Pulmonary Flashcards
(197 cards)
1
Q
Most important imaging study for diagnosis of Interstitial Lung Disease?
A
High-Resolution CT (1-2mm cuts of lung tissue)
2
Q
Interstitial Lung Disease shows a ___ pattern on PFTs
A
Restrictive
3
Q
Change to TLC in Interstitial Lung Disease?
A
Low
4
Q
Change to FVC in Interstitial Lung Disease?
A
Low
5
Q
Change to RV in Interstitial Lung Disease?
A
Low
6
Q
Change to DCLO in Interstitial Lung Disease?
A
Low
7
Q
Change to FEV1/FVC in Interstitial Lung Disease?
A
NML
8
Q
3 conditions that show mixed obstructive and restrictive patterns of lung disease?
A
Sarcoidosis, Lymphangioleiomyomatosis, Eosinophilic granuloma
9
Q
Pattern of asbestos-related ILD on CXR?
A
Involvement of lower lung fields
10
Q
Pattern of silicosis-related ILD on CXR?
A
Hilar egg-shell Ca2+
11
Q
Pattern of sarcoidosis-related ILD on CXR?
A
Bilateral hilar predominance
12
Q
Pattern of lymphangioleiomyomatosis-related ILD on CXR?
A
Pneumothorax in premenopausal female
13
Q
What is the most common work-related illness?
A
Pulmonary disease
14
Q
4 types of inorganic dust that cause interstitial lung disease?
A
Silicosis, Coal worker’ pneumoconiosis, Berylliosis, Asbestosis
15
Q
1 type of organic dust that cause interstitial lung disease?
A
Cotton duct
16
Q
Alternate name for cotton/flax dust?
A
Byssinosis
17
Q
Clinical presentation for Byssinosis?
A
Symptoms present M-F, Absent S-Su
18
Q
Best treatment for Byssinosis?
A
Exposure avoidance
19
Q
Image of eggshell calcifications seen on XR in silicosis?
A
20
Q
If patient with silicosis presents with fever – diagnosis?
A
Silicone-TB
21
Q
If patient with silicosis presents with fever – next step of workup?
A
Silicone-TB
22
Q
What is the cutoff value for PPD in Silicone-TB?
A
10mm
23
Q
5 occupations that have increased risk of silicosis exposure?
A
Construction, mining, ceramics, sandblasting, masonry
24
Q
3 aspects of clinical presentation for Caplan Syndrome?
A
Coal-worker’s pneumoconiosis, RA, Lung nodules
25
Change to lung in setting of coal-worker’s pneumoconiosis?
Anthracosis … black patches in lung
26
What accounts for anthracosis (black patches in lung) in setting of coal-worker’s pneumoconiosis?
Carbon-ingesting macrophages
27
Berylliosis mimics which condition?
Granulomatous sarcoidosis
28
Which portion of lung is affected by berylliosis?
Upper lung + Hilar lymphadenopathy
29
3 exposures that increase risk for developing berylliosis?
Fluorescent light bulbs, Aerospace, Electronics
30
Best treatment for berylliosis?
Corticosteroids
31
Best test for diagnosing berylliosis?
Beryllium lymphocyte transformation test … (not serum berylliosis level)
32
Which type of immune response mediates berylliosis?
Cell-mediated
33
Patient with asbestos exposure is most likely to develop which type of CA?
Squamous cell + Adenocarcinoma (NOT mesothelioma)
34
Ferruginous bodies seen in asbestos exposure will stain (+) for …
Prussian blue
35
3 asbestos-related pleural diseases?
Pleural plaques, Pleural effusion, Mesothelioma
36
What is definition of asbestosis (compared to pleural plaques)?
Asbestosis = ILD in lung bases
37
Characteristic of pleural effusion in setting of asbestos exposure?
Hemorrhagic
38
Prognosis of pleural effusion in setting of asbestos exposure?
Benign
39
Prognosis of mesothelioma in setting of asbestos exposure?
Malignant
40
Incidence of mesothelioma is affected by \_\_\_, but unaffected by \_\_\_
Asbestos exposure, Smoking
41
Best method of diagnosing mesothelioma?
Open pleural biopsy (DON’T do FNB … may seed the lungs/pleura)
42
Pathogen associated with Hypersensitivity PNA due to moldy hay?
Thermophilic actinomyces
43
Which lab value is ABSENT in Hypersensitivity PNA?
Eosinophilia
44
Most common cause of death in ARDS?
Sepsis, Organ failure
45
Cardiac output in Hypovolemic Shock?
Decreased
46
Wedge pressure in Hypovolemic Shock?
Decreased
47
SVR in Hypovolemic Shock?
