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Step 2 CK > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

Asthma categories

A
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2
Q

Asthma Treatment Progression

A
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3
Q

Tx Athletic Asthma

A

Cromolyn or Nedocromil

(Stabilizers)

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4
Q

Eval of Acute Asthma Exacerbation

A
  • PEFR
  • ABG
  • PE
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5
Q

Sputum with Carcot-Leyden Crystals, Curschmann Spirals, eosinophilia suggestive of?

A

Asthma

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6
Q

Tx Acute Asthma Exacerbation

A
  • O2
  • Albuterol/Ipratropium Nebs
  • Corticosteroids
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7
Q

Tx Refractory Asthma Exacerbation

A
  • Racemic Epi Nebs
  • SubQ Epi
  • IV Magnesium

(All together)

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8
Q

Histology: Adenocarcinoma

A

Mucin Glands

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9
Q

Dx: Adenocarcinoma of Lung

A

Percutaneous CT

b/c location is Peripheral

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10
Q

Tx: Adenocarcinoma of Lung

A

Surgery

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11
Q

Adenocarcinoma of Lung: Assoc. Exposure

A

Asbestosis

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12
Q

Histology: Squamous Cell Lung Ca

A

Intracellular bridges

Keratin pearls

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13
Q

Paraneoplastic Syndromes: Squamous Cell Lung Ca

A

Hypercalcemia

(PTH-rp)

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14
Q

Dx: Squamous Cell Lung Ca

A

Bronch/EBUS

(Centrally located)

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15
Q

Tx: Squamous Cell Lung Ca

A

Surgery

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16
Q

Histology: Small Cell Lung Ca

A

neuroendocrine granules on EM

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17
Q

Paraneoplastic Syndromes: Small Cell Lung Ca

A

Cushings (ACTH)

SIADH (ADH)

Lambert-Eaton Syndome

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18
Q

Dx: Small Cell Lung Ca

A

Bronchus, EBUS (Central)

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19
Q

Tx: Small Cell Lung Ca

A

Chemo + Radiation

VERY sensitive to chemo!

NO surgery

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20
Q

Possible locations of Carcinoid and Assoc. Sx

A
  • Lung
    • L-sided heart valve fibrosis
  • Intestines
    • R-sided heart valve fibrosis (lungs metabolize before reaching L heart)
  • Both: flushing, wheezing, diarrhea
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21
Q

Dx: Carcinoid

A

U/A for 5-HIAA

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22
Q

Tx: Carcinoid

A

Surgery

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23
Q

Dx: Lung Cancer

A
  1. CXR
  2. CT scan
  3. Best = Bx

If Confirmed:

  1. PET-CT to stage
  2. PFTs (can they tolerate surgery?)
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24
Q

Who should be screened for lung cancer?

A
  • Screening w/ annual low-dose chest CT
    • Age 55-80
    • Smoking (30 pack-years)
    • Quit < 15 years ago
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25
Q

Characteristics of Lung Nodule making it Low Cancer Risk (4 S’s)

A
  • Size < 8mm
  • Surface: Smooth, Calcified
  • Smoker
  • Self: Age > 70
26
Q

Characteristics of Lung Nodule making it High Cancer Risk (4 S’s)

A
  • Size > 2cm
  • Surface: Spiculated
  • Smoking: No
  • Self: Age < 45
27
Q

Pleural Effusion Algorhythm

A
28
Q

Light’s Criteria

A

Exudate if one of the following is true:

  1. LDH > 2/3 Upper Limit of Normal (~200)
  2. LDHfluid/LDHserum > 0.6
  3. Proteinfluid/Proteinserum > 0.5
29
Q

Tx: Loculated Pleural Effusion

A

Thoracostomy (+/- tPA to increase flow)

If this fails: Thoracotomy

30
Q

Dx: Suspected Pleural Effusion

A

Lateral Decubitus X-ray (Cheapest)

or

U/S

or

CT

31
Q

Tx: Repeat Pleural Effusions

A

Pleurodesis

(Surgical/chemical elimination of pleural space)

32
Q

Thoracentesis shows increased PMNs. Dx?

A

PNA

33
Q

Thoracentesis shows increased leukocytes. Dx?

A

TB/Malignancy

34
Q

Thoracentesis shows RBCs. Dx?

A

Hemothorax / Cancer

35
Q

Thoracentesis shows Adenosine Deaminase. Dx?

