Pulmonology Flashcards
(151 cards)
1
Q
Measurement of the volume of air that can be expelled from a maximally inflated lung
A
Force Vital Capacity (FVC)
2
Q
measurement of the volume of air that can be exhaled at the end of the 1st second
A
Forced Expiratory Volume in one second (FEV1)
3
Q
Auscultation sound described as snoring that may clear with cough: rattling low-pitch rumbling “Secretions”
A
Rhonchi
4
Q
Auscultation sound described as high-pitched popping: not cleared by cough: During inspiration
A
Crackles
5
Q
Auscultation sound described as whistling louder with expiration 2T narrow airways
A
Wheezing
6
Q
Loudest over the anterior neck 2T narrowing of the larynx or trachea. (Upper airway obstruction MC)
A
Stridor
7
Q
What is Samster’s Triad?
A
Asthma, Nasal polyps, and ASA/NSAID allergy
8
Q
Dx tool used if PFT is non-diagnostic
Bronchoprovocation with________
A
Bronchoprovocation
Methacholine
9
Q
Gold Standard for reversible obstruction
A
Pulmonary Function Test
10
Q
Best and most objective way to asses asthma exacerbation severity and Tx response
A
Peak Expiratory Flow Rate
11
Q
What PEFR % is considered responsive to treatment?
A
> 15% PEFR (Normal 400-600cc)
12
Q
Pulse Oximetry indicative of Respiratory Distress
A
SPO2 <90%
13
Q
Acute Exacerbation Admission criteria
A
- PEFR <50%
- <15% initial value (200cc)
- Revisit w/I 3 days of exacerbation
- Post-treatment failure
14
Q
Acute Asthma exacerbation Discharge criteria
A
- PEFR >70%
- PEFR >15%
- Adequate F/U w/i 24-72 hrs
15
Q
Asthma management anticholinergic/muscurinic that Inhibits vagal-mediated bronchoconstriction/ secretions
.
Synergistic B2 agonists and anticholinergics
A
Ipratropium
16
Q
1sts Line treatment for acute asthma exacerbations. Most effective and fastest within 2-5 min.
A
Albuterol or Terbutaline (B2 Agonist short acting)
17
Q
Anti-inflammatory: All but the mildest exacerbations should be discharged on a short course of these
A
Prednisone, Methyl prednisone, Prednisolone
Short course= 3-5 days
18
Q
Long-Term exacerbation medications (Chronic control)
A
- ICS
- LABA
- Mast Cell Modifiers
- Leukotriene receptor Antagonists (LTRA)
19
Q
Short-term exacerbation quick relief medications
A
- SABA
- Anticholinergics
- PO Corticosteroids
20
Q
Exacerbation treatment that inhibits mast cell and leukotriene mediated degranulation
Inhibits acute phase cold air and exercise response
A
Mast Cell Modifiers (Cromolyn)
21
Q
Exacerbation treatment that leukotriene-mediated neutrophil migration, capillary perm., M. contraction
Useful in asthmatics w allergic rhinitis/aspirin induced
A
LTRA (Montelukast or Zafirlukast)
22
Q
DOC for long term , persistent chronic maintenance.
Cytokine and inflammation inhibition
A
ICS (Beclomethasone/ Flunisolide/Triamcinolone
23
Q
Prevents symptoms especially nocturnal asthma. Used as a combo with ICS: not to be used alone.
A
LABA (Advair/ Salmeterol/Symbicort)
24
Q
Step down off LABA should be done if asthma control is maintained _________
A
> 3 months
25
Adjunct indicated in severe asthma acts as bronchodilator
IV Magnesium
26
Analgesic that has sedative and bronchodilator effects
Ketamine
27
Anti-Ige used in severe uncontrolled asthma
FEV1 <60%
Omalizumab
28
Bronchodilator that improves respiratory muscle endurance. similar to caffeine.
Toxicity causes arrhythmias/seizures.
Theophylline
29
Intermittent Asthma severity SABA use and Nighttime awakenings.
