Clinical Medicine Exam 3 - Pulmonology

Front 1

MC cause of CAP

Back 1

S. pneumoniae

(strep)

Front 2

MC cause of ICU noscominal pneumonia

Back 2

Pseudomonas aeruginosa

Front 3

MC cause of atypical pneumonia

Back 3

Mycoplasma pneumonia

Front 4

MC cause of noscominal pneumonia

Back 4

S. aureus

Front 5

Bacterial CAP pneumonia tx for outpatient

Back 5

Doxycycline

or

Macrolide (-mycins - clar/ azit)

or

FQ (levaquin)

Front 6

Bacterial pneumonia tx for atypical bacteria

Back 6

Erythromycin

Front 7

Bacterial pneumonia tx for CAP inpatient

Back 7

B-lactam ( cef-TAX/TRI) + macrolide/doxy

or

B-lactam + FQ (levaquin)

Front 8

MC opportunistic infection in patients w/HIV

- CD4 ?

Back 8

Pneumocystis JIROVECI

- CD4 LESS THAN 200

Front 9

HIV related pneumonia tx?

Back 9

BACTRIM

(tx+prevent - high death if untx)

Front 10

MC substance of foreign body aspiration

Back 10

gastric content

Front 11

4 upper respiratory infections?

- 2 lower?

Back 11

EPIC

epiglottis

pertussis

influenza

croup

- A. Bronchitis + pneumonia

Front 12

Sudden onset of flu prodrome + DROOLING + tripod

- organism?

- XR?

- TX?

Back 12

Epiglottitis - [TRI's - 3 fingers/ thumb/ wing pig]

- ham flu b

- thumb + tripod (3 fingers)

- support. SECURE AIRWAY. + Abx B-lac (cef-TRI/TAX)

Front 13

whooping cough

- organism?

- stages?

- tx?

- characteristic?

Back 13

Pertussis [ ER - MYCINS ]

- bord. pertus ( - - )

- cat-per-corn

- Erythromycin (1 year older) / macrolide (other MYCINS)

Front 14

Flu + ASPIRIN causes

Back 14

Reye's syndrome (fatty liver w/ encephalopathy)

Front 15

Child w/ barking seal like cough, low fever, stridor

- CXR

- organism?

- tx?

Back 15

Croup (largy/trach/bronchitis)

- Parainflu virus 1

- Steeple

- hydrate/ steroids/ vapo

Front 16

Inflammation of trachea and bronchi

- 90% organisms?

Back 16

Acute bronchitis

- Rhino/coro/RSV virus

Front 17

Inflammation of bronchioles

- size?

- who?

- MC organism?

- tx?

Back 17

acute bronchIOLITIS [2 little + RSV]

- < 2 mm airways

- < 2 years

- RSV (rhino/adeno/para)

- support/ fluid, CPT

- nasal wash for RSV + antigen ASSAY

Front 18

RF for aspiration pneumonia (4)

Back 18

1. Sleepy

2. Intoxicated

3. Mind problems

4. Esophagus problems

Front 19

Pulmonary nodule malignancy traits (3)

Back 19

1. fussy borders

2. grows fast

3. mushy (rarely calcified)

Front 20

Dx pulmonary nodule

Back 20

CT

- q3month x 1 year then q6months x 2 years

Front 21

Leading cause of CANCER deaths in M/F

- #1 RF

Back 21

Lung cancer

- smoking

Front 22

Early + Aggressive cancer. Central bronchi to lymph nodes + SMOKER

Back 22

SMALL cell cancer

"oat cell"

Front 23

Most common type of bronchogenic carcinoma of smokers and non-smokers

Back 23

Adenocarcinoma (peripheral) (non-smoker) 30 -40%

Front 24

MC type of bronchogenic carcinoma of central bronchi + nonsmokers

Back 24

Squamous cell carcinoma

Front 25

Lung cancer of nonsmokers that is mostly peripheral + very aggressive

Back 25

Large cell carcinoma (anaplastic)

Front 26

Prognosis of lung cancer - 5 year survival rate

Back 26

15% (usually dx late)

Front 27

pink/purple well vascular/diff. central tumor w/diarrhea + flushing (2 names)

- dx?

- tx?

Back 27

carcinoid tumor aka carcinoid adenomas

Well differentiated NEUROENDOCRINE tumor - URINARY 5- HIAA level increased

- slow, rare metasis, uncommon

- tx - cut it out

Front 28

blockage of artery in the lungs by fat, air, clot or tumor cells

- most originate where?

