Pulmonary Disorders Flashcards
You are examining a pediatric patient and notice noisy breathing with inspiration. You suspect a(n) ______ (upper/lower) airway problem.
Upper
Steeple sign is associated with ______ and is found on ______.
Croup, chest x-ray
A patient presents in severe respiratory distress after 3 days of outpatient treatment for pneumonia. T=101.5, BP=128/74, HR=130, RR=32, spO2=75% (on room air). CXR shows a diffuse “fluffy” opacity over all lung fields. BNP is negative. PaO2 is 50 on room air. What is the most likely diagnosis?
ARDS
A patient with a history of COPD presents with pitting pedal edema. Echocardiogram shows an EF of 55%. The EKG shows no evidence of left ventricular hypertrophy, but there is a right axis deviation and you note that the p-waves are tall and peaked, consistent with right atrial enlargement. On exam, you note hepatomegaly and distended neck veins. What is the most likely diagnosis?
Cor pulmonale
Physical exam findings ______ (are/aren’t) highly sensitive and specific in diagnosing pneumonia, so radiographic studies like the chest x-ray ______ (are/aren’t) usually required.
Aren’t, are
True or false: In patients diagnosed with community-acquired pneumonia managed in the outpatient setting, identification of the specific causative agent is imperative.
False
You are treating a patient in the ICU for ARDS. The patient develops right-heart failure. What pathophysiological mechanism is likely to blame?
Pulmonary hypertension
An otherwise healthy patient presents with a 3-week history of productive cough and low-grade fever. He also reports having a “cold” that started about the same time but has since resolved. On exam, you note some wheezing and rhonchi. What is the most likely diagnosis?
Acute bronchitis
You are treating a patient in the ICU for ARDS. When selecting ventilator settings, you opt for ______ (high/low) frequency and ______ (high/low) volume.
high, low
The most significant survival advances in ARDS patients are realized by ventilating at ______ (a number) ml/kg of ideal body weight.
6
For patients diagnosed with small cell carcinoma, the most common treatment is ______ (chemotherapy +/- radiation/surgery).
chemotherapy +/- radiation
A trauma patient presents with severe dyspnea. On exam, you find that breath sounds are decreased on the right and that the right lung fields are hyper-resonant to percussion. Neck veins are distended. HR=144, BP=72/48, RR=40/labored, spO2=82%. Which of the following would you do first?
A) Type and cross for possible blood transfusion
B) Needle decompression of the right chest
C) Chest X-ray to evaluate for mediastinal shift
D) Thoracentesis to drain the exudative pleural effusion
B-needle decompression of the right chest
Name two common causes of iatrogenic pneumothorax.
Thoracentesis
Mechanical ventilation
Pleural effusions secondary to congestive heart failure are classified as ______ (transudative/exudative).
Transudative
A trauma patient presents with severe dyspnea. On exam, you find that breath sounds are decreased on the right and that the right lung fields are hyper-resonant to percussion. Neck veins are distended. HR=144, BP=72/48, RR=40/labored, spO2=86%. What mechanism is causing the tachycardia and hypotension?
Mediastinal compression
A previously healthy trauma patient was orally intubated without adequate sedation/paralysis. During the procedure, the patient vomited. This patient is at risk for developing which type of pneumonia?
Aspiration
You are treating a patient for rib fractures. The pain limits chest wall excursion, and the patient develops some collapse of lung tissue as a result. Which word would you use to document this condition in the patient’s chart?
Atelectasis
You are treating a patient for rib fractures. The pain limits chest wall excursion, and the patient develops some collapse of lung tissue as a result. Which technique is often employed to prevent this complication?
Incentive spirometry
You diagnose a pediatric patient with bronchiolitis. What is the most common causative agent?
Respiratory syncytial virus (RSV)
A 62 year-old male patient presents with chronic and progressive exertional dyspnea and non-productive cough. He has never smoked, and there is no history of toxic, environmental, or occupational exposures. CT shows a “honeycomb” appearance in the lungs. What is the most likely diagnosis?
