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[2b] A- step 2 CK > Medicine - Pulm > Flashcards

Medicine - Pulm Flashcards

1
Q

Name the Causes of ARDS (10)

A

ARDS

A= Aspiration vs. [Acute Pancreatitis] vs. [Air Fluid Embolus (amniotic)]

R= Radiation

D= Drugs vs. DIC vs. Drowning

S= Sepsis vs. Smoking vs. Shock

ARDS is a restrictive pattern that –> ⬇︎Lung Compliance, Pulm HTN and impaired gas exchange

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2
Q

Tx for ARDS

A

PEEP (Positive End Expiratory Pressure)

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3
Q

Based on GOLD Criteria, how should COPD pts be treated?

A
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4
Q

What is the 4 Criteria for COPD Exacerbation

A
  1. SOB
  2. ⬆︎Cough
  3. Sputum ∆
  4. BL wheezing w/ respiratory acidosis
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5
Q

Tx for COPD Exacerbation-4

Which improves survival? Which ⬇︎future events?

A

“I’m having COPD Exacerbation! Give me DOPA! (but not really)”

  1. Duoneb (albuterol + ipratropium)
  2. O2 PRN via BiPAP (goal: 90-94% O2 Sat) -only when desat
  3. [Prednisone 40 mg qd x 5]
  4. Abx (Azithro-⬇︎future events or Levoflox or Doxy)
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6
Q

Criteria for Pulmonary HTN ; What are causes?-7

A

Pulm Arterial presure ≥25 (normal = 20);

  1. L Heart Dz = MOST COMMON
  2. Drugs (see image)
  3. [Limited CREST Scleroderma]
  4. SLE
  5. Recurrent VTE
  6. Idiopathic Primary
  7. Chronic Lung Dz
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7
Q

Difference between [Dead Space Ventilation] and [Physiological shunting]; Which causes Hypoxemia?

A

[Dead Space Ventilation] = Area of Lung that has Good Ventilation but poor perfusion

vs.

[Physiological Shunting] = Area of Lung with POOR Ventilation but good perfusion which—> physiological shunting –> Hypoxemia (Think PNA) - “You’ll get Shunts when the [VP is PG” = Ventilation Poor but Perfusion is Good]

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8
Q

What mediastinal masses are found in the…

A: Anterior mediastinum

B: Middle mediastinum

C: Posterior mediastinum

A

A: Anterior = Thymoma

B: Middle = Bronchogenic Cyst

C: Posterior = Neurogenic tumors (Meningocele/Lymphomas/Esophageal tumors)

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9
Q

For pts on ventilators, what are the best ventilator setting changes for ⬆︎ oxygenation-2 and why

A
  1. INC PEEP ( prevents alveolar collapse/Reopens old ones/Reduces shunting) AND Reduces mortality in ARDS pts
  2. INC FiO2 (note: >60% for long time–>proinflammatory O2 free radicals!)
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10
Q

Most common sx of Pulmonary Embolism-5

A
  1. Pleuritic Chest Pain
  2. SOB
  3. Cough
  4. Tachypnea
  5. Tachycardia

Physical Exam: Rales, low Fever, Hemoptysis

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11
Q

(LTOT-Long Term Oxygen Therapy) improves survival in Stage 4 COPD pts

When is LTOT indicated-3 and how long/day is it used?

A
  1. [PaO2 LOE 55 mm Hg] OR
  2. [Pulse Ox SaO2 LOE 88] OR
  3. FEV1 < 30%

should be used GOE 15 hours/day!

In Cor Pulmonale pts, PaO2 LOE 59 or SaO2 LOE 89

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12
Q

Describe the Approach to a PE pt

A
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13
Q

Classic Sx of Sarcoidosis-8

A

CCUBBEDD

Cardiac (Restrictive Cardiomyopathy)

HYPERCalcemia

Uveitis –> Vision loss

Bilateral Hilar LAD!

