Pulmonary Flashcards
(148 cards)
1
Q
steeple sign on XR of neck =
A
croup
2
Q
Lateral XR of neck with thumbprint sign =
A
epiglottitis
3
Q
Infection that causes acute bronchitis
A
most often viral - RSV, Rhinovirus, Influenza
5-10% bacterial
4
Q
I came in to see my physician assistant because of…
SOB, wheezing, cough 3+ weeks
A
acute bronchitis
5
Q
XR findings of acute bronchitis
A
hyperinflation of lungs
6
Q
Acute bronchitis treatment
A
H. flu vaccine
Supportive care including fluids, rest, use of humidifier
Antibiotics should play a small role here
Smoking cessation
7
Q
What type of patient gets acute bronchiolitis?
A
children under 2 yo
8
Q
Acute bronchiolitis most commonly caused by what infection?
A
RSV
9
Q
PE findings of child with acute bronchiolitis
A
crackles, wheezing
elevated respiratory rate
signs of respiratory distress - chest wall retractions, accessory muscle use, nasal flaring
10
Q
Acute bronchiolitis treatment
A
Supportive care: Humidifier, fluids, nebulized Albuterol or epinephrine
Self limiting
11
Q
I came in to see my physician assistant because my child is…
Difficulty swallowing
Drooling
Hoarseness
Stridor
A
epiglottitis
12
Q
Most common cause of epiglottitis
A
H-flu (prevent with vaccine)
13
Q
Best abx to treat epiglottitis
A
2nd or 3rd gen cephalosporin (Cefuroxime or Ceftriaxone/Rocephin)
Clindamycin or Erythromycin
14
Q
I came in to see my PA because my child…
Low grade fever Congestion Cough Stridor Barking or seal-like cough
A
Croup
15
Q
Most common causes of croup
A
Parainfluenza, RSV, Rhinovirus
16
Q
Croup treatment
A
Nebulized epinephrine for severe cases
Alway administer oral steroids
Supportive care
17
Q
Treatment of influenza
A
Influenza vaccination
Supportive care
Ribavirin aerosolized
Zanamivir and oseltamivir (expensive, must be started within 48 hrs of infection)
18
Q
Child with rapid consecutive coughs followed by a deep inspiration with characteristic high pitched whoop
A
pertussis
19
Q
Pertussis treatment
A
Vaccination available as Tdap
Macrolides: Erythromycin or Azithromycin
20
Q
The most common cause of lower respiratory infection in children and in immunocompromised
A
RSV
21
Q
Indications for Ribavirin
A
severe RSV infections in high risk patients
22
Q
Risk factors for TB
A
overcrowding, malnutrition, smoking, DM, HIV
23
Q
I came in to see my physician assistant because of…
Chronic productive cough with blood tinged sputum
Fever
Drenching night sweats
Weight loss
A
Tuberculosis
24
Q
What are positive results of TB skin test?
A
Normal healthy low risk person positive test at 15 mm of induration
Healthcare worker or moderate risk patient positive at 10 mm
Immunocompromised patients considered positive at 5 mm
25
How is TB diagnosed with labs and imaging?
TB skin test
Chest XR (apical/upper opacities)
Acid fast bacillus stain of sputum
Culture? (but slow growing, 2-6 wks)
26
Medical therapy for TB
Initial 6 or 9 month course of four antibiotics
Isoniazid(INH)
Rifampin
Pyrazinamide
Ethambutol
Once antibiotic sensitivities are complete patients usually continue on isoniazid and rifampin for at least 4 more months
27
Side effects of TB medications
Isoniazid: peripheral neuropathy, hepatitis, rash
Rifampin: orange body fluids, flu like symptoms, hepatitis
Pyrazinamide: arthralgias, hepatitis
Ethambutol: optic neuritis
28
hot potato voice =
epiglottitis or peritonsillar abscess
29
Pulmonary disease associated with caves and bird or bat droppings
histoplasmosis
30
About half of CAP cases are caused by what? Other causes?
strep pneumo
H flu, staph aureus, Klebsiella, influenza, RSV
31
PE findings of pneumonia
crackles
dullness to percussion
bronchial breath sounds
32
Chest XR findings of pneumonia
lobar consolidation
air bronchograms
pleural effusions
33
Treatment of community-aquired pneumonia
macrolides (erythromycin) or doxycycline
34
What is common name for atypical community acquired pneumonia?
walking pneumonia
35
How does atypical CAP present differently?
Variable symptoms
Little or no finding on PE
Chest XR with diffuse infiltrates
36
Criteria to diagnose nosocomial pneumonia
pneumonia after 48 hrs in hospital
37
Most common cause of nosocomial pneumonia? Most common cause in ICU?
G- bacillus and staph aureus
ICU is Pseudomonas
38
Immunocompromised patients with SOB and cough, should be treated for what?
pneumocystis pneumonia (pneumocystis jirovecii)
39
Complication of pneumocystis pneumonia
pneumothorax
40
Chest XR findings of pneumocystis pneumonia
diffuse interstitial infiltrates (ground glass appearance)
41
Best lab to eval severity of pneumonias
ABG (shows hypoxia)
42
Pneumocystis pneumonia treatment
TMP-SMX (Bactrim)
+/- steroid for alveoli inflammation
43
Histoplasmosis treatment
ANTI-FUNGAL
| Oral Itraconazole or Amphotericin B for a few months and for prophylaxis
44
Tidal volume
volume of air moved into and out of lungs during normal resting respirations
45
Vital capacity
volume of air exhaled slowly after the deepest inspiration possible
46
What does spirometry measure?
volume and speed of exhalation and inspiration
47
forced vital capacity (FVC)
volume of air forcefully exhaled after deepest breath possible
48
FEV 1
volume of air forcefully exhaled in 1 second
49
Peak expiratory flow rate (PEFR)
highest airflow rate during forced expiration
50
Bronchospasm leading to airflow obstruction
asthma
51
What is the atopic triad?
asthma, atopic dermatitis (eczema), allergic rhinitis
52
What is a paradoxical pulse? Seen in what pulmonary pathology?
pulse that is weaker during inhalation and stronger during exhalations
seen during asthma exacerbation
53
Spirometry results of asthma
decreased FEV1 and PEFR (both improved with bronchodilator)
| normal FVC
54
What other pulmonary function tests can be done if spirometry is not effective?
histamine or methacholine challenge
55
How are severities of asthma classified?
Intermittent
- Two or less episodes per week
- Two or less nighttime episodes per month
Mild persistent
- More than two episodes per week
- Three to four nighttime episodes per month
Moderate persistent
- Daily episodes
- One nighttime episodes per week
Severe persistent
- Symptoms continuous
- Night time episodes almost every night
56
Chronic treatment of intermittent and persistent asthma?
intermittent: SABA
mild persistent: SABA + daily low dose ICS
mod persistent: SABA + daily medium dose ICS + daily LABA
severe persistent: SABA + daily high dose ICS + daily LABA + systemic steroids
57
Most commonly used SABA, ICS, and LABA for asthma treatment
SABA - Albuterol
ICS - Beclomethasone
LABA - Salmeterol
58
Acute treatment of asthma exacerbation?
SABA
oxygen prn
consider upping steroid or using anticholinergic
59
What two conditions are under COPD umbrella?
chronic bronchitis
| emphysema
60
Number one cause of COPD
smoking
61
Differences between chronic bronchitis and emphysema
chronic bronchitis = "blue bloaters"
bronchi inflammation
productive cough, more hypoxic, larger air volume due to more trapped air
emphysema = "pink puffers"
alveoli collapse
dry cough, less hypoxic and more accessory muscle use, hyperventilation
62
Diagnostic criteria of COPD cough
3 consecutive months per year in 2 consecutive years
63
Pulmonary function test results of COPD
FEV1 decreased
FEV1/FVC decreased
Increased lung volume due to air trapping
64
Pulm findings on PE of COPD
diminished breath sounds
+/- rhonchi in chronic bronchitis
wheezing
65
Chest XR findings of COPD
hyperinflation with flat diaphragm
emphysema - parenchymal bullae, subpleural blebs
66
COPD treatment
Stop smoking!
Antibiotics due to repeated infections
SABA (albuterol)
Anticholinergics (ipratropium)
Inhaled steroids (budesonide)
Oral steroid
Oxygen is only medication that changes course of severe COPD
67
Best diagnostic test for cystic fibrosis
chloride sweat test showing elevated NaCl
68
Pathophysiology and etiology of cystic fibrosis
Autosomal recessive disease caused by mutation of CFTR protein
This causes viscous mucus leading to recurrent pulm infections, pancreatic insufficiency (malabsorption), biliary obstruction, intestinal obstruction
69
cystic fibrosis findings on lung exam
hyperresonance to percussion, apical crackles
70
PFT results of cystic fibrosis
total lung capacity decreased
71
Common complaints of patient with cystic fibrosis
```
chronic lung issues
recurrent sinusitis
diarrhea, abd pain
poor growth and weight gain
infertility
```
72
Cystic fibrosis treatment
```
Chest and back percussion
DNAse enzyme to break down mucus
Bronchodilators
Inhaled hypertonic saline
Antibiotics for recurrent infection
Dietary supplements
Pancreatic enzyme replacement
```
73
Irreversible dilation of the bronchial tubes caused by destruction of the tissue
Bronchiectasis
74
50% of bronchiectasis cases are caused by ________.
cystic fibrosis
75
Chest XR findings of bronchiectasis
Tram tracks or ring like markings – dilated thickened bronchi
Atelectasis
76
Bronchiectasis treatment
Prophylactic antibiotics may be necessary
Surgical resection if disease is found all in one area
77
Chest XR with parenchymal bullae, subpleural blebs
emphysema
78
Types of obstructive pulmonary diseases
Asthma
COPD (chronic bronchitis, emphysema)
Cystic fibrosis
Bronchiectasis
79
All obstructive pulmonary diseases have what finding on chest XR?
hyperinflation of lung fields
80
Types of restrictive pulmonary diseases
Idiopathic pulmonary fibrosis
Pneumoconiosis
Sarcoidosis
Pleural diseases
81
Dry cough
Dyspnea
Fine crackles at bases may be present
Lung volumes are reduced
Idiopathic pulmonary fibrosis
82
Idiopathic pulmonary fibrosis treatment
Prednisone may help
Oxygen improves symptoms
Lung transplant
83
Group of diseases which are restrictive and caused by inhalation of specific types of dust.
Pneumoconiosis
84
nodules in middle and upper lung fields with eggshell calcifications
Silicosis or asbestosis
85
This is the development of scar tissue within the lungs
Idiopathic pulmonary fibrosis
86
nodular opacities in upper lung fields. Eggshell calcifications
coal miners lung
87
Pulmonary function test results of restrictive pulmonary diseases
FEV1 is reduced
FVC is reduced
Lung volumes are reduced
88
Treatment of any pneumoconiosis
Oxygen will alleviate symptoms
Do not smoke!
Avoid dust of any type
89
inflammatory disease which is characterized by granulomas throughout the body
Sarcoidosis
90
Chest XR of sarcoidosis
Hilar adenopathy
Nodules or infiltrates in the parenchyma as in later disease
91
Pathophysiology of pleural effusion
Excess fluid between the pleural layers which limits breathing by limiting the ability of the lungs to expand
92
How is US guided thoracentesis useful in evaluating pleural effusion?
Find out the cause of effusion
```
exudative fluid (inflammation) = pneumonia
transudative fluid = CHF, cirrhosis
```
93
Sarcoidosis treatment
In most cases observation is first step
Corticosteroids
94
What is egophony? When is it positive?
on auscultation an E sounds like an A, indicating consolidation
Pleural effusion, pneumonia, idiopathic pulmonary fibrosis
95
What does dullness to percussion and diminished breath sounds indicate?
fluid in lungs
96
What do you hear on auscultation of pleural effusion?
diminished breath sounds
| pleural friction rub
97
Pleural effusion treatment
Antibiotics if appropriate
Therapeutic thoracentesis
Chest tube placement
Pleurodesis – obliteration of the pleural space
98
What is a pneumothorax?
air or gas in the pleural space which will limit the lungs ability to expand
99
Biopsy showing non-caseating granulomas? Caseating granulomas?
Noncaseating = Sarcoidosis
Caseating = TB
100
What type of person is at risk for primary pneumothorax (no underlying lung disease)?
Smokers
| Young, tall, thin males
101
Causes of secondary pneumothorax
Underlying lung disease - COPD, asthma, cystic fibrosis, TB, etc.
102
Hallmark CXR finding of tension pneumothorax
contralateral mediastinal shift
103
Visceral pleural line on CXR is diagnostic of ______.
pneumothorax
104
Pneumothorax treatment
A small primary pneumothorax (10-15% of hemithorax involvement) may be watched and will likely resolve on its own
Chest tube is definitive therapy for larger pneumothorax or tension pneumothorax
Pleurodesis - obliteration of the pleural space
105
What is Cor Pulmonale?
Right-sided heart failure secondary to severe pulmonary disease
106
EKG and CXR findings of cor pulmonale
EKG: tall peaked T waves, right axis deviation
XR: enlarged R ventricle, enlarged pulm artery
107
PE signs of right sided heart failure
cyanosis, peripheral edema, ascites, increased JVD
108
Treatment of right sided heart failure and cor pulmonale?
- Treat the underlying lung disease
- Oxygen
- Diuretics as well as salt and fluid restriction
109
___________ is a blockage of a main artery into the lungs by something that has traveled from somewhere else in the circulatory system.
Pulmonary embolism
110
What is Virchow's triad?
risk factors of pulmonary embolism
1. Immobility
2. Hypercoagable state
3. Vessel injury
111
How should pulmonary embolism be imaged?
CXR, Helical CT, pulmonary angiography
112
EKG of pulmonary embolism
sinus tachycardia most common finding
| S1Q3T3 pattern in 10%
113
How to treat pulmonary embolism?
Anticoagulation x 6-12 months; Heparin immediately, Warfarin long term
Thrombolytics
Inferior vena cava filter
Embolectomy
114
CXR showing Westermark sign and Hampton hump
pulmonary embolism
115
What test can rule out pulmonary embolism?
Normal VQ scan
116
right sided heart failure with splitting of S2 and exertional syncope
pulmonary HTN
117
Gold Standard for pulmonary HTN diagnosis
right heart catheterizations
118
Pulmonary HTN management
Treat underlying cause
Anticoagulants – warfarin
Diuretics and salt restriction
Oxygen
Calcium channel blockers
Lung transplant
119
Types of non-small cell lung cancers (NSCLC)
adenocarcinoma, squamous cell carcinoma, large cell
120
Labs and diagnostic studies to eval for lung tumor
```
biopsy
cytology of sputum
CT to look for nodules
PET to look for metastasis
Thoracocentesis
Video assisted thoracic surgery (VATS)
```
121
Pulmonary neoplasm most commonly found in large central bronchi
squamous cell carcinoma
122
Most common lung cancer in non smokers
adenocarcinoma
123
Most aggressive lung cancer with early metastasis
small cell carcinoma (oat cell)
124
Definition of pulmonary nodule
less than 3 cm consolidation w/o other lung findings
125
How should pulmonary nodule be managed?
watchful waiting with serial CT
126
Acute onset of dyspnea and tachypnea in baby that does not respond to oxygen therapy
ARDS
127
ARDS treatment
Typically mechanical ventilation
Treat underlying causes
Oxygen supplementation does NOT help
128
Symptoms of respiratory distress in premature infant with diffuse ground glass appearance on CXR
Hyaline membrane disease
129
Pathophysiology of hyaline membrane disease
insufficient surfactant production in premature infant
130
Hyaline membrane disease treatment
Oxygen
CPAP
Intubation
Surfactant spray
131
How can hyaline membrane disease be prevented?
Give steroids if risk of delivery before 34 weeks gestation
132
I came in to see my physician assistant because of…
Wheezing
Drooling
Dyspnea
Foul smell
Foreign body aspiration
133
CXR findings if foreign body aspiration
air trapping
134
FEV1/FVC ratio in PFTs of obstructive and restrictive lung disease
decreased in obstructive (low FEV1)
| same or increased in restrictive (low FVC)
135
How are asthma and COPD differentiated?
asthma is reversible bronchoconstriction and PFT's will improve with treatment
COPD is irreversible with chronic decrease in PFT's
136
How does the sympathetic and parasympathetic nervous system affect airways?
sympathetic dilates airways
| parasympathetic constricts airways
137
MOA of beta agonists in lungs
stimulates the sympathetic nervous system and dilates bronchioles
138
Which drug class treats obstructive pulmonary diseases by inhibiting parasympathetic nervous system to open airways?
anticholinergics (ex. ipratropium)
139
When would you not want to use a beta agonist to open airways?
if patient is on beta blocker or who needs beta blocker for angina or arrhythmias
140
What are crackles heard on lung exam?
sound of stiff alveoli popping open
141
A decreased _______ is hallmark of pulmonary fibrotic disease.
DLCO (diffusion defect)
142
3 causes of pulmonary HTN
Resistance in lungs
Backup from left heart
Increased flow into right heart (eg. VSD)
143
_________ is most common cause of pneumonia.
strep pneumo
144
What is Light's Criteria for pleural effusion?
fluid is exudative if any of following:
pleural fluid protein/serum protein ratio >0.5
pleural fluid LDH/serum LDH ratio >0.6
pleural fluid LDH level >2/3 upper limit for serum LDH
145
empyema
pus in pleural space; complication of pneumonia or caused by penetrating chest trauma
146
Hallmark of pleural effusion on XR
blunting of costophrenic angles
147
What does hyper-resonance on percussion indicate?
more air than usual; seen in asthma, COPD, and pneumothorax
148
tactile fremitus
feel vibrations on patient's back as patient speaks
| increased vibration if lung filled with something other than air
