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Pulmonary Review > Common Respiratory Symptoms, Imaging, and Procedures > Flashcards

Common Respiratory Symptoms, Imaging, and Procedures Flashcards

1
Q

This is dyspnea in a lateral decubitus position, suggesting unilateral lung disease

A

Trepopnea

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2
Q

This is dyspnea in thee upright position that is relieved with lying down

A

Platypnea

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3
Q

What can cause platypnea?

A

Hepatopulmonary syndrone
Right-left shunt
Cardiac abnormality (aortic aneurysm, pericardial effusion)

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4
Q

This is the softening and periungual erythema of the nail beds, increase in the normal 165 degree angle between the nail and the cuticle, enlargement of the distal phalynx, and curvature of the nails

A

Clubbing

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5
Q

You see a patient with clubbing and subperiosteal formation of new cancellous bone and the end of long bones (hypertrophic osteoarthropathy). What are you concerned about??

A

Lung carcinoma

There is circulatory bypass of the lung with localized acivation of platelet-endothelial cells and subsequent release of fibroblast growth factors, as well as tumor production and release of VEGF

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6
Q

What is the cause of the cough in the following patient example:

Frequent nasal discharge, sensation of liquid dripping down the back of the throat, frequent throat clearing

A

Upper airway cough syndrome

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7
Q

What is the cause of the cough in the following patient example:

Nonproductive cough that occurs after meals or worsens after lying down, may be accompanied by heartburn, bitter taste, belching

A

GERD

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8
Q

What is the cause of the cough in the following patient example:

Nocturnal cough, sputum can be thick and mucoid with casts

A

Asthma

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9
Q

What is the cause of the cough in the following patient example:

Cough productive of sputum on most days for >3 months for >2 years

A

Chronic bronchitis

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10
Q

What is the cause of the cough in the following patient example:

Cough with copious foul purulent dishcare, intermittent blood, influenced by posture

A

Bronchiectasis

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11
Q

What is the cause of the cough in the following patient example:

Sputum eosinophilia >3% of nonsquamous cells induced by nebulized hypertonic saline

A

Nonasthmatic eosinophilic bronchitis

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12
Q

Tell me the following tracheobronchial tree abnormality based on the following CT scan findings:

1-2cm narrowing of the trachea at the thoracic inlet

A

Tracheal stenosis

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13
Q

Tell me the following tracheobronchial tree abnormality based on the following CT scan findings:

> 50% decrease in cross-sectional area of lumen on dynamic expiratory images

Tracheobronchomalacia

A

Tracheobronchomalacia

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14
Q

Tell me the following tracheobronchial tree abnormality based on the following CT scan findings:

Marked decreased in transverse diameter of intrathoracic trachea associated with increase in saggital diameter

A

Saber-sheather trachea

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15
Q

Tell me the following tracheobronchial tree abnormality based on the following CT scan findings:

Calcified nodules protruding into the tracheal lumen and sparing of posterior membrane because of absence of cartilage in this area

A

Tracheobronchpathia osteochrondoplastica

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16
Q

Tell me the following tracheobronchial tree abnormality based on the following CT scan findings:

Thickening of anterolateral tracheal wall with sparinng of posterior membrane

A

Relapsing polychondritis

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17
Q

Tell me the following tracheobronchial tree abnormality based on the following CT scan findings:

With involvement of the tracheobronchial tree, concenntric/nodule thickening of the tracheal submucosa

A

Amyloidosis

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18
Q

Tell me the following tracheobronchial tree abnormality based on the following CT scan findings:

Involvement of tracheobronchial tree is rare, usually late in course of disease, with circumfrential thickening, ulceration, and luminal narrowing

A

Granulomatosis with polyangiitis

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19
Q

Tell me the following tracheobronchial tree abnormality based on the following CT scan findings:

Thin wall trachea with scalloped/corrugated appearance , diameter >3cm, diverticulosis

A

Mounier-Kuhn syndrome

20
Q

What is the cutoff value of FDG update to distinguish between benign and malignant tissue?

A

> 2.5 means likely malignant

knowing that infectious or inflammatory processes can give false positive results

21
Q

What things can give false negative results on PET scan?

A

Carcinoid
Adenocarcinoma in situ
Nodules <10mm

22
Q

What is the process to get a VQ scan done for the patienet?

A

Breath hold- give radiolabeled gas, ask to take breath and hold it, capture image

Equilibrium- 4 normal VT breaths

Washout- breath room air while radiolabeled gas is exhausted and image is taken (residual = air trapping)

23
Q 
For diseases that have a
cystic pattern, which ones
are predominant in the
upper lobe, predominant in
the lower lobe, and
diffuse?
A

Upper lobe: Langerhans cell
histiocytosis

Lower lobe: Lymphocystic
interstitial pneumonia and
Birt-Hogg-Dubé syndrome

Diffuse:
Lymphangioleiomyomatosis

24
Q 
A patient undergoes a
difficult central line
placement. Ultrasound is
used to evaluate the lungs
after the procedure. Lung
sliding is absent, with an A line-
predominant pattern.
What is the likely
explanation for the
ultrasound finding?
A

Pneumothorax

25
Q

A decrease in FVC from upright to supine of >30% is an indicator of what?

