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Clinical Medicine > Test 2 - Pulmonary > Flashcards

Test 2 - Pulmonary Flashcards

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1
Q

EOD Asthma

A
  1. Episodic/chronic Sx of airflow obstruction
  2. Reversibility of airflow obstruction, either spontaneously or following bronchodilator therapy
  3. Sx usually worse at night or in early morning
  4. Prolonged expiration & diffuse wheezes on physicals
  5. Limitation of airflow on PFT or +bronchoprovocation challenge
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2
Q

EOD COPD

A
  1. Hx of smoking
  2. Chronic cough, dyspnea & sputum production
  3. Rhonchi, dec. intensity of breath sounds & prolonged expiration on physical
  4. Airflow limitation on PFT that is not fully reversible & most often progressive
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3
Q

EOD Bronchiectasis

A
  1. Chronic productive cough w/ dyspnea & wheezing

2. Radiographic findings of dilated, thickened airways & scattered, irregular opacities

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4
Q

EOD Cystic Fibrosis

A
  1. Chronic or recurrent productive cough, dyspnea & wheezing
  2. Recurrent airway infections or chronic colonization w/ H influenza, P aeroginosa, S aureus or Burkholderia cepacia. Bronchiectasis & scarring on CXR
  3. Airflow obstruction on spirometry
  4. Pancreatic insufficiency, recurrent pancreatitis, distal intestinal obstruction syndrome, chronic hepatic disease, nutritional deficiencies, or male urogenital abnormalities
  5. Sweat Cl concentration >60 on two occasion or gene mutation
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5
Q

EOD Bronchiolitis

A
  1. Insidious onset of cough & dyspnea
  2. Irreversible airflow obstruction on PFT
  3. Minimal findings on CXR
  4. Relevant exposure or risk factor: toxic fumes, viral infections, organ transplantation, connective tissue disease
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6
Q

EOD Interstitial Lung Disease

A
  1. Insidious onset of progressive dyspnea & non-productive chronic cough
  2. Tachypnea, small lung volumes, bibasilar dry rales
  3. Digital clubbing & RHF w/ advanced disease
  4. CXR w/ low lung volumes & patchy distribution of ground glass, reticular, nodular, reticulonodular or cystic opacities
  5. Reduced lung volumes, pulmonary diffusing capacity & 6-min walk distance, hypoxemia w/ exercise
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7
Q

EOD Sarcoidosis

A
  1. Sx related to lung, skin, eyes, peripheral nerves, liver, kidney, heart & other issues
  2. Demonstration of noncaseating granulomas in a Bx
  3. Hepatosplenomegaly, hypercalcemia, inc. ACE
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8
Q

EOD Community Acquired Pneumonia

A
  1. Fever or hypothermia, tachypnea, cough w/ or w/o sputum, dyspnea, chest discomfort, sweats or rigors
  2. Bronchial breath sounds or inspiratory crackles
  3. Parenchymal opacity on CXR
  4. Occurs outside of the hospital or w/in 48 hrs of hospital admission in a Pt not residing in a long-term care facility
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9
Q

EOD Nosocomial pneumonia

A
  1. At least 2 of: fever, leukocytosis, purulent sputum
  2. New or progressive parenchymal opacity on CXR
  3. Especially common in Pts requiring intensive care or mechanical ventilation
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10
Q

EOD anaerobic pneumonia & lung abscess

A
  1. Hx or predisposition to aspiration
  2. Indolent Sx, including fever, wt loss, malaise
  3. Poor dentition
  4. Foul-smelling purulent sputum
  5. Infiltrate in dependent lung zone, w/ single or multiple areas of cavitation or pleural effusion
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11
Q

EOD Pulmonary Tuberculosis

A
  1. Fatigue, Wt loss, fever, night sweats & productive cough
  2. Risk factors for acquisition of infection: household exposure, incarceration, drug use, travel to an endemic area
  3. CXR - pulmonary opacities, most often apical
  4. Acid-fast bacilli on smear of sputum of sputum culture + for M tuberculosis
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12
Q

