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UWORLD-STEP2 (BA) > IM-Respiratory > Flashcards

IM-Respiratory Flashcards

1
Q

Empyemas are exudative effusions with a low glucose concentration due to ___ (2)

A
  • A high metabolic activity of leukocytes

- bacteria within the pleural fluid

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2
Q

Pt with high dose beta-2-agonists can develop what kind of electrolyte imbalance and pt presentations are (6)

A

Hypokalemia

  • Muscle weakness, arrhythmias & EKG abnormalities
  • tremor, palpitations and headache
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3
Q

The 3 main (>90%) causes of a chronic cough in non-smokers are

A
  • Postnasal drip
  • GERD
  • asthma
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4
Q

The main 3 systems that are affected by Theophylline toxicity are

A
  • CNS (headache, insomnia, sz)
  • GI (N/V)
  • Cardiac (arrthytmia)
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5
Q

Panacinar emphysema is typical of what cause

A

alpha-1-antitrypsin deficiency

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6
Q

Supplemental oxygen in pt with COPD can worsen hypercapnia due to the combination of increased dead space perfusion causing (3)

A
  • V/Q mismatch
  • decreased affinity of oxyhemoglobin for C02
  • Reduced alveolar ventilation
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7
Q

Acute exacerbation of COPD often reveals (4)

A
  • Wheezes
  • Tachypnea
  • Prolonged expiration
  • Accessory muscles
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8
Q

Bilateral wheezing can occur in acute PE due to _______ in response to hypoxia and infarction

A

cytokine-induced bronchoconstriction

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9
Q

PE causes V/Q mismatch resulting in an increase in ______

A

A-a oxygen gradient

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10
Q

Pneumonia causes hypoxemia due to (2)

A
  • Right-to-left intrapulmonary shunting

- An extreme V/Q mismatch

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11
Q

Increasing concentration of inspired oxygen does/ does not correct hypoxemia caused by intrapulmonary shunting

A

Does NOT

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12
Q

Chronic nonproductive cough in patient with hearth failure is likely an

A

adverse effect of ACE inhibitor

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13
Q

How is Massive PE defined?

A

PE complicated by hypotension (syncope) and/or acute right heart strain (JVD & RBBB)

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14
Q

What are the pulmonary function tests seen for interstitial lung disease? (4)

A

increased FEV1/FVC ratio
decreased DLCO (diffused lung capacity of CO)
decreased TLC
Decreased RV

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15
Q

Pt with interstitial lung disease will have impaired gash exchange resulting in (2)

A
  • reduced diffusion capacity of carbon monoxide

- increased alveolar-artery gradient

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16
Q

PE, atelectasis, pleural effusion, and pulmonary edema causes the

  • V/Q to _
  • A-a gradient _
  • PaCO2 __
  • RR__
A
  • V/Q to Mismatch
  • A-a gradient _ elevated
  • PaCO2 __ decrease (respiratory alkalosis)
  • RR__ Increased (to compensate)
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17
Q

GERD in pt with asthma can exacerbate asthma through micro aspiration of gastric contents leading to an increased in (2) & how to you treat

A
  • Vagal tone
  • Bronchial reactivity

-treat with PPI

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18
Q

Tx for mild non-allergic rhinitis

A

intranasal antihistamine or glucocorticoids

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19
Q

Tx for allergic rhinitis

A
  • intranasal glucocorticoids

- antihistamines

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20
Q

-Triad of Fever, chest pain, hemoptysis
- Pulmonary nodules with halo sign
- positive culture
- positive cell wall biomarkers (galactomannan, beta-D-glucan)
Dx?

A

Invasive aspergillosis

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21
Q

Risk factor for Invasive aspergillosis

A
  • Immunocompromise (neutropenia, glucocorticoids, HIV)
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22
Q

Tx of Invasive aspergillosis (2)

A

Voriconazole +/- Caspofungin

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23
Q
  • > 3 months: Weight loss (>90%), cough, hemolysis, fatigue
  • Cavitary lesion +/- fungus ball
  • Positive Aspergillus IgG serology
    Dx?
A

Chronic pulmonary aspergillosis

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24
Q

What is the risk factor for chronic pulmonary aspergillosis?

