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PANCE > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

Measurement of the volume of air that can be expelled from a maximally inflated lung

A

Force Vital Capacity (FVC)

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2
Q

measurement of the volume of air that can be exhaled at the end of the 1st second

A

Forced Expiratory Volume in one second (FEV1)

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3
Q

Auscultation sound described as snoring that may clear with cough: rattling low-pitch rumbling “Secretions”

A

Rhonchi

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4
Q

Auscultation sound described as high-pitched popping: not cleared by cough: During inspiration

A

Crackles

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5
Q

Auscultation sound described as whistling louder with expiration 2T narrow airways

A

Wheezing

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6
Q

Loudest over the anterior neck 2T narrowing of the larynx or trachea. (Upper airway obstruction MC)

A

Stridor

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7
Q

What is Samster’s Triad?

A

Asthma, Nasal polyps, and ASA/NSAID allergy

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8
Q

Dx tool used if PFT is non-diagnostic

Bronchoprovocation with________

A

Bronchoprovocation

Methacholine

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9
Q

Gold Standard for reversible obstruction

A

Pulmonary Function Test

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10
Q

Best and most objective way to asses asthma exacerbation severity and Tx response

A

Peak Expiratory Flow Rate

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11
Q

What PEFR % is considered responsive to treatment?

A

> 15% PEFR (Normal 400-600cc)

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12
Q

Pulse Oximetry indicative of Respiratory Distress

A

SPO2 <90%

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13
Q

Acute Exacerbation Admission criteria

A
  • PEFR <50%
  • <15% initial value (200cc)
  • Revisit w/I 3 days of exacerbation
  • Post-treatment failure
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14
Q

Acute Asthma exacerbation Discharge criteria

A
  • PEFR >70%
  • PEFR >15%
  • Adequate F/U w/i 24-72 hrs
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15
Q

Asthma management anticholinergic/muscurinic that Inhibits vagal-mediated bronchoconstriction/ secretions
.
Synergistic B2 agonists and anticholinergics

A

Ipratropium

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16
Q

1sts Line treatment for acute asthma exacerbations. Most effective and fastest within 2-5 min.

A

Albuterol or Terbutaline (B2 Agonist short acting)

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17
Q

Anti-inflammatory: All but the mildest exacerbations should be discharged on a short course of these

A

Prednisone, Methyl prednisone, Prednisolone

Short course= 3-5 days

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18
Q

Long-Term exacerbation medications (Chronic control)

A
  • ICS
  • LABA
  • Mast Cell Modifiers
  • Leukotriene receptor Antagonists (LTRA)
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19
Q

Short-term exacerbation quick relief medications

A
  • SABA
  • Anticholinergics
  • PO Corticosteroids
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20
Q

Exacerbation treatment that inhibits mast cell and leukotriene mediated degranulation

Inhibits acute phase cold air and exercise response

A

Mast Cell Modifiers (Cromolyn)

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21
Q

Exacerbation treatment that leukotriene-mediated neutrophil migration, capillary perm., M. contraction

Useful in asthmatics w allergic rhinitis/aspirin induced

A

LTRA (Montelukast or Zafirlukast)

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22
Q

DOC for long term , persistent chronic maintenance.

Cytokine and inflammation inhibition

A

ICS (Beclomethasone/ Flunisolide/Triamcinolone

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23
Q

Prevents symptoms especially nocturnal asthma. Used as a combo with ICS: not to be used alone.

A

LABA (Advair/ Salmeterol/Symbicort)

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24
Q

Step down off LABA should be done if asthma control is maintained _________

A

> 3 months

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25
Q

Adjunct indicated in severe asthma acts as bronchodilator

A

IV Magnesium

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26
Q

Analgesic that has sedative and bronchodilator effects

A

Ketamine

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27
Q

Anti-Ige used in severe uncontrolled asthma

FEV1 <60%

A

Omalizumab

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28
Q

Bronchodilator that improves respiratory muscle endurance. similar to caffeine.

Toxicity causes arrhythmias/seizures.

A

Theophylline

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29
Q

Intermittent Asthma severity SABA use and Nighttime awakenings.

A

< 2x week SABA

< 2x months at Night FEV1> 80

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30
Q

Mild Asthma severity SABA use and Nighttime awakenings. What %?

