Internal Medicine Essentials Questions: Pulmonary Medicine Flashcards
How can you distinguish between DLPD and respiratory muscle weakness?
- DLPD will have low DLCO and abnormalities on chest x-ray.
- Respiratory muscle weakness will have normal DLCO and x-ray significant only for decreased volumes.
List three diagnoses for a chronic cough with a normal chest x-ray.
- Cough-variant asthma (diagnosable with bronchial challenge)
- GERD (can diagnose with a pH probe or treat empirically with PPIs)
- Postnasal drip
____________ volume will be increased and ___________ capacity will be decreased in a person with respiratory muscle weakness.
Residual; total lung
They cannot exhale fully, so RV is increased, but they cannot inhale fully, so TLC is decreased.
A woman reports chronic dyspnea at rest. Her lung exam is normal and no stridor is noted. She had an MVC one year ago and required prolonged intubation. What test should you order to evaluate her dyspnea?
Flow-volume PFTs
Suspect tracheomalacia or tracheal stenosis in a person with prolonged intubation. Flow-volume loops will show a flattening of the inspiratory loop.
Describe the to-and-fro ventricular septal sign on echo.
This is a sign of constrictive pericarditis. Constrictive pericarditis causes a ventricular filling defect. One ventricle will fill and impede the other. The other will then fill on the next cycle and cause impedance.
This is useful because restrictive cardiomyopathy –which can resemble constrictive pericarditis –will not show this sign.
Why is the “do not tap a pleural effusion less than 1 cm” a good rule to know?
Most cases of pneumonia present with pleural effusions that are small (up to 50%!). Thus, you need to know that observation is indicated in uncomplicated cases (less than 1 cm, not loculated).
True or false: tactile fremitus is decreased in lobar consolidation.
False
Tactile fremitus is caused by lung consolidation and thus increases with lobar consolidation.
To definitively diagnose alpha-1 antitrypsin deficiency, you need to _______________.
measure the levels of A1AT
Start O2 therapy in patients with ______________.
SpO2 less than 88% or PaO2 less than 55 mm Hg
Review the tiers of ventilatory support for those with COPD having an exacerbation.
- Purely hypoxic: increase NC O2
- Mildly acidotic (7.25 - 7.35): non-invasive positive-pressure ventilation
- Severely acidotic (less than 7.25): intubation
Bibasilar interstitial fibrosis, honeycombing, increased septal thickness, and linear calcifications on x-ray are suggestive of _____________.
asbestosis
Describe the presentation of cryptogenic organizing pneumonia (also called BOOP).
- Insidious onset of dry cough and SOB
- Diffuse crackles
- No fever
- Patchy opacities on CXR
- Responds well to glucocorticoids
Pulmonary fibrosis typically affects which parts of the lungs?
Basal and peripheral
When should you not do a CTA in assessing PE?
- Renal failure (because of toxic contrast)
* Pregnancy (because of radiation)