Pulmonology Flashcards Preview

American Board of Internal Medicine > Pulmonology > Flashcards

Flashcards in Pulmonology Deck (33):
1

Define Light's Criteria

Transudate:
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

2

What spirometry value suggests obstruction?

FEV1/FVC less 70%

3

What spirometry value suggests REVERSIBLE airways?

1. Increase 12% of either FEV1 or FVC
2. Increase 200 mL baseline

4

What suggests Restrictive Lung Disease?

Equal reductions in FEV1 and FVC

5

1. What do Flow-Volume Loops identify?
2. Describe these flows:
a. COPD
b. Asthma
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

6

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
c. Bronchiectasis

2. a. Pulmonary vascular disease
b. Hemorrhage, L-to-R shunt, polycythemia

7

Define these Asthma Classifications:
1. Intermittent
2. Mild persistent
3. Moderate persistent
4. Severe persistent

1. Intermittent:
a. Day < 2/week
b. Night < 2/month
c. FEV1>80

2. Mild persistent:
a. Day > 2/week, less than daily
b. Night > 2/month
c. FEV1>80

3. Moderate persistent:
a. Daily
b. Night >1/week
c. FEV1 60-80

4. Severe persistent:
a. Continual
b. Night frequent
c. FEV1 <60

8

What drugs should be avoided with Theophylline (3)?

1. Fluorquinolones
2. Macrolides
3. Azole antifungals

9

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**
c. Nedocromil**

**Mast cell stabilizers

2. a. Montelukast
b. Zafirlukast

10

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

11

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

12

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%

13

1. What does clubbing suggest (3)?
2. What does it NOT suggest (1)?

1. a. Bronchiectasis
b. R-to-L shunt
c. Malignancy
2. NOT COPD

14

List causes of Transudative Pleural Effusions (3 increased hydrostatic, 4 decreased oncotic)

Increase hydrostatic pressure
1. CHF
2. Constrictive pericarditis
3. SVC syndrome

Decreased oncotic pressure
4. Ascites
5. Nephrotic syndrome
6. Hypoalbuminemia
7. Peritoneal dialysis

15

List causes of Exudative Pleural Effusions (5)

1. Infection
2. Neoplasm
3. Collagen vascular disorders
4. Pulmonary infarction
5. Hemothorax

16

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

17

What is the different between Primary and Secondary Pneumothorax?

Primary - normal lung, spontaneous
Secondary - overt lung disease (COPD, PCP...)

18

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

19

Contrast Malignant from Benign solitary pulmonary nodules (3 each)

Malignant:
1. Spiculated
2. Minimal calcification
3. Intermediate doubling times (30-500 days)

Benign:
1. Smooth margins
2. Central laminated calcifications
3. Doubling times 30-day or none over 2-years

20

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

21

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

22

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
TX: Dexamethasone

23

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

24

1. What are parameters for measuring pretest probability of DVT?
2. What are the pretest categories and their diagnostic algorithms (3)?

Mnemonic: C3PO+R2D2
Cancer
Calf diameter increase >3 cm
Collateral superficial veins visible
Pitting oedema -or-
Oedema of the whole leg
+ (t)enderness of the calf
Recent surgery/immobilization
Recent casting
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

25

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

26

What test should be done for CHRONIC thromboembolic pulmonary hypertension?

V/Q scan

27

What treatment options are used for Pulmonary Hypertension (5)?

1. Warfarin
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

28

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

29

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

30

What is a drug-treatment for Malignant Hyperthermia?

Dantrolene

31

Describe the follow-up for pulmonary nodules based on size and risk factors.

Less than 4mm
- No risks: None
- Smoker: 12m

4-6mm
- No risks: 12m
- Smoker: 6-12m then 18-24m

6-8mm
- 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



32

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

33

If a patient presents with suspected ACEI-angioedema, what two medications may not help?

1. Steroids
2. Epinephrine