Pulmonary Flashcards
(198 cards)
1
Q
Rapid, deep labored breathing
A
Kussmaul breathing - DKA, Metabolic acidosis
2
Q
Deep breathing alternating c apnea
A
Cheyne-Strokes breathing - HF, Brain damage
3
Q
Cavitations on CXR
A
Infection - lung abscess, TB (Gohn focus)
4
Q
Apical infiltrates, Fever, Chills, Dry cough
A
TB
5
Q
Pleural thickening on CXR
A
Mesothelioma
6
Q
Hilar mass on CXR
A
Lung CA
7
Q
Eggshell pattern on CXR
A
Silicosis (sandblasters)
8
Q
Diffuse ground glass appearance c/o pulmonary nodules on CXR
A
Infiltrative Lung Disease = Diffuse Pulmonary Lung Diseases
- Rheumatic = SLE, RA, SS
- Idiopathic = acute (<6 wks), chronic (> 6 mos)
- Drug induced = Bleomycin (macrolides), amiodoron, radiation
- Primary = sarcoidosis
- Exposure
- Asbestosis
- Hypersensitive pneumonitis
- Pneumocossis = Beryliosis, Silicosis, Black lung
9
Q
Diffuse ground glass appearance c pulmonary nodules on CXR
A
Lung cancer
10
Q
Reticular to nodular pattern on CXR
A
Black lung (Coal Miners)
11
Q
Pleural based plaques on CXR
A
Asbestosis (ship Builders, building demolition)
12
Q
Patchy fibrosis on CXR
A
Hypersensitivity pneumonitis (Farmer’s lung via biologic dusts from hay dust or mold spores or other agricultural products)
13
Q
Granulomas & inflammation of alveoli, small bronchi, and sm bvs
A
Sarcoidosis
14
Q
Dyspnea after surgery, travel (airplane), LE Fx. May have c/o calf pain also.
A
DVT/PE
15
Q
Lung scan with perfusion defects
A
PE
16
Q
Venous stasis, vessel wall injury, hypercoagulability
A
DVT/PE (Virchow’s triad)
17
Q
Pediatric with barking cough, stridor
A
Viral croup (laryngotracheobronchitis); Tx w/ racemic epi & glucocorticosteroids if stridor at rest.
18
Q
Pediatric wheezing
A
lower respiratory foreign body, Asthma
19
Q
Drooling, sniffing position, tripod, toxic
A
Epiglottitis
20
Q
Thumbprint sign
A
Epiglottitis
21
Q
Steeple sign
A
Foreign Body, viral croup (laryngotracheobronchitis)
22
Q
Inspiratory stridor
A
Foreign Body, viral croup (laryngotracheobronchitis)
23
Q
Premature infant with respiratory distress
A
Hyaline Mb Disease
24
Q
Preemie CXR w/ hypoexpansion (ATX), air bronchograms
A
Hyaline Mb Disease
25
Smoker, chronic productive cough. NO hemoptysis, wt. loss.
Brochitis (COPD) - Blue Bloater (decrease O2 = CYANOSIS, Pulm HTN, R CHF, EDEMA)
26
Smoker, DOE (dyspnea on exertion), cough
COPD
27
Hyperinflation on CXR, tear drop heart
Emphysema (COPD) - Pink Puffer (NORMAL O2, high CO2, increase AP diameter, PURSED LIPS)
28
Wheezing, prolonged expiration
Asthma
29
Airway edema with eosinophils, neutrophils, lymphocytes
Asthma
30
Fever, cough, sputum. Crackles, decreased breath sounds, dullness to percussion, +egophony, pectoriloquy. CXR - infiltrates or consolidation
Pneumonia (PNA)
31
\>35yo with PNA. **Rusty colored** or yellow-green sputum. Acute onset F/C
Strep. Pneumonia
32
\<35 yo, college students. Fever, cough, +/- sputum, chills, muscle aches
Mycoplasma pneumonia "walking pneumonia"
33
Bullous myringitis
Mycoplasma pneumonia; Bullous myringitis = middle ear infection "TM"
34
PNA c Smokers, COPD
H. influenza
35
PNA c DM, immunocomp, EtOH. Currant color sputum.
