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Step 2 > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

SIADH, ACTH, LE syndromes

A

Small cell –> chemo + rad

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2
Q

Small round blue cells

A

Small cell

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3
Q

Smoker

A

Squamous > small

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4
Q

Non-small cell lung CA mets

A

Brain (gray/white) - surgical excision

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5
Q

Pleomorphic giant cells w/ leukocyte fragments

A

Large cell

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6
Q

Keratin pearls & intercellular bridges, CENTRAL

A

SCC

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7
Q

PTHrP

A

SCC

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8
Q

Type II pneumocytes

A

Adenocarcinoma

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9
Q

Non-smoker or female

A

Adenocarcinoma

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10
Q

Peripheral

A

Adenocarcinoma

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11
Q

Psammoma bodies

A

Mesothelioma

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12
Q

Chromogranin

A

Carcinoid

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13
Q

Collar-button, polyp

A

Carcinoid

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14
Q

Shoulder pain, constricted pupil, ptosis, weak hand muscles, numbness

A

Pancoast tumor (non-small cell) –> XR

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15
Q

Clavicular LAD, (-) chest CT, metastatic SCC next step?

A

Panendoscopy (bronch, endo, laryngoscopy) to detect primary tumor

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16
Q

Coin lesion 1st step?

A

Obtain older XR

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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

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18
Q

Dx lung CA if not via cytology

A

Bronchoscopy + Bx

Percutaneous bx for peripheral or >2cm or likely malignant (better dx yield)

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19
Q

Operatability of lung CA

A

Central lesions = pneumonectomy w/ minimum 800ml FEV1

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20
Q

U/L earache, rhinorrhea of wheezing in a kid

A

Foreign body = endoscopy

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21
Q

Hemoptysis >600ml/d or 100/hr tx

A

Secure airway –> bronchoscopy of bleeding continues

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22
Q

> 100% DLCO

A

Obstructive = Asthma

Normal spirometry = Pul hemorrhage, PCV

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23
Q

100% DLCO

A

Chronic bronchitis

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24
Q

<100% DLCO

A

Obstructive = Emphysema
Restrictive = sarcoid, HF, asbestosis, COPD
Normal spirometry = Anemia, PE, pul HTN

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25
Q

Obstructive lung disease PFTs

A

Dec FEV1, FVC
FEV1/FVC <70%
V/Q mismatch
INC RV

Low DLCO = emphysema
Normal DLCO = chronic bronchitis
Inc DLCO = asthma

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26
Q

Restrictive lung disease PFTs

A

FEV1/FVC >70%
DEC VC, TLC
FRC is INC in ankylosing spondylitis

Low DLCO = asbestos, sarcoid, HF
Normal DLCO = MSK
Inc DLCO = morbid obesity

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27
Q

Chronic back pain, FEV1/FVC 95%, FRC 110%, FVC 75%

A

Ankylosing spondylitis –> restricted chest wall motion

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28
Q

Asthma >2x/wk, 3-4 nightime awakening/mo, FEV1 >80%

A

Mild persistent = Albuterol + corticosteroid

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29
Q

Daily Asthma, >1 awakening/wk, FEV1 60-80%

A

Moderate = Short + long B2 (salmeterol) + steroid

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30
Q

Many times daily asthma, daily nightime awakening, FEV1 <60%

A

Severe = Short + long B2 + inhaled + oral steroid

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31
Q

Recurrent RTIs, copious mucopurulent sputum. “tram-track” or “ring sign”

A

Bronchiectasis

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32
Q

Chronic productive cough w/ many Abx courses, massive hemoptysis

A

Bronchiectasis –> CT showing thick bronchial walls

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33
Q

Smoker, chronic productive cough, hemoptysis

A

Chronic bronchitis

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34
Q

Dyspnea, wheezing, boggy nose, cough, 40 y/o, Inc FEV1% post-bronchodilator

A

Asthma –> inhaled steroid preferred tx

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35
Q

Asbestosis malignancy & #1 cause of SVC syndrome

A

Bronchogenic CA

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36
Q

Methacholine % drop to dx asthma

A

20%

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37
Q

Dx eval for asthma

A

Peak flow w/ B-agonist, CXR, PFTs,

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38
Q

Alternative asthma therapy to inhaled steroids

A

Leukotriene antagonists - montelukast, zafrilukast

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39
Q

Tx for exercise-induced asthma, aspirin sensitive asthma

A

LT inhibitors (also albuterol for exercise)

