Respiratory Flashcards
1
Q
��”Q001. What is the most important determinant of the amount of oxygen delivery to tissues?”
A
A001. Hemoglobin
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
3
Q
Q003. Equation for Arterial Oxygen content
A
A003. 0.0031(PaO2) + 1.38(Hb x SaO2) = Art O2 content
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)
5
Q
Q005. What is a Right to Left shunt in the lungs do to?
A
A005. Perfusion of a non ventilated lung
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
7
Q
Q007. When does a Low inspired O2 occur?
A
A007. High altitude
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
9
Q
Q009. Definition:; Gas exchange compromise due to problem with alveolar interface; (ex: interstitial lung Dz)
A
A009. Diffusion defect
10
Q
Q010. With what neuromuscular disorders does Hypoventilation occur?; (3)
A
A010. Myasthenia gravis;; ALS;; Guillain Barre
11
Q
Q011. What does an increased Fremitus suggest?
A
A011. Consolidation of the lung
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
13
Q
Q013. What does a “Dull” percussion represent?
A
A013. Increased density; (increased fluid in the lungs)
14
Q
Q014. What does “hyperresonant” refer to with percussion?
A
A014. Decreased density and more air; (ex: emphysema)
15
Q
Q015. Lung Auscultation definition:; Crackle (rale)
A
A015. Excessive airway secretions; (Pneumonia, pulm edema, bronchitis)
16
Q
Q016. Lung Auscultation definition:; Wheeze
A
A016. Rapid airflow through obstructed airway; (Asthma, bronchitis)
17
Q
Q017. Lung Auscultation definition:; Pleural Rub
A
A017. Inflammation of the pleura; (Pneumonia, pulmonary infarction)
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
19
Q
Q019. Definition:; A transudate or exudate in the lung
A
A019. Pleural effusion
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
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
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
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
24
Q
Q024. Definition:; Pus in the pleural space; Lab criteria?
A
A024. Empyema; (WBC > 100,000)
25
Q025. What Dx Pleural effusions always require a chest tube?; (3)*
A025. Pleural Effusion Line:; Positive Cultures;; Empyema;; Loculated Effusion
26
Q026. What are the causes of gross blood in the pleural fluid?; (4)*
A026. blood: A PTT; Aortic Dissection:; Pulmonary Infarction;; Tumor;; Trauma
27
Q027. What are the causes of low glucose in the pleural fluid?; (4)*
A027. Glucose is a TREaT:; Tumor;; Rheumatoid Arthritis;; Empyema;; TB
28
Q028. What are the causes of high amylase in the pleural fluid?; (4)*
A028. Amy(lase) is PRETty:; Pancreatitis;; Renal failure;; Esophageal rupture;; Tumor
29
Q029. Device that measures the rate at which the lung changes during forceful breathing?
A029. Spirometry
30
Q030. Definition:; when the patient inhales normally, then exhales as rapidly and completely as possible that is recorded on Spirometry
A030. Forced Vital Capacity; (FVC)
31
Q031. Spirometry Normal values:; 1. FEV1; 2. FVC; 3. FEV1/FVC
A031. Normals:; FEV1 = > 80%; FVC = > 80%; FEV1/FVC = > 0.7
32
Q032. Values indicating Obstructive lung disease:; 1. FEV1; 2. FVC; 3. FEV1/FVC; 4. Lung volume
A032. FEV1 = DECREASED; FVC = normal or Decreased; FEV1/FVC < 0.7; Lung volume = normal or decreased
33
Q033. Values indicating Restrictive lung disease:; 1. FEV1; 2. FVC; 3. FEV1/FVC; 4. Lung volume
A033. FEV1 = normal or Decreased; FVC = DECREASED; FEV1/FVC > 0.7; Lung volumes = Always DECREASED
34
Q034. What are the (3) different types of Restrictive lung defects?
A034. Interstitial Lung Dz (fibrosis);; Neuromuscular Dz (ALS, MG);; Chest Wall disorders (obesity, kyphosis)
35
Q035. What does the Obstructive defect look like on Spirogram?
A035. "swoopie"
36
Q036. What does the Restrictive defect look like on Spirogram?
A036. Tall and thin
37
Q037. *When is a Bronchoscopy the most accurate test?; (2); Only test more accurate?
A037. 1. Infections such as TB or Pneumocystis; 2. Centrally located Abscess or Tumor; More accurate:; Open Lung Biopsy
38
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?
A038. Lung Abscess; test:; Lung Biopsy
39
Q039. Most accurate diagnostic test of any pulmonary bacterial infection?
A039. Gram Stain of the Sputum
40
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?
A040. Bacterial Pneumonia (MCC Strep); first test: CXR; most accurate: Gram Stain of Sputum
41
Q041. What causes interstitial infiltrates?; (4)
A041. causes:; Viral Pneumonia;; PCP;; Mycoplasma;; Legionella
42
Q042. Most accurate test for:; Interstitial Lung Infiltrates caused by PCP
A042. Bronchoalveolar Lavage; (also Increased LDH)
43
Q043. *Most accurate test for:; Interstitial Lung Infiltrates caused by Legionella
A043. Urine Antigen testing
44
Q044. *Most accurate test for:; Interstitial Lung Infiltrates caused by Mycoplasma or Chlamydia
A044. Serology Antibody titers
45
Q045. What is the MC etiology of a Pleural Effusion?; (2); Most accurate test?
