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Uworld Step 2 > Block 54, 55: Lung > Flashcards

Block 54, 55: Lung Flashcards

1
Q

Causes of hypoxemia?

A
  • reduced inspired oxygen tension
  • hypoventilation
  • diffusion limitation
  • shunt
  • V/Q mismatch
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2
Q

what is hypoventilation associated

A
  • respiratory acidosis

- normal A-a gradient

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3
Q

what is normal A-a gradiant

A

less than 15

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4
Q

equation for A-a gradient

A

PAO2 - PaO2

PAO2 = 170 - (CO2/.8)

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5
Q

what should you worry about a COPD patient given supplemntal oxygen

A

improves hypoxia but causes CO2 retention

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6
Q

hypercapnea causes what in the brain

A

reflex cerebral vasodilation

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7
Q

what clinical feature makes pericarditis feel better for aptient

A

leaning forward

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8
Q

flow-volume curve for fixed upper-airway obstruction

A

flattening the top and bottom of curve

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9
Q

how might an immunocompetent patient get aspergilus

A

history of pulmonary disease

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10
Q

what does CT show for aspergilloma

A
  • cavitary lesion

- pulmonary nodules with surrounding ground-glass opacities (“halo sign”)

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11
Q

equation for ventilaiton

A

respiratory rate times tidal volume

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12
Q

what metabolic disturbance causes hyperventilation

A

respiratory alkalosis

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13
Q

when do you use incentive spirometry

A

prevent atelectasis in bed-bound patients

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14
Q

most common acid-base disturbance in pulmonary embolism? why?

A

respiratory alkalosis

- because patient hyperventilates due to decrease O2 and the V/Q mismatch

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15
Q

Asbestos exposure increases the risk of what

A

pulmonary fibrosis and malignancy

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16
Q

most common cause of malignancy diagnosed in patients with exposed to asbestos

A

Bronchogenic carcinoma

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17
Q

occupations related to asbestosis exposure

A 
plumber
electrician
carpenter
pipefitters
insulation workers
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18
Q

PE exam for asbestosis

A

bibasilar, end-inspiratory crackles

fingernail clubbing

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19
Q

X-ray for asbestosis

A

babasilar reticulonodular infiltrates
honeycombing
bilateral pleural thickening

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20
Q

CT of asbestosis

A

subplerual linear densities
parenchymal fibrosis
- Plreural plaques are key for asbestosis

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21
Q

pulmonary fibrosis does what to forced expiratory volume in 1 second/ forced vital capacity ratio

A

preserved for increased

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22
Q

first-line treatment for exercise-induced bronchoconstriction if only required few times a week?
exercise daily?

A

short-acting beta-adrenergic agonist
10-20 min before exercise
Daily exercise: inhaled corticosteriods or antileukotriene agents

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23
Q

all patients with acute exacerbation of COPD should receive

A
  • inhaled bronchodialater ( B2 agonist and anticholinergic)

- systemic glucocorticoids

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24
Q

what is the diffusion capacity of the lung for carbon monoxide in interstitial lung disease?

A

decreased but normal in extrinsic causes of restrictive pulmonary physiology

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25
Q

what are side effects of beta-2 agonists

A
  • hypokalemia ( muscle weakness, arrhthymias, EGK abnormalities)
  • tremor
  • palpitations
  • headache
26
Q

Diagnose asthma in an adult

A
  • reversible airway obstruction ( 12% or more increase in FEV1)
  • normal diffusion capacity for CO
27
Q

complications of positive pressure ventillation

A
  • alveolar damage
  • pneumothorax
  • hypotension
28
Q

best step in management for hyponatermia due to SIADH

A

Fluid restriction

29
Q

common complication of small cell lung cancer

A

hyponetremia due to SIADH

30
Q

what lung cancer is the most common cause of SAIDH

A

small cell lung cancer

31
Q

lung compliance

A

ability to expand.

