Pulmonology Flashcards
(217 cards)
1
Q
Which pneumoconiosis has diffuse infiltrates and hilar lymphadenopathy?
A
Berylliosis
2
Q
Which pneumoconiosis has nodular opacities in the upper lung fields on chest X-ray?
A
Black lung from coal mining
3
Q
Which pneumoconiosis has egg shell calcification on chest X-ray?
A
Silicosis
4
Q
Lofgren’s syndrome may present like sarcoid. What major difference separates these diseases?
A
Lofgren’s syndrome is short term and spontaneously resolves - Sarcoid is chronic
5
Q
A DVT in what location is the most common source of pulmonary embolism?
A
Lower extremity above the knee
6
Q
What disorder should be considered in a young patient (20-30 years old) with severe emphysema?
A
Alpha 1 antitrypsin deficiency
7
Q
What medication must all asthma patients have regardless of the severity of their disease?
A
All asthma patients must have a short acting beta agonist (albuterol) as a rescue medication
8
Q
What should be considered with a diffuse ground glass appearance and no pulmonary nodules on chest X-ray?
A
Infiltrative lung disease
9
Q
What should be considered with a localized ground glass appearance and a pulmonary nodule on chest X-ray?
A
Lung cancer
10
Q
What should be considered in a patient with pneumonia who was exposed to bird or bat droppings in the Mississippi to the Ohio river area?
A
Histoplasma capsulatum
11
Q
List three classes of antibiotics which may be used for Klebsiella pneumonia
A
Cephalosporins - Aminoglycosides - Fluoroquinolones
12
Q
What two antibiotic classes may be considered to treat legionella pneumonia?
A
Macrolides and fluoroquinolones
13
Q
What other bacterial pneumonia are patients who have pseudomonas pneumonia prone to get?
A
S. aureus pneumonia shares similar risk factors specifically nosocomial
14
Q
What are the combinations of antibiotics which may be used for pseudomonas pneumonia?
A
Anti pseudomonal beta-lactam PLUS an anti- pseudomonal quinolone or aminoglycoside - Anti pseudomonal quinolone PLUS an aminoglycoside
15
Q
At least how many antibiotics should be used at the same time for pseudomonas pneumonia?
A
Always treat with at least two antibiotics
16
Q
What are the antibiotics which may be used for MRSA pneumonia?
A
Vancomycin or linezolid + Levofloxacin or ciprofloxacin
17
Q
List the antibiotics classes for inpatient ICU treatment in a patient with a pneumonia caused by Strep pneumoniae or non MRSA staph.
A
Beta-lactam + macrolide or fluoroquinolone
18
Q
List the antibiotics classes for inpatient non ICU treatment in a patient with a pneumonia caused by Strep pneumoniae or non MRSA staph.
A
Beta-lactam PLUS a macrolide
19
Q
List the antibiotics classes for outpatient treatment in a patient with comorbidities and a pneumonia caused by Strep pneumoniae or non MRSA staph.
A
Fluoroquinolone doxycycline or macrolide PLUS a beta lactam
20
Q
List the antibiotics classes for outpatient treatment in a healthy patient with pneumonia caused by S. pneumoniae or non MRSA staph.
A
Fluoroquinolone doxycycline or macrolide
21
Q
What must be considered with a young patient who has been exposed to rodent feces and has a “CHF like” presentation?
A
Hanta virus
22
Q
What situations predispose an infant to developing type 2 IRDS?
A
C-section or diabetic mother
23
Q
What type of Infant respiratory distress syndrome (IRDS) occurs in a near or full term infant?
A
Type 2 IRDS
24
Q
What type of Infant respiratory distress syndrome (IRDS) occurs in a pre-term infant? (usually born before 30 weeks)
A
Type 1 IRDS
25
Incomplete lung development due to congenital malformation?
Pulmonary hypoplasia
26
Long term inflammation and eventual scarring after episodes of severe respiratory distress and mechanical ventilation?