EOD Pulmonary Disease caused by Non-TB Mycobacteria

A
  1. Chronic cough, sputum production & fatigue; less commonly malaise, dyspnea, fever, hemoptysis & wt loss
  2. Parenchymal opacities on CXR, often w/ thin-walled cavities that spread contigously & often involve overlying pleura
  3. Isolation of non-TB mycobacteria in a sputum culture
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13
Q

EOD Histoplasmosis

A
  1. Linked to bird droppings & bat exposure, common along river valleys
  2. Most asymptomatic, respiratory illness most common problem
  3. Widespread disease common in AIDs or other immunosuppressed states w/ poor prognosis
  4. Bx of affected organs w/ culture or urinary polysaccharide antigen
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14
Q

EOD Coccidiodomycosis

A
  1. Flu-like illness w/ malaise, fever, backache, HA & cough
  2. Erythem nodosum common w/ acute infection
  3. Dissemination may result in meningitis, bony lesions or skin & soft tissue abscesses
  4. CXR findings vary from pneumonitis to cavitation
  5. Serologic tests useful, spherules containing endospores demonstrable in sputum or tissues
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15
Q

EOD Pneumocystosis (PCP)

A
  1. Fever, dyspnea, nonproductive cough
  2. Bilateral diffuse interstitial disease w/o hilar adenopathy by CXR
  3. Bibasilar crackles on auscultation in many cases
  4. Reduced pO2
  5. P jiroveci in sputum, bronchoalveolar lavage fluid or lung tissue
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16
Q

EOD Aspergillosis

A
  1. MCC of non-candidal invasive fungal infection in stem cell or organ transplant Pts
  2. Predisposing factors: leukemia, bone marrow or organ transplant, late HIV infection
  3. Pulmonary, sinus & CNS are most common disease sites
  4. Demonstration of galactomannan or beta-D-glucan in serum or other body fluid samples is useful for early Dx & Tx
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17
Q

EOD Respiratory Syncytial Virus & Other Paramyxoviruses

A
  1. RSV is a major cause of morbidity & mortality at extremes of age
  2. Care is supportive
  3. A monoclonal antibody against RSV, palivizumab, is good but expensive prophylaxis among Pts w/ certain at-risk pulmonary conditions
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18
Q

EOD Seasonal Influenza

A
  1. Abrupt onset w/ fever, chills, malaise, cough, coryza & myalgias
  2. Aching, fever & prostration out of proportion to catarrhal Sx
  3. Leukopenia
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19
Q

EOD Avian Influenza (H5N1)

A
  1. Mostly from SE Asia & Egypt
  2. Clinically indistinguishable from influenza
  3. Rapid antigen assays to confirm Dx
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20
Q

EOD H1N1

A
  1. Flu-like illness w/ consistent epidemiologic background

2. Respiratory swab

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21
Q

EOD Severe Acute Respiratory Syndrome (SARS)

A
  1. Mild, moderate or severe respiratory illness
  2. Travel to endemic area w/in 10 days before Sx onset (Places in Asia)
  3. Persistent fever, dry cough, dyspnea
  4. Dx confirmed by antibody testing or isolation of virus
  5. No specific Tx
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22
Q

EOD Pulmonary Venous Thromboembolism

A
  1. Predisposition to venous thrombosis
  2. Dyspnea, CP, hemoptysis, syncope
  3. Tachypnea & widened alveolar-arterial pO2 difference
  4. Elevated rapid D-dimer & characteristic defects on CT arteriogram of chest, ventilation-perfusion scan or pulmonary angiogram
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23
Q

EOD Pulmonary HTN

A
  1. Dyspnea, fatigue, CP & syncope on exertion
  2. Narrow splitting of 2nd heart sound w/ loud pulmonary component, findings of RV hypertrophy & cardiac failure in advanced disease
  3. Hypoxemia & inc. wasted ventilation on PFTs
  4. EKG evidence of RV strain or hypertrophy & RA enlargement
  5. Enlarged central pulmonary arteries on CXR
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24
Q

