Pulm Flashcards
1
Q
What cell types are typically involved w/ asthma?
A
eosinophils, basophils, & macrophages
2
Q
What is the single most important way to prevent the onset & progression of COPD?
A
Smoking cessation
3
Q
4 cardinal sx of COPD
A
- Chronic cough
- excessive sputum pdt’n
- DOE out of proportion to age
- wheezing
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
5
Q
What is a 1st-line maintenance tx for COPD?
A
Tiotropium (Spiriva)
- long-acting anticholinergic bronchodilator
6
Q
What methylxanthine is used as a supplement for pts w/ COPD?
A
Aminophylline (Theophylline)
7
Q
What class of medication does salmeterol (serevent) & fluticasone/salmterol (Advair discus) belong?
A
long, acting, inhaled bronchodilator
8
Q
What is the major cell involved w/ COPD?
A
Macrophages & PMNs
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)
10
Q
What are the 2 MC sx in a pt w/ asthma?
A
- chest tightness
2. wheezing
11
Q
For pts using high dose & frequent beta agonist therapy, what electrolyte abnormality is most likely to be encountered?
A
hypokalemia
12
Q
What is the MCly initially utilized rescue medication for the relief of an acute asthma attack?
A
beta agonists
13
Q
What medication class is considered to be the cornerstone of therapy for pts w/ persistent asthma?
A
inhaled corticosteroids
14
Q
What kind of cancer is the leading cancer death for both men & women in the US?
A
Lung cancer
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
16
Q
For the various types of tobacco use, which has the closest relationship to lung cancer?
A
smoking > cigars > pipe > chewing
17
Q
What is the MC cell type for lung cancer?
A
adenocarcinoma cell cancer
18
Q
What cell type of lung cancer has the best prognosis assoc. w/ it?
A
squamous cell
19
Q
What type of lung cancer is most likely to present as a PERIPHERAL nodule?
A
adenocarcinoma
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
21
Q
What type of lung cancer is most likely to arise in proximal airways?
A
small cell
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)
23
Q
What is the MC symptomatic presentation for lung cancer?
A
Cough w/ or w/o hemoptysis
24
Q
What is the MC location for Pancoast tumors?
A
Apical portion of the lung
25
What is the classic sx complex that is assoc. w/ Pancoast tumor?
Horner's syndrome
| - ptosis, miosis, & anhydrosis
26
What electrolyte disorder is most likely to be seen in a pt w/ squamous cell lung carcinoma?
hypercalcemia
27
What hormone is most frequently made in pts w/ bronchial carcinoid cancer?
serotonin
28
What is the MCly identified risk factor for a pt w/ malignant mesothelioma?
asbestos exposure
29
MC CXR finding for a pt w/ malignant mesothelioma
pleural thickening & the presence of pleural fluid
30
When tx is needed, what is the primary therapy for a pt w/ solitary pulmonary nodule?
surgical resection of the tumor
31
For the adult population, what is the MC reason for prescribing Abx?
community acquired respiratory tract infxns
32
In the US, what is the MC infectious cause of death?
CAP
33
What bacterial organism is the MCC of CAP?
Streptococcal pneumoniae
34
Name the 3 MC atypical org. that are seen in CAP
1. Mycoplasma
2. Legionella
3. Chlamydia species
35
What medications are recommended for use in the outpt tx of CAP pts who were not recently treated w/ Abx & who are otherwise healthy?
Macrolide therapy (azithromycin, clarithromycin, erythromycin) or doxycycline
36
For an otherwise healthy pt w/ CAP who are being treated as outpts & who recently received Abx, what is the appropriate tx regimen?
Azithromycin or clarithromycin + high dose amoxicillin or amoxicillin-clavulanate (Augmentin) or resp. FQ
37
What pattern of lung dz is assoc. w/ pulmonary fibrosis?
restrictive ventilatory defects w/ reduced total lung capacity, and decreased FVC
38
What is the classic CXR finding in a pt who has interstitial pulmonary fibrosis?
Honeycombing
39
What is the current medical therapy of choice for pts w/ interstitial pulmonary fibrosis?
immunomodulators
40
What is the classic CXR finding for a pt who is infected w/ TB?
upper lobe infiltrates &/or cavities (95%)
41
What are the 2 sputum analysis methods that are used to ID active TB?
1. acid fast sputum smear
| 2. sputum culture
42
What is the recommended medical therapy for pts w/ active TB?
1. INH
2. Rifampin
3. PZA
4. EMB
43
SE of INH
hepatitis & peripheral neuropathy
44
SE of Rifampin
orange-colored body fluids, hepatitis, & flu-like syndrome
45
SE of EMB
optic neuritis & red-green visual loss
46
SE of PZA
liver toxicity & LFT abnormalities
47
What are 3 clinical clues that a pt has obstructive sleep apnea (OSA)?
