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- Med School Review 🔥 > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

Mixed aerobic/anaerobic sputum Cx

A

Aspiration PNA

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2
Q

PNA in alcoholic

A

aspiration PNA

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3
Q

Foul-smelling sputum + periodontal dz

A

Aspiration PNA

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4
Q

2nd most common cause of death in AAT

A

Cirrhosis!

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5
Q

COPD w/o risk factors

A

AAT

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6
Q

ASA + Asthma

A

AERD

(Aspirin-exacerbated respiratory disease);

pseudoallergic rxn to NSAIDs in asthmatics,

chronic rhinositis w/ nasal polyposis.

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7
Q

Splinter hemorrhage

A

think septic emboli 2/2 subacute infective endocarditis (SIE).

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8
Q

Decreased PaCO2

A

Hyperventilation (e.g. PE)

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9
Q

Increased PaCO2

A

Respiratory failure

(e.g. botulism)

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10
Q

Right Axis Deviation on EKG

A

RV strain —> PE vs. pHTN

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11
Q

Enlarged pulmonary arteries on CXR

A

pHTN

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12
Q

Enlarged RV on CXR

A

pHTN

(RV failure is late manifestation)

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13
Q

Wedge-shaped density on CT

A

PE

(vascular distribution)

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14
Q

Diffuse interstitial lung pattern on CT

A

PJP

(CD<200/mm3)

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15
Q

Cavitary lesion on CT

A

TB

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16
Q

Leukocytes in methylprednisolone treatment

A

Leukocytosis w/ neutrophilic predominance

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17
Q

Eosinophilia

A

Drug/Allergic reaction vs. Parasitic infection vs. Malignancy

  • Hypersensitivity reaction
  • TEN
  • DRESS
  • Leukemia or Lymphoma
  • Churg-Strauss (eosinophilic granulomatosis w/ polyangiitis)
  • Helminths/schistosomes (NOT protozoans!)
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18
Q

Dopamine agonists treat

A

PD, prolactinomas, RLS

(restless leg syndrome).

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19
Q

Alpha 2-adrenergic agonists treat:

A
  • HTN (clonidine, methyldopa)
  • Anesthesia (dexmedetomidine)
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20
Q

Alpha-adrenergic blockers (vasodilators) treat

A

BPH & HTN

(prazosin, terazosin, doxazosin).

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21
Q

Renal + pulmonary findings

A

Goodpasture disease

(anti-basement membrane antibodies)

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22
Q

PTX in COPD pt

A

Rupture of alveolar blebs

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23
Q

PTX Auscultation

A

Decreased breath sounds,

decreased tactile fremitus,

hyperresonant percussion

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24
Q

Atalectasis Auscultation

A

Decreased BS,

decreased tactile fremitus,

dullness to percussion

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25
Q

Pleural effusion auscultation

A

Decreased BS,

decreased tactile fremitus, dullness to percussion

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26
Q

Consolidation

A

Increased BS

(+crackles, + egophony), Increased tactile fremitus, dullness to percussion

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27
Q

Emphysema

(same as PTX)

A

Decreased BS,

Decreased tactile fremitus, hyperresonant to percussion

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28
Q

Mediastinal shift

A
  • Away from = PTX, Pleural effusion (if large)
  • Toward = Atalectasis (if large)
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29
Q

COPD pt + seizures

A

2/2 hypercapnia

(CO2 retention) from chronic disease or

O2 supplementation (>92%)

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30
Q

Noncaseating granulomas + BL hilar adenopathy

A

Sarcoidosis

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31
Q

Noncaseating granulomas

A

Hypersensitivity pneumonitis or sarcoidosis

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32
Q

Elevation of L main bronchus on CXR

A

Enlarged LA from long-standing mitral stenosis

from RHD (think immigrants)

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33
Q

GERD can worsen asthma via

A

microaspiration

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34
Q

Urine osmolality in hypovolemia

A

ncreased

(dark urine; to conserve water)

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35
Q

Urine sodium in hypovolemia

A

decreased

(most sensitive indicator of hypovolemia)

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36
Q

Plasma renin activity in hypovolemia

A

increased

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37
Q

Urine urea nitrogen in hypovolemia

A

Decreased

(increased BUN reabsorption)

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38
Q

Aldosterone stimulates sodium exchange for _____

A

potassium

(in collecting tubules)

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39
Q

Serum potassium in hypovolemia

A

decreased

(due to aldosterone’s effects on collecting tubules)

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40
Q

Panacinar emphysema

A

Alpha-1 Antitrypsin Deficiency

(AAT)

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41
Q

Centriacinar emphysema

A

COPD

(smoking-induced)

42
Q

Lung cancer + hypercalcemia

A

SQUAMOUS CELL CARCINOMA of the lung (“sCa++mous” cell carcinoma of the Lung)

43
Q

Lung cancer + SIADH

A

SCLC

(Small-cell carcinoma of the lung)

44
Q

Lung cancer + ACTH production

A

SCLC

(Small cell carcinoma of the lung)

45
Q

Chest mass + Hypercalcemia

A

SCC of the lung vs. Sarcoidosis

  • Sarcoid = +Erythema nodosum, BL hilar adenopathy
  • SCC of the lung = +smoking hx, older
46
Q

Productive cough COPD

A

Chronic Bronchitis

47
Q

Dyspnea COPD

A

Emphysema

48
Q

PNA has increased/decreased lung sounds

A

increased

49
Q

Increased lung sounds

A

consolidation

50
Q

New-onset RBBB

A

Right heart strain

(think PE vs pHTN/cor pulmonale)

51
Q

cANCA+ —>

A

GPA

(Granulomatosis w/ Polyangiitis)

52
Q

pANCA+ —>

A
  • Microscopic polyangiitis
  • Eosinophilic granulomatosis w/ polyangiitis
  • PSC (Primary sclerosing cholangitis)
53
Q

Auditory canal ulcers

A

GPA

  • Granulomatosis with Polyangiitis (Wegener’s granulomatosis)
  • +triad of sinusitis, hemoptysis, hematuria
54
Q

Most common cause of hemoptysis in adults

A

Chronic bronchitis

(productive COPD)

55
Q

COPD

Exacerbations are most commonly triggered by

A

URIs

Thus, may present with fever

56
Q

Pleural plaques on CXR

A

Asbestosis

57
Q

Navy shipyard work

A

Asbestosis

58
Q

Drug-induced pulmonary fibrosis

A

Amiodarone, Bleomycin, Busulfan, MTX, Nitrofurantoin

59
Q

Restrictive PFTs w/ normal DLCO

A

OHS, MG, ALS

(not ILD; extrinsic)

60
Q

Most common adverse effect of low-dose inhaled corticosteroids

A

Thrush

Normal A-a gradient (oral candidiasis)

61
Q

Normal A-a gradient

A

<15 and increases with age

62
Q

Elevated A-a gradient regardless of age

A

>30

63
Q

Normal A-a gradient hypoxemia causes

A
  • Altitude (reduced inspired O2 tension)
  • Hypoventilation
  • Increased A-a gradient hypoxemia causes:
  • V/Q
  • R-L Shunt
  • Diffusion Limitation
64
Q

Anaerobic PNA is higher risk in

A

Alcoholics, Dysphagia

(foul-smelling sputum)

65
Q

Low bicarbonate

A

metabolic acidosis

66
Q

AAT presentation age

A

40s in nonsmokers, 30s in smokers

67
Q

Rhinosinusitis + Hemoptysis + Hematuria

A

GPA

(Wegener)

68
Q

Asthma Tx:

A

Asthma Tx

  • SABA
  • +ICS low-dose
  • +LABA or ICS med-dose
  • ICS med-dose + LABA
  • ICS high-dose + LABA
  • +oral corticosteroid
  • Consider omalizumab for pts w/ allergies
69
Q

Markedly decreased L breath sounds immediately after intubation

A

Malpositioned ETT

(R main bronchus)

70
Q

Positive bronchodilator response

(>12%) in FEV1

A

Asthma, always, 100% of the time.

