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PANCE review > pulmology > Flashcards

pulmology Flashcards

1
Q

asthma is what type of disease

A

immunological (hyper-responsiveness to IgE that has been released from trigger)

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2
Q

asthma is what type of disease

A

immunological (hyper-responsiveness to IgE that has been released from trigger)

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3
Q

ABG with SEVERE asthma attack

A

respiratory low Pa02, respiratory acidosis

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4
Q

tests to asthma

A

FEVI, Peak Flow, lungs and symptoms reversible with bronchodilator

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5
Q

X-ray asthma attack, what if no attack?

A

big lung and flatten diagram, no attack it will be normal

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6
Q

asthma has what % FEVI/FVC

A
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7
Q

ABG with severe asthma attack

A

respiratory low Pa02

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8
Q

tests to asthma

A

Peak Flow, lungs

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9
Q

X-ray asthma attack, what if no attack?

A

big lung and flatten diagram, no attack it will be normal

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10
Q

the triad involving asthma

A

The triad: atopy, nasal polyps, NSAID allergy

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11
Q

acute tx for asthma

A

O2, Beta-agonists (inhaled albuterol) sc terbutaline,
IV epinephrine
can be added: inhaled ipratropium, Corticosteroids (po/IV)
Magnesium and BiPAP (non-invasive mechanical ventilation)

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12
Q

chronic tx for asthma

A

Mast cell stabilizers (cromolyn)
Leukotriene inhibitors (montelukast or zileuton
Long acting β2-agonists (salmeterol)

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13
Q

asthma symptoms everyday, every night

A

severe persistant asthma

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14
Q

intermittent asthma and tx

A

almost no symptoms, > 2 days a week, most likely only need albuterol

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15
Q

mild asthma tx

A

use albuterol + low dose inhaled steroids

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16
Q

moderate asthma tx

A

Short acting and LONG acting beta agonist and inhaled steroid

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17
Q

what if patient is already on short and long acting beta agonist, and inhaled steroid but having break through therapy?

A

increase inhaled steroid dose or for severe add oral steroids + immune suppressive agent Omalizumab (causes anaphylaxis) works by binding IgE.

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18
Q

majority of PE are caused by_____from where in the body_______

A

Emboli from the Lower extremities

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19
Q

hampton’s hump and westermark on xray

A

HH: white lesion 1/2 circle attached to pleura, PE

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20
Q

EKG findings of PE

A

non-specific ST changes, tachycardia

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21
Q

what is Aa gradient

A

report card of how well body takes air from environment and shuttles it through alveoli to blood stream

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22
Q

the right heart is working hard with a PE, what are the EKG findings specific to this

A

S1Q3T3.
big wave p wave (p pulmonale).
Inverted Ts V1-V4.

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23
Q

you suspect PE, but d dimer is positive, what test is done next? (remember pt will be short of breath)

A

CT pulmonary angiogram and then VQscan (ventilation and perfussion scan)……US of chest will show a huge right ventricle

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24
Q

treatment for PE

A

HEPARIN, fibrinolysis (only in BAD cases) , mechanical thrombectomy, and IVC filter

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25
Q

signs of pulmonary HTN (right sided heart problem)

A

right ventricle heaving and prominent P2

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26
Q

what causes pulmonary HTN?

A

COPD and chronic PEs

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27
Q

tx for pulmonary HTN?

A
  1. O2
  2. vasodilator (sildenafil)
  3. chronic anticoagulant
  4. transplant
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28
Q

worst lung cancer

A

small cell

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29
Q

most common lung cancer

A

adenocarinoma (50% non-smokers)

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30
Q

where does small cell metastasize to

A

Iiver, bone, brain, adrenal

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31
Q

what is horner syndrome

A

pan coast tumor in the apex of the lung compresses the sympathetic nerve causing ptosis and mitosis of the eye

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32
Q

What is SVC obstruction

A

lung cancer tumors block drainage of vena cava and makes new routes

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33
Q

smoker with cancer symptoms and high calcium =

A

squamous cell carcinoma

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34
Q

tx lung ca

A

cut is to cure, then radiation…finally cancer

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35
Q

tx pulmonary nodule

A

CT guided biopsy (low risk people can follow just with imagining for first couple of months)

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36
Q

pulmonary carcinoid

A

cancer, pulmonary version grows in the bronchus and releases serotonin. This causes flushing, diarrhea, and bronchospasm

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37
Q

tx for pulmonary carcinoid

A

otreotide scintigraphy

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38
Q

what cell increases with asthma?

