Flashcards in Pulmonology Deck (33):
Define Light's Criteria
1. Pleural protein / Serum Protein LESS than 0.5
2. Pleural LDH / serum LDH LESS than 0.6
3. Pleural LDH LESS than 2/3 ULN
What spirometry value suggests obstruction?
FEV1/FVC less 70%
What spirometry value suggests REVERSIBLE airways?
1. Increase 12% of either FEV1 or FVC
2. Increase 200 mL baseline
What suggests Restrictive Lung Disease?
Equal reductions in FEV1 and FVC
1. What do Flow-Volume Loops identify?
2. Describe these flows:
c. Tracheal Stenosis
1. They localize anatomic airway obstruction
2. a. "Scooped-out", no change w/ bronchodilators
b. "Scooped-out", improve w/ bronchodilators
c. Flattened both expiration and inspiration
1. When spirometry/lung volumes are AB-normal and DLCO low, consider _ (3).
2. When spirometry/lung volumes are normal and:
a. Low DLCO
b. High DLCO
1. a. COPD
b. Pulmonary Fibrosis
2. a. Pulmonary vascular disease
b. Hemorrhage, L-to-R shunt, polycythemia
Define these Asthma Classifications:
2. Mild persistent
3. Moderate persistent
4. Severe persistent
a. Day < 2/week
b. Night < 2/month
2. Mild persistent:
a. Day > 2/week, less than daily
b. Night > 2/month
3. Moderate persistent:
b. Night >1/week
c. FEV1 60-80
4. Severe persistent:
b. Night frequent
c. FEV1 <60
What drugs should be avoided with Theophylline (3)?
3. Azole antifungals
What are treatment options for Exercise-Induced Asthma when:
1. Infrequent (3)
2. Frequent more than 2/week (2)
1. a. Albuterol
b. Cromolyn Sodium**
**Mast cell stabilizers
2. a. Montelukast
List some historical clues which would prompt testing for alpha1-antitrypsin (6)?
1. Age less 45
2. No risk for COPD
3. FHx AAT deficiency
4. Basilar lung predominant emphysema
5. Liver disease
6. Necrotizing panniculitis
Describe COPD stages (4) and their treatment
All have FEV1/FVC less 70%
I (mild): FEV1 greater 80% predicted
TX: SABA or anticholinergic
II (moderate): FEV1 less 80% predicated (50%)
TX: LABA and anticholinergic
TX: Pulmonary rehab
III (severe): FEV1 less 50% predicated (30%)
TX: Add ICS
IV (very severe): FEV1 less 30% predicated (50%)
TX: Surgery and oxygen
What are indications for daylong oxygen therapy for COPD (4)?
1. PO2 less 55 mmHg
2. PO2 between 55-60 with signs
3. Nocturnal oxygen less 88%
4. Ambulating oxygen less 88%
1. What does clubbing suggest (3)?
2. What does it NOT suggest (1)?
1. a. Bronchiectasis
b. R-to-L shunt
2. NOT COPD
List causes of Transudative Pleural Effusions (3 increased hydrostatic, 4 decreased oncotic)
Increase hydrostatic pressure
2. Constrictive pericarditis
3. SVC syndrome
Decreased oncotic pressure
5. Nephrotic syndrome
7. Peritoneal dialysis
List causes of Exudative Pleural Effusions (5)
3. Collagen vascular disorders
4. Pulmonary infarction
What pleural effusion features suggest empyema, thus require chest tube (4)?
1. pH 7.2
2. Pleural glucose less 50% plasma glucose
3. LDH more than 1,000
4. Positive gram stain
What is the different between Primary and Secondary Pneumothorax?
Primary - normal lung, spontaneous
Secondary - overt lung disease (COPD, PCP...)
