Pulmonology Flashcards Preview

Internal Medicine > Pulmonology > Flashcards

Flashcards in Pulmonology Deck (51):
1

Bronchial Asthma: Tiered Approach to Management
check handout page 44

okay :)

2

Bronchial Asthma:
What are the types of medications used in asthma management?

Relievers and Controllers

Relievers --- reduce bronchospasm --- SABA, ipratropium, theophylline, IV hydrocortisone

Controllers --- reduce inflammation --- steroids, LABA, leukotriene antagonists, mast cell stabilizers, anti-IgE antibodies (for refractory BA)

3

How is status asthmaticus treated?

IV hydrocortisone
nebulized epinephrine or albuterol
theophylline
MgSO4

4

What is status asthmaticus?

acute exacerbation of asthma that does not respond to standard treatments

5

Bronchial Asthma:
Poor prognostic factors?

pulsus paradoxus
respiratory fatigue
cyanosis

6

Bronchial Asthma:
how does ABG aid in exacerbations?

early stage: respiratory alkalosis, normal PO2
late stage: respiratory acidosis, pO2
impending respiratory failure: normal ABG

7

Bronchial Asthma:
if the patient is not in exacerbation, what is the next best diagnostic test?

Methacoline challenge (>20% decrease in FEV1)

8

Bronchial Asthma:
best initial test for diagnosis?

Pulmonary function test
12% improvement with FEV1 after beta agonist

9

Bronchial Asthma:
HP hallmarks?

Curschmann's spirals
Chargot Leyden crystals

10

Bronchial Asthma:
cause of bronchospasm?

IgE mediated degranulation of mast cells causing histamine release

11

Bronchial Asthma:
type of immune reaction?

Type I reaction (IgG mediated)

12

Bronchial Asthma:
pathology?

reversible airway inflammation and obstruction

13

18F
12 hour history of troublesome cough followed by wheezing and breathlessness unresponsive to albuterol
troublesome asthma since age of 18 months
poorly compliant with preventive medications
PE: extremely distressed
slightly cyanotic
oxygen saturation 84%

Diagnosis?

Bronchial Asthma in Acute Exacerbation

14

40F
presents with cough associated with headache, low grade fever, and joint pains
febrile at 38 degrees Celsius
HR90 RR15
chest PE: faint diffuse rales and wheezes in bilateral lung fields
CXR bilateral interstitial infiltrates
all labs are normal

diagnosis?

Atypical pneumonia

Most likely caused by Mycoplasma (skin rash, hemolysis, arthralgia)

Legionella: hyponatremia, diarrhea
Chlamydia: atherosclerosis

15

Atypical Pneumonia:
most common causes of this condition?

Mycoplasma
Chlamydia (staccato cough)
Legionella

16

Atypical Pneumonia:
Diagnostic tests to confirm clinical impression?

Mycoplasma: IgM titer or cold agglutinin test

Legionella: urinary antigen test

Chlamydia: serology or antigen detection

17

Atypical Pneumonia:
most appropriate treatment?

empiric therapy with azithromycin

18

Most common cause of high grade fever, rusty sputum, and lobar pneumonia?

S. pneumoniae

19

Most common cause of pneumonia with currant jelly sputum?

Klebsiella pneumoniae

20

Typical Bacterial Pneumonia:
Pathologic states?

Congestion
Red Hepatization
Grey Hepatization
Resolution

21

What are the indications for Pseudomonas coverage in a patient with CAP?

prolonged broad-spectrum antibiotic therapy
bronchiectasis
malnutrition
steroid therapy
diabetes mellitus

Ceftazidime
pseudomonas coverage --- check notes in micro!

22

When will you admit a patient with CAP?

confusion
uremia
RR>30
BP is low
age >65

(CURB-65 criteria: if 2 or more are present, admit)

23

Categories of pneumonia?

low risk
moderate risk
high risk
check page 42 of handout

24

Pneumonia: CXR showed pleural effusion --- how will you determine if it is exudative or transudative?

LIGHT'S CRITERIA
LDH, LDH/serum ratio, protein/serum ratio

EXUDATE
LDH >200
LDH/serum ratio >0.6
protein/serum ratio >0.5
e.g. pneumonia, cancer, infections, RHD

TRANSUDATE
LDH <0.5
e.g. CHF, cirrhosis, renal failure

Pulmonary embolism may manifest as exudate and/or transudate

25

75M with cough, decreased exercise tolerance, and SOB
50 year pack history of smoking
PE: barrel shaped chest, diminished breath sounds bilaterally with faint expiratory wheezing
CXR hyperinflation, and subpleural blebs

diagnosis?

