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Step2CK > Pulm > Flashcards

Pulm Flashcards

1
Q

XR hint to diaphragmatic rupture

A

NG tube in the thorax

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2
Q

XR hint to diaphragmatic rupture

A

NG tube in the thorax

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3
Q

what occurs with large areas of atelectasis

A

large ventilation perfusion mist match. hyperventilation to compensate for hypoxemia leading to respiratory alkalosis and decreased PaCO2

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4
Q

how does the body compensate for severe COPD causing acidosis

A

renal retention HCO3

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5
Q

apical lung tumor signs and Sx

A

horner syndrome if compress sympathetic trunk
brachial plexus affected with pancoast tumor
right recurrent laryngeal compression causes hoarse voice
superior vena cava syndrome

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6
Q

high Right atrial P and high pulm artery pressure but with normal PCWP

A

PE

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7
Q

risk for RDS in newborn

A

prematurity

DM, male, perinatal asphyxia and C section without labor

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8
Q

CXR for RDS

A

diffuse reticulogranular pattern (ground glass) with air bronchograms

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9
Q

horners

A

ptosis miosis anhidrosis

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10
Q

how to Dx pancoast tumor or superior sulcus

A

CXR

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11
Q

Hypertrophic pulmonary osteoarthropathy

A

clubbing and arthropathy of fingers and wrists due to lunderlying lung disease like lung cancer, TB, bronchiectasis or emphysema

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12
Q

hypoxemia post MVA is worsened with fluid challenge

A

pulmonary contusion

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13
Q

theophylline toxicity

A

CNS stimulation like HA, insomnia and seizures
GI nausea and vomiting
cardiac toxicity causing arrhythmia

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14
Q

PE can cause what arrhythmias

A

AFib

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15
Q

Dx PE

A

CTA

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16
Q

most common causes of secondary clubbing

A

lung malignancies, CF and right to left cardiac shunts

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17
Q

hypertrophic osteoarthropathy

A

digital clubbing with painful joint enlargement, periostosis of bones and synovial effusions

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18
Q

at what Saturation O2 is home O2 warranted for cOPD

A
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19
Q

at what Saturation O2 is home O2 warranted for cOPD

A
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20
Q

what occurs with large areas of atelectasis

A

large ventilation perfusion mist match. hyperventilation to compensate for hypoxemia leading to respiratory alkalosis and decreased PaCO2

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21
Q

how does the body compensate for severe COPD causing acidosis

A

renal retention HCO3

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22
Q

apical lung tumor signs and Sx

A

horner syndrome if compress sympathetic trunk
brachial plexus affected with pancoast tumor
right recurrent laryngeal compression causes hoarse voice
superior vena cava syndrome

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23
Q

high Right atrial P and high pulm artery pressure but with normal PCWP

A

PE

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24
Q

what happens when lay penumonia side down

A

increase physiologic shunting

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25
Q

CXR for RDS

A

diffuse reticulogranular pattern (ground glass) with air bronchograms

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26
Q

horners

A

ptosis miosis anhidrosis

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27
Q

how to Dx pancoast tumor or superior sulcus

A

CXR

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28
Q

Hypertrophic pulmonary osteoarthropathy

A

clubbing and arthropathy of fingers and wrists due to lunderlying lung disease like lung cancer, TB, bronchiectasis or emphysema

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29
Q

hypoxemia post MVA is worsened with fluid challenge

A

pulmonary contusion

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30
Q

theophylline toxicity

A

CNS stimulation like HA, insomnia and seizures
GI nausea and vomiting
cardiac toxicity causing arrhythmia

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31
Q

PE can cause what arrhythmias

A

AFib

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32
Q

Dx PE

A

CTA

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33
Q

most common causes of secondary clubbing

A

lung malignancies, CF and right to left cardiac shunts

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34
Q

hypertrophic osteoarthropathy

A

digital clubbing with painful joint enlargement, periostosis of bones and synovial effusions