Broncho-pulmonary dysplasia
27
What antibiotic is most strongly associated with hypertrophic pyloric stenosis?
Clarithromycin (Note all macrolides can cause hypertrophic pyloric stenosis)
28
What is laryngotracheo-bronchitis also known as?
Croup
29
Where does the cancer associated with asbestosis tend to locate in the lung?
Mesothelioma locates to the pleural lining at the base of the lung
30
What is the Dx? Looks like CHF on chest X-ray but pulmonary wedge pressure in normal.
Acute respiratory distress syndrome (ARDS)
31
What is the Dx? Nuclear plant worker with shortness of breath?
Berylliosis
32
What lab is elevated in sarcoidosis?
Angiotensin converting enzyme levels 4x higher than normal - Elevated ESR
33
Bilateral hilar adenopathy?
Sarcoidosis
34
What is the most likely Dx? 1 week post partum has syncopal episode and is now tachycardic and short of breath.
Pulmonary embolism
35
What is the treatment for sarcoidosis?
Steroids
36
Class 5 pulmonary HTN cause?
Sarcoidosis
37
Class 4 pulmonary HTN cause?
Pulmonary embolism
38
Class 3 pulmonary HTN cause?
COPD
39
Class 2 pulmonary HTN causes?
Mitral stenosis - Aortic stenosis -Left ventricular hypertrophy - Left heart failure
40
Class 1 pulmonary HTN causes?
Ventricular septal defect -Atrial septal defect -Patent ductus arteriosus
41
Patients with Virchows triad have an increased risk for what pulmonary disorder?
Pulmonary embolism
42
Virchow triad?
Stasis - Hypercoagulable - Trauma
43
Right heart failure caused by long term COPD history?
Cor pulmonale
44
Is chronic bronchitis or emphysema associated with an elevated hemoglobin?
Chronic bronchitis
45
Pink Puffer?
Emphysema
46
Blue bloater?
Chronic bronchitis
47
Only medication that improves morbidity and mortality in COPD?
Oxygen
48
Agent of choice for COPD exacerbation?
Ipratropium
49
First line agent of choice for acute asthma attack?
Albuterol
50
What is the likely Dx? Solitary pulmonary nodule of 2 cm in size found on chest X-ray incidentally
Lung cancer
51
What is a bloody pleural effusion concerning for?
Malignancy
52
What criteria determine transudate from exudate?
Light's criteria
53
What is the most common type of lung cancer in smokers?
Squamous cell
54
Most aggressive lung cancer?
Small cell
55
What is the most common type of lung cancer in non-smokers?
Adenocarcinoma
56
What does a positive whisper pectoriloquy represent?
Pulmonary consolidation
57
How many millimeters of induration is considered positive when reading a PPD result in an HIV positive patient?
> 5 mm
58
What is the most likely Dx? Smoker with hemoptysis weight loss and new DVT?
Lung cancer
59
A "cinnamon breath smell" is associated with what pulmonary infection?"
Tuberculosis
60
Red orange urine occurs with which tuberculosis medication?
Rifampin
61
Ethambutol side effect?
Optic neuritis
62
What is given to prevent neuropathy in a patient receiving isoniazid (INH) therapy?
B6 (pyridoxine)
63
Where will older pulmonary lesions from tuberculosis be found?
Lower lobes
64
Where will newer pulmonary lesions from tuberculosis be found?
Upper lobe cavitary lesion
65
What lab is elevated in PJP pneumonia?
LDH
66
What is the most likely Dx? Young IV drug user with fever severe hypoxia and diffuse infiltrates on X-ray?
PJP pneumonia
67
What pneumonia is associated with air conditioning vents and spas?
Legionella
68
Most common ventilator associated bacterial infection?
Pseudomonas
69
Bacterial pneumonia which occurs in a young patient after flu is most likely caused by what organism?
Staph aureus
70
Rusty sputum?
