Pulmonary topics Flashcards
18 year old college student has influenzae. What is the treatment of choice?
Zanamivir or oseltamivir
Your patient has a history of HIV/AIDs and presents with shortness of breath. What organism is likely the cause?
Pneumocystis jirovecii
Name one common infectious cause of nodular lesions seen on CXR?
Histoplasmosis, coccidiodomycosis, Cryptococcus
What test is used to base the diagnosis of tuberculosis?
Sputum culture
You suspect your patient has lung cancer. What lab result would help to confirm your suspicion.
Hyponatremia. Due to secretion of anti-diuretic hormone from small cell carcinoma
Your patient has acute asthma exacerbation. What lab finding is most expected?
Respiratory alkalosis followed by respiratory acidosis. Eosinophilia is common
What is a common side-effect of asthma anti-inflammatory agents like fluticasone, methylprednisone, prednisone, or triamcinolone?
Osteoporosis, edema, increased appetite
What is a common side effect of an asthma leukotriene inhibitor like montelukast or zafirlukast?
Elevated liver function tests, headache, dyspepsia
Your asthmatic patient’s INR keeps increasing. What medication is interfering with the warfarin?
Zafirlukast
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?
Mild persistent chronic asthma
Name one side effect of asthma medications like albuterol, salmeterol, or terbutaline?
Tachycardia, hyperglycemia, hypokalemia
Your 60 year “pink puffer” emphysema patient needs a CXR. What do you expect to see?
Hyperinflated with flat diaphragms
Your 35 year old “blue bloater” chronic bronchitis patient needs a CXR. What do you expect to see?
Increased interstitial markings and normal diaphragms
You newly diagnose a patient with emphysema. What is first line medical therapy?
Anti-cholinergic agents
Name one side effect of an anticholinergic agent.
Dry mouth, skin flushing, blurry vision, tachycardia, and urinary retention
Is pleural effusion seen in left-sided or right sided heart failure?
Left-sided heart failure
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?
Chronic brochitis. This is a chronic cough with excessive sputum production for at least 3 months for at least 2 consecutive years.
You suspect your patient has a pleural effusion. What might you see on CXR to make the diagnosis?
Blunting of margins/costophrenic angles, free pleural fluid seen on a lateral decubitus film
On CXR of a patient with a tension pneumothorax, will the mediastinum shift to the ipsilateral side or contralateral side?
Contralateral side. It will shift away from the affected side.
Where do you place a large bore needle to rapidly treat a pneumothorax?
Into the pleural space through the 2nd anterior intercostal space
List 2 risk factors for PE.
Hypercoagulability, pregnancy, birth control pills, recent surgery with anesthesia, atrial fibrillation, right ventricular MI, immobilization, history of prior PE
In a massive pulmonary embolism, what heart sound may be noted?
S3
What two signs could you see on a CXR of patient with a suspected pulmonary embolism?
Westermark’s sign, Hampton’s hump
What lab test do you order to rule out pulmonary embolism in low-risk patients?
D-dimer
Name one test to diagnose a pulmonary embolism
V/Q scan, spiral CT scan, pulmonary angiography
What is the gold standard for diagnosis of a pulmonary embolism?
Pulmonary angiography
What is the gold standard for acute treatment of a pulmonary embolism?
Heparin (LMW Heparin can be used)
How do you treat an overdose of heparin?
Protamine sulfate
How do treat an overdose of warfarin/Coumadin?
Fresh frozen plasma or vitamin K
Name two etiologies that can cause pulmonary hypertension and increased pulmonary venous return.
Left ventricular failure, mitral stenosis, ischemic heart disease
How is diagnosis of primary pulmonary hypertension confirmed?
Cardiac catheterization or pulmonary angiography
What is a common finding in CXR of a patient with pulmonary hypertension?
Kerley B lines
Name one finding you will see on EKG of a patient with pulmonary hypertension.
Right ventricular hypertrophy/enlargement, right-axis deviation
What disease typically produces a pleural effusion that is transudative?
CHF
What is the most common cause of cor pulmonale?
COPD
Name one symptom of right ventricular hypertrophy and failure.
Easily tires, increased shortness of breath, increased sputum production, peripheral edema
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?
Cor pulmonale
The EKG shows right ventricular enlargement and prominent P waves in leads II, III, and aVF. What does this indicate?
Right atrial enlargement
A radiologist uses the word “pruning” to describe your patient’s pulmonary vessels on a CXR. What condition does your patient have?
Cor pulmonale
Name a vasodilator that can decrease pulmonary vascular resistance
Hydralazine
Name a calcium channel blocker than can be used to treat pulmonary hypertension.
Nifedipine or diltiazem. Use amlodipine if patient is intolerant to either nifedipine or diltiazem
Name one side effect of corticosteroids used to treat idiopathic pulmonary fibrosis
Hyperglycemia, water retention, osteoporosis, peptic ulcer disease, depression
Name one side effect of cyclophosphamide used to treat idiopathic pulmonary fibrosis
Leukopenia, thrombocytopenia, hemorrhagic cystitis, nausea, vomiting
Name one side effect of azathioprine used to treat idiopathic pulmonary fibrosis
Leukopenia, anemia, thrombocytopenia, nausea, vomiting
Name one occupation at risk for developing silicosis
Foundry worker, glass makers, pottery workers, sandblasters
You see hilar node calcifications in an eggshell pattern on CXR. What is the best diagnosis?
Silicosis
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?
Coal workers Lung
What pulmonary disease is associated with inclusion bodies such as Schaumann’s bodies and asteroid bodies?
Sarcoidosis
Your patient is diagnosed with sarcoidosis. The CXR shows bilateral hilar adenopathy with diffuse parenchymal infiltrates. What stage is this?
Stage 2
What lab level is elevated in sarcoidosis?
Angiotensin-converting enzyme (ACE)
Name one medication used to treat sarcoidosis.
Glucocorticoids, methotrexate, cyclophosphamide
Name one characteristic of acute respiratory distress syndrome.
Pulmonary edema, high cardiac output, and low pulmonary wedge pressure
What is the major symptom of idiopathic pulmonary fibrosis?
Exertional dyspnea
Which pulmonary function test result is typical in restrictive lung disease?
Decreased total lung capacity (TLC), decreased vital capacity (VC), and decreased residual volume (RV)
Your 60 year old lung cancer patient presents with facial and neck swelling. What is the best diagnosis?
Superior vena cava syndrome
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?
Pneumothorax
Diagnose with a CXR and treat with a chest tube
Which medication is most beneficial in treatment of emphysema?
Atrovent (an anti-cholinergic)
Elderly patients, COPD patients and children aged 6-24 months should receive what vaccination routinely?
Influenzae
What is a common cause of pneumonia in patients with a recent history of influenzae?
Staphylococcus aureus
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?
Mycoplasma pneumonia
What is a risk factor for developing mesothelioma?
Asbestos exposure, radiation, and SV40 virus
Your 44 year old female patient has a 2-day history of fever, productive cough, and bronchial breath sounds. What is your best diagnosis?
Pulmonary consolidation
Are bronchial breath sounds soft and fine or loud and coarse?
Loud and coarse
You hear bronchial breath sounds over the lung fields. What is your best diagnosis?
Pulmonary consolidation that can happen in pneummococcal lobar pneumonia
