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Medicine (IM Platinum) > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

Amount of air remaining in the lungs after full exhalation, maintains oxygenation between breaths

A

Residual volume

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2
Q

Amount of air inhaled/exhaled with each normal breathing (~0.5ml)

A

Tidal volume

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3
Q

Area with no gas exchange from nose to terminal bronchiole

A

Anatomic dead space volume

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4
Q

Anatomic dead space volume

A

150 mL

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5
Q

Anatomic dead space volume + alveoli dead space

A

Physiologic dead space volume

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6
Q

TV x RR

A

Minute respiratory volume

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7
Q

RR x ( TV - physiologic dead space volume)

A

Alveolar ventilation per minute

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8
Q

Stimulate central chemoreceptors in medulla

A

Carbon dioxide (as CSF H+)

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9
Q

Lung zone with NO BLOOD FLOW

A

Zone 1

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10
Q

Lung zone with CONTINUOUS BLOOD FLOW

A

Zone 3

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11
Q

Lung zone with INTERMITTENT blood flow

A

Zone 2

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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

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13
Q

Increase in this factors will cause shift to the LEFT

A

Carbon MONOXIDE, Fetal Hgb

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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

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15
Q

Controls inspiration, sends inspiratory ramp signal

A

Dorsal respiratory group (DRG) of the medulla

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16
Q

Controls BOTH inspiration and expiration;

Overdrive mechanism in exercise

A

Ventral Respiratory Group (VRG) of the medulla

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17
Q

Limits inspiration and increases respiratory rates

A

Pneumotaxic center of the pons

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18
Q

Stimulates inspiration and decreases respiratory rate

A

Apneustic center of Pons

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19
Q

Areas of gas exchange from proximal to distal

A

Respiratory bronchiole
Alveolar ducts
Alveoli

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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

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21
Q

Found in carotid bodies (CN 9) and aortic bodies (CN 10); activated when PO2

A

Peripheral chemoreceptors

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22
Q

Hemoptysis of greater than 200 - 600 cc in 24H

A

Massive hemoptysis

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23
Q

Ausculation of “AH” instead of “EEE” when a patient phonates “EEE”

A

Egophony

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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
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25
Q

Irreversible airway dilatation that involves the lung in either a focal or diffuse manner

A

Bronchiectasis

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26
Q

Disease state characterized by airflow limitation that is not fully reversible; encompasses emphysema, chronic bronchitis and small airway disease

A

COPD

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27
Q

Anatomically defined condition characterized by destruction and enlargement of the lung alveoli

A

Emphysema

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28
Q

Clinically defined condition with chronic cough and phlegm

A

Chronic bronchitis

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29
Q

Narrowed small bronchioles

A

Small airways disease

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30
Q

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
A

Bristish Hypothesis

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31
Q

Contends that asthma and COPD are essentially variations of the same basic disease

A

Dutch hypothesis

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32
Q

Present with systemic arterial hypotension and usually with anatomically widespread thromboembolism

A

Massive pulmonary embolism

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33
Q

Present with RV hypokinesis on 2D echo but normal systemic arterial pressure

A

Moderate to large pulmonary embolism

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34
Q

Present with normal right heart function and normal systemic arterial function; excellent prognosis with adequate anticoagulation

A

Small to moderate pulmonary embolism

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35
Q

Benign ovarian tumors with ascitss and pleural effusion

A

Meig’s syndrome

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36
Q

Coexistence of unexplained excessive daytime sleepiness with at least five obstructive breathing events (apnea or hypopnea) per hour of sleep

A

Obstructive sleep apnea

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37
Q

Defined in adults as breathing pauses lasting >10 seconds

A

Apnea

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38
Q

> 10 second events where there is continued breathing but ventilation is reduced by at least 50% from the previous baseline during sleep

A

Hypopnea

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39
Q

Clinical syndrome defined by:

