1. Number one cause of mortality from infectious disease
  2. M/C cause of acute bronchitis
    viral (influenza, rhinovirus, adenovirus, coronavirus, parainfluenza, RSV)
  3. Bacterial cause of acute bronchitis
    mycoplasma, chlamydia
  4. Dx of bronchitis
    • constitutional sx
    • wheezing, rhonchi on lung exam
  5. Bronchitis tx
    • supportive
    • bronchodilators
  6. CXR in acute bronchiolitis
    hyperinflation, peribronchial cuffing
  7. Tx of acute bronchiolitis
    • supportive
    • oxygen
    • bronchodilators
    • fluids
  8. Bronchiolitis prophylaxis
  9. direct laryngoscopy reveals "cherry red" epiglottis
    acute epiglottitis
  10. Tx of acute epiglottitis adults
    • 2-3G ceph
    • B-lactam/B-lactamase inhibitor
    • PCN allergy: Bactrim, clinda
  11. Tx of acute epiglottitis children
    • stabilize airway
    • abx
    • dexamethasone
  12. When is eradication of HIB carrier warranted?
    If child is < 4yo and not vaccinated, give Rifampin to all family members x4days to eradicate carriage of HiB
  13. laryngotracheobronchitis
  14. m/c cause of croup
  15. seal like barking cough
  16. differentiate croup from epiglottitis
    presence of cough, lack of drooling
  17. steeple sign
  18. tx of croup
    • mild: supportive, hydrate, do not agitate
    • moderate WITH stridor: nebulized racemin epinephrine, oxygen if desaturating. Dexamethasone IM x 1
    • Admit to hospital: requires multiple racemic epi treatments, desaturating, in respiratory distress
  19. cause of influenza
  20. Type A influenza affects
    humans, swine, horses
  21. Type B influenza affects
  22. Type C influenza affects
  23. Dx of influenza
    • throat saw or nasal wash for rapid ELISA
    • HOWEVEr poor Sn, cannot distinguish b/w A and B
  24. Tx of influenza
    • supportive care
    • antivirals if: active malignancy, nursing home resident, those requiring hospitalization, at high risk
    • Relenza > 7 yo
    • Tamiflu > 1 yo
    • Both above if sx present < 48 hours
  25. Reye syndrome
    fatty liver plus encephalopathy in children with Type B influenza
  26. Influenza vaccine CI
    hypersensitivity to eggs, current illness, hx of GBS, hx of allergy to vaccines
  27. Mortality from influenze m/c due to what
    secondary bacterial pneumonia
  28. Gram negative pleomorphic bacillus
  29. pertussis reservoir
    humans only
  30. catarrhal stage of pertussis
    insidious onset of sneezing, coryza, loss of appetite, hacking cough most prominent at night
  31. stage of pertussis that is contagious
  32. paroxysmal stage of pertussis
    spasms of rapid coughing fits followed by high pitched inspiration.
