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[2a] A ⼀ Step 2 OD USLME > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

Name the Causes of ARDS (10)

A

ARDS

A= Aspiration vs. [Acute Pancreatitis] vs. [Air Fluid Embolus (amniotic)]

R= Radiation

D= Drugs vs. DIC vs. Drowning

S= Sepsis vs. Smoking vs. Shock

ARDS is a restrictive pattern that –> ⬇︎Lung Compliance, Pulm HTN and impaired gas exchange

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2
Q

Tx for ARDS

A

PEEP (Positive End Expiratory Pressure)

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3
Q

Based on GOLD Criteria, how should COPD pts be treated?

A
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4
Q

What are the 3 criteria for COPD Exacerbation

A

COPD

[Cough ⇪ with (Oral-Lung SPUTUM ∆ )]

[Pulmonary WHEEZING BL ➜ respiratory acidosis]

Dyspnea

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5
Q

Tx for COPD Exacerbation-4

A

“I’m having COPD Exacerbation! Give me DOPA! (but not really)”

  1. Duoneb (albuterol + ipratropium)
  2. O2 PRN via BiPAP (goal: 90-94% O2 Sat)
  3. [Prednisone 40 mg qd x 5]
  4. Abx (Azithro-⬇︎future events or Levoflox or Doxy)
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6
Q

Out of the Tx for COPD Exacerbation

Which improves survival?

________________

Which ⬇︎future events?

A

“I’m having COPD Exacerbation! Give me DOPA! (but not really)”

[O2 PRN via BiPAP (goal: 90-94% O2 Sat)]

________________

Abx (Azithro-⬇︎future events or Levoflox or Doxy)

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7
Q

Difference between [Dead Space Ventilation] and [Physiological shunting]

________________

Which causes Hypoxemia?

A

[Dead Space Ventilation] = [Ventilation with no perfusion]

________________

[Physiological shunting] = [Perfusion with no ventilation (think PNA)] ➜ [HYPOXEMIA refractory to supplemental O2]➜ SHUNTING of blood to better ventilated areas

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8
Q

What mediastinal masses are found in the…

A: Anterior mediastinum

B: Middle mediastinum

C: Posterior mediastinum

A

A: Anterior = Thymoma

B: Middle = Bronchogenic Cyst

C: Posterior = Neurogenic tumors (Meningocele/Lymphomas/Esophageal tumors)

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9
Q

For pts on ventilators, what are the best ventilator setting changes for ⬆︎ oxygenation-2 and why

A
  1. INC PEEP ( prevents alveolar collapse/Reopens old ones/Reduces shunting) AND Reduces mortality in ARDS pts
  2. INC FiO2 (note: >60% for long time–>proinflammatory O2 free radicals!)
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10
Q

Most common sx of Pulmonary Embolism-5

A
  1. Pleuritic Chest Pain
  2. SOB
  3. Cough
  4. Tachypnea
  5. Tachycardia

Physical Exam: Rales, low Fever, Hemoptysis

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11
Q

(LTOT-Long Term Oxygen Therapy) improves survival in Stage 4 COPD pts

When is LTOT indicated-3

________________

how many hours per day is it used?

A
  1. [PaO2 ≤55 mm Hg] OR
  2. [SaO2 ≤88] OR
  3. FEV1 < 30%

________________

used ≥15 hours/day!

In Cor Pulmonale pts, PaO2 LOE 59 or SaO2 LOE 89

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12
Q

Describe the Approach to a PE pt

A

W

L I H

P P D

N N P

N N i

________________

  • Wells = Don’t Die | Tell Team To | Calculate Criteria*
  • PERC = BREATHS*
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13
Q

Bronchiectasis Etx

A

Recurrent

[Poor mucociliary clearance] –> Bacterial infection –> Inflammation –> Bronchial Dilation and thickening–> [tenacious productive cough w/ hemopytsis]

________________

Dx = High Res CT Chest

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14
Q

Gold standard dx for Bronchiectasis

A

High Res CT chest scan (initial dx)

