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PANCE Review > Pulmonary topics > Flashcards

Pulmonary topics Flashcards

1
Q

18 year old college student has influenzae. What is the treatment of choice?

A

Zanamivir or oseltamivir

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2
Q

Your patient has a history of HIV/AIDs and presents with shortness of breath. What organism is likely the cause?

A

Pneumocystis jirovecii

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3
Q

Name one common infectious cause of nodular lesions seen on CXR?

A

Histoplasmosis, coccidiodomycosis, Cryptococcus

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4
Q

What test is used to base the diagnosis of tuberculosis?

A

Sputum culture

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5
Q

You suspect your patient has lung cancer. What lab result would help to confirm your suspicion.

A

Hyponatremia. Due to secretion of anti-diuretic hormone from small cell carcinoma

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6
Q

Your patient has acute asthma exacerbation. What lab finding is most expected?

A

Respiratory alkalosis followed by respiratory acidosis. Eosinophilia is common

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7
Q

What is a common side-effect of asthma anti-inflammatory agents like fluticasone, methylprednisone, prednisone, or triamcinolone?

A

Osteoporosis, edema, increased appetite

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8
Q

What is a common side effect of an asthma leukotriene inhibitor like montelukast or zafirlukast?

A

Elevated liver function tests, headache, dyspepsia

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9
Q

Your asthmatic patient’s INR keeps increasing. What medication is interfering with the warfarin?

A

Zafirlukast

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10
Q

Your patient has asthma symptoms more than two times per week and and more than two times per month at night. How is is this classified?

A

Mild persistent chronic asthma

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11
Q

Name one side effect of asthma medications like albuterol, salmeterol, or terbutaline?

A

Tachycardia, hyperglycemia, hypokalemia

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12
Q

Your 60 year “pink puffer” emphysema patient needs a CXR. What do you expect to see?

A

Hyperinflated with flat diaphragms

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13
Q

Your 35 year old “blue bloater” chronic bronchitis patient needs a CXR. What do you expect to see?

A

Increased interstitial markings and normal diaphragms

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14
Q

You newly diagnose a patient with emphysema. What is first line medical therapy?

A

Anti-cholinergic agents

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15
Q

Name one side effect of an anticholinergic agent.

A

Dry mouth, skin flushing, blurry vision, tachycardia, and urinary retention

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16
Q

Is pleural effusion seen in left-sided or right sided heart failure?

A

Left-sided heart failure

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17
Q

Your 55 year old male patient has a long history of a chronic cough. It has been present for 6 months for the last 3 years. He has no fever and CXR is unremarkable. What is the most likely diagnosis?

A

Chronic brochitis. This is a chronic cough with excessive sputum production for at least 3 months for at least 2 consecutive years.

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18
Q

You suspect your patient has a pleural effusion. What might you see on CXR to make the diagnosis?

A

Blunting of margins/costophrenic angles, free pleural fluid seen on a lateral decubitus film

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19
Q

On CXR of a patient with a tension pneumothorax, will the mediastinum shift to the ipsilateral side or contralateral side?

A

Contralateral side. It will shift away from the affected side.

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20
Q

Where do you place a large bore needle to rapidly treat a pneumothorax?

A

Into the pleural space through the 2nd anterior intercostal space

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21
Q

List 2 risk factors for PE.

A

Hypercoagulability, pregnancy, birth control pills, recent surgery with anesthesia, atrial fibrillation, right ventricular MI, immobilization, history of prior PE

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22
Q

In a massive pulmonary embolism, what heart sound may be noted?

A

S3

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23
Q

What two signs could you see on a CXR of patient with a suspected pulmonary embolism?

A

Westermark’s sign, Hampton’s hump

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24
Q

What lab test do you order to rule out pulmonary embolism in low-risk patients?

A

D-dimer

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25
Q

Name one test to diagnose a pulmonary embolism

A

V/Q scan, spiral CT scan, pulmonary angiography

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26
Q

What is the gold standard for diagnosis of a pulmonary embolism?

A

Pulmonary angiography

27
Q

What is the gold standard for acute treatment of a pulmonary embolism?

A

Heparin (LMW Heparin can be used)

28
Q

How do you treat an overdose of heparin?

A

Protamine sulfate

29
Q

How do treat an overdose of warfarin/Coumadin?

A

Fresh frozen plasma or vitamin K

30
Q

Name two etiologies that can cause pulmonary hypertension and increased pulmonary venous return.

A

Left ventricular failure, mitral stenosis, ischemic heart disease

31
Q

How is diagnosis of primary pulmonary hypertension confirmed?

A

Cardiac catheterization or pulmonary angiography

32
Q

What is a common finding in CXR of a patient with pulmonary hypertension?

