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x Medicine 200 > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

Small Cell Paraneoplastic syndromes

A

SIADH and ACTH

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2
Q

Squamous Cell Paraneoplastic syndromes

A

PTH-like hormone secretion. Eaton-Lambert syndrome.

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3
Q

NSCLC treatment

A

Surgery is the best option

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4
Q

SCLC treatment

A

No surgery. Chemo and radiation

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5
Q

Central lung tumors

A

Squamous cell and SCLC

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6
Q

Peripheral lung tumors

A

Adenocarcinoma and Large cell carcinoma

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7
Q

Tumor least association with smoking

A

Adenocarcinoma

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8
Q

Exudate vs. Transudate

A

Exudate if any one is positive: 1. Protein (pleura)/Protein (serum) >0.5 2. LDH (p)/LDH(s) >0.6 3. LDH>2/3 the upper limit of normal serum LDH

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9
Q

Serum total protein concentration

A

Upper limit of normal is 7 g/dL

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10
Q

High adenosine deaminase is seen in

A

TB pleural and ascites fluid

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11
Q

How to treat hypersensitivity pneumonitis

A

Avoid the antigen exposure

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12
Q

Chemotherapy and radiation for Hodgkin’s complications

A

Secondary malignancy within 20 yrs

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13
Q

ARDS is

A

A form of Non-cardiogenic pulmonary edema caused by leaky alveolar capillaries.

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14
Q

Theophylline toxicity

A

CNS stimulation (HA, insomnia), N/V, Cardiac toxicity (arrhythmia)

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15
Q

What affects theophylline metabolism

A

Ciprofloxacin and erythromycin decreases clearance and raises plasma concentration

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16
Q

How does theophylline cause toxicity

A

Phosphodiesterase inhibition, adenosine antagonism, and stimulation of epinephrine release.

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17
Q

Beta-agonists side effects

A

Arryhthmia, nervousness, tremor, but no CNS and GI effects

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18
Q

parapneumonic effusions pH

A

<7.2 need chest tube aspiration to prevent empyema

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19
Q

Normal pleural fluid pH

A

7.64, lower pH means pleural inflammation

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20
Q

Transudative pleural effusion pH

A

7.35

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21
Q

Parapneumonic effusions glucose

A

<60 mg/dL favors parapneumonic effusion, TB, or RA

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22
Q

High amylase in pleural fluid?

A

Pancreatitis associated effusion and esophageal rupture

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23
Q

Aspergilloma CXR

A

Cavitary lesions and fungus ball which can move around with position change

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24
Q

When to use O2 in COPD patients

A

PaO2<88%, or with looser guidelines if there is cor pulmonale

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25
Q

Wegener’s serum test

A

Antineurophilic cytoplasmic antibody (c-ANCA) positive in >90% of patients

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26
Q

Serum alpha fetoprotein use in

A

Hepatocellular carcinoma and testicular cancer

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27
Q

ESR used in

A

Temporal arteritis/polymyalgia rheumatica/Wegener’s

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28
Q

Wegener’s diagnosis

A

c-ANCA positivity and tissue biopsy

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29
Q

Wegener’s treatment

A

High-dose steroids and cytotoxic agents

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30
Q

Inpatient treatment of CAP

A

levofloxacin or gatifloxacin (antipneumococcal)

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31
Q

Outpatient tx of CAP

A

azithromycin or doxycycline

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32
Q

PCP diagnosis

A

Bronchoalveolar lavage!!!

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33
Q

uses of bronchoalveolar lavage

A

Suspected malignancy and opportunistic infection

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34
Q

What is the A-a gradient

A

….

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35
Q

A-a gradient in PE

A

Increased

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36
Q

Most common EKG finding with PE

A

Normal, or non-specific ST segment elevations and T wave changes

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37
Q

PE EKG findings

A

S1,Q3T3. Right axis deviation, RBBB

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38
Q

Hampton’s hump

A

Cone shaped area of opacification from atelectasis or infarction from PE on CXR

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39
Q

Westermark’s sign

A

Dilated proximal pulm. artery with distal oligemia

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40
Q

Most common findings on PE ABG

A

Hypoxemia and hypocarbia

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41
Q

Bronchiectasis signs

A

Cough (90%) ,mucopurulent and tenacious sputum that is foul smelling, and hemoptysis.

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42
Q

Most feared complication of bronchiectasis

A

Life-threatening hemoptysis and lung abscesses

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43
Q

How to diagnose bronchiectasis

A

High resolution chest CT

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44
Q

Pancoast syndrome

A

When a superior sulcus tumor of the right lung presses on the brachial plexus

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45
Q

Hypertrophic osteoarthropathy

A

Clubbing, and sudden onset joint arthropathy in chronic smoker. Often associated with lung cancer, CXR needed to rule out malignancy or other lung pathology.