Bell’s Palsy

Erythema Nodosum (SubQ Fat lesions)

[Dry cough & Dyspnea]

Diffuse interstitial fibrosis

  • elevated ACE and 1-25VitD production –> HYPERCalcemia and HYPERCalciuria*
  • Image showing b/l Hilar LAD*
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14
Q

Sarcoidosis Etx-2 (Etiology)

A

[CD4 Helper T] inappropriately respond to environmental triggers + Suppressed TRegs –> Non-Caseating Granulomas in Lung

Image showing b/l Hilar LAD

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15
Q

Sarcoidosis Tx-4

A

“Sarcoidosis is a SCAM”

Steroids

Cyclosporine

Azathioprine

MTX

Image showing b/l Hilar LAD

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16
Q

How long does it take Malignant Pulm Nodules to double in size? How does this affect diagnostics?

A

1 month - 1 year; Pt with stable Pulm Nodule > 1 year = NO CA!

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17
Q

Bronchiectasis Etx

A

Recurrent Cycle of

[Poor mucociliary clearance –> Bacterial infection –> Inflammation –> Bronchial Dilation and thickening–> Cough w/tenacious sputum and Hemoptysis]

Dx = High Res CT Chest

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18
Q

Gold standard dx for Bronchiectasis

A

High Res CT chest scan (initial dx)

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19
Q

List the Obstructive causes of Bronchiectasis (2)

A

A:

1) Tumor
2) Foreign Body

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20
Q

List the Infectious causes of Bronchiectasis (2)

A

1) TB
2) [Aspergillus Fumigatus in ABPA]-Allergic BronchoPulmonary Aspergillosis] –> will be associated with [recurrent transient pulm infiltrates]

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21
Q

List the Congenital causes of Bronchiectasis (3)

A

1) Immunodeficient Syndromes
2) cystic fibrosis
3) Kartagener (1° Ciliary Dyskinesia)

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22
Q

List the Random causes of Bronchiectasis (3)

A

1) Rheumatoid Arthritis
2) Lupus
3) Graft

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23
Q

What is the most common cause of Hemoptysis

A

Bronchitis (usually [acute s/p viral infection] but could be chronic also)

Tx = supportive

Also think about: Bronchiectsis/TB/CA/Trauma/PE

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24
Q

Describe Bronchial Breath Sounds-2

A

[Loud short inspiration]

+

[Loud LONG EXPIRATION]

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25
Q

What does Bronchial breath sounds indicate?-3 Where in the body are Bronchial bs normal?

A

Alveoli are full of blood/pus/water= Pulmonary Consolidation–> SHUNT;

THIS IS NORMAL OVER THE TRACHEA

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26
Q

Which bacteria cause Community Acquired PNA-8

A
  1. Strep Pneumo
  2. H. Flu
  3. Moraxella
  4. MRSA
  5. Mycoplasma pneumoniae-AT (ATypical)
  6. Chlamydophila pneumoniae-AT
  7. Chlamydophila Psittaci-AT
  8. Legionella-AT
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27
Q

Which NON-bacteria cause Community Acquired PNA-3

A
  1. Flu
  2. TB
  3. Histoplasmosis
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28
Q

What determines whether or not Community Acquired PNA is admitted?

A

If pt has 1 of the CURB 65

Confusion

BUN > 19

Respiratory Rate > 30

BP: Systolic < 90

65 y/o or older

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29
Q

Tx for Community Acquired PNA-4

A
  1. CefTriaxone
  2. CefTriaxone + Azithromycin
  3. Levofloxacin (For inpatient vs. Severe Outpatient)
  4. Vanc (MRSA suspicion only)
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30
Q

Name Drugs that cause Asthma exacerbation and why-4

A
  1. NSAIDs (pushes Arachodonic Acid pathway to leukotriene production)
  2. ASA (pushes Arachodonic Acid pathway to leukotriene production)
  3. General B Blockers (bronchospasms)
  4. MgSO4 (⬆︎Histamine)
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31
Q

What’s the most significant finding in this CXR and what does it indicate?

A

Westermark Sign! = Pulmonary Embolus!

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32
Q

Formula for Alveolar-arterial oxygen gradient

A
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33
Q

Normal Alveolar-arterial oxygen difference is Less than _____. What does Higher difference indicate?

