Term
| What are the two viruses that most commonly cause croup? |
|
Definition
| Parainfluenza 1,2, and 3 and RSV |
|
|
Term
| Is the airway obstruction in croup classified as upper or lower? What are the two breath sounds that are pathognomonic? |
|
Definition
Upper
Inspiratory strider
Harsh barking SEAL-like or BRASSY cough |
|
|
Term
| What are the X-rays that should be ordered in a patient with croup? What will each show? |
|
Definition
-AP will show steeple sign
-lateral will rule out epiglottitis |
|
|
Term
| What are the two classes of drugs that may be administered to a patient that is hospitalized for croup? |
|
Definition
Steroids (dexamethasone, prednisone)
Epinephrine |
|
|
Term
| RSV is a member of which virus family? |
|
Definition
|
|
Term
| What is the name of the vaccine against RSV and what children are eligible to receive it? |
|
Definition
Palivizumab aka synagis
Kids less than 2 yoa with cyanosis heart dz, bronchopulmonary dysplasia, and those who were born prematurely |
|
|
Term
| RSV can be a significant cause of mortality in which pt population? |
|
Definition
|
|
Term
| What drug is often given to hospitalized infants with RSV? |
|
Definition
| Ribavirin, which is shown only to be beneficial in infants. It is a teratogenic drug that is contraindicated in pregnancy and can be risky to pregnant Health care workers |
|
|
Term
| What other illness is commonly seen in children infected with RSV |
|
Definition
|
|
Term
| What class of drugs is commonly used to treat RSV but has never been proven in trials to be efficacious |
|
Definition
|
|
Term
| What are the three clinical stages of pertussis? |
|
Definition
1. Catarrhal stage: often confused for a UR viral illness
2. Paroxysmal stage: spasms and coughing fits followed by the "whoop"
3. Convalescent stage: decrease in severity and number of symptoms from stage 2 but this stage my last for weeks |
|
|
Term
| What abx are usually used to tx pertussis? In particular, babies less than 1 month? What should be explained to a pt being tx with abx for pertussis? |
|
Definition
- macrolides--> erythromycin is best
- azithromycin is the only macrolide indicated for less than 1 month of age
- will not alleviate or shorten duration of sx, but will prevent spread to others and secondary infection in the pt |
|
|
Term
| What are the top two complications seen in pertussis pt's? |
|
Definition
|
|
Term
| What causes the paroxysms of coughing seen in pertussis pt's? |
|
Definition
| Due to the need to dislodge plugs of necrotic epithelial bronchial tissues and thick mucus |
|
|
Term
| Neonates are the most likely pt's to be infected with pertussis- how do they present differently? |
|
Definition
| Unlikely to have the classic whoop. More likely to have cns damage due to hypoxia and more likely to have a secondary bacterial pna |
|
|
Term
| Immunization is the best way to prevent pertussis, when is dtap given? Tdap? |
|
Definition
Dtap: 2,4,6,15-18 mo and 4-6 yrs
Tdap: 11-18 yrs and ALL pregnant women |
|
|
Term
| When do most cases of pertussis occur? |
|
Definition
|
|
Term
| What is the only proven effective therapy in the treatment of bronchiolitis? |
|
Definition
| Oxygen and supportive care! |
|
|
Term
| What virus is the #1 cause of bronchiolitis? |
|
Definition
|
|
Term
| What virus is the most common cause of bronchiolitis obliterans, a more severe type of RSV? |
|
Definition
|
|
Term
| what is the most common etiology of acute bronchitis |
|
Definition
|
|
Term
| does colored sputum in acute bronchitis always indicate a bacterial infection? |
|
Definition
| no, this is usually due to peroxidase production by the leukocytes in the sputum and is NOT indicative of acute bacterial infection |
|
|
Term
| what acute phase reactant marker can be used when determining if an acute bronchitis is caused by a virus or bacteria? |
|
Definition
|
|
Term
| when are abx indicated in acute bronchitis |
|
Definition
| not recommended UNLESS there is risk of serious complications due to comorbid conditions or if the pt is >65 yoa with a hospital stay in the past year, has DM, CHF, or is on steroids |
|
|
Term
| what is a range for how long the cough in acute bronchitis can last? |
|
Definition
| 10-20 days, sometimes longer than 1 month |
|
|
Term
| when ordering a CRP to differentiate bronchitis from PNA, what is the cutoff value? |
|
Definition
| <20 inidcates bronchitis and not PNA |
|
|
Term
| What is the most common causative organism for epiglottitis |
|
Definition
| HiB. Incidence of epiglottitis has decreased since vaccines of HiB BECAME COMMON |
|
|
Term
| What are two signs that one may see on the lateral neck radiograph of a pt with epiglottitis |
|
Definition
|
|
Term
| What are the two classes of abx used to treat epiglottitis? What are the top two specific drugs |
|
Definition
-3rd gen cephalosporins or amoxicillin/clavulanic acid
-rocephin or ampicillin and sulbactam (unasyn) |
|
|
Term
| What is a common abx used in epiglottitis patients who are allergic to penicillins and cephalosporins |
|
Definition
|
|
Term
| Influenza virus is from which family |
|
Definition
|
|
Term
| What serious complication has been documented with influenza A |
|
Definition
|
|
Term
| What is the gold standard for influenza diagnosis |
|
Definition
| Viral culture via nasopharyngeal swabs or throat samples |
|
|
Term
| What class of antiviral is still recommended for use against influenza? What are the two drugs? What is the dosing ? |
|
Definition
Neuraminidase inhibitors
-oseltamivir (tamiflu) 75 mg PO BID
-zanamivir (relenza) inhaled 10 mg BID x 5 d |
|
|
Term
| What drug is often rx with tamiflu to double systemic exposure to the drug |
|
Definition
|
|
Term
| Can pregnant women receive the flu vaccine? |
|
Definition
|
|
Term
| what is the clinical definition of community acquired PNA (CAP)? |
|
Definition
| develops in an outpatient setting or within 48 hours of hospital admission |
