Pulmonary Flashcards
1
Q
What is the name of this triad?
1) Asthma
2) Nasal polyps
3) ASA/NSAID allergy
A
Samter’s Triad
2
Q
What is Dx GOLD for Asthma and what does it show?
A
- PFT
- Reversible obstruction: dec. FEV-1, dec. FEV-1 / FVC
3
Q
MCC of COPD in Cystic Fibrosis
A
Pseudomonas
4
Q
TOC for Bronchiectasis
A
CT scan
5
Q
What is a polysomnography?
A
Sleep study
6
Q
GI symptoms, hyponatremia, patchy unilobar lower lobe infiltrate. Dx?
A
Legionella Pneumonia
7
Q
What is the CURB-65 score?
A
Predict severity of PNA to help determine inpatient vs. outpatient treatment.
8
Q
What do the following fall under?
- CHF
- Cirrhosis
- Nephrotic Syndrome
- Pulmonary embolism
- Hypoalbuminemia
A
Transudative
9
Q
GOLD Dx for active/reactivated TB
A
Acid-Fast Smear and Sputum Culture (AFB)
10
Q
4 lab criteria for exudative effusion:
A
1) Serum Protein >0.5
2) Serum LDH >0.6
3) Pleural fluid LDH > 2/3 normal upper limit for serum LDH.
* *4) GLUCOSE <60
11
Q
-↓ breath sounds
-Dull percussion
-↓ tactile fremitus
Is found in:
A
Pleural Effusion
12
Q
Organism most associated with PNA and bullous myringitis:
A
Strep pneumoniae
13
Q
GOLD Dx for Latent/primary TB
A
PPD
14
Q
What PNA would be post H. flu infection?
A
Staph aureus
15
Q
What gram stain would you find with Strep pneumoniae?
A
Gram (+) cocci pairs
16
Q
Cardiac dysrhythmia d/t macrolide use:
A
QT prolongation
17
Q
Light’s Criteria
A
- Serum protein
- Serum pleural fluid lactate dehydrogenase (LDH)
18
Q
Acute Pancreatitis + Pleural Effusion (seen on CXR). Pleural fluid shows:
A
Elevated Amylase
19
Q
Patho of Laryngotracheitis:
A
Parainfluenza
20
Q
Sarcoidosis: decrease or increase in ACE?
A
Increase
21
Q
TOC for Pulmonary Embolism:
A
CT pulmonary angiography
22
Q
In active TB, do we need airborne or droplet precautions?
A
Airborne
23
Q
What is the common SE of Rifampin?
A
Orange discoloration of body fluids.
24
Q
Tx for Idiopathic Pulmonary Fibrosis
A
- O2
- Pulmonary rehab
25
Pt. presents with GI complaints, skin flushing and wheezing. Dx?
Carcinoid Syndrome
26
What is given to PREVENT risk of Infant Respiratory Distress Syndrome?
Glucocorticoids (MC Betamethasone)
27
PPD: high-risk, homeless, health-care workers, IVDU, foreign-born
≥ 10 mm
28
Tx of TB
RIPE
- Rifampin
- Isoniazid (need B6 [Pyridoxine] to prevent peri neuropathy**)
- Pyrazinamide
- Ethambutol
29
Tx for Psittacosis
Doxy
30
MCC lung abscess
Aspiration PNA
31
What is the significance of a high amylase in a pleural fluid?
Signs of:
- Pancreatitis
- Esophageal rupture
- Malignancy
32
What type of meds are Tiotropium and lpratropium?
Anticholinergics
33
-↓ breath sounds
-↓ fremitus
-hyperresonance to percussion
Is found in:
Pneumothorax
34
In a patient with CKD and suspected pulmonary embolism, what diagnostic tool is used?
Ventilation/perfusion scan
35
How do we Dx Carcinoid Syndrome?
24-hour URINE excretion of 5-hydroxyindoleacetic acid (5-HIAA)
36
MC presenting symptom of acute pulmonary embolism:
Dyspnea
37
Rheumatoid Arthritis (RA) + Pneumoconiosis =
Caplan’s syndrome
38
Elevated LDH and CXR bilateral infiltrates. Dx?
Pneumocystis jirovecii PNA
39
Carcinoid tumors commonly secrete:
Serotonin
40
When is Pertussis most contagious?
- Catarrhal stage
| - Lasts 1-2 wks
41
What is Hamman's sign?
Crunching sound heard during auscultation with Pneumomediastinum.
42
With low suspicion of pulmonary embolism, what diagnostic tool can we use to R/O?
D-dimer
43
PPD: immunosuppressed, recent TB contact, abnormal CXR, steroid use
≥ 5 mm
44
CXR: lobar. What type on PNA is this?
- Pneumococcal (AKA Strep pneumoniae)
| - The ONLY lobar PNA!***
45
Tx for Healthcare Associated Pneumonia (HCAP)
IV Abx and admit (D/T both typical and more resistant organisms)
46
Long-term complication of obstructive sleep apnea:
Pulmonary HTN
47
Exposure to shipyard, construction, and insulation occupations may lead to:
Asbestosis
48
PE findings that aids in differentiating the cause of crackles or rales, heard on lung auscultation:
Egophony
49
What sleep apnea is associated with Cheyne-Stokes breathing, drug use, or central nervous system disorders?
Central sleep apnea
50
Dx for Cystic Fibrosis
Elevated sweat chloride test
51
MCC of Chronic Cor Pulmonale
COPD
52
What is the name of this triad?
