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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
Q

Normal Alveolar-arterial oxygen difference is Less than ⬜ .

________________

What does Higher difference indicate?

A

[(Age/4) + 4]

________________

there’s something blocking O2 transport from Alveoli ➜ artery

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26
Q

CXR findings for PE -3

A
  1. Westermark sign
  2. Hampton’s hump (pulmonary infarction distal to thrombus)]
  3. [Elevated hemidiaphragm 2/2 Atelectasis]
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27
Q

Indications for IVC Filter -2

A
  1. Anticoagulation ctx
  2. Recurrent DVT/PE despite anticoag
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28
Q

Family hx of Thrombosis is best indicator for inherited hypercoagulability

Name the common inherited hypercoagulable diseases-5

A
  1. Antiphospholipid Syndrome
  2. Factor 5 Leiden
  3. ⬆︎ Factor 8
  4. Prothrombin 20210 mutation
  5. Hyperhomocysteinemia
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29
Q

List 2 major signs of impending respiratory failure

A
  1. Conversational Dyspnea
  2. Abd paradoxus (abd moves inward during inspiration = diaphragmatic fatigue)
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30
Q

Hospitalization, Nursing homes, abx use are common causes of healthcare-associated PNA

Name UnCommon causes of healthcare-associated PNA-5

A
  1. Hemodialysis
  2. Family member w/MDR pathogen
  3. Outpatient wound care
  4. Gastric acid suppressants (PPI, H2 blocker)
  5. Tube feedings
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31
Q

Which bacteria cause PNA in Immunodeficient pts -4

A

NACS

  1. Neg gram rods (NEUTROPENIC PTS)
  2. Aspergillus
  3. Candida
  4. Staph A
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32
Q

Tx for Healthcare associated PNA 2/2 Pseudomonas -2

A

[Piperacillin/Tazobactam] vs. cefTAZidime

“Zoe needs Pipe from Tae“(Piperacillin / Tazobactam)

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33
Q

Supplemental O2 should be given with what O2 Sat goal?

________________

Why is this?

A

90-94 %

________________

below 90% –> HUGE ⬇︎ Hb Saturation

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34
Q

Dead Space % is represented in formulas by ____ and is defined as ____

A

VD/VT ; % of Tidal volume that is NOT partcipating in gas exchange (anatomic vs physiologic)

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35
Q

⬜% of Tidal Volume (VT) is normally Dead Space

What conditions ⬆︎Dead space -3

A

Normally, 30% of VT is Dead Space

_________________

  1. PE
  2. Pulmonary HTN
  3. Volume Depletion
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36
Q

Name the Conditions in which Diffusion Capacity is INCREASED (3)

A

A: [CHF vs. Polycythemia vs. Hemorrhage] –> INC DLCO

**All others (PILEA) DEC diffusion capacity**

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37
Q

What is FDG-PET? How are results interpreted?-3

A

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

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38
Q

What are the Cons of FDG-PET?

A

NOT good for Brain/Liver/Kidney CA

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39
Q

What are the minimal PFT requirements before Lung CA resection - 2 ;

A

[PreOp FEV1 GOE 2L] or [Predicted PostOp FEV1 GOE 0.8L]

If MD expects to resect 25% Lung volume and pt PreOp FEV1 is 1.5 L, then Predicted PostOp FEV1 will = 1.125 L

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40
Q

Describe the system used to diagnose DVT

A

Wells Criteria!

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41
Q

DVT tx - 2

A

[Therapeutic (Heparin v Enoxaparin)] now

________________ ➜

[Px (Warfarin v NOAC)] x 3 mo

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42
Q

Advantages of Enoxaparin over Unfractionated Heparin - 4

A

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
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43
Q

You hear Stridor in a patient

What is your DDx?-4

________________

How can you differeniate between them?