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15
Q

List the Obstructive causes of Bronchiectasis (2)

A

A:

1) Tumor
2) Foreign Body

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16
Q

List the Infectious causes of Bronchiectasis (2)

A

1) TB
2) [Aspergillus Fumigatus in ABPA]-Allergic BronchoPulmonary Aspergillosis] –> will be associated with [recurrent transient pulm infiltrates]

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17
Q

List the Congenital causes of Bronchiectasis (3)

A

1) Immunodeficient Syndromes
2) cystic fibrosis
3) Kartagener (1° Ciliary Dyskinesia)

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18
Q

List the Random causes of Bronchiectasis (3)

A

1) Rheumatoid Arthritis
2) Lupus
3) Graft

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19
Q

What is the most common cause of Hemoptysis

A

Bronchitis (usually [acute s/p viral infection] but could be chronic also)

Tx = supportive

Also think about: Bronchiectsis/TB/CA/Trauma/PE

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20
Q

Describe Bronchial Breath Sounds-2

A

[Loud-LONG EXPIRATION]

+

[Loud-short inspiration]

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21
Q

What does Bronchial breath sounds indicate?

________________

Where in the body are Bronchial bs normal?

A

Pulmonary Consolidation (alveoli are full of blood/pus/water–> SHUNT)

________________

OVER THE TRACHEA

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22
Q

Name Drugs that cause Asthma exacerbation and why-4

A
  1. NSAIDs (pushes Arachodonic Acid pathway to leukotriene production)
  2. ASA (pushes Arachodonic Acid pathway to leukotriene production)
  3. General B Blockers (bronchospasms)
  4. MgSO4 (⬆︎Histamine)
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23
Q

What’s the most significant finding in this CXR and what does it indicate?

A

Westermark Sign! = Pulmonary Embolus!

