Pulmonology Flashcards
Classification of asthma 2
Intermittent and persistent
Presistent-Mild,Moderate,severe
Quid asthma intermittent and RX
Symptom
Quid asthma Mild persistent and RX
Symptom>2 f par semaine,3 a 4 nightime awakening/month
Rx albuterol + inhaled corticosteroid
Quid asthma moderate persistent and RX
daily symptom,weekly nightime awakening,FEV 60-80
SABA+inhaled corticisteroid +long acting B2 agonist
Quid severe asthma and RX
daily symptoms,frequent nightime awakening,FEV
Organ involved in wegener 3
Upper and lower respitatory
renal involvement
Renal involvement in wegener
rapidly progressive glomerulonephritis
Rx of wegener
corticosteroids
COPD and acute respiratory distress
Rule out secondary pneumothorax
Physiopato seconary pneumothorax in COPD
blebs rupture
quid Blebs
dilated apical alveoli
Dx of Blebs
CT scan
Management of acute exacerbation of COPD
NPPV,decreases Mortality
Cause of recurrent pneumonia involving same lung area(4)
Alcohol use,GERD,seizures,brochial stenosis
Community acquired Pneumonia with skin involvement
Mycoplasma Pneumoniae
Bugs causing Atypical pneumonia(4)
Mycoplasma P,Legionelle P,Chlamidya P,Coxiella and influenza
Disease causing granulomatous inflammation(2)….
TB,sarcoidosis
Dx confirmatory of Sarcoidosis
Biopsy by brochoscopy or by mediatinoscopy
Recurrent Pneumonia in smoker
Bronchogenic carcinoma
Pulmonary disease with high A-a gradient(2)….
PCP,PE
Causof recurrent pneumonia involving different sites of the lung(3)
Sinopulmonary disease
immunodeficiency
Nonn infectious cause,vasculitis
Cause of sinopulmonary disease reccurente(2)
Cystic fibrosis
immotile cilia
Rx CAP for inpatient
Levofloxacin
Rx CAP for out patient(2)
Azythromycin
Dox
Dx of pulmonary HT(2)
Prominent pulmonary arteries
Enlarged right heart
Physiopatho ARDS in acute pancreatitis
Phospholipase A2 causes inflammation in lung and destroys surfactant
quid Pancoast tumor
Non small cell carcinoma
Findings in Pancoast Tumor(5)
Shoulder Pain Horner's syndrome C8-T2 involvement weight loss supra clavicular lymph node
Manif for c8-t2 involvement(3)
Paresthesie 4e et 5e doigt,bras et face ant avant-bras
Pneumonia et digestive symptom or hyponatremia or neurologic problem
Legionella
dx of legionella(2)
antigen in urine or charcoal agar
Rx of legionella(2)
Quinolone or macrolide(Azytromycin or levofloxacin)
Why b2 agonists causes hypokaliemia
they drive k+ into cells
Manif of HypoK+(3)
Mx weakness
arythmia
EKG changes
Why shock in massive PE
RV dilation
Septum is pushed towards left ventricle
Low ejection fraction—shock
Epidemio of histoplasmosis(2)
Missisipi,Ohio river
Link with guano
Pulmonary nodule in non smoker
rule out histoplasmosis
Quid of respiratory acidosis(3)
Low PH45
Normal HCO3- 22-28
cause of respiratory acidosis
Hypoventilation
Main indication of BAL(2)
PCP
Malignancy
Indication for inferior vena cava filter placement(3)
contrindication to anticoagulant
HIT
DVT on heparin
Manif of Theophyline toxicity(2)
Neurologic
Palpitation
Metabolism of theophyline
Cytochrome P450
drug inhibiting CP450
Cimetidine clarythromycin ciprofloxacin erythromycin verapamil
FEV% in Obstructive disease
FEV% in restrictive disease
> 70
Restrictive disease with low DLCO
Intersticial disease
Restrictive disease with normal DLCO
Mx chest weakness
Bug causing pneumonia in alcoholics
Klebsiella
Quid Friedlander Pneumoniae(2)
Jelly sputum
Klebsiella
Bugs causing empyema(3)
Strep Pneumo
Staph aureus
Klebsiella
Quid Empyema
Pus in pleural space
Rx of empyema(2)
drainage
antibiotics
Most common site of Wegener
Upper respiratory tract
Wegener Quid(4)
Upper respiratory tract involvement
Lower respiratory tract involvement
Renal involvement
Ulcer in leg
rx for Wegener
cyclophosphamide
PH fluid for empyema
Acute productive cough with no fever and wheezing and sore throat
acute bronchitis
Rx of acute bronchitis
Supportive care
sleep apnea syndrome management
