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MKSAP > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

Asthmatic triad

A

Nasal Polyps
Sensitivity to ASA
Wheezing

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2
Q

Allergic Bronchopulmonary Aspergillosis

A

Ongoing immunologic response to Aspergillus causing persistent eosinophilic airway inflammation, increased IgE, and tissue damage w/ airway remodeling

Sx: Brown, mucous plugs in sputum, productive cough, wheeze

Dx: Elevated IgE, asthma, positive Aspergillius skin antigen test, bronchiectasis/infiltrates on CXR

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3
Q

Vocal Cord Dysfunction

A

Due to paradoxical adduction of the vocal cords during inspiration

May present like asthma w/ similar triggers but patients complain of throat tightness and voice dysfunction during attacks as well; they will not respond to oral inhalers

Tx: Speech therapy

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4
Q

Bronchial Thermoplasty

A

Radiofrequency airway treatment used for severe asthma that is not controlled despite high dose inhaled glucocorticoid/LABA therapy

Patients must also have FEV > 60%

=»Decreased exacerbations and improved quality of life

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5
Q

Antidote for Cyanide poisoning

A

IV hydroxycobalamin

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6
Q

CTEPH diagnostic criteria and treatment

A
  1. Mean pulmonary artery pressure >25mmHg
  2. Evidence of vascular webs, intimal irregularities, and luminal narrowing on CT-PA
    • **V/Q scan is more sensitive in this case

Tx: Pulmonary thromboendartectomy

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7
Q

Lung Volume Reduction Surgery candidate

A

Patients w/ upper lobe-predominant COPD and significant exercise limitation even after pulm rehab

***Not candidate w/ FEV1 <20%, DLCO <20%, or non-upper lobe predominant disease

Otherwise, can lead to increased exercise tolerance, quality of life, and survival

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8
Q

Chronic Simple Silicosis CT findings

A

Upper-zone predominant disease w/ centrilobular or perilymphatic nodules 1-9mm in diameter

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9
Q

Indicator for need of thoracostomy drainage for parapneumonic effusion

A

pH < 7.2

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10
Q

Cryptogenic Organizing Pneumonia

A

Present w/ cough, fever, and malaise for 6-8 weeks; initial CXR mimics pneumonia

CT: Patchy ground glass opacity, alveolar consolidation w/ peripheral and basal predominance

Assoc. w/ CT disease, infxn, drugs

Resolves w/ steroids

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11
Q

Idiopathic Pulmonary Fibrosis

A

Presents w/ >6month dry cough, dyspnea on exertion, often times clubbing as well

CXR: Bibasilar septal line thickening w/ reticular changes, volume loss, bronchiectasis

CT: Basal and peripheral predominant septal line thickening w/ traction bronchiectasis and honeycomb changes

Tx: Pirfenidone or nintedanib

  • **DO NOT INTUBATE =» Extremely poor prognosis
  • Typically, only 3-5yr life expectancy at diagnosis anyways
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12
Q

Respiratory bronchiolitis

A

Associated w/ smoking; presents w/ combined restriction and obstruction on PFTs

CT: Centrilobular nodules and ground-glass opacity in upper lobe distribution

Tx: Stop smoking; ? steroid beneft

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13
Q

Desquamative interstitial pneumonia

A

Found in smokers; CT shows basal-predominant and peripheral predominant ground glass opacities w/ occasional cysts; basically like respiratory bronchiolitis but peripheral

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14
Q

Pulmonary Langerhans Cell Histiocytosis

A

Smoking DPLD

CT: Diffuse, thin walled cysts and pulmonary nodules that are mid and upper lobe predominant, biopsy shows langerhan’s cells positive for CD1a or S100

Can be associated w/ PAH

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15
Q

Hypersensitivity Pneumonitis

A

Acutely presents w/ flu-like illness; manage by removing offending agent

CT: Acute-ground glass opacification w/ centrilobular micronodules that are upper and mid lobe predominant

Chronic- Mid and upper lung predominant septal lung thickening w/ traction bronchiectasis

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16
Q

Lofgren Syndrome

A
  1. Bilateral hilar lymphadenopathy
  2. Migratory polyarthralgia
  3. Erythema nodosum
  4. Fever
17
Q

Radiograph Staging of Sarcoid

A

I-Hilar lymphadenopathy w/ normal lung parenchyma
-90% resolution w/ no treatment
II-HIlar lymphadenopathy w/ abnormal lung parenchyma
-50% resolution w/ no treatment
III-No lymphadenopathy w/ abnormal lung parenchyma
-20% resolution w/ no treament
IV-Parenchymal changes w/ fibrosis and architectural distortion

18
Q

Gene associated w/ pulmonary arterial hypertension

A

BMPR2; associated w/ worse prognosis

19
Q

Other syndromes associated w/ PAH

A

AI disease: RA, lupus, Sjogrens

Connective tissue diseases: Systemic Sclerosis, CREST

Liver disease: Due to decreased clearance of vasoactive substances

HIV, HCV

Dasatinib, imatinib

20
Q

Last medication to try in patient’s with a severe asthma exacerbation

A

Mag sulfate

Shown to decrease bronchial constriction

21
Q

TPA for PE in code

A

50mg over one minute

22
Q

Intubation check list

A

Suction
Oxygenation
Airway (tube)
Pharmacy (etomidate 20 or 10 + succinylcholine or vecuronium if hyperkalemia or renal dysfunction)

MKSAP (15 decks)

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