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24
Q

Formula for Alveolar-arterial oxygen gradient

A
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25
Normal Alveolar-arterial oxygen difference is **Less than** ⬜ . \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ What does Higher difference indicate?
[(Age/4) + 4] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ there's something blocking O2 transport from Alveoli ➜ artery
26
CXR findings for PE -3
1. Westermark sign 2. Hampton's hump (pulmonary infarction distal to thrombus)] 3. [Elevated hemidiaphragm 2/2 Atelectasis]
27
Indications for IVC Filter -2
1. Anticoagulation ctx 2. Recurrent DVT/PE **despite** anticoag
28
*Family hx of Thrombosis is best indicator for inherited hypercoagulability* Name the common inherited hypercoagulable diseases-5
1. Antiphospholipid Syndrome 2. Factor 5 Leiden 3. ⬆︎ Factor 8 4. Prothrombin 20210 mutation 5. Hyperhomocysteinemia
29
List 2 major signs of impending respiratory failure
1. Conversational Dyspnea 2. Abd paradoxus (abd moves **inward** during inspiration = diaphragmatic fatigue)
30
*Hospitalization, Nursing homes, abx use are common causes of healthcare-associated PNA* Name UnCommon causes of healthcare-associated PNA-5
1. Hemodialysis 2. Family member w/MDR pathogen 3. Outpatient wound care 4. Gastric acid suppressants (PPI, H2 blocker) 5. Tube feedings
31
Which **bacteria** cause PNA in Immunodeficient pts -4
**NACS** 1. **N**eg gram rods (***N**EUTROPENIC PTS*) 2. **A**spergillus 3. **C**andida 4. **S**taph A
32
Tx for Healthcare associated PNA 2/2 Pseudomonas -2
[Piperacillin/Tazobactam] vs. cefTAZidime ## Footnote "*Zoe* needs *Pipe* from *Tae*"*(Piperacillin / Tazobactam)*
33
Supplemental O2 should be given with what O2 Sat goal? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Why is this?
90-94 % \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ below 90% --\> HUGE ⬇︎ Hb Saturation
34
Dead Space % is represented in formulas by ____ and is defined as \_\_\_\_
VD/VT ; % of Tidal volume that is NOT partcipating in gas exchange (*anatomic vs physiologic*)
35
⬜*% of Tidal Volume (VT) is normally Dead Space* What conditions ⬆︎Dead space -3
Normally, **30% of VT is Dead Space** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. PE 2. Pulmonary HTN 3. Volume Depletion
36
Name the Conditions in which **Diffusion Capacity** is *INCREASED* (3)
A: [CHF vs. Polycythemia vs. Hemorrhage] --\> INC DLCO ## Footnote *\*\*All others (PILEA) DEC diffusion capacity\*\**
37
What is FDG-PET? How are results interpreted?-3
*fluorodeoxyglucose (FDG)-positron emission tomography (PET)* Pt is given radioactive sugar water --\> taken up my tumor as main source of energy--\> SUV (Standard uptake value) \>3 SUV = Malignant 2 - 3 = Inderterminate \<2 = benign *not good for Brain/Liver/Kidney CA*
38
What are the Cons of FDG-PET?
NOT good for Brain/Liver/Kidney CA
39
What are the minimal PFT requirements before Lung CA resection - 2 ;
[PreOp FEV1 GOE 2L] or [Predicted PostOp FEV1 GOE 0.8L] ## Footnote *If MD expects to resect 25% Lung volume and pt PreOp FEV1 is 1.5 L, then Predicted PostOp FEV1 will = 1.125 L*
40
Describe the system used to diagnose DVT
Wells Criteria!
41
DVT tx - 2
[Therapeutic (Heparin v Enoxaparin)] now \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ➜ [Px (Warfarin v NOAC)] x 3 mo
42
Advantages of Enoxaparin over Unfractionated Heparin - 4
Enoxaparin... 1. Longer half life = administered SubQ qD/BID (but note: this also means it takes longer to reverse if surgery is needed) 2. No Lab monitoring 3. FIXED Dosing 4. ⬇︎probability of HIT Thrombocytopenia
43
*You hear Stridor in a patient* What is your DDx?-4 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ How can you differeniate between them?
Biphasic = Inspiratory AND Expiratory (Vascular Ring) *LaryngoMalcia: Laying down is Malicious (Supine worsens Stridor)*
44
Tx for Croup
Nebulized Racemic Epi breathing tx
45
Laryngomalacia Etx
