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Pulmonology Flashcards

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1
Q

EGPA vasculitis presentation and sx

A
  • chronic asthma and history of sinusitis
  • worsening asthma sx on tapering steroids
  • hemoptysis and epitaxis
  • cough + diffuse expiratory wheeze
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2
Q

What are the symptoms of anaerobic lung abscesses?

A

Subacute fevers and cough producing putrid sputum

These symptoms develop gradually over time.

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3
Q

What risk factors are associated with the development of anaerobic lung abscesses?

A

Alcohol use disorder, seizures, and stroke

These conditions increase the risk of aspiration.

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4
Q

What is the recommended treatment for anaerobic lung abscesses?

A

Ampicillin-sulbactam or clindamycin

Ampicillin-sulbactam provides good anaerobic and polymicrobial coverage.

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5
Q

True or False: Metronidazole is the most effective treatment for pulmonary abscesses.

A

False

Metronidazole has good anaerobic coverage but is less useful for pulmonary abscesses due to their polymicrobial nature.

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6
Q

Fill in the blank: The most appropriate treatment for an anaerobic lung abscess is _______.

A

ampicillin-sulbactam

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7
Q

Why is metronidazole less useful for pulmonary abscesses?

A

Because of their polymicrobial nature and predominance of gram-positive cocci

Pulmonary abscesses often involve multiple types of bacteria.

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8
Q

How does a history of cigarette smoking affect the clinical presentation of lung cancer?

A

It influences factors such as age at diagnosis, gender, and tumor differentiation.

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9
Q

What demographic is more likely to be diagnosed with lung cancer without a history of cigarette smoking?

A

Younger patients and females.

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10
Q

What type of lung cancer is more common in patients without a history of cigarette smoking?

A

Well-differentiated adenocarcinomas with a high rate of EGFR mutations.

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11
Q

What should patients with lung cancer who have never smoked be tested for?

A

EGFR mutations and other important driver mutations like ALK gene translocations.

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12
Q

Name three EGFR inhibitors used for patients with EGFR mutations.

A
  • osimertinib
  • erlotinib
  • gefitinib
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13
Q

True or False: Patients with EGFR mutations experience more toxicity from treatment compared to chemotherapy.

A

False

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14
Q

Fill in the blank: Patients with a history of cigarette smoking are more likely to be diagnosed with lung cancer at an _______ age.

A

older

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15
Q

What is the significance of high rates of EGFR mutations in lung cancer patients who have never smoked?

A

It indicates a need for targeted mutation testing and treatment options.

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16
Q

What is the most typical cause of long-standing mild leukocytosis and neutrophilia in a patient with asthma who smokes cigarettes?

A

Cigarette smoking

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17
Q

What effect do inhaled glucocorticoids have on airway neutrophilia?

A

Reduce airway neutrophilia

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18
Q

What is the average increase in absolute neutrophil count associated with systemic high-dose glucocorticoid use?

A

4000 per mm3

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19
Q

Is mild neutrophilia commonly seen with inhaled glucocorticoids?

A

No, the effect is rarely seen

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20
Q

What rare disorder is caused by an autosomal mutation in the CSF3R gene?

A

Hereditary neutrophilia

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21
Q

What results from the mutation in the CSF3R gene in hereditary neutrophilia?

A

Constitutively active granulocyte colony-stimulating factor receptor

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22
Q

What are the manifestations of hereditary neutrophilia?

A
  • Neutrophilia
  • Splenomegaly
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23
Q

What condition is chronic neutrophilic leukemia associated with?

A
  • Neutrophilia
  • Splenomegaly
  • Blood counts likely to worsen over time
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24
Q

What is a solitary pulmonary nodule?

A

A single nodule between 4 mm and 30 mm in diameter.

Lesions greater than 30 mm are called masses and are presumed to be malignant until proven otherwise.