Chronic Obstructive Pulmonary Disease

26

Chronic Obstructive Pulmonary Disease:
pathology?

destruction of the normal alveoli-capillary structures and enlargement of the airspaces

27

Chronic Obstructive Pulmonary Disease:
2 disease components?

Emphysema
Chronic Bronchitis (>3 months)

28

Chronic Obstructive Pulmonary Disease:
enzyme deficiency?

alpha 1 antitrypsin deficiency

29

Chronic Obstructive Pulmonary Disease:
most important risk factor for the development of this condition?

SMOKING

30

Chronic Obstructive Pulmonary Disease:
other important diagnostic test should one request aside from CXR? findings?

PFT = decreased FEV1 and FEV1/FVC ratio

31

Chronic Obstructive Pulmonary Disease:
most common pattern of involvement of this condition?

centriacinar emphysema of the upper lobes

32

Chronic Obstructive Pulmonary Disease:
congenital enzyme deficiency associated?
morphologic pattern?

alpha 1 antitrypsin deficiency
with bibasilar panacinar emphysem and liver cirrhosis

33

Chronic Obstructive Pulmonary Disease:
DOC?

inhaled bronchodilator + anticholinergic inhaled corticosteroids

34

Chronic Obstructive Pulmonary Disease:
only treatments shown to improve survival in this condition?

smoking cessation and home oxygen therapy
lung volume reduction surgery

35

Chronic Obstructive Pulmonary Disease:
if with R sided CHF, clinical impression?

Cor Pulmonale (COPD stage V)

36

Chronic Obstructive Pulmonary Disease:
most common cause of exacerbation of this disease?
preventive measures?

infections (H. influenzae, influenza virus)

pneumococcal, Hib, and influenza vaccinations (primary prevention)

37

Chronic Obstructive Pulmonary Disease:
DOC if with comorbid cardiac conditions?

Ipratropium (beta agonists may cause tachycardia and arrhythmias)

38

50F sudden onset SOB with pain on inspiration
underwent total knee replacement 2 weeks ago
meds include oxycodone and hormone replacement therapy
PE T38 deg Celsius HR120 RR30 BP110/75 O2sat89%
CXR normal
ECG sinus tachycardia

diagnosis?

Pulmonary Embolism

39

Pulmonary Embolism:
pathology?

DVT travels to lungs and obstructs pulmonary vasculature

40

Pulmonary Embolism:
risk factors?

hypercoaguability
estrogens
malignancy
genetic diseases
stasis: prolonged immobilization
Virchow's triad: endothelial injury, trauma, previous DVT

41

components of Virchow's triad?

endothelial injury
trauma
previous DVT

42

Pulmonary Embolism:
most appropriate diagnostic test? expected finding?

ventilation perfusion scan (V/Q scan)
multiple perfusion defects with normal ventilation (V/Q ratio 8)

43

Pulmonary Embolism:
gold standard for diagnosis?

pulmonary angiography

44

Pulmonary Embolism:
most common acid base disorder associated with this condition?

respiratory alkalosis

45

Pulmonary Embolism:
most common ECG seen in this condition?

sinus tachycardia (may also see NSSTTWC or S1Q3T3 strain pattern)

46

Pulmonary Embolism:
most appropriate treatment?

anticoagulation (heparin drip with warfarin, overlapping)

47

Pulmonary Embolism:
most appropriate treatment for those with CI to anticoagulation?

IVC filter

48

Pulmonary Embolism:
most common cause of death?

progressive Rside heart failure

49

35M
homeless
brought to ER after being seen coughing up blood
night sweats, fevers
cachexia
both lung fields clear on auscultation

diagnosis?

PTB

50

PTB:
causative agent?
most appropriate diagnostic test?
phases of infection?
MOT?
how are asymptomatic patients detected?

MTB
sputum AFB x 3
primary complex and reactivation TB
airborne droplets
PPD or Mantoux test

51

PTB:
CXR reveals?
most appropriate treatment?
most effective treatment strategy?
adverse effects of drugs --- INH? RMP? PZA? EMB?

Simon's focus, cicatricial changes (tent like pull on pulmonary parenchyma), cavitation

2HRZE/4HR for 6 months

DOTS

INH: neurotoxicity, hepatotoxicity
RMP: red orange urine
PZA: arthralgia, hepatotoxicity
EMB: retrobulbar neuritis, R-G color blindness