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Pulmonology > All > Flashcards

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1
Q

Which pneumocytes produce surfactant

A

T2

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2
Q

Max development of surfactant IuL

A

35th week

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3
Q

HMD treatment

A

Mild- CPAP

Severe- IMV+ surfactant replacement

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4
Q

Types and pathology of PAP

A

Impaired clearance of surfactant by macrophage

Primary- GMCSF Ab ( x macrophages)

Secondary- silicosis (x macrophages)

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5
Q

Investigations in PAP

A

BAL- Milky white/ PAS +

CXR- Diffuse fine reticulo-nodular infiltrates radiating from the hilum**

CT- CRAZY PAVING

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6
Q

MC bronchus for BXIS

A

Left main bronchus
(Horizontal, narrow—stasis of secretions-inflammation )

MC in babies

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7
Q

Mc lobe for aspiration overall/supine

A

RLL Superior&raquo_space; RUL Posterior

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8
Q

Mc lobe for aspiration standing/sitting

A

RLL Posterior

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9
Q

Mcc if hemoptysis

A

TB

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10
Q

Mcc if massive hemoptysis

A

BXIS

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11
Q

Massive hempotysis criteria

A

> 150ml/ episode

> 400-600ml/day

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12
Q

Mccd hemoptysis

A

Aspiration of blood clot

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13
Q

Mx persistent hemoptysis

A

Brochial artery embolization

Resection of affected lobe

Pulmonary artery embolization (rare)

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14
Q

Pneumocytes having dividing capability

A

T2

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15
Q

Majority of pneumocytes

A

T2

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16
Q

Pneumocytes covering maximum area of lung

A

T1

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17
Q

Airway obstruction is prominent during?

A

Expiration (exp wheeze)

Inspiration is an active process- can overcome obstruction easily comparatively

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18
Q

Factors preventing collapse of alveoli

During expiration

A

Elastase—(a1 antitrypsin)

Surfactant

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19
Q

Emphysema features

A

Early- bulla, air trapped in alveoli/ inc RV FRC TLV

Late-Complete encircling of inflammation—decreased oxygen transport to blood

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20
Q

Ideal o2 flow rate and sat for COPD

A

1-2L/min

88-92%

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21
Q

Mechanisms of hypoxia

A

VP mismatch (emph/pte)

Shunt (cardiac/pulmonary)
(Pulm= pneum/ILD/Fibrosis/Atelectasis—damaged alveoli)

Diffusion defect (T1RF)

Hypoventilation(T2RF)

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22
Q

Rx for Intra pulmonary shunt/ damaged alveoli

A

IMV

Supplementary oxygen doesnt work

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23
Q

DLCO normal range and formula

A

Inhaled CO-Exhaled CO

70-90%

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24
Q

Alveolar conditions causing decreased DLCO

A

Emphysema
ILD
Fibrosis
Pneumonia

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25
Q

Blood conditions causing decreased DLCO

A

Anemia
PHTN
PTE

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26
Q

Increased DLCO?

A

PCV

Alveolar haemorrhage**

ASTHMA** (Eosiniphilic inflammation—increased NO production—inc vessel size)

Exercise

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27
Q

V/P ration is a measure of?
Max
Min

A

Alveolar oxygen tension
Max= apex
Min= base

(Max venti and max perfusion at BASE)

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28
Q

Tb 1° and 2° location

A

1= middle/lower zone (max ventilation)

2= apex (max v/q)

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29
Q

Volume at which outward recoil of chest equals inward recoil of lung?

A

FRC

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30
Q

FeV1 value

A

70-80%

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31
Q

FVC normal value

A

> 80%

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32
Q

PEFR significance

MEFR significance

A

P= flow in large airways (air first moves out of large airways) —-ASTHMA

M= average flow calculated during mid expiration (SMALL AIRWAY)—COPD/EMPHYSEMA

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33
Q

Measurement of RV

A

Helium dilution

N2 washout

Body plethysmograph ***

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34
Q

Obstructive LD spirometry

A

FeV1 decreases

FVC normal

RV = INCREASED***

Fev1/FVC = DECREASED

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35
Q

Restrictive LD spirometry

A

Fev1 DECREASED

FVC DECREASED

Fev1/FVC = normal/increased

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36
Q

Intrinsic RLD

A

Fibrosis
ILD
OLD
SARCOIDOSIS***

RV/TLC= normal****
(As alveoli gone)