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35
Q

does COPD cause clubbing

A

no

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36
Q

at what Saturation O2 is home O2 warranted for cOPD

A
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37
Q

what are the anti cholinergics used in COPD

A

ipratropium and tiotropium

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38
Q

signs of wegeners

A

blood sputum or nasal discharge, oral ulcers, sinusitis, dyspnea, cough and hemoptysis
renal insufficiency, microscopic hematuria and RBC casts

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39
Q

CXR in wegeners

A

nodular densities and alveolar or pleural opacities

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40
Q

what does flattening of diaphragm in COPD do

A

increase work of breathing

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41
Q

normal DLCO but has obstructive pattern

A

chronic bronchitis

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42
Q

what happens when lay penumonia side down

A

increase physiologic shunting

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43
Q

what happens to A-a gradient in idiopathic pulmonary fibrosis

A

increased

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44
Q

what to check in middle aged person with recurrent sinusitis and gastroenteritis

A

Quantitative measurement of serum Ig levels

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45
Q

how does chlorpheniramine work

A

decrease nasal secretions

H1 R blocker

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46
Q

what bacteria cause empyema

A

step pneumo
staph aureus
klebsiella

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47
Q

what do you need to exclude when suspect ARDS in someone without risk factors

A

echo to rule out hydrostatic pulmonary edema

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48
Q

how to differentiate asthma and cOPD

A

before and after bronchodilator Tx on spirometry

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49
Q

high PaCO2 and low PaO2 suggest what

A

alveolar hypoventilation

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50
Q

Aa gradient with hypoventilation

A

normal with respiratory acidosis

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51
Q

why not use Positive pressure mechanical ventilation in someone with hypovolemic shock

A

it will acutely increase the intrathoracic pressure and so increase right atrial pressure and decrease systemic venous return– can cause circulatory collapse

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52
Q

what happens to Aa and V/q with pneumonia

A

Aa increases and there is a V/Q mistmatch

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53
Q

solitary pulmonary nodule, management

A

high risk malignancy- resect

mod risk- further imaging and studies

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54
Q

VC in COPD

A

decreased from air trapping

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55
Q

what are the anti cholinergics used in COPD

A

ipratropium and tiotropium

56
Q

Rx used for acute pulmonary thromboembolism

A

unfractionated heparin

57
Q

exudative fluid

A

fluid protein/ serum protein is >0.5

fluid LDH/serum LDH >0.6

58
Q

what cause exudative pleural effusions

A

infection, autoimmune, neoplasm

59
Q

what mechanism causes the exudate in pleural effusions

A

increased capillary permeability

60
Q

transudative mechanism

A

increased hydrostatic pressure or decreased capillary oncotic pressure

61
Q

what causes cough in ACEI Tx

A

increased kinin

62
Q

how to Dx CF

A

positive screening
increased sweat Cl test on 2+ occasions (quantitative pilocarpine iontophoresis)
identification of 2 CF mutations

63
Q

Bruton tyrosine kinase gene mutation

A

X linked agamma globulinemia

64
Q

what do we measure exhaled nasal nitric oxide for

A

primary ciliary dyskinesia

65
Q

best way to prevent post op pneumonia

A

incentive spirometry

66
Q

what are the complications of PEEP

A

alveolar damage, tension pneumo, hypotension

67
Q

Tx tension pneumo

A

needle insertion 2nd ICS MCL

68
Q

recurrent pneumonias in adult in same anatomic region every time

A

do CT to evaluate for potential obstructions

69
Q

what causes a increase in plateau pressure or (compliance)

A 
pneumothorax
PE
pneumonia
atelectasis
right mainstem intubation
70
Q

what happens to Aa and V/q with pneumonia

A

Aa increases and there is a V/Q mistmatch

71
Q

exudative fluid

A

fluid protein/serum protein >0.5
LDH fluid/serum LDH >0.6
pleural fluid LDH >2/3 uper limit normal serum LDH