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40
Q

Indicator of severe attack

A

Normal PCO2, speech difficulty, altered senses, ‘silent lung’

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41
Q

Naproxen use, recurrent nasal discharge/congestion, bland taste –> wheezing

A

Aspirin exacerbated respiratory disease = NASAL POLYP

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42
Q

Nosebleed during pregnancy

A

Pyogenic granuloma

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43
Q

Wheezing in cold air, exercise tx

A

Exercise induced asthma = B-agonist 20min b4

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44
Q

Apnea >15-20s + brady or dec O2

A

Apnea of prematurity = #1 mixed central & obstructive

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45
Q

B/L perihilar streaking, tachypnea

A

Transient tachy of newborn

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46
Q

GROUND GLASS CXR, air bronchogram, L:S >2:1, pre-me

A

RDS –> O2 and CPAP

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47
Q

Risks for RDS

A

Pre-me, DM, c-section, asphyxia

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48
Q

Severe cyanosis, resp distress, clear lungs, DEC pul vasculature markings

A

Persistent pulm HTN

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49
Q

Subcutaneous emphysema next step?

A

CXR to r/o pneumothorax

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50
Q

Cough, congestion –> wheezing, 89%, no better w/ albuterol, ipratropium, steroids, or inc CO2

A

Status asthmaticus –> intubation

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51
Q

Stridor WORSE WHEN SUPINE or crying, improves when upright, omega-shaped epiglottis

A

Laryngomalacia –> laryngoscopy & reassurance

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52
Q

6mo –> 6y/o, barky cough, fever, rhinorrhea, congestion, steeple sign + HYPOXIA (vs. epiglottitis)

A

Croup = parainfluenza–> raceamic epi

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53
Q

Drooling in tripod position, muffled voice, won’t lie flat, fever, thumb-print sign

A

Epiglottitis –> INTUBATE + Ceftriaxone

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54
Q

Malaise, low fever, cough –> worse, cough to vomit, stridor, subconjunctival hemorrhages, “butterfly XR”

A

Pertussis –> culture + erythromycin

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55
Q

Household contacts tx/prophylaxis of pertussis infected child

A

Erythromycin 14d, even if immunized

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56
Q

<1 y/o, stridor IMPROVES W/ NECK EXTENSION, assoc cardiac abn (VSD, ASD…), difficulty feeding

A

Vascular rings

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57
Q

Wheezing w/ runny nose, dry cough, low grade fever

A

Bronchiolitis/RSV –> risk for asthma

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58
Q

Fever, odynophagia, CANT extend neck, muffled voice, can’t open jaw, widened pre-vertebral space