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37
Q

Extrinsic RLD

A

Kyphoscoliosis

NM diseases (polio/GBS/MG/AL)

Diaphragm palsy

RV/TLC= INCREASES**
(RV normal/ TLC decreases)

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38
Q

Obstructive LD

A

Asthma
COPD
BXIS
Bronchiolitis

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39
Q

Breathing sounds in

Consolidation
Cavity
Large cavity

A

Tubular

Cavernous

Amphoric

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40
Q

Causes if rhonchi

Narrow lumen/free liquid/mucus

A 
Asthma
P. Edema
COPD
Foreign body
Tumour
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41
Q

Increased vocal resonance is called

A

BRONCHOPHONY

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42
Q

Increased whispered sounds on steth?

A

PECTORLIQUOY

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43
Q

E—->A change in sound pronunciation

A

AEGOPHONY

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44
Q

Wheeze types

A

Monophonic- Tumor

Polyphonic- COPD/ Asthma

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45
Q

Wheeze heard mainly during?

A

EXPIRATION

If during inspirtation—severe obstruction

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46
Q

Coarse crepts cause

A

BXIS

Airflow into secretions

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47
Q

Fine crepts cause

A

ILD
Fibrosis
Pneumonia
P Edema

(Popping of alveoli)

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48
Q

Velcro crepts due to?

A

Interstitial FIBROSIS

Aka cellophane crackles/ Bi-basilar

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49
Q

Stony dull note present in

A

Plef

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50
Q

No push pull lesion with positive breath sounds

A

Consolidation

AIRBRONCOGRAM++

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51
Q

Cf of HYDROPNEUMOTHORAX

A

Straight line (not meniscoid)

Shifting dullness

Succusion splash

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52
Q

T1RF PAO2 PaO2 PaCO2 A-a

A

Normal

Decreased

Normal»increased (Good diffusion)

A-a= INCREASED

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53
Q

T2RF PAO2 PaO2 PaCO2 A-a

A

Decreased
Decreased
Increased (RESP ACIDOSIS)
Normal

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54
Q

T1RF causes

A

ILD
Alveolar flooding (pneumonia/ards)
Fibrosis
PTE

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55
Q

T2RF causes- Hypoventilation / decreased respiratory effort

COPD

A

Central : brainstem injury/ narcotics
Obstructive: COPD (mc) / FB
Peripheral: NMJ Diseases
Diaphragmatic injury

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56
Q

Rx RF

A

IMV (in T1)

NIV (T2)

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57
Q

C/I NIV

A

UNCONCIOUS***

Altered sensorium/ unco-op
Cardiac arrest
Hemo unstable
Nasal sx
Active GIBleed
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58
Q

ARDS Cardinal features

A

SOB
Hypoxemia
Pulmonary infiltrates
Reduced lung compliance

(HALLMARK= DAD)

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59
Q

Other names of ARDS

A

Shock lung

Blast lung

Traumatic wet lung

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60
Q

Direct causes of ARDS

FANTTS

A 
Fat embolism
Toxin
Transplant (reperfusion injury)
Near drowning
Aspiration
Severe Pneumonia
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61
Q

Indirect causes of ARDS

A 
CABG
High altitude
Pancreatitis
Narcotic poisoning
Head injury
Sepsis (mc) 
BT
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62
Q

Normal PCWP

A

6-12

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63
Q

Pcwp in Cardiogenic PE

A

> 18

Interstitial edema 18-25
Alveolar edema >25

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64
Q

Which never occurs in T1 RF

A

HYPERCAPNEA

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65
Q

Berlin criteria for ARDS

A

Acute SOB

Pul. Infiltrates

Non cardiogenic PE

PaO2/Fio2 < 300. Or. PaO2<60’mmHg

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66
Q

Criteria for Resp failure

A

PaO2 < 60

PaCO2 > 45

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67
Q

Types of RF

A

1 Hypoxic
2 Hypercapneic
3 Peri-operative-Atelectasis-GA
4 Shock (Hypoperf of resp muscles)

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68
Q

Mild mod sever ards criteria

A

PaO2/FiO2

200-300 = mild
100-200 = mod
<100 = sev
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69
Q

Rx ARDS

A

Low TV MV (4-6ml/kg/min)

Adequate PEEP

Steroids

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70
Q

Newer Rx ARDS

A

ECMO

PRONE VENTILATION (12-16 hrs)- decreased diap compression of alveoli

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71
Q

Misc causes of ARDS

HELD

A

Hanging
Eclampsia
LF
Renal failure

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72
Q

Presentation time of PTE

A

cin 2 weeks

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73
Q

Predisposing genetic factors for PTE

A

Protein C S def

F5L mutation

Hyper- Homocystinemia

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74
Q

R/F PTE

A

DVT (estrogen pills)

Varicose veins

Trauma

Prolonged immobilization

Pregnancy

Malignancy

Nephrotic syndrome (AT3 excretion)

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75
Q

Lung pathology PTE

A

HEMOPTYSIS

Platelet thrombus—serotonin—BRONCHOSPASM

LUNG ISCHEMIA
(Pleuritis/Plef/dyspnea/tachypnea)

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76
Q

Mc sign and symptom of PTE

A

Sign TACHYPNEA

Syp DYSPNEA

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77
Q

Cardio Pathology of PTE

A

RVH—pushed septum in LV—decreased BP—shock

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78
Q

Cor pulmonale types

RV dysfn due to 1° resp cause excluding causes of keft heart

A

Acute—-PTE

Chronic- COPD (mc)/ ILD / CF / OSA / BXIS

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79
Q

CXR Findings of COR PULMONALE

A

Kerley B lines
(LAP > 20 then KBL++)

Prominent ULobe veins

Cardiac shadow

B/L plef

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80
Q

Well’s scoring PTE

SAPHHaI-C

A 
Signs and symptoms = 3
Alternative Diagnosis no? = 3
Prior PE/DVT = 1.5
Hemoptysis = 1
HR> 100
Immobilisation > 3 days or Sx cin 3wk =1.5
Cancer =1

If >4 = CTA with contrast(IxoC)&raquo_space;V/Q Scan

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81
Q

Low score Mx of PTE

A

D-dimer (95% sensitive)

If positive. CTA

Otherwise r/o PTE

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82
Q

ECG PTE

A

Mc= Sinus tachycardia

Msp= S1Q3T3

2nd Mc = inv T wave in V1-4

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83
Q

CXR PTE

A

Mc = normal**

WESTERMARK SIGN
(Focal oligaemia)

HAMPTON HUMP
(Wedge opacity)

PALLAS SIGN
(Dil. R descending Pul. Artery)

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84
Q

Other Ix PTE

A

ECG
CXR

LL usg (r/o DVT)
D-dimer
CTA (Ixoc)
INVASIVE PUL ARTERIOGRAPHY (GST)

V/Q scan (prenancy/RenalF/Contrast intol

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85
Q

Rx Massive PE

Shock+RV dysfn

A

500ml NS
Vasopressors
Anticoagulants

Definitive: Thrombolysis&raquo_space; sx embolectomy

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86
Q

Rx submassive(RV dysfunction) and Minimal PE (normal RV and BP)

A

S= > 70 years = Anticoagulant—Tlysis

< 70 years = Thrombolysis

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87
Q

Mcc of preventable hospital death/ Mccd in post sx patient

A

Acute PE

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88
Q

Anticoagulant? Thrombolysis? (Drugs)

A

Heparin bridge warfarin
Heparin f/b dabigatran (DTI)
Xa inhibitors

Thrombolysis : Alteplase&raquo_space; streptokinase

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89
Q

Rx Pul Edema

A

Furosemide + NTG sublingual (HR>100)

F + NE/DP (HR<100/ Shock -)

F + DOBUTAMINE (HR<100 / Shock +)

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90
Q

New tx for PTE

A

Catheter directed thrombolysis (CDT)

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91
Q

PHTN diagnosis

A

MPAP > 25

Pul.Vascular Resistance > 3 WOOD UNIT

92
Q

PHTN sex and age predisposition

A

F»M

Child bearing age

93
Q

Mc symptom if PHTN

A

SOB

94
Q

Initial Ix of PHTN

A

ECHO

95
Q

Most accurate method of Ix

A

Pul. Artery Catheterization

96
Q

WHO classification PHTN

A

1 DIRECT INVOLVEMENT

2 CARDIOGENIC

3 1° RESP D/O

4 Chronic Thromboembolic events

5 Miscellaneous

97
Q

Group 1 causes PHTN

A

Genetic : BMPR2 gene (Inc BV smooth muscle)

