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IM > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

confirms diagnosis of asthma

A

Spirometry

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2
Q

First line tx for BA

A

Inhaled Corticosteroid

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3
Q

Pathophysio of BA

A

Airway hyperresponsiveness

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4
Q

Chronic cugh

A

> 8 weeks

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5
Q

M/C chroic cough, non smoker, normal XRay

A

Post Nasal Drip
Asthma
GERD

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6
Q

Major risk factor for asthma

A

Atopy

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7
Q

M/C Allergens to trigger Asthma

A

Dermatophagoides

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8
Q

Worse art Night

A

Bronchial Asthma

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9
Q

Quantify expiratory airway obstruction

A

Simple spirometry

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10
Q

Determines reactive airway disease

A

Metachollne/ Histamine

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11
Q

Criteria BA by spirometry

A

Reduced FEV1/FVC <0.7

Reduced FEV1 that inc by >12% and by at least 200 mg from baseline post bronchodilator

Reduced FEV1 that inc by >12% and by at least 200 mg from baseline 4 weeks after steroid trial

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12
Q

When to start ICS

A

> 2 symptoms/ month
1 waking for asthma/ month
Asthma symptoms + risk for exacerbations

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13
Q

When to step up ICS

A

Persistence 2-3 mos

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14
Q

When to step down

A

Maintained for 3 mos

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15
Q

Asthma relievers

A

SABA
SAMA
Metylxanthine

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16
Q

Asthma Controllers

A 
Inhaled CS
Systemic Steroids
LABA
Leukotriene modifying agents
Cromolyn
Anti Ige
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17
Q

Indication for impending O2 failure

A

Normal or rising CO2

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18
Q

Exercise Induced asthma

A

Leukotrienes/ Bronchodilators Prior

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19
Q

Older, Smoker, Barrel Chest, Expiratory wheezes

A

COPD

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20
Q

Best initial test for COPD

A

CXR

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21
Q

Best diagnostic test during acute exacerbation

A

ABG

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22
Q

Target Organ Saturation COPD

A

> 90%

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23
Q

Most common risk factor COPD

A

Tobacco Smoking

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24
Q

Hallmark COPD

A

Airflow obstruciton

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25
Q

Confirms airway limitation in COPD

A

FEV1/FVC <0.7

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26
Q

COPD Manif

A 
Dyspnea
Chronic cough
Chronic sputum
Barrel Chest
Quiet Chest
Hyperresonance
Tripod position
Right Sided Heart Failure - Cor pulmonale
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27
Q

Definitive COPD diagnostic

A

FEV1/FVC <0.7

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28
Q

GOLD 1

A

> 80

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29
Q

GOLD 2

A

> 50-<80

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30
Q

GOLD 3

A

> 30-<50

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31
Q

GOLD 4

A

<30

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32
Q

Dyspnea Rating

A 
0 not troubled
1 level ground slight hill
2 slower similar age
3 100 m
4 leave the house
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33
Q

3 interventions COPD

A

Smoking cessation
O2 therapy
Lung volume reduction

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34
Q

When to start supplemental O2 in COPD

A

pO2 <55/ sat <88

pO2 <60/ sat <90

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35
Q

For moderate to severe exacerbations

A

Roflumilast

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36
Q

5As to quit smoking

A 
Ask
Advice
Assess
Assist
Arrange
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37
Q

COPD Exacerbation

A

Dyspnea
Cough
Change in Sputum

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38
Q

Bacteria in COPD exacebration

A

S. pneumoniae
H. influenzae
M. catarrhalis

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39
Q

Non Invasive Positive Pressure Ventilation

A

Respiratory acidosis
Severe dyspnea
Persistent hypoxemia

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40
Q

Antibiotics given in COPD

A

Azithromycin

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41
Q

Adequate sputum sample

A

> 25 neutrophils

< 10 squamous EC

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42
Q

Urinary Antigen for CAP

A

Pneumococcal and Legionella

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43
Q

CURB 65

A 
Confusion
Urea/ BUN >30
RR >30
BP >90/<60
65 yo
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44
Q

Low Risk CAP Tx

A

Amoxixcillin - no co morbids

Co Amox - stable co morbids

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45
Q

Moderate Risk

A

Ampi Sul/ Ceftri + Levoflox/ Moxiflox (same with high Risk)

