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Clinical Medicine > Respiratory > Flashcards

Respiratory Flashcards

1
Q

��”Q001. What is the most important determinant of the amount of oxygen delivery to tissues?”

A

A001. Hemoglobin

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2
Q

Q002. Dx:; A married couple comes to the hospital complaining of “flu like” symptoms including HA, N/V and disorientation. The wife thinks they caught the virus from a neighbor when they borrowed his home generator.

A

A002. Carbon Monoxide Poisoning

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3
Q

Q003. Equation for Arterial Oxygen content

A

A003. 0.0031(PaO2) + 1.38(Hb x SaO2) = Art O2 content

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4
Q

Q004. Definition:; Due to perfusion of poorly ventilated alveoli or due to alveoli not being perfused. What does it respond to?

A

A004. V/Q mismatch; responds to:; supplemental Oxygen; (ex: COPD, CHF, PE, asthma, etc)

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5
Q

Q005. What is a Right to Left shunt in the lungs do to?

A

A005. Perfusion of a non ventilated lung

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6
Q

Q006. Describe Anemia’s effect on hypoxia

A

A006. Anemia = decreased Hb; low Hb causes a decrease in O2 carrying capacity:; Normal PaO2; Decreased PvO2

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7
Q

Q007. When does a Low inspired O2 occur?

A

A007. High altitude

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8
Q

Q008. What does not cause cyanosis or discoloration until it reaches toxic levels, where the patient will present with “cherry red” lips and nails?

A

A008. Carbon Monoxide poisoning

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9
Q

Q009. Definition:; Gas exchange compromise due to problem with alveolar interface; (ex: interstitial lung Dz)

A

A009. Diffusion defect

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10
Q

Q010. With what neuromuscular disorders does Hypoventilation occur?; (3)

A

A010. Myasthenia gravis;; ALS;; Guillain Barre

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11
Q

Q011. What does an increased Fremitus suggest?

A

A011. Consolidation of the lung

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12
Q

Q012. What does an decreased Fremitus suggest?; (2)

A

A012. Air or fluid in the chest; (Pneumothorax or PE); or; Overexpansion of the lung

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13
Q

Q013. What does a “Dull” percussion represent?

A

A013. Increased density; (increased fluid in the lungs)

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14
Q

Q014. What does “hyperresonant” refer to with percussion?

A

A014. Decreased density and more air; (ex: emphysema)

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15
Q

Q015. Lung Auscultation definition:; Crackle (rale)

A

A015. Excessive airway secretions; (Pneumonia, pulm edema, bronchitis)

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16
Q

Q016. Lung Auscultation definition:; Wheeze

A

A016. Rapid airflow through obstructed airway; (Asthma, bronchitis)

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17
Q

Q017. Lung Auscultation definition:; Pleural Rub

A

A017. Inflammation of the pleura; (Pneumonia, pulmonary infarction)

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18
Q

Q018. What is it called if you ask the patient to say “eee” and it is heard as “aaa”?; What does it dx?; (2)

A

A018. Egophony; Consolidation;; Compressed lung above a Pleural Effusion

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19
Q

Q019. Definition:; A transudate or exudate in the lung

A

A019. Pleural effusion

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20
Q

Q020. What are (2) physiologic causes of Transudate pleural effusions?; (3) Dx illnesses

A

A020. Causes:; Increased Hydrostatic Pressure;; Decreased Oncotic Pressure; From:; CHF;; Cirrhosis;; Nephrosis

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21
Q

Q021. What is the physiologic cause of Exudate pleural effusions?; (3) Dx illnesses

A

A021. Cause:; Increased Capillary permeability; From:; Tumor;; Infection;; Trauma

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22
Q

Q022. What must be present to consider the pleural fluid an exudate?; (3 criteria only one must be present)

A

A022. 1. Ratio of Pleural to Serum Protein > 0.5; 2. Ratio of Pleural to Serum LDH > 0.6; 3. Pleural fluid LDH > 2/3 upper normal limit

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23
Q

Q023. When is the pleural effusion considered Parapneumonic?; (2)

A

A023. 1. Exudative Pleural fluid Leukocyte count > 10,000 with high PMNs; 2. Empyema

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24
Q

Q024. Definition:; Pus in the pleural space; Lab criteria?

A

A024. Empyema; (WBC > 100,000)

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25
Q

Q025. What Dx Pleural effusions always require a chest tube?; (3)*

A

A025. Pleural Effusion Line:; Positive Cultures;; Empyema;; Loculated Effusion

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26
Q

Q026. What are the causes of gross blood in the pleural fluid?; (4)*

A

A026. blood: A PTT; Aortic Dissection:; Pulmonary Infarction;; Tumor;; Trauma

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27
Q

Q027. What are the causes of low glucose in the pleural fluid?; (4)*

A

A027. Glucose is a TREaT:; Tumor;; Rheumatoid Arthritis;; Empyema;; TB

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28
Q

Q028. What are the causes of high amylase in the pleural fluid?; (4)*

A

A028. Amy(lase) is PRETty:; Pancreatitis;; Renal failure;; Esophageal rupture;; Tumor

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29
Q

Q029. Device that measures the rate at which the lung changes during forceful breathing?

A

A029. Spirometry

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30
Q

Q030. Definition:; when the patient inhales normally, then exhales as rapidly and completely as possible that is recorded on Spirometry

A

A030. Forced Vital Capacity; (FVC)

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31
Q

Q031. Spirometry Normal values:; 1. FEV1; 2. FVC; 3. FEV1/FVC

A

A031. Normals:; FEV1 = > 80%; FVC = > 80%; FEV1/FVC = > 0.7

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32
Q

Q032. Values indicating Obstructive lung disease:; 1. FEV1; 2. FVC; 3. FEV1/FVC; 4. Lung volume

A

A032. FEV1 = DECREASED; FVC = normal or Decreased; FEV1/FVC < 0.7; Lung volume = normal or decreased

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33
Q

Q033. Values indicating Restrictive lung disease:; 1. FEV1; 2. FVC; 3. FEV1/FVC; 4. Lung volume

A

A033. FEV1 = normal or Decreased; FVC = DECREASED; FEV1/FVC > 0.7; Lung volumes = Always DECREASED

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34
Q

Q034. What are the (3) different types of Restrictive lung defects?

A

A034. Interstitial Lung Dz (fibrosis);; Neuromuscular Dz (ALS, MG);; Chest Wall disorders (obesity, kyphosis)

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35
Q

Q035. What does the Obstructive defect look like on Spirogram?

A

A035. “swoopie”

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36
Q

Q036. What does the Restrictive defect look like on Spirogram?

A

A036. Tall and thin

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37
Q

Q037. *When is a Bronchoscopy the most accurate test?; (2); Only test more accurate?

A

A037. 1. Infections such as TB or Pneumocystis; 2. Centrally located Abscess or Tumor; More accurate:; Open Lung Biopsy

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38
Q

Q038. Dx:; an epileptic, febrile patient with cough for the last several weeks, weight loss and malodorus sputum; unusual finding in upper lung lobe on CXR; Most accurate test?

A

A038. Lung Abscess; test:; Lung Biopsy

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39
Q

Q039. Most accurate diagnostic test of any pulmonary bacterial infection?