-acute onset (

A

ARDE

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40
Q

TB: virulence factor

A

Cord factor

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41
Q

TB: prevents macrophage-lysosomal fusion

A

Sulfatides

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42
Q

TB: marker for TB infection

A

PPD

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43
Q

Pathologic sign of primary TB

A

Ghon’s focus

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44
Q

Ghon’s focus + hilar LAD

A

Ghon’s complex

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45
Q

Radiologic sign of primary TB

A

Ranke complex

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46
Q

Pathologic sign of SECONDARY TB

A

Simon focus

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47
Q

Most common site of extrapulmonary TB

A

Lymph nodes

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48
Q

Physiologic abnormality of asthma

A

Airway hyperresponsiveness

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49
Q

Pathogenesis behind asthma

A

Imbalance favoring TH2 production over TH1 ➡️ increase IL1, IL5 ➡️ increased eosinophils

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50
Q

Putative mediators of asthma

A

SRS-A (made up of Leukotrienes C4, D4, E4)

histamine is NOT a putative mediator

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51
Q

Whorls of shed epithelium in mucus plugs seen in asthma

A

Curschmann spirals

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52
Q

Crystalloid made up pf eosinophil membrane protein seen in BOTH asthma and amoebiasis

A

Charcot-leyden crystals

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53
Q

Predominant key cell involved in asthma

A

None

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54
Q

Characteristic feature of asthmatic airways

A

Eosinophil infiltration

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55
Q

Most common allergens to trigger asthma

A

Dermatophagoides species (dust mites)

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56
Q

Most common trigger of acute severe exacerbations

A

URTI: rhinovirus, RSV, coronavirus

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57
Q

Mechanism of exercise-induced asthma

A

Hyperventilatiom

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58
Q

Exercise induced asthma is best prevented by regular treatment with

A

Inhaled corticosteroids

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59
Q

Characteristic symptoms of asthma

A

Wheezing, dyspnea, and coughing

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60
Q

Confirms airflow limitation with a reduced FEV1, FEV1/FVC ration, and PEF

A

Spirometry

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61
Q

Confirms the diurnal variations in airflow obstruction

A

Measurement of PEF twice daily

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62
Q

Most effective bronchodilators in current use

A

B2-agonist

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63
Q

Primary action of B2-agonists

A

Relax airway smooth-muscle cells of all airways, where they act as functional antagonists

64
Q

Most common side effect of anticholinergics

65
Q

Most common side effect of B2 agonist

A

Muscle tremors and palpitations

66
Q

Most common side effect of Theophylline

A

Nausea, vomiting snd headaches

67
Q

Most effective controllers of asthma

A

Inhaled corticosteroids

68
Q

Most effective anti inflammatory agents used in asthma therapy

A

Inhaled corticosteroids

69
Q

Indicates the need for regular controller therapy

A

Use of reliever medication >3x week

70
Q

Most common reason for poor control of asthma

A

Non compliance with medication, particularly ICS

71
Q

Drugs that have now been shown to be SAFE in pregnancy and without teratogenic potential

A

Short-acting B2-agonists, ICS, theophylline

72
Q

Components of COPD

A

Emphysema, chronic bronchitis

73
Q

Pathogenesis behind emphysema

A

Imbalance between protease (elastase) and anti-protease (alpha-1-anti-trypsin)

74
Q

First symptom of emphysema

75
Q

Most highly significant predictor of FEV1

A

Pack-years of cigarette smoking

76
Q

Important causes of exacerbations of COPD

A

Respiratory infections

77
Q

Most common form of severe A1-antitrypsin deficiency

78
Q

Most typical finding in COPD

A

Persistent reduction in forced expiratory flow rates

79
Q

Accounts for essentially all of the reduction in PaO2 that occurs in COPD

A

Ventilation-perfusion mismatching

80
Q

Major site of increased resistance in most individuals with COPD

A

Small airways (

81
Q

Type of emphysema most frequently associated with cigarette smoking

A

Centriacinar emphysema

Mnemonic: sENTROacinar - Smoking

82
Q

Type of emphysema usually observed in patients with a1-AT deficiency

A

Panacinar emphysema

83
Q

Type of emphysema associated with spontaneous pneumothorax

A

Distal acinar emmphysema

84
Q

Mojor physiologic change in COPD resulting from both small airway obstruction and emphysema