A
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34
Q

CXR findings for PE -4

A
  1. Elevated hemidiaphragm
  2. Atelectasis
  3. Westermark sign
  4. Hampton’s Hump
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35
Q

Indications for IVC Filter -2

A
  1. Anticoagulation ctx
  2. Recurrent DVT/PE despite anticoag
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36
Q

Family hx of Thrombosis is best indicator for inherited hypercoagulability

Name the common inherited hypercoagulable diseases-5

A
  1. Antiphospholipid Syndrome
  2. Factor 5 Leiden
  3. ⬆︎ Factor 8
  4. Prothrombin 20210 mutation
  5. Hyperhomocysteinemia
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37
Q

List 2 major signs of impending respiratory failure

A
  1. Conversational Dyspnea
  2. Abd paradoxus (abd moves inward during inspiration = diaphragmatic fatigue)
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38
Q

Hospitalization, Nursing homes, abx use are common causes of healthcare-associated PNA

Name UnCommon causes of healthcare-associated PNA-5

A
  1. Hemodialysis
  2. Family member w/MDR pathogen
  3. Outpatient wound care
  4. Gastric acid suppressants (PPI, H2 blocker)
  5. Tube feedings
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39
Q

Which bacteria cause PNA in Immunodeficient pts -4

A

NACS

  1. Neg gram rods (NEUTROPENIC PTS)
  2. Aspergillus
  3. Candida
  4. Staph
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40
Q

Tx for Healthcare associated PNA 2/2 Pseudomonas -2

A

Zosyn vs. CefTazidime

“Zoe needs Pipe from Tae“(Piperacillin / Tazobactam)

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41
Q

Supplemental O2 should be given with what O2 Sat goal? Why is this?

A

90-94 %; below 90% –> HUGE ⬇︎ Hb Saturation

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42
Q

How does Cirrhosis cause Hypoxia?

A
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43
Q

Dead Space % is represented in formulas by ____ and is defined as ____

A

VD/VT ; % of Tidal volume that is NOT partcipating in gas exchange (anatomic vs physiologic)

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44
Q

___% of Tidal Volume (VT) is normally Dead Space

What conditions ⬆︎Dead space -3

A

Normally, 30% of VT is Dead Space

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45
Q

Name the Conditions in which Diffusion Capacity is INCREASED (3)

A

A: [CHF vs. Polycythemia vs. Hemorrhage] –> INC DLCO

**All others (PILEA) DEC diffusion capacity**

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46
Q

Define [Solitary Pulmonary Nodule]

A

Single Lung nodule 1-6 cm that does NOT invade

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47
Q

Pt with hemoptysis comes in with [Coin lesion on CXR]

What determines whether or not she needs w/u?

A

1ST: LOCATE PREVIOUS (At least 1 year prior or older) CXR! If lesion unchanged = NO CA

Coin lesions = 80% chance malignancy

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48
Q

3 characteristics of pulmonary nodules tht make them more likely to be Malignant

A
  1. Size: Bigger is worst
  2. Border: Spiculated / Retracted from surrounding tissue / irregular
  3. Location: Endobronchial proximal extension/Local invasion/Satellite Nodules
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49
Q

DDx for Solitary Pulmonary Nodule -5

A
  1. CA: hamartoma/metastasis/primary
  2. Infectious: granulomatous/fungal (blasto,histo)
  3. Pneumoconiosis
  4. Vasculitis
  5. Scar
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50
Q

What is FDG-PET? How are results interpreted?-3

A

fluorodeoxyglucose (FDG)-positron emission tomography (PET)

Pt is given radioactive sugar water –> taken up my tumor as main source of energy–> SUV (Standard uptake value)

>3 SUV = Malignant

2 - 3 = Inderterminate

<2 = benign

not good for Brain/Liver/Kidney CA

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51
Q

What are the Cons of FDG-PET?

A

NOT good for Brain/Liver/Kidney CA

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52
Q

What are the minimal PFT requirements before Lung CA resection - 2 ;

A

[PreOp FEV1 GOE 2L] or [Predicted PostOp FEV1 GOE 0.8L]

If MD expects to resect 25% Lung volume and pt PreOp FEV1 is 1.5 L, then Predicted PostOp FEV1 will = 1.125 L

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53
Q

Describe the system used to diagnose DVT

A

Wells Criteria!