Idiopathic pulmonary fibrosis
You suspect idiopathic pulmonary fibrosis. What is the gold standard test to confirm this diagnosis?
Surgical lung biopsy
A 62 year-old male patient presents with chronic and progressive exertional dyspnea and non-productive cough. He has never smoked, and there is no history of toxic, environmental, or occupational exposures. CT shows a “honeycomb” appearance in the lungs. Which therapeutic modality has demonstrated benefit for this patient.
Lung transplant
An otherwise healthy 35 year-old non-smoker presents with radiologic evidence of basilar emphysema as well as liver failure. Which single disorder best accounts for these symptoms?
Alpha-1 antitrypsin deficiency
You are working up a patient with a respiratory disease. The PFT shows a normal FEV1/FVC ratio. This patient’s disease is ______ (restrictive/obstructive).
Restrictive
You are working up a patient with a respiratory disease. The PFT shows a decreased FEV1/FVC ratio. After administration of bronchodilators, however, the FEV1/FEV ratio improves significantly. What is the most likely diagnosis?
Asthma
A pediatric patient presents with FTT (failure to thrive) and recurrent respiratory infections. The patient was treated for meconium ileus at birth. Which diagnostic test would be of most value for this patient?
Sweat chloride test
A 42 year-old female presents with a sudden onset of dyspnea and pleuritic chest pain after returning from a vacation to Europe. Which class of medication do you suspect that the patient might be taking?
Oral contraceptives
A 42 year-old female presents with a sudden onset of dyspnea and pleuritic chest pain after returning from a vacation to Europe. Which item from the social history would be most consistent with this clinical picture?
History of smoking
A 42 year-old female presents with a sudden onset of dyspnea and pleuritic chest pain after returning from a vacation to Europe. Which diagnostic test offers the greatest specificity in confirming your ddx?
CT
A pediatric patient develops paroxysms of barky cough and inspiratory stridor during the night. The symptoms abate when the child is taken outside. What is the most common causative agent for the patient’s condition?
Parainfluenza virus
An unvaccinated pediatric patient presents with an acutely onset sore throat and fever that quickly progresses to difficulty swallowing. You find the patient leaning forward in a tripod position and drooling. What is your most immediate concern in treating this pt?
Airway management
An unvaccinated pediatric patient presents with an acutely onset sore throat and fever that quickly progresses to difficulty swallowing. You find the patient leaning forward in a tripod position and drooling. What is the most likely diagnosis?
Epiglottitis
Most cases of COPD are ______ (primary/secondary) and the key risk factor is ______.
Secondary, smoking
Increased a/p diameter (barrel chest) is caused by which pathological feature of emphysema?
Air trapping
A patient was diagnosed with asthma two years ago, but has not responded to therapy. You order a PFT and find that the patient has a decreased FEV1/FVC ratio that is not responsive to bronchodilators. Notably, the patient reports having been exposed to chlorine gas in a small industrial accident just prior to his diagnosis. What disease might you suspect?
Bronchiolitis obliterans
You are treating a patient in the ICU who is being mechanically ventilated. The FIO2 is 0.7 (70% inspired oxygen). A PaO2 below ______ might be suggestive of ARDS.
210
You are following a patient for asthma that has been well-controlled with minimal use of a short acting beta agonist inhaler. Of late, however, the patient has been having symptoms 4-5 times per week. What therapy might you consider adding to the patient’s regimen?
Low-dose inhaled corticosteroid
A specialist consult should be requested when asthma patients require treatment at or beyond step ______.
3
In which COPD patients should surgical treatment be considered?
A. FEV1/FVC < 0.7
B. FEV1 between 50% and 80% of predicted value
C. FEV1 between 30% and 50% of predicted value
D. FEV1 between 30% and 50% of predicted value with chronic respiratory failure
D. FEV1 between 30% and 50% of predicted value with chronic respiratory failure
An infant is born at 30 weeks gestation to a diabetic mother. Within a few minutes, the infant develops tachypnea, grunting, retractions, and cyanosis. CXR shows a “ground glass” opacity. What is the most likely diagnosis?