EOD Obstructive Sleep Apnea

A
  1. Daytime somnolence or fatigue
  2. Hx of loud snoring w/ witnessed apneic events
  3. Overnight polysomnography demonstrating apneic episodes w/ hypoxemia
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25
EOD Acute Respiratory Distress Syndrome
1. Acute onset of respiratory failure 2. Bilateral radiographic pulmonary opacities 3. Absence of elevated LA pressure 4. Ratio of pO2 in arterial blood to fraction conc. of inspired O2 (FIO2) <200, regardless of the level of PEEP
26
EOD Cor Pulmonale
1. Sx & signs of chronic bronchitis & pulmonary emphysema 2. Elevated JVP, parasternal lift, edema, hepatomegaly & ascites 3. EKG tall peaked P waves, R axis dev & RVH 4. CXR - enlarged RV & PA 5. Echo or radionuclide angiography excludes primary LV dysfunction
27
EOD Pleural Effusion
1. May be asymptomatic; CP common w/ pleuritis, trauma or infection, dyspnea w/ large effusions 2. Dullness to percussion & dec. breath sounds over the effusion 3. Radiographic evidence of pleural effusion 4. Diagnostic findings on thoracentesis
28
EOD Spontaneous Pneumothorax
1. Acute onset of unilateral CP & dyspnea 2. Minimal physical findings in mild cases 3. Unilateral chest expansion, dec. tactile fremitus, hyperresonance, diminished breath sounds, mediastinal shift, cyanosis & HOTN in tension pneumo 4. Presence of pleural air on CXR
29
EOD Bronchogenic Carcinoma
1. New cough or change in chronic cough 2. Dyspnea, hemoptysis, anorexia & wt loss 3. Enlarging nodule or mass, persistent opacity, atelectasis or pleural effusion on CXR or CT 4. Cytologic or histologic findings of lung CA in sputum, pleural fluid or Bx
30
EOD Mesothelioma
1. Unilateral, nonpleuritic CP & dyspnea 2. Distant (>20 yrs) Hx of exposure to asbestos 3. Pleural effusion or pleural thickening or both on CXR 4. Malignant cells in pleural fluid or tissue Bx
31
COPD vs asthma pathophysiology
C - CD8 cells, macrophages & neutrophils A - CD4, eosinophils, leukotrienes, IgE
32
Obstruction vs restriction
O - big lungs, dec. airflow, normal/inc. lung V, normal/dec. DLCO R - Normal airflow, dec. lung V, normal/dec. DLCO
33
FEV1/FVC ratio
Amount of air exhaled in 1st sec compared to total amount of air exhaled Above LLN - 70% = restrictive or normal If FVC is below normal = obstructive
34
What diseases can cause a dec. DLCO?
1. Emphysema 2. Fibrosis 3. Pulmonary vascular disease 4. Anemia
35
What disease can cause an inc. DLCO?
Inc. pulmonary capillary blood volume 1. Polycythemia 2. Pulmonary hemorrhage 3. L to R shunt 4. Asthma
36
What are the obstructive diseases?
1. Emphysema 2. Chronic bronchitis 3. Asthma 4. Bronchiectasis 5. Cystic Fibrosis 6. Sarcoidosis (sometimes)
37
What are the restrictive diseases?
1. Pleural disease - effusions, mass 2. Alveolar disease - edema, infiltrates 3. Interstitial disease - fibrosis, sarcoidosis 4. Neuromuscular disease - ALS, Myasthenia Gravis, Guillan-Barre 5. Diaphragmatic paralysis 6. Thoracic cage abnormality - obesity, kyphoscoliosis
38
Common S/S w/ obstructive diseases?
1. DOE, cough, wheeze 2. Smoker/exsmoker 3. Quiet lungs/wheeze 4. FH 5. Barrel chest 6. Pursed lip breathing 7. Clubbing in CF
39
Common S/S w/ restrictive diseases?
1. DOE, cough, orthopnea 2. Smoker/exsmoker 3. Crackles/rales 4. FH 5. Abnormal chest wall 6. Clubbing
40
What is emphysema?