A

goblet cells

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39
Q

Bronchiectasis (most common cause)

A

CF

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40
Q

what organs does CF affect

A

lungs, pancreas, intestines

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41
Q

what organism causes infections in CF

A

pseudomonas

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42
Q

COPD, liver failure, but no smoking. what is the dx?

A

Alpha 1 antitypsin

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43
Q

how does the inflammation in asthma and COPD differ?

A

COPD is mediated with neutrophil, which destroys the lungs. whereas Asthma is just hypertrophy

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44
Q

what is COR PULMONALE

A 
chronic lung disease and hypoxia causes
pulmonary vasoconstriction (b/c lungs experience chronically low O2 level and become stenosis)  which leads to pulmonary HTN and right-sided heart failure
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45
Q

why does home O2 work for COPD

A

reduces the narrowing and pressure in the lungs

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46
Q

how do you DX COPD

A

pulmonary function test

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47
Q

treatment for severe COPD

A

O2, steroid, beta 2 agonist, and BiPAP

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48
Q

what are blebs with COPD confused with on X-ray

A

pneumothorax

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49
Q

another name for small cell lung cancer

A

oat cells

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50
Q

syndrome that occurs with lung cancer

A

paraneoplastic syndromes

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51
Q

what do pulmonary function tests reveal for CF

A

mixed obstructive and restrictive pattern

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52
Q

finding for pulmonary function test and restrictive dz?

A

all get smaller

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53
Q

what do medication can cause restrictive lung disease

A

amiodarone and nitrofuratoin

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54
Q

patient has x ray that shows reticulonodular & honeycombing with clubbing or erythema nodosum. what category of restrictive diz

A

ldiopathic pulmonary fibrosis

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55
Q

Bilateral hilar adenopathy, with high ca+ what lung dz?

A

sarcoidosis

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56
Q

linear opacities at bases and pleural plaques worked in industrial environment

A

asbestosis

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57
Q

nodular opacities at upper lung field?

A

coal mining or silicosis

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58
Q

what do medication can cause restrictive lung disease

A

amiodarone and nitrofuratoin

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59
Q

acute respiratory distress syndrome =

A

noncardiogenic pulmonary edema (normal sized heart with kerly b-lines)

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60
Q

Hypoxia: pO2 0.5
Normal heart function: no evidence of CHF
Diffuse infiltrates: with normal heart size. BUT
X-ray shows pulmonary edema
what is the diagnosis?

A

ARDS

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61
Q

ARDS is caused by

A

sepsis, multiple trauma and aspiration of gastric contents

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62
Q

increased permeability of the alveolar capillary membranes which lead to protein rich edema, PE shows frothy pink or red sputum, diffuse crackles. what is this? tx?

A

ARDS (end point, lung failure due to sepsis)

Tx: supportive and low levels of positive end expiratory pressure.

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63
Q

what do you do with aspiration of foreign body?

A

bronchoscopy, remove FB and get cultures if post obstructive pneumo is suspected.

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64
Q

who gets hyaline membrane dz

A

preterm infants

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65
Q

hyaline membrane is caused by

A

membrane surfactant

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66
Q

X-ray shows ground glass appearance and domed diaphragm. what is the dx

A

hyaline membrane disease.

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67
Q

you suspect FB aspiration, what imagines do you order

A

expiratory film: expiratory view: failure of right lung to deflate on lateral decubitus film indicates a
foreign body in the right main stem bronchus. Right main stem usually lodges here due to anatomy

lateral soft tissue neck.

