Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

2CK Smartbook > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

beta-blockers are contraindicated in patients with _____ lung disease

A

obstructive (due to bronchoconstriction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

amiodarone is contraindicated in patients with _____ lung disease

A

restrictive (due to pulmonary fibrosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are the primary long-term treatments for asthma vs. COPD

A

asthma: albuterol inhaler
COPD: anticholinergics (ipatropium, tiotropium)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is the diagnostic test for allergic bronchopulmonary aspergillosis

A

serum IgE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Pickwickian syndrome involves what three main symptoms

A 
Pickwickian syndrome (obesity hyperventilation)
-BMI > 30, daytime hypercapnea/hypoxemia, sleep-disordered breathing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

how do patients with Pickwickian syndrome develop decreased respiratory drive

A

chronic hypercapnia decreases chemoreceptor sensitivity to CO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

a cavitary lesion with adjacent crescent and movement within the lesion with position change in a patient with intermittent hemoptysis for several months should make you think of what disease

A

aspergillosis (fungus ball moves around in cavitary lesion on position change)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are some ways to increase functional residual capacity after surgery

A

coughing, chest physiotherapy, incentive spirometry, ambulation, repositioning, elevate head of bed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

a large mediastinal mass with associated elevations in AFP and beta-hCG are suggestive of what disease

A

non-seminomatous germ cell tumor (seminomatous has only beta-hCG elevation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

treatment for Legionnaire’s

A

a macrolide or floroquinolone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

are proximal or distal deep veins of the leg more common sources of PE’s

A

proximal (ileofemoral vein)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

when a patient who experienced blunt chest trauma experiences worsening dyspnea, hypoxia and alveolar opacities on x-ray after fluid rescucitation what do you suspect was the original problem

A

pulmonary contusion

fluid rescucitation after contusion leads to pulmonary edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what three conditions comprise Light’s criteria for determining pleural exudate

A
  1. pleural protein/ serum protein > 0.5
  2. pleural LDH/ serum LDH > 0.6
  3. pleural LDH > 2/3 the limit for serum LDH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

workup algorithm for categories of lung disease diagnosed with spirometry

A

check FEV1/FVC ratio; if low do albuterol challenge test –> if improves then asthma, if not then COPD
if FEV1/FVC ratio is high check DLCO; if normal then chest wall musculoskeletal weakness, if low suspect interstitial lung disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

popcorn calcification on chest CT suggests

A

hammartoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

bull’s eye calcification on chest CT suggests

A

granuloma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

how can you differentiate consolidation from pleural effusion on lung exam

A

consolidation: bronchial breath sounds, dullness to percussion, increased tactile fremitus (good sound transmission)
pleural effusion: decreased breath sounds, dullness to percussion, decreased tactile fremitus (poor sound transmission)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

best initial therapy for anaphylactic shock

A

IM epinephrine (antihistamines, bronchodilators, vasopressors are all secondary to getting epi on board)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what are some extrapulmonary manifestations of sarcoidosis

A

erythema nodosum (w/ painful shin lesions), high ACE, hypercalcemia, periosteal bone resorption, uveitis, polyarthralgias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

a patient with COPD suddenly develops dypsnea and decreased oxygenation; what disease process should you automatically suspect

A

spontaneous secondary pneumothorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

how do you manage massive hemoptysis (>600mL per day or 100mL per hour)

A
  1. secure ABC’s and intubate
  2. position patient with bleeding lung in dependent position
  3. bronchoscopy to locate source and provide interventions (electrocautery, balloon tamponade)
  4. pulmonary artery embolization or thoracotomy if patient does not improve
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what value of PaO2/FiO2 is considered severe hypoxemia in ARDS

A

PaO2/FiO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what are the different management bundles for mild vs. moderate vs. severe asthma exacerbation