permanent enlargement of the airspaces distal to the terminal bronchioles w/ destruction of their walls w/o obvious fibrosis -T lymphocytes, macrophages release elastases leading to destruction of airspaces
41
What is chronic bronchitis?
chronic, productive cough for 3 months in 2 successive years | -CD8 T lymphocytes, neutrophils
42
S/S Emphysema
Pink Puffers 1. Dyspnea 2. Thin 3. Accessory muscle use 4. Quiet chest 5. Presents after 50
43
S/S Chronic Bronchitis
Blue Bloaters 1. Chronic cough 2. Productive mucopurulent sputum 3. DOE 4. Overweight & cyanotic 5. Peripheral edema 6. Noisy chest - rhonchi & wheezes 7. Presents in late 30s & 40s
44
Causes of COPD
1. Smoking 2. alpha-1 antitrypsin deficiency 3. Chemicals/pollution
45
Chest exam findings in COPD
1. Hyperinflation w/ inc. A/P 2. Inc. resonance 3. Dec. breath sounds & early inspiratory crackles 4. Wheezing may not be present at rest but can be evoked w/ forced expiration/exertion 5. Prolonged duration of expiration
46
CXR w/ COPD
Hyperinflation of lungs & flat diaphragms if emphysema main - parenchymal bullae or subpleural blebs bronchitis - nonspecific peribronchial & perivascular markings
47
Tx COPD
A. FEV1 >50%, 0-1 exacerbations/yr, low risk - SABA PRN, Anticholinergic/beta-agonist B. A w/ more Sx - SABA w/ pulmonary rehab, LABA, anticholinergic C. FEV1 2 exac/yr - SABA w/ pulmonary rehab, LABA w/ corticosteroid or anticholinergic, consider surgery D. C w/ more Sx - LABA + corticosteroid or anticholinergic, LABA + corticosteroid + phosphodiesterase inhibitors, consider surgery
48
What can cause asthma symptoms?
1. Extrinsic allergies 2. Allergic bronchopulmonary aspergillosis 3. Intrinsic asthma 4. Extrinsic nonallergenic 5. Aspirin sensitivity 6. Exercise induced 7. Asthma w/ COPD
49
What can cause bronchiectasis?
1. Cystic Fibrosis 2. Alpha-1 antitrypsin deficiency 3. Hypogammaglobulinemia 4. Common variable immunodeficiency 5. Primary ciliary diskinesia 6. Congenital anatomic defects 7. Pulmonary infections -TB, pertussis 8. Foreign body aspiration 9. Tumors
50
What disease causes a 'finger in glove' appearance on a CXR?
Bronchiectasis | -thickened bronchial walls w/ ring shadows
51
Dx Bronchiectasis
1. Crackles, esp in bases 2. Clubbing 3. Cachexia 4. Lady Windmere Syndrome 5. C&S - H influenza, Pseudomonas aeruginosa, S PNA 6. PFTs normal at 1st, restrictive or obstructive later 7. CXR - finger in glove appearance 8. CT - dilated & thickened airways, cystic lesions
52
Tx Bronchiectasis
1. Hydration 2. O2 3. Postural drainage w/ chest percussion or flutter valves 4. Smoking cessation 5. Flu & pneumovax vaccines 6. Surgical resection maybe 7. Abx
53
What is the most common fatal hereditary disorder in whites?
Cystic Fibrosis
54
What is the most common cause of severe chronic lung disease in the young?
Cystic Fibrosis
55
S/S Cystic Fibrosis
1. Inc. AP diameter 2. Basilar crackles 3. Hyperresonance to percussion 4. Clubbing 5. Salty taste to skin
56
PFT & CXR in Cystic Fibrosis
1. Dec. FEV1/FVC ratio 2. Dec. FEV1 3. Inc. TLC 4. Dec. DLCO 5. Diffuse interstitial disease w/ bronchiectasis & nodular densities of mucoid impactions
57
Causes of interstitial lung disease
1. Hypersensitivity pneumonitis - birds, hottub, molds, fungus 2. Idiopathic 3. Drugs - chemo, radiation, amiodarone, methotrexate, macrodantin 4. Occupations - foundry, mining, stoneworker, asbestos 5. Connective tissue disorders - scleroderma, RA, polymyositis, lupus
