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Flashcards in Pulmonology Deck (168)
1

SIADH, ACTH, LE syndromes

Small cell --> chemo + rad

2

Small round blue cells

Small cell

3

Smoker

Squamous > small

4

Non-small cell lung CA mets

Brain (gray/white) - surgical excision

5

Pleomorphic giant cells w/ leukocyte fragments

Large cell

6

Keratin pearls & intercellular bridges, CENTRAL

SCC

7

PTHrP

SCC

8

Type II pneumocytes

Adenocarcinoma

9

Non-smoker or female

Adenocarcinoma

10

Peripheral

Adenocarcinoma

11

Psammoma bodies

Mesothelioma

12

Chromogranin

Carcinoid

13

Collar-button, polyp

Carcinoid

14

Shoulder pain, constricted pupil, ptosis, weak hand muscles, numbness

Pancoast tumor (non-small cell) --> XR

15

Clavicular LAD, (-) chest CT, metastatic SCC next step?

Panendoscopy (bronch, endo, laryngoscopy) to detect primary tumor

16

Coin lesion 1st step?

Obtain older XR

17

Initial lung CA work-up

CXR --> compare to old, sputum cytology
CT scan w/ liver --> determine malignancy risk --> CT, Bx or PET

18

Dx lung CA if not via cytology

Bronchoscopy + Bx
Percutaneous bx for peripheral or >2cm or likely malignant (better dx yield)

19

Operatability of lung CA

Central lesions = pneumonectomy w/ minimum 800ml FEV1

20

U/L earache, rhinorrhea of wheezing in a kid

Foreign body = endoscopy

21

Hemoptysis >600ml/d or 100/hr tx

Secure airway --> bronchoscopy of bleeding continues

22

>100% DLCO

Obstructive = Asthma
Normal spirometry = Pul hemorrhage, PCV

23

100% DLCO

Chronic bronchitis

24

<100% DLCO

Obstructive = Emphysema
Restrictive = sarcoid, HF, asbestosis, COPD
Normal spirometry = Anemia, PE, pul HTN

25

Obstructive lung disease PFTs

Dec FEV1, FVC
FEV1/FVC <70%
V/Q mismatch
INC RV

Low DLCO = emphysema
Normal DLCO = chronic bronchitis
Inc DLCO = asthma

26

Restrictive lung disease PFTs

FEV1/FVC >70%
DEC VC, TLC
FRC is INC in ankylosing spondylitis

Low DLCO = asbestos, sarcoid, HF
Normal DLCO = MSK
Inc DLCO = morbid obesity

27

Chronic back pain, FEV1/FVC 95%, FRC 110%, FVC 75%

Ankylosing spondylitis --> restricted chest wall motion

28

Asthma >2x/wk, 3-4 nightime awakening/mo, FEV1 >80%

Mild persistent = Albuterol + corticosteroid

29

Daily Asthma, >1 awakening/wk, FEV1 60-80%

Moderate = Short + long B2 (salmeterol) + steroid

30

Many times daily asthma, daily nightime awakening, FEV1 <60%

Severe = Short + long B2 + inhaled + oral steroid

31

Recurrent RTIs, copious mucopurulent sputum. "tram-track" or "ring sign"

Bronchiectasis

32

Chronic productive cough w/ many Abx courses, massive hemoptysis

Bronchiectasis --> CT showing thick bronchial walls

33

Smoker, chronic productive cough, hemoptysis

Chronic bronchitis

34

Dyspnea, wheezing, boggy nose, cough, 40 y/o, Inc FEV1% post-bronchodilator

Asthma --> inhaled steroid preferred tx

35

Asbestosis malignancy & #1 cause of SVC syndrome

Bronchogenic CA

36

Methacholine % drop to dx asthma

20%

37

Dx eval for asthma

Peak flow w/ B-agonist, CXR, PFTs,

38

Alternative asthma therapy to inhaled steroids

Leukotriene antagonists - montelukast, zafrilukast

39

Tx for exercise-induced asthma, aspirin sensitive asthma

LT inhibitors (also albuterol for exercise)

40

Indicator of severe attack

Normal PCO2, speech difficulty, altered senses, 'silent lung'

41

Naproxen use, recurrent nasal discharge/congestion, bland taste --> wheezing

Aspirin exacerbated respiratory disease = NASAL POLYP

42

Nosebleed during pregnancy

Pyogenic granuloma

43

Wheezing in cold air, exercise tx

Exercise induced asthma = B-agonist 20min b4

44

Apnea >15-20s + brady or dec O2

Apnea of prematurity = #1 mixed central & obstructive

45

B/L perihilar streaking, tachypnea

Transient tachy of newborn

46

GROUND GLASS CXR, air bronchogram, L:S >2:1, pre-me

RDS --> O2 and CPAP

47

Risks for RDS

Pre-me, DM, c-section, asphyxia

48

Severe cyanosis, resp distress, clear lungs, DEC pul vasculature markings

Persistent pulm HTN

49

Subcutaneous emphysema next step?

