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Pulmonary Flashcards

1
Q

What is the range of FEV1 for mild, moderate, and severe obstructive disease?

A 
Mild = (75,60]
Moderate = (60, 40]
Severe = less than 40
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2
Q

What is the MOA of theophylline?

A

Probably causes bronchodilation by inhibiting phosphodiesterase,

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3
Q

What is the MOA and use of cromolyn?

A

Prevents the release of vasoactive mediators from mast cells

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4
Q

What is the MOA and use of Zileuton?

A

5-lipoxygenase inhibitor

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5
Q

What is the MOA and use of Montelukast?

A

Blocks leukotriene receptors

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6
Q

What is the MOA and use of Zafirlukast?

A

Blocks leukotriene receptors

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7
Q

How many days/week or nights/month of asthma exacerbations fall into the “mild intermittent” category?

A

2 or less days / week or nights per month

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8
Q

How many days/week or nights/month of asthma exacerbations fall into the “mild persistent” category?

A

More than 2x per week, but less than 1 per day, and greater than 2 per month

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9
Q

How many days/week or nights/month of asthma exacerbations fall into the “moderate persistent” category?

A

Daily asthma exacerbations

More than 1 night per week

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10
Q

How many days/week or nights/month of asthma exacerbations fall into the “severe persistent” category?

A

Continual, frequent

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11
Q

What is the medication regimen for mild intermittent asthma?

A

PRN short acting bronchodilators

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12
Q

What is the medication regimen for mild persistent asthma?

A

Daily low dose inhaled corticosteroids

PRN short acting bronchodilators

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13
Q

What is the medication regimen for moderate persistent asthma?

A

Low- to medium-dose inhaled corticosteroids + long-acting inhaled β2 -agonists.

PRN short-acting bronchodilator.

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14
Q

What is the medication regimen for severe persistent asthma?

A
  • High-dose inhaled corticosteroids + long-acting inhaled β2 -agonists.
  • Possible PO corticosteroids.
  • PRN short-acting bronchodilator.
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15
Q

What is the FEV1 value for mild intermittent asthma?

A

Over 80%

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16
Q

What is the FEV1 value for mild persistent asthma?

A

Over 80%

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17
Q

What is the FEV1 value for moderate persistent asthma?

A

60-80%

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18
Q

What is the FEV1 value for severe persistent asthma?

A

Less than 60%

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19
Q

What are tram lines on CXR that are seen in bronchiectasis?

A

Parallel lines outlining dilated bronchi as a result of peribronchial inflammation and fibrosis

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20
Q

What is the definitive test for bronchiectasis? What will it show?

A

high resolution CT

Dilated airways and ballooned areas at the end of the airways

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21
Q

What is the pharmacotherapy for bronchiectasis?

A

Abx and maybe inhaled corticosteroids

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22
Q

What is the definitive treatment for bronchiectasis?

A

Lung transplant

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23
Q

What is the duration that is needed to diagnose chronic bronchitis?

A

Productive cough for more than 3 months per year for 2 consecutive years

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24
Q

What causes centrilobular vs panlobular emphysema?

A 
Centi = smoking
Panacinar = alpha-1-antitrypsin
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25
Q

What are the only two interventions shown to increase survival in COPD patients?

A

Smoking cessation and oxygen therapy

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26
Q

Which has early and which late hypercapnia: emphysema vs chronic bronchitis?

A

Emphysema is late

Chronic bronchitis is early

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27
Q

What is the treatment for COPD

A

Corticosteroids
Oxygen
Prevention (pneumococcal vaccine, flu vaccine)
Dilators (beta 2 agonists)

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28
Q

What are the components of the AINT mnemonic for restrictive lung etiologies?

A
  • Alveolar (edema, hemorrhage, pus)
  • Interstitial/Inflammatory (Sarcoid, COP, idiopathic pulmonary fibrosis
  • Neuromuscular (Myasthenia, phrenic nerve palsy)
  • Thoracic wall (kyphoscoliosis, ascites, prego, ankylosing spondylitis)
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29
Q

What are the high res CT findings of interstitial lung disease?

A

Honeycombing

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30
Q

What type of breathing do patients with restrictive lung diseases usually present with?

A

Shallow, rapid breathing

DOE

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31
Q

What happens to DLCO with restrictive lung diseases?

A

Decreases

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32
Q

What is the pathological feature of sarcoidosis?

A

noncaseating granulomas

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33
Q

What are the s/sx of sarcoidosis?

A

Fever
Cough
Malaise
Arthritis

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34
Q

What dermatologic manifestation can appear with sarcoidosis?

A

Erythema nodosum

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35
Q

What is the treatment for sarcoidosis?

A

Corticosteroids

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36
Q

What are the pathological changes that occur with hypersensitivity pneumonitis?

