PULM Flashcards
1
Q
volume of air moved into or out of the lungs during quiet breathing
A
tidal volume
2
Q
the volume of air remaining in the lungs after maximal expiration
A
residual volume
3
Q
the volume of air that can be further exhaled at the end of normal expiration
A
Expiratory reserve volume
4
Q
the volume of air that can be further exhaled at the end of normal inspiration
A
Inspiratory reserve volume
5
Q
maximum volume of air that can be exhaled following maximal inspiration
A
vital capacity
6
Q
the volume in the lungs at maximal inspiration
A
total lung capacity
7
Q
the volume of gas in the lungs at normal tidal volume end expiration
A
functional residual capacity
8
Q
the volume of air that has been exhaled at the end of the first second of forced expiration
A
FEV1
9
Q
measurement of volume of air that can be expelled from a maximally inflated lung with pt breathing as hard and fast as possible
A
forced vital capacity
10
Q
continuous, whistling, musical, high-pitched sounds heard during expiration due to narrowed obstructed airways
A
wheezing
–seen with obstructive lung diseases
11
Q
continuous, rumbling, coarse, low-pitched sounds that clear with cough
A
rhonchi
–caused by secretions
12
Q
discontinuous, high pitched sounds heard during inspiration
A
rales (crackles)
–not cleared w/ cough
–seen with pneumonia, atelectasis, bronchitis, bronchiectasis, pulm fibrosis
13
Q
monophonic sound over trachea due to narrowing of larynx
A
stridor
14
Q
MC RF for COPD
A
smoking and/or exposure
15
Q
only genetic disease linked to COPD in younger patients <40 yo
A
alpha-1 antitrypsin deficiency
16
Q
Dx for COPD
A
PFTs with decreased FEV1, decreased FEV1/FVC <70% predicted (decreased DLCO in emphysema)
17
Q
Define chronic bronchitis
A
productive cough for a least 3 months a year for 2 consecutive years
18
Q
Factors that reduce mortality in COPD:
A
1- smoking cessation
2- O2 therapy
3- PCP and Flu vaccines annually
19
Q
Indications of O2 therapy in COPD: (3)
A
paO2 <55 mmHg, O2 sat <88%, or cor pulmonale
20
Q
Abx Tx for AECOPD:
A
macrolides (azith, clarith), cephalosporins (cefuroxime, cefixime), Augmentin, fluoroquinolones
21
Q
categorizes severity of COPD based on FEV1 and FEV1/FVC ratios
A
GOLD criteria
22
Q
Gold Criteria: Category C patients should be treated with
A
LAMA
23
Q
Maximal COPD therapy includes:
A
LAMA + LABA + inhaled glucorticoid
–supportive: O2, smoking cessation, annual vaccines
–steroids and abx in AECOPD
24
Q
MC cause of bronchiectasis in US
A
CF
25
Dx of CF
sweat chloride test (Cl levels >60 on 2 occasions after pilocarpine administration)
26
CF results due to a mutation in this receptor
CF transmembrane conductance receptor
--causes abnormal chloride and water transport across exocrine glands, resulting in thick viscous secretions of lungs, pancreas, sinuses, intestines in CF
27
MC organism to cause recurrent lung infections in bronchiectasis
pseudomonas aeruginosa if CF
--H flu if not related to CF
28
MC RFs for CF
Caucasians, Northern Europeans
29
Dx for bronchiectasis and classic findings
High resolution CT with thickened bronchial walls (tram track) and increased airway diameter > adjacent vessel diameter (signet ring sign)
PFTs with decreased FEV1, decreased FEV1/FVC <70% predicted
30
MC RF for asthma
atopy
31
Atopic triad
asthma
allergic rhinitis
atopic dermatitis (eczema)
32
Samter's triad
asthma
chronic rhinosinusitis with polyps
sensitivity to ASA/NSAIDs
33
Dx for asthma
PFTs with reversible obstruction (decreased FEV1, decreased FEV1/FVC following methacholine challenge)
34
best and most objective way to assess severity & treatment response in asthma exacerbation
peak expiratory flow rate
35
Tx of moderate persistent asthma
Low ICS + LABA
--alternatives, Medium ICS or add LTRA
36
Tx of severe persistent asthma
High ICS + LABA +/- Omalizumab
37
MC RFs for sarcoidosis
Female, AA, Northern Europeans
38
Dx for sarcoidosis
CXR with bilateral hilar LAD
PFTs with restrictive pattern
Tissue biopsy with noncaseating granulomas
39
MC RF for pulmonary fibrosis
men >40 yo
40
Dx for pulmonary fibrosis
Chest CT with reticular honeycombing, focal ground-glass opacifications
PFTs with restrictive pattern
Tissue biopsy with honeycombing
41
RF for silicosis
coal mining, quarry work with granite, slate, quartz, pottery makers, sandblasting, glass and cement manufacturing
42
CXR with silicosis
multiple, small (<10mm) round nodular opacities in UL
