Pulmonary Medicine Flashcards
Test for suspected cough-variant asthma with normal spirometry
Methacholine challenge test
MKSAP 20
High-prevalence condition in young patients with DPLD
Connective tissue disease
MKSAP 20
Anterior mediastinal mass entities
Thymoma, teratoma, lymphoma, thyroid
MKSAP 20
Common drug cause of CSA
Opioids
MKSAP 20
Treatment for snoring and mild OSA
Weight loss
MKSAP 20
Add-on therapy to short-acting bronchodilators in COPD
LABA and/or LAMA
MKSAP 20
Treatment for vasoreactive-positive PAH
CCB
MKSAP 20
Conditions causing an elevation in Dlco
Pulmonary alveolar hemorrhage, left-to-right shunt, asthma
MKSAP 20
First step in evaluating excessive daytime sleepiness
Actigraphy or sleep diary
MKSAP 20
Sarcoidosis management for asymptomatic patients without organ dysfunction
Observation
MKSAP 20
Conditions warranting in-lab polysomnography
Cardiopulmonary or neuromuscular disease
MKSAP 20
Treatment for uncontrolled severe eosinophilic phenotype asthma
Mepolizumab, reslizumab, or benralizumab
MKSAP 20
Test for occupational asthma
Spirometry before and after workplace exposure
MKSAP 20
Glucocorticoid treatment for moderate to severe COPD exacerbation
Oral prednisone, 40 mg for 5 days
MKSAP 20
Pulmonary infections suggestive of bronchiectasis
Pseudomonas aeruginosa, Aspergillus, non-TB mycobacteria
MKSAP 20
Diagnosis suggested by anterior mediastinal mass, myasthenia gravis
Thymoma
MKSAP 20
Treatment for high-altitude cerebral edema
Descent, dexamethasone, supplemental oxygen, hyperbaric oxygen therapy
MKSAP 20
Asthma monotherapy associated with increased mortality
LABA
MKSAP 20
An underlying cause of neutrophil-predominant pleural effusion
Acute pneumonia
MKSAP 20
Management for malignant pleural effusion
Repeat thoracentesis, indwelling pleural catheter, or chemical pleurodesis
MKSAP 20
Preferred test for high likelihood of moderate/severe OSA
Home sleep apnea test
MKSAP 20
Diagnosis suggested by respiratory distress, unilateral absent breath sounds, tracheal deviation
Tension pneumothorax
MKSAP 20
Role of sputum culture in COPD exacerbation
None
MKSAP 20
Pleural fluid enzyme test for TB
Adenosine deaminase
MKSAP 20
Most common middle mediastinal mass
Lymphadenopathy
MKSAP 20
Lifestyle interventions for asthma
Allergen control, weight loss, no smoking
MKSAP 20
These interventions aim to reduce asthma triggers and improve overall health.
Nonmalignant asbestosis-related pulmonary and pleural disease manifestations
Pulmonary fibrosis, pleural effusion, pleural plaques
MKSAP 20
These manifestations are associated with long-term exposure to asbestos.
Test to determine supplemental O2 needs during air travel
Hypoxia altitude simulation testing or 6-minute walk test
MKSAP 20
These tests assess the body’s response to low oxygen levels at high altitudes.
Safe anti-inflammatory agent in aspirin-exacerbated respiratory disease
The selective COX-2 inhibitor celecoxib
MKSAP 20
Celecoxib is preferred due to its lower risk of triggering respiratory symptoms.
Initial treatment for mild COPD
Short-acting bronchodilator
MKSAP 20
This helps relieve symptoms by opening the airways.
Recommended test for lung cancer screening
Low-dose CT
MKSAP 20
This method is effective in detecting lung cancer at an early stage.
Treatment for severe COPD
Triple inhaler therapy with LABA, LAMA, inhaled glucocorticoid
MKSAP 20
This combination addresses different aspects of COPD management.
COPD indication for systemic glucocorticoid
Acute COPD exacerbation
MKSAP 20
Systemic glucocorticoids are used to reduce inflammation during exacerbations.
Treatment for CTEPH
Pulmonary thromboendarterectomy and anticoagulation
MKSAP 20
These treatments are aimed at removing clots and preventing new ones.