< 2x week SABA
| < 2x months at Night FEV1> 80
30
Mild Asthma severity SABA use and Nighttime awakenings. What %?
>2x week (not daily)
| 3-4x month at night FEV1> 80%
31
Moderate Asthma severity SABA use and Nighttime awakenings.
Daily SABA
| >1x week (not nightly) FEV1 60-80%
32
Severe Asthma severity SABA use and Nighttime awakenings.
Several a day SABA
| Nightly FEV1 < 60%
33
Asthma Daily Medication Step 1
SABA PRN
34
Asthma Daily Medication Step 2
- SABA
| - Low ICS or Cromolyn
35
Asthma Daily Medication Step 3
- SABA
- Low ICS
- LABA or LTRA
36
Asthma Daily Medication Step 4
- SABA
- Medium ICS
- LABA or LTRA
37
FEV1/FVC Obstructive pattern
1. FEV1/FVC <70%
2. FVC >80%
3. > 200cc or 15% with SABA (20% if Methacholine)
38
Disorder with loss of elastic recoil and increased airway resistance. Alpha 1 antitrypsin deficiency genetic link.
RF- smoking/Exposure 90%
COPD (Antitrypsin protects Elastin in lungs)
39
Abnormal permanent enlargement of the terminal spaces. PE-hyperinflation, Barrel chest, pursed lips.
Respiratory alkalosis (Acidosis in acute exacerbations). Pink and cachectic (
Emphysema
40
Gold Standard Dx for COPD
PFT/Spirometry
41
Productive cough >3 mos X 2 consecutive years is hallmark: Chronic inflammation. Rales/rhonchi/wheezing
Cyanosis and cor pulmonale. respiratory acidosis. Increased Hct. Cyanotic & obese
Chronic Bronchitis
42
Chronic Bronchitis Management
```
Corticosteroids
Oxygen- only that decreases mortality
Anticholinergics
Albuterol
Theophylline
```
43
COPD staging
FEV1 >80 Mild
FEV1 50-79% moderate
FEV1 30-50% Severe
FEV1<30% Very Severe
44
Irreversible bronchial dilation 2t transmural inflammation of bronchi. destruction of muscular/elastic tissues of wall
Recurrent chronic lung infections. Productive cough with foul smelling sputum. MCC of massive hemoptysis.
H. Influenza MCC
Bronchiectasis
45
Bronchiectasis Dx and Treatment
High Resolution CT
MAC- Clarithromycin + Ethambutol + Corticosteroids
Empiric- Ampicillin, Bactrim, Amoxicillin
(Pseudomonas MC= Fluoroquinolone)
Physiotherapy
46
Autosomal recessive defective transmembrane Receptor protein prevents Cl- transport out of cell.
Thick mucus buildup in lungs, pancreas, liver, intestines, and reproductive tract.
Cystic Fibrosis
47
Cystic Fibrosis clinical manifestations
- At birth Ileus
- Pancreatic insufficiency (Decr. ADEK absorption)
- Recurrent Respiratory infections
- Infertility
48
Cystic Fibrosis Dx and Treatment
Dx- Elevated sweat chloride Test (primary) Twice >60
DNA= Definitive
Tx- B2 Ag, mucolytics, Abx, ADEK vit. and vaccinations
49
Clinical manifestations include Dry cough, dyspnea, CP: BL Hilar nodes LAD: Erythema Nodosum, Lupus pernio
Anterior uveitis: Cardiomyopathies: Rheumatologic: Noncaseating granulomas.
Sarcoidosis
50
Chronic multisystemic inflammatory, granulomatous DO 2T exaggerated T cell response--> granulomas
Sarcoidosis
51
Sarcoidosis Dx and Tx
CT- Ground-glass Opacities and BL Hilar LAD
Tissue Bx= Non-caseating Granulomas
Management- Corticosteroids PO (TOC)
- Methotrexate (if CS refractory)
52
Chronic progressive interstitial scarring 2T persistent inflammation.