A

Lung disease/ damage (Cavity tuberculosis)

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25
Q

How do you treat chronic pulmonary aspergillosis (3)

A
  • Resect aspergilloma (if possible)
  • Azole medication (voriconazole)
  • Embolization (if severe hemoptysis)
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26
Q
  • Shoulder pain
  • Horner syndrome
  • C8-T2 neurological involvement
  • Supraclavicular lymph node enlargement
  • Weight loss
A

Pancoast tumors

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27
Q

The flattened diaphragm in COPD has more difficulty contracting to expand the thoracic cavity resulting in

A

Increased work of breathing

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28
Q

ARDS pt that are on mechanical ventilation will have a required goals to avoid complication of ventilation by (2)

A
  • Low tidal volume ventilation (LTVV) to decrease over-distending alveoli
  • Providing adequate oxygenation by increasing FiO2 but avoid toxicity.
  • Increases PEEP to improve oxygenation to prevent alveoli collapse at the end of expiration
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29
Q

Causes of recurrent pneumonia involving same region of lung (2)

A
  • Local airway obstruction (neoplasm, bronchiectasis, foreign body)
  • Recurrent aspiration (GERD, Drug and alcohol use, Sz, dysphagia)
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30
Q

Causes of recurrent pneumonia involving different region of lung (3)

A
  • Immunodeficiency (leukemia, CVID, HIV)
  • Sinopulmonary disease (CF, immotile cilia..)
  • Noninfectious (Vacuities, …)
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31
Q

Daytime sleepiness, snoring, brief choking or gagging sensation while sleeping, morning headache

A

OSA

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32
Q
  • Cough for >5days to 3 weeks (+ purulent sputum)
  • Absent systemic findings (fever, chills)
  • Wheezing or rhonchi, chest wall tenderness
A

Acute bronchitis

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33
Q

How do you diagnoses bronchitis?

A

Clinical diagnosis

CXR only when PNA is suspected

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34
Q

How to tx bronchitis?

A
  • Symptomatic (NSAIDs &/or bronchodilators)

- Abx NOT recommended

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35
Q

Acute massive PE results in abrupt increase in pulmonary vascular resistance and subsequently _______

A

Right ventricular pressure

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36
Q
  • Present <24hr after blunt thoracic trauma

- Tachypnea, tachycardia, hypoxia

A

Pulmonary contusion

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37
Q

How do you diagnosis Pulmonary contusion? (2)

A

_ CT scan (most sensitive)

- CXR with patchy, alveolar infiltrate not restricted by anatomical borders

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38
Q

How do you manage pulmonary contusion? (3)

A
  • Pain control
  • Pulmonary hygiene (Neb, chest PT)
  • Supplemental oxygen and ventilator support
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39
Q

Diagnostic testing for acute exacerbation of COPD (2) and they will show?

A
  • Chest xray- hyperinflation

- ABG: Hypoxia, CO2 retention (Chronic &/or acute)

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40
Q

What are the physical findings for cor pulmonale? (6)

A
  • Peripheral edema
  • JVD with prominent a wave
  • Loud S2
  • Right-side heave
  • Pulsatile liver from congestion
  • Tricuspid regurgitation murmur
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41
Q

The 4 common ethioplogies for Cor pulmonale

A
  • COPD
  • Interstitial lung disease
  • Pulmonary vascular disease (Thromboembolic)
  • Obstructive sleep apnea
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42
Q
  • Dyspena on exerition, fatigue, lethargy
  • Exertional syncope ( deceased CO)
  • Exertional angina (increased myocardial demand)
A

Cor pulmonale

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43
Q

Imagining used for Cor pulmonale diagnosis (3)

A
  • EKG
  • Echo
  • Right heart catherterization (Golden standard)
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44
Q

What do you expect to see on EKG for cor pulmonale (4)

A
  • RBBB
  • Right axis deviation (RAD)
  • RV hypertrophy
  • Right Atrial enlargement
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45
Q

What do you expect to see on Echo for cor pulmonale (3)

A
  • Pulmonary hypertension
  • Dilated right ventricle
  • Tricuspid regurgitation
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46
Q

What do you expect to see on R heart catheterization for cor pulmonale (3)

A
  • R ventricular dysfunction
  • Pulmonary hypertension
  • No left heart disease
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47
Q

In addition to all the medication used for COPD what other medication is needed for acute exacerbation?

A

Antibiotics

48
Q

Progressive dyspnea, clubbing and end-inspiratory crackles with person working in industrial process

A

Asbestosis

49
Q

Pleural plaques on imaging are the hallmark for

A

Asbestosis

50
Q

The 3 main complication of Positive pressure ventilation are

A
  • Alveolar damage
  • Pneumothorax
  • Hypotension
51
Q

3 pulmonary causes of hemoptysis

A
  • Bronchitis
  • Lung cancer
  • Bronchiectasis
52
Q

Cardiac causes of hemoptysis

A

Mitral stenosis/acute Pulmonary edema

53
Q

4 infectious causes of hemoptysis

A
  • TB
  • Lung abscess
  • Bacterial pneumonia
  • Aspergillosis
54
Q

2 vascular causes of hemoptysis

A
  • Pulmonary Embolism

- Arteriovenous malformation

55
Q

2 systemic disease causes of hemoptysis

A
  • Granulomatosis with plyangitis

- Goodpasture syndrome

56
Q

Othe causes of hemoptysis that are not systemic cause

A
  • trauma

- Cocaine (inhalation use)