A045. etiology:; 1. CHF; 2. Pneumonia; test: Thoracentesis for fluid analysis
46
Q046. What is the best test to tell the difference b/t Obstructive and Restrictive lung disease?
A046. Flow Volume Loop
47
Q047. *When is a Pulmonary Function Test the most accurate Dx Test?; What part of the test is most accurate in Dx?
A047. Distinguish b/t Obstructive and Restrictive lung disease; most accurate part:; FEV/FVC ratio
48
Q048. Dx:; African American female with cough, dyspnea, chest pain and bilateral hilar lymphadenopathy. First test?; Most accurate Dx test?
A048. Sarcoidosis; first test: ACE levels (increased); most accurate: Noncaseating Granuloma on Biopsy
49
Q049. Dx:; a young non smoker with emphysema and liver disease; First test?
A049. Alpha 1 Antitrypsin Deficiency (low levels); First test: serum A1A levels
50
Q050. *When is Performing an ABG the best answer?; (3)
A050. 1. COPD; 2. possible Respiratory Acidosis; 3. Low serum Bicarb (possible severe Met acidosis)
51
Q051. Dx:; chronic respiratory problems, cough, SOB, fat malabsorption, vitamin deficiency, sterile. Blood gas reveals hypoxemia. Best test?
A051. Cystic Fibrosis; best test: Sweat Chloride; (Pilocarpine is given and Na + Cl is measured in the sweat)
52
Q052. (3) Typical Sx of Pneumonia
A052. Fever;; Cough with sputum;; Pleurtic Chest pain
53
Q053. (4) Physical Exam findings with Pneumonia
A053. Dullness to Percussion;; Rales (Crackles);; Egophany;; Tactile Fremitus in consolidated segment
54
Q054. Bug Dx:; 27 yo patient has pneumonia, bullous myringitis and a chest film that looks worse then expected
A054. Mycoplasma Pneumonia
55
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?
A055. Thoracentesis
56
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
A056. PCP; (Pneumocystis Carinii Pneumonia)
57
Q057. Bug Dx:; Elderly man presents with pneumonia, GI Sx, bradycardia, and hypoN
A057. Legionella
58
Q058. Pneumonia Bug Dx:; Currant Jelly sputum
A058. Klebsiella
59
Q059. Pneumonia Bug Dx:; Rusty sputum
A059. Pneumococcus
60
Q060. Pneumonia Bug Dx:; patient develops a post influenza pneumonia
A060. Pneumococcus
61
Q061. Pneumonia Bug Dx:; Buldging fissure on CXR
A061. Klebsiella
62
Q062. Pneumonia Bug Dx:; No bacteria on sputum gram stain culture; (2)
A062. Legionella; Mycoplasma
63
Q063. Pneumonia Bug Dx:; signs of pneumonia and Serum LDH is high
A063. PCP
64
Q064. MC Community Acquired, typical pneumonia; (2)
A064. S. pneumoniae; H. Influenzae
65
Q065. MC Community Acquired, atypical pneumonia; (3)*
A065. Community Lung Mess:; Chlamydia pneumoniae;; Legionella;; Mycoplasma
66
Q066. MC Hospital Acquired pneumonia; (3)
A066. Pseudomonas aeruginosa;; S. aureus;; Enteric organisms (E. coli)
67
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.
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)
68
Q068. MCC of pneumonia in the immunocompromised host with Neutropenia; (4)*
A068. Pseudomonas;; Enterobacteriaceae;; S. Aureus;; Aspergillus
69
Q069. MCC of pneumonia in the immunocompromised host with sickle cell or a splenectomy
A069. Encapsulated organisms
70
Q070. MCC of pneumonia in the immunocompromised host with chronic Steroid use; (2)
A070. TB;; Nocardia
71
Q071. MCC of pneumonia in Alcoholics; (4)
A071. S. pneumoniae;; H. Influenzae;; Klebsiella;; TB
72
Q072. Pneumonia Bug Dx:; Small gram negative rod with a halo on gram stain
A072. H. Influenzae
73
Q073. CXR pneumonia findings:; Upper lobe; (2)
A073. TB;; Klebsiella
74
Q074. CXR pneumonia findings:; small cavities w/o air fluid levels
A074. TB; (Mycobacterium)
75
Q075. CXR pneumonia findings:; Large cavities with air fluid levels that do not culture; (2)
A075. Coccidioidomycosis;; Nocardia
76
Q076. CXR pneumonia findings:; Diffuse Bilateral Infiltrates; (2)
A076. PCP;; Mycoplasma
77
Q077. Definition:; Idiopathic Eosinophilic Pneumonia
A077. Loeffler's pneumonia
78
Q078. Pneumonia bugs causing "Relative Bradycardia
A078. Legionella;; Salmonella;; Chlamydia Psittaci
79
Q079. What drug prevents respiratory failure and improves survival in PCP pneumonia patients?; Criteria for when it is given?; (2)
A079. Steroids; give: A a gradient > 35, PaO2 < 75
80
Q080. Drug of choice for:; Any Community Acquired Pneumonia with no risk factors
A080. Macrolide; (Erythromycin, Azithromycin)
81
Q081. Drug of choice for:; Any Community Acquired Pneumonia with risk factors; (CHF, DM, etc); (2)
A081. 1. Macrolide + 2nd generation Cephalosporin; 2. FQ (Extended spectum)
82
Q082. Drug of choice for:; Any Hospital Acquired Pneumonia; (2)
A082. 1. Cefixime; 2. Piperacillin tazobactam; [both for Pseudomonas coverage]
83
Q083. Drug of choice for:; Any Immunocompromised patient with Pneumonia
A083. TMP SMX; [for PCP coverage]
84
Q084. Dx:; Productive cough, night sweats, hemoptysis, anorexia, weight loss, chest pain, fever, chills
A084. TB
85
Q085. (3) Dx tests for TB
A085. Positive PPD;; Granuloma in upper lobes of lung;; Acid fast bacilli on sputum
86
Q086. How is latent TB treated?
