Pulmonology Flashcards
1
Q
Amount of air remaining in the lungs after full exhalation, maintains oxygenation between breaths
A
Residual volume
2
Q
Amount of air inhaled/exhaled with each normal breathing (~0.5ml)
A
Tidal volume
3
Q
Area with no gas exchange from nose to terminal bronchiole
A
Anatomic dead space volume
4
Q
Anatomic dead space volume
A
150 mL
5
Q
Anatomic dead space volume + alveoli dead space
A
Physiologic dead space volume
6
Q
TV x RR
A
Minute respiratory volume
7
Q
RR x ( TV - physiologic dead space volume)
A
Alveolar ventilation per minute
8
Q
Stimulate central chemoreceptors in medulla
A
Carbon dioxide (as CSF H+)
9
Q
Lung zone with NO BLOOD FLOW
A
Zone 1
10
Q
Lung zone with CONTINUOUS BLOOD FLOW
A
Zone 3
11
Q
Lung zone with INTERMITTENT blood flow
A
Zone 2
12
Q
Increase in what substances causes unloading of O2 FROM Hgb or shift to the RIGHT in O2 -Hgb dissociation curve?
A
CO2, Acidosis, 2,3-DPG, Exercise, Temperature
Mnemonic: CADET face RIGHT
13
Q
Increase in this factors will cause shift to the LEFT
A
Carbon MONOXIDE, Fetal Hgb
14
Q
Percentage of blood thqt gives up its oxygen as it passes thru tissue capillaries
(25% resting , 75-80% during exercise)
A
Utilization coefficient
15
Q
Controls inspiration, sends inspiratory ramp signal
A
Dorsal respiratory group (DRG) of the medulla
16
Q
Controls BOTH inspiration and expiration;
Overdrive mechanism in exercise
A
Ventral Respiratory Group (VRG) of the medulla
17
Q
Limits inspiration and increases respiratory rates
A
Pneumotaxic center of the pons
18
Q
Stimulates inspiration and decreases respiratory rate
A
Apneustic center of Pons
19
Q
Areas of gas exchange from proximal to distal
A
Respiratory bronchiole
Alveolar ducts
Alveoli
20
Q
Made up of DRG and VRG in ventral medulla; excited by CSF H+ from blood CO2; adapt within 1-2 days
A
Central chemoreceptors
21
Q
Found in carotid bodies (CN 9) and aortic bodies (CN 10); activated when PO2
A
Peripheral chemoreceptors
22
Q
Hemoptysis of greater than 200 - 600 cc in 24H
A
Massive hemoptysis
23
Q
Ausculation of “AH” instead of “EEE” when a patient phonates “EEE”
A
Egophony
24
Q
Reversibility in asthma
A
> 12% and 200mL increase in FEV1
- -15min after an inhaled short acting B2agonist, or
- -2 to 4 week trial of Oral corticosteroids (Pred 30-40mg daily
25
Irreversible airway dilatation that involves the lung in either a focal or diffuse manner
Bronchiectasis
26
Disease state characterized by airflow limitation that is not fully reversible; encompasses emphysema, chronic bronchitis and small airway disease
COPD
27
Anatomically defined condition characterized by destruction and enlargement of the lung alveoli
Emphysema
28
Clinically defined condition with chronic cough and phlegm
Chronic bronchitis
29
Narrowed small bronchioles
Small airways disease
30
Contends that asthma and COPD are fundamentally different diseases
- -Asthma is viewed as largely an allergic phenomenon
- -COPD results from smoking-related inflammation and damage
Bristish Hypothesis
31
Contends that asthma and COPD are essentially variations of the same basic disease
Dutch hypothesis
32
Present with systemic arterial hypotension and usually with anatomically widespread thromboembolism
Massive pulmonary embolism
33
Present with RV hypokinesis on 2D echo but normal systemic arterial pressure
Moderate to large pulmonary embolism
34
Present with normal right heart function and normal systemic arterial function; excellent prognosis with adequate anticoagulation
Small to moderate pulmonary embolism
35
Benign ovarian tumors with ascitss and pleural effusion
Meig's syndrome
36
Coexistence of unexplained excessive daytime sleepiness with at least five obstructive breathing events (apnea or hypopnea) per hour of sleep
Obstructive sleep apnea
37
Defined in adults as breathing pauses lasting >10 seconds
Apnea
38
>10 second events where there is continued breathing but ventilation is reduced by at least 50% from the previous baseline during sleep
Hypopnea
39
Clinical syndrome defined by:
| -acute onset (
ARDE
40
TB: virulence factor
Cord factor
41
TB: prevents macrophage-lysosomal fusion
Sulfatides
42
TB: marker for TB infection
PPD
43
Pathologic sign of primary TB
Ghon's focus
44
Ghon's focus + hilar LAD
Ghon's complex
45
Radiologic sign of primary TB
Ranke complex
46
Pathologic sign of SECONDARY TB
