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PANCE prep JQ > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

Is pulmonology what is considered a shunt?

A

An area of lung that is perfused but has no ventilation

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2
Q

What is cor pulmonale?

A

Right heart failure due to pulmonary hypertension

*pulmonary htn is usually caused by chronic local hypoxic vasoconstriction due to dz like asthma or chronic bronchitis

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3
Q

Physiologic V:Q mismatch

A

Low V:Q in lung bases

High V:Q in lung apices

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4
Q

Pathologic V:Q mismatch

A

Low: asthma, chronic bronchitis, pulmonary edema

High: emphysema, PE, foreign body

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5
Q

Control of respiration

A

Central receptors in the medulla or peripheral receptors in the carotid bodies and aortic bodies detect increased PaCO2

Phrenic nerve stimulation increases rate and depth of respiration

*peripheral receptors are sensitive to low PaO2 but only if hypoxia is significant

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6
Q

Samter’s triad

A

Asthma

Nasal polyps

ASA/NSAID allergy

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7
Q

Lung exam findings in asthma

A

Prolonged expiration with wheezing, decreased breath sounds, and hyperresonance to percussion

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8
Q

Signs of status asthmaticus

A

Inability to speak in full sentences

AMS

pulsus paradoxus

Cyanosis

Tripod positioning

Silent chest

Tachycardia/tachypenea

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9
Q

Pulsus paradoxus

A

SBP decreases >10 mmHg with inspiration

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10
Q

Best way to assess asthma exacerbation/severity and monitor asthma

A

Peak expiratory flow rate (PEFR)

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11
Q

Asthma management in ED

A

Nebulized SABA q20min x3 then reassess

dc on short course (3-5d) oral corticosteroids

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12
Q

SE of SABAs

A

Tachycardia, tremor, CNS stimulation, and hypokalemia

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13
Q

SE of antimuscarinics

A 
Thirst
dry mouth
blurred vision
urinary retention
dysphasia
acute glaucoma
BPH
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14
Q

SE of steroids

A 
Immunosuppression
Hyperglycemia
Fluid retention
Osteoporosis 
Growth delay
Psychosis
Thinning skin

Thrush-inhaled

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15
Q

DOC long term persistent asthma

A

Inhaled corticosteroids

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16
Q

MOA cromolyn and nedcromil

A

Inhibits mast cell and leukotriene mediated degranulation

*helps limit acute response to cold air and exercise

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17
Q

Omalizumab

A

Anti-IgE antibody

Used in severe uncontrolled asthma

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18
Q

Classification of intermittent asthma

A

Sx <2x week and <2x a month at night

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19
Q

Treatment of intermittent asthma

A

SABA prn

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20
Q

Classification of mild persistent asthma

A

Sx >2d/wk and night sx >2x month

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21
Q

Treatment of mild persistent asthma

A

Low dose ICS

SABA prn

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22
Q

Classification of moderate persistent asthma

A

Daily sx and nightly sx >1xweek

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23
Q

Treatment of moderate persistent asthma

A

Low dose ICS with LABA(especially if night sx are worse)

OR

Increase ICS dose

OR

Add LTRA (especially if allergic or asa induced)

SABA prn

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24
Q

Classification of severe persistent asthma

A

Sx throughout the day and usually nightly

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25
Q

Treatment of severe persistent asthma

A

High dose ICS and LABA

Consider omalizumab

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26
Q

When should you try to step down therapy is asthma?

A

After sx controlled for 3months

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27
Q

Most important risk factor for COPD

A

Smoking

*15% of smokers develop COPD

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28
Q

COPD in a patient younger than 40 should make you think for this

A

a-1 antitrypsin deficiency

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29
Q

To dx chronic bronchitis

A

Productive cough >3m for 2 consecutive years

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30
Q

MC symptom in emphysema

A

Dyspnea

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31
Q

Signs of cor pulmonale

A

Peripheral edema and cyanosis

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32
Q

How does COPD affect blood pH?

A

Chronic bronchitis: respiratory acidosis

Emphysema: resp alkalosis but possible resp acidosis in acute exacerbations

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33
Q

When is anticholinergic therapy contraindicated?

A

BPH and glaucoma

Increased urinary retention and pupillary dilation

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34
Q

When do you use antibiotic when managing acute exacerbations of COPD?

