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PULM Flashcards

1
Q

volume of air moved into or out of the lungs during quiet breathing

A

tidal volume

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2
Q

the volume of air remaining in the lungs after maximal expiration

A

residual volume

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3
Q

the volume of air that can be further exhaled at the end of normal expiration

A

Expiratory reserve volume

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4
Q

the volume of air that can be further exhaled at the end of normal inspiration

A

Inspiratory reserve volume

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5
Q

maximum volume of air that can be exhaled following maximal inspiration

A

vital capacity

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6
Q

the volume in the lungs at maximal inspiration

A

total lung capacity

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7
Q

the volume of gas in the lungs at normal tidal volume end expiration

A

functional residual capacity

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8
Q

the volume of air that has been exhaled at the end of the first second of forced expiration

A

FEV1

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9
Q

measurement of volume of air that can be expelled from a maximally inflated lung with pt breathing as hard and fast as possible

A

forced vital capacity

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10
Q

continuous, whistling, musical, high-pitched sounds heard during expiration due to narrowed obstructed airways

A

wheezing
–seen with obstructive lung diseases

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11
Q

continuous, rumbling, coarse, low-pitched sounds that clear with cough

A

rhonchi
–caused by secretions

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12
Q

discontinuous, high pitched sounds heard during inspiration

A

rales (crackles)
–not cleared w/ cough
–seen with pneumonia, atelectasis, bronchitis, bronchiectasis, pulm fibrosis

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13
Q

monophonic sound over trachea due to narrowing of larynx

A

stridor

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14
Q

MC RF for COPD

A

smoking and/or exposure

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15
Q

only genetic disease linked to COPD in younger patients <40 yo

A

alpha-1 antitrypsin deficiency

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16
Q

Dx for COPD

A

PFTs with decreased FEV1, decreased FEV1/FVC <70% predicted (decreased DLCO in emphysema)

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17
Q

Define chronic bronchitis

A

productive cough for a least 3 months a year for 2 consecutive years

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18
Q

Factors that reduce mortality in COPD:

A

1- smoking cessation
2- O2 therapy
3- PCP and Flu vaccines annually

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19
Q

Indications of O2 therapy in COPD: (3)

A

paO2 <55 mmHg, O2 sat <88%, or cor pulmonale

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20
Q

Abx Tx for AECOPD:

A

macrolides (azith, clarith), cephalosporins (cefuroxime, cefixime), Augmentin, fluoroquinolones

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21
Q

categorizes severity of COPD based on FEV1 and FEV1/FVC ratios

A

GOLD criteria

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22
Q

Gold Criteria: Category C patients should be treated with

A

LAMA

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23
Q

Maximal COPD therapy includes:

A

LAMA + LABA + inhaled glucorticoid
–supportive: O2, smoking cessation, annual vaccines
–steroids and abx in AECOPD

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24
Q

MC cause of bronchiectasis in US

A

CF

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25
Q

Dx of CF

A

sweat chloride test (Cl levels >60 on 2 occasions after pilocarpine administration)

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26
Q

CF results due to a mutation in this receptor

A

CF transmembrane conductance receptor
–causes abnormal chloride and water transport across exocrine glands, resulting in thick viscous secretions of lungs, pancreas, sinuses, intestines in CF

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27
Q

MC organism to cause recurrent lung infections in bronchiectasis

A

pseudomonas aeruginosa if CF
–H flu if not related to CF

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28
Q

MC RFs for CF

A

Caucasians, Northern Europeans

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29
Q

Dx for bronchiectasis and classic findings

A

High resolution CT with thickened bronchial walls (tram track) and increased airway diameter > adjacent vessel diameter (signet ring sign)

PFTs with decreased FEV1, decreased FEV1/FVC <70% predicted

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30
Q

MC RF for asthma

A

atopy

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31
Q

Atopic triad

A

asthma
allergic rhinitis
atopic dermatitis (eczema)

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32
Q

Samter’s triad

A

asthma
chronic rhinosinusitis with polyps
sensitivity to ASA/NSAIDs

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33
Q

Dx for asthma

A

PFTs with reversible obstruction (decreased FEV1, decreased FEV1/FVC following methacholine challenge)

