Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Pulmonology > Pulmo > Flashcards

Pulmo Flashcards

1
Q

2.2cm peripheral spicy later nodule with eccentric calcification - next best step?

A

Surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Features of spn- factors increasing malignant probability?

7 features

A 
Large size
Advance age
Female
Active or previous smoking
Family or personal history of lung ca 
Upper lobe location
Spiculated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Nodule- .8

A

Less than 6mm - no follow up

More than 8 mm- additional management or follow up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

If nodule more than 8mm what will u do ?

A

Additional if any of 7 features present- intermediate or high probability category- requires biopsy or surgical excision
This has 5 % probability of malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

2cm Spiculated nodule, in smoker- >50 percent malignant probability- what to do?

A

Timely surgical excision, thoracotomy or VATS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Acute PTE- modified wells score

A

> 4 - high pretest probability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Drug for alcohol withdrawal

A

Benzodiazepines - lorazepam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Signs of alcohol withdrawal

A

History of heavy alcohol use
48-96 hours after hospital admission
Sympathetic nervous system activation- agitation, tachycardia , hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Opioid poisonin- hydrocodone

A

Naloxone

Signs- hypoventilation leading to hypoxemia, somnolent with decreased respiratory rate and pinpoint pupils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Fever causes

A

> 101 is fever
Infection, rheumatologic , malignancy , medication

Acute PTE- cause fever- cause of tissue necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Clostridium difficile colitis- features

A

Fever, abdominal tenderness, diahrroea, recent antibiotic use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Bronchiolitis features

A 
Nasal congestion
Rhinorrhoea
Coarse breath sounds
Wheezing with or without crackles
Low grade fever
Increase work of breathing - chest retra
Nasal flaring
Grunting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When to hospitalise RSV bronchiolitis child

A 
With respiratory distress
Apnea
Hypoxia  
Dehydration
Should follow contact and droplet precautions to prevent nosocomial spread
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Treatment of bronchiolitis

A 
IVF
NASAL BULB SUCTIONING
HUMIDIFIED O2
No need of inhaled bronchodilator 
No antibiotics- use only in secondary pneumonia - fso - high fever , focal crackles, consolidation on x ray

For immunocompromise with severe disease- ribavarin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Season for RSV bronchiolitis

A

Winter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When to give palivizumab for infants

A

Preterm <29 weeks
Chronic lung disease of prematurity
Hemodynamically sig CHD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Complications of RSV BRONCHIOLITIS

A

Apnea- infants less than 2 months

Respiratory failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When to do antigen testing or NAAT in RSV

A

In patients receiving palivizumab prophylaxis - as RSV infection provides active immunity
- then pali should be discontinued

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

RSV complI in older patients

A

Recurrent wheezing in 30 percent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

IVC filter indications

A

Complications of anticoagulant
Contraindication
Failure of anticoagulant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Laryngeal Edema features

A

Post extubation stridor
Resp failure
Occurs in 30 percent - 5 percent requires- reintubation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Risk factors for l. Edema

A

Female
Small tracheal diameter
Large et tube
Prolonged duration

How to prevent- give iv multiple dose steroids prior to extubation

If signs of Resp failure is there- consider reintubation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Features of extubation failure

A

Symptoms of impending failure-
Ph <7.35 or paco2- >45
Clinical signs of Resp failure
RR more than 25/min for 2 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Risk factors for extubation failure