AID : Ssc&raquo_space; RA , SLE

Toxin : Rapseed oil/ Fenfluramine

High Altitude

98
Q

GROUP 3 causes PHTN

A 
COPD
BXIS
ILD
OSA
Hypoventilation

(Hypoxia—vasoconstriction)

99
Q

Group 5 causes PHTN

A 
Sickle cell
Sarcoidosis 
Langerhans cell histiocytosis
Lymphangio leiomyomatosis
Morbid obesity
100
Q

Rx PHTN

P3EG

A

PDE5= Sildenaf/Taladafil

ETRA= Ambrisentan/Bosentan

Prostacyclin = Iloprost (i.n)

Prostacyclin antagonist = Selexipag

Guanyl Cyclase + = Riociguat

101
Q

Emergency PHTN RX

A

I.v EPOPROSTENOL

102
Q

Regimen PHTN

A

ETRA + PDE5

Fail?

Add prostacyclin

103
Q

Rx Airway remodelling in chronic untreated asthma

A

Bronchial thermoplasty

104
Q

Main types of asthma

A

Atopic- Children/skin test+/ mild / IgE inc
(Mcc= dermatophagoides)

Idiosyncratic- Adults/ all normal/ severe

105
Q

What structures does asthma involve

A

Large airway and small airway

NEVER ALVEOLI

106
Q

Ix in Asthma

A

Spirometry (main)- Bronchodilator reversal

PEFR variability in a day (>20%)

Broncho-provocation by methacholine
(fev1 dec by >20%)

107
Q

Bronchodilator reversal % diagnostic of asthma

A

Fev1 increase by 12% or 200’ml

108
Q

C/f status asthmaticus

A 
SOB at rest
Single words
Hr > 120
Rr>30
B/l wheeze
Accessory muscles
Resp acidosis
Pulsus paradoxus
109
Q

Diagnosis of status asthmaticus

A

PEFR <50% of expected

PaO2 < 60

SpO2< 90

110
Q

Life threatening signs of SA

A 
Altered sensorium
Silent chest (collapsed bronchus)
Dec resp effort (cyanosis)
Bradycardia
Pulsus paradoxus
Hypotension
111
Q

Rx status asthmaticus

A

O2 + SABA + SAMA (IpBro) + ICS

I.v steroid

Trial of MgsO4

Last resort- IMV : High flow (correct hypoxia)+ Prolonged expiratory time(dec hypercapnea)

112
Q

Is inverse ratio ventilation useful in status asthmaticus?

A

No

Normal I:E = 1:3
IRV= 2:1

113
Q

Rescue Rx asthma

A

LDICS + LABA

114
Q

Type of drugs in asthma

A

Controllers : SABA LABA SAMA (bronchodilators)

Relievers : ICS LT (dec inflammation)

115
Q

Step1-step 5 asthma mx

A 
1 -
2 LDICS + Anti LT
3 LDICS + LABA + Anti LT
4 MDICS+ LABA + Anti LT + Tiotropium
5 HDICS + LABA + Oral steroids + Tio

Fail?
Anti IgE
Anti IL5– MEPOLIZUMAB
/RESLIZUMAB

116
Q

DOC Exercise induced asthma

A

Short term : SABA
Long Term : ICS

RECOVERY TIME= 30 min

117
Q

Samters triad

A

Asthma+ nasal polyp + aspirin sensitivity

118
Q

AERD quatrad

A

Samters triad + Rhinosinusitis

Aspirin Exacerbated Respiratory Disease

119
Q

Brittle asthma types

A

1- freq fluctuations/ HDICS+ oral steroids+ continuous B agonists

2- severe sudden anaphylaxis / inj ADR

120
Q

Chronic bronchitis definition

A

Cough > 3 months for 2 consecutive years

121
Q

C/f of chronic bronchitis

A

COUGH** : purulent/blood

Cyanosis (BLUE BLOATERS)
Pulmonary Edema (cor pulmonale-RVF)
Crackles and wheeze
OBESE

122
Q

Chronic bronchitis index?