Emergency treatment for tension pneumothorax
Needle thoracostomy
MKSAP 20
This procedure quickly relieves pressure in the pleural space.
PSP indication for pleurodesis
Second ipsilateral occurrence
MKSAP 20
Pleurodesis is indicated to prevent further pneumothorax in recurrent cases.
Most sensitive test for small pleural effusions while semirecumbent/supine
Ultrasonography
MKSAP 20
This imaging technique is effective in detecting fluid in the pleural space.
Most common anterior mediastinal tumor
Thymoma
MKSAP 20
Thymomas can be associated with autoimmune disorders.
Number of pleural fluid cytology exams for maximum yield
Two
MKSAP 20
Performing multiple tests increases the likelihood of detecting malignant cells.
Common symptoms of bronchiectasis
Chronic productive cough, frequent respiratory infections
MKSAP 20
These symptoms result from damage to the airways.
Pleural fluid LDH level in exudative pleural effusion
> 2/3 upper limit of normal for serum LDH
MKSAP 20
This helps differentiate exudative from transudative effusions.
Treatment for severe radiation pneumonitis
Glucocorticoids
MKSAP 20
This treatment reduces inflammation caused by radiation therapy.
Bronchiectasis CT findings
Bronchial wall thickening, cysts, dilated airways without distal tapering
MKSAP 20
These findings are characteristic of bronchiectasis.
OHS defining parameter
Daytime hypercapnia
MKSAP 20
This indicates an inability to adequately ventilate.
Physical manifestation of CSA due to heart failure
Cheyne-Stokes breathing
MKSAP 20
This pattern of breathing is often observed in patients with heart failure.
OSA symptom most responsive to treatment
Daytime sleepiness
MKSAP 20
Effective treatment can significantly improve alertness.
Positive bronchial challenge test result
≥20% FEV1 reduction
MKSAP 20
This indicates airway hyperresponsiveness.
Initial test for PH
Transthoracic echocardiography
MKSAP 20
This is the first-line diagnostic tool for pulmonary hypertension.
USPSTF criteria for lung cancer screening with low-dose CT
Age 50-80 years, asymptomatic, ≥20 pack-years, smoker in past 15 years
MKSAP 20
These criteria define the population at risk for lung cancer.
Treatment for IPF
Nintedanib or pirfenidone
MKSAP 20
These medications are used to slow the progression of idiopathic pulmonary fibrosis.
First-line therapy for PAH if tolerated
Ambrisentan and tadalafil
MKSAP 20
PAH stands for pulmonary arterial hypertension, and these medications help in vasodilation and improving exercise capacity.
MKSAP 20
Drug treatments for high-altitude pulmonary edema
Nifedipine, PDE-5 inhibitor
MKSAP 20
Nifedipine is a calcium channel blocker that helps reduce pulmonary artery pressure.
COPD indications for supplemental oxygen
Po2 ≤55 mm Hg, Spo2 ≤88%
MKSAP 20
These values indicate severe hypoxemia requiring oxygen therapy.
Diagnosis suggested by asthma, sinusitis, nasal polyp
Aspirin-exacerbated respiratory disease
MKSAP 20
This condition is characterized by respiratory reactions to aspirin and other NSAIDs.
Treatment for aspirin-exacerbated respiratory disease
Leukotriene-receptor antagonists
MKSAP 20
These medications help block the action of leukotrienes, which are inflammatory mediators.
Initial test for cystic fibrosis
Sweat chloride
MKSAP 20
Elevated sweat chloride levels indicate cystic fibrosis due to defective chloride channels.
Treatment after first occurrence of SSP
Pleurodesis
MKSAP 20
This procedure helps to prevent recurrence of spontaneous pneumothorax.
Diagnosis suggested by asymptomatic bilateral hilar lymphadenopathy
Pulmonary sarcoidosis
MKSAP 20
Sarcoidosis is an inflammatory disease that can affect multiple organs, primarily the lungs.
Most effective class of asthma controller medications
Glucocorticoids
MKSAP 20
These medications reduce inflammation and help control asthma symptoms.
Most common cause of excessive daytime sleepiness
Insufficient sleep syndrome
MKSAP 20
This syndrome is often due to inadequate sleep duration or quality.
