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Flashcards in Pulmonology Deck (265):
1

Classification of asthma 2

Intermittent and persistent
Presistent-Mild,Moderate,severe

2

Quid asthma intermittent and RX

Symptom< ou egal 2f par semaine nightime awakening,RX:Albuterol

3

Quid asthma Mild persistent and RX

Symptom>2 f par semaine,3 a 4 nightime awakening/month
Rx albuterol + inhaled corticosteroid

4

Quid asthma moderate persistent and RX

daily symptom,weekly nightime awakening,FEV 60-80
SABA+inhaled corticisteroid +long acting B2 agonist

5

Quid severe asthma and RX

daily symptoms,frequent nightime awakening,FEV<60
Same as Astma moderate +prednisone oral

6

Organ involved in wegener 3

Upper and lower respitatory
renal involvement

7

Renal involvement in wegener

rapidly progressive glomerulonephritis

8

Rx of wegener

corticosteroids

9

COPD and acute respiratory distress

Rule out secondary pneumothorax

10

Physiopato seconary pneumothorax in COPD

blebs rupture

11

quid Blebs

dilated apical alveoli

12

Dx of Blebs

CT scan

13

Management of acute exacerbation of COPD

NPPV,decreases Mortality

14

Cause of recurrent pneumonia involving same lung area(4)

Alcohol use,GERD,seizures,brochial stenosis

15

Community acquired Pneumonia with skin involvement

Mycoplasma Pneumoniae

16

Bugs causing Atypical pneumonia(4)

Mycoplasma P,Legionelle P,Chlamidya P,Coxiella and influenza

17

Disease causing granulomatous inflammation(2)....

TB,sarcoidosis

18

Dx confirmatory of Sarcoidosis

Biopsy by brochoscopy or by mediatinoscopy

19

Recurrent Pneumonia in smoker

Bronchogenic carcinoma

20

Pulmonary disease with high A-a gradient(2)....

PCP,PE

21

Causof recurrent pneumonia involving different sites of the lung(3)

Sinopulmonary disease
immunodeficiency
Nonn infectious cause,vasculitis

22

Cause of sinopulmonary disease reccurente(2)

Cystic fibrosis
immotile cilia

23

Rx CAP for inpatient

Levofloxacin

24

Rx CAP for out patient(2)

Azythromycin
Dox

25

Dx of pulmonary HT(2)

Prominent pulmonary arteries
Enlarged right heart

26

Physiopatho ARDS in acute pancreatitis

Phospholipase A2 causes inflammation in lung and destroys surfactant

27

quid Pancoast tumor

Non small cell carcinoma

28

Findings in Pancoast Tumor(5)

Shoulder Pain
Horner's syndrome
C8-T2 involvement
weight loss
supra clavicular lymph node

29

Manif for c8-t2 involvement(3)

Paresthesie 4e et 5e doigt,bras et face ant avant-bras

30

Pneumonia et digestive symptom or hyponatremia or neurologic problem

Legionella

31

dx of legionella(2)

antigen in urine or charcoal agar

32

Rx of legionella(2)

Quinolone or macrolide(Azytromycin or levofloxacin)

33

Why b2 agonists causes hypokaliemia

they drive k+ into cells

34

Manif of HypoK+(3)

Mx weakness
arythmia
EKG changes

35

Why shock in massive PE

RV dilation
Septum is pushed towards left ventricle
Low ejection fraction---shock

36

Epidemio of histoplasmosis(2)

Missisipi,Ohio river
Link with guano

37

Pulmonary nodule in non smoker

rule out histoplasmosis

38

Quid of respiratory acidosis(3)

Low PH45
Normal HCO3- 22-28

39

cause of respiratory acidosis

Hypoventilation

40

Main indication of BAL(2)

PCP
Malignancy

41

Indication for inferior vena cava filter placement(3)

contrindication to anticoagulant
HIT
DVT on heparin

42

Manif of Theophyline toxicity(2)

