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Internal Medicine > Pulmonary > Flashcards

Pulmonary Flashcards

0
Q

Pt in sepsis then become dyspnic, tachypneic hypoxic and hypercapnic. Dx? Test? Rx? Complications from treatment?

A

CXR, ABG, PCWP( tells difference btw ARDS and carcinogenic pulmonary edema - pressure in left heart will be severely elevated), if pt is acutely ill u can do bronchoscopy with alveolar lavage. Rx: oxygenation , PEEP, fluid management. Complications - from peep -barotrauma (pneumothorax) and hypotension due low cardiac output due to low venous return , nocosomial infections

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1
Q

Obese Pt sleeps during day all the time. Wife says he snores a lot. On physical exam you notic large tonsils. Dx? Test ? Rx? Complications of OSA?

A

Obstructive sleep apnea. Sleep study (polysomnogrsphy). Mild to moderate ( 20 apneic episodes) - CPAP, if fails then uvuolplstopharyngoplasty, if field then tracheostomy complications is pulmonary and systemic HTN.

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2
Q

120 pack year smoker presents with worsening hoarsness, dyspnea, cough, hemoptysis and weightloss for 6 months. Dx? Test? Rx?

A

Bronchiogenic Carcinoma. Bronchoscopy for centrally located carcinomas (sqamous and small cell) If not central located(Large cell and adenocarcinoma - associated with non smokers) then Needle Aspiration Biopsy.

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3
Q

How to diagnose mediastinal tumors?

A

Mediastinoscopy

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4
Q

How to treat small cell carcinoma vs large cell carcinoma?

A

Large cell can be excised. Small cell can not be excised, needs radiation and chemo ( CAP- Cyclophosphamide, Adriamycin, Platinum)

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5
Q

Young nonsmoker found to have a single pulmonary nodule that is calcified and

A

Follow up CTs. Old smoker you would resect and do tissue diagnosis.

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6
Q

Fever, malaise, cough, athralgias, Blurry vision, upper respiratory complaints, erythema nodosum. Dx? Test? What will it show? Rx?

A

Sarcoidosis. CXR will show bilateral hilar adnepathy. May show granulomas. Granulomas on heart causing restrictive cardiomyopathy. Elevated ACE and hypercalciuria and hypercalemia. Definitive test is biopsy which shows non caseating granulomas. Rx is steroid. Most symptoms will resolve in 2 years.

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7
Q

5 pulmonary causes of hemoptysis ?

A
  1. Bronchitis 2. Broncitectasis 3.lung cancer 4. pulmonary embolism 5. TB
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8
Q

What is the next test after diagnosing obstructive dz with PFTs

A

Bronchodilator reversiblility test diagnose asthma vs copd. If reversible you have asthma

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9
Q

If a patient has normal PFTs and you suspect asthma what is he next test to perform for diagnosis ?

A

Methocoline challenge test.

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10
Q

Most common cause of abnormal extra pulmonary restriction ? Name another cause.

A

Kyphoscoliosis. Obesity is another. This is restrictive dz associated with normal DLCO. Abnormal would be a pneumocosis which is not extra pulmonary.

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11
Q

What is the most common cause of fixed extra thoracic obstruction that will decrease the volume flow loop on inspiration and expiration? Name another cause.

A

Laryngeal edema. Another cause is tracheal stenosis.

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12
Q

Test and rx for obstructive and central sleep apnea ?

A

Test: polysomnogrsphy ( sleep study) for obstructive pts need CPAP. For central patients need acetozolamide or progesterone.

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13
Q

Name the findings of ARDS with each test. 1. Physical exam 2. CXR 3. ABGs 4.Swan-Ganz Catheter Treatment?

A
  1. Rales 2. White out of lung 3. Decreased PO2 and increased or normal pco2 4. Increase pulmonary artery pressures. Treat underlying disorder and give peep
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14
Q

Name one cause of causing hypoxemia and normal A-a gradient.

A

Barbituite over dose causing cns depressions and hypoventilation.

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15
Q

What pharmocologic therapy can exacerbate asthma it? Rx for acute asthma exacerbation?

A

Aspirin and NSAIDS can exacerbate. Rx give 1. 02 2.beta 2 dual neb and 3. systemic steroid for 10-14 days .

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16
Q

Chronic asthma rx? Which reduces hospitalization/exacerbations? Which one is used in children and why? When is it used in adults - under what variant?

