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ABR > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

F/u for single solid lung nodule < 6mm with low risk factors

A

No f/u

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2
Q

F/u for single solid lung nodule < 6mm with high risk factors

A

CT 6-12 mo

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3
Q

F/u for multiple solid lung nodules < 6mm with low risk factors

A

No f/u

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4
Q

F/u for multiple solid lung nodule < 6mm with high risk factors

A

CT 6-12 mo

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5
Q

F/u for single ground glass and/or part solid lung nodule < 6mm

A

No f/u

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6
Q

F/u for single ground glass and/or part solid lung nodule > 6mm

A

CT 3-6 mo

GG: if no change, q2years x 5 years

PS: if no change, q1year x 5 years

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7
Q 
Low FEV1
Low FEV1/FVC
High TLC
Low DLCO
High RV
A

Emphysema (obstructive)

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8
Q 
Low FEV1
Low FEV1/FVC
High TLC
Normal DLCO
High RV
A

Bronchitis (obstructive)

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9
Q 
Low FEV1
Low FEV1/FVC
High TLC
Normal DLCO
Normal/High RV
A

Bronchiectasis (obstructive)

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10
Q 
Low FEV1
Low FEV1/FVC
High TLC
Normal/high DLCO
High RV
A

Asthma (obstructive)

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11
Q 
Low FEV1
Normal FEV1/FVC
Low TLC
Low DLCO
Low RV
A

Restrictive (intra-thoracic)

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12
Q 
Low FEV1
Normal FEV1/FVC
Low TLC
Normal DLCO
High RV
A

Restrictive (extra-thoracic)

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13
Q

Causes of high DLCO

A

More blood in alveoli

CHF
MS
ASD/VSD
PDA
Polycythemia 
Squatting
Exercise
Alveolar hemorrhage
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14
Q

Causes of low DLCO

A

Less blood in alveoli

COPD
Restrictive disease
PE
pHTN
Anemia
Standing
Valsalva
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15
Q

Causes of normal DLCO

A

Asthma

CO poisoning

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16
Q

Fixed extrathoracic obstruction (flat inspiratory and expiratory phase on flow loop)

A

Tumors

Tracheal stenosis

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17
Q

Dynamic extrathoracic obstruction (flat inspiratory phase on flow loop)

A

Epiglottitis
Obstruction
Vocal cord paralysis

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18
Q

Dynamic intrathoracic obstruction (flat expiratory phase on flow loop)

A

Intrathoracic tracheomalacia

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19
Q

Diagnose asthma with PFT/bronchodilators

A

FEV1 increases by 12% with bronchodilators

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20
Q

Diagnose asthma with methacholine challenge (bronchoprovocation test)

A

FEV1 drops by 20%

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21
Q

NSAIDs/ASA, nasal polyps, rhinitis

Management

A

Dx: Aspirin-exacerbated respiratory disease (aka aspirin induced asthma)

Tx: Montelukast, ICS

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22
Q

Management for asthma with high serum IgE levels

A

Add omalizumab

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23
Q

Management for asthma with high eosinophil count

A

IL-5 inhibitor (mepolizumab or beralizumab) - decreases exacerbation and improved FEV1

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24
Q

Management for asthma with high eosinophil count and resistance to PO corticosteroids

A

IL-4 inhibitor (dupilumab)

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25
Q

Diagnosing exercise induced asthma

A

Eucapnic voluntary hyperpnea challenge test - drop in FEV1 by 15%

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26
Q

Brownish mucus plugs
Gloves finger sign on CXR
+eosinophils

A

ABPA

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27
Q

BAL: CD8 > CD4

Ground glass appearance with no eosinophils

A

Hypersensitivity pneumonitis

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28
Q

Asthma
Weakness of right hand/foot
IgE elevated

A

Eosinophilic GPA

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29
Q

Recent immigrant
High eosinophils
CXR with round infiltrates

Management

A

Dx: Strongyloides infection (Loeffler’s syndrome)

