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EOR - Internal Med > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

definition of acute bronchitis

A

cough > 5 days w or w.o sputum x 2-3 weeks

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2
Q

when would you suspect pna w. bronchitis sx

A

HR > 100
RR > 24
T > 38

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3
Q

tx for acute bronchitis

A

symptomatic
abx not recommended

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4
Q

pathophys of asthma

A

airway inflammation -> hyperresponsiveness -> reversible airflow obstruction

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5
Q

dx for asthma

A

-FEV1:FVC ratio < 80%
-greater than 12% increase in FEV1 after bronchodilator therapy

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6
Q

asthma classificaitons

A

-intermittent: daytime sx </= 2 days/week
-mild persistent: daytime sx > 2 days/week, nocturnal sx 3-4/month
-moderate persistent: daily sx, nighttime sx >1/week
-severe persistent: sx all day, nightly sx

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7
Q

asthma step up therapy

A

step 1: SABA PRN
step 2: daily low dose ICS, SABA PRN
step 3: low dose ICS/LABA daily, SABA PRN
step 4: med dose ICS/LABA daily, SABA PRN
step 5: med dose ICS/LABA, SABA PRN, +/- biologics
step 6: high dose ICS/LABA, +/- LAMA, SABA PRN, oral steroids

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8
Q

what are FEV and FVC

A

FEV: how much air a person can exhale during a forced breath

FVC: total amt of air exhaled during FEV test

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9
Q

during PFT testing, you would expect _ to be the greatest amt of air, but this value is decreased in asthma

A

FEV 1

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10
Q

25 yo CF pt w, chronic frequent coughing of yellow/green sputum and hemoptysis - HPI includes recent pseudomonas pna - she has foul breath - CXR shows “plate-like” atelectasis

A

bronchiectasis

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11
Q

pathophys of bronchiectasis

A

lungs airways become dilated/damaged -> inadequate mucus clearance -> mucus builds up -> frequent infxns

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12
Q

what conditions are associated w. bronchiectasis (5)

A

CF - 1/2 of cases
immune compromised
recurrent pna
aspiration
tumor

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13
Q

what is this showing

A

plate like atelectasis -> bronchiectasis

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14
Q

3 hallmark sx of bronchiectasis

A

daily cough
copious foul smelling sputum
frequent respiratory infxns

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15
Q

2 CXR findings of bronchiectsis

A

tram track lung markings
plate-like atelectasis

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16
Q

gs for bronchiectasis dx

A

CT

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17
Q

lung sounds associated w. bronchiectasis

A

crackles
wheezes

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18
Q

tx for bronchiectasis

A

ambulatory O2
abx for acute
CPT
lung transplant

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19
Q

43 yo w. cutaneous flushing, diarrhea, wheezing - PMH HTN and T2DM - P 125, RR 30, BP 90/60 - diffuse wheezes in both lungs, diffuse “v” wave of jugular vein, 1/6 holosystolic murmur over LLSB, hyperactive bowel sounds

A

carcinoid tumor

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20
Q

carcinoids tumors arise from _ cells leading to excessive secretion of _ (3)

A

neuroendocrine
serotonin, histamine, bradykinin

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21
Q

common primary sites of carcinoid tumor (7)

A

GI (SI/LI)
stomach
pancreas
liver
lungs
ovaries
thymus

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22
Q

mc site of neuroendocrine/carcinoid tumor metastasis

A

liver

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23
Q

mcc of neuroendocrine tumor metastasis

A

carcinoid tumor of the appendix -> metastasizes to the liver

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24
Q

hallmark sx of carcinoid syndrome

A

cutaneous flushing
diarrhea
wheezing

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25
Q

increased serotonin secretion w. carcinoid tumors leads to

A

collagen fiber thickening, fibrosis ->
-tricuspid regurgitation
-pulmonary stenosis
-bronchoconstriction
-wheezing
-pellagra

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26
Q

histamine release with carcinoid tumors leads to

A

vasodilation -> flushing

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27
Q

dx for carcinoid tumor

A

CT
octreoscan
UA
CXR
bronchoscopy

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28
Q

UA findings of carcinoid tumor

A

elevated f-HIAA (metabolite of serotonin)

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29
Q

CXR findings of carcinoid tumor

A

pedunculated sessile growth on the central bronchi

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30
Q

bronchoscopy findings of carcinoid tumor

A

well vascularized pink/purple cental lesion

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31
Q

tx for carcinoid tumor

A

surgical excision
octreotide (decreases serotonin)
niacin supplement

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32
Q

pathophys of COPD

A

chronic lung inflammation -> loss of elastic recoil and increasing airway resistance -> obstructed airflow