1. loud snoring
2. observation of apnea or gasping by bedmate
3. thick neck
48
In addition to the abnormalities that are seen w/ sleeping, what is the cardinal feature of OSA?
Daytime sleepiness
49
What portion of the sleep cycle is OSA mostly seen?
REM sleep
50
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)
Narcolepsy
51
Name 4 sx of narcolepsy
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)
52
What type of nocturnal movements are seen in a pt w/ periodic limb movements in sleep (PMLS)?
"Babinski" like leg movements
53
What class of medications is the TOC for Period Limb Movement in Sleep & RLS?
dopaminergic medications
54
What is the 1st line therapy for tx of pulmonary arterial HTN?
CCBs & anticoagulants
55
What protein permeates all tissues in the body & its main effect is to inactivate proteases in the body?
Alpha-1 antitrypsin
56
The volume of gas expired w/ forced from a full inhalation (TLC) down to the residual volume
forced vital capacity (FVC)
57
Reduced FEV1 < 80% than predicted w/ a normal or reduced FVC defines what type of lung problem?
obstructive lung dz
58
name this specific type of lung dz: Normal FEV-1% but w/ reduced FEF 25-75% on PFTs
small airways obstruction
59
Spirometry shows reduced FVC & FEV-1 w/ normal or elevated FEV-1 along w/ decreased level of TLC
Restrictive lung dz
60
Residual volume + vital capacity
TLC
61
Reduced TLC but w/ NORMAL flow patterns defines what type of lung dz?
restrictive lung dz
62
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:
Cystic fibrosis (CF)
63
Mode of inheritance for CF
autosomal recessive
64
Pts w/ ongoing chronic CF classically has colonization w/ what org?
pseudomonas aeruginosa
65
What test is used in order to dx CF
chloride sweat teast (CL > 70)
66
hypersensitivity pneumonitis leads to the development of what type of pulm. dz?
restrictive
67
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?
Cor pulmonale
68
In the physical assessment of a pt w/ cor pulmonale, what is the primary change in the heart tones?
increased P2
69
Virchow's triad:
1. venous stasis
2. hypercoagulability
3. endothelial damage
70
Acquired Protein C resistance (APC) is better known as what?
Leiden Factor V
71
S1Q3T3 on an EKG is pathognomonic for what condition?
Pulmonary Embolism (PE)
72
This test ordered when a PE is suspected, has its true value in r/o PE when it's normal
D dimer
73
Parapneumonic pleural effusion will have an increase in what type of what cell line on differential?
neutrophils
74
Cancer, TB, & post CABG will have an increase in what white cell line in pleural effusion?
Lymphocytosis
75
If a pleural effusion's Hct is >50% than the peripheral Hct, what is the most likely cause?
trauma (this is due to hemothorax)
76
What is the MCC of death from infectious dz in the U.S.?
CAP
77
2 classes of meds that are used for a pt w/ atypical PNA
1. Macrolide
| 2. FQs
78
describe the typical pt w/ spontaneous PTX
tall, thin young male who performs valsalva maneuver
79
Type of chest film that most readily recognizes PTX
end expiratory film
| - helps billustrate the loss of peripheral lung markings
80
1st step in the tx for tension PTX
Needle decompression in the 2nd intercostal space on the MCL
81
Pt has HoTN, shifted trachea due to shifting of the mediastinum & JVD
Tension PTX
82
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:
clubbing
83
What is the correct term for pigeon chest?
Pectus carinatum
| - sternum is displaced anteriorly, Increased AP diameter
84
What is another term for Pectus excavatum?
Funnel chest
| - lower portion of the sternum is depressed
85
failure of part of the lung to expand
atelectasis
86
For hemoptysis to occur, where anatomically does the blood originate from?
below the vocal cords
87
High-pitched, discontinuous sounds caused by air passing through moisture in the alveoli or bronchioles
Rales
88
Name 3 conditions that produce crackles or rales:
1. bronchitis
2. pulmonary edema
3. pneumonia
89
Snoring or gurgling sounds from fluid or obstruction in lrg airways:
Rhonchi
90
2 conditions in which rhonchi could be heard
1. chronic bronchitis
| 2. pneumonia
91
2 measurements that are done during spirometry:
1. vital capacity
| 2. airflow rates
92
As opposed to spirometry studies, what do PFTs assess that spirometry studies do not?
gas exchange
93
Total volume of air exhaled after maximal inspiration:
FVC
94
To be considered normal, what percentage of air should be exhaled in 1 second?
