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
2
Q
What is the MOA of theophylline?
A
Probably causes bronchodilation by inhibiting phosphodiesterase,
3
Q
What is the MOA and use of cromolyn?
A
Prevents the release of vasoactive mediators from mast cells
4
Q
What is the MOA and use of Zileuton?
A
5-lipoxygenase inhibitor
5
Q
What is the MOA and use of Montelukast?
A
Blocks leukotriene receptors
6
Q
What is the MOA and use of Zafirlukast?
A
Blocks leukotriene receptors
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
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
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
10
Q
How many days/week or nights/month of asthma exacerbations fall into the “severe persistent” category?
A
Continual, frequent
11
Q
What is the medication regimen for mild intermittent asthma?
A
PRN short acting bronchodilators
12
Q
What is the medication regimen for mild persistent asthma?
A
Daily low dose inhaled corticosteroids
PRN short acting bronchodilators
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.
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.
15
Q
What is the FEV1 value for mild intermittent asthma?
A
Over 80%
16
Q
What is the FEV1 value for mild persistent asthma?
A
Over 80%
17
Q
What is the FEV1 value for moderate persistent asthma?
A
60-80%
18
Q
What is the FEV1 value for severe persistent asthma?
A
Less than 60%
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
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
21
Q
What is the pharmacotherapy for bronchiectasis?
A
Abx and maybe inhaled corticosteroids
22
Q
What is the definitive treatment for bronchiectasis?
A
Lung transplant
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
24
Q
What causes centrilobular vs panlobular emphysema?
A
Centi = smoking Panacinar = alpha-1-antitrypsin
25
What are the only two interventions shown to increase survival in COPD patients?
Smoking cessation and oxygen therapy
26
Which has early and which late hypercapnia: emphysema vs chronic bronchitis?
Emphysema is late
| Chronic bronchitis is early
27
What is the treatment for COPD
Corticosteroids
Oxygen
Prevention (pneumococcal vaccine, flu vaccine)
Dilators (beta 2 agonists)
28
What are the components of the AINT mnemonic for restrictive lung etiologies?
- Alveolar (edema, hemorrhage, pus)
- Interstitial/Inflammatory (Sarcoid, COP, idiopathic pulmonary fibrosis
- Neuromuscular (Myasthenia, phrenic nerve palsy)
- Thoracic wall (kyphoscoliosis, ascites, prego, ankylosing spondylitis)
29
What are the high res CT findings of interstitial lung disease?
Honeycombing
30
What type of breathing do patients with restrictive lung diseases usually present with?
Shallow, rapid breathing
| DOE
31
What happens to DLCO with restrictive lung diseases?
Decreases
32
What is the pathological feature of sarcoidosis?
noncaseating granulomas
33
What are the s/sx of sarcoidosis?
Fever
Cough
Malaise
Arthritis
34
What dermatologic manifestation can appear with sarcoidosis?
Erythema nodosum
35
What is the treatment for sarcoidosis?
Corticosteroids
36
What are the pathological changes that occur with hypersensitivity pneumonitis?
Alveolar thickening and noncaseating granulomas 2/2 environmental exposures
37
What are the acute s/sx of hypersensitivity pneumonitis?
Dyspnea
Fever /systemic inflammatory s/sx
Cough
38
What are the chronic s/sx of hypersensitivity pneumonitis?
Progressive DOE
39
What is a common CXR finding of hypersensitivity pneumonitis?
upper lobe fibrosis
40
What is the treatment for hypersensitivity pneumonitis?
Corticosteroids and avoidance of the trigger
41
What is pneumoconiosis?
a disease of the lungs due to inhalation of dust, characterized by inflammation, coughing, and fibrosis.
42
What are the classic imaging findings of asbestosis?
Linear opacities at the lung bases, and interstitial fibrosis
43
What is the major risk with coal worker's disease?
Progressive massive fibrosis
44
What is the major complication with berylliosis?
Requires chronic corticosteroid treatment
45
What are the classic CXR findings of silicosis?
Eggshell calcifications
46
What is the major complication associated with silicosis?
Increased risk of TB
47
What, generally, are the eosinophilic pulmonary syndromes?
A diverse group of disorders characterized by eosinophilic pulmonary infiltrates and abnormal peripheral blood eosinophilia.
48
What are the major eosinophilic pulmonary disorders?
- Allergic bronchopulmonary aspergillosis
- Loffler syndrome
- Acute eosinophilic pneumonia
- Drug induced
49
What are the s/sx of eosinophilic pulmonary disorders?
Dyspnea
cough
hemoptysis
50
What are the lab and CXR findings of eosinophilic pulmonary disorders?
Peripheral eosinophilia
| pulmonary infiltrates
51
What is the treatment for eosinophilic pulmonary disorders?
Removal of the extrinsic cause of treatment of underlying infection
Corticosteroids
52
What type of shunt is produced with ARDS?
Right to left
53
What happens to the A-a gradient with the following:
- hypoventilation
- low inspired oxygen
- V/Q mismatch
- Shunting
hypoventilation and low FiO2 will have normal A-a gradient
V/Q mismatch and shunting will produce higher than normal A-a gradient
54
What is the treatment for ARDS patients who are hypercapnic?
Increase ventilation to increase CO2
55
What are the three major clinical features of ARDS?
- hypoxemia
- Decreased lung compliance
- Pulmonary edema
56
What are the PE findings for phase 1 of ARDS?
normal to possible respiratory alkalosis
57
What are the PE findings for phase 2 of ARDS?
Hyperventilation
Hypocapnia
Widening A-a gradient
58
What are the PE findings for phase 3 of ARDS?
