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Challenge Bowl > Pulm > Flashcards

Pulm Flashcards

1
Q

What cell types are typically involved w/ asthma?

A

eosinophils, basophils, & macrophages

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2
Q

What is the single most important way to prevent the onset & progression of COPD?

A

Smoking cessation

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3
Q

4 cardinal sx of COPD

A
  1. Chronic cough
  2. excessive sputum pdt’n
  3. DOE out of proportion to age
  4. wheezing
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4
Q

In add’n to stopping smoking, what is the other known intervention for COPD that has been proven to improve mortality?

A

chronic O2 therapy

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5
Q

What is a 1st-line maintenance tx for COPD?

A

Tiotropium (Spiriva)

- long-acting anticholinergic bronchodilator

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6
Q

What methylxanthine is used as a supplement for pts w/ COPD?

A

Aminophylline (Theophylline)

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7
Q

What class of medication does salmeterol (serevent) & fluticasone/salmterol (Advair discus) belong?

A

long, acting, inhaled bronchodilator

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8
Q

What is the major cell involved w/ COPD?

A

Macrophages & PMNs

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9
Q

What medication class has been show to be beneficial as an anti-inflammatory agent that helps to drop increased pulmonary pressures in pts w/ advanced COPD?

A

Phosphodiesterase-4 inhibitors such as sildenafil (Viagra)

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10
Q

What are the 2 MC sx in a pt w/ asthma?

A
  1. chest tightness

2. wheezing

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11
Q

For pts using high dose & frequent beta agonist therapy, what electrolyte abnormality is most likely to be encountered?

A

hypokalemia

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12
Q

What is the MCly initially utilized rescue medication for the relief of an acute asthma attack?

A

beta agonists

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13
Q

What medication class is considered to be the cornerstone of therapy for pts w/ persistent asthma?

A

inhaled corticosteroids

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14
Q

What kind of cancer is the leading cancer death for both men & women in the US?

A

Lung cancer

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15
Q

What is the single most important factor for causing lung cancer?

A

cigarette smoking

- related to the duration, depth of inhalation, & amount smoked

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16
Q

For the various types of tobacco use, which has the closest relationship to lung cancer?

A

smoking > cigars > pipe > chewing

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17
Q

What is the MC cell type for lung cancer?

A

adenocarcinoma cell cancer

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18
Q

What cell type of lung cancer has the best prognosis assoc. w/ it?

A

squamous cell

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19
Q

What type of lung cancer is most likely to present as a PERIPHERAL nodule?

A

adenocarcinoma

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20
Q

What type of lung cancer is most likely to present w/ a CENTRALIZED thoracic mass or nodule?

A

Squamous

- remember squamous means central

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21
Q

What type of lung cancer is most likely to arise in proximal airways?

A

small cell

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22
Q

What type of lung cancer has the worst prognosis & is considered to be metastatic when it is discovered?

A

small cell (aka as oat cell)

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23
Q

What is the MC symptomatic presentation for lung cancer?

A

Cough w/ or w/o hemoptysis

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24
Q

What is the MC location for Pancoast tumors?

A

Apical portion of the lung

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25
Q

What is the classic sx complex that is assoc. w/ Pancoast tumor?

A

Horner’s syndrome

- ptosis, miosis, & anhydrosis

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26
Q

What electrolyte disorder is most likely to be seen in a pt w/ squamous cell lung carcinoma?

A

hypercalcemia

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27
Q

What hormone is most frequently made in pts w/ bronchial carcinoid cancer?

A

serotonin

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28
Q

What is the MCly identified risk factor for a pt w/ malignant mesothelioma?

A

asbestos exposure

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29
Q

MC CXR finding for a pt w/ malignant mesothelioma

A

pleural thickening & the presence of pleural fluid

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30
Q

When tx is needed, what is the primary therapy for a pt w/ solitary pulmonary nodule?

A

surgical resection of the tumor

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31
Q

For the adult population, what is the MC reason for prescribing Abx?