Klebsiella
36
PNA c water, late summer (AC), construction site. Diarrhea. Toxic looking
Legionella
37
PNA from Nursing homes, chronic care facility. Purulent sputum
S. aureus
38
PNA in HIV+, AIDS, Immunocompromised. Sx out of proportion to exam, **elevated LDH and Hyper-hypoxia**. Diffuse interstitial & alveolar infiltrates
Pneumocystis jerovecii (PJC); Tx = TMP-SMX Drug of choice
39
PNA & decreased mental status, poor dental hygiene, dentures, foul smelling sputum, bronchiectasis. Patchy infiltrates in dependant lung zones
Aspiration PNA
40
Pediatric with Hx recurrent lung infections, pancreatitis, reproductive problems, Failure to thrive (FTT)
Cystic fibrosis (Staph & Pseudomonal infections usually cause of death) (CF = autosomal recessive =\> thick & sticky fluids of mucus, sweat, and digestive juices =\> plug up tubes, ducts, and passageways =\> fatty stool, clubbing, etc...)
41
Sweat chloride test
Cystic fibrosis
42
Cystic fibrosis c PNA
Pseudomonas aueroginosa causative agent
43
\< 2 days post-op c fever
Atelectasis
44
Stab wound, hyperresonance to percussion, decreased breath sounds, tympany
Pneumothorax (PTX)
45
Stab wound, dullness to percussion, decreased breath sounds.
Hemothorax (pleural effusion of blood accumulates in pleural cavity)
46
Tall, skinny, male, band student, acute onset one-sided chest pain, dyspnea
Spontaneous PTX
47
Stab wound to chest. Hypotension, tracheal shift
Tension PTX
48
Poor sleeping, obese, daytime fatigue & drowsy, snoring, HTN, PM wakening
Obstructive sleep apnea
49
s/p thoracic trauma. Multiple rib fractures. Chest wall moves in with inspiration, out c expiration.
Flail chest. Tx = pain control, incentive spirometry, pulmonary toilet, intubation
50
Asthma
Wheezing, reversible airway disorder. Samter's triad: Asthma, ASA allergy, nasal polyp. Reduced FEV1 to FVC ratio
51
Acute Bronchitis
Viral, cough, negative CXR
52
Bronchiolitis
RSV (respiratory syncytial virus)
53
Epiglottitis
HIB (Haemophilus influenzae type B). Hot potato voice, sniffing position, drooling. X-ray: Thumb sign
54
Croup
Barking cough. X-ray: Steeple sign
55
Pertussis
Inspiratory whoop
56
Pneumonia
Productive cough, pleuritic chest pain, fever. lobar consolidation = bacteria. bilateral interstitial infiltrates = viral/pneumocystis
57
Tuberculosis
Fever, night sweats, hemoptysis. AFB/culture x 3 days. RIPE therapy. Screen with TNF inhibitors, immigration
58
Carcinoid Syndrome
Carcinoid tumor (rare) secretes chemicals into your bloodstream =\> Diarrhea, flushing, bronchospasm
59
Bronchiectasis
Cystic fibrosis. Tram lines. Obstructive pattern.
60
Obstructive lung dz
Obstructive pattern = inflamed + easily collapsible airways, obstruction to airflow, problems exhaling. Types = asthma, bronchiectasis, bronchitis and COPD
61
Emphysema
Smoking, alpha 1 antitrypsin deficiency, barrel chest, decreased DLCO and FEV1
62
Chronic Bronchitis
Smoking, decreased FEV1
63
Cystic Fibrosis
Autosomal recessive, infertility, sweat chloride test
64
Pulmonary embolism (PE)
Virchow's triad (Venous stasis, vessel wall injury, hypercoagulability), sinus tachycardia, pleuritic chest pain, S1Q3T3, Westermark sign, Hampton hump
65
Asbestosis
1. E
2. CXR
3.