A

Retropharyngeal abscess –> CT

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59
Q

Causes of colds

A

Rhinovirus, parainfluenza, RSV, corona

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60
Q

Low fever, rhinorrhea, cough, sore throat

A

Hydration - exclude bacterial if >10d

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61
Q

1 sinusitis bug

A

Strep pneumo

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62
Q

Rhinorrhea + cough >10d, HA, facial pain

A

Sinutitis –> Augmentin or cefalexin 10-14d

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63
Q

Congestion –> worsened 5ds, or fever >102, purulent discharge >3d

A

Bacterial sinusitis –> Augmentin

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64
Q

Causes of pharyngitis

A

Coxsackie, EBV, CMV, Strep, Diptheria

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65
Q

Fever, sore throat w/ exudates, palatal petechiae –> amoxicillin –> rash

A

EBV

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66
Q

Sore throat W/O rhinorrhea or cough, fever, rash, + painful LNs

A

Strep pharyngitis –> PCN V or IM benzathine PCN

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67
Q

Sore throat, conjunctivitis, rhinorrhea

A

Viral pharyngitis

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68
Q

U/L parotid enlargement

A

Bacterial - SA, pyogenes, TB

69
Q

Recurrent sinusitis + abx, PNA, nasal polyps, clubbing, snoring

A

CF –> Quant pilocarpine iontophoresis

70
Q

CF + influenza or virus –> RDS, wheezing, crackles Tx

A

IV Vanco - SA > PA until 20 y/o

71
Q

1 acute otitis media bug

A

Strep pneumo&raquo_space;Hib, moraxella

72
Q

Otitis media complications

A

Mastoiditis, Meningitis, hearing loss, perforation

73
Q

When to place tubes on ears

A

> 3 in 6months of >4 in 12 mo w/ abx treatment

74
Q

Middle ear effusion + inflammation (bulging, fever)

A

Acute otitis media

75
Q

Middle ear effusion - inflammation

A

Otitis media w/ effusion

76
Q

Blisters on TM

A

Bullous myringitis

77
Q

Pain, unable to view TM

A

Cerumen impaction

78
Q

Purple/red TM +/- bulging

A

Hemotympanum

79
Q

Pain w/ traction, erythematous +/- otorrhea

A

Otitis externa

80
Q

Chronic otitis media, Abx + wks of drainage, granulation, skin debris, hearing loss

A

Cholesteatoma

81
Q

Most reliable method for middle ear fluid

A

Pneumatic otoscopy

82
Q

Inc RA (>10), RV, Pul artery pressures (>40), Inc CI, normal PCWP, SVR

A

PE —> resp alkalosis, inc A-a gradient

83
Q

Hypoxemia, acute dyspnea, tachpynea, alkalosis

A

PE –> RV dilation

84
Q

Pleuritic CP, tachypnea, hemoptysis, tachy, low fever, wedge-shaped CT

A

PE - GI illness –> dehydration –> hemoconcentration = PE

85
Q

Post-op, JVD, new RBBB, hypotension

A

Massive PE –> cardiogenic shock

86
Q

PE/DVT possible but unlikely 1st step

A

D-dimer –> >500 –> CT angio

87
Q

1st step in new, unstable clot

A

Heparin (stabilizes 5d whiel warfarin reaches INR >2) + Warfarin (6mo)

88
Q

Indication for IVC filter

A

Recurrent or extending while fully anti-coagulated

89
Q

Pulmonary fibrosis findings

A

Clubbing, cough, INC A-a gradient, dec volume, honeycomb

90
Q

Bird poop, reticulonodular opacities, oral ulcers, pancytopenia, inc LDH

A

Histoplasmosis –> URINE Ag –> amphotericin B (severe) or oral itraconazole

91
Q

Pleural glucose <30

A

Empyema or Rheumatic effusion

92
Q

Pulmonary edema w/ PCWP >18 etiology

A

Cardiogenic - impaired LVF

93
Q

Pulmonary edema w/ PCWP <18 etiology

A

Non-cardiac = ARDS

94
Q

Effusion w/ dec protein & LDH

A

Transudative

  • CHF, atelectasis, nephrotic, cirrhosis
  • Inc capillary pressure
  • Dec oncotic pressure
95
Q

Effusion cloudy, protein:serum >0.5, LDH>0.6 or upper 2/3

A

Exudative

  • Malignancy, infection, trauma, PNA, PE, CT disease
  • Inc permeability
  • Dec lymphatic flow
96
Q

Progressive dyspnea, cough, young AA female, uveitis, diffuse interstitial infiltrate, erythema nodosum or maculopapular eruptions

