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Flashcards in Pulmonology Error List Deck (60):
1

What is Pneumonia

Inflammatory, Infectious process in lower airways (alveolar)

2

What are the typical pathogens

Strep. Pneumo is most common
H.Flu, Moraxella, Staph. Aureus, Klebsiella

3

What should you associated with pneumonia and Klebsiella

Alcoholics and Aspirators

4

Sx of pneumonia with Typical pathogens

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

5

What sputum do you see with Klebsiella

Currant Jelly

6

What sputum do you see with Pneumococcus

Rust Colored

7

What do you see on CXR with Typical Pneumonia

Lobar/Segmental Infiltrates

8

Tx for Typical Pneumonia

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

9

What are pneumococcal Vaccines

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

10

What are common pathogens for Atypical Pneumonia

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

11

Where do you find Legionella

Contaminated Water Sources
A/C Units, Cooling Towers

12

What other sx is Legionella associated with

GI and Neuro sx

13

Sx of Atypical Pneumonia

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

14

Dx of Atypical Pneumonia

Clinical
RSV and Influenza have rapid antigen test

15

What do you see on CXR with Atypical Pneumonia

Diffuse patchy infiltrates

16

Tx of Atypical Pneumonia

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

17

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

Pseudomonas is most common
Staph. Aureus

18

Tx for Health Care Acquired

Cefepime, Imipenem, Meropenem, Piperacillin-Tazobactam, Piperacillin

19

What is a Pulmonary Embolism

Thrombus in pulmonary artery or branches, most are from DVT

20

What is Virchow's Triad

Stasis, Hypercoagulability, Intimal Damage
All 3 must be present for PE to occur

21

Sx of Pulmonary Embolism

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

22

What are the different tests for PE

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

23

What is the Gold Standard for PE dx

Pulmonary Angiogram

24

What is the first initial screening test for PE

Helical CT scan

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!