CXR- ground-glass opacities and Honeycombing
Idiopathic Fibrosing Interstitial Pneumonia
No effective treatment- Lung transplant
53
what is the Lofgren's syndrome triad for sarcoidosis
Erythema Nodosum
BL Hilar LAD
Polyarthralgias + Fever
54
Chronic Fibrotic lung disease 2T inhalation of mineral dust.
Pneumoconioses (Environmental Lung Disease)
55
Inhalation DO, 2T granite/slate/quartz/pottery sandblasting
Silicosis
56
Inhalation DO, 2T coal: CXR: small upper lobe nodules
Coal Worker's Pneumoconiosis
57
Inhalation DO, 2T electronics, ceramics, fluorescent light bulbs.
Berylliosis
58
Inhalation DO, 2T textile or cotton exposure
Byssinosis
59
Inhalation DO, 2T destruction/renovation of old buildings, insulation, or ship buildings. Pleural thickening
Asbestosis
60
Malignant Mesothelioma of the pleura
Asbestosis
61
Hypersensitivity pneumonitis from nitrogen dioxide gas exposure released from plant matter.
(Chute and base of a Silo) --> bronchiolitis obliterans.
Silo Filler Disease (N95 Mask)
62
Pneumonitis due to moldy hay exposure.
Farmer's Lung (Allergic Alveolitis/pneumonitis)
63
Tumor originating from the pleura due to chronic asbestos exposure. Poor prognosis if malignant.
Pleuritic CP, dyspnea, fever, night-sweats, hemoptysis.
Tx:?
Mesothelioma
TX: resection/radiation/Chemo
64
Acute inflammation of the costochondral, costosternal, or sternoclavicular joints. Common post viral infx/trauma
Pleuritic CP worse with coughing or certain limbs or Torso. TTP 2nd-5th Costochondral Jx.
Costochondritis
65
Acute inflammation of the costochondral, costosternal, or sternoclavicular joints. Common post viral infx/trauma
Positive palpable edema/swelling, heat, and erythema
Tietze Syndrome
66
Abnormal accumulation of fluid in the pleural space. Decreased fremitus, BS, and dullness on percussion
Lights criteria= > 0.5 protein, >0.6 LDH, <7.2 pH, < 40 glucose
Exudative Pleural effusion
67
MCC of Transudate Pleural Effusion > 90%
CHF
Nephrotic Syndrome, Cirrhosis, hypoalbuminemia
68
MCC of Exudative Pleural effusion
Infection/Inflammation
Malignancy
69
Positive Menisci sign means
Blunting of the costophrenic angles
70
DX for Pleural effusion is best done with a CXR positioned how?
Lateral decubitus on the affected side down
71
Pleural Effusion treatment
Thoracentesis= GS (exudative inject Streptokinase)
Pleurodesis= Malignant/Chronic (Talc/Doxy to obliterate)
72
Primary pneumothorax includes
Trauma (No underlying Lung disease)
73
Secondary Pneumothorax includes
PTX 2T Underlying Lung Disease (COPD/Asthma)
74
PTX during menstruation due to ectopic endometrial tissue in the pleura?
Catamenial Pneumothorax
75
Tension pneumothorax TRIAD
JVD, Pulsus Paradoxus, and hypotension
76
Management of small primary spontaneous PTX
What is the percentage/measurement?
Observe at least 6 hours then repeat CXR
(Resolves w/I 10 days w O2 absorbs 3-4x faster)
<15-20% or = 2-3 cm between chest wall and lung
77
Tension PTX Tx?
Needle Aspiration- 2nd ICS MCL--> Chest tube
78
Pulmonary nodule: Mediastinal Tumor MC
Thymoma
79
Malignant Pulmonary nodule presentation
- Irregular
- speculated
- Rapid growing (Double in 4mos)
- Cavitary with thickened walls
80
Nodule < 5% probability of malignance in <50 yoa patient w/o smoking Hx. Tx?