A086. INH daily for 9 months; (or Rifampin for 4 if in contact with INH resistant TB)
87
Q087. How is Active TB treated?
A087. RIPE for 2 months:; Rifampin; INH, Pyrazinamide; Ethambutol; followed with 4 months of:; INH and Rifampin
88
Q088. How is tx of TB different with pregnant pt?
A088. No pyrazamide; (other med ok)
89
Q089. Toxicity of INH; (2)*
A089. INH: Infects Neuro and Hepatic:; Neruopathy;; Seizures;; Hepatitis
90
Q090. Dx:; patient brought by ambulance in status epilepticus. Patient says only medical history is TB; How is it treated?
A090. INH toxicity; Tx: Pyridoxine
91
Q091. Toxicity of Rifampin; (2)
A091. Induces P450; Gives Red orange secretions; (tears, urine, sweat, etc)
92
Q092. Toxicity of Ethambutol
A092. Optic neuritis and impaired color vision
93
Q093. Risk factors for DVT.
A093. stasis; endothelial injury; hypercoagulability; (Virchow's triad)
94
Q094. Criteria for exudative effusion.
A094. pleural/serum protein > 0.5; pleural/serum LDH > 0.6
95
Q095. Causes of exudative effusion.
A095. Think of leaky capillaries. Malignancy; TB; bacterial or viral infection; pulmonary embolism with infarct; pancreatitis
96
Q096. Causes of transudative effusion.
A096. Think of intact capillarie. CHF; liver or kidney disease; protein losing enteropathy
97
Q097. Normalizing PCO2 in a patient having an asthma exacerbation may indicate?
A097. Fatigue & impending respiratory failure
98
Q098. dyspnea; lateral hilar lymphadenopathy on CXR; noncaseating granulomas; increased ACE; hypercalcemia
A098. Sarcoidosis
99
Q099. PFT showing decreased FEV1/FVC.
A099. Obstructive pulmonary disease (e.g. asthma)
100
Q100. PFT showing increased FEV1/FVC.
A100. Restrictive pulmonary disease
101
Q101. Honeycomb pattern on CXR. Diagnosis?; Treatment?
A101. Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help.
102
Q102. Treatment for SVC syndrome.
A102. Radiation
103
Q103. Treatment for mild, persistent asthma.
A103. Inhaled beta agonists & inhaled corticosteroids
104
Q104. Acid base disorder in pulmonary embolism.
A104. Hypoxia & hypocarbia
105
Q105. Non small cell lung cancer (NSCLC) associated with hypercalcemia.
A105. Squamous cell carcinoma
106
Q106. Lung cancer associated with SIADH.
A106. Small cell lung cancer (SCLC)
107
Q107. Lung cancer highly related to cigarette
A107. Small cell lung cancer (SCLC)
108
Q108. A tall white male presents with acute shortness of breath. Diagnosis?; Treatment?
A108. Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful.
109
Q109. Treatment of tension pneumothorax.
A109. Immediate needle thoracostomy
110
Q110. Characteristics favoring carcinoma in an isolated pulmonary nodule.
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
111
Q111. Hypoxemia & pulmonary edema with normal pulmonary capillary wedge pressure.
A111. ARDS
112
Q112. Increased risk of what infection with silicosis?
A112. Mycobacterium tuberculosis
113
Q113. Causes of hypoxemia.