72
Q

pleural effusion fluid with glucose

A

rheumatoid pleurisy, parapneumonic effusion or empyeme, malignant effusion, TB pleurisy, lupus pleuritis, esophageal rupture

73
Q

where do bronchogenic cysts occur

A

middle mediastinum

74
Q

complication bronchilitis in infant

A

apnea

75
Q

what cause V/Q mismatch

A

obstrucive lung disease, atelectasis, pulmonary edema and pneumonia

76
Q

what is Aa gradient in V/Q mistmatch

A

increased

77
Q

what type of lung pathology does not correct with supp O2

A

shunt

78
Q

what causes increased tactile fremitus

A

consolidation lobar or pneumonia

79
Q

what cause decreased tactile fremitus

A

pleural effusion COPD and pneumothorax

80
Q

what is mainstay ventilation settings for ARDS

A

low tidal volumes and PEEP

81
Q

ARDS is from what underlying physiologic process

A

pulmonary edema from leaky alveolar capillaries

82
Q

COPD excacerbation not improving with medicaitons. next step

A

Noninvasive positive pressure ventilation

83
Q

what are Sx for someone requiring albuterol and corticosteroids

A

mild persistent asthma (more than 2x a week and 3-4x night awakenings a month)

84
Q

next step in pleural effusion management once diagnosed by CXR

A

thoracocentesis to find cause. transudate or exudate

85
Q

in newborn with polyhydramnios nasal flaring, barrel chest, breath sounds absent on left and heart sounds loudest at right. abdomen is scaphoid

A

congenital diaphragmatic hernia pushing everything to the right

86
Q

recurrent pneumonias in adult in same anatomic region every time

A

do CT to evaluate for potential obstructions

87
Q

location of adenocarcinoma of lung

A

peripheral. most common lung CA

88
Q

Tx for non allergic rhinitis

A

intranasal antihistamines or glucocorticoids

89
Q

effects of squamous cell carcinoma of lung

A

hypercalcemia

90
Q

what can small cell carcinoma of lung cause

A

cushing, SIADH, lambert eaton

91
Q

where does large cell carcinoma in lung occur

A

peripheral and can cause gynecomastia and galactorrhea

92
Q

intial management of PE

A

anticoagualte if no contraindicaitons

93
Q

what lung pathogen can cause lytic bone lesions

A

blastomycosis

94
Q

what lba test is most helpful indetermining need for chest tube in papapneumonic effusion

A

pH lower than 7.2 indicates empyema

95
Q

spontaneous pneumothorax usually caused by

A

alveolar bleb rupture

96
Q

hours after gastric secretion aspiration have cough and decreased O2 saturation

A

pneumonitis from inflammation from the gastric acid

97
Q

new solitary pulmonary nodule compared to 2 years ago on CX

A

need a CT to evaluate

98
Q

management of laryngomalacia in child

A

reassurance

sometimes supraglottoplasty

99
Q

diagnosis laryngomalacia

A

flexible laryngoscopy showing collapse of supraglottic structures with inspiration and omega shaped epiglottis

100
Q

chronic low back pain in young adult male and also is having trouble breathing, DOE

A

ankylosing spondylitis that causes restrictive pattern in lungs

101
Q

what are Sx for someone requiring albuterol and corticosteroids

A

mild persistent asthma (more than 2x a week and 3-4x night awakenings a month)

102
Q

when do you give long acting beta 2 agonist

A

moderate persistent asthma daily Sx, weekly nighttime awakenings, limits on activities, FEV1 60-80% predicted

