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UWorld > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

2 classic aspects of clinical presentation for PE?

A

Tachycardia, Hypoxemia … in a patient with recent immobilization

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2
Q

Best test for evaluation of suspected PE?

A

CT angiogram

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3
Q

When would CT angiogram be contraindicated for suspected PE?

A

Patient with CKD

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4
Q

Best alternate study for patient with suspected PE and CKD?

A

VQ scan

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5
Q

3 risk factors for PE?

A

Hip fracture, Smoking, Immobilization

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6
Q

What accounts for fever in setting of PE?

A

Tissue necrosis in setting of pulmonary infarction

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7
Q

5 aspects of clinical presentation that make infection unlikely as cause of fever in setting of PE?

A

Stable WBCs, No consolidation on CXR, NML UA, No incisional purulence, No PIC line erythema

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8
Q

How can you differentiate aspiration pneumonitis from aspiration PNA?

A

Aspiration pneumonitis = no clinical signs of infection

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9
Q

Best treatment for aspiration pneumonitis?

A

Supportive

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10
Q

ABX of choice for aspiration PNA?

A

Clindamycin, or blactam + b lactam inhibitor

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11
Q

Appearance of pulmonary contusion on CXR?

A

Irregular, localized opacification at site of injury

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12
Q

Best treatment for pulmonary contusion?

A

Admission + supportive care (supplemental O2, adequate pain control to avoid hypoventilation, pulmonary hygiene)

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13
Q

CXR appearance of mesothelioma?

A

Nodular thickening of the pleura

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14
Q

Appearance of large cell carcinoma on CXR?

A

Large peripheral mass

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15
Q

Appearance of squamous cell carcinoma on CXR?

A

Central cavitary lesion

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16
Q

Lab value + paraneoplastic syndrome associated with small cell carcinoma?

A

Hyponatremia; SIADH

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17
Q

Best treatment for mild SIADH-associated hyponatremia (without neurologic symptoms)?

A

Water restriction

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18
Q

3 medications that can be used to treat moderate SIADH-associated?

A

Furosemide, Lithium, Demeclocycline

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19
Q

Pattern of pulmonary nodule calcification that is typically benign?

A

Popcorn, concentric, central, diffuse homogeneous

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20
Q

Popcorn calcification in a pulmonary nodule is suggestive of …

A

Pulmonary hamartoma

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21
Q

Pattern of pulmonary nodule calcification that is typically malignant?

A

Eccentric, reticular, punctate

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22
Q

3 lifestyle modifications that may reduce snoring?

A

Weight loss, Decreased EtOH consumption, Smoking cessation

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23
Q

Pathogen responsible for Allergic Bronchopulmonary Aspergillosis?

A

Aspergillus

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24
Q

Pathophysiology of Allergic Bronchopulmonary Aspergillosis?

A

Hypersensitivity reaction to Aspergillosis

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25
Q

Hypersensitivity reaction in Allergic Bronchopulmonary Aspergillosis is mediated by …

A

IgE + IgG

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26
Q

Epidemiology of Allergic Bronchopulmonary Aspergillosis?

A

Patients with asthma or cystic fibrosis

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27
Q

Clinical presentation for Allergic Bronchopulmonary Aspergillosis?

A

Recurrent asthma exacerbations

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28
Q

Hallmark CXR finding for Allergic Bronchopulmonary Aspergillosis?

A

Fleeting infiltrates (transient infiltrates in different parts of lung)

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29
Q

Hallmark CT finding for Allergic Bronchopulmonary Aspergillosis?

A

Central bronchiectasis

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30
Q

2 lab values that suggest Allergic Bronchopulmonary Aspergillosis?

A

Elevated IgE, Eosinophilia

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31
Q

Best treatment for Allergic Bronchopulmonary Aspergillosis?

A

Glucocorticoids + Itraconazole

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32
Q

77 yo male presents with worsening fever, productive cough … after several days of viral URI symptoms – diagnosis?

A

Secondary PNA

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33
Q

Best management of suspected Secondary PNA in patients of advanced age + underlying comorbidities?