A

Reid Index

Thickness of mucus/Thickness of bronchial wall

123
Q

Type of failure in CB

A

T2RF (bronchioles get damaged, not enough PAO2)

T2= Hypercapneic—-> RESP ACIDOSIS

124
Q

DLCO in CB

A

NORMAL

125
Q

Etiology Emphysema

A

Smoking (xElastase)
A1 antitrypsin deficiency
Pollution
Coal exposure

126
Q

A1AT Deficiency features

A

Chr 14
A/w Liver disease
Young AOE
Family H/o

127
Q

Cf Emphysema

A

DYSPNEA**

Pursed lip breathing (accessory muscles)
Pink skin (PINK PUFFER)
Lean build (cachexia dt inc WOB)
HOOVER SIGN (Paradox CW movement)
Inc AP Diameter
128
Q

Type of RF in emphysema

A

T1RF—-> normal paCo2—RESPIRATORY ALKALOSIS

129
Q

Organisms responsible for acute exacerbation of COPD

A

Moraxella
S. Pneumoniae
H. Influenzae

130
Q

Types of emphysema***

A

Centrilobular
Panlobular
Paraseptal
Distal Acinar

131
Q

Pan lobular v/s Centrilobular (mc)

A

All resp tree. Central bronchioles

Lower Lobe. Upper Lobe + Up LL

A1AT. Smoking

132
Q

GOLD Staging COPD (Fev1)

A

Mild >80%
Mod 50-80
Sev 30-50
Vsev <30

133
Q

Prognostic index COPD

BODE

A

BMI
Obstruction
Dyspnoea
Exercise Capacity (6MWT)

134
Q

Rx COPD

STOP-BASS M

A

Smoking cessation

Tx (ILD» COPD)

O2

PDE5 (ROFUMILAST- dec inflammation)

Bronchodilator(LAMA>LABA)

Abx (Azithro—against H.infl—mc in exacerbations)

Sx (bullectomy—c/I in diffuse emph)

Steroids (systemic+ ics)

Mucolytics (N Acetyl Cysteine)

135
Q

Bronchodilators in COPD Drugs

A

LABA- Indacetrol, Olodetrol

LAMA- Tio Umclinidium Glycopyrronium

136
Q

Best modality to reduce mortality in COPD

A

Low flow O2

14-15 hr/day

137
Q

COPD ABCD Rx

A 
A- SABA/SAMA
B-LABA/LAMA
C-LAMA
D-LAMA——fail—-LAMA+ LABA
               —-asthma?—-LABA+ ICS

+ ROFULMILAST + AZITHROMYCIN

138
Q

BXIS vicious cycle

A

Initiating event—Abn clearance of airway secretions—stasis and obst—Infection and inflammation (PSEUDOMONAS)—destruction and dilatation of airway—abn clearance—

139
Q

Three layered sputum in BXIS

A

Serous—Mucus—-Pus

140
Q

C/f BXIS

A

Mc- PRODUCTIVE COUGH

Coarse crepts

Dilated airway

141
Q

Mccd BXIS

A

RHF

Cor pulmonale

142
Q

Etiology of BXIS

GOBII

A

OBSTRUCTION

BRONCHIAL INJURY

TRACTION BXIS

GENETIC

IDIOPATHIC

143
Q

Obstructive causes of BXIS

A

Intraluminal: Cancers / Carcinoid / FB

Extraluminal: TB lymph node—RML collapse = BROCKS SYNDROME (BXIS + RML Collapse)

144
Q

Bronchial injury causes BXIS

A

Infection : TB Adenovirus Bacterial

CTD: SLE RA Ssc

145
Q

Genetic causss BXIS

A

Yellow nail syndrome (cong lymphedema+ plef + yellow nails)

BXIS Sicca (KARTAGENER)— Situs+polyp+BXIS

CF

WILLIAM CAMPBELL SYN (Airway cartilage defect)

146
Q

Lobes of BXIS preference

A

LL»RML»Lingula

147
Q

Diseases and lobes

PACTS CM ICI

A

UL) Post Radiation / AnkSpond / ABPA / CF / TB / Sarcoidosis

ML) Ciliary Dyskinesia / Myco Avium

LL) IPF (busalfan, bleomycin) /Chronic Aspiration/ Idio BXIS/ SLE/ RA

148
Q

Ix BXIS

A

Volumetric multidetector CT&raquo_space; HRCT

149
Q

HRCT App of BXIS

A

Tram track/Tree bud/ Bronchial wall thickening

150
Q

Rx BXIS

A

Airway clearance- mucolytics + physio

Abx (during exacerbations)