58
Idiopathic Pulmonary Fibrosis
1. Usually older people 2. M>F 3. Insidious onset 4. Dyspnea, dry cough 5. Asymptomatic, routine CXR finding 6. FH
59
Findings w/ ILD
1. Non-specific 2. Bilateral rales 3. Connective tissue disease signs 4. Clubbing 5. Cor Pulmonale
60
CXR ILD
1. Reduced expansion | CT is key for diagnosis
61
Which diseases have a lower lung zone predominance?
1. Idiopathic pulmonary fibrosis 2. Connective tissue disease assoc. w/ ILD 3. Asbestosis
62
Which diseases have an upper lung zone predominance?
1. Sarcoidosis 2. Hypersensitivity pneumonitis 3. Silicosis 4. Langerhans Cell Histiocytosis 5. Ankylosing spondylitis
63
CT w/ idiopulmonary fibrosis
1. Subpleural reticular changes inc. in bases 2. Minimal ground glass 3. Honeycombing 4. Bronchiectasis May need Bx to diagnose
64
Tx idiopulmonary fibrosis
No real Tx 1. O2 2. Flu shot & pneumovax 3. Pulmonary rehab 4. Lung transplant
65
S/S Asbestosis
1. Inspiratory crackles 2. Clubbing 3. Pleural plaques 4. Linear opacities in lower lungs 5. Restrictive PFT 6. Exertional dyspnea 7. Dry cough Lung Bx for definitive Dx Supportive Tx
66
S/S Silicosis
May be asymptomatic 1. Hilar node calcification - egg shell pattern 2. Small rounded opacities 3. Tachypnea 4. Prolonged expiration, wheezes, rhonchi, rales 5. Cor pulmonale, cyanosis possible 6. Restrictive PFT
67
Diseases w/ caseating granulomas
central necrosis or dead cells 1. TB 2. Histoplasmosis 3. Coccidiomycosis 4. Bastomycosis 5. Cat scratch fever
68
Diseases w/ non-caseating granulomas
NOT related to infection 1. Sarcoidosis 2. Berylliosis 3. Wegeners granulomatosis 4. Crohns
69
What is Lofgren's syndrome?
Seen in sarcoidosis | fever, bilateral hilar adenopathy & erythema nodosum
70
What is Heerdfordt Syndrome?
Seen in Sarcoidosis | Fever, uveitis & parotitis w/o VII nerve involvement
71
What is the most common neurologic finding in Sarcoidosis?
CN VII Nerve palsy | Bell's Palsy
72
What are common findings w/ cardiac Sarcoidosis?
1. CP 2. Palpitations/Fluttering/skipping 3. PVCs 4. AV Blocks 5. PSVT Tx w/ steroids
73
CXR scale in sarcoidosis
0 - Normal 1 - Bilateral hilar adenopathy 2 - BHA w/ parenchymal infiltrates (esp upper & middle lobes) 3 - Parenchymal infiltrates w/o BHA 4 - Fibrotic parenchymal disease w/ retraction of the hilar
74
CURB-65 scoring
``` Confusion U BUN >20 RR >30 breaths/min B SBP <60 65 or older ``` 0-1 OutPt 2 short inPt 3 0 InPt 4-5 InPt/ICU
75
What are the common causes of CAP?
1. Strep pneumonia 2. H influenza 3. M Catarrhalis 4. S aureus 5. K pneumonia 6. Viral
76
Which PNA shows a current jelly sputum?
& hemoptysis K pneumonia Common in EtOH users
77
Which PNA is linked to air conditioners?
Legionella Diarrhea, hyponatremia Elderly, smokers, IC
78
Which PNA should you suspect w/ acute rigors?
S pneumonia | Rusty colored sputum
79
What is required on CXR to Dx CAP?
Pulmonary opacity
80
How can you differentiate btwn viral/bacterial CAP?
Procalcitonin test
81
Most common pathogens in Nosocomial PNA
HAP - MRSA, MSSA, Pseudomonas VAP - Acineteobacter, Stenotrophomonas, MDROs HCAP - S penumonia, H influenza Anaerobic - Bacteroides, Fusobacterium
82
What typically causes viral PNA?
1. Influenza 2. RSV 3. Adenovirus 4. Parainfluenza 5. Metapneumovirus
83
What are some complications of influenza?