weight reduction
avoid supine position
avoid alcohol and sedatives
Therapeutic INR
2-3
indication of endotracheal intubation in asthma
Normal or High PCO2
Bad prognosis in asthma acute exacerbation
Normal or High PCO2
First measure in hypersensitivity pneumonitis
avoid antigen exposure
Two forms of hypersensitivity pneumonitis(2)
Bird fancier’s Lung
farmer’s Lung
Pneumonia linked with cruise
Legionella
PE and renal failure :RX
unfractionnated heparin
abnormal GFR
Dx of adult astma
Increase FEV% after administration of bronchodilator
COPD exacerbation management(4)
Albuterol
ipratopium
antibiotics
corticosteroids
Management of exercice induced astma
Short acting agonist 20 mn before exercising
Light criteria(4)
Protein pleural fluid/protein serum >0.5
LDH pleural fluid/LDH serum>0,6
LDH pleural fluid>2/3 upper limit LDH serum
Favor exsudate
Management of solitary nodule in non smoker
serial chest xray to see if mass is incresing in volume
Prognosis of solitary nodule in nonsmoker
stable during 2 years ,no cancer
Indication of home oxygen in COPD(3)
Pa0255 si Pao2
PH of pleura transudate
7,4-7,55
PH of pleural exsudate
7,30-7,45
Quid of flail chest
> / 3 ribs adjacent ruptured in two places
Rx
Positive pressure ventilation
Risk of flail chest
Paradoxical respiration
Co2 Narcosis Manif(2)
Seizure
cardiac problem
Risk for co2 narcosis
patient with acute or chronic respiratory failure treated with high o2 flow
Best site to biopsy for wegener
nasopharynx
Anapath wegener(2)
Medium and small size arteries involvement
granulomatous inflammation
PCO2 value in secondary pneumothorax causing by COPD
Normal 33-45
PCO2 value in acute exacerbation causing by COPD
High
2e cause of reccurent pneumoniae involving same site
Local anatomic brochial obstruction
Lofgren syndrome(4)
Adenonopathie hilaire
erythema nodosum
fever
polyarthritis migratory
disease with lofgren syndrome
sarcoidosis
Biopsy findings in sarcoidosis
Non caseating granuloma
cause of bronchial obstruction(3)
Bronchial stenosis
ca(bronchogenic carcinoma or carcinoisd tumor)
foreign body
In reccurrent pneumonia test to do and why
Chest CT
to rule out bronchial obstruction
Seizures and respiratory
seizures can cause apnea and hypoventilation
Workup of PVCP pneumonia(3)
Chest xray
Sputum induction by hypertonic saline
BAL si sputum induction fails
Quid of bronchodilator challenge in obstructive pulmonary disease
Si FEV% increases:asthma
No change:COPD
Triad of wegener
Systemic vasculitis
Upper and lower respiratory tract infection
renal impairment
Rx of severe asthma exacerbation(4)
SABA
Ipratopium
corticisteroid
si no improvement intubation
Rx for mild to moderate asthma exacerbation(2)
SABA
No Improvement corticosteroids
Confirmatory test for legionella(2)
Charcoal agar
or Urine antigen testing
When to initiate warfarin in DVT
when PTT>1,5 or 2 fois la normale
Inchronic respiratory acidosis ,link between PCO2 et HCO3
each 10 mm de hg of PCO2,HCO3- increases 0f 3,5
Exsudate physio patho
Increase capillary permeability
Transudate physio patho
Increase hydrostatic pressure
Decrease oncotic pressure
Centrally located nodule work up
Broncoscopy for Biopsy
peripherically located nodule
CT guided Biopsy
Measure to decrease mortality in COPD (3)
Home 02
stop smoking
lung reduction surgery
Ideal sao2 for patient with acute exacerbation of COPD on O2
90-94%
Risk for patient with acute exacerbation COPD and high Sao2(3)
Haldane effect
risk of co2 narcosis because of low affinity of HB for CO2
co2 is free in tissue
First site of matastasis of choriocarcinoma
Lung
Dx of choriocarcinoma
BHCG en serie
hematologic side effect of steroids
Leukocytosis(Neutropphilia)
Link between GERD and astma
GERD can exacerbate asthma
Cor Pulmonale findings
Dyspnea
dialted pulmonary artery
Right heart failure(Increased P2)
Middle mediastinum Mass DX(5)
Trachea tumor bronchogenic cyst pericardic cyst aorta aneurysm lymphoma
