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Pulmonology Flashcards

1
Q

Classification of asthma 2

A

Intermittent and persistent

Presistent-Mild,Moderate,severe

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2
Q

Quid asthma intermittent and RX

A

Symptom< ou egal 2f par semaine nightime awakening, 2f month use B2 agonist 2f par semaine
RX:Albuterol

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3
Q

Quid asthma Mild persistent and RX

A

Symptom>2 f par semaine,3 a 4 nightime awakening/month

Rx albuterol + inhaled corticosteroid

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4
Q

Quid asthma moderate persistent and RX

A

daily symptom,weekly nightime awakening,FEV 60-80

SABA+inhaled corticisteroid +long acting B2 agonist

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5
Q

Quid severe asthma and RX

A

daily symptoms,frequent nightime awakening,FEV<60

Same as Astma moderate +prednisone oral

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6
Q

Organ involved in wegener 3

A

Upper and lower respitatory

renal involvement

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7
Q

Renal involvement in wegener

A

rapidly progressive glomerulonephritis

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8
Q

Rx of wegener

A

corticosteroids

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9
Q

COPD and acute respiratory distress

A

Rule out secondary pneumothorax

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10
Q

Physiopato seconary pneumothorax in COPD

A

blebs rupture

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11
Q

quid Blebs

A

dilated apical alveoli

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12
Q

Dx of Blebs

A

CT scan

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13
Q

Management of acute exacerbation of COPD

A

NPPV,decreases Mortality

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14
Q

Cause of recurrent pneumonia involving same lung area(4)

A

Alcohol use,GERD,seizures,brochial stenosis

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15
Q

Community acquired Pneumonia with skin involvement

A

Mycoplasma Pneumoniae

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16
Q

Bugs causing Atypical pneumonia(4)

A

Mycoplasma P,Legionelle P,Chlamidya P,Coxiella and influenza

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17
Q

Disease causing granulomatous inflammation(2)….

A

TB,sarcoidosis

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18
Q

Dx confirmatory of Sarcoidosis

A

Biopsy by brochoscopy or by mediatinoscopy

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19
Q

Recurrent Pneumonia in smoker

A

Bronchogenic carcinoma

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20
Q

Pulmonary disease with high A-a gradient(2)….

A

PCP,PE

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21
Q

Causof recurrent pneumonia involving different sites of the lung(3)

A

Sinopulmonary disease
immunodeficiency
Nonn infectious cause,vasculitis

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22
Q

Cause of sinopulmonary disease reccurente(2)

A

Cystic fibrosis

immotile cilia

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23
Q

Rx CAP for inpatient

A

Levofloxacin

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24
Q

Rx CAP for out patient(2)

