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Clinical Medicine > Pulm > Flashcards

Pulm Flashcards

1
Q

normal FEV1

A

> 80%

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2
Q

normal FVC

A

> 80%

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3
Q

normal FEV1/FVC

A

> 70-75

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4
Q

obstructive disease levels

A 
hi volume
hi residual volume
low vital capacity
low FEV1
low FEV1/FVC
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5
Q

restrictive disease levels

A 
low volume
low residual vol
low VC
low FEV1
normal or hi FEV1/FVC
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6
Q

most accurate way to measure TLC

A

plethysmography

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7
Q

normal PO2

A

75-100

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8
Q

normal PCO2

A

38-42

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9
Q

normal HCO3

A

22-28

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10
Q

normal pH

A

7.38-7.42

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11
Q

upper limit compensation (pH)

A

0.25 x (PCO2actual - PCO2norm)

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12
Q

lower limit compensation (pH)

A

0.75 x (PCO2actual - PCO2norm)

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13
Q

diff alkalosis

A

resp: pH up cuz CO2 down (27)(hypovent)

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14
Q

diff acidosis

A

resp: pH down cuz CO2 up (>50)
met: pH down cuz HCO3 down (

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15
Q

mixed acidosis

A

pH down cuz PCO2 up and HCO3 down

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16
Q

alveolar disease (area affected)

A

peripheral only

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17
Q

alveolar disease CXR (characteristics)

A

homogenous opacity
obscured BVs
poor marginations
air bronchograms

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18
Q

pneumonia CXR sign

A

silhouette sign

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19
Q

CHF/pulm edema CXR sign

A

bat wing

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20
Q

pulm infacrtion sign

A

wedge shaped density

hampton’s hump

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21
Q

interstitial disease (area affected)

A

bronchoarterial
parenchymal
peripheral

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22
Q

interstitial disease CXR (characteristics)

A 
Kerley B lines
reticular
ground glass
nodular
reticulonodular
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23
Q

atelectasis CXR (characteristics)

A

tracheal, mediastinal, fissure deviation (twd side of atelectasis)
elevated hemidiaphragm
overinflation of other lung

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24
Q

linear atelectesis sign

A

plate like?

post abdominal surgery

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25
Q

flat line on CXR –>

A

air-fluid level

hemopneumothorax

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26
Q

HIV PEP for HCWs

A

raltegravir (or dolutegravir)
+ emitricitabine/tenofovir
start w/in hours
treat 4 weeks

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27
Q

transudative vs exudative effusions

A

light’s criteria (any = exudative)
pleural prt/serum prt > 0.5
pl LDH/serum LDH > 0.6
pl LDH > 2/3 upper limit normal lab serum LDH

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28
Q

d/o w/ transudative effusions

A 
CHF
cirrhosis
nephrotic syndrome
PE
peritoneal dialysis
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29
Q

d/o w/ exudative effusions

A 
infections
malignancy
GI
collagen vasc disease
drugs
hemo/chylothorax
PE
asbestos
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30
Q

PPD: 5 mm + population

A 
HIV
close contact TB
CXR show old unTx TB
organ trans
immunocomp
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31
Q

PPD: 10mm+ pop

A 
recent immigrants
IVDU
high risk med conditions
high risk job
myco lab ppl
kids exposed to adult @ hi risk
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32
Q

PPD: 15mm+ pop

A

no known TB RFs

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33
Q

tx latent TB

A

INH 9 months (+kids)

RIF 4 months

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34
Q

latent TB vs disease

A

both + PPD, QFT

latent: normal CXR, smears, cultures, no Sx, not infectious
disease: abnormal CXR, +smears/cultures, cough, fever, weight loss, infectious

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35
Q

EKG in PE

A

MC: sinus tachy
rare: S1Q3T3

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36
Q

BOOP path

A

fibroproliferative plug
lipid laden macs
minimal architectural distortion

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37
Q

histiocytosis aka

A

eosinophil granuloma

pulm langerhans cell granulomatosis

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38
Q

histiocytosis mech/progression

A

interstitial w/ obstructive granulomatous lesions
langerhans cell proliferation in small airways/parenchyma
later, more fibrosis
restrictive or obstructive

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39
Q

histiocytosis CXR

A

bilat, upper lobe
cysts/nodules
pneumothorax

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40
Q

sarcoidosis stages

A

I: lymphocytic alveolitis
II: non-casseating granulomas
III: fibrosis

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41
Q

sarcoid periphery

A

lymphocytes (T)

fibrocytes

42
Q

sarcoid core

A

non necrotic

mac + epitheliod cells = multinucleated giant cells

43
Q

MNGC inclusion bodies

A

asteroid
schumann
hamazaki-wesenberg

44
Q

phys causes of hypoxemia

A

asphyxia
low V/Q
shunt (not better with O2)
hypoventilation

45
Q

phys causes of hypercapnea

A 
alveolar hypoventilation
high V/Q
haldane
VD/VT
up CO2 production
46
Q

ways to impair tissue oxygenation

A

fail to vent
fail to oxygenate arteries
fail to transport o2
failt to use O2

47
Q

drug OD tx

A 
intubate/ventilate
treat OD (narcan, romazicon)
resp stim?
48
Q

CHF tx

A

O2, ASA
diuresis
nitrates
heparin

49
Q

pulm HTN from lung issues - causes

A 
COPD
interstitial 
sleep apnea
high altitude (chronic)
bronchopulm dysplagia
developmental
50
Q

mPAP for pulm HTN

A

mild 25-34
mod 35-44
severe >45

51
Q

lung changes that cause pulm HTN

A

increased PVR
increased CO
increased wedge pressure

52
Q

how obesity -> hypoventilation syndrome

A

low resp musc strength
low chest wall compliance
defect in central resp control system (down responsiveness to CO2 or hypoxia)

