Pulmonary system

What patient population is most commonly affected by primary spontaneous pneumothorax?

Tall, thin, young males who smoke (often due to apical bleb rupture)

What are common secondary causes of spontaneous pneumothorax?

COPD, Marfan syndrome, tuberculosis, cystic fibrosis

What classic CXR finding suggests pneumothorax?

Deep sulcus sign

What is the treatment for a pneumothorax <3 cm?

Observation and supplemental oxygen

What is the treatment for a pneumothorax >3 cm?

Chest tube placement

What are surgical interventions for pneumothorax?

Needle aspiration or chest tube thoracostomy

What are surgical interventions for Tension Pneumothorax

needle decompression f/u Chest tube thoracostomy

What are surgical interventions for Hemothorax

Chest tube and drainage

What is the most common cause of foreign body aspiration?

Food

Which bronchus is most commonly involved in foreign body aspiration?

Right main bronchus

What are key clinical signs of foreign body aspiration?

Stridor, wheezing, decreased breath sounds

What is the diagnostic imaging of choice for suspected aspiration?

Chest X-ray

What is the preferred removal technique in children vs adults?

Children: Rigid bronchoscopy |

Adults: Flexible bronchoscopy

What are complications of foreign body aspiration?

Pneumonia, ARDS, asphyxia

In what population is hyaline membrane disease most common?

Preterm infants <30 weeks gestation

What causes hyaline membrane disease?

Surfactant deficiency leading to alveolar collapse and decreased lung compliance

What are clinical features in hyaline membrane in preterm infants?

Tachypnea, nasal flaring, grunting, retractions, cyanosis

What are characteristic CXR findings in neonatal Hyaline membrane disease / RDS?

Ground-glass appearance, air bronchograms, low lung volume

What ABG changes occur in hyaline membrane disease?

Hypoxemia, respiratory acidosis, ↑ PaCO₂ as disease worsens

What is the best preventive measure for neonatal RDS/hyaline membrane disease?

Antenatal corticosteroids (e.g., betamethasone) before 34 weeks

What is the definitive treatment for neonatal RDS/hyaline membrane disease?

Exogenous surfactant via ET tube

What are potential complications of neonatal hyaline membrane disease/RDS?

Pneumothorax, bronchopulmonary dysplasia, retinopathy of prematurity

What is the PaCO₂ threshold for diagnosing obesity hypoventilation syndrome?

PaCO₂ > 45 mmHg

What BMI is used in diagnosing OHS?

BMI ≥ 30

What are symptoms of Obesity hypoventilation syndrome?

Daytime fatigue, morning headache, cyanosis, signs of cor pulmonale

What ABG findings are expected in OHS?

Persistent hypercapnia (↑ PaCO₂), elevated bicarbonate (compensatory)

What is the test of choice to evaluate for hypoventilation and OSA?

Polysomnography

What is the preferred non-invasive ventilation in OHS without OSA?

BiPAP

What is the cornerstone of treatment in OHS?

Weight loss (goal: 25–30% of body weight)

What treatment should be avoided in OHS?

Excessive oxygen (may worsen hypercapnia)

What are the two main types of pleural effusions?

Transudative and exudative

What are common causes of transudative effusion?

CHF, cirrhosis with ascites, nephrotic syndrome

What are common causes of exudative effusion?

Pneumonia, pulmonary embolism, cancer, autoimmune disease

What physical exam findings suggest pleural effusion?

Decreased tactile fremitus and breath sounds, dullness to percussion

What is a pleural friction rub suggestive of?

Inflammation of pleura, seen in pleuritis

What are classic CXR findings in pleural effusion?

Blunting of the costophrenic angle

What is the diagnostic and therapeutic procedure for pleural effusion?

Thoracentesis

What Light's criteria define exudative effusion?

Pleural protein:serum >0.5, LDH >0.6, or pleural LDH >⅔ upper limit of normal serum LDH

What are the most common pathogens causing epiglottitis?

Group A Strep and Haemophilus influenzae type B (HiB)

What are the classic “3 D’s” of epiglottitis?

Drooling, dysphagia, distress

What are key physical exam findings in epiglottitis?

Stridor, hoarseness, toxic appearance

What imaging sign is seen on lateral neck X-ray in epiglottitis?

Thumbprint sign

What is the treatment for epiglottitis?

Airway management,

IV dexamethasone

IV antibiotics (ceftriaxone, cefotaxime, or ampicillin)

What is acute bronchitis?

Inflammation of the bronchi, typically viral

What are typical symptoms of acute bronchitis?

Persistent cough lasting 1–3 weeks, wheezing, mild dyspnea

What is the most common cause of croup?

Parainfluenza virus (also RSV)

What are hallmark symptoms of croup?

Barking seal-like cough, inspiratory stridor, hoarseness, fever

What imaging sign is seen in croup?

Steeple sign (subglottic narrowing on neck X-ray)

What is the treatment for croup?

Dexamethasone; nebulized epinephrine if severe

What is the most common pathogen causing bacterial tracheitis?

Staphylococcus aureus

What are symptoms of bacterial tracheitis?