A

Azythromycin

Dox

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25
Dx of pulmonary HT(2)
Prominent pulmonary arteries | Enlarged right heart
26
Physiopatho ARDS in acute pancreatitis
Phospholipase A2 causes inflammation in lung and destroys surfactant
27
quid Pancoast tumor
Non small cell carcinoma
28
Findings in Pancoast Tumor(5)
``` Shoulder Pain Horner's syndrome C8-T2 involvement weight loss supra clavicular lymph node ```
29
Manif for c8-t2 involvement(3)
Paresthesie 4e et 5e doigt,bras et face ant avant-bras
30
Pneumonia et digestive symptom or hyponatremia or neurologic problem
Legionella
31
dx of legionella(2)
antigen in urine or charcoal agar
32
Rx of legionella(2)
Quinolone or macrolide(Azytromycin or levofloxacin)
33
Why b2 agonists causes hypokaliemia
they drive k+ into cells
34
Manif of HypoK+(3)
Mx weakness arythmia EKG changes
35
Why shock in massive PE
RV dilation Septum is pushed towards left ventricle Low ejection fraction---shock
36
Epidemio of histoplasmosis(2)
Missisipi,Ohio river | Link with guano
37
Pulmonary nodule in non smoker
rule out histoplasmosis
38
Quid of respiratory acidosis(3)
Low PH45 | Normal HCO3- 22-28
39
cause of respiratory acidosis
Hypoventilation
40
Main indication of BAL(2)
PCP | Malignancy
41
Indication for inferior vena cava filter placement(3)
contrindication to anticoagulant HIT DVT on heparin
42
Manif of Theophyline toxicity(2)
Neurologic | Palpitation
43
Metabolism of theophyline
Cytochrome P450
44
drug inhibiting CP450
``` Cimetidine clarythromycin ciprofloxacin erythromycin verapamil ```
45
FEV% in Obstructive disease
<70
46
FEV% in restrictive disease
>70
47
Restrictive disease with low DLCO
Intersticial disease
48
Restrictive disease with normal DLCO
Mx chest weakness
49
Bug causing pneumonia in alcoholics
Klebsiella
50
Quid Friedlander Pneumoniae(2)
Jelly sputum | Klebsiella
51
Bugs causing empyema(3)
Strep Pneumo Staph aureus Klebsiella
52
Quid Empyema
Pus in pleural space
53
Rx of empyema(2)
drainage | antibiotics
54
Most common site of Wegener
Upper respiratory tract
55
Wegener Quid(4)
Upper respiratory tract involvement Lower respiratory tract involvement Renal involvement Ulcer in leg
56
rx for Wegener
cyclophosphamide
57
PH fluid for empyema
<7,2
58
Acute productive cough with no fever and wheezing and sore throat
acute bronchitis
59
Rx of acute bronchitis
Supportive care
60
sleep apnea syndrome management
weight reduction avoid supine position avoid alcohol and sedatives
61
Therapeutic INR
2-3
62
indication of endotracheal intubation in asthma
Normal or High PCO2
63
Bad prognosis in asthma acute exacerbation
Normal or High PCO2
64
First measure in hypersensitivity pneumonitis
avoid antigen exposure
65
Two forms of hypersensitivity pneumonitis(2)
Bird fancier's Lung | farmer's Lung
66
Pneumonia linked with cruise
Legionella
67
PE and renal failure :RX
unfractionnated heparin
68
abnormal GFR
<30/ml/mn/1,73m2
69
Dx of adult astma
Increase FEV% after administration of bronchodilator
70
COPD exacerbation management(4)
Albuterol ipratopium antibiotics corticosteroids
71
Management of exercice induced astma
Short acting agonist 20 mn before exercising
72
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
73
Management of solitary nodule in non smoker <40 ans
serial chest xray to see if mass is incresing in volume
74
Prognosis of solitary nodule in nonsmoker
stable during 2 years ,no cancer
75
Indication of home oxygen in COPD(3)
Pa0255 si Pao2<60
76
PH of pleura transudate
7,4-7,55
77
PH of pleural exsudate
7,30-7,45
78
Quid of flail chest
>/ 3 ribs adjacent ruptured in two places
79
Rx
Positive pressure ventilation
80
Risk of flail chest
Paradoxical respiration
81
Co2 Narcosis Manif(2)
Seizure | cardiac problem
82
Risk for co2 narcosis
patient with acute or chronic respiratory failure treated with high o2 flow
83
Best site to biopsy for wegener
nasopharynx
84
Anapath wegener(2)
Medium and small size arteries involvement | granulomatous inflammation
85
PCO2 value in secondary pneumothorax causing by COPD
Normal 33-45
86
PCO2 value in acute exacerbation causing by COPD
High
87
2e cause of reccurent pneumoniae involving same site
Local anatomic brochial obstruction
88
Lofgren syndrome(4)
Adenonopathie hilaire erythema nodosum fever polyarthritis migratory
89
disease with lofgren syndrome
sarcoidosis
90
Biopsy findings in sarcoidosis
Non caseating granuloma
91
cause of bronchial obstruction(3)
Bronchial stenosis ca(bronchogenic carcinoma or carcinoisd tumor) foreign body
92
In reccurrent pneumonia test to do and why
Chest CT | to rule out bronchial obstruction