A
  1. increased sputum
  2. change in sputum quality
  3. CXR evidence of infection

(Azithromycin has anti-inflammatory properties)

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35
Q

Irreversible bronchial dilation of bronchi due to infection

A

Bronchiectasis

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36
Q

MC pathogenic cause of bronchiectasis

A

H flu

Pseudomonas if cystic fibrosis pt

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37
Q

MC cause of massive hemoptysis

A

Bronchiectasis

*acute bronchitis and lung ca MC causes of hemoptysis overall

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38
Q

Thx of mycobacterium avium complex

A

Clarithromycin and ethambutol

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39
Q

Describe Aspergillosis sputum

A

Thick brown

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40
Q

Tx of aspergillosis

A

Corticosteroids and itraconazole

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41
Q

Inheritance pattern for CF

A

Autosomal recessive

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42
Q

Presentation of CF

A

Meconium lieus at birth

FTT/bulky pale stools from pancreatic insufficiency

Bronchiectasis/chronic sinusitis

43
Q

Cholinergic drug used to induce perspiration on sweat chloride test

A

Pilocarpine

44
Q

Definitive test for cystic fibrosis

A

DNA analysis

45
Q

Pathophysiology of sarcoidosis

A

Exaggerated T cell response leads to granuloma formation

46
Q

Common manifestation of sarcoidosis

A

Pulmonary-dry cough, sob, cup
LAD-hilar
Skin-erythema nodosum, lupus pernio, rash, parotid enlargement
Visual-anterior uveitis/blurred vision

*b symptoms, joint pain, Bell’s palsy, and myocardial involvement also possible

47
Q

Describe the pathognomicc skin finding of sarcoidosis

A

Lupus pernio: violaceous raised discoloration on face (resembles frost bite)

48
Q

Noncaseating granulomas, Hilar LAD and eggshell nodal calcifications should make you think of

A

Sarcoidosis

49
Q

Management of sarcoidosis

A

Observation for most (spontaneous remission in 2yr 40%)

Steroids then methotrexate if worsening or bad sxs

Hydroxychloroquine for skin lesions

50
Q

Classic presentation of sarcoid

A

Young or with resp and constitutional sxs, blurred vision and erythema nodosum

51
Q

Löfgren syndrome

A

Common presentation of sarcoidosis in Northern Europeans

  1. Erythema nodosum
  2. Bilateral hilar LAD
  3. Polyarthralgias and fever

Associated with good prognosis and spontaneous remission

52
Q

Histological findings of sarcoid

A

Noncaseating granulomas

And

Langerhans giant cells containing asteroid bodies or schaumann bodies

53
Q

How does idiopathic pulmonary fibrosis usually present?

A

Gradual onset of dyspnea and nonproductive cough in 40-50yo male

54
Q

Diffuse reticular opacities/honeycombing and ground glass opacities should make you think

A

Idiopathic pulmonary fibrosis

55
Q

Management of idiopathic pulmonary fibrosis

A

No effective treatment

Lung transplant is the only cure

56
Q

Professions associated with pneumoconiosis

A 
Mining and quarry work: silicosis
Coal or carbon mining: black lung
Electronic &amp; aerospace: berylliosis
Textile industry: byssinosis
Ship building, pipe fitting and renovation: asbestosis
57
Q

Parrot fever is caused by

A

Chlamydophila psittaci

58
Q

How do you differentiate costochondritis from Tietze syndrome?

A

Costochrondritis: no edema

Tietze syndrome: edema

59
Q

Etiology of transudative pleural effusion

A

CHF (MC), nephrotic syndrome,, cirrhosis, hydpoalbuminemia, atelectasis, and sometimes PE

60
Q

Etiology of exudative fluid

A

Infection, inflammation, and sometimes PE

61
Q

Test for small pleural effusions

A

Lateral decubitus films

62
Q

Lights criteria

A

Presence of any of these indicates exudative effusion

  • pleural protein:serum protein ration >0.5
  • pleural LDH:serum LDH >0.6
  • pleural LDH >2/3 ULN
63
Q

Tx of pleural effusion

A

Diuretics

Thoracentesis

Chest tube

Pleurodesis

64
Q

Common pathogens that cause empyema

A

Staph aureus

Strep pneumo

S. Pyogenes

H flu

65
Q

Describe a cystic fibrosis diet

A

Fat soluble vitamins (ADEK)

Pancreatic enzymes

High protein

High calorie

Sometimes zinc or iron

66
Q

2 ways to get toxoplasmosis

A

Eating undercooked meat and changing kitty litter

67
Q

TB treatment regimen for pregnant women

A

Isoniazid, rifampin, and ethambutol

Streptomycin is C/I and pyrazinamide safety is undetermined so only use if dealing with resistance

68
Q

What is catamenial pneumothorax?

A

Pneumothorax occurring during mensuration due to ectopic endometrial tissue in pleura

69
Q

Management of pneumothorax

A

Observation if small (<20%) and no severe symptoms - repeat CXR in 6hr to confirm no progression

Chest tube placement/thoracostomy

Needle aspiration followed by chest tube if tension pneumothorax

70
Q

Rare neuroemdocrine tumor of enterochromaffin cells which secrete serotonin, ACTH, ADH, and melanocytes stimulating hormone

A

Carcinoid tumors

MC in GI system but 2nd MC in lungs

71
Q

Where does lung cancer like to metastasize to?

