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Pulmonology Error List Flashcards

(60 cards)

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1
Q

What is Pneumonia

A

Inflammatory, Infectious process in lower airways (alveolar)

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2
Q

What are the typical pathogens

A

Strep. Pneumo is most common

H.Flu, Moraxella, Staph. Aureus, Klebsiella

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3
Q

What should you associated with pneumonia and Klebsiella

A

Alcoholics and Aspirators

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4
Q

Sx of pneumonia with Typical pathogens

A

Abrupt onset of fever and chills, productive cough, purulent sputum and pleuritic chest pain
Tachypnea, Tachycardia, Crackles, Dullness to Percussion, Consolidation or Effusion, Bronchial breath sounds, Increased Tactile Fremitus

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5
Q

What sputum do you see with Klebsiella

A

Currant Jelly

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6
Q

What sputum do you see with Pneumococcus

A

Rust Colored

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7
Q

What do you see on CXR with Typical Pneumonia

A

Lobar/Segmental Infiltrates

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8
Q

Tx for Typical Pneumonia

A

Outpatient: Macrolides (Clarithromycin, Azithormycin) or Doxycycline
Inpatient: Ceftriaxone + Azithromycin or Fluroquinolones

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9
Q

What are pneumococcal Vaccines

A

PCV13: Childhood Vaccine
PPV23: Polyvalent Pneumococcal for adults (elderly or immunocompromised)
Seasonal Flu for workers, elderly, immunocompromised

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10
Q

What are common pathogens for Atypical Pneumonia

A

Walking Pneumonia
Mycoplasm is most common
Influenza, Chlamydia, Legionella, RSV

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11
Q

Where do you find Legionella

A

Contaminated Water Sources

A/C Units, Cooling Towers

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12
Q

What other sx is Legionella associated with

A

GI and Neuro sx

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13
Q

Sx of Atypical Pneumonia

A

Low grade fever, mild pulmonary sx, myalgias, mild headaches, non-productive cough
Scattered rales/rhonchi, consolidation less common

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14
Q

Dx of Atypical Pneumonia

A

Clinical

RSV and Influenza have rapid antigen test

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15
Q

What do you see on CXR with Atypical Pneumonia

A

Diffuse patchy infiltrates

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16
Q

Tx of Atypical Pneumonia

A

Usually self-limited
Bacteria: Erythromycin for Mycoplasma and Legionella
Tetracycline for Chlamydia
If influenza: Antivirals, Tamiflu, Zanamivir

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17
Q

What is the most common pathogen for nosocomial: Health Care Acquired Pneumonia

A

Pseudomonas is most common

Staph. Aureus

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18
Q

Tx for Health Care Acquired

A

Cefepime, Imipenem, Meropenem, Piperacillin-Tazobactam, Piperacillin

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19
Q

What is a Pulmonary Embolism

A

Thrombus in pulmonary artery or branches, most are from DVT

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20
Q

What is Virchow’s Triad

A

Stasis, Hypercoagulability, Intimal Damage

All 3 must be present for PE to occur

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21
Q

Sx of Pulmonary Embolism

A

Dyspnea, Pleuritic Chest Pain, Hemoptysis, Syncope, Hypoxia, Cyanosis, Tachycardia, Tachypnea
Positive Homan Sign (calf pain with dorsiflexion)

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22
Q

What are the different tests for PE

A

CXR: Westermark’s Sign (avascular markings distal to emboli site)
Hampton’s Hump: Wedge shaped infiltrate on CXR
EKG: Sinus Tachycardia and non-specific ST/T Changes
ABG: At first Respiratory Alkalosis, but Respiratory Acidosis with time
Helical CT, Pulmonary Angiogram, V/Q Scan, Doppler Ultrasound