A

Biphasic = Inspiratory AND Expiratory (Vascular Ring)

LaryngoMalcia: Laying down is Malicious (Supine worsens Stridor)

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44
Q

Tx for Croup

A

Nebulized Racemic Epi breathing tx

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45
Q

Laryngomalacia Etx

A

Collapse of supraglottic structures during inspiration –> Laying down is Malicious (LaryngoMalacia) = Supine worsens Stridor

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46
Q

Asthma Etx

A

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.

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47
Q

List the 5 Step Asthma action plan based on

SABA use -4

A
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48
Q

List the 5 Step Asthma action plan based on

Nighttime Awakenings -4

A
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49
Q

Describe Kerley B lines and what they represent

A

Interstitial fluid in lung tissue appearing as 3 cm linear densities in lung periphery = CHF

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50
Q

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

A
  1. CHF which can –> Pulmonary Edema
  2. Pulmonary edema
  3. Asthma
  4. Chronic Bronchitis
  5. OSA
  6. Panic Disorder
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51
Q

Why is an inspiratory hold maneuver performed?

A

To measure the pulmonary compliance (sum of the elastic pressure) so that the PEEP can be matched with that

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52
Q

Common side effects for Beta 2 agonist - 4

A
  1. hypOkalemia –> muscle weakness, arrhythmias
  2. Palpitations
  3. Tremor
  4. HA
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53
Q

Imaging findings for Bronchogenic Carcinoma - 3

________________

Asbestos –> Bronchogenic carcinoma > mesothelioma

A
  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

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54
Q

Which pulmonry process targets the bilateral lower lobes of the lung?

A

AAT-Alpha 1 antitrypsin deficiency –> Panacinar Basilar predominant emphysema –> ⬇︎Bilateral Breath Sounds

________________

Smoking –> Upper lobe centriacinar emphysema

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55
Q

Alpha 1 Antitrypsin Dx?

________________

Tx?

A

Dx=serum AAT levels

________________

Tx = Pooled AAT

This is a Panacinar Basilar predominant disease

56
Q

What is the difference between Aspiration Pneumonitis and Aspiration PNA?

A

A Pneumonitis = Lung inflammation from gastric acid

A PNA = Lung INFECTION from oropharygeal secretions

57
Q

How do you diagnose Asthma - 2

A
  1. FEV1/FVC ⬆︎ ≥12% with Bronchodilator OR
  2. FEV1/FVC ⬇︎ ≥20% with Methacholine
58
Q

How can you tell if a pt has GERD-induced or ASA-induced asthma, or true asthma?

A

True asthma will be REVERSIBLE with bronchoDilator. Others will NOT!

59
Q

Somter’s Triad describes ⬜

________________

What is the triad?

________________

Tx?

A

Drug-induced Asthma

________________

  1. Asthma (or chronic rhinosinusitis)
  2. Nasal Polyps
  3. [ASA sensitivity] is the cause

________________

Tx = Montelukast Leukotriene inhibitor

60
Q

Most lung conditions cause a respiratory (⬜acidosis/alkalosis). Why is this?

________________

Which lung condition causes the opposite of this?

A

Respiratory Alkalosis; PE, atelectasis, pleural effusion, pulm edema –> V/Q mismatch –> compensatory tachypnea

________________

alveolar hypOventilation –> respiratory acidosis

61
Q

What is the mainstay tx for COPD

A

Muscarinic R Blockers

62
Q

Name the conditions associated with Granulomas - 6

A
  1. TB
  2. Tertiary syphillis gummas
  3. Blastomycosis
  4. Histoplasma
  5. Sarcoidosis
  6. Churg Strauss Eosinophilic Granulomatosis with Polyangiitis
63
Q

How do pts with ____ minimize their [Work of Breathing]

A: Obstructive Disorders

B: Restrictive Disorders

A

A: O**bstructive= [slOO**w + Deep] Breaths

B: Restrictive= [fast + shallow] Breaths

64
Q

Based on the image:

Is the pathology Obstructive vs. Restrictive vs. Tracheal Stenosis

A

Obstructive - Emphysema (intraAlveolar wall destruction)

66
Q

What is Bronchiectasis

A

[Chronic Necrotizing Inflammation of Bronchi & Bronchioles]—> [Permanent Dilatation of Bronchi & Bronchioles] —> [Daily Copious Mucus production]

67
Q

Is ARDS an obstructive, restrictive or normal breathing pattern?