Increased
48
Cardiac output in Cardiogenic Shock?
Decreased
49
Wedge pressure in Cardiogenic Shock?
Increased
50
SVR in Cardiogenic Shock?
Increased
51
Cardiac output in Septic Shock?
Increased
52
Wedge pressure in Septic Shock?
NML
53
SVR in Septic Shock?
Decreased
54
Tidal volume of ___ mL/kg is associated with decreased mortality
6
55
Patient in ICU after septic shock; Recently removed from ventilator; HGB now is 7.9 – at what point should patients in ICU receive blood transfusion?
HGB \< 7.0
56
What are 2 exceptions to rule that ICU should not receive blood transfusion until HGB \< 7.0?
Active bleeding; Unstable CAD
57
ICU admission for COPD exacerbation is associated with ___ year mortality
1
58
Appropriate duration of oral/IV corticosteroids in COPD exacerbation?
2 weeks
59
Pulmonary arterial pressure that indicates pulmonary HTN?
Pulmonary arterial systolic pressure \> 35 mmHg
60
Etiology of secondary pulmonary HTN?
Vasoconstriction secondary to COPD, chronic hypoxia, OSA; Scleroderma
61
Etiology of pulmonary HTN in setting of Scleroderma?
Proliferation of intimal smooth muscle cells
62
Diagnostic test for Pulmonary HTN?
R heart catheterization
63
Best treatment for Pulmonary HTN?
CCBs, Lung transplantation
64
2 tools for diagnosis of PE?
V/Q scan, Helical CT
65
Hallmark EKG sign associated with PE?
S1-Q3-T3
66
What accounts for appearance of S1Q3T3 in setting of PE?
R heart strain
67
Most common finding on chest examination in setting of PE?
Clear breath sounds
68
Which of the following is NOT a risk factor for DVT – female, advanced age, trauma, recent surgery, homocystinuria?
Female … pregnancy = yes, OCP = yes … but NML women have no increased risk
69
Is knee surgery OR hip surgery considered a greater risk factor for DVT?
Knee surgery
70
Best DVT prophylaxis for CA patients?
LMWH
71
Best treatment for superficial thrombophlebitis?
Not heparin … NSAIDs, rest
72
2 serious symptoms associated with altitude mountain sickness?
Cerebral edema, Pulmonary edema
73
3 DOCs for altitude mountain sickness?
Furosemide, Nifedipine, Dexamethasone
74
DOC for prevention of altitude mountain sickness?
Acetazolamide
75
Structure of Streptococcus pneumoniae on Gram stain?
Gram (+) lancet-shaped diplococci
76
Clinical presentation of PNA due to Klebsiella?
Currant jelly sputum
77
Pathogen responsible for PNA + cattle/sheep exposure?
Q fever, coxsiella
78
Pathogen responsible for PNA + bird exposure?
Chlamydia psittacosis
79
Pathogen responsible for PNA + hunters?
Tularemia
80
Pathogen responsible for PNA + homosexuality?
PCP
81
Pathogen responsible for PNA + nursing home?
Klebsiella
82
Pathogen responsible for PNA + ETOH?
Klebsiella
83
Pathogen responsible for PNA + aspiration, poor dental hygiene?
Anaerobes
84
Pathogen responsible for PNA + cystic fibrosis?
Pseudomonas
85
Pathogen responsible for PNA + post-influenza infection?
Staph aureus
86
Pathogen responsible for PNA + neonate?
GBS
87
3 most common pathogens responsible for atypical PNA?
Mycoplasma, Leigonella, Chlamydia
88
2 pathogens causing PNA that are diagnosed with urinary antigen?
Leigonella, Histoplasmosis
89
Subtype of lung adenocarcinoma that causes peripheral lung CA in non-smoker females?
Bronchoalveolar Carcinoma
90
Next step of workup for patient with suspected Pancoast Tumor?
CT needle-guided biopsy
91
Nerve roots of ulnar nerve?
C8-T1
92
Paraneoplastic syndrome associated with lung adenocarcinoma?
Hypertrophic osteoarthropathy
93
Paraneoplastic syndrome associated with large cell lung CA?
Gynecomastia
94
Appearance of small cell lung CA on CXR?
Centrally-located … near hilum
95
3 Paraneoplastic syndromes associated with small cell lung CA?
SIADH, Eaton-Lambert Syndrome, Cushing Syndrome
96
Best treatment for brain metastasis?
Surgical resection + whole brain XRT
97
Treatment of choice for idiopathic interstitial PNA?
Corticosteroids
98
Which medication can induce Bronchiolitis Obliterans Organizing Pneumonia (BOOP)?
Penicillamine
99
Diagnostic test for sarcoidosis?