  33. Convalescent stage of pertussis
    decrease in frequency and severity of paroxysms, stage is usually 4 weeks after onset of cough
  34. Dx of pertussis
    nasopharyngeal culture
  35. Tx of pertussis
    • erythromycin
    • alternatives: clarithromycin, Bactrim, azithromycin
  36. m/c cause of viral pneumonia
    influenza a and b
  37. cause of viral pneumonia in ilitary, colleges
  38. cxr in viral pneumonia
    interstitial infiltrates
  39. tx of viral pneumonia
  40. m/c causes of HAP
    pseudomonas, klebsiella, e coli, acinetobacter, staph
  41. Sx of legionella pneumonia
  42. sx of mycoplasma pneumonia
    bullous myringitis, rash, hemolytic anemia
  43. sx of chalmydia pneumonia
    sore throat, hoarseness
  44. labs for mycoplasma pneumonia
    IgG, IgM on top of nl
  45. Tx of HAP
    • cefepime
    • zosyn
    • cabrapenem
    • vanco/zyvox if MRSA suspected
  46. pneumococcal vaccines
    • PCV < 4 yo
    • PPV > 65, > 2 yo with chronic illness that predisposes them to CAP
  47. m/c mycosis occuring in the US
  48. found predominately in the Ohio and Mississippi River valley
  49. tx of histoplasmosis
    • amphotericin for life threatening disease
    • itraconazole for all other cases
  50. where is aspergillus found
    in soil and moist environments (compost, hay, grain, gardens)
  51. tx of aspergillus
  52. found in desert soil of southwest UA
  53. San Joaquin Valley Fever
  54. CXR findings in coccidiomycoses
    single infiltrate or multilobar involvement
  55. tx of coccidiomycoses
    • immunocompetent: no tx
    • severe infection: azole, amphotericin
  56. Primary TB
    Occurs after initial infection, may be asx or presnt with fever, pleuritic CP
  57. Latent TB
    • bacterium is contained, person is asx and not infectious
    • Tb reactivated in setting of immune compromise
  58. hallmark of TB
    bx demonstrating caseating granulomas
  59. TB dx
    +AFB smear (3 consecutive mornings)
  60. ghon complex
    calcified primary focus in TB
  61. ranke complex:
    calcified primary focus and calcified hilar LN
  62. miliary TB
    millet seed appearance diffusely throughout lungs (hematogenous spread)
  63. TB Tx
    • RIPE
    • Rifampin, Isoniazid, Pyrazinamide, Ethambutol
    • Tx regular person 6-9 months
    • Tx HIV postive 1 year
    • Tx previously neg pts with positive PPD 6-9 months
  64. Side effects of INH
    hepatitis, peripheral neuropathy
  65. Side effects of rifampin
    hepatitis, orange urine, flu-like sx
  66. Side effects of ethambutol
    optic neuritis
  67. oat cell carcinoma
  68. SCC CXR findings
    bronchial in origin, centrally located, sessile mass, more likely to present with hemoptysis
  69. Adenocarcinoma CXR findings
    arises from mucous glands, usually in periphery of lung
  70. m/c type of bronchogenic carcinoma
  71. large cell carcinoma CXR findings
    central or peripheral masses
  72. small cell carcinoma
    tumor of bronchial origin, begins centrally, may cause bronchus obstruction
  73. Paraneoplastic syndrome
    • Endocrine: cushings, SIADH, hypercalcemia, gynecomastia
    • Neuromuscular: peripheral neuropathy, Eaton-Lambert
    • Hematologic: anemia
    • Cutaneous: acanthosis nigricans
  74. Tx of NSCLC
  75. Tx of SCLC
    chemo +/- XRT
  76. overall 5 year survival rate for lung ca:
  77. Pancoast's tumor
    • tumor of lung apex, causes Horner's and shoulder pain
    • associated with bronchogenic carcinoma
  78. carcinoid tumors
    • well differentiated neuroendocrine tumores that are considered to be low-grade malignant neoplasms