A

RESTRICTIVE

So is Laryngeal Edema

68
Q

What is normal Jugular Venous Pressure? - 2

A

<4cmH20

OR

<7mmHg

69
Q

Name the diseases that are

Obstructive but with a Low Diffusion Capacity

70
Q

Name the diseases that are

Obstructive but with a Normal Diffusion Capacity - 2

71
Q

Name the diseases that are

Obstructive but with a HIGH Diffusion Capacity

72
Q

Name the diseases that are

Restrictive but with a low Diffusion Capacity - 4

73
Q

Name the diseases that are

Restrictive but with a Normal Diffusion Capacity - 2

74
Q

Name the diseases that are

Restrictive but with a HIGH Diffusion Capacity

75
Q

Name the diseases that are

Normal Spirometry but with a low Diffusion Capacity - 3

76
Q

Name the diseases that are

Normal Spirometry but with a HIGH Diffusion Capacity - 2

77
Q

A Diagnostic pleuracentesis is performed

HIGH LEVELS OF AMYLASE are detected

________________

Causes -2

A
  1. PANCREAS ASSOCIATED
  2. esophageal rupture
78
Q

Would you expect CHF to cause respiratory Alkalosis or Acidosis?

________________

Why?

A

Respiratory Alkalosis

________________

CHF pulm edema –> tachypnea

79
Q

What should the goal O2 sat be when placing a COPD pt on supplemental Oxygen? ; Why is this?

A

SaO2: 90-93% only

HIGH O2 will knock out COPDers drive to breath –> hypOventilation –> Respiratory acidosis –> cerebral vasoDilation –> seizures and AMS

80
Q

What are the 3 key things to remember when manging ARDS

A
  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
Q

Hypersenstivity Pneumonitis etx

________________

mngmt?

A

[bird droppings or molds a/w farming] ➜ lung parenchymal inflammation

________________

Avoidance

episodes last 4-6 hrs after exposure and chronically can –> pulm fibrosis

82
Q

What is the most common side effects for long term inhaled Corticosteroids?

A

Oral Candidasis (Thrush) for INHALED CTS

83
Q

What’s the most sensitive renal indicator for a pt who’s Hypovolemic/Dehydrated?

A

⬇︎Urine Na+

Urine Na:Urine Creatinine < 1%

84
Q

In pts with PE, what is the mechanism for why they have symptoms?

A

Pulmonary Infarction from the embolus –> sx

85
Q

In Asbestos Interstitial Lung Disease, what is the mechanism for why pts become SOB?

A

Pulmonary Fibrosis (restrictive lung disease)

Image: Pleural Plaques = pathopgnomonic

86
Q

What are the major causes of Interstitial Lung Disease - 4

A
  1. Dust inhalation (Asbestos, Beryllium, Silicon)
  2. Drugs (Amiodarone, Bleomycin, Macrobid)
  3. Radiation
  4. Connective tissue disease (RA, Scleroderma)
87
Q

Pulmonary Bleb rupture is the most common cause of spontaneous ptx in pts with ⬜

88
Q

Risk factors for Aspiration PNA - 4

A
  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
Q

cp for MASSIVE Pulmonary Embolism - 3

A
  1. hypOtension
  2. JVD
  3. RBBB acutely from severe R Heart Strain
90
Q

Chronic smokers who present with suddent joint pains is suggestive of ⬜

________________

This indicates what underlying disease?

A

hypertrophic osteoarthropathy

________________

LUNG CA

91
Q

What is the purpose of Chest Physiotherapy?

________________

Indication?

A

Loosens mucus and promotes expectoration of secretions

________________

Bronchiectasis

92
Q

A diagnostic pleuracentesis is performed

There are high levels of Triglycerides present

Dx

A

Chylothorax exudate

from lymph leaking out of the thoracic duct (milky white fluid)

93
Q

List the 5 Step Asthma action plan Treatment

94
Q

Any pt with Decreased Breath Sounds Bilaterally should be suspected for ______

A

AAT - Alpha 1 Antitrypsin Deficiency Panacinar Emphysema

Look for fam hx (NonAlcoholic Liver cirrhosis) or slight transaminitis

95
Q

Alpha 1 Antitrypsin deficiency cp - 3

A
  1. ⬇︎breath sounds bilaterally (from panacinar basilar predominant emphysema)
  2. transaminitis (could be slight)
  3. +/- Skin panniculitis

NonAlcoholic Liver Cirrhosis is 2nd most common cause of death in these pts

96
Q

Chronic Bronchitis diagnostic criteria

A

3 consecutive months

of [tenacious productive cough]

within a 2 year period

97
Q

In Idiopathic Pulmonary Fibrosis interstitial lung disease, would you expect Alveolar-arterial gradient to be High or low? ; Why?

A

HIGH (A-a gradient = difference between oxygen content in Alveoli and artery)

IPF (collage deposition in peri-alveolar tissue) ILD –> impaired gas exchange

98
Q

How does Lung Consolidations present? - 3

A
  1. ⬆︎breath sounds
  2. ⬆︎tactile fremitus
  3. Dullness to percussion
99
Q

Kartagener Syndrome cp triad ; etx?

A
  1. Situs Inversus
  2. Recurrent Sinusitis (impaired mucociliary clearance)
  3. Bronchiectasis (impaired mucociliary clearance)

etx = primary ciliary dyskinesia

100
Q

What are the main complications of [positive pressure mechanical ventilation] - 2

A
  1. tension PTX –> hypOtension
  2. alveolar overdistension
101
Q

Why is it alarming when a pt who clearly has ⬆︎Work of Breathing has a normal pH and normal PaCO2?

A

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
Q

How do these parameters change in COPD pts

Elasticity

Compliance

A

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
Q

Tx for Upper Airway Cough Syndrome

A

1st Gen Antihistamine +/- Decongestant

104
Q

How do Anaerobic lung infections present on imaging?

A

CAVITARY LESIONS (not lobar infiltrate) in lower lobes

(lobar infiltrates more likely represent typical PNA)

105
Q

Describe the following values for PNA:

breath sounds

tactile fremitus

percussion

A

⬆︎bs / ⬆︎TF / Dullness to percussion

106
Q

Describe the following values for Pleural Effusion:

breath sounds

tactile fremitus

percussion

A

⬇︎bs / ⬇︎TF / Dullness to percussion

107
Q

Describe the following values for PTX or emphysema:

breath sounds

tactile fremitus

percussion

A

⬇︎bs / ⬇︎TF / Hyperresonance to percussion

108
Q

What are the txs for SIADH - 1st/2nd/3rd line?

A

1st: FLUID RESTRICTION
2nd: Hypertonic saline
3rd: ADH R Blocker (Demeclocycline)

109
Q

What paraneoplastic syndromes are Small Oat Cell Lung carcinoma (SOLC) associated with? - 2

A
  1. SIADH
  2. ACTH (Cushings Syndrome)
110
Q

Pts with underlying lung disease like ____ are at risk for develoing chronic pulmonary aspergillosis

Diagnostic criteria for this?

A

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
Q

Where is lung ADC located? ; what’s the most important prognostic factor?

A

peripherally ; Stage at diagnosis since survival is determiend by resectability

112
Q

Main clinical characteristic of Microscopic Polyangiitis ; Which antibody?

A

Hemoptysis; p-ANCA

113
Q

Main clinical characteristic of Wegener Granulomatosis with polyangiitis-2 ; Which antibody?

A

Hemoptysis and ELK; C-ANCA

114
Q

DDx for Hemoptysis - 5

A

BBcTT

  1. *** Bronchitis - MOST COMMON! ***
  2. Bronchiectasis
  3. Cancer
  4. TB
  5. Trauma (PE)
115
Q

What are the common causes of clubbing? - 2

A
  1. Lung ADC
  2. Cystic Fibrosis
116
Q

Silicosis ⬆︎risk for developing _____ and causes _____ lesions on imaging

Which demographics are mostly affected?-2

A

TB ; cavitary lung lesions

  1. Stone Workers
  2. Miners

Stone Miners are Sili and they’re going to get TB!

117
Q

Physiologically, what causes hypoxemia in pts with Pneumonia?

A

Ventilation/Perfusion mismatch - a shunt occurs direct blood away from alveoli and this is why O2 supplement barely help

118
Q

pt presents with pulmonary nodules surrounded by ground glass opacities

Dx? ; Tx?-2

A

Aspergillosis

tx:

  1. Voriconazole AND
  2. Caspfungin

Image shows “halo sign”

119
Q

Brutons X linked agammaglobulinemia etx

A

low B lymphocytes –> low Ig –> sinopulmary and GI infections

puts pt at risk for infections like Giardia

120
Q
  • 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?

A
  1. Gum Hypertrophy - Cyclosporine
  2. Hirsuitsm - Cyclosporine
  3. Nephrotoxicity with HyperKalemia
  4. Tremor
121
Q

Side effects of Azathioprine - 3

A
  1. Diarrhea
  2. Hepatotoxicity
  3. Leukopenia
122
Q

Side effect of Mycophenolate

A

Marrow Suppression

123
Q

A neonate is born with absent T cells and dysfunctional B cells

Diagnosis? ; Tx?

A

Severe Combined ImmunoDeficiency (SCID) ; Stem Cell Transplant

Absent T causing fucked up B

124
Q

In pts with chronic granulomatous disease, there is an impaired _______ which leads to ⬆︎infection with which organisms? ; Dx?-2

A

oxidative burst ; catalase positive (Staph A, Serratia, Burkholderia)

  1. nitroblue tetrazolium OR
  2. dihydrorhodamine

Both of these are neutrophil function test

125
Q

What is Leukocyte Adhesion Deficiency associated with? - 3

A
  1. Delayed umbilical cord separation
  2. periOdontal disease
  3. recurrent sinopulmonary infection
126
Q

After transplant, when does Acute Cellular Rejection occur? ; How does it present? - 3

A

<90 days ;

  1. RUQ pain
  2. Transaminitis
  3. Fever

HYPERacute occurs in < 7 days

127
Q

Hereditary Angioedema etx

A

deficiency or dysfunction of C1 inhibitor –> ⬆︎bradykinin and C2b

128
Q

pts with pharyngeal cobblestoning likely have _____ and need to be treated with ______

A

allergic rhinitis ; nasal corticosteroids

129
Q

MOD for Severe Combined Immunodeficiency (SCID) ; tx?

A

Defective T cell maturation –>dysfunctional B cells –> recurrent viral, fungal, bacterial infections

“Absent T causing fucked up B”

Tx = stem cell transplant

130
Q

MOD for Common Variable Immunodeficiency

A

hypOgammaglobulinemia –> recurrent Sinopulmonary and GI bacterial infections

131
Q

Wiskott Aldrich Syndrome presents at what stage of life? ; cp?-3

A

infancy;

  1. eczema
  2. bleeding
  3. sinopulmonary infections

MOD = disables cytoskeleton remodeling

132
Q

Why should a pt with recurrent sinopulmonary and GI infections be thoroughly screened before receiving blood transfusions?

A

They could have Selective IgA Deficiency which –> production of Anti-IgA in their blood. After receiving blood transfusion those Anti-IgA would –> anaphylaxis

133
Q

MOD for Hyper IgM Syndrome ; What would the laboratory values show? -4

A

CD40 ligand defect –> severe sinopulmonary infections ;

  1. Hyper IgM
  2. low IgG
  3. low IgA
  4. normal lymphocyte (CD4/CD8) populations
134
Q

Guidelines for Lung CA screening - 3

A

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
Q

Normal Respiratory Rate

136
Q

Normal Sodium level

[2a] A ⼀ Step 2 OD USLME (21 decks)

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