A

TB

36
Q

Thoracentesis shows triglycerides. Dx?

A

Chylothorax

37
Q

Thoracentesis shows amylase. Dx?

A

Chylothorax

38
Q

Tx: Chronic Thromboembolic Pulmonary HTN

A

Thrombectomy

39
Q

Escalation of Therapy in COPD

A
  1. SABA (albuterol)
  2. LAMA (tiotropium)
  3. LABA
  4. ICS
  5. LDE4 inhibitors (roflumilast)
  6. Oral Steroids
40
Q

Tx: Acute COPD Exacerbation

A
  • O2
  • Nebulizer tx
    • Ipratropium > Albuterol
  • Abx
    • Doxycycline vs Azithro (prolongs QT so needs EKG first)
  • Oral vs IV steroids
41
Q

Dx: Possible COPD Exacerbation

A
  • CXR - flattening of diaphragm
  • ABG = CO2 retention (hypoxic hypercarbic respiratory acidosis)
  • EKG
42
Q

PCWP and LV Fxn in ARDS vs CHF

A
  • ARDS = Non-cardiogenic Pulm Edema
    • PCWP = Down
    • LV Fxn = Up
    • (Or Normal; Normal)
  • CHF
    • PCWP = Up
    • LV Fxn = Down
43
Q

Dx in ARDS

A

Clinical!

  • CXR = Pulm edema; SICK!!!
  • No fluid overload (ECHO shows normal heart, BNP normal)
44
Q

Tx ARDS

A
  • Intubation
  • PEEP!

Can also increase respiratory rate to increase oxygenation

45
Q

Causes of ARDS

A
  • Gram Negative Septicemia
  • TRALI
  • Near-Drowning
46
Q

Dx DPLD

A
  1. CXR
  2. High-res CT = ground glassopacities
  3. Bx
47
Q

PFTs in DPLD

A
  • Decreased FEV1
  • Decreased FVC
  • Normal FEV1/FVC
48
Q

Tx DPLD

A

(General)

  • ***STEROIDS***
  • DMARDS
  • Biologics
49
Q

Conditions associated with Sarcoidosis

A
  • Skin:
    • Erythema Nodosum
    • Lupus Pernio
      • frost bite-like skin lesion
      • Pathognomonic
  • Eye:
    • Uveitis = decreased vision/blindness
  • Heart:
    • Restrictive Lung Dz
    • Heart Block
  • Bells Palsy
50
Q

Dx Sarcoidosis

A
  • CXR = Bilateral Hilar Lymphadenopathy
  • High-res CT
  • PFTs = restrictive
  • Bx = Non-caseating granuloma
51
Q

Tx Sarcoidosis

A

Methotrexate and Cyclophosphamide

Extrapulmonary manifestations: Prednisone

52
Q

Dx: Rule in Cardiac Sarcoid w/o Pulm manifestations

A
  1. Cardiac MRI
  2. Endomyocardial Bx
53
Q

Restrictive Lung Dz and Sand Blasting

A

Silicosis

  • Dx:
    • CXR = Upper Lobe Nodules
  • Note; rule out TB
  • F/U:
    • annual TB test
54
Q

Restrictive Lung Dz and electronics

A

Berylliosis

55
Q

Restrictive Lung Dz and coal

A

Coal Miner’s Lung

  • Caplan’s Syndrome
    • Arthralgia + Pulm Fibrosis
    • Dx: r/o RA with RF or anti-CCP
56
Q

Restrictive Lung Dz and Rock Quary Work

A

Silicosis

  • Dx:
    • CXR = Upper Lobe Nodules
  • Note; rule out TB
  • F/U:
    • annual TB test
57
Q

Restrictive Lung Dz and Aeronautics

A

Berylliosis

58
Q

Restrictive Lung Dz and Farmer

A

Hypersensitivity Pneumonitis

  • Dx: Gets better after day or two away from exposure
  • Tx: remove exposure
59
Q

Restrictive Lung Dz and Shipyard worker

A

Asbestosis

  • Dx:
    • CXR = Pleural plaques; mesothelioma
    • Bx = Barbell Bodies
  • Tx
    • Smoking cessation
  • F/U
    • High risk adenocarcinoma and mesothelioma
60
Q

Restrictive Lung Dz and Heavy Metal Exposure

A

Pneumoconiosis

61
Q

O2 level below which the patient needs O2

A

55%

Step 2 CK (9 decks)

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