A

community acquired respiratory tract infxns

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32
Q

In the US, what is the MC infectious cause of death?

A

CAP

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33
Q

What bacterial organism is the MCC of CAP?

A

Streptococcal pneumoniae

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34
Q

Name the 3 MC atypical org. that are seen in CAP

A
  1. Mycoplasma
  2. Legionella
  3. Chlamydia species
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35
Q

What medications are recommended for use in the outpt tx of CAP pts who were not recently treated w/ Abx & who are otherwise healthy?

A

Macrolide therapy (azithromycin, clarithromycin, erythromycin) or doxycycline

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36
Q

For an otherwise healthy pt w/ CAP who are being treated as outpts & who recently received Abx, what is the appropriate tx regimen?

A

Azithromycin or clarithromycin + high dose amoxicillin or amoxicillin-clavulanate (Augmentin) or resp. FQ

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37
Q

What pattern of lung dz is assoc. w/ pulmonary fibrosis?

A

restrictive ventilatory defects w/ reduced total lung capacity, and decreased FVC

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38
Q

What is the classic CXR finding in a pt who has interstitial pulmonary fibrosis?

A

Honeycombing

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39
Q

What is the current medical therapy of choice for pts w/ interstitial pulmonary fibrosis?

A

immunomodulators

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40
Q

What is the classic CXR finding for a pt who is infected w/ TB?

A

upper lobe infiltrates &/or cavities (95%)

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41
Q

What are the 2 sputum analysis methods that are used to ID active TB?

A
  1. acid fast sputum smear

2. sputum culture

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42
Q

What is the recommended medical therapy for pts w/ active TB?

A
  1. INH
  2. Rifampin
  3. PZA
  4. EMB
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43
Q

SE of INH

A

hepatitis & peripheral neuropathy

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44
Q

SE of Rifampin

A

orange-colored body fluids, hepatitis, & flu-like syndrome

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45
Q

SE of EMB

A

optic neuritis & red-green visual loss

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46
Q

SE of PZA

A

liver toxicity & LFT abnormalities

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47
Q

What are 3 clinical clues that a pt has obstructive sleep apnea (OSA)?

A
  1. loud snoring
  2. observation of apnea or gasping by bedmate
  3. thick neck
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48
Q

In addition to the abnormalities that are seen w/ sleeping, what is the cardinal feature of OSA?

A

Daytime sleepiness

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49
Q

What portion of the sleep cycle is OSA mostly seen?

A

REM sleep

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50
Q

This is a dz of unknown cause which results in excessive daytime sleepiness & manifestations of rapid eye movement sleep at inappropriate times (known as sleep attacks)

A

Narcolepsy

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51
Q

Name 4 sx of narcolepsy

A
  1. sleep attacks - episodes of irresistible sleepiness
  2. sleep paralysis - inability to move at sleep onset or on awakening
  3. hypnogogic hallucinations - vivid dream-like experiences at sleep onset
  4. cataplexy - loss of motor tone during movements of high emotion or excitement (laughter, surprise, anger)
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52
Q

What type of nocturnal movements are seen in a pt w/ periodic limb movements in sleep (PMLS)?

A

“Babinski” like leg movements

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53
Q

What class of medications is the TOC for Period Limb Movement in Sleep & RLS?

A

dopaminergic medications

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54
Q

What is the 1st line therapy for tx of pulmonary arterial HTN?

A

CCBs & anticoagulants

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55
Q

What protein permeates all tissues in the body & its main effect is to inactivate proteases in the body?

A

Alpha-1 antitrypsin

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56
Q

The volume of gas expired w/ forced from a full inhalation (TLC) down to the residual volume

A

forced vital capacity (FVC)

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57
Q

Reduced FEV1 < 80% than predicted w/ a normal or reduced FVC defines what type of lung problem?