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68
Q

exam findings for pleural effusion

A

dullness to percussion, mediastinum usually shifted

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69
Q

x ray shows meniscus, blunting of costophrenic angle

A

pleural effusion

70
Q

isolated left-sided pleural effusion

A

pneumonia, PE, cancers, Boerhaave syndrome
(esophageal rupture), aortic dissection. goes to Left b/c of weakness in wall on that side. CHF will not be isolated to the left side.

71
Q

exudate effusion due to?

A

thick nasty fluid, infection, CA or trauma

72
Q

transudate effusion

A

thin and watery. due to intake capillaries that are overloaded or low oncotic pressure. caused by medical conditions; CHF, renal or liver failure

73
Q

is glucose low or high in exudate

A

low: infections the bugs are eating the sugars

74
Q

how does treatment differ from exudate vs. transudate

A

exudate must be pulled out of lung. Transudate may be treated medically.

75
Q

bilateral pleural effusions suggest

A

CHF (transudate)

76
Q

right sided pleural effusion

A

CHF, pneumonia, PE, cancer

77
Q

test to figure out effusion vs emphyema

A

X-ray on side (thick emphyema will not change position) effusion is more watery and will migrate

78
Q

tx for emphyema

A

early on use chest tube, may need surgery

79
Q

imagining that shows difference between parechymal and pleural densities

A

try x-ray, then go to CT

80
Q

gold standard to diagnosis effusion

A

thoracentesis

81
Q

what tests are sent with thoracentesis fluid?

A

protein, LDH, glucose, WBC,and gram stain

82
Q

thoracentesis fluid shows: increased LDH and protein, decreased glucose. what type of effusion

A

exudative

83
Q

thoracentesis fluid shows: low LDH, low protein and high glucose

A

transudative

84
Q

tx for malignant effusions

A

drainage pleurodesis. using doxycycline and talc

85
Q

tx for large pneumo (spontaneous)

A

Heimlich flutter valve:

86
Q

x ray shows: collapsed lung, loss of vascular markings in the periphery, visible cupola

A

pneumothorax

87
Q

primary cause of pneumo

A

spontaneous, manfans

88
Q

secondary

A

trauma, pneumonia,

89
Q

tension pneumo is tx with?

A

needle to chest, decompress and tube

90
Q

small pneumo

A

resolved spontaneously, place on O2.

91
Q

you are thinking a simple pneumo, but the patent’s blood pressure drops and O2 sat drops =

A

tension pneumo

92
Q

where to place needle to decompress

A

2nd mid-clavicular line 2 intercostal space, or 5-6th rib mid-axillary

93
Q

when do you place Tube thoracostomy?

A

hemopneumothorax, persistent or recurrent

pneumothorax

94
Q

tx sicker kids with bronchiolitis

A

hospitalization, steroids, Ribavirin for confirmed RSV

95
Q

usually caused by RSV and during winter, wheezing in kids under 2 years old, usually viral. Fever, mild respiratory distress

A

Acute Bronchiolitis

96
Q

steep sign

A

croup

97
Q

Wheezes kid, you think acute bronchiolitis, all sudden wheezes stop…think

A

collasped airway

98
Q

do you need labs with acute bronchiolitis?

A

no you can swab for RSV

99
Q

tx sicker kids with bronchiolitis

A

hospitalization, steroids, Ribavirin for confirmed RSV

100
Q

thumb print sign

A

epiglotitis

101
Q

steep sign

A

croup

102
Q

croup is most commonly caused by?

A

Parainfluenza virus type 1 in kids 3 months to 3 years

old in Fall and early Winter

103
Q

tx for croup if patient comes to ER or office

A

humidified air or oxygen, nebulized epinephrine q15-20min,

oral/IM/IV dexamethasone (0.6mg/kg up to 10mg), IV fluids if necessary

104
Q

The most common “complication” from a typical influenza

A

pneumonia

105
Q

what do you use to treat pneumonia caused by influenza

A

antiviral—can move to be bacteria

106
Q

best influenza test

A

Reverse transcription polymerase chain reaction (RT-PCR) is best

107
Q

pertussis is caused by

A

Bordetella Pertussis is a Gram negative coccobacillus causing respiratory infection
● HIGHLY contagious

108
Q

test to confirm pertussis

A

viral cultures, PCR and serology

109
Q

tx for pertussis

A

supportive. if

110
Q

if kids have not been vaccinated for pertussis give

A

DTaP. For adults give booster Tdap

111
Q

x ray findings for reactivation TB

A

fibrocavitary apical disease and ghon complexes

112
Q

does the TST skin test differentiate between active or latent forms

A

no

113
Q

definitive dx requires the id of m. tuberculosis from?

