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IM AOA Inservice > Pulm/CC > Flashcards

Pulm/CC Flashcards

1
Q

Name the 2 reasons for hypoxia with a normal A-a gradient.

A

Decreased FiO2

Hypoventilation

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2
Q

Name the 3 reasons for hypoxia with abnormal or increased A-a gradient.

A

V/Q mismatch
Shunt
Decreased diffusion

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3
Q

Patient presents with hypoxia and a normal A-a gradient when taking opiates/benzos?

A

Central respiratory depression (neuro disorder)

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4
Q

What drug causes foamy changes in lamellar inclusions on a BAL?

A

Amiodarone induced disease

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5
Q

How to interpret PFTs?

A 
Obstructive: FEV1/FVC < 0.7
Mild FEV1> 80% = GOLD I
Moderate FEV1 50-79% = GOLD II
Severe FEV1 30-49% = GOLD III
Very severe FEV1 < 30% = GOLD iV
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6
Q

What is the only medication known to improve survival in COPD?
How does pulm rehab contribute?

A

Oxygen

Pulm rehab decreases healthcare costs and quality of life but does not impact survival

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7
Q

Name the hierarchy of asthma control inhalers?

A

Albuterol ICS LABA

And you can step down therapy

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8
Q

What BP med is best for asthma patients?

A

CCB

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9
Q

How do you diagnose asthma on PFTs?

A

Methacholine challenge test. 12% reversability and a 200cc increase with bronchodilators

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10
Q

Test question - you have a pregnant patient admitted for asthma, now improved, what do you do on discharge?

A

Send home on ICS as 30% will get worse with pregnancy

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11
Q

How do you diagnose exercise induced asthma and what is the treatment?

A

Exercise challenge test

albuterol 15-30 minutes before exertion

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12
Q

What the diagnosis? Young smokers with bulloous COPD, famhx liver/lung disease

A

Alpha 1 anti-trypsin deficiency

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13
Q

What testing do you perform for alpha 1 AT? What is the treatment?

A

serum level testing; genetic testing of Pi locus

Tx: weekly alpha 1 antiprotease infusions, does not treat liver disease

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14
Q

What’s the diagnosis? Plumber with GI plaquing and pleural thickening on CXR?

A

mesothelioma

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15
Q

What’s the diagnosis? Young AA female with skin lesions on anterior legs, cough, dyspnea, uveitis.

A

Sarcoidosis

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16
Q

Young AA female with pleural effusion that on tap is lymphocyte predominant

A

Sarcoidosis

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17
Q

What’s the diangosis? Arthritis, erythema nodosum, b/l hilar lymphadenopathy

A

Lofgren’s syndrome

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18
Q

What’s the diagnosis? anterior uveitis, parotid gland enlargement, facial palsy, fever

A

Heerfordt syndrome

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19
Q

What’s the diagnosis? Premenopausal women, pneumothorax, chylous effusion (TG> 110), tuberous sclerosis. CXR with diffuse honeycombing

A

Lymphangioleioyomatosis

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20
Q

What’s the next best step after diagnosis LAM?

A

always image the kidneys

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21
Q

What’s the diagnosis? Upper respiratory tract dx, sinusitis, glomerulonephritis and ILD.

A

Granulomatosis with polyangiitis (Wegners)

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22
Q

What are the serology markers for Wegners?

A

c-ANCA & anti-PR3

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23
Q

What’s the diagnosis? Upper respiratory tract dx, sinusitis, glomerulonephritis, ILD but (-) ANCA

A

Glomerular basement membrane disease

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24
Q

What’s the diagnosis? URI, asthma, eosinophilia

A

Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)