Bronchoscopy with bonchial wall biopsy … looking for non-caseating granulomas
100
Biopsy shows caseating granulomas … diagnosis?
TB
101
\_\_\_ is a condition that mimics sarcoidosis?
Beryllosis
102
Indication for steroid treatment of sarcoidosis?
Other organ involvement; Hypercalcemia; Neurosarcoidosis
103
Clinical presentation of neurosarcoidosis?
CN VII involvement
104
Patient presents with hilar LAD, polyarthralgia (especially involving ankle), erythema nodosum – diagnosis?
Lofgren Syndrome … variant of sarcoidosis
105
Patient presents with lytic bone lesions, diabetes insipidus, exophthalmos – diagnosis?
Hand-Schuller-Christian Syndrome
106
Which test confirms diagnosis of Hand-Schuller-Christian Syndrome?
Lung biopsy that shows Langerhans cells
107
Treatment for Systemic Langerhans cell granulomatosis?
2-chlorodeoxyadenosine (2-CDA)
108
Additional condition that is treated with 2-CDA?
Hairy cell leukemia
109
Most common cause of chylothorax?
Lymphoma
110
Lung condition that may result in chylous pleura effusions?
Lymphangiomyomatosis (LAM)
111
Best treatment for Churg-Strauss Disease?
Corticosteroids, Cyclophosphamide
112
Medication that might induce Churg-Strauss Disease?
Leukotriene receptor antagonist
113
Alternate name for Acute Eosinophilic PNA?
Loeffler Syndrome
114
2 lab results seen in setting of Loeffler Syndrome?
Eosinophils in blood + sputum
115
Clinical presentation of aspergilloma?
Massive hemoptysis
116
Best treatment of aspergilloma?
Surgical removal
117
Appearance of aspergilloma on CXR?
Fungal ball
118
Clinical presentation of invasive pulmonary aspergillosis?
Necrotizing PNA in immunocompromised patients (neutropenia)
119
Best treatment for invasive pulmonary aspergillosis?
Voriconazole
120
Best treatment for allergic bronchopulmonary aspergillosis?
Steroids … (not antifungals)
121
Parapneumonic effusion is associated with …
Bacterial PNA
122
Most common cause of massive hemothorax pleural effusion?
Malignant pleural effusion
123
What type of pleural effusion is associated with rheumatoid pleurisy?
Exudative
124
Change to LDH in rheumatoid pleurisy?
Increased
125
Change to glucose in rheumatoid pleurisy?
Decreased
126
What distinguishes rheumatoid pleurisy from other exudative pleural effusion?
Low glucose (without WBCs or signs of infection)
127
2 characteristics of lupus pleuritis?
Bilateral, painful
128
Most common cause of chylothorax?
Lymphoma
129
Laterality of chylothorax?
Unilateral
130
Rare cause of chylothorax?
Lymphangioleiomyomatosis
131
Epidemiology of hepatic hydrothorax?
ETOH with cirrhosis
132
Hepatic hydrothorax represents a type of ___ pleural effusion
Transudative
133
Etiology of hepatic hydrothorax?
Hypoalbuminemia
134
Best treatment for hepatic hydrothorax?
Salt restriction, diuretics
135
What is NOT a treatment option for hepatic hydrothorax?
Chest tube, Thoracentesis … (the effusion accumulates too rapidly)
136
Most common laterality of developing hepatic hydrothorax?
R
137
3 criteria for exudative pleural effusion?
Pleural fluid protein \>2.9, Pleural fluid LDH \>60%, Pleural fluid cholesterol \>45
138
WBC \>1000 in pleural effusion means …
Exudate
139
WBC \>10,000 in pleural effusion means …
Parapneumonic
140
WBC \>100,000 in pleural effusion means …
Empyema (pus collection)
141
Eosinophils \> 10% in pleural effusion means …
Drug reaction
142
Lymphocytes \> 50% in pleural effusion means …
TB or malignancy
143
What are 2 markers for TB?
Adenosine deaminase (ADA), IFNg
144
Next step of workup for patient with TB effusion?
Pleural biopsy
145
Glucose \< 20 in pleural effusion means …
RA
146
PMN predominance in pleural effusion means …
PNA
147
High amylase in pleural effusion means …
Pancreatic fistula
148
High triglycerides (\>115) in pleural effusion means …
Thoracic duct injury, Lymphangioleiomyomatosis
149
Pleural effusion with (+) ANA, low complement means …
SLE
150
Best next step of workup for patient with suspected pleural mesothelioma?
Open pleural biopsy
151
What should you NOT do in patient with suspected pleural mesothelioma?
