Boards Vitals Pulmonary Flashcards
When a patient has asthma, polyposis (nasal polyps) and NSAID sensitivity - what should you think of?
Aspirin exacerbated respiratory disease
What should you do for patients with ARDS, hypoxia and worsening mental status?
Intubation and mechanical ventilation
What cells are involved in inflammation in COPD?
- CD8-positive T lymphocytes
- Neutrophils
- CD68-positive macrophages
Which cells are involved in the pathogenesis of all cases of asthma, but not in the inflammation related to COPD?
CD4-positive T lymphocytes
Are mast cells involved in the pathogenesis of COPD?
No
Which cells are involved in the pathogenesis of some cases of asthma, but not in the inflammation related to COPD?
Eosinophils
Which conditions cause decreased surface area of alveolar-capillary membranes?
- Emphysema
- Lung resection
What causes the hypoxemia in a lobar pneumonia?
Ventilation-perfusion mismatch
Silicosis predisposes to tuberculous infection because crystalline silica can inhibit the ability of macrophages to kill phagocytized mycobacteria due to disruption of phagolysosomes (impaired macrophage-phagolysosome function).
True or false?
True
Patient presents with progressive shortness of breath and fatigue. Oxygen saturation is on the lower side. Physical examination shows prominent jugular venous pulsations and a parasternal heave.
Diagnosis?
Pulmonary hypertension
How many categories of pulmonary hypertension are there?
5
What happens to endothelin in pulmonary hypertension?
Increases
What happens to nitric oxide in pulmonary hypertension?
Decreases
What group is pulmonary artery hypertension?
Group 1
What is the cause of pulmonary hypertension Group 2?
Left heart failure
What is the cause of pulmonary hypertension Group 3?
Intrinsic lung disease
What is the cause of pulmonary hypertension Group 4?
Chronic thromboembolic disease
What is the cause of pulmonary hypertension Group 5?
Multifactorial etiologies
What happens to prostacyclin in pulmonary hypertension?
Decreases
Does acetazolamide help high altitude pulmonary edema?
No
What is the mainstay of treatment of high-altitude pulmonary edema?
Oxygen
(Descent also important)
In normal pleural fluid what is the predominant cell type?
Macrophages
Is macrolide monotherapy indicated for outpatient community acquired pneumonia therapy in the United States?
No (> 25% macrolide resistance)
What is used to predict the likelihood of a pulmonary embolism?
Wells score
What are patients treated with Bleomycin at risk for?
Lung toxicity
What percentage of patients on Bleomycin develop fatal interstitial lung disease?
Up to 10%
Immunocompromised patient has bilateral ground glass opacities, cough, fever and elevated beta-D-glucan assay.
Diagnosis?
Pneumocystis pneumonia
Does cryptococcal pneumonia have ground glass opacities on imaging?
No
Does cryptococcal pneumonia have clustered nodular pattern and cavitation on imaging?
Yes
Does the alveolar-arterial O2 gradient change with hyperventilation?
No
Does the partial pressure of carbon dioxide (PaCO2) increase, decrease or stay the same with hyperventilation?
Decreases
Bronchoalveolar lavage is notable for a thick, milky, opaque fluid, in a patient with bilateral, diffuse ground glass opacities.
Diagnosis?
Silicosis
Does decreasing tidal volume improve oxygenation in ARDS?
No
Does increasing PEEP improve oxygenation in ARDS?
Yes
Does treating patients with glucocorticoids improve oxygenation in ARDS?
No
Does treating patients with glucocorticoids reduce mortality in ARDS?
Yes
How is Legionella diagnosed?
Urinary antigen
Can a chest X-ray diagnose the specific type (organism) of pneumonia?
No
What is the first line drug for pulmonary artery hypertension in patients with positive vasoreactivity?
Calcium channel blockers
What is the first line drug for pulmonary artery hypertension in patients with negative vasoreactivity and severe symptoms?
Epoprostenol
(Prostacyclin or prostacyclin analogue)
What happens to nitric oxide levels when patient is given a phosphodiesterase type 5 inhibitor?
Increase
In mild Alzheimer’s dementia should you use galantamine or memantine?