53
Q

kyphoscoliosis lung changes

A

down VC
down TV
RV about the same

54
Q

COPD and hypoventilation

A

decreased chemical responsiveness to CO2 and hypoxia

abnormal diaphragm fxn from fatigue and mechanical disadvantage

55
Q

sniff test for…

A

unilateral diaphragmatic paralysis

56
Q

+ sniff test is

A

paradoxical elevation of diaphragm with sniff

57
Q

hemoptysis description

A 
no n/v
bright red blood
frothy
alkaline
blood-tinged sputum
hemosederin macs
hx lung disease
blood loss uncommon
58
Q

causes of hemoptysis (infection)

A 
bronchitis, bronchiectasis
 pneumonia
TB 
abscess
aspergilloma
59
Q

causes of hemoptysis (neoplasm)

A

bronchogenic carcinoma
bronchial adenoma
carcinoid
met carcinoma

60
Q

causes of hemoptysis (CV)

A

CHF
mitral stenosis
pulm HTN

61
Q

causes of hemoptysis (broad)

A 
infection
neoplasm
CV
vascular
trauma
62
Q

causes of hemoptysis (vascular)

A 
PE
aneurysms
AV malformations
collagen vascular
pulmonary renal
wegners
churg-strauss
63
Q

telangiectasias

A

dilation of small vessels –> flat red marks on skin

64
Q

hemoptysis vasculitic workup

A

anti GBM ab: goodpatsures
anti DS DNA: SLE
ANCA to proteinase-3: wegners
ANCA to myloperoxidase: microscopic polyangiitis

65
Q

when bronchoscopy

A 
suspect tumor
localize bleeding site
collect samples
biopsy
laser
66
Q

pulm HTN Tx

A

endothelin rec blockers
nitric oxide
PDE inhibitors
prostacyclins

67
Q

vasoreactivity test (pulm HTN)

A

give short acting vasodilator (adenosine, NO)

(+) mPAP down by 10 with up in CO

68
Q

(+) vasoreactivity test tx

A

CCBs

69
Q

(-)vasoreactivity test tx

A

endothelin rec blockers
nitric oxide
prostacyclins

70
Q

T1

A

tumor

71
Q

T2

A 
tumor btwn 3-7
or
tumor which invades visceral pleura
or
atelectasis (
72
Q

T3

A 
prox extent w/in 2 cm of carina
or involve diaphragm, mediastinal pleura or pericardium
or atelectasis of whole lung
or separate tumor nodules in same lobe
or chest wall invasion
73
Q

T4

A

invasion of mediastinum, heart, great vessels, trachea, esophagus, vert body, carina
or separate nodules w/in diff ipsi lobe

74
Q

N0

A

N0: no regional node involved

75
Q

N1

A

met to ipsi hilar +/or peribronchial nodes

76
Q

N2

A

met to ipsi mediastinal +/or subcarinal

77
Q

N3

A

met to contra mediastinal or hilar, ipsilateral or contralateral scalene or supraclavicular nodes

78
Q

M1

A

distant mets
include nodules in contra lobe
malignant pleural/pericardial effusions

79
Q

stage IA

A

T1N0M0 (nothing but T)

80
Q

stage IB

A

T2N0M0 (nothing but T)

81
Q

stage IIA

A

T1N1M0 (N only 1)

82
Q

stage IIB

A

T2N1M0
T3N0M0
(N only 1)

83
Q

stage IIIA

A

T3N1M0

T1-3N2M0

84
Q

stage IIIB

A

TanyN3M0

T4NanyM0

85
Q

stage IV

A

TanyNanyM1 (Mets)

86
Q

stage IA management

A

surgical resection

87
Q

stage IB management

A

surgical resection

paclitaxel+carboplatin before and after surg

88
Q

stage II management

A

surgical resection w/ or w/o therapy

89
Q

stage IIIA management

A

chemo then surgery + post op chemo/rad

90
Q

stage IIIB management

A

vhemo+rad

91
Q

stage IV

A

chemo or palliative

92
Q

sarcoidosis imaging

A

panda sign

93
Q

asbestosis CXR

A

pleural plaque

pleaurl thickening

94
Q

small airway definition

A
95
Q

bronchiolitis

A

SA destruction from inflammation and fibrosis

96
Q

obliterative bronchiolitis

A

begin in and destroy SA

97
Q

proliferative bronchiolitis

A

debris collection w/in alveolus extends back to airways but doesn’t destroy them

98
Q

bronchiolitis obliterans

A

CT: mosaic

obliterative, obstructive

99
Q

BOOP

A

CXR: bilat peripheral infiltrates
proliferative
restrictive
no CRP

100
Q

resp bronchiolitis interstitial lung disease

A

smokers only
ground glass
pigmented macs

Clinical Medicine (9 decks)

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