A
  1. Short acting beta 2 agonist and inhaled steroids (oral thrush). Steroids reduce exacerbations 2. If they still have prolong nocturnal symptoms - add long acting beta 2 (salmeterol and formeterol) 3. Still failing then add anticholinergic (tiotrpium and iptropium) these are used for heart dz patients with asthma. 4. still not better- Leukotriene modifier (zileuton, zafirkast) 5. Cromolyn better use in children they try to avoid steroids that stunt growth. In adult it’s used for exercise induced asthma.
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17
Q

Chronic rx of COPD?

A
  1. Ipotropium or tiotropium 2. Albuterol 3. Theophylline
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18
Q

Name 2 things that decrease mortality in COPD patients?

A

Smoking cessation and home O2 ( needed at <88%)

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19
Q

Rx of acute COPD exacerbation ?

A
  1. Albuterol 2. Systemic steroids 3. Abx azithromycin (check theophylline levels) 4. Supplemental 02 5. If needed CPAP or BIPAP.
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20
Q

Young child with chronic cough and foul smelling mucopurulent sputum that fills up 3 cups. Also has hemoptysis. Dx? Test ? Rx?

A

Bronchiectasis. High resolution CT. Give abx (cipro, gentamicin, ceftazidime ) in acute exacerbation only to cover gram negatives. Bronchial hygiene is important since the cilia are impaired. Pseudomonas. For cf patients can treat with vtiamins and pancreatic enzymes (to help with diarrhea and malabsorption)

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21
Q

Man presents with excericse intolerance for 6 months. Negative pmhx. No medications. Never smoked. He complains SOB. RR 24 JVd is 8cm, clubbing present, pedal edema. On CXR there is diffuse reticular dz. Dx? What’s the most specific test? Rx?

A

Idiopathic pulmonary fibrosis. High resolution ct show ps ground glass appearance. CXR the lower lungs are affected upper lungs are spared. Then PFTs, lavage and and biopsy to rule out infection, vasculitis No effective on rx. Can try supplemental 02 and steroids. Definitive is lung transplant.

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22
Q

Young patient with no other symptoms but has bilateral hilar adenpathy dx?

A

Sarcoidosis

23
Q

Pt presents with papules and swollen joints dx? Test? Rx?

A

Sarcoidosis (lofgren syndrome) - erythema nodosum and arthritis athralgias. CXR shows bilateral hilar adenopathy. ACE and hypercalcemia. Rx: Systemic steroids

24
Q

Fever, parotid gland enlargement (CN 7 palsy), uveitis. dx?

A

Heerfordt-waldenstorm syndrome - another type of sarcoidosis

25
Q

Pt has pleural plaques and pleural thickening on CXR. Dx? What is seen on biopsy? What part of the lung is affected? What is the common cancer ?

A

Asbestosis. Affects the Lower lung like idiopathic. Bar bell bodies seen on biopsy. Bronchopneumonia carcinoma is the most common.

26
Q

Cause is pottery, mining and sandblasting. What does CXR and biopsy show? Where in the lung does it affect? What infection is associated with this?

A

Silicosis. CXR shows calcification of nodules or lymph nodes. Biopsy confirms silica dust. Associated with to make sure pts have PPD.

27
Q

< age 35, no smoking history, has calcified nodule. Next step?

A

Look at previous X-ray if new then Follow up 6 months.

28
Q

> 50 yrs age, smoking history, calcified nodule

A

Look at repeat X-ray and make sure it’s new. Then perform ct guided biopsy or open lung biopsy.

29
Q

What is the limitation to pet scan ?

A

If patient has high glucose this can lead to false positive

30
Q

Lymphocytic and predominant Exudative effusions. Dx? Test? Rx?

A

TB. ADA level, PCR, AFB, pleural biopsy (confirmatory study)

31
Q

What test is used for centrally located lesions? What to use of this test is equivocal ?

A

Bronchoscopy. Use needle aspiration biopsy if equivocal and for peripheral nodules.

32
Q

What test is used for peripheral nodules ?

A

Needle aspiration biopsy

33
Q

What cancer has the highest yield for sputum cytology?

A

Squamous cell carcinoma

34
Q

Name 4 conditions that cause bronchiogenic carcinoma to be unresctable. What is one exception.