Collapse of supraglottic structures during inspiration --\> *Laying down is Malicious (LaryngoMalacia) = Supine worsens Stridor*
46
**Asthma** Etx
Excess TH2 cells *(recruited by hypersensitive APC to inhaled allergens)* secrete **IL4** --\>activates [B-lymphocyte class switching for IgE Ab]--\> IgE binds to Mast cells which will then secrete **IL5** --\> Recruits Eosinophils--\>which release mediators like Leukotrienes.
47
List the 5 Step Asthma action plan based on SABA use -4
48
List the 5 Step Asthma action plan based on Nighttime Awakenings -4
49
Describe Kerley B lines and what they represent
Interstitial fluid in lung tissue appearing as 3 cm linear densities in lung periphery = CHF
50
*Orthopnea differs from Paroxysmal Nocturnal Dyspnea in that it occurs **while pt is awake** EVERY time they lie down* Which conditions are associated with Orthopnea? - 6
1. CHF which can --\> Pulmonary Edema 2. Pulmonary edema 3. Asthma 4. Chronic Bronchitis 5. OSA 6. Panic Disorder
51
Why is an inspiratory hold maneuver performed?
To measure the pulmonary compliance (sum of the elastic pressure) so that the PEEP can be matched with that
52
Common side effects for Beta 2 agonist - 4
1. **hypOkalemia** --\> muscle weakness, arrhythmias 2. Palpitations 3. Tremor 4. HA
53
Imaging findings for Bronchogenic Carcinoma - 3 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Asbestos --\> Bronchogenic carcinoma \> mesothelioma*
1. [**BL** Pleural Plaques and thickening] (pleural mesothelioma will have uL pleural ∆ ) 2. Honeycoming (cystic areas surrounded by interstitial infiltrates) 3. BL CENTRAL reticulonodular infiltrates \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *smoking enhances asbestos damage. SOB comes from fibrosis, NOT pleural calcifications*
54
Which pulmonry process targets the bilateral lower lobes of the lung?
AAT-Alpha 1 antitrypsin deficiency --\> Panacinar Basilar predominant emphysema --\> **⬇︎Bilateral Breath Sounds** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Smoking --\> Upper lobe centriacinar emphysema*
55
Alpha 1 Antitrypsin Dx? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Tx?
Dx=serum AAT levels \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Tx = Pooled AAT *This is a Panacinar Basilar predominant disease*
56
What is the difference between Aspiration Pneumonitis and Aspiration PNA?
A Pneumonitis = Lung inflammation from gastric acid A PNA = Lung INFECTION from oropharygeal secretions
57
How do you diagnose Asthma - 2
1. FEV1/FVC ⬆︎ ≥12% with Bronchodilator OR 2. FEV1/FVC ⬇︎ ≥20% with Methacholine
58
How can you tell if a pt has GERD-induced or ASA-induced asthma, or true asthma?
True asthma will be REVERSIBLE with bronchoDilator. Others will NOT!
59
Somter's Triad describes ⬜ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ What is the triad? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Tx?
Drug-induced Asthma \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. Asthma (or chronic rhinosinusitis) 2. Nasal Polyps 3. [ASA sensitivity] is the cause \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Tx = Montelukast Leukotriene inhibitor
60
Most lung conditions cause a respiratory (⬜acidosis/alkalosis). Why is this? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Which lung condition causes the opposite of this?
Respiratory **Alkalosis**; PE, atelectasis, pleural effusion, pulm edema --\> V/Q mismatch --\> compensatory tachypnea \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ alveolar hypOventilation --\> respiratory acidosis
61
What is the mainstay tx for COPD
Muscarinic R Blockers
62
Name the conditions associated with Granulomas - 6
1. TB 2. Tertiary syphillis gummas 3. Blastomycosis 4. Histoplasma 5. Sarcoidosis 6. Churg Strauss Eosinophilic Granulomatosis with Polyangiitis
63
How do pts with ____ minimize their [Work of Breathing] A: ***Obstructive*** Disorders B: ***Restrictive*** Disorders
A: ***O**bstructive*= [sl**OO**w + Deep] Breaths B: *Restrictive*= [fast + shallow] Breaths
64
*Based on the image:* Is the pathology **Obstructive** vs. **Restrictive** vs. **Tracheal Stenosis**