A

mild: oxygenate, inhaled SABA, steroids
moderate: oxygenate, inhalted SABA + ipatropium, steroids
severe: intubate, inhaled SABA + ipatropium, steroids, consider mag sulfate, to ICU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

asthma exacerbation patients with normal PaCO2 are likely experiencing what

A

decreased respiratory drive due to fatigue (they should be blowing off more CO2 to result in low CO2 due to hypoxemia); you will likely need to intubate soon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

massive PE=

A

PE complicated by hypotension or acute right heart strain (can be evidenced by RBBB or JVD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

in a child with inspiratory stridor, what governs whether you will do laryngoscopy vs. neck x-ray

A

laryngomalacia is more chronic and no infectious sx ==> laryngoscopy
progressive soft tissue airway compression is usually due to infection and you would see fever ==> neck x-ray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

treatment for laryngomalacia

A

reassurance as most cases resolve by 1.5 years

in severe cases (apnea, cyanosis, rapidly increasing stridor, poor weight gain) do supraglottoplasty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

peak airway pressure = _____ + ______

A

peak airway pressure = resistive pressure (which is flow x resistance) + plateau pressure (the pressure measured at the end of an inspiratory hold)

29
Q

plateau pressure = _____ + _______

A

elastic pressure + positive end-expiratory pressure

30
Q

what is elastic pressure in terms of compliance and tidal volume

A

elastic pressure = tidal volume / compliance

31
Q

list some causes of exudative effusion

A

(cause increased capillary or pleural membrane permeability or lymphatic drainage obstruction)
-PE (sometimes transudative), malignancy, infection, connective tissue disease, trauma

32
Q

list the modified well’s criteria with associated points (note: >4 = likely PE, go straight to CT angio)

A

+3: clinical signs of DVT, no higher likelihood dx than PE

+1.5: hx of PE or DVT, HR >100, recent surgery (

33
Q

what antibiotics should be given to a patient with community acquired pneumonia (healthy vs. comorbidities)

A

healthy: macrolide or doxycycline

comorbidities (diabetes, CHF, etc.): floroquinolone or beta-lactam + macrolide

34
Q

list the CURB-65 criteria and how it is used

A

Confusion, Uremia, RR > 30, BP 65 years

score of 2 or higher ==> admit
score of 4 or higher ==> to ICU

35
Q

what would you expect for DLCO in emphysema vs. chronic bronchitits

A

DLCO is normal in chronic bronchitis and decreased in emphysema (due to breakdown of alveolar walls)

36
Q

which lung cancer produces PTHrP and consequent hypercalcemia

A

squamous cell lung cancer

37
Q

which lung cancer is most associated with hypertrophic osteoarthropathy (clubbing)

A

adenocarcinoma

38
Q

which vent settings mediate pO2 level?

which vent settings mediate pCO2 level?

A

pO2 is mediated by FiO2 and PEEP

pCO2 is mediated by tidal volume and RR

39
Q

below which point is the ideal FiO2 setting to avoid oxygen toxicity

A

if patient oxygenation is adequate (pO2>60) then lower FiO2 to an ideal of

40
Q

what happens to lung compliance in COPD

A

it increases due to break down of elastin and connective alveolar tissues

41
Q

what is the most common lung cancer seen in nonsmokers and where in the lung is it usually located

A

adenocarcinoma; located peripherally

42
Q

Hodgkin’s lymphoma patients s/p chemo and radiation therapy are at increased risk of what major complication of treatment long-term

A

secondary malignancy due to chemo or radiation (i.e. GI, lung, breast malignancy)

43
Q

what two major broad categories of diseases are best diagnosed via bronchoalveolar lavage

A

suspected malignancy and opportunistic infections (i.e. PCP)

44
Q

which patients are predisposed to allergic bronchopulmonary aspergillosis

A

asthma and cystic fibrosis patients

45
Q

a patient with a symptoms of asthma who has an inflammed pharynx and larynx on laryngoscopy likely has what condition

A

GERD; 75% of patients with asthma also have GERD, which can trigger asthma

46
Q

complete this triad: nasal polyps, asthma, _____

A

aspirin intolerance

47
Q

how can you differentiate between chronic bronchitis and emphysema using PFT’s

A

DLCO is normal in chronic bronchitis (DLCO > 60%) and abnormal in emphysema (DLCO

