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pance/eoc > Pulmonology (Current) > Flashcards

Pulmonology (Current) Flashcards

1
Q

Risk factors for Sarcoidosis

A
  • African American
  • Females
  • Northern Europeans
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2
Q

Symptoms of Sarcoidosis

A
  • Dry (nonproductive) cough
  • Skin: erythema nodosum, lupus pernio
  • Parotid gland enlargement
  • Anterior Uveitis
  • Restrictive cardiomyopathy
  • Diabetes Insipidus
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3
Q

What is Lofgren Syndrome in regards to sarcoidosis?

A

-Erythema nodosum + bilateral hilar LAD + polyarthralgias with fever

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4
Q

Best initial test and what does it show for sarcoidosis

A

-Bilateral hilar LAD on CXR

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5
Q

What kind of pattern is on a PFT for Sarcoidosis?

A

Restrictive pattern: normal or increased FEV1/FVC, normal or decreased FVC

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6
Q

What is the most accurate diagnostic for sarcoidosis?

A

Tissue Biopsy: noncaseating granulomas

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7
Q

What is one other lab that is significant in sarcoidosis?

A

Increased ACE levels

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8
Q

If the patient is symptomatic and has sarcoidosis, what is the first line treatment?

A

Oral corticosteroids

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9
Q

What is a pleural effusion?

A

Abnormal accumulation of fluid in the pleural space

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10
Q

Physical exam findings of a pleural effusion

A
  • Dullness to percussion
  • Decreased fremitus
  • Decreased breath sounds
  • Dyspnea, pleuritic chest pain, cough
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11
Q

Lateral decubitus chest radiographs are the best type of radiographs to get to evaluate for a pleural effusion. What do you see?

A

Blunting of the costophrenic angles (meniscus sign)

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12
Q

What is the gold standard diagnostic for pleural effusion?

A

Thoracocentesis

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13
Q

What are the factors of Light’s Criteria? If any of the three are present, it is an exudate cause?

A
  • Pleural fluid protein: serum protein > 0.5
  • Pleural fluid LDH: serum LDH > 0.6
  • Pleural fluid LDH: > 2/3 of the upper limit of normal LDH
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14
Q

When do you perform a chest tube for the fluid drainage?

A 
If empyema (pleural fluid pH < 7.2, glucose < 40, or positive gram stain)
-May inject with streptokinase to facilitate breakup of loculations
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15
Q

Symptoms of a pneumothorax

A
  • Hyperresonance to percussion
  • Decreased fremitus
  • Decreased breath sounds over affected area
  • Unequal respiratory expansion
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16
Q

Initial test of choice for a pneumothorax

A

Chest radiograph (expiratory upright view preferred)

  • Companion lines
  • Decreased peripheral markings
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17
Q

Primary spontaneous pneumothorax:
Secondary spontaneous pneumothorax:
Tension pneumothorax:
Traumatic pneumothorax:

A

Primary: no underlying lung disease
Secondary: underlying lung disease
Tension: positive air pressure pushes trachea and heart to contralateral side
Traumatic: Car accident, subclavian line placement

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18
Q

Stable secondary spontaneous pneumothorax treatment

A

Chest tube or catheter thoracotomy + hospitalization

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19
Q

Tension Pneumothorax treatment

A

-Needle aspiration followed by chest tube thoracostomy

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20
Q

Patient education following a pneumothorax

A

-Avoid pressure changes for a minimum of 2 weeks (high altitudes, smoking, scuba diving, etc.)

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21
Q

Strongest risk factor for sleep apnea

A

Obesity

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22
Q

First line diagnostic test for sleep apnea

A

In-laboratory polysomnography (15 or more events per hour)

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23
Q

Treatment for sleep apnea

A
  • Behavioral changes including weight loss, no alcohol, changes in sleep positioning
  • CPAP (mainstay)
  • Tracheostomy is definitive treatment
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24
Q

What is the first-line in prevention of meconium aspiration?

A

Prevention of post-term delivery (> 41 weeks) via labor induction and prevention of fetal hypoxia

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25
Q

What is pulmonary hypertension defined as?

A

Elevated mean arterial pressure > 20 mmHg with a pulmonary vascular resistance > 3 Wood units

26
Q

What is on physical exam of a patient with pulmonary hypertension?

A
  • Accentuated S2
  • Signs of right heart failure: increased JVP, peripheral edema, ascites
  • Pulmonary regurgitation, right ventricular heave
  • Dyspnea, fatigue, chest pain, weakness
27
Q

On a chest radiograph for pulmonary hypertension, you see enlarged pulmonary arteries and signs of right sided heart failure. However, what is the definitive diagnostic for pulmonary HTN?

A

-Right heart catheterization: elevated pulmonary artery pressure, RV pressure

28
Q

On a CBC for pulmonary HTN, what is seen?

A

Polycythemia (high # of RBC)

Increased hematocrit

29
Q

If primary pulmonary HTN (idiopathic in cause), what is the treatment?

A
  • Vasoreactivity trial with Nitric Oxide, IV Adenosine, or CCB
  • -If vasoreactive: CCB first line
  • -Prostacyclins (Iloprost)
  • -PD5-inhibitors (Tadalafi)
30
Q

What is the definitive treatment for pulmonary HTN?