A
  1. Outside the lung 2. In the pleura 3. On both sides of the lungs 4. If it’s close to the Mainstem Bronchus exception : small lung tumor with single metastasis to brain.
35
Q

Rx for malignant pleural effusion?

A

Give teteracycline to sclerose the area

36
Q

Which cancer has the worst prognosis ?

A

Small cell carcinoma (adh ) and Cushings ACTH

37
Q

Pt with distended neck veins and discoloration of face dx? Test? Rx?

A

Pancoast tumor suppressing superior vena cava. CXR shows nodule. Needs to be irriradiated for relief.

38
Q

Cavitation lesion with calcification and it moves with position (mobile)

A

Aspergillosis

39
Q

Post op day 3 pt is confused and has slurred speech. Neck veins are distended. BP is 96/50. Hr is 122. EKG shows RBBB. Dx?

A

Massive pulmonary embolism.

40
Q

Fever, malaise, productive cough and hemotyisis with eosinophilia. Present in patients with asthma or CF. Dx?

A

Allergic Bronchopulmonary Aspergilosis

41
Q

Pt with ARDS on FIO2 of 70%, tidal volume of 370ml and rate of 14min has a ph of 7.45 P02 of 59, PC02 of 30, hco3 of 21 what’s the next best step?

A

Add peep, alveolar are probably significantly collapsed. Try not to increased FIO2 greater than 40 this could lead to O2 toxicity and barotrauma.

42
Q

Smoker presents with bilateral wrist thickening, distal finger thickening with convex nail beds. Dx? When is this seen? What should you do?

A

Hypertrophic osteoathropathy seen in lung cancer so get chest xray.

43
Q

Asthma, crhonic rhinosinusitis, nasal polyps and bronchospam after ingestion of aspirin or NSAIDs. Dx?

A

Aspirin Exacerbated Respiratory Disease

44
Q

Name 2 important side effects of Beta 2 agonist?

A

Palpitations and hypokalemia causing muscle weakness.

45
Q

Pt with 25 pack year hx presents cough, fatigue with drooping of R eyelid and miosis and shoulder pain. Dx? Next step in management?

A

Suspect Pancoast turmor - lung cancer. Get a CXR.

46
Q

Pt has reccurent pneumonia and sinusitis infections as well as mutliple gastroenteritis infections. Dx?

A

Think IgA dificiency or some other type of immunodeficiency and not CF because CF will not have gastroenteritis issues.

47
Q

After establishing diagnosis of myasthenia with EMG and Ach antibody test. What is the next step?

A

CT scan to r/o thymoma.

48
Q

Name 3 main reasons ppl are placed on IVC filters.

A
  1. Previous surgery or bleed 2. Failed medical therapy. 3. HITT
49
Q

When is tPa used for PE?

A

When patient is hemodynamically unstable

50
Q

What kind of breath sounds would be heard with consolidation of the lung? pleural effusion of the lung?

A

Consolidation will have increase breath sounds (Bronchial breath sounds). pleural effusion will have decreased or distant breath sounds.

51
Q

For a patient with renal dz what type of heparin would you give them?

A

unfractionated over low molecular weight because renal failure can increase the levels of low molecular weight heparin and enhance bleeding risk.

52
Q

Pt presents with non healing ulcer, rhinorrhea and SOB. Dx?

A

Wegners granulomatosis.

53
Q

Prominent pulmonary arteries and enlarge heart border Dx? Test?

A

pulmonary hypertension. Xray can show prominent pulmonary arteries. ECG - RAD due to R ventricular hypertrophy ECHO- dilated right atrium and ventricle CAtherization - increased pulmonary artery pressure

54
Q

What 2 things are included in the modified Wells critieria?

A

D-dimer and CT angio. if Pe unlikely due d-dimer if pe likely go straight to CT agnio

55
Q

Explain CO2 narcosis in COPD patient. (3) reasons

A
  1. Excess 02 causes vasodilation and blood is directed to poorly ventilated areas which causes a decresae in C02 excretion 2.Increase 02 with hemoglobin and no space for CO2 to bind so that leads to decrease excretion 3. Decreases there respiratory drive
56
Q

Another common cause of cough not related, to ACEI, GERD and asthma? Rx?

A

Upper airway syndrome post nasal drip. Give antihistamines to suppress nasal secretions.

Internal Medicine (13 decks)

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