Pulmonology Flashcards
(144 cards)
1
Q
Pt with a hx of eczema and seasonal rhinitis is at risk of developing?
A
asthma
2
Q
T/F Asthma is reversible?
A
true
3
Q
What is the mechanism of asthma?
A
inflammed airway
4
Q
How should asthma be monitored?
A
peak flow
5
Q
If you admin a inhaler in asthma what should go up with improvement?
A
FEV1 - forced expiratory volume in 1 sec
6
Q
What two drugs can precipitate a acute asthma attack?
A
NSAIDS and aspirin
7
Q
What is seen on peak flow in asthma?
A
decreased FEV1 and reduced FEV1 to FVC
8
Q
Gold standard for diagnosing asthma?
A
Peak expiratory flow rate
9
Q
Intermittent asthma?
A
symptoms < 2days/week, <2month
10
Q
Mild persistent asthma?
A
symptoms > 2 days/wk, 3-4xmo, short b agonist use 2wk
11
Q
Moderate persistent asthma?
A
daily symptoms, 1wk night, daily albuterol use, limits in normal acitivty
12
Q
Severe persistent?
A
symptoms throughout day, 7x night, albuterol several times a day, extremely limited activity
13
Q
Txt for intermittent asthma?
A
short acting beta 2 agonist (SABA)
14
Q
Txt for mild persistent asthma?
A
lose dose inhaled corticosteroid + SABA
15
Q
Txt for moderate persistent asthma?
A
Low ICS, LABA daily
Medium dose ICS + LABA
16
Q
Txt for severe persistent asthma?
A
High dose ICS + LABA
+ oral steroids
17
Q
What is the acute txt for asthma?
A
oxygen, nebulized SABA, ipratropium bromide and oral corticosteriods
18
Q
What is the atopic triad of asthma?
A
wheeze, eczema, seasonal rhinitis
19
Q
One week history of cough productive of whitish sptum, that was preceded by a URI?
A
Acute bronchitis
20
Q
What is acute bronchitis?
A
a cough that persists over > 5 days
21
Q
What symptom should not be seen in acute bronchitis?
A
fever (think pneumonia)
22
Q
95% of acute bronchitis is?
A
viral
23
Q
What is the most common bacterial cause of acute bronchitis?
A
M. Catarrhalis
24
Q
What is the treatment of acute bronchitis?
A
supportive (analgesics, B2-agonist, cough suppressants)
25
In whom are antibiotics indicated for in acute bronchitis?
elderly pts
underlying cardiopulmonary disease and cough for > 7-10 days
immunocompromised
26
bacterial acute bronchitis txt?
1st- 2nd gen cephalosporin, 2nd- 2nd gen macrolide or Bactrim
27
Blue bloaters
Chronic bronchitis
28
Increased interstitial marking, thickening of bronchial walls, diaphragms are not flattend
chronic bronchitis
29
Gold standard Dx of chronic bronchitis?
lung biopsy
30
What is the FEV1/FVC ratio in chronic bronchitis?
< 0.7
31
What is a classic physiologic feature of chronic bronchitis?
airflow limitation that is irreversible or only partially reversible
32
What is the most contributory factor of COPD?
Smoking
33
What classifies as chronic bronchitis?
productive cough producing phlegm occurring on most days for 3 mo for 2 yrs
34
What is the txt for acute exacerbation bronchitis?
```
O2
beta agonist
anticholinergics
Inhaled/IV steroids
abx
```
35
What is the txt for chronic exacerbation bronchitis?
```
smoking cessation
ambulatory o2
bronchodilator
steroids
vaccines
```
36
What is the pathophysiology of chronic bronchitis?
enlargement of mucous glands and goblet cell hypertrophy in large airways
37
In pts with COPD, which of the following has been shown to decrease rate of malignancy and cardiovascular disease and improve survival?
smoking cessation
38
What has been shown to prolong life in pts with COPD and alter the natural history of the disease?
Home oxygen
39
CXR shows parenchymal bullae or subplueral blebs?
emphysema
40
Independently associated with an increased risk for all cause mortality in pts with COPD?
Bronchiectasis
41
What is the most significant symptom of COPD?
Breathlessness
42
What is emphysema?
airway inflammation and loss of elasticity of the alveoli over time, secondary to destruction of the walls of the alveoli
43
What is a genetic cause of emphysema?
alpha-1 antitrypsin (ATT) deficiency
44
Empysema that predominately affect the upper lobes?
centrilobular emphysema
45
Empysema that causes changes in the lower lobes and commonly occurs with alpha-1 antitrypsin deficiency?
Panacinar emphysema
46
A young age person with elevated liver function tests or liver failure and worsening emphysema what do they have?
Alpha 1 antitrypsin deficiency emphysema
47
What's the txt for alpha 1 antitrypsin deficiency?
alpha 1 antitrypsin protein
48
Diagnosis of COPD?
pulmonary function tests
49
In acute COPD exacerbation what ABG is seen?
acute respiratory acidosis (low pH and elevated pCO2)
50
Pink puffer
emphysema
51
Thin, barrel chest, hyperventilation, pursed lip breathing
emphysema
52
chronic productive cough, peripheral edema, overweight and cyanotic?
bronchitis
53
Parenchymal bullae and blebs, flattened diaphragm, decreased lung markings at apices, small thin appearing heart
emphysema
54
increased interstitial markings at bases, diaphragms are not flattened
bronchitis
55
Patho for emphysema?
alveolar enlargement and loss of septal wall integrity without any evidence of fibrosis
56
What is the worst type of lung cancer?
small cell
57
Lung cancer associated with smoking, aggressive, and has already metastasized?
small cell
58
What is lung cancer associated with?
paraneoplastic phenomena
59
What is paraneoplastic phenomena?
ACTH secretion
SIADH
Lambert- Eaton syndrome
60
Most common type of non-small cell lung cancer?
Adenocarcinoma
61
Someone who develops lung cancer but has no smoking history
Adenocarcinoma
62
What is the common paraneoplastic syndrome associated with squamous cell carcinoma?
hypercalcemia
63
What is the primary treatment of squamous cell lung cancer?
surgery
64
It primarily affects women and is the only lung malignancy not associated with tobacco use?
Bronchoalvelar cancer
65
Triad of Horner Syndrome?
miosis (constricted pupil), ptosis, and anhidrosis
66
Patient presents a a smoker w/ hemoptysis and an abnormal chest x ray showing a large central solitary tumor?
squamous cell carcinoma
67
Treatment of non-small cell lung cancer?
surgery, chemo, rads
68
Txt for small cell lung cancer?
CHEMO
69
The most common cause of acute bronchiolitis?
Respiratory syncytial virus (RSV)
70
Dx of bronchiolitis?
nasal washing for RSV culture and antigen assay
71
What circumstances is Ribavirin admin for bronchiolitis?
infants born premature
O2< 95%
respiratory rate > 70
or atelectasis
72
Txt for bronchiolitis?
supportive: oxygenation and hydration
73
Bronchiolitis is seen in whom?
infants and young children < 2years
74
Precedes a URI prodrome, with rhinorrhea, nasal flaring, tachypnea, and retractions, expiratory wheezes
bronchiolitis
75
What is the MC cause of croup?
parainfluenza virus
76
What is seen on CXR for croup?
steeple sign
77
Whom does croup occur?
6 months and 3 years
78
What is the characteristic symptom of croup?
barking cough and noisy breathing inspiratory stridor
79
What is the txt for severe croup?
humidified oxygen racemic epinephrine
80
What is the txt for mild croup?
oral corticosteroids (dexamethasone)
81
Symptom associated with laryngotracheobronchitis (viral coup)?
barking cough
82
Thumb print on CXR?
epiglottis
83
Dx of croup?
Posterioranterior (PA) neck film showing subglottic narrowing (steeple sign)
84
Rust colored sputum, common in pts with splenectomy?
S. pneumoniae
85
Salmon colored sputum
S. aureus
86
Organism causing Infection seen in pts on ventilators, cystic fibrosis
Pseudomonas
87
Hyponatremia, GI symptoms (diarrhea), and high fever, air conditioning, aerosolized water
Legionella
88
Young people living in dorms, + cold agglutinins, bullous myringitis, walking pneumonia, low temp
Mycoplasma
89
currant jelly sputum, DRINKERS, aspiration
Klebsiella
90
Organism responsible for viral pneumonia in adults?
flu
91
Organsim responsible for viral pneumonia in kids?