Anterior Mediastinum Mass(4)
Terrible Lymphoma
Thymoma
Teratoma
Thyroid Mass
Posterior Mediastinum Mass(3)
Neurogenic Mass
aortic aneurism
esophageal mass(Leiyomyoma)
Physiopatho respiratory distress in ARDS
Infection or Phoslipase A2 cause inflamamatory change in alveli=gaz exchange -
cytokines or Phospholipase A2 destroy surfactant=stiff lung=decrease lung compliance
Quid of hypertrophic osteoarthropathy(2)
clubbing
hand pain
significance of Hypertrophic osteoarthropathy
Lun cancer
TB
Emphysema
bronchiectasis
chronic cough causes(12)
Post nasal drip asthma bronchiectasis GERD ACE inhibitor Mtral stenosis TB Broncite chroniques sclerodermia sarcoidosis fungal infection cancer of lung
Rx of post nasal drip
anti histaminique with anti cholinergic effect
COPD plus clubbing
Lung cancer
Risk for DVT above the knee
PE
Quid of DVT above the knee(3)
-illiac
femoral
popliteal
travel to mexico or any developing countries
Infectious disease
Physio patho of chronic cough in Mitral stenosis(3)
Left atrial enlargement
compression on reccurent laryngeal nerve–>cough and hoarsening of the voice
Cause of exsudate(5)
Infection Malignancy rhumatologic disease(connective tissue ) PE Iatrogenic
Dx of bronchiectasis
chest ct scan
Clue for GERD induced asthma
Hoarseness in the morning
dx et Rx of GERD induced asthma
Pomp inhibitor
When suspect anaerobic pneumonia(3)
After any procedure involving upper digestive tract
Failure in rx CAP rx
Any neurologic problem impairing swallowing ability
Normal A-a gradient
cause high A-a gradient(3)
Diffusion limitation(Interticial disease) VQ mismatch(PE,pulmonary edema) Shunt intra cardiac
Calculation of A-a gradient
PAo2-Pao2
Respiratory distress in new intubated patient/why(2)
right main bonchus intubation
because of pulmonary edema
VQ mismatch physiologic shunting effect
lyng down on affected lung decreases SAO2 because of increase physiologic shunting
role of FIO2 in ventilation settings(2)
Helps to know the degree of oxygenation
50 a 60 is the required value
why glucose is low in exsudate
because of presence of white cells
indication of chest thoracostomy in the setting of parapneumonic effusion(2)
low PH
OPD with normal DLCO (carbone monoxyde diffusion a 100%)
chronic bronchitis
OPD with high DLCO
asthma
OPD with decreased DLCO
Emphysema
pulmonary cause of hemoptysis(7)
Bronchitis PE Bronchiectasis cancer TB Lung abcess Wegener
Quid of chronic bronchitis
productive cough lasting for 3 months 2 years consecutives
COPD exacerbation with respiratory failure
NPPV noninvasive positive pressure ventilation
COPD with failure of NPPV
endotracheal intubation
spirometry of ARDS
Pao2/fi02
xray of ARDS
bilateral opacily
Bugs causing lung infection in bronchiectasis
Pseudomonas
VQ mismatch(3)
Pulmonary edema
PE
PCP
cause of respiratory distress(4)
ARDS
Trauma
Infection
OPD
PAo2 calculation
Fio2(Patm-PH20)-Pco2/r
0,21 (760-47)-pco2/0,80
149,73-pco2/0,80
Cause of Hypoxia(5)
Hypoventilation(CNS depression) Reduced o2 inspired(high altitude) Vq mismatch diffusion limitation intracardiac shunt
hypoxia which can be corrected by O2
intracardiac shunt
cause of low glucose in pleural fluid(4)
TB
Empyema
Rhumatoid arthritis
Malignancy
drug induced lupus(3)
hydralazine
isoniazid
procainamide
Drug induced lupus causes exsudate ou transudate
exsudate
cause of hyper coagulable state(6)
OCP use Facteur V leiden Dehydration Protien C et S deficiency cancer Hyperhomocyteinemie(folate,B12,B6)
Does seminoma produce AFP
no
Mixed germ cell tumor dx
AFP and BHCG are produced
Extra pulmonary manif of ca pulmonaire(3)
Paraneoplastic syndrome
Pancoast syndrome
SVC syndrome
Cause of ARDS(4)
infection
acute pancreatitis
trauma
massive transfusion
Physical exam in pneumonia(4)
consolidation—>
Dulness to percussion
Increase tactile fremitus
bronchial type sound or decreased breath sound
Physical exam in pleural effusion(3)
Decreased breath sound
decrease tactile fremitus