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46
Q

What happens if you get pneumonia in the same place over and over

A

Red flag for lung cancer

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47
Q

COPD and functional residual capacity

A

Increased, and TLC increased as well

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48
Q

Sounds in fluid filled regions

A

Bronchial breath sounds, louder with more prominent expiratory component

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49
Q

Egophony

A

Sounds bleating, E sounds like A with nasal or sheep like quality

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50
Q

Pleural effusion

A

Decreased breath sounds

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51
Q

Vesicular vs. bronchial breath sounds

A

Vesicular are quiet insp. and exp. Bronchial are louder exp. sounds.

52
Q

Mucuous plugging sounds

A

No breath sounds over affected areas because no air is getting there

53
Q

Emphysema breath sounds

A

Vesicular, decreased breath sounds

54
Q

Interstitial lung disease breath sounds

A

Vesicular with crackles at the end of inspiration

55
Q

Atypical PNA etiologies

A

Mycoplasma, Chlamydia, legionella, coxiella, influenza

56
Q

Mycoplasma presentation

A

Non-productive cough, more indolent course, erythema multiforme

57
Q

How to diagnose legionella

A

Urine test

58
Q

Skin finding in Mycoplasma PNA

A

Look for Erythema Multiforme

59
Q

Most common cause of atypical PNA

A

Mycoplasma pneumoniae

60
Q

CXR in atypical PNA

A

Out of proportion to findings on physical exam

61
Q

Chronic bronchitis and hemoptysis

A

Frequent cause of mild hemoptysis in patients with significant smoking hx

62
Q

Chronic bronchitis presentation

A

Chronic productive cough for at least 3 months over 2 years with PFTs c/w COPD, prominent bronchovascular marking, mild flattening of the diaphgram, and normal DLCO.

63
Q

Difference between emphysema and chronic bronchitis

A

DLCO decreased in emphysema, decreased vascular markings in emphysema

64
Q

Restrictive lung disease FEV1/FVC

A

Normal ratio, but both are decreased

65
Q

Alveolar consolidation on PE

A

Decreased breath sounds, dullness to percussion, tactile fremitus, egophony, whispered pectoriloquy, and bronchophony

66
Q

tx for Cor pulmonale

A

Tx underlying cause + bosentan

67
Q

Bosentan is

A

endothelin receptor antagonist that is used to treat PAH

68
Q

Pulmonary HTN prez

A

PA pressure >25 mmHG rest or >30 mmHg exercise, exerional dyspnea, fatigue, CP +/- syncope

69
Q

Dx pulm htn

A

Loud P2+, CXR, pfts, abg, ekg, echo, catherization

70
Q

Synchronous intermittent mandatory ventilation

A

Backup RR< does not have present tidal volume per breath

71
Q

When is the A-a nl

A

If you are hypoventilating or not enough PaO2 (like high elevation)

72
Q

What happens when the A-a is elevated

A

V/Q mismatch vs. shunting

73
Q

ARDS CXR

A

Diffuse b/l pulmonary infiltrates (lung white-out)

74
Q

ARDS PCWP

A

low PCWP, NO CHF

75
Q

ARDS tx

A

decrease FiO2, increase PEEP

76
Q

Dx of pleural effusion

A

Thoracentesis + 4 Cs: chemistry (glucose, protein), cytology, CBC+diff, culture

77
Q

Effusion with amylase

A

Esophageal rupture, pancreatitis, malignancy

78
Q

effusion with milky fluid

A

chylothorax

79
Q

effusion with pururlence

A

empyema

80
Q

bloody effusion

A

cancer

81
Q

lymphocytic fluid effusion

A

TB

82
Q

pH<7.2 in effusion

A

empyema or parapneumonic effusion

83
Q

glucose <60 in effusion

A

r/o RA!

84
Q

MCC of empyema in effusion

A

Staph aureus

85
Q

mesothelioma surgery

A

Extrapleural pneumonectomy (high morbidity/mortality)

86
Q

Asbestos exposure hotspots

A

shipyards, rooftops

87
Q

Most common lung cancer in nonsmokers

A

Adenocarcinoma

88
Q

Pancoast tumor tx

A

xrt for 6 wks to shrink tumor

89
Q

Lung cancer complications

A

SPHERE: SVC syndrome, pancoast tumor, endocrine (paraneoplastic), recurrent laryngeal nerve, effusions

90
Q

Small cell paraneoplastic

A

ADH, ACTH, anti-VGCC antibodies (Lambert-Eaton myasthenic syndrome)

91
Q

Squamous cell paraneoplastic

A

PTH-rP ….