A113. right to left shunt; hypoventilation; low inspired O2 tension; diffusion defect; V/Q mismatch
114
Q114. Classic CXR findings for pulmonary edema
A114. cardiomegaly; prominent pulmonary vessels; Kerley B lines; "bat's wing" appearance of hilar shadows; perivascular & peribronchial cuffing
115
Q115. pulmonary function tests
A115. spirometry (mechanical ventilation); Dlco (gas exchange); methacholine challenge test (bronchial hyperreactivity); TLC
116
Q116. restrictive pattern
A116. FEV1/FVC > 80%
117
Q117. obstructive pattern
A117. FEV1/FVC < 80%; seen in emphysema, chronic bronchitis, asthma, bronchiectasis
118
Q118. Decreased DLco
A118. if FEV1/FVC < 80% suggests emphysema; if FEV1/FVC > 80% suggests interstitial lung disease or mild left heart failure
119
Q119. Increased DLco
A119. suggests hemorrhage such as in Goodpasture
120
Q120. methacholine test
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%
121
Q121. A a gradient formula
A121. 150 (1.25 x PaCO2) PaO2 normal: 5 15mmHg;; increases with age and all forms of hypoxemia except hypoventilation and high altitude
122
Q122. solitary pulmonary nodule
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
123
Q123. transudative pleural effusion
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
124
Q124. exudative pleural effusion
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
125
Q125. transudative causes of pleural effusion
A125. heart failure; nephrotic syndrome; liver disease; pulmonary embolism; atelectasis
126
Q126. exudative causes of pleural effusion
A126. pneumonia; cancer (lung, breast or lymphoma); pulmonary embolism; drug induced; pancreatitis; TB; RA; SLE
127
Q127. transudative pleural effusion with no apparent cause
A127. consider pulmonary embolism which can be either transudative or exudative
128
Q128. indications of thoracocentesis
A128. any new and unexplained pleural effusion > rule out empyema; decubitus x ray > minimal risk; if non free fluid need ultrasound guidance
129
Q129. malignant pleural effusions
A129. due mostly to breast cancer, lung cancer and lymphoma; send thoracocentesis fluid for cytologic exam also
130
Q130. hemorrhagic pleural effusion
A130. seen in mesothelioma, metastatic lung or breast cancer, pulmonary embolism with infarction and trauma
131
Q131. lymphocytic predominant pleural effusions
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
Q132. respiratory compromise and distress
A132. presents with shortness of breath, dyspnea, tachypnea (>30) and associated symptoms such as agitation, confusion or decreased consciousness
133
Q133. evaluation of respiratory distress
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
Q134. acute respiratory distress with fever, cough or sputum
A134. suggests infectious etiology
135
Q135. acute respiratory distress without systemic symptoms
A135. suggests airway obstruction, cardiac disease or thromboembolism
136
Q136. chronic respiratory distress
A136. suggests interstitial lung disease or COPD
137
Q137. common lung physical exam findings
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
Q138. B natriuretic peptide in acute dyspnea
A138. elevation is sensitive for heart failure but can also be elevated in cor pulmonale and acute right ventricular failure (thromboembolism)
139
Q139. chest x ray without parenchymal infiltrates in acute dyspnea
A139. suggests thromboembolism; central respiratory depression; neuromuscular disease; upper airway obstruction
140
Q140. chest x ray hyperinflation in acute dyspnea
A140. suggests asthma and COPD
141
Q141. chest x ray with focal infiltrates in acute dyspnea
A141. suggests bacterial, viral or fungal pneumonia, aspiration or pulmonary hemorrhage
142
Q142. chest x ray with diffuse edema in acute dyspnea
A142. suggests heart failure or ARDS
143
Q143. ICU indications in respiratory failure
A143. persistent hypoxemia > hospitalization; ICU indications >; need for mechanical ventilation; close monitoring; increasing oxygen demand; continuous nursing
144
Q144. indications for intubation and/or mechanical ventilation
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
Q145. respiratory distress in hospitalized patients
A145. inpatient who develops dyspnea, tachypnea and/or hypoxemia should raise possibility of pulmonary embolism or aspiration
146
Q146. types of asthma
A146. intrinsic (50%) is secondary to nonimmunologic stimuli (infections, irritating inhalants, cold air and emotional);; extrinsic (20%) due to allergens
147
Q147. asthma stimuli
A147. infections (RSV, rhinovirus),; drugs (aspirin/NSAIDs, coloring agents, betablockers),; allergens,; cold air,; emotions
148
Q148. asthma presentation
A148. tachypnea,; tachycardia,; diffuse wheezing,; use of accessory muscles,; diminished breath sounds,; hyperresonance,; intercostal retractions
149
Q149. asthma poor prognosis factors
A149. fatigue; diaphoresis; pulsus paradoxus; inaudible breath sounds; decreased wheezing; cyanosis; bradycardia
150
Q150. asthma diagnosis
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
Q151. acute asthma management
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
Q152. chronic asthma management
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
Q153. mild asthma definition and treatment
A153. symptoms ~2 days/week and rare night symptoms; FEV1 is normal; no long term control needed only inhaled beta agonists for attacks
154
Q154. moderate asthma definition and treatment
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
Q155. severe asthma definition and treatment
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
Q156. physical exam in emphysema
A156. distant breath sounds; pink skin; thin; barrel chest; accessory muscles; symptoms of right heart failure and clubbing
157
Q157. physical exam in chronic bronchitis
