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Pulm Flashcards

1
Q 
Obstructive lung disease:
(↓/↑) TLC
(↓/↑) FEV1/FVC
(↓/↑) compliance
(↓/↑) elasticity
A

↑TLC, ↓FEV1/FVC (<70%), ↑compliance, ↓elasticity

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2
Q 
Restrictive lung disease:
(↓/↑) TLC
(↓/↑) FEV1/FVC
(↓/↑) compliance
(↓/↑) elasticity
A

↓TLC, ↑FEV1/FVC, ↓compliance, ↑elasticity

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3
Q

Emphysema:
smoking causes…
A1AT deficiency causes…

A

smoking causes centriacinar emphysema (upper lungs)

A1AT deficiency causes panacinar emphysema (lower lungs, pts <50 y/o)

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4
Q

Defn and Tx of stage I-IV obstructive lung disease?

A
  1. (FEV1 ≥80%) Tx short-acting bronchodilators (albuterol, ipratropium)
  2. (FEV1 50-80%) add long-acting
    bronchodilators (salmeterol, tiotropium)
  3. (FEV1 30-50%) add inhaled steroids (fluticasone, triamcinolone)
  4. (FEV1 <5o% w/ hypoxia) add O2 therapy for 18 hrs/day
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5
Q

COPD exacerbation tx?

A

bronchodilators + abx + systemic steroids + O2 therapy

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6
Q 
Management of Asthma:
1-2 attacks/wk?
2+ attacks/wk?
daily attacks?
continuous attacks?
A

1-2 = prn albuterol

2+ = add low dose inhaled CS

daily = add LABA (salmeterol)

ct = add high dose inh CS

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7
Q

Churg-Strauss syndrome:

A

asthma + eosinophilia + granulomatous vasculitis

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8
Q

Infection a/w bronchiectasis?

Dx of bronchiectasis?

A

recurrent Pseudomonas pneumonia

high-res CT scan shows “signet rings”

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9
Q

Etiology of bronchiectasis?

A

cystic fibrosis (MCC), Kartagener syndrome (∆dynein)

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10
Q

MC lung cancer in women and nonsmokers?

tx?

A

Bronchial adenoma; lobectomy is curative

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11
Q

Lambert-Eaton myasthenic syndrome =

A

SCLC → anti- VGCC antibodies → myasthenia gravis-like presentation

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12
Q

Paraneoplastic syndromes a/w lung cancers?

A

squamous cell makes PTH-rP

SCLC makes ADH and ACTH (SIADH and cushings)

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13
Q

tx Pleural effusion if:
transudative?
exudative?
paraneoplastic?

A

transudative → Tx diuretics + Na+ restriction
exudative → Tx underlying disease
parapneumonic → abx ± chest tube drainage

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14
Q 
Pleural fluid analysis:
amylase = 
milky fluid =
bloody fluid =
lymphocytic fluid = 
pH <60 =
A

amylase = esophageal rupture, pancreatitis, malignancy

milky fluid = chylothorax

bloody fluid = cancer

lymphocytic fluid = TB

pH <60 = r/o RA

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15
Q

Empyema: MCC?

A

s aureus

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16
Q

Presentation of tension pneumothorax?

A

mediastinal shift, hypOtension, JVD, absent breath sounds, hyperresonance to percussion

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17
Q

ILD presentation?
Dx?
management?

A

dyspnea, nonproductive cough, fatigue

Dx spirometry (↓TLC, ↑FEV1/FVC) → get CXR (honeycomb lung) + tissue bx + UA if hematuria

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18
Q

Causes of Drug-induced pulmonary fibrosis?

A

amiodarone, busulfan, bleomycin, MTX, or nitrofurantoin

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19
Q

Presentation of Sarcoidosis?

tx?

A

young black female w/ respiratory complaints,
erythema nodosum, and blurry vision (anterior uveitis)

steroids

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20
Q

dx of Sarcoidosis?

complications?

A

CXR shows bilateral hilar LN-opathy (pulmonary fibrosis is end-stage finding); tissue bx shows noncaseating granulomas w/ Schaumann and asteroid bodies

GRAINeD – ↑IgG, rheumatoid arthritis, ↑ACE, interstitial lung dz, noncaseating granulomas, ↑1α- hydroxylase → ↑vitamin D

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21
Q

presents as classic ILD

CXR –> honeycomb lung
tissue bx shows eosinophilic granulomas

dx?
tx?

A

Histiocytosis X

steroids vs. lung txp (if not responding)



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22
Q

triad of necrotizing vasculitis, necrotizing granulomas in lungs and upper respiratory tract, and
necrotizing glomerulonephritis → hematuria + hemoptysis

dx?
tx?

