Pulmonology Flashcards
1
Q
SIADH, ACTH, LE syndromes
A
Small cell –> chemo + rad
2
Q
Small round blue cells
A
Small cell
3
Q
Smoker
A
Squamous > small
4
Q
Non-small cell lung CA mets
A
Brain (gray/white) - surgical excision
5
Q
Pleomorphic giant cells w/ leukocyte fragments
A
Large cell
6
Q
Keratin pearls & intercellular bridges, CENTRAL
A
SCC
7
Q
PTHrP
A
SCC
8
Q
Type II pneumocytes
A
Adenocarcinoma
9
Q
Non-smoker or female
A
Adenocarcinoma
10
Q
Peripheral
A
Adenocarcinoma
11
Q
Psammoma bodies
A
Mesothelioma
12
Q
Chromogranin
A
Carcinoid
13
Q
Collar-button, polyp
A
Carcinoid
14
Q
Shoulder pain, constricted pupil, ptosis, weak hand muscles, numbness
A
Pancoast tumor (non-small cell) –> XR
15
Q
Clavicular LAD, (-) chest CT, metastatic SCC next step?
A
Panendoscopy (bronch, endo, laryngoscopy) to detect primary tumor
16
Q
Coin lesion 1st step?
A
Obtain older XR
17
Q
Initial lung CA work-up
A
CXR –> compare to old, sputum cytology
CT scan w/ liver –> determine malignancy risk –> CT, Bx or PET
18
Q
Dx lung CA if not via cytology
A
Bronchoscopy + Bx
Percutaneous bx for peripheral or >2cm or likely malignant (better dx yield)
19
Q
Operatability of lung CA
A
Central lesions = pneumonectomy w/ minimum 800ml FEV1
20
Q
U/L earache, rhinorrhea of wheezing in a kid
A
Foreign body = endoscopy
21
Q
Hemoptysis >600ml/d or 100/hr tx
A
Secure airway –> bronchoscopy of bleeding continues
22
Q
> 100% DLCO
A
Obstructive = Asthma
Normal spirometry = Pul hemorrhage, PCV
23
Q
100% DLCO
A
Chronic bronchitis
24
Q
<100% DLCO
A
Obstructive = Emphysema
Restrictive = sarcoid, HF, asbestosis, COPD
Normal spirometry = Anemia, PE, pul HTN
25
Obstructive lung disease PFTs
Dec FEV1, FVC
FEV1/FVC <70%
V/Q mismatch
INC RV
Low DLCO = emphysema
Normal DLCO = chronic bronchitis
Inc DLCO = asthma
26
Restrictive lung disease PFTs
FEV1/FVC >70%
DEC VC, TLC
FRC is INC in ankylosing spondylitis
Low DLCO = asbestos, sarcoid, HF
Normal DLCO = MSK
Inc DLCO = morbid obesity
27
Chronic back pain, FEV1/FVC 95%, FRC 110%, FVC 75%
Ankylosing spondylitis --> restricted chest wall motion
28
Asthma >2x/wk, 3-4 nightime awakening/mo, FEV1 >80%
Mild persistent = Albuterol + corticosteroid
29
Daily Asthma, >1 awakening/wk, FEV1 60-80%
Moderate = Short + long B2 (salmeterol) + steroid
30
Many times daily asthma, daily nightime awakening, FEV1 <60%
Severe = Short + long B2 + inhaled + oral steroid
31
Recurrent RTIs, copious mucopurulent sputum. "tram-track" or "ring sign"
Bronchiectasis
32
Chronic productive cough w/ many Abx courses, massive hemoptysis
Bronchiectasis --> CT showing thick bronchial walls
33
Smoker, chronic productive cough, hemoptysis
Chronic bronchitis
34
Dyspnea, wheezing, boggy nose, cough, 40 y/o, Inc FEV1% post-bronchodilator
Asthma --> inhaled steroid preferred tx
35
Asbestosis malignancy & #1 cause of SVC syndrome
Bronchogenic CA
36
Methacholine % drop to dx asthma
20%
37
Dx eval for asthma
Peak flow w/ B-agonist, CXR, PFTs,
38
Alternative asthma therapy to inhaled steroids
Leukotriene antagonists - montelukast, zafrilukast
39
Tx for exercise-induced asthma, aspirin sensitive asthma
LT inhibitors (also albuterol for exercise)
40
Indicator of severe attack
Normal PCO2, speech difficulty, altered senses, 'silent lung'
41
Naproxen use, recurrent nasal discharge/congestion, bland taste --> wheezing
Aspirin exacerbated respiratory disease = NASAL POLYP
42
Nosebleed during pregnancy
Pyogenic granuloma
43
Wheezing in cold air, exercise tx
Exercise induced asthma = B-agonist 20min b4
44
Apnea >15-20s + brady or dec O2
Apnea of prematurity = #1 mixed central & obstructive
45
B/L perihilar streaking, tachypnea
Transient tachy of newborn
46
GROUND GLASS CXR, air bronchogram, L:S >2:1, pre-me
RDS --> O2 and CPAP
47
Risks for RDS
Pre-me, DM, c-section, asphyxia
48
Severe cyanosis, resp distress, clear lungs, DEC pul vasculature markings
Persistent pulm HTN
49
Subcutaneous emphysema next step?
CXR to r/o pneumothorax
50
Cough, congestion --> wheezing, 89%, no better w/ albuterol, ipratropium, steroids, or inc CO2
Status asthmaticus --> intubation
51
Stridor WORSE WHEN SUPINE or crying, improves when upright, omega-shaped epiglottis
Laryngomalacia --> laryngoscopy & reassurance
52
6mo --> 6y/o, barky cough, fever, rhinorrhea, congestion, steeple sign + HYPOXIA (vs. epiglottitis)
Croup = parainfluenza--> raceamic epi
53
Drooling in tripod position, muffled voice, won't lie flat, fever, thumb-print sign
Epiglottitis --> INTUBATE + Ceftriaxone
54
Malaise, low fever, cough --> worse, cough to vomit, stridor, subconjunctival hemorrhages, "butterfly XR"
Pertussis --> culture + erythromycin
55
Household contacts tx/prophylaxis of pertussis infected child
Erythromycin 14d, even if immunized
56
<1 y/o, stridor IMPROVES W/ NECK EXTENSION, assoc cardiac abn (VSD, ASD…), difficulty feeding
Vascular rings
57
Wheezing w/ runny nose, dry cough, low grade fever
Bronchiolitis/RSV --> risk for asthma
58
Fever, odynophagia, CANT extend neck, muffled voice, can't open jaw, widened pre-vertebral space
Retropharyngeal abscess --> CT
59
Causes of colds
Rhinovirus, parainfluenza, RSV, corona
60
Low fever, rhinorrhea, cough, sore throat
Hydration - exclude bacterial if >10d
61
#1 sinusitis bug
Strep pneumo
62
Rhinorrhea + cough >10d, HA, facial pain
Sinutitis --> Augmentin or cefalexin 10-14d
63
Congestion --> worsened 5ds, or fever >102, purulent discharge >3d
Bacterial sinusitis --> Augmentin
64
Causes of pharyngitis
Coxsackie, EBV, CMV, Strep, Diptheria
65
Fever, sore throat w/ exudates, palatal petechiae --> amoxicillin --> rash
EBV
66
Sore throat W/O rhinorrhea or cough, fever, rash, + painful LNs
Strep pharyngitis --> PCN V or IM benzathine PCN
67
Sore throat, conjunctivitis, rhinorrhea
Viral pharyngitis
68
U/L parotid enlargement
Bacterial - SA, pyogenes, TB
69
Recurrent sinusitis + abx, PNA, nasal polyps, clubbing, snoring
CF --> Quant pilocarpine iontophoresis
70
CF + influenza or virus --> RDS, wheezing, crackles Tx
IV Vanco - SA > PA until 20 y/o
71
#1 acute otitis media bug
Strep pneumo >>Hib, moraxella
72
Otitis media complications
Mastoiditis, Meningitis, hearing loss, perforation
73
When to place tubes on ears
>3 in 6months of >4 in 12 mo w/ abx treatment
74
Middle ear effusion + inflammation (bulging, fever)
Acute otitis media
75
Middle ear effusion - inflammation
Otitis media w/ effusion
76
Blisters on TM
Bullous myringitis
77
Pain, unable to view TM
Cerumen impaction
78
Purple/red TM +/- bulging
Hemotympanum
79
Pain w/ traction, erythematous +/- otorrhea
Otitis externa
80
Chronic otitis media, Abx + wks of drainage, granulation, skin debris, hearing loss
Cholesteatoma
81
Most reliable method for middle ear fluid
Pneumatic otoscopy
82
Inc RA (>10), RV, Pul artery pressures (>40), Inc CI, normal PCWP, SVR
PE ---> resp alkalosis, inc A-a gradient
83
Hypoxemia, acute dyspnea, tachpynea, alkalosis
PE --> RV dilation
84
Pleuritic CP, tachypnea, hemoptysis, tachy, low fever, wedge-shaped CT
PE - GI illness --> dehydration --> hemoconcentration = PE
85
Post-op, JVD, new RBBB, hypotension
Massive PE --> cardiogenic shock
86
PE/DVT possible but unlikely 1st step
D-dimer --> >500 --> CT angio
87
1st step in new, unstable clot
Heparin (stabilizes 5d whiel warfarin reaches INR >2) + Warfarin (6mo)
88
Indication for IVC filter