71
Q

Ring sign or tram-track sign on CXR

A

Bronchiectasis

72
Q

How to confirm diagnosis of bronchiectasis

A

HRCT

(High-res CT)

73
Q

Diffuse BL interstitial infiltrates in imcx

A

PJP

(PCP)

74
Q

Fever, chest pain, hemoptysis triad + halo sign on CXR in imcx

A

Invasive aspergillosis

75
Q

+galactomannan in serum

A

Invasive aspergillosis

76
Q

CXR: Nodules w/ surrounding ground-glass opacities

A

Invasive aspergillosis

(“Halo” sign)

77
Q

Peripheral lung cancer

A

Adenocarcinoma vs. Large cell carcinoma

78
Q

Infusion of NS may worsen hyponatremia in patients with ___

A

SIADH

79
Q

Elevated AFP only

A

Hepatoblastoma/HCC

80
Q

Elevated AFP + B-hCG

A

Non-seminomatous germ cell tumor

81
Q

Elevated B-hCG only

A

Seminomatous tumor

82
Q

Anterior Mediastinal Mass

A

“4 T’s”

  • Thymoma
  • Thyroid neoplasm
  • Teratoma (+ other germ cell tumors)
    • Seminomatous - Elevated B-hCG (30%), Normal AFP
    • Non-seminomatous - Elevated B-hCG, Elevated AFP (yolk sac, choriocarcinoma, embryonal carcinoma, mixed germ cell) -
  • “Terrible” Lymphoma
83
Q

Lung disease superimposed on cavitary TB

A

CPA

Chronic Pulmonary Aspergillosis

84
Q

Localized airway obstruction

(e.g. recurrent PNA in same anatomic location)

A

CT Scan

(for malignancy)

85
Q

____ improves mortality in patients with ARDS

A

LTVV

86
Q

Most common cancer in pts

w/ asbestos exposure

A

Bronchogenic carcinoma

(pleural mesothelioma is actually much more rare)

87
Q

Honeycombing

A
  • Asbestosis
  • Eosinophilic granuloma
  • Bronchiectasis
88
Q

Normal/High FEV1/FVC

A

Restrictive

  • +Decreased DLCO = ILD
  • +Normal DLCO = Chest wall weakness
89
Q

Low FEV1/FVC

A

Obstructive

  • +Decreased DLCO = COPD
90
Q

Central lung cancer

A

SCC or SCLC

91
Q

Lung cancer + hypercalcemia

A

SCC of lung

92
Q

Lung cancer + clubbing + HPOA

A

Adenocarcinoma

93
Q

Lung cancer + Cushing syndrome

A

SCLC

94
Q

Lung cancer + SIADH

A

SCLC

95
Q

Lung cancer + Lambert-Eaton syndrome (LE)

A

SCLC

96
Q

Lung cancer + Gynecomastia/Galactorrhea

A

Large Cell Carcinoma of the lung

97
Q

Lung cancer + e/o necrosis/cavitation

A

SCC

98
Q

Most common primary lung cancer in smokers and non-smokers

A

Adenocarcinoma

99
Q

Most common complications of near drowning

A
  • ARDS
  • Brain damage (increased ICP or cerebral edema)
  • Arrhythmias
  • Acidosis (metabolic or respiratory)
  • ATN (2/2 prolonged hypoxemia/shock)
100
Q

Tx for Hypersensitivity Pneumonitis or Sarcoidosis

A

Steroids

(Glucocorticoids)

101
Q

Rule out TB before initiating these treatments:

A
  • Glucocorticoids (e.g. for hypersensitivity pneumonitis or sarcoidosis)
  • MTX

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