Pulmonology Flashcards
(112 cards)
1
Q
DDX for hemoptysis
A
Bronchiectasis Acute bronchitis Lung carcinoma Tuberculosis PE Foreign body aspiration
2
Q
DDX for pleuritic chest pain
A
Bronchiectasis Costochondritis Pleural effusion Pneumothorax Pulmonary embolism Pneumonia Tuberculosis
3
Q
Acute bronchitis often follows
A
URI
4
Q
Acute bronchitis is most commonly caused by
A
Viruses
Adenovirus
Parainfluenza, influenza, coxsackie, rhinovirus
5
Q
Diagnosis of acute bronchitis
A
Usually clinical w/o need for imaging
If suspect pneumonia - order CXR
CXR will be normal or nonspecific
6
Q
Management of acute bronchitis
A
Symptomatic - fluids, rest, +/- bronchodilators, +/- antitussives
Antibiotics no statistical benefit in healthy pts
7
Q
Lower respiratory tract infection of the small airways leading to mucus plugging and peripheral airway narrowing and variable obstruction
A
RSV - Acute bronchiolitis
8
Q
Most common cause of acute bronchiolitis
A
RSV - respiratory syncytial virus
9
Q
Most common age group affected by RSV
A
< 6 mo (esp ~ 2 mo)
10
Q
Risk factors for RSV
A
Cigarette exposure
Lack of breastfeeding
Premature
Crowded conditions
11
Q
Complications of RSV
A
Otitis media - most common acute
Asthma - most common later in life
12
Q
Fever, URI symptoms for 1-2 days followed by respiratory distress (wheezing, tachypnea, nasal flaring, cyanosis, retractions)
A
RSV - acute bronchiolitis
13
Q
Diagnosis of RSV/acute bronchiolitis
A
CXR - hyperinflation, peribronchial cuffing
Nasal washings using monoclonal Ab testing
Pulse ox
14
Q
Best predictor of disease in children with RSV
A
Pulse ox
< 96% - admit
15
Q
Management of RSV
A
Supportive: O2 mainstay
Albuterol, racemic epi if albuterol not effective
Ribavirin if severe
16
Q
Prevention of RSV
A
Palivizumab prophylaxis in high risk groups
Hand washing preventative!
17
Q
Mortality from acute epiglottitis is usually secondary to
A
Asphyxiation
18
Q
Most common cause of acute epiglottitis
A
Haemophilus influenza type B
Reduced incidence due to Hib vaccination
Strept pneumonia, S. aureus, GABHS
19
Q
Epidemiology of acute epiglottitis
A
3 mo - 6 years
Males 2X more common
20
Q
3 D’s: dysphagia, drooling, distress
A
Acute epiglottitis
21
Q
Inspiratory stridor, dyspnea, hoarseness, tripoding
A
Acute epiglottitis
22
Q
Suspect in pt with rapidly developing pharyngitis, muffled voice and odynophagia out of proportion to physical findings
A
Acute epiglottitis
23
Q
Diagnosis of acute epiglottitis
A
- Laryngoscopy - definitive diagnosis - cherry red epiglottis with swelling
- Lateral cervical radiograph - thumb sign
24
Q
Management of acute epiglottitis
A
- Airway management - dexamethasone, intubation if severe
- Abx - ceftriaxone or cefotaxime
- +/- add penicillin, ampicillin
25
Inflammation most commonly secondary to acute viral infxn of the upper airway leading to subglottic larynx/trachea swelling
Laryngotracheitis (croup)
26
Signs/symptoms of Laryngotracheitis (croup)
1. Barking cough (seal-like, harsh)
2. Stridor (both inspiratory and expiratory)
3. Hoarseness
4. Dyspnea (especially worse at night)
5. +/- preceding URI sx
27
Diagnosis of laryngotracheitis (croup)
1. Clinical
| 2. Frontal cervical radiograph - steeple sign
28
Steeple Sign
Laryngotracheitis (croup)
29
Management of mild croup (no stridor at rest, no respiratory distress)
Cool humidified air mist, hydration
Dexamethasone
Supplemental O2 if < 92%
30
Management of moderate croup (stridor at rest with mild-mod retractions)
Dexamethasone PO or IM
+/- nebulized epinephrine
Should be observed 3-4 hrs
31
Management of severe croup (stridor at rest with marked retractions)
Dexamethasone + nebulized epinephrine and hospitalization
32
Highly contagious infection secondary to bordetella bacteria
Pertussis (Whooping Cough)
33
Signs/Symptoms of pertussis (whooping cough)
Catarrhal Phase - URI
Paroxysmal Phase
Convalescent Phase