A

> 2x week (not daily)

3-4x month at night FEV1> 80%

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31
Q

Moderate Asthma severity SABA use and Nighttime awakenings.

A

Daily SABA

>1x week (not nightly) FEV1 60-80%

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32
Q

Severe Asthma severity SABA use and Nighttime awakenings.

A

Several a day SABA

Nightly FEV1 < 60%

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33
Q

Asthma Daily Medication Step 1

A

SABA PRN

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34
Q

Asthma Daily Medication Step 2

A
  • SABA

- Low ICS or Cromolyn

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35
Q

Asthma Daily Medication Step 3

A
  • SABA
  • Low ICS
  • LABA or LTRA
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36
Q

Asthma Daily Medication Step 4

A
  • SABA
  • Medium ICS
  • LABA or LTRA
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37
Q

FEV1/FVC Obstructive pattern

A
  1. FEV1/FVC <70%
  2. FVC >80%
  3. > 200cc or 15% with SABA (20% if Methacholine)
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38
Q

Disorder with loss of elastic recoil and increased airway resistance. Alpha 1 antitrypsin deficiency genetic link.

RF- smoking/Exposure 90%

A

COPD (Antitrypsin protects Elastin in lungs)

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39
Q

Abnormal permanent enlargement of the terminal spaces. PE-hyperinflation, Barrel chest, pursed lips.

Respiratory alkalosis (Acidosis in acute exacerbations). Pink and cachectic (

A

Emphysema

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40
Q

Gold Standard Dx for COPD

A

PFT/Spirometry

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41
Q

Productive cough >3 mos X 2 consecutive years is hallmark: Chronic inflammation. Rales/rhonchi/wheezing

Cyanosis and cor pulmonale. respiratory acidosis. Increased Hct. Cyanotic & obese

A

Chronic Bronchitis

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42
Q

Chronic Bronchitis Management

A 
Corticosteroids 
Oxygen- only that decreases mortality
Anticholinergics
Albuterol
Theophylline
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43
Q

COPD staging

A

FEV1 >80 Mild
FEV1 50-79% moderate
FEV1 30-50% Severe
FEV1<30% Very Severe

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44
Q

Irreversible bronchial dilation 2t transmural inflammation of bronchi. destruction of muscular/elastic tissues of wall

Recurrent chronic lung infections. Productive cough with foul smelling sputum. MCC of massive hemoptysis.

H. Influenza MCC

A

Bronchiectasis

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45
Q

Bronchiectasis Dx and Treatment

A

High Resolution CT

MAC- Clarithromycin + Ethambutol + Corticosteroids
Empiric- Ampicillin, Bactrim, Amoxicillin

(Pseudomonas MC= Fluoroquinolone)

Physiotherapy

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46
Q

Autosomal recessive defective transmembrane Receptor protein prevents Cl- transport out of cell.

Thick mucus buildup in lungs, pancreas, liver, intestines, and reproductive tract.

A

Cystic Fibrosis

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47
Q

Cystic Fibrosis clinical manifestations

A
  • At birth Ileus
  • Pancreatic insufficiency (Decr. ADEK absorption)
  • Recurrent Respiratory infections
  • Infertility
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48
Q

Cystic Fibrosis Dx and Treatment

A

Dx- Elevated sweat chloride Test (primary) Twice >60
DNA= Definitive

Tx- B2 Ag, mucolytics, Abx, ADEK vit. and vaccinations

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49
Q

Clinical manifestations include Dry cough, dyspnea, CP: BL Hilar nodes LAD: Erythema Nodosum, Lupus pernio

Anterior uveitis: Cardiomyopathies: Rheumatologic: Noncaseating granulomas.

A

Sarcoidosis

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50
Q

Chronic multisystemic inflammatory, granulomatous DO 2T exaggerated T cell response–> granulomas

A

Sarcoidosis

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51
Q

Sarcoidosis Dx and Tx

A

CT- Ground-glass Opacities and BL Hilar LAD
Tissue Bx= Non-caseating Granulomas

Management- Corticosteroids PO (TOC)
- Methotrexate (if CS refractory)

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52
Q

Chronic progressive interstitial scarring 2T persistent inflammation.