Neurologic
Palpitation

43

Metabolism of theophyline

Cytochrome P450

44

drug inhibiting CP450

Cimetidine
clarythromycin
ciprofloxacin
erythromycin
verapamil

45

FEV% in Obstructive disease

<70

46

FEV% in restrictive disease

>70

47

Restrictive disease with low DLCO

Intersticial disease

48

Restrictive disease with normal DLCO

Mx chest weakness

49

Bug causing pneumonia in alcoholics

Klebsiella

50

Quid Friedlander Pneumoniae(2)

Jelly sputum
Klebsiella

51

Bugs causing empyema(3)

Strep Pneumo
Staph aureus
Klebsiella

52

Quid Empyema

Pus in pleural space

53

Rx of empyema(2)

drainage
antibiotics

54

Most common site of Wegener

Upper respiratory tract

55

Wegener Quid(4)

Upper respiratory tract involvement
Lower respiratory tract involvement
Renal involvement
Ulcer in leg

56

rx for Wegener

cyclophosphamide

57

PH fluid for empyema

<7,2

58

Acute productive cough with no fever and wheezing and sore throat

acute bronchitis

59

Rx of acute bronchitis

Supportive care

60

sleep apnea syndrome management

weight reduction
avoid supine position
avoid alcohol and sedatives

61

Therapeutic INR

2-3

62

indication of endotracheal intubation in asthma

Normal or High PCO2

63

Bad prognosis in asthma acute exacerbation

Normal or High PCO2

64

First measure in hypersensitivity pneumonitis

avoid antigen exposure

65

Two forms of hypersensitivity pneumonitis(2)

Bird fancier's Lung
farmer's Lung

66

Pneumonia linked with cruise

Legionella

67

PE and renal failure :RX

unfractionnated heparin

68

abnormal GFR

<30/ml/mn/1,73m2

69

Dx of adult astma

Increase FEV% after administration of bronchodilator

70

COPD exacerbation management(4)

Albuterol
ipratopium
antibiotics
corticosteroids

71

Management of exercice induced astma

Short acting agonist 20 mn before exercising

72

Light criteria(4)

Protein pleural fluid/protein serum >0.5
LDH pleural fluid/LDH serum>0,6
LDH pleural fluid>2/3 upper limit LDH serum
Favor exsudate

73

Management of solitary nodule in non smoker <40 ans

serial chest xray to see if mass is incresing in volume

74

Prognosis of solitary nodule in nonsmoker

stable during 2 years ,no cancer

75

Indication of home oxygen in COPD(3)

Pa0255 si Pao2<60

76

PH of pleura transudate

7,4-7,55

77

PH of pleural exsudate

7,30-7,45

78

Quid of flail chest

>/ 3 ribs adjacent ruptured in two places

79

Rx

Positive pressure ventilation

80

Risk of flail chest

Paradoxical respiration

81

Co2 Narcosis Manif(2)

Seizure
cardiac problem

82

Risk for co2 narcosis

patient with acute or chronic respiratory failure treated with high o2 flow

83

Best site to biopsy for wegener

nasopharynx

84

Anapath wegener(2)

Medium and small size arteries involvement
granulomatous inflammation

85

PCO2 value in secondary pneumothorax causing by COPD

Normal 33-45

86

PCO2 value in acute exacerbation causing by COPD

High

87

2e cause of reccurent pneumoniae involving same site

Local anatomic brochial obstruction

88

Lofgren syndrome(4)

Adenonopathie hilaire
erythema nodosum
fever
polyarthritis migratory

89

disease with lofgren syndrome

sarcoidosis

90

Biopsy findings in sarcoidosis

Non caseating granuloma

91

cause of bronchial obstruction(3)

Bronchial stenosis
ca(bronchogenic carcinoma or carcinoisd tumor)
foreign body

92

In reccurrent pneumonia test to do and why

Chest CT
to rule out bronchial obstruction

93

Seizures and respiratory

seizures can cause apnea and hypoventilation

94

Workup of PVCP pneumonia(3)

Chest xray
Sputum induction by hypertonic saline
BAL si sputum induction fails

95

Quid of bronchodilator challenge in obstructive pulmonary disease

Si FEV% increases:asthma
No change:COPD

96

Triad of wegener

Systemic vasculitis
Upper and lower respiratory tract infection
renal impairment

97

Rx of severe asthma exacerbation(4)

SABA
Ipratopium
corticisteroid
si no improvement intubation

98

Rx for mild to moderate asthma exacerbation(2)

SABA
No Improvement corticosteroids

99

Confirmatory test for legionella(2)

Charcoal agar
or Urine antigen testing

100

When to initiate warfarin in DVT

when PTT>1,5 or 2 fois la normale

101

Inchronic respiratory acidosis ,link between PCO2 et HCO3

each 10 mm de hg of PCO2,HCO3- increases 0f 3,5

102

Exsudate physio patho

Increase capillary permeability

103

Transudate physio patho

Increase hydrostatic pressure
Decrease oncotic pressure

104

Centrally located nodule work up

Broncoscopy for Biopsy

105

peripherically located nodule

CT guided Biopsy

106

Measure to decrease mortality in COPD (3)

Home 02
stop smoking
lung reduction surgery

107

Ideal sao2 for patient with acute exacerbation of COPD on O2

90-94%

108

Risk for patient with acute exacerbation COPD and high Sao2(3)

Haldane effect
risk of co2 narcosis because of low affinity of HB for CO2
co2 is free in tissue

109

First site of matastasis of choriocarcinoma

Lung

110

Dx of choriocarcinoma

BHCG en serie

111

hematologic side effect of steroids

Leukocytosis(Neutropphilia)

112

Link between GERD and astma

GERD can exacerbate asthma

113

Cor Pulmonale findings

Dyspnea
dialted pulmonary artery
Right heart failure(Increased P2)

114

Middle mediastinum Mass DX(5)

Trachea tumor
bronchogenic cyst
pericardic cyst
aorta aneurysm
lymphoma

115

Anterior Mediastinum Mass(4)

Terrible Lymphoma
Thymoma
Teratoma
Thyroid Mass

116

Posterior Mediastinum Mass(3)

Neurogenic Mass
aortic aneurism
esophageal mass(Leiyomyoma)

117

Physiopatho respiratory distress in ARDS

Infection or Phoslipase A2 cause inflamamatory change in alveli=gaz exchange -
cytokines or Phospholipase A2 destroy surfactant=stiff lung=decrease lung compliance

118

Quid of hypertrophic osteoarthropathy(2)

clubbing
hand pain

119

significance of Hypertrophic osteoarthropathy

Lun cancer
TB
Emphysema
bronchiectasis

120

chronic cough causes(12)

Post nasal drip
asthma
bronchiectasis
GERD
ACE inhibitor
Mtral stenosis
TB
Broncite chroniques
sclerodermia
sarcoidosis
fungal infection
cancer of lung

121

Rx of post nasal drip

anti histaminique with anti cholinergic effect

122

COPD plus clubbing

Lung cancer

123

Risk for DVT above the knee

PE

124

Quid of DVT above the knee(3)

-illiac
femoral
popliteal

125

travel to mexico or any developing countries

Infectious disease

126

Physio patho of chronic cough in Mitral stenosis(3)

Left atrial enlargement
compression on reccurent laryngeal nerve-->cough and hoarsening of the voice

127

Cause of exsudate(5)

Infection
Malignancy
rhumatologic disease(connective tissue )
PE
Iatrogenic

128

Dx of bronchiectasis

chest ct scan

129

Clue for GERD induced asthma

Hoarseness in the morning

130

dx et Rx of GERD induced asthma

Pomp inhibitor

131

When suspect anaerobic pneumonia(3)

After any procedure involving upper digestive tract
Failure in rx CAP rx
Any neurologic problem impairing swallowing ability