Acute respiratory failure
tachypnea / dyspnea
Decreased lung compliance
59
What are the PE findings for phase 4 of ARDS?
Severe hypoxemia
| Increased intrapulmonary shunting
60
What are the four criteria for ARDS?
- Acute onset
- A PaO2/FiO2 ratio of less than 300
- bilateral pulmonary infiltrates on CXR
- Respiratory failure
61
What is the the PaO2 / FiO2 ratio criteria for ARDS?
Less than 300 with PEEP/CPAP more than 5 cm H2O
62
What is the goal oxygen saturation with ARDS?
PaO2 of more than 55 mmHg or SaO2 over 88%
63
What is the appropriate ventilator setting for ARDS patients?
Low Vt and higher PEEP
64
What is the appropriate ventilator setting for ARDS patients?
Low Vt and higher PEEP to recruit alveoli, but prevent barotrauma
65
What is normal pulmonary arterial pressure? Above what level defines pHTN?
15 mmHg
| More than 25 mmHg
66
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?
RR / TV
| Less than 105
67
What vital capacity is needed to be weaned from a ventilator?
More than 10 mL/kg
68
What resting minute ventilation is needed to be weaned from a ventilator?
More than 10 L / min
69
What spontaneous RR is needed to be weaned from a ventilator?
More than 10 / min
70
What lung compliance is needed to be weaned from a ventilator?
More than 100 mL/cm of water
71
What negative inspiratory force is needed to be weaned from a ventilator?
Less than -25 cm of water
72
What A-a gradient is needed to be weaned from a ventilator?
Less than 400 mmHg
73
What shunt fraction is needed to be weaned from a ventilator?
Less than 15%
74
What PaO2 is needed to be weaned from a ventilator?
More than 70 mmHg
75
What PaCO2 is needed to be weaned from a ventilator?
Less than 45 mmHg
76
What are the s/sx of pulmonary HTN?
DOE
Fatigue
Syncope with exertion
77
What are the classic heart sounds for pHTN?
Loud S2, fixed
| S4
78
What is the definitive test for pHTN?
Catheterization
79
What is the treatment for pHTN?
Supplemental O2
Vasodilators (PDE5 inhibitors)
Anticoagulation
80
What percent of PEs originate from DVTs?
95%
81
What are the s/sx of PEs?
Sudden onset dyspnea
Pleuritic chest pain
Mild fever
82
What is Hampton's hump?
Wedge shaped infarct in the lungs 2/2 PE
83
What is the treatment for an acute PE?
Heparin bolus then heparin infusion or low-molecular-weight heparin [LMWH] subcutaneously
84
What is the treatment for a chronic PE?
Anticoagulation for 3–6 months or during predisposition (goal INR = 2–3).
85
When is thrombolysis indicated for treating a PE?
Massive PE causing right heart failure and hemodynamic instability
86
What is used prophylactically for PEs?
SQ heparin
87
What type of cells give rise to small cell carcinoma?
Neuroendocrine cells
88
Are small cell lung cancers more or less likely to metastasize than large cell cancers?
More
89
Pulmonary nodules above what size are suspicious for malignancy?
2 cm
90
What type of calcification of a pulmonary nodule indicates malignancy? What about benign?
Irregular or absent
Popcorn, central or uniform denotes benign
91
Where is coccidioidomycosis endemic to?
Southwest
92
Where is histoplasmosis endemic to?
Ohio river valley
93
What are the paraneoplastic syndromes that small cell carcinoma can produce?
ACTH
SIADH
Lambert-Eaton syndrome
94
What are the activating mutations in adenocarcinomas?
KRAS
EGRF
ALK
95
What is the histological pattern of adenocarcinoma?
Glandular pattern with mucin +
96
What is the pattern of growth the bronchioloalveolar subtype of adenocarcinoma?
Thickening of the bronchial walls
97
What are the histological characteristics of squamous cell carcinoma?
Keratin pearls and intercellular bridges
98
Where in the lung do squamous cell carcinomas usually arise?
From the bronchus
99
What is the prognosis for large cell carcinoma?
Poor--highly anaplastic
100
What are the histological characteristics of large cell carcinoma?
Pleomorphic giant cells
101
What is the prognosis for bronchial carcinoid tumors?
Good
102
What are the four organs that commonly receive mets from the lungs?
Liver
Adrenals
Brain
Bone
103
What is the one lung cancer not associated with smoking?
Adenocarcinoma
104
What lung cancer usually produces hypercalcemia via PTHrP?
Squamous cell carcinoma
105
What lung cancer usually produces hypertrophic pulmonary osteoarthropathy and digital clubbing?
non-small cell
106
What lung cancer usually produces subacute cerebellar degeneration?
Small
107
What lung cancer usually produces migratory thrombophlebitis?
Adenocarcinoma
108
What lung cancer usually produces hypercoagulability?
Adenocarcinoma
109
What lung cancer usually produces gynecomastia?
Large cell
110
What are the two major, general etiologies of transudative pleural effusion?
Increased pulmonary capillary wedge pressure
| Decreased oncotic pressure
111
What causes an exudative pleural effusion?
Increased vascular permeability
112
What are the three major causes of transudative effusions?
CHF
CIrrhosis
Nephrotic syndrome
113
What are the three components of light's criteria for transudative vs exudative effusions?
- 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
What is the major differentiating factor (IMO) for a pneumothorax vs a tension pneumothorax?
Hemodynamic instability for a tension pneumothorax 2/2 cardiac tamponade
115
Where is the needle inserted for decompression of a tension pneumothorax?
Midclavicular line at the second intercostal space
