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Clin Med I > Pulmonology Test > Flashcards

Pulmonology Test Flashcards

1
Q

Acute inflammation of the trachea and bronchi (pathology)

A

Acute bronchitis

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2
Q

MCC of acute bronchitis

A

Viral agent

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3
Q

Acute bronchitis tx

A

Symptomatic tx to control cough, discomfort, and fever

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4
Q

Acute inflammation of the terminal bronchioles (pathology)

A

Acute broncholitis

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5
Q

Population in which acute broncholitis is MC

A

Infants and children

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6
Q

MC cause of acute broncholitis

A

RSV or Adenovirus

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7
Q

Acute broncholitis - how are CXR’s different between children and adults?

A
  • Children: resembles patchy pneumonia

- Adults: looks like ground glass densities (looks fuzzy)

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8
Q

You see “ground glass” densities on CXR. What’s in your differential based solely on that finding?

A
  • Acute broncholitis in adults

- Interstitial lung disease (Diffuse parenchymal lung disease)

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9
Q

TX for acute broncholitis

A

Supportive treatment

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10
Q

Acute infection of the supraglottis with viral or bacterial pathogen (pathology)

A

Acute epiglottitis

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11
Q

MC Cause of acute epiglottitis?

A

HIB (but rare now with the HIB vaccine)

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12
Q

Child presents with severe odynophagia, muffled voice, and they’re drooling. You check their tonsils and the back of their throat and find nothing. What should you suspect?

A

Epiglottitis

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13
Q

“Thumb print sign” on x-ray is related to what pathology?

A

Epiglottitis

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14
Q

MCC of croup

A

Parainfluenza (flu-like) viruses

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15
Q

Acute inflammatory disease of the larynx, accompanied by barking cough and stridor

A

Croup

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16
Q

X-ray sign with croup

A
  • Steeple sign

- From narrowing supraglottic narrowing secondary to edema

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17
Q

Pertussis causative agent

A

Bordetella pertussis (Gram negative bacteria)

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18
Q

How do you transmit Pertussis?

A

Via respiratory droplets

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19
Q

3 stages of Pertussis

A
  • Catarrhal stage
  • Paroxysmal stage
  • Convalescent stage
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20
Q

Patient presents with rapid, consecutive coughs followed by a deep, high-pitched inspiration. What stage of what disease state are they in?

A

-The paroxysmal stage (the 2nd stage) of Pertussis (AKA “Whooping cough”)

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21
Q

If suspicious of Pertussis (Whooping cough), on what agar should you use to plate a sputum sample?

A

Bordet-Gengou agar

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22
Q

Antibiotics used for Pertussis (Whooping cough)

A

Macrolides (Erythromycin, Azithromycin, Clarithromycin)

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23
Q

MCC of classic CA pneumonia

A

Strep pneumoniae

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24
Q

Rust colored sputum is associated with what organism and what pathology?

A
  • Strep pneumoniae

- pneumonia

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25
Q

Currant jelly sputum is associated with what organism and what pathology?

A
  • Klebsiella

- Pneumonia

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26
Q

Organism that will likely be responsible for pneumonia in alcoholics

A

Klebsiella

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27
Q

DOC family for classic CAP not requiring hospitalization in a young, otherwise healthy patient

A

Macrolide (Clarithromycin, Azithromycin, or Erythromycin)

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28
Q

DOC family for classic CAP not requiring hospitalization in an older patient with comorbidities

A

Doxycycline or Fleouroquinalone (Levofloxacin)

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29
Q

Treatment for classic CAP requiring hospitalization

A
  • Extended spectrum beta lactam (PCN or cephalosporin) plus a Macrolide (Like Ceftriaxone IV with Azithromycin)
  • Extended spectrum beta lactam (PCN or cephalosporin) plus a Flouroquinalone (Like Ceftriaxone IV with Levofloxacin)
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30
Q

MCC of atypical CAP

A

Mycoplasma pneumonia (or chlamydia, legionella, viruses)

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31
Q

What’s the likely causative agent of an atypical pneumonia in a patient who may have consumed contaminated water?