A

A039. Gram Stain of the Sputum

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40
Q

Q040. Dx:; patient has a fever, cough and shortness of breath. There are crackles and consolidation over a lung lobe. First test?; Most accurate Dx test?

A

A040. Bacterial Pneumonia (MCC Strep); first test: CXR; most accurate: Gram Stain of Sputum

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41
Q

Q041. What causes interstitial infiltrates?; (4)

A

A041. causes:; Viral Pneumonia;; PCP;; Mycoplasma;; Legionella

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42
Q

Q042. Most accurate test for:; Interstitial Lung Infiltrates caused by PCP

A

A042. Bronchoalveolar Lavage; (also Increased LDH)

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43
Q

Q043. *Most accurate test for:; Interstitial Lung Infiltrates caused by Legionella

A

A043. Urine Antigen testing

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44
Q

Q044. *Most accurate test for:; Interstitial Lung Infiltrates caused by Mycoplasma or Chlamydia

A

A044. Serology Antibody titers

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45
Q

Q045. What is the MC etiology of a Pleural Effusion?; (2); Most accurate test?

A

A045. etiology:; 1. CHF; 2. Pneumonia; test: Thoracentesis for fluid analysis

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46
Q

Q046. What is the best test to tell the difference b/t Obstructive and Restrictive lung disease?

A

A046. Flow Volume Loop

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47
Q

Q047. *When is a Pulmonary Function Test the most accurate Dx Test?; What part of the test is most accurate in Dx?

A

A047. Distinguish b/t Obstructive and Restrictive lung disease; most accurate part:; FEV/FVC ratio

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48
Q

Q048. Dx:; African American female with cough, dyspnea, chest pain and bilateral hilar lymphadenopathy. First test?; Most accurate Dx test?

A

A048. Sarcoidosis; first test: ACE levels (increased); most accurate: Noncaseating Granuloma on Biopsy

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49
Q

Q049. Dx:; a young non smoker with emphysema and liver disease; First test?

A

A049. Alpha 1 Antitrypsin Deficiency (low levels); First test: serum A1A levels

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50
Q

Q050. *When is Performing an ABG the best answer?; (3)

A

A050. 1. COPD; 2. possible Respiratory Acidosis; 3. Low serum Bicarb (possible severe Met acidosis)

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51
Q

Q051. Dx:; chronic respiratory problems, cough, SOB, fat malabsorption, vitamin deficiency, sterile. Blood gas reveals hypoxemia. Best test?

A

A051. Cystic Fibrosis; best test: Sweat Chloride; (Pilocarpine is given and Na + Cl is measured in the sweat)

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52
Q

Q052. (3) Typical Sx of Pneumonia

A

A052. Fever;; Cough with sputum;; Pleurtic Chest pain

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53
Q

Q053. (4) Physical Exam findings with Pneumonia

A

A053. Dullness to Percussion;; Rales (Crackles);; Egophany;; Tactile Fremitus in consolidated segment

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54
Q

Q054. Bug Dx:; 27 yo patient has pneumonia, bullous myringitis and a chest film that looks worse then expected

A

A054. Mycoplasma Pneumonia

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55
Q

Q055. If a patient comes to the ER with consolidation and pleural effusion on CXR, what is the most important test to determine admission / Tx?

A

A055. Thoracentesis

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56
Q

Q056. Bug Dx:; patient with HIV who has a CD 4 count of 52 does not take antiretroviral meds or TMP SMX, is hypoxic on room air, and has a diffuse bilateral infiltrate on chest film

A

A056. PCP; (Pneumocystis Carinii Pneumonia)

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57
Q

Q057. Bug Dx:; Elderly man presents with pneumonia, GI Sx, bradycardia, and hypoN

A

A057. Legionella

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58
Q

Q058. Pneumonia Bug Dx:; Currant Jelly sputum

A

A058. Klebsiella

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59
Q

Q059. Pneumonia Bug Dx:; Rusty sputum

A

A059. Pneumococcus

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60
Q

Q060. Pneumonia Bug Dx:; patient develops a post influenza pneumonia

A

A060. Pneumococcus

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61
Q

Q061. Pneumonia Bug Dx:; Buldging fissure on CXR

A

A061. Klebsiella

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62
Q

Q062. Pneumonia Bug Dx:; No bacteria on sputum gram stain culture; (2)

A

A062. Legionella; Mycoplasma

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63
Q

Q063. Pneumonia Bug Dx:; signs of pneumonia and Serum LDH is high

A

A063. PCP

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64
Q

Q064. MC Community Acquired, typical pneumonia; (2)

A

A064. S. pneumoniae; H. Influenzae

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65
Q

Q065. MC Community Acquired, atypical pneumonia; (3)*

A

A065. Community Lung Mess:; Chlamydia pneumoniae;; Legionella;; Mycoplasma

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66
Q

Q066. MC Hospital Acquired pneumonia; (3)

A

A066. Pseudomonas aeruginosa;; S. aureus;; Enteric organisms (E. coli)

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67
Q

Q067. What is the MCC of pneumonia (bugs) in the HIV patients as the CD 4 count decreases to the following numbers; (in order of occurrence)*:; 1.

A

A067. The Pneumonia HIV Causes Are Count based:; 1. TB (500); 2. PCP (200); 3. Histoplasma (200); 4. Cryptococcus (200); 5. Avium (mycoplasma) (50); 6. CMV (50)

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68
Q

Q068. MCC of pneumonia in the immunocompromised host with Neutropenia; (4)*

A

A068. Pseudomonas;; Enterobacteriaceae;; S. Aureus;; Aspergillus

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69
Q

Q069. MCC of pneumonia in the immunocompromised host with sickle cell or a splenectomy

A

A069. Encapsulated organisms

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70
Q

Q070. MCC of pneumonia in the immunocompromised host with chronic Steroid use; (2)

A

A070. TB;; Nocardia

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71
Q

Q071. MCC of pneumonia in Alcoholics; (4)

A

A071. S. pneumoniae;; H. Influenzae;; Klebsiella;; TB

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72
Q

Q072. Pneumonia Bug Dx:; Small gram negative rod with a halo on gram stain

A

A072. H. Influenzae

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73
Q

Q073. CXR pneumonia findings:; Upper lobe; (2)

A

A073. TB;; Klebsiella

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74
Q

Q074. CXR pneumonia findings:; small cavities w/o air fluid levels

A

A074. TB; (Mycobacterium)

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75
Q

Q075. CXR pneumonia findings:; Large cavities with air fluid levels that do not culture; (2)

A

A075. Coccidioidomycosis;; Nocardia

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76
Q

Q076. CXR pneumonia findings:; Diffuse Bilateral Infiltrates; (2)

A

A076. PCP;; Mycoplasma

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77
Q

Q077. Definition:; Idiopathic Eosinophilic Pneumonia

A

A077. Loeffler’s pneumonia

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78
Q

Q078. Pneumonia bugs causing “Relative Bradycardia

A

A078. Legionella;; Salmonella;; Chlamydia Psittaci

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79
Q

Q079. What drug prevents respiratory failure and improves survival in PCP pneumonia patients?; Criteria for when it is given?; (2)

A

A079. Steroids; give: A a gradient > 35, PaO2 < 75

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80
Q

Q080. Drug of choice for:; Any Community Acquired Pneumonia with no risk factors

A

A080. Macrolide; (Erythromycin, Azithromycin)

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81
Q

Q081. Drug of choice for:; Any Community Acquired Pneumonia with risk factors; (CHF, DM, etc); (2)

A

A081. 1. Macrolide + 2nd generation Cephalosporin; 2. FQ (Extended spectum)

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82
Q

Q082. Drug of choice for:; Any Hospital Acquired Pneumonia; (2)

A

A082. 1. Cefixime; 2. Piperacillin tazobactam; [both for Pseudomonas coverage]

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83
Q

Q083. Drug of choice for:; Any Immunocompromised patient with Pneumonia

A

A083. TMP SMX; [for PCP coverage]

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84
Q

Q084. Dx:; Productive cough, night sweats, hemoptysis, anorexia, weight loss, chest pain, fever, chills

A

A084. TB

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85
Q

Q085. (3) Dx tests for TB

A

A085. Positive PPD;; Granuloma in upper lobes of lung;; Acid fast bacilli on sputum

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86
Q

Q086. How is latent TB treated?