    • grow slowly and rarely met
  79. bronchial gland tumors
    carcinoid tumors
  80. bronchoscopy reveals pink or purple lesion that is well vascularized
    carcinoid tumor
  81. tx of carcinoid tumor
    surgical excision, lesions are RESISTANT to XRT and chemo
  82. Where can lung ca met to?
    • adrenal glands
    • liver
    • brain
    • bone
  83. coin lesion
    solitary pulm nodule < 3 cm
  84. etiologies of coin lesions
    • old or active TB
    • fungal infection
    • FB reaction
    • malignancy
  85. Benign coin lesions vs malignant lesions
    • benign: smooth, well defined edge, dense calcifications
    • malignant: rapidly progressive, rarely calcified, usually >2 cm in diameter, indistinct margins, spiculated peripheral halo
  86. Dx of asthma
    • < FEV/FVC ratio < 70%
    • Improvement in FEV1 and FVC after administration of B2 agonist
  87. Tx of mild intermittent asthma
    no daily meds, just SABA
  88. tx of mild persistant asthma
    daily low dose inhaled corticosteroid or cromolyn
  89. tx of moderate persistant asthma
    daily inhaled medium dose steroid or low-dose inhaled steroid + LABA (Advair)
  90. Tx of severe persistent asthma
    daily inhaled high dose steroid and long acting B2 AND PO steroids
  91. bronchectasis
    abnl, permanent dilation of bronchi and destruction of bronchial walls
  92. clinical manifestations of bronchiectasis
    clubbing, lung crackles
  93. CXR findings in bronchiectasis
    tram-track lung markings, honeycombing, atelectasis
  94. Tx of bronchiectasis
    • Bronchodilators, chest PT
    • ABX for acute sx: bactrim, tetracycline, augmentin
    • Suppressive therapy
  95. CF cause
    abnl in membrane chloride channel
  96. median survival with CF
  97. CF puts pts at risk for what other dz
    GI tract malignancies, malnutrtion and arthropathies, and pancreatic insufficiency
  98. Chronic bronchitis def
    productive cough >3 months for two consecutive years
  99. emphysema def
    permanent enlargement of air spaces distal to terminal bronchiole, no obvious fibrosis
  100. PFTs in COPD
    FEV1/FVC < 70% of predicted, > RV, > TLC, > FRC
  101. CXR in COPD
    hyperinflated with flat diaphragms, parenchymal blebs
  102. ABG in COPD
    hypoxemia, chronic respiratory acidosis in advanced disease
  103. TX of COPD
    • First line: SABAs (anticholinergics over BA, ie atrovent over albuterol)
    • Second line: LABA + inhaled steroid +/- long acting anticholinergic (Spiriva)
  104. m/c cause of transudative pleural effusion
  105. exudative pleural effusion
    abnl capillary permeability
  106. transudative pleural effusion
    d/t increased hydrostatic or decreased oncotic pressure
  107. causes of exudative pleural effusions
    • parapneumonic effusion
    • Ca
    • fungal infection
    • CT dz
    • TB
  108. Causes of transudative pleural effusion
    CHF, cirrhosis, nephrotic syndrome
  109. Lung PE findings in pleural effusion
    • dullness to percussion
    • decreased to absent lung sounds
    • no air bronchograms
  110. CXR findings in pleural effusion
  111. blunting of costophrenic angle
    mediastinum shifted away from effusion
  112. Light's criteria
    • An effusion is likely exudative if at least one of the following exist:
    • Pleural protein to serum protein ratio > 0.5
    • Pleural LDH to serum LDH ratio > 0.6
    • Pleural LDH to serum LDH ratio > 0.6
  113. tx of transudative pleural effusion
    therapy directed at underlying condition, chest tube rarely indicated
  114. tx of malignant pleural effusions
    drainage through repeat thoracentesis, chest tube, pleurodesis
  115. Tx of parapneumonic pleural effusions
    • simple: respond to abx
    • complicated: CT or abx
    • Empyema: CT
  116. Tx of hemothorax
    • small volume: close observation
    • everything else: CT
  117. tension ptx
    secondary to sucking chest wound or pulmonary laceration that allows air to enter with inspiration, but dow not allow it to leave
  118. lung PE findings in PTX
    • diminished breath sounds
    • asymmetrical chest wall movement
    • hyperresonance
  119. CXR findings of tension ptx
    large am of air and contralateral mediastinal shift
  120. m/c cause of PE
    DVTs in lower extremities
  121. Virchow's triad
    endothelial injury, hypercoaguable state, hemostasis
  122. Dx of PE
    • D-dimer (very Sn, no Sp, need to have low clinical suspicion)
    • EKG (S1Q3T3 <20%)