132

Normal A-a gradient

<15

133

cause high A-a gradient(3)

Diffusion limitation(Interticial disease)
VQ mismatch(PE,pulmonary edema)
Shunt intra cardiac

134

Calculation of A-a gradient

PAo2-Pao2

135

Respiratory distress in new intubated patient/why(2)

right main bonchus intubation
because of pulmonary edema

136

VQ mismatch physiologic shunting effect

lyng down on affected lung decreases SAO2 because of increase physiologic shunting

137

role of FIO2 in ventilation settings(2)

Helps to know the degree of oxygenation
50 a 60 is the required value

138

why glucose is low in exsudate<60

because of presence of white cells

139

indication of chest thoracostomy in the setting of parapneumonic effusion(2)


low PH < 7,2 in pleural fluid
low glucose <60

140

OPD with normal DLCO (carbone monoxyde diffusion a 100%)

chronic bronchitis

141

OPD with high DLCO

asthma

142

OPD with decreased DLCO

Emphysema

143

pulmonary cause of hemoptysis(7)

Bronchitis
PE
Bronchiectasis
cancer
TB
Lung abcess
Wegener

144

Quid of chronic bronchitis

productive cough lasting for 3 months 2 years consecutives

145

COPD exacerbation with respiratory failure

NPPV noninvasive positive pressure ventilation

146

COPD with failure of NPPV

endotracheal intubation

147

spirometry of ARDS

Pao2/fi02<300mm de hg

148

xray of ARDS

bilateral opacily

149

Bugs causing lung infection in bronchiectasis

Pseudomonas

150

VQ mismatch(3)

Pulmonary edema
PE
PCP

151

cause of respiratory distress(4)

ARDS
Trauma
Infection
OPD

152

PAo2 calculation

Fio2(Patm-PH20)-Pco2/r
0,21 (760-47)-pco2/0,80
149,73-pco2/0,80

153

Cause of Hypoxia(5)

Hypoventilation(CNS depression)
Reduced o2 inspired(high altitude)
Vq mismatch
diffusion limitation
intracardiac shunt

154

hypoxia which can be corrected by O2

intracardiac shunt

155

cause of low glucose in pleural fluid(4)

TB
Empyema
Rhumatoid arthritis
Malignancy

156

drug induced lupus(3)

hydralazine
isoniazid
procainamide

157

Drug induced lupus causes exsudate ou transudate

exsudate

158

cause of hyper coagulable state(6)

OCP use
Facteur V leiden
Dehydration
Protien C et S deficiency
cancer
Hyperhomocyteinemie(folate,B12,B6)

159

Does seminoma produce AFP

no

160

Mixed germ cell tumor dx

AFP and BHCG are produced

161

Extra pulmonary manif of ca pulmonaire(3)

Paraneoplastic syndrome
Pancoast syndrome
SVC syndrome

162

Cause of ARDS(4)

infection
acute pancreatitis
trauma
massive transfusion

163

Physical exam in pneumonia(4)

consolidation--->
Dulness to percussion
Increase tactile fremitus
bronchial type sound or decreased breath sound

164

Physical exam in pleural effusion(3)

Decreased breath sound
decrease tactile fremitus
dulness to percussion

165

Pulmonary embolism and RV dilation(2)

Increase pulmonary artery pressure
right atrial and ventricular dilation

166

Physio patho of ACE inhibitor induced cough

accumulation of kinin

167

respiratory acidosis compensation(2)

renal retention of bicarb
decrease chloride reabsorbtion

168

why sleep apnea can cause respiratory acidosis

hypoventilation

169

complication of sleep apnea(3)

respiratory acidosis
cor pulmonale
hta pulomanire

170

bad prognosis of acute asthma attack(5)