A

A086. INH daily for 9 months; (or Rifampin for 4 if in contact with INH resistant TB)

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87
Q

Q087. How is Active TB treated?

A

A087. RIPE for 2 months:; Rifampin; INH, Pyrazinamide; Ethambutol; followed with 4 months of:; INH and Rifampin

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88
Q

Q088. How is tx of TB different with pregnant pt?

A

A088. No pyrazamide; (other med ok)

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89
Q

Q089. Toxicity of INH; (2)*

A

A089. INH: Infects Neuro and Hepatic:; Neruopathy;; Seizures;; Hepatitis

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90
Q

Q090. Dx:; patient brought by ambulance in status epilepticus. Patient says only medical history is TB; How is it treated?

A

A090. INH toxicity; Tx: Pyridoxine

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91
Q

Q091. Toxicity of Rifampin; (2)

A

A091. Induces P450; Gives Red orange secretions; (tears, urine, sweat, etc)

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92
Q

Q092. Toxicity of Ethambutol

A

A092. Optic neuritis and impaired color vision

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93
Q

Q093. Risk factors for DVT.

A

A093. stasis; endothelial injury; hypercoagulability; (Virchow’s triad)

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94
Q

Q094. Criteria for exudative effusion.

A

A094. pleural/serum protein > 0.5; pleural/serum LDH > 0.6

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95
Q

Q095. Causes of exudative effusion.

A

A095. Think of leaky capillaries. Malignancy; TB; bacterial or viral infection; pulmonary embolism with infarct; pancreatitis

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96
Q

Q096. Causes of transudative effusion.

A

A096. Think of intact capillarie. CHF; liver or kidney disease; protein losing enteropathy

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97
Q

Q097. Normalizing PCO2 in a patient having an asthma exacerbation may indicate?

A

A097. Fatigue & impending respiratory failure

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98
Q

Q098. dyspnea; lateral hilar lymphadenopathy on CXR; noncaseating granulomas; increased ACE; hypercalcemia

A

A098. Sarcoidosis

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99
Q

Q099. PFT showing decreased FEV1/FVC.

A

A099. Obstructive pulmonary disease (e.g. asthma)

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100
Q

Q100. PFT showing increased FEV1/FVC.

A

A100. Restrictive pulmonary disease

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101
Q

Q101. Honeycomb pattern on CXR. Diagnosis?; Treatment?

A

A101. Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help.

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102
Q

Q102. Treatment for SVC syndrome.

A

A102. Radiation

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103
Q

Q103. Treatment for mild, persistent asthma.

A

A103. Inhaled beta agonists & inhaled corticosteroids

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104
Q

Q104. Acid base disorder in pulmonary embolism.

A

A104. Hypoxia & hypocarbia

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105
Q

Q105. Non small cell lung cancer (NSCLC) associated with hypercalcemia.

A

A105. Squamous cell carcinoma

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106
Q

Q106. Lung cancer associated with SIADH.

A

A106. Small cell lung cancer (SCLC)

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107
Q

Q107. Lung cancer highly related to cigarette

A

A107. Small cell lung cancer (SCLC)

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108
Q

Q108. A tall white male presents with acute shortness of breath. Diagnosis?; Treatment?

A

A108. Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful.

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109
Q

Q109. Treatment of tension pneumothorax.

A

A109. Immediate needle thoracostomy

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110
Q

Q110. Characteristics favoring carcinoma in an isolated pulmonary nodule.

A

A110. Age > 45 50 yrs; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins

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111
Q

Q111. Hypoxemia & pulmonary edema with normal pulmonary capillary wedge pressure.

A

A111. ARDS

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112
Q

Q112. Increased risk of what infection with silicosis?

A

A112. Mycobacterium tuberculosis

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113
Q

Q113. Causes of hypoxemia.

A

A113. right to left shunt; hypoventilation; low inspired O2 tension; diffusion defect; V/Q mismatch

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114
Q

Q114. Classic CXR findings for pulmonary edema

A

A114. cardiomegaly; prominent pulmonary vessels; Kerley B lines; “bat’s wing” appearance of hilar shadows; perivascular & peribronchial cuffing

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115
Q

Q115. pulmonary function tests

A

A115. spirometry (mechanical ventilation); Dlco (gas exchange); methacholine challenge test (bronchial hyperreactivity); TLC

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116
Q

Q116. restrictive pattern

A

A116. FEV1/FVC > 80%

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117
Q

Q117. obstructive pattern

A

A117. FEV1/FVC < 80%; seen in emphysema, chronic bronchitis, asthma, bronchiectasis

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118
Q

Q118. Decreased DLco

A

A118. if FEV1/FVC < 80% suggests emphysema; if FEV1/FVC > 80% suggests interstitial lung disease or mild left heart failure

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119
Q

Q119. Increased DLco

A

A119. suggests hemorrhage such as in Goodpasture

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120
Q

Q120. methacholine test

A

A120. bronchoprovocation in patients with cough or wheezing who have normal pulmonary function tests, for possible asthma; do basal and postprovocation spirometry; positive test if baseline FEV1 decreased >20%

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121
Q

Q121. A a gradient formula

A

A121. 150 (1.25 x PaCO2) PaO2 normal: 5 15mmHg;; increases with age and all forms of hypoxemia except hypoventilation and high altitude

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122
Q

Q122. solitary pulmonary nodule

A

A122. 1/3 are malignant; first step in management is looking for previous image study; if none available then consider if patient is high or low risk for cancer; low risk nonsmoker x ray every 3 months for 2 years, if no growth stop follow up; high risk smoker >50 > open lung biopsy and removal due to cancer risk

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123
Q

Q123. transudative pleural effusion

A

A123. Decreased hydrostatic pressure or decreased oncotic pressure; usually bilateral and equal; low LDH and proteins in fluid and serum (200, 0.6, 0.5); need all three values for diagnosis, else exudate

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124
Q

Q124. exudative pleural effusion

A

A124. due to local process; usually unilateral; need further investigation; high LDH and proteins in fluid and serum (200, 0.6, 0.5); don’t need all three values high to make diagnosis

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125
Q

Q125. transudative causes of pleural effusion

A

A125. heart failure; nephrotic syndrome; liver disease; pulmonary embolism; atelectasis

126
Q

Q126. exudative causes of pleural effusion

A

A126. pneumonia; cancer (lung, breast or lymphoma); pulmonary embolism; drug induced; pancreatitis; TB; RA; SLE