1. E: Insulation, ship building
2. CXR: thickened pleura and basilar lesions c DPLD
3. Cause mesothelioma (lung ca)
66
Silicosis
1. E
2. CXR
3. Tx
Silicosis pneumoconiosis
1. E: Sandblasting, mines
2. CXR: **egg shell calcification** c DPLD/pulmonary fibrosis
3. Tx: steroids
67
Coal
1. E
2. CXR
3. Tx
Black lung Pneumoconiosis
1. E: Coal miners
2. CXR: nodular opacities in the upper lung fields c DPLD
3. Tx: steroids
68
Beryllium
1. E
2. CXR
3. Tx
Berylliosis Pnemoconiosis
1. E: Aerospace, electrical/nuclear plants
2. CXR: diffuse infiltrates (DPLD) & hilar LAD
3. Tx: steroids
69
Sarcoidosis
1. CXR: Non caseating granulomas, erythema nodosum, bilateral hilar adenopathy
2. Labs: elevated ACE (4x), elevated ESR
70
Pneumothorax
Smoking, family history, males tall/skinny, pleuritic chest pain
71
Rust-colored sputum - common in patients with splenectomy
S. Pneumoniae
72
Salmon colored sputum - MRSA treat with vancomycin
S. Aureus (think you can catch salmon with a "staph")
73
Ventilator associated pneumonia patients become sick fast, treat c 2 abx
Pseudomonas
74
low Na+ (hyponatremia), GI sxs (diarrhea) and high fever
Legionella
75
Young people living in dorms, (+) **cold agglutinins**, **bullous myringitis**
Mycoplasma
76
**Currant jelly sputum, drinkers, aspiration**
Klebsiella (Clubbing - jello shots)
77
bird or bat droppings (caves, zoo, bird), Mississippi or Ohio river valley, mediastinal or hilar lymphadenopathy (looks like sarcoid)
Histoplasma capsulatum Chronic cavitary histoplasmosis is characterized by pulmonary lesions that are often apical and resemble cavitary TB. Manifestations are worsening cough and dyspnea, progressing eventually to disabling respiratory dysfunction. Dissemination does not occur. Treat: Amphotericin B
78
found in soil can disseminate and can cause meningitis
Cryptococcus Immunocompromised patients usually symptomatic Lumbar puncture for meningitis Treatment: Amphotericin B
79
Common in HIV-infected patients with a low CD4 count of less than 200, treat (and prophylax) with Bactrim
(PJP) Pneumocystis jiroveci - Formerly PCP Pneumonia
80
majority of cases in people c underlying illnesses such as tuberculosis or COPD, but c otherwise healthy immune systems
Pulmonary aspergillosis Treat: fluconazole or itraconazole
81
Look for this in a patient with non-remitting cough/bronchitis non-responsive to conventional treatments. Caused by fungal inhalation in western states.
Coccidioides (Valley Fever) Treat: fluconazole or itraconazole
82
Causes mediastinal or hilar lymphadenopathy (looks like sarcoidosis)
Histoplasma capsulatum
83
Transmission of vocal sounds through consolidation leads to the changes heard with
egophony Patients c pneumonia = (+) egophony
84
Consolidation would increase the transmission of vocal vibrations and manifest as
(+) tactile fremitus
85
Upper (apical) cavitary lesions
Active Tuberculosis
86
(+) cold agglutinins
Mycoplasma Pneumonia or Autoimmune hemolytic anemia
87
1st episode of cough and wheezing in a 4 month old
Bronchiolitis
88
+ PPD in a patient 1) HIV, 2)Rural mexico, 3)Nurse, 4)Traveler, 5)Homeless, 6)Soccer Mom
\>5 mm (HIV) \>10 mm (Rural Mexico, Nurse, Traveler, Homeless) \>15 mm (Soccer mom)
89
Tuberculosis to spine
Potts disease
90
1) optic neuritis (red-green vision loss) "Eyes" 2) orange discoloration of body fluids
1) Ethambutol. 2)Rifampin
91
Patients on Isoniazid (INH) should take what supplement
Vitamin B6 (Pyridoxine) daily to prevent neuropathy
92
CXR =\> low grade CA seen as pedunculated sessile growth in central bronchi - Cutaneous flushing, diarrhea, wheezing and low BP
Carcinoid syndrome = Cutaneous flushing, diarrhea, wheezing and low blood pressure. This is the hallmark sign of carcinoid tumors which are GI tract cancers that have metastasized to the lungs
93
Patient will present with → cough and dyspnea for 6 days
Acute bronchitis
94
Patient will present as → first episode of wheezing in a child 12-24 months with findings of viral respiratory infection
Acute bronchiolitis
95
Patient will present with → sudden onset of high fever, respiratory distress, severe dysphagia, drooling and a muffled voice in an unvaccinated child. Thumbprint sign on lateral neck film
Acute epiglottitis
96
Patient will present as → a 2-year-old with barking cough and stridor. "Steeple sign" on PA neck X-Ray
Croup
97
Patient will present with → sudden onset of fever, chills, malaise, sore throat, headache coryza and myalgia (especially in the back and legs)
Influenza
98
Patient will present with → severe paroxysmal cough followed by an inspiratory high-pitched whoop, if untreated will develop a chronic cough lasting for weeks
Pertussis
99
Patient will present with → fever, dyspnea, tachycardia, tachypnea, cough +/- sputum
Bacterial Pneumonia
100
Patient will present with → 1 week history of hacking non-productive cough, low grade fever, malaise and myalgias. The chest x-ray reveals bilateral interstitial infiltrates and a cold agglutinin titer that is negative
Viral Pneumonia
101
Patient will present with → non-remitting cough/ bronchitis non-responsive to conventional treatments
Fungal Pneumonia
102
Patient will present as → a young person who you don't know has HIV, bc of the pneumonia they have you become suspect. The radiograph shows diffuse interstitial or bilateral perihilar infiltrates
HIV-related Pneumonia
103
Patient will present with → 4-month-old with wheezing, cough and dyspnea
Respiratory syncytial virus (RSV) infection
104
Patient will present with → FEVER, hemoptysis, recent travel, NIGHT SWEATS, weight loss, shortness of breath, social contact with same symptoms
Tuberculosis
105
Patient will present with → haemoptysis, cough, focal wheezing or recurrent pneumonia. Carcinoid syndrome (the hallmark sign of cutaneous flushing, diarrhea, wheezing and low blood pressure) is actually quite rare.