A

Sarcoidosis

97
Q

B/L Hilar LA, alpha-1 hydroxylase, hyperCa/calciuria, ACE, stellate/asteroid

A

Sarcoidosis

  • NON-caseating granuloma
  • Steroids
98
Q

Cirrhosis, emphysema at young age

A

a-1-anti-trypsin

99
Q

Peripheral, pneumonia-like consolidation

A

Brochioalveolar

100
Q

Pleural plaques, plumber, roofer, dec diffusion capacity, dec pul compliance, RV

A

Asbestosis –> BRONCHOGENIC carcinoma

101
Q

“Egg sheel” hilar LNs

A

Silicosis –> lung cancer, TB

102
Q

Only pneumoconiosis in Lower lung

A

Asbestosis

103
Q

Diseases assoc w/ alveolar/pulmonary hemorrhage

A

Goodpasture, Churg-strauss, Behcet, anti-phospholipid Ab

104
Q

New clubbing in COPD

A

Malignancy

105
Q

COPD, Widespread B/L wheezes, PO2 80% acidosis

A

COPD exacerbation –> ipratropium, albuterol, levofloxacin, O2, methylprednisolone

106
Q

Home O2 requirement

A

PO2 55mmHg, O2 <88%, nocturnal hypoxia

107
Q

Only tx shown to dec mortality in COPD

A

Stop smoking, home O2

108
Q

Changes in COPD –> inc work of breathing

A

Inc RV, TLC, recoil, flat diaphragm + inc compliance and dec flow rate

109
Q

Preferred tx for COPD

A

Long-acting anti-cholinergic

110
Q

Resp distress w/in minutes of transfusion

A

Anaphylaxis = recipient anti-IgA Abs

111
Q

Resp distress w/in 6hrs of transfusion, pul edema

A

TRALI = donor anti-leukocyte Abs

112
Q

Hypotension w/in minutes of transfusion in pt taking ACE-I

A

Primary hypotension rxn = bradykinin

113
Q

Hampton’s hump (wedge opacity on lung), pleural effusion

A

Pulmonary infarct

114
Q

Hypoxemia mech in PNA, inflammation

A

V/Q mismatch –> Inc A-a gradient

115
Q

Hypoxia mech in obesity/obstruction

A

Alveolar hypoventilation

116
Q

MVA, bleeding, on vent, new lung infiltrates - how to improve oxygenation?

A

ARDS = Inc PEEP –> keeps alveoli open

117
Q

Tidal volume on vents

A

6ml/kg

118
Q

FEV1 in obstructive disease

A

<80%

119
Q

FEV1/FVC in obstructive disease

A

<70%

120
Q

FVC in obstructive disease

A

Normal or increased

121
Q

Fever, chills, sore throat, muffled “hot potato” voice, uvula deviation, UL LAD

A

Tonsillitis –> peritonsillar abscess –> needle aspiration

122
Q

Fixed upper airway obstruction flow-volume-loop

A

Dec flow rate (laryngeal edema)

123
Q

Apnea definition

A

Breathing pause >10s + 90% drop in airflow

124
Q

Conditions assoc w/ OSA

A

Obesity, AFIB, HTN, ACS, CHF, DM, Stroke, Pul HTN, Malampati 3-4, etOH, hypothyroid

125
Q

OSA Hx

A

Nocturia, dec libido, morning HA, concentration, memory, driving, alertness

126
Q

Dx of OSA

A

> 15 events/hr on PSG OR >5/hr in pt w/ sx

127
Q

Tx OSA

A

Weight loss, no etOH, no supine sleep position, + airway pressure

128
Q

Unable to tolerate CPAP 1st step?

A

Add heated humidification –> diff mask –> oral appliance w/ sleep study

129
Q

Hypoventilation at night w/o waking/normal respiration, obesity

A

Obesity hypoventilation syndrome

130
Q

Consequences of obesity hypoventilation syndrome

A

Pul HTN, sec erythrocytosis, hypoxia, hyperCO2 –> inc bicarb, low CO2 compensation

131
Q

Cruise ship, high fever, lobar consolidation, neutrophils w/o organisms

A

Legionella –> azithromycin or levofloxacin

132
Q

Recurrent PNAs in same region next step?

