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MS3 - USMLE Step 2 CK > First Aid for the USMLE Step 2 CK: Pulmonary > Flashcards

First Aid for the USMLE Step 2 CK: Pulmonary Flashcards

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USMLE® Step 1 flashcards
1
Q

List the four obstructive lung diseases.

A 
ABCO 
•Asthma
•Bronchiectasis
•Cystic fibrosis / COPD
• Obstruction (tracheal or bronchial)
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2
Q

Obstructive lung diseases primarily affect which part of the lungs?

A

The airways

Restrictive lung diseases, meanwhile, affect the alveoli and interstitium.

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3
Q

An FEV/FVC ratio less than _________ is suggestive of obstructive lung disease.

A

0.7

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4
Q

List Samter’s triad.

A

Samter’s triad (of asthma):
•Asthma
•Nasal polyps
•Aspirin/NSAID sensitivity

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5
Q

True or false: those having moderate asthma attacks usually have mild respiratory acidosis.

A

False

Initially, asthma leads to respiratory alkalosis from hyperventilation. Respiratory acidosis is a sign of severe respiratory failure in asthma.

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6
Q

List the four lung volumes.

A
  • Inspiratory reserve volume (IRV): volume after inhaling
  • Tidal volume (TV): volume from end of resting expiration to end of resting inspiration
  • Expiratory reserve volume (ERV): volume from end of normal expiration to end of forced expiration
  • Residual volume (RV): volume in lung at the end of a forced expiration
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7
Q

RV __________ in obstructive lung diseases.

A

increases

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8
Q

Which spirometry value is best for gauging the severity of restrictive lung diseases?

A

FVC

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9
Q

Inspiratory capacity (IC) is _____________.

A

IRV plus tidal volume

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10
Q

IRV + TV + ERV = _____________.

A

VC

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11
Q

FRC is equal to what two values _______________.

A

ERV + RV

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12
Q

FEV is best at marking the severity of _____________ lung disorders.

A

obstructive

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13
Q

___________ is caused by repeat infection/irritation that leads to widening of the airways.

A

Bronchiectasis

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14
Q

Bronchiectasis can present with what auscultation findings?

A
  • Wheezes
  • Rales
  • Rhonchi
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15
Q

How is bronchiectasis diagnosed?

A
  • First, CXR

* Second, CT (definitive)

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16
Q

How is the DLCO affected by emphysema?

A

Decreased

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17
Q

Review First Aid’s mnemonic for restrictive lung diseases.

A

When you’re lungs AIN’T compliant, it’s likely:
•Alveolar: edema, hemorrhage, pus
•Interstitial (IIP), Idiopathic (pulmonary fibrosis), Inflammatory (sarcoidosis)
• Neuromuscular (myasthenia gravis, phrenic nerve palsy)
•Thoracic wall (scoliosis, ankylosing spondylitis)

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18
Q

List five medications that can cause pulmonary fibrosis.

A
  • Methotrexate
  • Amiodarone
  • Nitrofurantoin
  • Busulfan
  • Bleomycin
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19
Q

Review the history, exam, and diagnostic workup of pulmonary fibrosis.

A
  • History: chronic, non-productive cough; dyspnea
  • Exam: diffuse crackles; cyanosis; clubbing; signs of right-heart failure
  • Diagnostic workup: CXR showing ground-glass opacity; spirometry showing decreased TLC, decreased FVC, and a normal FEV/FVC ratio; surgical biopsy
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20
Q

Describe three treatment approaches to interstitial lung disease.

A
  • Prevention: avoid further exposure to causative agent
  • Treat fibrosis: antifibrotic agents for some disease
  • Transplant for severe disease
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21
Q

Go over First Aid’s mnemonic for sarcoidosis.

A 
GRUELING
•Granulomas
• aRthritis
•Uveitis
• Erythema nodosum
•Lymphadenopathy
•Interstitial lung disease (fibrosis) 
• Negative TB test 
•Gammaglobulinemia
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22
Q

A person has dyspnea, fever, cough, and shivering 4-6 hours after being exposed to a cockatiel. What is this syndrome?

A

Hypersensitivity pneumonitis –can also present with noncaseating granulomas

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23
Q

What occupations predispose people to asbestosis?

A
  • Brake repair
  • Shipbuilding
  • Insulation
  • Demolition
24
Q

Coal worker’s lung and silicosis present with ___________ on x-ray.

A

small nodular opacities

25
Q

How are berylliosis and sarcoidosis similar?

A

They both present with a restrictive lung disease and hilar lymphadenopathy, and both require steroid treatment.

26
Q

NSAID use, aspergillosis, and Löffler syndrome all share what commonality?

A

They are eosinophilic lung disorders.

27
Q

List the five causes of hypoxemia.

A
  • V/Q mismatch
  • Cardiac shunt
  • Decreased partial pressure of inhaled O2
  • Hypoventilation
  • Diffusion impairment
28
Q

The pathogenesis of acute respiratory distress syndrome (ARDS) is thought to be due to ______________.

A

endothelial injury in the pulmonary vasculature

29
Q

How is ARDS diagnosed?

A
  • Hypoxemia refractory to oxygenation
  • Noncardiogenic pulmonary edema
  • PaO2/FiO2 less than 300
30
Q

How do you calculate PaO2/FiO2 ratio?