80%
95
Classic triad of atopy & asthma
1. aspirin sensitivity
2. asthma
3. nasal polyps
96
TOC for chronic persistent asthma
inhaled steroids
97
What medication is used as a "challenge" for asthma in between sxs?
methacholine
98
Combivent inhaler combines what 2 medications?
ipratropium (Atrovent) + albuterol
99
Class of medication that cromolyn (intal) & nedocromil (Tilade) belongs:
mast cell stabilizer
| - these medications stop mast cell degranulation & also stop eosinophil recruitment
100
Class of medication that zileutin (Zyflo), zafirlukast (Accolate) belongs:
Leukotriene modifiers
101
class of medication that theophylline belongs
phosphodiesterase inhibitor
102
What part of the lungs are involved w/ asthma?
distal to the terminal bronchioles
103
MC inherited cause of emphysema
Alpha-1 antitrypsin deficiency
104
This condition is characterized by chronic cough, abundant pdt'n of purulent sputum, hemoptysis, & recurrent PNA:
bronchiectasis
105
This condition has the following CXR abnormalities: hyperinflation of lungs, parenchymal bullae or blebs are pathognomonic:
emphysema
106
What condition is assoc. w/ Curschmann's spirals w/ mucus plugs & epithelial cells on sputum?
asthma
107
Condition of permanent dilation or destruction of the bronchial walls:
bronchiectasis
108
MC congenital cause for bronchiectaiss
CF
109
What urologic abnormality do almost all men w/ CF have?
BL congenital absence of the vas deferens w/ azoopermia
110
MCC of death for pts w/ CF
PNA
111
What is another term for solitary pulmonary lesion?
coin lesion
112
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?
malignancy
113
What is the most likely etiology for a pt w/ a POPCORN LESION ID'd on CXR?
Hamartoma
| - a mixed tissue mass that results from faulty development in an organ
114
MC type of lung cancer-related death in the US?
Bronchogenic cancer
115
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?
Influenza
116
Primary way in which influenza is ID'd
nasopharyngeal smear w/ rapid antigen test
117
Class of medication that zanamivir or oseltamivir belongs
neuraminidase inhibitors
118
type of allergy that prohibits administration of the influenza vaccine:
egg allergy
119
2 MC viral causes of acute bronchitis
1. rhinovirus
| 2. coronavirus
120
What is the main way to differentiate b/w true bronchitis & PNA?
CXR
121
What has been shown to be the most effective therapy for pts w/ acute bronchitis?
bronchodilators
122
Name the MCCs of CAP in U.S.
1. Strep. pneumoniae
2. H. influenzae
3. M. Catarrhalis
4. atypicals
123
What type of PNA is assoc. w/ HA, loose stools, bullous myringitis & a mild nonexudative pharyngitis?
Mycoplasma
124
In add'n to urinary antigen test for strep pneumonia, what other cause of PNA is ID'd by urinary antigen test?
Legionella
125
In add'n to sputum & blood cultures, what is the other method of identifying PNA due to Strep pneumonia?
urinary antigen test
126
What type of PNA is classically assoc. w/ a single episode of a shaking chill?
strep pneumoniae
127
What type of PNA may present w/ sore throat, hoarseness, HA, & laryngitis?
chlamydia PNA
128
What type of PNA is assoc. w/ a high fever, hyponatremia, & diarrhea?
Legionella
129
What type of PNA commonly presents w/ tracheobronchitis & a cough that is dry or produces mucoid sputum & is assoc. w/ a low-grade fever:
Mycoplasma
130
What PNA is considered to be a zoonotic atypical PNA that is more commonly seen in veterinarians, poultry processing, & pet shop employees?
Psittacosis from Chlamydia psittaci
131
What type of PNA is more commonly seen in alcoholics?
klebsiella
132
Pts w/ leukemia & those who have other immunocompromised states are at risk for what type of PNA?
Aspergillus & other fungi
133
What type of infxn is seen in pts who are exposed to milk or postparturition pdts?
Coxiella burnetti (Q fever)
134
Franciella tularensis is assoc. w/ what type of exposure?
Rabbits - tularemia
135
What grp of hosts carry the plague?
rats
136
Pts w/ CF are typically colonized w/ what bacterial pathogen?
Pseudomonas
137
Name the 3 respiratory FQs.
1. Levofloxacin (Levaquin)
2. Moxifloxacin (Avelox)
3. Gatifloxacin (Tequin)
138
Name the 2 MC lethal causes of CAP
1. legionella
| 2. Strep. pneumo
139
Name the 2 Abx regimens for inpt Abx therapy for CAP
Ceftriaxone (Rocephin) + macrolide OR resp. FQ
140
Fever, night sweats, anorexia, wt. loss w/ cough, pleuritic chest pain, dyspnea, & hemoptysis
TB
141
What is Pott's dz?
