PULMONOLOGY Flashcards
(104 cards)
1
Q
TX for infant w/ severe coughing spells followed by apneic or cyanotic episodes, NO fever
A
pertussis - azithromycin
2
Q
Do close contacts of pertussis get prophylaxis if they are vaccinated?
A
yes, azithromycin
3
Q
How many total doses of DTaP (for primary series)?
A
5 - after that, boosters every 5-10 years and with every pregnancy
4
Q
Describe step-up therapy for asthma
A
- ICS-SABA or ICS-LABA (preferred) PRN
- ICS-LABA daily (low dose ICS)
- ICS-LABA daily (inc. dose ICS)
- ICS-LABA + LAMA
5
Q
Examples of SABA, LABA, SAMA, LAMA
A
SABA = albuterol
LABA = formoterol, salmeterol
SAMA = ipratropium
LAMA = tiotropium
6
Q
TX for asthma exacerbation
A
SHORT ACTING.
Mild/moderate = SABA + PO CCS
Mod/severe = SABA + SAMA + PO/IV CCS, oxygen if needed
7
Q
What is Lofgren syndome?
A
classic triad for sarcoidosis:
1. fever
2. erythema nodosum
3. b/l hilar adenopathy
8
Q
Pt presents with progressive cough, dyspnea, skin lesions, uveitis, blurry vision. She is a young black woman. There is b/l hilar adenopathy on CXR. What lab abnormalities should you expect to see?
A
hypercalcemia, hypercalciuria, high serum ACE
9
Q
TX for sarcoidosis
A
PO CCS (prednisone) ONLY if there is worsening pulmonary disease
10
Q
When do you perform a tube thoracostomy vs. operative emergency thoracotomy for a hemothorax?
A
usually tube thoracostomy is sufficient.
indications for a thoracotomy:
- BIG HTX (>1,500 blood loss on chest tube)
- persistent hemorrhage
11
Q
Pt brought to ED in severe respiratory distress. CXR shows tension pneumo. What are the next steps in management?
A
- thoracostomy FIRST
- intubate (positive-pressure ventilation can worsen tension pneumo)
12
Q
RFs for spontaneous pneumothorax
A
- thin, young men
- COPD, cystic fibrosis, other underlying lung disease
13
Q
Do you thoracostomy all pneumothoraces?
A
no - small (2cm or less) can get oxygen w/ close observation
14
Q
TX for CO toxicity
A
100% oxygen
15
Q
Pt brought in by neighbor for headache, confusion, dizziness, cherry red lips
A
CO poisoning
16
Q
Hampton hump and pleural effusion on CXR suggests:
A
PE.
Hampton hump is wedge-shaped opacity on CXR (= infarct)
17
Q
Next steps for +IGRA or +TB skin test, asymptomatic
A
CXR to differentiate between latent or active disease
18
Q
+IGRA, CXR negative. Next steps?
A
INH x 9 months. After therapy is complete, no further tx or monitoring is needed unless sxs of active disease develop.
19
Q
What should you supplement with during INH therapy?
A
vit B6 (pyridoxine) to prevent peripheral neuropathy
20
Q
Obstructive pattern on spirometry
A
FEV1/FVC <70%
(due to low FEV1, nml FVC)
21
Q
Restrictive pattern on spirometry
A
FEV1/FVC >70%
(due to low both)
22
Q
Obstructive or restrictive: asthma, emphysema, chronic bronchitis
A
obstructive
23
Q
Obstructive or restrictive: HF, sarcoidosis, asbestosis, interstitial lung disease, morbid obesity
A
restrictive
24
Q
How do you differentiate between COPD and asthma?
A
spirometry – if asthma, FEV1 should improve after bronchodilator administration
25
Besides spirometry, how else can you assess for asthma?
methacholine test (bronchoprovocation) - negative result r/o asthma
- this is better for asxs pts
26
Clinical definition of chronic bronchitis (timeline of sxs)
productive cough x at least 3 months over 2 consecutive years
27
LOW DLCO (diffusing capacity of the lung for carbon monoxide) on spirometry
emphysema or interstitial lung disease (pulmonary fibrosis)
28
According to GOLD guidelines, what is the treatment for high-risk COPD pts?
(High-risk = FEV1 under 50, 2+ exacerbations in 1 year, 1+ hospitalization)
If few symptoms, LAMA (Group C).
If many symptoms, LAMA + LABA (Group D).
29
According to GOLD guidelines, what is the treatment for low-risk COPD with few/no symptoms?
(Low-risk = 1 or less exacerbation, no hospitalizations)
SAMA/SABA PRN (Group A)
30
According to GOLD guidelines, what is the treatment for low-risk COPD with many symptoms?
(Low-risk = 1 or less exacerbation, no hospitalizations)
something long acting - LABA or LAMA (Group B)
31
According to GOLD guidelines, what is the treatment for COPD associated with high eosinophils (>300)?
