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Internal Medicine > Deja - Internal - Pulmonology > Flashcards

Deja - Internal - Pulmonology Flashcards

1
Q

What is a common underlying cause of decr. RR?

A

Drugs - Opiates.

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2
Q

What is a common underlying cause of incr. RR?

A
  1. Infection

2. Trauma

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3
Q

When is low FiO2 mostly a problem?

A

High altitudes or closed spaces with no fresh air or fire.

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4
Q

Give an example of hypoxia caused by underutilization.

A

When there is impairment of cytochrome due to toxins/poisons, such as cyanide.

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5
Q

What are some examples of causes of V/Q mismatch?

A
  1. Pulm. embolism.
  2. Underlying lung disease (lung cancer or COPD).
  3. Bronchospasm.
  4. Pneumonia.
  5. Pulm. edema.
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6
Q

What is the clinical sign of CO poisoning?

A

Cherry red lips and nails.

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7
Q

PaCO2 and A-a gradient - Hypoventilation:

A

PaCO2 –> UP.

A-a gradient –> N.

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8
Q

PaCO2 and A-a gradient - R-L shunt:

A

PaCO2 –> UP.

A-a gradient –> UP.

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9
Q

PaCO2 and A-a gradient - Low FiO2:

A

PaCO2 –> N.

A-a gradient –> N.

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10
Q

PaCO2 and A-a gradient - V/Q mismatch:

A

PaCO2 –> N.

A-a gradient –> UP.

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11
Q

What type of hypoxemia does not improve with incr. FiO2?

A

R–>L shunt.

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12
Q

What is the male:female of emphysema?

A

10:1.

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13
Q

What are the pathognomonic symptoms associated with emphysema?

A
  1. Pursed lip breathing (with prolonged expiratory phase).
  2. Barrel chest.
  3. Hyperventilation.
  4. Weight loss.
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14
Q

ABGs in a person with early-stage emphysema?

A

Low PaCO2.

N/Low PaO2.

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15
Q

What is the difference in symptomatology in chronic bronchitis vs emphysema?

A

Chronic bronchitis includes a persistent productive cough as well as more hypoxia than seen in emphysema, and patients are usually overweight.

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16
Q

What do you expect to see in an ABG in a person with chronic bronchitis?

A

High PaCO2.
Low PaO2.
Compensated respiratory acidosis.

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17
Q

What are the only treatments proven to extend life in COPD?

A

O2 therapy + smoking cessation.

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18
Q

What are the MC pathogens that colonize the lung in an individual with bronchiectasis?

A

SHiPS

S.aureus.
H.flu
i
Pseudomonas
S.pneumoniae
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19
Q

How do you treat the organism that most commonly infect the lung in bronchiectasis?

A

3rd gen cephalosporins.

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20
Q

How can bronchiectasis be diagnosed?

A

High res CT –> Shows TRAM TRACK lung markings.

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21
Q

What is often the 1st symptom of asthma that a patient will often describe?

A

Nighttime cough - for some people this is the only symptom.

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22
Q

ABGs in an asthma attack?

A

Hypoxia and respiratory alkalosis.

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23
Q

What is a sign of impending respiratory failure in a case of asthma?

A

ABG that shows normalizing PaCO2.

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24
Q

What is the classic diagnosis that you should think of if the CBC of an asthmatic demonstrates eosinophilia?

A

Churg-Strauss syndrome.

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25
Q

What is the 1st line treatment for an acute asthma exacerbation?

A
  1. O2.
  2. Bronchodilators (includes beta-agonist and ipratropium).
  3. Steroids.
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26
Q

What is a 2nd line treatment for an acute asthma attack?

A

Subcutaneous epinephrine + MgSO4.

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27
Q

Asthma classification by symptoms:

A
  1. Mild intermittent –> >2/wk + nighttime >2/month.
  2. Moderate persistent –> Daily asthma with nighttime >1/wk.
  3. Severe persistent –> Continuous symptoms.
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28
Q

What is the MCC of atelectasis?

A

A postoperative patient who is non ambulatory for a long period of time.

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29
Q

What types of chemotherapy can cause a restrictive lung disease?