CPAP treatment alternative for mild/moderate OSA
Oral appliance
MKSAP 20
Oral appliances help keep the airway open during sleep for patients with obstructive sleep apnea.
Possible complication during air travel in asthma or COPD
Pneumothorax
MKSAP 20
Changes in cabin pressure can lead to lung overinflation and subsequent pneumothorax.
Trimester of pregnancy with most frequent asthma exacerbations
Second trimester
MKSAP 20
Hormonal changes and increased lung function can lead to exacerbations during this period.
Treatment for poorly controlled asthma, elevated IgE, and allergies
Omalizumab
MKSAP 20
Omalizumab is a monoclonal antibody that targets IgE to reduce allergic responses.
Diagnosis suggested by nocturnal absence of respiratory effort, airflow
CSA
MKSAP 20
CSA stands for central sleep apnea, characterized by a lack of respiratory effort during sleep.
Most common causes of pleural effusion
Heart failure, pneumonia, malignancy
MKSAP 20
These conditions can lead to fluid accumulation in the pleural space.
MKSAP 20
Postbronchodilator FEV1/FVC value consistent with COPD
<0.7
MKSAP 20
A ratio of less than 0.7 indicates airflow obstruction consistent with COPD.
Emphysema amenable to lung reduction surgery
Upper lobe predominant
MKSAP 20
Patients with upper lobe predominant emphysema may benefit from surgical intervention.
Diagnosis suggested by TLC <80% of predicted
Restrictive lung disease
MKSAP 20
Total lung capacity (TLC) less than 80% indicates a restriction in lung expansion.
Diagnosis suggested by headache, nausea, disturbed sleep at altitude
Acute mountain sickness
MKSAP 20
This condition occurs due to reduced oxygen availability at high altitudes.
Treatment for complicated parapneumonic effusion
Thoracostomy tube drainage
MKSAP 20
This procedure helps drain infected or complicated pleural effusions.
Ratio of pleural fluid LDH to serum LDH in exudative pleural effusion
> 0.6
MKSAP 20
This ratio helps differentiate exudative from transudative pleural effusions.
Tests for atopy in patients with suspected allergic asthma
Skin prick or allergen-specific IgE
MKSAP 20
These tests help identify specific allergens causing the allergic response.
Symptoms suggestive of COP
Subacute cough, fever, malaise, patchy infiltrates unresponsive to antibiotics
MKSAP 20
COP stands for cryptogenic organizing pneumonia, which presents with these clinical features.
Medications for acute mountain sickness
Acetazolamide or dexamethasone
MKSAP 20
These medications help alleviate symptoms and prevent progression of acute mountain sickness.
Symptoms and history suggestive of mesothelioma
Asbestos exposure, chest pain, night sweats, recurrent pleural effusion
MKSAP 20
Mesothelioma is often linked to occupational asbestos exposure and presents with respiratory symptoms.
Systemic sclerosis variant associated with PAH
Limited cutaneous systemic sclerosis
MKSAP 20
This variant of systemic sclerosis is characterized by skin changes confined to the fingers and face.
Diagnoses suggested by elevated pleural fluid amylase
Pancreatitis, esophageal rupture
MKSAP 20
Elevated amylase levels in pleural fluid can indicate these underlying conditions.
Initial imaging for CTEPH
Ventilation-perfusion scan
MKSAP 20
This scan helps assess blood flow in the lungs and detect chronic thromboembolic pulmonary hypertension.
First step in evaluating solid pulmonary nodule >8 mm
Estimate probability of malignancy
MKSAP 20
This step is crucial in determining the management approach for pulmonary nodules.
Characteristic biomarkers in patients with allergic asthma
Serum eosinophilia, high IgE, elevated fractional exhaled nitric oxide
MKSAP 20
These biomarkers help in diagnosing and monitoring allergic asthma.
Antifibrotic therapy for progressive fibrotic CTD-ILD
Nintedanib
MKSAP 20
Nintedanib is used to slow the progression of interstitial lung disease associated with connective tissue disease.
Clinical presentation of allergic bronchopulmonary aspergillosis
Difficult-to-control asthma, productive cough, expectoration of mucus plugs
MKSAP 20
This condition often complicates asthma and may require specific antifungal treatment.
Diagnosis suggested by environmental exposure, fever, fatigue, cough
Hypersensitivity pneumonitis
MKSAP 20
This condition is caused by an immune response to inhaled organic antigens.