- Stasis (shoulder immobilization)
- Venous injury (recent trauma)
- Hypercoagulability (OCPs)
Virchow triad
53
Dx for Cor Pulmonale
Right heart cath
54
Dx GOLD for Pneumomediastinum
CT
55
Tx of choice for Respiratory Distress Syndrome (Hyaline Membrane Disease)
Surfactant
56
Newborn baby begins to have difficulties breathing. CXR shows parenchymal infiltrates and fluid in the pulmonary fissures. Dx?
Transient Tachypnea of the Newborn
57
Bronchitis Tx for cough:
OTC Dextromethorphan or Guaifenesin
58
MC EKG finding in acute pulmonary embolism:
Sinus tachy
59
What spirometry values would be seen in COPD?
- ↓ FEV-1
- ↓ FVC
- ↓ FEV1/FVC <70%
60
Exposure to foundries, sandblasting, mines, stone may lead to:
Silicosis
61
MCC of Acute Cor Pulmonale
Pulmonary Embolism
62
MCC of Bronchiectasis
Cystic Fibrosis
63
MCC of Epiglottitis
H. flu
64
Tx for Pertussis
Macrolides
65
Which lung cancer presents with "CCCP" → Central, Cavitary lesions, hyperCa+, Pancoast syndrome?
SCC
66
In Newborn Chlamydia Pneumonia, what is the cough described as? Does it present with fever?
- Staccato
| - NO fever
67
What is Psittacosis?
Chlamydia psittaci (D/T birds)
68
When diagnosing PNA in kids, which findings has the highest odds ratio?
Ox sat. <92%
69
Dx of Pertussis
PCR of nasopharyngeal secretions
70
What is the name of this triad?
- Hilar adenopathy
- Erythema nodosum
- Polyarthralgia
Lofgren syndrome
71
Rx for pulmonary arterial hypertension
Sildenafil
72
How is pertussis spread?
Respiratory droplet
73
MC opportunistic respiratory infection in patients with AIDS?
Pneumocystis jiroveci
74
MCC pleural effusion in U.S.
HF
75
MCC massive pleural effusion (> 1.5–2 L)
Malignancy
76
Tx for Sarcoidosis
PO Steroids
77
Tx for lung abscess
- Ampicillin-sulbactam
- Carbapenems
- Clindamycin
78
Beta 2 Agonists MOA
Increase cAMP (cyclic adenosine monophosphate) to bronchodilate
79
Tx for Psittacosis in kids and pregnancy
Erythromycin
80
Screening for lung cancer is tested by ______ and recommended for ______.
```
Low dose CT
------------------------------------
55 to 80yo with:
-30 pack-year Hx and still smoke
OR
-Quit within last 15 yrs
```
81
Which Dx's require airborne precautions?
- TB
- Pneumocystis jirovecii
- Measles
- Zoster
82
Criteria for Pneumocystis PNA and getting Prednisone before Tx with Bactrim
- PaO2 <70 mm Hg
| - A-a gradient >35 mm Hg
83
If unexplained isolated pleural effusion, think _______.
Pulmonary Embolism
84
Tx for acute asthma exacerbation
Oxygen and beta-2-agonist neb (Albuterol)
85
MC patho of Bronchiolitis
RSV
86
Mgmg for pulmonary nodule <6mm and no RFs
No F/U
87
Albuterol can lead to what electrolyte abnormality?
HypoK
88
Tx for Infant Respiratory Distress Syndrome
Surfactant
89
MC and 2nd MC type of lung cancer
Non-small cell:
1st Adenocarcinoma
2nd: SCC
90
What is the treatment of choice for Pneumococcal (AKA Strep pneumoniae)?
Penicillin
| 2nd: Azithro or Augmentin
91
Tx for Pneumothorax
Needle decompression of the chest in 2nd intercostal space at midclavicular line or 5th intercostal space in midaxillary line followed by chest tube insertion
92
Post-op fever on day 1-2 would likely be:
Atelectasis (partial or complete collapsed lung)
93
56 yo patient presents with a 6mm pulmonary nodule. What is your next step in management?
If given the options of CT of chest and biopsy, DO BX 1ST
94
25 yo with has a Hx of DM. She has no TB RFs and is starting a new job at the hospital. What is the minimal number on PPD?
15mm (doesn’t matter that she has DM)
95
Dx for Sarcoidosis
Bronchoscopy with Bx → noncaseating granulomas
96
Decreased breath/heart sounds and hyperresonance to percussion is found in:
Emphysema
97
A 50 yo presents with a community acquired pneumonia. He was previously treated with Azithromycin but he is back reporting no change. What is the next best med?
Levofloxacin (used for bounce-backs)
98
SE of Ethambutol
Optic neuritis
99
What is the best treatment for PNA caused by H. flu (HIB, type B MC)?
Ceftriaxone
| 2nd: Azithro
100
2nd line Tx for Mycoplasma
Doxy
101
To identify a bacteria, what is the best initial test?
IFA (indirect fluorescent antibody)
102
Tx for PNA in HIV pt.
Bactrim
103
Pt. present with parents. He has a bowel obstruction. What do you worry about?
Cystic Fibrosis
104
What is the most sensitive and specific pulmonary function test (PFT) for COPD?
Residual Volume (trash that's left, CO2)
105
1st and 2nd line Tx for COPD
- Rescue inhaler
| - L/A Anticholinergic (Tiotropium) + L/A Beta-2 (Salmeterol)
106
Pt. presents with lung CA and Hx of endocrine dysfunction. What is the likely lung CA involved?
Small cell (always involves endo)
107
Pt. with ARDS is placed on Positive end-expiratory pressure (PEEP). What is a side effect?
Pulmonary fibrosis
108
Pt. presents with an asthma exacerbation. What would you expect to see on ABG?
Respiratory acidosis
109
≤ 14yo Tx for PNA? What does it switch to at >15yo?
- Amoxi
| - Azithro