CXR to r/o pneumothorax

50

Cough, congestion --> wheezing, 89%, no better w/ albuterol, ipratropium, steroids, or inc CO2

Status asthmaticus --> intubation

51

Stridor WORSE WHEN SUPINE or crying, improves when upright, omega-shaped epiglottis

Laryngomalacia --> laryngoscopy & reassurance

52

6mo --> 6y/o, barky cough, fever, rhinorrhea, congestion, steeple sign + HYPOXIA (vs. epiglottitis)

Croup = parainfluenza--> raceamic epi

53

Drooling in tripod position, muffled voice, won't lie flat, fever, thumb-print sign

Epiglottitis --> INTUBATE + Ceftriaxone

54

Malaise, low fever, cough --> worse, cough to vomit, stridor, subconjunctival hemorrhages, "butterfly XR"

Pertussis --> culture + erythromycin

55

Household contacts tx/prophylaxis of pertussis infected child

Erythromycin 14d, even if immunized

56

<1 y/o, stridor IMPROVES W/ NECK EXTENSION, assoc cardiac abn (VSD, ASD…), difficulty feeding

Vascular rings

57

Wheezing w/ runny nose, dry cough, low grade fever

Bronchiolitis/RSV --> risk for asthma

58

Fever, odynophagia, CANT extend neck, muffled voice, can't open jaw, widened pre-vertebral space

Retropharyngeal abscess --> CT

59

Causes of colds

Rhinovirus, parainfluenza, RSV, corona

60

Low fever, rhinorrhea, cough, sore throat

Hydration - exclude bacterial if >10d

61

#1 sinusitis bug

Strep pneumo

62

Rhinorrhea + cough >10d, HA, facial pain

Sinutitis --> Augmentin or cefalexin 10-14d

63

Congestion --> worsened 5ds, or fever >102, purulent discharge >3d

Bacterial sinusitis --> Augmentin

64

Causes of pharyngitis

Coxsackie, EBV, CMV, Strep, Diptheria

65

Fever, sore throat w/ exudates, palatal petechiae --> amoxicillin --> rash

EBV

66

Sore throat W/O rhinorrhea or cough, fever, rash, + painful LNs

Strep pharyngitis --> PCN V or IM benzathine PCN

67

Sore throat, conjunctivitis, rhinorrhea

Viral pharyngitis

68

U/L parotid enlargement

Bacterial - SA, pyogenes, TB

69

Recurrent sinusitis + abx, PNA, nasal polyps, clubbing, snoring

CF --> Quant pilocarpine iontophoresis

70

CF + influenza or virus --> RDS, wheezing, crackles Tx

IV Vanco - SA > PA until 20 y/o

71

#1 acute otitis media bug

Strep pneumo >>Hib, moraxella

72

Otitis media complications

Mastoiditis, Meningitis, hearing loss, perforation

73

When to place tubes on ears

>3 in 6months of >4 in 12 mo w/ abx treatment

74

Middle ear effusion + inflammation (bulging, fever)

Acute otitis media

75

Middle ear effusion - inflammation

Otitis media w/ effusion

76

Blisters on TM

Bullous myringitis

77

Pain, unable to view TM

Cerumen impaction

78

Purple/red TM +/- bulging

Hemotympanum

79

Pain w/ traction, erythematous +/- otorrhea

Otitis externa

80

Chronic otitis media, Abx + wks of drainage, granulation, skin debris, hearing loss