CXR- ground-glass opacities and Honeycombing

A

Idiopathic Fibrosing Interstitial Pneumonia

No effective treatment- Lung transplant

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53
Q

what is the Lofgren’s syndrome triad for sarcoidosis

A

Erythema Nodosum
BL Hilar LAD
Polyarthralgias + Fever

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54
Q

Chronic Fibrotic lung disease 2T inhalation of mineral dust.

A

Pneumoconioses (Environmental Lung Disease)

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55
Q

Inhalation DO, 2T granite/slate/quartz/pottery sandblasting

A

Silicosis

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56
Q

Inhalation DO, 2T coal: CXR: small upper lobe nodules

A

Coal Worker’s Pneumoconiosis

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57
Q

Inhalation DO, 2T electronics, ceramics, fluorescent light bulbs.

A

Berylliosis

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58
Q

Inhalation DO, 2T textile or cotton exposure

A

Byssinosis

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59
Q

Inhalation DO, 2T destruction/renovation of old buildings, insulation, or ship buildings. Pleural thickening

A

Asbestosis

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60
Q

Malignant Mesothelioma of the pleura

A

Asbestosis

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61
Q

Hypersensitivity pneumonitis from nitrogen dioxide gas exposure released from plant matter.

(Chute and base of a Silo) –> bronchiolitis obliterans.

A

Silo Filler Disease (N95 Mask)

62
Q

Pneumonitis due to moldy hay exposure.

A

Farmer’s Lung (Allergic Alveolitis/pneumonitis)

63
Q

Tumor originating from the pleura due to chronic asbestos exposure. Poor prognosis if malignant.

Pleuritic CP, dyspnea, fever, night-sweats, hemoptysis.
Tx:?

A

Mesothelioma

TX: resection/radiation/Chemo

64
Q

Acute inflammation of the costochondral, costosternal, or sternoclavicular joints. Common post viral infx/trauma

Pleuritic CP worse with coughing or certain limbs or Torso. TTP 2nd-5th Costochondral Jx.

A

Costochondritis

65
Q

Acute inflammation of the costochondral, costosternal, or sternoclavicular joints. Common post viral infx/trauma

Positive palpable edema/swelling, heat, and erythema

A

Tietze Syndrome

66
Q

Abnormal accumulation of fluid in the pleural space. Decreased fremitus, BS, and dullness on percussion

Lights criteria= > 0.5 protein, >0.6 LDH, <7.2 pH, < 40 glucose

A

Exudative Pleural effusion

67
Q

MCC of Transudate Pleural Effusion > 90%

A

CHF

Nephrotic Syndrome, Cirrhosis, hypoalbuminemia

68
Q

MCC of Exudative Pleural effusion

A

Infection/Inflammation

Malignancy

69
Q

Positive Menisci sign means

A

Blunting of the costophrenic angles

70
Q

DX for Pleural effusion is best done with a CXR positioned how?

A

Lateral decubitus on the affected side down

71
Q

Pleural Effusion treatment

A

Thoracentesis= GS (exudative inject Streptokinase)

Pleurodesis= Malignant/Chronic (Talc/Doxy to obliterate)

72
Q

Primary pneumothorax includes

A

Trauma (No underlying Lung disease)

73
Q

Secondary Pneumothorax includes

A

PTX 2T Underlying Lung Disease (COPD/Asthma)

74
Q

PTX during menstruation due to ectopic endometrial tissue in the pleura?

A

Catamenial Pneumothorax

75
Q

Tension pneumothorax TRIAD

A

JVD, Pulsus Paradoxus, and hypotension

76
Q

Management of small primary spontaneous PTX

What is the percentage/measurement?

A

Observe at least 6 hours then repeat CXR
(Resolves w/I 10 days w O2 absorbs 3-4x faster)

<15-20% or = 2-3 cm between chest wall and lung

77
Q

Tension PTX Tx?

A

Needle Aspiration- 2nd ICS MCL–> Chest tube

78
Q

Pulmonary nodule: Mediastinal Tumor MC

79
Q

Malignant Pulmonary nodule presentation

A
  • Irregular
  • speculated
  • Rapid growing (Double in 4mos)
  • Cavitary with thickened walls
80
Q

Nodule < 5% probability of malignance in <50 yoa patient w/o smoking Hx. Tx?