|
|
Term
| Besides being hospitalized for 48 hours, what are some other clinical indications of hospital acquired PNA? |
|
Definition
-hospitalization greater than 2 days in prior 3 mos
-home or extended care facility resident
-abx in prior three months
-chronic dialysis
-home infusion tx, home wound care
-contact with a patient with MDRO infection |
|
|
Term
| what are three things that could put a pt at high risk for aspiration PNA |
|
Definition
| decrease ability to clear oropharyngeal secretions, increase volume of secretions, or other comorbidities (GERD, achalasia, etc) |
|
|
Term
| PNA with productive sputum that is rust colored is likely due to what bacteria? |
|
Definition
|
|
Term
| PNA with productive sputum that is green colored is likely due to what bacteria? |
|
Definition
|
|
Term
| PNA with productive sputum that is red-currant jelly-like is likely due to what bacteria? |
|
Definition
|
|
Term
| PNA with productive sputum that is foul smelling and bad tasting is likely due to what bacteria? |
|
Definition
|
|
Term
| what causative organism of PNA is often seen in the winter/early spring time? |
|
Definition
|
|
Term
| what causative agent of PNA can present with mental status changes or diarrhea? |
|
Definition
|
|
Term
| PNA that has bradycardia on exam is likely due to what organism |
|
Definition
|
|
Term
| PNA in a pt that also has periodontal dz is likely due to what organism? |
|
Definition
|
|
Term
| PNA that also presents with bullous myringitis is likely due to what causative organism? |
|
Definition
|
|
Term
| PNA that presents with cutaneous nodules and CNS findings is likely due to what causative organism? |
|
Definition
|
|
Term
| What is the CURB-65 scoring system used for and what are the components? |
|
Definition
-to determine inpatient or outpatient tx in a patient with PNA
*one point for each of the following:
-confusion (altered mental status), -uremia (BUN >20 mg/dL), -resp rate >30 bpm, -BP <90/OR ,60, - age >65
*0-1 outpatient; 2: admit to medical ward; 3 or >: ICU admit |
|
|
Term
| what is the gold standard for diagnosing pna? |
|
Definition
|
|
Term
| what are two classes of abx recommended in pts with CAP who are previously healthy and have not had abx in the past 90 days? |
|
Definition
macrolide (azithromycin)
doxycycline |
|
|
Term
| how long after initiation of abx tx should PNA be evaluated? when can an abx be changed after initiation? |
|
Definition
48-72
dont change in less than 72 hours unless there is marked clinical deterioration |
|
|
Term
| what patients are eligible for the pneumococcal vaccine? |
|
Definition
| >65 yoa, and younger if at high risk (heart disease, SSD, pulm dz, DM, alcoholic cirrhosuis, or asplenic pts) |
|
|
Term
| alcoholic patients with PNA, think what as causative organism... |
|
Definition
|
|
Term
| immigrants with signs of PNA, think what as causative organism... (something that needs to be ruled out) |
|
Definition
|
|
Term
| pts with organ transplants, renal failure, chronic lung dz, or smokers with PNA think what as causative organism... |
|
Definition
|
|
Term
| HIV pts who present with PNA are likely to have a common pathogen as a causative organism, but what are two other possible causative agents |
|
Definition
pneumocystis carinii
mycobacterium TB |
|
|
Term
| COPD pts with PNA, think what as causative organism... |
|
Definition
|
|
Term
| pts with cystic fibrosis that present with PNA, think what as causative organism... |
|
Definition
|
|
Term
| young adults (esp in the college setting) that present with atypical PNA,think what as causative organism... |
|
Definition
|
|
Term
| what causative agent of PNA is associated with air conditioning units/aerosolized water? |
|
Definition
|
|
Term
| pts s/p splenectomy that present with PNA, what 3 causative agents should be investigated? |
|
Definition
| encapsulated organisms , step pneumo, and h flu |
|
|
Term
| leukemia or lymphoma patients that present with PNA, think what as causative organism... |
|
Definition
|
|
Term
| what are the 4 MC viral etiologies of PNA? |
|
Definition
| influenza, RSV, parainfluenza, and adenovirus |
|
|
Term
| what two age groups have an increased prevalence of viral PNA? |
|
Definition
|
|
Term
| viral etiologies are the second MCC of PNA behind _________ |
|
Definition
|
|
Term
| viral etiologies are the second MCC of PNA behind _________ |
|
Definition
|
|
Term
| what patient populations are at increased risk of influenza PNA? |
|
Definition
-kids with transplant or CF hx
-Adults with chronic disease or IC
-nursing home or chronic care facility resident
-healthy pt >65 yoa |
|
|
Term
| cytomegalovirus cells have a characteristic look on cytologic eval, what is it? |
|
Definition
|
|
Term
| what is common in viral PNA seen on CXR that can help begin to differentiate from bacterial PNA? |
|
Definition
| viral is usually bilateral and bacterial is often lobar |
|
|
Term
| What is the causative agent of histoplasmosis? What part of the world is it usually found? What is another name for it? |
|
Definition
-histoplasma capsulatum
-OH, MS, MO river valleys
-"OH River Valley Fever" |
|
|
Term
| what two animals' droppings can contribute to greater spread of histoplasma capsulatum in the soil? |
|
Definition
bird and bat
-birds dont carry dz and cannot spread it, but their droppings do enhance the soil's ability to grow the fungus
-bats can carry the dz and their droppings can actually be the source of spread |
|
|
Term
| What is the MC endemic fungal infection in humans |
|
Definition
|
|
Term
| What is the tx plan for histoplasmosis- mild, moderate and severe |
|
Definition
-mild or asymptomatic: supportive care
-s/sx >4 wks or overwhelming pulm involvement: itraconazole x6-12 weeks
-severe cases: start amphotericin B x 1-2 weeks then change to itraconazole x 1 year |
|
|
Term