A

Legionella

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32
Q

Preferred family of antibiotics for atypical CAP

A

Macrolides (Azithromycin, Erythromycin, Clarithromycin)

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33
Q

Likely causative agent in nosocomial pneumonia in an intubated patient or in a patient in the ICU

A

Pseudomonas

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34
Q

Two MC causes of nosocomial pneumonia

A

MRSA or pseudomonas

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35
Q

Treatment choice for nosocomial pneumonia with mild symptoms

A

2nd/3rd gen Cephalosporin (like Rocephin) and a Macrolide

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36
Q

Treatment choice for nosocomial pneumonia in a patient in the ICU or intubated

A
  • Aminoglycoside (Streptomycin, Gentamicin, etc.) OR Flouoquinalone (Levofloxacin)
  • AND an Antipseudomonal beta lactam (PCN, Cephalosporin, or Aztreonam)
  • Add Vancomycin if MRSA is suspected
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37
Q

Likely causative agent of pneumonia in HIV patient

A

Pneumocystic jiroveci

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38
Q

What tool do we use to help us decide if pneumonia patient needs to be hospitalized?

A

PORT Score

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39
Q

Rare, aggressive manifestation of TB

A

Miliary TB

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40
Q

Inability to react to PPD test because of immunosuppression

A

Anergy

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41
Q

Isoniazid (INH) adverse effects

A
  • Hepatitis

- Peripheral neuropathy

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42
Q

Rifampin (RIF) adverse effects

A
  • Hepatitis
  • Flu-like symptoms
  • Orange body fluid
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43
Q

Which TB treatment is contraindicated in pregnancy?

A

Streptomycin

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44
Q

Ethambutol (EMB) adverse effects

A

Optic neuritis (red-green vision loss)

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45
Q

Which types of bronchogenic carcinoma tend to originate centrally?

A
  • Squamous cell carcinoma

- Small cell

46
Q

Which types of bronchogenic carcinoma tend to be located more peripherally?

A
  • Adenocarcinoma

- Large cell carcinoma (although this can also be located more centrally)

47
Q

Which type of lung cancer may present as a cavitary lesion?

A

Large cell carcinoma

48
Q

Two subtypes of large cell carcinoma

A

Giant and clear cell

49
Q

Horner’s syndrome consists of what?

A
  • Enophthalmos
  • Ptosis
  • Miosis
  • Ipsilateral anhydrosis
50
Q

What type of tumor can cause Horner’s syndrome?

A

Pancoast tumor

51
Q

System used to stage non-small cell lung cancer

A

TMN

  • T: tumor
  • M: metastasis
  • N: nodal involvement
52
Q

2 classifications of small cell lung cancer

A
  • Limited

- Extensive

53
Q

Pancoast tumors are one of what two “types” of tumor?

A
  • Large cell

- Or adenocarcinoma

54
Q

Tumor of the lung’s superior sulcus

A

Pancoast tumor

55
Q

Imaging studies good for looking for Pancoast tumor

A

CT/MRI

56
Q

How can you distinguish pleuritis from costochondritis?

A

-Costochondritis pain will be reproducible with pressure or palpation

57
Q

Effusion caused by an increased production of fluid, with normal capillaries

A

Transudative

58
Q

Type of effusion caused by fluid leaking through abnormal capillary walls, or from decreased lymphatic clearance

A

Exudative effusion

59
Q

What labs would be significant in distinguishing a transudative effusion from an exudative effusion?

A

For an EXUDATIVE effusion:

  • Pleural protein to serum protein ratio will be > 0.5
  • Pleural LDH to serum LDH ration will be > 0.6
60
Q

What changes in percussion and tactile fremitus will be observed with a pleural effusioN?

A
  • Dullness to percussion

- Decreased tactile fremitus

61
Q

Procedure that drains a pleural effusion

A

Pleurodesis

62
Q

Procedure that will likely be performed to drain a pleural effusion of pus

A

Tube thoracostomy

63
Q

When a patient presents with a pneumothorax, what measurement will guide our treatment? (Either conservative wait-and-see treatment or insertion of a chest tube)

A
  • If the pneumothorax is < 15%, conservative treatment

- If the pneumothorax is > 15%, chest tube placement

64
Q

Procedure indicated in patients with recurrent pneumothoracies

A

Pleurodesis (fusion of the pleura to obliterate the pleural space)

65
Q

Where do we perform (anatomically) a needle thoracostomy?

A

2nd ICS, MCL

66
Q

Primary tumors of the mesothelial cells arising from the surface lining of the pleura (pathology)

A

Mesothelioma

67
Q

Inflammation and fibrosis of interalveolar septum or capillary endothelial cells (pathology)

A

Interstitial lung disease (diffuse parenchymal lung disease)

68
Q

Most common diagnosis among patients with interstitial lung disease

A

Idiopathic fibrosing interstitial pneumonia

69
Q

Systemic, inflammatory, multisystem disease of unknown cause with granulomatous inflammation of the lung in 90% of patients (pathology)

A

Sarcoidosis

70
Q

Is sarcoidosis obstructive or restrictive?