Otherwise >5% and smoker >50 yoa?
Observation
Dx- Needle aspiration or bronchoscopy Tx- Resection
81
Pulmonary Nodule that May secrete serotonin, ACTH, ADH, melanocyte stimulating hormone. MC < 60 YOA
Diarrhea (serotonin), Flushing, and Tachychardia 2T A-H1 and Incr. Bradykinin
Bronchial Carcinoid Tumor
82
Pink to purple well vascularized central tumor in bronchoscopy =
Tx
Bronchial Carcinoid Tumor
Excision Sx
83
MCC of cancer death in Men and women. MCC smoking
| Greatest tendency to METS to brain, bone, liver, LAD
Bronchogenic Carcinoma
84
Bronchogenic Carcinomas include
NSCC- Adenocarcinoma, Squamous cell, Large cell
Small Cell Carcinoma (Oat Cell)-
85
Metastasizes early: Central and aggressive: Mets at presentation--> Chemotherapy is TOC
Central, Cabronado, Chemotherapy,
Hyponatremia and SIADH
Small Cell Carcinoma
86
Centrally located, cavitary lesions, Calcinosis, Pancoast tumor (CCCP). Treatment?
Hemoptysis and maybe picked up on sputum cytology
Squamous Cell
TOC= Surgical Resection
87
MC type of NSCC in smokers, women and non-smokers
35%.
Peripheral with voluminous sputum production
NSCC- Adenocarcinoma
88
Most aggressive and 2nd MC NSCC?
Large Cell Carcinoma (Anaplastic)
89
Shoulder pain, cervical cranial sympathetic compression (_____) syndrome, atrophy of hand arm m.,
+ superior sulcus tumor
Pancoast Tumor Syndrome
90
Horner's Syndrome includes
Anhidrosis, Ptosis, and miosis
91
Dyspnea, Pleuritic CP (70%), hemoptysis, MC post-op with sudden tachypnea? Lung auscultation ML normal
Pulmonary Embolism
92
PE MC symptom and MC sign
Symptom is Dyspnea
Sign- Tachypnea
93
Pulmonary Embolism ordered if high suspicion and negative CT/or VQ scan: Dx Gold standard
Pulmonary Angiography
94
Best initial test for suspected Pulmonary Embolism
Helical CT scan
95
If CT scan contraindicated then use
VQ scan (Low Probability use only)
96
Most Common ECG changes in PE
Tachycardia and nonspecific ST/T changes
97
Most specific ECG changes for PE
S1Q3T3
98
Pulmonary Embolism management Hemodynamically stable? If ____ treatment is CI?
IF UFH or SQ LMWH
PO Warfarin or Novel Oral AC (Apix/Rivax/Edox-aban
CI-AC/unsuccessful= IVC Filter
99
Pulmonary Embolism management Hemodynamically un-stable?
```
Thrombolytic Tx (Strepto/Uro-Kinase or Alteplase)
[Preferred over embolectomy]
```
Embolectomy Tx- If thrombolytic CI
100
Antidote for Coumadin is?
Vitamin K (Extrinsic II, VII, IX, X) [Monitor INR 2-3]
101
Antidote for LMWH is ?
Protamine Sulfate (Intrinsic) [CI: in renal failure]
Lower Risk of HIT (HIT incr. with UFH and monitor PTT 1.5-2.5)
102
Must be overlapped with Heparin for at least 5 days?
Coumadin
103
PE prophylaxis
Early Ambulation
Elastic stockings/Pneumatic compressions
LMWH
104
PERC criteria
< 50 yoa
Pulse <100
O2 sat >95%
No prior PE
105
Pulmonary Hypertension Mean Pulmonary Arterial Pressure?
>25mmHg (normal= <20 mmHg or 30mmHg during ex.)
106
MCC of primary Pulmonary HTN?
idiopathic MC in middle aged or young women
107
MCC of secondary Pulmonary HTN?
COPD
Sleep apnea, PE, Metabolic
108
Pulmonary HTN DX and Tx?