57
Q

Sinusitis/otitis, saddle-nose deformity, lung nodules/cavitation, rapidly progressive granumloma, Skin:Livedo reticularis, nonhealing ulcers

A

Granulomatosis vasculitis (Wegener granulomatosis)

58
Q

Granulomatosis vasculitis (Wegener granulomatosis) treatment (2)

A

-Corticosteroids and Immunomodulators (MTX, cyclophosphamide)

59
Q

Granulomatosis vasculitis (Wegener granulomatosis) Is diagnositic methods (2)

A
  • ANCA

- BIopsy

60
Q

What is found on skin biopsy for Granulomatosis vasculitis (Wegener granulomatosis)

A

-Leukocytoclastic vasculitis)

61
Q

What is found on kidney biopsy for Granulomatosis vasculitis (Wegener granulomatosis)

A
  • Pauci-immune GN
62
Q

What is found on lung biopsy for Granulomatosis vasculitis (Wegener granulomatosis)

A

-Granulomatous vasculities

63
Q

3 things shown on Right heart catheterization for PE

A
  • Elevated Right atrial
  • Elevated pulmonary artery pressures
  • Normal PCWP
64
Q

In COPD Vital capacity is _____ and total lung capacity is ___

A

VC decreased

TLC increased

65
Q

_____ is associated with mortality benefit and reduced progression of disease in pt with COPD

A
  • Smoking cessation
66
Q

What is the most effective way to differentiate asthma with COPD?

A

Spirometers before and after administration of bronchodilator ( reversal of airway obstruction with asthma)

67
Q

What are the 2 markings for complicated parapneumonic effusions or empyemas

A
  • Very low pH (<7.2)

- Glucose (<60mg/dL)

68
Q

Dullness or percussion
Increased intensity of breath sounds
Increased tactile fremitus

A

Lung consolidation (lobar PNA)

69
Q

What are the 2 aspiration syndromes affecting lung

A
  • Pneumonia

- Pneumonitis

70
Q

What is the pathophysiology of pneumonitis caused by aspiration

A

Lung parenchyma inflammation with aspiration of gastric acid causing direct tissue injury

71
Q

What is the pathophysiology of pneumonia caused by aspiration

A

Lung parenchyma infection , aspiration of upper airway or stomach microbes (anaerobes)

72
Q

Abx for aspiration PNA (2)

A

Clindamycin or beta-lactam & Beta-lactamase inhibitor

73
Q

which type of the two aspiration syndromes, does the presentation occurs within hours instead of days after the aspiration?

A

Pneumonitis in hours

no abx need to treat

74
Q

Oxygenation can be improved in 2 ways on a mechanical ventilated patient

A

PEEP

FiO2

75
Q

Pt with PE can have small pleural effusions due to (2)?

A

hemorrhage or inflammation

76
Q

Pleural effusion from PE is

A

Exudative and grossly bloody

77
Q 
Should pain
Ipsilateral ptosis, miosis, enophthalmos and anhidrosis
C8-T2 neurological involvement 
Supraclavicular lymph node enlargement 
Weight loss
A

Superior pulmonary sulcus tumore (Pancoast tumor)

78
Q

Asbestos exposure increase the risk for two disease

A
  • pulmonary fibrosis

- Malignancy (Bronchogenic carcinoma most common )

79
Q

The most common endemic mycosis in US?

A

Histoplasma capsulatum

80
Q

Location of exposure for Histoplasma capsulatum

A

Midwest (Ohio and Mississippi river valleys)

Northeast (less extent)

81
Q

Histoplasma capsulatum proliferates most readily in what environment?

A

Soil contaminated with bat or bird droppings

82
Q

Subacute fever, chills, malaise, headache, myalgias, and dry cough
CXray- mediastinal or hilar lymphadenopathy with focal, reticulonodular or miliary infiltrates, granulomas with narrow-based budding yeasts

A

Histoplasma capsulatum

2-4 weeks after exposure

83
Q

Why does urine sodium decrease in a hypovolemic patients?

A

decreased renal perfusion-> RAAS activation

84
Q

What are the 2 criteria for patient to a candidate for home oxygen treatment?

A
  • PaO2 =55mmHg

- O2 sat = 88%

85
Q

Alveolar consolidation in PNA causes hypoxemia because of

A

right-to-left intrapulmonary shunting

86
Q

what position makes v/q mismatch worsen?

