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Internal Medicine > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Diagnosis of asthma

A

Diagnosis of asthma

  • PFTs/spirometry to assess bronchodilator response-> no response-> methacoline challenge test
  • Nocturnal or early morning peak expiratory flow rates measurement–for those with nocturnal symptoms only
    Alternative approach: 2-4 wks treatment with inhaled glucocorticoids-> improved condition-> asthma diagnosed
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2
Q

Asthma and comorbid GERD

A

Comorbid GERD is usually present in pts with asthma-›microaspiration of gastric contents-> 1 vagal tone and bronchial reactivity-> exacerbates asthma symptoms-> sore throat, morning hoarseness, 1 cough only at night, 1 need of albuterol inhaler after meals may not be associated with typical GERD sims+ symptoms- 1 risk with obesity > Rx: PPl improve asthma symptoms and peak expiratory flow rates in asthma

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3
Q

Treatment of asthma exacerbation

A

Mild to moderate exacerbation: exygen and inhaled short acting beta 2 adrenergic agonists (SAGA
usually respond? il no response-> systeric corticosteraids
Severe exacerbation: SABAs+ ipratropium nebulizer» systemic corticosteroids ( oral/IV - takes se hour to show effect) -> no improvement after one hour of therapy-> one time dosing with IV
magnesium sulfate (bronchodilation) -> signs of respiratory failure > admit to ICU with endotrach
intubation

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4
Q

ABG in Asthma & PE

A

Respiratory Alkalosis

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5
Q

ABG in COPD

A

Respiratory acidosis

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6
Q

Anterior mediastinal masses

A

4Ts
terrible lymphoma,
thyroid,
thymoma,
teratogenic tumors

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7
Q

Anti GBM antibody (goodpasture disease)

A

Immune mediated IGg type 2 hypersensitivity reaction. can lead to proliferative GN and renal failure. poor prognosis
TTX: plasmapheresis, cyclophosphamide, steroids.

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8
Q

ARDS berlin criteria

A

1) acute onset <1 week 2)
bilateral involvement 3)
pulmonary edeam not casued by fluid overload or CHF( PCWP <18) 3)
abnormal Pa02/ Fi02
ratio <200)

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9
Q

ARDS casues

A

1) sepsis 2) aspiration of gastric contents 3) severe trauma, pancreatitis, burns, 4) drug overdose
5) intracranial HT 6)
cardiopulmonary bypass

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10
Q

Arrythmia thats common in
patients with COPD is?

A

MAT, treated by managing
COPD not by giving antiarrythmic drugs.

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11
Q

Best mechanical ventilation method for COPD pt?

A

Bipap

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12
Q

Causes of Bronchiectasis:

A

1) reccurent infections (allergic bronchopulmonary asperigillosis is a risk factor)
2) Cystic fibrosis
3) primary cillary dyskinesia (kartegner syndrome)
4) autoimmune disease (RA, SLE)
5)Humoral immunodeficienev

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13
Q

Causes of exudative Pleural effusion

A

1) malginancy
2) viral,bacterial infection (TB)
3) PE
4) collagen vascular disease

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14
Q

Causes of transudative
Pleural effusion

A

1) CHF
2)atelectasis
3)PE
4) peritoneal dyalisis
5) nephrotic syndrome
6)hypoalbuminemia
7) cirhosis

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15
Q

Classical CXR findings in silicosis

A

egg shell calcifications, localized and nodular peribronchial fibrosis

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16
Q

classical CXR findings of asbestosis

A

linear opacities, pleural plaques, barbell bodies on
biopsy

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17
Q

clinical manifestations of sarcoidosis

A

1) Constitutinal symptoms (fever, weight loss, anorexia)
2) CNS involvement ( Optic nerve, facial nerve palsy, peripheral neuropathy, papilledema)
3) Eyes (anterior Uveitis, posterior
Uveitis, conjunctivits)
4)Lungs ( dry cough, dyspnea)
5) Cardiac ( arrythmias, conduction disturbances)
6)MSS (arthitis, arthralgia)
7)Skin (erythema nodosum, subcutanous nodules,)

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18
Q

Comorbidites associated with Asthma?

