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Pulmonology Flashcards

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1
Q

Bronchitis-common organisms

A

90% rhinovirus, Coronavirus, and RSV

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2
Q

Bronchitis-Tx

A

Supportive, B2 agonist, COPD: exacerbations-First line: 2nd gen cephalosporin, 2nd line: 2nd generation macrolide or bactrim;
Abx indicated: Elderly with cardiopulmonary dz and cough >7-10 days or immunocompromised

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3
Q

Epiglottitis: Most common organism & symptoms

A

Haemophilus Influenzae Tybe B–most common

S/S: Drooling (80%), Muffled voice, severe dysphagia, Tripod position

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4
Q

Epiglottitis Treatment

A

Secure Airway, Broad-spectrum 2nd or 3rd gen cephalosporin (Cefoaxime or ceftriaxone x 7-10 days)

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5
Q

Croup–AKA and Most common cause

A

AKA: viral laryngotracheobronchitis

Parainfluenza Virus 1 & 2

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6
Q

Croup Signs/Symptoms

A

Barking seal-like cough, Inspiratory stridor, “sounds worse than they look” opposite of Epiglottitis

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7
Q

Croup-Diagnostics

A

PA neck x ray: Steeple sign

lateral X ray: normal (diff Croup from epiglottitis)

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8
Q

Croup-Treatment and vaccination

A

Mild: supportive care
+ stridor (AT REST): active intervention, Steroids (dexamethasone), Nebulized epi, Humidified O2
Vaccination: kids-DTaP if incompletely immunized; Adults: booster Tdap

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9
Q

what is Reye’s syndrome?

A

Fatty liver with encephalopathy, May develop 2-3 weeks after onset of influenzae–esp. if ASA ingested

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10
Q

Influenzae-what treatment? And when is it C/I?

A

Neuraminidase Inhibitors: Zanamivir inhalation (relenza) and Oral oseltamivir (tamiflu)–will decrease severity if given within 48 hours of onset of symptoms (C/I in children <12 years)

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11
Q

C/I of the Influenza vaccination

A

Hypersensitivity to eggs, during febrile illness, thrombocytopenia

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12
Q

Pertussis: Cause?

A

Bordetella pertussis (gram negative bacteria)

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13
Q

Describe the 3 stages of Pertussis

A

Catarrhal Stage (1-2 weeks): Most infectious stage, URI symptoms
Paroxysmal stage (2-4 weeks): Spasms of rapid coughing; Deep, high pitched inspiration (the whoop)
Convalescent stage: (4 weeks after onset)
cough disappears, Decreased symptoms

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14
Q

Pertussis: Treatment of choice

A

Erythromycin (avoid in infants <1 y/o)

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15
Q

Most common Pneumonia Etiology of alcoholics and sputum

A

Klebsiella Pneumoniae; Sputum: Currant jelly

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16
Q

Most common Pneumonia etiology in cystic fibrosis patient:

A

Pseudomonas

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17
Q

Most common Pneumonia etiology in HIV/AIDs

A

Pneumocystic Jirovecii

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18
Q

Most common Pneumonia etiology in IV drug users

A

S. Aureus and Tuberculosis

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19
Q

Most common Nosocomial Pneumonia

A

Staph Aureus; Pseudomonas Aeruginosa (ICU)

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20
Q

Most common Cause of PNeumonia. (CAP); Gram stain?

A

Streptococcus Pneumoniae: Gram stain-Gram Positive Diplococci

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21
Q

CXR mycoplasma Pneumonia vs. Typical

A

Mycoplasma: Patchy Interstitial Infiltrates; Typical: Lobar infiltrates

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22
Q

Risk factors for the fungal Pneumonia Histoplasma Capsulatum

A

Ohio and Missippi river valleys, found in soil, Bat exposure, Cave explorers

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23
Q

Risk Factors for the Fungal Pneumonia: Coccidioides Immitis

A

Dimorphic fungus, Construction workers

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24
Q

Most common Oppurtunistic infection in HIV patients–Characteristics, CD4 counts, diagnostics, and TX

A

Pneumocystis Jiroveci
CXR: Butterfly pattern
CD4 count: 90% of patietns
Tx/Prophlyaxis: Bactrim