A

obstructive lung dz

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58
Q

name this specific type of lung dz: Normal FEV-1% but w/ reduced FEF 25-75% on PFTs

A

small airways obstruction

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59
Q

Spirometry shows reduced FVC & FEV-1 w/ normal or elevated FEV-1 along w/ decreased level of TLC

A

Restrictive lung dz

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60
Q

Residual volume + vital capacity

A

TLC

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61
Q

Reduced TLC but w/ NORMAL flow patterns defines what type of lung dz?

A

restrictive lung dz

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62
Q

This dz affects the lower respiratory tract w/ persistent cough producing viscous, purulent, & often greenish colored sputum w/ periods of clinical stability interrupted by exacerbations. This dz is characterized by increased cough, wt. loss, increased sputum volume & decrements in pulmonary fxn:

A

Cystic fibrosis (CF)

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63
Q

Mode of inheritance for CF

A

autosomal recessive

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64
Q

Pts w/ ongoing chronic CF classically has colonization w/ what org?

A

pseudomonas aeruginosa

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65
Q

What test is used in order to dx CF

A

chloride sweat teast (CL > 70)

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66
Q

hypersensitivity pneumonitis leads to the development of what type of pulm. dz?

A

restrictive

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67
Q

Hypertrophy &/or dilation of the right ventricle due to respiratory dz that is not due to congenital or acquired heart dz is known as what condition?

A

Cor pulmonale

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68
Q

In the physical assessment of a pt w/ cor pulmonale, what is the primary change in the heart tones?

A

increased P2

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69
Q

Virchow’s triad:

A
  1. venous stasis
  2. hypercoagulability
  3. endothelial damage
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70
Q

Acquired Protein C resistance (APC) is better known as what?

A

Leiden Factor V

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71
Q

S1Q3T3 on an EKG is pathognomonic for what condition?

A

Pulmonary Embolism (PE)

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72
Q

This test ordered when a PE is suspected, has its true value in r/o PE when it’s normal

A

D dimer

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73
Q

Parapneumonic pleural effusion will have an increase in what type of what cell line on differential?

A

neutrophils

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74
Q

Cancer, TB, & post CABG will have an increase in what white cell line in pleural effusion?

A

Lymphocytosis

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75
Q

If a pleural effusion’s Hct is >50% than the peripheral Hct, what is the most likely cause?

A

trauma (this is due to hemothorax)

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76
Q

What is the MCC of death from infectious dz in the U.S.?

A

CAP

77
Q

2 classes of meds that are used for a pt w/ atypical PNA

A
  1. Macrolide

2. FQs

78
Q

describe the typical pt w/ spontaneous PTX

A

tall, thin young male who performs valsalva maneuver

79
Q

Type of chest film that most readily recognizes PTX

A

end expiratory film

- helps billustrate the loss of peripheral lung markings

80
Q

1st step in the tx for tension PTX

A

Needle decompression in the 2nd intercostal space on the MCL

81
Q

Pt has HoTN, shifted trachea due to shifting of the mediastinum & JVD

A

Tension PTX

82
Q

structural change of the nail bed w/ loss of the normal 150 degree angle b/w the nail & cuticle - this may reflect underlying severe COPD:

A

clubbing

83
Q

What is the correct term for pigeon chest?

A

Pectus carinatum

- sternum is displaced anteriorly, Increased AP diameter

84
Q

What is another term for Pectus excavatum?

A

Funnel chest

- lower portion of the sternum is depressed

85
Q

failure of part of the lung to expand

A

atelectasis

86
Q

For hemoptysis to occur, where anatomically does the blood originate from?

A

below the vocal cords

87
Q

High-pitched, discontinuous sounds caused by air passing through moisture in the alveoli or bronchioles

A

Rales

88
Q

Name 3 conditions that produce crackles or rales:

A
  1. bronchitis
  2. pulmonary edema
  3. pneumonia
89
Q

Snoring or gurgling sounds from fluid or obstruction in lrg airways:

A

Rhonchi

90
Q

2 conditions in which rhonchi could be heard

A
  1. chronic bronchitis

2. pneumonia

91
Q

2 measurements that are done during spirometry:

A
  1. vital capacity

2. airflow rates

92
Q

As opposed to spirometry studies, what do PFTs assess that spirometry studies do not?