Recurrent or extending while fully anti-coagulated
89
Pulmonary fibrosis findings
Clubbing, cough, INC A-a gradient, dec volume, honeycomb
90
Bird poop, reticulonodular opacities, oral ulcers, pancytopenia, inc LDH
Histoplasmosis --> URINE Ag --> amphotericin B (severe) or oral itraconazole
91
Pleural glucose <30
Empyema or Rheumatic effusion
92
Pulmonary edema w/ PCWP >18 etiology
Cardiogenic - impaired LVF
93
Pulmonary edema w/ PCWP <18 etiology
Non-cardiac = ARDS
94
Effusion w/ dec protein & LDH
Transudative
- CHF, atelectasis, nephrotic, cirrhosis
- Inc capillary pressure
- Dec oncotic pressure
95
Effusion cloudy, protein:serum >0.5, LDH>0.6 or upper 2/3
Exudative
- Malignancy, infection, trauma, PNA, PE, CT disease
- Inc permeability
- Dec lymphatic flow
96
Progressive dyspnea, cough, young AA female, uveitis, diffuse interstitial infiltrate, erythema nodosum or maculopapular eruptions
Sarcoidosis
97
B/L Hilar LA, alpha-1 hydroxylase, hyperCa/calciuria, ACE, stellate/asteroid
Sarcoidosis
- NON-caseating granuloma
- Steroids
98
Cirrhosis, emphysema at young age
a-1-anti-trypsin
99
Peripheral, pneumonia-like consolidation
Brochioalveolar
100
Pleural plaques, plumber, roofer, dec diffusion capacity, dec pul compliance, RV
Asbestosis --> BRONCHOGENIC carcinoma
101
"Egg sheel" hilar LNs
Silicosis --> lung cancer, TB
102
Only pneumoconiosis in Lower lung
Asbestosis
103
Diseases assoc w/ alveolar/pulmonary hemorrhage
Goodpasture, Churg-strauss, Behcet, anti-phospholipid Ab
104
New clubbing in COPD
Malignancy
105
COPD, Widespread B/L wheezes, PO2 80% acidosis
COPD exacerbation --> ipratropium, albuterol, levofloxacin, O2, methylprednisolone
106
Home O2 requirement
PO2 55mmHg, O2 <88%, nocturnal hypoxia
107
Only tx shown to dec mortality in COPD
Stop smoking, home O2
108
Changes in COPD --> inc work of breathing
Inc RV, TLC, recoil, flat diaphragm + inc compliance and dec flow rate
109
Preferred tx for COPD
Long-acting anti-cholinergic
110
Resp distress w/in minutes of transfusion
Anaphylaxis = recipient anti-IgA Abs
111
Resp distress w/in 6hrs of transfusion, pul edema
TRALI = donor anti-leukocyte Abs
112
Hypotension w/in minutes of transfusion in pt taking ACE-I
Primary hypotension rxn = bradykinin
113
Hampton's hump (wedge opacity on lung), pleural effusion
Pulmonary infarct
114
Hypoxemia mech in PNA, inflammation
V/Q mismatch --> Inc A-a gradient
115
Hypoxia mech in obesity/obstruction
Alveolar hypoventilation
116
MVA, bleeding, on vent, new lung infiltrates - how to improve oxygenation?
ARDS = Inc PEEP --> keeps alveoli open
117
Tidal volume on vents
6ml/kg
118
FEV1 in obstructive disease
<80%
119
FEV1/FVC in obstructive disease
<70%
120
FVC in obstructive disease
Normal or increased
121
Fever, chills, sore throat, muffled "hot potato" voice, uvula deviation, UL LAD
Tonsillitis --> peritonsillar abscess --> needle aspiration
122
Fixed upper airway obstruction flow-volume-loop
Dec flow rate (laryngeal edema)
123
Apnea definition
Breathing pause >10s + 90% drop in airflow
124
Conditions assoc w/ OSA
Obesity, AFIB, HTN, ACS, CHF, DM, Stroke, Pul HTN, Malampati 3-4, etOH, hypothyroid
125
OSA Hx
Nocturia, dec libido, morning HA, concentration, memory, driving, alertness
126
Dx of OSA
>15 events/hr on PSG OR >5/hr in pt w/ sx
127
Tx OSA
Weight loss, no etOH, no supine sleep position, + airway pressure
128
Unable to tolerate CPAP 1st step?