| What is the causative agent of blastomycosis? What part of the world is it usually found? What is another name for it? |
|
Definition
-blastomyces dermatitidis
-mid west and northern US and Canada
-Gilchrist's disease |
|
|
Term
| Blastomycosis is common among what animal in endemic areas? |
|
Definition
|
|
Term
| What is the causative agent of coccidoidmycosis? What part of the world is it usually found? What is another name for it? |
|
Definition
-coccidoides immitus
-SW US and northern mexico
-San Jaoquin valley fever OR desert rheumatism |
|
|
Term
| What are some common extra-pulmonary skin manifestations of fungal PNA? |
|
Definition
erythema nodosum
erythema multiforme |
|
|
Term
| What is the MC extra-pulm manifestation of blastomycosis? |
|
Definition
|
|
Term
| What is the causative agent of paracoccidioidomycosis? What part of the world is it usually found? What is another name for it? |
|
Definition
-paracoccidoides brasilienessis
- Central and S america
-"S. American Blastomycosis" or "Lutz-Splendore-Almeida disease" |
|
|
Term
| what are the pathognomonic mucosal lesions associated with paracoccidioidomycosis? what is another extra-pulm manifestation? |
|
Definition
mulberry lesions
lymphadenopathy |
|
|
Term
| What is the causative agent of aspergillosis? What part of the world is it usually found? What is another name for it? |
|
Definition
-aspergillus
-growing on dead leaves, stored grain, compost piles, other decaying vegetation or marijuana leaves
-"FUNGUS BALL" may be seen on xray |
|
|
Term
| when an HIV patient presents with symptoms of PNA, what organism must you be worried about? |
|
Definition
|
|
Term
| what type of organism is pneumocystis jiroveci? |
|
Definition
|
|
Term
| What is the most common opportunistic infection in patients with HIV disease, particularly with CD4 counts less than 200? |
|
Definition
|
|
Term
| what does the CXR of a pt with pneumocystis jiroveci show? |
|
Definition
| diffuse perihilar infiltrates and no effusions . but may be NL |
|
|
Term
| what is the #1 tx for patients with pneumocystis jiroveci? |
|
Definition
|
|
Term
| who are candidates for prophylaxis of pneumocystis jiroveci and what is the prophylactic agent? |
|
Definition
| HIV patients with CD4 counts less than 200 and Bactrim is used |
|
|
Term
| Pts with pneumocystis jiroveci can have extra pulm manifestations in the thyroid and the eye... name them |
|
Definition
eye: retinal cotton wool spots
thyroid: rapidly enlarging mass |
|
|
Term
| What is the most common cause of disease related mortality in the world |
|
Definition
|
|
Term
| What organ of the body is the most common site of infection in patients with TB |
|
Definition
|
|
Term
| What is the most common extra plum manifestation of tb? What's the name for this? |
|
Definition
|
|
Term
|
Definition
| TB infection of the vertebral bodies |
|
|
Term
| Describe what a typical TB lesion looks like |
|
Definition
| Granuloma with central cassation and necrosis |
|
|
Term
|
Definition
| Evidence of healed primary lesion of TB in the lungs. Aka ranke's complex |
|
|
Term
| What can cause hyponatremia in TB patients? |
|
Definition
| Release of adh-like hormone from affected lung tissue |
|
|
Term
| What are the criteria for a positive PPD in the avg patient, a high risk patient, or a patient that is HIV pos or in close contact with a TB pos patient? |
|
Definition
Greater than or equal to 15
10
5 |
|
|
Term
| What is the gold standard for diagnosis of TB |
|
Definition
| Acid fast bacilli sputum smear and culture |
|
|
Term
| What TB drug should be suspect of overdose if the pt presents with seizures? What are two other adverse effects of this drug |
|
Definition
Isoniazid
Hepatotoxicity and peripheral neuropathy |
|
|
Term
| What TB drug turns body fluids red-orange? |
|
Definition
|
|
Term
| What TB drug can cause gout? |
|
Definition
|
|
Term
| What TB drug can cause retro bulbar optic neuritis resulting in decreased visual acuity and decrease in red green color perception? |
|
Definition
|
|
Term
| Which rarely used TB drug causes ototoxicity? |
|
Definition
|
|
Term
| What TB drugs should be used in pregnancy ? What only in MDRTB? What never used? |
|
Definition
-isoniazid, rifampin, and ethambutol
-pyrazinamide only if MDRTB
-do not use streptomycin |
|
|
Term
| What TB drug is avoided in kids? |
|
Definition
| Ethambutol bc it is hard to monitor visual side effects |
|
|
Term
| What class of abx is often employed in MDRTB |
|
Definition
|
|
Term
| What is a common tx for latent TB |
|
Definition
| Many different recommendations but isoniazid x9 months is popular as long as active TB has been ruled out |
|
|
Term
| Are patient with primary TB contagious ? |
|
Definition
|
|
Term
| In what part of the lungs does secondary (reactivation) TB usually occur? |
|
Definition
| The most oxygenated parts of the lungs -apical or posterior segments |
|
|
Term
| Carcinoid tumors most often arise in the small intestine, but what part of the lung are they also found? |
|
Definition
|
|
Term
| What is the most common primary lung tumor in kids |
|
Definition
| Bronchial carcinoid tumors |
|
|
Term
| What are some syndromes seen in pt's with bronchogenic carcinoid tumors |
|
Definition
-carcinoid syndrome (serotonin excess)
-cushings syndrome (excess ACTH)
-acromegaly (excess ghrh) |
|
|
Term
| Bronchogenic carcinoid tumors arise from what type of cells? Even more specific? |
|
Definition
Neuroendocrine
Klutchitsky cells |
|
|
Term
| What is the classic triad of carcinoid syndrome? What are other symptoms |
|
Definition
-cutaneous flushing, diarrhea, valvular heart dz
- also : wheezing, chest pain, cough, weight gain |
|
|
Term
| Describe what a bronchogenic carcinoid tumor looks like on bronchoscopy |
|
Definition
| Pink or purple and very well vascularized |
|
|
Term
| What is the mainstay of tx for a bronchogenic carcinoid tumor? What drug can be given to help with sx of hormone excess |