A

Inspiratory muscle weakness

5-10% is normal but more than that means diaphragmatic weakness

26
Q

A decrease in what value in FEV1 is abnormal in exercise challenge testing?

A

10-15%

27
Q 
A patient is receiving a
long-acting anticholinergic
and a methacholine test is
ordered for further
evaluation. How long
should the medication be
withheld before testing?
A

Up to 7 days

28
Q

What happens to the following values in pregnancy:

ERV
RV
FRC
TLC
IC
VC
TV
RR
Minute ventilation
FEV1
DLCO
A 
ERV- ↓ by 8-40%
RV - ↓ by 7-22%
FRC - ↓ by 10-25%
TLC - mild ↓
IC ↑
VC - no change
TV- ↑ by 30-50% (progesterone mediated incnrease in central respiratory drive)
RR - no change or mild ↑
Minute ventilation ↑ by 20-50%
FEV1 - no change
DLCO - ↑ then ↓
29
Q 
A 26-year-old woman is
evaluated for dyspnea on
exertion. PFTs show FEV1
84%, total lung capacity
96%, ERV 50%, FRC 76%,
and DLCO 119%. These
findings are most
consistent with what
diagnosis?
A

Obesity can cause a
reduction in ERV and FRC
and an increase in DLCO.

30
Q

What happens to the slope in heart rate reserve (HRR) on the graph of HR vs VO2 in heart disease?

A

Increased slope and shifted to the left

31
Q

What happens to the line in heart rate reserve (HRR) on the graph of HR vs VO2 in trained individuals?

A

Shifted to the right

32
Q

True/False: in lung disease, maximal predicated heart rate is not achieved on CPET

A

TRUE

33
Q

This is the relationship between ventilatory demand and ventilatory capacity

A

Ventilatory reserve (VR)

34
Q

This is the peak minute ventilation achieived during exercise (VEmax)

A

Ventilatory demand

35
Q

How is ventilatory capacity typically measured?

A

MVV

Which is measured by FEV1x40

36
Q

What’s a normal VEmax/MVV?

A

70%

37
Q

What happens to VE/VO2 and VE/VCO2 in normal subjects?

In those who are hyperventilating?

A

Normally VE/VO2 increases at AT and VE/VCO2 has a delayed increase

Hyperventilation - the two increase simultaneously

38
Q

Tell me the disease process given the following CPET interpretation:

VO2max ↓
AT ↓ 
HRR normal
O2 pulse ↓
VE/MVV nomral/↓
VE/VCO2 normal ↑
VD/VT ↑ 
PaO2 normal
PAO2-PaO2 normal
A

Heart disease

39
Q

Tell me the disease process given the following CPET interpretation:

VO2max ↓
AT normal/↓/absent
HRR ↑
O2 pulse normal/↓
VE/MVV ↑
VE/VCO2 ↑
VD/VT ↑
PaO2 variable
PAO2-PaO2 variable
A

COPD

40
Q

Tell me the disease process given the following CPET interpretation:

VO2max ↓
AT normal/↓
HRR ↑
O2 pulse normal/↓
VE/MVV normal/↑
VE/VCO2 ↑
VD/VT ↑
PaO2 ↓
PAO2-PaO2 ↑
A

ILD

41
Q

Tell me the disease process given the following CPET interpretation:

VO2max ↓
AT ↓
HRR normal
O2 pulse ↓
VE/MVV normal
VE/VCO2 ↑
VD/VT ↑
PaO2 ↓
PAO2-PaO2 ↑
A

PVD

42
Q

Tell me the disease process given the following CPET interpretation:

VO2max ↓ (VO2/kg)
AT normal
HRR normal
O2 pulse normal
VE/MVV normal/↑
VE/VCO2 normal
VD/VT normal
PaO2 normal
PAO2-PaO2 normal
A

Obesity

43
Q

Tell me the disease process given the following CPET interpretation:

VO2max ↓
AT normal/↓
HRR normal
O2 pulse ↓
VE/MVV normal
VE/VCO2 normal
VD/VT normal
PaO2 normal
PAO2-PaO2 normal
A

Deconditioned

44
Q

Tell me the disease process given the following CPET interpretation:

VO2max ↓
AT normal or absent
HRR ↑
O2 pulse ↓
VE/MVV ↓
VE/VCO2 normal
VD/VT normal
PaO2 normal
PAO2-PaO2 normal
A

Poor effort

45
Q 
A 70-year-old man who is
undergoing
cardiopulmonary exercise
testing for further
evaluation of dyspnea on
exertion has a reduced O2
pulse and an oscillatory
pattern of changes on
ventilation. What is the
most likely diagnosis?
A

Congestive heart failure

46
Q 
A 78-year-old man who is
undergoing
cardiopulmonary exercise
testing for evaluation of
dyspnea has increased
ventilator equivalents,
increased VE/MVV ratio,
and significant oxygen
desaturation. Baseline
spirometry results show no
obstructive ventilatory
impairment. What is the
most likely diagnosis?
A

Interstitial lung disease

47
Q

FYI, lots of basic IP and PFT stuff, which, at this point is

A

common sense

Pulmonary Review (14 decks)

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