A

Present to ER for labs, CXR

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34
Q

2 characteristics of pleural effusions seen in TB?

A

­ lymphocytes, ­ elevated adenosine deaminase

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35
Q

Next step for evaluation of suspected pleural effusions seen in TB?

A

Pleural biopsy

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36
Q

Pattern of TB lung involvement seen in newly-diagnosed HIV cases?

A

Cavitary apical lesions

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37
Q

Pattern of TB lung involvement seen in chronic HIV cases?

A

Pleural, lobar disease

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38
Q

Role of Pleural biopsy in TB?

A

Histopathologic demonstration of pleural granulomas

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39
Q

Metabolic abnormality associated with obstructive sleep apnea (OSA)?

A

Hypercapnic, hypoxic respiratory acidosis

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40
Q

Change to HCO3- in setting of chronic respiratory acidosis?

A

Increased

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41
Q

Complication of OSA in peri-operative setting (sedation, anesthesia)?

A

Increased risk of respiratory complications

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42
Q

Change to CXR in setting of acute respiratory failure?

A

Bibasilar atelectasis

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43
Q

Hallmark CXR finding for malignant mesothelioma?

A

Plural calcification, thickening

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44
Q

Typical management of malignant mesothelioma?

A

Palliative care

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45
Q

PE finding that is almost always present in patients with malignant mesothelioma?

A

Pleural effusion

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46
Q

2 most important predictors of survival during COPD exacerbation?

A

Age, FEV1 <40%

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47
Q

Clinical appearance of children with complete airway obstruction?

A

Cyanosis, difficulty speaking/coughing/breathing

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48
Q

Best management for conscious children > 1 yo with complete airway obstruction?

A

Abdominal thrusts (Heimlich maneuver)

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49
Q

Best management for conscious children < 1 yo with complete airway obstruction?

A

Place infant face-down on arm; Deliver alternating chest and back blows

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50
Q

Best management for unconscious children with complete airway obstruction?

A

CPR

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51
Q

Clinical presentation of COPD exacerbation?

A

Wheezing, prolonged expiration, SOB, productive cough

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52
Q

4 common post-operative pulmonary complications?

A

Atelectasis, respiratory failure, infection, hypoxia

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53
Q

When should smoking cessation occur prior to surgery?

A

4+ weeks

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54
Q

Best management of pre-op patient who develops COPD exacerbation?

A

Delay surgery to treat COPD exacerbation

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55
Q

5 extra-pulmonary manifestations of sarcoidosis?

A

Hepatomegaly, LAD, erythema nodosum, uveitis, facial nerve palsy

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56
Q

Initial step of workup for sarcoidosis?

A

CXR

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57
Q

Diagnostic test for sarcoidosis?

A

Biopsy … of either lung OR lymph node

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58
Q

(+) biopsy result for sarcoidosis?

A

Non-caseating granulomas

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59
Q

4 lab changes seen in setting of sarcoidosis?

A

Hyper-Ca2+, Elevated ACE, Elevated ESR, Elevated alkaline phosphatase

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60
Q

CXR findings associated with sarcoidosis?

A

Bilateral hilar + mediastinal adenopathy

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61
Q

62 yo male presents with new-onset, RLE pain; Reports CABG performed 3 months ago; Presented to ED 2 nights ago for recurrent CP; Troponin = elevated, angiogram was (+) for coronary artery stenosis; Patient was treated with heparin, anti-platelet agents, b blocker, NTG; Stenting was performed; ECHO was (-); PE shows RLE that is cool to touch, diminished pulses; Labs show thrombocytopenia – diagnosis?

A

Type 2 HIT

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62
Q

3 hallmark clinical findings for Type 2 HIT?

A

Thrombocytopenia, Onset after Heparin administration, Thrombosis

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63
Q

Etiology of Type 2 HIT?

A

Auto-Ig directed against heparin-platelet factor 4 complexes

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64
Q

Difference between Type 1 HIT and Type 2 HIT?

A

Type 1 = non-immune mediated; Type 2 = immune mediated

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65
Q

Diagnostic test for Type 2 HIT?