Otherwise >5% and smoker >50 yoa?

A

Observation

Dx- Needle aspiration or bronchoscopy Tx- Resection

81
Q

Pulmonary Nodule that May secrete serotonin, ACTH, ADH, melanocyte stimulating hormone. MC < 60 YOA

Diarrhea (serotonin), Flushing, and Tachychardia 2T A-H1 and Incr. Bradykinin

A

Bronchial Carcinoid Tumor

82
Q

Pink to purple well vascularized central tumor in bronchoscopy =

Tx

A

Bronchial Carcinoid Tumor

Excision Sx

83
Q

MCC of cancer death in Men and women. MCC smoking

Greatest tendency to METS to brain, bone, liver, LAD

A

Bronchogenic Carcinoma

84
Q

Bronchogenic Carcinomas include

A

NSCC- Adenocarcinoma, Squamous cell, Large cell

Small Cell Carcinoma (Oat Cell)-

85
Q

Metastasizes early: Central and aggressive: Mets at presentation–> Chemotherapy is TOC

Central, Cabronado, Chemotherapy,
Hyponatremia and SIADH

A

Small Cell Carcinoma

86
Q

Centrally located, cavitary lesions, Calcinosis, Pancoast tumor (CCCP). Treatment?

Hemoptysis and maybe picked up on sputum cytology

A

Squamous Cell

TOC= Surgical Resection

87
Q

MC type of NSCC in smokers, women and non-smokers
35%.

Peripheral with voluminous sputum production

A

NSCC- Adenocarcinoma

88
Q

Most aggressive and 2nd MC NSCC?

A

Large Cell Carcinoma (Anaplastic)

89
Q

Shoulder pain, cervical cranial sympathetic compression (_____) syndrome, atrophy of hand arm m.,

+ superior sulcus tumor

A

Pancoast Tumor Syndrome

90
Q

Horner’s Syndrome includes

A

Anhidrosis, Ptosis, and miosis

91
Q

Dyspnea, Pleuritic CP (70%), hemoptysis, MC post-op with sudden tachypnea? Lung auscultation ML normal

A

Pulmonary Embolism

92
Q

PE MC symptom and MC sign

A

Symptom is Dyspnea

Sign- Tachypnea

93
Q

Pulmonary Embolism ordered if high suspicion and negative CT/or VQ scan: Dx Gold standard

A

Pulmonary Angiography

94
Q

Best initial test for suspected Pulmonary Embolism

A

Helical CT scan

95
Q

If CT scan contraindicated then use

A

VQ scan (Low Probability use only)

96
Q

Most Common ECG changes in PE

A

Tachycardia and nonspecific ST/T changes

97
Q

Most specific ECG changes for PE

98
Q

Pulmonary Embolism management Hemodynamically stable? If ____ treatment is CI?

A

IF UFH or SQ LMWH

PO Warfarin or Novel Oral AC (Apix/Rivax/Edox-aban

CI-AC/unsuccessful= IVC Filter

99
Q

Pulmonary Embolism management Hemodynamically un-stable?

A 
Thrombolytic Tx (Strepto/Uro-Kinase or Alteplase)
[Preferred over embolectomy]

Embolectomy Tx- If thrombolytic CI

100
Q

Antidote for Coumadin is?

A

Vitamin K (Extrinsic II, VII, IX, X) [Monitor INR 2-3]

101
Q

Antidote for LMWH is ?

A

Protamine Sulfate (Intrinsic) [CI: in renal failure]

Lower Risk of HIT (HIT incr. with UFH and monitor PTT 1.5-2.5)

102
Q

Must be overlapped with Heparin for at least 5 days?

103
Q

PE prophylaxis

A

Early Ambulation
Elastic stockings/Pneumatic compressions
LMWH

104
Q

PERC criteria

A

< 50 yoa
Pulse <100
O2 sat >95%
No prior PE

105
Q

Pulmonary Hypertension Mean Pulmonary Arterial Pressure?

A

> 25mmHg (normal= <20 mmHg or 30mmHg during ex.)

106
Q

MCC of primary Pulmonary HTN?

A

idiopathic MC in middle aged or young women

107
Q

MCC of secondary Pulmonary HTN?

A

COPD

Sleep apnea, PE, Metabolic

108
Q

Pulmonary HTN DX and Tx?