34
Inspiratory whooping sounds after coughing fits
Paroxysmal Phase of pertussis (whooping cough)
35
The convalescent phase of pertussis may last for up to
6 weeks
36
Diagnosis of pertussis (whooping cough)
PCR of nasopharyngeal swab - gold standard
| Lymphocytosis - elevated lymphocytes and WBC
37
Management of pertussis (whooping cough)
1. Supportive (oxygen, nebulizers)
| 2. Erythromycin, Azithromycin (Bactrim if PCN allergic)
38
Complications of pertussis (whooping cough)
```
Pneumonia
Encephalopathy
Otitis media
Sinusitis
Seizures
```
39
Most common cause of CAP
Streptococcus pneumoniae
| Haemophilus influenzae
40
Klebsiella pneumonia is seen in ________ and is associated with _________
Alcoholics
| Cavitary lesions
41
Most common viral cause of pneumonia in infants/small children
RSV
| Parainfluenza
42
Most common viral cause of pneumonia in adults
Influenza
43
Most common causes of hospital acquired pneumonia
Pseudomonas
E coli
Klebsiella
S. aureus (MRSA)
44
When to hospitalize for pneumonia
- Multilobar
- Neutropenia
- Comorbidities
45
Still considered community acquired if pt develops pneumonia within ___________ of initial hospital admission
48 hours
46
Physical exam signs of pneumonia
Dullness on percussion
Egophony
Increased tactile fremitus
Inspiratory rales (crackles)
47
Mycoplasma pneumonia (atypical) is associated with:
bullous myringitis
48
Legionella pneumonia is associated with
GI symptoms
| Increased LFTs
49
Diagnosis of pneumonia
1. CXR/CT
| 2. Sputum (Gram stain/culture)
50
Rusty (blood-tinged) sputum in pneumonia
Step pneumoniae
51
Currant jelly sputum in pneumonia
Klebsiella
52
Management of CAP outpatient
Macrolide or Doxycycline
53
Management of CAP inpatient
B lactam + macrolide or doxycycline
| OR fluoroquinolone
54
Management of HAP
B lactam + AG or FQ
55
Reverse hyperirritability of the tracheobronchial tree, leading to airway inflammation and bronchoconstriction
Asthma
56
Most common chronic childhood disease
Asthma
57
Samter's Triad
1. Asthma
2. Nasal polyps
3. ASA/NSAID allergy
58
Classic triad of asthma
1. Dyspnea
2. Wheezing
3. Coughing (esp at night)
59
Prolonged expiration with wheezing, hyperresonance to percussion
Asthma
60
Diagnosis of asthma
1. PFT - gold standard (reversible obstruction)
2. Bronchoprovocation - methacholine challenge
3. Peak Flow Rate - best for assessing severity
4. Pulse Ox
5. ABG
6. CXR
61
Admission criteria for asthma
```
PEFR < 50% predicted
Er visit within 3 days of exacerbation
Status asthmaticus
Post treatment failure
AMS
```
62
Adjuncts for asthma management
IV magnesium - indicated in severe asthma
| Omalizumab - used in severe, uncontrolled asthma
63
Abnormal accumulation of fluid in the pleural space (not a disease itself but a sign of a disease)
Pleural effusion
64
Grossly purulent/turbulent effusion (direct infection of the pleural space)
Empyema
65
Circulatory system fluid in pleural effusion due to either increased hydrostatic and/or decreased oncotic pressure
Transudative fluid
66
Most common causes of transudative pleural effusion
CHF
Nephrotic syndrome
Cirrhosis
67
Occurs when local factors within the lungs themselves cause a pleural effusion by increasing vascular permeability
Exudative fluid
68
Signs/symptoms of pleural effusion
Typically asymptomatic
| If symptomatic: dyspnea, pleuritic chest pain, cough
69
Physical exam with pleural effusion
Decreased breath sounds
Decreased tactile fremitus
Dullness to percussion
+/- pleural friction rub
70
Diagnosis of pleural effusion
1. CXR - PA/lateral, lateral decubitus best
2. Thoracentesis - test of choice - send fluid for culture, chemistry, cell count, cytology
3. CT scan - used to determine empyema
71
Light's Criteria:
Pleural Effusion
| Presence of any criteria determines exudative fluid
72
Management of pleural effusion
1. Treat underlying condition
2. Thoracentesis - gold standard