A
  • PaO2 is given in mm Hg: ~ 90 mm Hg
  • FiO2 is given in decimal fraction: ~ 0.21

Thus, a normal PaO2/FiO2 is 90/0.21 = ~ 425.

31
Q

Once you know that a person’s PaO2 is decreased (that is, that they have hypoxemia), then you should check their _______________.

A

A-a gradient

  • If the A-a gradient is normal, then the cause of hypoxemia is either decreased FiO2 or hypoventilation (which PaCO2 can distinguish).
  • If the A-a gradient is increased, then the cause is either V/Q mismatch, diffusion problems, or shunt (which administration of FiO2 can help distinguish, as FiO2 will not correct shunts).
32
Q

One of the key caveats in diagnosing ARDS is that their respiratory failure has to not be explainable by _______________.

A

CHF

33
Q

Review the management of ARDS.

A
  • Treat the underlying cause (e.g., pneumonia)
  • Use minimal tidal volume ventilation to prevent ventilator-associated injury
  • Use PEEP to open atelectatic alveoli
  • Titrate FiO2 to maintain PaO2 above 55 mm Hg
  • Wean from ventilation as tolerated
34
Q

Pulmonary hypertension is defined as ______________.

A

pulmonary pressure greater than 25 mm Hg

35
Q

There are five causes of pulmonary hypertension: ________________.

A
  • Chronic lung disease leading to vasoconstriction
  • Thromboembolic disease
  • Left-sided heart failure leading to pulmonary congestion
  • Pulmonary arterial hypertension (which I think is idiopathic)
36
Q

The best predictor of successful extubation is _____________.

A

a frequency / tidal volume ratio less than 105

37
Q

Review the diagnosis of pulmonary hypertension.

A
  • History: SOB, lethargy, syncope, symptoms of right-sided HF (edema, abdominal distention)
  • PE: loud split S2, JVD
  • Workup: CXR shows increased pulmonary vasculature; ECG shows RV hypertrophy; right-heart catheterization shows PHTN
38
Q

List Virchow’s triad and some common examples of each.

A
  • Venous stasis: CHF, immobility, obesity
  • Endothelial injury: trauma, surgery, catheterization
  • Hypercoagulability: cigarettes, OCPs, pregnancy, coagulopathy, malignancy, burns
39
Q

Describe the workup of PE.

A
  • History: SOB, pleuritic chest pain, Virchow’s risk factors
  • Labs: D-dimer
  • Imaging: CT angiogram, V/Q scan
  • ECG: S1Q3T3
40
Q

Why does the S1Q3T3 ECG finding present in PE?

A

Right heart strain

41
Q

Review the treatment of PEs.

A
  • Acute: heparin
  • Chronic: warfarin (INR 2-3)

For PE that causes acute right-heart failure (with hypotension), give tPA.

42
Q

___________ lung cancer is neuroendocrine in origin.

A

Small cell lung

43
Q

Review the characteristics that make a pulmonary nodule low risk.

A
  • Age of person younger than 35
  • Size of nodule less than 2 cm
  • Smooth borders
  • No calcification (or calcification that is central and uniform)
  • Person not a smoker
44
Q

Review the lung cancers by prevalence.

A

1) Metastases
2) Adenocarcinoma
3) Small cell, squamous cell, and large cell

45
Q

Which lung cancer presents with cavitations?

A

Squamous cell carcinoma

46
Q

Gynecomastia can be seen in what lung cancer?

A

Large cell

47
Q

Hypertrophic pulmonary osteoarthropathy is a feature of which lung cancer?

A

Adenocarcinoma

48
Q

All of the neuromuscular conditions are seen in which kind of lung cancer?

A

Small cell

Although dermatomyositis can be caused by any lung cancer.

49
Q

What hematologic abnormalities can be seen in lung cancer?

A
  • Anemia
  • Eosinophilia
  • Thrombocytosis
  • Hypercoagulability
50
Q

How should you work up suspected pulmonary embolus?

A

It depends on the initial clinical suspicion:

  • High suspicion, given by multiple symptoms and a history suspicious for PE: give heparin immediately and then do a CTA to confirm.
  • Low suspicion, given by only one or two symptoms and a history without features of PE: do CTA first.
51
Q

The triad of Horner syndrome is ________________.

A

ptosis, miosis, and anhidrosis

52
Q

How should you work up a pulmonary effusion?

A

You need to determine if it is a transudate or an exudate. To do this, tap the fluid:

  • Transudate: low in protein; caused by CHF, liver disease, or nephrotic syndrome
  • Exudate: high in protein; caused by infection, malignancy, pancreatitis, or embolism
53
Q

The best initial test for diagnosing pleural effusion is ______________.

A

lateral decubitus x-ray

54
Q

Go through the mnemonic for the presentation of pneumothorax.

A 
P-THORAX
•Pleuritic chest pain 
•Tracheal deviation (if tension) 
•Hyperresonance
•Onset sudden
•Reduced breath sounds 
•Asymmetric chest wall
•X-ray showing absent lung fields

These don’t fit into the mnemonic, but tachypnea and JVD can be present, too.

55
Q

Review the three types of pneumothorax.

A
  • Spontaneous
  • Secondary (to COPD, pneumonia, or iatrogenic factors)
  • Tension (traumatic)
56
Q

Tension pneumothoraces require what treatment?

A

Immediate needle decompression in the second intercostal space, midclavicular line

MS3 - USMLE Step 2 CK (91 decks)

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