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34
Q

best and most objective way to assess severity & treatment response in asthma exacerbation

A

peak expiratory flow rate

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35
Q

Tx of moderate persistent asthma

A

Low ICS + LABA
–alternatives, Medium ICS or add LTRA

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36
Q

Tx of severe persistent asthma

A

High ICS + LABA +/- Omalizumab

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37
Q

MC RFs for sarcoidosis

A

Female, AA, Northern Europeans

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38
Q

Dx for sarcoidosis

A

CXR with bilateral hilar LAD
PFTs with restrictive pattern
Tissue biopsy with noncaseating granulomas

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39
Q

MC RF for pulmonary fibrosis

A

men >40 yo

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40
Q

Dx for pulmonary fibrosis

A

Chest CT with reticular honeycombing, focal ground-glass opacifications
PFTs with restrictive pattern
Tissue biopsy with honeycombing

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41
Q

RF for silicosis

A

coal mining, quarry work with granite, slate, quartz, pottery makers, sandblasting, glass and cement manufacturing

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42
Q

CXR with silicosis

A

multiple, small (<10mm) round nodular opacities in UL
*eggshell calcifications of hilar and mediastinal nodes

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43
Q

lung disease from inhalation of coal dust particles

A

coal worker’s pneumoconiosis (black lung disease)

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44
Q

lung disease from inhalation of silicon dioxide

A

silicosis

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45
Q

Caplan syndrome

A

coal worker’s pneumoconiosis + RA

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46
Q

Dx for coal worker’s pneumoconiosis

A

CXR with small nodules in ULs and hyperinflation in LLs in obstructive pattern

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47
Q

lung disease from inhalation of beryllium

A

Berylliosis

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48
Q

RF for Berylliosis

A

aerospace, electronics, ceramics, tool and dye manufacturing, jewelry making

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49
Q

lung disease due to cotton exposure

A

Byssinosis

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50
Q

RF for Byssinosis

A

employed in textile industries (flax or hemp exposure)

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51
Q

lung disease due to inhalation of asbestos fibers

A

asbestosis

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52
Q

RF for Asbestosis

A

destruction, repair, or renovation of old buildings, insulation

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53
Q

Dx for asbestosis

A

CXR with pleural plaques in LLs
PFTs with restrictive pattern
Tissue biopsy with linear asbestos bodies

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54
Q

MC complication of asbestosis

A

bronchogenic carcinoma (mesothelioma is most specific)

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55
Q

hypersensitivity pneumonitis from nitrogen dioxide gas exposure released from plant matter

A

silo filler disease

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56
Q

infection with chlamydophila psittaci due to exposure to infected birds

A

Psittacosis (Parrot Fever)

57
Q

Influenza vaccine recommended for

A

annually for all individuals >6 months old

58
Q

CI to inactivated influenza vaccine

A

GB within 6 weeks of prior vaccine
high fevers
infants <6 months of age

59
Q

CI to live influenza vaccine

A

pregnancy
immunocompromised patients
adults age 50 or older

60
Q

MC cause of acute bronchitis

A

viral (adenovirus, parainfluenza, influenza, coronavirus, coxsackie, rhinovirus, RSV)

61
Q

Highly contagious infection secondary to bordatella pertussis

A

`Pertussis (whooping cough)

62
Q

Tdap administration

A

Tdap at 2, 4, 6, 15-18 mos, and 4-6 yo
–5 doses
–booster at 11-18 yo

63
Q

MC cause of acute bronchiolitis

64
Q

Acute bronchiolitis is MC seen in this age group

A

ages 2 mos to 2 yo

65
Q

Acute bronchiolitis prevention

A

palivizumab during the 1st year of life for children <29 weeks old, prematurity, CHD, NM disorders, immunodeficiency
*handwashing preventative

66
Q

MC cause of acute epiglottitis

A

Haemophilus influenzae B (unvaccinated children)
Streptococcal species (GAS, S. pneumo if vaccinated)

67
Q

3 Ds of acute epiglottis

A

dysphagia
drooling
distress

68
Q

Dx for acute epiglottis

A

Lateral Cervical XR with thumbprint sign
*Laryngoscopy (cherry red epiglottis with swelling)