**Obstructive - *Emphysema*** *(intraAlveolar wall destruction)*
66
What is **Bronchiectasis**
[Chronic Necrotizing Inflammation of Bronchi & Bronchioles]---\> [Permanent **Dilatation** of Bronchi & Bronchioles] ---\> [Daily Copious Mucus production]
67
Is ARDS an obstructive, restrictive or normal breathing pattern?
**RESTRICTIVE** So is Laryngeal Edema
68
What is normal Jugular Venous Pressure? - 2
\<4cmH20 OR \<7mmHg
69
Name the diseases that are Obstructive but with a Low Diffusion Capacity
70
Name the diseases that are Obstructive but with a Normal Diffusion Capacity - 2
71
Name the diseases that are Obstructive but with a HIGH Diffusion Capacity
72
Name the diseases that are Restrictive but with a low Diffusion Capacity - 4
73
Name the diseases that are Restrictive but with a Normal Diffusion Capacity - 2
74
Name the diseases that are Restrictive but with a HIGH Diffusion Capacity
75
Name the diseases that are Normal Spirometry but with a low Diffusion Capacity - 3
76
Name the diseases that are Normal Spirometry but with a HIGH Diffusion Capacity - 2
77
*A Diagnostic pleuracentesis is performed* HIGH LEVELS OF AMYLASE are detected \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Causes -2
1. PANCREAS ASSOCIATED 2. esophageal rupture
78
Would you expect CHF to cause respiratory Alkalosis or Acidosis? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Why?
Respiratory Alkalosis \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ CHF pulm edema --\> tachypnea
79
What should the goal O2 sat be when placing a COPD pt on supplemental Oxygen? ; Why is this?
SaO2: 90-93% only HIGH O2 will knock out COPDers drive to breath --\> hypOventilation --\> Respiratory acidosis --\> cerebral vasoDilation --\> seizures and AMS
80
What are the 3 key things to remember when manging ARDS
1. Prevent SpO2 \< 88% (may need to use high PEEP\> 5) 2. Prevent alveolar overdistension with low tidal volumes ≤6cc/kg 3. Prevent Hyperventilation (RR x TV) as this --\> Respiratory Alkalosis \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *ARDS etx = Lung injury --\> fluid and cytokine leakage into the alveoli --\> refractory hypoxia and Pulm HTN*
81
Hypersenstivity Pneumonitis etx \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ mngmt?
[bird droppings or molds a/w farming] ➜ lung parenchymal inflammation \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Avoidance episodes last 4-6 hrs after exposure and chronically can --\> pulm fibrosis
82
What is the most common side effects for long term inhaled Corticosteroids?
Oral Candidasis (Thrush) for **INHALED CTS**
83
What's the most sensitive *renal* indicator for a pt who's Hypovolemic/Dehydrated?
⬇︎Urine Na+ ## Footnote Urine Na:Urine Creatinine \< 1%
84
In pts with PE, what is the mechanism for why they have symptoms?
**Pulmonary Infarction** from the embolus --\> sx
85
In Asbestos Interstitial Lung Disease, what is the mechanism for why pts become SOB?
Pulmonary Fibrosis (restrictive lung disease) ## Footnote *Image: Pleural Plaques = pathopgnomonic*
86
What are the major causes of Interstitial Lung Disease - 4
1. Dust inhalation (Asbestos, Beryllium, Silicon) 2. Drugs (Amiodarone, Bleomycin, Macrobid) 3. Radiation 4. Connective tissue disease (RA, Scleroderma)
87
Pulmonary Bleb rupture is the most common cause of spontaneous ptx in pts with ⬜
COPD
88
Risk factors for Aspiration PNA - 4
1. Altered consciousness due to EtOH 2. Vomiting due to EtOH 3. Neurologic dysphagia (stroke) 4. Mechanical disruption of glottic closure (ET or NG tube)
89
cp for MASSIVE Pulmonary Embolism - 3
1. hypOtension 2. JVD 3. RBBB acutely from severe R Heart Strain
90
Chronic smokers who present with suddent joint pains is suggestive of ⬜ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ This indicates what underlying disease?
hypertrophic osteoarthropathy \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ LUNG CA
91
What is the purpose of Chest Physiotherapy? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Indication?
