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Internal Medicine > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

Clinical Presentation of Asthma?

A
  • Wheezing
  • Episodic Coughing
  • Intermittent Dyspnea
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2
Q

Diagnostic criteria for Asthma?

A

Reduced FEV1 to FVC ratio on Spirometry

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3
Q

Complications of Asthma Exaberation?

A
  • Severe Hypoxema
  • Hypercapnia
  • Respiratory acidosis
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4
Q

Treatment for Acute Asthma Exaberation?

A
  • Supplemental Oxygen
  • Inhaled Albuterol
  • Systemic Corticosteriods
  • Ipratropium/Magnesium Sulfate
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5
Q

Maintenance Treatment for Intermittent Asthma?

A

Intermittent Asthma= 2 episodes a wk, 2 night episodes a month, FEV1= 80%

  • Treat with Inhaled B2-agonists (albuterol)
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6
Q

Maintenance Treatment for Mild Persistent Asthma?

A

Mild Persistent = 2+ episodes a wk (not daily), 3-4 night episodes a month, FEV1= 80%

  • Treat with Inhaled Albuterol + Low dose corticosteriod
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7
Q

Maintenance Treatment for Moderate Persistent Asthma?

A

Moderate Persistent = Daily symptoms, Night episodes 1x a week, FEV1= 60-80%

  • Treat with Low/med dose corticosteriods, Long acting inhaled B2 agonists, Quick acting inhaled B2 agonists
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8
Q

Maintenance Treatment for Severe Persistent Asthma?

A

Severe Persistent Asthma = Symptoms throughout the day, Night symptoms multiple times a week, FEV1= < 60%

  • Treat with Med/High dose corticosteriods, Long acting inhaled B2 agonists, Quick acting inhaled B2 agonists
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9
Q

Treatment for Asthma-exaberated Respiratory disease?

A
  • Montelukast

- Zafirlukast

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10
Q

Clinical Presentation of COPD?

A
  • “Barrel chest” (increased AP diameter)
  • Diminished breath sounds
  • Hyperresonance on percussion
  • Prolonged expiration with “pursed lips” breathing
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11
Q

Diagnostic Criteria for COPD?

A

Pulmonary Function Tests results of:

  • Decreased FEV1
  • Decreased FEV1/FVC ratio
  • Decreased VC
  • Normal DLCO in chronic bronchitis vs decreased DLCO in emphysema
  • Increased TLC, RV, FRC (from trapped air)
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12
Q

Chest X-Ray findings in COPD?

A
  • Flattening of the diaphram
  • Hyperlucent lungs
  • Elongated, tubular shaped Heart (severe)
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13
Q

Complications of COPD?

A
  • Respiratory Acidosis
  • Cor pulmonale
  • Spontaneous Pneuothorax
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14
Q

Treatment of COPD symptoms?

A
  • Inhaled and Long Acting B2- agonists
  • Inhaled anti-cholinergics (Ipratropium)
  • Corticosteriods (Severe only)
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15
Q

Indications for supplemental oxygen in COPD?

A
  • PaO2 < 55 mmhg
  • SpO2 < 88 mmhg

or presence of Cor-pulmonale or Erythrocytosis

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16
Q

Treatment for Acute COPD exaberations?

A
  • Supplemental oxygen titratedto goal(SpO2) of 88 to 92%
  • Inhaled bronchodilators(e.g.albuterol,ipratropium)
  • Intravenous glucocorticoids
  • Antibiotics
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17
Q

Clinical Presentation of Lung Cancer?

A
  • Cough
  • Dyspnea
  • Wheezing
  • Hemoptysis
  • Fatigue
  • Weight loss
  • Paraneoplastic syndromes
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18
Q

Initial test for suspected Lung Cancer?

A

Chest CT

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19
Q

Definitive Diagnostic test for Lung Cancer?

A

Biopsy (Endobronchial ultrasound guided biopsy)

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20
Q

Complications of Lung Cancer?

A
  • Metastatic Disease
  • Mass effects
  • Paraneoplastic Syndrome
  • Pleural Effusion
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21
Q

Clinical Presentation of Superior Vena Cava Syndrome and most common cause?

A
  • Facial fullness
  • Edema of neck, arms, head
  • JVD
    Associated with small cell lung cancer
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22
Q

Types of Mass effects as a result of Lung Cancer?