|
Definition
Surgical resection
Sandostatin (octreotide) |
|
|
Term
| War type of tumor of the lung is not associated with smoking, air pollution, or chemical exposure? |
|
Definition
|
|
Term
| What is the leading cause of chance deaths in men and women? |
|
Definition
|
|
Term
| What is another name for sclc (small cell lung cancer) |
|
Definition
|
|
Term
| Where does SCLC usually arise in the lung and where does It usually metastasize? |
|
Definition
| Central bronchi with metastasis to regional lymph nodes |
|
|
Term
| What type of NSCLC is usually bronchial in origin and what is it more likely to present with |
|
Definition
|
|
Term
| What is the most common NSCLC and lung tumor in general ? Where does it usually originate in the lung ? |
|
Definition
Adenocarcinoma
Lung periphery |
|
|
Term
|
Definition
| Invasion of the superior vena cava by a lung tumor, causing HA dyspnea, facial swelling and neck pain |
|
|
Term
| What syndrome is caused by apical tumors? Give the s/sx |
|
Definition
Horner's syndrome (due to invasion of the cervical sympathetic chain)
Sinking eyeball, lid drop, miosis, and anhidrosis (no sweating) |
|
|
Term
| What two nerve palsies are often seen with lung tumors |
|
Definition
Recurrent laryngeal (hoarse voice)
Phrenic (diaphragm hemiparesis) |
|
|
Term
| What endocrine syndromes are associated wit SCLC |
|
Definition
| Cushing's syndrome and SIADH |
|
|
Term
| What neuromuscular side effects are often seen with SCLC |
|
Definition
| Peripheral neuropathy, myasthenia (eaton lambert), cerebellum degeneration |
|
|
Term
| What endocrine issues are associated with squamous cell lung carcinoma |
|
Definition
|
|
Term
| What endocrine issue is associated with large cell lung cancer |
|
Definition
|
|
Term
| Thrombophlebitis is associated with which type of lung tumor |
|
Definition
|
|
Term
| Which type of NSCLC shows cavitation on CXR |
|
Definition
|
|
Term
| What 4 cancers most often metastasize to the lung |
|
Definition
Breast
Colon
Prostate
Bladder |
|
|
Term
| Where is a pancoast tumor located?? What are the s/sx? What syndrome are they associated with 60% of the time |
|
Definition
Superior sulcus, apical tumor involving the c8 and t1-2 nerve roots causing shoulder pain radiating down the arm
Horners syndrome |
|
|
Term
| What are the 4 most common sites of lung cancer metastasis |
|
Definition
Brain
Bone
Adrenal glands
Liver |
|
|
Term
| What two types of NSCLC can cause hypertrophic pulmonary osteoarthropathy? |
|
Definition
|
|
Term
| What is the tx for NSCLC? SCLC? |
|
Definition
NSCLC: surgery is best, radiation is usually an important adjunct to surgery but chemo doesn't really have any use
SCLC: usually chemo, sometimes radiation, but surgery is not usually useful bc these tumors are usually unresectable |
|
|
Term
| When evaluating a solitary pulmonary nodule, does this characteristic make you think benign or malignant? Age less than 50 |
|
Definition
| Benign, greater than 50 think malignant |
|
|
Term
| When evaluating a solitary pulmonary nodule, does this characteristic make you think benign or malignant? Smoking patient or a hx of smoking |
|
Definition
|
|
Term
| When evaluating a solitary pulmonary nodule, does this characteristic make you think benign or malignant? Size of nodule less than 2 cm |
|
Definition
| Benign, greater than 3 cm think malignant |
|
|
Term
| When evaluating a solitary pulmonary nodule, does this characteristic make you think benign or malignant? Nodule grossly irregular or spiculated |
|
Definition
| Malignant, if its circular with regular shape think benign |
|
|
Term
| When evaluating a solitary pulmonary nodule, does this characteristic make you think benign or malignant? Central laminated calcification |
|
Definition
| Benign, if there is a stipples or eccentric pattern of calcification think malignant |
|
|
Term
| When evaluating a solitary pulmonary nodule, does this characteristic make you think benign or malignant? Nodule changed in size over 2 years compared to past CXR... What's the next step? |
|
Definition
| Malignant, do a ct scan with thin sections through the nodule |
|
|
Term
| When evaluating a solitary pulmonary nodule, does this characteristic make you think benign or malignant? No change in nodule size over the past 2 years... Next step? |
|
Definition
| Benign, stop work up and follow up with pt yearly |
|
|
Term
| When evaluating a solitary pulmonary nodule, if the CXR shows either a new nodule or a nodule with change in size over a 2 yr period OR if there is no CXR available, so a ct scan is ordered with thin sections through the nodule- if the ct shows benign nodule how often should the patient be followed? |
|
Definition
|
|
Term
| What is another name for a solitary pulmonary nodule? At what size is it no longer called this? |
|
Definition
Coin lesion
At greater than 3 cm it is called a mass |
|
|
Term
|
Definition
| Aspirin sensitivity, asthma , and nasal polyps |
|
|
Term
| What is the atopic triad? |
|
Definition
| Wheeze, eczema, and seasona rhinitis |
|
|
Term
| Which two type of Cv medications can exacerbate asthma |
|
Definition
| Non selective beta blockers and ace inhibitors |
|
|
Term
| When spirometry is non diagnostic, what type of challenge test can be used to dx asthma ? |
|
Definition
| Histamine or methacholine challenge test |
|
|
Term
| For asthma diagnosis, a greater than ____% increase in FEV1 after bronchodilator therapy is diagnostic |
|
Definition
|
|
Term
| Normal people's FEV1 is > ???? |
|
Definition
|
|
Term
| Describe the characteristics of mild intermittent asthma |
|
Definition
| Sx less than 2 x per week, a symptomatic and normal PEF between exacerbations. Nighttime sx are less than or equal to 2 times per month . Fev1 greater than or equal to 80% predicted |
|
|
Term
| Describe the characteristics of mild persistent asthma |
