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Internal Medicine > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

a 23-year-old female with a one-week history of cough productive of whitish sputum. This was preceded one week prior by a URI. She denies chills, night sweats, shortness of breath, or wheeze. Temperature is 99.9°F (37.7°C). What is the likely diagnosis

A

Acute/chronic bronchitis

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2
Q

What is the DX criteria for acute bronchitis

A

Cough > 5 days with or without sputum production, lasts 2-3 weeks

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3
Q

What is the most common cause of acute bronchitis

A

Virus –> symptomatic tx only unless pneumonia is also suspected

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4
Q

a 5-year-old boy who is brought to the emergency department by his parents for a cough and shortness of breath. He has a past medical history of eczema and seasonal rhinitis. On physical exam, you note a young boy in respiratory distress taking deep slow breaths to try and catch his breath. He has diminished breath sounds in all lung fields with prolonged, expiratory wheezes. What is his likely diagnosis

A

Asthma

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5
Q

What is the atopic triad

A

Eczema
Asthma
Allergies

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6
Q

How do you diagnose someone with asthma

A

monitor with peak flow. PFT’s: Greater than 12% increase in FEV1 after bronchodilator therapy

*you will have a decreased FEV1 and therefore a reduced FEV1 to FVC ratio

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7
Q

What is the acute treatment for asthma

A
  • Albuterol (neb) + O2 + Oral steroids + Ipratropium (SAMA)
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8
Q

What is the tx of intermittent asthma

A

Albuterol (SABA) PRN

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9
Q

What is considered intermittent asthma

A
  • Daytime symptoms ≤2 days/week
  • Nocturnal awakenings ≤2/month
  • Normal FEV1
  • Exacerbations ≤1/year
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10
Q

How do you treat mild persistent asthma

A

Low-dose ICS daily with SABA as needed

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11
Q

What is considered mild persistent asthma

A

Daytime symptoms >2 but <7 days/week
Nocturnal awakenings 3 to 4 nights/month
Minor interference with activities
>2 exacerbations per year

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12
Q

How do you treat moderate asthma

A

Combination low-dose ICS-formoterol daily and 1 to 2 inhalations as needed up to 12 inhalations/day

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13
Q

What is considered moderate asthma

A

Daily symptoms
Nocturnal awakenings >1/week
Daily need for SABA
Some activity limitation
FEV1 60 to 80% predicted

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14
Q

What is severe asthma

A

Symptoms all-day
Nocturnal awakenings nightly
Need for SABA several times/day
Extreme limitation in activity

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15
Q

How do you treat severe asthma

A

Combination medium dose ICS-formoterol daily and 1 to 2 inhalations as needed to 12 inhalations/day

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16
Q

a 25-year-old cystic fibrosis patient complaining of chronic, frequent coughing productive of yellow and green sputum. She recently recovered from a Pseudomonas spp. Pneumonia requiring hospitalization. On physical examination, you notice foul breath, purulent sputum, and hemoptysis, along with a CXR demonstrating dilated and thickened airways with “plate-like” atelectasis. What is the likely diagnosis

A

Bronchiectasis

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17
Q

What is bronchiectasis

A

A condition in which the lungs’ airways become dilated and damaged, leading to inadequate clearance of mucus in airways

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18
Q

What are the symptoms of bronchiectasis

A

daily cough that occurs over months or years, production of copious foul-smelling sputum, and frequent respiratory infections

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19
Q

How do you diagnose bronchiectasis

A

linear “tram track” lung markings, dilated and thickened airways – “plate-like” atelectasis

*GOLD STANDARD is chest CT

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20
Q

a 43-year-old man who comes to the emergency department because of a 3-week history of episodic cutaneous flushing, diarrhea, and wheezing. He has a past medical history of hypertension and type 2 diabetes mellitus. His temperature is 36.6°C (97.9°F), pulse is 125/min, respirations are 30/min, and blood pressure is 90/60 mm Hg. Pulmonary examination shows diffuse wheezes in both lung fields. Cardiac examination shows a prominent “v” wave of the jugular vein and a 1/6 holosystolic murmur best heard on the left lower sternal border. Abdominal examination shows hyperactive bowel sounds. What is the likely diagnosis

A

Carcinoid tumor

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21
Q

What is a carcinoid tumor

A

A tumor arising from neuroendocrine cells → leading to excess secretion of serotonin, histamine, and bradykinin

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22
Q

What are the common primary sites of a carcinoid tumor and where is the most common site for it to metastasize

A

Primary: GI (small and large intestines, stomach, pancreas, liver), lungs, ovaries, and thymus

Metastasize: Liver

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23
Q

What are the hallmark signs of a carcinoid tumor

A

Cutaneous flushing, diarrhea, wheezing and low blood pressure ( but rare to see)

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24
Q

a 56 yo female with shortness of breath, as well as a productive cough that has occurred over the past two years for at least three months each year. She is a heavy smoker. Physical exam reveals a respiratory rate of 32, slightly labored breathing, and a temperature of 98.9F. Her SpO2 is 90% while receiving oxygen via nasal cannula at 2 Lpm. What is the most likely dx

A

COPD

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25
Q

What is the largest risk factor for COPD

A

Cigarette smoking

26
Q

What is the hallmark symptom of emphysema

A

DOE

27
Q

Why are those with emphysema considered pink puffers

A

Individuals are able to oxygenate blood (pink) but they have to purse their lips to do so

