Pulmonology High Yield Flashcards Preview

Internal Medicine > Pulmonology High Yield > Flashcards

Flashcards in Pulmonology High Yield Deck (81):
1

What is Asthma

Reversible Hyperirritability of tracheobronchial Tree
Trouble getting air OUT
FEV1/FVC

2

What causes Asthma

Airway Obstruction
Airway Hyperactivity
Chronic Airway Inflammation
Atopy is common: Wheezing, Eczema, Seasonal Rhinitis

3

Sx of Asthma

Dyspnea, Wheezing, Cough (especially at night)
Prolonged expiration with wheezing, hyperresonance, decreased breath sounds

4

What is the gold standard for dx of Asthma

PFT
Shows reversible Obstruction (increase RV, TLC, RV/TLC)

5

What are other ways to dx Asthma

Peak Expiratory Flow Rate
*PEFR>15% from initial attempt (response to treatment)
Pulse Oximetry

6

What are the steps in Bronchoprovocation to assess if Asthma is present

Metacholine Challenge Test (causes bronchospasms)
Bronchodilator Challenge Test (if >12% increase in FEV1 or >200cc)
Exercise Challenge Test (if >15% decrease in FEV1)

7

Dx and TX of intermittent Asthma

Day:

8

Dx and Tx of Mild Persistent Asthma

Day: >2x/wk
Night: >2x/month
Tx: SABA + ICS
FEV >80%
ICS: Beclomethasone, Flunisolide, Triamcinolone

9

Dx and Tx of Moderate Persistent Asthma

Day: Daily
Night: >1x/wk
FEV: 60-80%
Tx: SABA + higher dose of ICS

10

Dx an Tx of Severe Persistent Asthma

Day: All day
Night: Nightly
FEV:

11

What are examples of SABA

Albuterol
Terbutaline
Epinephrine

12

What are examples of Anticholinergics

Ipratropium

13

What are examples of ICS

Beclomethasone, Flunisolide, Triamcinolone

14

What are examples of systemic steroids

Prednisone, Methylpredniosne, Prednisolone

15

What are examples of LABA

Salmeterol, Formoterol, Fluticasone/Salemetrol

16

What are examples of Mast Cell Modifiers

Cromyolyn
Nedocromil

17

What are examples of Leukotriene Modifiers/Receptor Antagonists

Montelukast, Zafirlukast, Zileuton

18

What is Pulmonary Hypertension

Increased pulmonary vascular resistance leads to RVH and high right sided HF

19

What are the different types of Pulmonary Hypertension

Primary: Idiopathic
Secondary: Due to Left Heart, Due to Lung Pathology (COPD), Due o Chroic Embolic disease, Misc.

20

Sx of Pulmonary Hypertension

Dyspnea, Chest Pain, Weakness, Fatigue, Cyanosis, Syncope, Edema
Increased JVP, signs of right sided HF, RV Heave

21

Dx of Pulmonary Hypertension

Definitive: Right sided Cath
EKG: Cor Pulmonale (RVH, RAE, RAD, RBB)
CXR

22

Tx of Pulmonary Hypertension

Vasodilators
*CCB for primary
Phosphodiesterase 5-Inhibitors (Sildenafil/Viagra)
Prostacyclins
Endothelin Receptor Antagonists
O2, Anticoagulation

23

What is Bronchiectasis

This is when you get an obstruction further up the bronchial tree that leads to accumulation of sputum/mucus further down
Irreversible bronchial dilation secondary to transmural inflammation of bronchi
Destruction of muscular and elastic tissues, inflamed airways collapse easily
Obstruction of airflow and impaired clearance of mucous secretion leads to lung infections

24

What causes bronchiectasis

Chronic lung infections like H.Flu, Pseudomonas, Moraxella, CF

25

What is the most common cause of bronchiectasis

Cystic Fibrosis

26

Sx of Bronchiectasis

Daily chronic cough with thick, mucopurulent sputum
Hemoptysis
Persistent crackles at the base