3. Chest tube pleural fluid drainage (if empyema)
4. Pleurodesis - if malignant effusions or chronic
73
Accumulation of air in the pleural space
Pneumothorax
74
Risk factors for spontaneous pneumothorax
1. Family history
2. Smoking
3. Males
75
Diagnosis of pneumothorax
CXR
76
Treatment for spontaneous pneumothorax
Small - oxygenation and observation - repeat CXR after 6 hours
Large - pleural aspiration, chest tube
Unstable - chest tube
77
Treatment for tension pneumothorax
Immediate needle decompression and chest tube
78
Thrombus in the pulmonary artery or its branches - not a disease itself but a complication of a DVT
Pulmonary embolism
79
Most people who die from PE die from:
Subsequent PEs (not initial one)
80
Most common signs/symptoms of PE
Dyspnea, tachypnea
| Pleuritic chest pain
81
Most common predisposing condition for PE
Factor V Leiden
82
Diagnosis for PE
1. Helical CT scan - best initial test
2. V/Q scan
3. Pulmonary angiography - gold standard
4. Doppler US - 70% of pts with PE will be positive for lower extremity DVT
83
A normal CXR in the setting of hypoxia is highly suspicious for
Pulmonary embolism
84
Westermark's Sign
Pulmonary embolism on CXR
85
Hampton's Hump
Pulmonary embolism on CXR
86
Most specific result for PE on EKG
S1Q3T3
87
Simple lab test to r/o PE if low
D-dimer
88
Management of Pulmonary embolism
```
LMWH - low risk pts
Warfarin for at least 3 mo
May use dabigatran or apixaban instead
IVC filter if anticoag CI or failed
Thrombolysis of clot - streptokinase
Thrombectomy/Embolectomy - unstable/massive PE if thrombolysis ineffective
```
89
Life threatening acute hypoxemic respiratory failure (organ failure from prolonged hypoxemia)
Acute respiratory distress syndrome
90
Most common cause of ARDS
Sepsis
Severe trauma
Aspiration of gastric contents
91
Signs/Symptoms of ARDS
acute dyspnea and hypoxemia
| Multi-organ failure if severe
92
Diagnosis of ARDS
1. Severe refractory hypoxemia (HALLMARK)
2. Bilateral pulmonary infiltrates on CXR
3. Absence of cardiogenic pulmonary edema/CHF
93
Pulmonary Capillary Wedge Pressure that is < _________ is indicative of ARDS as opposed to cardiogenic pulmonary edema
18 mmHg
| If > 18 mmHg, points towards cardiogenic pulmonary edema
94
Management of ARDS
Noninvasive or mechanical ventilation and treat underlying cause
95
Diagnosis of foreign body aspiration
1. Bronchoscopy - allows for removal
| 2. CXR
96
Chronic infection leading to granuloma formation
Tuberculosis
97
High risk populations for TB
```
Healthcare workers
Homeless
Immigrants
Immunodeficiency
Incarcerated
```
98
Diagnosis of tuberculosis
1. Acid-Fast Smear and Sputum Culture x 3 days
2. CXR
3. Interferon Gamma Release Asay
99
Treatment for Active TB infection
```
RIPE
Rifampin
INH
Pyrazinamide
Ethambutol
```
100
S/E of rifampin
Thrombocytopenia, orange colored secretions
101
S/E of isoniazid
Hepatitis
Peripheral neuropathy
Drug-induced lupus
102
S/E of pyrazinamide
Hepatitis
Hyperuricemia
Photosensitive dermatologic rash
103
S/E of ethambutol
Optic neuritis, peripheral neuropathy
104
Treatment of latent TB infection
INH + pyridoxine x 9 mo
105
Most common cause of cancer death in the world
Lung cancer
106
90% of lung cancer cases are associated with
Cigarette smoking
107
Most common type of lung cancer
Non-small cell carcinoma (75%)
108
Most common type of non-small cell carcinoma
Adenocarcinoma
109
Screening for lung cancer
> 55 y/o
30 pack year smoker
Must have smoked in last 15 years
Screen annually until 80 or if person has not smoked in 15 years
110
Diagnosis of lung cancer
1. CXR
2. Chest CT
3. Biopsy
111
Treatment for small cell carcinoma lung cancer
Chemo and radiation
| Very poor prognosis
112
Treatment for non-small cell carcinoma lung cancer
Surgical resection with or without chemo
| If mass is resectable but pt has poor pulmonary fxn, not a candidate for surgery