Dx- Right Sided heart catheterization GS
CBC= Policythemia and Incr. Hct
Tx- Nitric Oxide, Adenosine, CCBs
Secondary- Tx COPD with O2
109
MCC and 2nd MCC of Community Acquired Pneumonia
(CXR=Lobar): "Rusty Blood Tinged"
COPD and Cystic Fibrosis
Strep Pneumonia
H. Influenza 2nd MCC
110
MCC of Atypical Pneumonia. (CXR=Diffuse and Patchy)
Military recruits and college
Mycoplasma Pneumoniae (Walking)
111
Related to contaminated water supplies.
"Currant-Jelly"
increased LFTs, hyponatremia, NVD, anorexia
Legionella (Urine Testing Ag PCR)
112
Pneumonia Often seen after a viral illness:
Hematogenous spread in IVDU, immunoincomp, elderly
Staphylococcus Aureus
113
Pneumonia seen in aspirators, alcoholics, and assoc with cavitary lesions
Klebsiella (Aspiration = Anaerobes)
114
Seen in Cystic Fibrosis, Immuno comp., HIV, transplant
Pseudomonas Aeruginosa
115
MC viral Pneumonia in infants and children
RSV and Parainfluenza
116
MC viral pneumonia in adults
Influenza
117
MC Pneumonia in Transplants and Aids
CMV
118
MC pneumonia with fungal or parasites immunocompromised patient
Pneumocystis Jirovecii
119
CAP Pneumonia Tx
Macrolide (Azithromycin) or Doxycycline 1st Line (Out-Pt)
B-LactamAmoxicillin-Clavunate/Amp-sulbactam + Macrolide Azithromycin (In-Pt) or Doxy or FQ (Levo)
120
CAP in ICU
B-LactamAmoxicillin-Clavunate/Amp-sulbactam + Macrolide Azithromycin (In-Pt) or
FQ (Levo) + B-Lactam
121
HAP Tx Pseudomonas? MRSA? Legionella
Pseudomonas- FQ (Levo) + B-Lactam
MRSA- Linezolid + Vancomycin
FQ (Levo) + Azithromycin
122
Pneumococcal Vaccines
PCV13= 13 Ag used in childhood
PPSV23= 23 MC serotypes >2-64 w chronic dz
for >65 yoa
123
Chronic Lung infection leading to granuloma formation.
Inhalation of airborne droplets.
night sweats, fevers/chills, weight-loss, anorexia, fatigue
Tuberculosis
124
Outcome of infection leads to caseating granulomas.
Become PPD positive 2-4 weeks post infx.
Not contagious
Chronic (Latent) Tuberculosis
125
Reactivation of TB with waning immune defenses: MC localized at apex/upper lobes w cavitary lesions
Patients are contagious
Secondary Reactivation TB
126
Outcome of initial TB infection. Rapidly progressive. Patients are contagious
Primary TB
127
Extra pulmonary TB if in Vertebrae=_____
| if in LAD = ________
Pott's Disease (Vertebrae TB)
Scrofula (LAD)
128
TB PPD screening mm size
>/= 5mm: HIV, TB Pt contact, CXR TB
>/= 10mm: High risk contact
>/= 15mm: everyone else
129
TB DX studies
Acid Fast Smear sputum Cx X 3 days- yearly for active
CXR- exclude Active (+) PPD and Screen yearly active
Interferon Gamma Release Essay- Not BCG Vax affected
130
Active TB Tx
RIPE X2 mos (Active 6 mos)
Rifampin- Orange secretions
Isoniazid- Peripheral Neuropathy (Pyridoxine B6)
Pyrazinamide- Rash (photosensitive)
Ethambutol- Optic neuritis (Color blind)
Streptomycin- ototoxicity (aminoglycoside)
131
Latent TB Tx
INH + Pyridoxine 9 mos
HIV= INH + Pyridoxine X12 mos
132
MCC pathogen of Laryngotracheitis (Croup)
Parainfluenza virus Type 1
133
MCC pathogen of Acute Epiglottitis (Supraglottitis)?