dulness to percussion
Pulmonary embolism and RV dilation(2)
Increase pulmonary artery pressure
right atrial and ventricular dilation
Physio patho of ACE inhibitor induced cough
accumulation of kinin
respiratory acidosis compensation(2)
renal retention of bicarb
decrease chloride reabsorbtion
why sleep apnea can cause respiratory acidosis
hypoventilation
complication of sleep apnea(3)
respiratory acidosis
cor pulmonale
hta pulomanire
bad prognosis of acute asthma attack(5)
High or normal PCO2 silent lung cyanosis altered sensorium difficulty speech
Characteristic of atypical pneumonia
cause extra pulmonary features
Dx of bronchiectasis
CT of chest
Complication of bronchiectasis
Hemoptysis
side effect# 1 of bclomethasone use
oral thrush
type of hypersensitivity is aspirin induced asthma(2)
indeterminate
It’a a pseudo allergic reaction
Rx of aspirin induced asthma
antagonist of leukotrien
action of aspirin(2)
block cox 1 and cox 2
Accumulalation of leukotrien from lipoxygenase pathway
action of steroid(3)
block phospholipase no arachidonic acid produced both pathways(lipoxygenase and cyclooygenase ) are blocked
gold standard for DX CAP
chest xray
gold standard to DX sleep apnea
nocturnal polysomnography
cause of empyema(4)
Lung infection
post hemothorax
neighborhood abcess(hepatic )
esophageal rupture
Post hemothorax empyema dx and rx(2)
CT of chest
surgery
Most common inherited disorder causing hypercoagulable state
factor v leiden
Physiopatho factor v leiden
Point mutation
Can be activate by protein C
Acido basis balance in COPD
respiratory acidosis
acidobasic balance in CHF
respiratory alkalosis
organ involvement in goodpasture disease(2)
lung involvement
renal involvement
physio patho of goodpasture(2)
antibody against type iv collagen
antibody anti basement membrane
ventilated patient with high PA02 but normal PH,management
decrease FIO2
ventilated patient with high Pao2 and respiratory alkalosis,management
decrease respiratory rate
clue for alpha 1 anti trypsine deficiency(2)
emphysema in non smoker and young
cirrhosis in young patient
confirmatory dx of AAT deficiency
Measure alpha 1 anti trypsine
cause of transudat(4)
CHF
cirrhosis
nephrotic syndrome
peritoneal dyalisis
Qui of non allergic rhinitis(2)
Post nasal drip,
chronic cough important clue
modality of treatment of non allergic rhinitis(2)
intranasal glucocorticoid or intra antihistaminique
oral anti allergic with anticholinergic effect
Xray findings in PE
Hampton’s hump
westermak’s sign
Most common symptom of PE(2)
Shortness of breath
pleuritic chest pain
EKG in PE(2)
sinus tachycardia
S1Q3T3
Bad prognosis in PE(2)
AFIB
Low saturation
wells modified criteria 3 points(2)
3 points si DVT
si aucun autre dx ne peut etre retenu
wells modified criteria 1,5 points(3)
immobilisation
recent surgery
tachycardy >100
Wells modified criteria 1 point (2)
Ca
Hemoptysis
Next step in Wells modified >4(3)
Ct angiography of chest
si positif heparin
si negatif exlude PE
Next step if wells criteria
Ddimer measure
>500 ng—>ct scan chest
epidemio of blastomycosis(3)
ohio
missisipi
great lakes
clue for blastomycosis
Lung infection
ulcerative skin lesion
bone osteolytic lesion
normal PH in blood
7,35-7,45
normal PaO2
75-105
Normal PaCO2
33-45
Lung exam during food allergy
stridor
Physiopatho of stridor in food allergy
laryngeal edema
Why diaphram is flat in late COPD
Hyperinflation
Consequence of diaphram flattening
increase work of breathing
What are increased in COPD(2)
-residual lung volume
total lung capacity
Why residual lung volume is increased in COPD
because air is trapped in lungs
Why total lung capacity is increased in COPD
because of hyperinflation
Mobile cavity mass on chest xray and hemoptysis
aspergiloma
Rx of anaphylactic shock
IM epinephrine
Common cause of anaphylaxis in the US
bee stung
20 years later pateient treated for hodgkin lymphoma by radiation develops lung mass Dx?
