Pulmonology Flashcards by anitha roy

Can severe coughing cause pneumothorax? How?

Causes subcutaneous emphysema,air leaks into the chest->pneumothorax

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Rx for pneumonia in cystic fibrosis

Iv cefepime - MSSA,P. Aeruginosa

Iv vancomycin-MRSA

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Complication of subclavian CV catheter

Tension pneumothorax

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C/f of tension pneumothorax

Decrease Bp
JVP
u/l absent breath sounds 
Tracheal deviation 
Rapid onset acute dyspnea,chest pain

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How to know it’s faulty intubation and not pneumothorax ?

U/l breath sounds,hypoxia

But no tachycardia

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Increase in pulmonary vascular resistance seen in…..

Acute P.E

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Acute onset dyspnea and chest pain s/o……

Other findings of P.E

P.E

Tachypnea
Tachycardia
Low grade fever

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2 poor prognosis of P.E

Decrease in SaO2, A.F

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DLCO finding in asthma and COPD

Asthma: normal

COPD : increased

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Rx for ARDS

Intubation

MV( low TV high PEEP-permissive hyoercapnia)

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ARDS Vs volume overload-diff?

PCWP : normal for ARDS

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Signs of pulmonary HTN (6)

Left parasternal lift 
Rt sided heave 
Loud P2
Rt sided S3
RHF
pansystoli TR

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Scleroderma seen in limited vs diffuse systemic sclerosis

Limited: head and tip of UE

Diffuse: trunk &UE

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Sms of P.jiroveci pneumonia

SOB
Non productive cough
Fever

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Formula for peak airway pressure

Resistive pressure + plateau pressure
Resistive pressure: flow x resistance
Plateau pressure: elastic pressure + PEEP

Elastic pressure = Tv/ compliance

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If peak pressure is increased but Plateau pressure normal s/o (3)

Mucus plug
Bronchospasm
Biting tube

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If both peak pressure and plateau pressure are increased s/o (5)

Pneumothorax 
P.edema
Pneumonia 
Atelactasis 
Rt mainstem intubation

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Drugs when given along with theophylline that can cause its toxicity .

CYP inhibitors 
Verapamil 
Cimetidine 
Ciplox 
Erythromycin 
Clarithromycin

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Cardiac probs with theophylline toxicity

Multifocal atrial tachycardia

Premature ventricular beats

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C/f of eosinophilic Granulomatosis (3)

Nasal polyps
Asthma
Eosinophilia

Seen in churg Strauss syndrome

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C/f of severe combined immunodeficiency (4)

Recurrent diarrhoea
Failure to thrive
Recurrent infections

Infants should undergo stem cell transplantation; else they die within 1 yr age.

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Define HPOA

Hypertrophic osteoarthropathy + clubbing + lung probs: Ca,bronchiectasis etc

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Conditions where DLCO is normal (4)

Asthma
OHS
Myasthenia gravis
ALS

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Large anterior mediastinal mass with increase beta HCG, AFP s/0…..

Non-seminomatous Lung cancer

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Dx for primary mediastinal tumor

Bx + testicular USG

Anterior mediastinal mass in hogkins lymphoma involves .....

Cervical Supraclavicular axillary LN

Rx for P.E plus bleed is...

IVC filter

Highly characteristic feature of Wegners granulomatosis is.....

Tracheal narrowing and ulceration

Ab with wegners is.....

PR3 ANCA

Rx for wegners

High dose GC ,cyclophosphamide, rituximab

2 important things to determine etiology of hyponatremia

Serum osmolality | ECF volume

Rx for flail chest

Pain meds,O2 | PAP- to improve paradoxical resp motion

Tachypnea with severe cyanosis in newborn is...... | CXR.....

Persistent pulm HTN CXR: clear lungs + decreased pulm vascularity

Tachypnea that begins shortly after birth, resolved by day 2..... CXR....

Transient Tachypnea of newborn CXR: b/l peri hilar streaks

PFT in ILD

Increased FEV1/FVC | Decreased DLCO,TLC,RV

How does pulmonary edema decrease lung ventilation?