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54
Q

DVT tx - 2

A

1st: Therapeutic Heparin vs Lovenox
2nd: [Warfarin px vs NOAC] x at least 3 months

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55
Q

Advantages of Lovenox over Unfractionated Heparin - 4

A

Lovenox…

  1. Longer half life = administered SubQ only 1-2/day (but note: this also means it takes longer to reverse if surgery is needed)
  2. No Lab monitoring
  3. FIXED Dosing
  4. ⬇︎probability of HIT Thrombocytopenia
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56
Q

You hear Stridor in a patient

What is your DDx?-4 ; How can you differeniate between them?

A

Biphasic = Inspiratory AND Expiratory (Vascular Ring)

LaryngoMalcia: Laying down is Malicious (Supine worsens Stridor)

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57
Q

Tx for Croup

A

Nebulized Racemic Epi breathing tx

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58
Q

Laryngomalacia Etx

A

Collapse of supraglottic structures during inspiration –> Laying down is Malicious (LaryngoMalacia) = Supine worsens Stridor

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59
Q

Asthma Etx

A

Excess TH2 cells (recruited by hypersensitive APC to inhaled allergens) secrete IL4 –>activates [B-lymphocyte class switching for IgE Ab]–> IgE binds to Mast cells which will then secrete IL5 –> Recruits Eosinophils–>which release mediators like Leukotrienes.

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60
Q

List the 5 Step Asthma action plan based on

SABA use

and

Nighttime Awakenings

A
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61
Q

Describe Kerley B lines and what they represent

A

Interstitial fluid in lung tissue appearing as 3 cm linear densities in lung periphery = CHF

62
Q

Orthopnea differs from Paroxysmal Nocturnal Dyspnea in that it occurs while pt is awake EVERY time they lie down

Which conditions are associated with Orthopnea? - 6

A
  1. CHF which can –> Pulmonary Edema
  2. Pulmonary edema
  3. Asthma
  4. Chronic Bronchitis
  5. OSA
  6. Panic Disorder
63
Q

Why is an inspiratory hold maneuver performed?

A

To measure the pulmonary compliance (sum of the elastic pressure) so that the PEEP can be matched with that

64
Q

Common side effects for Beta 2 agonist - 4

A
  1. hypOkalemia –> muscle weakness, arrhythmias
  2. Palpitations
  3. Tremor
  4. HA
65
Q

Imaging findings for Bronchogenic Carcinoma - 4

Asbestos –> Bronchogenic carcinoma > mesothelioma

A
  1. BL Pleural Plaques (pleural mesothelioma will have uL pleural abnormality)
  2. BL Pleural thickening
  3. Honeycoming (cystic areas surrounded by interstitial infiltrates)
  4. BL CENTRAL reticulonodular infiltrates

smoking enhances asbestos damage. SOB comes from fibrosis, NOT the pleural calcifications

66
Q

Which pulmonry process targets the bilateral lower lobes of the lung?

A

AAT-Alpha 1 antitrypsin deficiency –> Panacinar Basilar predominant emphysema –> ⬇︎Bilateral Breath Sounds Smoking –> Upper lobe centriacinar emphysema

67
Q

Alpha 1 Antitrypsin Dx? ; Tx?

A

Dx=serum AAT levels ; Tx = Pooled AAT

This is a Panacinar Basilar predominant disease

68
Q

What is the difference between Aspiration Pneumonitis and Aspiration PNA?

A

A Pneumonitis = Lung inflammation from gastric acid

A PNA = Lung INFECTION from oropharygeal secretions

69
Q

How do you diagnose Asthma - 2

A
  1. FEV1/FVC ⬆︎ ≥12% with Bronchodilator OR
  2. FEV1/FVC ⬇︎ ≥20% with Methacholine
70
Q

How can you tell if a pt has GERD-induced or ASA-induced asthma, or true asthma?

A

True asthma will be REVERSIBLE with bronchoDilator. Others will NOT!

71
Q

Somter’s Triad describes ____

What is the triad? ; Tx?