A

gas exchange

93
Q

Total volume of air exhaled after maximal inspiration:

A

FVC

94
Q

To be considered normal, what percentage of air should be exhaled in 1 second?

A

80%

95
Q

Classic triad of atopy & asthma

A
  1. aspirin sensitivity
  2. asthma
  3. nasal polyps
96
Q

TOC for chronic persistent asthma

A

inhaled steroids

97
Q

What medication is used as a “challenge” for asthma in between sxs?

A

methacholine

98
Q

Combivent inhaler combines what 2 medications?

A

ipratropium (Atrovent) + albuterol

99
Q

Class of medication that cromolyn (intal) & nedocromil (Tilade) belongs:

A

mast cell stabilizer

- these medications stop mast cell degranulation & also stop eosinophil recruitment

100
Q

Class of medication that zileutin (Zyflo), zafirlukast (Accolate) belongs:

A

Leukotriene modifiers

101
Q

class of medication that theophylline belongs

A

phosphodiesterase inhibitor

102
Q

What part of the lungs are involved w/ asthma?

A

distal to the terminal bronchioles

103
Q

MC inherited cause of emphysema

A

Alpha-1 antitrypsin deficiency

104
Q

This condition is characterized by chronic cough, abundant pdt’n of purulent sputum, hemoptysis, & recurrent PNA:

A

bronchiectasis

105
Q

This condition has the following CXR abnormalities: hyperinflation of lungs, parenchymal bullae or blebs are pathognomonic:

A

emphysema

106
Q

What condition is assoc. w/ Curschmann’s spirals w/ mucus plugs & epithelial cells on sputum?

A

asthma

107
Q

Condition of permanent dilation or destruction of the bronchial walls:

A

bronchiectasis

108
Q

MC congenital cause for bronchiectaiss

A

CF

109
Q

What urologic abnormality do almost all men w/ CF have?

A

BL congenital absence of the vas deferens w/ azoopermia

110
Q

MCC of death for pts w/ CF

A

PNA

111
Q

What is another term for solitary pulmonary lesion?

A

coin lesion

112
Q

A pt w/ a coin lesion is found to have the mass w/ a speculated margin or peripheral halo. What is the most likely dx?

A

malignancy

113
Q

What is the most likely etiology for a pt w/ a POPCORN LESION ID’d on CXR?

A

Hamartoma

- a mixed tissue mass that results from faulty development in an organ

114
Q

MC type of lung cancer-related death in the US?

A

Bronchogenic cancer

115
Q

Pts presents w/ a sudden onset of fever, chills, HA, coryza, & myalgias, esp in the back & legs. Pt then develops a cough. What is the most likely dx?

A

Influenza

116
Q

Primary way in which influenza is ID’d

A

nasopharyngeal smear w/ rapid antigen test

117
Q

Class of medication that zanamivir or oseltamivir belongs

A

neuraminidase inhibitors

118
Q

type of allergy that prohibits administration of the influenza vaccine:

A

egg allergy

119
Q

2 MC viral causes of acute bronchitis

A
  1. rhinovirus

2. coronavirus

120
Q

What is the main way to differentiate b/w true bronchitis & PNA?

A

CXR

121
Q

What has been shown to be the most effective therapy for pts w/ acute bronchitis?

A

bronchodilators

122
Q

Name the MCCs of CAP in U.S.

A
  1. Strep. pneumoniae
  2. H. influenzae
  3. M. Catarrhalis
  4. atypicals
123
Q

What type of PNA is assoc. w/ HA, loose stools, bullous myringitis & a mild nonexudative pharyngitis?

A

Mycoplasma

124
Q

In add’n to urinary antigen test for strep pneumonia, what other cause of PNA is ID’d by urinary antigen test?

A

Legionella

125
Q

In add’n to sputum & blood cultures, what is the other method of identifying PNA due to Strep pneumonia?