A

cultures or DNA/RNA amplification

114
Q

does acid fast bacilli on sputum confirm dx?

A

no, only supports dx

115
Q

Hallmark histologic finding

A

caseting granulomas

116
Q

isoniazid, rifampin, pyrazinamide, and ethambutol are

A

TB drugs

117
Q

how is active TB treated

A

with all drugs for 2 month, followed by 4 months of additional drug therapy

118
Q

SE effects of isoniazid

A

hepatitis, periperial neuropathy

119
Q

SE effects of Rifampin

A

hepatitis, flu syndrome, orange body fluid

120
Q

how are pt with HIV treated

A

therapy for a least 1 year

121
Q

what is the bacilli Calmette guerin vaccine

A

TB vaccine given to individuals in high risk settings

122
Q

typical pneumonia organisms

A

Strep pneumoniae, Haemophilus influenzae, Klebsiella, Moraxella

123
Q

common most organisms overall

A

Strep pneumoniae, gram + dipplococci

124
Q

typical pneumonia signs and symptoms

A

abrupt onset fever/chills, cough with sputum, abnormal vitals, abnormal lung exam, and an obvious lobar infiltrate on CXR

125
Q

Atypical pneumonia organisms

A

Mycoplasma (MOST COMMON), chlamydophila, legionella, and viruses like influenza, RSV,
and parainfluenza

126
Q

current colored sputum

A

Klebsiella

127
Q

what is the difference between, pneuococcal polysaccharide vaccine and pneumococcal conjugate vaccine

A

PPSV: children 2-5 who have not been previously immunized and those over 65yo
PCV: four doses for children 6 weeks and 15 weeks

128
Q

rust colored sputum

A

Strep pneumoniae

129
Q

low grade fever, cough, bullous myringitis, cold agglutinins

A

mycoplasma pneumo

130
Q

high procalcitonin levels suggest what type of pneumonia

A

bacteria

131
Q

who not to give vaccine to?

A

egg allergy

132
Q

what is the difference between, pneuococcal polysaccharide vaccine and pneumococcal conjugate vanccine

A

PPSV: children 2-5 who have not been previously immunized and those over 65yo
PCV: four doses for children 6 weeks and 15 weeks

133
Q

treatment for typical pneumonia

A

marcolide (clarithromycin, azthromycin or doxycycline)

134
Q

X-ray chest for atypical infection

A

fluffier infiltrate

135
Q

college student has what type of pneumonia

A

chlamydia and mycoplasma

136
Q

Alcohols have what type of pneumonia

A

klebsiella

137
Q

most common cause of bacterial pneumonia in HIV

A

streptococcus

138
Q

COPD + pneumonia

A

H. flu

139
Q

air condition + pneumonia

A

legionella

140
Q

bird dropping + pneumonia

A

histo or chlamydia

141
Q

tx: CAP but person is sick enough to be admitted

A

3rd gen cephalosporin+macrolide, or a FQ by itself

142
Q

tx CAP with co-morbidities

A

fluoroquinolone (FQ) OR Augmentin + a macrolide

143
Q

tx CAP

A

macrolide like azithromycin, or maybe doxycycline

144
Q

influenza can cause pneumonia do antivirals help

A

yes. zanamivir and oseltamivir

145
Q

Hospital acciqured bugs include

A

s. aureus, gram negative bacilli

146
Q

what bug causes ICU pneumo

A

pseudomonas

147
Q

tx hospital /ICU pneumo with?