By decreasing pulmonary compliance->restrictive pattern

MV paO2 Vs SaO2 values

PaO2: 55-80 mmHg SaO2: 88-95%

Risk factors for transient Tachypnea of newborn (3)

1. C.S 2. Prematurity 3. Maternal DM

RDS CXR features

Decrease lung volume Ground glass opacities Air bronchogram

M.c presentation of pancoast tumor

Shoulder pain

What is seen in C8-T2 involvement in pancoast tumor?

Weakness and atrophy of intrinsic hand muscles

CXR findings of bronchiectasis vs chronic bronchitis

Bronchiectasis: dilated conducting airways Chronic bronchitis: prominent bronchovascular markings Flattened diaphragm

FVC in bronchiectasis vs chronic bronchitis

Bronchiectasis: (<80%> decreased Chronic bronchitis: (>95%) increased

CXR features of emphysema

Decreased vascular markings | Hyperinflated lungs

Hypoxemia in CB vs emphysema

CB: increased Emphysema: mild

Basilar lucency in CXR in a young patient should prompt....

ATT

Risk factors for bronchial obstruction secondary to atelactasis

H/o FB aspiration Malignancy Severe pneumonia

Mgt of spontaneous pneumothorax vs tension pneumothorax

Spontaneous: Small (<2cm): observe Large: needle thoracotomy Tension: Urgent needle aspiration

CXR of spontaneous pneumothorax

Visceral pleural line | Absent lung marking

What is diffuse alveolar hypoventilation? | Causes?

Diffuse alveolar hypoventilation: All alveoli damaged-decrease TV,RR Causes: Narcotic use Neuromuscular weakness

Complication of PAP (3)

Alveolar damage Pneumothorax Hypotension

How is high PEEP bad for ARDS?

Lung collapse,poor oxygenation PEEP—> decrease wob, increase FRC Pneumothorax—> decrease RV filling —> decrease bp, increase HR. —> decrease venous compliance Leading to increase venous stiffness,CVP also rises

Recurrent pneumonia on same side s/o....

Adenopathy, neoplasm FB Bronchiectasis

Rx of bronchiolitis & prevention

Rx: supportive Prevention : palivizumab

Palivizumab is given for.....(3)

1. Premature (<29weeks) 2. Chronic lung disease of prematurity 3. Hemodynamically significant congenital heart disease

Complication of bronchiolitis (2)

Apnea (<2mo old) | Respiratory failure

Main sms of sinusitis

Purulent rhinorrhoea | Facial pain

How does maternal hyperglycemia cause ARDS?

Causes fetal hyperinsulinemia

GERD exacerbates asthma sms. How?

Micro aspiration of gastric contents Increase vagal tone Bronchial Hyperreactivity

CXR features of pleural mesothelioma vs bronchogenic ca

Pleural mesothelioma: u/l pleural prob U/l large pleural effusion Bronchogenic Ca: B/l pleural plaques + atelactasis

Diastolic collapse with Increase RV pressure Decrease RV pressure

Increase: cardiac tamponade Decrease: hypovolemic shock

Signs of post nasal drip

Oropharyngeal cobblestoning on P.E

Risk factor for Chronic pulmonary aspergillosis Invasive aspergillosis

Chronic pulmonary aspergillosis: Cavitary TB Invasive : GC,neutropenia,HIV

Pulmonary nodules with ground glass opacities seen in.....

Invasive aspergillosis

Tests for invasive aspergillosis vs chronic pulmonary aspergillosis

Invasive: cell wall bio markers (Galactomann, beta glucan) Chronic pulmonary: aspergillosis IgG serology

Aspergillosis with weight loss

Chronic pulm aspergillosis

Why is the goal for spo2 in COPD at 90-95%?

Else there will be hypercapnia secondary to: Increase dead space perfusion Decrease alveolar ventilation and affinity for oxyhb to CO2.

CXR features of histoplasmosis

B/l mediastinal /hilar LAD | Focal reticulonodular infiltrates

CXR features of coccidiomycosis

U/l infiltrate and I/L hilar LAD

Bx findings of histoplasmosis vs coccidiomycosis

Histoplasmosis: granulomas Narrow based budding yeasts Coccidiomycosis: sperules and endospores

Decrease in FE urea (<35%) is used as an indicator for.....

Decreased renal perfusion in patients taking diuretics