A157. rhonchi and wheezes; signs of cyanosis; weight gain; symptoms of right heart failure and clubbing
158
Q158. chest x ray findings in COPD
A158. chronic bronchitis > increased pulmonary markings; emphysema > bilateral hyperinflantion, diaphragm flattening, small heart size, increase in retrosternal space
159
Q159. COPD diagnosis
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
Q160. COPD complications
A160. hypoxemia with nocturnal desaturation; secondary erythrocytosis; cor pulmonale; chronic ventilatory failure; CO2 retention
161
Q161. maintenance treatment for COPD
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
Q162. only treatment that reduces mortality in COPD
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
Q163. COPD exacerbation general management
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
Q164. COPD exacerbation specific treatment
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
Q165. bronchiectasis etiology
A165. secondary to recurrent pneumonias, TB, fungal or abscess; cystic fibrosis, immotile cilia syndrome (50% Kartagener)
166
Q166. bronchiectasis presentation
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
Q167. bronchiectasis diagnosis
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
Q168. bronchiectasis treatment
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
Q169. bronchiectasis complications
A169. massive hemoptysis,; amyloidosis,; cor pulmonale,; visceral abscesses
170
Q170. interstitial lung disease general presentation
A170. exertional dyspnea; nonproductive cough; crackles; pulmonary hypertension; clubbing; restrictive pattern
171
Q171. interstitial lung diseases
A171. idiopathic pulmonary fibrosis; sarcoidosis; pneumoconiosis > asbestosis, silicosis, coal pneumoconiosis
172
Q172. idiopathic pulmonary fibrosis presentation
A172. exercise intolerance, dyspnea, coarse crackles
173
Q173. idiopathic pulmonary fibrosis diagnosis
A173. reticular or reticulonodular pattern on chest x ray; restrictive pattern on PFTs; increased macrophages on bronchoalveolar lavage (nonspecific)
174
Q174. idiopathic pulmonary fibrosis treatment
A174. steroids with or without azathioprine works in 20%;; the rest develop fatal lung disease
175
Q175. idiopathic pulmonary fibrosis prognosis
A175. 20 40% 5 year survival;; best prognostic factor is response to steroids as evidenced in PFTs
176
Q176. sarcoidosis presentation
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
Q177. chest x ray findings in sarcoidosis
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
Q178. sarcoidosis diagnosis
A178. biopsy of affected tissue showing noncasseating granulomas;; all patients should have ophthalmologic exam
179
Q179. sarcoidosis prognosis
A179. 80% remain stable or spontaneously resolves;; 20% progress to organ compromise
180
Q180. sarcoidosis treatment
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
Q181. pneumoconiosis general presentation
A181. dyspnea,; shortness of breath,; cough,; sputum,; cor pulmonale,; clubbing,; restrictive pattern,; decreased DLco,; hypoxemia with increased A a
182
Q182. ocupations associated with asbestosis
A182. mining,; milling,; foundry work,; shipyards,; pipes,; break linings,; insulation,; boilers;; history of exposure necessary for Dx
183
Q183. asbestosis x ray findings
A183. diffuse or local pleural thickening,; pleural plaques,; calcifications near diaphragm,; pleural effusions,; lower lobe interstitial infiltrate
184
Q184. asbestosis associated cancers
A184. lung adenocarcinoma or SCC; pleural mesothelioma is less common
185
Q185. asbestosis diagnosis
A185. history of exposure + lung biopsy showing barbell shaped asbestos fibers
186
Q186. asbestosis treatment
A186. no effective treatment;; must stop smoking due 75x increased risk of cancer
187
Q187. ocupations associated with silicosis
A187. mining,; quarrying,; tunneling,; glass and pottery making,; sandblasting
188
Q188. silicosis x ray findings
A188. 1 10mm nodules throughout the lungs, most prominent in upper lobes; in progressive massive fibrosis nodules are >10mm and coalesce
189
Q189. silicosis diagnosis
A189. history of exposure + lung biopsy showing silica particles; pathologic lesion is the hyaline nodule
190
Q190. silicosis treatment
A190. no effective treatment; should have yearly PPD test and if >10mm > INH prophylaxis for 9 months
191
Q191. Lofgren syndrome
A191. acute sarcoidosis presentation with erythema nodosum, arthritis, hilar adenopathy
192
Q192. Heefordt Waldenstrom syndrome
A192. acute sarcoidosis presentation with fever,; parotid enlargement,; uveitis and facial palsy
193
Q193. Caplan syndrome
A193. rheumatoid nodules in periphery of lung,; rheumatoid arthritis and coexisting pneumoconiosis (usually CWP)
194
Q194. coal worker's pneumoconiosis x ray findings
A194. small round parenchymal densities; usually in upper half of lungs; progressive massive fibrosis has 1cm densities in whole lung
195
Q195. coal worker's pneumoconiosis immunologic findings
A195. increased IgA,; increased IgG,; increased C3, ANA and rheumatoid factor
196
Q196. pulmonary embolus site of origin
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
Q197. criteria for high risk pulmonary embolism patients
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
Q198. signs and symptoms consistent with pulmonary embolism
A198. sudden onset of dyspnea,; tachypnea,; thigh/calf swelling,; pleuritic chest pain,; hemoptysis,; tachycardia,; increased P2
199
Q199. when to consider pulmonary embolism
A199. all patients with dyspnea and normal chest x ray
200
Q200. nonspecific routine tests for dyspnea; may suggest PE
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
Q201. specific tests for pulmonary embolism
A201. best initial test is spiral CT scan;; V/Q scan (if normal excludes PE);; angiogram is gold standard
202
Q202. deep venous thrombosis specific tests