*eggshell calcifications of hilar and mediastinal nodes
43
lung disease from inhalation of coal dust particles
coal worker's pneumoconiosis (black lung disease)
44
lung disease from inhalation of silicon dioxide
silicosis
45
Caplan syndrome
coal worker's pneumoconiosis + RA
46
Dx for coal worker's pneumoconiosis
CXR with small nodules in ULs and hyperinflation in LLs in obstructive pattern
47
lung disease from inhalation of beryllium
Berylliosis
48
RF for Berylliosis
aerospace, electronics, ceramics, tool and dye manufacturing, jewelry making
49
lung disease due to cotton exposure
Byssinosis
50
RF for Byssinosis
employed in textile industries (flax or hemp exposure)
51
lung disease due to inhalation of asbestos fibers
asbestosis
52
RF for Asbestosis
destruction, repair, or renovation of old buildings, insulation
53
Dx for asbestosis
CXR with pleural plaques in LLs
PFTs with restrictive pattern
Tissue biopsy with linear asbestos bodies
54
MC complication of asbestosis
bronchogenic carcinoma (mesothelioma is most specific)
55
hypersensitivity pneumonitis from nitrogen dioxide gas exposure released from plant matter
silo filler disease
56
infection with chlamydophila psittaci due to exposure to infected birds
Psittacosis (Parrot Fever)
57
Influenza vaccine recommended for
annually for all individuals >6 months old
58
CI to inactivated influenza vaccine
GB within 6 weeks of prior vaccine
high fevers
infants <6 months of age
59
CI to live influenza vaccine
pregnancy
immunocompromised patients
adults age 50 or older
60
MC cause of acute bronchitis
viral (adenovirus, parainfluenza, influenza, coronavirus, coxsackie, rhinovirus, RSV)
61
Highly contagious infection secondary to bordatella pertussis
`Pertussis (whooping cough)
62
Tdap administration
Tdap at 2, 4, 6, 15-18 mos, and 4-6 yo
--5 doses
--booster at 11-18 yo
63
MC cause of acute bronchiolitis
RSV
64
Acute bronchiolitis is MC seen in this age group
ages 2 mos to 2 yo
65
Acute bronchiolitis prevention
palivizumab during the 1st year of life for children <29 weeks old, prematurity, CHD, NM disorders, immunodeficiency
*handwashing preventative
66
MC cause of acute epiglottitis
Haemophilus influenzae B (unvaccinated children)
Streptococcal species (GAS, S. pneumo if vaccinated)
67
3 Ds of acute epiglottis
dysphagia
drooling
distress
68
Dx for acute epiglottis
Lateral Cervical XR with thumbprint sign
*Laryngoscopy (cherry red epiglottis with swelling)
69
Acute epiglottitis prevention
Rifampin given to all close contacts
Routine HiB vaccination
70
Abx treatment for pertussis
Macrolides (azith, erythromycin)
71
Abx treatment for acute epiglottis
2nd or 3rd gen cephalosporins (ceftriaxone, cefotaxime)
72
MC organism to cause Croup
Parainfluenza virus type 1
73
Dx for Croup
*Clinical (rule out FB and epiglottis)
Frontal Cervical XR with steeple sign
74
Tx for severe croup
dexamethasone, nebulized epinephrine, and hospitalization
75
MC organism to cause pneumonia
S. pneumoniae
76
MC organism to cause of CAP
S. pneumoniae
77
MC cause of atypical (walking) pneumonia
M. pneumoniae
78
RF for haemophilus pneumoniae pneumonia
Extremes of age (<6 yo, elderly)
Immunocompromised (DM, HIV)
Underlying pulmonary disease (asthma, copd, bronchiectasis, CF)
Alcoholism
79
MC organism to cause HAP
S. aureus
80
Define CAP
individual who develops pneumonia <48 hours of hospital admission (does not reside in SNF)
81
Define HAP
individual who develops pneumonia >48 hours of hospital admission
82
Tx for outpt CAP
macrolide (azith, clarith) or doxycycline
83
Tx for inpt CAP
Beta-lactam (ceftriaxone, cefotaxime) and either macrolide/doxy OR broad spectrum FQ
84
Tx for HAP and or MDR
Anti-pseudomonal beta-lactam (zosyn, ceftazidime, cefepime) and Anti-pseudomonal AG or FQ (gentamicin, tobramycin or levaquin)
+/- Vanco if suspect mrsa
+/- Azith or Levaquin if suspect legionella
85
Tx for aspiration pneumonia
Unasyn or Augmentin
86
Define CURB-65
admission if at least 2:
confusion, uremia (>30 mg/dL), RR >30, BP low (SBP <90 or DBP <60), Age >65
87
MC organisms to cause aspiration pneumonia
peptostreptococcus, bacteroides, and fusobacterium
88
Associated with foul smelling, "rotten egg" sputum and RLL lesions on CXR
aspiration pneumonia
89
Associated with purple jelly, currant sputum and cavitary lesions on CXR
k. pneumoniae
90
lung disease due to inhalation of bird, bat droppings in Mississippi and Ohio river valley
Histoplasmosis
91