A

ceftriaxone, cefepime and imipenem

148
Q

_____ is the most common cause of opportunistic infections in HIV

A

pneumocystis jiroveci

149
Q

pneumocystis jiroveci occurs when CD4 counts drop below what number

A
150
Q

how do you dx pneumocystis pneumonia

A

sputum spain via induced sputum or bronchalveloar lavage

151
Q

tx for HIV with pneumocystis infections

A

Bactrim (trimethoprim-sulfamethoazole) . Also, used prophylactic when CD4 counts are below 200 cells

152
Q

what type of pneumo with Cystic fibrosis

A

pseudomonas

153
Q

what type of pneu if you are under one

A

RSV

154
Q

pneum associated with post viral infection

A

staph. aureus

155
Q

what physical exam finding are consistent with chronic silicosis.

A

Diffuse rhonchi and low pitched rales

156
Q

Idiopathic pulmonary fibrosis findings

A

honeycombing and restrictive

157
Q

What is the therapy of choice for a patient diagnosed with Coccidioidomycosis?
A.

A

The first line drug of choice for Valley Fever is fluconazole. Patient may remain on therapy up to 6 months to prevent relapse while recovery is monitored via serum complement fixation titers.

158
Q

Which acid-base abnormality is most commonly associated with chronic obstructive pulmonary disease?

A

respiratory acidosis

159
Q

name the 3 stages of pertussis

A

The three phases of pertussis that have been described are catarrhal, paroxysmal, and convalescent. The catarrhal phase is characterized by upper respiratory symptoms such as nasal congestion, rhinorrhea, and sneezing and this phase is when the patient is most infectious. The paroxysmal phase is the phase of intense episodes of coughing with post-tussive vomiting. The convalescent phase is the phase in which symptoms begin to resolve, but the patient may have a lingering cough for weeks.

160
Q

ou suspect that he has a partial obstruction of the trachea due to a foreign body. What is the most appropriate next step in the care of this patient?

A

Bronchoscopy is the definitive test to confirm the diagnosis of tracheal foreign body, and removal can be accomplished at the same time.

161
Q

young women with cough for 3 months and obstructive lung symptoms, she does not have asthma, what might she have?

A

Alpha-1-antitrypsin deficiency This deficiency allows the natural proteases produced in the lungs to break down the alveolar walls resulting in the emphysema-like symptoms.

162
Q

You have recently diagnosed a patient with a pulmonary embolism. While beginning anticoagulation therapy with heparin and warfarin, at what point can you discontinue heparin?

A

When the INR is greater than 2.0 (for 24 hours) heparin therapy can be discontinued. Warfarin therapy should be continued with an INR goal of between 2.0 and 3.0.

163
Q

Which of the following organisms is likely to cause a lobar pneumonia

A

Streptococcus pneumoniae

164
Q

fungal pneumonia, which of the following drugs would be contraindicated?

A

steroids

165
Q

A common complication in placing a subclavian central venous catheter is which of the following?

A

Pneumothorax

166
Q

gold standard to dx TB

A

putum cultures revealing Mycobacterium tuberculosis are the gold standard in diagnosis of pulmonary TB. Typically sputum samples are obtained in the morning on three consecutive days.

167
Q

what are the lung cancer screen recommendations for smokers and what imaging is used?

A

recommend low-dose chest CT scan annually for high-risk individuals (age 55-74 years with 30-pack year smoking history)

168
Q

On physical exam you note clubbing of the fingers and inspiratory crackles diffusely throughout both lungs. Chest x-ray reveals pleural plaques with a reticular pattern through both lung bases. What is the most likely diagnosis for this patient?

A

Asbestosis

169
Q

ou suspect she may have pulmonary hypertension. What is the next best step in the diagnostic workup of this patient?

A

Trans-thoracic echocardiogram

170
Q

By what mechanism do inhaled corticosteroids enhance the overall effectiveness of other pharmacologic agents used in the treatment of asthma?

A

The preservation of beta-2 receptors in the lungs allows medicines such as albuterol to remain tolerance free over time.

171
Q

In the treatment of pulmonary tuberculosis, what should be coadministered with isoniazid to reduce the risk of peripheral neuropathy?

A

b6

172
Q

x-ray findings of foreign body in the lungs

A

Ipsilateral hyperlucency and hyperexpansion of the ipsilateral hemithorax

PANCE review (19 decks)

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