127
Q

Q127. transudative pleural effusion with no apparent cause

A

A127. consider pulmonary embolism which can be either transudative or exudative

128
Q

Q128. indications of thoracocentesis

A

A128. any new and unexplained pleural effusion > rule out empyema; decubitus x ray > minimal risk; if non free fluid need ultrasound guidance

129
Q

Q129. malignant pleural effusions

A

A129. due mostly to breast cancer, lung cancer and lymphoma; send thoracocentesis fluid for cytologic exam also

130
Q

Q130. hemorrhagic pleural effusion

A

A130. seen in mesothelioma, metastatic lung or breast cancer, pulmonary embolism with infarction and trauma

131
Q

Q131. lymphocytic predominant pleural effusions

A

A131. suggests TB due to tuberculin hypersensitivity; check increased adenosine deaminase and positive PCR for TB; acid fast and culture of fluid are only positive in 30%

132
Q

Q132. respiratory compromise and distress

A

A132. presents with shortness of breath, dyspnea, tachypnea (>30) and associated symptoms such as agitation, confusion or decreased consciousness

133
Q

Q133. evaluation of respiratory distress

A

A133. ensure patent airway; focus on quickness of onset and associated symptoms; most important lab test is arterial blood gases then B natriuretic peptide and chest x ray

134
Q

Q134. acute respiratory distress with fever, cough or sputum

A

A134. suggests infectious etiology

135
Q

Q135. acute respiratory distress without systemic symptoms

A

A135. suggests airway obstruction, cardiac disease or thromboembolism

136
Q

Q136. chronic respiratory distress

A

A136. suggests interstitial lung disease or COPD

137
Q

Q137. common lung physical exam findings

A

A137. diffuse wheezing > asthma; localized wheezing > foreign object; rales > pneumonia, interstitial disease, heart failure; dull percussion > pneumonia or atelectasis; normal exam > pneumocystis jirovecci, central respiratory problems

138
Q

Q138. B natriuretic peptide in acute dyspnea

A

A138. elevation is sensitive for heart failure but can also be elevated in cor pulmonale and acute right ventricular failure (thromboembolism)

139
Q

Q139. chest x ray without parenchymal infiltrates in acute dyspnea

A

A139. suggests thromboembolism; central respiratory depression; neuromuscular disease; upper airway obstruction

140
Q

Q140. chest x ray hyperinflation in acute dyspnea

A

A140. suggests asthma and COPD

141
Q

Q141. chest x ray with focal infiltrates in acute dyspnea

A

A141. suggests bacterial, viral or fungal pneumonia, aspiration or pulmonary hemorrhage

142
Q

Q142. chest x ray with diffuse edema in acute dyspnea

A

A142. suggests heart failure or ARDS

143
Q

Q143. ICU indications in respiratory failure

A

A143. persistent hypoxemia > hospitalization; ICU indications >; need for mechanical ventilation; close monitoring; increasing oxygen demand; continuous nursing

144
Q

Q144. indications for intubation and/or mechanical ventilation

A

A144. respiratory acidosis and hypercapnia in asthmatic patient; upper airway injury (burns, laryngeal edema, trauma); neurologic airway depression (often with loss of gag and cough reflexes)

145
Q

Q145. respiratory distress in hospitalized patients

A

A145. inpatient who develops dyspnea, tachypnea and/or hypoxemia should raise possibility of pulmonary embolism or aspiration

146
Q

Q146. types of asthma

A

A146. intrinsic (50%) is secondary to nonimmunologic stimuli (infections, irritating inhalants, cold air and emotional);; extrinsic (20%) due to allergens

147
Q

Q147. asthma stimuli

A

A147. infections (RSV, rhinovirus),; drugs (aspirin/NSAIDs, coloring agents, betablockers),; allergens,; cold air,; emotions

148
Q

Q148. asthma presentation

A

A148. tachypnea,; tachycardia,; diffuse wheezing,; use of accessory muscles,; diminished breath sounds,; hyperresonance,; intercostal retractions

149
Q

Q149. asthma poor prognosis factors

A

A149. fatigue; diaphoresis; pulsus paradoxus; inaudible breath sounds; decreased wheezing; cyanosis; bradycardia

150
Q

Q150. asthma diagnosis

A

A150. initial tests for acute attacks > decreased PaCO2, increased pH, normal or decreased PaO2; severe attack >decreased PaO2, increased PaCO2, decreased pH; chest x ray to rule out infection as cause; spirometry > obstructive pattern that reverses with beta agonist (FEV1 reverses by 12%); methacholine test > decreased FEV1/FVC of 20%

151
Q

Q151. acute asthma management

A

A151. O2; metered inhaled beta agonists > albuterol/salbutamol, terbutaline; salmeterol is long lasting for nocturnal variant; catecholamines may be used but not routinely; aminophylline and theophyline have modest potency and are not routine; anticholinergics (ipratropium) if heart disease (slow onset, medium potency)

152
Q

Q152. chronic asthma management

A

A152. acute exacerbations: systemic prednisone 10 14 days along with inhaled albuterol;; inhaled corticosteroids are first line maintenance;; cromolyn is first line maintenance in children and prophylaxis in adults;; zileuton, zafirlukast, mmonteleukast for severe asthma resistant to maximum doses of inhaled steroids

153
Q

Q153. mild asthma definition and treatment

A

A153. symptoms ~2 days/week and rare night symptoms; FEV1 is normal; no long term control needed only inhaled beta agonists for attacks

154
Q

Q154. moderate asthma definition and treatment

A

A154. symptoms on most days and at least 5 nights/month with FEV1 60 80%; treat with daily inhaled steroids (also cromolyn specially in children); maybe also salmeterol

155
Q

Q155. severe asthma definition and treatment

A

A155. daily symptoms, frequent night symptoms and hospital emergencies with FEV1 <60%;; daily inhaled steroids, daily inhaled salmeterol along with antileukotriene drug and possibly low dose oral steroid

156
Q

Q156. physical exam in emphysema

A

A156. distant breath sounds; pink skin; thin; barrel chest; accessory muscles; symptoms of right heart failure and clubbing

157
Q

Q157. physical exam in chronic bronchitis

A

A157. rhonchi and wheezes; signs of cyanosis; weight gain; symptoms of right heart failure and clubbing

158
Q

Q158. chest x ray findings in COPD

A

A158. chronic bronchitis > increased pulmonary markings; emphysema > bilateral hyperinflantion, diaphragm flattening, small heart size, increase in retrosternal space

159
Q

Q159. COPD diagnosis

A

A159. decreased FEV1/FVC; FEF 25 75; increased RV and TLC; emphysema has decreased DLco and chronic bronchitis has normal DLco; FEV1/FVC after bronchodilation will stay the same

160
Q

Q160. COPD complications

A

A160. hypoxemia with nocturnal desaturation; secondary erythrocytosis; cor pulmonale; chronic ventilatory failure; CO2 retention

161
Q

Q161. maintenance treatment for COPD

A

A161. first line > ipratropium via metered inhaler;; inhaled beta agonists can be used concomitantly;; inhaled corticosteroids are not used in COPD;; if above fails > theophylline (watch for cytochrome inhibitors and inducers)

162
Q

Q162. only treatment that reduces mortality in COPD

A

A162. home O2 supplementation and smoking cessation; home oxygen for hypoxemia (PaO2<88%); pneumococcal vaccine every 5 years, influenza vaccine yearly and haemophilus vaccine if unvaccinated

163
Q

Q163. COPD exacerbation general management

A

A163. 1) measure O2 saturation (pulse oximetry); 2) arterial blood gases; 3) chest x ray; 4) check theophylline levels; 5) CBC and ECG; 6) hospital admission if significant hypercapnia or hypoxemia; 7) consider intubation and mechanical ventilation; 8) specific treament; spirometry is NOT done or useful in exacerbation

164
Q

Q164. COPD exacerbation specific treatment

A

A164. 1) O2 supplementation; 2) inhaled bronchodilators and anticholinergics concomitantly; 3) IV or oral prednisone for 2 weeks; 4) antibiotics despite normal x ray; 5) council on smoking cessation; 6) teach optimal use of MDI; no benefit in IV theophylline and avoid opiates and sedatives

165
Q

Q165. bronchiectasis etiology

A

A165. secondary to recurrent pneumonias, TB, fungal or abscess; cystic fibrosis, immotile cilia syndrome (50% Kartagener)

166
Q

Q166. bronchiectasis presentation

A

A166. suspect in anyone with; chronic cough; foul smelling sputum; hemoptysis; recurrent pulmonary infections; sinusitis; immune deficiencies; presents with purulent copious sputum, wheezes, crackles and history of recurrent pneumonias (specially gram and pseudomonas)

167
Q

Q167. bronchiectasis diagnosis

A

A167. early chest x ray may be normal or severe cases show 1 2cm cysts and crowding of bronchi;; chest CT is best noninvasive test

168
Q

Q168. bronchiectasis treatment

A

A168. bronchodilators, chest physical therapy, postural drainage, rotating gram antibiotics; surgery in cases of localized bronchiectasis or massive hemoptysis; yearly influenza vaccine and pneumococcal vaccine with booster at 5 years

169
Q

Q169. bronchiectasis complications

A

A169. massive hemoptysis,; amyloidosis,; cor pulmonale,; visceral abscesses

170
Q

Q170. interstitial lung disease general presentation

A

A170. exertional dyspnea; nonproductive cough; crackles; pulmonary hypertension; clubbing; restrictive pattern

171
Q

Q171. interstitial lung diseases

A

A171. idiopathic pulmonary fibrosis; sarcoidosis; pneumoconiosis > asbestosis, silicosis, coal pneumoconiosis

172
Q

Q172. idiopathic pulmonary fibrosis presentation

A

A172. exercise intolerance, dyspnea, coarse crackles

173
Q

Q173. idiopathic pulmonary fibrosis diagnosis

A

A173. reticular or reticulonodular pattern on chest x ray; restrictive pattern on PFTs; increased macrophages on bronchoalveolar lavage (nonspecific)

174
Q

Q174. idiopathic pulmonary fibrosis treatment

A

A174. steroids with or without azathioprine works in 20%;; the rest develop fatal lung disease

175
Q

Q175. idiopathic pulmonary fibrosis prognosis

A

A175. 20 40% 5 year survival;; best prognostic factor is response to steroids as evidenced in PFTs

176
Q

Q176. sarcoidosis presentation

A

A176. “GRAIN ( gammaglubilinemia, rheumatoid arthritis, ACE increase, interstitial fibrosis, non casseating granuloma, hilar and left paratracheal adenopathy, hypercalcemia due to vitamin activation by macrophages, uveitis/conjunctivitis in >25%, chest x ray findings and restrictive or normal PFTs”

177
Q

Q177. chest x ray findings in sarcoidosis

A

A177. four stages found (not progressive); bilateral hilar adenopathy; hilar adenopathy with reticulonodular parenchyma; reticulonodular parenchyma alone; honeycombing of bilateral lung fields with fibrosis

178
Q

Q178. sarcoidosis diagnosis

A

A178. biopsy of affected tissue showing noncasseating granulomas;; all patients should have ophthalmologic exam

179
Q

Q179. sarcoidosis prognosis

A

A179. 80% remain stable or spontaneously resolves;; 20% progress to organ compromise

180
Q

Q180. sarcoidosis treatment

A

A180. no treatment is effective; if organ compromise may use trial of high dose steroids; if uveitis, CNS involvement or hypercalcemia > steroids are mandatory

181
Q

Q181. pneumoconiosis general presentation

A

A181. dyspnea,; shortness of breath,; cough,; sputum,; cor pulmonale,; clubbing,; restrictive pattern,; decreased DLco,; hypoxemia with increased A a

182
Q

Q182. ocupations associated with asbestosis

A

A182. mining,; milling,; foundry work,; shipyards,; pipes,; break linings,; insulation,; boilers;; history of exposure necessary for Dx

183
Q

Q183. asbestosis x ray findings

A

A183. diffuse or local pleural thickening,; pleural plaques,; calcifications near diaphragm,; pleural effusions,; lower lobe interstitial infiltrate

184
Q

Q184. asbestosis associated cancers

A

A184. lung adenocarcinoma or SCC; pleural mesothelioma is less common

185
Q

Q185. asbestosis diagnosis

A

A185. history of exposure + lung biopsy showing barbell shaped asbestos fibers

186
Q

Q186. asbestosis treatment

A

A186. no effective treatment;; must stop smoking due 75x increased risk of cancer

187
Q

Q187. ocupations associated with silicosis

A

A187. mining,; quarrying,; tunneling,; glass and pottery making,; sandblasting

188
Q

Q188. silicosis x ray findings

A

A188. 1 10mm nodules throughout the lungs, most prominent in upper lobes; in progressive massive fibrosis nodules are >10mm and coalesce

189
Q

Q189. silicosis diagnosis

A

A189. history of exposure + lung biopsy showing silica particles; pathologic lesion is the hyaline nodule

190
Q

Q190. silicosis treatment

A

A190. no effective treatment; should have yearly PPD test and if >10mm > INH prophylaxis for 9 months

191
Q

Q191. Lofgren syndrome

A

A191. acute sarcoidosis presentation with erythema nodosum, arthritis, hilar adenopathy

192
Q

Q192. Heefordt Waldenstrom syndrome

A

A192. acute sarcoidosis presentation with fever,; parotid enlargement,; uveitis and facial palsy

193
Q

Q193. Caplan syndrome

A

A193. rheumatoid nodules in periphery of lung,; rheumatoid arthritis and coexisting pneumoconiosis (usually CWP)

194
Q

Q194. coal worker’s pneumoconiosis x ray findings

A

A194. small round parenchymal densities; usually in upper half of lungs; progressive massive fibrosis has 1cm densities in whole lung

195
Q

Q195. coal worker’s pneumoconiosis immunologic findings

A

A195. increased IgA,; increased IgG,; increased C3, ANA and rheumatoid factor

196
Q

Q196. pulmonary embolus site of origin

A

A196. most are from above the knee deep veins which result from distal deep vein thrombosis;; in patients with catheters it can originate from upper limb, subclavian and internal jugular veins

197
Q

Q197. criteria for high risk pulmonary embolism patients

A

A197. recent surgery (specially orthopedic, knee replacement has 70% risk);; cancer history (prostate, breast, pelvic, abdominal);; immobilized patients;; acquired thrombophilia (lupus anticoagulant, nephrotic syndrome);; oral contraceptives;; inherited thrombophilia (factor V Leiden, protein C/S deficiency, antithrombin III deficiency);; pregnancy;; need 1 risk factor and consistent signs and symptoms for high risk label