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33
Q

COPD includes

A

emphysema
chronic bronchitis

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34
Q

2 rf for COPD

A

smoking
alpha 1 antitrypsin deficiency

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35
Q

COPD in pt < 40 yo makes you think

A

alpha 1 antitrypsin deficiency

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36
Q

emphysema causes loss of _, permanently enlarged _, and difficulty _

A

loss of elastin
enlarged alveolar sacs
difficulty exhaling

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37
Q

hallmark sx of emphysema

A

DOE

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38
Q

6 PE findings of emphysema

A

hyperresonance to percussion
decreased/absent breath sounds
decreased tactile fremitus
barrell chest
pursed lip breathing
cachexia

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39
Q

what is this showing

A

loss of lung markings
hyperinflation
increased A/P diameter

emphysema

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40
Q

PFT findings of COPD

A

FEV1/FVC ratio < 0.7
increased TLC

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41
Q

ABG findings of COPD

A

respiratory acidosis

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42
Q

definition of chronic bronchitis

A

chronic productive cough on most days x 3 months of the year x 2 or more consecutive years

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43
Q

pathophys of chronic bronchitis

A

hypertrophy/hyperplasia of bronchial mucous glands/goblet cells in bronchioles -> cilia less mobile -> increased mucus production -> mucus plugs -> obstruction -> air trapping

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44
Q

5 PE findings associated w. chronic bronchitis

A

rales
ronchi
wheezing
cor pumonale (peripheral edema, cyanosis, JVD)
hepatomegaly

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45
Q

CXR findings of chronic bonchitis

A

perivascular markings

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46
Q

CBC findings of COPD

A

chronic hypoxic state leads to increased Hgb/Hct

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47
Q

gs dx for COPD

A

PFTs/spirometry

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48
Q

_ < 1L = increased mortality w. COPD

A

FEV1

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49
Q

CXR findings associated w. chronic bronchitis

A

increased AP diameter
increased vascular markings
enlarged right heart border

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50
Q

tx for COPD

A

LABA/LAMA combo
SAMA preferred over SABA

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51
Q

name a LAMA

A

tiotropium (spiriva)

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52
Q

name a SAMA

A

ipratropium (atrovent)

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53
Q

2 contraindications for SAMA/LAMA

A

glaucoma
bph

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54
Q

name a LABA

A

salmeterol (serevent)

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55
Q

s.e of SABA/LABA

A

tachycardia/arrhythmias
muscle tremor
CNS stimulation
hyperglycemia

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56
Q

contraindications for SABA/LABA

A

severe CAD
hyperthyroid
caution w. DM

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57
Q

adenosine antagonist that acts as a bronchodilator but is only used for refractory COPD/asthma due to narrow therapeutic index

A

theophylline

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58
Q

higher doses of theophylline are needed for what 2 pt pops

A

smokers
coffee drinkers

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59
Q

are ICS considered first line for COPD

A

no ma’am

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60
Q

indications for O2 therapy w. COPD

A

resting PaO2 < 55
OR
SpO2 < 89%

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61
Q

stages of COPD

A

I/mild: FEV1>80%
II/mod: FEV1 50-80%
III/severe: FEV1 30-50%
IV/very severe: FEV1 < 30%, e/o cor pulmonale

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62
Q

tx for COPD

A

I: SAMA
II: SAMA/LAMA
III: SAMA/LAMA, ICS, pulm rehab
IV: SAMA/LAMA, ICS, pulm rehab, O2

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63
Q

2 vaccines super important for COPD

A

influenza
pneumococcal

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64
Q

PE findings associated w. cor pulmonale

A

hepatojugular reflex
pulsus paradoxus
ventricular gallop
LE edema
JVD
hepatomegaly
parasternal lift
tricuspid.pulmonic insufficiency
loud S2

65
Q

pathophys of cor pulmonale

A

RVH -> pulmonary HTN -> RV failure

66
Q

6 causes of cor pulmonale

A

COPD - mc
PE
vasculitis
asthma
ILD
ARDS

67
Q

dx for cor pulmonale

A

-echo: increased pressure in pulmonary a’s and RV
-spirometry
-right heart cath

68
Q

gs dx for cor pulmonale

A

right heart catheterization

69
Q

what med used for CHF is not indicated for cor pulmonale and may be harmful

70
Q

tx for cor pulmonale

A

treat underlying cause

71
Q

5 causes of hypoventilation syndrome

A

-central respiratory drive dpn - drugs, MS
-neuromuscular - ALS, MG
-chest wall abnl’s
-obesity
-COPD