A

1) GERD 2) OSA 3) Sinus disease
4) Obesity 5) Vocal cord dysfunction

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19
Q

Complications of COPD

A

1) Acute exacerbations
2) polycythemia 3) cor pulmonale

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20
Q

COPD risk factors and causes:

A

1) Smoking 2) Chronic asthma
3) A-1 antitrypsin deficiency
4) environmental factors (2nd hand smoke)

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21
Q

CXR findings of pulmonary embolism

A

hampton & westmark signs

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22
Q

DDX of finger clubbing

A

1) LUNG (ILD, CF, lung ca., sarcoidosis) 2) CHF, bacterial endocarditis 3) IBD 4) liver cirhoisis 5) primary billary cirhosis

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23
Q

definition of sarcodiosis

A

is a chronic systemic disease characterizied with Non caseating granulomas, commonly found in african american women under 40 yr of age, mostly asymptomatic

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24
Q

difference between
Panlobular and centrilobular emphysema

A

Centrilobular:
1) MC type,
in smokers
2) involves emphysema proximal Acini
3) common in upper lobes
Panlobular:
1) MC in a1 antitrypsin deficiency
2) involves distal and proximal acini
3)common in lung Base

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25
Q

Drug that treats CF

A

Ivacaftor (CFTR regulator)

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26
Q

ECG finding of Pulmonary
embolism

A

S1Q3T3

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27
Q

Eosinophilic Granulomatosis with polyangitis (churg strauss)

A

Granulomatous vasculitis
common in asthma patients,
has high P-ANCA levels

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28
Q

genetic mutation of cystic
fibrosis

A

CFTR gene, autosomal
recessive, seventh chromosome.

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29
Q

gold standard diagnostic test for ILD

A

HRCT

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30
Q

Good pasture disease has
high levels of which antibody

A

PANCA

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31
Q

Granulomatosis with polyangitis (Wegner granulomatosis )

A

is a necrotizing
granulmatous vasculitis, affects kidneys and lung,
GOLD STANDARD for diganosis is tissue biopsy. has high C- ANCA level

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32
Q

how to treat samters triad?

A

Montelukast ( a leukotrine modifier)

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33
Q

hypersensitivity pneumonitis

A

immune mediated
pneumonitis, by IGg, IGa antibodies. Results in non caseating granulomas & peribronchial mononuclear infiltrates with giant cells.
MANAGMENT: removal of offending agent

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34
Q

idiopathic pulmonary fibrosis

A

unknown etiology, 50-70yr
old, men, smokers presents with >6months of dry cough & SOB 50% association with finger clubbing

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35
Q

ILD that affect the upper parts of lung

A

Myobacteruim Settles
Superiorly At Lung
1) TB
2)sarcoidosis
3) silicosis
4)Ankylosing spondylitis
5)Langerhans histocytosis

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36
Q

ILD that affects base of lung

A

AAPC
1) asbestosis
2)aspiration
3) Pulmonary fibrosis (idiopathic)
4)Collagen vascular disease

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37
Q

Important clincal feature of Bronchiectasis?

A

chornic cough with LARGE amouts of mucopurluent
FOUL smelling sputum.

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38
Q

Indications for Oxygen therapy in COPD:

A

1) if Pa02 (55mmhg) OR
02sat <88%
2) if Pa02 (59mmhg) OR 02sat 89% in patients with HF, Cor palmonale

39
Q

Local invasion forms of lung
cancer?

A

1) SVC syndrome (5%)
caused by mediastinal tumors
2) phrenic nerve palsy (1%)
3) Reccurent laryngeal nerve palsy (3%)
4) Horner syndrome: invasion of cervial sympthatic plexus
5) Pancost tumor: involvment of C8-T2: causes weakness, numbness in upper extermities. COMMONLY from squamous cancers
6)Malignant pleural effusion (considerd stage 4 cancer )

40
Q

Lung PFT in ILD

A

Both FEV1 & FVC are reduced equally, thus FEV1/ FVC ration remains normal or is increased

41
Q

Main precipitants for COPD exacerbations (organisms)

A

1) MCC is viral causes
2) strep. pneumonia 3)
H.influenza 4) mycoplasma pneumonia 5) Moraxella catarrhalis

