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Pulmonology > Test #2 > Flashcards

Test #2 Flashcards

(108 cards)

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1
Q

Croup causative agent

A

Parainfluenza virus

Can also be caused by:

RSV

Influenza virus

Adenovirus

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2
Q

Croup hallmarks

A

Occurs between 6 months and 3 years most commonly

URI sx with barking cough and stridor on inspiration with absent/low grade fever

Triggered by circaidian rhythms (happens @ night)

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3
Q

Croup treatment

A

Stridor at rest: Racemix epi via nebulizer

Steroids - Decadron (liquid or powder)

Barking, no stridor at rest: mist therapy, cold air to dilate bronchioles

Worse on 3rd day

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4
Q

Epiglottitis causative agent

A

Most commonly H. flu Type B

Can also be cause by Group A Strep

Worry about asplenic kids - encapsulated bacteria

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5
Q

Epiglottotis hallmarks

A

Drooling, muffled “hot potato” voice

“Cherry red spot” epiglottis, stoic child

Can have grunting or soft stridor

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6
Q

Epiglottitis treatment

A

Be ready to intubate

Call in pediatric anesthesia

Get STAT soft-tissue lateral portable xray

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7
Q

Bronchiolitis (in peds)

A

Inflammatory process of smaller, lower airways

Can proceed to respiratory failure -> death

Preemies or infants with congenital heart/chronic lung/immunodeficiencies at risk for more severe disease and poorer outcomes

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8
Q

Bronchiolitis presentation

A

Fever, URI sx, tachypnea, wheezing

WBC normal

CXR clear

Mucopurulent sputum is possible, usually always viral

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9
Q

Bronchiolitis causative agents

A

RSV

can also be caused by Adenovirus and parainfluenza

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10
Q

Bronchiolitis Treatment

A

Only effective agents are oxygen and Ribavirin (reserved for immunocompromised/severly ill/premature infants

Palivizumab (Synagis) - IM monoclonal Ab providing passive immunity against RSV

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11
Q

Pneumonia in kids

A

Most cases are viral, but unable to predict so usually tx w/ Abx

Bacterial pneumonia presentation is more abrupt

Viral often with prodrome

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12
Q

Pneumonia in kids - causative agents

A

Varies with age

Newborns: group B Strep, Listeria, Gram negatives (E. coli, Klebsiella_

After 3 months of age: Strep pneumonae

Adolescent: Mycoplasma

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13
Q

Pneumonia in kids - presentation

A

Varies more, can be as little as tachypnea

Bacterial: Sudden, rapid onset with shaking chills, higher fevers

Viral: prodrome of rhinorrhea, cough, low-grade fever, pharyngitis

Newborns: poor feeding, irritable early on but become stoic later, cyanosis, hypoxic

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14
Q

Pneumonia in kids - labs

A

WBC elevated

CXR is more variable than adults, typically lacks classic lobar consolidation

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15
Q

Pertussis

A

“Whooping Cough”

Highly communicable, not all vaccinated seroconvert - can lose immunity over time

Dangerous for small infants - respiratory distress from coughing is what kills them

Lasts 4-12 weeks

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16
Q

Pertussis causative agent

A

Bordetella pertussis (Gram negative, aerobic, encapsulated coccobaccilus)

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17
Q

Pertussus presentation

A

Insidious onset with URI sx, +/- slight fever, cough but not paroxysmal

Cough for weeks, becomes paroxysmal with classic “whoop” after 2 weeks - this lasts 2-4 weeks

Cough so hard they vomit

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18
Q

Pertussis labs

A

Nasal swab for culture (Bordet-Gengou medium)

Or nasal swab for PCR - more sensitive, results in 3-7 days

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19
Q

Pertussis Treatment

A

Tx while awaiting labs - only shortens cough if tx in early phase

Tx prevents further transmission

Erythromycin for 14 days

Azithromycin for 5-7 days

Pt can cough for 3 months - educate!

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20
Q

Pediatric Infectious Disease Pearls

A

Bronchiolitis - RSV w/ wide spectrum -> peaks ~6 months old

Difficult to distinguish bronchitis from pneumonia or bacterial from viral -> tx with Abx

Pertussis -> Tx w/ confirmed exposure, dont wait for labs

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21
Q

Cystic fibrosis pneumonia treatment

A

Aminoglycoside (cover pseudomonas)