    • ABG resp alkalosis, hypoxic with elevated A-a gradient
    • CXR needed to exclude other pathology and permanent V/Q read
    • V/QL best if high probability, if low probability, do CTA
  123. EKG findings in PE
  124. When is CTA CI in PE?
    dye allergies or renal failure
  125. Gold standard for PE dx
    pulm angiography
  126. Gold standard for dx of DVT
  127. Tx of PE
    • full dose anticoag with Hep or LMWH
    • tx 3-6 months for first episode; 1 year to life for recurrent
    • TPA if hemodynamic instability
    • IVC filter if anticoag not possible
    • thombectomy
  128. Pulm HTN
    present when mean pulm arterial pressure is > 25 mmHg
  129. Causes of secondary pulm HTN
    • Systemic sclerosis
    • COPD
    • cirrhosis
    • left heart failure
    • thromboembolic disease
    • HIV infection
    • sickle cell
    • OSA/OHS
  130. Clinical manifestations of pulm HTN
    • edema
    • ascites
    • cyanosis
    • splitting of S2
  131. Sx of pulm HTN
    • dyspnea
    • angina like retrosternal CP
    • weakness
    • fatigue
  132. CXR findings in pulm HTN
    enlarged pulm arteries
  133. EKG findings in pulm HTN
    RVH, RV strain
  134. Dx of pulm HTN
    right heart cath
  135. Tx of pulm HTN
    • chronic anticoag, CCB, prostacyclin, heart-lung transplant
    • secondary pulm tx: tx underlying disorder
  136. Cor pulmonale
    RV systolic and diastolic failure resulting from lung disease or pulm vascular disease
  137. Causes of cor pulmonale
    • COPD
    • idiopathic pulmonary fibrosis
    • OSA
    • OHS
    • pneumoconiosis
    • chronic thromboembolic pulm HTN
  138. Dx of cor pulmonale
    • polycythemia
    • hypoxemia on ABG
    • PFTs confirm underlying lund disease
  139. EKG findings in cor pulmonale
    RAD, frank RVH
  140. Echo findings in cor pulmonale
    dilated RA, RV; RV dysfunction
  141. Tx of cor pulmonale
  142. Oxygen
    • salt and fluid restriction
    • diuretics
  143. prognosis of cor pulmonale
    life expectancy 2-5 years after signs of HF develop
  144. Labs in idiopathic pulm fibrosis
    PFTs show restrictive pattern
  145. CT findings in idiopathic pulmonary fibrosis
    peripheral reticular opacities at the bases, honeycombing
  146. Tx of idiopathic pulm fibrosis:
    contraversial bc nothing has shown to improve survival or quality of life
  147. Pneumoconiosis
    chornic fibrotic lung dz caused by the inhalation of coal dust or various inert, inorganic, silicate dusts
  148. four types of pneumoconiosis
    • coal worker's
    • silicosis
    • asbestosis
    • berryliosis
  149. occupations at risk for asbestosis
    insulation, demolition, shipyard
  150. CXR/CT findings of asbestosis
    linear streaking at base, honeycombing
  151. complications of asbestosis
    increased risk of mesothelioma, lung Ca
  152. CXR/CT findings in coal worker's lung
    opacities prominent in the upper lung
  153. Caplan syndrome
    RA nodules in lung periphery, associated with coal worker's lung
  154. complications of coal worker's lung
    progressive fibrosis, caplan syndrome
  155. occupations at risk for silicosis
    mining, sand blasting, quarry work, stone work
  156. CXR/CT findings of silicosis
    Calcification of periphery hilar LN "shells"
  157. complications of silicosis
    increased risk of TB, fibrosis
  158. Calcification of periphery hilar LN "shells"
  159. occupations at risk for beylliosis
    aerospace, nuclear power, ceramics, foundries
  160. complications of berylliosis
    requires chronic steroids
  161. Pneumoconiosis labs
    restrictive dysfunction
  162. pneumoconiosis tx
    • O2 as needed
    • quit smoking
    • bronchodilators
    • abx when infected
    • monitor for complications
  163. sarcoidosis
    multiorgan disease of idiopathic cause