A202. best initial test is compression or duplex ultrasound;; venogram is rarely done;; MRI
203
Q203. tests for DVT and PE
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
Q204. tests results that exclude pulmonary embolism
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
Q205. generalities of pulmonary embolism diagnosis
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
Q206. pulmonary embolism treatment
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
Q207. heparin considerations in pulmonary embolism
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
Q208. warfarin considerations in pulmonary embolism
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
Q209. contraindications of anticoagulation therapy in PE
A209. contraindicated in patients with recent neurosurgery or eye surgery; use inferior vena cava filter instead
210
Q210. post thrombotic syndrome
A210. pain; edema; hyperpigmentation; skin ulceration in 2/3 of PE patients; compression stockings can prevent it
211
Q211. fat embolism
A211. acute dyspnea, petechiae in neck or axilla, confusion,; 3 days after long bone fracture or after CPR;; no anticoagulation necessary
212
Q212. ARDS etiology
A212. sepsis; trauma; DIC; Goodpasture; SLE; drug overdose; toxin inhalation; drowning
213
Q213. ARDS presentation
A213. dyspnea,; tachypnea,; diffuse rales and ronchi
214
Q214. ARDS diagnosis
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
Q215. ARDS treatment
A215. treat underlying cause;; mechanical ventilation with positive end expiratory pressure
216
Q216. ARDS prognosis
A216. 70% mortality
217
Q217. sleep apnea
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
Q218. lung cancer etiology
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
Q219. types of lung cancer
A219. most common is adenocarcinoma (40%);; squamous cell carcinoma,; small cell and large cell
220
Q220. centrally located lung cancers
A220. squamous cell and small cell
221
Q221. peripheral located lung cancers
A221. adenocarcinoma and large cell
222
Q222. lung cancer paraneoplastic syndromes
A222. SCC > hypercalcemia (PTH like peptide); small cell > SIADH and Eaton Lambert
223
Q223. lung cancer metastasis
A223. SCC > direct extension to hilar node and mediastinum; small cell and adenocarcinoma > liver, adrenals, brain, bones
224
Q224. lung cancer presentation
A224. cough; weight loss; dyspnea; hemoptysis; chest pain; recurrent pneumonic processes; hoarseness
225
Q225. lung cancer diagnosis
A225. sputum cytology (specially SCC); bronchoscopy for centrally located lesions; needle aspiration biopsy if highly suspicious and nonspecific bronchoscopy findings or peripheral lesion
226
Q226. symptoms of unresectable lung cancer
A226. weight loss >10%; bone pain; extrathoracic metastasis; CNS symptoms; SVC syndrome; hoarseness; contralateral mediastinal adenopathy
227
Q227. lung cancer treatment
A227. resectable small cell > VP16 (etoposide, platinum);; resectable non small > CAP (cyclo, adriamycin, platinum) and radio
228
Q228. lung cancer prognosis
A228. 5 8% 5 year survival; after resection of SCC > 30 35%; after resection of large cell and adeno > 25%
229
Q229. atelectasis etiology
A229. most common is postsurgery;; also mucuous plug, foreign body or tumor
230
Q230. atelectasis presentation
A230. tachycardia,; dyspnea,; fever,; hypoxemia
231
Q231. atelectasis diagnosis
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
Q232. What muscles are responsible for inspiration during exercise?
A232. external intercostals; scalenes,; sternocleidomastoid,
233
Q233. What muscles are responsible for expiration during exercise?
A233. Internal intercostals,; rectus abdominis,; transversus abdominis,; internal and external obliques
234
Q234. What ratio indicates fetal lung maturity?
A234. lecithin: sphingomyelin > 2.0
235
Q235. What is deficiency in neonatal respiratory distress syndrome?
A235. dipalmitoyl phosphatidylcholine (lecithin)
236
Q236. How do ACE inhibitors cause cough?
A236. Normally ATII inactivates bradykinin;; when blocked, kallikrein is unopposed > activates bradykinin > cough and angioedema
237
Q237. Where are ACE and kallikrein synthesized?
A237. In the lungs
238
Q238. What is the formula for collapsing pressure?
A238. 2(tension)/radius; As radius decreases, alveoli are more likely to collapse
239
Q239. How is inspiratory capacity calculated?
A239. tidal volume + inspiratory reserve capacity
240
Q240. Formula for calculated Vd physiologic dead space
A240. tidal volume x (PaCO2 PeCo2)/PaCO2; PaCO2 = arterial PCO2; PeCO2 = expired air CO2
241
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?
A241. At FRC; System pressure is equal to atmospheric pressure
242
Q242. What is the treatment for methemoglobinemia?
A242. Methylene blue
243
Q243. What is the treatment for cyanide poisoning?
A243. Give nitrates to oxidize Hb to metHb > allows cyt oxidase to function; > thiosulfate to bind cyanide; > thiocyanide is renally excreted
244
Q244. What is methemoglobin?
A244. oxidized form (Fe3+ instead of Fe2+) > poorer O2 binding
245
Q245. What is the effect of carboxyhemoglobin on the oxygen dissociation curve?
A245. Left shift (increased affinity for oxygen, decreased unloading)
246
Q246. What is the effect of increased metabolic needs on the oxygen dissociation curve?
A246. Right shift (increased oxygen unloading)
247
Q247. What is the effect of acidemia on the oxygen dissociation curve?
A247. Right shift (increased oxygen unloading)
248
Q248. What is the effect of alkalemia on the oxygen dissociation curve?
A248. Left shift (increased affinity for oxygen, decreased unloading)
249
Q249. What is the effect of increased 2,3 DPG on the oxygen dissociation curve?
A249. Right shift (increased oxygen unloading)
250
Q250. How does the oxygen dissociation curve of fetal Hb differ from adult Hb?