LABA + ICS
32
Which bronchodilator class has been shown to reduce COPD exacerbations?
LAMA (tiotropium)
33
MC type of lung cancer
adenocarcinoma
34
Which lung cancers are located peripheral?
adenocarcinoma, large cell carcinoma
35
Which lung cancers are located central?
squamous cell carcinoma, small cell carcinoma
36
Which lung cancer is associated with hypercalcemia, smoking, and necrosis/cavitary lesions?
squamous cell carcinoma
37
Which lung cancer is associated with paraneoplastic syndrome (Cushing, SIADH, Lambert-Eaton)?
small cell carcinoma -- secretes hormones like cortisol, ADH, etc.
38
What is Lambert-Eaton syndrome?
rare autoimmune condition that causes muscle weakness in the limbs (body attacks nerves/muscles), associated with SMALL CELL LUNG CANCER
39
Bones, stones, groans, moans
hypercalcemia
40
Trousseau and Chvostek sign
hypocalcemia
- +Trousseau = carpopedal spasm when BP cuff inflated
- +Chvostek = twitch when facial nerve is tapped
41
What 2 conditions are malignant hypercalcemia usually related to?
- squamous cell carcinoma of the lung (malignant squamous cells secrete PTHrP which mimic PTH = calcium release)
- osteolytic bone mets
42
Which lung cancer is associated with women and non-smokers?
adenocarcinoma
43
Sxs of superior pulmonary sulcus tumor (pancoast tumor)
- referred shoulder pain!!! (usually presenting symptom)
- arm/hand pain, atrophy of hand muscles (think of the tumor disturbing brachial plexus)
- Horner syndrome: ptosis, miosis, anhidrosis
44
What diaphragmatic findings can CXR show for a pancoast tumor?
elevation of hemidiaphragm (tumor can involve the phrenic nerve = hemidiaphragmatic paralysis)
45
What is the size cutoff for a nodule to be considered a SPN?
3 cm or less
46
What is the size cutoff for a SPN to be surveilled or managed? Less than this size does not need follow up.
0.8 cm
47
Concerning features of SPN
- large size (2cm)
- upper lobe
- spiculated appearance
- advanced age
- female
- smoking hx or lung cancer hx
48
"Currant jelly" blood sputum, also associated w/ alcohol or IVDU
Klebsiella PNA
49
TX PJP PNA
bactrim
50
CXR changes for PJP PNA
diffuse interstitial changes (easily missed)
51
CD4+ count for PJP PNA
<200
52
TX for Legionella PNA
FQ or macrolide
53
Coccidioides (Valley fever) geographic distribution
Southwestern states, esp after rainfall
54
CD4+ count for aspergillosis
<50 (VERY LOW)
55
TX for mycoplasma PNA
macrolide.
presents with WEEKS of cough + malaise, b/l patchy infiltrates on CXR
56
VAP usually occurs how long after intubation?
~48 hours
57
What CXR findings would lead you to suspect VAP?
b/l lower infiltrates (history of recent intubation is more important)
58
What are next steps for abnormal CXR and history that is suspicious for VAP?
1. respiratory culture (lower respiratory tract)
2. empiric abx while culture pending
59
TX for outpt management of CAP
amoxicillin/augmentin + doxy/zpak
60
TX for inpt management of CAP
- IV ceftriaxone + zpak
- FQ
61
Asbestosis increases risk for developing:
mesothelioma (and more commonly bronchial carcinoma but mesothelioma is more specific)
62
Occupation exposure to shipyards, mining, roofing, insulation manufacturing
asbestosis -- takes >20yrs to develop after exposure
63
Occupation exposure to quarries, stone cutting, glass/ceramic manufacturing
silicosis
64
CXR shows small upper nodules and "eggshell" calcifications of hilum
silicosis
65
CXR shows ground-glass opacities, honeycombing, emphysema. Pt owns a parrot.
Hypersensitivity pneumonitis ("bird fancier's lung)
66
What drugs can cause lung fibrosis / interstitial lung disease?
methotrexate, amiodarone, bleomycin (chemo drug)
67
Is it concerning to see pleural effusion with PNA?
no, almost 1/2 of PNAs will have uncomplicated pleural effusion (STERILE fluid in the pleural space)
68
Pathophys of ARDS
protein-rich fluid leaks into alveoli due to direct pulmonary trauma OR medical (sepsis, burn, pancreatitis) --> alveoli eventually gets fibrotic
69
Empyema vs lung abscess
- empyema (complicated pleural effusion): bacteria invades into the pleural space; infection of pleural fluid
- abscess: infection of lung parenchyma, usually 2/2 aspiration PNA
70
TX for ARDS
supportive only; high PEEP vent
71
New respiratory distress and crackles in a pt recently admitted for sepsis. B/l pulmonary infiltrates on CXR. Echo is negative for HF.
