Pulmonology Flashcards
(83 cards)
1
Q
F/u for single solid lung nodule < 6mm with low risk factors
A
No f/u
2
Q
F/u for single solid lung nodule < 6mm with high risk factors
A
CT 6-12 mo
3
Q
F/u for multiple solid lung nodules < 6mm with low risk factors
A
No f/u
4
Q
F/u for multiple solid lung nodule < 6mm with high risk factors
A
CT 6-12 mo
5
Q
F/u for single ground glass and/or part solid lung nodule < 6mm
A
No f/u
6
Q
F/u for single ground glass and/or part solid lung nodule > 6mm
A
CT 3-6 mo
GG: if no change, q2years x 5 years
PS: if no change, q1year x 5 years
7
Q
Low FEV1 Low FEV1/FVC High TLC Low DLCO High RV
A
Emphysema (obstructive)
8
Q
Low FEV1 Low FEV1/FVC High TLC Normal DLCO High RV
A
Bronchitis (obstructive)
9
Q
Low FEV1 Low FEV1/FVC High TLC Normal DLCO Normal/High RV
A
Bronchiectasis (obstructive)
10
Q
Low FEV1 Low FEV1/FVC High TLC Normal/high DLCO High RV
A
Asthma (obstructive)
11
Q
Low FEV1 Normal FEV1/FVC Low TLC Low DLCO Low RV
A
Restrictive (intra-thoracic)
12
Q
Low FEV1 Normal FEV1/FVC Low TLC Normal DLCO High RV
A
Restrictive (extra-thoracic)
13
Q
Causes of high DLCO
A
More blood in alveoli
CHF MS ASD/VSD PDA Polycythemia Squatting Exercise Alveolar hemorrhage
14
Q
Causes of low DLCO
A
Less blood in alveoli
COPD Restrictive disease PE pHTN Anemia Standing Valsalva
15
Q
Causes of normal DLCO
A
Asthma
CO poisoning
16
Q
Fixed extrathoracic obstruction (flat inspiratory and expiratory phase on flow loop)
A
Tumors
Tracheal stenosis
17
Q
Dynamic extrathoracic obstruction (flat inspiratory phase on flow loop)
A
Epiglottitis
Obstruction
Vocal cord paralysis
18
Q
Dynamic intrathoracic obstruction (flat expiratory phase on flow loop)
A
Intrathoracic tracheomalacia
19
Q
Diagnose asthma with PFT/bronchodilators
A
FEV1 increases by 12% with bronchodilators
20
Q
Diagnose asthma with methacholine challenge (bronchoprovocation test)
A
FEV1 drops by 20%
21
Q
NSAIDs/ASA, nasal polyps, rhinitis
Management
A
Dx: Aspirin-exacerbated respiratory disease (aka aspirin induced asthma)
Tx: Montelukast, ICS
22
Q
Management for asthma with high serum IgE levels
A
Add omalizumab
23
Q
Management for asthma with high eosinophil count
A
IL-5 inhibitor (mepolizumab or beralizumab) - decreases exacerbation and improved FEV1
24
Q
Management for asthma with high eosinophil count and resistance to PO corticosteroids
A
IL-4 inhibitor (dupilumab)
25
Diagnosing exercise induced asthma
Eucapnic voluntary hyperpnea challenge test - drop in FEV1 by 15%
26
Brownish mucus plugs
Gloves finger sign on CXR
+eosinophils
ABPA
27
BAL: CD8 > CD4
| Ground glass appearance with no eosinophils
Hypersensitivity pneumonitis
28
Asthma
Weakness of right hand/foot
IgE elevated
Eosinophilic GPA
29
Recent immigrant
High eosinophils
CXR with round infiltrates
Management
Dx: Strongyloides infection (Loeffler’s syndrome)
Tx: Thiabendazole
30
Asthma
Very peripheral infiltrates
BAL: high eosinophils. High ESR
Management
Dx: Chronic eosinophilic pneumonia
Tx: chronic steroids
31
+eosinophils
Ground glass appearance on CXR
Management
Dx: acute eosinophilic pneumonia
Tx: steroids
32
```
Diffuse opacities (homogenous infiltrates) or ground glass appearance
Tan colored fluid
```
Management
Dx: alveolar proteinosis
(Defective macrophages causing build up of surfactant in the lung)
Tx: whole lung ma age
33
GOLD stages for COPD
Gold 1: >80%
Gold 2: < 80%
Gold 3: < 50%
Gold 4: < 30%
34
```
COPD management per severity:
A (low risk, less symptoms)
B (Low risk, more symptoms)
C (high risk, less symptoms)
D (high risk, more symptoms)
```
A: SABA +/- SAMA
B: LAMA
C: LAMA
D: LAMA + LABA + ICS +/- PDE4 (roflumilast)
35
Adverse effect of Giotto policy in men > 60 y/o
Acute urinary retention
36
Criteria for starting O2 therapy in COPD
PaO2 < 55 mmHg or SpO2 < 88%
PaO2 < 59 mmHg or SpO2 < 89% with evidence of cor pulmonale, erythrocytosis (Hct > 55%)
37
Benefits of pulmonary rehab
Improvement in 6 min exercise endurance
Improvement in dyspnea and quality of life.
Trains muscles of ambulation
38
Management for COPD with FEV1 20-50% (despite pulm rehab) and bilateral upper lobe emphysema.