Strep pneumoniae pneumonia
71
What pneumonia associated with diarrhea and low sodium levels?
Legionella
72
Flu + aspirin in children can cause what condition?
Reye syndrome
73
Flu can be treated with oseltamivir within how many hours of onset of symptoms?
48 hours
74
Wet cough and foul smelling sputum in a child?
Bronchiectasis
75
First episode of wheezing in child?
Bronchiolitis
76
Chronic aspiration in kids leads to plate like atelectasis on X-ray and what condition?
Bronchiectasis
77
Salty baby?
Cystic fibrosis
78
Treatment for Berylliosis?
Chronic steroids
79
How high does pulmonary pressure need to be to diagnose pulmonary HTN?
25 mmHg at rest
80
What cancer is a patient with asbestos exposure at increased risk for.
Mesothelioma
81
What is the Dx? Patient worked with insulation. Chest X-ray shows thickened pleura and basilar lesions.
Asbestosis
82
What is the Dx? Pulmonary fibrosis in a patient who was a sandblaster. Chest X-ray shows egg shell calcifications.
Silicosis
83
What is the Dx? Chronic dry cough dyspnea fatigue and clubbing. Chest X-ray shows fibrosis and CT chest shows honeycombing.
Idiopathic pulmonary fibrosis
84
Does patient with sarcoidosis tend to have high or low serum calcium levels?
High (hypercalcemia)
85
What is the Dx? Chest X-ray shows bilateral hilar adenopathy and non caseating granulomas?
Sarcoidosis
86
Gold standard test used to diagnose Pulmonary HTN?
Right heart cardiac catheterization
87
Treatment for acute respiratory distress syndrome (ARDS)?
Supportive care/ventilatory support - Find and treat underlying cause
88
Right sided heart failure due to pulmonary HTN?
Cor Pulmonale
89
Initial Treatment for pulmonary embolism?
Heparin
90
What is the Dx? Young healthy female smoker on oral contraception with acute chest pain and SOB?
Pulmonary embolus
91
Initial treatment for all pneumothorax patients?
100% oxygen
92
What is the Dx? Thin young healthy male runner who develops acute onset of chest pain and dyspnea?
Spontaneous pneumothorax
93
What are the chest X-ray findings with acute respiratory distress syndrome (ARDS)?
Bilateral infiltrates/white out (may look like CHF)
94
What type of COPD is associated with hyperventilation flat diaphragm on CXR and a normal Hgb/HCT?
Emphysema
95
What are the two types of COPD?
Chronic bronchitis and emphysema
96
Most common cause of acute bronchitis?
Viral
97
Types of asthma classifications?
Intermittent - Mild persistent - Moderate persistent - Severe persistent
98
In a patients with asthma the FEV1 to FVC will be
FEV1 to FVC < 75% = diagnosis of asthma in pt with chronic wheezing/cough
99
In a patient with malignancy is the pleural effusion transudative or exudative?
Exudative
100
In a patient with CHF is the pleural effusion transudative or exudative?
Transudative
101
What conditions is a right sided pleural effusion often associated with?
CHF or cirrhosis
102
What is the main treatment for a pleural effusion?
Thoracentesis
103
Name 3 types of non small cell (bronchogenic) cancers.
Squamous cell - Adenocarcinoma - Large cell
104
What is a Hallmark sign seen with carcinoid tumors?
Cutaneous Flushing
105
Name the commonly used meds to treat active tuberculosis infection.
RIPE: Rifampin - isoniazid (INH) - Pyrazinamide - Ethambutol
106
Which vitamin should be given along with isoniazid (INH) therapy?
Vitamin B6 (pyridoxine)
107
What is the recommended treatment for a healthcare worker with a first time positive PPD?
Isoniazid (INH) for 6 months
108
What is the sputum test for tuberculosis?
AFB smear and cultures
109
What is the Dx? Recent international travel now with fever night sweats cough hemoptysis SOB and weight loss.
Tuberculosis
110
Treatment for PJC pneumonia?