Galantamine
Is a solid or semi-solid pulmonary nodule more likely to be malignant?
Semi-solid (solid with ground glass opacity)
Does small cell lung cancer usually occur in people who smoke or don’t smoke?
Smoke
Lung mass with pathology showing undifferentiated small round blue cells.
Diagnosis?
Small cell lung carcinoma
Lung mass with pathology showing sheets of epithelial cells with psammoma bodies.
Diagnosis?
Mesothelioma
Lung mass with pathology showing anaplastic pleomorphic giant cells.
Diagnosis?
Large cell carcinoma
Lung mass with pathology showing sheets of large pleomorphic cells containing keratin and intracellular bridges.
Diagnosis?
Squamous cell carcinoma
Which treatment has evidence of greatest reduction in mortality in COPD?
Oxygen therapy
Does lung transplantation reduce mortality significantly in COPD?
No
Does lung transplantation improve quality of life in COPD patients?
Yes
Do systemic corticosteroids decrease morbidity and mortality in patients with COPD?
No
What is the gold standard for ruling out asthma?
Methacholine challenge test
What is the first line treatment for allergic rhinitis?
Nasal steroids
Young women with history of spontaneous pneumothorax and CT chest showing diffuse thin-walled cysts.
Diagnosis?
Pulmonary lymphangioleiomyomatosis
What does TGF-beta (transforming growth factor beta) do?
Induces fibroblast proliferation
What is the mechanism of action of pirfenidone?
Inhibits TGF-beta
What is the mechanism of action of pirfenidone?
Inhibits TGF-beta (reduces fibroblast proliferation)
What is the mechanism of action of bosentan?
Endothelin 1 receptor antagonist
What is bosentan used to treat?
Pulmonary hypertension
What is omalizumab used to treat?
Allergic asthma
Is spirometry and bronchoprovocation typically normal at rest in exercise induced asthma?
No
What is seen on pleural biopsy in mesothelioma?
Spindle cells
Alpha-1 antitrypsin deficiency increases the activity of which enzyme?
Neutrophil elastase
Is the mechanism of oxygen-induced hypercapnia in chronic obstructive pulmonary disease (COPD) due to decreased respiratory drive?
No
What is the mechanism of oxygen-induced hypercapnia in chronic obstructive pulmonary disease (COPD)?
Increased ventilation/perfusion mismatch
What is the most common organism causing community acquired pneumonia?
Streptococcus pneumoniae
Patient with asthma has symptoms more than 2 days a week but not every day - what severity of asthma is this?
Mild persistent asthma
What is the primary method of hypoxemia in ARDS?
Intrapulmonary shunt (V/Q mismatch)
Which variable is monitored to indicate prognosis in case of septic shock?
Lactic acid
What is the pleural LDH in SLE related ILD?
Elevated
What percentage of SLE patients develop ILD?
3 - 7%
What drug class is nintedanib?
Tyrosine kinase inhibitor
Are nighttime headaches associated with obstructive sleep apnea?
No
Can a lung abscess be seen on CXR?
Yes - lucent area surrounded by consolidation
Which syndromic cause of infertility is associated with dextrocardia?
Primary ciliary dyskinesia (Kartagener syndrome)
Is silicosis reversible?
No
Can antitussives help in acute bronchitis?
Yes
Streptococcus pneumoniae has a capsular polysaccharide that acts as a major virulence factor.
True or false?
True
How is the diagnosis of sarcoidosis confirmed?
Biopsy
What, when associated with life-threatening hypoxia is an indication for administering a neuromuscular blocking agent, in mechanically ventilated patients?
Severe ventilator desynchrony
Which ventilatory injury can later lead to pulmonary fibrosis?
Diffuse alveolar damage from high inspired oxygen
What is the treatment of organophosphate toxicity?
Atropine plus pralidoxime
Absence of breath sounds on one side, with new hypoxemia and hypotension.
Diagnosis?
Tension pneumothorax
Smoking cessation eight weeks before surgery reduces the risk of complications.
True or false?
True
Which selective endothelin A receptor antagonist has been shown to limit the progression of idiopathic pulmonary hypertension?
Ambrisentan