A

urinary antigen test

126
Q

What type of PNA is classically assoc. w/ a single episode of a shaking chill?

A

strep pneumoniae

127
Q

What type of PNA may present w/ sore throat, hoarseness, HA, & laryngitis?

A

chlamydia PNA

128
Q

What type of PNA is assoc. w/ a high fever, hyponatremia, & diarrhea?

A

Legionella

129
Q

What type of PNA commonly presents w/ tracheobronchitis & a cough that is dry or produces mucoid sputum & is assoc. w/ a low-grade fever:

A

Mycoplasma

130
Q

What PNA is considered to be a zoonotic atypical PNA that is more commonly seen in veterinarians, poultry processing, & pet shop employees?

A

Psittacosis from Chlamydia psittaci

131
Q

What type of PNA is more commonly seen in alcoholics?

A

klebsiella

132
Q

Pts w/ leukemia & those who have other immunocompromised states are at risk for what type of PNA?

A

Aspergillus & other fungi

133
Q

What type of infxn is seen in pts who are exposed to milk or postparturition pdts?

A

Coxiella burnetti (Q fever)

134
Q

Franciella tularensis is assoc. w/ what type of exposure?

A

Rabbits - tularemia

135
Q

What grp of hosts carry the plague?

A

rats

136
Q

Pts w/ CF are typically colonized w/ what bacterial pathogen?

A

Pseudomonas

137
Q

Name the 3 respiratory FQs.

A
  1. Levofloxacin (Levaquin)
  2. Moxifloxacin (Avelox)
  3. Gatifloxacin (Tequin)
138
Q

Name the 2 MC lethal causes of CAP

A
  1. legionella

2. Strep. pneumo

139
Q

Name the 2 Abx regimens for inpt Abx therapy for CAP

A

Ceftriaxone (Rocephin) + macrolide OR resp. FQ

140
Q

Fever, night sweats, anorexia, wt. loss w/ cough, pleuritic chest pain, dyspnea, & hemoptysis

A

TB

141
Q

What is Pott’s dz?

A

TB of the spine

142
Q

TB affecting the skin & SQ tissues w/ drainage

A

scrofula

143
Q

Disseminated pulmonary dz seen in AIDS pts that is due to atypical mycobacterium infxn:

A

Macobacterium avum complex (MAC)

144
Q

CXR for this condition reveals PATCHY, GROUND GLASS reticular or reticulonodular infiltrates w/ advancement to honeycombing of the lung:

A

interstitial lung dz

145
Q

interstitial lung dz (ILD) is aka:

A

diffuse parenchymal lung dz

146
Q

what type of lung dz classification do pts w/ interstitial lung dz (ILD) have?

A

restrictive lung dz

147
Q

What is the MC dx for pts w/ ILD?

A

idiopathic pulmonary fibrosis

148
Q

2 tx modalities used in the mgmt of Idiopathic pulmonary fibrosis

A

prednisone & interferon

149
Q

Presentation for this illness: chronic sinusitis, arthralgias, fever, skin rash, & wt. loss. CXR reveals nodular pulmonary infiltrates:

A

Wegener’s granulomatosis

150
Q

This is a systemic dz of unknown etiology that is characterized by granulomatous inflammation of the lung:

A

sarcoidosis

151
Q

laboratory study that is followed in pts w/ sarcoidosis

A

ACE levels

152
Q

MC CXR finding for pts w/ sarcoidosis

A

BL adenopathy w/ R paratracheal adenopathy

153
Q

What will a lung bx show for a pt w/ sarcoidosis?

A

non-caseating granuloma

154
Q

electrolyte abnormality that occurs in a pt w/ sarcoidosis

A

hypercalcemia

155
Q

Classic triad for this dz: glomerulonephritis, necrotizing granulomas, & sm. vessel vasculitis:

A

Wegener’s granulomatosis

156
Q

What laboratory test is followed for pts w/ Wegener’s granulomatosis?