A

Weak cough
Frequent SUCTIONING
Poor mental status
Positive fluid balance 24 hours prior ṭo extubation
Pneumonia as intial cause of respiratory failure
Age >65
Comorbid conditions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
NI PPV FOR WHOM
Copd patients to prevent re intubation and decrease mortality
26
Prior to extubation -
Give steriods to decrease the risk of failure
27
OSA STOP BANG QUESTIONAIRE
``` Snoring Excessive daytime tiredness Observed apnea or choking or gasping High BP BMI More than 35 ; Age more than 50 Neck size - men >17 inch ; female>16 Male gender ``` One point for each 0-2 low risk 3-4 - intermediate >5- high risk
28
OSA-
Do polysomnography Due to nocturnal hypoxia- causes cognitive impairment in elderly- irritability, poor concentration, decreased short term memory
29
Features of sepsis
Hypotension, hypothermia and leukocytosis- infection from undetermined source.
30
qSOFA score
RR - > 22 /min Altered mentation Systolic BP less than 100 One point each More than 2 means septic
31
Two major intial interventions to reduce mortality
1) aggressive IVF - 30 ml per kg is given over the first 3 hours 2) early broad spectrum antibiotics - within one hour eg- vancomycin plus cefepime.
32
Supplemental O2 in copd does what?
It improves oxygenation of a lung unit that has a low ventilation perfusion ratio.
33
How is hypoxia caused in copd?
By v/q mismatch Emphysematous component of COPD causes air flow limitation - which is due to destruction of elastic tissue and bronchiolar collapse. - second component is bronchitis limiting air flow. Copd exacerbation- causes mucus plugging and bronchospasm - which limits air flow Lot of vq mismatch areas- reason for hypoxemia in copd- low vq will cause vasoconstricton - so air is directed to good vq areas. Supplement O2- reach alveoli - increase in q - as it removes vasoconstricton - improves gas exchange to blood- hypoxemia improves. Emphysema- dead space ventilation increase - leading to high vq in these areas- which is due destruction of alveolar- capillary interface- this mechanism is responsible for hypercapnia. Here 02 improves v . But q doesn't significantly improve- so less effective mechanism
34
SPN features
Rounded opacity Surrounded by lung parenchyma <3 cm diameter No LN If stable for 2-3 years- leave it.
35
Large size spn
More than 2cm - independently correlates with more than 50 percent malignant probability
36
Surveillance for more than 8mm lesions
Repeat ct in 3 months - this is only for nodules with low malignant probability - eg- 1cm nodule in 50 yo man- non smoker
37
IVC filter indications
Complications of anticoagulant Contraindication Failure of anticoagulant
38
How is snoring caused?
Respiration induced soft tissue vibration in the setting of a relaxed upper airway during sleep. Can be isolated or a part of OSA. More than 50 percent don't have OSA STOP Bang questionnaire - has high negative predictive value
39
Smoking and alcohol in snoring
Both increases snoring Alcohol- causes relaxation. Of pharyngeal muscles Stop these first If not respond- do oral appliance - physical manipulation of airway- mandible advancement, tongue retraction Surgical - uvulopalatopharyngoplasty
40
Prelimi test for OSA
Nocturnal O2 saturation Gold std- polysomnography
41
Septic Shock features
Hypothermia, hypotension, leukocytosis - has an ongoing infection from an undetermined site. See if there is sepsis- qSOFA score- RR more than 22 Altered mentation Systolic BP less than 100 More than 2 - septic
42
TB in HIV
New or reactivation can occur No cavitation occurs Lobar , pleural or disseminated infection occurs Features- fever, cough, pleurisy and weight loss Thoracocentesis- lymphocyte predominant exudative effusion. Elevated adenosine deaminase- occurs both in malignancy and tb Pleural effusion occurs due to hypersensitivity to m. Tubercular antigen, pleural fluid is aseptic So do pleural biopsy - to confirm
43
ART in Tb
Att started first - then ART after 1-2 weeks delay- to reduce IRIS- immune reconstitution inflammatory syndrome
44
PCP
Indolent fever, dyspnea, dry cough and bilateral interstitial infiltrates. Usually with sputum BAL is second line
45
Histo in HIV