High or normal PCO2
silent lung
cyanosis
altered sensorium
difficulty speech

171

Characteristic of atypical pneumonia

cause extra pulmonary features

172

Dx of bronchiectasis

CT of chest

173

Complication of bronchiectasis

Hemoptysis

174

side effect# 1 of bclomethasone use

oral thrush

175

type of hypersensitivity is aspirin induced asthma(2)

indeterminate
It'a a pseudo allergic reaction

176

Rx of aspirin induced asthma

antagonist of leukotrien

177

action of aspirin(2)

block cox 1 and cox 2
Accumulalation of leukotrien from lipoxygenase pathway

178

action of steroid(3)

block phospholipase
no arachidonic acid produced
both pathways(lipoxygenase and cyclooygenase ) are blocked

179

gold standard for DX CAP

chest xray

180

gold standard to DX sleep apnea

nocturnal polysomnography

181

cause of empyema(4)

Lung infection
post hemothorax
neighborhood abcess(hepatic )
esophageal rupture

182

Post hemothorax empyema dx and rx(2)

CT of chest
surgery

183

Most common inherited disorder causing hypercoagulable state

factor v leiden

184

Physiopatho factor v leiden

Point mutation
Can be activate by protein C

185

Acido basis balance in COPD

respiratory acidosis

186

acidobasic balance in CHF

respiratory alkalosis

187

organ involvement in goodpasture disease(2)

lung involvement
renal involvement

188

physio patho of goodpasture(2)

antibody against type iv collagen
antibody anti basement membrane

189

ventilated patient with high PA02 but normal PH,management

decrease FIO2

190

ventilated patient with high Pao2 and respiratory alkalosis,management

decrease respiratory rate

191

clue for alpha 1 anti trypsine deficiency(2)

emphysema in non smoker and young
cirrhosis in young patient

192

confirmatory dx of AAT deficiency

Measure alpha 1 anti trypsine

193

cause of transudat(4)

CHF
cirrhosis
nephrotic syndrome
peritoneal dyalisis

194

Qui of non allergic rhinitis(2)

Post nasal drip,
chronic cough important clue

195

modality of treatment of non allergic rhinitis(2)

intranasal glucocorticoid or intra antihistaminique
oral anti allergic with anticholinergic effect

196

Xray findings in PE

Hampton's hump
westermak's sign

197

Most common symptom of PE(2)

Shortness of breath
pleuritic chest pain

198

EKG in PE(2)

sinus tachycardia
S1Q3T3

199

Bad prognosis in PE(2)

AFIB
Low saturation

200

wells modified criteria 3 points(2)

3 points si DVT
si aucun autre dx ne peut etre retenu

201

wells modified criteria 1,5 points(3)

immobilisation
recent surgery
tachycardy >100

202

Wells modified criteria 1 point (2)

Ca
Hemoptysis

203

Next step in Wells modified >4(3)

Ct angiography of chest
si positif heparin
si negatif exlude PE

204

Next step if wells criteria<4

Ddimer measure
>500 ng--->ct scan chest
<500 exclude PE

205

epidemio of blastomycosis(3)

ohio
missisipi
great lakes

206

clue for blastomycosis

Lung infection
ulcerative skin lesion
bone osteolytic lesion

207

normal PH in blood

7,35-7,45

208

normal PaO2

75-105

209

Normal PaCO2

33-45

210

Lung exam during food allergy

stridor

211

Physiopatho of stridor in food allergy

laryngeal edema

212

Why diaphram is flat in late COPD

Hyperinflation

213

Consequence of diaphram flattening

increase work of breathing

214

What are increased in COPD(2)

-residual lung volume
total lung capacity

215

Why residual lung volume is increased in COPD

because air is trapped in lungs

216

Why total lung capacity is increased in COPD

because of hyperinflation

217

Mobile cavity mass on chest xray and hemoptysis

aspergiloma

218

Rx of anaphylactic shock

IM epinephrine

219

Common cause of anaphylaxis in the US

bee stung

220

20 years later pateient treated for hodgkin lymphoma by radiation develops lung mass Dx?

secondary malignancy induced by radiation

221

other complication of radiation used during Hogkin lymphoma treatment(2)