O2 (if hypoxia)

Resection (If localized)

Tx (if diffuse)

151
Q

Prophylactic abx in BXIS

A

Inhaled : Colistin/ Genta/ Tobra

Oral : FQ/ Azithro

152
Q

Eosinophilic lung diseases pathology wise classification

A

UNKNOWN: AEP/ CEP / Hyper Eosinophilic syndrome / Churg -Strauss

KNOWN: Loffler syndrome (parasite infection) / ABPA / Drugs (NSIP) / TPE

NSIP= Nitrofurantoin Sulfonamide INH Penicillamine

153
Q

TPE cause

A

Lymphatic filariasis +++

D/t immune reaction to filariae

154
Q

TPE c/f

A

Paroxysmal wheeze/cough
Eosinophilia > 3000

CXR- Diffuse miliary lesions
MOTTLED OPACITIES

Restrictive LD spirometry

Microfilaria ABSENT on PBS
(Cleared in lungs only)

155
Q

Triad of Idiopathic Pulmonary Hemosiderosis

A

IDA + HeMoptysis + Alveolar infiltrates

RECURRENT EPISODES OF. DAH (Alveolar capillary tortuosity)

156
Q

AEP v/s CEP

A 
Smokers.         -
     -                Asthma +
     -                Peripheral Eo+
  >25%.          > 40% eosi on BAL
  RespF+              -
157
Q

Radiological features of CEP

A

REVERSE BAT WING APP

PHOTOGRAPHIC NEGATIVE OF P. EDEMA

158
Q

ABPA HSr

A

1 3 4

159
Q

Ix ABPA

A

(H/o asthma OR CF)

Peripheral Eosinophilia (1000ng/ml)
SKIN TEST + for aspergillus fumigatus
Aspergillus sensitive IgE and IgG

CXR= UPPER ZONE INFILTRATES

CT= Para hilar BXIS (central)

160
Q

Cf ABPA

A

Hemoptysis

Bronchispasm

BXIS

161
Q

Rx ABPA

A

Steroids

Itraconazole

162
Q

INVASIVE PULMONARY ASPERGILLOSIS

CT findings

A

(Trans bronchial angio-invasion)

Active phase : Halo sign (centre fungus- peripheral blood)

Recovery phase : Air crescent sign( immunity clearing the central fungus)

Rx VORICONAZOLE

163
Q

Aspergilloma other name and CT finding + rx

A

Saprophytic Pulmonary Aspergillosis

CT- 1) Monads sign ( crescent)
2) shifting ball on decubitus

Rx- resection

164
Q

Which conditions can aspergilloma be present in

A

TB
Sarcoidosis
Histoplasmosis

165
Q

Hypersensitivity Pneumonitis features

A

D/D ABPA or Asthma

Aka Extrinsic Allergic Alveolitis

HSR 3,4

NO PERIPHERAL EOSINOPHILIA

Skin test +ve for aspergillus Ag

166
Q

Biopsy of HS Pneumonitis

A

Non caeseating GRANULOMAS
Cellular bronchiolitis
Inflammation of INTERSTITIUM

167
Q

Diagnostic criteria for HSPneumonitis

A

Serum precipitins against known Ag

Inspiratory creeps

Weight loss

Infection + on re-exposure

Occurrence of symptoms in 4-8 hours

Exposure to known Ag

168
Q

Farmers lung?

Source and organism

A

Mouldy hay- Micropolyspora faeni

169
Q

Hot tub lung?

A

HSPneumonitis d/t mycobacterium avium

Source- contaminated h2o

170
Q

Bagassosis lung?

A

Sugarcane dust— Thermoactinomyces sacchari

171
Q

Malt worker lung?

A

Mouldy barley—— Aspergillus clavatus

172
Q

Bird fancier’s lung?