42
Q

Management of Asthma exacerbations

A

1) Inhaled b2 agnoist
2)oral steroids or IV 3) IV magnesuim (only used in unresponsive cases to above medications)
4) Supplemental oxygen
5) Antibiotics (ONLY if suspicion of bacterial penumonia is present) 6)
intubation

43
Q

Managment of Asthma

A

1) Inhaled B2 agonists
2) Inhaled steroids 3)
Leukotrine modifers (montelukast) 4) Theophyline

44
Q

Managment of COPD exacerbations

A

1) FIRST LINE:
Bronchodilators alone or combination of B2 agonists or anticholinergics) 2)
Oral Steroids 3) oxygen 4) antibiotics 5) intubation if refractory

45
Q

middle mediastinal masses

A

MACLL morgagni hernia, aneursym, Cyst, lymphoma, lung cancer

46
Q

most common cardiac finding in patients with Plumonary embolism is

A

Sinus tachycardia

47
Q

Most common form of lung cancer?

A

1) Non small cell 75% (adenocarcioma is most common type) 2) small cell
25%

48
Q

most common lung cancer in general?

A

is metz. from breast and
colon

49
Q

Most common sites of Metz.

A

LABB 1) liver 2) adrenal in lung cancer
glands 3) brain 4) bone

50
Q

most likely organism to
cause pneumonia in patients with CF?

A

Pseudomonas

51
Q

MX of NSCLC

A

resection tradiation

52
Q

MX of SCLC

A

if limited: combination chemo + radiation if extensive: chemo alone followed by whole brain irradiation if responsive to chemo

53
Q

Paraneoplastic syndromes of
Lung cancer

A

SCLC: 1) Inappropriate
ADH 2) ACTH (cushing) 3) eaton lambert syndrome
4) hypercalcemia due to PTH secretion (commonly squamous) 5)
hypercalcemic pulmonary osteoarthropathy squamous & adenocarcinoma)

54
Q

Risk factors of Lung cancer?

A

1) smoking 2) asbestos 3)
radon 4) COPD 5) second hand smoke exposure

55
Q

screening test of lung cancer

A

low dose CT annually for: 1)
pt. with >30 pack years 2)
stopped smoking less than
15 yr ago 3) older than 55 yrs of age

56
Q

what is not a determinent of
Resection for lung cancer

A

size

57
Q

PFT in restrictive lung disease

A

DECREASE IN TLC, VC, FRC

58
Q

PFT vaules in COPD:

A

INCREASE in TLC, FRC, RV DECREASE in VC, FEV1, FEV1/FVC ratio, peak expiratory flow

59
Q

positive tests in Sarcodosis

A

1) tuberculin skin test 2)
ACE enzyme elevation
3) Hypercalcemia and hypercalcuria

60
Q

posteroir medisatinal masses

A

neurogenic tumors, esophageal mass, bochadelk hernia, enteric cyst

61
Q

Pulmonary alveolar protienosis

A

accumulations of
surfactant like protien and phospholipids.

62
Q

Risk factors for solitary pulmonary nodules

A

AB 2S 2C 1) age >60 2)
Borders: irregular 3) Smoking
4) size: >2cm has 50% chance of malignancy 5)
Calcification: malignant if eccentric and asymmetrical
6) change in size: if rapid more likely to be malignant

63
Q

Risk factors of Lung cancer?

A

1) smoking 2) asbestos 3)
radon 4 COPD 5) second hand smoke exposure

64
Q

Sarcoidosis findings on chest XR

A

bilateral hilar adenopathy is a hallmark finding.