Carcinoid tumors
106
Patient will present as → a previous smoker with a new or changing cough, weight loss, hemoptysis and hoarseness
Lung cancer
107
Patient will present → after having had a radiograph for something else and found to have a small \< 3 cm pulmonary lesion, they are likely asymptomatic.
Pulmonary nodules
108
Patient will present with → foul breath, purulent sputum and hemoptysis along with a CXR demonstrating dilated and thickened airways with "plate-like" atelectasis (scarring)
Bronchiectasis
109
18/30 Patient will present with → foul breath, purulent sputum and hemoptysis along with a CXR demonstrating dilated and thickened airways with "plate-like" atelectasis (scarring) Bronchiectasis Patient will present with → a chronic cough that is productive of phlegm occurring on most days for 3 months of the year for 2 or more consecutive years without an otherwise-defined acute cause
Chronic bronchitis
110
Patient will present as → a young patient with a history of chronic lung disease, pancreatitis or infertility. May have clubbing of fingers CXR may reveal hyperinflation, mucus plugging and focal atelectasis. Labs will reveal an elevated quantitative sweat chloride test
Cystic fibrosis
111
Patient will present with → exertional dyspnea, minimal cough, quite lungs, thin, barrel chest. Chest X-ray will reveal flattened diaphragm, hyperinflation and small, thin appearing heart
Emphysema
112
Patient presents with → dyspnea, and a vague discomfort or sharp pain that worsens during inspiration. Physical exam reveals decreased tactile fremitus, dullness to percussion and diminished breath sounds over the effusion
Pleural effusion
113
Patient will present with → acute onset of ipsilateral chest pain and dyspnea. Physical findings will include decreased tactile fremitus, deviated trachea, hyperresonance, and diminished breath sounds.
Pneumothorax
114
Patient will present with → left parasternal systolic lift, a loud pulmonic component of S2 , functional tricuspid and pulmonic insufficiency murmurs, and later, distended jugular veins, hepatomegaly, and lower-extremity edema.
Cor pulmonale
115
Patient will present with → risk factors such as COCP use or recent surgery with a sudden onset of pleuritic chest pain, dyspnea, apprehension, cough, hemoptysis, and diaphoresis. Signs include tachycardia, tachypnea and crackles.
Pulmonary embolism
116
Patient will present with → dyspnea, chest pain, weakness, fatigue, edema, and ascites along with a narrow splitting of the second heart sound and a systolic ejection click.
Pulmonary hypertension
117
Patient will present with → insidious dry cough, dyspnea, fatigue, malaise, clubbing, inspiratory crackles
Idiopathic pulmonary fibrosis
118
Patient will present with → dyspnea, inspiratory crackles, clubbing of fingers, cyanosis and a work or exposure history that will provide you with the diagnosis
Pneumoconiosis
119
Patient will present as → a 30-year-old African American female with a cough, fever and generalized body aches. You order a CXR which shows bilateral hilar adenopathy
Sarcoidosis
120
Patient will present with → rapid onset of profound dyspnea occurring 12-24 hours after the precipitating event. Physical exam will show tachypnea, frothy pink or red sputum and diffuse crackles.
Acute respiratory distress syndrome
121
Patient will present as → a preterm infant with typical signs of respiratory distress shortly after birth
Foreign body aspiration
122
Who is the pneumococcal polysaccharide vaccine recommended for?