A

Airflow limitation

85
Q

Three most common symptoms in COPD

A

Cough, chronic sputum production, exertional dyspnea

86
Q

The only pharmacologic therapy demonstrated to unequivocally decrease mortality rates

A

Supplemental O2

87
Q

Strong predictor of future exacerbations

A

History of prior exacerbations

88
Q

Bacteria assoc. with COPD exacerbations

A

Streptococcus pneumoniae
Haemophilus influenza
Moraxella catarrhalis

89
Q

Only three interventions demonstrated to influence the natural history of patients with COPD

A

Smoking cessation
Oxygen therapy in chronically hypoxemic patients
Lung volume reduction surgery in selected patients

90
Q

Most common pathogenesis of pneumonia

A

Aspiration

91
Q

Most common etiology of CAP

A

Streptococcus pneumonia

92
Q

Most common etiology of atypical pneumonia

A

Mycoplasma pneumonia

93
Q

Most common cause of nosocomial pneumonia and pneumonia in cystic fibrosis patients

A

Pseudomonas aeruginosa

94
Q

Most common viral cause of atypical pneumonia and bronchiolitis in children

95
Q

Most common cause of Pneumonia in AIDS patient

A

P. jiroveci

96
Q

Main purpose of sputum gram stain

A

Ensure that sample is suitable for culture

97
Q

What is an adequate sputum sample?

A

> 25 PNM and

98
Q

Most frequently isolated pathogen in blood cultures of CAP

A

S. Pneumonia

99
Q

Most widely cited mechanism of infectious bronchiectasis

A

Vicious cycle hypothesis

100
Q

Most common clinical presentation of bronchiectasis

A

Persistent productive cough with ongoing production of thick, tenacious sputum

101
Q

Imaging modality of choice for confirming diagnosis of bronchiectasis

102
Q

Most common cause of viral croup/LTB in infants

A

Parainfluenza

Steeple sign xray

103
Q

1st step in the diagnostic approach of pleural effusion

A

Determine whether effusion is transudative or exudative

104
Q

Transudate or exudate: left ventricular failure

A

Transudative

105
Q

Transudate or exudate: cirrhosis

A

Transudative

106
Q

Leading cause of transudative pleural effusion

A

LV failure and cirrhosis

107
Q

Leading cause of EXUDATIVE pleural effusion

A

Bacterial pneumonia
Malignancy
Viral infection
Pulmonary embolism

108
Q

Transudate or exudate: bacterial pneumonia

109
Q

Transudate or exudate: malignancy

110
Q

Transudate or exudate: viral infection

111
Q

Transudate or exudate: pulmonary embolism

112
Q

Most common cause of chylous pleural effusion

A

Malignancy

113
Q

Second most common type of exudative pleural effusion

A

Malignant pleural effusions secondary to metastatic disease

114
Q

Three tumors that cause 75% of all malignant pleural effusions

A

Lung Cancer
Breast cancer
Lymphoma

115
Q

The only symptom that can be attributed to the effusion itself (in effusion from malignancy)

116
Q

Most commonly overlooked in the differential diagnosis of patient with an undiagnosed effusion

A

Pulmonary embolism

117
Q

In many parts of the world, most common cause of exudative pleural effusion

118
Q

Most common cause of chylothorax

119
Q

Treatment of choice for most chylothorax

A

CTT plus Octreotide

120
Q

Most common cause of hemothorax

121
Q

1st step in evaluating mediastinal mass

A

Determine which mediastinal compartment

122
Q

Most common lesions in ANTERIOR mediastinum

A

Thymomas
Lymphomas
Teratomatous neoplasm
Thyroid masses

123
Q

Most common masses in the MIDDLE mediastinum

A

Vascular masses
LN enlargement from metastases or granulomatous disease
Pleuropericardial and bronchogenic cysts