Piperacillin/Ticarcillin (antipseudomonal PCN)

bronchodilators, O2 as needed, myolytics, possible steroids

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22
Q

Cystic fibrosis diagnostic tests

A

Sweat chloride testing

DNA Assay

IRT Assay

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23
Q

Cystic fibrosis

A

Autosomal recessive

Exocrine gland system disease

defective chloride channels -> highly viscous secretions

Causes both respiratory and pancreatic insufficieny

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24
Q

Cystic fibrosis treatment

A

Pulmonary: bronchodilators, mucolytics, steroids, Abx

Pancreatic: enzyme and vitamin supplements, high-caloric high-protein diet

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25
Cystic fibrosis morbidity
Progressive obstructive lung disease
26
Cystic fibrosis presentations
Meconium ileus (not passed w/in 24 hrs of birth) abdominal distention with thick, sticky meconium infantile failure to thrive, respiratory compromise, or both
27
Fetal lung development
Cannalicular stage - 16-25th week -\> lungs transition to viable Sacular stage - 24th week -\> gas exchange is now possible Surfactant delivered during 3rd trimester
28
Respiratory Distress Syndrome of Newborn
Commonly in preterm infants Due to pulmonary surfactant deficiency Inflammation, pulmonary edema, and hypoxemia also contribute 28 weeks and less at greatest risk
29
Respiratory Distess Syndrome of the Newborn Clinical manifestations
Tachypnea Nasal flaring Expiratory grunting Accessory muscle breathing Cyanosis Abnormal pulmonary function w/in 48 hrs post-birth
30
Respiratory Distress Syndrome of Newborns Treatment
Surfactant CPAP O2 Antinatal glucocorticoids
31
Acute bronchitis common causes
Viral (80-90% all cases) - usually influenza A and B Bacteria - strep pneumo, h-flu, Chlamydia and Mycoplasma Have to r/o Bordatela pertussis cause
32
Whooping cough organism and treatment
Bordatella pertussis Tx w/ a macrolide
33
Acute bronchitis Abx for \<65 yo, no cardiac disease, FEV1\> 50%, or \<3 exacerbations per year
Azithromycin - 500 mg PO day 1 - 250 mg PO x4 days Clarithromycin - 250-500 PO BID x7-14 days Doxycycline - 100 mg PO BID x7 days Bactrim (160/800) - 1 tab PO BID x10-14 days Cefuroxime - 250-500 PO q12 hrs x10 days Cefdinir - 300 PO BID x5-10 days Cefpodoxime - 200 PO q12 hrs x10 days Make sure to tx w/ alternative class if Abx use w/in 3 months
34
Acute bronchitis Abx for pts w/ COPD exacerbation, \>65 y/o
Consider hospitalization Augmentin - 1 tab PO BID x7-10 Fluroquinalones - Cipro if Pseudomonas risk
35
Latent TB treatment
Isonazid for 6-9 months -\>9 if HIV+ OR isonizaid + rifapentine for 3 months if HIV- OR isonizaid + rifampin for 3 months if HIV+
36
Active TB treatment
Isonazid + Rifampin + Ethambutol + Pyrazinamide for 2 months THEN Isonazid + rifampin for 4 months Increase tx to 9 months if sputum culture is not negative at 8 weeks
37
Aspergillosis
Commonly affect immunosuppressed Fungal spores found in soil/dead matter Hemopytsis, cough, fever, malasie, wheezing, weight loss CXR nonspecific
38
Aspergillosis treatment
Voriconazole Ampho B - watch for dizziness, N/V/D, SOB, fever, weight loss
39
Abx effective against bactera lacking a cell wall
Macrolides Imipenim
40
Pneumonias with a non-productive cough
Mycoplasma Chlamydia
41
CXR shows cavitary lesion and pleural effusions
H-flu Staph aureus Anaerobic TB
42
Legionella in lung
lower lobes
43
Klebsiella in lungs
upper lobes
44
HAP common bacteria
Pseudomonas Staph aureus Enterobacter Klebsiella E. coli
45
leukopenia sign of
sepsis
46
Intrapulmonary pressure
pressure w/in the alveoli becomes more negative with chest expansion to suck air into lungs
47
Intrapleural pressure
Negative pressure in the pleural space Keeps lungs flush against chest wall and eases chest wall expansion May be lost if fluid collects in pleural space -\> lung cannot fully expand
48
Light's criteria
Has to meet any one =\> exudative 1. Pleural fluid protein/serum protein ratio \> 0.5 2. Pleural fluid LDH/serum LDH \> 0.6 3. Pleural fluid LDH \> 2/3 lab normal serum LDH (~ \>200)
49
Benign pulmonary neoplasms
grow in fairly ordered manner stick together w/out migration encapsulated with smooth borders Hamartomas and granulomas