92
Q

benign coin lesions

A

calcification = granuloma, bull’s eye shape, popcorn chape = hamartoma, air-crescent or halo sign= aspergilloma, southwest region=coccidio, ohio river valley = histolasmosis) LEAVE ALONE

93
Q

malignant coin lesions

A

spiculations or 20+ pack year smoking = primary lung cancer, multiple lesions = metastatic cancer leading to resection indication

94
Q

Chronic Bronchitis

A

Chronic cough for 3 months/yr for 2 yrs

95
Q

Panacinar emphysema caused by

A

A1AT deficiency, pts <50 y/o

96
Q

Centriacinar emphysema in upper lungs caused by

A

Smoking

97
Q

Emphysema in patient <50 y/o

A

Dx A1AT levels

98
Q

COPD exacerbation tx

A

Bronchodilators + abx + systemic steroids + O2 therapy

99
Q

bronchiectasis gets what infection

A

Pseudomonas PNA recurrently

100
Q

Bronchiectasis high res CT

A

Signet rings

101
Q

Bronchiectasis tx

A

Bronchodilators + abx for acute exacerbations

102
Q

Causes of bronchiectasis

A

MCC is cystic fibrosis, kartagener syndrome (dynein mutation)

103
Q

Atopy

A

asthma +allergic rhinitis + atopic dermatitis

104
Q

triad asthma

A

asthma +aspirin sensitivity + nasal polyps

105
Q

ABPA (allergic bronchopulmonary aspergillosis)

A

asthma + pulm. infiltrates + aspergillus allergy

106
Q

Churg-Strauss syndrome

A

Asthma + eosinophilia + granulomatous vasculitis

107
Q

Stages for COPD

A

Stage 1 FEV1>80% predicted, Stage 2 50-80, stage 3 30-50, Stage 4 <50% with hypoxia

108
Q

Tx for COPD

A

Stage 1: SABA, ipratropium Stage 2: LABA, tiotropium, Stage 3: Add inhaled steroids, Stage 4: Add O2 therapy for 18 hrs/day

109
Q

Lung volumes

A

VC: the most you can breathe in, FRC: end tidal ..asdfa.sdf.asd.fa.sdf

110
Q

ILD presentation

A

dyspnea, nonproductive cough, fatigue

111
Q

Drug-induced pulmonary prez

A

classic ILD sx s/p amiodarone, bufulfan, bleomycin, MTX< or nitrofurantoin

112
Q

Sarcoidosis prez

A

young black female w/ respiratory complaints, erythema nodosum, and blurry vision (ant. uveitis)

113
Q

Sarcoid histology

A

Schaumann and asteroid bodies

114
Q

Sarcoid tx

A

steroids

115
Q

Sarcoid complications

A

GRAINeD: Inc. IgG, RA, increased ACE, ILD, noncaseating granulomas, increased vitamin D from increased 1alpha-hydroxylase

116
Q

Histiocytosis X can cause ILD?

A

Yes

117
Q

Histiocytosis X dx

A

Honeycomb lung on CXR, histology eosinophilic granulmas, tx with steroids vs. lung txp

118
Q

Wegener grenulomatosis (granulomatosis with polyangiitis)

A

Triad of necrotizing vasculitis, necrotizing granulomas in lungs and upper respiratory tract, and necrotizing glomerulomephritis leading to hematuria and hemoptysis

119
Q

Wegeners dx

A

Inc. c-ANCA, tissue bx shows necrotizing granulomas

120
Q

Wegeners tx

A

cyclophosphamide

121
Q

Churg-Strauss syndrome

A

Triad of asthma, eosinophilia, necrotizing vasculitis with elevated p-ANCA tx with steroids

122
Q

caplan syndrome

A

Rheumatoid nodules + pneumoconiosis

123
Q

Asbestosis

A

dx CXR shows LOWER lung fibrosis +oleural plaques, tissue bx shows ferruginous bodies, tx supportive care

124
Q

Most common cancer from asbestosis

A

Bronchogenic carcinoma»mesothelioma

125
Q

Silicosis

A

Fibrosis of UPPER LUNGS, “egg shell” calcifications, mining, stone cutting, glass manufacturing

126
Q

berylliosis

A

Sarcoid-like presentation, dx beryllium lymphocyte proliferation test, tx steroids

127
Q

Goodpasture syndrome

A

anti-GBM antibodies attack alveolar and glomerular BM leading to hematuria and hemoptysis, tissue bx shows linear staining, get c-ANCA to r/o Wegener tx steroids+cyclophosphamide+plasmapharesis

x Medicine 200 (14 decks)

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