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Step 2 > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

diminished breath sounds bilaterally with scattered expiratory wheezes & prolonged expiratory phase describes what illness?

A

COPD

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2
Q

In patients with severe, acute asthma, ____ PaCO2 suggests respiratory muscle weakness & impending respiratory failure, which require mechanical ventilatory support.

A

elevated or inappropriately normal

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3
Q

Long-term ____ therapy has been proven to prolong survival in patients with COPD and significant chronic hypoxemia.

A

supplemental oxygen

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4
Q

The criteria for initiating LT Oxygen therapy in COPD pts include:

  1. Resting PaO2 __%.
A

55

59

Hct >55

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5
Q

What is the most effective measure to decrease mortality in patients with COPD?

A

Smoking Cessation

  • LTOT is associated with decreased mortality ONLY in pts with COPD + significant hypoxemia (PaO2 <59-55)
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6
Q

____ deficiency should be considered in pts with COPD sxs who are <45 or have no/minimal h/o smoking, or a FMH of emphysema or liver disease.

A

Alpha-1 antitrypsin (AAT)

Tx: IV- AAT supplements + bronchodilators & corticosteroids

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7
Q

4 Common causes of chronic cough include

A

Asthma
GERD
Upper airway cough syndrome (post-nasal drip)
ACE inhibitors

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8
Q

Patients can have chronic hypoventilation s/t (3)

resulting in a gradual increase of PaCO2

A

COPD
Obesity hypoventilation syndrome
Neuromuscular disease (Ank Spondy, MS)

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9
Q

Patients with chronic hypoventilation result in gradual increases in PaCO2 that result in chronic respiratory acidosis; to compensate, the kidneys increase HCO3- retention, creating a chronic _____.

A

secondary metabolic alkalosis

Renal tubular compensation

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10
Q

Increased ___ ventilation is the main cause of hypercapnia in COPD and worsens the respiratory acidosis.

A

dead space

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11
Q

All pts with acute exacerbation of COPD should receive inhaled ____ & systemic ____.

PLUS: supplemental oxygen, ABx, and ventilatory support, if indicated.

A

Bronchodilators (β2 agonists & ipratropium/tiotropium)

Glucocorticoids* (IV methylprednisolone/ PO Prednisone)

*improve lung function, hypoxemia & decrease risk of relapse, treatment failure, and length of hospital stay.

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12
Q

The 1st mainstays of treatment for COPD are

inhaled bronchodilators like ___ + ___

A

Albuterol ( SA β2 agonists)

Ipratropium/ Tiotropium (anti-cholinergic/muscarinic)

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13
Q

___ + ___ may be used in the maintenance therapy of

more severe COPD not controlled by bronchodilators

A 
Inhaled steroids (Fluticasone) 
Long-acting β2 agonists (Salmeterol)
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14
Q

Patients admitted for acute COPD exacerbation now has headache, delirium, and lethargy. Next best step in evaluation?

A

get an ABG

rising levels of PaCO2 >75 can cause neuro sxs, coma or seizures

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15
Q

CO2 narcosis is when a pt goes into ____

s/t PaCO2 > __

A

coma

75+

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16
Q

pulmonary flow-volume loop characteristic for Asthma/ COPD: “______” pattern

A

“scooped-out” pattern

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17
Q

pulmonary flow-volume loop characteristics for restrictive lung disease:

A

Low/narrow lung volumes
+
Low expiratory/inspiratory flow rates

18
Q

pulmonary flow-volume loop characteristics for a fixed upper-airway obstruction: “______” pattern

A

“Cheese-burger” pattern

Flattening of both the top & bottom of the flow-volume loop.

19
Q

DLCO is
__ in chronic bronchitis
and
__ in emphysema predominant COPD

A

normal

decreased

20
Q

Paradoxical vocal fold motion (PVFM) aka vocal cord dysfunction presents like exercise asthma.

Vocal cords inappropriately adduct (close) during inspiration, causing laryngeal obstruction diagnosed via [imaging].

Long-term treatment primarily consists of therapy with a

A

Laryngoscopy

speech-language pathologist

*Episodes may be triggered by strong smells, stress, or exercise

21
Q

Transfusion-related acute lung injury typically occurs within minutes to 6 hours of blood product transfusion.

It manifests with acute hypoxemic respiratory failure, crackles/rales, and [seen on CXR] .