Young and old, sick, sickle cell, smokers, no spleen and liver disease
123
What bug is most likely to cause pneumonia in a patient
1. c ETOH abuse
2. c COPD
3. c Cystic Fibrosis
4. c Exposure to aerosolized water
5. in Young adults
6. in children \< 1 yo
7. in children \< 2 yo
8. mc CAP
9. mc HCAP/ICU
10. mc HCAI (infection)
11. mc opportunistic infection in HIV pts
1. c ETOH abuse = Klebsiella (Klub jello shots)
2. c COPD = Haemophilus (Phyllis husband has COPD)
3. c Cystic Fibrosis = Pseudomonas (Mona Lisa in chlorine tub)
4. c Exposure to aerosolized water = Legionella
5. in Young adults = Mycoplasma/ Chlamydia
6. in children \< 1 yo = RSV
7. in children \< 2 yo = Parainfluenza
8. mc CAP = S. pneumoniiae \> H. flu \> Klebsiella, S. aureus, Legionella, Chlamydia, Mycoplasma
9. mc HCAP = Pseudomonas \> MRSA
10. mc HCAI = UTI
11. mc opportunistic infection in HIV pts = Pneumocystis jiroveci (formerly P. carinii)
124
What are the classic symptoms of TB?
Fever, night sweats, weight loss
125
What are Ghon complexes?
Represent healed infection = Calcified primary focus in the lungs
126
What is the historical landmark of TB?
Caseating granuloma that is AKA necrotizing granuloma
127
Side effects
1. Rifampin
2. Isoniazid
3. Pyrazinamide
4. Ethambutol
RIPE = all 4 for active TB
INH + B6 for 9 mo for latent TB
1. Rifampin = red/orange discoloration and hepatitis
2. Isoniazid = B6 deficiency, hepatitis, neuropathy
3. Pyrazinamide = hyperuricemia =\> gout
4. Ethambutol = optic neuritis
128
What radiographic finding is diagnostic for
1. epiglottitis?
2. croup?
1. Thumbprint sign
2. Steeple Sign
129
1. What is the leading cause of cancer death?
2. What is the most common cause of bronchogenic CA?
3. What is the treatment of choice for Non-small cell CA?
1. What is the leading cause of cancer death?
1. Bronchogenic CA
2. What is the most common cause of bronchogenic CA?
1. Adenocarcinoma
3. What is the treatment of choice for Non-small cell CA?
1. Surgical resection
130
1. What are the three components of asthma?
2. What change in FEV1 after bronchodilation is supportive of the diagnosis of asthma?
3. What is the most effective anti-inflammatory for chronic asthma?
4. What medication must all asthma patients have regardless of the severity of their disease?
1. What are the three components of asthma?
1. **Obstructive Airflow (Decrease FEV1 and Increase FVC), Hyperreactivity, Inflammation**
2. What change in FEV1 after bronchodilation is supportive of the diagnosis of asthma?
1. **0.1**
3. What is the most effective anti-inflammatory for chronic asthma?
1. **Inhaled steroids**
4. ****What medication must all asthma patients have regardless of the severity of their disease?
1. **short acting beta agonist (albuterol) as a rescue medication**
131
1. What is the most contributing cause of COPD?
2. What deficiency leads to COPD?
3. What is the single most important intervention in COPD
4. What is superior to B agonists in achieving bronchodilation?
5. What therapy is the only therapy that may alter the course of COPD?
6. What are the main symptoms of cystic fibrosis?
1. What is the most contributing cause of COPD?
1. **Smoking**
2. What deficiency leads to COPD?
1. **Alpha 1 antitrypsin**
3. What is the single most important intervention in COPD
1. **Smoking cessation**
4. What is superior to B agonists in achieving bronchodilation?
1. **Anticholinergics (ipratropium or tiotropium)**
5. What therapy is the only therapy that may alter the course of COPD?
1. **Supplemental oxygen**
6. What are the main symptoms of cystic fibrosis?
1. **Cough, excessive sputum, sinusitis, steatorrhea and ABD pain**
132
What is the gold standard for identifying a pleural effusion?
Thoracentesis
133
What are the most common irritants used for pleurodesis?
**Doxycycline and** **talc**
A pleurodesis is a surgical procedure used to treat pleural effusion in mesothelioma patients. It is not a curative treatment, but rather an approach that is recommended when symptoms like chest pain and shortness of breath are causing discomfort.
134
What type of image reveals the presence of pneumothorax?
Expiratory CXR
135
1. What are the risk factors for DVT/PE?
2. What are the most common hypercoaguable states?
3. What is the initial method for the diagnosis of PE?
4. When is a negative D.Dimer helpful in ruling out PE?
1. What are the risk factors for DVT/PE?
1. **Virchowís Triad: Damage, Stasis and** **hypercoaguable** **state**
2. What are the most common hypercoaguable states?
1. **High estrogen,** **cancer** **and genetics**
3. What is the initial method for the diagnosis of PE?
1. **Spiral CT**
4. When is a negative D.Dimer helpful in ruling out PE?
1. **With low pre-test probability**
5. What is the definitive test for PE?
1. **Pulmonary angiogram** (V/Q study can be helpful too)
136
What physical findings are suggestive of pulmonary HTN?