|
Definition
| Sx greater than 2 x per week but less than 1x per day. Nighttime sx are greater than. 2x per month . Fev1 greater than or equal to 80% predicted |
|
|
Term
| Describe the characteristics of moderate persistent asthma |
|
Definition
| Sx are daily and daily use of SABA, exacerbations affect activity, exacerbations are greater than or equal to 2 times a week and may last days. Nighttime sx are greater than 1x per week . Fev1 greater than 60 but less than 80% predicted |
|
|
Term
| Describe the characteristics of severe persistent asthma |
|
Definition
| Continual symptoms with limited physical activity and frequent exacerbations. Nighttime sx are frequent, fev1 is less than 60% predicted |
|
|
Term
| Describe the stepwise tx for asthma (6) |
|
Definition
1 (intermittent): SABA (these are used in all steps)
2 low dose ICS
3 low dose ICS and LABA OR medium dose ICS
4 medium dose ICS and LABA
5 high dose ICS and LABA
6 high dose ICS and LABA and oral corticosteroid |
|
|
Term
| If an asthma pt is using their SABA greater than ____ days per week their tx is considered uncontrolled and treatment needs to be stepped up |
|
Definition
|
|
Term
|
Definition
| A abnormal, permanent dilatation of the bronchi and destruction of the bronchial walls |
|
|
Term
| Which genetic disorder causes over half the cases of bronchiectasis |
|
Definition
|
|
Term
| What is a main symptom of bronchiectasis |
|
Definition
Chronic purulent sputum that becomes foul smelling with a bacterial exacerbation
Hemoptysis may be seen!!! |
|
|
Term
| What is the diagnostic test of choice for diagnosis of bronchiectasis and what findings does it show |
|
Definition
| Chest ct which will reveal dilated tortuous airways |
|
|
Term
| A CXR on a patient with severe bronchiectasis cou,d possibly show what three pathological signs |
|
Definition
| Tram track lung markings, honey combing, and atelectasis |
|
|
Term
| What are the top three isolated bacterial pathogens in acute bronchiectasis exacerbations in adults |
|
Definition
H flu
Pseudomonas
Strep pneumoniae |
|
|
Term
| If a pt with bronchiectasis has severe hemoptysis what can be done? |
|
Definition
| Embolization is an option |
|
|
Term
| The induction of bronchiectasis requires what one thing PLUS one of three other things.... |
|
Definition
1. An infectious insult PLUS
Impairment of drainage a/o airway obstruction a/o defect in host defenses |
|
|
Term
| What class of abx is recommended for patients with bronchiectasis acute exacerbations according to the top three most common bacterial pathogens |
|
Definition
| Fluoroquinolones (we need pseudomonas coverage!) |
|
|
Term
| a forced expiratory time greater than _____ seconds indicates severe expiratory outflow |
|
Definition
|
|
Term
| Define pulmonary emphysema |
|
Definition
| abnormal permanent enlargement and destruction of the air spaces distal to the terminal bronchioles |
|
|
Term
| What is the pathogenesis of emphysema? |
|
Definition
destruction of alveolar walls is due to relative excess in protease (elastase) activity, or relative deficiency of anti protease (A1AT def.) activity in the lung. Elastase is released from PMNs and macrophages and digests human lung. This is inhibited by a-1 antitrypsin.
tobacco smoke increases the # of activated PMNs and macrophages, inhibits a-1 antitrypsin, and increases oxidative stress on the lung by free radical production |
|
|
Term
| Pulmonary emphysema patients are often nicknamed _______. Explain the physiology behind this (hint: begins with the destruction in the lung and its effect on the ability to oxygenate blood) |
|
Definition
PINK PUFFERS
due to the lowered ability to oxygenate blood, the body compensates with lowered cardiac output and hyperventilation. This V/Q mismatch results in relatively limited blood flow through the lung and a fairly well oxygenated lung with normal blood gases and pressures. Because of the low CO, the rest of the body suffers from hypoxia and pulmonary cachexia which eventually leads to muscle wasting and weight loss. |
|
|
Term
| What is the definition of chronic bronchitis |
|
Definition
| a productive cough occurring on most days for at least three months in a year for at least two consecutive years |
|
|
Term
| Chronic bronchitis patients are often nicknamed _______. Describe the phsyiology behind this (hint: the obstruction in the lungs leads to hypercapnia and respiratory acidosis....) |
|
Definition
| the respiratory acidosis leads to pulmonary artery vasoconstriction and cor pulmonale. the ensuring hypoxemia, polycythemia, and increased CO2 retention---- these patients have signs of right heart failure and are known as BLUE BLOATERS |
|
|
Term
| If a patient has smoked one pack of cigarettes per day for one year, how many pack years is this? |
|
Definition
|
|
Term
| the PaO2 in a patient with COPD generally stays normal until the FEV1 falls to < ______%, but hypercarbia and pulm HTN are not common until after it has fallen to < ______% |
|
Definition
|
|
Term
| What genetic disorder is the second leading cause of emphysema |
|
Definition
| alpha 1 antitrypsin deficiency |
|
|
Term
| What are the tx guidelines for a pt with mild-moderate COPD |
|
Definition
| begin with bronchodilator and MDI (anticholinergics- ipratropium A/O b agonists (albuterol) with low dose inhaled glucocorticoids (budesonide) |
|
|
Term
| What is the criteria for long term O2 therapy in a patient with COPD |
|
Definition
| PaO2 of <55mmHg OR O2 sat <88% OR PaO2 55-59 mmHg with evidence of polycythemia or cor pulmonale |
|
|
Term
| Pursed lip breathing and grunting expirations are common sx in which subset of cOPD |
|
Definition
|
|
Term
| What is a pathognomonic sign of emphysema that is present on the surface of the lung? |
|
Definition
| subpleural blebs or parenchymal bullae |
|
|
Term
| What will the BNP in a patient with chronic bronchitis look like? |