A

BILATERAL pulmonary infiltrates

22
Q

How to differentiate TRALI vs TACO:

  1. BNP
  2. JVD
  3. S3
  4. EF
A
  1. TACO = ↑ BNP (vs wnl)
  2. TACO = JVD Present (vs none)
  3. TACO = S3 Present (vs none)
  4. TACO = ↓EF (vs wnl)
23
Q

Hyperinflation on CXR, Wheezing, Dyspnea =
Bronchoconstriction
As seen in (2)

A

Asthma, chronic bronchitis

24
Q

presents with acute dyspnea, Hypotension, JVD, unilaterally absent breath sounds and pleuritic chest

A

Tension pneumothorax

25
Q

Increased pulmonary vascular resistance (PVR) leads to Right Ventricular (RV) stress and dilation =

  1. Signs of right-sided ___ develop.
  2. ↑ Intensity of __ sound.
  3. __ DLCO s/t loss of vasculature
A
  1. congestion (pedal edema, hepatomegaly)
  2. Pulmonic component of S2 (loud P2).
  3. ↓ DLCO
    * Narrowing of pulm arteries → RV systolic failure & ↓ CO bc impaired LV filling.
26
Q 
Injury and narrowing of terminal airways
non-reversible air outflow limitation
↓ DLCO
± normal CXR
Diagnosis?
A

Bronchiolitis obliterans (COPD)

27
Q

Exertional dyspnea
↓ DLCO (parenchymal scarring)
Fine inspiratory crackles (velcro)
Diagnosis?

A 
Pulmonary fibrosis
(restrictive lung disease)
28
Q

[Medication] may worsen bronchospasm in patients with exacerbation of COPD. Avoid them.

A

𝛽 blockers

29
Q

Diagnosis is made by renal biopsy showing linear IgG antibodies along the glomerular basement membrane.
Diagnosis?

A

Anti–glomerular basement membrane disease
(Goodpasteur’s Syndrome)

Antibodies agains lung BM (cough, dyspnea, and hemoptysis) and kidneys BM (nephritic range proteinuria <3.5 g/day, acute renal failure, and dysmorphic red cells/red cell casts on UA).

Systemic symptoms are uncommon.

30
Q

Presents with RAPIDLY worsening cough, fevers, chills, and dyspnea.
CXR = Alveolar infiltrates, Opacification, Consolidation

Diagnosis?

A

Bacterial pneumonia

31
Q

A Chest CT scan showing a peripheral, wedge-shaped infarction is virtually pathognomonic for

A

pulmonary embolism

32
Q

Pt with dyspnea and JVD
CXR = peribronchial thickening; prominent pulmonary vascular markings; and patchy, perihilar opacities
General Lung Diagnosis?

A

Pulmonary Edema

33
Q

(pleural/serum) LDH ratio >0.6
(pleural/serum) protein ratio >0.5

suggest a ____ pleural effusion

A

Exudative effusion
↳due to inflammation with a
↳pleural fluid pH 7.30–7.45

➣Normal pleural fluid pH: 7.60

34
Q

Pleural fluid pH <7.30 (+ low pleural glucose <60 mg/dL)
or
(pleural/serum) glucose ratio <0.5 usually s/t:
1.
2.
➣Normal pleural fluid pH: 7.60

A

Bacteria (empyema)

Tumors, (& TB, Rheumatoid arthritis)

35
Q

women in early and middle adulthood with chronic progressive dyspnea & inspiratory crackles.

CXR = interstitial reticular opacities, parenchymal scars

General Lung Diagnosis?

A

Interstitial lung disease (ILD)

↳can cause PH (group 3)

36
Q 
Classically triad of:
– respiratory distress (tachypnea, hypoxemia)
– neurologic dysfunction (confusion)
± petechial rash
± Thrombocytopenia

Develop Pulmonary edema (mimicking ARDS after 1-2d) ↳Bilateral ground-glass opacities on chest CT
↳No pulmonary arterial filling defects

A

Fat Embolism Syndrome

37
Q

A chemical irritation of the lung parenchyma that can lead to ARDS and respiratory failure.
+ Fever & Leukocytosis

Patients with periods of impaired consciousness (seizure, alcohol use, stoke, multiple sclerosis w bulbar sxs) are most commonly affected.

A

Aspiration pneumonitis

*onset is insidious (progressing over several weeks)

38
Q

[↑/↓] Alveolar-arterial oxygen gradient is commonly seen in Pulmonary Embolism

A

↑ A-a Gradient

*Wheezing can occur in acute PE.

39
Q

Hypoalbuminemia can cause transudative pleural effusions due to decreased ___ pressure.

A

oncotic

40
Q

Non-caseating granulomas in the lungs s/t a reaction from environmental antigens like dust or dandruff.

CXR ± reticular, nodular, or alveolar opacities
↳No cavitations

Diagnosis?

A

Hypersensitivity pneumonitis

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