A

Kerley B lines

33
Q

Name one finding you will see on EKG of a patient with pulmonary hypertension.

A

Right ventricular hypertrophy/enlargement, right-axis deviation

34
Q

What disease typically produces a pleural effusion that is transudative?

A

CHF

35
Q

What is the most common cause of cor pulmonale?

A

COPD

36
Q

Name one symptom of right ventricular hypertrophy and failure.

A

Easily tires, increased shortness of breath, increased sputum production, peripheral edema

37
Q

On exam, you hear a systolic murmur along the left sternal border that changes with inspiration and you notice peripheral edema and distended neck veins. What is the best diagnosis?

A

Cor pulmonale

38
Q

The EKG shows right ventricular enlargement and prominent P waves in leads II, III, and aVF. What does this indicate?

A

Right atrial enlargement

39
Q

A radiologist uses the word “pruning” to describe your patient’s pulmonary vessels on a CXR. What condition does your patient have?

A

Cor pulmonale

40
Q

Name a vasodilator that can decrease pulmonary vascular resistance

A

Hydralazine

41
Q

Name a calcium channel blocker than can be used to treat pulmonary hypertension.

A

Nifedipine or diltiazem. Use amlodipine if patient is intolerant to either nifedipine or diltiazem

42
Q

Name one side effect of corticosteroids used to treat idiopathic pulmonary fibrosis

A

Hyperglycemia, water retention, osteoporosis, peptic ulcer disease, depression

43
Q

Name one side effect of cyclophosphamide used to treat idiopathic pulmonary fibrosis

A

Leukopenia, thrombocytopenia, hemorrhagic cystitis, nausea, vomiting

44
Q

Name one side effect of azathioprine used to treat idiopathic pulmonary fibrosis

A

Leukopenia, anemia, thrombocytopenia, nausea, vomiting

45
Q

Name one occupation at risk for developing silicosis

A

Foundry worker, glass makers, pottery workers, sandblasters

46
Q

You see hilar node calcifications in an eggshell pattern on CXR. What is the best diagnosis?

A

Silicosis

47
Q

Your patient has pneumoconiosis. The pulmonary function test reveals an obstructive pattern. The CXR shows small nodules in the lower lung fields. What is the best diagnosis?

A

Coal workers Lung

48
Q

What pulmonary disease is associated with inclusion bodies such as Schaumann’s bodies and asteroid bodies?

A

Sarcoidosis

49
Q

Your patient is diagnosed with sarcoidosis. The CXR shows bilateral hilar adenopathy with diffuse parenchymal infiltrates. What stage is this?

A

Stage 2

50
Q

What lab level is elevated in sarcoidosis?

A

Angiotensin-converting enzyme (ACE)

51
Q

Name one medication used to treat sarcoidosis.

A

Glucocorticoids, methotrexate, cyclophosphamide

52
Q

Name one characteristic of acute respiratory distress syndrome.

A

Pulmonary edema, high cardiac output, and low pulmonary wedge pressure

53
Q

What is the major symptom of idiopathic pulmonary fibrosis?

A

Exertional dyspnea

54
Q

Which pulmonary function test result is typical in restrictive lung disease?

A

Decreased total lung capacity (TLC), decreased vital capacity (VC), and decreased residual volume (RV)

55
Q

Your 60 year old lung cancer patient presents with facial and neck swelling. What is the best diagnosis?

A

Superior vena cava syndrome

56
Q

A 25 year old presents with sudden shortness of breath and chest pain. He has no breath sounds on the right side. What is best diagnosis? What is best treatment?

A

Pneumothorax

Diagnose with a CXR and treat with a chest tube

57
Q

Which medication is most beneficial in treatment of emphysema?

A

Atrovent (an anti-cholinergic)

58
Q

Elderly patients, COPD patients and children aged 6-24 months should receive what vaccination routinely?

A

Influenzae

59
Q

What is a common cause of pneumonia in patients with a recent history of influenzae?

A

Staphylococcus aureus

60
Q

A 25-year old presents with non-productive cough, headache, and malaise. Denies shortness of breath, chest pain, or fever. Normal lung exam. CXR shows patchy infiltrates. What is the best diagnosis?

A

Mycoplasma pneumonia

61
Q

What is a risk factor for developing mesothelioma?

A

Asbestos exposure, radiation, and SV40 virus

62
Q

Your 44 year old female patient has a 2-day history of fever, productive cough, and bronchial breath sounds. What is your best diagnosis?

A

Pulmonary consolidation

63
Q

Are bronchial breath sounds soft and fine or loud and coarse?

A

Loud and coarse

64
Q

You hear bronchial breath sounds over the lung fields. What is your best diagnosis?

A

Pulmonary consolidation that can happen in pneummococcal lobar pneumonia

PANCE Review (13 decks)

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