Tx: Thiabendazole

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30
Q

Asthma
Very peripheral infiltrates
BAL: high eosinophils. High ESR

Management

A

Dx: Chronic eosinophilic pneumonia

Tx: chronic steroids

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31
Q

+eosinophils
Ground glass appearance on CXR

Management

A

Dx: acute eosinophilic pneumonia

Tx: steroids

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32
Q 
Diffuse opacities (homogenous infiltrates) or ground glass appearance 
Tan colored fluid

Management

A

Dx: alveolar proteinosis
(Defective macrophages causing build up of surfactant in the lung)

Tx: whole lung ma age

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33
Q

GOLD stages for COPD

A

Gold 1: >80%
Gold 2: < 80%
Gold 3: < 50%
Gold 4: < 30%

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34
Q 
COPD management per severity: 
A (low risk, less symptoms)
B (Low risk, more symptoms)
C (high risk, less symptoms)
D (high risk, more symptoms)
A

A: SABA +/- SAMA
B: LAMA
C: LAMA
D: LAMA + LABA + ICS +/- PDE4 (roflumilast)

35
Q

Adverse effect of Giotto policy in men > 60 y/o

A

Acute urinary retention

36
Q

Criteria for starting O2 therapy in COPD

A

PaO2 < 55 mmHg or SpO2 < 88%

PaO2 < 59 mmHg or SpO2 < 89% with evidence of cor pulmonale, erythrocytosis (Hct > 55%)

37
Q

Benefits of pulmonary rehab

A

Improvement in 6 min exercise endurance

Improvement in dyspnea and quality of life.

Trains muscles of ambulation

38
Q

Management for COPD with FEV1 20-50% (despite pulm rehab) and bilateral upper lobe emphysema.

A

Lung volume reduction survey

39
Q

Management for COPD with FEV1 < 20% (despite pulm rehab)

A

Lung transplant

40
Q

Bilateral basal bullies cysts on CXR

A

Alpha-1 antitrypsin deficiency

41
Q

Prominent cystic spaces in RLL and streaming opacities in the direction of bronchial tree (tram lines) on CXR

A

Bronchiectasis

42
Q

Bronchiectasis
Sinusitis
Infertility
+/- situs inversus

Screening test

A

Dyskinetic cilia syndrome (Kartaganer syndrome)

Screening test: inhaled NO test
Confirmation test: biopsy of bronchi or sinus with video electron microscopy

43
Q

Apical bullous changes on CXR

A

Cystic fibrosis

44
Q

Leading bacteria that increases mortality in CF

A

Burkholderia cepecia

45
Q

DOE
Severe obstruction
High/normal DLCO
No change with bronchodilator

A

Broncholitis obliterates

Associated with RA, carcinoid tumor, lung transplant

46
Q

CXR with patchy of focal infiltrates with “organizing pattern”
Migratory infiltrates
Decreased DLCO

Management

A

Dx: Cryptogenic organizing pneumonia

Tx: steroids

47
Q

Ankle pain
Hilary LAD
Non-caseating granulomas
BAL: CD4>CD8 (4:1)

A

Sarcoidosis

48
Q

1) Random tree in bud pattern
2) Widespread tree in bud
3) consolidation with tree in bud
4) tree in bud dependent areas and esophageal abnormality

A

1) MAI/MTB
2) ABPA
3) aspiration bronchiolitis
4) aspiration bronchiolitis

49
Q

Mechanics. Brake pads

Calcified plaques

A

Asbestosis

50
Q

Sand blasting
Increased MTB incidence
Egg shell calcifications

51
Q

Premenopausal
Pneumothorax
Honeycomb appearance
Chylous effusion

A

Lymphangiomyomatosis

52
Q

Indications for thrombolytics

A

Acute massive PE

Large DVT, such as iliofemoral

53
Q

Indications for IVC filter

A

H/o PE and another PE will cause death
Contraindication to anticoagulation
Emboli post-anticoagulation
Cirrhotic with PT/INR > 3.5 + DVT