93
Seizures and respiratory
seizures can cause apnea and hypoventilation
94
Workup of PVCP pneumonia(3)
Chest xray Sputum induction by hypertonic saline BAL si sputum induction fails
95
Quid of bronchodilator challenge in obstructive pulmonary disease
Si FEV% increases:asthma | No change:COPD
96
Triad of wegener
Systemic vasculitis Upper and lower respiratory tract infection renal impairment
97
Rx of severe asthma exacerbation(4)
SABA Ipratopium corticisteroid si no improvement intubation
98
Rx for mild to moderate asthma exacerbation(2)
SABA | No Improvement corticosteroids
99
Confirmatory test for legionella(2)
Charcoal agar | or Urine antigen testing
100
When to initiate warfarin in DVT
when PTT>1,5 or 2 fois la normale
101
Inchronic respiratory acidosis ,link between PCO2 et HCO3
each 10 mm de hg of PCO2,HCO3- increases 0f 3,5
102
Exsudate physio patho
Increase capillary permeability
103
Transudate physio patho
Increase hydrostatic pressure | Decrease oncotic pressure
104
Centrally located nodule work up
Broncoscopy for Biopsy
105
peripherically located nodule
CT guided Biopsy
106
Measure to decrease mortality in COPD (3)
Home 02 stop smoking lung reduction surgery
107
Ideal sao2 for patient with acute exacerbation of COPD on O2
90-94%
108
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
109
First site of matastasis of choriocarcinoma
Lung
110
Dx of choriocarcinoma
BHCG en serie
111
hematologic side effect of steroids
Leukocytosis(Neutropphilia)
112
Link between GERD and astma
GERD can exacerbate asthma
113
Cor Pulmonale findings
Dyspnea dialted pulmonary artery Right heart failure(Increased P2)
114
Middle mediastinum Mass DX(5)
``` Trachea tumor bronchogenic cyst pericardic cyst aorta aneurysm lymphoma ```
115
Anterior Mediastinum Mass(4)
Terrible Lymphoma Thymoma Teratoma Thyroid Mass
116
Posterior Mediastinum Mass(3)
Neurogenic Mass aortic aneurism esophageal mass(Leiyomyoma)
117
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
118
Quid of hypertrophic osteoarthropathy(2)
clubbing | hand pain
119
significance of Hypertrophic osteoarthropathy
Lun cancer TB Emphysema bronchiectasis
120
chronic cough causes(12)
``` Post nasal drip asthma bronchiectasis GERD ACE inhibitor Mtral stenosis TB Broncite chroniques sclerodermia sarcoidosis fungal infection cancer of lung ```
121
Rx of post nasal drip
anti histaminique with anti cholinergic effect
122
COPD plus clubbing
Lung cancer
123
Risk for DVT above the knee
PE
124
Quid of DVT above the knee(3)
-illiac femoral popliteal
125
travel to mexico or any developing countries
Infectious disease
126
Physio patho of chronic cough in Mitral stenosis(3)
Left atrial enlargement | compression on reccurent laryngeal nerve-->cough and hoarsening of the voice
127
Cause of exsudate(5)
``` Infection Malignancy rhumatologic disease(connective tissue ) PE Iatrogenic ```
128
Dx of bronchiectasis
chest ct scan
129
Clue for GERD induced asthma
Hoarseness in the morning
130
dx et Rx of GERD induced asthma
Pomp inhibitor
131
When suspect anaerobic pneumonia(3)
After any procedure involving upper digestive tract Failure in rx CAP rx Any neurologic problem impairing swallowing ability
132
Normal A-a gradient
<15
133
cause high A-a gradient(3)
``` Diffusion limitation(Interticial disease) VQ mismatch(PE,pulmonary edema) Shunt intra cardiac ```
134
Calculation of A-a gradient
PAo2-Pao2
135
Respiratory distress in new intubated patient/why(2)
right main bonchus intubation | because of pulmonary edema
136
VQ mismatch physiologic shunting effect
lyng down on affected lung decreases SAO2 because of increase physiologic shunting
137
role of FIO2 in ventilation settings(2)
Helps to know the degree of oxygenation | 50 a 60 is the required value
138
why glucose is low in exsudate<60
because of presence of white cells
139
indication of chest thoracostomy in the setting of parapneumonic effusion(2)
low PH < 7,2 in pleural fluid | low glucose <60
140
OPD with normal DLCO (carbone monoxyde diffusion a 100%)
chronic bronchitis
141
OPD with high DLCO
asthma
142
OPD with decreased DLCO
Emphysema
143
pulmonary cause of hemoptysis(7)
``` Bronchitis PE Bronchiectasis cancer TB Lung abcess Wegener ```
144
Quid of chronic bronchitis
productive cough lasting for 3 months 2 years consecutives
145
COPD exacerbation with respiratory failure
NPPV noninvasive positive pressure ventilation
146
COPD with failure of NPPV
endotracheal intubation
147
spirometry of ARDS
Pao2/fi02<300mm de hg
148
xray of ARDS
bilateral opacily
149
Bugs causing lung infection in bronchiectasis
Pseudomonas
150
VQ mismatch(3)