Loosens mucus and promotes expectoration of secretions \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Bronchiectasis
92
A diagnostic pleuracentesis is performed There are high levels of Triglycerides present Dx
Chylothorax exudate from lymph leaking out of the thoracic duct (milky white fluid)
93
List the 5 Step Asthma action plan Treatment
94
Any pt with Decreased Breath Sounds Bilaterally should be suspected for \_\_\_\_\_\_
AAT - Alpha 1 Antitrypsin Deficiency Panacinar Emphysema ## Footnote *Look for fam hx (NonAlcoholic Liver cirrhosis) or slight transaminitis*
95
Alpha 1 Antitrypsin deficiency cp - 3
1. **⬇︎breath sounds bilaterally** (from panacinar basilar predominant emphysema) 2. transaminitis (could be slight) 3. +/- Skin panniculitis ## Footnote *NonAlcoholic Liver Cirrhosis is 2nd most common cause of death in these pts*
96
Chronic Bronchitis diagnostic criteria
3 consecutive months of [tenacious productive cough] within a 2 year period
97
In Idiopathic Pulmonary Fibrosis interstitial lung disease, would you expect Alveolar-arterial gradient to be High or low? ; Why?
HIGH (A-a gradient = difference between oxygen content in Alveoli and artery) IPF (collage deposition in peri-alveolar tissue) ILD --\> impaired gas exchange
98
How does Lung Consolidations present? - 3
1. ⬆︎breath sounds 2. ⬆︎tactile fremitus 3. Dullness to percussion
99
Kartagener Syndrome cp triad ; etx?
1. Situs Inversus 2. Recurrent Sinusitis (impaired mucociliary clearance) 3. Bronchiectasis (impaired mucociliary clearance) etx = primary ciliary dyskinesia
100
What are the main complications of [positive pressure mechanical ventilation] - 2
1. tension PTX --\> hypOtension 2. alveolar overdistension
101
Why is it alarming when a pt who clearly has ⬆︎Work of Breathing has a normal pH and normal PaCO2?
If they visually have ⬆︎WOB than you expect their PaCO2 to be low and pH to be low but if these values are normal, the pt is likely going into **RESPIRATORY COLLAPSE** and can no longer maintain adequate ventilation due to fatigue
102
How do these parameters change in COPD pts Elasticity Compliance
alveolar Elasticity (how well tissue snaps back) **DECREASES** --\> ⬇︎ability to expel air alveolar Compliance **INCREASES** --\> making it easier for incoming air to fill alveoli BOTH of these --\> diaphragm flattening, difficulty expanding thoracic cavity --\> ⬆︎WOB
103
Tx for Upper Airway Cough Syndrome
1st Gen Antihistamine +/- Decongestant
104
How do Anaerobic lung infections present on imaging?
**CAVITARY** **LESIONS** (not lobar infiltrate) in lower lobes ## Footnote (*lobar infiltrates more likely represent typical PNA*)
105
Describe the following values for PNA: breath sounds tactile fremitus percussion
⬆︎bs / ⬆︎TF / Dullness to percussion
106
Describe the following values for Pleural Effusion: breath sounds tactile fremitus percussion
⬇︎bs / ⬇︎TF / Dullness to percussion
107
Describe the following values for PTX or emphysema: breath sounds tactile fremitus percussion
⬇︎bs / ⬇︎TF / Hyperresonance to percussion
108
What are the txs for SIADH - 1st/2nd/3rd line?
1st: FLUID RESTRICTION 2nd: Hypertonic saline 3rd: ADH R Blocker (Demeclocycline)
109
What paraneoplastic syndromes are Small Oat Cell Lung carcinoma (SOLC) associated with? - 2
1. SIADH 2. ACTH (Cushings Syndrome)
110
Pts with underlying lung disease like ____ are at risk for develoing chronic pulmonary aspergillosis Diagnostic criteria for this?
cavitary TB; Dx = ALL 3 must be present 1. \>3 mo sx (fever, wt loss, hemoptysis) 2. Cavitary lesions contains aspergilloma fungal balls 3. IgG serology positive for Aspergillus
111
Where is lung ADC located? ; what's the most important prognostic factor?
peripherally ; Stage at diagnosis since survival is determiend by resectability
112
Main clinical characteristic of Microscopic Polyangiitis ; Which antibody?
Hemoptysis; p-ANCA
113
Main clinical characteristic of Wegener Granulomatosis with polyangiitis-2 ; Which antibody?
Hemoptysis and ELK; **C**-ANCA