  164. sarcoidosis characteristics
    affects lungs, eyes, liver, skin, LN, heart, nervous system
  165. Sx and clinical manifestations of sarcoidosis
    • cough
    • dyspnea
    • chest discomfort
    • malaise
    • fever
    • erythema nodosum
    • arthritis
    • parotid gland, LN enlargement
    • HSM
    • peripheral neuropathy
  166. Labs in sarcoidosis
    • leukopenia
    • eosinophilia
    • > SED
    • hypercalcemia, hypercalciuria
    • ACE
  167. Imaging in sarcoidosis
    • CXR shows symmetric B/L hilar adenopathy
    • Bronch shows > lymphocytes
  168. Tx of sarcoid
    • most cases respond to steroids
    • immunosuppressives
  169. complications of sarcoid
    • progressive fibrosis, bronchiectasis
    • respiratory failure
    • death
  170. 4 characteristics of ARDS
    • acute onset
    • PaO2/FiO2 ratio < 200
    • CXR with B/L infiltrates
    • No LVD
  171. Causes of ARDS
    • Severe multiple trauma
    • sepsis
    • aspiration of gastric contents
    • drugs
  172. Dx of ARDS
    • CXR with B/L infiltrates
    • air bronchograms ni 80%
    • Heart nl
  173. Tx of ARDS
    • tx underlying cause
    • lung protective vent management
    • ? steroids
  174. M/C cause of respiratory distress in preterm infant
    Hyaline membrane disease
  175. cause of hyaline membrane disease
    deficiency of surfactant
  176. sx and clinical manifestations of hyaline membrane disease
    • respiratory distress
    • cyanosis
    • expiratory grunting
  177. Imaging in hyaline membrane disease
    • CXR shows air bronchograms
    • Diffuse B/L atelectasis causing ground glass appearance
    • doming of diaphragm
  178. doming of diaphragm
    hyaline membrane disease
  179. tx of hyaline membrane dz
    • oxygen
    • SIMV support
    • exogenous surfactants
  180. best method of dx adenovirus pna
  181. tx of klebsiella pna
  182. gram positive diplococci in chains
    strep pneumo
  183. m/c complaint in person with TB
    chronic cough
  184. Which organism can cause hemorrhagic necrotizing consolidation pneumonia
  185. dx of sarcoidosis
    bronchoscopy with tissue biopsies
  186. dx of whooping cough
    nasopharyngeal culture
  187. m/c bug in empyemas
  188. empyema presentation
    • pneumonia that persists despite tx
    • fever despite abx
    • consolidation on CXR
  189. atelectasis
    pulmonary alveoli collapse
  190. most common cause of ectopic ACTH syndrome
    small cell lung carcinoma
  191. m/c hematologic findings in pulm HTN
  192. CXR finding in reactivation of TB
    fibrocavitary apical disease
  193. ABG
    respiratory alkalosis, d/t hyperventilation
  194. m/c heart sound in pulm HTN
    S2 split
  195. What range of time does it take for a PPD test to become positive as an immune response?
    2-10 weeks
  196. dense consolidation with bulging fissures
  197. Which lobe is most affected by infection of tuberculosis?
  198. air hunger and labored, deep respirations
    Kussmaul's respirations
  199. Kussmaul's causes what type of ABG abnormality?
    Metabolic acidosis
  200. PTX recurrence rate
  201. most common cause of pneumothorax in a healthy patient?
    ruptured bleb
  202. Which tumor is of bronchial  origin, and is known to grow rapidly and have diffuse metastases at the time of diagnosis?
    small cell
  203. primary cause of morbidity in pts with systemic sclerosis
    lung dz
  204. difference between pneumonia and pleural effusion lung exam
    in PNA, consolidation INCREASES tactile fremitus; in pleural effusion, tactile fremitus is decreased
  205. mean survival of sclc
    6-18 weeks
  206. m/c solitary nodules
    infectious granulomas from old or active TB, fungal infection, or foreign body reaction
  207. dilated, tortuous airways on CT
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