54
Q

S/p pneumonia treatment

Cough and Opacity persists

A

Underlying malingnancy

55
Q

Recurrent pneumonia

CT with fibrosis

A

Post-obstructive pneumonia

56
Q

Indications for Abx in sinusitis

A

Symptoms > 10 days

Fever/pain > 3 days

57
Q

Sore throat, fever

Pain with swallowing and turning neck

A

Lemierre’s disease
Internal jugular vein thrombosis
Fusobacterium necrophorum

58
Q

Mouth pain
Difficulty swallowing
Stiff neck with woody induration

A

Ludwig’s angina

59
Q

Allergies made worse with medication (vasoconstrictors)

A

Rhinitis medicamentosa

60
Q

Posterior RUL pneumonia

A

Klebsiella

61
Q

RLL pneumonia

62
Q

Adverse effects of fluoroquinolones

A

Prolong QTc
Tendon rupture
Paresthesias
Aortic aneurysms + dissection

63
Q

Seizure

Upper lobe infiltrate

A

Peptostreptococcus

64
Q

Ear pain, fever

Inflamed tympanic membrane

A

Mycoplasma

65
Q

Fever, chest pain, cough
OCP

Management

A

Dx: pleurodynia due to coxsackie B virus

Tx: indomethacin

66
Q

Management for influenza vaccine outbreak in nursing home

A

Vaccine + oseltamivir x 2 weeks

67
Q

Nitrofurantoin
Crepitance over nasal lung fields
Ground glass appearance

A

Nitrofurantoin-induced pulmonary injury

68
Q

Management for LTBI

A

INH and rifapentine weekly x 3 mo

69
Q

Transudative pleural effusion

A

Total protein < 3g/dL
Fluid/serum protein ratio < 0.5
Total LDH < 200
Fluid/serum LDH ratio < 0.6

70
Q

Milky pleural effusion

A

Triglycerides

71
Q

Dull percussion
Decreased breath sounds
Absent VF/VR

A

Pleural effusion

72
Q

Dull percussion
Bronchial breath sounds
Increased VF/VR

73
Q

Hyperresonant percussion
Decreased breath sounds
Decreased VF/VR

A

Pneumothorax

74
Q

Orthodexia

Platypnea

A

Hepatopulmonary syndrome

75
Q

Bubble study with < 4 heart beats

A

PFO or ASD

76
Q

Bubble study with > 4 heart beats

A

Hepatopulmonary syndrome

77
Q

SOB
Elevated left hemiduaphragm

Confirmation test

A

Dx: phrenic nerve injury

Confirmation test: fluoroscopic sniff test

78
Q

Obesity

Elevated daytime PaCO2 and hypoxemia

A

Obesity hypoventilation syndrome

79
Q

Abnormal respirations in CHF

A

Cheyenne-stokes

80
Q

BAL results

1) increased neutrophils
2) increased lymphocytes
3) increased eosinophils
4) + silver methanamine
5) inclusion bodies
6) increased bacteria
7) foamy with lamellar inclusions

A

1) IPF
2) sarcoidosis (CD4>CD8); hypersensitivity pneumonitis (CD8>CD4)
3) Eosinophilic pneumonia
4) PJP
5) CMV
6) pneumonia
7) amiodarone

81
Q

Light’s criteria

A

Exudative if either of the following:
Pleural/serum protein > 0.5
Pleural/serum LDH > 0.6
Pleural LDH >2/3 uln serum LDH

Transudative if ALL of above are met

82
Q

Serum-pleural effusion protein difference > 3.1

OR

Serum-pleural effusion albumin gradient > 1.2

A

Transudative effusion

83
Q

Therapies which prolong survival in COPD

A

Smoking cessation
Long-term O2 therapy (if resting PaO2 < 55 or SpO2 < 88% OR resting PaO2 < 59 or SpO2 < 89% + cor pulmonale or erythrocytosis)

ABR (12 decks)

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