114
DDx for Hemoptysis - 5
**BBcTT** 1. \*\*\* **B**ronchitis - MOST COMMON! \*\*\* 2. **B**ronchiectasis 3. **C**ancer 4. **T**B 5. **T**rauma (PE)
115
What are the common causes of clubbing? - 2
1. Lung ADC 2. Cystic Fibrosis
116
Silicosis ⬆︎risk for developing _____ and causes _____ lesions on imaging Which demographics are mostly affected?-2
TB ; cavitary lung lesions 1. Stone Workers 2. Miners ***Stone Miners*** *are **Sili** and they're going to get **TB**!*
117
Physiologically, what causes hypoxemia in pts with Pneumonia?
Ventilation/Perfusion mismatch - a shunt occurs direct blood away from alveoli and this is why O2 supplement barely help
118
pt presents with pulmonary nodules surrounded by ground glass opacities Dx? ; Tx?-2
Aspergillosis tx: 1. Voriconazole AND 2. Caspfungin Image shows "halo sign"
119
Brutons X linked agammaglobulinemia etx
**low B lymphocytes** --\> low Ig --\> sinopulmary and GI infections ## Footnote *puts pt at risk for infections like Giardia*
120
* Cyclosporine and Tacrolimus have the same MOA* * Side Effects for these two are similar as well.* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ List side effects for Cyclosporine - 4 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ which 3 does Tacrolimus share?
1. Gum Hypertrophy - Cyclosporine 2. Hirsuitsm - Cyclosporine 3. Nephrotoxicity with HyperKalemia 4. Tremor
121
Side effects of Azathioprine - 3
1. Diarrhea 2. Hepatotoxicity 3. Leukopenia
122
Side effect of Mycophenolate
Marrow Suppression
123
A neonate is born with absent T cells and dysfunctional B cells Diagnosis? ; Tx?
Severe Combined ImmunoDeficiency (SCID) ; Stem Cell Transplant Absent T causing fucked up B
124
In pts with chronic granulomatous disease, there is an impaired _______ which leads to ⬆︎infection with which organisms? ; Dx?-2
oxidative burst ; catalase positive (Staph A, Serratia, Burkholderia) 1. nitroblue tetrazolium OR 2. dihydrorhodamine Both of these are neutrophil function test
125
What is Leukocyte Adhesion Deficiency associated with? - 3
1. Delayed umbilical cord separation 2. periOdontal disease 3. recurrent sinopulmonary infection
126
After transplant, when does Acute Cellular Rejection occur? ; How does it present? - 3
\<90 days ; 1. RUQ pain 2. Transaminitis 3. Fever *HYPERacute occurs in \< 7 days*
127
Hereditary Angioedema etx
deficiency or dysfunction of C1 inhibitor --\> ⬆︎bradykinin and C2b
128
pts with pharyngeal cobblestoning likely have _____ and need to be treated with \_\_\_\_\_\_
allergic rhinitis ; nasal corticosteroids
129
MOD for Severe Combined Immunodeficiency (SCID) ; tx?
Defective T cell maturation --\>dysfunctional B cells --\> recurrent **viral, fungal, bacterial** infections "Absent T causing fucked up B" Tx = stem cell transplant
130
MOD for Common Variable Immunodeficiency
**hypOgammaglobulinemia** --\> recurrent Sinopulmonary and GI bacterial infections
131
Wiskott Aldrich Syndrome presents at what stage of life? ; cp?-3
infancy; 1. eczema 2. bleeding 3. sinopulmonary infections MOD = disables cytoskeleton remodeling
132
Why should a pt with recurrent sinopulmonary and GI infections be **thoroughly** screened before receiving blood transfusions?
They could have Selective IgA Deficiency which --\> production of Anti-IgA in their blood. After receiving blood transfusion those Anti-IgA would --\> anaphylaxis
133
MOD for Hyper IgM Syndrome ; What would the laboratory values show? -4
CD40 ligand defect --\> **severe sinopulmonary infections** ; 1. Hyper IgM 2. low IgG 3. low IgA 4. normal lymphocyte (CD4/CD8) populations
134
Guidelines for Lung CA screening - 3
**low dose annual CT** if fits all 3 criteria: 1. [55-80 yo] 2. smoked for 30 pack years 3. still smoking or quit within last 15 years * Pack Year = [# of packs/day x # of years smoking]* * ex: [4 packs/ day x 30 years smoking = 120 pack years]*
135
Normal Respiratory Rate
12-20
136
Normal Sodium level
135-145

[2a] A ⼀ Step 2 OD USLME (21 decks)

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