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Internal Medicine > Pulmonology High Yield > Flashcards

Pulmonology High Yield Flashcards

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1
Q

What is Asthma

A

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

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2
Q

What causes Asthma

A

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

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3
Q

Sx of Asthma

A

Dyspnea, Wheezing, Cough (especially at night)

Prolonged expiration with wheezing, hyperresonance, decreased breath sounds

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4
Q

What is the gold standard for dx of Asthma

A

PFT

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

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5
Q

What are other ways to dx Asthma

A

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

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6
Q

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

A

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

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7
Q

Dx and TX of intermittent Asthma

A

Day:

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8
Q

Dx and Tx of Mild Persistent Asthma

A 
Day: >2x/wk
Night: >2x/month
Tx: SABA + ICS
FEV >80%
ICS: Beclomethasone, Flunisolide, Triamcinolone
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9
Q

Dx and Tx of Moderate Persistent Asthma

A

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

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10
Q

Dx an Tx of Severe Persistent Asthma

A

Day: All day
Night: Nightly
FEV:

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11
Q

What are examples of SABA

A

Albuterol
Terbutaline
Epinephrine

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12
Q

What are examples of Anticholinergics

A

Ipratropium

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13
Q

What are examples of ICS

A

Beclomethasone, Flunisolide, Triamcinolone

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14
Q

What are examples of systemic steroids

A

Prednisone, Methylpredniosne, Prednisolone

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15
Q

What are examples of LABA

A

Salmeterol, Formoterol, Fluticasone/Salemetrol

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16
Q

What are examples of Mast Cell Modifiers

A

Cromyolyn

Nedocromil

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17
Q

What are examples of Leukotriene Modifiers/Receptor Antagonists

A

Montelukast, Zafirlukast, Zileuton

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18
Q

What is Pulmonary Hypertension

A

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

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19
Q

What are the different types of Pulmonary Hypertension

A

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

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20
Q

Sx of Pulmonary Hypertension

A

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

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21
Q

Dx of Pulmonary Hypertension

A

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

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22
Q

Tx of Pulmonary Hypertension

A 
Vasodilators
*CCB for primary
Phosphodiesterase 5-Inhibitors (Sildenafil/Viagra)
Prostacyclins
Endothelin Receptor Antagonists
O2, Anticoagulation
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23
Q

What is Bronchiectasis

A

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

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24
Q

What causes bronchiectasis

A

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

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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

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