A250. Left shift (increased affinity for oxygen, decreased unloading)
251
Q251. What is the effect of a decrease in PAO2?
A251. Vasoconstriction that shunts blood towards well ventilated regions of lung
252
Q252. How do emphysema and pulmonary fibrosis impact diffusion?
A252. Both decrease it. Diffusion is proportional to A(rea)/T(hickness). Emphysema reduces area. Fibrosis increases thickness.
253
Q253. What types of gases show perfusion limited patterns of exchange along pulmonary capillaries?
A253. O2 (normally), CO2, N2O. These equilibrate before the end of the capillary. Diffusion can only be increased if blood flow increases.
254
Q254. What types of gases show diffusion limited patterns of exchange along pulmonary capillaries?
A254. O2 (in emphysema or fibrosis); CO
255
Q255. What is the normal pressure in pulmonary arteries?
A255. 10 14 mmHg; >25 mmHg = HTN; >35 mmHg during exercise = HTN
256
Q256. What histologic changes are seen as a result of pulmonary HTN?
A256. medial thickening, intimal fibrosis, atherosclerosis
257
Q257. What causes primary pulmonary HTN?
A257. Inactivating mutation in BMPR2 gene (normally inhibits smooth muscle proliferation)
258
Q258. What causes secondary pulmonary HTN?
A258. COPD,; mitral stenosis; systemic sclerosis; left to right shunt; sleep apnea (hypoxic vasoconstrict); high altitude (hypoxic vasoconstrict); recurrent thromboemboli
259
Q259. What is the formula for pulmonary vascular resistance?
A259. PVR = (Ppulm artery Pleft atrium)/CO; R = (change in P)/Q; R = (8)(viscosity)(length)/(pi)(radius^4)
260
Q260. What is the alveolar gas equation?
A260. PAO2 = 150 (PACO2)/0.8; 150 = PO2 in inspired air; 0.8 = respiratory quotient
261
Q261. What is the A a gradient?; When is it increased?
A261. PAO2 PaO2 = 10 15; Increased in hypoxemia (V/Q mismatch, fibrosis)
262
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
A262. At the bases; At the apices; At the bases; During exercise
263
Q263. In what type of V/Q mismatch should 100% O2 be used?
A263. Only in physiologic dead space (V>Q) due to blood flow obstruction. Does not help in physiologic shunt (V
264
Q264. In zone 2 of the lung, how to the partial pressures of oxygen in the alveoli, veins, and arteries compare?
A264. PA > Pa > Pv
265
Q265. What are the 3 forms in which carbon dioxide is transferred from the tissues to the lungs?
A265. 1. Bicarbonate, HCO3 (90%); 2. Carbaminohemoglobin, bound to Hb at N terminus (5%), favors T form > O2 unloading; 3. Dissolved CO2 (5%
266
Q266. Pt presents with sudden onset dyspnea, chest pain, and tachycardia. What could be the underlying causes?
A266. Embolus (95% from deep leg veins):; Fat (bone fractures, liposuction); Air; Thrombus; Bacteria; Amniotic fluid ( > postpartum DIC); Tumor
267
Q267. Pt presents with calf tenderness occurring with foot dorsiflexion. What is wrong?
A267. DVT (positive Homan's sign)
268
Q268. Pt has productive cough, wheezing, crackles, and cyanosis. What is causing this?
A268. Chronic bronchitis ("blue bloater") due to hypertrophy of mucus secreting glands in bronchioles > early onset hypoxemia, late onset dyspnea
269
Q269. Pt has dyspnea, decreased breath sounds, tachycardia. What is causing this?
A269. Emphysemia ("pink puffer") due to increased elastase activity > destruction of alveolar walls
270
Q270. What type of emphysema is caused by smoking?
A270. Centriacinar
271
Q271. What type of emphysema is caused by alpha1 antitrypsin deficiency?
A271. Pancacinar
272
Q272. What type of emphysema is associated with spontaneous pneumothorax in a young male?
A272. Paraseptal (cyst/bulla forming)
273
Q273. Pt has dyspnea, cough, wheezing, tachypnea, hypoxemia, decreased inspiratory/expiratory ratio
A273. Asthma: bronchial hyperresponsiveness > bronchoconstriction; Smooth muscle hypertrophy, Curschmann's spirals (shed epithelium from mucus plugs)
274
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?
A274. Bronchiectasis; CF, Kartagener's, poor ciliary motility; Aspergillosis
275
Q275. What are the mechanical causes of restrictive lung disease?
A275. Muscle polio, myasthenia gravis; Structural scoliosis, obesity
276
Q276. What are the causes of restrictive lung disease that are attributable to lowered diffusing capacity?
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
Q277. Pt presents with cough, dyspnea, morning stiffness, and painful joints. What caused it?; What part of lung is affected?
A277. Coal dust (coal miner's lung) > Caplan syndrome; Upper lobes
278
Q278. Sandblaster presents with cough, dyspnea, and "eggshell" calcification of hilar lymph nodes. What caused it?; What part of lung is affected?
A278. Silicosis (macrophages respond to silica > fibrogenesis); may increase susceptibility to TB if macrophages are impaired. Upper lobes
279
Q279. Plumber/roofer presents with bronchogenic carcinoma. What caused it?; What part of lung is affected?; What is seen on biopsy?
