pulmonology Flashcards
1
Q
What is the vector for transmission of Lyme disease, anaplasmosis, and babesiosis?
A
The deer tick.
2
Q
What does lymphangioleiomyomatosis result from?
A
Smooth muscle growth in the lungs, leading to widespread cyst formation.
3
Q
How can eosinophilic granulomatosis with polyangiitis be described?
A
Asthma with peripheral eosinophilia.
4
Q
What are the diagnostic features of diffuse panbronchiolitis?
A
Diffuse centrilobular nodules in a tree in bud distribution and dilation of distal bronchioles.
5
Q
What is the prognosis for advanced stages of non-small cell lung cancer adenocarcinomas with EGFR mutations?
A
More favorable prognosis.
6
Q
What will a CBC show for hantavirus?
A
Thrombocytopenia as well as lymphocytosis.
7
Q
What is the best treatment for a patient with COPD who has had at least two exacerbations and a blood eosinophil count of less than 300?
A
LABA and a LAMA.
8
Q
What is the normal range for initial flow on ventilator when delivering a breath.
A
Approximately 40-60 Lpm.
9
Q
What is the recommended duration of systemic anticoagulation for a provoked VTE?
A
3 months.
10
Q
What RSBI value is positive for extubation?
A
Less than 105.
11
Q
What do radiographs for idiopathic giant bullous emphysema show?
A
Paraseptal asymmetric upper lobe predominant giant bullae.
12
Q
What is the vector for tularemia and Rocky Mountain spotted fever?
A
The dog tick.
13
Q
Where is hantavirus most common in the United States?
A
Arizona, Colorado, New Mexico, and Utah.
14
Q
What are the symptoms of hantavirus pulmonary syndrome?
A
Pulmonary edema, bronchorrhea, and cardiopulmonary collapse.
15
Q
What is the typical length of a SBT?
A
Around 30 minutes.
16
Q
What characterizes UIP?
A
Peripheral honeycombing, traction bronchiectasis, and basilar and subpleural predominance.
17
Q
What is wrong with the P/F ratio calculation of 80 (PaO2)/40 (FiO2)?
A
You must convert FiO2 to a decimal: 80/.4 = 200.
18
Q
How do you obtain the Vt value for the RSBI calculation?
A
Take the minute ventilation/RR.
19
Q
What is diagnostic for airway obstruction?
A
FEV1/FVC ratio <70% or outside the 95% confidence interval for predicted FEV1/FVC.
20
Q
What are the most common manifestations of Osler-Weber-Rendu syndrome?
A
Nosebleeds, GI bleeds, and AVMs on the mucosal surfaces.
21
Q
When is pneumocystis jirovecii an unlikely diagnosis?
A
In a patient with a CD4 count of >200.
22
Q
What is the normal range for initial pressure trigger sensitivity?
A
2 cmH2O.
23
Q
What is the best strategy for treating IPF?
A
Supportive care including pulmonary rehabilitation and supplemental oxygen.
24
Q
What is the next step for someone with uncontrolled asthma on medium dose inhaled steroid?
A
Add an inhaled LABA.
25
What symptoms indicate a diver may be suffering from nitrogen narcosis?
Acute onset of poor judgment, euphoria, or confusion.
26
What is decompression sickness associated with?
Pain/end organ damage due to nitrogen gas bubbles in tissue.
27
What is nitrogen narcosis associated with?
Neurological symptoms due to high partial pressure of nitrogen in the brain.
28
Who is lymphangioleiomyomatosis typically found in?
Young women and those with tuberous sclerosis.
29
What is granulomatosis with polyangiitis positive for?
cANCA.
30
What is the normal Vt range to set on a ventilator?
Typically 6-8 mL/kg.
31
What is the initial therapeutic management for exercise induced bronchoconstriction?
Administration of a SABA 15 minutes before activity.
32
What can long-term steroid use lead to in COPD patients?
Worsening dyspnea as a result of muscle weakness and volume overload.
33
What is idiopathic giant bullous emphysema most common in?
Young men with a short history of smoking.
34
What is the most common idiopathic interstitial pneumonitis?
Idiopathic pulmonary fibrosis.
35
What VC value is positive for extubation?
Greater than 10 ml/kg.
36
What is a typical SBT setting for proportional assist ventilation?
30 percent of the WOB.
37
What do radiographs for idiopathic giant bullous emphysema show?
Asymmetric upper lobe predominant giant bullae.
38
What is the treatment for a new diagnosis of uncomplicated PE without hemodynamic compromise?
Oral apixaban or rivaroxaban.
39
What is Langerhans cell histiocytosis associated with?
Patients aged 20 to 40 and smoking.
40
What is the benefit for lung transplantation in IPF greatest in?
Younger patients.
41
What do DOACS treat?
Patients with uncomplicated VTE.
42
What is the common finding on CBC differential for ABPA?
Peripheral eosinophilia.
43
What is the formula for Total Cycle Time?
Total Cycle Time = (60/RR).
44
What is the IBW male formula in pounds?
106 + 6(H-60).
45
What is the IBW female formula in pounds?
105 + 5(H-60).
46
What is the RSBI calculation?
RR/Vt (in liters).
47
What is the treatment for new diagnosis of uncomplicated PE?
Oral apixaban or rivaroxaban.
48
What does hantavirus show on peripheral smear?
Myelocytosis along with immunoblasts.
49
What is the preferred treatment for non-small cell lung cancer stage 1 to 2A?
Surgical resection.
50
What should LAMAs be used with caution in patients with?
BPH or bladder neck obstruction.
51
What is the most critical factor for reducing instances of VAP?
Daily assessment for extubation readiness.
52
What is the normal plateau pressure range?
Typically below 30 cm H2O.
53
What is the shortcut for determining mechanical ventilator tidal volume range?
IBW (kg)= 50 + (2 x inches over 5 feet), then add zero to get max tidal volume and divide by 2 for minimum.
54
What is the normal PIP range?
25-30 cm H2O.
55
What are the symptoms of chronic cough and dyspnea in a patient with Hodgkin's lymphoma?
Interstitial lung opacities likely due to bleomycin.
56
What is the treatment for allergic bronchopulmonary Aspergillosis?
Often found in patients with a history of asthma.
57
What is the NIF value positive for extubation?
Less than -20.
58
What rare side effect can Nitrofurantoin cause?
Pulmonary fibrosis.
59
What is the most common pulmonary manifestation of hereditary hemorrhagic telangiectasia?
AVMs can also be in the pulmonary, hepatic, and cerebral vasculature.
60
What is the recommended treatment for patients with uncomplicated VTE?
DOACS are now the recommended treatment for patients with uncomplicated VTE.
61
What are common radiographic findings in ABPA?
ABPA may have central bronchiectasis with mucus plugging as common radiographic findings.
62
What characterizes diffuse panbronchiolitis?
Diffuse panbronchiolitis is characterized by dyspnea on exertion, chronic sinusitis, and chronic productive cough.
63
What is UIP characterized by?
UIP is characterized by peripheral honeycombing, traction bronchiectasis, and basilar and subpleural predominance.
64
What is the most common pulmonary manifestation of hereditary hemorrhagic telangiectasia?
The most common pulmonary manifestation of hereditary hemorrhagic telangiectasia is pulmonary arteriovenous malformations, also called Osler-Weber-Rendu syndrome.
65
What are typical SBT settings for weaning?
Typical SBT settings for weaning would be a CPAP of 5 and a PS of 5.
66
In which patients should LAMAs be used with caution?
LAMAs should be used with caution in patients with BPH or bladder neck obstruction.
67
What are the symptoms of hantavirus pulmonary syndrome?
Hantavirus pulmonary syndrome includes pulmonary edema, bronchorrhea, and cardiopulmonary collapse.
68
What describes decompression sickness?
Decompression sickness describes pain in the limbs/end organ damage due to nitrogen gas bubbles in tissue in a diver.
69
What is nitrogen narcosis characterized by?
Nitrogen narcosis is characterized by neurological symptoms due to high partial pressure of nitrogen in the brain.
70
What is diagnostic of pulmonary HTN?
Mean pulmonary artery pressures >20 on a right heart cath is diagnostic of pulmonary HTN.
71
What indicates a positive cuff leak for extubation?
Cuff leak greater than 15 percent is positive for extubation.
72
In which demographic is lymphangioleiomyomatosis typically found?
Lymphangioleiomyomatosis is typically found in young women and those with tuberous sclerosis.
73
What is idiopathic giant bullous emphysema most common in?
Idiopathic giant bullous emphysema is most common in young men with a short history of smoking.
74
What histologic pattern characterizes idiopathic pulmonary fibrosis?
Idiopathic pulmonary fibrosis is characterized by the histologic pattern of UIP.
75
What is the normal P/F ratio?
Normal P/F ratio is greater than or equal to 400.
76
What is the best strategy for treating IPF?
The best strategy for treating IPF is supportive care.
77
What should be avoided in chronic steroid use for COPD patients?
Chronic steroid use in COPD patients should be avoided if possible as it could lead to increased risk of pneumonia.
78
From which region do adenocarcinomas typically arise?
Adenocarcinomas typically arise from the periphery of the lung.
79
What is the appearance of Langerhans cell histiocytosis?
Langerhans cell histiocytosis has the appearance of thin walled cysts and small nodules in the mid and upper zones of the lungs.
80
What is the normal range FIO2 to start ventilation?
Normal range FIO2 to start ventilation is 40 to 60 percent.
81
From which region do large cell carcinomas typically arise?
Large cell carcinomas typically arise from the periphery of the lung.
82
What is the diagnostic test for COPD?
The diagnostic test for COPD is spirometry.
83
What autoimmune disease can be described as asthma with peripheral eosinophilia?
Eosinophilic granulomatosis with polyangiitis can be described as asthma with peripheral eosinophilia.
84
What is the anatomic dead space equal to?
Anatomic dead space is equal to 1 mL/pound of IBW.
85
What are the diagnostic features of diffuse panbronchiolitis?
Diffuse centrilobular nodules in a tree in bud distribution and dilation of distal bronchioles are diagnostic of diffuse panbronchiolitis.
86
What should patients with severe chronic obstructive pulmonary disease be routinely screened for that is non medical?
The nonpulmonary comorbidity of depression
## Footnote
Screening for comorbidities is essential for comprehensive patient care
87
What is the only screening modality that has shown a survival benefit for early-stage lung cancers?
Yearly low-dose CT of the chest in high-risk patients.
## Footnote
This method is specifically beneficial for certain demographics based on smoking history.
88
What age range is recommended for annual screening with low-dose chest CT?
50 to 80 years.
## Footnote
This recommendation applies to individuals with a significant smoking history.
89
What is the smoking history requirement for annual low-dose chest CT screening?
At least 20 pack-years of cigarette smoking.
## Footnote
A pack-year is defined as smoking one pack of cigarettes per day for one year.
90
Who is eligible for annual low-dose chest CT screening?
Individuals aged 50 to 80 who currently smoke or have quit within the past 15 years.
## Footnote
This criterion emphasizes both current and former smokers for early detection.
91
True or False: Most current guidelines recommend screening for all adults over 50 for lung cancer.
False.
## Footnote
Screening is specifically targeted at high-risk individuals based on smoking history.
92
What is the most common indication for lung transplantation in adults?
Chronic obstructive pulmonary disease (COPD)
## Footnote
COPD is a progressive lung disease that causes breathing difficulties.
93
What post-bronchodilator FEV1 percentage indicates the need for consideration of lung transplantation in severe COPD patients?
<25% of predicted
## Footnote
FEV1 stands for Forced Expiratory Volume in one second.
94
What baseline partial pressure of carbon dioxide suggests a need for lung transplantation in COPD patients?
>50 mm Hg
## Footnote
Elevated carbon dioxide levels can indicate respiratory failure.
95
What condition related to COPD may prompt consideration for lung transplantation?
COPD-associated pulmonary arterial hypertension/cor pulmonale
## Footnote
Cor pulmonale refers to right heart failure due to lung disease.
96
What should be considered for COPD patients who require oxygen supplementation and exhibit progressive deterioration?
Possible lung transplantation
## Footnote
This recommendation comes from the American Thoracic Society and the European Respiratory Society.
97
True or False: All COPD patients should be considered for lung transplantation regardless of their condition.
False
## Footnote
Only patients with severe COPD and specific clinical indicators should be considered.
98
What is the recommended oxygen saturation level for COPD patients to receive long-term supplemental oxygen therapy?
≤88%
99
What is the partial pressure of oxygen threshold for COPD patients to qualify for long-term supplemental oxygen therapy?
≤55 mm Hg
100
Which organizations provide guidelines for oxygen therapy in COPD patients?