|
Definition
| It will be abnormal, but not as crazy high as in a person with CHF |
|
|
Term
| What is the most common lethal inherited disease in white people? |
|
Definition
|
|
Term
| what type of genetic disorder is cystic fibrosis? |
|
Definition
|
|
Term
| is a disease of _____crine gland dysfunction |
|
Definition
|
|
Term
| Which two organ systems are most often affected in CF? |
|
Definition
| these patients often have chronic lung disease and exocrine pancreatic dysfunction |
|
|
Term
| what may be seen on the nose exam of a CF patient |
|
Definition
|
|
Term
| What finding of vitamin A and what finding of B complex deficiency may be seen in CF patients? |
|
Definition
A- dry skin
B complex- cheilosis |
|
|
Term
| Why are some male CF patients sterile? |
|
Definition
| absence of the vas deferens |
|
|
Term
| Requirements for a CF diagnosis include either a positive genetic testing OR what one definite thing and an option of three others... |
|
Definition
-positive sweat chloride findings (>60 mEq/L) and 1 of the following:
-typical COPD
-documented exocrine pancreatic insufficiency
-positive family history (usually an affected sibling) |
|
|
Term
| recovery of which organism from bronchoalveolar lavage fluid supports the diagnosis of CF in a clinically atypical case and in children... |
|
Definition
|
|
Term
| What are the three primary goals in the tx of CF |
|
Definition
1. maintaining lung function as near to normal as possible by controlling respiratory infection and clearing airways of mucus
2. administering nutritional therapy to maintain adequate growth (CF patients have trouble absorbing fat soluble vitamins)
3. managing complications |
|
|
Term
| the CF transmembrane conductance regulator (CFTR) protein is the underlying cause of CF, what is the name of the first type of CFTR potentiator used to treat CF |
|
Definition
|
|
Term
| Which disease on the blueprint is a specific form of chronic progressing fibrosing interstitial PNA? |
|
Definition
| idiopathic pulmonary fibrosis (IPF) |
|
|
Term
| A pt presents with DOE ond nonproductive cough x 8 months that has been gradual in onset.... what is your initial thought about a dx... |
|
Definition
| idiopathic pulmonary fibrosis |
|
|
Term
| What might be heard when auscultating the chest of a person with idiopathic pulmonary fibrosis? |
|
Definition
| fine bibasilar inspiratory crackles (velcro) that start at the base and progress upwards with increasing disease |
|
|
Term
| A very common comorbidity of patients with idiopathic pulmonary fibrosis (20-40%) is.... |
|
Definition
|
|
Term
| What are two things that may be seen on the CXR of a pt with idiopathic pulmonary fibrosis? |
|
Definition
| honeycombing! and possibly ground glass opacities |
|
|
Term
| What is the best radiological study for the diagnosis of idiopathic pulm fibrosis |
|
Definition
|
|
Term
| What may a pulm function test show in a patient with idiopathic pulm fibrosis? |
|
Definition
| a restrictive defect with a decreased lung volume and a NL to increased FEV1/FVC ratio |
|
|
Term
| What is the only definitive treatment for idiopathic pulm fibrosis |
|
Definition
| lung transplantation because no effective pharmacologic treatment has yet been discovered |
|
|
Term
| Do anti inflammatory medications work for a patient with idiopathic pulm fibrosis? |
|
Definition
| NO. this is not a disease of inflammation, rather it is due to fibroblast proliferation and fibrogenesis |
|
|
Term
| What two classes of drugs used in combo have been tried in patients with idiopathic pulm fibrosis? |
|
Definition
| corticosteroids (10-15% of pts are responders) with Cytotoxic drugs (ex's: azathioprine and cyclophosphamide) |
|
|
Term
| What are the three most common presenting symptoms of a patient with pulm HTN (sx relating to their pulm HTN- disregard if the HTN is secondary) |
|
Definition
dyspnea
weakness
recurrent syncope |
|
|
Term
| What is the most common abnormal heart sound heard on auscultation in a pt with pulm HTN |
|
Definition
|
|
Term
| What two heart murmurs may be heard in a pt with pulm HTN |
|
Definition
| pulmonic regurg (graham steell murmur) a/o tricuspid regurg |
|
|
Term
| What are the findings on lung exam in a patient with pulm HTN |
|
Definition
| usually normal unless there is another pulmonary problem causing the pulm HTN |
|
|
Term
| WHAT is the criterion standard for diagnosing pulm hTN |
|
Definition
|
|
Term
| What type of thyroid disorder is often discovered in pts with idiopathic pulm HTN |
|
Definition
|
|
Term
| What is usually found on the EKG of a pt with pulm htn? |
|
Definition
| R axis deviation, R atrial enlargement, R ventricle hypertrophy, ST depression and T wave inversions in the anterior leads |
|
|
Term
| WHat class of drugs is often used to treat pulm HTN |
|
Definition
CCBs because they act on vascular smooth muscle to dilate the pulmonary resistance vessels and lower pressure
-they are used in high doses |
|
|
Term
| What are contraindications for CCB use in a pt with pulm HTN |
|
Definition
|
|
Term
| Name 4 ancillary tx's for pts with pulm HTN |
|
Definition
warfarin
digoxin (improve the RV fxn)
diuretics (for peripheral edema)
O2 |
|
|
Term
| Pulm HTN is defined as what pulmonary arterial pressures? |
|
Definition
| >25 mmHg at rest or >30 mm Hg during exercise |
|
|
Term
| what is the definition of cor pulmonale? |
|
Definition
| an alteration in the structure and function of the right ventricle caused by a primary disorder of the respiratory system |
|
|
Term
| what type of heart murmurs could be heard on a patient with cor pulmonale |
|
Definition
| split 2nd heart sound with an accentuated pulmonary component and systolic ejection click |
|
|
Term
| What would a CXR, ECG, and echo show on a patient with cor pulmonale? |
|
Definition
CXR: emlargement of the RA RV and pulm arteries