A

Pigeon excreta—- Avian protein

173
Q

Etiology ILD

A

INHALATIONAL
(Organic-HSPneumonitis ; Inorganic-Silica ,Asbestos)

DRUGS (NABB)
(Nitrofurantoin/ Amiodarone / Bleomycin /Busalfan)

AID
(SLE/RA/Ssc)

SYSTEMIC DISEASES
(Sarcoidosis/IBD)

IDIOPATHIC (mc)

174
Q

Clf ILD

A

Progressive dyspnea

End expiratory Bi-basilar fine crepts**

175
Q

Types of ILD

CAR LUND

A

UIP (aka IPF)

NSIP ( Non specific)

AIP (Acute)

COP (Cryptogenic Organising)

Respiratory Bronchiolitis ILD

LIP (Lymphocytic)

DIP (Desquamative)

176
Q

ILD IxOC

A

HRCT

GGO(early)—-> Consolidation(late)—-> Interstitial Fibrosis——> Traction BXIS——-> ADVANCED ILD

177
Q

Features of ADVANCED ILD

A

Honeycombing

Sub-pleural involvement

Worst prognosis ( inc chance of PNTx)

178
Q

C/f UIP Vs NSIP

A 
M.                     F.
Smoker.        Non smoker
Chronic.        Sub-acute
Clubbing+.    Clubbing+
Fine crepts.   Fine crepts.
179
Q

Biopsy UIP vs NSIP

A

Fibroblastic foci. Rare

Heterogeneous. Lymphocytic

180
Q

CT UIP vs NSIP

A

Honeycombing+. Rare

                               Low zone GGO

Taction BXIS (both)

181
Q

Rx UIP

A

PIRFENIDONE**

Ninentanib

182
Q

Rx NSIP

A

STEROIDS

183
Q

HAMAN RICH SYNDROME??

A

AIP

SOB+ Hypoxemia+ diffuse infiltrates

High mortality

184
Q

Massons’s bodies seen in?

A

COP

Accumulation of granulation tissue

B/L consolidation

Rx STEROIDS

185
Q

ILD s a/w smoking

A 
UIP
RBILD
DIP
LCH
Pulm Hemorrhage syndrome
186
Q

ILD rare in smokers

A

Sarcoidosis

HSPneumonitis

187
Q

Sarcoidosis main feature?

A

Multi system disorder with non caeseating granulomas

188
Q

Etiology sarcoidosis?

A

TB
AID
Propioniibacterium**

189
Q

MC site of involvement of Sarcoidosis

A

Lungs

190
Q

Scadding staging of Lung (Sarcoidosis)

A

1 Hilar LN B/L
2 Lung infiltrates + Hilar LN
3 Lung infiltrates only
4 Fibrosis

CAVITATION IS NEVER SEEN IN SARCOIDOSIS

191
Q

Sarcoidosis syndromes

A

LUPUS PERINIO
(Rash under eyes and cheek)

LOFGREN SYNDROME—good px
(ENL+ Uveitis+ Arthritis + Hilar LN)

HEERFORDT SYNDROME
(Uveitis+Parotiditis+CN7 palsy+ Fever)
(

192
Q

Ix Sarcoidosis

A

CBC- Lymphopenia (sequestration of lymphocytes in lung)

S.ACE- Increased***

Vit D- Increased—Hypercalcemia

CT- Uniform hilar lymphadenopathy
(TB= central necrosis)

BAL***- CD4/CD8 ratio increase
(NOT BLOOD)

Ixoc= BIOPSY- NC GRANULOMAS

GALLIUM SCAN- 1) Panda sign (parotid&lacrimal gland)
2) Lambda sign (Mediastinal LN)

KVIEM SLITZBACH TEST
(Skin test-anergy test)

193
Q

Rx sarcoidosis

A

Self resolution (asymptomatic)

HCQ/Steroids/Mtx (symptomatic)

194
Q

Mc OLD

A

Silicosis

195
Q

Malignancy OLD order

A

Asbestosis > silicosis > cwp

196
Q

1st symptom in byssinosis

A

Chest tightness

197
Q

Asbestosis occupation

A

Ship building

Construction

198
Q

Silicosis occupation

A

Sand blasting

Stone crushers

199
Q

Asbestosis radiology

A

Lower zone Fibrosis

HOLLY LEAF APPEARANCE**

Pleural plaques (msp but asymptomatic)

Benign plef*

200
Q

Asbestosis Cx

A

Mesothelioma—pleural+ peritoneal (msp)