Global Initiative for Chronic Obstructive Lung Disease (GOLD) and American Thoracic Society
101
True or False: Only patients with severe COPD should receive long-term supplemental oxygen therapy.
False
102
Fill in the blank: Patients with chronic obstructive pulmonary disease (COPD) should be treated with _______ if their oxygen saturation is ≤88% or their partial pressure of oxygen is ≤55 mm Hg.
long-term supplemental oxygen therapy
103
What is roflumilast?
A phosphodiesterase type 4 (PDE4) inhibitor
104
What condition does roflumilast primarily treat?
Severe chronic pulmonary obstructive disease (COPD) with features of chronic bronchitis and recurrent exacerbations
105
What effect does roflumilast have on exacerbations in COPD patients?
Reduces the frequency of exacerbations
106
What improvements are seen when roflumilast is added to therapy?
Small improvements in lung function
107
What type of therapy is roflumilast often combined with?
Long-acting bronchodilator therapy
108
According to the current GOLD guidelines, when should roflumilast be considered?
In patients who have chronic bronchitis, an FEV1 <50% of predicted, and persistent exacerbations despite optimal medical management
109
What is the initial dose of roflumilast?
250 μg daily
110
For how long is the initial dose of roflumilast typically continued?
For a month
111
At what dose is the clinical effect of roflumilast observed?
500 μg daily
112
What effect does long-term use of azithromycin 250 mg daily have?
Reduces the frequency of COPD exacerbations
## Footnote
COPD stands for Chronic Obstructive Pulmonary Disease.
113
According to current GOLD guidelines, who should consider azithromycin use?
Former smokers with continued frequent exacerbations despite treatment
## Footnote
Treatment includes inhaled steroids and long-acting bronchodilators.
114
True or False: Long-term azithromycin use is recommended for all COPD patients.
False
## Footnote
It is specifically recommended for former smokers with frequent exacerbations.
115
What should a patient with severe chronic obstructive pulmonary disease presenting with acutely worsening dyspnea and no infection be evaluated for?
Myocardial ischemia, congestive heart failure, and pulmonary thromboembolic disease
## Footnote
These conditions should be considered especially when there is no evidence of an infectious etiology.
116
Fill in the blank: A patient with severe chronic obstructive pulmonary disease presenting with worsening dyspnea and no infection should be evaluated for _______.
myocardial ischemia, congestive heart failure, and pulmonary thromboembolic disease
117
What are the findings most consistent with a diagnosis of allergic bronchopulmonary aspergillosis?
Recurrent asthma exacerbations, patchy opacities, central bronchiectasis, eosinophilia, elevated immunoglobulin E level
## Footnote
These findings are indicative of the inflammatory response associated with allergic bronchopulmonary aspergillosis.
118
Which radiographic finding is associated with allergic bronchopulmonary aspergillosis?
Patchy opacities and central bronchiectasis
## Footnote
These findings reflect the structural changes in the lungs due to chronic inflammation.
119
True or False: Recurrent asthma exacerbations are a common finding in allergic bronchopulmonary aspergillosis.
True
## Footnote
Asthma exacerbations can be triggered by the allergic response to Aspergillus species.
120
What are the mainstays of treatment for patients hospitalized for an exacerbation of chronic obstructive pulmonary disease (COPD)?
Glucocorticoids and bronchodilators
## Footnote
They reduce symptoms and often shorten hospital stays.
121
What role do antibiotics play in the treatment of COPD exacerbations?
They improve outcomes, lower the risk for treatment failure, increase time between exacerbations, and reduce the risk for death
## Footnote
Particularly effective in cases with purulent sputum.
122
What percentage of acute exacerbations of COPD are caused by bacterial infection?
About 50%
## Footnote
This highlights the importance of antibiotics in treatment.
123
Which classes of antibiotics are recommended to treat COPD exacerbations?
Fluoroquinolones, doxycycline, or macrolide antibiotics
## Footnote
Azithromycin is an example of a macrolide antibiotic.
124
True or False: Glucocorticoids and bronchodilators only alleviate symptoms in COPD exacerbations without affecting hospital stay duration.
False
## Footnote
They often shorten hospital stays as well.
125
Fill in the blank: Antibiotics have been shown to significantly improve outcomes in COPD exacerbations, particularly when _______ is present.
purulent sputum
## Footnote
This indicates a bacterial infection.