Simon focus
47
Most common site of extrapulmonary TB
Lymph nodes
48
Physiologic abnormality of asthma
Airway hyperresponsiveness
49
Pathogenesis behind asthma
Imbalance favoring TH2 production over TH1 ➡️ increase IL1, IL5 ➡️ increased eosinophils
50
Putative mediators of asthma
SRS-A (made up of Leukotrienes C4, D4, E4)
| histamine is NOT a putative mediator
51
Whorls of shed epithelium in mucus plugs seen in asthma
Curschmann spirals
52
Crystalloid made up pf eosinophil membrane protein seen in BOTH asthma and amoebiasis
Charcot-leyden crystals
53
Predominant key cell involved in asthma
None
54
Characteristic feature of asthmatic airways
Eosinophil infiltration
55
Most common allergens to trigger asthma
Dermatophagoides species (dust mites)
56
Most common trigger of acute severe exacerbations
URTI: rhinovirus, RSV, coronavirus
57
Mechanism of exercise-induced asthma
Hyperventilatiom
58
Exercise induced asthma is best prevented by regular treatment with
Inhaled corticosteroids
59
Characteristic symptoms of asthma
Wheezing, dyspnea, and coughing
60
Confirms airflow limitation with a reduced FEV1, FEV1/FVC ration, and PEF
Spirometry
61
Confirms the diurnal variations in airflow obstruction
Measurement of PEF twice daily
62
Most effective bronchodilators in current use
B2-agonist
63
Primary action of B2-agonists
Relax airway smooth-muscle cells of all airways, where they act as functional antagonists
64
Most common side effect of anticholinergics
Dry mouth
65
Most common side effect of B2 agonist
Muscle tremors and palpitations
66
Most common side effect of Theophylline
Nausea, vomiting snd headaches
67
Most effective controllers of asthma
Inhaled corticosteroids
68
Most effective anti inflammatory agents used in asthma therapy
Inhaled corticosteroids
69
Indicates the need for regular controller therapy
Use of reliever medication >3x week
70
Most common reason for poor control of asthma
Non compliance with medication, particularly ICS
71
Drugs that have now been shown to be SAFE in pregnancy and without teratogenic potential
Short-acting B2-agonists, ICS, theophylline
72
Components of COPD
Emphysema, chronic bronchitis
73
Pathogenesis behind emphysema
Imbalance between protease (elastase) and anti-protease (alpha-1-anti-trypsin)
74
First symptom of emphysema
Dyspnea
75
Most highly significant predictor of FEV1
Pack-years of cigarette smoking
76
Important causes of exacerbations of COPD
Respiratory infections
77
Most common form of severe A1-antitrypsin deficiency
PiZ
78
Most typical finding in COPD
Persistent reduction in forced expiratory flow rates
79
Accounts for essentially all of the reduction in PaO2 that occurs in COPD
Ventilation-perfusion mismatching
80
Major site of increased resistance in most individuals with COPD
Small airways (
81
Type of emphysema most frequently associated with cigarette smoking
Centriacinar emphysema
| Mnemonic: sENTROacinar - Smoking
82
Type of emphysema usually observed in patients with a1-AT deficiency
Panacinar emphysema
83
Type of emphysema associated with spontaneous pneumothorax
Distal acinar emmphysema
84
Mojor physiologic change in COPD resulting from both small airway obstruction and emphysema
Airflow limitation
85
Three most common symptoms in COPD
Cough, chronic sputum production, exertional dyspnea
86
The only pharmacologic therapy demonstrated to unequivocally decrease mortality rates
Supplemental O2
87
Strong predictor of future exacerbations
History of prior exacerbations
88
Bacteria assoc. with COPD exacerbations
Streptococcus pneumoniae
Haemophilus influenza
Moraxella catarrhalis
89
Only three interventions demonstrated to influence the natural history of patients with COPD
Smoking cessation
Oxygen therapy in chronically hypoxemic patients
Lung volume reduction surgery in selected patients
90
Most common pathogenesis of pneumonia
Aspiration
91
Most common etiology of CAP
Streptococcus pneumonia
92
Most common etiology of atypical pneumonia
Mycoplasma pneumonia
93
Most common cause of nosocomial pneumonia and pneumonia in cystic fibrosis patients
Pseudomonas aeruginosa
94
Most common viral cause of atypical pneumonia and bronchiolitis in children
RSV
95
Most common cause of Pneumonia in AIDS patient
P. jiroveci
96
Main purpose of sputum gram stain
Ensure that sample is suitable for culture
97
What is an adequate sputum sample?