Haemophilus Influenza B
134
MCC pathogen of Pertussis Whooping cough?
Bordetella Pertussis
135
Highly contagious cough infection. MC in <2yo Manifests in three stages. Resolution may last 6 wks
Coughing fits with inspiratory whooping. DX- Nasal Swab PCR: Lymphocytosis > 50K: DOC for treatment ?
Pertussis (Whooping cough)
Nasal Swab=GS DX
Azithromycin/Erythromycin (Macrolide)
136
Inflammation MC 2T viral infx of upper airway. Barking cough hoarseness. worse at night. Virus: steeple sign.
Tx? Mild-Mod-Severe
Laryngotracheitis(Croup)
(Racemic Epi)
Tx- Mild= Dex, air mist, hydrate: MOD-Sev- Dex- Epi, Dex
137
Manifestation of Dysphagia, Drooling, and distress 3Ds.
Muffled voice, tripoding, inspiratory stridor. 3mos-6 yo
Dx- Laryngoscopy (cherry red). X-ray- Thumb print sign.
TX?
Acute Epiglottitis (Supraglottitis)
Tx: Supportive Airway is "Mainstay" Ceftriaxone + Dex
Cefotaxime
138
Pertussis stage where patient is most contagious?
Catarrhal Phase
139
Pertussis stage with severe cough fits w emesis?
Paroxysmal phase
140
Pertussis phase with resolution of cough? (up to 6 wks)
Convalescent Phase
141
Inflammation of tracheal/bronchi: often follow URI. MCC is Adenovirus. Hallmark is cough for 1-3 weeks.
Tx:
Acute Bronchitis
Tx: Symptomatic (ABX= Immunocomp or >7-10 days)
142
Inflammation of the bronchioles: LRI of the small airways. infants <2 YOA MC affected. --> Resp. Distress
Tx:
Acute Bronchiolitis
Tx: Humid O2, B-Agonist, racemic epi, (Ribavirin- immu)
"No Steroids"
143
Acute Bronchiolitis MCC
Respiratory Syncytial Virus
144
Irreversible bronchial dilation 2t transmural inflammation of bronchi. destruction of muscular/elastic tissues of wall
Recurrent chronic lung infections. Productive cough with foul smelling sputum. MCC of massive hemoptysis.
H. Influenza MCC
Bronchiectasis
145
Abrupt onset of Fever, chills, malaise, Myalgias (Legs/Lumbosacral area), pneumonia, pharyngitis.
Dx: Nasal swab or viral culture
Tx:?
Influenza
Tx: W/I 48 hrs onset= Olseltamivir/Zanamivir
Ribavirin= covers A n B
146
Recommended population influenza vaccine
>/= 65 yoa (Indicated >6mos
Asthma, COPD, Sickle cell, DM
Influenza contacts
147
Inflammatory lung injury 2T cytokines. MC developed in critically ill patients (MCC Sepsis). --> acute Resp Failure
dx- catheterization of Pulmonary artery PCWP of ____
"swan-Ganz"
Tx:
Acre Respiratory Distress syndrome
Dx- Capillary wedge pressure <18mm Hg (12-18mmHg)
Tx- Positive end Expiratory Pressure (PEEP) PaO2>55 mmHg
148
What are the three main components of ARDS
1. Severe refractory hypoxemia
2. BL Infiltrates on CXR
3. Pulmonary edema/CHF absence (PCWP<18 mmHg)
149
Sleep Apnea 1st Line Dx ?
In-Lab Polysomnography (>/= 15 events/hr)
Tx- CPAP
150
Acid Base disorders step approach
1. pH > 7.45 or < 7.35
2. PCo2 Opposite=Resp/ same=Met (35-45)
3. HCO3- (22-26)
151
Anion GAP formula is
AG= Na- (Cl- (+) HCO3-) (10-12 normal)