50
Hamartoma
local tissue grows in disorganized manner often have bronchial tissue and calcifications
51
Granuloma
chronic inflammatory lesions with macrophages TB, sarcoidosis, histoplasmosis, cryptococcosis
52
Most common metastatic to lungs
Breast Colon Prostate Bladder
53
Malignant cells
Tumors rapid growth w/ continuous division Little/no differentiation with most normal function lost Irregular, invasive borders that metastasize
54
Malignant cell spread routes
Transcoelomic Lymphatic Hematogenous Iatrogenic
55
Transcoelomic spread
Along the surface of an organ Mesothelioma
56
Lymphatic spread
Most common route for carcinomas
57
Hematogenous spread
Most common route for sarcoidosis
58
Iatrogenic spread
Transplantation or implantation
59
Small cell lung cancer (SCLC)
Primitive neuroendocrine cells Metstasizes early, commonly to brain (90%) Aggressive, rapidly fatal, few curable Highly prevelant among smokers
60
SCLC hormone production
Adrenocorticotrophic hormone (ACTH) Arginine vasopressin (AVP) Atrial natriuretic factor (ANF) Gastrin-releasing peptide (GRP)
61
Types of non small cell lung carcinomas
80% all lung cancers Adenocarcinoma Squamous cell carcinoma Large cell carcinoma Adenocarcinoma most common All have similar prognosis and treatment, but different locations and spread patterns
62
Adenocarcinoma
Associated w/ smoking, but also most common lung CA in never-smokers Peripheral -\> arises from epithelium May see metastatic dx before primary symptoms
63
Bronchoalveolar adenocarcinoma
subtype of adenocarcinoma More aggressive, rapidly progressive Occurs in young (2nd decade) - non-resolving focal/bilateral "pneumonia"
64
Squamous cell carcinoma
"Epidermoid carcinoma" Occurs in proximal bronchi - tends to obstruct local, infiltrating nest of tumor cells w/ central necrosis -\> cavitation late metastasis
65
Large cell carcinoma
Lest common, Dx of exclusion Large, poorly differentiated cellular mass w/ prominent necrosis Occurs peripherally Syncytial (multinucleate cytoplasmic mass) groups and single cells
66
Lung cancer commonly metastasizes to:
Brain Adrenals (50%) Liver(30-50%) Lymph node Bone
67
Routine lab test indicitave of metastatic disease
Hematocrit: \<40% men, \<35% women Elevated alkaline phosphatase, GGT, SGOT, and calcium levels
68
Horner's Syndrome
Miosis (smaller pupil), eyelid droop, and loss of sweating on one side of face Due to superior cervical ganglion lesion OR inflammatory involvement of cervical lymph nodes and proximal brachial plexus
69
Pancoast's Syndrome
Shoulder pain radiaing in the ulnar distribution Due to apex tumor extension to C8, T1, T2 nerves Rib destruction possible
70
Superior vena cava syndrome (SVCS)
Venous dilation 90% due to bronchogenic cancer Swelling of face/tongue/neck/arms, SOB, hoarseness, nasal congestion HA, syncopy, lethargy from cerebral edema
71
Pediatric Respiratory rate
Newborn: 30-50 Infant-12yo: 20-30 Adolescent (13+): 12-20
72
Pediatric Heart rate
Newborn: 120-160 Infant-5yo: 80-140 (120 5yo) 6-12 yo: 70-110 13+: 55-105
73
Pediatric Systolic BP
Newborn: 50-70 Infant (1-12mo): 70-100 1-12 yrs: 80-120
74
Paraneoplastic syndromes
Cachexia - common w/ NSCLC Hypercalcemia - common w/ squamous cell CA Hypertropic pulmonary osteoarthropathy - clubbing of fingers and toes
75
Eaton-lambert syndrome
Autoimmune response -\> proximal muscle weakness w/ depressed deep tendon reflexes usually occurs in lower extremities r/o Myasthenia gravis: strength should improve w/ serial effort
76
Solitary pulmonary nodule
Likely benign if \<5mm Likely malignant if \>3cm If likely benign - serial CT over 2 years - shouldnt grow If likely malignant - tissue bx & resect
77
Multiple pulmonary nodules
Usually malignant if \>1cm - usually mets If benign - infection, wegners, AV malformation, pneumoconiosis Pattern matters
78
Lung cancer workup
CBC, CMP, CXR, PFT Bronchoscopy or fine needle bx (for peripheral) Stage: CT, PET, MRI
79
TNM Staging
T = primary tumor, get location and size N = regional lymph node metastasis M = distant metastasis
80
Small cell lung cancer stages
1. Limited = confined to single hemi-thorax 2. Extensive = malignant pleural effusion or metastatic disease
81
Non small cell lung cancer stages
