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CDP > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

Mild hypoxia SpO2 levels and who this is most common in

A

91-94%

Elderly, obese, smokers

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2
Q

Biggest contraindication for CT with contrast

A

Chronic or acutely worsening renal disease

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3
Q

What is the “5th vital sign”?

A

Arterial oxygenation measured by pulse oximeter

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4
Q

Is a total lung capacity <80% suggestive of obstructive or restrictive lung disease?

A

Restrictive

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5
Q

Three most common causes of cough

A

Infectious agents

Sinus drainage

Acid reflux

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6
Q

Diagnostic labs (3) used in patients with dyspnea

A

BNP

D-dimer

ABGs

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7
Q

Preferred imaging method for evaluating incidental pulmonary nodules

A

CT scan WITHOUT contrast

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8
Q

Is an FEV1/FVC ratio <70% suggestive of obstructive or restrictive lung disease?

A

Obstructive

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9
Q

Follow-up is not required for lung nodules of this size in patients 35 or older without symptoms or risk factors of lung cancer

A

<6mm

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10
Q

Which cause of dyspnea is of mixed origin (cardiac and pulmonary)

A

Pulmonary emboli

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11
Q

Normal ranges on ABGs for:
1.) pH
2.) PaO2
3.) PaCO2
4.) HCO3

A

1.) pH - 7.35 to 7.45
2.) PaO2 - 80 to 100 mmHg
3.) PaCO2 - 35 to 45 mmHg
4.) HCO3 - 22 to 26 mmHg

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12
Q

Spirometry improvement with bronchodilator administration is more common in COPD or asthma?

A

Asthma

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13
Q

When CT with contrast is contraindicated, what can be used to assess likelihood of PE?

A

V/Q scan (nuclear)

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14
Q

pH - 7.12
PaO2 - 95
PaCO2 - 44
PaHCO3 - 12

Diagnose me!

A

Metabolic acidosis, uncompensated

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15
Q

Name the three corners of Virchow’s Triad

A

Vascular injury

Circulatory stasis

Hypercoagulable state

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16
Q

Gold standard for evaluating a PE

A

CTPA

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17
Q

pH - 7.38
PaO2 - 86
PaCO2 - 46
PaHCO3 - 32

Diagnose me!

A

Metabolic alkalosis, fully compensated

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18
Q

S1Q3T3 EKG changes are suggestive of …

A

Pulmonary embolism

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19
Q

Breathing faster will increase or decrease PaCO2?

A

Decrease

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20
Q

A normal shaped, small-sized flow-loop pattern is suggestive of …

A

Restrictive lung disease

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21
Q

True or false. A negative d-dimer is sufficient to rule out DVT/PE

A

True

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22
Q

What might you see in a chest x-ray of a patient with acute heart failure?

A

Cardiomegaly
Cephalization (stag)
Interstitial edema
Vascular congestion
Pleural effusions

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23
Q

Three indications for chest CT angiography

A

PE

Aortic aneurysm

Aortic dissection

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24
Q

Common reasons (3) for anion gap to be elevated

A

Lactic acidosis

Renal failure

Ketoacidosis

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25
Q

Two major types of CT with contrast

A

Helical and Axial

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26
Q

Diagnostic tests (7) used in patients with dyspnea

A

EKG
Pulse oximetry
CXR
Ultrasound
V/Q scan
CT scan
PFTs

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27
Q

Normal SpO2 levels

A

95-100%

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28
Q

This diagnostic lab test checks the function of a patient’s lungs and how well they are able to move oxygen in to and CO2 out of the blood

A

ABGs

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29
Q

CBC findings with pulmonary hypertension

A

Polycythemia (chronic hypoxia)

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30
Q

Most common cause of hemoptysis

A

Infection (60-70%)

(consider lung cancer though if patient is a big smoker)

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31
Q

ARDS would look like this on chest x-ray

A

Diffusely filled patchy infiltrates

32
Q

Exudative effusions can be evaluated and empyema loculations can be broken up using this pulmonary procedure

A

Thorascopy

33
Q

DLCO threshold for lung pathology

A

<80% = pathology

(>80% = normal)

34
Q

If a patient with tuberculosis symptoms has a positive IGRA test, how should you proceed?