69
Q

Acute epiglottitis prevention

A

Rifampin given to all close contacts
Routine HiB vaccination

70
Q

Abx treatment for pertussis

A

Macrolides (azith, erythromycin)

71
Q

Abx treatment for acute epiglottis

A

2nd or 3rd gen cephalosporins (ceftriaxone, cefotaxime)

72
Q

MC organism to cause Croup

A

Parainfluenza virus type 1

73
Q

Dx for Croup

A

*Clinical (rule out FB and epiglottis)
Frontal Cervical XR with steeple sign

74
Q

Tx for severe croup

A

dexamethasone, nebulized epinephrine, and hospitalization

75
Q

MC organism to cause pneumonia

A

S. pneumoniae

76
Q

MC organism to cause of CAP

A

S. pneumoniae

77
Q

MC cause of atypical (walking) pneumonia

A

M. pneumoniae

78
Q

RF for haemophilus pneumoniae pneumonia

A

Extremes of age (<6 yo, elderly)
Immunocompromised (DM, HIV)
Underlying pulmonary disease (asthma, copd, bronchiectasis, CF)
Alcoholism

79
Q

MC organism to cause HAP

80
Q

Define CAP

A

individual who develops pneumonia <48 hours of hospital admission (does not reside in SNF)

81
Q

Define HAP

A

individual who develops pneumonia >48 hours of hospital admission

82
Q

Tx for outpt CAP

A

macrolide (azith, clarith) or doxycycline

83
Q

Tx for inpt CAP

A

Beta-lactam (ceftriaxone, cefotaxime) and either macrolide/doxy OR broad spectrum FQ

84
Q

Tx for HAP and or MDR

A

Anti-pseudomonal beta-lactam (zosyn, ceftazidime, cefepime) and Anti-pseudomonal AG or FQ (gentamicin, tobramycin or levaquin)
+/- Vanco if suspect mrsa
+/- Azith or Levaquin if suspect legionella

85
Q

Tx for aspiration pneumonia

A

Unasyn or Augmentin

86
Q

Define CURB-65

A

admission if at least 2:
confusion, uremia (>30 mg/dL), RR >30, BP low (SBP <90 or DBP <60), Age >65

87
Q

MC organisms to cause aspiration pneumonia

A

peptostreptococcus, bacteroides, and fusobacterium

88
Q

Associated with foul smelling, “rotten egg” sputum and RLL lesions on CXR

A

aspiration pneumonia

89
Q

Associated with purple jelly, currant sputum and cavitary lesions on CXR

A

k. pneumoniae

90
Q

lung disease due to inhalation of bird, bat droppings in Mississippi and Ohio river valley

A

Histoplasmosis

91
Q

Pneumococcal conjugate vaccine (PCV13) administration

A

4 dose immunization series (2, 4, 6, 12-15 mos)

92
Q

Tx for moderate and severe histoplasmosis

A

moderate: itraconazole
severe: amphotericin B

93
Q

Pneumococcal polysaccharide vaccine (PPSV23) administration

A

all adults 65 yo and older, as well as, young patients with comorbidities and increased risk for complications from s. pneumo infection

94
Q

MC opportunistic infection in HIV, esp if CDC <200

A

pneumocystis pneumonia (PCP)

95
Q

Tx for pneumocystis pneumonia

A

Bactrim x21 days (add prednisone if hypoxic)

96
Q

Dx for latent TB (3)

A

1- Positive PPD
2. No active symptoms
3. No active lesions on CXR

97
Q

4 drug treatment for primary TB

A

Rifampin
Isoniazid
Pyrazinamide
Ethambutol
(RIPE x2 mos + RI x4 mos = 6 mo duration)

98
Q

2 drug treatment for latent TB

A

INH + Pyridoxine (Vit B6) x 9 mos
**patients are not contagious

99
Q

TB (PPD) screening for active infection

A

> 5mm- HIV, immunodeficiency, close contacts, cxr findings of old/healed TB
10mm- High risk populations (prisoners)
15mm- everybody else