A

Dx- Right Sided heart catheterization GS
CBC= Policythemia and Incr. Hct

Tx- Nitric Oxide, Adenosine, CCBs
Secondary- Tx COPD with O2

109
Q

MCC and 2nd MCC of Community Acquired Pneumonia
(CXR=Lobar): “Rusty Blood Tinged”

COPD and Cystic Fibrosis

A

Strep Pneumonia

H. Influenza 2nd MCC

110
Q

MCC of Atypical Pneumonia. (CXR=Diffuse and Patchy)

Military recruits and college

A

Mycoplasma Pneumoniae (Walking)

111
Q

Related to contaminated water supplies.
“Currant-Jelly”

increased LFTs, hyponatremia, NVD, anorexia

A

Legionella (Urine Testing Ag PCR)

112
Q

Pneumonia Often seen after a viral illness:

Hematogenous spread in IVDU, immunoincomp, elderly

A

Staphylococcus Aureus

113
Q

Pneumonia seen in aspirators, alcoholics, and assoc with cavitary lesions

A

Klebsiella (Aspiration = Anaerobes)

114
Q

Seen in Cystic Fibrosis, Immuno comp., HIV, transplant

A

Pseudomonas Aeruginosa

115
Q

MC viral Pneumonia in infants and children

A

RSV and Parainfluenza

116
Q

MC viral pneumonia in adults

117
Q

MC Pneumonia in Transplants and Aids

118
Q

MC pneumonia with fungal or parasites immunocompromised patient

A

Pneumocystis Jirovecii

119
Q

CAP Pneumonia Tx

A

Macrolide (Azithromycin) or Doxycycline 1st Line (Out-Pt)

B-LactamAmoxicillin-Clavunate/Amp-sulbactam + Macrolide Azithromycin (In-Pt) or Doxy or FQ (Levo)

120
Q

CAP in ICU

A

B-LactamAmoxicillin-Clavunate/Amp-sulbactam + Macrolide Azithromycin (In-Pt) or

FQ (Levo) + B-Lactam

121
Q

HAP Tx Pseudomonas? MRSA? Legionella

A

Pseudomonas- FQ (Levo) + B-Lactam

MRSA- Linezolid + Vancomycin

FQ (Levo) + Azithromycin

122
Q

Pneumococcal Vaccines

A

PCV13= 13 Ag used in childhood

PPSV23= 23 MC serotypes >2-64 w chronic dz
for >65 yoa

123
Q

Chronic Lung infection leading to granuloma formation.
Inhalation of airborne droplets.

night sweats, fevers/chills, weight-loss, anorexia, fatigue

A

Tuberculosis

124
Q

Outcome of infection leads to caseating granulomas.
Become PPD positive 2-4 weeks post infx.

Not contagious

A

Chronic (Latent) Tuberculosis

125
Q

Reactivation of TB with waning immune defenses: MC localized at apex/upper lobes w cavitary lesions

Patients are contagious

A

Secondary Reactivation TB

126
Q

Outcome of initial TB infection. Rapidly progressive. Patients are contagious

A

Primary TB

127
Q

Extra pulmonary TB if in Vertebrae=_____

if in LAD = ________

A

Pott’s Disease (Vertebrae TB)

Scrofula (LAD)

128
Q

TB PPD screening mm size

A

> /= 5mm: HIV, TB Pt contact, CXR TB

> /= 10mm: High risk contact

> /= 15mm: everyone else

129
Q

TB DX studies

A

Acid Fast Smear sputum Cx X 3 days- yearly for active

CXR- exclude Active (+) PPD and Screen yearly active

Interferon Gamma Release Essay- Not BCG Vax affected

130
Q

Active TB Tx

A

RIPE X2 mos (Active 6 mos)

Rifampin- Orange secretions
Isoniazid- Peripheral Neuropathy (Pyridoxine B6)
Pyrazinamide- Rash (photosensitive)
Ethambutol- Optic neuritis (Color blind)
Streptomycin- ototoxicity (aminoglycoside)

131
Q

Latent TB Tx

A

INH + Pyridoxine 9 mos

HIV= INH + Pyridoxine X12 mos

132
Q

MCC pathogen of Laryngotracheitis (Croup)

A

Parainfluenza virus Type 1

133
Q

MCC pathogen of Acute Epiglottitis (Supraglottitis)?