Stage 1 = confined to lung Stage 2 = spread to lung lymph nodes Stage 3 = spread to mediastinal lymph nodes - IIIA = lymph nodes on same side as lung - IIIB = wider spread Stage 4 = spread to other lobes or distal metastasis
82
Surgical lung cancer treatment
limited disease w/ resectable lesion lobectomy most effective w/ NSCLC
83
Chemotherapy lung cancer treatment
4-6 cycles recommended Drug combinations to kill cancer cells May lessen symptoms with widespread disease
84
Radiation lung cancer treatment
Mediastinum, node positive-limited stage disease High energy X-rays to kill cells Significant side effect - radiation pneumonitis in 15% Get PFTs first to ensure sufficient function
85
Targeted lung cancer treatment
Stop action of abnormal proteins that promote growth Avastin - prevents new blood vessel formation Tarceva - helps in NSCLC
86
Adjucant lung cancer treatment
Treatment w/ chemo/radiation/target therapy before or after surgery to prevent reoccurance
87
SCLC treatment
Limited stage: 4-6 cycles chemo w/ simultaneous radiation Extensive stage: chemo, consider radiation w/ painful bone mets or SVC syndrome Cranial mets are common - consider prophylactic radiation
88
NSCLC treatment
Stage 1: resect, consider adjucant tx Stage 2: resect w/ nodes, chemo +/- radiation Stage 3 - IIIA: radiation + chemo, consider resection IIIB: chemo +/- radiation Stage 4: chemo
89
Types of Respiratory failure
Type 1 - Hypoxia (pO2 \<60) Type 2 - Hypercapneia (pCO2 \>50)
90
Type 1 Respiratory failure reasons
1. low PiO2 - high altitute 2. Hypoventilation 3. Diffusion - pneumonia, fibrosis 4. Shunt - blood not getting oxygenated 5. V/Q mismatch - treat w/ O2 to differentiate from shunt - will respond
91
Type 2 respiratory failure reasons
Increased CO2 production (sepsis, fever, burn) Alveolar hypoventilation - reduced minute volume - increased dead space
92
Hypoxemia signs
Cyanosis Restlessness Confusion Anxiety Tachypnea
93
Signs of Hypercapnia
Dyspnea HA HTN Tachycardia w/ Tachypnea AMS
94
BiPAP good for what pts in emergency cases?
COPD and CHF
95
Danger signs of impending respiratory failure
Deteriorating mental status silent chest pulsus paradoxus CO2 retention Acidosis/Cyanosis/Hypoxemia
96
Acute asthma medical therapy
Albuterol - 4-8 puff MDI q20 mins for up to 4 hours Ipratropium bromide - 8 puffs MDI q20mins up to 3 hrs Methylprednisolone - 60-125 g IV Epinephrine - .3-.5 mg IM Terbutaline - .25 mg SQ q20 mins x3 doses DO NOT GIVE BOTH EPI AND TERBUTALINE
97
Emphysema predominant COPD exacerbation first complaint
Dyspnea appear uncomfortable, accessory muscle use
98
COPD Chronic bronchitis pts exacerbation first complaint
Chronic, productive cough Overweight and cyanotic, can appear comfortable
99
COPD Exacerbation treatment
Ipretropium MDI 4-8 puggs q1-2 hrs Albuterol 4-8 puffs q1-2hrs Corticosteroids - 30-40 prednisome, 125 methylprednisone May need NIPPV if severe, hypercapnic, acidemia
100
High altitude illness parameters
Moderate altitude - 8000-10000ft High altitude - 10,000-18,000 ft
101
High altitude sickness pathophysiology
Hypobaric hypoxic condition - fluid retention - vasoconstriction - pulmonary artery HTN - increased endothelial permeability - edema
102
High altitude illness management
Stop ascent/descend Supplemental O2 Axetazolamide (250 BID/TID) Dexamethasone (8mg loading, 4 mg q6hrs) Antiemetics
103
High altitude pulmonary edema (HAPE)
Most common fatal high-altitude ilness -occurs above 8,000 ft, usually 2-4 days after activity Dyspnea @ rest, cough, fatigue, HA
104
HAPE treatment
Hyperbaric tx 2,000 ft descent O2/CPAP Rest/warth Acetazolamide/dexamethasone Ascend no more than 2,000 ft/night
105
Carbon monoxide treatment
100% O2 for 4 hours Hyperbaric if severe/underlying illness/pregnant
106
Cyanide poisoning
Hard to confirm Consider in all pts w/ smoke inhalation and CNS/CV findings Can cause immediate respiratory arrest Increased lactate production with anion gap metabolic acidosis
107
Cyanide poisoning treatment
Inhaled and injected nitrites, injected sodium thiosulfate -promotes cyanide binding/excretion via kidneys 3-step kit CI w/ concomitant CO poisoning supplemental O2
108
Pneumothorax treatment
Needle decompression 16 G needle mid-clavicular line over 2nd rib

Pulmonology (2 decks)

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