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00000 IM PLATINUM BOARD CORRELATES > PULMO > Flashcards

PULMO Flashcards

1
Q

4 lung volumes

A
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2
Q

3 lung zones

A
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2
Q

4 lung capacities

A
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3
Q

V/Q at apex of lung
vs V/Q at base of lung

A
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4
Q

V/Q = 0
vs
V/Q = infinity

A
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5
Q

How O2 is transported in blood (2)

A
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6
Q

How CO2 ins transported in blood (3)

A
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7
Q

Increase in the following factors (5) would cause shift to the RIGHT of the 02-Hgb dissociation curve (unloading of 02 from Hgb)

A
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8
Q

Main respiratory center in the medulla; sends inspiratory ramp signal to diaphragm

A
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9
Q

Central control of both inspiration and expiration (supplements DRG) during exercise

A
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10
Q

Decreases duration of inspiration and increases resoiratory rate

A
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11
Q

Increases duration of inspiration and decreases respiratory rate

A
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12
Q

Reversibility in asthma (spirometry) is demonstrated by

A
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13
Q

Physiologic abnormality of asthma

A

Airway hyperresponsiveness

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14
Q

Major risk factor for asthma

A

Atopy

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15
Q

Pathogenesis behind asthma:
Imbalance favoring TH1 production over TH2

True or False

A

False… kasi dapat…

Imbalance favoring TH2 production over TH1

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16
Q

Term for the Whorls of shed epithelium in mucus plugs in asthma

A

Curschmann’s spirals

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17
Q

Term for Eosinophilic, hexagonal, double-pointed crystals formed from breakdown of eosinophils in sputum (in asthma )

A

Charcot-Leyden Crystals

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18
Q

Characteristic finding in asthamtic airways

A

Thickening of the basement membrane due to subepithelial collagen deposition

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19
Q

Key predominant cell in asthma

A

None

Many inflammatory cells are involved in asthma with no key cell that is predominant

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20
Q

Most common allergens that trigger asthma
vs
Most common triggers of acute severe asthma exacerbations

A

Dermatophagoides (house dust mites)
vs
URTI: rhinovirus, respiratory syncytial virus (RSV), coronavirus

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21
Q

Mechanism of exercise-induced asthma (EIA)

A

hyperventilation

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22
Q

Typical presentation of EIA

A

Begins after exercise has ended, and recovers spontaneously within about 30 min.

Worse in cold, dry climates than in hot, humid conditions.

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23
Q

EIA is best prevented by regular treatment with

A

ICS

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24
Q

Confirms airflow limitation with a reduced FEY,, FEV,/FVC ratio, and PEF

A

spirometry

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25
Q

Confirms diurnal variations in airflow obstruction in asthma

A

Measurements of PEF twice daily

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26
Q

Most common side effects of B2-agonists used in asthma (2)

A

muscle tremor
palpitations

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27
Q

Most common side effect of anticholinergics used in asthma

A

dry mouth

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28
Q

in elderly patients with asthma using anticholinergics, these 2 side effects can be observed…

A

glaucoma
urinary retention

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29
Q

Most effective controllers for asthma

A

ICS

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30
Q

Use of a reliever medication >1x a week Indicates the need for regular controller therapy in asthma

True or false…

A

False… kasi dapat…
Use of a reliever medication >2x a week Indicates the need for regular controller therapy in asthma

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31
Q

Most common reason for poor control of asthma

A

Noncompliance with medications, usually ICS

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32
Q

Drugs that are safe for asthma in pregnancy (3)

A
  • Short-acting B2-agonists
  • ICS
  • Theophylline
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33
Q

Pathogenesis behind emphysema

A

Imbalance between Protease (Elastase) and Anti-Protease (Alpha 1- Anti-Trypsin)

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34
Q

First symptom of emphysema

A

progressive dyspnea

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35
Q

What is Reid’s Index

A

Ratio of mucus gland layer thickness to the thickness of the wall between the epithelium and the cartilage orthe trachea and bronchi

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36
Q

Reid’s index for chronic bronchitis

A

more than 0.4

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37
Q

Most highly significant predictor of FEV1 in COPD

A

Pack-years of cigarette smoking

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38
Q

Important cause of COPD exacerbations

A

respiratory infections

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39
Q

Most common form of severe alpha 1-AT deficiency

A
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40
Q

Most typical objective finding in COPD

A

Persistent reduction in forced expiratory flow rates

41
Q

This mechanism accounts for essentially all of the reduction in Pa02 that occurs in COPD

A

Ventilation-perfusion mismatching

42
Q

Major site of increased resistance in COPD

A

Small airways < 2 mm diameter

43
Q

Type of emphysema frequently associated with cigarette smoking, characterized by enlarged air spaces found (initially) in association with respiratory bronchioles

A
44
Q

Type or emphysema usually observed in patients with alpha 1-AT deficiency, characterized by abnormally large air spaces evenly distributed within and across acinar units

A
45
Q

Type or emphysema distributed along the pleural margins with relative sparing of the lung core or central regions

A
46
Q

Major physiologic change in COPD

A

Airflow limitation

47
Q

Characteristic of COPD reflecting the heterogeneous nature of the disease process within the airways and lung parenchyma

A

non uniform ventilation and VQ mismatching

48
Q

Newly-developed clubbing of-the digits (not a sign ofCOPD) should alert an investigation for

A

lung cancer

49
Q

Hallmark of COPD

A

airflow obstruction

50
Q

The only pharmacologic therapy demonstrated decrease mortality rates in COPD

A

Supplemental O2

51
Q

Strong predictor of future COPD exacerbations

A

history of prior exacerbations

52
Q

Bacteria frequently implicated in COPD exacerbations (3)