A

HIT antibody testing

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66
Q

Best management of Type 2 HIT?

A

Discontinue all heparin-containing products; Begin non-heparin anticoagulants … Don’t wait for (+) HIT antibody testing to return

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67
Q

2 types of non-heparin anticoagulants that can be used in setting of Type 2 HIT?

A

Argatroban, Fondaparinux

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68
Q

Approach to future heparin use in a patient diagnosed with Type 2 HIT?

A

Avoid all forms of heparin for life

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69
Q

Alternate name for upper airway cough syndrome?

A

Post-nasal drip

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70
Q

In addition to cough, what are 2 other aspects of clinical presentation seen in Post-nasal drip?

A

Rhinorrhea, Pharyngeal Cobblestoning

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71
Q

Clinical presentation of laryngeal nodules?

A

Hoarseness

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72
Q

Etiology of tracheomalacia?

A

Weakness of tracheal walls … leading to expiratory airway collapse

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73
Q

1 aspect of physical exam seen in setting of tracheomalacia?

A

Stridor

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74
Q

Most common time of cough seen in asthma?

A

Nighttime cough

75
Q

Cough in asthma is triggered by which 3 events?

A

Cold weather, exercise, forced expiration

76
Q

Which allergen has the strongest association with asthma?

A

House dust mites

77
Q

Result of PFTs in patient without active symptoms?

A

Normal

78
Q

Result of PFTs in patient with active symptoms?

A

Obstructive pattern

79
Q

Change to FEV1 in obstructive PFT pattern?

A

Decreased

80
Q

Change to FEV1/FVC in obstructive PFT pattern?

A

Decreased

81
Q

Change to total lung capacity in obstructive PFT pattern?

A

Normal

82
Q

Change to DCLO in obstructive PFT pattern?

A

Normal

83
Q

Medication that can induce asthma symptoms before PFTs?

A

Methacholine

84
Q

Size that corresponds to pulmonary nodule?

A

Size < 3 cm

85
Q

Size that corresponds to pulmonary mass?

A

Size > 3 cm

86
Q

First step in evaluation of pulmonary nodule?

A

Compare to old film

87
Q

Next step in evaluation of pulmonary nodule, changed from previous films OR no previous film?

A

Order CT

88
Q

Solitary pulmonary nodules with size ___ require additional management or surveillance

A

> 0.8 cm

89
Q

Best management of Solitary pulmonary nodules with size > 0.8 and spiculated appearance?

A

Surgical excision, Biopsy

90
Q

Classic triad of clinical symptoms seen in invasive pulmonary aspergillosis?

A

Chest pain, Cough, Hemoptysis

91
Q

Epidemiology of invasive pulmonary aspergillosis?

A

Immunosuppression … chronic steroid use, prolonged neutropenia, organ transplant

92
Q

2 hallmark appearances of invasive pulmonary aspergillosis on chest CT?

A

Nodules with ground-glass opacity (halo sign), Cavitation with air-fluid levels

93
Q

Treatment for invasive pulmonary aspergillosis?

A

Voriconazole

94
Q

Definition of mild-moderate asthma exacerbation, using Peak Expiratory Flow?

A

Peak Expiratory Flow = 40-70%

95
Q

Best management of mild-moderate asthma exacerbation?

A

Inhaled b agonists (SABA)

96
Q

2 AEs of SABAs?

A

Tachycardia, tremors

97
Q

Definition of severe asthma exacerbation, using Peak Expiratory Flow?

A

Peak Expiratory Flow < 40%

98
Q

Best management of severe asthma exacerbation?

A

Inhaled b agonists (SABA) + Ipratropium

99
Q

3 signs of impeding respiratory failure in a patient who presents with asthma exacerbation?

A

AMS, Depressed respiratory drive, Hypoxemia

100
Q

Best management of impeding respiratory failure in a patient who presents with asthma exacerbation?

A

Immediate intubation

101
Q

4 signs of clinical deterioration in a patient who presents with asthma exacerbation?

