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USMLE Step 2 CK Flash Cards > Pulmonary > Flashcards

Pulmonary Flashcards

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USMLE® Step 1 flashcards
1
Q

Difference in lung compromise between smoking-induced COPD and alpha-1 antitrypsin deficiency-related COPD

A
  • Smoking-induced centriacinar (centrilobular) emphysema➡upper lobes
  • AAT deficiency panacinar emphysema➡greater destruction of lower lobes

*Chest x-ray AAT deficiency➡bilateral basilar lucency

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2
Q

Clues to suspect Alpha-1 antitrypsin

A
  1. COPD at a younger age (<45 years old)
  2. COPD with minimal or no smoking history
  3. Bibasilar predominant COPD
  4. History of unexplained liver disease
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3
Q

When do you use bronchoprovocation testing with methacholine?

A

Patients with typical asthma symptoms but normal spirometry

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4
Q

Recommendations for lung cancer screening

A
  • Annual screening→low-dose CT in adults age 55 - 80 who have a 30-pack-year smoking history and currently smoke or have quit within past 15 years
  • Discontinue Screening→Once a person has not smoked for 15 years or develops a health problem limiting life expectancy or ability/willingness to have curative lung surgery
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5
Q

Difference of the diffusion capacity of the lung for carbon monoxide between emphysema and chronic bronchitis, and why?

A
  • Low in Emphysema→loss of alveolar capillaries

- Normal in Chronic Bronchitis

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6
Q

Difference between the pleural exudate of tuberculous effusion and malignancy etiology

A
  • Tuberculous→usually lymphocytosis>70%

- Malignancy→lymphocytosis is uncommon

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7
Q

Most common causes of secondary digital clubbing

A
  • Lung malignancies (intrathoracic neoplasms)
  • Intrathoracic suppurative diseases (cystic fibrosis, bronchiectasis)
  • Right to left cardiac shunts (cyanotic congenital heart disease)

*COPD with or without hypoxemia does not cause digital clubbing

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8
Q

Best initial test in acute exacerbation of asthma

A
  • Peak expiratory flow (PEF)→approximation of the FVC

- Arterial blood gas (ABG)→↑ A-a gradient

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9
Q

Most accurate test for asthma in an asymptomatic patient

A

> 20% decrease in FEV1 with use of methacholine or histamine

*Less likely to find an ↑ in FEV1 using a SABA (albuterol)→false negative

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10
Q

Findings in the pulmonary function testing in asthma

A
  • ↓ FEV1, FVC and FEV1/FVC
  • ↑>12% and 200 mL in FEV1 with albuterol
  • ↓>20% in FEV1 with methacholine or histamine
  • ↑ Diffusion capacity of the lung for Carbon monoxide (DLCO)
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11
Q

When do you use anticholinergics in chronic asthma management?

A

If SABA, LABA and inhaled corticosteroids at maximum doses are not sufficient

*Iptratropium, Tiotropium

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12
Q

Typical presentation in acute asthma exacerbation in arterial blood gas. Which finding suggests the patient is getting worse?

A
  • Hyperventilation→Respiratory alkalosis
  • ↑ work of breathing→respiratory muscle fatigue→inability to maintain adequate ventilation (hyper)►normal pH and PaCO2 (normalized or elevated from respiratory alkalosis)►impending respiratory collapse
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13
Q

Which are the 3 most common causes of chronic cough? What is chronic cough?

A
  • Chronic cough→lasting >8 weeks
  • Upper airway cough syndrome (postnasal drip)
  • Asthma
  • Gastroesophageal reflux disease (GERD)
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14
Q

What is a solitary pulmonary nodule? What is the first step when evaluating it?

A
  • Rounded opacity, <3cm, completely surrounded by pulmonary parenchyma, No associated with lymph node enlargement
  • Determine if nodule is low, intermediate or high malignancy risk
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15
Q

Which is the management of high, intermediate and low malignancy risk solitary pulmonary nodule?

A
  • High risk→surgical excision
  • Intermediate risk→FDG-PET, serial CT scans or Bx depending radiographic findings
  • Low risk→serial CT scans
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16
Q

First line inpatient non-ICU treatment for community-acquired pneumonia

A
  • Fluoroquinolone: Respiratory→moxifloxacin, levofloxacin

- Beta-lactam + macrolide

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17
Q

Best initial and most accurate diagnostic test for COPD?

A
  • Best initial: chest x-ray

- Most accurate: Pulmonary Function Test

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18
Q

Which sodium disturbance you may find secondary to a pulmonary pathology and why?

A

Hypotonic Euvolemic Hyponatremia

  • Pulmonary pathology (Pneumocystis pneumonia, Ex)→ SIADH
  • Infusion of normal saline - worsen hyponatremia
19
Q

Kartagener syndrome screening test

A

Decreased nasal nitric oxide

20
Q

COPD patient with acute-on-chronic respiratory acidosis

A

Hypoventilation→CO2 narcosis

21
Q

Pulmonary variable reflected when doing inspiratory hold maneuver?