A279. Asbestosis; Lower lobes; "Ivory white" calcified pleural plaques, dumbbell shaped bodies in macrophages, "ferruginous bodies" on Prussian blue
280
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?
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
Q281. Protein rich fluid in alveoli, hyaline membranes. What caused damage?; What incited this diffuse alveolar damage?
A281. Toxic neutrophilic substances OR coagulation cascade OR free radicals; Trauma, sepsis, shock, gastric aspiration, uremia, pancreatitis, amniotic fluid embolism
282
Q282. Obese pt who snores, has HTN, is always tired... Has what?; Should do what?; Could die from what?
A282. Obstructive sleep apnea (central is no respiratory effort); Get CPAP, lose weight, surgery; Arrhythmia
283
Q283. Decreased breath sounds in one area, decreased resonance to percussion, decreased fremitus, tracheal deviation.
A283. Bronchial obstruction (ipsilateral to tracheal deviation), e.g. cancer
284
Q284. Decreased breath sounds, dullness to percussion, decreased fremitus
A284. Pleural effusion
285
Q285. Bronchial sounds in one area, dullness to percussion, increased fremitus
A285. Lobar pneumonia
286
Q286. Decreased breath sounds, hyperresonance to percussion, absent fremitus, tracheal deviation
A286. Tension pneumothorax (on contralateral side to tracheal deviation)
287
Q287. Pt presents with cough, hemoptysis, decreased breath sounds in one area, wheezing, coin lesions. Possible complications?
A287. Lung cancer SPHERE:; Superior vena cava syndrome; Pancoast's tumor; Horner syndrome; Endocrine (paraneoplastic); Recurrent laryngeal symptoms; Effusions (pleural or pericardial)
288
Q288. Hx of smoking; Hilar mass arising from bronchus, cavitation, PTHrP production; What would show up on histology?
A288. Squamous cell carcinoma
289
Q289. Keratin pearls and intracellular bridges
A289. Squamous cell carcinoma
290
Q290. Clara cells > type II pneumocytes; multiple densities on chest X ray
A290. Bronchial or bronchioloalveolar Adenocarcinoma
291
Q291. Peripheral tumor in site of prior pulmonary inflammation or injury
A291. Bronchial adenocarcinoma
292
Q292. Peripheral tumor presenting like pneumonia, grows along airways; Can result in hypertrophic osteoarthropathy
A292. Bronchioloalveolar adenocarcinoma
293
Q293. Most common lung cancer in nonsmokers and females?
A293. Bronchial adenocarcinoma
294
Q294. Central, aggressive tumor. Associated with ectopic ACTH or ADH, Lambert Eaton Syndrome (anti Ca channel Igs)
A294. Small (oat) cell carcinoma
295
Q295. Poorly differentiated; neuroendocrine Kulchitsky cells (dark blue)
A295. Small (oat) cell carcinoma
296
Q296. Inoperable but responsive to chemotherapy
A296. Small (oat) cell carcinoma
297
Q297. Pleomorphic giant cells with leukocyte fragments
A297. Large cell carcinoma
298
Q298. Peripheral tumor composed of anaplastic cells; unresponsive to chemotherapy; surgically removed
A298. Large cell carcinoma
299
Q299. Secretes serotonin, can cause flushing, diarrhea, wheezing, salivation
A299. Carcinoid tumor
300
Q300. Malignancy of the pleura resulting in hemorrhagic pleural effusions and pleural thickening
A300. Mesothelioma
301
Q301. Psammoma bodies seen on histology
A301. Mesothelioma
302
Q302. Common sites of lung metastases
A302. adrenals; brain (seizures); bone (fractures); liver (jaundice, hepatomegaly)
303
Q303. Ptosis, miosis, anyhydrosis can be caused by a lung tumor in what location?
A303. Apex (Pancoast's) > compresses cervical sympathetic plexus
304
Q304. What organisms are usually responsible for lobar pneumonia?; Produce intra alveolar exudate > consolidation
A304. Streptococcus pneumoniae; Klebsiella
305
Q305. What organisms are usually responsible for bronchopneumonia?; Inflammatory infiltrates from bronchioles > alveoli; patchy distribution in >1 lobe
A305. S. aureus; H. flu; Klebsiella; S. pyogenes
306
Q306. What organisms are usually responsible for interstitial pneumonia?; Diffuse patchy infiltrates localized to interstitial areas at alveolar walls; more indolent
A306. Viruses (RSV, adenovirus); Mycoplasma; Legionella; Chlamydia
307
Q307. What situations predispose to lung abscess with S. aureus and anaerobes?
A307. Bronchial obstruction (e.g. cancer); Aspiration of oropharyngeal contents (e.g. alcoholics, epileptics)
308
Q308. Pleural effusion with low protein content is due to...
A308. (Transudate):; CHF; Nephrotic syndrome; Hepatic cirrhosis; Anything that causes increased hydrostatic or decreased oncotic P
309
Q309. Cloudy pleural effusion with high protein content is due to...
A309. (Exudate must drain):; Malignancy; Pneumonia; Collagen vascular disease; Infection; Trauma; Anything that causes increased vascular permeability
310
Q310. Milky fluid with high triglyceride content is composed of...
A310. lymphatic fluid (lymphatic effusion)