A

CT - r/o CA, foreign body

133
Q

RLL consolidation, worsening after abx, hypoNa, diarrhea

A

Legionella

134
Q

COPD PNA

A

H. influenzae

135
Q

Recent influenza PNA

A

SA

136
Q

Pneumococcal vaccine mechanism

A

Polysaccharide –> B-cell response only, T-cell independent (no protein, unlike for kids)

137
Q

1 PNA in nursing homes

A

Strep pnuemo

138
Q

PNA, no-organisms on gram stain, cold-agglutinin +

A

Mycoplasma pneumoniae

139
Q

Young person, multiple enlarged LNs, low fever, weight loss

A

Lymphoma –> FNA, bx –> chemo

140
Q

Old men, smoke, drink, rotten teeth, large neck LN

A

SCC of mucosae –> triple endoscopy/panendoscopy for primary tumor

141
Q

Adults, sensory hearing loss in ONE ear, no shooting sports

A

Acoustic neuroma –> MRI

142
Q

GRADUAL U/L facial paralysis

A

Facial nerve tumor –> Gadolinium MRI

143
Q

Palpable mass near jaw angle, in front of ear

A

Parotid tumor –> FNA, superficial parotidectomy

144
Q

Bad tooth infection, abscess + threat to airway

A

Lugwing angina (mouth abscess) –> I&D

145
Q

SUDDEN U/L facial paralysis

A

Bell Palsy –> anti-virals + steroids

146
Q

Trauma, normal facial nerve fxn –> paralysis later

A

Swelling –> resolves on its own

147
Q

Paralysis of EOM + ethmoid or frontal sinusitis

A

Cavernous sinus thrombosis –> Abx, CT, and drainage emergently

148
Q

Nasal obstruction + mass + epistaxis + bony erosions (vs. reactive polyp)

A

Juvenile angiofibroma

149
Q

18 y/o epistaxis + septal perforation cause

A

Cocaine –> packing

150
Q

Whistling noise s/p rhinoplasty

A

Nasal septal perforation

151
Q

Blue when feeding, pink when crying

A

Choanal atresia –> oral airway

152
Q

Ear drops

A

Atipyrene & Benzocaine

153
Q

Eye drops

A

Tetracaine

154
Q

Conjunctivitis and otitis abx

A

Omnicef (Hib)

155
Q

Chronic sinusitis, nasal obstruction, epistaxis, Asian, smoker

A

Nasopharyngeal CA = EBV, nitrosamines, smoking

156
Q

Factors affecting PO2

A

FiO2 and PEEP

157
Q

Non-toxic FiO2 goal

A

50-60% –> PO2 of >60

158
Q

RQ 0.7

A

Fat usage

159
Q

RQ 0.8

A

Normal & or protein metabolism

160
Q

RQ 1.0

A

Carbs are main nutrition –> excess CO2 = difficult weaning

161
Q

RQ in sepsis

A

<1 d/t fat and protein breakdown

162
Q

Acute U/L LAD, <5 y/o, non-toxic appearing, warm, tender, 3-6cm

A

Bacterial - SA > GAS

163
Q

Acute U/L LAD, toxic appearing, animal contact

A

Tularemia,

164
Q

Acute U/L LAD + periodontal disease bug

A

Peptostreptococcus

165
Q

Chronic U/L LAD, non-tender, firm, skin violaceous bug

A

Non-TB mycobacteria

166
Q

Immunocompromised pt (BM transplant) w/ fever, cough, hemoptysis + pulmonary nodule w/ “halo sign” or air crescent bug

A

Aspergillus

167
Q

Asthma, pulmonary infiltrates, EOSINOPHILIA, P-ANCA

A

Churg-Strauss

168
Q

Hypoxemia NOT responsive to O2, PCWP <18 + diffuse b/l pulmonary infiltrates

A

ARDS

  • inc capillary permeability & massive intrapulmonary shunt
  • # 1 cause is SEPSIS

Step 2 (20 decks)

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