A
  1. Busulfan

2. Bleomycin

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30
Q

What lab tests should be sent in order to evaluate the pleural fluid?

A
  1. Fluid + SERUM protein, glucose, LDH.
  2. Fluid culture + gram stain.
  3. Fluid cytology.
  4. Cell count with DIFFERENTIAL.
  5. Additionally:
    a. Amylase.
    b. AFB.
    c. ANA.
    d. RF.
    e. pH.
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31
Q

What defines an exudative effusion?

A

If ANY of the following is true, the fluid effusion is considered exudative:

Pleural protein/Serum protein > 1/2.
Pleural LDH/Serum LDH >0.6.
Pleural LDH>200.

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32
Q

What can low glucose (glucose <60) in the pleural fluid be associated with?

A
  1. Tumor.
  2. Empyema.
  3. Rheumatologic etiology.
  4. Parapneumonic exudate.
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33
Q

What are high amylase levels in pleural fluid associated with?

A

Pancreatitis, but can also be:

  1. Malignancy.
  2. Esophageal rupture.
34
Q

What percentage of pleural effusions caused by malignancy will have a fluid cytology that has malignant cells?

A

Only 40%.

35
Q

What are the MCCs of postnasal drip?

A
  1. Sinusitis.
  2. Allergic rhinitis.
  3. Seasonal or environmental allergies.
  4. Flu or cold.
36
Q

What is the preferred method of treatment of postnasal drip caused by the cold?

A

Antihistamine as well as a decongestant.

37
Q

What is the MCC of an acute cough?

A

Postnasal drip (also very common are asthma and GERD).

38
Q

MCCs of postnasal drip:

A
  1. Sinusitis.
  2. Allergic rhinitis.
  3. Seasonal or environmental allergies.
  4. Flu or cold.
39
Q

What is the preferred method of treatment of postnasal drip caused by the cold?

A

Antihistamine as well as a decongestant.

40
Q

Define acute, subacute, and chronic sinusitis.

A

Acute –> 21-60d.

Chronic –> >60d.

41
Q

What is the treatment for acute sinusitis?

A

Viral rhinosinusitis does not require antimicrobial treatment.
Nasal corticosteroids + decongestants are helpful.
–> Steroids lead to faster symptom resolution.
–> Bacterial causes should be treated with amoxicillin, augmentin, or bactrim for 1-2weeks.

42
Q

What are the potential complications secondary to chronic sinusitis?

A
  1. Meningitis.
  2. Osteomyelitis.
  3. Orbital cellulitis.
  4. Cavernous sinus thrombosis.
  5. Abscess.
43
Q

What is the classic organism causing sinusitis in a diabetic?

A

Aspergillus causing mucormycosis.

44
Q

What are the 3 MCC of chronic cough?

A
  1. Post nasal drip.
  2. Asthma.
  3. GERD.
45
Q

What are the criteria needed to diagnose ARDS?

A
  1. Acute onset of respiratory distress.
  2. PaO2: FiO2 ratio <200mmHg.
  3. Bilateral pulmonary infiltrates on CXR.
  4. Normal capillary wedge pressure.
46
Q

What is an important question to ask in the patient’s history regarding PE?

A

Recent travel or other immobilization.

47
Q

What is the MC sign in a patient with PE?

A

Sinus tachycardia.

48
Q

What are the classic CXR findings in a PE?

A

Hampton hump - wedge-shaped infarct.

Westmark sign - Hyperlucency in the lung region supplied by the affected artery.

49
Q

What is the classic EKG finding in a PE patient?

A

S1Q3T3 - S wave in lead I, Q wave in lead III, and inverted T wave in lead III.

50
Q

What diagnostic test can be done to rule out a DVT?

A

Duplex US.

51
Q

What is found on physical examination in a person with pneumothorax?

A

Absent breath sounds on the side of the pneumothorax and hyperresonance to percussion.

52
Q

What is seen on CXR in a pneumothorax?

A

Absent lung markings on the side of the pneumothorax.

53
Q

What is the treatment of a spontaneous pneumothorax?