A

Wegener granulomatosis:

↑c-ANCA; tissue bx shows necrotizing granulomas

cyclophosphamide

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23
Q

asthma + eosinophilia + necrotizing vasculitis

dx?
tx?

A

Churg-Strauss syndrome:

incr p-ANCA

steroids

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24
Q

rheumatoid nodules + pneumoconiosis 

A

Caplan syndrome (a/w coal workers pneumoconiosis)

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25
Q

cancer a/w Asbestosis?

A

bronchogenic carcinoma&raquo_space; mesothelioma

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26
Q

inhalation of silicon → fibrosis of upper lungs
Dx CXR shows upper lung fibrosis + “egg shell” calcifications

Tx?

A

Silicosis:

Tx supportive care

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27
Q

(classic ILD sx) + fever + eosinophilia
Dx CXR shows peripheral infiltrates,

dx?
tx?

A

Eosinophilic pneumonia:

get p-ANCA to r/o Churg-Strauss

Tx steroids

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28
Q

Goodpasture’s:
dx?
tx?

A

Dx tissue bx shows linear staining get c-ANCA to r/o Wegener

Tx steroids + cyclophosphamide + • plasmapheresis

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29
Q

accumulation of surfactant-like protein and phospholipids in alveoli → (classic ILD sx)

CXR = ground glass appearance w/ bat-shaped bilateral alveolar infiltrates

dx?
tx?

A

Pulmonary alveolar proteinosis:

*tissue bx (definitive)

Tx lung lavage vs. GM-CSF

30
Q

CXR shows honeycomb lungs w/ temporal heterogeneity;
tissue bx shows UIP (usual interstitial pneumonia)

dx?
tx?

A

Idiopathic pulmonary fibrosis:

steroids (temporizing), lung txp

31
Q

infectious pneumonia-like presentation (cough, dyspnea, flu-like sx) but unresponsive to abx
CXR shows bilateral patchy infiltrates
dx?
tx?

A

Cryptogenic organizing infectious pneumonitis:
presentation?

steroids

32
Q

Physical exam findings a/w pulmonary htn?

A

loud P2 + subtle sternal lift on auscultation

33
Q

Tx pulmonary htn vs primary pulmonary htn?

A

PH –> underlying cause + bosentan

1’ –> pulmonary vasodilators (CCB) + lung transplant

34
Q

Cor pulmonale:
presentation?
physical exam?
tx?

A

pulmonary HTN + RVH

loud P2 + subtle sternal lift on auscultation

Tx underlying cause + bosentan

35
Q 
destruction of bronchial walls
→ permanent bronchiolar
dilation → chronic cough w/
“cupfuls” of sputum, dyspnea,
hemoptysis, recurrent pneumonia
A

bronchiectasis

36
Q 
airway
inflammation → reversible
airflow obstruction →
wheezing, shortness of breath,
cough, chest tightness
A

asthma attack

37
Q 
chronic productive cough of 3
months/year for 2 years →
“blue bloaters”, overweight
and cyanotic, may have signs of
cor pulmonale
A

chronic bronchitis

38
Q

destruction of alveolar walls →
permanent alveolar dilation →
“pink puffers”, thin w/ barrel
chest, expiration w/ pursed lips

39
Q

CXR finding more specific to emphysema

A

hyperinflated lungs and increased AP diameter

40
Q

cough, hemoptysis, dyspnea,
wheezing, recurrent PNA in
same lobe

A

think lung cancer

41
Q

work up for suspected lung cancer

A

CXR, sputum cytology and CT scan –> bronchoscopy and mediastinoscopy with BIOPSY

42
Q

Staging and treatment for NSCLC

A
  • NSCLC stage I (local) → pneumonectomy vs. sleeve lobectomy
  • NSCLC stage II (hilar LN) → pneumonectomy vs. sleeve lobectomy
  • NSCLC stage III (distal LN) → chemo/radiation
  • NSCLC stage IV (mets) → chemo/radiation
43
Q

treatment for pancost tumor

A

irradiation for 6 weeks to shrink tumor, then surgical resection

44
Q

Complications assc with lung cancer

A 
SPHERE – 
> SVC syndrome
> Pancoast tumor →Horner syndrome
> Endocrine(paraneoplastic), 
> Recurrent laryngeal nerve (hoarseness),
> Effusions (pleural or pericardial)
45
Q

differentail for coin lesion

A

primary lung cancer
granuloma (TB or fungal)
hamatoma
metastatic cancer

46
Q

characteristic a/w benign coin lesion

A

> calcification = granuloma,
bull’s-eye shape, popcorn shape = hamartoma,
air-crescent or halo sign = aspergilloma,
Southwest region = coccidioidomycosis
Ohio river valley = histoplasmosis) → leave alone