Pulmonary edema PE PCP
151
cause of respiratory distress(4)
ARDS Trauma Infection OPD
152
PAo2 calculation
Fio2(Patm-PH20)-Pco2/r 0,21 (760-47)-pco2/0,80 149,73-pco2/0,80
153
Cause of Hypoxia(5)
``` Hypoventilation(CNS depression) Reduced o2 inspired(high altitude) Vq mismatch diffusion limitation intracardiac shunt ```
154
hypoxia which can be corrected by O2
intracardiac shunt
155
cause of low glucose in pleural fluid(4)
TB Empyema Rhumatoid arthritis Malignancy
156
drug induced lupus(3)
hydralazine isoniazid procainamide
157
Drug induced lupus causes exsudate ou transudate
exsudate
158
cause of hyper coagulable state(6)
``` OCP use Facteur V leiden Dehydration Protien C et S deficiency cancer Hyperhomocyteinemie(folate,B12,B6) ```
159
Does seminoma produce AFP
no
160
Mixed germ cell tumor dx
AFP and BHCG are produced
161
Extra pulmonary manif of ca pulmonaire(3)
Paraneoplastic syndrome Pancoast syndrome SVC syndrome
162
Cause of ARDS(4)
infection acute pancreatitis trauma massive transfusion
163
Physical exam in pneumonia(4)
consolidation---> Dulness to percussion Increase tactile fremitus bronchial type sound or decreased breath sound
164
Physical exam in pleural effusion(3)
Decreased breath sound decrease tactile fremitus dulness to percussion
165
Pulmonary embolism and RV dilation(2)
Increase pulmonary artery pressure | right atrial and ventricular dilation
166
Physio patho of ACE inhibitor induced cough
accumulation of kinin
167
respiratory acidosis compensation(2)
renal retention of bicarb | decrease chloride reabsorbtion
168
why sleep apnea can cause respiratory acidosis
hypoventilation
169
complication of sleep apnea(3)
respiratory acidosis cor pulmonale hta pulomanire
170
bad prognosis of acute asthma attack(5)
``` High or normal PCO2 silent lung cyanosis altered sensorium difficulty speech ```
171
Characteristic of atypical pneumonia
cause extra pulmonary features
172
Dx of bronchiectasis
CT of chest
173
Complication of bronchiectasis
Hemoptysis
174
side effect# 1 of bclomethasone use
oral thrush
175
type of hypersensitivity is aspirin induced asthma(2)
indeterminate | It'a a pseudo allergic reaction
176
Rx of aspirin induced asthma
antagonist of leukotrien
177
action of aspirin(2)
block cox 1 and cox 2 | Accumulalation of leukotrien from lipoxygenase pathway
178
action of steroid(3)
``` block phospholipase no arachidonic acid produced both pathways(lipoxygenase and cyclooygenase ) are blocked ```
179
gold standard for DX CAP
chest xray
180
gold standard to DX sleep apnea
nocturnal polysomnography
181
cause of empyema(4)
Lung infection post hemothorax neighborhood abcess(hepatic ) esophageal rupture
182
Post hemothorax empyema dx and rx(2)
CT of chest | surgery
183
Most common inherited disorder causing hypercoagulable state
factor v leiden
184
Physiopatho factor v leiden
Point mutation | Can be activate by protein C
185
Acido basis balance in COPD
respiratory acidosis
186
acidobasic balance in CHF
respiratory alkalosis
187
organ involvement in goodpasture disease(2)
lung involvement | renal involvement
188
physio patho of goodpasture(2)
antibody against type iv collagen | antibody anti basement membrane
189
ventilated patient with high PA02 but normal PH,management
decrease FIO2
190
ventilated patient with high Pao2 and respiratory alkalosis,management
decrease respiratory rate
191
clue for alpha 1 anti trypsine deficiency(2)
emphysema in non smoker and young | cirrhosis in young patient
192
confirmatory dx of AAT deficiency
Measure alpha 1 anti trypsine
193
cause of transudat(4)
CHF cirrhosis nephrotic syndrome peritoneal dyalisis
194
Qui of non allergic rhinitis(2)
Post nasal drip, | chronic cough important clue
195
modality of treatment of non allergic rhinitis(2)
intranasal glucocorticoid or intra antihistaminique | oral anti allergic with anticholinergic effect
196
Xray findings in PE
Hampton's hump | westermak's sign
197
Most common symptom of PE(2)
Shortness of breath | pleuritic chest pain
198
EKG in PE(2)
sinus tachycardia | S1Q3T3
199
Bad prognosis in PE(2)
AFIB | Low saturation
200
wells modified criteria 3 points(2)
3 points si DVT | si aucun autre dx ne peut etre retenu
201
wells modified criteria 1,5 points(3)
immobilisation recent surgery tachycardy >100
202
Wells modified criteria 1 point (2)
Ca | Hemoptysis
203
Next step in Wells modified >4(3)
Ct angiography of chest si positif heparin si negatif exlude PE
204
Next step if wells criteria<4
Ddimer measure >500 ng--->ct scan chest <500 exclude PE
205
epidemio of blastomycosis(3)
ohio missisipi great lakes
206
clue for blastomycosis