32
Q

are there pulmonary symptoms in wilson diesase

A

NO

33
Q

young patient with chronic dyspnea on exertion, decreased breath sounds, slight liver function test abnormalities, and a family history of cirrhosis has

A

alpha-1 antitrypsin deficiency

34
Q

why are impaired consciousness, advanced dementia, and other neurologic paitents predisposed to aspiration pneumonia

A
  • impaired swallowing and cough reflex
35
Q

what happened during endotrachial intubation when there is overinflation of right lung, underventilation of left lung, and asymmetric chest expansion

A

right mainstem bronchus intubation

36
Q

when is needle thoracostomy performed

A

emergency procedure, for life-threatening tension pneumothorax

37
Q

test of choice in clinically stable patients in whom PE is likely

A

CT angiography

38
Q

patient with chronic shortness of breath, productive cough, and evidence of destruction of the lower lung lobes has

A

alpha-1 antitrypsin deficiency

39
Q

panacinar eymphysema

A

usually due to alpha1 antitrypsin defieicny

- destruction of lower lobes

40
Q

Centriacinar emphysema

A

smoking induced

- upper lobe of lung destruction

41
Q

what is considered young age for COPD

A

less than 45

42
Q

triad for asperigillosis

A

fever
pleuritic chest pain
hemoptysis

43
Q

Chest X-ray of sarcoidosis? histology of it?

A

bilateral hilar adenopathy

- noncaseating granulomas on tissue biopsy

44
Q

loss of elastin in lung matrix occurs in what

A

alpha-1-antitrypsin deficiency

45
Q

necrotizing pulmonary vasculitis occurs in

A

granulomatosis with polyangiitis

- Wegener granulomatosis

46
Q

Chronic low back pain in an otherwise young healthy man, pain at night, improvement of pain with activity, and elevated erythrocyte sedimentation rate suggests

A

ankylosing spondylitis

47
Q

how does ankylosing spondylitis imipact lungs

A

limits lungs expansion due to diminished chest wall and spinal mobility

  • mild restrictive pattern
  • reduce VC, TLC
  • normal FEV1/FVC
  • normal or increase FRC, RV
48
Q

PFT for pulmonary fibrosis vs just restrictive disease

A

FRC, TLC and RV are also reduced in pulmonary fibrosis

49
Q

define massive PE

A
  • most likely postoperative pt
  • PE complicated by hypotension and/or acute right heart strain
  • jugular venous distension
50
Q

patient with significant smoking history, hypercalcemia, and a hilar mass

A

squamous cell carcinoma of lungs

51
Q

what anticoagulation therapy is sued for severe renal insufficiency

A

unfractionated heparin

52
Q

what GFR rate indicates severe renal insufficiency

A

less than 30 mL/min/1.73 m^2

53
Q

Transudative effusion caused by

A
  • decreased intrapleural or plasma oncotic pressures

- elevated hydrostatic pressure

54
Q

exudative effusions caused by

A
  • increased capillary or pleural membrane permeability

- disruptions to lymphatic outflow

55
Q

pleural fluid shows moderate lymphocytosis, very elevated protein, elevated LDH. what does the patient have

A

tuberculous effusion

56
Q

what indicates severe asthma exacerbation with signs of impending respiratory failure? what should you do?

A

elevated or normal PaCO2

  • endotracheal intubation
  • mechanical ventilation
57
Q

what should you give during severe asthma exacerbation

A
  • inhaled short-acting Beta agonist
  • inhaled ipratropium
  • systemic corticosteroids
58
Q

how does hypoxemia occur in alveolar consolidation

A

right-to-left intrapulmonary shunting

59
Q

define dead space

A

ventilation of areas of lung that are not perfused with blood

60
Q

a patient who can fall back asleep quickly after experiencing choking sensation, most likely has what

A

obstructive sleep apnea

61
Q

atelectasis

A

alveolar collapse

- can be due to obstruction

62
Q

pneumothorax

A

air in pleural space

Uworld Step 2 (30 decks)

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