47
Q

how to diagnose pleural effusion/type

A 
thoracentesis + 4 Cs – 
chemistry (glucose,protein), 
cytology
CBC+diff
culture
48
Q

lights criteria

A

pleural fluid is exudative if any of the following:

> p/s protein p/s LDH p LDH at upper 2/3 of normal

49
Q

Dx tissue bx shows noncaseating granulomas

w/ Schaumann and asteroid bodies

A

Sarcoidosis

50
Q

Dx CXR shows lower lung fibrosis + pleural plaques Dx tissue bx shows ferruginous bodies

A

asbestosis

51
Q

intersitital lung dz with Etiology: mining, stone cutting, glass manufacturing

52
Q

ILD that presents similar to sarcoid

A

berylliosis

  • Dx beryllium lymphocyte proliferation test
  • Tx steroids
53
Q

What is hypersensitivity pneumonitis?

How to Dx and tx?

A

Acute form: inhalation of
antigenic agent (e.g. bird
droppings) → type III and IV
hypersensitivity → flu-like sx

Chronic form: (classic ILD sx)

  • Dx CXR shows pulmonary infiltrates (acute form), interstitial fibrosis (chronic form)
  • Tx steroids + avoid birds
54
Q

goodpastures is type __ HS rxn

A

II

(anti-GBM antibodies attack
alveolar and glomerular
basement membrane)

55
Q

prognosis of idiopathic pulm fibrosis

A

death in 3-7 years

56
Q

lung changes with radiation pneumonitis

CXR and CT findings?

A

alveolar thickening and pulm fibrosis

CT shows diffuse infiltrates (CRX is usually normal)

57
Q

2 types of respiratory failure

A

hypoxia (PaO2 < 60)

hypercapnia (PaCO2 > 50)

58
Q

what can cuase inc A-a gradient with elevated to nml CO2

A

V/Q mismatch to shunting

59
Q

how to distinguish between V/Q mismatch and shunting

A

V/Q mismatch: responds to supplmental O2; imbalance
between lung perfusion and
ventilation, presents as ↓O2 but
nl CO2

Shunting: lack of ventilation in
well-perfused areas (e.g. PNA,
atelectasis); not responsive to
supplemental O2

60
Q

nml A-a gradient with normal Co2 and dec PaO2

A

high altitudes

61
Q

pathophys of ARDS

A 
diffuse inflammatory response
→ neutrophil activation →
interstitial damage and alveolar
collapse → massive shunting →
dyspnea + respiratory distress
62
Q

How to Dx and Tx ARDS

A
  • Dx CXR shows diffuse bilateral pulmonary infiltrates (white-out of lungs)
  • Dx ABG shows hypoxia (PaO2 <60) not responsive to O2 therapy
  • Dx PCWP shows no evidence of CHF
  • Tx ventilation w/ ↓FiO2, ↑PEEP
63
Q

etiologies of ARDS

A

septic shock (MCC), aspiration pneumonia, trauma

64
Q

goals of ventialtion

A

maintian alveolar ventialtion and correct hypoxia

65
Q 
Distinguish between the following ventilator settings
AC
SIMV
CPAP
PSV
A
  1. AC (assisted control) – has backup RR, gives preset VT per attempted breath
  2. SIMV (synchronous intermittent mandatory ventilation) – has backup RR, does not have preset VT per breath
  3. CPAP (continuous positive airway pressure) – no backup RR, continuous PEEP support
  4. PSV (pressure support ventilation) – PEEP support only with attempted breath
66
Q

What ventiator settings control CO2? O2?

A

CO2 with EE and TV

O2 with FiO2 and PEEP

67
Q

softening of tracheal cartilage w/ prolonged ventilation; PPx tracheostomy if ventilator-dependent for 2+ wks

A

tracheomalacia

68
Q

PA pressure >25 mmHg (rest) or>30 mmHg (exercise) →

presents as exertional dyspnea, fatigue, chest pain, ±syncope

69
Q

etiology of primary pukm HTN

Prognosis ?

A

∆BMPR2 → uninhibited smooth muscle growth → ↑pulmonary resistance
Px: mean survival 2-3 yrs

70
Q

Etiologies of cor pulmonale

A

COPD (MCC), recurrent PE, ILD, asthma, sleep apnea, CF, pneumoconioses

71
Q

acute onset chest pain,
dyspnea, hyperventilation,
hemoptysis, right-sided heart failure → death

Dx and Tx

A

PE

  • Dx D-dimer to r/o, spiral CT or V/Q scan to r/in
  • Tx heparin + warfarin
  • Tx tPA to speed up clot resolution (massive
  • PE, unstable, right heart failure, no c/i)
  • recurrent PE → Tx IVC filter

Internal Medicine (15 decks)

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