Flashcards in Pulmonology Deck (35):
What will pulmonary function testing show in asthma?
This will show a reduced FEV1:FVC ratio. After bronchodilator administra tion the pulmonary function should return to baseline.
What is the last step in management for uncontrolled asthma?
High dose inhaled steroids plus oral corticosteroids plus a long acting beta agonist. This is last resort therapy.
What is the most common etiology in bronchitis?
It is usually viral in nature (influenza, parainfluenza, and coronavirus). For this reason, antibiotics are not indicated.
How long can the cough in bronchitis last?
The cough can last up to three weeks. A cough lasting for a week or two weeks does not require antibiotic treatment. Three weeks of cough is constant with viral bronchitis.
What is the most common etiology in bronchiolitis?
RSV (respiratory syncytial virus)
What x-ray finding will be present in patients with epiglottitis?
X-ray is not needed for diagnosis. But, when done, will show thumb sign which represents an enlarged epiglottis.
What is the typical presentation for a patient presenting with croup?
Your going to look for a child presenting with a barking cough and stridor.
What is outpatient management for croup?
Dexamethasone. Those with more severe symptoms are given nebulized epinephrine and oxygen.
What is the treatment of choice if patients have had influenza type symptoms over 2 days?
Symptomatic treatment is indicated after two days of disease. If the patient pre sents less than 48 hours of symptom onset, then you may treat with oseltamivir or zanamivir.
What is the first line treatment for pertussis?
First line treatment will be a macrolide. Remember to treat all close contacts as well prophylactically.
What is the most common etiology in pneumonia?
Streptococcus pneumonia. This will be the most common etiology in all scenarios. Certain situations will have associations such as HIV and pneumocystis, but overall, strep pneumo will be the most common etiology.
What are the three atypical organisms that cause pneumonia?
Mycoplasma, chlamydia, and legionella. Atypical means that they cannot be cul tured with the typical medium and will present differently. They are important to know because collectively they make up about half of all pneumonia.
Currant jelly sputum is associated with which type of pneumonia?
Klebsiella, which is also associated with alcoholics. Know your associations!
First line treatment for community acquired pneumonia in a diabetic?
Respiratory fluoroquinolone (due to comorbidity). Another option is ceftriaxone plus a macrolide (doxycycline can be substituted for macrolide).
What is initial treatment for active tuberculosis?
Remember the acronym RIPE
R - rifampin
I - isoniazid
P - pyrazinamide
E - ethambutol
Treat with RIPE for 2 months, then continue with rifampin and isoniazid for the re maining 4 months. This will give 6 months of treatment.
A recent immigrant was screened with a PPD. His result was 10mm. What is the next step in management?
Recent immigration means that a 10mm reading is a positive reading. The next step will be chest x-ray to rule out active infection.
What should always be concurrently given to patients whenever initiating isoniazid?
Always give patients vitamin B6 (pyridoxine) to prevent peripheral neuropathy.
What paraneoplastic syndroms are small cell carcinoma associated with?
Look for Cushing syndrome or SIADH.
Most common cause of bronchiectasis?
What is the most likely etiology of emphysema when found in a young non- smoking patient?
This is going to be alpha 1 anti trypsin deficiency.
What arrhythmia is associated with COPD?
MAT - multifocal atrial tachycardia
What constitues an obstructive pattern on PFT?
The obstruction will make it difficult to blow out air - this results in a decreased
When is oxygen therapy indicated in patients with COPD?
All patients with an O2 saturation less than 88% or PAO2 less than 55 should be given supplemental oxygen.
How are patients with cystic fibrosis diagnosed?
All newborns should be universally screened. Diagnosis is made with a sweat chloride test (>60 moml/L).
What antibiotic is given as a daily dose for cystic fibrosis patients due to its anti inflammatory and anti bacterial properties?
Will heart failure lead to a transudative or exudative pleural effusion?
This will lead to transudative effusion. Other common causes of transudative pleural effusion will be hypoalbuminuria and cirrhosis.
What does the classic patient look like who will present with spontaneous pneu mothorax?
You will look for a tall young male who smokes. A family history of pneumotho rax might also be present.
What chest x-ray finding will be present in patients with tension pneumothorax?
The chest x-ray will show the trachea and heart shifted to the contralateral side of the pneumothorax.
What is the most common cause of cor pulmonale?
What is the most common presentation for pulmonary embolism?
The most common presentation will be a female with virchows triad presenting with dyspnea and pleuritic chest pain (pain with inhalation).
What is the most common EKG finding in pulmonary embolism?
Sinus tachycardia and non specific ST segment and T wave changes. S1Q3T3 is not the most common ECG finding, and is almost never seen.
When should a D-dimer be ordered in the workup for PE?
This is only ordered in patients with a low suspicion for PE. If a high clinical suspicion for PE exists, you will go straight to CTA or VQ scan.
What is the gold standard for the diagnosis of PE?
Angiography, but is rarely needed because of the high sensitivity and specificity of CTA.
What pulmonary function testing pattern will be seen in pulmonary fibrosis?
A restrictive pattern. A reduced FVC and total lung capacity is seen (the lungs are stiff and don't move).