Trimethoprim-sulfamethoxazole or pentamidine
111
Pneumonia seen in HIV patients with low CD4 counts?
PJC= Pneumocystis jiroveci (formerly called PCP)
112
Treatment for Histoplasma pneumonia?
Amphotericin B
113
Pneumonia associated with inhalation of bat or bird droppings?
Histoplasma
114
Treatment for immunocompromised patient with fungal pneumonia?
Itraconazole or fluconazole
115
Chest X-ray shows RUL abscess. Most likely organism?
Klebsiella (often associated with aspiration)
116
Pt with suspected pneumonia has “currant jelly colored” sputum. Most likely organism?
Klebsiella
117
What organism os associated with positive cold agglutinins?
Mycoplasma
118
What is the preferred treatment for atypical or “walking pneumonia”?
Macrolides
119
Name 2 antibiotics you can use to treat Legionella.
Macrolide or Fluoroquinolone
120
Chest X-ray shows lobar pneumonia. Most likely organism?
Strep pneumoniae
121
What medications are recommended for MRSA pneumonia?
Vancomycin or linezolid + levofloxacin or ciprofloxacin
122
Organism causing pneumonia spread by contaminated water?
Legionella pneumonia
123
Pneumonia often related to post intubation, ventilator or hospital?
Pseudomonas pneumonia
124
Pt with suspected pneumonia/URI has salmon/pink colored sputum. Most likely organism?
Staph aureus
125
Pt with suspected pneumonia/URI has rusty colored sputum. Most likely organism?
Strep pneumoniae
126
Which virus can lead to pneumonia after URI and also often causes diarrheal illness/GI symptoms?
Adenovirus
127
Virus causing pneumonia after exposure to rodent feces (Western states)?
Hanta Virus
128
Most common cause of viral pneumonia in adults?
Influenza
129
Name the organisms that cause typical pneumonia
Strep pneumoniae - Staph aureus - Group A Strep
130
Organisms responsible for atypical pneumonia?
Mycoplasma pneumoniae- Chlamydia pneumoniae- Legionella
131
Organism usually causing pneumonia after aspiration?
Klebsiella
132
Should normal percussion over the lung fields sound dull or resonant?
Resonant
133
What does positive egophony on auscultation in a patient with pneumonia mean?
When listening over the area of consolidation, patient will say “eee” and it sounds like “aaa”
134
What is the Dx? Previously healthy patient with abrupt onset of fever headache malaise occurring in the winter months.
Influenza
135
What condition is bronchiectasis often associated with?
Cystic fibrosis
136
Child with chronic persistent productive cough foul smelling sputum?
Bronchiectasis
137
Treatment for infant with Hyaline membrane disease (AKA: infant respiratory distress syndrome - IRDS)?
Respiratory support - Ventilatory support - Exogenous surfactant
138
Treatment to prevent Hyaline membrane disease in the newborn?
Give antenatal corticosteroids
139
What is the cause of hyaline membrane disease in infants?
Surfactant deficiency
140
What childhood vaccine protects children from pertussis?
DTaP
141
Preferred treatment for pertussis?
Clarithromycin or azithromycin
142
Organism that causes whooping cough?
Bordetella pertussis
143
Steeple sign on a frontal chest X-ray showing tracheal narrowing?
Croup
144
Virus that causes croup?
Parainfluenza virus type 1
145
Child has barking cough and stridor?
Croup
146
What is the Dx? Child presents with dysphagia, drooling and respiratory distress. Lateral neck X-ray shows “thumbprint sign”.
Acute Epiglottitis
147
How is RSV diagnosed?
Analysis/culture of Respiratory secretions
148
Most common cause of acute bronchiolitis in an infant?
Respiratory syncytial virus (RSV)
149
What dermatologic condition is associated with sarcoidosis?
Erythema nodosum
150
A 30 year old female presents with a dry cough. Her chest X-ray shows bilateral hilar adenopathy with non-caseating granulomas. What is your suspected diagnosis?