65
Q

screening test of lung cancer

A

low dose CT annually for: 1)
pt. with >30 pack years 2)
stopped smoking less than
15 yr ago 3) older than 55 yrs of age

66
Q

Signs of COPD:

A

INSEPCTION: 1) cyanosis 2)
use of accessory muscles
3) prolonged expiratory phase with pursed lips
PALPATION: 4) tachypneia 5) tachycardia PERCUSSION:
6) hyperressonance
AUSCULTATION: 7)
inspiratory crackles 8)
expiratory wheeze 9)
decreased breath sounds.
*** in advanced disease signs of COR PULMONALE

67
Q

Treatment of Bronchiectasis

A

1) MAINLY antibitoics 2)
hydration 3) physiotherapy
4) inhaled bronchodilators (rarely)

68
Q

Treatment of choice in sarcoidosis

A

if asymptomatic = nothing
if symptomatic = Steroids
are treatment of choice, if refractory to steroids after 6 months try methorexate

69
Q

Treatment of COPD:

A

1) SMOKING CASSATION is the most important.
2) oxygen therapy 3)
inhaled anti cholinergics ( ipratropuim bromide, tiotropium) 4) inhaled beta 2 agonists 5) combination of both (anticholinergics and B2 agonist) 6)
Inhaled corticosteroids
IN COMBINATION with B2 agnoist (NEVER ALONE
7) theophyline (narrow theraputic index (IN
REFRACTORY CASES)
8) Phosphodiestrase

70
Q

What is pulmonary langerhan cell histocytosis

A

a chronic interstial pneumonia caused by abnormal proliferation of histocytes. 90% in smokers

71
Q

What is samters triad?

A

Combination of asthma, aspirin sensitivity and nasal polyps

72
Q

what is the cause of samters triad?

A

Leukotrine overproduction

73
Q

What is the most frequent non cardiac cause of pulsus paradoxes

A

COPD & ASTHMA

74
Q

what organ systems does cystic fibrosis affect?

A

1) RS
2) GI (exocrine pancrease, intestines)
3) Fertility (gentourinary system)

75
Q

what should patiens
with pulmonary alveolar
protienosis NOT be given

A

steroids because there at increased risk of infections

76
Q

what type of hypersensitivity response is Asthma?

A

type 1 IGE mediated

77
Q

What’s the A-a gradiant in
Pulmonary embolism

A

elevated due to V/Q mismatch

78
Q

what’s the gold standard
for Dx of pulmonary hypertension

A

Right heart catheterization

79
Q

whats the defenitive
diagnositc test in sarcoidosis

A

transbronchial biopsy

80
Q

whats the gold standard for
Pulmonary embolism ?

A

Pulmonary angiography

81
Q

whats the hallmark
diganositic finding of ILD?

A

desaturation more than 4% with ambulation

82
Q

when is surgical resection of
Lung ca C/I

A

1) Bilatera 2) metz. 3) malignant pleural effusion

83
Q

when is thoracocentisis not done in Pleural effusion?

A

1) if fluid is lobulated
2) if <10ml
3) if pt. has CHF – try duretics first.

84
Q

When to measure A1 antitrypsin level?

A

in patients with family history
of premature COPD (<45yr) or in nonsmokers presenting with emphysema

85
Q

which anticoagulants can
be taken in patients with
GFR

A

1) warfrain
2) Unfractinated low heprain
3) apixiban

86
Q

which race is CF comonly in?

A

caucasians

87
Q

treatment of Pulmonary alveolar protienosis

A

1) lung lavage 2) granulocyte stimulating factor

88
Q

vitamin deficiency in CF

A

AKED vits. 1) vit. A = night blindness 2) Vit. K = coagulopathy 3) Vit, E = ataxia, hemolysis 4) Vit. D = rickets

89
Q

what drugs should be avoided in Samters triad?

A

NSAIDS, like aspirin

90
Q

What finding on HRCT indicated poor pronosis and end stage lung disease?

A

Honey coomb pattern

91
Q

What is an indication that pleural effusion could be due to RA?

A

if pleural glucose is <60 Low ph
High LDH and cell count
Exudative pleural effusion

92
Q

What is GOLD staging for
COPD?

A

measures severity of
COPD according to FEV1
1)>80% = Mild dz
2) 80-50% =moderate
3) 50-30% = severe
4) <30% = very severe

93
Q

What is Lights Criteria

A

used to diagnose Exudative pleural effusion. (HAS TO HAVE AT LEAST ONE)
1)Pleural Protien/ Serum
protien = >0.5
2) Pleural LDH/ Serum LDH = >0.6
3) LDH >2/3rd of upper normal limit of serum LDH

Internal Medicine (10 decks)

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