Systolic ejection click and splitting/accentuation S2
137
What causes pneumoconoises?
Coal dust, silicate or other inert dusts
138
What is used to relieve chronic alveolitis in silicosis?
139
1. What CXR findings are seen in asbestosis?
2. What is the number one complication of asbestosis?
1. What CXR findings are seen in asbestosis?
1. **Pleural based** **plaques c ground glass (DPLD)**
2. What is the number one complication of asbestosis?
1. **Mesothelioma**
140
What disease is a multiorgan disease of idiopathic cause characterized by noncaseating granulomatous inflammation in affected organs?
Sarcoidosis
141
What is the main presentation of an aspirated foreign body?
Choking, coughing or unexplained wheezing or hemoptysis
142
1. What is the most common cause of respiratory disease in a preterm infant?
2. What can be used as prophylaxis or rescue in a patient with the established dz?
1. What is the most common cause of respiratory disease in a preterm infant?
1. **Hyaline membrane disease**
2. What can be used as prophylaxis or rescue in a patient with the established Hyaline membrane disease?
1. **Exogenous surfactant**
143
Pneumonia tx
1. Fungal pneumonia
2. Pneumocystis jiroveci (PJC)
3. Histoplasma pneumonia
4. Klebsiella pneumoniae
5. Legionella pneumonia
6. Pseudomonas pneumonia
7. MRSA
8. Mycoplasma
9. Strep.pneumonia or non MRSA staph
1. inpateitn ICU
2. inpatient
3. outpatient c comorbidities
4. outpatient
1. Fungal (immunocomp)
1. Itraconazole or fluconazole
2. PJC (HIV pts c low CD4 counts, or AIDS \<200 CD4)
1. Trimethoprim-sulfamethoxazole or pentamidine
3. Histoplasma (inhlaled bat or bird droppings)
1. Amphotericin B
4. Klebsiella (ETOH, aspirations) =\> RUL abscess & currant jelly colored sputum
1. Cephalosporins, Aminoglycosides, Fluoroquinolones
5. Legionella (diarhea, water contamination, spa)
1. Macrolides & Fluoroquinolones
6. Pseudomonas - always 2 abx combo (post intubation, ventilator or hospital)
1. Anti pseudomonal beta-lactam + antipseudomonal quinolone/aminoglycoside
2. Antipseudomonal quinolone + aminoglycoside
7. MRSA (salmon sputum)
1. Vancomycin/linezolid + Levofloxacin/ciprofloxacin
8. Mycoplasma (young, + cold agglutinins)
1. Same as Strep ??
9. Strep.pneumonia (lobar pneumonia, URI + rust colored sputum) or non MRSA staph (URI + salmon colored sputum)
1. inpateitn ICU
1. Beta-lactam + macrolide/fluoroquinolone
2. inpatient
1. Beta-lactam + macrolide
3. outpatient c comorbidities
1. Beta-lactam + macrolide/fluroquinolone/doxycyline
4. outpatient
1. macrolide/fluroquinolone/doxycyline
144
What must be considered with a young patient who has been exposed to rodent feces and has a "CHF like" presentation?
Hanta virus
145
1. What type of Infant respiratory distress syndrome (IRDS) occurs in a near or full term infant?
2. What type of Infant respiratory distress syndrome (IRDS) occurs in a preterm infant? (usually born before 30 weeks)
3. What situations predispose an infant to developing type 2 IRDS?
4. What situations predispose an infant to developing type 1 IRDS?
1. What type of Infant respiratory distress syndrome (IRDS) occurs in a near or full term infant?
1. Type 2 IRDS
2. What type of Infant respiratory distress syndrome (IRDS) occurs in a preterm infant? (usually born before 30 weeks)
1. Type 1 IRDS
3. What situations predispose an infant to developing type 2 IRDS?
1. C-section or diabetic mother
4. What situations predispose an infant to developing type 1 IRDS?
1. Incomplete lung development due to congenital malformation = pulmonary hypoplasia
146
Long term inflammation and eventual scarring after episodes of severe respiratory distress and mechanical ventilation?
Bronchopulmonary dysplasia
147
What antibiotic is most strongly associated with hypertrophic pyloric stenosis?
Clarithromycin (Note all macrolides can cause hypertrophic pyloric stenosis)
148
What is laryngotracheo-bronchitis also known as?
Croup
149
Where does the cancer associated with asbestosis tend to locate in the lung?