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25
List the main differential diagnoses for a solitary pulmonary nodule.
* Malignancy * Infections * Benign tumors * Inflammatory conditions
26
What are the malignancies associated with solitary pulmonary nodules?
* Primary lung cancer * Metastatic cancer
27
What infections can cause solitary pulmonary nodules?
* Endemic fungi * Mycobacteria
28
Name two benign tumors that can present as solitary pulmonary nodules.
* Hamartoma * Fibroma
29
What inflammatory conditions are associated with solitary pulmonary nodules?
* Granulomatosis with polyangiitis (GPA) * Eosinophilic granulomatosis with polyangiitis * Sarcoidosis
30
True or False: Most solitary pulmonary nodules are symptomatic.
False
31
What symptoms suggest a pulmonary infection in the context of a solitary pulmonary nodule?
* Fever * Night sweats * Weight loss * Cough with sputum production
32
What initial evaluation should be done for a solid, indeterminate pulmonary nodule?
Comparison to any previous chest imaging.
33
What is the follow-up if a nodule has been stable for the past 2 years?
No further follow-up is needed.
34
What should be done if a nodule shows growth during the past 2 years?
Biopsy or resection is indicated.
35
What is the significance of validated models in evaluating solitary pulmonary nodules?
They assist in predicting the likelihood of malignancy.
36
List some risk factors included in the Brock University model for predicting malignancy.
* Female sex * Age >35 years * Family history of lung cancer * Emphysema * Larger nodule size * Location in the upper lobe * Partially solid nodule * Lower nodule count * Spiculated appearance
37
What is the recommended follow-up for a solid solitary pulmonary nodule >8 mm with a low probability of malignancy (<5%)?
Repeat chest CT in 3 months.
38
What should be done for a solid solitary pulmonary nodule with an intermediate probability of malignancy (5%–65%)?
Undergo integrated positron emission tomography and CT (PET/CT).
39
What is the recommended action for a solid solitary pulmonary nodule with a high probability of malignancy (>65%)?
Nodule resection.
40
What is the degree of uptake on a PET scan used to differentiate?
It helps differentiate between a benign nodule (low uptake) and a malignant one (high uptake).
41
In which type of nodules is the sensitivity and specificity of a PET scan lower?
Subsolid nodules, such as those with ground-glass portions.
42
What is the key learning point regarding the next step in the workup of a 2.0-cm, solid, noncalcified solitary pulmonary nodule?
Integrated positron emission tomography and CT.
43
What is the initial treatment for a patient with an exacerbation of chronic obstructive pulmonary disease (COPD) without hypercapnic respiratory failure or pneumonia?
Bronchodilator therapy, systemic glucocorticoids, and doxycycline, a fluoroquinolone, or a macrolide antibiotic ## Footnote This treatment approach is essential for managing COPD exacerbations.
44
Are long-acting bronchodilators indicated for acute exacerbations of COPD?
No ## Footnote Long-acting bronchodilators are not suitable for immediate treatment during acute exacerbations.
45
When should a long-acting bronchodilator be considered for a patient with COPD?
On discharge for the outpatient regimen ## Footnote It is appropriate to add long-acting bronchodilators when managing COPD in outpatient settings.
46
What type of ventilation has been shown to improve outcomes in COPD exacerbations?
Noninvasive positive-pressure ventilation ## Footnote This method is effective but limited to specific patient conditions.
47
What conditions must be present for noninvasive positive-pressure ventilation to be used in COPD exacerbations?
Hypercapnia, persistent hypoxemia, or increased work of breathing ## Footnote These criteria ensure that the patient is suitable for this type of ventilation.
48
Fill in the blank: Noninvasive positive-pressure ventilation is limited to patients with _______.
hypercapnia, persistent hypoxemia, or increased work of breathing ## Footnote This highlights the specific clinical scenarios for its application.
49
What symptoms are associated with occupation-related asthma in an auto body-repair technician?
Pruritus and asthma
50
What is the most likely cause of occupation-related asthma in auto body-repair technicians?
Exposure to diisocyanates
51
In what professions should diisocyanate exposure be suspected as a cause of asthma?
People who use spray paint, make or repair automobiles, install insulation, or make plastic, rubber, or polyurethane foam
52
Name other chemicals associated with occupation-related asthma.
* Persulfates * Aldehydes * Amines
53
True or False: Diisocyanates are among the most well-described causes of occupational asthma.
True
54
What is a symptomatic hemoglobinopathy that can lead to pulmonary arterial hypertension?
Sickle cell disease, alpha-thalassemia, or beta-thalassemia ## Footnote 'Intermedia' implies symptomatic conditions
55
What is one of the most common causes of death in patients with symptomatic hemoglobinopathy?
Pulmonary hypertension ## Footnote It is particularly relevant in conditions like sickle cell disease and thalassemias
56
What is the test of choice for diagnosing pulmonary hypertension?
Transthoracic echocardiogram ## Footnote This imaging test is commonly used to assess heart function and blood flow
57
What is the pathophysiology of high-altitude pulmonary edema (HAPE)?
Related to acute pulmonary arterial hypertension secondary to extreme hypoxic pulmonary vasoconstriction ## Footnote The primary mechanism involves stress failure of pulmonary capillaries and leakage of edema fluid into alveolar spaces.
58