A

gravity dependent (laying on the side of the sick lung)

87
Q

mild leukicytosis, fever, pleuritic chest pain, hemoptysis, wedge-shaped Chest CT

A

Pulmonary Embolism

88
Q

Tx of SIADH

A

fluid restriction +/- salt tabs

Hypertonic saline

89
Q

What is the SE of steroids seen on CBC?

A

Leukocytosis: Increased Neutrophils

90
Q

low back pain, <40YO, insidious onset, improves with exercise but not with rest, pain at night , Hip & buttock pain, limited chest expansion and spinal mobility, enthesitis, acute anterior uveitis

A

ankylosing spondylitis

91
Q

50YO smoker with anorexia, constipation, increased thirst, easy fatigability, hypercalemia

A

SSC of lung

92
Q

The 2 markers for nonseminomatous germ cell tumors are

A

AFP

B-hCG

93
Q

Definition of ventilation

A

RR x VT

94
Q

what is the best drug to use for symptom management in COPD?

A

Inhaled anti-muscarinic ages like Ipratropium

- may combine with short-acting beta-adrenergic for greater symptom relief

95
Q

what drug is used for intermittent asthma

A

PRN short-acting beta2-agonis (SABA)

-Albuterol

96
Q

What is the number of symptoms frequency that require SABA use in & drug additions

  • intermittent
  • Mild persistent
  • Moderat persistent
  • Severe persistent
A
  • intermittent (=2days)- SABA ONLY
  • Mild persistent (>2days)-add low dose ICS
  • Moderate persistent (1/day)-add moderate dose ICS + LABA
  • Severe persistent (ALL day)- High dose ICS+LABA+ ORAL corticosteroids

Might consider malizumab after last step

97
Q

How is diagnosis of Goodpastrure’s disease made

A

bx of renal - shows IgG antibodies in the glomerular basement membrane

98
Q

You will have increased Tactile fremitus in which pulmonary disease

A

consolidation (lobar PNA)

99
Q

You will have hyper-resonant on percussion in which two lung diseases?

A
  • Pneumothorax

- Emphysema

100
Q

You will have JUST resonant on percussion in which lung diseases?

A

It is NORMAL lung

101
Q

You will have dullness on percussion in which 3 lung diseases?

A
  • consolidation (PNA)
  • Pleural effusion
  • Atelectasis (mucus plugging)
102
Q

In Pleural effusion mediastinal shift is in what direction?

A

away from effusion if large

103
Q

In Pneumothorax mediastinal shift is in what direction?

A

Away from the tension pneumothorax

104
Q

In Atelectasis mediastinal shift is in what direction?

A

Toward the atelectasis

105
Q

The best diagnostic test for bronchiectasis

A

High-resolution CT (HRCT)

106
Q

The 2 most common symptoms of PE

A

Acute onset dyspnea (73%)

Pleuritic chest pain (66%)

107
Q

What is the mean pulmonary arterial pressure at rest to define Pulmonary hypertension?

A

> /= 25 mmHg at rest

108
Q

RV failure happens late in pHTN and manifests with (5)

A
  • RV heave
  • JVD
  • Tender hepatomegaly
  • Acites
  • Edema
109
Q

Cxray in pHTN shows (2)

A
  • Enlargement of the pulmonary arteries with rapid taping of distal vessels (pruning)
  • Enlargement of the RV
110
Q

A condition where digital clubbing is accompanied by sudden-onset arthropathy, commonly affecting the wrist and hand joints

A

Hypertrophic osteoarthropathy (HOA)

111
Q

a subset of HOA where the cladding and arthropathy are attributable to underlying lung disease like cancer, TB, bronchiectasis or emphysema

A

Hypertrophic pulmonary osteoarthropathy (HPOA)

112
Q

Diagnostic for granulomatosis with polyangiitis (Wegener granumonatosis ) 2

A
  • ANCA

- Bx; Skin (leukocytoclastic vasculitis); Kidney (Pauci-immune GN), Lung (granulomatous vasculitis)

113
Q

How to manage granulomatosis with polyangiitis using medication (2)

A
  • Cortiosteroids

- Immunomoedulators (MTX, cyclophosphamide)

114
Q

1st line tx for exercise induced brnchoconstriction if required only a few times a week

A

short-acting beta-adrenergic agonists 10-20 mins before

115
Q

The peripheral wedge of lung opacity due to pulmonary infarction is called? Seen in?

A

Hampton’s hump, PE

116
Q

Peripheral hyperlucency due to oligemia is called? seen in?

A

Westermark’s sign, PE

117
Q

Enlarged pulmonary artery seen in PE is called?

A

Fleischner sign

UWORLD-STEP2 (BA) (19 decks)

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