48
Q

predisposing factors for neonatal respiratory distress syndrome

A
  1. prematurity
  2. male sex
  3. maternal diabetes (fetal hyperinsulinemia causes decreased endogenous cortisol)
  4. perinatal asphyxia
  5. Cesarean delivery without labor
49
Q

how can you differentiate between alveolar hypoventilation and V/Q mismatch

A

alveolar ventilation (i.e. sedation, obesity, obstructive lung disease) is characterized by high pCO2 whereas in V/Q mismatch (i.e. atelectasis, PE, pulm edema) pCO2 is low due to compensatory tachypnea

50
Q

normal A-a gradient is _____

A
51
Q

what intervention should you attempt in COPD exacerbation patients with hypercapnia before intubating

A

non-invasive positive pressure ventilation (can decrease intubation rate, hospital LOS, etc.)

52
Q

when do you use fibrinolytics via chest tube vs. surgery for a pleural effusion that is think and not draining

A

if it is localized, complex (loculated) or with a thick rim then surgery, if not, streptokinase drainage
also if the patient didn’t have recent surgery

53
Q

what is Pancoast syndrome

A

tumor involvement of the brachial plexus, manifesting as radiating pain in ulnar distribution due to T1 and C8 compression as well as shoulder pain

54
Q

a wedge-shaped pleural opacification in a patient with dyspnea and pleuritic chest pain is likely

A

pulmonary infarction

55
Q

list the different respiratory quotients:

  • normal
  • fatty acid metabolism only
  • mainly protein metabolism
  • carbohydrate heavy metabolism
A

-normal: 0.8
-mainly fatty acid: 0.7
-mainly proteins: 0.8
-mainly carbs: 1.0
(this is important because RQ > 1 is harder to wean from vent)

56
Q

pleural fluid pH for:

  • normal
  • transudate
  • exudate
A
  • normal: 7.6
  • transudate: 7.4-7.55
  • exudate: 7.3- 7.4
57
Q

what is contraction alkalosis

A

when the body is volume contracted aldosterone will increase and promote volume expansion at the cost of dumping H+ resulting in alkalosis

58
Q

when should you start a COPD patient on home supplemental oxygen

A

paO2 55% when paO2

59
Q

what is the recommended tidal volume on a ventilator

A

6mL/kg of body weight

60
Q

describe the Haldane effect

A

increased oxygen will displace H+ on hemoglobin which then combines with bicarb to eventually produce CO2
so increasing oxygen promotes CO2 release into blood stream

61
Q

a patient with bilateral pleural plaques seen on CXR likely has what exposure and what cancer?

A

asbestosis (causes b/l pleural plaques, reticulonodular infiltrates and pleural thickening)

bronchogenic carcinoma > mesothelioma

62
Q

vesicular vs. bronchial breath sounds

A

vesicular=normal in the pulmonary tissue; soft best heard in inspiration, usually silent expiration

bronchial=abnormal in pulm tissue; suggestive of consolidation; louder, audible, stronger expiratory component

63
Q

when do you give warmed IV fluids and active warming (warm blankets) vs. IV fluids and passive warming (cold clothing removal)

A

warmed IV fluids are given for severe hypothermia of

64
Q

how does hypothermia cause bradycardia and hypotension

A

cold pacemaker cells develop decreased reactivity

cold-induced diuresis promotes fluid loss

65
Q

what distinguishes bronchiectasis from chronic bronchitis

A

bronchiectasis is more associated with recurrent respiratory tract infections and copious amounts of mucopurulent sputum

66
Q

name two indications for drainage of pleural effusion via thoracostomy

A

pH

67
Q

cobblestoning of the posterior pharynx should make you think of…

A

allergic rhinnitis

68
Q

first line treatment for PCP? what should you add for patients with PaO2 35?

A

bactrim; add corticosteroids for PaO2 35

69
Q

diarrhea and diffuse pulmonary infiltrates in a bone marrow transplant patient

A

CMV pneumonitis

2CK Smartbook (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions