Cram the PANCE pulmonology

Question 1

Differentiate pathology of emphysema vs chronic bronchitis

Answer 1

Emphysema: damaged alveoli (diffusing problem and loss of elasticity)
Chronic bronchitis: overproduction/hypersecretion of mucous secondary to chronic inflammation (poor ventilation, not enough air in)

Question 2

what is diagnostic criteria for chronic bronchitis

Answer 2

productive cough for 3 months/year for 2 consecutive years.

Question 3

what is the unique cause of emphysema that is NOT smoking

Answer 3

alpha-1-antitrypsin deficiency

Question 4

what is the diagnostic indicative of COPD

Answer 4

• Decreased FEV1
• FEV1/FVC <70%
• Decreased DCLO

Question 5

what will you see on CXR on emphysema

Answer 5

flattened diaphragm

Question 6

what do you see on ABG for COPD

Answer 6

compensated respiratory acidosis

Question 7

where does TB typically reside in the lungs

Answer 7

• reactivation: apical portion
• primary: middle/lower lobe

Question 8

after CXR suspicious for TB, what is the next diagnostic step

Answer 8

• sputum acid-fast bacilli smear
• Nucleic acid amplification test (PCR test)
• sputum culture (most sensitive/specific but takes weeks to come back)

Question 9

What are the Aadverse reactions of isoniazid

Answer 9

peripheral neuropathy
always give with B6

“I-so-numb-azid”

Question 10

what are teh side effects of pyrazinimade

Answer 10

• hyperuricemia
• photosensitive rashes

Question 11

what is the side effect of ethambutol

Answer 11

eye = optic neuritis

Question 12

blood tinged/rusty sputum

Answer 12

strep pneumo (MCC of CAP)

Question 13

what is the most common organism that causes pneumonia in patients with COPD

Answer 13

H flu

Question 14

what pneumonia presents with currant jelly sputum

Answer 14

klebsiella pneumonia

Question 15

who is susceptable to klebsiella pneumonia

Answer 15

chronic alcoholics

Question 16

presenation of atypical pnuemonia

Answer 16

• URI symptoms (sore throat, otalgia, cough)
• mild symptoms
• younger/healthier populations in close proximities

Question 17

penumonia symptoms WITH diarrhea should suggest what organism

Answer 17

legionella

Question 18

what lab findings are elevated in legionella

Answer 18

elevated liver enzyes

L-L-L Liveeeerrrr L-L-L-legioneLLAAAA

Question 19

what is CURB-65

Answer 19

Confusion
Urea (BUN>19)
RR >30
BP <90/60
>65 years old

2 points = inpatient treatment 3 = ICU

Question 20

fould smelling sputum suggests what

Answer 20

anaerobic pnuemonia 2/2 aspiration

Question 20

how to treat pneumonia with MRSA/pseudomonas risk

Answer 20

pseudomonas: pip/taz
MRSA: linezolid or vanc

Question 21

how do you treat aspiration pneumonia/anaerobic infection pneumonia

Answer 21

bactrim or augmentin

Question 22

what is the overview of histoplasmosis

Answer 22

BIRD
Bird/bat droppings (cave spurlunking)
Itraconazole 1st line
River valleys (mississippi/ohio)
Defining illness for AIDS/HIV

Question 23

Overview for pneumocystitis jirovecii

Answer 23

1. aids defining illness
2. increased LDH
3. bilateral interstitial infiltrates
4. treat with bactrim

Question 24

demographics for sarcoidosis

Answer 24

female african american

Question 25

Presentation of sarcoidosis

Answer 25

* nonproductive cough * derm findings (erythema nodosum, lupus pernio (pic below)) * migratory polyarthralgias w fever * bilateral hilar LAD * restricitive cardiomyopathy

Question 26

what labs would be present for sarcoidosis

Answer 26

* increased ACE levels * Restrictive patterns (FEV1/FVC normal or increased) * noncaseating granuloma on lung biopsy

Question 27

Tx for sarcoidosis

Answer 27

steroids

Question 28

What is the pneumonic for sarcoidosis

Answer 28

ACE Levels Super High

Question 29

what is the MC demographic for idiopathic pulmonary fibrosis

Answer 29

old man who smokes

Question 30

labs on idiopathic pulmonary fibrosis and imaging

Answer 30

* PFT restrictive pattern (FEV1/FVC normal/high) * Increased reticular marking on CXR * Chest CT w honey combing, traction bronchiectasis and ground glass opacities

Question 31

tx for idiopathic pulmonary fibrosis

Answer 31

* supportive * nintedanib and pirfenidone * lung transplant

Question 32

where does coal workers pneumoconiosis present in lungs

Answer 32

nodules in upper lobes can present with RA as well

Question 33

byssinosis is associated with what occupation

Answer 33

cotton mill

Question 34

asbestosis presents in what part of the lungs

Answer 34

nodules in lower lung lobes

Question 35

what occupation assocaited with berylliosis

Answer 35

aerospace and electornics

Question 36

what occupation associated with silicosis

Answer 36

rocks (sandblasting, slate, wuartz or granite) | found in upper lobes, can be describied as "eggshell calcifications)

Question 37

what is the name for tuberculosis of the vertebrae

Answer 37

pots disease

Question 38

what is the most aggressive form of lung cancer

Answer 38

small cell lung cancer

Question 39

what is samters triad

Answer 39

* asthma * nasal polyps * sensitivity to aspirin

Question 40

what do you see on soft tissue ct for epiglottitis

Answer 40

thumb print sign

Question 41

Presentation of bronchiectasis

Answer 41

productive cough for at least 2 months

Question 42

what Xray finding will be seen in croup

Answer 42

steeple sign

Question 43

describe the catarrhal, paroxsysmal and convalescent phase for pertussis

Answer 43

Catarrha: mimics common cold Paroxsysmal: intense coughing fits w whooping and vomiting Convalescent: gradual reduction in coughing

Question 44

superior sulcus (pancoast) tumors commonly present with what syndrome?

Answer 44

Horners syndrome: Ptosis anhydrosis Miosis (constriction of pupil)

Question 45

where are inhaled foreign bodies most likely lodged in children

Answer 45

right main bronchus

Question 46

Flushing, wheezing, palpitations and diarrhea are all part of what syndrome

Answer 46

carcinoid syndrome with a carcinoid bronchial tumor!