Lung Ca- Adenocarcinoma / SCC
Smoking is a synergist

201
Q

Silicosis radiology

A

Upper zone nodules—-merge—PMF

Egg shell calcifications with B/L Hilar lymphadenopathy

202
Q

Silicosis cx

A

Silico-TB

Lung Ca

SLE, Ssc

203
Q

CWP Radiology

A

Upper zone lesions—merge —-PMF

204
Q

CWP cx

A

COPD

CAPLAN syndrome
(RA + silica/coal)

Never CANCER*****

205
Q

Silicosis D/D

A

PAP

206
Q

Apnea vs hypopnea

A

> 10s no breathing

> 30% reduction in airflow a/w >3% fall in SpO2

207
Q

Types of Sleep Apnoea Syndromes

A

Central Sleep Apnoea (CSA)
(No effort/ CHF, Narcotic use)

Obst Sleep Apnoea (OSA)
(Obesity/ inc effort/ upper airway close/ SNORING**)

208
Q

Pathophysiology OSA

A

Apnea—hypoxia—p. Vasoconstriction—PHTN

Apnea—Arousal—catecholamines—CAD/MI/Stroke/ Uncontrolled glycemic status/ arrythmias/ SCD

Apnea—arousal—decreased sleep— behaviour changes/RTA/Depression

209
Q

R/f OSA

A

Obesity

Acromegaly ( large tongue)

Males

Cranio-facial abnormalities

210
Q

IxOC OSA

A

POLYSOMNOGRAPHY (sleep study)

211
Q

Rx OSA

A

Depends upon episodes

< 5 = normal
5-14 = LSM
15-30 = CPAP (mxoc)
> 30 = CPAP/ Sx

Sx= UVULO-PALATO-PHARYNGO-plasty

212
Q

Pickwickian syndrome?

A

OBESITY HYPOVENTILATION SYNDROME

213
Q

Lung Adenocarcinoma features

A

Peripheral location

Females and young Males

Non smokers

Asbestos+

Clubbing ++ (Last stage- Hypertrophic Osteoarthropathy)

Hematological Paraneoplastic syndromes

Trosseau syndrome (migratory thrombophlebitis)

Mets to opposite lung ++

Mutation in EFGR

214
Q

Lung SCC features

C5PAA

A

Central

Cigarette smoking a/w

Clubbing +++

hyperCalcemia (Life threatening)

Cavity formation (also + in LCC Lung)

Polyuria (Ca++ effect on tubules)

Abdominal pain (PTH related peptide)

Altered Sensorium

215
Q

Features of Small CC Lung

A

Central

Strongest a/w smoking

Chemo and radiosensitive***

Rapid recurrence

SVC obstruction +++

Poorest prognosis

Paraneoplastic syndromes

216
Q

Horner syndrome?

SAMPLE

A

+ve in lung ca.

Sympathetic ganglion
Anhidrosis
Miosis
Ptosis
Loss of CilioSpinal rfx
Enopthalmos
217
Q

Mets of Lung Ca

A

Mc BRAIN

Msp ADRENALS

218
Q

Rx NSCLC

A

Resectable (1 to 3A) —- SX

Non resectable (3b-4) —- Chemo

SCC= Gemcitabine + Cisplatin/Paclitaxel

Adeno= Cisplatin + Pemetrexed/Bevacizumab

219
Q

Rx SCLC

A

Chemo

CISPLATIN + ETOPSIDE

220
Q

Targeted Rx Adenocarcinoma Drugs

A

EGFR x = Erlotinib/Gefitinib

ALK x = CRIZOTINIB

221
Q

New immunotherapy drugs in Lung Cancer

A

Anti PD4 antibodies

NIVOLUMAB
PEMBROLIZUMAB

PD4 is a brake protein of T cells, cancer cells attach to this protein and disable T cells.

222
Q

Pancoast tumor histology

A

SCC» Adenocarcinoma

223
Q

Pancoast Syndrome?

A

Horner + 1&2 rib destruction + C8T1T2 (pain and weakness @ ulnar distribution)

224
Q

Pancoast tumor Ixoc

A

MRI

225
Q

Lung Ca GST

A

Biopsy

226
Q

Paraneoplastic syndrome Small cell

A

SIADH (decreased Na)

ACTH (decreased K)

Calcitonin (decreased Ca)

Lamberton Eaton (Ab against cancer cell similar to P/Q Presynaptic Ca++ channels)

Gonadotropins (Gynecomastia)

Vasopressin

AnF

GRp (Gastrin releasing peptide)

Pulmonology (1 decks)

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