A

Drug-induced Asthma

  1. Asthma or chronic rhinosinusitis
  2. Nasal Polyps
  3. ASA sensitivity is the cause

Tx = Montelukast Leukotriene inhibitor

72
Q

Most lung conditions cause a respiratory _____[acidosis/alkalosis]. Why is this?

Which lung condition causes the opposite of this?

A

Respiratory Alkalosis; PE, atelectasis, pleural effusion, pulm edema –> V/Q mismatch –> compensatory tachypnea

alveolar hypOventilation –> respiratory acidosis

73
Q

What is the mainstay tx for COPD

A

Muscarinic R Blockers

74
Q

Name the conditions associated with Granulomas - 6

A
  1. TB
  2. Tertiary syphillis gummas
  3. Blastomycosis
  4. Histoplasma
  5. Sarcoidosis
  6. Churg Strauss Eosinophilic Granulomatosis with Polyangiitis
75
Q

How do pts with ____ minimize their [Work of Breathing]

A: Obstructive Disorders

B: Restrictive Disorders

A

A: O**bstructive= [slOO**w + Deep] Breaths

B: Restrictive= [fast + shallow] Breaths

76
Q

Based on the image:

Is the pathology Obstructive vs. Restrictive vs. Tracheal Stenosis

A

Obstructive - Emphysema (intraAlveolar wall destruction)

78
Q

What is Bronchiectasis

A

[Chronic Necrotizing Inflammation of Bronchi & Bronchioles]—> [Permanent Dilatation of Bronchi & Bronchioles] —> [Daily Copious Mucus production]

79
Q

Is ARDS an obstructive, restrictive or normal breathing pattern?

A

RESTRICTIVE

So is Laryngeal Edema

80
Q

What is normal Jugular Venous Pressure? - 2

A

<4cmH20

OR

<7mmHg

81
Q

Name the diseases that are

Obstructive but with a Low Diffusion Capacity

82
Q

Name the diseases that are

Obstructive but with a Normal Diffusion Capacity - 2

83
Q

Name the diseases that are

Obstructive but with a HIGH Diffusion Capacity

84
Q

Name the diseases that are

Restrictive but with a low Diffusion Capacity - 4

85
Q

Name the diseases that are

Restrictive but with a Normal Diffusion Capacity - 2

86
Q

Name the diseases that are

Restrictive but with a HIGH Diffusion Capacity

87
Q

Name the diseases that are

Normal Spirometry but with a low Diffusion Capacity - 3

88
Q

Name the diseases that are

Normal Spirometry but with a HIGH Diffusion Capacity - 2

89
Q

A diagnostic pleuracentesis is performed

What are the diagnostic measurement values for EXUDATIVE pleural fluid - 5

Usually caused by ⬆︎capillary or pleural membrane permeability

A
  1. Pleural:Serum protein >0.5
  2. Pleural:Serum LDH >0.6
  3. Pleural LDH > 2/3 of the upper limit of normal serum LDH
  4. pH<2
  5. Glucose<60
90
Q

A diagnostic pleuracentesis is performed

What are the diagnostic measurement values for Transudative pleural fluid - 2

A

pH = 7.40-7.55

normal pleural pH = 7.6

91
Q

A diagnostic pleuracentesis is performed

There are high levels of amylase present

Dx?-2

A
  1. pancreas-associated
  2. esophageal rupture
92
Q

A diagnostic pleuracentesis is performed

There is a Pleural fluid glucose<60

Dx?-4

A
  1. Empyema (complicated parapneumonic effusion)
  2. CA
  3. RA
  4. TB

Glucose is low in Empyema because of the high metabolic activity of leukocytes and/or bacteria

93
Q

Would you expect CHF to cause respiratory Alkalosis or Acidosis? Why?

A

Respiratory Alkalosis ; CHF pulm edema –> tachypnea

94
Q

What should the goal O2 sat be when placing a COPD pt on supplemental Oxygen? ; Why is this?