124
Q

Most common masses in the POSTERIOR mediastinum

A 
Neurogenic tumors
Meningoceles
Meningomyeloceles
Gastrogenic cysts
Esophageal diverticula
125
Q

Most valuable imaging technique and the only imaging technique that should be done in mostinstances

A

CT scanning

126
Q

Population at risk for spontaneous pneumothorax

A

20-40year-old Tall thin smoker men

127
Q

Tracheal deviation in spontaneous pneumothorax

A

Ipsilateral tracheal deviation

128
Q

Tracheal deviation in tension pneumothorax

A

Contralateral tracheal deviation

129
Q

One of the three major cardiovascular causes of death, along with MI and stroke

A

Venous thromboembolism (VTE)

130
Q

Causes of pulmonary embolism

A 
Fat
Foreign body
Air
DVT
Bone marrow
Amniotic fluid
Tumor
131
Q

Risk factors of pulmonary infarction

A

Pre-existing heart/lung disease

132
Q

Usual cause of death in Pulmonary embolism

A

Progressive right heart failure

133
Q

DVT: most frequent history

A

Cramp in the lower calf that persists for several days and becomes more uncomfortable

134
Q

Pulmonary embolism: most frequent history

A

Unexplained breathlessness

135
Q

Classic signs of Pulmonary embolism

A

Tachycardia
Low-grade fever
Neck vein distention

136
Q

Most frequent symptom of pulmonary embolism

137
Q

Most frequent sign of pulmonary embolism

138
Q

Useful rule out test in pulmonary embolism

A

Plasma D-dimer ELISA (quantitative)

139
Q

Most common abnormality in ECG of pulmonary embolism

A

T-wave inversion in leads V1-V4

140
Q

Principal imaging modality/test for the dx of pulmonary embolism

A

Chest CT scan with IV contrast

141
Q

2nd line diagnostic test for Pulmonary embolism, used mostly for patients who can’t tolerate IV contrast

A

Lung scanning

142
Q

Best known indirect sign of Pulmonary embolism on 2D-echo

A

McConnell’s sign

143
Q

Hypokinesis of the RV wall with normal motion of the RV apex

A

MCConnell’s sign

144
Q

Definitive diagnosis of Pulmonary embolism

A

Chest CT with contrast

145
Q

Foundation for successful treatment of DVT and PE

A

Anticoagulation

146
Q

Most serious adverse effect of anticoagulation

A

Hemorrhage

147
Q

Top 3 causes of ARDS

A

Gram-negative sepsis
Gastric aspiration
Severe trauma

148
Q

Short-term morphology of ARDS

A

Waxy hyaline membrane

149
Q

Long-term morphology of ARDS

A

Intra-alveolar fibrosis

150
Q

Histologic manifestation of ARDS

A

Diffuse alveolar damage

151
Q

Pulmonary artery wedge pressure (PAWP) in ARDS

152
Q

Important in differentiating ARDS from cardiogenic pulmonary edema

A

Pulmonary artery wedge pressure (PAWP) in ARDS of

153
Q

Focal oligemia in chest xray

A

Westernark’s sign (pulmonary embolism)

154
Q

Peripheral wedge-shaped density above the diaphragm in chest xray

A

Hampton’s hump (pulmonary embolism)

155
Q

Enlarged right descending pulmonary artery in chest xray

A

Palla’s sign

156
Q

Most frequently cited ECG abnormality in pulmonary embolism in additon to sinus tachycardia

A

S1Q3T3

S wave in lead I
Q wave in lead III
Inverted T-wave in lead III

157
Q

Tx of choice for massive pulmonary embolism

A

Fibrinolysis with tPA

Medicine (IM Platinum) (2 decks)

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