1. Secondary bacterial PNA 2. Sinusitis, OM, purulent bronchitis 3. Influenza PNA 4. Inc. risk of MI 5. Rhabdomyolysis 6. Reye Syndrome 7. Acute necrotizing encephalopathy 8. Guillan Barre Syndrome
84
Tx for influenza
1. Balanced electrolyte fluids 2. NSAIDS, APA 3. Neuraminidase inhibitors -Zanamivir -Osetlamivir -Tamilflu ...best if 48h after Sx onset
85
What is the most common respiratory tract infection?
Human rhinovirus Type C Triggers asthma & COPD OM, croup, bronchiolitis, PNA
86
What is the MCC of bronchiolitis?
RSV seen in children <6mo common cause of AOM
87
What is the MCC of croup in kids?
Human parainfluenza virus Tx - mild humidified air, neb epinephrine & steroids
88
Who commonly gets Pertussis?
<2 yo Transmitted via respiratory droplets Prevent w/ Tdap
89
Which PNA is seen more in COPD Pts?
H influenza
90
Stages of Pertussis
1. Catarrhal - sneezing, coryza, malaise, cough at night 2. Paroxysmal - bursts of harsh coughing followed by high pitching inspiratory whoop 3. Convalescent - 4 wks after illness onset, cont. cough w/ dec. frequency & severity
91
S/S TB
1. Slowly progressive constitutional 2. Malaise, anorexial, unexplained wt loss, fever, night sweats 3. Dry cough becoming purulent later 4. Blood streaked sputum 5. Post-tussive apical rales
92
Extrapulmonary findings of TB
1. Scofula Ptts 2. Meningitis 3. Pericarditis 4. Pleuritis w/ effusion 5. Osteomyelitis 6. Hepatosplenomegaly
93
ADRs Isoniazid
Tx for TB used in pregnancy 1. Hepatotoxicity 2. Depletes B6 - give pyridoxine
94
Which TB drug causes optic neuritis?
Ethambutol Avoided in kids
95
What labs should you monitor in TB Pts?
1. LFTs 2. BUN 3. Serum Creatinine 4. CBC 5. Uric acid 6. Baseline visual acuity & color vision testing 7. ? monthly for signs of toxicity 8. CXR baseline & final
96
What can causes a PE?
1. Air (from caths during surgery) 2. Fat (long bone Fx) 3. Septic (IE) 4. Tumor cells (RCC) 5. Foreign bodies (talc, drug users)
97
S/S PE
1. Dyspnea 2. Pleuritic CP 3. Cough, hemoptysis 4. Palpitations, syncope 5. Leg swelling & tenderness 6. Tachycardia 7. Tachypnea 8. Inc. S2 9. Presence of S4 10. Crackles, wheezing 11. Pleural friction rub 12. RV heave 13. Homan's sign
98
What is Homan's sign & when can it be seen?
Pain upon dorsiflexion of foot sign of PE
99
Well's criteria
1. S/S of DVT 2. Alternative Dx less likely than PE 3. HR >100bpm 4. Immobilization >3days or surgery in past 4 wks 5. Previous PE/DVT 6. Hemoptysis 7. Cancer Score >4 PE likely
100
What is Ortner's syndrome?
Hoarseness/cough from compression of L recurrent laryngeal nerve by dilated main PA Could be caused by Pulmonary HTN
101
S/S Pulmonary HTN
1. Loud P2 2. Pansystolic murmur of tricuspid regurg 3. RV heave 4. JVD 5. Peripheral edema 6. Hepatomegaly Lungs usually clear
102
EKG changes w/ pulmonary HTN
1. RVH 2. Rt axis dev 3. RBBB or normal
103
What is normal RV systolic P & when is wrong when it's raised?
28 mmHg Raised >35 in pulmonary HTN
104
Tx of Pulmonary HTN
1. Anticoagulants 2. CCBs to lower systemic arterial P 3. Prostacyclin - pulm vasodilator 4. Heart-lung transplant usually needed
105
Causes of Cor Pulmonale
1. Anatomic reduction of pulmonary vascular bead - Emphysema, ILD, PE 2. Inc. blood viscosity - Polycythemia 3. Inc. Pulmonary blood flow - Congenital heart disease w/ L to R shunts
106
Causes of ARDS
1. Sepsis 2. Aspiration of gastric contents 3. PNA 4. Burns 5. Chest trauma 6. Fat embolism from long bone Fx 7. Near drowning 8. Pancreatitis