What is a possible secondary mechanism in HAPE?
Decreased alveolar fluid clearance
59
What medication has been shown to blunt the hypoxic rise in pulmonary arterial pressure in HAPE?
Nifedipine
60
What is the role of Nifedipine in the treatment of HAPE?
First-line treatment for HAPE and reduces the rate of recurrent HAPE
61
Which medication prevents HAPE by lowering pulmonary arterial pressure?
Tadalafil (a phosphodiesterase type 5 inhibitor)
62
Was Dexamethasone shown to be effective for HAPE?
Yes, for secondary prevention in a single small trial
63
What is Acetazolamide used for?
To prevent acute mountain sickness (AMS) and high-altitude cerebral edema
64
Does Acetazolamide provide some benefit in preventing HAPE?
Yes, but it is not first-line therapy for secondary prevention of HAPE
65
Fill in the blank: Nifedipine is also known for blunting the _______ rise in pulmonary arterial pressure.
hypoxic
66
True or False: Dexamethasone is a first-line treatment for HAPE.
False
67
What are the most common secondary causes of hypertension?
The most common secondary causes of hypertension are primary hyperaldosteronism, renal-artery stenosis, chronic kidney disease, and obstructive sleep apnea.
68
What percentage of patients with resistant hypertension have obstructive sleep apnea?
Obstructive sleep apnea is found in up to 83% of patients with difficult-to-control (resistant) hypertension.
69
What factors suggest a greater likelihood of obstructive sleep apnea?
A large neck circumference (>40 cm in women, >43 cm in men), male sex, general obesity, loud snoring, and daytime sleepiness suggest a greater likelihood of obstructive sleep apnea.
70
What physical examination finding supports obstructive sleep apnea?
A crowded oral airway on examination would support obstructive sleep apnea.
71
What are the different radiographic and pathologic patterns of drug-induced lung injury?
Noncardiogenic pulmonary edema, pulmonary fibrosis, eosinophilic pneumonia, organizing pneumonia, diffuse alveolar hemorrhage ## Footnote These patterns can vary significantly among patients.
72
What does pulmonary-function testing typically reveal in cases of drug-induced lung injury?
A restrictive pattern ## Footnote This indicates a reduction in lung volume.
73
Which medication is most commonly associated with lung injury?
Nitrofurantoin ## Footnote This antibiotic is frequently prescribed but has a low incidence of lung injury.
74
What is the incidence of drug-induced lung injury among long-term users of nitrofurantoin?
Less than 1% ## Footnote This suggests that while nitrofurantoin can cause lung injury, it is relatively rare.
75
Name other medications linked to drug-induced lung injury.
* Amiodarone * Isoniazid * Thiazides * Sulfonamides * Bleomycin * Methotrexate ## Footnote These medications have varying mechanisms of causing lung injury.
76
What is the most effective approach for patients with drug-induced lung injury?
Medication discontinuation ## Footnote Stopping the offending drug is crucial, although recovery may take time.
77
True or False: Symptoms from drug-induced lung injury can improve immediately after discontinuation of the offending medication.
False ## Footnote It may take months for symptoms to improve after stopping the medication.
78
What is the condition characterized by antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis?
Conditions such as granulomatosis with polyangiitis (GPA), eosinophilic granulomatosis with polyangiitis (EGPA), or microscopic polyangiitis (MPA) ## Footnote GPA was formerly known as Wegener’s, and EGPA was referred to as Churg-Strauss syndrome.
79
What are common organs involved in ANCA-associated vasculitis?
Multiorgan involvement including lungs, kidneys, peripheral nerves, or skin ## Footnote Eye, ear, nose, and throat manifestations are more common in GPA.
80
Which condition is more likely in patients with upper-airway symptoms, GPA or MPA?
GPA ## Footnote Eye, ear, nose, and throat manifestations occur more commonly in GPA than in MPA.
81
What are the characteristic laboratory findings in patients with GPA?
Positive testing for antibodies to proteinase 3 (PR3-ANCA) with a cytoplasmic-staining pattern (c-ANCA) ## Footnote This is observed on immunofluorescence microscopy of neutrophils.
82
What laboratory findings are associated with MPA and EGPA?
Antimyeloperoxidase (MPO-ANCA) antibodies and a perinuclear ANCA (p-ANCA) pattern ## Footnote This is also observed on immunofluorescence microscopy of neutrophils.
83
True or False: A significant percentage of ANCA-associated vasculitis patients can be persistently negative for ANCA.
True ## Footnote Negative ANCA serology is commonly seen in patients with EGPA or GPA limited to the upper airway.
84
Fill in the blank: A patient with severe respiratory compromise, renal impairment, and sinusitis is most likely to have a diagnosis of _______.
antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis ## Footnote Particularly granulomatosis with polyangiitis.
85
What is a common precursor condition for EGPA?
Years of asthma ## Footnote EGPA is characterized by peripheral blood eosinophilia on laboratory testing.
86
How does sinus and nasal involvement in EGPA typically manifest?
More allergic in nature, with rhinitis and polyps ## Footnote This contrasts with GPA, which may not have the same allergic features.
87
What type of ANCA pattern is associated with GPA?
Cytoplasmic-staining pattern (c-ANCA) ## Footnote This is linked to antibodies to proteinase 3 (PR3-ANCA).
88
What type of ANCA pattern is associated with MPA?
Perinuclear ANCA (p-ANCA) pattern ## Footnote This is linked to antimyeloperoxidase (MPO-ANCA) antibodies.

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