Pneumococcal conjugate vaccine (PCV13) administration
4 dose immunization series (2, 4, 6, 12-15 mos)
92
Tx for moderate and severe histoplasmosis
moderate: itraconazole
severe: amphotericin B
93
Pneumococcal polysaccharide vaccine (PPSV23) administration
all adults 65 yo and older, as well as, young patients with comorbidities and increased risk for complications from s. pneumo infection
94
MC opportunistic infection in HIV, esp if CDC <200
pneumocystis pneumonia (PCP)
95
Tx for pneumocystis pneumonia
Bactrim x21 days (add prednisone if hypoxic)
96
Dx for latent TB (3)
1- Positive PPD
2. No active symptoms
3. No active lesions on CXR
97
4 drug treatment for primary TB
Rifampin
Isoniazid
Pyrazinamide
Ethambutol
(RIPE x2 mos + RI x4 mos = 6 mo duration)
98
2 drug treatment for latent TB
INH + Pyridoxine (Vit B6) x 9 mos
**patients are not contagious
99
TB (PPD) screening for active infection
>5mm- HIV, immunodeficiency, close contacts, cxr findings of old/healed TB
>10mm- High risk populations (prisoners)
>15mm- everybody else
100
False negative in PPD test
anergy (HIV, sarcoidosis)
faulty application
101
False positive in PPD test
improper reading
cross reaction with an atypical
BCG vaccination within 10 years
102
Rifampin AE
thrombocytopenia, orange colored secretions
103
Isoniazid AE
hepatitis (esp >35 yo), peripheral neuropathy (Rq B6 coadministration)
104
Pyrazinamide AE
hepatitis, hyperuricemia, photosensitive dermatologic rash
105
Ethambutol AE
optic neuritis, peripheral neuropathy
106
MC cause of solitary pulmonary nodule
infectious granulomas
107
Syndrome characterized by periodic episodes of diarrhea, flushing, tachycardia, and bronchoconstriction
Carcinoid syndrome
108
MC cause of cancer related deaths in US
bronchogenic carcinoma
109
MC primary lung cancer in smokers, women, men, and nonsmokers
adenocarcinoma
110
Lung cancer prevention
Annual CT for 55-80 yo with >30 pack year history
111
MC paraneoplastic syndrome seen in bronchogenic carcinoma
superior vena cava syndrome
112
Horner syndrome
ipsilateral ptosis, anhidrosis, miosis seen in pancoast tumors associated with SCLC
113
Tumor MC caused due to chronic asbestosis exposure
Mesothelioma
114
Dx for FB aspiration
rigid bronchoscopy
115
MC cause of transudative pleural effusion
CHF (followed by nephrotic syndrome, cirrhosis, atelectasis, hypoalbuminemia)
116
MC cause of exudative pleural effusion
any associated infection or inflammation (also, pulmonary emboli)
117
noninfected pleural effusion
parapneumonic
118
infected pleural effusion
empyema
119
Dx for pleural effusion
Thoracentesis: Light's criteria
1. pleural fluid protein : serum protein >0.5
2. pleural fluid LDH : serum LDH >0.6
3. pleural fluid LDH >2/3 the upper limit of normal LDH
120
Dx for empyema
pleural fluid pH <7.2, glucose <40, or positive gram stain of pleural fluid
121
Tx for empyema
chest tube fluid drainage
122
Dx for PTX
CXR with companion lines (visceral pleural line running parallel with ribs)
123
Tx for PTX
<3 cm - observe, O2
>3 cm - needle aspiration vs chest tube
124
Define pulmonary hypertension
Elevated mean pulmonary arterial pressure >20 mmHg
125
Dx for pulmonary hypertension
right heart catheterization
126
Virchow's triad
intimal damage, stasis, hypercoagulability
127
MC sign associated with pulmonary emboli
tachypnea
128
IVC filter indications (3)
1. AC contraindicated (recent bleed, bleeding disorders)
2. Failed AC
3. RV dysfunction on echo
129
MC EKG findings with PE
nonspecific ST/T wave changes and sinus tachycardia most common (also, S1Q3T3)
130
MC RF for ARDS
critically ill patients (gram neg sepsis most common)
131
Dx for ARDS
right heart catheterization with PCWP <18 mmHg
132
MC RF for OSA
obesity
133
cyclic breathing in response to hypercapnia
cheyne-stokes
(due to decreased brain blood flow)
134
irregular respirations (quick shallow breaths of equal depth) with irregular periods of apnea
biot's breathing
(due to damage to medulla oblongata or opioid use)
135
deep, rapid, continuous respirations as a result of metabolic acidosis
kussmaul's respiration
136
MC RF for neonatal respiratory distress syndrome
*primarily pre-term infants
Caucasians, males, multiple births, maternal DM, C-section
137
Atelectasis and pulmonary perfusion without ventilation due to insufficiency of surfactant production by an immature lung
neonatal respiratory distress syndrome
138
MC RF for meconium aspiration
*primarily post-term infants