28
Q

What will be seen on CXR with those who have emphysema

A

loss of lung markings, hyperinflation, increased anterior-posterior diameter

29
Q

What is the dx criteria for chronic bronchitis

A

chronic cough that is productive of phlegm occurring on most days for 3 months of the year for 2 or more consecutive years without an otherwise-defined acute cause

PFT’s: FEV1/FVC ratio of less than 0.7

30
Q

What are the signs of cor pulmonale

A

peripheral edema and cyanosis

31
Q

what is the best treatment regimen for chronic bronchitis

A

Short-acting (SAMA) or long-acting (LAMA) muscarinic agent (also known as an anticholinergic agent) (ipartropium and tiotropium)

32
Q

When is theophylline utilized

A

only used in refractory cases due to narrow therapeutic index – higher doses are needed in smokers and coffee drinkers- DONT USE IN ACUTE EXACERBATIONS

33
Q

When is long term oxygen therapy needed with those who have COPD

A

all patients with COPD who have chronic hypoxemia defined as resting PaO2 < 55 mmHg or SaO2 <89%

34
Q

65 y/o with 3 days of progressive dyspnea and purulent sputum production. The patient takes albuterol and tiotropium bromide for moderate COPD. His PMH is relevant for a 40 pack-year smoking history, type II DM, hyperlipidemia, and coronary artery stenting 2 years ago. PE shows barrel-shaped chest, inspiratory crackles, hepatojugular reflux, pulsus paradoxus, and ventricular gallop. His temperature is 38.1°C (100.5°F), his pulse is 130/min, respirations are 28/min, blood pressure is 130/84 mmHg, and pulse oximetry on room air shows an oxygen saturation of 86%. What is the likely diagnosis

A

Cor pulmonale

35
Q

What is the most common cause of cor pulmonale

A

COPD

36
Q

What is the gold standard for dx of cor pulmonale

A

Right heart Cath

37
Q

Can diuretics be used in those with right heart failure

A

NO! can be harmful

38
Q

a 55-year-old female who is a current smoker presents with a 9-month history of respiratory symptoms, including dyspnea on exertion, thoracic pain, and dry cough, which were preceded by a pulmonary infection. On auscultation, you hear inspiratory crackles. Pulmonary function tests (PFTs) show only mild impairment of vital capacity with decreased lung volume and a normal to increased FEV1/FVC ratio. What is the likely diagnosis

A

Idiopathic pulmonary Fibrosis

39
Q

What will be seen on a chest CT in those who have IPF

A

diffuse patchy fibrosis with pleural-based honeycombing

40
Q

What are the treatments for IPF

A

antifibrotic drugs (pirfenidone or nintedanib), oxygen therapy, and eventually lung transplant

41
Q

a 53-year-old man presents to the office complaining of progressive dyspnea over the past few years. History reveals that he has worked in construction for the past 20 years demolishing and refurbishing old buildings. He rarely uses any protective breathing equipment. Physical examination demonstrates an afebrile man in mild respiratory distress with inspiratory crackles. The chest x-ray reveals a reticular linear pattern with basilar predominance, opacities, and honeycombing. What is the likely diagnosis

A

Pneumoconiosis

42
Q

What is seen on CXR in those who have prolonged silicosis exposure

A

small rounded opacities throughout the lung, hilar lymph nodes may be calcified - “eggshell” calcifications

43
Q

Who is at an increased risk of mesothelioma

A

Those who have a prolonged exposure of asbestos

44
Q

What is the tx of pulmonary aspergillosis

A

Itraconazole or fluconazole

45
Q

What is the treatment for histoplasmosis

A

Amp B

46
Q

Which patient demographics are at high risk of developing PJP

A

HIV patients

47
Q

What is the treatment for PJP

A

Bactrim and steroids

48
Q

a 43-year-old woman with a history of COPD presents to the office with worsening dyspnea, especially at rest. She also complains of dull, retrosternal chest pain. On examination, she has persistent widened splitting of S2. What is the likely diagnosis

A

Pulmonary hypertension

49
Q

What are the normal pulmonary pressures and what are they in pulmonary hypertension

A

normal: 15/5
Pulmonary hypertension: >20

50
Q

What typically causes pulmonary hypertension

A

an underlying disorder (constrictive pericarditis, mitral stenosis = MC, LV failure, mediastinal disease compression pulmonary veins)

51
Q

How do you diagnose pulmonary hypertension

A

Right heart Cath

52
Q

What type of lung cancer has the worst prognosis

A

Small cell lung cancer

53
Q

Which patients typically get small cell lung cancer

A

Smokers

54
Q

What is the most common type of non-small cell lung cancer

A

Adenocarcinoma

55
Q

What type of lung cancer can NOT be treated with surgery

A

SCLC

56
Q

What is Horners syndrome

A

unilateral miosis, ptosis, and anhidrosis

57
Q

a 30-year-old African American female with a cough, fever, and generalized body aches. You order a CXR which shows bilateral hilar adenopathy. what is the likely diagnosis

A

Sarcoidosis

58
Q

What is sarcoidosis

A

Chronic autoimmune inflammatory disease in which small nodules (granulomas) develop in lungs, lymph nodes, and other organs

59
Q

What will be seen on biopsy with sarcoidosis

A

Non-caseating granulomas

60
Q

What is the treatment of sarcoidosis

A

Steroids

61
Q

What will be seen on CXR in those with sarcoidosis

A

bilateral hilar lymphadenopathy

Internal Medicine (8 decks)

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