Febrile wasting illness- fever, fatigue, weight loss, vomiting and dyspnea X-ray - diffuse infiltrates
46
Lung cancer Screening recommendation
Yearly with low dose CT 55-80 years Eligibility for screening based on smoking history- pt with more than 30 pac year history and who is a current smoker or quit smoking with last 15 years Termination- above 80 years, quit more than 15 years ago , less life expectancy Smokers have 10-30 fold increase risk . Cumulative risk- 30 percent in heavy smokers to 1 percent in non smokers
47
Smoking cessation
Reduce COPD , copd exacerbations and luṅG ca Lung ca by 80-90 % if left more than 15 years ago in comparison with current smokers
48
Rapid sequence intubation
Rapidly acting sedative- etomidate, propofol, midazolam Paralytic agent- succinylcholine , rocuronium No benzodiazepines - decrease respiratory drive Nippv- for copd exacerbation
49
New Rbbb in PE
Means RV strain- bedside echo - RV DYSFUNCTION, decreased contractility and RV thrombus Massive embolism- pul HT leading to dilatation of tricuspid valve annulus and moderate TR INFERIOR AND POSTERIOR WALL HYPOKINESIA - in MI
50
Capnography- quantitative waveform or calorimetric analysis
Normal rectangular waveform- all waves are present - measures end tidal co2 If flat- et is in esophagus Calorimetric test- paper changes from purple to yellow
51
Pertussis
``` Lethal Relentless coughing fits Post tussiv emesis Apnea Lymphocyte predominant leukocytosis Sick contacts with cough paroxysms ```
52
Mycoplasma pneumonia
School age and young adults Malaise, headache and fever Rhinorrhoea and sore throat Progress to atypical pneumonia - walking pneumonia - doesn't cause bronchiolitis
53
Croup- laryngotracheitis
Hoarseness Barky cough Inspiratory stridor Parainfluenza Fall or early Winter month- 6months to 3 years Rx- mild- no stridor- humidified ( to soften the secretions and prevent drying)air-+ steroids (single dose oral or im) Moderate or severe- stridor at rest- corticosteroids plus nebulized epinephrine Prevention- hand washing , decontamination of surfaces, proper ventilation Pa neck - steeple sign- subglottic Edema Self limited- resolves within a week
54
Cough variant asthma
Non productive cough Due to exertion or cold air exposure- bronchospasm Allergens- dust and mites are triggers Wheezing and rhochi are absent Treatment is same as asthma
55
Treatment of asthma
``` Intermittent(<2/2)- SABA Mild persistent(more than 2/ 3-4 times a month) Low dose ICS ``` MODERATE( daily/more than once weekly)- low dose ICS and LABA or medium dose ICS SEVERE PERSISTENT- ( throughout the day/ 4-7 times a week) - step 4- medium dose ICS and LABA STEP 5- high dose ICS and LABA and consider omalizumab for allergics Step 6- step 5 + oral steroids
56
Trachea alavida
Coughing Sob Stridor Weakness of tracheal walls - expiratiory air way collapse Chest tightness - present in asthma
57
Transient tachypnea of new born
TTN- due to retained Fetal lung fluid - decreased clearance Cesarean, prematurity, maternal diabetes Cf- tachypnea, increase work of breathing Clear breath sounds Cxr- hyperinflation, fluid In fissures, cardiomegaly, prominent vascular markings and small effusion Rx- supportive care- O2 , nutrition Resolves in 1-3 days
58
RDS
in premature infants - lack of surfactant Persistent wheezing and steriod dependence- have chronic lung disease Cxr- GGO with air bronchograms
59
Vsd murmur
Holosystolic
60
Calcification in spn
Popcorn, laminated, central and diffuse homogenous- benign Eccentric, reticular or punctate- malignant
61
Acute bronchitis
With copd- give antibiotics | For those with increased dyspnea, sputum volume and purulence
62
Mitral stenosis
Recurrent laryngeal nerve compression- due to LAE- ortners syndrome Mitral facies- pink purplish patches on cheeks Loud S1 , loud s2 if pulmonary ht Opening snap - high frequency early diastolic sound Mid diastolic rumble- best at apex Cxr- pbf to upper lobes , dilated pulm vessels, LAE, flattened left heart border Ecg- p mitrale, broad and notched p waves, atrial tachyarrhthmias, RVH ( tall R waves in v1 and v2 ) TTE- MV thickening / calcification / decreased mobility , coexisting MR

Pulmonology (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions