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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
Whorls of shed epithelium in mucus plugs in asthma
Curschmann?s Spirals
26
Crystalloid made up of eosinophil membrane protein seen in both asthma & amoebiasis
Charcot-Leyden Crystals
27
Predominant key cell involved in asthma
None
28
Characteristic feature of asthmatic airways
Eosinophil infiltration
29
Most common triggers of acute severe asthma exacerbations
URTI: rhinovirus, respiratory syncytial virus (RSV), coronavirus
30
Mechanism of exercise-induced asthma (EIA)
Hyperventilation
31
EIA is best prevented by regular treatment with
Inhaled corticosteroids (ICS)
32
Confirms airflow limitation with a reduced FEV1, FEV1/FVC ratio, and PEF
Spirometry
33
Confirms diurnal variation in airflow obstruction
Measurements of PEF twice daily
34
Primary action of B2-agonists
Relax smooth-muscle cells of all airways, where they act as functional antagonists
35
Most common side effect of anticholinergics
Dry mouth
36
Most common side effects of theophylline
Nausea, vomiting, headaches
37
Most effective controllers for asthma
ICS
38
Indicates the need for regular controller therapy
------------
39
Most common reason for poor control of asthma
--------------
40
Drugs that are safe for asthma in pregnancy
-----------
41
Most common pathogenesis of pneumonia
Aspiration
42
Most common etiology of community-acquired pneumonia
Streptococcus pneumoniae
43
Most common etiology of atypical pneumonia
Mycoplasma pneumonia
44
Most common cause of nosocomial pneumonia and pneumonia in cystic fibrosis patients
Pseudomonas aeruginosa
45
Most common viral cause of atypical pneumonia and bronchitis in children
Respiratory Syncytial Virus (RSV)
46
Main purpose of the sputum gram stain
Ensure suitability of sample for culture
47
To be adequate for culture, a sputum sample must have
>25 neutrophils; and
48
Most frequently isolated pathogen in blood cultures of community-acquired pneumonia
Streptococcus pneumoniae
49
Irreversible airway dilation that involves the lung in either a diffuse or focal manner
Bronchiectasis
50
Most common form of bronchiectasis
Cylindrical or tubular
51
Most cited mechanism for infectious bronchiectasis
Vicious cycle hypothesis
52
Most common clinical presentation
Persistent cough with production of thick sputum
53
Imaging modality of choice for confirming bronchiectasis
Chest CT
54
First step in diagnostic approach to pleural effusion
Determine whether the effusion is an exudate or a transudate
55
Leading causes of transudative pleural effusion
LV failure and cirrhosis
56
Leading causes of exudative pleural effusion
Bacterial pneumonia, malignancy, viral infection, pulmonary embolism
57
Most common cause of chylous pleural effusion
Malignancy
58
Three tumors that cause ~75% of all pleural effusions
Lung carcimona, breast carcimona, lymphoma
59
Benign ovarian tumors producing ascites and pleural effusion
Meigs' Syndrome
60
The only symptom that can be attributed to the malignant pleural effusion itself
Dyspnea
61
Condition most commonly overlooked in the differential diagnosis of a patient with undiagnosed effusion
Pulmonary embolism
62
Most common cause of chylothorax
Trauma (most frequently, thoracic surgery)
63
Treatment choice for most cases of chylothorax
Insertion of a chest tube plus administration of octreotide
64
Population at risk for spontaneous pneumothorax
Tall, thin men 20-40 y/o, smoker
65
Ipsilateral tracheal deviation
Tracheal deviation in spontaneous pneumothorax
66
Contralateral tracheal deviation
Tracheal deviation in tension pneumothorax
67
Coexistence of unexplained excessive daytime sleepiness with at least five obstructed breathing events (apnea or hypopnea) per hour of sleep
Obstructive sleep apnea
68
Breathing pauses lasting >10 seconds
Apnea
69
>10 second events where ventilation is reduced by at least 50% from the previous baseline
Hypopnea
70
First step in evaluating a mediastinal mass
Place it in one of the three mediastinal components
71
Most common lesions in anterior mediastinum
Mnemonic: Terrible T?s!
72
Most common lesions in middle mediastinum
Vascular masses, Lymphadenopathy from metastases or granulomatous disease, Pleuropericardial and bronchogenic cysts
73
Most common masses in the posterior mediastinum
Neurogenic tumors, Meningocoelesm Meningomyelocoeles, Gastroenteric cysts, Esophageal diverticula
74
First step in evaluating a mediastinal mass
Place it in one of the three mediastinal components
75
Most common lesions in anterior mediastinum
Mnemonic: Terrible T?s!
76
Most common lesions in middle mediastinum
Vascular masses, Lymphadenopathy from metastases or granulomatous disease, Pleuropericardial and bronchogenic cysts
77
Most common masses in the posterior mediastinum
Neurogenic tumors, Meningocoelesm Meningomyelocoeles, Gastroenteric cysts, Esophageal diverticula
78
One of the three major cardiovascular causes of death, along with MI and stroke
Venous thromboembolism
79
Causes of pulmonary embolism
Fat, foreign body, air, DVT, bone marrow, ambiotic fluid, tumor
80
Population at risk for pulmonary embolism
Patients with preexisting heart/lung disease (occurs in lower lobes)
81
Usual cause of death from pulmonary embolism
Progressive right HF
82
Most frequent history in DVT
Cramp in the lower calf that persists and worsens for several days
83
Most frequent history in PE
Unexplained breathlessness
84
Classic signs of PE
Tachycardia, low-grade fever, neck vein distension
85
Most frequent symptom of PE
Dyspnea
86
Most frequent sign of PE
Tachypnea
87
Useful rule-out test: >95% of patients with normal levels (<500 ng/ml) do not have PE
Quantitative plasma D-dimer ELISA
88
Most frequently cited ECG abnormality in PE (in addition to sinus tachycardia)
S1 Q3 T3 Sign (specific but insensitive)
89
Most common ECG abnormality in PE
T-wave inversion leads V1 to V4
90
Principal imaging test for the diagnosis of PE
Chest CT scan with IV contrast
91
Second-line diagnostic test for PE, used mostly for patients who cannot tolerate IV contrast
Lung scanning
92
Best known indirect sign of PE on transthoracic echo
McConnell's sign: hypokinesis of the RV free wall with normal motion of RV apex
93
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
Lung scanning
94
Foundation for successful treatment of DVT and PE
Anticoagulation
95
Massive pulmonary embolism
Systemic arterial hypotension with usually anatomically widespread thromboembolism
96
Moderate to large pulmonary embolism
RV hypokinesis with normal systemic arterial pressure
97
Small to moderate pulmonary embolism
Normal RV function and normal systemic arterial pressure (excellent prognosis with adequate anticoagulation)
98
Definition of ARDS
Acute onset (<24 hours), Bilateral patchy airspace disease, Absence of of left atrial hypertension (PCWP < 18 mmHg), Profound shunt physiology
99
Top 3 causes of ARDS
Gram-negative sepsis, gastric aspiration, severe trauma
100
Short-term morphology of ARDS
Waxy hyaline membranes
101
Long-term morphology of ARDS
Intra-alveolar fibrosis
102
Histologic manifestation of ARDS
Diffuse alveolar damage

Internal Medicine Mnemonics (8 decks)

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