A

Accessory muscle use (with suprasternal retractions), Diaphoresis, Exhaustion, PaCO2 > 42 mmHg

102
Q

Most likely cause of recurrent PNA episodes in a patient with 50 pack-year smoking HX?

A

Partial endobronchial obstruction … most likely lung CA

103
Q

What is next best test for patient with recurrent PNA and 50 pack-year smoking HX?

A

Lung CT

104
Q

Best confirmatory test for patient with recurrent PNA and 50 pack-year smoking HX?

A

Flexible bronchoscopy … can visualize obstruction AND perform a biopsy

105
Q

Best diagnostic test for suspected PNX in the acute setting?

A

Bedside US

106
Q

Best diagnostic test for suspected PNX in the non-acute setting?

A

Upright PA CXR

107
Q

Etiology of hemoptysis in setting of acute bronchitis?

A

Erosion of superficial lung vessels

108
Q

Best initial test for patient with COPD exacerbation presenting with hemoptysis?

A

CXR

109
Q

Best management of acute COPD exacerbation?

A

Glucocorticoids, ABX (azithromycin), Albuterol

110
Q

Which lobes of lung are typically affected by aspiration PNA?

A

R

111
Q

ABX of choice for aspiration PNA?

A

Clindamycin (anaerobic coverage)

112
Q

Next step of worup for patient with confirmed aspiration PNA?

A

Fluoroscopic swallow study

113
Q

Clinical presentation of laryngeal edema after intubation?

A

Post-extubation stridor

114
Q

Best method for prevention of laryngeal edema after intubation?

A

Steroids prior to extubation

115
Q

Best management for laryngeal edema in patient with signs of respiratory failure?

A

Reintubation

116
Q

4 clinical predictors of increased 30-day mortality in patients with pulmonary embolism?

A

Hypotension, tachycardia, hypothermia, AMS

117
Q

1 radiological predictor of increased 30-day mortality in patients with pulmonary embolism?

A

RV dysfunction

118
Q

2 laboratory predictors of increased 30-day mortality in patients with pulmonary embolism?

A

Troponin, BNP

119
Q

Best management of pulmonary embolism with hypotension (hemodynamic instability)?

A

Thrombolysis

120
Q

What is the most important indication for thrombolysis in setting of pulmonary embolism?

A

Hemodynamic instability

121
Q

Additional indication for thrombolysis in setting of pulmonary embolism?

A

RV dysfunction

122
Q

Clinical presentation of bronchiectasis?

A

Recurrent infection, Daily cough with mucopurulent sputum production

123
Q

What accounts for hemoptysis in setting of bronchiectasis?

A

Airway damage causes rupture of superficial blood vessels

124
Q

74 yo male presents with recent memory problems; Reports HA, poor sleep, decreased libido, irritibality, mood changes; PE shows BMI 34, BP 155/95 – diagnosis?

A

OSA … causing cognitive impair (irritability, poor sleep, short-term memory loss)

125
Q

Classic HEENT finding associated with OSA?

A

Increased neck circumference > 17 inches

126
Q

Appearance of post-operative atelectasis on CXR?

A

Linear opacifications,

127
Q

Best management of post-operative atelectasis?

A

Chest physiatry + Suctioning

128
Q

Change to Aa gradient in post-operative atelectasis?

A

Increased

129
Q

Typical time of presentation for post-operative atelectasis?

A

2-5 days post-operatively

130
Q

Recommended test for lung CA screening?

A

Low-dose CT chest

131
Q

How oftern should patients undergo low-dose CT chest for lung CA screening?

A

Yearly

132
Q

Age for lung CA screening via low-dose CT chest?

A

50-80 yo

133
Q

Eligibility for low-dose CT chest as lung CA screening?

A

20+ pack-year HX … AND … current smoking or quit smoking within past 15 years

134
Q

Benefit of smoking cessation?