Preferred test for patients with likely mild OSA
In-lab polysomnography
MKSAP 20
This test provides comprehensive data on sleep patterns and breathing abnormalities.
Diagnostic tests for allergic bronchopulmonary aspergillosis
Aspergillus-specific IgE and IgG; Aspergillus antigen skin test
MKSAP 20
These tests help confirm the diagnosis by identifying an immune response to Aspergillus species.
Symptoms most suggestive of DPLD
Subacute/chronic nonproductive cough and dyspnea
MKSAP 20
These symptoms indicate possible diffuse parenchymal lung disease.
Empiric antibiotic class for bronchiectasis exacerbation
Fluoroquinolone
MKSAP 20
This antibiotic class is often used due to its effectiveness against common pathogens in bronchiectasis.
DPLD commonly associated with clubbing
Idiopathic pulmonary fibrosis
MKSAP 20
Clubbing is a notable clinical feature in patients with this condition.
Change in SABA and inhaled glucocorticoid asthma treatment during pregnancy
None
MKSAP 20
Standard asthma medications are typically continued during pregnancy unless contraindicated.
Indicators of well-controlled asthma
Daytime symptoms <2 times/week, nighttime symptoms <2 times/month
MKSAP 20
These indicators help assess the effectiveness of asthma management.
Most common causes of lymphocyte-predominant pleural effusion
TB, cancer
MKSAP 20
These conditions often lead to a lymphocytic response in pleural effusions.
Diagnostic test for mesothelioma
Pleural biopsy
MKSAP 20
This test is essential for confirming the diagnosis of mesothelioma.
Characteristics of idiopathic NSIP compared with IPF
Typically affects younger population, has more favorable prognosis
MKSAP 20
Idiopathic nonspecific interstitial pneumonia (NSIP) is often distinguished from idiopathic pulmonary fibrosis (IPF) by these traits.
Primary risk factor for CSA
Heart failure
MKSAP 20
Central sleep apnea (CSA) is commonly associated with underlying heart conditions.
Spo2 level requiring supplemental O2 during air travel
<92%
MKSAP 20
This threshold is important for ensuring adequate oxygenation during flights.
Imaging for evaluation of solid lung nodule >8 mm
CT and PET
MKSAP 20
These imaging modalities help characterize lung nodules and assess for malignancy.
Asthma indication for adding LAMA
Poor control on glucocorticoid plus LABA
MKSAP 20
Long-acting muscarinic antagonists (LAMA) are added for better asthma control.
DPLD mimic of ARDS
Acute interstitial pneumonia
MKSAP 20
This condition can present similarly to acute respiratory distress syndrome (ARDS).
Test for exercise-induced bronchoconstriction
Methacholine or exercise bronchial challenge test
MKSAP 20
These tests help diagnose bronchial hyperreactivity in patients with asthma.
Pleural fluid pH and glucose level in complicated parapneumonic effusion
pH <7.2, glucose <60 mg/dL
MKSAP 20
These values indicate a more severe underlying infection or inflammation.
Common cystic fibrosis symptoms
Chronic productive cough, recurrent sinusitis and pulmonary infections, GI disease
MKSAP 20
These symptoms are often due to mucus buildup and chronic infection.
Antibiotic class for severe COPD with frequent exacerbations
Macrolide
MKSAP 20
Macrolides are used for their anti-inflammatory properties in addition to their antibacterial effects.
Noninvasive tool to quantify eosinophilic airway inflammation
Fractional exhaled nitric oxide test
MKSAP 20
This test measures nitric oxide levels in exhaled air, which can indicate inflammation in asthma.
PDE-4 inhibitor to reduce severe COPD exacerbations, chronic bronchitis symptoms
Roflumilast
MKSAP 20
Roflumilast is used to decrease inflammation and relax airway muscles.
Most common posterior mediastinal mass
Neurogenic neoplasms
MKSAP 20
These tumors arise from nerve tissue and can be benign or malignant.
Factors predicting high risk for recurrent acute COPD exacerbations
FEV1 <50%, ≥2 acute exacerbations yearly, hospitalization for exacerbation
MKSAP 20
These factors help identify patients who may benefit from more aggressive management.