198
Q

Q198. signs and symptoms consistent with pulmonary embolism

A

A198. sudden onset of dyspnea,; tachypnea,; thigh/calf swelling,; pleuritic chest pain,; hemoptysis,; tachycardia,; increased P2

199
Q

Q199. when to consider pulmonary embolism

A

A199. all patients with dyspnea and normal chest x ray

200
Q

Q200. nonspecific routine tests for dyspnea; may suggest PE

A

A200. arterial blood gases show hypoxemia with increased A a; chest x ray (normal in PE); ECG (to exclude others) shows S1, Q3, T3, tachycardia

201
Q

Q201. specific tests for pulmonary embolism

A

A201. best initial test is spiral CT scan;; V/Q scan (if normal excludes PE);; angiogram is gold standard

202
Q

Q202. deep venous thrombosis specific tests

A

A202. best initial test is compression or duplex ultrasound;; venogram is rarely done;; MRI

203
Q

Q203. tests for DVT and PE

A

A203. D dimer is most sensitive;; can only exclude thromboembolism if normal levels; may also be high in surgery, infection, trauma, pregnancy and DIC; normal D dimer and CT scan rule out thromboembolism in 98% of low risk patients

204
Q

Q204. tests results that exclude pulmonary embolism

A

A204. normal CT + normal D dimer in low risk patients; normal CT + normal doppler in low risk patients; V/Q scan is completely normal

205
Q

Q205. generalities of pulmonary embolism diagnosis

A

A205. all patients should be on heparin during diagnosis and imaging;; if PE is suspected start CT scan right after chest x ray;; if all tests are negative but it’s high risk patient > angiogram;; normal CT + normal D dimer or doppler excludes PE in low risk patients

206
Q

Q206. pulmonary embolism treatment

A

A206. 1) O2; 2) start heparin before confirmation and during work up; 3) concomitant warfarin; 4) if hemodynamically unstable or massive PE > thrombolytics (tPa, streptokinase)

207
Q

Q207. heparin considerations in pulmonary embolism

A

A207. if LMWH then no need to follow PTT and less chance of heparin induced thrombocytopenia; HIT is associated with more thrombotic events, not bleeding diathesis, and is treated with new anticoagulants (argatroban, lepirudin); start heparin immediately

208
Q

Q208. warfarin considerations in pulmonary embolism

A

A208. monitor PT; titrate to INR of 2 3; skin necrosis can occur if protein C deficiency already present; contraindicated in pregnancy (use LMWH 6 months instead)

209
Q

Q209. contraindications of anticoagulation therapy in PE

A

A209. contraindicated in patients with recent neurosurgery or eye surgery; use inferior vena cava filter instead

210
Q

Q210. post thrombotic syndrome

A

A210. pain; edema; hyperpigmentation; skin ulceration in 2/3 of PE patients; compression stockings can prevent it

211
Q

Q211. fat embolism

A

A211. acute dyspnea, petechiae in neck or axilla, confusion,; 3 days after long bone fracture or after CPR;; no anticoagulation necessary

212
Q

Q212. ARDS etiology

A

A212. sepsis; trauma; DIC; Goodpasture; SLE; drug overdose; toxin inhalation; drowning

213
Q

Q213. ARDS presentation

A

A213. dyspnea,; tachypnea,; diffuse rales and ronchi

214
Q

Q214. ARDS diagnosis

A

A214. chest x ray > diffuse interstitial or alveolar infiltrates; ABGs > decreased PaO2, increased PaCO2; Swan Ganz > normal cardiac output and capillary wedge pressure but increased pulmonary artery pressure

215
Q

Q215. ARDS treatment

A

A215. treat underlying cause;; mechanical ventilation with positive end expiratory pressure

216
Q

Q216. ARDS prognosis

A

A216. 70% mortality

217
Q

Q217. sleep apnea

A

A217. cessation of airflow >10s at least 10 15/hour of sleep + daytime somnolence; confirm with polysomnography; treat obstructive with weight loss and nasal continuous positive airway pressure (CPAP); treat central with acetazolamide, progesterone and O2

218
Q

Q218. lung cancer etiology

A

A218. 90% of cases are directly related to cigarette smoke;; nonsmokers develop adenocarcinoma;; all lung cancers are associated with smoking;; active smokers have 10x greater risk;; 40 pack year history increases risk 60 70x;; asbestos increases risk 75x

219
Q

Q219. types of lung cancer

A

A219. most common is adenocarcinoma (40%);; squamous cell carcinoma,; small cell and large cell

220
Q

Q220. centrally located lung cancers

A

A220. squamous cell and small cell

221
Q

Q221. peripheral located lung cancers

A

A221. adenocarcinoma and large cell

222
Q

Q222. lung cancer paraneoplastic syndromes

A

A222. SCC > hypercalcemia (PTH like peptide); small cell > SIADH and Eaton Lambert

223
Q

Q223. lung cancer metastasis

A

A223. SCC > direct extension to hilar node and mediastinum; small cell and adenocarcinoma > liver, adrenals, brain, bones

224
Q

Q224. lung cancer presentation

A

A224. cough; weight loss; dyspnea; hemoptysis; chest pain; recurrent pneumonic processes; hoarseness

225
Q

Q225. lung cancer diagnosis

A

A225. sputum cytology (specially SCC); bronchoscopy for centrally located lesions; needle aspiration biopsy if highly suspicious and nonspecific bronchoscopy findings or peripheral lesion

226
Q

Q226. symptoms of unresectable lung cancer

A

A226. weight loss >10%; bone pain; extrathoracic metastasis; CNS symptoms; SVC syndrome; hoarseness; contralateral mediastinal adenopathy

227
Q

Q227. lung cancer treatment

A

A227. resectable small cell > VP16 (etoposide, platinum);; resectable non small > CAP (cyclo, adriamycin, platinum) and radio

228
Q

Q228. lung cancer prognosis

A

A228. 5 8% 5 year survival; after resection of SCC > 30 35%; after resection of large cell and adeno > 25%

229
Q

Q229. atelectasis etiology

A

A229. most common is postsurgery;; also mucuous plug, foreign body or tumor

230
Q

Q230. atelectasis presentation

A

A230. tachycardia,; dyspnea,; fever,; hypoxemia

231
Q

Q231. atelectasis diagnosis

A

A231. ipsilateral trachea deviation > upper lobe; mediastinal deviation > massive atelectasis; elevation of hemidiaphragm > lower lobe; atelectatic lobe looks denser, consolidated and smaller than normal contralateral lobe

232
Q

Q232. What muscles are responsible for inspiration during exercise?

A

A232. external intercostals; scalenes,; sternocleidomastoid,

233
Q

Q233. What muscles are responsible for expiration during exercise?

A

A233. Internal intercostals,; rectus abdominis,; transversus abdominis,; internal and external obliques

234
Q

Q234. What ratio indicates fetal lung maturity?

A

A234. lecithin: sphingomyelin > 2.0

235
Q

Q235. What is deficiency in neonatal respiratory distress syndrome?

A

A235. dipalmitoyl phosphatidylcholine (lecithin)

236
Q

Q236. How do ACE inhibitors cause cough?