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46
Q

High Risk with Risk for Pseudomonas

A

Pip Taz + Genta/ Amika

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47
Q

Resolution Time

A

1 week Fever
4 weeks Sputum
6 weeks Cough
6 mos normal

Normal XRay 4-12 weeks
Leukocytosis 2-4 days

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48
Q

Most accurate test CAP

A

Chest CT

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49
Q

DOC Lung Abscess

A

Clindamycin

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50
Q

CD4 <200

A

Pneumocytsis Pneumonia

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51
Q

Gold Standard for Pneumocystis Pneumonia

A

Bronchial Alveolar Lavage

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52
Q

DOC Pneumocystis Pneumnia

A

TMP/SMX

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53
Q

Best initial test PTB

A

XRay + Sputum AFB

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54
Q

Most infectious form of TB

A

Cavitary and Laryngeal

55
Q

Primary TB

A

Children
Ghons Focus
Middle and Lower Lung

56
Q

Post Primary

A

Adult
Reactivation
Apical and Posterior

57
Q

Presumptive TB

A

Cough of 2 weeks
Contact with Known TB + Cough
CXR -> + TB

58
Q

Dilated vessel in cavity -> Hemptysis

A

Rasmusens Aneurysm

59
Q

Gold Standard TB dx

A

TB Culture

60
Q

Gene XPert

A

Initial Test
Smear Neg TB but with + X Ray
Presumptive Drug resistant TB (Rifampin)

61
Q

> 10 mm TST, but neg symptoms and X Ray

A

Latent TB

62
Q

DSSM

A

Primary Diagnostic Method

2 sputum specimen 1 hr apart; at least 1 +

63
Q

Most Hepatotoxic anti TB

A

Pyrazinimide

*All TB Drugs are hepatotoxic

64
Q

Peripheral Neuropathy

A

Isoniazid

Antidote : Vit B6

65
Q

Autoimmune thromocytopenia

A

Rifampin

66
Q

Most common extrapulmonary TB

A

TB Lymphadenitis

67
Q

Potts Disease

A

Lower Thoracid Upper Lumbar

68
Q

Gold Standard for TB Meningitis Dx

A

CSF Culture

69
Q

Choroidal Tubercle in eyes

A

Miliary TB

70
Q

Dysepnea, Absent BS, Dullness of Percussion at Base of Lung

A

Pleural Effusion

71
Q

Best initial Diagnostic Test for PE

A

CXR PA - L

72
Q

Most accurate test

A

UTZ guided thoracintesis

73
Q

Exudative PE

A

Measure the serum and pleural fluid protein

74
Q

Transudative effusion measurement

A

Serum - PF protein gradient: >31 g/L or 3.1 g/dL

75
Q

M/C Cause of pleural effusion

A

LV Heart Failure

76
Q

M/C Cause of exudative pleural effusion (PH)