27

Dx of Bronchiectasis

CT: Airway dilation, lack of tapering of bronchi, tram-track appearance (bronchial wall thickening)
See Signet Ring Sign (pulmonary artery coupled with dilated bronchus)
PFT: Obstructive Pattern (Low FEV1, Low FVC, Low FEV1/FVC

28

Tx of Bronchiectasis

Antibiotics
Empiric: Ampicillin, Amoxicillin, Bactrim
Pseudomonas: Fluoroquinolones, Zosyn, Aminoglycoside
Bronchodilators, Anti-inflammatory agents

29

What is Cystic Fibrosis

Autosomal recessive inherited disorder of defective CFTR protein
Prevents chloride transport (water movement out of cell), leads to buildup of thick, viscous mucus in lungs, pancreas, liver, intestines

30

Sx of Cystic Fibrosis

Young patient with bronchiectasis, pancreatic insufficiency, growth dealys and infertility
GI: Meconium Ileus at birth, Steatorrhea, Bulky pale/foul smelling stools, vitamin deficiency
Pulmonary: Recurrent URI, Dyspnea, Chest pain

31

Dx of Cystic Fibrosis

Elevated Sweat Chloride Test
CXR: Bronchiectasis, Hyperinflation of lungs
PFT: Obstructive pattern
Sputum Pattern

32

Tx of Cystic Fibrosis

Airway Clearance with bronchodilators, Mucolytics, Abx, decongestants
Pancreatic enzyme replacement
Vitamin Replacement: A, De, E, K

33

What is Acute Bronchitis

Inflammation of trachea/bronchi

34

What causes Acute Bronchitis

Viral (adenovirus, parainfluenza, Influenza, Coxsackie)

35

Sx of Acute Bronchitis

URI
Cough for more than 5 days

36

Dx of Acute Bronchitis

Clinical
CXR non-specific

37

Tx of Acute Bronchitis

Fluids, rest, antitussive agents, bronchodilators
Abx if immunocompromised, elderly, COPD

38

What is Idiopathic Pulmonary Fibrosis

Chronic Progression of intersitital scarring (fibrosis) from persistent inflammation
Results from loss of pulmonary function and restrictive component

39

What defines a restrictive disease such as Idiopathic Pulmonary Fibrosis

Decreased TLC, RV, Normal or Increased FEV1/FVC

40

Sx of Idiopathic Pulmonary Fibrosis

Dyspnea, Nonproductive cough
Fine babasilar inspiratory crackles, clubbing of fingers

41

Dx of Idiopathic Pulmonary Fibrosis

CXR/CT: Diffuse reticular opacities (Honeycombing), Ground Glass
Biopsy: Honeycombing (large cystic airspaces from CF alveolitis)

42

Tx of Idiopathic Pulmonary Fibrosis

Stop Smoking
Oxygen
Lung transplant is only cure

43

What is a Pneumoconiosis

Chronic fibrotic lung disease secondary to inhalation of mineral dust
Causes fibrosis and therefore restrictive lung disease

44

Where do people who get Silicosis work

Mining, Quarry, Granite

45

What do you see on CXR with Silicosis

Round nodular opacities in UPPER LOBES
Eggshell Calcifications of hilar and mediastinal nodes