A

Reduces risk of lung CA and COPD exacerbations … even in heavy, long-term smokers

135
Q

56 yo female presents for shortness of breath, generalized itching; Just ate a PB cookie; BP 88/60, HR 124, O2 sat 92% on RA, RR 26; PE shows use of accessory muscles, exhalation through pursed lips, wheezing; Patient given IM dose of epinephrine; 10 minutes later, no significant change in condition - what is next best step of treatment?

A

IM epiphrine

136
Q

4 aspects of initial management for anaphylaxis?

A

IM epinephrine (up to 3 doses), albuterol, IVF

137
Q

Is there benefit to smoking cessation after 60 yo?

A

Lowers risk of all-cause mortality and cardiovascular events

138
Q

When is the all-cause mortality and cardiovascular benefit of smoking cessation after 60 yo seen?

A

Within 5 years of cessation

139
Q

When is the benefit on osteoporosis seen after smoking cessation?

A

Within 10 years of cessation

140
Q

What accounts for hypoxemia in COPD?

A

Low V/Q ratio

141
Q

Which clinical finding would suggest need for urgent intervention in a patient with a Pancoast tumor?

A

Asymmetric LE reflexes … suggests tumor spread near spinal cord

142
Q

Ventilator-associated PNA (VAP) is a common complication of …

A

ARDS

143
Q

Etiology of VAP?

A

Micro-aspiration of virulent oropharyngeal organisms

144
Q

Most common pathogens responsible for VAP?

A

E. coli, Strep species

145
Q

Clinical presentation of VATS?

A

Increased oxygenation, increased respiratory secretions, fever, worsening pulmonary infiltrates on CXR, worsening WBCs

146
Q

38 yo female in ICU develops worsening hypoxia; Intubated about 1 week ago; Now having increased tracheobronchial secretions; T 102, HR 114; Increased FiO2 from 40% to 70%, increased PEEP from 5 to 10; Increased WBC from 11 to 18 – what is next best step in diagnosis?

A

Tracheobronchial aspiration sampling, BAL

147
Q

46 yo male presents for 3 days of cough, wheezing, SOB; Reports congestion, sore throat, myalgias about 1 week ago; PE shows prolonged expiration, peak expiratory flow = 30% lower than BL – diagnosis?

A

Asthma exacerbation

148
Q

Definition of acute asthma exacerbation on PFTs?

A

Reduction of peak expiratory flow >20% lower than BL

149
Q

Most common trigger for acute asthma exacerbation?

A

Viral URI

150
Q

Best management of acute asthma exacerbation?

A

Systemic corticosteroids (if moderate exacerbation, of mild unresponsive to bronchodilators)

151
Q

Best dosing of systemic corticosteroids for asthma exacerbation?

A

PO prednisone 40-60mg x 5-10 days

152
Q

38 yo female in ICU develops worsening hypoxia; Intubated about 1 week ago; Now having increased tracheobronchial secretions; T 102, HR 114; Increased FiO2 from 40% to 70%, increased PEEP from 5 to 10; Increased WBC from 11 to 18 – diagnosis?

A

Ventilator-associated PNA (VAP)

153
Q

29 yo female develops cough, SOB, joint pain, fatigue; PFTs show FEV1 60%, FEV1/FVC 80%, DCLO 60%; Labs show hypercalcemia, high ESR - diagnosis?

A

Sarcoidosis

154
Q

Pattern of lung disease seen in Sarcoidosis?

A

Mixed obstructive and restrictive

155
Q

Long-term prognosis for Sarcoidosis?

A

Resolution

156
Q

Best management of Sarcoidosis?

A

Oral steroids

157
Q

Classic appearance of Sarcoidosis on CXR?

A

Bilateral hilar adenopathy

158
Q

38 yo female presents for DOE; PE shows BP 143/91, prominent S2, BMI 34; CXR shows prominent pulmonary arteries; EKG shows R axis deviation – diagnosis?

A

Pulmonary HTN

159
Q

First step in management of Pulmonary HTN?

A

TTE

160
Q

Definitive diagnosis for Pulmonary HTN?

A

R heart catheterization

161
Q

Classic appearance of Pulmonary HTN on CXR?

A

Enlargement of pulmonary arteries

162
Q

Appearance of Pulmonary HTN on TTE?