103
Q

panacinar empysema from AAT deficiency affects what part of lungs

A

lower lobes

104
Q

pH of transudate vs exudate

A

exudate is usually 7.3-7.45

transudate is usually 7.4-7.55

105
Q

manifestations of sarcoid

A

pulmonary: bilateral hilar adenopathy, interstitial infiltrates
opthalmologic: anterior uveitis and posterior uveitis
reticuloendothelial: peripheral lymphadenopathy, hepatomegaly and splenomegaly
MSK: acute polyarthritis, chronic arthritis with periosteal bone resorption
CNS: central DI, hypercalcemia
Lofgren’s syndrome: erythema nodosum, hilar adenopathy, migratory polyarthralgias, fever

106
Q

Tx for non allergic rhinitis

A

intranasal antihistamines or glucocorticoids

107
Q

Tx for bacterial sinusitis

A

amoxicillin-clavunate

108
Q

neonate CXR shows bilateral perihilar linear streaking shortly after birth

A

transient tachypnea of the newborn

109
Q

if a newborn CXR shows clear lungs with decreased pulm vascularity

A

persisten pulmonary HTN

110
Q

primary problem in RDS newborns

A

surfactant deficiency

111
Q

massive hemoptysis, next step

A

secure airway and if bleeding continues do bronchoscopic interventions

112
Q

what lba test is most helpful indetermining need for chest tube in papapneumonic effusion

A

pH lower than 7.2 indicates empyema

113
Q

what to use to rule in or out PE if PE clinically unlikely? clinically likely?

A

unlikely based on Wells– do D-dimer

likely based on Wells– do CTA

114
Q

metabolic imbalance from Obstructive sleep apnea

A

metabolic alkalosis to counteract respiratory acidosis. will have low Cl from bicarb retention

115
Q

fungal ball on CT

A

aspergilloma, most common in preexisting lung cavities like old TB lesion

116
Q

velcro like inspiratory crackles

A

idiopathic pulm fibrosis

117
Q

Hypersensitivity pnuemonitis

A

inhalation of inciting Ag leading to alveolar inflammation

ground glass opacity or haziness of lower lung fields

118
Q

outpatient Tx CAP

A

macrolide or doxy

if have comorbidity: fluorquinolone or beta lactam+macrolide

119
Q

ICU Tx CAP

A

betalactam + macrolide IV
or
betalactam +fluoroquinolone

120
Q

non ICU Tx CAP

A

fluoroquinolone
or
betalactam+ macrolide

121
Q

CURB-65

A 
for CAP hospitalization
Confusion
Uremia (BUN>20(
Tachypnea >30
hypotension
Age>65

2 or more will benefit from inpatient. 4 or more ICU

122
Q

skin manifestations wegeners.

A

painful subcut nodules, palpable purpura and pyoderma gangrenosum-like lesions

123
Q

immunocompromised from chemo and now has pneumonia, pathogen? CXR findings?

A

P jiroveci

diffuse interstitial infiltrates in perihilar region

124
Q

PE cause transudate or exudate

A

both

125
Q

male has SOB and cough with some hemoptysis. also UA shows dysmorphic RBC

A

goodpastures

Ab to basement membrane, alpha 3 chain IV collagen, linear IgG deposits

126
Q

how is recent GI illness risk factor for PE

A

dehydration and hemoconcentration

127
Q

wedge shaped pleural opacification in CTA

A

pulmonary emoblism

128
Q

signs hyeprcalcemia

A

anorexia, constipation, increased thirst and easy fatiguability

129
Q

how does squamous cell carcinoma of lung cause hyperCa

A

release PTHrp

130
Q

what is produced by non-seminomatous germ cell tumors

A

bhCG and AFP

131
Q

Aa gradient in PE

A

high

132
Q

target INR for warfarin in idiopathic DVT patient

A

2-3 for at least 6 mo

133
Q

Tx aspergilloma

A

itraconazole, resectino or bronchial artery embolization

134
Q

confirm Dx aspergilloma

A

IgG serology for aspergillus

135
Q

APGAR stand for

A 
Appearnce(color)
Pulse
Grimace (reaction)
Activity (muscle tone)
Respiratory effort

Step2CK (26 decks)

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