A

Pulmonary compliance

Inspiratory hold maneuver➡measure plateau pressure=elastic pressure + PEEP

*Elastic recoil is inverse related to lung compliance; Elastic pressure=TV/compliance. ⬇Compliance (pulmonary fibrosis)➡stiffer lungs, ⬆elastic pressure

22
Q

Radiologic feature of invasive aspergillosis in the lungs

A

Chest CT scan: Pulmonary nodules with surrounding ground-glass opacities (“halo sign”)

23
Q

Pulmonary function test results in a patient with amyotrophic lateral sclerosis (ALS)

A
  • Restrictive pattern (normal or ⬆FEV1/FVC, ⬇VC)➡extrinsic limitation of lung expansion
  • Diaphragmatic involvement (weakness)➡⬇FVC, ⬇Maximal inspiratory pressure (reflect diaphragmatic strength), DLCO normal (pulmonar parenchyma and alveoli unaffected)
24
Q

Best predictors of postoperative outcomes following lung resection surgery

A

FEV1 and DLCO

25
Q

First step in evaluating solitary pulmonary nodule (SPN)

A

Comparison with previous x-ray➡stable lesion in 2-3 years▶malignancy ruled out, no further testing

26
Q

Chest radiograph findings of pulmonary embolism

A
  • Atelectasis (most common)
  • Infiltrates
  • Pleural effusions
  • Westermark’s sign➡peripheral hyperlucency due oligemia
  • Hampton’s hump➡peripheral wedge of lung opacity due pulmonary infarction
  • Fleischner sign➡enlarged pulmonary artery
27
Q

Most likely diagnosis in a nonsmoker young patient with liver disease + emphysema (COPD). Treatment.

A
  • Alpha 1-antitrypsin deficiency

- Replace enzyme

28
Q

Major manifestation of chronic lung transplant rejection

A

Bronchiolitis obliterans

  • 50% of recipients after 5 years posttransplant
  • Obstructive pattern on PFT
29
Q

Most common type of lung cancer in never smokers

*Clinical associations

A

Adenocarcinoma

*Lung periphery, clubbing, hypertrophic osteoarthropathy

30
Q

Conditions associated with bronchiectasis

A

Chronic bronchial obstruction, tobacco use, cystic fibrosis, primary immunodeficiency disorders, Kartagener syndrome, allergic bronchopulmonary aspergillosis

31
Q

Most common lung malignancy in young nonsmokers

A

Bronchial carcinoid tumor

32
Q

Treatment options that improve mortality and delay the progression of COPD

A
  • Smoking cessation
  • Oxygen therapy➡benefit directly proportional to the number of hours used
  • Influenza and pneumococcal vaccine
33
Q

Criteria for oxygen use in COPD

A
  • pO2<55, SatO2≤88%

- If pulmonary hypertension, ⬆hematocrit, right-sided heart disease/failure▶pO2<60, SatO2≤90%

34
Q

Treatment for allergic bronchopulmonary aspergillosis (ABPA)

A
  • Oral steroids

- Oral itraconazole for recurrent episodes

35
Q

Single most common cause of bronchiectasis

A

Cystic fibrosis

*Half of the cases

36
Q

Treatment for specific mutation on cystic fibrosis

A
  • Ivacaftor + lumacaftor➡⬆activity of CFTR in the 5%
    of patients who have a specific mutation
  • Tezacaftor is an alternative.
37
Q

Results in the pulmonary function test in a restrictive lung disease

A
  • ⬇of everything proportionately: FEV1, FVC, TLC, and residual volume▶FEV1/FVC ratio will be normal
  • ⬇DLCO in proportion to the severity of the thickening of the alveolar septum
38
Q

When you may use steroids for interstitial lung disease?

A
  • If the biopsy shows white blood cell or inflammatory infiltrate
  • Berylliosis is the most likely to respond to treatment with steroids
39
Q

Which treatment could help to decrease the rate of progression of idiopathic pulmonary fibrosis?

A
  • Pirfenidone: antifibrotic➡❌collagen synthesis

- Nintedanib: tyrosine kinase inhibitor➡❌fibrogenic growth factors➡❌fibroblasts

40
Q

Best initial test and finding in sarcoidosis

A

Chest x-ray: Hilar adenopathy

41
Q

Most accurate test and findings in sarcoidosis

A

Lymph node biopsy: Noncaseating granulomas

42
Q

Most accurate test for pulmonary hypertension

A

Right heart or Swanz-Ganz catheter

43
Q

Treatment options for idiopathic pulmonary hypertension

A
  • Prostacyclin analogs (PA vasodilators): epoprostenol, treprostinil, iloprost, beraprost, or selexipag
  • Endothelin antagonists: bosentan, ambrisentan, macitentan
  • Phosphodiesterase inhibitors: sildenafil, tadalafil
  • cGMP stimulators: riociguat
  • Calcium channel blockers
44
Q

Gastrointestinal manifestation of Sarcoidosis

A
  • Patchy infiltration by noncaseating granulomas in liver (65%)➡mixed cholestatic and hepatocellular changes▶asymptomatic ⬆AST, ALT, AP; Hepatomegaly
  • Reticuloendothelial granulomatous infiltration▶splenomegaly

USMLE Step 2 CK Flash Cards (17 decks)

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