107
Signs of ARDS
1. S3, S4 2. JVD 3. LE edema 4. Cardiomegaly 5. Effusions 6. Kerley B lines
108
Tx of ARDS
Supportive 1. Fluid mgmt 2. DVT prophylaxis 3. Stress ulcer prophylaxis - PPI 4. Nutritional support 5. Sedation/analgesia 6. PEEP if necessary 7. Prone ventilation
109
Obstructive vs. Restrictive sleep apnea
O - chest & abdomen move but no airflow due to position or anatomy R - no signal to make you breathe
110
Influenza vaccinations
Recommended for everyone >6 mo unless egg allergy, febrile illness, guillan barre 1. Trivalent inactivated vaccine - Fluzone, more Ag for elderly 2. Trivalent live attenuated vaccine - contraindication in pregnancy 3. Tamiful
111
TB CXR
1. Primary Progressive Disease - unilateral lower or middle lobe infiltrates, pleural effusion, hilar adenopathy 2. Reactivation - cavitary apical disease 3. Elderly - often lower lobe 4. Miliary - all over 5. HIV/Immunocompromised - variable 6. Resolution - hilar nodules + calcification, pleural scarring, Ranke complexes, bronchiectasis
112
What are Ranke Complexes & when are they seen?
calcified primary foci & lymph nodes seen in TB
113
What is the MCC of respiratory disease in premies?
Hyaline membrane disease Deficiency of surfactant
114
Causes of Pulmonary HTN
1. Idiopathic 2. Heritable - mutation in BMPR2, ALK-1 or ENG 3. Drug & toxins 4. Connective tissue disease (scleroderma) 5. HIV 6. Portal HTN 7. Congenital heart disease 8. Schistomiasis 9. Chronic hemolytic anemia 10. Newborns 11. L heart disease
115
Risk factors for obstructive sleep apnea
1. Middle-aged over wt male 2. >18 size neck 3. Loud snoring w/ sudden awakenings 4. Morning HA 5. Not rested in AM 6. Daytime fatigue 7. BMI >30 8. Retrognathia/micronathia 9. Crowded oropharynx 10. Tonsillar & adenoid hypertrophy 11. Pendulous uvula 12. Nasal obstruction
116
Tx Sleep apnea
1. CPAP 2. Surgery 3. Weight loss - sleep on side, avoid EtOH, avoid meds
117
Transudate Causes
1. CHF 2. Cirrhosis 3. Nephrotic syndrome 4. Hypoalbuminemia 5. Peritoneal dialysis 6. Early atelectasis 7. Central venous cath in pleural space 8. Urinothorax
118
Exudate Causes
1. Malignancy 2. Infections 3. PE 4. Connective tissue diseases 5. GI disease (pancreatitis, esophageal rupture) 6. Asbestosis 7. Drugs 8. Post-cardic syndrome 9. Hemothorax 10. Chylothorax 11. Uremia
119
What is Light's Criteria?
Used to distinguish btwn exudative/transudative pleural effusion 1. PF to serum protein ratio >0.05 2. PF to serum LDH ratio >0.06 3. PF LDH ?2/3 ULN serum LDH
120
What is a tension pneumothorax?
P intrapleural exceeds Patm emergency
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Tx of pneumothorax
1. O2 2. Observation for small iatrogenic or primary spontaneous pneumo 3. Aspiration - if >4L, admit & chest tube 4. Chest tubes
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Risk factors for Bronchiogenic carcinoma
1. Tobacco 2. Asbestos 3. Radon 4. Radiation 5. Arsenic, Cr, Ni, benzene 6. Air pollution 7. Age ~71 8. Hx of CA 9. Hx of COPD or lung disease 10. M>F 11. Poor Blacks
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If calcium is seen in a lung nodule what does this usually mean?
benign small, round, solid are good ground glass or sub-solid is bad
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What is a hamartoma?
Fat density tumor Benign May have popcorn calcification