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25
What's the serology for Churg-strauss?
p-ANCA, anti-MPO assay positive
26
What's the diagnosis? Female patient with RA, weight loss, low fevers, dry cough for 2 months, failed treatment with multiple rounds of abx
Cryptogenic Organizing pneumonia | CXR often with migratory consolidations
27
Treatment for COP?
steroids
28
What's the diagnosis? Allergic rxn to aspergillus, chronic cough, mucus plugging, recurrent pulmonary infiltrates with eosinophilia, elevated IgE > 1000 Usually presents as difficult to control asthma
allergic bronchopulmonary aspergillosis (ABPA)
29
What is the order of diagnosis for ABPA? | What is the treatment?
1. Eosinophilia 2. Aspergillus antigen skin prick test 3. IgE > 1000 4. Serum specific A fumigatus antibody testing 5. Galactomannon test Tx: Steroids + itraconazole
30
What are 2 markings you can see on imaging with suspected PE?
Westermark sign: lack of vascular markings downstream of embolism Hampton's hump: wedge shaped defect from infarction just above the diaphragm
31
Management of a clinically unstable patient suspected of having PE?
tPA
32
what are the relative contraindications and absolute contraindications for thrombolytics?
Surgery within 10 days is a relative contraindication | Intracranial/intraspinal surgeries are absolute
33
What are the Wells criteria and number ranking?
``` Clinical signs/symptoms of DVT: +3 PE is #1 diagnosis OR equally likely: +3 HR > 100: +1.5 Immobilization at least 3 days OR surgery in the previous 4 weeks: +1.5 Previous diagnosis PE or DVT: +1.5 Hemoptysis: +1 Malignancy w/ treatment within 6 months or palliative: +1 Low risk <2 Moderate risk: 2-6 pts high risk: >6 points ```
34
What's the diagnosis? RLL infiltrate, consolidation, patient incapacitated
aspiration syndromes > 48 hrs before infection leading to chemical pneumonitis, cavitary/empyema
35
Treatment for aspiration syndromes?
Always think anaerobes. Amox-clavulanate (Augmentin), amp-sulbactam (Unasyn), clinda
36
What are Light's criteria?
Exudative effusion if: - fluid prot/serum prot > 0.5 - fluid LDH/serum LDH > 0.6 - fluid LDH > 2/3 upper limits of normal
37
What are causes of exudative vs transudative effusions?
exudative: PNA, CA, PE transudative: HF, cirrhosis, nephrotic syndrome/ESRD
38
Pleural effusion with adenosine deaminase
TB
39
Pleural effusion with glu<60, glu<30?
<60: infectious, TB, RA, malignancy | <30: empyema, PE
40
pleural effusion in an AAF with increased lymphocytes =
sarcoidosis
41
Indications for CT on pleural effusions?
pH < 7.2, glucose < 60, positive cx or gram stain; loculated pleural thickening
42
What's the diagnosis? Immunocompromised patient with septate hyphae at narrow/acute angles?
Aspergillosis | Tx: Voriconazole IV
43
PNA: alcoholic, currant, jelly sputum
Klebsiella
44
PNA: Gram stain with GN diplococci, COPD-er
Moraxella catarrhalis
45
PNA: rust colored sputum, lancet shaped G+ diplococci
streptococcus pneumonia
46
PNA: reverse bat wing, infiltrate spares hilum
eosinophilic PNA
47
PNA in a young patient and can cause elevated d-dimer
mycoplasma pneumoniae
48
PNA with pharyngitis, hoarsness, CAP in patients > 65 y/o
Chlamydophila pneumoniae
49
PNA from inhaled contaminated water, diarrhea, confusion
legionella
50
Patient presents with green sputum, alcoholic with dental caries
Bacteroides, Tx: clinda
51
Which is the most likely in an aspiration PNA isolate?
Haemophilus aegyptius
52
URI symptoms unresponsive to cipro
Bordatella pertussis
53
Southwest US fungus
Coccidioides
54
Southern/Midwestern US fungus
Histoplasmosis
55
Mid-Atlantic/Central/SE US fungus; broad based budding yeast
Blastomyces dermatitidis
56
PNA in immunosuppressed patients, AIDS
PJP | Diagnose with GOmori methenamine silver stain (GMS)
57
In active Tb, give INH with ____ to prevent ____
pyridoxine (B6) to prevent neuropathy
58
Patient with resistant HTN, next step?
PSG
59
Lung cancer most associated with non-smokers and CEA tumor marker?
adenocarcinoma
60
Lung cancer that is cavitary and can cause hypercalcemia
squamous cell
61
Lung cancer associated with SIADH, ectopic ACTH production, Eaton Lambert syndrome
SCLC
62
What is the screening recommendation for lung cancer?
55-80 y/o with >30 pack year hx and currently smoking or has quit smoking in the last 15 years
63
What's the diagnosis? Asthma, allergic rhinitis, atopic dermatitis, food allergies, elevated IgE
Jobs Syndrome
64
Pulm HTN WHO classification
WHO 1 = Idiopathic (autoimmune, heritable, drugs/toxins, HIV) WHO 2 = cardiac related (left heart failure) WHO 3 = pulmonary related (COPD, ILD) WHO 4 = CTEPH WHO 5 = miscellaneous / multifactorial (sarcoidosis, histiocytosis, vasculitis, ESRD on HD) Treat underlying cause WHO 2 = heart failure WHO 3 = treat copd WHO 4 = anticoagulation Remember CTEPH is best confirmed with V/Q scan
65
What's the diagnosis? Aspirin provoked dyspnea, cough, nasal polyps, asthma
Samters syndrome Avoid NSAIDs Treat with montelukast
66
Infusion that can cause hypotension, erythema, urticaria
Dilaudid
67
Next best step in patient with Gram (-) sepsis with refractory hypotension despite negative cx
R/o adrenal insufficiency
68
Drug for prevention of altitude sickness?
acetazolamide
69
On CXR, with wide mediastinum, think ____
anthrax

IM AOA Inservice (5 decks)

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