A

Haemophilus Influenza B

134
Q

MCC pathogen of Pertussis Whooping cough?

A

Bordetella Pertussis

135
Q

Highly contagious cough infection. MC in <2yo Manifests in three stages. Resolution may last 6 wks

Coughing fits with inspiratory whooping. DX- Nasal Swab PCR: Lymphocytosis > 50K: DOC for treatment ?

A

Pertussis (Whooping cough)

Nasal Swab=GS DX

Azithromycin/Erythromycin (Macrolide)

136
Q

Inflammation MC 2T viral infx of upper airway. Barking cough hoarseness. worse at night. Virus: steeple sign.

Tx? Mild-Mod-Severe

A

Laryngotracheitis(Croup)

                                                                    (Racemic Epi) Tx- Mild= Dex, air mist, hydrate: MOD-Sev- Dex- Epi, Dex
137
Q

Manifestation of Dysphagia, Drooling, and distress 3Ds.
Muffled voice, tripoding, inspiratory stridor. 3mos-6 yo

Dx- Laryngoscopy (cherry red). X-ray- Thumb print sign.
TX?

A

Acute Epiglottitis (Supraglottitis)

Tx: Supportive Airway is “Mainstay” Ceftriaxone + Dex
Cefotaxime

138
Q

Pertussis stage where patient is most contagious?

A

Catarrhal Phase

139
Q

Pertussis stage with severe cough fits w emesis?

A

Paroxysmal phase

140
Q

Pertussis phase with resolution of cough? (up to 6 wks)

A

Convalescent Phase

141
Q

Inflammation of tracheal/bronchi: often follow URI. MCC is Adenovirus. Hallmark is cough for 1-3 weeks.

Tx:

A

Acute Bronchitis

Tx: Symptomatic (ABX= Immunocomp or >7-10 days)

142
Q

Inflammation of the bronchioles: LRI of the small airways. infants <2 YOA MC affected. –> Resp. Distress

Tx:

A

Acute Bronchiolitis

Tx: Humid O2, B-Agonist, racemic epi, (Ribavirin- immu)
“No Steroids”

143
Q

Acute Bronchiolitis MCC

A

Respiratory Syncytial Virus

144
Q

Irreversible bronchial dilation 2t transmural inflammation of bronchi. destruction of muscular/elastic tissues of wall

Recurrent chronic lung infections. Productive cough with foul smelling sputum. MCC of massive hemoptysis.

H. Influenza MCC

A

Bronchiectasis

145
Q

Abrupt onset of Fever, chills, malaise, Myalgias (Legs/Lumbosacral area), pneumonia, pharyngitis.

Dx: Nasal swab or viral culture
Tx:?

A

Influenza

Tx: W/I 48 hrs onset= Olseltamivir/Zanamivir
Ribavirin= covers A n B

146
Q

Recommended population influenza vaccine

A

> /= 65 yoa (Indicated >6mos

Asthma, COPD, Sickle cell, DM

Influenza contacts

147
Q

Inflammatory lung injury 2T cytokines. MC developed in critically ill patients (MCC Sepsis). –> acute Resp Failure

dx- catheterization of Pulmonary artery PCWP of ____
“swan-Ganz”
Tx:

A

Acre Respiratory Distress syndrome

Dx- Capillary wedge pressure <18mm Hg (12-18mmHg)

Tx- Positive end Expiratory Pressure (PEEP) PaO2>55 mmHg

148
Q

What are the three main components of ARDS

A
  1. Severe refractory hypoxemia
  2. BL Infiltrates on CXR
  3. Pulmonary edema/CHF absence (PCWP<18 mmHg)
149
Q

Sleep Apnea 1st Line Dx ?

A

In-Lab Polysomnography (>/= 15 events/hr)

Tx- CPAP

150
Q

Acid Base disorders step approach

A
  1. pH > 7.45 or < 7.35
  2. PCo2 Opposite=Resp/ same=Met (35-45)
  3. HCO3- (22-26)
151
Q

Anion GAP formula is

A

AG= Na- (Cl- (+) HCO3-) (10-12 normal)

PANCE (13 decks)

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