minute walk test
To quantify exercise tolerance and effectiveness of interventions
110
Hemoptysis ; stridor ; DOB retrieval ; staging of cancer think what diagnostic
Bronchoscopy
111
Catemenial asthma is what
Only present with menses
112
Anticholinergic work how for asthma
Lead to bronchial smooth muscle dilation to relieve constriction
113
When can you step down asthma therapy
After 3 months of control
114
A1 Anti trypsin think early onset COPD + what else
Hepatic dysfunction
115
Elongated lungs with diaphragmatic flattening think what on CXR
COPD
116
COPD therapy that can help ; only proven one
O2 supplementation if hypoxic
117
What is the step up course for COPD ABCD
BD *SABA / SAMA*
LABA or LAMA
LAMA
LAMA + LABA
*CC are not proven to be helpful*
118
What electrolyte can be helpful in COPD exacerbations
Magnesium
119
Think what drugs for inducing interstitial lung disease
Amiodarone
Methotrexate
120
2 complications of IPFibrosis
RVH Dz
Pulmonic HTN
121
IPFibrosis has what nail changes
Clubbing ;; DRY INSPIRATORY CRACKLES
122
Pneumoconiosis treatment
Inhaled BD
Supplemental O2
Consider Lung TXPLT
123
Coal workers pneumo [4]
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
Silicosis [4]
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
Asbestosis [4]
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
Non caseating granulomatous lung disease
Sarcoidosis
*elevated ACE* *Hypercalcemia* *elevated ESR*
127
What organs are involved in sarcoidosis [4]
Cardiac restrictive cardiomyopathy
Skin : erythema nodusum ; arthritis
Constitutional : malaise ; fever ; dyspnea
Organomegaly
128
CXR of sarcoidosis
Mediastinal and hilar LAD
129
Pulmonary nodules vs masses
Less than 3 cm - nodules
Mass = greater 3cm
130
MC malignant pulmonary nodule
Adenocarcinoma
131
Small cell lung cancer are usually where
Central discrete NO discrete intraluminal mass
132
If central mass with intraluminal mass think what lung cancer
Squamous cell
133
Where do lung Adenocarcinoma often arise from
Mucous glands
134
Complications of lung cancer SPHERE ; that can be a pts first presentation
SVC syndrome
Pancoast tumors
Horners syndrome
Endocrine Tumores / carcinoid SIADH=small cell
Recurrent laryngeal symptoms
Effusions
135
Should you recommend surgery for small cell lung cancer
No ROLE , just chemo and radiation
136
MC location for carcinoid tumor
GI tract
137
Why is there flushing diarrhea and bronchospasms in carcinoid tumors
Serotonin release
138
PE percussion causes what ; tactile fremitus
Dullness
Decreased
139
TRANSUDATIVE effusion think about
Hypoalbuminemia [cirrhosis, nephrotic syndrome]
Malnutrition’
CHF
Constrictive pericarditis
140
EXUDATIVE effusions think
Malignancy
Pancreatitis
Post cardiac surgery
141
PTX think what physical exam
Hyperresonance to percussion
Diminished breathe sound
Reduced lung expansion
142
Location for ND / Chest tube
2-3 Mid clavicular = acute unstable, ND
4-5 mid axillary = stable, chest tube
143
Recurrent PTX treatment
VATS or pleurodesis
144
U/S for PTX +
Barcode sign
= no lung sliding
145
Age of croup infection commonly
6 mo - 5 years
146
Does croup usually have fever
NO
147
MC pathogen in epiglottis
HIB
Strep
148
Good abx for epiglottis
Ceftriaxone
149
What is an example of gram negative PNA
Klebsiella = ETOH
Pseudomonas = cystic fibrosis
150
HAP vs VAP Mc pathogens
HAP = Staph A
VAP = Acinobacter
151
Greater than what age for flu vaccine
6 months
152
Paramyxovirus think [3]
Rsv
Parainfulenza —> croup
153
TB risk factors
Incarcerated
Drug use
Homeless
Droplets —> alveoli —> macrophages engulf infection [becomes active or latent]
154
Chronic cough w rusty sputum hemoptysis
TB
155
Does TB screening decide active vs latent disease
NO!
156
Definitive test for TB diagnosis
Culture of sputum
157
What does CSF look like in TB meningitis
Lymphocytic pleocytosis
Elevated protein
Decreased glucose
158
What does pleural fluid have in pleural TB
Elevated adenosine deaminase levels
159
Spinal TB is defined as
POTTS dz
160
Military TB is defined as what on CXR
Small nodular densities that are in a diffuse machine gun like pattern
161
Active TB treatment
6 month of TXM :
Initial 2 months RIPE
Last 4 months IR
162
Latent TB TXM options [3]
9 months of I
3 moths of IR
4 months of R
163
Rifampin ADR
Hepatitis ; rash
Interferes with retroviral agents
164
Pyrazinimide ADRs
Hyperuricemia ; monitor uric acid levels
165
Pertussis transmitted by
Droplets - respiratory
Cataraall ; paraxysmsal ; convalascent [STAGES]
166
CXR of PCP PNA
Diffuse interstitial or alveolar infiltrates
Elevated LDH
167
PCP PNA first line
Bactrim
168
CD4 count below what is risk for fungal PNA
200
169
Normal PA pressure
8- 20 mmHg
HTN = greater than 25
170
Pulmonary HTN findings [3]
Split S2 with Loud pulmonic component ; tricuspid regurgitation
Hepatosplenomegaly JVD peripheral edema
Palpable RVHeave
*Get a right sided cath to eval pressures*
171
Cor pulmonale is what
Right sided HF with no Left sided HF
massive PE ; ARDS = acute
COPD ILS = chronic
EKG Echo
TXM = 02 ; decrease pulm vascular resistance
172
4 RF for OSA
Macroglossia
Micrognathia
Tonsillar hypertrophy
Obesity
173
High risk OSA STOP BANG
5-8
174
What does psmn test in OSA
Apnea hypopnea index [5-15] is mild
175
Obesity hypoventilation syndrome has what
Day time hypercapnia
176
What is a good ratio to get to mange ARDS
Pa o2 / Fi o2
177
When should a patient be placed in prone position for ARDS
P/F ratio less than 150
178
Cystic fibrosis is what genetic disorder
Autosomal recessive
179
CF would be what to percussion
Hyper-resonant
180
MC cause of respiratory distress in preterm infants
Hyaline membrane disease
Lack of surfactant
181
What medication should be administered to pre term infants to accelerate lung maturation
Betamethasone