A

Isolate patient

Obtain chest x-ray

Three sputum samples (NAAT on at least one but Acid-fast bacilli is gold standard)

Still high suspicion but negative AFB = bronchoscopy with biopsies

35
Q

This diagnostic lab is useful in patients with acute decompensated heart failure

A

BNP

36
Q

Direct visualization of the larynx, trachea, and bronchi is done with this pulmonary procedure

A

Bronchoscopy

37
Q

Most common sleep-related breathing disorder

A

Sleep apnea

38
Q

The anion gap is most helpful in identifying the cause of …

A

Metabolic acidosis

39
Q

DLCO measure the lungs capability to …

A

Perform gas exchange

40
Q

PFT contraindications (6)

A

Anything that means they’re not currently at respiratory baseline

Exacerbation of acute severe asthma
Respiratory distress
Angina aggravated by testing
Pneumothorax
Ongoing hemoptysis
Active TB

41
Q

This type of lung condition is characterized by airflow limitation

A

Obstructive

42
Q

Gold standard for pneumonia diagnosis

A

Chest x-ray

43
Q

Order we evaluate arterial blood gases

A

1.) Look at pH
2.) Look at CO2
3.) Look for compensation

44
Q

How is the anion gap calculated?

A

Cations (Na + K) minus Anions (Chloride + Bicarb)

45
Q

pH - 7.52
PaO2 - 88
PaCO2 - 45
PaHCO3 - 33

Diagnose me!

A

Metabolic alkalosis, uncompensated

46
Q

pH - 7.29
PaO2 - 82
PaCO2 - 62
PaHCO3 - 26

Diagnose me!

A

Respiratory acidosis, uncompensated

47
Q

This diagnostic lab is used in cases of dyspnea to detect markers of coagulation and fibrinolysis

A

D-dimer

48
Q

This score is used to assess chance of morbidity/mortality if patient has community acquired pneumonia

A

PSI/PORT score

49
Q
A
50
Q

In a suspected pulmonary neoplasm, the first thing you should look for is …

A

Old films (old x-rays to compare to)

51
Q

For solid lung nodules, growth is defined as …

A

Increase in size of >2mm

52
Q

The two PE risk calculators

A

Well’s criteria

Perc rule

53
Q

Indications for PFTs

A

Diagnosing and monitoring disease course and response to therapy

54
Q

Two main types of pulmonary diseases

A

Obstructive

Restrictive

55
Q

A scooped out, small flow-loop pattern is suggestive of …

A

Mixed obstructive and restrictive lung disease

56
Q

Severe hypoxemia SpO2 levels

A

<85%

57
Q

Things measured during polysomnography testing

A

Apnea hypopnea index (AHI)
- number of apneas per hour

Sometimes Respiratory Disturbance Index is used (more sensitive, includes hypopneas and apneas)

Oxygen desaturation

58
Q

A scooped out, normal sized flow-loop pattern is suggestive of …

A

Obstructive lung disease

59
Q

True or false. Pneumothorax is best visualized on chest x-ray in the expiratory view

A

True

60
Q

pH - 7.29
PaO2 - 90
PaCO2 - 20
PaHCO3 - 16

Diagnose me!

A

Metabolic acidosis, partially compensated

61
Q

pH - 7.35
PaO2 - 90
PaCO2 - 48
PaHCO3 - 37

Diagnose me!

A

Respiratory acidosis, fully compensated

(taken from slide 30 first example)

Bicarb is more out of range, so I think it should be fully comp met. alkalosis

62
Q

Most important part of a patient encounter when trying to diagnose a patient with dyspnea

A

Patient history!

63
Q

Calcifications are best viewed with this type of CT scan

A

CT without contrast

64
Q

Reasons (8) for D-dimer to be elevated

A

DVT
PE
Pregnancy
Malignancy
Surgery
Infection
Inflammation
Smoking

(she did say “just know lots of things elevate”)

65
Q

Describe initial diagnosis method for TB

A

1.) Consider TB skin test

2.) TB blood tests/IGRAs (T-SPOT or QuantiFERON)

Consider IGRAs first if patient had bacille Calmette-Guerin (BCG) vaccine OR people who can’t come back for skin test follow-up

66
Q

Diagnostic therapy used in patients with dyspnea

A

Oxygen

67
Q

Pulmonary embolism is present in this percentage of patients with DVT

A

60-80%

68
Q

Diagnostic procedures (2)

A

Bronchoscopy

Thorascopy (VATS)

69
Q

In patients 35 or older without symptoms or risk factors of lung cancer, at what size should a lung nodule be followed up on?

A

> 8mm

70
Q

Biggest indication for DLCO testing

A

Restrictive (intrinsic) lung disease

71
Q

Is FEV1 <80% suggestive of obstructive or restrictive lung disease?

A

Obstructive

72
Q

pH - 7.12
PaO2 - 56
PaCO2 - 80
PaHCO3 - 34

Diagnose me!

A

Respiratory acidosis, partially compensated

73
Q

Moderate hypoxia SpO2 levels and who this is most common in

A

86-91%

Chronic lung conditions

74
Q

pH - 7.55
PaO2 - 90
PaCO2 - 22
PaHCO3 - 24

Diagnose me!

A

Respiratory alkalosis, uncompensated

75
Q

Breathing faster will increase or decrease blood pH?

A

Increase (more basic)

CDP (12 decks)

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