A

TB

77
Q

2nd most common cause of exudative PE

A

Malignancy

78
Q

Lights Criteria

A

PF/Serum Protein >0.5
PF/Serum LDH > 0.6
PF LDH > 2/3 upper normal serum limit

79
Q

Light Criteria Met

A

Exudative

80
Q

M/C cause of Malignant Pleural Effusion

A

Lung CA

81
Q

Bilateral PE in the absence of Cardiomegaly

A

Malignancy

82
Q

Chylothorax

A

Milky gross appearance
Fat content > 400 mg/dl
Chylomicrons seen

83
Q

Most common cause of Chylothorax

A

Lymphoma

84
Q

Rupture of subpleural bleb

A

Pneumothorax

85
Q

Diminished breath sounds, hyperresonance

A

Peumothorax

86
Q

Best initial test for pneumothorax

A

CXR

87
Q

Most appropriate tx for Pneumothroax

A

Chest tube thoraccostomy

88
Q

Occurs without antecedent trauma to the thorax

A

Spontaneous pneumothorax - Smoking m/c cause

89
Q

Pneumothorax, absence of underlying lung disease

A

Primary Pneumothorax - M/C Smoking

90
Q

MC cause of Secondary pneumothorax

A

COPD

91
Q

Pneumothorax, trachea away

A

Tension pneumothorax

92
Q

CXR Pneumothorax

A

Partial lung collapse on side of pneumothorax

93
Q

Non tension pneumothorax X Ray

A

Trachea/ mediastinum unchanged, will shift towards affected side

94
Q

Preferred insertion site for tube thoracostomy

A

4th or 5th ICS Anterior Axillary line

95
Q

Tx Primary Spontaneous Pneumothorax

A

Simple Aspiration

96
Q

Tx Secondary Spontaneous Pneumothorax

A

Tube Thoracostomy

97
Q

Tx Traumatic Pneumothorax

A

Supplemental O2 + Aspiration

98
Q

Respi Failure Type I

A

Acute Hypoxemic

99
Q

Respi Failure Type II

A

Hyperbaric

100
Q

Respi Failure Type III

A

Atelectasis

101
Q

Repi Failure Type IV

A

Hypoperfusion

102
Q

Hypercarbia corrected by

A

Increasing RR and TV

103
Q

Hypoxemia corrected by

A

Increasing FiO2 and PEEP

104
Q

Severe dyspnea of sudden onset, hypoxemia, diffuse pulmonary inflitrates

A

ARDS

105
Q

Mechanical ventilator strategy that improved survuval

A

Low Tidal Volume

106
Q

ARDS Criteria

A

Berlin Criteria

107
Q

Berlin Criteria

A

Acute onset: Within 1 week
Ratio: PaO2/FiaO2
Diffuse Bilateral alveolar or interstitial infiltrates
Swan Ganz Wedge Pressure <18 mmHg

108
Q

Severity of ARDS

A

PaO2/FiO2: 200-300 - MILD
PaO2/FiO2: 100-200 - MODERATE
PaO2/FiO2: <100 - SEVERE

109
Q

MV management in ARDS

A

Low Tidal Volume 6 mL/kg

High PEEP 12-15 mmHg

110
Q

Early muscular blockade in ARDS

A

Cistatracurium besylate

111
Q

Hypotension, HR 140, Elavated JVP, Bilateral Crackles

A

Cardiogenic Shock

112
Q

3 components of shock state

A

Systemic Arterial Hypotension - SBP <90 MAP <70 with Tachycardia
Tissue Hypoperfusion
Hyperlactatetemia >1.5

113
Q

First choice fluid for circulatory shock

A

Crystalloid 300-500 mL in 30 mins

114
Q

First choice vasopressor for Circulatory Shock

A

Norepinephrine

115
Q

Inotropic of choice for Circulatory shock

A

Dobutamine

116
Q

Approach for Circulatory Shock

A

O2
Fluid
Vasoconstrictors
Inotropics

117
Q

VIP Rule

A

Ventilate Infuse Pump

118
Q

Most serious complication of fluid ifusion

A

Pulmonary Edema

119
Q

Best Initial Test Legionnaires disease

A

Urine Antigen Test

120
Q

Onset is midlife, symptoms slow and progressive, exposure to engine smoke

A

COPD

121
Q

Childhood onset, symptoms worse at night, history of atopy

A

Asthma

122
Q

Restrictive ventilatory defect on spirometry with pulmonary edema and cardiomegaly

A

Congestive HF

123
Q

Large volume purulent sputum, bronchial dilatation and wall thickening

A

Bronchiectasis

124
Q

Young non smoker, history of RHEUMATOID arthritis, seen after lung and bone marrow TRANSPLANT

A

Obliterative bronciolitis

125
Q

Chronic sinusitis, diffuse small centrilobar nodule opacities

A

Bronchiectasis

126
Q

Ship Building/Tile/ Brick making, Calcified Pleural Plaques

A

Asbestosis

127
Q

Mining, Stone cutting, sand blasting, EGG Shell calcification

A

Silicosis

128
Q

Alloys, aerospace, nuclear, fluorescent bulbs

A

Berryliosisc

129
Q

Cotton

A

Byssiniosis

130
Q

Coal

A

Coal workers pneumoconiosis

131
Q

Motorvehicular Accident, No breath sounds

A

Tension Pneumothorax

132
Q

Most urgent step tension pneumothorax

A

Large bore needle - 2nd anterior IC space

133
Q

Confirms diagnosis

A

Rush of air

134
Q

P THORAX

A 
Pleuritic Pain
Tracheal Deviation
Hyperresonance
Onset Sudden
Reduced BS
Absent Fremitus
XRay - collapsed lung

IM (7 decks)

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