A

SaO2: 90-93% only

HIGH O2 will knock out COPDers drive to breath –> hypOventilation –> Respiratory acidosis –> cerebral vasoDilation –> seizures and AMS

95
Q

What are the 2 key things to remember when manging ARDS

A
  1. Prevent SpO2 < 88% (may need to use high PEEP> 5)
  2. Prevent alveolar overdistension with low tidal volumes ≤6cc/kg
  3. Prevent Hyperventilation (RR x TV) as this –> Respiratory Alkalosis

ARDS etx = Lung injury –> fluid and cytokine leakage into the alveoli –> refractory hypoxia and Pulm HTN

96
Q

Hypersenstivity Pneumonitis etx ; mngmt?

A

Lung parenchyma inflammation from antigen exposure (usually from bird droppings or molds a/w farming ; Avoidance

episodes last 4-6 hrs after exposure and chronically can –> pulm fibrosis

97
Q

What is the most common side effects for long term inhaled Corticosteroids?

A

Oral Candidasis (Thrush) for INHALED CTS

98
Q

What’s the most sensitive indicator for a pt who’s Hypovolemic/Dehydrated?

A

⬇︎Urine Na+

Urine Na:Urine Creatinine < 1%

99
Q

In pts with PE, what is the mechanism for why they have symptoms?

A

Pulmonary Infarction from the embolus –> sx

100
Q

In Asbestos Interstitial Lung Disease, what is the mechanism for why pts become SOB?

A

Pulmonary Fibrosis (restrictive lung disease)

Image: Pleural Plaques = pathopgnomonic

101
Q

What are the major causes of Interstitial Lung Disease - 4

A
  1. Dust inhalation (Asbestos, Beryllium, Silicon)
  2. Drugs (Amiodarone, Bleomycin, Macrobid)
  3. Radiation
  4. Connective tissue disease (RA, Scleroderma)
102
Q

Alveolar bleb rupture is the most common cause of spontaneous ptx in pts with ___ disease

103
Q

Risk factors for Aspiration PNA - 4

A
  1. Altered consciousness due to EtOH
  2. Vomiting due to EtOH
  3. Neurologic dysphagia (stroke)
  4. Mechanical disruption of glottic closure (ET or NG tube)
104
Q

cp for MASSIVE Pulmonary Embolism - 3

A
  1. hypOtension
  2. JVD
  3. RBBB acutely from severe R Heart Strain
105
Q

Chronic smokers who present with suddent joint pains is suggestive of _____, which can indicate what underlying disease?

A

hypertrophic osteoarthropathy ; LUNG CA

106
Q

What is the purpose of Chest Physiotherapy? ; Indication?

A

Loosens and promotes expectoration of secretions ; Bronchiectasis

107
Q

A diagnostic pleuracentesis is performed

There are high levels of Triglycerides present

Dx

A

Chylothorax exudate

from lymph leaking out of the thoracic duct (milky white fluid)

108
Q

List the 5 Step Asthma action plan Treatment

109
Q

Any pt with Decreased Breath Sounds Bilaterally should be suspected for ______

A

AAT - Alpha 1 Antitrypsin Deficiency Panacinar Emphysema

Look for fam hx (NonAlcoholic Liver cirrhosis) or slight transaminitis

110
Q

Alpha 1 Antitrypsin deficiency cp - 3

A
  1. ⬇︎breath sounds bilaterally (from panacinar basilar predominant emphysema)
  2. transaminitis (could be slight)
  3. +/- Skin panniculitis

NonAlcoholic Liver Cirrhosis is 2nd most common cause of death in these pts

111
Q

Chronic Bronchitis diagnostic criteria

A

3 consectuve months of productive cough within a 2 year period

112
Q

In Idiopathic Pulmonary Fibrosis interstitial lung disease, would you expect Alveolar-arterial gradient to be High or low? ; Why?

A

HIGH (A-a gradient = difference between oxygen content in Alveoli and artery)

IPF (collage deposition in peri-alveolar tissue) ILD –> impaired gas exchange

113
Q

How does Lung Consolidations present? - 3

A
  1. ⬆︎breath sounds
  2. ⬆︎tactile fremitus
  3. Dullness to percussion
114
Q

Kartagener Syndrome cp triad ; etx?