A
  • Streptococcus pneumoniae
  • Haemophilus injluenzae
  • Moraxella catarrhalis

In addition, Mycoplasma pneumoniae or Chlamydia pneumoniae are found in 5-10% of exacerbations

53
Q

The only three interventions shown to influence the natural history of COPD

A
54
Q

Most common way microorganisms gain access to the lower respiratory tract in pneumonia

A

Aspiration from the oropharynx

55
Q

Most common etiology of community-acquired pneumonia

A

Streptococcus pneumoniae

56
Q

Major risk factor for anaerobic pneumonia

A

Combination of
* an unprotected airway ( e.g., in patients with alcohol or drug overdose or a seizure disorder)
* and significant gingivitis

57
Q

Organism well known to complicate influenza infection

A

S. aureus

58
Q

Organism well known to cause necrotizing pneumonia

A

S. aureus

59
Q

To be adequate for culture, a sputum sample must have
* ____neutrophils
* ____sq cells per lpf

A

> 25 neutrophils
<10 squamous cells per lpf

60
Q

Most frequently isolated pathogen in blood cultures or community·acquired pneumonia

A

Strep pneumoniae

61
Q

Irreversible airway dilation that involves the lung in either a focal or a diffuse manner

A

Bronchiectasis

62
Q

Most common form of bronchiectasis

A

cyclindrical or tubular

63
Q

Most widely cited mechanism of infectious bronchiectasis

A

Vicious Cycle Hypothesis - susceptibility to infection and poor mucociliary clearance result in microbial colonization of the bron· chial tree.

64
Q

Most common clinical presentation of bronchiectasis

A

Persistent productive cough with ongoing production of thick, tenacious sputum

65
Q

Imaging modality of choice for confirming bronchiectasis

A

chest CT

66
Q

First step in the diagnostic approach to pleural effusion

A

Determine whether effusion is a transudate or exudate

67
Q

Leading causes of transudative pleural effusion (2)

A

LV failure and cirrhosis

68
Q

Lab test that is Virtually diagnostic that the effusion is secondary to congestive heart failure.

A

pleural fluid NT-proBNP >1500 pg/mL

69
Q

Most common cause of chylothorax

A

Trauma (most frequently thoracic surgery), but it also may result from tumors in the mediastinum

70
Q

Three tumors that cause ~75% of all malignant pleural effusions

A
  • Lung carcinoma
  • Breast carcinoma
  • Lymphoma
71
Q

Term for Benign ovarian tumors producing ascites and pleural effusion

A

Meigs syndrome

72
Q

Condition most commonly overlooked in the DDX of patient with an undiagnosed effusion

A

pulmonary embolism

73
Q

Treatment of choice for most cases of chylothorax

A

Insertion of a chest tube plus administration of octreotide

74
Q

Primary spontaneous pneumothoraxes
occur almost exclusively in what px population

A

smokers

75
Q

how to diagnose OSA/Hypopnea syndrome

A
76
Q

differentiate apnea vs hypopnea

A
77
Q

First step in evaluating a mediastinal mass

A

Place it in one of the three mediastinal compartments

78
Q

most common lesions in the anterior mediastinum (4)

A
79
Q

masses of vascular origin are found at what compartment of mediastinum

A
80
Q

hernia through foramen of Bochdalek is found at what compartment of mediastinum

A
81
Q

Most common preventable cause of death among hospitalized patients.

A

pulmonary embolism

82
Q

Most common gas exchange abnormalities in Pulmo embo

A

Arterial hypoxemia and an increased 02 tension gradient,

83
Q

Hallmarks of massive PE (4)

A
  • Dyspnea,
  • syncope,
  • hypotension,
  • and cyanosis
84
Q

Most common symptom of DVT

A

Cramp of “‘charley horse” in the lower calf that persists and intensifies over several days

85
Q

Most common symptom of PE

A

Unexplained breathlessness

86
Q

Useful rule out test: > 95% of patients with normal levels do not have PE

A

Quantitative plasma D-dimer ELISA

87
Q

Most frequently cited ECG abnormality in PE (in addition to sinus tachycardia)

vs

Most common ECG abnormality in PE

A

S1 Q3 T3 sign
vs
T-wave inversion in leads V1 to V4

88
Q

Principal imaging test for the diagnosis of PE

A

Chest CT Scan with IV contrast

89
Q

Second-line diagnostic test for PE, used mostly for patients who cannot tolerate IV contrast

A

lung scan

90
Q

Best known indirect sign of PE on transthoracic echo

A

McConnell’s sign: hypokinesls of the RV free wall with normal motion of the RV apex

91
Q

what is McConnell’s sign:

A
  • hypokinesis of the RV free wall with normal motion of the RV apex
  • best known indirect sign of PE on transthoracic echo
92
Q

Definite diagnostic test for PE which visualizes an intra1uminal filling defect in more than one projection

A

pulmo angiography

93
Q

Foundation for successful treatment of DVTand PE

A

anticoagulation

94
Q

diagnostic criteria for ARDS

A
95
Q

Most cases of ARDS are caused by (2)

A

Pneumonia and sepsis (-40-60%)

96
Q

3 phases of ARDS

A
  • Exudative
  • Proliferative
  • Fibrotic phase
97
Q

The only Grade A recommendation in treatment of ARDS

A

Low VT ventilation
(6 mL/kg of predicted body weight)

98
Q

Mortality in ARDS is largely attributable to

A

Nonpulmonary causes, with sepsis and nonpulmonary organ failure accounting for >80% of deaths

99
Q

What is type 3 respiratory failure

A

Respiratory failure due to atelectasis (aka perioperative respiratory failure

100
Q
A

00000 IM PLATINUM BOARD CORRELATES (7 decks)

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