A

Brain

Bone

Liver

Lymph nodes

Adrenal glands

72
Q

Describe different types of lung cancer

A
  • non-small cell
    1. adenocarcinoma MS, often peripherally located and associated with gynecomastia
    2. squamous cell central located and associated with cavitary lesions, hemoptysis, hypercalcemia and pancoast syndrome
    3. Large cell/anaplastic carcinoma is very aggressive
  • small/oat cell which Mets early and is associated with SVC syndrome, SIADH/hypernatremia, Cushing syndrome, and lambert Eaton syndrome
73
Q

Describe pancoast syndrome

A

Tumors at superior sulcus cause

  1. Shoulder pain
  2. horner syndrome (miosis, ptosis, and anhydrosis due to cervical cranial sympathetic compression)
  3. atrophy of hand/arm muscles

*assoicated with squamous cell lung carcinoma

74
Q

Management of lung cancer

A

Non-small cell: surgical resection, especially if isolated to chest

Small/oat cell: chemo with or without radiation (because this type of Ca Mets early)

75
Q

Expected CXR findings for PE

A

Normal CXR in setting of hypoxia highly suspicious for PE

Classic findings of westermark sign or Hampton’s hump are rare

76
Q

Management of PE

A

Initiate heparin therapy for 2-3d followed by 3mo warfarin or NOAC therapy

IVE filter if anticoag therapy C/I or unsuccessful

Thrombolytic tx or embolectomy only if hemodynamically unstable and no C/Is

77
Q

PERC rule

A

Pulmonary Embolism Rule our Criteria

  • age <50
  • pulse <100
  • O2 sat >95%
  • no hx PE
  • no recent surg/trauma
  • no hemoptysis
  • no exogenous estrogen use
  • no unilateral leg swelling
78
Q

Normal mean pulmonary arterial pressure

A

<20

79
Q

Who gets primary idiopathic pulmonary htn?

A

Middle aged or young women

80
Q

Tx of pulmonary htn

A

CCB if vasoreactive

Phosphodieterase-5-inhibitors if not

*O2 only therapy to decrease mortality

81
Q

Infection associated with bird/bat dropping in Mississippi & Ohio river valley

A

Histoplasmosis

82
Q

Hospital acquired/nosocomial pneumonia

A

Occurs >48hrafter hospital admission

83
Q

Labs to dx legionella

A

Urine antigen

*hyponatremia and elevated LFTs often seen

84
Q

Atypical pneumonia with GI symptoms should made you consider this

A

Legionella

85
Q

Describe pneumonococcal vaccines

A

PVC 13 - 4 doses at 2, 4, 6, and 12-15mo

PPSV23 given time 2 yo at least 8wk after completing PCV13, adults>65, and people with chronic dz

86
Q

Diagnosis of TB

A

Gold standard:AFB sputum cultures

CXR: May show CASEATING granulomas, Ghon’s complex, or Ranke’s complex

Quantiferon assay

87
Q

Tx of active TB

A 
4 drugs (RIPE or RIPS) for 2mo
Rifampin
Isoniazid 
Pyrazinamide 
Ethambutol or Streptomycin

Then continue isoniazid and rifampin for another 4mo or 3mo after negative sputum culture

88
Q

What should you give with isoniazid to prevent peripheral neuropathy?

A

Pyridoxine (B6)

89
Q

Treatment of latent TB

A

Isoniazid and B6 for 9mo 12mo if HIV)

90
Q

Pertussis/whooping cough is caused by

A

Bordetella pertussis

91
Q

Diagnosis of pertussis

A

Nasal swab for PCR

CBC may show profound lymphocytosis

92
Q

Treatment of pertussis

A

Supportive (O2, nebulizers, ventilation prn)

Macrolides to decrease contagiousness and for exposed contacts (Bactrim 2nd line)

93
Q

Tx of epiglottis

A

Supportive/intubation if needed

Dexamethasone for edema

Ceftriaxone or cefotaxime

94
Q

RSV causes

A

Acute bronchiolitis

95
Q

Laryngotracheitis(croup) is most commonly caused by

A

Parainfluenza

96
Q

Tx of croup

A

Cool humidifier

Hydration

Dexamethasone

(Nebulized epinephrine and hospitalization is moderate to severe)

97
Q

How do you differentiate ARDS from pulmonary edema with pulm capillary wedge pressure?

A

ARDS <18mmHg

Pul edema >18mmHg

98
Q

Biggest risk factor for sleep apnea

A

Obesity

99
Q

Evaluation of sleep apnea

A

Polysonogram (>15event/hr is diagnostic)

Check CBC for polycythemia

Epsworth sleepiness scale

100
Q

What type of abn breathing pattern do you see with hypercapnia?

A

Cheyenne-stokes

Cyclic breathing pattern with gradual decrease in rate followed by 10-15 sec apnea

101
Q

What type of abn breathing pattern do you see with opioid use of damage to the medulla oblongata?

A

Biot’s breathing

Quick if shallow breaths with periods of apnea

102
Q

What type of abn breathing pattern do you see with metabolic acidosis?

A

Kussmaul’s respirations

Deep rapid continuous respirations

103
Q

Normal values to know for acid base disorders

A

pH 7.35-7.45
Pco2 35-45
HCO3 22-26
AG 10-12

PANCE prep JQ (15 decks)

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