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25
Symptoms of Carcinoid syndrome
Flushing, diarrhea, wheezing, hypotension | If given in a test scenario---Think carcinoid tumor
26
Type of lung cancer most likely to metastasize early and rarely amenable to surgery?
Small cell lung cancer (oat cell)
27
Where does Small cell lung cancer originate?
Central bronchi
28
Most common type of bronchogenic carcinoma and where does it appear?
Adenocarcinoma; Periphery of the lungs
29
Type of lung cancer most likely to present with Hemptysis. Location? How is it diagnosed?
Squamous cell carcinoma; More likely to be diagnosed via sputum cytology than the other types; Usually central
30
Type of non small cell lung cancer that metastasizes the earliest.
Large cell carcinoma
31
Symptoms of Horner's syndrome
Constricted pupil, Partial Ptosis, and loss of sweating
32
Which type of lung cancer has the lowest association with Smoking?
Adenocarcinoma
33
Symptoms of Superior vena cava syndrome; What type of lung CA
Facial fullness, facial and arm edema, dilated veins over anterior chest, arms, face, JVD; Most common with Small cell Carcinoma
34
Symptoms of Pancoasts tumor; What type of Lung CA?
Causing shoulder pain radiating down to the arm; Usually Squamous celll cancers; Associated with Horner's sydnrome 60% of the time; UE weakness 2 to brachial plexus invasion; C8 radiculopathy--> 5th digit numbness; Usually squamous cell cancer
35
Eaton Lambert syndrome: Type of lung CA most commonly associated, Symtoms
Most common in Small cell lung CA; Similar to Myasthenia Gravis with proximal muscle weakness/fatigability, diminished deep tendon reflexes, paresthesisas in LE.
36
Obstructive lung disease (COPD): PFT (Spirometry) Findings
Decreased FEV1 and Decreased FEV1/FVC ratio< 75%; Normal or increased TLC
37
Restrictive Lung Disease Spirometry results
Low TLC, Normal or high FEV1/FVC
38
Bronchiectasis: What is it? Diagnostic study of choice; CXR signs
Permanent, abnormal dilation of the bronchi and destruction of the bronchial walls; 50% associated with Cystic fibrosis CT-->DOC CXR: Dilated thickened airways, Tram-track lung markings, honeycombing; "Signet ring" sign; "tree-in-bud" opacities, atelectasis
39
First line agents of mild to mod COPD
Anticholinergic drugs or Beta agonists
40
Most common causes of Transudative Pleural effusion
CHF (most common); PE, cirrhosis, post-surgery (open heart)
41
Most common cause of Exudative Pleural effusion
Pneumonia (MCC) | Cancer, PE, kidney disease, or inflammatory disease
42
criteria for Exudative PLeural effusion
Pleural fluid protein-to-serum protein >0.5 Pleural fluid LDH to serum LDH >0.6 Pleural Fluid LDH >2/3 the normal upper limit for serum Exudative: high protein Transudative: low protein
43
Primary Spontaneous Pneumothorax: who does it typically occur in?
Typically Tall, Thin, Young Male smokers, (who are otherwise healthy)
44
When does Tension pneumothorax most commonly occur? How do you treat it?
During mechanical ventilation or pulmonary resuscitation; Post central line placement, trauma with resp. distress; mEdical emergency!Large bore needle into pleural space! Do not obtain CXR if tension pneumothorax is suspected!
45
Signs and symptoms of Pneumthorax
Symptoms: ipsilateral CP; Dyspnea PE: Hyperresonance, decreased Tactile fremitus and breath sounds
46
What is Cor pulmonale and Most common cause
Failure of Right side of heart brought on by long term high blood pressure in pulmonary arteries and RV of the heart Most commonly secondary to COPD
47
What is the gold standard diagnostic test for PE? What test is the most commonly used to diagnose PE?
Gold standard: Pulmonary Angiography | Best test: Spiral CT scan
48
Idiopathic Pulmonary Fibrosis: Most common among what type of patients? How is it characterizeD? Gold standard of diagnosis? CT findings? PFT findings? Mainstay of treatment?