A

Alveolar thickening and noncaseating granulomas 2/2 environmental exposures

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37
Q

What are the acute s/sx of hypersensitivity pneumonitis?

A

Dyspnea
Fever /systemic inflammatory s/sx
Cough

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38
Q

What are the chronic s/sx of hypersensitivity pneumonitis?

A

Progressive DOE

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39
Q

What is a common CXR finding of hypersensitivity pneumonitis?

A

upper lobe fibrosis

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40
Q

What is the treatment for hypersensitivity pneumonitis?

A

Corticosteroids and avoidance of the trigger

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41
Q

What is pneumoconiosis?

A

a disease of the lungs due to inhalation of dust, characterized by inflammation, coughing, and fibrosis.

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42
Q

What are the classic imaging findings of asbestosis?

A

Linear opacities at the lung bases, and interstitial fibrosis

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43
Q

What is the major risk with coal worker’s disease?

A

Progressive massive fibrosis

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44
Q

What is the major complication with berylliosis?

A

Requires chronic corticosteroid treatment

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45
Q

What are the classic CXR findings of silicosis?

A

Eggshell calcifications

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46
Q

What is the major complication associated with silicosis?

A

Increased risk of TB

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47
Q

What, generally, are the eosinophilic pulmonary syndromes?

A

A diverse group of disorders characterized by eosinophilic pulmonary infiltrates and abnormal peripheral blood eosinophilia.

48
Q

What are the major eosinophilic pulmonary disorders?

A
  • Allergic bronchopulmonary aspergillosis
  • Loffler syndrome
  • Acute eosinophilic pneumonia
  • Drug induced
49
Q

What are the s/sx of eosinophilic pulmonary disorders?

A

Dyspnea
cough
hemoptysis

50
Q

What are the lab and CXR findings of eosinophilic pulmonary disorders?

A

Peripheral eosinophilia

pulmonary infiltrates

51
Q

What is the treatment for eosinophilic pulmonary disorders?

A

Removal of the extrinsic cause of treatment of underlying infection
Corticosteroids

52
Q

What type of shunt is produced with ARDS?

A

Right to left

53
Q

What happens to the A-a gradient with the following:

  • hypoventilation
  • low inspired oxygen
  • V/Q mismatch
  • Shunting
A

hypoventilation and low FiO2 will have normal A-a gradient

V/Q mismatch and shunting will produce higher than normal A-a gradient

54
Q

What is the treatment for ARDS patients who are hypercapnic?

A

Increase ventilation to increase CO2

55
Q

What are the three major clinical features of ARDS?

A
  • hypoxemia
  • Decreased lung compliance
  • Pulmonary edema
56
Q

What are the PE findings for phase 1 of ARDS?

A

normal to possible respiratory alkalosis

57
Q

What are the PE findings for phase 2 of ARDS?

A

Hyperventilation
Hypocapnia
Widening A-a gradient

58
Q

What are the PE findings for phase 3 of ARDS?

A

Acute respiratory failure
tachypnea / dyspnea
Decreased lung compliance

59
Q

What are the PE findings for phase 4 of ARDS?

A

Severe hypoxemia

Increased intrapulmonary shunting

60
Q

What are the four criteria for ARDS?

A
  • Acute onset
  • A PaO2/FiO2 ratio of less than 300
  • bilateral pulmonary infiltrates on CXR
  • Respiratory failure
61
Q

What is the the PaO2 / FiO2 ratio criteria for ARDS?

A

Less than 300 with PEEP/CPAP more than 5 cm H2O

62
Q

What is the goal oxygen saturation with ARDS?

A

PaO2 of more than 55 mmHg or SaO2 over 88%

63
Q

What is the appropriate ventilator setting for ARDS patients?

A

Low Vt and higher PEEP

64
Q

What is the appropriate ventilator setting for ARDS patients?

A

Low Vt and higher PEEP to recruit alveoli, but prevent barotrauma

65
Q

What is normal pulmonary arterial pressure? Above what level defines pHTN?

A

15 mmHg

More than 25 mmHg

66
Q

What is the main measure that is used to determine if a patient is able to be weaned from a ventilator? What value of this is needed?

A

RR / TV

Less than 105

67
Q

What vital capacity is needed to be weaned from a ventilator?

A

More than 10 mL/kg

68
Q

What resting minute ventilation is needed to be weaned from a ventilator?

A

More than 10 L / min

69
Q

What spontaneous RR is needed to be weaned from a ventilator?

A

More than 10 / min

70
Q

What lung compliance is needed to be weaned from a ventilator?

A

More than 100 mL/cm of water

71
Q

What negative inspiratory force is needed to be weaned from a ventilator?

A

Less than -25 cm of water

72
Q

What A-a gradient is needed to be weaned from a ventilator?