ARDS
72
Air bronchograms and diffuse ground glass opacities on CXR for a neonate born at 30wks gestation
neonatal RDS (hyaline membrane disease) -- caused by surfactant deficiency (made by alveolar cells type II)
73
Age group for bronchiolitis
<2 years
74
MCC of bronchiolitis, croup, epiglottitis
- bronchiolitis = RSV
- croup = parainfluenza
- epiglottitis = HIB
75
10 month old baby presents with tachypnea, retractions, nasal flaring, cough, congestion. TX?
bronchiolitis = supportive only (hydration, nasal suctioning)
76
Newborn baby has horizontal streaky interstitial fluid in the lung on CXR
transient tachypnea of the newborn
77
What type hypersensitivity is anaphylaxis?
type I
78
What position for anaphylactic shock (or any other hypotensive state)
trendelenburg (increase venous return to heart = improve cardiac output)
79
What inheritance pattern is alpha-1 antitrypsin deficiency
autosomal dominant
80
Panacinar emphysema in a younger pt with limited smoking history and liver fibrosis
alpha-1 antitrypsin deficiency
81
Pt with 1 week history of persistent cough after URI-like sxs and wheezing on exam.
Acute bronchitis -- supportive tx, no CXR (unless PNA is suspected)
82
Light's criteria for exudative pleural effusion
1. pleural:serum protein ratio > 0.5
2. pleural:serum LDH ratio > 0.6
3. pleural LDH is > 2/3 upper limit of nml serum LDH
83
What triggers acute COPD exacerbation?
- infection (MC): either viral or bacterial URI
- other: inflammation from underlying dz, inhaling irritants, PE
84
TX of acute COPD exacerbation
- bronchodilators
- steroids
- abx
- bipap
85
Who gets AAA screening
men 65-75y/o who have smoked ever
86
Who gets low-dose lung CT
anyone with 20+ pack-yr hx AND has smoked within the past 15 years. age 50-80.
87
Who gets pneumococcal vaccine and when
starting at age 50. options are:
- PCV20 or PCV21 (once)
- PCV15 --> PPSV23 1yr later
** high-risk can get BEFORE age 50 (alcoholics, smokers, DM, cochlear implant, sickle cell, immunocompromised, etc.)
88
Indications for tamiflu
- >65y/o
- chronic medication conditions
- pregnant
** must present within 48hr of sxs onset **
89
TX for mild (no resting stridor) vs. severe (resting stridor) croup
mild = CCS (dexamethasone)
severe = racemic epi --> observe x 4hr after administration (sxs can recur)
90
B/l infiltrates on CXR a few hours after a witnessed aspiration.
aspiration pneumonitis: lung inflammation 2/2 gastric acid aspiration
91
TX for aspiration pneumonitis
supportive; no abx
92
Pt w/ history of MG took an aminoglycoside. He now presents with general weakness as well as dyspnea, weakness of the tongue, and difficulty swallowing.
myasthenic crisis -- INTUBATE and give IVIG/plasmapheresis/steroids
93
What can trigger myasthenic crisis?
BBs, aminoglycosides, infection, surgery, pregnancy, tapering off immunosuppressants
94
Causes of chronic vs. acute cor pulmonale
chronic = COPD (hypoxic pulmonary vasoconstriction all over the lung in response to poor ventilation = pulmonary HTN = RV hypertrophy)
acute = PE, ARDS (sudden increase in pulmonary resistance causes RV dilation; BAD!)
95
TX for TB
1. INH, rifampin, pyrazinamide, ethambutol x 2mo
2. then INH, rifampin x 4mo
96
definitive DX for cor pulmonale
R heart catherization
97
Carcinoid syndrome
episodic skin flushing, wheezing, diarrhea, tachycardia ... can eventually lead to fibrotic heart valves (carcinoid heart disease)
98
How does carcinoid tumor cause carcinoid syndrome?
carcinoid tumor (neuroendocrine tumor of lungs/GI tract) secretes serotonin, histamine, catecholamines, etc.
99
How to dx carcinoid syndrome?
24hr urine 5-HIAA (hydroxyindoleacetic acid)
100
What condition to suspect for pt who presents with sxs similar to OSA but occurs during the day and has a high BMI?
obesity hypoventilation syndrome
101
TX for idiopathic pulmonary fibrosis
supportive (supplemental O2 & pulm rehab), NO STEROIDS
102
Facial swelling, cough, dyspnea, headache, arm swelling
SVC syndrome (MCC lung cancer) = compresses SVC & causes high venous pressure in the upper body
103
What ages is AAA screening for (men, lifetime smoking hx)?
65-75
104
"Bat wing" appearance on CXR and high LDH
PJP pneumonia