Lung infection ulcerative skin lesion bone osteolytic lesion
207
normal PH in blood
7,35-7,45
208
normal PaO2
75-105
209
Normal PaCO2
33-45
210
Lung exam during food allergy
stridor
211
Physiopatho of stridor in food allergy
laryngeal edema
212
Why diaphram is flat in late COPD
Hyperinflation
213
Consequence of diaphram flattening
increase work of breathing
214
What are increased in COPD(2)
-residual lung volume | total lung capacity
215
Why residual lung volume is increased in COPD
because air is trapped in lungs
216
Why total lung capacity is increased in COPD
because of hyperinflation
217
Mobile cavity mass on chest xray and hemoptysis
aspergiloma
218
Rx of anaphylactic shock
IM epinephrine
219
Common cause of anaphylaxis in the US
bee stung
220
20 years later pateient treated for hodgkin lymphoma by radiation develops lung mass Dx?
secondary malignancy induced by radiation
221
other complication of radiation used during Hogkin lymphoma treatment(2)
Acute leukemia | Non hogkin lymphoma
222
First cause of daytime sleepiness in the US
sleep apnea
223
complication of sleep apnea
Erythrocytosis HTA pulmonaire right ventricular failure
224
Most common secodary ca in radiation during H Lymphoma(5)
``` Lung breast bone thyroid digestive ```
225
Risk factor for sleep apnea(3)
obesity tonsillar hypertrophy hypothyroidism
226
Asbestosis and occupation(7)
``` Mining plumbing construction worker shipyard insulation worker carpenter Plastic and rubber industry ```
227
when worker will develop asbestosis
>20 years after exposure
228
Key pulmonary findings of asbestosis
pleural plaques
229
what's the risk of asbestosis(2)
Malignant mesothelioma | Bronchogenic carcinoma
230
chest xray findings in asbestosis
Pleural plaques | intersticial abnormalities
231
Spirometry in asbestosis(2)
Normal FEV% | Low DLCO
232
Mainstay of rx of acute COPD exacerbation(2)
Albuterol nebulizer | corticosteroid
233
Cause of ARDS(5)
``` Sepsis acute pancreatitis severe bleeding burns toxic ingestion ```
234
Cause of digital clubbing
Lung cancer | cystic fibrosis
235
Mainstay of rx of ARDS
Mechanical ventilation with low tidal volume and PEEP
236
role of PEEP
preventing alveolar collapse
237
PEEP in ARDS
15 mm de h20
238
respiratory failure in setting of infection
ARDS
239
Chest trauma and respiratory failure DX
ARDS
240
syptomatic rx of COPD(2)
Anti muscarinic | SABA
241
Cause of Pancoast tumor
Sulcus superior tumor
242
Physical exam in Pneumonia with no airway obstruction(2)
Dullness to percussion | Bonchial type sound(louder expiratory component or louder breath sounds)
243
Physical exam in pneumonia with airway obstruction(2)
Dulness to percussion | decrease breath sound
244
recurrent pnemonia in dementia patient
aspiration
245
cause of aspiration in dementia patient or inconsciousness state
impaired epiglottic reflexe
246
% risk of cancer in smoker with asbestosis
59 fold risk
247
Localisation of pleural plaques in chest xray and morphology of plaques(2)
on diaphram coupole | needle shape
248
3 most common causes of chronic cough
post nasal drip GERD asthma
249
what's the primary long term intervention in asthma management
inhaled corticosteroid
250
what's the primary long term intervention in COPD management
Anticholinergic(ipratopium)
251
How will be urine PH in respiratory alkalosis
HIGH
252
why Urin PH is high in respiratory alkalosis(3)
renal compensation decrease reabsorbtion of HCO3 Increase reabsorption of H+
253
Pneumonie in immunocompromised patient
PCP
254
chest Xray in PCP
Diffuse intersticial infiltrates
255
V/q scan in PE(2)
perfusion defect | without ventilation defect
256
High PEEP complication(3)
tension pneumothorax Alveolar damage hypotension
257
Patient on mechanical ventilation develops absence of breath sound unilaterally
tension pneumothorax
258
Quid of idiopathic pulmonary fibrosis
deposition of collagen in perialveolar tissues
259
A-a gradient in Idiopathic pulmonary fibrosis(2)
High | diffusion problem
260
Most common infection causing intersticial lung disease(3)
TB viral pneumonia Fungal infection
261
Most common vasculitis involved in intersticial lung disease
Wegener
262
Most common occupationnal disorder causing intersticial lung disease(2)
silicose | Hypersensitivity pneumonitis
263
most common connective tissue causing intersticial lung disease(2)
SLE | Sclerodema
264
other causes of Intersticial lung disease(3)
idipathic pulmonary fibrosis Intersticial pneumonia cryptogenic organising pneumonia
265
Chest xray of interticial lung disease(2)
reticular | nodular opacities

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