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Boards Studying > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

Tx for PE in pt with GFR <30

A

Unfractionated heparin - more convenient to monitor therapeutic level with PTT
- Avoid LMWH (enoxaparin), fondaparinux, rivaroxaban

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2
Q

Pt with sudden onset chest pain, dyspnea, and hemoptysis with wedge-shaped plearual base opacification. Patient has HIV and chronic smoker

A

Pulmonary infarction from pulmonary embolism

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3
Q

38 year old with progressive SOB and cough. Smoked cigarettes for 5 years. CXR show bilateral basal lucency.

A

alpha 1 antitrypsin deficiency

  • classically results in destruction of lower lobes
  • COPD at young age, COPD with minimal smoking hx, basilar predominant COPD
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4
Q

Most common cause of PNA in cystic fibrosis pts

A

<20: staph aureus

>20: pseudomonas

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5
Q

Light’s Criteria

A

Protein (pleural/serum) >0.5
LDH (pleural/serum) >0.5
Pleural LDH >2/3 ULN serum LDH

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6
Q

Transudative vs exudative

A

Transudative: decreased intrapleural and plasma oncotic pressures or elevated hydrostatic pressure
Exudative: increased capillary or pleural membrane permeability or disruptions to lymphatic outflow

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7
Q

9 year old girl with frequent sinus infections and pneumonia. Vitamin D deficiency. Multiple nasal polyps. Digital clubbing

A

Cystic fibrosis

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8
Q

54 year old man emigrated from Vietnam where he was treated for TB had fatigue, cough with blood-tinged sputum, and 15 pound weight loss. Cavitary lesion present on CT filled with stuff.

A

Chronic pulmonary aspergillosis

  • fungus ball on CT
  • > 3 months of sx (fever, weight loss, cough, hemoptysis)
  • immunocompetent pts with past hx of lung dz have a hard time clearing it
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9
Q

Tachypnea begins shortly after birth and resolves by day 2

A

Transient tachypnea of the newborn

  • inadequate alveolar fluid clearance at birth results in mild pulmonary edema
  • CXR: bilateral perihilar streaking, hyperextended, wet lungs
  • near term infants
  • tx: ppv
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10
Q

Severe respiratory distress and cyanosis after premature birth

A

Respiratory distress syndrome

  • surfactant deficiency results in alveolar collapse and diffuse atelectasis
  • CXR: diffuse, reticulogranular (ground-glass) appearance, air bronchograms, low lung volume
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11
Q

Obstructive pattern (<70%)

  • low DLCO
  • normal DLCO
  • increased DLCO
A
  • emphysema
  • chronic bronchitis, asthma
  • asthma
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12
Q

Restrictive pattern (>70%)

  • low DLCO
  • normal DLCO
  • increased DLCO
A
  • interstitial lung dz, sarcoidosis, asbestosis, heart failue
  • MSK deformity, neuromuscular dz
  • morbid obesity
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13
Q

Normal spirometry

  • low DLCO
  • increased DLCO
A
  • anemia, PE, pulm HTN

- pulmonary hemorrhage, polycythemia

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14
Q

PEEP

A

prevents alveolar collapse and may reopen some already collapsed alveoli

  • improves oxygenation
  • counteracts one of the mechanisms of ARDS
  • if high levels of FiO2 (>60%) are required to maintain oxygenation, PEEP should be increased as well to prevent oxygen toxicity
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15
Q

Premature newborn develops respiratory distress after birth. Is given surfactant and put on mechanical ventilation. Comes of mechanical ventilation but remains hypoxic. Cause?

A

Bronchopulmonary dysplasia

- due to repeated insult to neonatal lungs from mechanical ventilation, prolonged oxygen exposure, and inflammation

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16
Q

pH of pleural fluid

A

normal: 7.6
transudate: 7.4-7.55
exudate: 7.3-7.45
Empyema, tumor, pleuritis, pleural fibrosis: <7.3

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17
Q

Post hemicolectomy, pt develops SOB and unilateral white out on CXR. Mediastinum is shifted towards side of opacification. Pt is a smoker. Most likely cause

A

Atelectasis due to bronchial mucus plug

18
Q

Causes of pleural effusion with high amylase

A
  • pancreatitis

- esophageal rupture

19
Q

Pt with sudden onset of digital clubbing (convex nail beds) and hypertrophic osteoarthropathy (thickening of distal fingers) of wrists and fingers

A

often associated with lung cancer

- get cxr

20
Q

Side effect of tuberculosis

A

primary adrenal insufficiency

  • leads to low aldosterone
  • non-anion gap metabolic acidosis
21
Q

Most common pathogenic organism in children with CF

A

staph aureus

  • cefepime: covers MSSA and pseudomonas
  • vancomycin: covers MRSA
22
Q

COPD acute exacerbation

A

change in

  • cough
  • sputum
  • dyspnea
23
Q

Respiratory distress, confusion, and petechial rash following femur fracture from an ATV accident.

A

fat embolism

24
Q

Parapneumonic effusions and empyemas fluid findings

A 
low glucose (<60)
low pH (<7.2)
25
Q

Pleural effusion with >50,000 lymphocytes

A

empyema

26
Q

MOA for cromolyn

A

inhibits mast cell degranulation

- used in exercise induced asthma

27
Q

asthmatics with poorly-controlled disease who are unable to wean themselves from corticosteroids. Pt with productive coughing, mucous plugging (sometimes forming bronchial casts), and hemoptysis

A

aspergillosis

28
Q

initial tx for nasal polyps

A

steroid nose spray

29
Q

rheumatologic effusion

A

exudative with high LDH (>700) and low glucose (<50)

30
Q

why is glucose low in an empyema

A

high metabolic activity of leukocytes

31
Q

supplemental oxygen in patients with advanced COPD

A

can worsen hypercapnia

  • increased dead space causing VQ mismatch
  • decreased affinity of oxyhemoglobin for CO2 and reduced alveolar ventilation
  • decreases respiratory drive
  • the goal oxyhemoglobin saturation is 90-93%
32
Q

What has been shown to prolong survival in COPD patients

A

long term O2 therapy

33
Q

respiratory distress, confusion, petechial rash after orthopedic surgery

A

fat embolism

34
Q

hoarseness and multiple finger shaped lesions on vocal cords in a 3 year old

A

laryngeal papillomas due to recurrent respiratory papillomatosis

  • caused by HPV 6 and 11
  • most likely transmitted vertically
35
Q

Theophylline toxicity

A

CNS stimulation (HA, insomnia, seizures), GI disturbances (N/V), and cardiac toxicity (arrhythmia)

36
Q

safe FiO2 levels to prevent oxygen toxicity

A

<60%

37
Q

ARDS

A

impaired gas exchange, decreased lung compliance. pulmonary htn

38
Q

peritonsillar abscess tx

A

aspirate and IV Abx

39
Q

TLC in obstructive (asthma) and restictive (obesity) lung disease

A

obstructive: increased
restrictive: decreased

40
Q

method of removing swallowed foreign objects

A

kids: rigid bronchoscopy
adults: flexible bronchoscopy

Boards Studying (15 decks)

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