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DSE > Pulmonology, part 3 > Flashcards

Pulmonology, part 3 Flashcards

1
Q

Pneumoconiosis/silicosis

A

Lung dz caused by inhalation of mineral dust.

Silicosis is caused by inhalation of dust containing crystalline silica

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2
Q

Pathophys of silicosis

A

Small particles are dangerous because they deposit distally in the bronchiole, ducts, and alveoli. The inflammation leads to fibroblast and collagen formation that leads to fibrosis

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3
Q

Other causes of pneumoconiosis

A

Asbestosis
Coal dust
Other chemical exposures

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4
Q

Occupation risk for pneumoconiosis

A 
Mining or tunneling
Quarrying
Drilling
Crushing stone
Chipping
Grinding/sandblasting
Pottery or stone work
Cement manufacturing
Masonry
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5
Q

Tx of pneumoconiosis

A 
Prevent exposure
Quit smoking
Immunize- flu and pneumococcal
No known cure
Lung transplant for severe pt
Treat complications (airflow obstruction, cor pulmonale, resp failure)
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6
Q

Silicosis sx

A 
SOB
Fever
Bluish skin at the earl lobes or lips
As the dz progresses:
Fatigue
Extreme shortness of breath
Loss of appetite
CP
Respiratory failure
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7
Q

Respiratory distress syndrome

A

Used to be called hyaline membrane disease
An acute lung dz caused by surfactant deficiency.
Seen in neonates <36 wks gestation and weighing <3 lbs

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8
Q

Prognosis of resp distress syndrome

A

Outcome has improved with use of antenatal steroids to improve pulm.
Maturity, early postnatal surfactant tx, and gentle techniques of ventilation to reduce barotrauma to the immature lungs

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9
Q

F/u of respiratory distress syndrome

A

Support IV nutrition within 24 hrs of birth once breathing is stabilized
Prevent hypothermia with a double-walled incubator
Start oral feedings with small feedings through an orogastric tube as soon as tolerated
Support circulatory status which may require blood transfusion
Start abx in all infants who present with resp distress at birth after BCx are drawn. D/c within 2-5 days if cultures are neg

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10
Q

Cause of immune compromise/fungal PNA

A

Candida
Aspergillus
Cryptococcus

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11
Q

Complications of fungal PNA

A

Disease dissemination to other sites

Blood vessel invasion, which can lead to pulmonary hemoptysis

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12
Q

Conditions that predispose pts to immune compromise/fungal PNA

A 
Leukemia
Lymphoma
Bone marrow transplant
Organ transplant
Prolonged high-dose steroids
HIV
Congenital immune deficiency syndrome
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13
Q

Tx for immune compromise/fungal PNA

A

Amphotericin B- treat for Histoplasmosis, Coccidiodomycosis, Cryptococcosis, Candidiasis
-Then azoles after improvement
Itraconazole- treat Blastomycosis

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14
Q

When is viral PNA more common?

A

Childhood PNA

Elderly

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15
Q

What are the four most frequent viruses in PNA?

A

Influenza
RSV
Adenovirus
Parainfluenza

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16
Q

Presentation of viral pneumonia

A 
Fever
Chills
Nonproductive cough
Rhinitis
Myalgias
HA
Fatigue
17
Q

PE of viral PNA

A 
Wheezes
Crackles
Increased fremitus
Bronchial breath sounds
Rapid antigen detection of viruses can be ordered along with viral culture
18
Q

Tx of viral pneumonia

A

Tamiflu for influenza A and B
Ribavirin used for RSV PNA
Cidofovir is being studied for adenovirus
Ribavirin has shown some benefit with parainfluenza

19
Q

What is the MC opportunistic infection in persons with HIV infection

A

Pneumocystis carinii pneumonia

20
Q

Tx of PCP

A

Abx are primarily recommended and TMP-SMX has been shown to be as effective than IV abx

21
Q

Mortality rate of PCP and tx duration

A

10-20% in pts with HIV infection

Tx with TMP-SMX is 21 days

22
Q

Smear of PCP

A

Crinkled cyst with a crushed ping pong shape

23
Q

Air entrance in pneumo

A

Air can enter the intrapleural space through a communication from the chest wall or through the lung parenchyma across the visceral pleura

24
Q

When does primary spontaneous pneumo?

Secondary?

A

Occurs in people without underlying lung dz and in the absence of an inciting event
Occurs in pts with a wide variety of lung dz

25
Q

What lung cancer accounts for about 85% of all lung CA?

A

Non-small cell lung CA

26
Q

How is non-small cell lung cancer further divided?

A

Adenocarcinoma
Squamous cell carcinoma
Large cell carcinoma

27
Q

Progression of non-small cell lung cancer

A

Often insidious, and it may produce no sx until well advanced

28
Q

Small cell lung CA

A

A neuroendocrine carcinoma that is aggressive with rapid growth, early spread, but sensitive to chemo and radiation

29
Q

Spread and consequences of small cell lung CA

A

Spread to adrenal glands and brain

Can also cause SIADH and the syndrome of ectopic ACTH production

30
Q

Hx/PE of non-small cell lung CA

A 
Most are asymptomatic in early stages
Wt loss
Only subtle findings on exam
Check supraclavicular nodes
Hemoptysis
SOB
Wheezing
SVC obstruction
Horner syndrome
31
Q

Hx/PE small cell lung CA

A 
95% asymptomatic at presentation
SOB
Cough
Bone pain
Wt loss
Fatigue
Neurologic dysfunction
32
Q

RFs for lung CA

A 
Quit smoking
Asbestos exposure
Radon exposure
Chromium, nickel exposure
Vinyl chloride exposure
33
Q

Lung CA work up

A 
CXR PA and lateral
Sputum cytology
Bronchoscopy
Chest CT
CBC with diff
CMP
PFT
PET scan to determine metastasis
34
Q

Tx/prognosis of non-small cell lung CA

A

Stage I and II: surgical resection then chemo
Stage III: Chemo radiotherapy and surgical resection
Stage IV: Cisplatin-based chemo. Surgical resection if solitary metastatic lesion along with resectable primary tumor
Prognosis: 5 yr survival rate 50-70% Stage I-IIA
Stage II_IV: 5-15%

35
Q

Tx/prognosis of small cell lung CA

A 
Cisplatin + etoposide
Early stage I may benefit from surgical resection, then chemo
Prognosis: 
Stage I-IIA: 40%
Late stages: <5%
36
Q

What types of pulmonary nodules are considered masses?

A

> 3 cm and are treated as malignancies until proven otherwise

37
Q

Why do nodules need to be investigated?

A

To answer:
Is the nodule benign or malignant?
Should it be investigated with bx or observed?
Should it be surgically removed?

38
Q

What constitute most benign nodules?

A

Adenomas and hamartomas

39
Q

What does a nodule have to be to be identified on a CXR?

A

> 1 cm

DSE (14 decks)

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