1. How are pneumothorax under 2cm treated (2 scenarios)?
2. When should chest tube be placed?
3. When should VATS pleurodesis be considered?
1. Less than 2cm
- Primary: observation
- Secondary: aspiration if mild and <50yo
otherwise chest tube
2. Greater than 3cm, small tubes only
3. a. Refractory or recurrent PTX
b. Certain occupations like pilots
Contrast Malignant from Benign solitary pulmonary nodules (3 each)
2. Minimal calcification
3. Intermediate doubling times (30-500 days)
1. Smooth margins
2. Central laminated calcifications
3. Doubling times 30-day or none over 2-years
1. Besides erythema nodosum, what are skin finding with Sarcoidosis?
2. What is a facial finding with Sarcoidosis?
3. What occupational hazard would cause a Sarcoidosis-like syndrome?
1. Lupus Pernio - violaceous discoloration of the nose, cheek, chin
2. Parotid enlargement with facial nerve palsy
3. Beryllium - light bulb factories or semiconductors
What is the illness script for Langerhans cell histiocytosis, what is found on HRCT (2) and what is treatment?
1. Young male smoker with recurrent PTX
2. HRCT with stellate nodules and upper cysts
3. Treatment is smoking cessation
1. What is prophylaxis for Mountain Sickness?
2. What is HAPE and treatment?
3. What is HACE and treatment?
1. Acetazolamide 1-2 days prior
2. High-Altitude Pulmonary Edema
TX: Furosemide and Nifedipine
3. High-Altitude Cerebral Edema
What are relative indications for mechanical ventilation (4)?
1. PaO2 < 60 mmHg on FiO2 50%
2. PaCO2 > 45 mmHg with acidemia
3. pH less 7.25
4. RR greater 35
1. What are parameters for measuring pretest probability of DVT?
2. What are the pretest categories and their diagnostic algorithms (3)?
Calf diameter increase >3 cm
Collateral superficial veins visible
Pitting oedema -or-
Oedema of the whole leg
+ (t)enderness of the calf
Different diagnosis more likely (subtract 2 points)
0 Low - order d-dimer
1-2 Moderate - order V/Q or CT-->if negative US
3 or more High - start therapy then do imaging
1. What pulmonary artery pressure suggests Pulmonary Hypertension?
2. What is the confirmatory test?
1. PA pressure more than 40 mmHg
2. Right-heart catheterization
What test should be done for CHRONIC thromboembolic pulmonary hypertension?
What treatment options are used for Pulmonary Hypertension (5)?
2. Oxygen for SaO2 less 90%
3. Calcium channel blockers if reduction of PAP
4. Endothelin antagonists, sildenafil...
5. Lung transplant for NYHA III-IV
1. What is a serologic test for Organophosphate Poisoning?
2. What are treatment options (3)?
1. Acetylcholinesterase levels
- DON'T WAIT TO TREAT IF CONCERNED
- Follow during treatment
2. a. Atropine
b. Pralidoxime for CNS toxicity
c. Benzos for convulsions
What are key differences between poisoning with:
1. Methanol (wood alcohol)
2. Ethylene glycol
3. Isopropyl alcohol
1. Methanol - visual symptoms
2. Ethylene glycol - urine oxalate crystals
3. Isopropryl alcohol - NO ACIDOSIS or AKI
What is a drug-treatment for Malignant Hyperthermia?
Describe the follow-up for pulmonary nodules based on size and risk factors.
Less than 4mm
- No risks: None
- Smoker: 12m
- No risks: 12m
- Smoker: 6-12m then 18-24m
- No risks: 6-12m
- Smoker: 3-6m then 9-12m then 24m
Greater than 8mm
- No risks: Contrast CT, PET, biopsy
- Smoker: Contrast CT, PET, biopsy
What type of tumors appear in the __ mediastinum?
1. Anterior (3)
2. Middle (3)
3. Posterior (2)
1. Anterior = thyroid, thymus, lymph
2. Middle= bronchogenic, pericardial, lymph
3. Posterior = neural (Schwann), esophageal