A

Increased R-sided pressure, RV dilation

163
Q

TTE results that suggest idiopathic pulmonary HTN?

A

Elevated pulmonary arterial pressure, NML pulmonary capillary wedge pressure (so not due to LH failure)

164
Q

DOC for management of Pulmonary HTN?

A

Endothelin receptor antagonist

165
Q

2 examples of endothelin receptor antagonists?

A

Bosentan, Ambrisentan

166
Q

16 yo female presents with SOB, which occurs 10-15 minutes after she starts exercising; PE shows no murmur, normal splitting of P2 heart sound – what is next step of workup?

A

Bronchoprovocation test

167
Q

16 yo female presents with SOB, which occurs 10-15 minutes after she starts exercising; PE shows no murmur, normal splitting of P2 heart sound – diagnosis?

A

Exercise-Induced Bronchoconstriction

168
Q

Description of Bronchoprovocation test for Exercise-Induced Bronchoconstriction?

A

Inhalation of cold air … diagnostic if FEV1 decreases by at least 15%

169
Q

Best management of Exercise-Induced Bronchoconstriction in patients with occasional symptoms?

A

Pre-exercise warmup

170
Q

Best management of Exercise-Induced Bronchoconstriction in patients with persistent symptoms, but exercise infrequently?

A

Short-acting b2 agonists

171
Q

Best management of Exercise-Induced Bronchoconstriction in patients with persistent symptoms, but exercise very frequently?

A

Daily inhaled corticosteroids + SABAs PRN

172
Q

___ should be suspected when patients with extensive smoking history have delayed resolution of PNA

A

Endobronchial malignancy

173
Q

What is best next step of workup for patients with suspected Endobronchial malignancy?

A

Chest CT

174
Q

36 yo male presents for sudden-onset L-sided CP, described as a stabbing, worsens with deep inspiration; HX of T1DM and R TMA after stepping on nail 1 month ago and developing osteomyelitis; Vitals show O2 sat 92%, tachycardia; PE shows pleural friction rub, heart sounds with accentuated P2 sound; CXR shows blunting of L costophrenic angle – diagnosis?

A

PE

175
Q

60 yo male is taken to post-anesthesia care unit less than 1 hour after elective laparoscopic CCY; HX of OSA; PE shows RR 7, O2 sat drops to 87% on RA; CXR shows mild hypo-inflation; pH 7.25, PaCO2 58, PaO2 170 – what is most likely cause of respiratory distress?

A

Residual anesthesia effect

176
Q

Which condition pre-disposes patients to post-operative respiratory failure?

A

OSA

177
Q

Etiology of post-operative respiratory failure?

A

Decreased central respiratory drive, depressed state of arousal

178
Q

Clinical presentation of post-operative respiratory failure?

A

Decreased RR, Hypoinflated lungs on CXR

179
Q

ABG results associated with post-operative respiratory failure?

A

Respiratory acidosis with normal Aa gradient

180
Q

42-year-old female presents for right-sided neck pain, cough, shortness of breath; significant smoking history; PE shows decreased breath sounds in upper right lung, moderate swelling and erythema of neck, moderate right sided JVD, increased venous marks on right arm; CXR reveals right-sided opacity; what is best immediate step in management?

A

CT chest/neck with contrast

181
Q

42-year-old female presents for right-sided neck pain, cough, shortness of breath; significant smoking history; PE shows decreased breath sounds in upper right lung, moderate swelling and erythema of neck, moderate right sided JVD, increased venous marks on right arm; CXR reveals right-sided opacity; diagnosis?

A

Superior vena cava syndrome, secondary to lung malignancy

182
Q

Most common etiology of superior vena cava syndrome?

A

Bronchogenic carcinoma

183
Q

19-year-old male presents after MVA; BP 150/95, HR 110; PE shows anterior bruises on chest, peripheral cyanosis, shallow and rapid respiration – diagnosis?

A

Flail chest

184
Q

Best management of uncomplicated flail chest?

A

Supplemental O2, pain control

UWorld (21 decks)

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