Needle biopsy … may seed the needle track
152
First step of workup for patient with pulmonary nodules?
Check previous CXR
153
3 conditions that would warrant biopsy of pulmonary nodules?
CA, Exposure (asbestos), Smoking
154
Most likely fungal infection – Mississippi, Ohio river valley?
Histoplasmosis
155
Most likely fungal infection – Chicago, Midwest?
Blastomycosis
156
Most likely fungal infection – California?
Coccidioidomycosis
157
Pattern of pulmonary nodule calcification that suggests benign lesion?
Popcorn, laminar, central, diffuse
158
Pattern of pulmonary nodule calcification that suggests malignant lesion?
Stippled, eccentric
159
Diameter of pulmonary nodule in which probability of CA is low?
Diameter \< 1.5cm
160
Best treatment for pulmonary nodule in which probability of CA is low?
Serial CXR monitoring every 3 months
161
Diameter of pulmonary nodule in which probability of CA is high?
Diameter \> 2cm
162
Best treatment for pulmonary nodule in which probability of CA is high?
Resection
163
When should you add inhaled corticosteroids for patient who has HX of asthma?
When patient begins to use of inhaled b agonist every day
164
Value of spacers during use of inhaled corticosteroids for asthma?
Decrease AE by decrease amount of drug swallowed each day
165
Indication for short-term oral corticosteroids in asthma?
Acute outpatient flare
166
T/F – regular use of inhaled corticosteroids has been shown to improve pulmonary function and reduce mortality in patients with asthma?
True
167
Which inhaler is indicated for asthmatic patients with b-blocker induced bronchospasm?
Atrovent inhaler
168
DOC for prevention of exercise-induced asthma in children?
Cromolyn
169
MOA of cromolyn in prevention of exercise-induced asthma in children?
Mast cell stabilizer
170
3 drug interactions associated with theophylline?
Increased clearance of phenytoin, phenobarbital, lithium
171
In patients with atypical symptoms of asthma, which step of workup has high NPV to exclude asthma?
Methacholine challenge
172
Most common etiology of occupational exposure?
Isocyanates (pesticides)
173
Which substance is unlikely to induce asthma?
Not silica
174
Is airflow limitation in COPD reversible?
Not fully
175
Classic CXR appearance of COPD?
Lung hyperinflation
176
T/F – 80% of cigarette smokers do not experience marked airflow obstruction?
True
177
Which intervention should not be prescribed for patient with severe COPD that requires admission?
Inhaled high-dose corticosteroids … Use ORAL or IV steroids!
178
What is the best prognostic indicator for COPD?
FEV1
179
What is the only therapy that has been proven to increase lifespan in patients with COPD?
O2
180
Goal O2 sat in patients with COPD?
90%
181
Which intervention has been shown to reduce the need for intubation for patients with COPD?
Non-invasive mask ventilation
182
What is the preferred method of O2 delivery for patients who are acutely ill and may be at risk for developing hypercapnia?
Venturi mask delivery
183
Change to PE seen in asthma?
Asthmatic patients usually have NML resting PE
184
Next step of workup to distinguish asthma from COPD in setting of decreased FEV1/FVC?
Bronchodilator challenge (b2 agonist)
185
Patient with low FEV1/FVC experiences improvement in FEV1 after bronchodilator challenge – diagnosis?
Asthma
186
Patient with low FEV1/FVC experiences NO improvement in FEV1 after bronchodilator challenge – next step of workup?
Check DCLO
187
Patient with low FEV1/FVC experiences NO improvement in FEV1 after bronchodilator challenge; DCLO is low – diagnosis?
COPD
188
Patient with low FEV1/FVC experiences NO improvement in FEV1 after bronchodilator challenge; DCLO is high – diagnosis?
Asthma
189
In patient with low FVC, TLC – what is next step of workup?
Check DLCO
190
In patient with low FVC, TLC and low DLCO – what is diagnosis?
Interstitial lung disease
191
In patient with low FVC, TLC and NML DLCO – what is diagnosis?
Chest wall lesions
192
2 aspects of clinical presentation seen in males with Cystic Fibrosis?
Bronchiectasis, Aspermia
193
27 yo male presents with recurrent sinusitis, bronchiectasis, sterility, hearing loss; PE shows heart sounds that are more prominent on R side – diagnosis?
Kartagener Syndrome
194
Etiology of Kartagener Syndrome?
Defective ciliary function
195
4 organ systems affected by Kartagener Syndrome?
Sinuses, Bronchi, Sperm, Organ of Corti
196
Classic CXR finding associated with a1 anti-trypsin?
Lower lobe emphysematous bullae
197
Inheritance pattern of a1 anti-trypsin?
AR
