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IM > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is the presentation of tension pneumo

A

compression of mediastinum, absent breath stounds, hypotension

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2
Q

Presentation of GPA?

A

upper airway - bloody discharge, sinusitis, oral ulcers
lower airway - dyspnea, cough, hemoptysis
renal: hematuria, renal insufficiency,

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3
Q

What are the treatment modalities available for asthsma?

A 
mild intermittent - SABA PRN
mild persistent: SABA + ICS
moderate persistent: SABA + ICS + LABA 
Severe: SABA + medium ICS + LABA
controller - theophylline = leukotriene antagonist, can be used 
fluticasone - persistent
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4
Q

What are the causes of hilar lymphadenopathy?

A

CLL, lymphoma, sarcoidosis, mets, granulomatous infection

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5
Q

What are the causes of pulmonary hypertension?

A

Cardiac - congenital heart disease, acquired heart disease
Pulmonary - COPD, restrictive lung disease
Pulmonary vascular - chronic PE, vasculitis, primary pulmonary hypertension

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6
Q

What masses can be found in the anterior mediastinum?

A

thymoma, thymus lymphoma, teratomas, thyroid masses

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7
Q

What are the possibilities for posterior mediastinum masses?

A

Nerve - schwannoma, neurofibromas,

Bone - primary bone tumor ( osteosarcoma, myeloma, osteomyelitis)

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8
Q

What are the possibilities for a middle mediastinum mass?

A

Aorta- Aortic dissection, aortic aneurysm, esophagus - esophageal alchalasia, adenocarcinoma, cyst,
Heart - cysts

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9
Q

What is the most common pneumonia in post flu patients?

A

Staph

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10
Q

What lab finding is an indication of a worsening asthma attack?

A

Normal PCO2

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11
Q

What is the treatment protocol for COPD?

A

Bronchodilators (albuterol, ipatroprium = anti muscarininc)
Oxygen
Systemic steroids
Antibiotics (cover moxella, h flu and strep pneumo)
For persistent COPD - advisor (LABA + ICS)
Possibly NSAIDs

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12
Q

Run through the whole differential for pulmonary massess

A 
See rads lecture
Neoplasm - carcinoma, hamartoma, carcinoid, lymphoma, met
Infection - TB, histo, coccidio, abscess
Infarct
Trauma - hematoma
Other: Wegener's, rheumatoid, BOOP,
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13
Q

Run through differential for multiple pulmonary nodules

A

Mets -
Infection - Septic emboli, Miliary TB, fungal, invasive aspergillus
Inflammatory - AVM, Wegener’s, Rh nodules

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14
Q

Run through differential for chest wall lesions, pleural lesions, apical

A

Chest wall - abscess, hematoma, hamartoma, fibroma, lipoma, lymphoma
Pleural - fibroma, lipoma, loculated effusion, lymphoma, mets, mesothelioma,
Apical - TB, Abscess, pancoast tumor, TB mimics, PNA

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15
Q

What are the different causes of pulmonary effusions?

A

Unilateral - cirrhosis, PE, empyema, TB, mesothelioma, PNA, Dressler’s syndrome
Bilateral - CHF, nephrotic syndrome, mixed connective tissue disease, malnutrition, hypothyroid, viruses
Both - ascites, pancreatitis, trauma, pericarditis, chylous

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16
Q

What are the criteria for diagnosis of asthma?

A

airflow obstruction partially reversible with inhaled SABA as shown by
An increase in FEV1 of 12% from baseline, an increase of 10% points from baseline or increase of PEF of greater than 20% from baseline

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17
Q

What are the treatment options available for empyema?

A

streptokinase early - can help bust, but not if thick
antibiotics - helpful early
can do second chest tube if not too complex
otherwise, surgery

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18
Q

Describe the gram negative bacilli that can cause PNA

A

e coli, klebsiella, pseudomonas, proteus, enterobacter,

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19
Q

How does klebsiella mediated PNA often present?

A

currant jelly-like sputum with tissue necrosis, early abscess formation, often happens in alcoholics
produces mucoid colonies

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20
Q

A patient comes in with a complicated PNA. Treatment?

A

antibiotics +corticosteroids - minimizes pulmonary complications from inflammatory effects of dead organisms in tissue

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21
Q

What is peak airway pressure? What is plateau pressure?

A 
peak  = resistive + plateau
plateau = elastic + PEEP
22
Q

A patient presents with low grade fevers, lytic bone lesions, skin involvement from the Mississipi river valley. This is.. (and what is the treatment?)