>25 PNM and
98
Most frequently isolated pathogen in blood cultures of CAP
S. Pneumonia
99
Most widely cited mechanism of infectious bronchiectasis
Vicious cycle hypothesis
100
Most common clinical presentation of bronchiectasis
Persistent productive cough with ongoing production of thick, tenacious sputum
101
Imaging modality of choice for confirming diagnosis of bronchiectasis
Chest CT
102
Most common cause of viral croup/LTB in infants
Parainfluenza
| Steeple sign xray
103
1st step in the diagnostic approach of pleural effusion
Determine whether effusion is transudative or exudative
104
Transudate or exudate: left ventricular failure
Transudative
105
Transudate or exudate: cirrhosis
Transudative
106
Leading cause of transudative pleural effusion
LV failure and cirrhosis
107
Leading cause of EXUDATIVE pleural effusion
Bacterial pneumonia
Malignancy
Viral infection
Pulmonary embolism
108
Transudate or exudate: bacterial pneumonia
Exudative
109
Transudate or exudate: malignancy
Exudative
110
Transudate or exudate: viral infection
exudative
111
Transudate or exudate: pulmonary embolism
Exudative
112
Most common cause of chylous pleural effusion
Malignancy
113
Second most common type of exudative pleural effusion
Malignant pleural effusions secondary to metastatic disease
114
Three tumors that cause 75% of all malignant pleural effusions
Lung Cancer
Breast cancer
Lymphoma
115
The only symptom that can be attributed to the effusion itself (in effusion from malignancy)
Dyspnea
116
Most commonly overlooked in the differential diagnosis of patient with an undiagnosed effusion
Pulmonary embolism
117
In many parts of the world, most common cause of exudative pleural effusion
TB
118
Most common cause of chylothorax
Trauma
119
Treatment of choice for most chylothorax
CTT plus Octreotide
120
Most common cause of hemothorax
Trauma
121
1st step in evaluating mediastinal mass
Determine which mediastinal compartment
122
Most common lesions in ANTERIOR mediastinum
Thymomas
Lymphomas
Teratomatous neoplasm
Thyroid masses
123
Most common masses in the MIDDLE mediastinum
Vascular masses
LN enlargement from metastases or granulomatous disease
Pleuropericardial and bronchogenic cysts
124
Most common masses in the POSTERIOR mediastinum
```
Neurogenic tumors
Meningoceles
Meningomyeloceles
Gastrogenic cysts
Esophageal diverticula
```
125
Most valuable imaging technique and the only imaging technique that should be done in mostinstances
CT scanning
126
Population at risk for spontaneous pneumothorax
20-40year-old Tall thin smoker men
127
Tracheal deviation in spontaneous pneumothorax
Ipsilateral tracheal deviation
128
Tracheal deviation in tension pneumothorax
Contralateral tracheal deviation
129
One of the three major cardiovascular causes of death, along with MI and stroke
Venous thromboembolism (VTE)
130
Causes of pulmonary embolism
```
Fat
Foreign body
Air
DVT
Bone marrow
Amniotic fluid
Tumor
```
131
Risk factors of pulmonary infarction
Pre-existing heart/lung disease
132
Usual cause of death in Pulmonary embolism
Progressive right heart failure
133
DVT: most frequent history
Cramp in the lower calf that persists for several days and becomes more uncomfortable
134
Pulmonary embolism: most frequent history
Unexplained breathlessness
135
Classic signs of Pulmonary embolism
Tachycardia
Low-grade fever
Neck vein distention
136
Most frequent symptom of pulmonary embolism
Dyspnea
137
Most frequent sign of pulmonary embolism
Tachypnea
138
Useful rule out test in pulmonary embolism
Plasma D-dimer ELISA (quantitative)
139
Most common abnormality in ECG of pulmonary embolism
T-wave inversion in leads V1-V4
140
Principal imaging modality/test for the dx of pulmonary embolism
Chest CT scan with IV contrast
141
2nd line diagnostic test for Pulmonary embolism, used mostly for patients who can't tolerate IV contrast
Lung scanning
142
Best known indirect sign of Pulmonary embolism on 2D-echo
McConnell's sign
143
Hypokinesis of the RV wall with normal motion of the RV apex
MCConnell's sign
144
Definitive diagnosis of Pulmonary embolism
Chest CT with contrast
145
Foundation for successful treatment of DVT and PE
Anticoagulation
146
Most serious adverse effect of anticoagulation
Hemorrhage
147
Top 3 causes of ARDS
Gram-negative sepsis
Gastric aspiration
Severe trauma
148
Short-term morphology of ARDS
Waxy hyaline membrane
149
Long-term morphology of ARDS
Intra-alveolar fibrosis
150
Histologic manifestation of ARDS
Diffuse alveolar damage
151
Pulmonary artery wedge pressure (PAWP) in ARDS
152
Important in differentiating ARDS from cardiogenic pulmonary edema
Pulmonary artery wedge pressure (PAWP) in ARDS of
153
Focal oligemia in chest xray
Westernark's sign (pulmonary embolism)
154
Peripheral wedge-shaped density above the diaphragm in chest xray
Hampton's hump (pulmonary embolism)
155
Enlarged right descending pulmonary artery in chest xray
Palla's sign
156
Most frequently cited ECG abnormality in pulmonary embolism in additon to sinus tachycardia
S1Q3T3
S wave in lead I
Q wave in lead III
Inverted T-wave in lead III
157
Tx of choice for massive pulmonary embolism
Fibrinolysis with tPA