Mesothelioma locates to the pleural lining at the base of the lung
150
What is the Dx? Looks like CHF on chest X-ray but pulmonary wedge pressure in normal.
Acute respiratory distress syndrome (ARDS)
151
Pulmonary HTN Classes \*list 5"
1. Class 1 = Ventricular septal defect, Atrial septal defect, -Patent ductus arteriosus
2. Class 2 = Mitral/Aortic stenosis, LV hypertrophy/falure
3. Class 3 = COPD
4. Class 4 = PE
5. Class 5 = Sarcoidosis
152
Right heart failure caused by long term COPD history?
Cor pulmonale
153
Is chronic bronchitis or emphysema associated with an elevated hemoglobin?
chronic bronchitis
154
Pink Puffer?
Blue bloater?
1. Pink Puffer? = Emphysema
2. Blue bloater? = Chronic Bronchitis
155
1. Only medication that improves morbidity and mortality in COPD?
2. Agent of choice for COPD exacerbation?
1. Oxygen
2. Ipratropium
156
What is the likely Dx? Solitary pulmonary nodule of 2 cm in size found on chest X-ray incidentally.
Lung ca
157
What is a bloody pleural effusion concerning for?
malignancy
158
What criteria determine transudate from exudate?
Light's criteria
159
1. What is the most common type of lung cancer in smokers?
2. Most aggressive lung cancer?
3. What is the most common type of lung cancer in nonsmokers?
4. What cancer is a patient with asbestos exposure at increased risk for.
1. What is the most common type of lung cancer in smokers?
1. Squamous cell
2. Most aggressive lung cancer?
1. Small cell
3. What is the most common type of lung cancer in nonsmokers?
1. Adenocarcinoma
4. What cancer is a patient with asbestos exposure at increased risk for.
1. Mesothelioma
160
What does a positive whisper pectoriloquy represent?
pulmonary consolidation
161
What is the most likely Dx? Smoker with hemoptysis weight loss and new DVT?
Lung ca
162
A "cinnamon breath smell" is associated with what pulmonary infection?"
Tuberculosis
163
1. Where will older pulmonary lesions from tuberculosis be found?
2. Where will newer pulmonary lesions from tuberculosis be found?
3. What is the recommended treatment for a healthcare worker with a first time positive PPD?
4. What is the sputum test for tuberculosis?
1. Older = lower & middle lobe
2. Newer = upper lobe
3. Isoniazid (INH) for 6 months
4. AFB smear and cultures
164
1. What lab is elevated in PJP pneumonia?
2. Tx PJP pna?
1. LDH
2. Trimethoprim-sulfamethoxazole or pentamidine
165
1. What pneumonia is associated with air conditioning vents and spas?
2. Most common ventilator associated bacterial infection?
3. Young IV drug user with fever severe hypoxia and diffuse infiltrates on X-ray?
4. Young patient after flu will get what infection?
1. Legionella PNA
2. Pseudomonas PNA
3. PJP PNA
4. S. aureus PNA
166
What pneumonia associated with diarrhea and low sodium levels?
Legionella
167
Flu + aspirin in children can cause what condition?
Reye syndrome
168
Flu can be treated with oseltamivir within how many hours of onset of symptoms?
48 hrs
169
Wet cough and foul smelling sputum in a child?
Bronchiectasis
170
Chronic aspiration in kids leads to plate like atelectasis on X-ray and what condition?
Bronchiectasis
171
How high does pulmonary pressure need to be to diagnose pulmonary HTN?
25 mmHg at rest
172
1. What is the Dx? Patient worked with insulation. Chest X-ray shows thickened pleura and basilar lesions.
2. What is the Dx? Pulmonary fibrosis in a patient who was a sandblaster. Chest X-ray shows egg shell calcifications.
3. What is the Dx? Chronic dry cough dyspnea fatigue and clubbing. Chest X-ray shows fibrosis and CT chest shows honeycombing.
4. What is the Dx? Chest X-ray shows bilateral hilar adenopathy and non caseating granulomas?
1. What is the Dx? Patient worked with insulation. Chest X-ray shows thickened pleura and basilar lesions.
1. Asbestosis
2. What is the Dx? Pulmonary fibrosis in a patient who was a sandblaster. Chest X-ray shows egg shell calcifications.
1. Silicosis
3. What is the Dx? Chronic dry cough dyspnea fatigue and clubbing. Chest X-ray shows fibrosis and CT chest shows honeycombing.
1. Idiopathic pulmonary fibrosis
4. What is the Dx? Chest X-ray shows bilateral hilar adenopathy and non caseating granulomas?
1. Sarcoidosis
173
174
Does patient with sarcoidosis tend to have high or low serum calcium levels?