A
  1. Situs Inversus
  2. Recurrent Sinusitis (impaired mucociliary clearance)
  3. Bronchiectasis (impaired mucociliary clearance)

etx = primary ciliary dyskinesia

115
Q

What are the main complications of positive pressure ventilation - 2

A
  1. tension PTX –> hypOtension
  2. alveoalar damage
116
Q

How do you work up a Solitary Pulmonary Nodule

Round, <3cm, no LAD

117
Q

Why is it alarming when a pt who clearly has ⬆︎Work of Breathing has a normal pH and normal PaCO2?

A

If they visually have ⬆︎WOB than you expect their PaCO2 to be low and pH to be low but if these values are normal, the pt is likely going into RESPIRATORY COLLAPSE and can no longer maintain adequate ventilation due to fatigue

118
Q

How do these parameters change in COPD pts

Elasticity

Compliance

A

alveolar Elasticity (how well tissue snaps back) DECREASES –> ⬇︎ability to expel air

alveolar Compliance INCREASES –> making it easier for incoming air to fill alveoli

BOTH of these –> diaphragm flattening, difficulty expanding thoracic cavity –> ⬆︎WOB

119
Q

Tx for Upper Airway Cough Syndrome

A

1st Gen Antihistamine +/- Decongestant

120
Q

How do Anaerobic lung infections present on imaging?

A

CAVITARY LESIONS (not lobar infiltrate) in lower lobes

(lobar infiltrates more likely represent typical PNA)

121
Q

Describe the following values for PNA:

breath sounds

tactile fremitus

percussion

A

⬆︎bs / ⬆︎TF / Dullness to percussion

122
Q

Describe the following values for Pleural Effusion:

breath sounds

tactile fremitus

percussion

A

⬇︎bs / ⬇︎TF / Dullness to percussion

123
Q

Describe the following values for PTX or emphysema:

breath sounds

tactile fremitus

percussion

A

⬇︎bs / ⬇︎TF / Hyperresonance to percussion

124
Q

What are the txs for SIADH - 1st/2nd/3rd line?

A

1st: FLUID RESTRICTION
2nd: Hypertonic saline
3rd: ADH R Blocker (Demeclocycline)

125
Q

What paraneoplastic syndromes are Small Oat Cell Lung carcinoma (SOLC) associated with? - 2

A
  1. SIADH
  2. ACTH (Cushings Syndrome)
126
Q

What paraneoplastic syndromes is Squamous cell lung carcinoma associated with?

A

sCa++mous cell carcinoma!

⬆︎⬆︎PTHrelatedProtein –> HYPERCALCEMIA

127
Q

Pts with underlying lung disease like ____ are at risk for develoing chronic pulmonary aspergillosis

Diagnostic criteria for this?

A

cavitary TB;

Dx = ALL 3 must be present

  1. >3 mo sx (fever, wt loss, hemoptysis)
  2. Cavitary lesions contains aspergilloma fungal balls
  3. IgG serology positive for Aspergillus
128
Q

Where is lung ADC located? ; what’s the most important prognostic factor?

A

peripherally ; Stage at diagnosis since survival is determiend by resectability

129
Q

Main clinical characteristic of Microscopic Polyangiitis ; Which antibody?

A

Hemoptysis; p-ANCA

130
Q

Main clinical characteristic of Wegener Granulomatosis with polyangiitis-2 ; Which antibody?

A

Hemoptysis and ELK; C-ANCA

131
Q

Main clinical characteristic of Churg Strauss Eosinophilic Granulomatosis with polyangiitis-4 ; Which antibody?

A
  1. Asthma
  2. Granulomas
  3. Eosinophilia
  4. Nasal polyps with rhinitis

; p-ANCA

132
Q

DDx for Hemoptysis - 5

A

BBcTT

  1. *** Bronchitis - MOST COMMON! ***
  2. Bronchiectasis
  3. Cancer
  4. TB
  5. Trauma (PE)
133
Q

What are the common causes of clubbing? - 2

A
  1. Lung ADC
  2. Cystic Fibrosis
134
Q

Silicosis ⬆︎risk for developing _____ and causes _____ lesions on imaging

Which demographics are mostly affected?-2

A

TB ; cavitary lung lesions

  1. Stone Workers
  2. Miners

Stone Miners are Sili and they’re going to get TB!