TB of the spine
142
TB affecting the skin & SQ tissues w/ drainage
scrofula
143
Disseminated pulmonary dz seen in AIDS pts that is due to atypical mycobacterium infxn:
Macobacterium avum complex (MAC)
144
CXR for this condition reveals PATCHY, GROUND GLASS reticular or reticulonodular infiltrates w/ advancement to honeycombing of the lung:
interstitial lung dz
145
interstitial lung dz (ILD) is aka:
diffuse parenchymal lung dz
146
what type of lung dz classification do pts w/ interstitial lung dz (ILD) have?
restrictive lung dz
147
What is the MC dx for pts w/ ILD?
idiopathic pulmonary fibrosis
148
2 tx modalities used in the mgmt of Idiopathic pulmonary fibrosis
prednisone & interferon
149
Presentation for this illness: chronic sinusitis, arthralgias, fever, skin rash, & wt. loss. CXR reveals nodular pulmonary infiltrates:
Wegener's granulomatosis
150
This is a systemic dz of unknown etiology that is characterized by granulomatous inflammation of the lung:
sarcoidosis
151
laboratory study that is followed in pts w/ sarcoidosis
ACE levels
152
MC CXR finding for pts w/ sarcoidosis
BL adenopathy w/ R paratracheal adenopathy
153
What will a lung bx show for a pt w/ sarcoidosis?
non-caseating granuloma
154
electrolyte abnormality that occurs in a pt w/ sarcoidosis
hypercalcemia
155
Classic triad for this dz: glomerulonephritis, necrotizing granulomas, & sm. vessel vasculitis:
Wegener's granulomatosis
156
What laboratory test is followed for pts w/ Wegener's granulomatosis?
C-ANCA (anti-nuclear cytoplasmic Ab)
157
tx for Wegener's granulomatosis
Cyclophosphamide w/ or w/o prednisone
158
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:
Churg-Strauss Syndrome (allergic angiits & granulomatosis)
159
What WBC abnormality MCly is seen in a pt w/ Churg-Strauss Syndrome?
marked peripheral eosinophilia
160
Pts w/ chronic silicosis have an increased incidence of what pulmonary dz?
TB
161
For pts w/ asbestos exposure, what env. factor will accelerate the dz & risk of lung cancer?
smoking
162
Light's criteria are used for what purpose in pulm medicine?
to differentiate transudates from exudates after thoracentesis
163
This is an EXUDATIVE pleural effusion caused by direct infxn of the pleural space is known as;
empyema
164
Pt has a thoracentesis performed. The tap is milky white after being centrifuged. What is the most likely cause?
chylothorax
| - due to disruption of the thoracic duct where cholesterol complexes accumulate
165
what is the most likely cause for hemothorax to occur?
trauma
166
What is the gold standard for evaluating a pleural effusion?
diagnostic thoracentesis
167
If too much fluid is w/drawn from the chest during thoracentesis, what complication is possible?
reexpansion pulmonary edema
168
TOC for parapneumonic pleural effusion:
drainage followed by Abx therapy
169
2 MCCs for exudative pleural effusion:
malignancy & PNA
170
What is done to prevent persistent reaccumulation of pleural effusion due to malignant pleural effusion?
pleurodesis
171
What type of embolism is most frequently seen following long bone fracture?
fat embolism
172
What type of embolism is seen in a pt who is undergoing active labor?
amniotic fluid embolism
173
What is the MC PE sign seen in a pt w/ pulmonary embolism?
tachypnea
174
What is the MC sx for pulmonary embolism?
dyspnea & pain on inspiration
175
Gold standard for diagnosing PE
pulmonary angiography
176
What specific class of agents are primarily used to tx PE in a hemodynamically unstable pt who is at high risk for death?
thromolytic therapy
177
What is the MCly employed therapy for pts w/ a SADDLE embolism?
surgical thrombectomy
178
Hypoxia from any cause has what chronic effect on the pulmonary vessels?
causes pulm. HTN
179
What are the 2 MC medication classes for pts w/ pulm. HTN?
1. CCBs
| 2. diuretics
180
CXR for this condition reveals a clear, wedge-shaped defect along w/ a sm. effusion. What is the most likely cause?
PE
181
In add'n to treating the underlying dz, what are the 2 primary txs for cor pulmonale?
O2 & diuretics
182
In add'n to CPAP, what is the key to tx for Pickwickian Syndrome?
wt. loss
183
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?
ARDS
184
What is the other name for Pickwickian Syndrome?
obesity-hypoventilation syndrome
185
This condition is an acute hypoxemic respiratory failure following systemic or pulmonary insult w/o assoc. HF:
ARDS
186
MC underlying condition leading to ARDS
Sepsis
187
What LE DVT has the highest risk for causing a PE?
proximal vein DVTs
188
A pt undergoes a V/Q scan. A ventilation defect is > a perfusion defect. What is the correct interpretation for this scan?
low probability for PE
189
If a pt cannot tolerate anticoagulation long term after having a DVT & PE< what is the next step?
IVC or Greenfield filter