Acute leukemia
Non hogkin lymphoma

222

First cause of daytime sleepiness in the US

sleep apnea

223

complication of sleep apnea

Erythrocytosis
HTA pulmonaire
right ventricular failure

224

Most common secodary ca in radiation during H Lymphoma(5)

Lung
breast
bone
thyroid
digestive

225

Risk factor for sleep apnea(3)

obesity
tonsillar hypertrophy
hypothyroidism

226

Asbestosis and occupation(7)

Mining
plumbing
construction worker
shipyard
insulation worker
carpenter
Plastic and rubber industry

227

when worker will develop asbestosis

>20 years after exposure

228

Key pulmonary findings of asbestosis

pleural plaques

229

what's the risk of asbestosis(2)

Malignant mesothelioma
Bronchogenic carcinoma

230

chest xray findings in asbestosis

Pleural plaques
intersticial abnormalities

231

Spirometry in asbestosis(2)

Normal FEV%
Low DLCO

232

Mainstay of rx of acute COPD exacerbation(2)

Albuterol nebulizer
corticosteroid

233

Cause of ARDS(5)

Sepsis
acute pancreatitis
severe bleeding
burns
toxic ingestion

234

Cause of digital clubbing

Lung cancer
cystic fibrosis

235

Mainstay of rx of ARDS

Mechanical ventilation with low tidal volume and PEEP

236

role of PEEP

preventing alveolar collapse

237

PEEP in ARDS

15 mm de h20

238

respiratory failure in setting of infection

ARDS

239

Chest trauma and respiratory failure DX

ARDS

240

syptomatic rx of COPD(2)

Anti muscarinic
SABA

241

Cause of Pancoast tumor

Sulcus superior tumor

242

Physical exam in Pneumonia with no airway obstruction(2)

Dullness to percussion
Bonchial type sound(louder expiratory component or louder breath sounds)

243

Physical exam in pneumonia with airway obstruction(2)

Dulness to percussion
decrease breath sound

244

recurrent pnemonia in dementia patient

aspiration

245

cause of aspiration in dementia patient or inconsciousness state

impaired epiglottic reflexe

246

% risk of cancer in smoker with asbestosis

59 fold risk

247

Localisation of pleural plaques in chest xray and morphology of plaques(2)

on diaphram coupole
needle shape

248

3 most common causes of chronic cough

post nasal drip
GERD
asthma

249

what's the primary long term intervention in asthma management

inhaled corticosteroid

250

what's the primary long term intervention in COPD management

Anticholinergic(ipratopium)

251

How will be urine PH in respiratory alkalosis

HIGH

252

why Urin PH is high in respiratory alkalosis(3)

renal compensation
decrease reabsorbtion of HCO3
Increase reabsorption of H+

253

Pneumonie in immunocompromised patient

PCP

254

chest Xray in PCP

Diffuse intersticial infiltrates

255

V/q scan in PE(2)

perfusion defect
without ventilation defect

256

High PEEP complication(3)

tension pneumothorax
Alveolar damage
hypotension

257

Patient on mechanical ventilation develops absence of breath sound unilaterally

tension pneumothorax

258

Quid of idiopathic pulmonary fibrosis

deposition of collagen in perialveolar tissues

259

A-a gradient in Idiopathic pulmonary fibrosis(2)

High
diffusion problem

260

Most common infection causing intersticial lung disease(3)

TB
viral pneumonia
Fungal infection

261

Most common vasculitis involved in intersticial lung disease

Wegener

262

Most common occupationnal disorder causing intersticial lung disease(2)

silicose
Hypersensitivity pneumonitis

263

most common connective tissue causing intersticial lung disease(2)

SLE
Sclerodema

264

other causes of Intersticial lung disease(3)

idipathic pulmonary fibrosis
Intersticial pneumonia
cryptogenic organising pneumonia

265

Chest xray of interticial lung disease(2)

reticular
nodular opacities