A
  • Superior Vena Cava Syndrome
  • Horner’s Syndrome
  • Pancoast Tumor
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23
Q

Common sites of metastasis in Lung Cancer?

A
  • Brain
  • Bone
  • Adrenal Glands
  • Liver
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24
Q

Lung Cancer that is commonly found centrally near the hilum and how to treat it?

A

Small Cell Lung Cancer, Treat with Chemotherapy and Radiation

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25
Q

Parneoplastic Syndromes associated with Small Cell Lung Cancer?

A
  • Cushing syndrome (ectopic ACTH secretion)
  • SIADH
  • Ectopic growth hormone secretion
  • Peripheral neuropathy
  • Subacute cerebellar degeneration
  • Lambert-Eaton syndrome
  • Limbic encephalitis
  • Dermatomyositis
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26
Q

Common Peripherally located lung cancer and how to treat it?

A

Large Cell Lung Cancer, Treat with Surgery

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27
Q

Paraneoplastic syndromes associated with Large cell lung cancer?

A
  • Gynecomastia

- Galactorrhea

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28
Q

Centrally locateted Lung Cancer that is heavily associated with smoking?

A

Squamous Cell Lung Cancer

Appears as cavitating lesions on CXR

29
Q

Paraneoplastic syndromes associated with Squamous cell lung cancer?

A
  • Hypercalcemia

- Dermatomyositis

30
Q

Location of Adenocarcinoma of the lung?

A

Peripherally located. Associated with women and not smoking

31
Q

Paraneoplastic syndromes associated with Adenocarcinoma of the lung?

A
  • Hypertrophic osteoarthropathy(a specific form of clubbing)
  • DIC
  • Thrombophlebitis
  • Microangiopathic hemolytic anemia
  • Dermatomyositis
32
Q

Etiologies of Acute Respiratory Distress Syndrome?

A

“AAARDDDSSS”

  • Aspiration
  • Acute pancreatitis
  • Air orAmniotic embolism
  • Radiation
  • Drug overdose
  • DIC
  • Drowning
  • Shock
  • Sepsis
  • Smoke inhalation
33
Q

Clinical Presentation of ARDS?

A
  • Dyspnea
  • Tachypnea
  • Diffuse Crackles
  • Tachycardia
34
Q

Increased Positive End-Expiratory Pressure in ARDS causes what?

A

Opening of collapsed alveoli

35
Q

Target partial pressure of oxygen (PaO2) and oxygen saturation (SaO2) for patients with ARDS?

A 
PaO2= 55-80%
SaO2= 88-95%
36
Q

Treatment for ARDS that is refractory to standard mechanical ventilation?

A

Venovenous extracorporeal membrane oxygenation (ECMO)

37
Q

Etiologies of exudative Pleural Effusions?

A

Due to increase vessel permeability:

  • Lung infections (e.g., pneumonia)
  • Tuberculosis
  • Cancers (e.g., lung, breast, lymphoma, mesothelioma)
  • Pulmonary embolism
  • Impaired pleural lymphatic drainage
38
Q

Etiologies of transudative Pleural Effusions?

A
  • Increased Hydrostatic pressure (e.g., CHF)
  • Decreased Oncotic pressure (e.g., nephrosis, cirrhosis)
  • Injuries to the pleural lining (e.g., central venous catheter misplacement)
39
Q

Clinical Presentation of Pleural Effusion?

A
  • Dyspnea
  • Pleuritic Chest Pain
  • Worsens over time
40
Q

Physical Exam Findings in Pleural Effusion?

A
  • Decreased breath sounds to auscultation
  • Dullness to percussion
  • Decreased fremitus
  • Pleural rub
  • Tracheal deviation, if large
41
Q

Criteria to diagnose Exudative Pleural Effusions?

A
  • Protein/Serum Protein Ratio > 0.5
  • LDH/Serum LDH Ration > 0.6
  • LDH > 2/3 of the upper normal limit of serum LDH
42
Q

Treatment for Pleural Effusions?

A

Treat underlying condition

43
Q

Treatment for Parapneumonic Pleural Effusions?

A
  • Antibiotics

- Chest tube drainage (for complicated pneumo)

44
Q

Virchow’s Triad?

A
  • Hypercoagulability
  • Stasis
  • Endothelial Damage
45
Q

Risk Factors for DVT? (5)

A
  • Recent surgery(especially orthopedic surgery)
  • Pregnancy (current or recent)
  • Cancer
  • Long-distance plane travel
  • Prolonged bedrest
46
Q

Clinical Presentation of DVT?

