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Internal Medicine Mnemonics > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

Areas of gas exchange in the respiratory tract

A

Respiratory bronchiole

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2
Q

4 basic lung volumes

A

Inspiratory Reserve Volume (IRV)

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3
Q

Amount of air inhaled /exhaled with each normal breath

A

TV (~0.5L)

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4
Q

Amount of air remaining in the lungs after full exhalation

A

RV (maintains oxygenation between breaths)

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5
Q

Maximum amount of air that one can inhale/exhale

A

Vital Capacity (IRV + TV + ERV)

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6
Q

Anatomic dead space volume

A

Area with no gas exchange from nose to terminal bronchiole (~150mL)

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7
Q

Physiologic dead space volume

A

Anatomic dead space volume + alveolar dead space volume

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8
Q

Alveolar Ventilation per minute

A

Respiratory Rate x (TV - Physiologic Dead Space Volume)

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9
Q

Minute Respiratory Volume

A

TV x RR

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10
Q

Stimulates central chemoreceptors in the medulla

A

Carbon Dioxide (as CSF +)

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11
Q

Lung Zones

A

Zone 1 (no blood flow)

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12
Q

Increase in the following factors would cause shift to the right of the O2-Hgb dissociation curve (unloading of O2 from Hgb)

A

Mnemonic: CADET face RIGHT: CO2, Acidosis, 2,3-DPG, Exercise, Temperature

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13
Q

Increase in the following factors would cause shift to the left of the O2-Hgb dissociation curve (increased binding of O2 to Hgb)

A

Carbon monoxide, fetal hemoglobin

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14
Q

Percentage of blood that gives up oxygen as it passes through the tissue capillaries

A

Utilization coefficient (25% at rest, 75-85% during exercise)

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15
Q

Central control of inspiration; sends inspiratory ramp signals

A

Dorsal respiratory group (DRG) of the medulla

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16
Q

Central control of both inspiration and expiration; sends overdrive mechanism in exercise

A

Ventral respiratory group (VRG) of the medulla

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17
Q

Limits inspiration and increases respiratory rate

A

Pneumotaxic center of the pons

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18
Q

Stimulates the inspiration and decreases the respiratory rate

A

Apneustic center of the pons

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19
Q

Receptors in the ventral medulla that is stimulated by CSF H+ from blood CO2; adapts within 1-2 days

A

Central chemoreceptors

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20
Q

Receptors in carotid bodies (CN IX) and aortic bodies (CN X); activated when PO2 < 70 mmHg and to a lesser extent, CO2

A

Peripheral chemoreceptors

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21
Q

Reversibility in asthma (spirometry)

A

> 12% and 200mL increase in FEV1: 15 minutes after an inhaled short-acting B2-agonist; or

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22
Q

Physiologic abnormality of asthma

A

Airway hyperresponsiveness

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23
Q

Pathogenesis behind asthma

A

Imbalance favoring TH2 production over TH1 -> increases IL-1, IL-5 -> increased eosinophils

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24
Q

Putative mediators of asthma

A

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

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25
Q

Whorls of shed epithelium in mucus plugs in asthma

A

Curschmann?s Spirals

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26
Q

Crystalloid made up of eosinophil membrane protein seen in both asthma & amoebiasis

A

Charcot-Leyden Crystals

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27
Q

Predominant key cell involved in asthma

A

None

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28
Q

Characteristic feature of asthmatic airways

A

Eosinophil infiltration

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29
Q

Most common triggers of acute severe asthma exacerbations

A

URTI: rhinovirus, respiratory syncytial virus (RSV), coronavirus

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30
Q

Mechanism of exercise-induced asthma (EIA)

A

Hyperventilation

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31
Q

EIA is best prevented by regular treatment with

A

Inhaled corticosteroids (ICS)

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32
Q

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

A

Spirometry

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33
Q

Confirms diurnal variation in airflow obstruction

A

Measurements of PEF twice daily

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34
Q

Primary action of B2-agonists

A

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

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35
Q

Most common side effect of anticholinergics

A

Dry mouth

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36
Q

Most common side effects of theophylline

A

Nausea, vomiting, headaches

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37
Q

Most effective controllers for asthma

A

ICS

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38
Q

Indicates the need for regular controller therapy

A
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39
Q

Most common reason for poor control of asthma

A
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40
Q

Drugs that are safe for asthma in pregnancy

A
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41
Q

Most common pathogenesis of pneumonia

A

Aspiration

42
Q

Most common etiology of community-acquired pneumonia

A

Streptococcus pneumoniae

43
Q

Most common etiology of atypical pneumonia

A

Mycoplasma pneumonia

44
Q

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

A

Pseudomonas aeruginosa

45
Q

Most common viral cause of atypical pneumonia and bronchitis in children

A

Respiratory Syncytial Virus (RSV)

46
Q

Main purpose of the sputum gram stain

A

Ensure suitability of sample for culture

47
Q

To be adequate for culture, a sputum sample must have

A

> 25 neutrophils; and

48
Q

Most frequently isolated pathogen in blood cultures of community-acquired pneumonia

A

Streptococcus pneumoniae

49
Q

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

A

Bronchiectasis

50
Q

Most common form of bronchiectasis

A

Cylindrical or tubular

51
Q

Most cited mechanism for infectious bronchiectasis

A

Vicious cycle hypothesis

52
Q

Most common clinical presentation

A

Persistent cough with production of thick sputum

53
Q

Imaging modality of choice for confirming bronchiectasis

A

Chest CT

54
Q

First step in diagnostic approach to pleural effusion

A

Determine whether the effusion is an exudate or a transudate

55
Q

Leading causes of transudative pleural effusion

A

LV failure and cirrhosis

56
Q

Leading causes of exudative pleural effusion

A

Bacterial pneumonia, malignancy, viral infection, pulmonary embolism

57
Q

Most common cause of chylous pleural effusion

A

Malignancy

58
Q

Three tumors that cause ~75% of all pleural effusions

A

Lung carcimona, breast carcimona, lymphoma

59
Q

Benign ovarian tumors producing ascites and pleural effusion

A

Meigs’ Syndrome

60
Q

The only symptom that can be attributed to the malignant pleural effusion itself

A

Dyspnea

61
Q

Condition most commonly overlooked in the differential diagnosis of a patient with undiagnosed effusion

A

Pulmonary embolism

62
Q

Most common cause of chylothorax

A

Trauma (most frequently, thoracic surgery)

63
Q

Treatment choice for most cases of chylothorax

A

Insertion of a chest tube plus administration of octreotide

64
Q

Population at risk for spontaneous pneumothorax

A

Tall, thin men 20-40 y/o, smoker

65
Q

Ipsilateral tracheal deviation

A

Tracheal deviation in spontaneous pneumothorax

66
Q

Contralateral tracheal deviation

A

Tracheal deviation in tension pneumothorax

67
Q

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

A

Obstructive sleep apnea

68
Q

Breathing pauses lasting >10 seconds

A

Apnea

69
Q

> 10 second events where ventilation is reduced by at least 50% from the previous baseline

A

Hypopnea

70
Q

First step in evaluating a mediastinal mass

A

Place it in one of the three mediastinal components

71
Q

Most common lesions in anterior mediastinum

A

Mnemonic: Terrible T?s!

72
Q

Most common lesions in middle mediastinum

A

Vascular masses, Lymphadenopathy from metastases or granulomatous disease, Pleuropericardial and bronchogenic cysts

73
Q

Most common masses in the posterior mediastinum

A

Neurogenic tumors, Meningocoelesm Meningomyelocoeles, Gastroenteric cysts, Esophageal diverticula

74
Q

First step in evaluating a mediastinal mass

A

Place it in one of the three mediastinal components

75
Q

Most common lesions in anterior mediastinum

A

Mnemonic: Terrible T?s!

76
Q

Most common lesions in middle mediastinum

A

Vascular masses, Lymphadenopathy from metastases or granulomatous disease, Pleuropericardial and bronchogenic cysts

77
Q

Most common masses in the posterior mediastinum

A

Neurogenic tumors, Meningocoelesm Meningomyelocoeles, Gastroenteric cysts, Esophageal diverticula

78
Q

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

A

Venous thromboembolism

79
Q

Causes of pulmonary embolism

A

Fat, foreign body, air, DVT, bone marrow, ambiotic fluid, tumor

80
Q

Population at risk for pulmonary embolism

A

Patients with preexisting heart/lung disease (occurs in lower lobes)

81
Q

Usual cause of death from pulmonary embolism

A

Progressive right HF

82
Q

Most frequent history in DVT

A

Cramp in the lower calf that persists and worsens for several days

83
Q

Most frequent history in PE

A

Unexplained breathlessness

84
Q

Classic signs of PE

A

Tachycardia, low-grade fever, neck vein distension

85
Q

Most frequent symptom of PE

A

Dyspnea

86
Q

Most frequent sign of PE

A

Tachypnea

87
Q

Useful rule-out test: >95% of patients with normal levels (<500 ng/ml) do not have PE

A

Quantitative plasma D-dimer ELISA

88
Q

Most frequently cited ECG abnormality in PE (in addition to sinus tachycardia)

A

S1 Q3 T3 Sign (specific but insensitive)

89
Q

Most common ECG abnormality in PE

A

T-wave inversion leads V1 to V4

90
Q

Principal imaging test for the diagnosis of PE

A

Chest CT scan with IV contrast

91
Q

Second-line diagnostic test for PE, used mostly for patients who cannot tolerate IV contrast

A

Lung scanning

92
Q

Best known indirect sign of PE on transthoracic echo

A

McConnell’s sign: hypokinesis of the RV free wall with normal motion of RV apex

93
Q

Definite diagnostic test for PE, used mostly for patients who cannot tolerate IV contrast PE which visualizes an intraluminal filling defect in more than one projection

A

Lung scanning

94
Q

Foundation for successful treatment of DVT and PE

A

Anticoagulation

95
Q

Massive pulmonary embolism

A

Systemic arterial hypotension with usually anatomically widespread thromboembolism

96
Q

Moderate to large pulmonary embolism

A

RV hypokinesis with normal systemic arterial pressure

97
Q

Small to moderate pulmonary embolism

A

Normal RV function and normal systemic arterial pressure (excellent prognosis with adequate anticoagulation)

98
Q

Definition of ARDS

A

Acute onset (<24 hours), Bilateral patchy airspace disease, Absence of of left atrial hypertension (PCWP < 18 mmHg), Profound shunt physiology

99
Q

Top 3 causes of ARDS

A

Gram-negative sepsis, gastric aspiration, severe trauma

100
Q

Short-term morphology of ARDS

A

Waxy hyaline membranes

101
Q

Long-term morphology of ARDS

A

Intra-alveolar fibrosis

102
Q

Histologic manifestation of ARDS

A

Diffuse alveolar damage

Internal Medicine Mnemonics (8 decks)

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