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23
Q

What is the Gold Standard for PE dx

A

Pulmonary Angiogram

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24
Q

What is the first initial screening test for PE

A

Helical CT scan

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25
Tx of PE
Anticoagulation with Heparin, Warfarin for 3-6 months IVC filter Thrombectomy/Embolectomy
26
What is the workup for PE
Low Suspicion: D-Dimer If Negative: No PE If Positive: Do Helical CT High Suspicion: Helical CT If Normal: No PE Not sure: Pulmonary Angiogram or Lower Extremity Ultrasound Positive: Treat
27
How do you dx Lung Cancer
Bronchoscopy with Biopsy CT Guided Biopsy Cytology
28
Where does Lung Cancer Mets
Brain, Bone, Liver, Lymph Nodes, Adrenals
29
What are the categories for Lung Cancer
``` Non-Small Cell *Adenocarcinoma *Large Cell *Squamous Cell Small Cell ```
30
What is the deadliest lung cancer
Small Cell Carcinoma
31
What is the most common lung cancer
Non-Small Cell Carcinoma (Adenocarcinoma)
32
What is the most common lung cancer in non-smokers
Adenocarcinoma
33
Where is Adenocarcinoma
Peripheral | So tumor gets big before you start seeing sx
34
Where is Large Cell Carcinoma
Peripheral, very aggressive
35
Where is Squamous Cell
Central
36
What are features of Squamous Cell Carcinoma in lungs
Cavitary Lesions Hypercalcemia Pancoast Syndrome (Shoulder Pain, Horner's Syndrome due to compression of nerve, Atrophy of hands/arm Muscles) Horners: Miosis, Ptosis, Anhydrosis
37
What endocrine feature is seen with Squamous Cell Carcinoma in lungs
High Calcium due to PTHrp Low PTH with High Calcium Sx: Constipation, Irritable, Kidney Stones
38
Where is Small Cell Carcinoma in lung
Central
39
Sx of Small Cell Carcinoma of lung
Paraneoplastic: Lamber-Eaton, SIADH, Cushings Syndrome, Dermatomyositis, Clubbing, SVC Syndrome Lambert-Eaton: Muscle Weakness but gets better with use SVC Syndrome: Dilated Neck Veins, Facial Plethora, Prominent Chest Veins
40
What is Sarcoidosis
A Chronic Multisystemic inflammatory granulomatous disorder of unknown etiology Lung is most commonly affected AA in 20's-40's
41
Sx of Sarcoidosis
Dry, nonproductive cough, dyspnea, chest pain Hilar Lymphadenopathy Skin: Erythema Nodosum (tender, painful bumps under the skin, usually legs), Lupus Pernio, Maculopapular Rash Visual: Uveitis, Conjunctivitis Arrhythmias, Cardiomyopathies, Arthralgias, Fever, Malaise, Weight Loss
42
Dx of Sarcoidosis
``` Imaging: Non-Caseating Granulomas Tissue Biopsy: Noncaseating Granulomas CXR: Bilateral Hilar Lymphadenopathy PFT: Restrictive Pattern CT Scan: Hilar/Mediastinal Lymphadenopathy, Nodules, Ground Glass Opacities ```
43
Tx of Sarcoidosis
Observation due to spontaneous remission Oral Corticosteroids Methotrexate, NSAIDS
44
What is a Pleural Effusion
Abnormal accumulation of fluid in the pleural space
45
What defines a Transudate in a Pleural Effusion
Not due to infection Circulatory system fluid due to either increased hydrostatic and or decreased oncotic pressure Usually due to CHF, Nephrotic Syndrome, Cirrhosis
46
What defines an Exudate in a Pleural Effusion
Inflammation, has proteins, WBC, Platelets Occurs when local factors increase vascular permeability Lights Criteria *Pleural fluid protein: Serum Protein >0.5 *Pleural fluid LDH: Serum LDH >0.6 or Pleural Fluid LDH >2/3 upper limit of LDH
47
Sx of Pleural Effusion
Asymptomatic, Dyspnea, Pleuritic Chest Pain, Cough | Decreased Fremitis, Decreased breath sounds, Dullness to Percussion, Audible Pleural Friction Rub
48
Dx of Pleural Effusion
CXR: Menisucs, Lateral Decubitus is best | CT need to confirm empymea: Loculations
49
Tx of Pleural Effusion
Tx underlying Condition Thoracentesis is gold standard Fluid MUST be drained if empyema (pH
50
What is COPD
Progressive, Irreversible Airflow Obstruction | Loss of elastic recoil and increased airway resistance
51
RF for COPD
Smoking, Genetic (Alpha-1 Antitrypsin Deficiency)
52
What are the 2 categories of COPD
Chronic Bronchitis | Emphysema
53
What is Chronic Bronchitis
Increased airway resistance leads to airway obstruction, mucus plugging and mucociliary escalator destruction Productive cough for > 3 month for 2 consecutive years
54
Sx of Chronic Bronchitis
Rales, Rhonchi, Wheezing, Cor Pulmonale (peripheral edema, cyanosis) Severe V/Q Mismatch Blue Bloater
55
What is Emphysema
Abnormal permanent enlargement of terminal airspace Smoking leads to chronic inflammation which decreases protective enzymes Loss of elastic recoil and increased compliance leads to airway trapping
56
Sx of Emphysema
Accessory muscle use, tachypnea, prolonged expiration Hyperinflation, Hyperressonance, Decreased breath sounds Pink Puffers
57
What is the gold standard for Dx of COPD
PFT/Spirometry * Decreased FEV1 * Decreased FEV1/FVC
58
What are other ways to dx COPD
CXR: Hyperinflation, Flat Diaphragm, Vascular Markings EKG: Cor Pulmonale (RVH, RAE, RAD, Right sided HF)
59
Tx of COPD
Stop Smoking Oxygen is the only therapy to decrease mortality Bronchodilators (Anticholinergics like Triotropium Ipratoprium) SABA/LABA (Albuterol, Terbutaline, Salmetrol) Theophylline (in refractory cases) Corticosteroids
60
What is the most important step in management of COPD
Stop Smoking!

Internal Medicine (16 decks)

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