Lung volume reduction survey
39
Management for COPD with FEV1 < 20% (despite pulm rehab)
Lung transplant
40
Bilateral basal bullies cysts on CXR
Alpha-1 antitrypsin deficiency
41
Prominent cystic spaces in RLL and streaming opacities in the direction of bronchial tree (tram lines) on CXR
Bronchiectasis
42
Bronchiectasis
Sinusitis
Infertility
+/- situs inversus
Screening test
Dyskinetic cilia syndrome (Kartaganer syndrome)
Screening test: inhaled NO test
Confirmation test: biopsy of bronchi or sinus with video electron microscopy
43
Apical bullous changes on CXR
Cystic fibrosis
44
Leading bacteria that increases mortality in CF
Burkholderia cepecia
45
DOE
Severe obstruction
High/normal DLCO
No change with bronchodilator
Broncholitis obliterates
Associated with RA, carcinoid tumor, lung transplant
46
CXR with patchy of focal infiltrates with “organizing pattern”
Migratory infiltrates
Decreased DLCO
Management
Dx: Cryptogenic organizing pneumonia
Tx: steroids
47
Ankle pain
Hilary LAD
Non-caseating granulomas
BAL: CD4>CD8 (4:1)
Sarcoidosis
48
1) Random tree in bud pattern
2) Widespread tree in bud
3) consolidation with tree in bud
4) tree in bud dependent areas and esophageal abnormality
1) MAI/MTB
2) ABPA
3) aspiration bronchiolitis
4) aspiration bronchiolitis
49
Mechanics. Brake pads
| Calcified plaques
Asbestosis
50
Sand blasting
Increased MTB incidence
Egg shell calcifications
Silicosis
51
Premenopausal
Pneumothorax
Honeycomb appearance
Chylous effusion
Lymphangiomyomatosis
52
Indications for thrombolytics
Acute massive PE
| Large DVT, such as iliofemoral
53
Indications for IVC filter
H/o PE and another PE will cause death
Contraindication to anticoagulation
Emboli post-anticoagulation
Cirrhotic with PT/INR > 3.5 + DVT
54
S/p pneumonia treatment
| Cough and Opacity persists
Underlying malingnancy
55
Recurrent pneumonia
| CT with fibrosis
Post-obstructive pneumonia
56
Indications for Abx in sinusitis
Symptoms > 10 days
| Fever/pain > 3 days
57
Sore throat, fever
| Pain with swallowing and turning neck
Lemierre’s disease
Internal jugular vein thrombosis
Fusobacterium necrophorum
58
Mouth pain
Difficulty swallowing
Stiff neck with woody induration
Ludwig’s angina
59
Allergies made worse with medication (vasoconstrictors)
Rhinitis medicamentosa
60
Posterior RUL pneumonia
Klebsiella
61
RLL pneumonia
Strep
62
Adverse effects of fluoroquinolones
Prolong QTc
Tendon rupture
Paresthesias
Aortic aneurysms + dissection
63
Seizure
| Upper lobe infiltrate
Peptostreptococcus
64
Ear pain, fever
| Inflamed tympanic membrane
Mycoplasma
65
Fever, chest pain, cough
OCP
Management
Dx: pleurodynia due to coxsackie B virus
Tx: indomethacin
66
Management for influenza vaccine outbreak in nursing home
Vaccine + oseltamivir x 2 weeks
67
Nitrofurantoin
Crepitance over nasal lung fields
Ground glass appearance
Nitrofurantoin-induced pulmonary injury
68
Management for LTBI
INH and rifapentine weekly x 3 mo
69
Transudative pleural effusion
Total protein < 3g/dL
Fluid/serum protein ratio < 0.5
Total LDH < 200
Fluid/serum LDH ratio < 0.6
70
Milky pleural effusion
Triglycerides
71
Dull percussion
Decreased breath sounds
Absent VF/VR
Pleural effusion
72
Dull percussion
Bronchial breath sounds
Increased VF/VR
Pneumonia
73
Hyperresonant percussion
Decreased breath sounds
Decreased VF/VR
Pneumothorax
74
Orthodexia
| Platypnea
Hepatopulmonary syndrome
75
Bubble study with < 4 heart beats
PFO or ASD
76
Bubble study with > 4 heart beats
Hepatopulmonary syndrome
77
SOB
Elevated left hemiduaphragm
Confirmation test
Dx: phrenic nerve injury
Confirmation test: fluoroscopic sniff test
78
Obesity
| Elevated daytime PaCO2 and hypoxemia
Obesity hypoventilation syndrome
79
Abnormal respirations in CHF
Cheyenne-stokes
80
BAL results
1) increased neutrophils
2) increased lymphocytes
3) increased eosinophils
4) + silver methanamine
5) inclusion bodies
6) increased bacteria
7) foamy with lamellar inclusions
1) IPF
2) sarcoidosis (CD4>CD8); hypersensitivity pneumonitis (CD8>CD4)
3) Eosinophilic pneumonia
4) PJP
5) CMV
6) pneumonia
7) amiodarone
81
Light’s criteria
Exudative if either of the following:
Pleural/serum protein > 0.5
Pleural/serum LDH > 0.6
Pleural LDH >2/3 uln serum LDH
Transudative if ALL of above are met
82
Serum-pleural effusion protein difference > 3.1
OR
Serum-pleural effusion albumin gradient > 1.2
Transudative effusion
83
Therapies which prolong survival in COPD
Smoking cessation
Long-term O2 therapy (if resting PaO2 < 55 or SpO2 < 88% OR resting PaO2 < 59 or SpO2 < 89% + cor pulmonale or erythrocytosis)