A

blastomyces - treatment is amphotericin B

23
Q

What are Light’s criteria?

A

fluid/serum protein > 0.5, fluid/serum LDH > 0.6,

24
Q

What is the cause of transudative vs. exudative effusions?

A

exudative - infection, malignancy, autoimmune, PE

25
Q

A patient presents with pneumonia and extrapulmonary symptoms such as elevated LFTs and loose stools. What test should you do?

A

legionella antigen test

26
Q

What are the organisms that cause community aquired pneumonia?

A

strep pneumo, moraxella, H. Flu

27
Q

What does decreased tactile fremitus mean?

A

pneumothorax or effusion

28
Q

What are Well’s Criteria?

A

score 3+ (clinical signs of DVT, alternate diagnosis less likely)
score 1.5 (previous PE/DVT, Heart rate >100, recent surgery (in last 4 weeks),
Score 1 (hemopytisis, cancer)
if score greataer than 4, PE is likely

29
Q

How does well’s criteria inform treatmetn?

A

if PE likely, give heparin before diagnostic studies

30
Q

How do PPIs affect patients with asthsma?

A

improves peak expiratory flow, nocturnal respiratory symptoms

31
Q

A patient comes in with an acute exacerbation of COPD with minimal air movement. What is the next step?

A

BIPAP unless hemodynamic unstability, worsening respiratory acidosis, etc.

32
Q

What is the best prophy available for DVT?

A

sub q heparin

33
Q

A patient presents with clubbing of the digits, periosteal bone formation and arthritis - what should be the next steps?

A

this is hypertrophic osteoarthropathy - associated with intrathoracic malignancy, so order an X ray

34
Q

A patient presents with milky white pleural effusion. What is the likely cause?

A

lymphoma

35
Q

What is the diagnostic method of choice for sarcoid?

A

fiberoptic bronchoscopy

36
Q

What are frequent complications of cystic fibrosis?

A

chronic pulm infections, bronchiectasis, diabetes and GI problems (pancreatic insufficiency), infertility

37
Q

A patient presents with bilateral lung fibrosis after starting an antiarrhythmic drug. This is likely caused by..

A

amiodarone

38
Q

The presence of new onset clubbing in a patient with COPD is strongly suspicious for…

A

malignancy

39
Q

What is the presentation of ABPA?

A

fever, malaise, cough, hemoptysis, eosinphilia

40
Q

A patient with HIV presents with cough, fatigue, night sweats, lymphadenopathy and liver enlargement. reticulonodular opacities are seen. He has also palatal ulcers. how do you diagnose this dissem. fungal?

A

urine antigen for histoplasmosis

41
Q

What is the tx for histoplasmosis?

A

itraconazole

42
Q

Distinguish intermittent asthsma from mild persistent, moderate persistent, and severe persistent

A

intermittent - symptoms occur less than 2 days/week
nighttime awakenings - less than 2x per month

mild persisent - symptoms more than 2 days a week, but not daily- add corticosteroids

moderate persistent - daily symptoms, weekly nighttime prescribe long acting beta 2 agonist

severe persisent - symptoms throughout day- albuterol, long acting AND high dose corticosteroids

43
Q

A patient presents with SOB, cough, hemoptysis and a non healing leg ulcer. What is the most likely explanation?

A

GPA

44
Q

What are the causes of lung disease that present with low DLCO and obstructive pattern?

A

emphysema

45
Q

What are the patterns of lung disease that present with low DLCO and restrictive patterN/

A

interstitial lung disease, sarcoid, asbestosis

46
Q

What are the patterns of lung disease that present with obstructive pattern and normal DLCO?

A

chronic bronchitis

47
Q

A patient presents with fever, malaise, chills, breathlessness and a dry cough and chest X ray shows generalized haziness in both lung fields. she breeds birds - what is this?

A

hypersensitivity pneumonitis

48
Q

A smoking patient who works as a plumber presents with worsening dyspnea, fingernail clubbing. Chest X ray shows atelectasis and bilateral pleural plaques over the diaphragm. What is this?

A

bronchogenic carcinoma

49
Q

A patient presents with headaches, insomnia, seizures, nausea, vomiting and heart palpitations. He is being treated with theophylline. What is this?

A

check serum theophylline levels

50
Q

What is the pH of normal pleural fluid? How does it compare to the pH of transudative and exudative fluid?

A

7.6 is normal. transudative - 7.4 - 7.55. exudative 7.3

IM (24 decks)

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