High (hypercalcemia)
175
Gold standard test used to diagnose Pulmonary HTN?
Right heart cardiac catheterization
176
Treatment for acute respiratory distress syndrome (ARDS)?
Supportive care/ventilatory support - Find and treat underlying cause
177
Right sided heart failure due to pulmonary HTN?
Cor Pulmonale
178
Initial Treatment for pulmonary embolism?
Heparin
179
1. What is the Dx? Young healthy female smoker on oral contraception with acute chest pain and SOB?
2. What is the Dx? Thin young healthy male runner who develops acute onset of chest pain and dyspnea?
1. Pulmonary embolus
2. Spontaneous PTX
180
Initial treatment for all pneumothorax patients?
100% oxygen
181
What are the chest X-ray findings with acute respiratory distress syndrome (ARDS)?
Bilateral infiltrates/white out (may look like CHF)
182
1. What type of COPD is associated with hyperventilation flat diaphragm on CXR and a normal Hgb/HCT?
2. What are the two types of COPD?
1. Emphysema
2. Chronic bronchitis and emphysema
183
Most common cause of acute bronchitis?
Viral
184
1. Types of asthma classifications?
2. In a patients with asthma the FEV1 to FVC will be \<\_\_\_\_\_\_ ?
1. Classes
1. Intermittent =\> Mild persistent =\> Moderate persistent =\> Severe persistent
2. FEV1 to FVC \< 75% = diagnosis of asthma in pt with chronic wheezing/cough
185
1. In a patient with malignancy is the pleural effusion transudative or exudative?
2. In a patient with CHF is the pleural effusion transudative or exudative
3. What conditions is a right sided pleural effusion often associated with?
4. What is the main treatment for a pleural effusion?
1. exudative
2. transudative
3. CHF or cirrhosis
4. Thoracentesis
186
Name 3 types of non small cell (bronchogenic) cancers.
Squamous cell - Adenocarcinoma - Large cell
187
What is a Hallmark sign seen with carcinoid tumors?
Cutaneous Flushing
188
189
190
1. Which virus can lead to pneumonia after URI and also often causes diarrheal illness/GI symptoms?
2. Virus causing pneumonia after exposure to rodent feces (Western states)?
3. Most common cause of viral pneumonia in adults?
4. Organisms responsible for typical pneumonia?
5. Organisms responsible for atypical pneumonia?
1. Which virus can lead to pneumonia after URI and also often causes diarrheal illness/GI symptoms?
1. Adenovirus
2. Virus causing pneumonia after exposure to rodent feces (Western states)?
1. Hantavirus
3. Most common cause of viral pneumonia in adults?
1. Influenza
4. Name the organisms that cause typical pneumonia?
1. S. pneumonia \> H. flu \> S. aureus \> S. pyogenes (GAS)
5. Organisms responsible for atypical pneumonia?
1. Mycoplasma, Chlamydia, Legionella
191
1. Should normal percussion over the lung fields sound dull or resonant?
2. What does positive egophony on auscultation in a patient with pneumonia mean?
1. Resonant
2. When listening over the area of consolidation, patient will say "eee" and it sounds like "aaa"
192
What is the Dx? Previously healthy patient with abrupt onset of fever headache malaise occurring in the winter months.
Influenza
193
What condition is bronchiectasis often associated with?
What is the Dx? Previously healthy patient with abrupt onset of fever headache malaise occurring in the winter months.
Influenza
What condition is bronchiectasis often associated with?
194
Child with chronic persistent productive cough foul smelling sputum?
Bronchiectasis
195
1. What is the cause of hyaline membrane disease in infants?
2. Treatment for infant with Hyaline membrane disease (AKA: infant respiratory distress syndrome - IRDS)?
3. Treatment to prevent Hyaline membrane disease in the newborn?
1. Surfactant deficiency
2. Respiratory support, Ventilatory support, Exogenous surfactant
3. Give antenatal corticosteroids
196
1. Organism that causes whooping cough?
2. Childhood vaccine?
3. Preferred treatment?
1. Bordetella pertussis
2. DTaP
3. Clarithromycin or azithromycin (Macrolides)
197
1. Steeple sign on a frontal chest X-ray showing tracheal narrowing & barking cough and stridor?
2. Cause
1. Croup
2. Parainfluenza virus type 1
198
1. Most common cause of acute bronchiolitis in an infant?
2. How is it diagnosed?
1. Respiratory syncytial virus (RSV)
2. Analysis/culture of Respiratory secretions