A

Heart-lung transplant

31
Q

Acute Respiratory Distress Syndrome develops in who?

A

Critically ill patients (Gram-negative sepsis)
Severe Trauma
Near Drowning
Severe Pancreatitis

32
Q

What does chest radiographs for acute respiratory distress syndrome classically show?

A

-Bilateral diffuse pulmonary infiltrates that spare costophrenic angles

33
Q

With right heart catheterization, what is diagnostic for ARDS?

A

Pulmonary capillary wedge pressure < 18 mm Hg

34
Q

Treatment for ARDS

A

Noninvasive or mechanical ventilation + treat underlying cause

35
Q

What is the difference between costochondritis and Tietze Syndrome?

A

Costochondritis: reproducible chest wall tenderness without palpable edema
Tietze Syndrome: reproducible chest wall tenderness with palpable edema

36
Q

What is the treatment for costochrondritis and Tietze Syndrome?

A

NSAIDs

37
Q

Parrot Fever (Psittacosis) is an infection with _______ that is due to exposure of ______

A

Chlamydia Psittaci

Infected birds

38
Q

Treatment for Psittacosis

A

Tetracyclines

39
Q

Risk Factors for Berylliosis

A

-Aerospace, electronics, ceramics, tool and dye manufacturing, jewelry making

40
Q

What is Berrylium?

A

Alloyed with nickel, aluminum, and copper so people working in those industries are at increased exposure

41
Q

Treatment for Berylliosis

A

Corticosteroids, oxygen

-Methotrexate if corticosteroids fail

42
Q

Risk factors for Silicosis

A

-Quarry work, sandblasting with granite, slate, quartz, pottery makers, coal mining

43
Q

Silicosis greatly increases the risk for _____

A

Tuberculosis

44
Q

What is seen on chest radiographs with silicosis

A
  • Multiple, small round nodular opacities primarily in upper lobes
  • Eggshell calcifications of hilar and mediastinal nodes
45
Q

Definitive diagnostic for silicosis

A

Lung biopsy

46
Q

What is Caplan Syndrome?

A

Coal worker’s pneumoconiosis + Rheumatoid Arthritis

47
Q

What does a chest radiograph for coal worker’s pneumoconiosis show?

A

Small nodules in upper lung with hyperinflation of lower lobes in obstructive pattern

48
Q

Treatment for Coal Worker’s Pneumoconiosis

A

Supportive

49
Q

Risk factors for a PE

A

-Virchow’s Triad: hyper coagulability, stasis, intimal damage

50
Q

Symptoms of a PE

A
  • Tachypnea (most common sign)
  • Tachycardia
  • Dyspnea (most common symptom)
  • Pleuritic chest pain
  • Hemoptysis
51
Q

What is highly suspicious of a PE?

A

Normal chest xray in the setting of hypoxia

52
Q

What does an ECG show for a PE?

A

Nonspecific ST/T changes and sinus tachycardia

-S1Q3T3 (deep wide S in lead I; both isolated Q and T wave inversion in III)

53
Q

When is a D-dimer helpful in PE?

A

Only if negative and low suspicion for PE

54
Q

What is the best initial test to confirm the presence of a PE?

A

Helical (Spiral) CT angiography

55
Q

A V/Q scan is performed when patients cannot undergo a CT. Who are these people?

A

Pregnancy

Increased creatinine

56
Q

Gold standard and definitive diagnostic for PE

A

Pulmonary angiography

57
Q

An IVC filter is indicated in stable 3 patients:

A
  • Anticoagulation contraindicated (recent bleed, bleeding disorder)
  • Anticoagulation unsuccessful
  • RV dysfunction seen on echocardiogram (next embolus can be fatal)
58
Q

If the patient is hemodynamically stable, treatment for PE is

A

-Anticoagulation (first line): Heparin bridge plus Warfarin or novel oral anticoagulant (Dabigatran, Rivaroxaban, Apixaban, Edoxaban)

59
Q

If the patient is hemodynamically unstable (SBP < 90, acute RV dysfunction), what is the treatment for a PE?

A

Thrombolysis (LMWH)

Thromectomy or embolectomy

60
Q

PE prophylaxis is warranted in patients undergoing surgery with prolonged immobilization, pregnant women, or history of DVT/PE. What are the recommendations?

A
  • Early ambulation ( < 40, minor procedures)
  • Elastic stockings, compression devices
  • LMWH (orthopedic surgery, trauma)
61
Q

The Wells’ Criteria for DVT. Explain

A

3 points added for: Clinical signs and symptoms of DVT, PE is #1 diagnosis
1.5 points for: HR > 100, Immobilization at least 3 days or surgery in past 4 weeks, previous DVT or PE
1 point: hemoptysis, malignant with treatment in past 6 months

Low probability: < 2 points = D-dimer
Moderate: 2-6 points = CTA or D-dimer
High: > 6 = CTA

62
Q

What is the antidote for LMWH and UFH?

A

Protamine Sulfate

pance/eoc (63 decks)

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