A

O2 is he mainstay of therapy, but if the pneumothorax is symptomatic, a tube thoracostomy may be indicated.
–> Pleurodesis can be used to make the visceral and parietal pleura adhere to each other.

54
Q

MCCs of hemoptysis in the USA and worldwide?

A

USA –> Bronchitis, bronchogenic carcinoma.

Worldwide –> TB, bronchiectasis.

55
Q

Causes of lung cancer other than smoking?

A
  1. 2nd hand smoke.
  2. Exposure to asbestos.
  3. Nickel.
  4. Arsenic.
  5. Radon gas.
56
Q

How is lung cancer diagnosed?

A

Usually a nodule or mass is seen on CXR or CT of the chest and is diagnosed with a biopsy usually done via bronchoscopy or CT-guided fine-needle aspiration.

57
Q

What is the diagnostic test for a carcinoid tumor?

A

Test for elevated 5-HIAA, a serotonin metabolite.

58
Q

How is carcinoid syndrome treated?

A

Serotonin antagonist.

59
Q

What studies should be ordered if a PNA is suspected?

A
  1. CXR
  2. CBC
  3. Sputum culture
  4. Gram stain
  5. Blood culture (in hospitalized patients)
60
Q

Name the MC organism in each of the following cases - Hospital-acquired pneumonia?

A
  1. Pseudomonas.
  2. S.aureus.
  3. Enteric Gram(-) rods.
61
Q

Pneumonia after the flu:

A

S.aureus.

62
Q

Positive agglutinin test:

A

Mycoplasma

63
Q

Pneumonia in a butcher who sells rabbit meat?

A

Francisella tularensis

64
Q

Pneumonia in a person who likes to explore caves in the Ohio valley?

A

Histoplasma

65
Q

Pneumonia in a person from SOUTH-WESTERN USA?

A

Coccidioides immitis

66
Q

Pneumonia in a bird keeper?

A

C.psittaci

67
Q

Pneumonia that mimics TB, and is Gram(+)?

A

Nocardia.

68
Q

Aspiration pneumonia in an alcoholic, a patient with dementia, or a person who became unconscious.

A

Anaerobes.

69
Q

Pneumonia contracted from FARM ANIMALS and called Q fever:

A

Coxiella burnetii

70
Q

Pneumonia with hyponatremia, LDH>700, diarrhea, mental status change:

A

Legionella.

71
Q

3 pneumonias in AIDS patients with CD4 <200:

A
  1. P.carinii.
  2. Histoplasma.
  3. Cryptococcus.
72
Q

Bilateral infiltrates on CXR:

A
  1. Mycoplasma.

2. P.carinii pneumonia

73
Q

Typical pneumonia - Treatment:

A

3rd gen cephalosporin + macrolide or fluoroquinolone.

74
Q

Atypical pneumonia - Treatment:

A
  1. Doxycycline.
  2. Macrolide.
  3. Quinolone.
75
Q

Anaerobic pneumonia - Treatment:

A
  1. Clindamycin

2. Metronidazole

76
Q

What is considered a positive PPD?

A

> 15mm in any person.
10mm in immunocompromised, IVDA, foregn-born, prisoner, nursing home resident, people who work in the medical field (that means me).
5mm in HIV, abnormal CXR, close contact with someone who had TB.

77
Q

How is positive PPD treated?

A

INH for 9 months + vit B6.

78
Q

What lab tests should be done when starting a patient on INH?

A

LFTs because of possible hepatotoxicity.

79
Q

What is the MC extrapulmonary location for TB to spread:

A

Kidneys.

80
Q

What is cervical lymphadenopathy 2o to TB infection called?

A

Scrofula

81
Q

What is the standard of treatment for ACTIVE TB?

A 
4-drug therapy initially for 2 months followed by a 2-drug therapy (INH + Rifampin) for 4 months.
Rifampin
Isoniazid
Pyrozinamide 
Ethambutol
82
Q

What is the mnemonic for the mechanisms of hypoxia?

A

CIRCULAR

Circulation
Increased O2 requirement
Respiratory
CO poisoning
Underutilization
Low fraction of inspired O2 FiO2
Anemia
R-->L shunt

Internal Medicine (106 decks)

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