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What is a cardinoid nodule?
``` Slow growers Low malignant potential Assoc/ w/ an airway May have Ca2+ seen in younger Pts -pink/purple central lesion that is well vascularized Cut it out!!! ```
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What are ground glass nodules
Hazy appearance Slow growers can represent early adenocarcinoma
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What can intense shoulder pain be caused from?
Pancoast syndrome | Superior sulcus tumor
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What is the most common lung CA?
adenocarcinoma | More common in young women & never smokers
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Which CA has the strongest assoc to smoking?
Squamous cell carcinoma assoc. w/ hypercalcemia
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What is carcinoid syndrome?
1. Wheezing 2. Flushing 3. Diarrhea rarely seen w/ carcinoid tumors
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Tx of NSCLC
IA-IIB - surgical resection, chemo w/ IIA&B IIIA - Trimodality therapy IIIA/B - chemoradiation IV - Chemo w/ palliative care
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How often to get CT w/ lesions?
Low risk - q 3mo for a year then q 6 mo for next 2 years high risk - cut that shit out! intermediate risk - Bx & CT
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1st line test to Dx PE?
Spiral CT
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What is the underlying abnormality in ARDS?
inc. permeability of the alveolar capillary membranes that leads to development of protein rich pulmonary edema
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What is pulmonary alveolar proteinosis?
rare disease where phospholipids accumulate w/in alveolar spaces Dx by bronchoalveolar lavage - milky appearance & PAS-positive lipoproteinaceous material
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What is Loffler syndrome?
acute eosinphilic pulmonary infiltrates in response to transpulmonary passage of helminth larvae
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Granulomatosis w/ polyangiitis
Idiopathic combination of glomerulonephritis, necrotizing granulomatous vasculitis, small vessel vasculitis Chronic sunusitis, arthralgias, fevers, skin rach & wt loss
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What is bronchopleural fistula & when is it seen?
Large bronchus involved in lung injury Complication w/ pneumothorax
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How long does it take to see a normal CXR after PNA Tx?
up to 6 weeks may show signs before CXR shows anything
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What should you suspect with bullous myringitis?
Atypical CAP seen in healthy young adults MCC Mycoplasma PNA
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What commonly infects neutropenic IC Pts?
Aspergillus, GNB & Candida often have neg cultures
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Causes of OM?
1. Mycoplasma PNA 2. Influenza 3. Human rhinovirus Group C 4. RSV
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How do you treat human parainfluenza virus?
Steroids + Mild - humidified air Mod - Nebulized epinephrine

Clinical Medicine (11 decks)

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