100
Q

False negative in PPD test

A

anergy (HIV, sarcoidosis)
faulty application

101
Q

False positive in PPD test

A

improper reading
cross reaction with an atypical
BCG vaccination within 10 years

102
Q

Rifampin AE

A

thrombocytopenia, orange colored secretions

103
Q

Isoniazid AE

A

hepatitis (esp >35 yo), peripheral neuropathy (Rq B6 coadministration)

104
Q

Pyrazinamide AE

A

hepatitis, hyperuricemia, photosensitive dermatologic rash

105
Q

Ethambutol AE

A

optic neuritis, peripheral neuropathy

106
Q

MC cause of solitary pulmonary nodule

A

infectious granulomas

107
Q

Syndrome characterized by periodic episodes of diarrhea, flushing, tachycardia, and bronchoconstriction

A

Carcinoid syndrome

108
Q

MC cause of cancer related deaths in US

A

bronchogenic carcinoma

109
Q

MC primary lung cancer in smokers, women, men, and nonsmokers

A

adenocarcinoma

110
Q

Lung cancer prevention

A

Annual CT for 55-80 yo with >30 pack year history

111
Q

MC paraneoplastic syndrome seen in bronchogenic carcinoma

A

superior vena cava syndrome

112
Q

Horner syndrome

A

ipsilateral ptosis, anhidrosis, miosis seen in pancoast tumors associated with SCLC

113
Q

Tumor MC caused due to chronic asbestosis exposure

A

Mesothelioma

114
Q

Dx for FB aspiration

A

rigid bronchoscopy

115
Q

MC cause of transudative pleural effusion

A

CHF (followed by nephrotic syndrome, cirrhosis, atelectasis, hypoalbuminemia)

116
Q

MC cause of exudative pleural effusion

A

any associated infection or inflammation (also, pulmonary emboli)

117
Q

noninfected pleural effusion

A

parapneumonic

118
Q

infected pleural effusion

119
Q

Dx for pleural effusion

A

Thoracentesis: Light’s criteria
1. pleural fluid protein : serum protein >0.5
2. pleural fluid LDH : serum LDH >0.6
3. pleural fluid LDH >2/3 the upper limit of normal LDH

120
Q

Dx for empyema

A

pleural fluid pH <7.2, glucose <40, or positive gram stain of pleural fluid

121
Q

Tx for empyema

A

chest tube fluid drainage

122
Q

Dx for PTX

A

CXR with companion lines (visceral pleural line running parallel with ribs)

123
Q

Tx for PTX

A

<3 cm - observe, O2
>3 cm - needle aspiration vs chest tube

124
Q

Define pulmonary hypertension

A

Elevated mean pulmonary arterial pressure >20 mmHg

125
Q

Dx for pulmonary hypertension

A

right heart catheterization

126
Q

Virchow’s triad

A

intimal damage, stasis, hypercoagulability

127
Q

MC sign associated with pulmonary emboli

128
Q

IVC filter indications (3)

A
  1. AC contraindicated (recent bleed, bleeding disorders)
  2. Failed AC
  3. RV dysfunction on echo
129
Q

MC EKG findings with PE

A

nonspecific ST/T wave changes and sinus tachycardia most common (also, S1Q3T3)

130
Q

MC RF for ARDS

A

critically ill patients (gram neg sepsis most common)

131
Q

Dx for ARDS

A

right heart catheterization with PCWP <18 mmHg

132
Q

MC RF for OSA

133
Q

cyclic breathing in response to hypercapnia

A

cheyne-stokes
(due to decreased brain blood flow)

134
Q

irregular respirations (quick shallow breaths of equal depth) with irregular periods of apnea

A

biot’s breathing
(due to damage to medulla oblongata or opioid use)

135
Q

deep, rapid, continuous respirations as a result of metabolic acidosis

A

kussmaul’s respiration

136
Q

MC RF for neonatal respiratory distress syndrome

A

*primarily pre-term infants
Caucasians, males, multiple births, maternal DM, C-section

137
Q

Atelectasis and pulmonary perfusion without ventilation due to insufficiency of surfactant production by an immature lung

A

neonatal respiratory distress syndrome

138
Q

MC RF for meconium aspiration

A

*primarily post-term infants

PANRE (9 decks)

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