Back 28

pulmonary embolism

- 90% deep veins in legs clots

Front 29

1. Hyper-coag state

2. Venous statis - sitting long time

3. vascular endothelial injury

Back 29

Virchow's triad

- RF for clotting ( + Surgery, CA, OTC, pregnancy)

Front 30

Dorsiflexion of the foot causes pain

Back 30

Homan's sign

- looks for lower extremity DVT that travels to pulmonary vas.

Front 31

Initial test for PE

- definitive test?

Back 31

Spiral CT (initial)

- pulmonary angiography (gold standard/definitive)

Front 32

Low/high clinical suspicion of PE, test before scan?

Back 32

D-dimer

- low suspicion, neg d = no PE

- high suspicion, neg d = CT

Front 33

Primary tx for small PE

- massive PE tx?

- secondary therapy?

Back 33

1. Anti-coag - HEPARIN DRIP

- thrombolytic therapy or remove sx

- prevent clotting risk - LMWH, warfarin, heart filter, walk, stockings

Front 34

Abnormally high blood pressure in the arteries of the lungs, making the right side of the heart work harder than normal

Back 34

Pulmonary HTN

Front 35

Primary vs secondary pulmonary HTN

Back 35

1. primary - idiopathic- rare + fatal

2. secondary - many causes

Front 36

Best initial dx test for pulmonary HTN

- Gold?

- tx?

Back 36

1. ECHO

- right heart catheterization

- vasodilators ( CaCB + prostacyclins) / (anticoag)

Front 37

Right sided heart failure caused by pulmonary HTN

Back 37

cor pulmonale

- right ventricle stretched out and fails

Front 38

Gold standard dx for TB

Back 38

sputum cultures showing mycobacterium

Front 39

Upper lobe nodules that progresses to CAVITARY lesion

Back 39

TB until proven otherwise

Front 40

Pressure that keeps lung open

Back 40

Negative pressure between lung and chest wall

- inspiration - increase in pressure differential

Front 41

Pulm. test result indicative of destruction of lung paraychema or dissociation of its capillaries -

Back 41

DL-CO - diffusion capacity of CO

- decreased in severe emphysema + pulm. fibrosis

Front 42

FEV1 increases 10% pre/post bronchodilator indicative

Back 42

asthma

Front 43

Dx Asthma

Back 43

PFT's : FEV1/FVC < 75%

- greater than 10% FEV1 increase post inhaler or greater than 200 ml increase

Front 44

Hallmark of Chronic bronchitis

- emphysema?

Back 44

Chronic productive cough

- DOE (dyspnea on exertion)

Front 45

Enzyme deficiency that mimics emphysema

Back 45

alpha 1 antitrypsin deficiency (AAT)

Front 46

Abnormal permanent dilation of bronchi and destruction of bronchial walls

- Disease that causes 50%

- DX?

Back 46

Bronchiectatasis

- CF

- High res. CT

Front 47

CF patients are likely to be infected by what organism?

Back 47

Pseudomonas aeruginosa ( like ICU/vent pt)

Front 48

chronic PROGRESSIVE parenchymal scarring and loss of pulmonary function from persistent inflammation

- key words?

Back 48

Idiopathic pulmonary fibrosis [idiots slowly comb the grass]

- restrictive

- PROGRESSIVE DOE + nonproductive cough

- honeycombing + groundglass

Front 49

Multi-organ disorder. Noncaseating granulomatous inflammation in affected organ

-opposite disease?

Back 49

Sarcoidosis

-ERYTHEMA NODOSUM

- spleen/ liver megaly - other organs

-BILATERAL HILAR + right paratracheal adenopathy

- TB (caseating granulomas)

- tx - prednisone

Front 50

What does CHF commonly cause in the lung?

- pneumonia?

Back 50

transudative (watery fluid) pleural effusion

- exudative (cell/protein rich fluid)

Front 51

chronic fibrotic lung disease caused by inhalation of dust particles from work

Back 51

pneumoconiosis

- avoid

- steroids

Front 52

Disease with increased risk of lung cancer and mesothelioma from work setting

Back 52

asbestosis - pneumonconiosis

[think commercial]

Front 53

pink frothy sputum from trach on vent patients indicates?

- most important setting?

Back 53

ARDS

- HM - severe refractory hypoxic resp. fail

- sepsis syndrome

- DANGER acute hypoxemic respiratory failure (organ failure from hypoxemia)

Front 54

Infant deficient of pulmonary surfactant

Back 54

Infant respiratory distress syndrome (IRDS) aka hyaline membrane disease

- ground glass

-premies (give mom steroids days before delivery)