A

A236. Normally ATII inactivates bradykinin;; when blocked, kallikrein is unopposed > activates bradykinin > cough and angioedema

237
Q

Q237. Where are ACE and kallikrein synthesized?

A

A237. In the lungs

238
Q

Q238. What is the formula for collapsing pressure?

A

A238. 2(tension)/radius; As radius decreases, alveoli are more likely to collapse

239
Q

Q239. How is inspiratory capacity calculated?

A

A239. tidal volume + inspiratory reserve capacity

240
Q

Q240. Formula for calculated Vd physiologic dead space

A

A240. tidal volume x (PaCO2 PeCo2)/PaCO2; PaCO2 = arterial PCO2; PeCO2 = expired air CO2

241
Q

Q241. At what point in the breath cycle is the tendency for the lungs to collapse equal to the tendency for the chest wall to spring outward?; What is the system pressure at this point?

A

A241. At FRC; System pressure is equal to atmospheric pressure

242
Q

Q242. What is the treatment for methemoglobinemia?

A

A242. Methylene blue

243
Q

Q243. What is the treatment for cyanide poisoning?

A

A243. Give nitrates to oxidize Hb to metHb > allows cyt oxidase to function; > thiosulfate to bind cyanide; > thiocyanide is renally excreted

244
Q

Q244. What is methemoglobin?

A

A244. oxidized form (Fe3+ instead of Fe2+) > poorer O2 binding

245
Q

Q245. What is the effect of carboxyhemoglobin on the oxygen dissociation curve?

A

A245. Left shift (increased affinity for oxygen, decreased unloading)

246
Q

Q246. What is the effect of increased metabolic needs on the oxygen dissociation curve?

A

A246. Right shift (increased oxygen unloading)

247
Q

Q247. What is the effect of acidemia on the oxygen dissociation curve?

A

A247. Right shift (increased oxygen unloading)

248
Q

Q248. What is the effect of alkalemia on the oxygen dissociation curve?

A

A248. Left shift (increased affinity for oxygen, decreased unloading)

249
Q

Q249. What is the effect of increased 2,3 DPG on the oxygen dissociation curve?

A

A249. Right shift (increased oxygen unloading)

250
Q

Q250. How does the oxygen dissociation curve of fetal Hb differ from adult Hb?

A

A250. Left shift (increased affinity for oxygen, decreased unloading)

251
Q

Q251. What is the effect of a decrease in PAO2?

A

A251. Vasoconstriction that shunts blood towards well ventilated regions of lung

252
Q

Q252. How do emphysema and pulmonary fibrosis impact diffusion?

A

A252. Both decrease it. Diffusion is proportional to A(rea)/T(hickness). Emphysema reduces area. Fibrosis increases thickness.

253
Q

Q253. What types of gases show perfusion limited patterns of exchange along pulmonary capillaries?

A

A253. O2 (normally), CO2, N2O. These equilibrate before the end of the capillary. Diffusion can only be increased if blood flow increases.

254
Q

Q254. What types of gases show diffusion limited patterns of exchange along pulmonary capillaries?

A

A254. O2 (in emphysema or fibrosis); CO

255
Q

Q255. What is the normal pressure in pulmonary arteries?

A

A255. 10 14 mmHg; >25 mmHg = HTN; >35 mmHg during exercise = HTN

256
Q

Q256. What histologic changes are seen as a result of pulmonary HTN?

A

A256. medial thickening, intimal fibrosis, atherosclerosis

257
Q

Q257. What causes primary pulmonary HTN?

A

A257. Inactivating mutation in BMPR2 gene (normally inhibits smooth muscle proliferation)

258
Q

Q258. What causes secondary pulmonary HTN?

A

A258. COPD,; mitral stenosis; systemic sclerosis; left to right shunt; sleep apnea (hypoxic vasoconstrict); high altitude (hypoxic vasoconstrict); recurrent thromboemboli

259
Q

Q259. What is the formula for pulmonary vascular resistance?

A

A259. PVR = (Ppulm artery Pleft atrium)/CO; R = (change in P)/Q; R = (8)(viscosity)(length)/(pi)(radius^4)

260
Q

Q260. What is the alveolar gas equation?

A

A260. PAO2 = 150 (PACO2)/0.8; 150 = PO2 in inspired air; 0.8 = respiratory quotient

261
Q

Q261. What is the A a gradient?; When is it increased?

A

A261. PAO2 PaO2 = 10 15; Increased in hypoxemia (V/Q mismatch, fibrosis)

262
Q

Q262. Where in the lung are ventilation and perfusion greatest?; Where is V/Q = 3?; Where is V/Q = 0.6; Where is V/Q = 1

A

A262. At the bases; At the apices; At the bases; During exercise

263
Q

Q263. In what type of V/Q mismatch should 100% O2 be used?

A

A263. Only in physiologic dead space (V>Q) due to blood flow obstruction. Does not help in physiologic shunt (V<Q) due to airway obstruction.

264
Q

Q264. In zone 2 of the lung, how to the partial pressures of oxygen in the alveoli, veins, and arteries compare?

A

A264. PA > Pa > Pv

265
Q

Q265. What are the 3 forms in which carbon dioxide is transferred from the tissues to the lungs?

A

A265. 1. Bicarbonate, HCO3 (90%); 2. Carbaminohemoglobin, bound to Hb at N terminus (5%), favors T form > O2 unloading; 3. Dissolved CO2 (5%

266
Q

Q266. Pt presents with sudden onset dyspnea, chest pain, and tachycardia. What could be the underlying causes?

A

A266. Embolus (95% from deep leg veins):; Fat (bone fractures, liposuction); Air; Thrombus; Bacteria; Amniotic fluid ( > postpartum DIC); Tumor

267
Q

Q267. Pt presents with calf tenderness occurring with foot dorsiflexion. What is wrong?

A

A267. DVT (positive Homan’s sign)

268
Q

Q268. Pt has productive cough, wheezing, crackles, and cyanosis. What is causing this?

A

A268. Chronic bronchitis (“blue bloater”) due to hypertrophy of mucus secreting glands in bronchioles > early onset hypoxemia, late onset dyspnea

269
Q

Q269. Pt has dyspnea, decreased breath sounds, tachycardia. What is causing this?

A

A269. Emphysemia (“pink puffer”) due to increased elastase activity > destruction of alveolar walls

270
Q

Q270. What type of emphysema is caused by smoking?

A

A270. Centriacinar

271
Q

Q271. What type of emphysema is caused by alpha1 antitrypsin deficiency?

A

A271. Pancacinar

272
Q

Q272. What type of emphysema is associated with spontaneous pneumothorax in a young male?

A

A272. Paraseptal (cyst/bulla forming)

273
Q

Q273. Pt has dyspnea, cough, wheezing, tachypnea, hypoxemia, decreased inspiratory/expiratory ratio

A

A273. Asthma: bronchial hyperresponsiveness > bronchoconstriction; Smooth muscle hypertrophy, Curschmann’s spirals (shed epithelium from mucus plugs)

274
Q

Q274. Pt has dilated airways, purulent sputum, recurrent infections, and hemoptyis. What is this called?; What is it caused by?; What infection are they at risk for?