ECG: right axis deviation, peaked P waves, RV hypertrophy
Echo: positive for RV dilatation (NL LV size and fxn) |
|
|
Term
| what are the two things that can cause acute cor pulmonale? What would be characteristics of the RV in this case? |
|
Definition
-massive pulmonary embolism (sudden increase in pulm resistance)
-ARDS (RV overload caused by the pathologic features of the syndrome and mechanical ventilation requires a higher transpulmonary pressure)
-RV would be dilated as opposed to hypertrophied |
|
|
Term
| Name some meds used in cor pulmonale |
|
Definition
Diuretics- to decrease elevated RV filling volume and pressure
CCBs- pulm artery vasodilators to decrease RV afterload
O2 to decrease RV afterload
Warfarin- to prevent thromboembolism in high risk pt AND in patients where thromboembolus caused the problem |
|
|
Term
| what are some rescue drugs for unstable patients with cor pulmonale |
|
Definition
DRUGS that help RV contractility:
milrinone (inotropic agent, vasodilator)
norepinephrine
dobutamine (adrenergic CV agent) |
|
|
Term
| pneumoconioses are (obstructive/restrictive) lung diseases |
|
Definition
|
|
Term
| what is a restrictive pattern on PFTs |
|
Definition
| normal FEV1/FVC with decreased TLC |
|
|
Term
| what are some occupations that could expose someone to asbestos? |
|
Definition
| insulation, demolition, construction, mining, manufacturing, ship building |
|
|
Term
| what are two characteristic findings on CXR of asbestosis? |
|
Definition
| linear opacities and pleural plaques |
|
|
Term
| Coal worker's pneumoconiosis is usually (sx-atic/asx-atic) |
|
Definition
| asymptomatic until nodules are greater than 1 cm |
|
|
Term
| 62% of patients with coal workers pneumoconiosis will develop what? |
|
Definition
|
|
Term
| what are some occupations that could expose someone to silica? |
|
Definition
| mining, sand blasting, quarry work, stone work, glass and pottery work |
|
|
Term
| what are some diagnostic characteristics on CXR of silicosis? |
|
Definition
small nodular opacities in the upper lobes (silicotic nodules)
EGGSHELL appearance! (calcified hilar lymph nodes) |
|
|
Term
| what lung CA is not due to smoking, but due to asbestos exposure? |
|
Definition
|
|
Term
| what are some occupations that may expsoure a pt to beryllium? |
|
Definition
| high techonology fields (aerospace, nuclear power), ceramics, tool and dye manufacturing |
|
|
Term
| What is the tx for most pneumoconioses? |
|
Definition
Supportive: O2, vaccinations (pneumovax and flu) and rehab
corticosteroids may relieve chronic alveolitis in silicosis, but other pneumoconioses are unresponsive |
|
|
Term
| What is the pathognomic lesion of sarcoidosis |
|
Definition
|
|
Term
| what two organ systems are most often affected by sarcoidosis? |
|
Definition
| lungs and lymph nodes (hilar) |
|
|
Term
| A 45 yo black female presents with dry cough, dyspnea, and non-specific chest pain x 2 months.... you think.... |
|
Definition
|
|
Term
| What skin condition is commonly associated with arthralgic manifestations of sarcoidosis |
|
Definition
|
|
Term
| What is the name for the rash associated with sarcoidosis? |
|
Definition
lupus perino
violaceous papular lesions commonly on the face |
|
|
Term
| What radiographic modality is central to evaluation of sarcoidosis |
|
Definition
|
|
Term
| What are the serum ACE and calcium levels of a sarcoid patient |
|
Definition
| elevated because NCGs secrete ACE and 1,25 vitamin D |
|
|
Term
| What is the gold standard for diagnosing sarcoidosis? |
|
Definition
| biopsy showing non-caseating epitheloid granulomas |
|
|
Term
| What is the first line tx for a pt with sarcoidosis? |
|
Definition
Prednisone if the pt is stage 2 or 3
if no response after 1-3 months, taper off
if response, continue for 12 months |
|
|
Term
| What medication is an alternative to steroid tx in a pt with sarcoidosis |
|
Definition
|
|
Term
| A sarcoidosis patient should have monitoring follow up visits every 6-12 months (3-6 months if more severe disease) and what two things should be checked for progression or regression of disease |
|
Definition
|
|
Term
| what is another name for hyaline membrane disease? |
|
Definition
infant respiratory distress syndrome
surfactant deficiency |
|
|
Term
describe what is happening, surfactant wise, at the following weeks in gestation
24-28
28-32
35 |
|
Definition
24-28: surfactant begins to be produced
28-32: found in amniotic fluid
35: most neonates have adequate amounts of surfactant |
|
|
Term
| what may be seen on a CXR in a baby with hyaline membrane disease |
|
Definition
air bronchograms!
atelectasis
doming of diaphragm |
|
|
Term
| a baby with hyaline membrane disease may have what results on an ABG |
|
Definition
| increase CO2 and decrease O2 leading to a respiratory acidosis |
|
|
Term
| administration of exogenous surfactant for a baby with hyaline membrane disease is most efficacious within ______ hours of birth |
|
Definition
|
|
Term
| what type of ventilation is used in babies with hyaline membrane disease |
|
Definition
| CPAP low and slow and IV fluids |
|
|
Term
| what is the prophylaxis for a baby that is going to be premature and may not have enough surfactant |
|
Definition
| mom takes glucocorticoids (dexamethasone and beclamethasone) to help baby's lung maturity speed up |
|
|
Term
| which bronchus is more likely to have a foreign body lodged in it? |
|
Definition
|
|
Term
| What is a pleural effusion? |
|
Definition
| an abnormal collection of fluid in the pleural space resulting form excess fluid production or decreased absorption |
|
|
Term
| what is the pathophysiological balance that prevents pleural effusions? |
|
Definition
1. hydrostatic and oncotic forces
2. extensive lymphatic drainage
- when something disrupts this balance effusions can develop |
|
|
Term
| what is the #1 sx of pleural effusion? name some more... |
|
Definition
DYSPNEA!