Barky cough, stridor, hoarseness, dysphagia, toxic appearance

How is bacterial tracheitis diagnosed?

Clinical + bronchoscopy with cultures

What is the treatment for bacterial tracheitis?

IV antibiotics: Clindamycin or Vancomycin + 3rd gen cephalosporin

What are the 3 stages of pertussis and timing?

Catarrhal (1–2 wks): mild URI, most contagious
Paroxysmal (2–6 wks): severe coughing fits with whoop
Convalescent (6+ wks): residual cough

What is a classic feature of the paroxysmal stage? pertussis

Post-tussive emesis

What confirms pertussis diagnosis?

Clinical diagnosis + nasopharyngeal PCR

What is the treatment for pertussis?

Macrolides (azithromycin or erythromycin)

What are common symptoms of influenza?

Fever, myalgia, headache, cough, sore throat

How is influenza diagnosed?

Rapid antigen test or viral culture

What is the treatment of influenza if diagnosed within 48 hours?

Oseltamivir (Tamiflu)

What is the most common cause of bronchiolitis?

Respiratory syncytial virus (RSV)

What are risk factors for severe bronchiolitis?

Prematurity, age <6 months, smoke exposure, no breastfeeding

What are clinical signs of bronchiolitis?

Wheezing, nasal flaring, tachypnea, intercostal retractions

What is the best initial management for bronchiolitis?

Supportive care: nasal suctioning, fluids, humidified oxygen

When should a child with bronchiolitis be admitted?

SpO₂

What are the main complications of RSV?

Apnea in infants, later reactive airway disease (asthma)

What diagnostic tests confirm RSV?

Nasal swab antigen test, CXR (bilateral infiltrates)

What is the management of RSV?

Supportive (O₂, suctioning); bronchodilators trial-based

What is used for RSV prophylaxis in high-risk infants?

Palivizumab (Synagis)

What is the most common TB screening method?

Tuberculin skin test (TST) or IGRA (Quantiferon)

What TST result is considered positive in high-risk patients (e.g., HIV+)?

≥5 mm induration

What radiographic finding is classic for reactivation TB?

Upper lobe infiltrates or cavitary lesions

What is the gold standard for TB diagnosis?

Sputum culture with AFB staining

What are the 4 drugs in initial RIPE therapy for active TB?

Rifampin, Isoniazid, Pyrazinamide, Ethambutol

What TB drug is associated with peripheral neuropathy?

Isoniazid (give with vitamin B6)

What is the treatment for latent TB?

INH + Rifapentine weekly x 3 months, or Rifampin alone x 4 months

What is the most common cause of ARDS?

Gram-negative sepsis

What are diagnostic criteria for ARDS?

PaO₂/FiO₂ < 300

bilateral infiltrates on CXR

PCWP < 18 mmHg

What is the cornerstone of ARDS treatment?

1st: Mechanical ventilation with PEEP

2nd: prone positioning

What is the most common cause of community-acquired pneumonia (CAP)?

Streptococcus pneumoniae

What is the classic sputum description of pneumococcal pneumonia?

Rust-colored sputum

What conditions are associated with Haemophilus influenzae pneumonia?

COPD, CHF

What pneumonia pathogen is common post-influenza or in IV drug users?

Staphylococcus aureus

What pathogen is associated with pneumonia in alcoholics or nursing homes, producing currant jelly sputum?

Klebsiella pneumoniae

What is the CXR finding in typical bacterial pneumonia?

Lobar consolidation

What is the empiric outpatient treatment for CAP without comorbidities?

Amoxicillin + macrolide OR doxycycline

What is the empiric treatment for inpatient pneumonia?

Ceftriaxone + macrolide or respiratory FQ

What is the most common setting for aspiration pneumonia?

Altered mental status, NG tube, or recent anesthesia

What is the classic symptom of aspiration pneumonia?

Foul-smelling sputum

What is the common location of aspiration pneumonia on CXR?

Right lower lobe infiltrate

What is the treatment for aspiration pneumonia?

Ampicillin-sulbactam or clindamycin (anaerobic coverage)

What is the hallmark of Mycoplasma pneumoniae infection?

Nonproductive cough, low-grade fever, patchy CXR

What extra-pulmonary symptoms are associated with Mycoplasma pneumoniae?

Rash (erythema multiforme), hemolytic anemia

What is the treatment for Mycoplasma pneumonia?

Macrolide or doxycycline

What pneumonia pathogen causes cough + diarrhea from contaminated water sources?

Legionella pneumophila

What are hallmark features of Legionella pneumonia?

High fever, hyponatremia, GI symptoms, nonproductive cough

What is the treatment for Legionella pneumonia?

Respiratory fluoroquinolone or azithromycin

What fungus is linked to caves and bird/bat droppings in the Ohio/Mississippi River valley?

Histoplasma capsulatum

What are radiologic findings in histoplasmosis?

Hilar/mediastinal lymphadenopathy

What is the treatment for mild vs severe histoplasmosis?

Mild: Itraconazole | Severe: Amphotericin B