46

Tx for Silicosis

Supportive, Steroids, Oxygen

47

What is the Black Lung

Coal Workers Pneumoconiosis

48

What do you see with Black Lung

Small upper lobe nodules with hyperinflation of lower lobes

49

What is associated with Asbestosis

Mesothelioma

50

What do you see on CXR with Asbestosis

Pleural Plaques
Interstitial Fibrosis (honeycombing) in LOWER LOBES

51

Tx for Asbestosis

Steroids, Oxygen, Stop Smoking

52

What is Mesothelioma

Originates from pleura, associated with Asbestos

53

Sx of Mesothelioma

Pleuritic chest pain, dyspnea, fever, night sweats, weight loss, hemoptysis

54

Dx of Mesothelioma

Pleural Biopsy via video assisted thorascopy

55

Tx of Mesothelioma

Pleurectomy, Resection, Radiation and/or Chemo

56

What is Bronchial Carcinoid Tumor

Rare neuroendocrine tumors characterized by slow growth, low METS

57

What neuroendorcrine abnormalities are seen with Bronchial Carcinoid Tumor

ACTH, ADH, MSH

58

Sx of Bronchial Carcinoid Tumors

SIADH, Cushings Syndrome, Hemoptysis
Carcinoid Syndrome: Makes serotonin, increased bradykinin and histamine leading to FLUSHING, tachycardia, bronchoconstriction, hemodynamic, Diarrhea

59

Dx of Bronchial Carcinoid Tumor

Otreotide
Pink to purple well-vascularized central tumor

60

Tx of Bronchial Carcinoid Tumor

Tumor Excision

61

What is a pneumothorax

Air within the pleural space
It increases positive pleural pressure which causes collapse of the lung

62

Who is more likely to get a Spontaneous Pnemothorax

Primary: Tall men in their 20's
Secondary: Underlying lung disease without trauma (COPD, Asthma)

63

What causes traumatic pneumothorax

CPR, Thoracentesis, PEEP, Sublclavian Lines, MVA

64

What is a Tension Pneumothorax

Positive air pressure pushes the lungs, trachea and heart to the contralateral side
Life Threatening

65

Sx of a Tension Pneumothorax

Increased JVP, Pulsus Paradoxus, Shift of trachea or heart to contralateral side

66

Tx of Tension Pneumothorax

Needle Aspiration first
Followed by Chest tube thoracostomy

67

Sx of a Spontaneous Pneumothorax

Chest pain, usually pleuritic and unilateral, Dyspnea
Increased Hyperresonance, decreased fremitius, decreased breath sounds, unequal respiratory expasion, Hypotension

68

Dx of Spontaneous Pneumothorax

CXR with Expiratory view
Decreased peripheral lung markings, may have copnanion lines, deep sulcus

69

Tx of Spontaneous Pneumothorax

Observation if small, will close spontaneously
Chest tube placement if large

70

Sx of TB

Gradual onset of fever, cough, weight loss, night sweats, dyspnea, blood tinged sputum

71

What pathogen causes TB

Mycobacterium Tuberculosis

72

Who are high risk populations for TB

Health Care Workers, Immigrants, Homeless, HIV

73

What is primary TB

Contagious
Active initial infectin with clinical progression, usually self-limited

74

What is Chronic (latent) TB

Patients who had primary TB that are controlled due to granuloma formation
Usually are PPD positive in 2-4 weeks after infection
Not Contagious

75

What is secondary (Reactivation) TB

Localized in apex/upper lobes with cavitary lesions
Patients are contagious

76

Dx of TB

PPD skin test
If positive CXR to confirm
>5mm if HIV Positive or immunosuppressed
>10mm in high risk populations (immigrants)
>15mm everyone else (no known RF)

77

What is the gold standard for Dx TB

Acid-Fast Smear and Sputum Cultures
Need 3 cultures

78

What are CXR findings with TB

Primary: Middle/Lower Lobes
Reactivation: Apical
Miliary: Millet-Seed

79

Tx of TB

RIPE
Rifampin, Isoniazid, Pyrazinamide, Ethambutol
RIPE for 2 months, followed by RI for 4 months

80

What are side effects of TB Drugs

Rifampin: Orange colored secretions
Isoniazid: Peripheral neuropathies, Hepatotoxicity
Pyrazinamide: Hyperuricemia
Ethambutol: Optic Neuropathy (red/green colorblindness)

81

How do you treat latent TB

Isoniazid and Pyridozinomide for 9 months