RSV
92
A non- remitting cough/bronchitis non responsive to conventional txt
Coccidioides
93
bird or bat droppings (caves, zoo, bird), looks like sarcoidosis on CXR
Histoplasma capsulatum
94
Found in soil in dry states can disseminate and can cause meningitis?
cryptococcus
95
HIV related pneumonia?
Pneumocystis jiroveci (PJP)
96
Walking pneumonia is cause by?
atypical pneumonia
97
Poor dental hygiene is associated with pneumonia caused by?
anaerobes
98
characterized by a more precipitous onset and fulminant course?
influenza pneumonia
99
Seen in community acquired pneumonia
lobar consolidation
100
apical infiltration is seen in?
TB
101
Transmission of vocal sounds through consolidation leads to the changes heard with _______________ .
Ephony
102
Consolidation would increase the transmission of vocal vibrations and manifest as increased ____________ .
Tactile fremitus
103
COPD, smokers, post-splenectomy?
Haemophilus influeza
104
College kids, sore throat, long prodrome
Chlamydia pneumoniae
105
Lobar consolidation is seen in ?
Community acquired pneumonia
106
What 3 things will a pt with pneumonia have on physical exam?
+ egophony
+ tactile fremitus
+ dullness to percussion
107
Txt for outpt therapy?
Doxycycline, Marcolides
108
Txt for inpt therapy?
Ceftriaxone + azithromycin, fluq
109
Why are macrolides used to txt mycoplasma pneumonia?
bc mycoplasma lacks a cell wall
110
Dx of viral pneumonia?
CXR bilateral interstitial infiltrates
111
Txt for viral pneumonia?
symptomatic oseltamivir (Tamiflu)
112
When must Tamiflu be given to treat influenza?
within 48hrs
113
Amantadine and Rimantadine treat only
influenza A
114
Txt for coccidioides?
flucanazole or itraconazole
115
Txt for cryptococcus?
Amp B
116
Mississippi or Ohio river valley
Histoplasma capsulatum
117
Txt for histoplasma?
Amp B
118
Txt for Pneumocystis Jiroveci?
Bactrim and steriods
119
Diffue intersitial or bilateral perihilar infiltrates?
Pneumocystis jiroveci
120
Txt for pneumocystis jiroveci?
Bactrim (Pentamidine if allergic)
121
Daily prophylaxis of choice for PJP?
Bactrim
122
DX for sleep apnea?
polysomnography in lab or home
123
Txt for sleep apnea?
CPAP
Oral appliance
Uvulopalatopharyngoplasty
Tracheostomy
124
Fever, night sweats, anorexia and weight loss
TB
125
> 5mm PPD?
cxr of past TB, immunocompromisted ex HIV, close contacts w/ infectous TB
126
>10mm PPD?
IV drug users, recent immigrants, prisons, homeless shelters, pt with DM, or those with gastro surgery
127
>15mm PPD?
Pts w/ no risk
128
Dx of TB?
3 sputum specimens for acid fast bacilli (AFB smears), and TB cultures
129
What does the cxr for TB look like?
cavitary lesions, infiltrates, ghon complexes in apex of lungs, caseating granulomas
130
What is miliary TB?
Tb spread outside the lungs
131
What is Potts dz?
Tb to spine
132
What is Scrofula?
Tb to cervical lymph nodes
133
What's next after a + TB test?
CXR
134
Txt for a neg TB cxr?
latent Tb- Isoniazid for 9 mo
135
What should a pt taking Isoniazid also take?
Supplemental Vit B6 (Pyridoxine)
136
What does Pyridoxine prevent in TB?
Neuropathy
137
sde of Isoniazid?
peripheral neuropathy
138
Txt for active TB?
RIPE
| Rifampin, Isoniazide, Pyrazinamide, Ethambutol
139
Sde of TB drugs?
hepatotoxic
140
Orange body fluids, hepatitis
Rifampin
141
Hyperuricemia (gout)
Pyrazinamide
142
Optic neuritis, red-green blindness
Ethambutol
143
What drug can cause reactivation of TB?
Etanercept
144
How long are TB pts treated?
Four drugs x 8 weeks
| 2 drugs x 16 weeks