Respiratory distress syndrome (RDS) or hyaline membrane disease (HMD)
An infant is born at 30 weeks gestation to a diabetic mother. Within a few minutes, the infant develops tachypnea, grunting, retractions, and cyanosis. CXR shows a “ground glass” opacity. Which prenatal treatment would have been most effective at preventing this complication?
maternal beta-methasone injection
An infant is born at 30 weeks gestation to a diabetic mother. Within a few minutes, the infant develops tachypnea, grunting, retractions, and cyanosis. CXR shows a “ground glass” opacity. In addition to supplemental oxygenation and supportive ventilation, which intervention should be considered for this patient?
Surfactant
What is the most common cause of acute upper airway obstruction in children?
Croup (laryngotracheobronchitis)
A previously healthy two year-old patient presents with a sudden onset of stridor, coughing, and hoarseness without associated constitutional symptoms. What is the most likely diagnosis?
Foreign-body aspiration
Which component of the patient history is likely to be of most benefit in diagnosing pneumoconiosis?
Social history/work history
A patient develops a pleural effusion secondary to liver failure. This effusion is most likely ______ (transudative/exudative).
Transudative
Pulmonary edema secondary to congestive heart failure is caused by ______ (increased/decreased) ______ (hydrostatic/oncotic) pressure.
Increased, hydrostatic
The preferred treatment for localized early-stage lung cancers is generally ______.
Surgical removal
A 50 year-old female patient who has never smoked is diagnosed with non-small cell lung cancer. Which type of carcinoma is most likely?
Adenocarcinoma
Concerning findings when evaluating lung lesions include ______ size and ______ borders.
Large, irregular/spiculated
Which of the following is/are associated with pulmonary hypertension?
A. Pulmonary vein stenosis B. Cor pulmonale C. Right ventricular hypertrophy D. ARDS E. Pedal edema F. Angioedema G. Pulmonary Embolus H. Right atrial enlargement I. Elevated central venous pressure
A, B, C, D, E, G, H, I
A 32 year-old asymptomatic female presents with incidentally discovered bilateral hilar lymphadenopathy. Histology is positive for non-caseating granulomas. What is your diagnosis?
Sarcoidoisis
Caseating granulomas are associated with ______.
Tuberculosis
An HIV patient presents with dyspnea, cough, hemoptysis, night sweats, and weight loss for the past several weeks. CXR is positive for hilar lymphadenopathy and cavitations. Which test might you perform next?
PPD
An HIV patient presents with dyspnea, cough, hemoptysis, night sweats, and weight loss for the past several weeks. CXR is positive for hilar lymphadenopathy and cavitations. Which disease do you suspect?
Tuberculosis
A patient presents with severe dyspnea, fever, and non-productive cough that originally onset as flu-like symptoms. CXR shows diffuse infiltrates. What is the most likely diagnosis?
Viral pneumonia
An elderly nursing home resident presents with fever, productive cough, and dyspnea. On exam, you find the right middle lobe dull to percussion and the CXR shows infiltrates in the right middle lobe. What is the most likely diagnosis, and how would you classify the disease?
Pneumonia, healthcare associated
True or false: Most COPD patients have symptoms of either emphysema or chronic bronchitis, but not both.
False
A patient with a 40 pack-year history of smoking presents with chronic cough and exertional dyspnea. On physical exam, you find the patient cachexic with an increased a/p chest diameter. You order a pulmonary function test, expecting which value to be increased?
TLC (total lung capacity)
Reduced diffusion capacity is a hallmark feature of which COPD disorder?
Emphysema
This disease, which affects the pancreas and lungs, is caused by abnormal movement of chloride ions.
Cystic fibrosis