A

Restrictive

71
Q

TX of sarcoidosis

A
  • Oral corticosteroids are first line
  • Methotrexate
  • Lung transplant
72
Q

Chronic fibrotic lung disease caused by inhalation of various dusts (Asbestos, silica, coal) (Pathology?)

A

Pneumoconiosis

73
Q

What is “Hampton’s Hump” on CXR associated with?

A

PE

74
Q

What “rule” do we use to help rule out the possibility of a PE?

A

PERC (Pulmonary Embolism Rule out Criteria)

75
Q

What is “Westermark’s Sign” on CXR associated with?

A

Pulmonary embolism

76
Q

Will patients with a PE be acidotic or alkalotic? Why?

A

Alkalotic from hypervntilation

77
Q

Only available definitive medicinal treatment for PE

A

Thrombolysis with Streptokinase, Alteplase, etc.

78
Q

Treatment for PE when thrombolytic therapy is absolutely contraindicated

A

Embolectomy

79
Q

Patient population in whom primary PHTN tends to occur?

A

Young and middle-aged women

80
Q

What might a CBC reveal in a patient with PHTN? Why?

A
  • Polycythemia

- From chronic hypoxemia causing increased RBC production

81
Q

Pulmonary vasodilator drug

A

Epoprostenol

82
Q

Most common cause of cor pulmonale

A

COPD

83
Q

3 components of asthma as an obstructive disease

A
  • Airway hyper-responsiveness
  • Inflammation
  • Allergic/Immunologic-mediated
84
Q

What will CXR of asthmatic patient show?

A
  • Hyperinflation

- Increased rib spacing

85
Q

FEV1/FVC value indicative of obstructive disease

A

< 75%

86
Q

What value should asthmatics test for every morning to make sure they’re well-controlled?

A

Peak Expiratory Flow

87
Q

What change in FEV1 is considered a positive bronchial provocation test?

A

Decrease in FEV1 by at least 20%

88
Q

Type of asthma that’s unrelated to allergens

A

Idiosyncratic (intrinsic) asthma

89
Q

Lung functions defining intermittent asthma

A
  • FEV1 > 80%
  • Less than 20% variability
  • FEV1/FVC is normal
90
Q

Lung functions defining mild persistent asthma

A
  • FEV1 > 80%
  • 20-30% variability
  • FEV1/FVC is normal
91
Q

Lung functions defining moderate persistent asthma

A
  • FEV1 60-80%
  • > 30% variability
  • FEV1/FVC is reduced by 5%
92
Q

Lung functions defining severe persistent asthma

A
  • FEV1 < 60%
  • > 30% variability
  • FEV1/FVC reduced by > 5%
93
Q

How is FEV1 affected in obstructive disease?

A

Decreased

94
Q

How is FVC affected in obstructive disease?

A

Decreased

95
Q

How is FEV1/FVC affected in obstructive disease?

A

Decreased

96
Q

How is PEF affected in obstructive disease?

A

Decreased

97
Q

How is TLC affected in obstructive disease?

A

Increased (air-trapping)

98
Q

How is RV affected in obstructive disease?

A

Increased (air-trapping)

99
Q

TOC for acute symptoms in asthma?

A

Fast-acting beta agonists

100
Q

TOC for bronchospasms in patients on beta-blockers or with COPD

A

Anticholinergic

101
Q

Preferred agents for long-term control of asthma?

A

Long-acting corticosteroids

102
Q

Indicated for maintenance therapy of mild-moderate asthma, or for exercised-induced asthma prophylaxis

A

Mediator inhibitors

103
Q

Green zone for asthmatics (PEF value)

A

PEF > 80%

104
Q

Yellow zone for asthmatics (PEF value)

A

PEF 50-80%

105
Q

Red zone for asthmatics (PEF value)

A

PEF < 50%

106
Q

“Mild” COPD FEV1 value

A

60-80% of predicted

107
Q

“Moderate” COPD FEV1 value

A

40-59% of predicted

108
Q

“Severe” COPD FEV1 value

A

< 40% of predicted

109
Q

What cause of COPD should you be suspicious of if you have COPD in a patient < 40 yo?

A

Alpha-1 antitrypsin deficiency

110
Q

Mainstay of drug therapy for COPD patients

A

Bronchodilators

111
Q

Abnormal dilation of the bronchi resulting from inflammation and permanent destructive changes in the elastic and muscular layers of the bronchial walls

A

Bronchiectasis

Clin Med I (4 decks)

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