72
Q

what is OHS/pickwickian syndrome

A

severe obesity -> failure to breathe rapidly/deeply enough -> low O2, high CO2

73
Q

sx of OHS

A

daytime sleepy/sluggish

74
Q

3 complications of OHS

A

pulmonary HTN
cor pulmonale
secondary erythrocytosis

75
Q

dx for OHS

A

PFTs
sleep studies
CXR
ABGs
bicarb

76
Q

t/f: sleep apnea falls into the category of OHS

77
Q

scarring/fibrosis of the lungs for an unknown reason

A

idiopathic pulmonary fibrosis

78
Q

mc interstitial lung dz

79
Q

non idiopathic causes of IPF

A

amiodarone
smoking
viral infxns
silica/hard metal dust
genetic
XRT
GERD

80
Q

lung sound associated w. IPF

A

inspiratory crackles

81
Q

what is this showing

A

diffuse patchy fibrosis -> pulmonary fibrosis

82
Q

what is this showing

A

honeycombing -> pulmonary fibrosis

83
Q

PFT findings of pulmonary fibrosis

A

normal vs increased FEV1/FVC ratio

84
Q

tx for pulmonary fibrosis

A

antifibrotics: pirfenidone, nintedanimb
O2
lung transplant

85
Q

53 yo M construction worker w. progressive dyspnea x a few years - afebrile, mild respiratory distress, inspiratory crackles - reticular linear pattern of opacities on CXR

A

pneumoconiosis

86
Q

any fibrosis of the lung tissues w. a known cause

A

pneumoconiosis

87
Q

mcc of pneumoconiosis

A

environmental/occupational exposure

coal miners

88
Q

4 CXR findings of pneumoconiosis

A

small, nodular opacities in upper lung fields
eggshell calcifications
clacified plaques
hilar adenopathy

89
Q

4 occupational exposures associated w. pneumoconiosis

A

coal
silicosis
asbestos
berylliosis

90
Q

mining, sandblasting, stone, quarry work -> massive pulmonary fibrosis

91
Q

insulation, demolition, shipbuilding, construction

92
Q

what condition other than pneumoconiosis is associated w. asbestos

A

mesothelioma

93
Q

high tech field, nuclear power, ceramics, aerospace, electrical plants, foundries -> pulmonary fibrosis

A

berylliosis

94
Q

4 sx of pneumoconiosis

A

SOB
nonproductive cough
chronic hypoxia
cor pulmonale

95
Q

dx for pneumoconiosis

96
Q

tx for pneumoconiosis

A

supportive
O2
steroids

97
Q

mcc cause of pna in adults vs peds

A

peds: RSV
adults: influenza

98
Q

CXR findings of viral pna

A

bilat interstitial infiltrates

99
Q

pna w. positive cold agglutinin titer

A

mycoplasma

100
Q

sx of bacterial pna

A

fever
dyspnea
tachycardia
tachypnea

101
Q

cxr findings of bacterial pna

A

patchy, segmental, lobar/multilobar consolidations

102
Q

tx for bacterial pna, outpt vs inpt

A

outpt: doxycycline vs macrolides
inpt: ceftriaxone + azithromycin/resp fluoroquin

103
Q

fungal pna makes you think what pt pop

A

immunocompromised (AIDS, steroids, organ transplant)

104
Q

4 types of fungal pna to know

A

coccidioides (valley fever)
pulmonary aspergillosis
cryptococcus
histoplasma capsulatum

105
Q

fungal pna found in western states

A

coccidioides (valley fever)

106
Q

fungal pna found in non immunocompromised pt

A

pulmonary aspergillosis

107
Q

fungal pna found in soil

A

cryptococcus

108
Q

fungal pna that can be mistaken for TB due to cavitary lesions

A

histoplasma capsulatum

109
Q

where is histoplasma found

A

bird/bat droppings
caves
zoos
mississippi ohio river valley

110
Q

what fungal pna can cause meningitis

A

cryptococcus

111
Q

tx for fungal pna

A

coccidioides: fluconazole/itraconazole
aspergillosis: fluconazole/itracontazole
cryptococcus: amphotericin B
histoplasma: ampthotericin B

112
Q

what type of pna is associated w. HIV

A

pneumocystis jiroveci

113
Q

PJP is common in HIV pt’s w. CD4 count <

114
Q

tx and prophlaxis for PJP

115
Q

CURB 65

A

confusion
urea > 7
RR > 30
SBP < 90 OR DBP < 60
age > 65

0-1 = low risk
2 = probs should admit
3-5 = admit

116
Q

43 yo F w. COPD - cc worsening dyspnea at rest, retrosternal CP - has widened splitting of S2 - CXR shows pruning of the large pulmonary a’s