135
Q

Physiologically, what causes hypoxemia in pts with Pneumonia?

A

Ventilation/Perfusion mismatch - a shunt occurs direct blood away from alveoli and this is why O2 supplement barely help

136
Q

pt presents with pulmonary nodules surrounded by ground glass opacities

Dx? ; Tx?-2

A

Aspergillosis

tx:

  1. Voriconazole AND
  2. Caspfungin

Image shows “halo sign”

137
Q

Brutons X linked agammaglobulinemia etx

A

low B lymphocytes –> low Ig –> sinopulmary and GI infections

puts pt at risk for infections like Giardia

138
Q

Cyclosporine and Tacrolimus have the same MOA

Side Effects for these two are similar as well. List side effects for Cyclosporine - 4 ; which 2 does Tacrolimus share?

A
  1. Gum Hypertrophy - Cyclosporine
  2. Hirsuitsm - Cyclosporine
  3. Nephrotoxicity with HyperKalemia
  4. Tremor
139
Q

Side effects of Azathioprine - 3

A
  1. Diarrhea
  2. Hepatotoxicity
  3. Leukopenia
140
Q

Side effect of Mycophenolate

A

Marrow Suppression

141
Q

A neonate is born with absent T cells and dysfunctional B cells

Diagnosis? ; Tx?

A

Severe Combined ImmunoDeficiency (SCID) ; Stem Cell Transplant

Absent T causing fucked up B

142
Q

In pts with chronic granulomatous disease, there is an impaired _______ which leads to ⬆︎infection with which organisms? ; Dx?-2

A

oxidative burst ; catalase positive (Staph A, Serratia, Burkholderia)

  1. nitroblue tetrazolium OR
  2. dihydrorhodamine

Both of these are neutrophil function test

143
Q

What is Leukocyte Adhesion Deficiency associated with? - 3

A
  1. Delayed umbilical cord separation
  2. periOdontal disease
  3. recurrent sinopulmonary infection
144
Q

After transplant, when does Acute Cellular Rejection occur? ; How does it present? - 3

A

<90 days ;

  1. RUQ pain
  2. Transaminitis
  3. Fever

HYPERacute occurs in < 7 days

145
Q

Hereditary Angioedema etx

A

deficiency or dysfunction of C1 inhibitor –> ⬆︎bradykinin and C2b

146
Q

pts with pharyngeal cobblestoning likely have _____ and need to be treated with ______

A

allergic rhinitis ; nasal corticosteroids

147
Q

MOD for Severe Combined Immunodeficiency (SCID) ; tx?

A

Defective T cell maturation –>dysfunctional B cells –> recurrent viral, fungal, bacterial infections

“Absent T causing fucked up B”

Tx = stem cell transplant

148
Q

MOD for Common Variable Immunodeficiency

A

hypOgammaglobulinemia –> recurrent Sinopulmonary and GI bacterial infections

149
Q

Wiskott Aldrich Syndrome presents at what stage of life? ; cp?-3

A

infancy;

  1. eczema
  2. bleeding
  3. sinopulmonary infections

MOD = disables cytoskeleton remodeling

150
Q

Why should a pt with recurrent sinopulmonary and GI infections be thoroughly screened before receiving blood transfusions?

A

They could have Selective IgA Deficiency which –> production of Anti-IgA in their blood. After receiving blood transfusion those Anti-IgA would –> anaphylaxis

151
Q

MOD for Hyper IgM Syndrome ; What would the laboratory values show? -4

A

CD40 ligand defect –> severe sinopulmonary infections ;

  1. Hyper IgM
  2. low IgG
  3. low IgA
  4. normal lymphocyte (CD4/CD8) populations
152
Q

Guidelines for Lung CA screening - 3

A

low dose annual CT if fits all 3 criteria:

  1. [55-80 yo]
  2. smoked for 30 pack years
  3. still smoking or quit within last 15 years
  • Pack Year = [# of packs/day x # of years smoking]*
  • ex: [4 packs/ day x 30 years smoking = 120 pack years]*

[2b] A- step 2 CK (16 decks)

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