cough
pleuritic chest pain
tachypnea |
|
|
Term
| physical exam findings for pleural effusions usually do not show up unitl >_____ mL of fluid are present in the pleural space? |
|
Definition
| >300 mL (NL amount of fluid in the pleura space is about 0.13 ml/kg of 1 mL in most healthy people) |
|
|
Term
| what are some PE findings present with a pleural effusion? |
|
Definition
-dimished/absent breath sounds
-dullness to percussion
-decreased tactile fremitus
-egophony |
|
|
Term
| What is the criteria used to determine if a pleural effusion is transudative or exudative? Name some criteria |
|
Definition
Lights criteria
-pleural fluid (PF) PRO/serum PRO >0.5 = exudative
-PF LDH/serum LDH >0.6= exudative
-PF LDH >2/3 the lab's upper limit of normal SERUM LDH |
|
|
Term
| Describe the difference between a transudative and exudative pleural effusion |
|
Definition
-transudative: usually ultrafiltrates of plasma in the pleura due to imbalance of hydrostatic and oncotic forces in the chest
-exudative: caused by inflammatory conditions and the pleural membrane is involved- permeability of pleural capillaries to PRO is incr. resulting in high PRO content in the fluid |
|
|
Term
|
Definition
| accumulation of air in the pleural space |
|
|
Term
| what is the MC RF for a primary spontaneous PTX |
|
Definition
|
|
Term
| What are the O2 sats often for a pt with a PTX? |
|
Definition
| They are often NL, so don't let this fool you |
|
|
Term
| What is the #1 diagnostic exam for PTX |
|
Definition
|
|
Term
|
Definition
-small will resolve on their own
-large or symptomatic: Chest tube inserted at the 4-5th intercostal space (nipple line in men) at the midaxillary line
-THEN O2 and serial CXR Q24hrs until resolved |
|
|
Term
| What are the differences between the presenting sx of a spontaneous PTX and a tension PTX |
|
Definition
spontaneous- acute onset of chest pain and SOB
tension- hypotension, hypoxia, chest pain, dyspnea |
|
|
Term
| Describe a primary spontaneous PTX (PSP) |
|
Definition
| occurs in pts without underlying lung dz (however many have underlying blebs!) and in absence of inciting event. pts are usually male, age 20-40 who are very tall and thin and are SMOKERS |
|
|
Term
| describe a secondary spontaneous PTX |
|
Definition
| occurs in pts with a wide variety of parenchymal lung disease- air enters the pleural space via distended, damaged, or compromised alveoli |
|
|
Term
| Describe a traumatic/tension PTX |
|
Definition
traumatic- due to blunt or penetrating trauma
tension- life threatening condition that develops when air is trapped in the pleural cavity under positive pressure- displacing mediastinal structures and compromising cardiopulmonary function |
|
|
Term
| name the chest tube sizes used for a pt with large PTX in stable condition, unstable condition, and a pt with an effusion |
|
Definition
16-22 French
22-28 French
8-16 French first, if ineffective try 22 or bigger |
|
|
Term
| What is a pulmonary embolism? |
|
Definition
| obstruction of the pulmonary arterial system with material that originated elsewhere in the body |
|
|
Term
| Name some common sources of pulmonary emboli |
|
Definition
-DVT (90%)
-tumors that invaded venous circ
-air
-fat from a long bone fx
-amniotic fluid from active labor |
|
|
Term
| Name the most common s/sx of PE |
|
Definition
Dyspnea/SOB
Tachypnea!
PLeuritic CHest pain
Hemoptysis
tachycardia |
|
|
Term
| Explain using a D-Dimer test to eval a possible PE |
|
Definition
| a normal D-Dimer always ruled out a PE, but if it is elevated it needs to be examined further. Many patients have elevated D-dimers for an assortment of reasons (esp hospitalized patients) |
|
|
Term
| What blood count is sometimes elevated in pts with PE |
|
Definition
| WBC- not always, but its not uncommon to see a WBC of >20,000 |
|
|
Term
| What are the gold standard radiological tests for eval of PE |
|
Definition
-#1 multi row detector CTA
-#2 pulm angio gram if #1 is not available
-CXR to rule out other diagnoses |
|
|
Term
| What are the first steps of tx for a pt with pe |
|
Definition
-O2!
-Heparin for at least 5 days
-Long term Warfarin (X3 months)- should be overlapped at least 5 days with heparin |
|
|
Term
| When is thrombolysis indicated in PE |
|
Definition
| when there is shock, refractory hypoxemia, or signs of RHF |
|
|
Term
|
Definition
hypercoagulability
endothelial injury
hemodynamic stasis |
|
|
Term
| What is Wells Criteria a scoring system for? |
|
Definition
|
|
Term
| What is acute respiratory distress syndrome (ARDS)? |
|
Definition
| the acute onset of BL pulmonary infiltrates and severe hypoxemia in the absence of evidence of cardiogenic pulmonary edema |
|
|
Term
| How is ARDS differentiated from an acute lung injury (ALI)? |
|
Definition
| PaO2/FIO2 is <200 in ARDS and <300 in ALI |
|
|
Term
| What is the basic pathophysiology of ARDS? |
|
Definition
| associated with diffuse alveolar damage (DAD) and lung capillary endothelial injury. early phase is considered exudative and later phase is considered fibroproliferative |
|
|
Term
| What are some causes of ARDS |
|
Definition
-direct lung injury (gastric acid aspiration, PNA, near drowning, pulm contusion, O2 toxicity, toxic inhalation)
-Sepsis (#1 RF for ARDS)
-drug OD
-acute pancreatitis |
|
|
Term
| When does ARDS usually present |
|
Definition
| within 24-48 hrs of the triggering event |
|
|
Term
| give the timeline of ARDS sx |
|
Definition
| dyspnea with exertion that progresses to dyspena at rest, tachypnea, anxiety, agitation, and increased O2 demands |
|
|
Term
| What diagnosis must be ruled out before a pt can be said to have ARDS |
|
Definition
| cardiogenic pulm edema- look for CHF, volume overload, JVD, murmurs, hepatomegaly, edema |
|
|
Term
| What Labs/Rads are useful for a pt with ARDS |
|
Definition
|
|
Term
| Are any drugs implicated for the tx of ARDS |
|
Definition
No
-corticosteroids are recommended but only show an increase in mortality to >14 days |
|
|
Term
|
Definition
| a colorless, odorless gas produced by combustion of carbonaceous material |
|
|
Term
| describe the pathophysiology of CO toxicity |
|
Definition
-causes impaired O2 delivery and utilization at the cellular level
-toxicity primarily results from cellular hypoxia from impedence of O2 delivery. CO reversibly binds hgb
-CO binds myoglobin even better than hgb-- causing myocardial depression and hypotension that exacerbates the problem |
|
|
Term
| what are the most common symptoms for non traumatic non fatal nonfire exposure to CO |
|
Definition
| HA (37%) dizziness (18%) nausea (17%) |
|
|
Term
| cherry red skin is known as a classic sign of CO toxicity, is it reliable? |
|
Definition
not really- "when youre cherry red, youre dead"
most patients present with pallor |
|
|
Term
| Whats an example work up for a pt with possible CO toxicity |
|
Definition
HbCO levels
ABG
Troponin, CKMB
CK (non traumatic rhabdo)
CXR and CT head to r/o other dx if no improvement |
|
|
Term
| what is the tx for CO toxicity? |
|
Definition
remove from expsoure
intubate if necessary
100% o2 until HbCO <10% |
|
|
