Pulmonary Flashcards
Most important imaging study for diagnosis of Interstitial Lung Disease?
High-Resolution CT (1-2mm cuts of lung tissue)
Interstitial Lung Disease shows a ___ pattern on PFTs
Restrictive
Change to TLC in Interstitial Lung Disease?
Low
Change to FVC in Interstitial Lung Disease?
Low
Change to RV in Interstitial Lung Disease?
Low
Change to DCLO in Interstitial Lung Disease?
Low
Change to FEV1/FVC in Interstitial Lung Disease?
NML
3 conditions that show mixed obstructive and restrictive patterns of lung disease?
Sarcoidosis, Lymphangioleiomyomatosis, Eosinophilic granuloma
Pattern of asbestos-related ILD on CXR?
Involvement of lower lung fields
Pattern of silicosis-related ILD on CXR?
Hilar egg-shell Ca2+
Pattern of sarcoidosis-related ILD on CXR?
Bilateral hilar predominance
Pattern of lymphangioleiomyomatosis-related ILD on CXR?
Pneumothorax in premenopausal female
What is the most common work-related illness?
Pulmonary disease
4 types of inorganic dust that cause interstitial lung disease?
Silicosis, Coal worker’ pneumoconiosis, Berylliosis, Asbestosis
1 type of organic dust that cause interstitial lung disease?
Cotton duct
Alternate name for cotton/flax dust?
Byssinosis
Clinical presentation for Byssinosis?
Symptoms present M-F, Absent S-Su
Best treatment for Byssinosis?
Exposure avoidance
Image of eggshell calcifications seen on XR in silicosis?
If patient with silicosis presents with fever – diagnosis?
Silicone-TB
If patient with silicosis presents with fever – next step of workup?
Silicone-TB
What is the cutoff value for PPD in Silicone-TB?
10mm
5 occupations that have increased risk of silicosis exposure?
Construction, mining, ceramics, sandblasting, masonry
3 aspects of clinical presentation for Caplan Syndrome?
Coal-worker’s pneumoconiosis, RA, Lung nodules
Change to lung in setting of coal-worker’s pneumoconiosis?
Anthracosis … black patches in lung
What accounts for anthracosis (black patches in lung) in setting of coal-worker’s pneumoconiosis?
Carbon-ingesting macrophages
Berylliosis mimics which condition?
Granulomatous sarcoidosis
Which portion of lung is affected by berylliosis?
Upper lung + Hilar lymphadenopathy
3 exposures that increase risk for developing berylliosis?
Fluorescent light bulbs, Aerospace, Electronics
Best treatment for berylliosis?
Corticosteroids
Best test for diagnosing berylliosis?
Beryllium lymphocyte transformation test … (not serum berylliosis level)
Which type of immune response mediates berylliosis?
Cell-mediated
Patient with asbestos exposure is most likely to develop which type of CA?
Squamous cell + Adenocarcinoma (NOT mesothelioma)
Ferruginous bodies seen in asbestos exposure will stain (+) for …
Prussian blue
3 asbestos-related pleural diseases?
Pleural plaques, Pleural effusion, Mesothelioma
What is definition of asbestosis (compared to pleural plaques)?
Asbestosis = ILD in lung bases
Characteristic of pleural effusion in setting of asbestos exposure?
Hemorrhagic
Prognosis of pleural effusion in setting of asbestos exposure?
Benign
Prognosis of mesothelioma in setting of asbestos exposure?
Malignant
Incidence of mesothelioma is affected by ___, but unaffected by ___
Asbestos exposure, Smoking
Best method of diagnosing mesothelioma?
Open pleural biopsy (DON’T do FNB … may seed the lungs/pleura)
Pathogen associated with Hypersensitivity PNA due to moldy hay?
Thermophilic actinomyces
Which lab value is ABSENT in Hypersensitivity PNA?
Eosinophilia
Most common cause of death in ARDS?
Sepsis, Organ failure
Cardiac output in Hypovolemic Shock?
Decreased
Wedge pressure in Hypovolemic Shock?
Decreased
SVR in Hypovolemic Shock?
Increased
Cardiac output in Cardiogenic Shock?
Decreased
Wedge pressure in Cardiogenic Shock?
Increased
SVR in Cardiogenic Shock?
Increased
Cardiac output in Septic Shock?
Increased
Wedge pressure in Septic Shock?
NML
SVR in Septic Shock?
Decreased
Tidal volume of ___ mL/kg is associated with decreased mortality
6
Patient in ICU after septic shock; Recently removed from ventilator; HGB now is 7.9 – at what point should patients in ICU receive blood transfusion?
HGB < 7.0
What are 2 exceptions to rule that ICU should not receive blood transfusion until HGB < 7.0?
Active bleeding; Unstable CAD
ICU admission for COPD exacerbation is associated with ___ year mortality
1
Appropriate duration of oral/IV corticosteroids in COPD exacerbation?
2 weeks
Pulmonary arterial pressure that indicates pulmonary HTN?
Pulmonary arterial systolic pressure > 35 mmHg
Etiology of secondary pulmonary HTN?
Vasoconstriction secondary to COPD, chronic hypoxia, OSA; Scleroderma
Etiology of pulmonary HTN in setting of Scleroderma?
Proliferation of intimal smooth muscle cells
Diagnostic test for Pulmonary HTN?
R heart catheterization
Best treatment for Pulmonary HTN?
CCBs, Lung transplantation
2 tools for diagnosis of PE?
V/Q scan, Helical CT
Hallmark EKG sign associated with PE?
S1-Q3-T3
What accounts for appearance of S1Q3T3 in setting of PE?
R heart strain
Most common finding on chest examination in setting of PE?
Clear breath sounds
Which of the following is NOT a risk factor for DVT – female, advanced age, trauma, recent surgery, homocystinuria?
Female … pregnancy = yes, OCP = yes … but NML women have no increased risk
Is knee surgery OR hip surgery considered a greater risk factor for DVT?
Knee surgery
Best DVT prophylaxis for CA patients?
LMWH
Best treatment for superficial thrombophlebitis?
Not heparin … NSAIDs, rest
2 serious symptoms associated with altitude mountain sickness?
Cerebral edema, Pulmonary edema
3 DOCs for altitude mountain sickness?
Furosemide, Nifedipine, Dexamethasone
DOC for prevention of altitude mountain sickness?
Acetazolamide
Structure of Streptococcus pneumoniae on Gram stain?
Gram (+) lancet-shaped diplococci
Clinical presentation of PNA due to Klebsiella?
Currant jelly sputum
Pathogen responsible for PNA + cattle/sheep exposure?
Q fever, coxsiella
Pathogen responsible for PNA + bird exposure?
Chlamydia psittacosis