A

A274. Bronchiectasis; CF, Kartagener’s, poor ciliary motility; Aspergillosis

275
Q

Q275. What are the mechanical causes of restrictive lung disease?

A

A275. Muscle polio, myasthenia gravis; Structural scoliosis, obesity

276
Q

Q276. What are the causes of restrictive lung disease that are attributable to lowered diffusing capacity?

A

A276. ARDS; Neonatal RDS (hyaline membrane dz); Sarcoidosis; Pneumoconioses; Idiopathic pulmonary fibrosis (collagen); Goodpasture’s syndrome; Wegener’s granulomatosis; Eosinophilic granuloma (histiocytosis X); Drug toxicity (bleomycin, amiodarine, busulfan)

277
Q

Q277. Pt presents with cough, dyspnea, morning stiffness, and painful joints. What caused it?; What part of lung is affected?

A

A277. Coal dust (coal miner’s lung) > Caplan syndrome; Upper lobes

278
Q

Q278. Sandblaster presents with cough, dyspnea, and “eggshell” calcification of hilar lymph nodes. What caused it?; What part of lung is affected?

A

A278. Silicosis (macrophages respond to silica > fibrogenesis); may increase susceptibility to TB if macrophages are impaired. Upper lobes

279
Q

Q279. Plumber/roofer presents with bronchogenic carcinoma. What caused it?; What part of lung is affected?; What is seen on biopsy?

A

A279. Asbestosis; Lower lobes; “Ivory white” calcified pleural plaques, dumbbell shaped bodies in macrophages, “ferruginous bodies” on Prussian blue

280
Q

Q280. Baby is born before 35 weeks. What is his L:S ratio?; What did his mom have?; How was he delivered?; What congenital heart defect?; Giving 100% O2 does what?; Treatment?

A

A280. L:S < 1.5; maternal diabetes; Cesarean section; low O2 tension > PDA; 100% O2 > retinopathy; Give maternal steroids before birth, artificial surfactant, thyroxine

281
Q

Q281. Protein rich fluid in alveoli, hyaline membranes. What caused damage?; What incited this diffuse alveolar damage?

A

A281. Toxic neutrophilic substances OR coagulation cascade OR free radicals; Trauma, sepsis, shock, gastric aspiration, uremia, pancreatitis, amniotic fluid embolism

282
Q

Q282. Obese pt who snores, has HTN, is always tired… Has what?; Should do what?; Could die from what?

A

A282. Obstructive sleep apnea (central is no respiratory effort); Get CPAP, lose weight, surgery; Arrhythmia

283
Q

Q283. Decreased breath sounds in one area, decreased resonance to percussion, decreased fremitus, tracheal deviation.

A

A283. Bronchial obstruction (ipsilateral to tracheal deviation), e.g. cancer

284
Q

Q284. Decreased breath sounds, dullness to percussion, decreased fremitus

A

A284. Pleural effusion

285
Q

Q285. Bronchial sounds in one area, dullness to percussion, increased fremitus

A

A285. Lobar pneumonia

286
Q

Q286. Decreased breath sounds, hyperresonance to percussion, absent fremitus, tracheal deviation

A

A286. Tension pneumothorax (on contralateral side to tracheal deviation)

287
Q

Q287. Pt presents with cough, hemoptysis, decreased breath sounds in one area, wheezing, coin lesions. Possible complications?

A

A287. Lung cancer SPHERE:; Superior vena cava syndrome; Pancoast’s tumor; Horner syndrome; Endocrine (paraneoplastic); Recurrent laryngeal symptoms; Effusions (pleural or pericardial)

288
Q

Q288. Hx of smoking; Hilar mass arising from bronchus, cavitation, PTHrP production; What would show up on histology?

A

A288. Squamous cell carcinoma

289
Q

Q289. Keratin pearls and intracellular bridges

A

A289. Squamous cell carcinoma

290
Q

Q290. Clara cells > type II pneumocytes; multiple densities on chest X ray

A

A290. Bronchial or bronchioloalveolar Adenocarcinoma

291
Q

Q291. Peripheral tumor in site of prior pulmonary inflammation or injury

A

A291. Bronchial adenocarcinoma

292
Q

Q292. Peripheral tumor presenting like pneumonia, grows along airways; Can result in hypertrophic osteoarthropathy

A

A292. Bronchioloalveolar adenocarcinoma

293
Q

Q293. Most common lung cancer in nonsmokers and females?

A

A293. Bronchial adenocarcinoma

294
Q

Q294. Central, aggressive tumor. Associated with ectopic ACTH or ADH, Lambert Eaton Syndrome (anti Ca channel Igs)

A

A294. Small (oat) cell carcinoma

295
Q

Q295. Poorly differentiated; neuroendocrine Kulchitsky cells (dark blue)

A

A295. Small (oat) cell carcinoma

296
Q

Q296. Inoperable but responsive to chemotherapy

A

A296. Small (oat) cell carcinoma

297
Q

Q297. Pleomorphic giant cells with leukocyte fragments

A

A297. Large cell carcinoma

298
Q

Q298. Peripheral tumor composed of anaplastic cells; unresponsive to chemotherapy; surgically removed

A

A298. Large cell carcinoma

299
Q

Q299. Secretes serotonin, can cause flushing, diarrhea, wheezing, salivation

A

A299. Carcinoid tumor

300
Q

Q300. Malignancy of the pleura resulting in hemorrhagic pleural effusions and pleural thickening

A

A300. Mesothelioma

301
Q

Q301. Psammoma bodies seen on histology

A

A301. Mesothelioma

302
Q

Q302. Common sites of lung metastases

A

A302. adrenals; brain (seizures); bone (fractures); liver (jaundice, hepatomegaly)

303
Q

Q303. Ptosis, miosis, anyhydrosis can be caused by a lung tumor in what location?

A

A303. Apex (Pancoast’s) > compresses cervical sympathetic plexus

304
Q

Q304. What organisms are usually responsible for lobar pneumonia?; Produce intra alveolar exudate > consolidation

A

A304. Streptococcus pneumoniae; Klebsiella

305
Q

Q305. What organisms are usually responsible for bronchopneumonia?; Inflammatory infiltrates from bronchioles > alveoli; patchy distribution in >1 lobe

A

A305. S. aureus; H. flu; Klebsiella; S. pyogenes

306
Q

Q306. What organisms are usually responsible for interstitial pneumonia?; Diffuse patchy infiltrates localized to interstitial areas at alveolar walls; more indolent

A

A306. Viruses (RSV, adenovirus); Mycoplasma; Legionella; Chlamydia

307
Q

Q307. What situations predispose to lung abscess with S. aureus and anaerobes?

A

A307. Bronchial obstruction (e.g. cancer); Aspiration of oropharyngeal contents (e.g. alcoholics, epileptics)

308
Q

Q308. Pleural effusion with low protein content is due to…

A

A308. (Transudate):; CHF; Nephrotic syndrome; Hepatic cirrhosis; Anything that causes increased hydrostatic or decreased oncotic P

309
Q

Q309. Cloudy pleural effusion with high protein content is due to…

A

A309. (Exudate must drain):; Malignancy; Pneumonia; Collagen vascular disease; Infection; Trauma; Anything that causes increased vascular permeability

310
Q

Q310. Milky fluid with high triglyceride content is composed of…

A

A310. lymphatic fluid (lymphatic effusion)

Clinical Medicine (7 decks)

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