secondary malignancy induced by radiation
other complication of radiation used during Hogkin lymphoma treatment(2)
Acute leukemia
Non hogkin lymphoma
First cause of daytime sleepiness in the US
sleep apnea
complication of sleep apnea
Erythrocytosis
HTA pulmonaire
right ventricular failure
Most common secodary ca in radiation during H Lymphoma(5)
Lung breast bone thyroid digestive
Risk factor for sleep apnea(3)
obesity
tonsillar hypertrophy
hypothyroidism
Asbestosis and occupation(7)
Mining plumbing construction worker shipyard insulation worker carpenter Plastic and rubber industry
when worker will develop asbestosis
> 20 years after exposure
Key pulmonary findings of asbestosis
pleural plaques
what’s the risk of asbestosis(2)
Malignant mesothelioma
Bronchogenic carcinoma
chest xray findings in asbestosis
Pleural plaques
intersticial abnormalities
Spirometry in asbestosis(2)
Normal FEV%
Low DLCO
Mainstay of rx of acute COPD exacerbation(2)
Albuterol nebulizer
corticosteroid
Cause of ARDS(5)
Sepsis acute pancreatitis severe bleeding burns toxic ingestion
Cause of digital clubbing
Lung cancer
cystic fibrosis
Mainstay of rx of ARDS
Mechanical ventilation with low tidal volume and PEEP
role of PEEP
preventing alveolar collapse
PEEP in ARDS
15 mm de h20
respiratory failure in setting of infection
ARDS
Chest trauma and respiratory failure DX
ARDS
syptomatic rx of COPD(2)
Anti muscarinic
SABA
Cause of Pancoast tumor
Sulcus superior tumor
Physical exam in Pneumonia with no airway obstruction(2)
Dullness to percussion
Bonchial type sound(louder expiratory component or louder breath sounds)
Physical exam in pneumonia with airway obstruction(2)
Dulness to percussion
decrease breath sound
recurrent pnemonia in dementia patient
aspiration
cause of aspiration in dementia patient or inconsciousness state
impaired epiglottic reflexe
% risk of cancer in smoker with asbestosis
59 fold risk
Localisation of pleural plaques in chest xray and morphology of plaques(2)
on diaphram coupole
needle shape
3 most common causes of chronic cough
post nasal drip
GERD
asthma
what’s the primary long term intervention in asthma management
inhaled corticosteroid
what’s the primary long term intervention in COPD management
Anticholinergic(ipratopium)
How will be urine PH in respiratory alkalosis
HIGH
why Urin PH is high in respiratory alkalosis(3)
renal compensation
decrease reabsorbtion of HCO3
Increase reabsorption of H+
Pneumonie in immunocompromised patient
PCP
chest Xray in PCP
Diffuse intersticial infiltrates
V/q scan in PE(2)
perfusion defect
without ventilation defect
High PEEP complication(3)
tension pneumothorax
Alveolar damage
hypotension
Patient on mechanical ventilation develops absence of breath sound unilaterally
tension pneumothorax
Quid of idiopathic pulmonary fibrosis
deposition of collagen in perialveolar tissues
A-a gradient in Idiopathic pulmonary fibrosis(2)
High
diffusion problem
Most common infection causing intersticial lung disease(3)
TB
viral pneumonia
Fungal infection
Most common vasculitis involved in intersticial lung disease
Wegener
Most common occupationnal disorder causing intersticial lung disease(2)
silicose
Hypersensitivity pneumonitis
most common connective tissue causing intersticial lung disease(2)
SLE
Sclerodema
other causes of Intersticial lung disease(3)
idipathic pulmonary fibrosis
Intersticial pneumonia
cryptogenic organising pneumonia
Chest xray of interticial lung disease(2)
reticular
nodular opacities