A

Less than 400 mmHg

73
Q

What shunt fraction is needed to be weaned from a ventilator?

A

Less than 15%

74
Q

What PaO2 is needed to be weaned from a ventilator?

A

More than 70 mmHg

75
Q

What PaCO2 is needed to be weaned from a ventilator?

A

Less than 45 mmHg

76
Q

What are the s/sx of pulmonary HTN?

A

DOE
Fatigue
Syncope with exertion

77
Q

What are the classic heart sounds for pHTN?

A

Loud S2, fixed

S4

78
Q

What is the definitive test for pHTN?

A

Catheterization

79
Q

What is the treatment for pHTN?

A

Supplemental O2
Vasodilators (PDE5 inhibitors)
Anticoagulation

80
Q

What percent of PEs originate from DVTs?

81
Q

What are the s/sx of PEs?

A

Sudden onset dyspnea
Pleuritic chest pain
Mild fever

82
Q

What is Hampton’s hump?

A

Wedge shaped infarct in the lungs 2/2 PE

83
Q

What is the treatment for an acute PE?

A

Heparin bolus then heparin infusion or low-molecular-weight heparin [LMWH] subcutaneously

84
Q

What is the treatment for a chronic PE?

A

Anticoagulation for 3–6 months or during predisposition (goal INR = 2–3).

85
Q

When is thrombolysis indicated for treating a PE?

A

Massive PE causing right heart failure and hemodynamic instability

86
Q

What is used prophylactically for PEs?

A

SQ heparin

87
Q

What type of cells give rise to small cell carcinoma?

A

Neuroendocrine cells

88
Q

Are small cell lung cancers more or less likely to metastasize than large cell cancers?

89
Q

Pulmonary nodules above what size are suspicious for malignancy?

90
Q

What type of calcification of a pulmonary nodule indicates malignancy? What about benign?

A

Irregular or absent

Popcorn, central or uniform denotes benign

91
Q

Where is coccidioidomycosis endemic to?

92
Q

Where is histoplasmosis endemic to?

A

Ohio river valley

93
Q

What are the paraneoplastic syndromes that small cell carcinoma can produce?

A

ACTH
SIADH
Lambert-Eaton syndrome

94
Q

What are the activating mutations in adenocarcinomas?

A

KRAS
EGRF
ALK

95
Q

What is the histological pattern of adenocarcinoma?

A

Glandular pattern with mucin +

96
Q

What is the pattern of growth the bronchioloalveolar subtype of adenocarcinoma?

A

Thickening of the bronchial walls

97
Q

What are the histological characteristics of squamous cell carcinoma?

A

Keratin pearls and intercellular bridges

98
Q

Where in the lung do squamous cell carcinomas usually arise?

A

From the bronchus

99
Q

What is the prognosis for large cell carcinoma?

A

Poor–highly anaplastic

100
Q

What are the histological characteristics of large cell carcinoma?

A

Pleomorphic giant cells

101
Q

What is the prognosis for bronchial carcinoid tumors?

102
Q

What are the four organs that commonly receive mets from the lungs?

A

Liver
Adrenals
Brain
Bone

103
Q

What is the one lung cancer not associated with smoking?

A

Adenocarcinoma

104
Q

What lung cancer usually produces hypercalcemia via PTHrP?

A

Squamous cell carcinoma

105
Q

What lung cancer usually produces hypertrophic pulmonary osteoarthropathy and digital clubbing?

A

non-small cell

106
Q

What lung cancer usually produces subacute cerebellar degeneration?

107
Q

What lung cancer usually produces migratory thrombophlebitis?

A

Adenocarcinoma

108
Q

What lung cancer usually produces hypercoagulability?

A

Adenocarcinoma

109
Q

What lung cancer usually produces gynecomastia?

A

Large cell

110
Q

What are the two major, general etiologies of transudative pleural effusion?

A

Increased pulmonary capillary wedge pressure

Decreased oncotic pressure

111
Q

What causes an exudative pleural effusion?

A

Increased vascular permeability

112
Q

What are the three major causes of transudative effusions?

A

CHF
CIrrhosis
Nephrotic syndrome

113
Q

What are the three components of light’s criteria for transudative vs exudative effusions?

A
  • Pleural protein / serum protein More than 0.5
  • Pleural LDH / serum LDH more than 0.6
  • Pleural fluid LDH more than 2/3 the ULN of serum LDH
114
Q

What is the major differentiating factor (IMO) for a pneumothorax vs a tension pneumothorax?

A

Hemodynamic instability for a tension pneumothorax 2/2 cardiac tamponade

115
Q

Where is the needle inserted for decompression of a tension pneumothorax?

A

Midclavicular line at the second intercostal space

A1 (32 decks)

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