Add heated humidification --> diff mask --> oral appliance w/ sleep study
129
Hypoventilation at night w/o waking/normal respiration, obesity
Obesity hypoventilation syndrome
130
Consequences of obesity hypoventilation syndrome
Pul HTN, sec erythrocytosis, hypoxia, hyperCO2 --> inc bicarb, low CO2 compensation
131
Cruise ship, high fever, lobar consolidation, neutrophils w/o organisms
Legionella --> azithromycin or levofloxacin
132
Recurrent PNAs in same region next step?
CT - r/o CA, foreign body
133
RLL consolidation, worsening after abx, hypoNa, diarrhea
Legionella
134
COPD PNA
H. influenzae
135
Recent influenza PNA
SA
136
Pneumococcal vaccine mechanism
Polysaccharide --> B-cell response only, T-cell independent (no protein, unlike for kids)
137
#1 PNA in nursing homes
Strep pnuemo
138
PNA, no-organisms on gram stain, cold-agglutinin +
Mycoplasma pneumoniae
139
Young person, multiple enlarged LNs, low fever, weight loss
Lymphoma --> FNA, bx --> chemo
140
Old men, smoke, drink, rotten teeth, large neck LN
SCC of mucosae --> triple endoscopy/panendoscopy for primary tumor
141
Adults, sensory hearing loss in ONE ear, no shooting sports
Acoustic neuroma --> MRI
142
GRADUAL U/L facial paralysis
Facial nerve tumor --> Gadolinium MRI
143
Palpable mass near jaw angle, in front of ear
Parotid tumor --> FNA, superficial parotidectomy
144
Bad tooth infection, abscess + threat to airway
Lugwing angina (mouth abscess) --> I&D
145
SUDDEN U/L facial paralysis
Bell Palsy --> anti-virals + steroids
146
Trauma, normal facial nerve fxn --> paralysis later
Swelling --> resolves on its own
147
Paralysis of EOM + ethmoid or frontal sinusitis
Cavernous sinus thrombosis --> Abx, CT, and drainage emergently
148
Nasal obstruction + mass + epistaxis + bony erosions (vs. reactive polyp)
Juvenile angiofibroma
149
18 y/o epistaxis + septal perforation cause
Cocaine --> packing
150
Whistling noise s/p rhinoplasty
Nasal septal perforation
151
Blue when feeding, pink when crying
Choanal atresia --> oral airway
152
Ear drops
Atipyrene & Benzocaine
153
Eye drops
Tetracaine
154
Conjunctivitis and otitis abx
Omnicef (Hib)
155
Chronic sinusitis, nasal obstruction, epistaxis, Asian, smoker
Nasopharyngeal CA = EBV, nitrosamines, smoking
156
Factors affecting PO2
FiO2 and PEEP
157
Non-toxic FiO2 goal
50-60% --> PO2 of >60
158
RQ 0.7
Fat usage
159
RQ 0.8
Normal & or protein metabolism
160
RQ 1.0
Carbs are main nutrition --> excess CO2 = difficult weaning
161
RQ in sepsis
<1 d/t fat and protein breakdown
162
Acute U/L LAD, <5 y/o, non-toxic appearing, warm, tender, 3-6cm
Bacterial - SA > GAS
163
Acute U/L LAD, toxic appearing, animal contact
Tularemia,
164
Acute U/L LAD + periodontal disease bug
Peptostreptococcus
165
Chronic U/L LAD, non-tender, firm, skin violaceous bug
Non-TB mycobacteria
166
Immunocompromised pt (BM transplant) w/ fever, cough, hemoptysis + pulmonary nodule w/ "halo sign" or air crescent bug
Aspergillus
167
Asthma, pulmonary infiltrates, EOSINOPHILIA, P-ANCA
Churg-Strauss
168
Hypoxemia NOT responsive to O2, PCWP <18 + diffuse b/l pulmonary infiltrates
ARDS
- inc capillary permeability & massive intrapulmonary shunt
- #1 cause is SEPSIS