A

pulmonary htn

117
Q

normal pulmonary BP

118
Q

pulmonary bp associated w. pulmonary HTN

A

> 20 at rest

119
Q

mcc of pulmonary htn

A

mitral stenosis

120
Q

4 causes of pulmonary htn

A

mitral stenosis
constrictive pericarditis
LV failure
mediastinal dz

121
Q

5 PE findings of pulmonary htn

A

loud S2
JVD
ascites
hepatojugular reflex
lower limb edema

122
Q

gs dx for pulmonary htn

A

right heart catheterization

123
Q

what is this showing

A

enlarged pulmonary arteries
enlarged cardiac silhouette

pulmonary htn

124
Q

ecg findings of pulmonary htn/right heart strain

A

t wave inversion in V1-V4, and inferior leads

125
Q

tx for pulmonary htn

A

treat underlying cause
+/- diuretics
digoxin
anticoags
pde5 inhibitors

126
Q

2 categories of ulng cancer

127
Q

lung cancer with the poorest prognosis

128
Q

4 subtypes of NSCLC

A

adenocarcinoma
squamous cell
large cell
carcinoid

129
Q

masses w. SCLC are located

130
Q

tx for SCLC

A

chemo

surgery is contraindicated

131
Q

5 conditions associated w. lung carcinoma

A

cushing’s
SIADH
superior vena cava syndrome
pancoast tumor
horner’s syndrome

132
Q

mc subtype of NSCLC

A

adenocarcinoma

133
Q

masses w. adenocarcinoma are located

A

peripherally

134
Q

central lung cancer masses make you think of (2)

A

SCLC
squamous cell carcinoma

135
Q

2 rf for lung adenocarcinoma

A

smoking
asbestos

136
Q

paraneoplastic syndrome associated w. adenocarcinoma of the lung

A

thrombophlebitis

137
Q

paraneoplastic syndrome associated w. squamous cell lung ca

A

hypercalcemia

138
Q

paraneoplastic syndrome associated w. large cell lung ca

A

gynecomastia

139
Q

mc type of carcinoid tumor

A

adenocarcinoma

140
Q

tx for NSCLC

A

stage 1-2: surgery
stage 3: chemo then surgery
stage 4: palliative
carcinoid: surgery

141
Q

facial/arm edema and swollen chest wall veins

A

superior vena cava syndrome

142
Q

shoulder pain, horner’s syndrome, brachial plexus compression

A

pancoast tumor

143
Q

unilateral miosis, ptosis, and anhidrosis

A

horner’s syndrome

144
Q

flushing, diarrhea, telangiectasia

A

carcinoid syndrome

145
Q

chronic autoimmune inflammatory dz in which nodules/granulomas develop in the lungs, lympho nodes, and other organs

A

sarcoidosis

146
Q

2 mc manifestations of sarcoidosis

A
  1. lung
  2. skin and lymph
147
Q

5 sx of sarcoidosis

A

fever
wt loss
arthralgias
erythema nodosum
lupus pernio

148
Q

what is this showing

A

lupus pernio - chronic, violaceous raised plaques/nodules on cheeks/nose/eyes -> think sarcoidosis

149
Q

_ is pathognomonic and the most specific PE finding for sarcoidosis

A

lupus pernio

150
Q

2 CXR finding of sarcoidosis

A

bilat hilar LAD
reticular infiltrates

151
Q

lab findings of sarcoidosis

A

hypercalcemia
ACE 4x norml

152
Q

dx for sarcoidosis

A

CXR
bx of peripheral lesions
bronchoscopy of central lesions
serial PFTs

153
Q

bx findings of sarcoidosis

A

non-caseating granulomas

154
Q

tx for sarcoidosis

A

steroids
MTX
ACEI for HTN

155
Q

leading cause of death for sarcoidosis

A

pulmonary fibrosis

156
Q

definition of pulmonary nodule vs mass

A

nodule: < 3 cm
mass: > 3 cm

157
Q

management of pulmonary nodules/masses

A

CT if found on CXR
suspicious -> bx
not suspicious -> monitor q 3 mo, 6 mo, yearly x 2 yr

158
Q

characteristics of suspicious lung nodule

A

ill defined or lobular border
spiculated
double from 21-40 days
diameter > 5.3 cm

159
Q

characteristics of non suspicious lung nodule

A

< 1 cm
calcifications
smooth, well defined edges
no growth > 2 yr
diameter < 1.5 cm

EOR - Internal Med (13 decks)

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