A
  • Unilateral leg pain
  • Warmth
  • Swelling
47
Q

Diagnostic tests for DVT?

A
  • Compression Ultrasound

- D-Dimer

48
Q

Treatment for DVTs and/or Pulmonary Embolism?

A
  • Anticoagulation (warfarin, heparin, Factor Xa inhibitors)
49
Q

Treatment for DVT when anticoagulation is contraindicated (bleeding risks)?

A

Inferior Vena Cava Filter

50
Q

Pulmonary arterial pressure above what number indicates Pulmonary HTN?

51
Q

Cause of Secondary Pulmonary HTN?

A
  • Cardiac (Congential defects, Lt HF, Valvular disease)
  • Recurrent Thrombotic Events
  • Pulm. Disease (COPD, Sleep apnea, Interstitial Disease)
52
Q

Auscultation of the heart findings in Pulm. HTN?

A
  • Loud P2 heart sound

- Right Ventricular Heave

53
Q

Diagnostic test for Pulm. HTN?

A
  • Echocardiogram

- Right Heart Catherization (Definite)

54
Q

EKG Findings in Pulm. HTN?

A
  • Right axis deviation
  • Peaked P waves (P pulmonale)
  • Right ventricular hypertrophy
55
Q

Treatment for Primary (Idiopathic) Pulmonary HTN?

A
  • Calcium Channel Blockers
  • Prostanoids(epoprostenol, treprostinil and iloprost)
  • Endothelin receptor antagonists( ambrisentan, bosentan, macitentan)
  • PDE5 inhibitors(sildenafil) (Viagra)
  • Lung Transplant
56
Q

Non-caseating granulomas in multiple organs but most commonly the lungs characterizes what disease?

A

Sarcoidosis

57
Q

Clinical Manifestations of Sarcoidosis?

A
  • Skin Findings (Erythema nodosum, Lupus pernio)
  • Arthrirtis
  • Cough, Dyspnea, Anthralgias
  • Anterior Uveitis
  • Lymphadenopathy
  • Interstitial Fibrosis
58
Q

Diagnostic Tests for Sarcoidosis and its Findings?

A

Chest X-ray

  • Bilateral hilar lymphadenopathy
  • Interstitial infiltrates.

Lymph node biopsy is definitive

59
Q

Lab Abnormalities in Sarcoidosis?

A
  • Increased serum ACE and gammaglobulins
  • Hypercalcemia and Hypercalciuria
  • Increased Vitamin D
  • Elevated ALP if there is liver involvement
60
Q

Most Common Cardiac Compications of Sarcoidosis?

A
  • Heart Block (3rd or 1st)

- Ventricular Arrhythmia

61
Q

Treatment of Sarcoidosis?

A
  • Spontaneous Remission (non-progressive)
  • Prednisone
  • Methotrexate(Trexall)
  • Infliximab(Remicade)
  • Lung transplantation
62
Q

Health care acquired Pneumonia occurs after?

A

2 days after admission

63
Q

Common location of Aspiration Pneumonia?

A

Right Lower Lobe

64
Q

Risk Factors for Aspiration Pneumonia?

A
  • GERD
  • Poor dentition
  • Reduced consciousness(eg,seizures, alcoholism)
  • Procedures (eg,bronchoscopy, upper endoscopy, nasogastric feeding)
  • Oropharyngeal muscle fatigue(eg,myasthenic syndromes, muscular dystrophy)
65
Q

Treatment for Aspiration Pneumonia?

A
  • Oral Amoxicillin/Clavulanate

- Parenteral Ampicillin/Sulbactam

66
Q

Diagnostic test for Pneumonia and its findings?

A
  • Interstitial infiltrates
  • Lobar consolidation
  • Cavitation
67
Q

Criteria for hospitalizing a Pneumonia Patient?

A

CURB 65

  • C: confusion
  • U: blood urea nitrogen >20 mg/dL
  • R: respiratory rate >30/min
  • B: blood pressure systolic <90, diastolic <60
  • 65: age >65 years
68
Q

Outpatient Treatment for Community-Acquired Pneumonia?

A
  • Azithromycin

- Doxycycline

69
Q

Inpatient Treatment for Community Acquired Pneumonia?

A
  • Respiratory Flouroquinolone or
  • Beta-lactam + Macrolide

Give both for patients in the ICU

Internal Medicine (15 decks)

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