Cholesteatoma

81

Most reliable method for middle ear fluid

Pneumatic otoscopy

82

Inc RA (>10), RV, Pul artery pressures (>40), Inc CI, normal PCWP, SVR

PE ---> resp alkalosis, inc A-a gradient

83

Hypoxemia, acute dyspnea, tachpynea, alkalosis

PE --> RV dilation

84

Pleuritic CP, tachypnea, hemoptysis, tachy, low fever, wedge-shaped CT

PE - GI illness --> dehydration --> hemoconcentration = PE

85

Post-op, JVD, new RBBB, hypotension

Massive PE --> cardiogenic shock

86

PE/DVT possible but unlikely 1st step

D-dimer --> >500 --> CT angio

87

1st step in new, unstable clot

Heparin (stabilizes 5d whiel warfarin reaches INR >2) + Warfarin (6mo)

88

Indication for IVC filter

Recurrent or extending while fully anti-coagulated

89

Pulmonary fibrosis findings

Clubbing, cough, INC A-a gradient, dec volume, honeycomb

90

Bird poop, reticulonodular opacities, oral ulcers, pancytopenia, inc LDH

Histoplasmosis --> URINE Ag --> amphotericin B (severe) or oral itraconazole

91

Pleural glucose <30

Empyema or Rheumatic effusion

92

Pulmonary edema w/ PCWP >18 etiology

Cardiogenic - impaired LVF

93

Pulmonary edema w/ PCWP <18 etiology

Non-cardiac = ARDS

94

Effusion w/ dec protein & LDH

Transudative
- CHF, atelectasis, nephrotic, cirrhosis
- Inc capillary pressure
- Dec oncotic pressure

95

Effusion cloudy, protein:serum >0.5, LDH>0.6 or upper 2/3

Exudative
- Malignancy, infection, trauma, PNA, PE, CT disease
- Inc permeability
- Dec lymphatic flow

96

Progressive dyspnea, cough, young AA female, uveitis, diffuse interstitial infiltrate, erythema nodosum or maculopapular eruptions

Sarcoidosis

97

B/L Hilar LA, alpha-1 hydroxylase, hyperCa/calciuria, ACE, stellate/asteroid

Sarcoidosis
- NON-caseating granuloma
- Steroids

98

Cirrhosis, emphysema at young age

a-1-anti-trypsin

99

Peripheral, pneumonia-like consolidation

Brochioalveolar

100

Pleural plaques, plumber, roofer, dec diffusion capacity, dec pul compliance, RV

Asbestosis --> BRONCHOGENIC carcinoma

101

"Egg sheel" hilar LNs

Silicosis --> lung cancer, TB

102

Only pneumoconiosis in Lower lung

Asbestosis

103

Diseases assoc w/ alveolar/pulmonary hemorrhage

Goodpasture, Churg-strauss, Behcet, anti-phospholipid Ab

104

New clubbing in COPD

Malignancy

105

COPD, Widespread B/L wheezes, PO2 80% acidosis

COPD exacerbation --> ipratropium, albuterol, levofloxacin, O2, methylprednisolone

106

Home O2 requirement

PO2 55mmHg, O2 <88%, nocturnal hypoxia

107

Only tx shown to dec mortality in COPD

Stop smoking, home O2

108

Changes in COPD --> inc work of breathing

Inc RV, TLC, recoil, flat diaphragm + inc compliance and dec flow rate

109

Preferred tx for COPD

Long-acting anti-cholinergic

110

Resp distress w/in minutes of transfusion

Anaphylaxis = recipient anti-IgA Abs

111

Resp distress w/in 6hrs of transfusion, pul edema

TRALI = donor anti-leukocyte Abs

112

Hypotension w/in minutes of transfusion in pt taking ACE-I

Primary hypotension rxn = bradykinin

113

Hampton's hump (wedge opacity on lung), pleural effusion

Pulmonary infarct

114

Hypoxemia mech in PNA, inflammation

V/Q mismatch --> Inc A-a gradient

115

Hypoxia mech in obesity/obstruction

Alveolar hypoventilation

116

MVA, bleeding, on vent, new lung infiltrates - how to improve oxygenation?

ARDS = Inc PEEP --> keeps alveoli open

117

Tidal volume on vents

6ml/kg

118

FEV1 in obstructive disease

<80%

119

FEV1/FVC in obstructive disease

<70%

120

FVC in obstructive disease

Normal or increased

121

Fever, chills, sore throat, muffled "hot potato" voice, uvula deviation, UL LAD

Tonsillitis --> peritonsillar abscess --> needle aspiration

122

Fixed upper airway obstruction flow-volume-loop

Dec flow rate (laryngeal edema)

123

Apnea definition

Breathing pause >10s + 90% drop in airflow

124

Conditions assoc w/ OSA

Obesity, AFIB, HTN, ACS, CHF, DM, Stroke, Pul HTN, Malampati 3-4, etOH, hypothyroid

125

OSA Hx

Nocturia, dec libido, morning HA, concentration, memory, driving, alertness

126

Dx of OSA

>15 events/hr on PSG OR >5/hr in pt w/ sx

127

Tx OSA

Weight loss, no etOH, no supine sleep position, + airway pressure

128

Unable to tolerate CPAP 1st step?

