IM Pulm - Rd 2 Flashcards

1
Q

Pt that has rheumatologic condition that presents w/cough, fever, hemoptysis, and Hg drop has what?

Often assoc w/what?

A

Diffuse alveolar hemorrhage

Drugs

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2
Q

What are the PE findings of pts w/Cor pulmonale?

A
Peripheral edema
Inc JVP
Loud S2
Pulsatile liver from congestion
TR
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3
Q

Exudative pleural effusions occur d/t what physiology?

A

Increase capillary permeability d/t cytokines release during inflammation

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4
Q

What can cause a small pleural effusion in a pt with sudden onset chest pain, dyspnea, and tachycardia?

A

PE

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5
Q

PCP in HIV pts can cause what additional problem?

A

SIADH

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7
Q

What can cause abrupt increases in RA pressure to > 10 mmHg and PA pressure to > 40 mmHg?

Can lead to what?

A

Massive PE

Dec CO, HoTN, Obstructive shock

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8
Q

According to uWorld, when should long-term supplemental home oxygen be given?

A

PaO2 = 55 or SaO2 = 88% on room air
OR
PaO2 = 59 or SaO2 = 89% in pts w/Cor pulmonale, RHF or Hct > 55%

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9
Q

Lung biopsy in a pt w/pulmonary arterial HTN demonstrates what?

A

Arterial intimal hyperplasia

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10
Q

What makes the Dx for chronic pulmonary aspergillosis?

Who is at increased risk?

A

> 3 months of B sx
Cavitary lesion
+ aspergillus IgG serology

Immunocompromised pt —> had TB in the past

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11
Q

How much should the TV be in pt when setting the ventilation controls?

A

6 mL/kg of IBW

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12
Q

What is ASA-exacerbated respiratory disease?

Presents in whom?

Presents how?

A

Pseudoallergic reaction to NSAIDs, NOT IgE mediated

Pts w/asthma, chronic rhinosinutitis w/nasal polyps

Bronchospasm and nasal congestion following ASA ingestion

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13
Q

JVD and RBBB on EKG indicate what?

A

Right heart strain

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13
Q

How is the DLCO effected in interstitial fibrosis?

A

Decreased capacity

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14
Q

How are the following effected in pleural effusion?
Breath sounds?

Tactile fremitus?

Percussion?

A

Dec (fluid insulates sounds and vibrations originating in the lung, making it quiet)

Dec

Dull

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15
Q

What things cause a high A-a gradient?

A

V/Q mismatch (PE)
R—>L shunt
Pulmonary fibrosis

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17
Q

Pt that has PNA in the left lobe and lies on left side, what will happen physiologically?

Why?

A

R—>L intrapulmonary shunting and V/Q mismatch

Gravity increases blood flow to left lung, but there is markedly decrease V d/t alveolar consolidation —> worse V/Q shunt

17
Q

Diphragmatic flattening in COPD is d/t what?

A

Increased work of breathing

19
Q

What improves mortality in ARDS pts?

A

Preventing alveolar overdistention

20
Q

Aspergillosis appears in what settings?

A

TB, sarcoidosis, bronchial cyst, neoplasm

20
Q

CT scan that shows pulmonary nodules w/surrounding ground-glass opacities is what?

Seen in what?

A

Halo sign

Invasive aspergillosis

21
Q

What is CREST syndrome?

A
Calcinosis
Raynaud’s
Esophageal dysmotility
Sclerodactyly 
Telangiectasia
21
Q

Normal diffusion capacity of the lung (DLCO) is seen in what obstructive diseases?

Restrictive?

A

Chronic bronchitis, asthma

MSK deformity, Neuromuscular disease

23
Q

What lung infection presents w/subacute fever, chills, malaise, HA, myalgia, dry cough with CXR showing Hilary LAD w/focal, reticulonodular infiltrates?

Biopsy shows what?

A

Histoplasmosis

Granulomas w/narrow-based budding yeasts

24
Q

Pt that comes in with RECURRENT episodes of LARGE amounts of productive sputum production with hemoptysis and dyspnea, what is the most likely Dx?

Dx how?

A

Bronchiectasis

High Res CT

25
What tumor presents w/elevated bHCG and AFP?
Nonseminomatous germ cell tumor
25
Wedge shaped infarct is called what? Seen in what condition?
Hampton hump PE
26
Pt that may be developing ARDS, what is the goal PaO2? This corresponds to what O2 Sat? What should the FiO2 be immediately following intubation? Prolonged FiO2 can cause what?
55-80 88-95% > 60% then weaned down Oxygen toxicity d/t O2 free radicals
27
What features help diagnose a pulmonary contusion?
Rales/dec breath sounds | CXR shows patchy, alveolar infiltrate
29
ABG shows hypoxia, hypocapnia, and respiratory alkalosis indicates what pathology?
CHF
30
Panacinar emphysema seen in what condition? Centriacinar?
A1AT Smoking (Senter - Smoking)
32
Why do COPD pts have relatively normal pH in their blood and not more acidosis?
Renal tubular compensation via increased bicarbonate retention
36
What do the PFTs look like in a pt w/Ankylosing spondylitis?
Dec VC and dec TLC Normal FEV1/FVC FRC 110% of predicted d/t fixation of the rib cage in an inspiratory position