Most common diagnosis among pts with interstitial lung dz; Characterized by progressive parenchymal scarring and loss of pulmonary function; Gold standard: Lung biopsy; CT: diffuse, patchy fibrosis with pleural based honeycombing PFT: restrictive pattern Tx: Corticosteroids in combo with immunosuppressive agents
49
Alpha- 1 antitrypsin deficiency
Think in any nonsmoker under age of 30 with Emphysema
50
Classic CXR findings in environmental Lung dz: Asbestosis and Silicosis
RESTRICTIVE PATTERN! Asbestosis: Pleural Plaques-Reticular linear pattern with basilar predominance, opacities, and honeycombing; Associated with increased risk of lung cancer and malignant mesothelioma Silicosis: egg shell calcificiation; Nodular pattern with upper lobe predominance Sources: Mining, stone cutting, and glass manufacturing
51
Sarcoidosis: Characteristics, Population
Noncaseating granulomatous inflammation 90% with lung involvement Population: More common in young (<40 y/o) black females
52
Sarcoidosis: Symptoms, Diagnostics, and tx
S/S: dry cough, dyspnea, fatigue Extramanifestations: Uveitis (blurred vision with tearing), Erythema Nodosom-Maculopapular lesions; CXR: Bilateral hilar and right paratracheal adenopathy Elevated ACE Bx: Noncaseating gransulomas Tx: Prednisone
53
Hyaline Membrane disease: What is it? What population is it commonly seen? Tx?
Caused by deficiency of pulmonary surfactant Most commonly seen in premature infants Tx: steroids to mom 48 hours pre-delivery to help fetal lung maturity; Exogenous surfactant in the delivery room
54
Tx for CAP, CAP + comorbidities, CAP + Hospitalization?
CAP: Azithromycin CAP + Comorbidities: Fluoroquinolone CAP + hospitalization: Ceftriaxone + Azithromycin
55
Tx of Nosocomial Pneumonia
3 drug regimen: (4th gen ceph + Floroquinolone + Vanco) Cefepime, Pipercillin/Taxobactam, or Meropenem (need to cover Gram -, Pseudomonas, and MRSA)
56
Tuberculin Skin Test
5 mm for HIV patients, Close contacts, immunosuppressed 10 mm: Healthcare workers 15 mm: Healthy individuals with low likelihood of TB
57
TX of TB
Initial phase: 2 months with 4 drug Regimen-RIPE: Rifampin, Isoniazid, Pyrazinamide, ethambutol Continuation phase: 4 months with 2 drug regimen: Rifampin and Isoniazid
58
Which type of lung cancer is associated with Hypercalcemia?
Squamous cell carcinoma
59
What is the most common important stimulant of pulmonary artery vasoconstriction (as seen in secondary Pulmonary HTN)?
Hypoxia
60
Legionella: Risk Factors; TOC for immunocompromised pts
INdoor (exposure to Air conditioning), TOC for immunocompromised pts: Azithromycin, or a fluoroquinolone (Levofloxacin)
61
What imaging modality is most sensitive to detect a small Amount of pleural fluid?
Chest CT
62
Pleural findings consistent with a transudative pleural effusion? (think LDH, WBC, glucose, and protein
Glucose >60 mg/dL; Protein <3g/dL
63
Pleural findings associated with Exudative pleural effusion?
Glucose 3.0 g/dL, LDH>200 IU/L Pleural serum:protein >0.5, pleural serum LDH ratio >0.6, total pleural protein >3g/dL
64
Chest examination findings in a pt with a PNEUMOTHORAX
Decreased tactile fremitus on the affected side and Percussion will be hyperresonant
65
What kind of chest film will best demonstrate a small pneumothorax?
Expiratory; Other findings: visceral pleural line on a chest film and a "deep sulcus sign" on a supine film
66
What is the drug of choice for treating apnea in the preterm infant?
Methylxanthines in the form of caffeine citrate
67
Define APhonia
The inability to vocalize; Sign of complete obstruction of the airway.
68
First line agents for the treatment of acute exacerbations of chronic bronchitis
Macrolides, Fluorquinolones, and Augmentin

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