Add heated humidification --> diff mask --> oral appliance w/ sleep study

129

Hypoventilation at night w/o waking/normal respiration, obesity

Obesity hypoventilation syndrome

130

Consequences of obesity hypoventilation syndrome

Pul HTN, sec erythrocytosis, hypoxia, hyperCO2 --> inc bicarb, low CO2 compensation

131

Cruise ship, high fever, lobar consolidation, neutrophils w/o organisms

Legionella --> azithromycin or levofloxacin

132

Recurrent PNAs in same region next step?

CT - r/o CA, foreign body

133

RLL consolidation, worsening after abx, hypoNa, diarrhea

Legionella

134

COPD PNA

H. influenzae

135

Recent influenza PNA

SA

136

Pneumococcal vaccine mechanism

Polysaccharide --> B-cell response only, T-cell independent (no protein, unlike for kids)

137

#1 PNA in nursing homes

Strep pnuemo

138

PNA, no-organisms on gram stain, cold-agglutinin +

Mycoplasma pneumoniae

139

Young person, multiple enlarged LNs, low fever, weight loss

Lymphoma --> FNA, bx --> chemo

140

Old men, smoke, drink, rotten teeth, large neck LN

SCC of mucosae --> triple endoscopy/panendoscopy for primary tumor

141

Adults, sensory hearing loss in ONE ear, no shooting sports

Acoustic neuroma --> MRI

142

GRADUAL U/L facial paralysis

Facial nerve tumor --> Gadolinium MRI

143

Palpable mass near jaw angle, in front of ear

Parotid tumor --> FNA, superficial parotidectomy

144

Bad tooth infection, abscess + threat to airway

Lugwing angina (mouth abscess) --> I&D

145

SUDDEN U/L facial paralysis

Bell Palsy --> anti-virals + steroids

146

Trauma, normal facial nerve fxn --> paralysis later

Swelling --> resolves on its own

147

Paralysis of EOM + ethmoid or frontal sinusitis

Cavernous sinus thrombosis --> Abx, CT, and drainage emergently

148

Nasal obstruction + mass + epistaxis + bony erosions (vs. reactive polyp)

Juvenile angiofibroma

149

18 y/o epistaxis + septal perforation cause

Cocaine --> packing

150

Whistling noise s/p rhinoplasty

Nasal septal perforation

151

Blue when feeding, pink when crying

Choanal atresia --> oral airway

152

Ear drops

Atipyrene & Benzocaine

153

Eye drops

Tetracaine

154

Conjunctivitis and otitis abx

Omnicef (Hib)

155

Chronic sinusitis, nasal obstruction, epistaxis, Asian, smoker

Nasopharyngeal CA = EBV, nitrosamines, smoking

156

Factors affecting PO2

FiO2 and PEEP

157

Non-toxic FiO2 goal

50-60% --> PO2 of >60

158

RQ 0.7

Fat usage

159

RQ 0.8

Normal & or protein metabolism

160

RQ 1.0

Carbs are main nutrition --> excess CO2 = difficult weaning

161

RQ in sepsis

<1 d/t fat and protein breakdown

162

Acute U/L LAD, <5 y/o, non-toxic appearing, warm, tender, 3-6cm

Bacterial - SA > GAS

163

Acute U/L LAD, toxic appearing, animal contact

Tularemia,

164

Acute U/L LAD + periodontal disease bug

Peptostreptococcus

165

Chronic U/L LAD, non-tender, firm, skin violaceous bug

Non-TB mycobacteria

166

Immunocompromised pt (BM transplant) w/ fever, cough, hemoptysis + pulmonary nodule w/ "halo sign" or air crescent bug

Aspergillus

167

Asthma, pulmonary infiltrates, EOSINOPHILIA, P-ANCA

Churg-Strauss

168

Hypoxemia NOT responsive to O2, PCWP <18 + diffuse b/l pulmonary infiltrates

ARDS
- inc capillary permeability & massive intrapulmonary shunt
- #1 cause is SEPSIS