A

C-ANCA (anti-nuclear cytoplasmic Ab)

157
Q

tx for Wegener’s granulomatosis

A

Cyclophosphamide w/ or w/o prednisone

158
Q

This condition is an idiopathic multisystem vasculitis of sm. & med.-sized arteries that occurs in a pt w/ asthma - it commonly affects the skin & lungs predominately:

A

Churg-Strauss Syndrome (allergic angiits & granulomatosis)

159
Q

What WBC abnormality MCly is seen in a pt w/ Churg-Strauss Syndrome?

A

marked peripheral eosinophilia

160
Q

Pts w/ chronic silicosis have an increased incidence of what pulmonary dz?

A

TB

161
Q

For pts w/ asbestos exposure, what env. factor will accelerate the dz & risk of lung cancer?

A

smoking

162
Q

Light’s criteria are used for what purpose in pulm medicine?

A

to differentiate transudates from exudates after thoracentesis

163
Q

This is an EXUDATIVE pleural effusion caused by direct infxn of the pleural space is known as;

A

empyema

164
Q

Pt has a thoracentesis performed. The tap is milky white after being centrifuged. What is the most likely cause?

A

chylothorax

- due to disruption of the thoracic duct where cholesterol complexes accumulate

165
Q

what is the most likely cause for hemothorax to occur?

A

trauma

166
Q

What is the gold standard for evaluating a pleural effusion?

A

diagnostic thoracentesis

167
Q

If too much fluid is w/drawn from the chest during thoracentesis, what complication is possible?

A

reexpansion pulmonary edema

168
Q

TOC for parapneumonic pleural effusion:

A

drainage followed by Abx therapy

169
Q

2 MCCs for exudative pleural effusion:

A

malignancy & PNA

170
Q

What is done to prevent persistent reaccumulation of pleural effusion due to malignant pleural effusion?

A

pleurodesis

171
Q

What type of embolism is most frequently seen following long bone fracture?

A

fat embolism

172
Q

What type of embolism is seen in a pt who is undergoing active labor?

A

amniotic fluid embolism

173
Q

What is the MC PE sign seen in a pt w/ pulmonary embolism?

A

tachypnea

174
Q

What is the MC sx for pulmonary embolism?

A

dyspnea & pain on inspiration

175
Q

Gold standard for diagnosing PE

A

pulmonary angiography

176
Q

What specific class of agents are primarily used to tx PE in a hemodynamically unstable pt who is at high risk for death?

A

thromolytic therapy

177
Q

What is the MCly employed therapy for pts w/ a SADDLE embolism?

A

surgical thrombectomy

178
Q

Hypoxia from any cause has what chronic effect on the pulmonary vessels?

A

causes pulm. HTN

179
Q

What are the 2 MC medication classes for pts w/ pulm. HTN?

A
  1. CCBs

2. diuretics

180
Q

CXR for this condition reveals a clear, wedge-shaped defect along w/ a sm. effusion. What is the most likely cause?

A

PE

181
Q

In add’n to treating the underlying dz, what are the 2 primary txs for cor pulmonale?

A

O2 & diuretics

182
Q

In add’n to CPAP, what is the key to tx for Pickwickian Syndrome?

A

wt. loss

183
Q

An ICU pt presents w/ acute dyspnea along w/ pdt’n of pink, frothy sputum 12 hrs after being diagnosed w/ urosepsis. What is the MC explanation?

A

ARDS

184
Q

What is the other name for Pickwickian Syndrome?

A

obesity-hypoventilation syndrome

185
Q

This condition is an acute hypoxemic respiratory failure following systemic or pulmonary insult w/o assoc. HF:

A

ARDS

186
Q

MC underlying condition leading to ARDS

A

Sepsis

187
Q

What LE DVT has the highest risk for causing a PE?

A

proximal vein DVTs

188
Q

A pt undergoes a V/Q scan. A ventilation defect is > a perfusion defect. What is the correct interpretation for this scan?

A

low probability for PE

189
Q

If a pt cannot tolerate anticoagulation long term after having a DVT & PE< what is the next step?

A

IVC or Greenfield filter

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