Sarcoidosis
151
How will idiopathic pulmonary fibrosis present on CT scan?
Diffuse patchy fibrosis with pleural-based honeycombing
152
Which of the pneumoconiosis have an increased risk of contracting tuberculosis?
Silicosis
153
What is the diagnosis if a patient presents with pulmonary fibrosis and an extensive history and workup does not reveal a cause?
Idiopathic pulmonary fibrosis
154
Which pneumoconiosis has an eggshell calcification look on chest x-ray?
Silicosis
155
`What pneumoconiosis presents like sarcoidosis and is due to a work environment in ceramics, nuclear power or as a tool maker?
Berylliosis
156
Where does mesothelioma appear in the lung?
It appears at the pleural base
157
What lung cancer is associated with asbestosis?
Mesothelioma
158
What is a normal blood pressure in the lungs?
15/5 mmHg - Compared to systemic arterial blood pressure of 120/80
159
What two classes of pulmonary hypertension are treated with warfarin?
Group 1 and group 4
160
What medication is the mainstay of long-term treatment for group 4 pulmonary hypertension or pulmonary embolus?
Warfarin
161
What is the recommended treatment for preventing pulmonary hypertension due to severe Mitral Stenosis?
Early surgical repair or replacement of the valve
162
A 42 year old female develops severe pulmonary hypertension due to an unrepaired ASD and subsequent right heart failure. What syndrome has she acquired?
Cor pulmonale - Since it is due to a congenital unrepaired ASD it is called Eisenmenger syndrome
163
Acute respiratory distress syndrome will have what x-ray findings?
Findings similar to congestive heart failure due to the leaky capillaries but the patient is not volume overloaded
164
A patient in a car accident presents with a tension pneumothorax. Which way will the trachea deviate?
Toward the good lung
165
What is the diagnostic test of choice to evaluate cor pulmonale?
Right heart catheterization
166
What is Cor Pulmonale?
Right heart failure due to severe pulmonary hypertension
167
What is the diagnostic modality of choice for suspected pulmonary embolus in a pregnant woman?
VQ scan
168
What treatment of choice do all sizes of pneumothorax have in common?
Oxygen
169
Tall thin males, patients with cystic fibrosis and emphysema patients all have what potential complication in common?
Spontaneous pneumothorax
170
What is the most common cause of acute respiratory distress syndrome?
Sepsis
171
Can salmeterol ,a long acting beta agonist, be used as solo therapy in a patient with asthma?
Never - At minimum, a short acting beta agonist is required is required as a rescue inhaler. LABAs may only be used in combination with inhaled corticosteroids
172
Deficiency in what enzyme can lead to early emphysema-like condition in young non-smokers?
Alpha-1 antitrypsin deficiency
173
Which of the COPD disease states will be found to have an elevated hematocrit on CBC, due to chronic hypoxic state
Chronic bronchitis
174
A child has daily asthma attacks and two to three night time attacks per week. What is the recommended addition to his albuterol inhaler therapy?
Inhaled corticosteroids
175
A patient presents to your office afebrile with a nonproductive cough for five days. What is the suspected disease process?
Bronchitis
176
In addition to steroids, albuterol plus ipratropium treatment and oxygen, what additional medication should be given to all acute COPD exacerbations?
Antibiotics
177
Which COPD is considered reversible?
Asthma is considered reversible
178
What are the three types of COPD?
Asthma - Chronic bronchitis - Emphysema
179
What is the only medicine that will improve mortality and morbidity of a COPD patient?
Oxygen
180
What is the preferred inhaled agent for emphysema?
Ipratropium bromide inhaler
181
What is the preferred inhaled agent for an acute asthma exacerbation?
Albuterol inhaler
182
Which of the lung cancers is nonsurgical and is only treated with chemotherapy?
Small cell carcinoma
183
When performing a lung exam, you have the patient whisper and the sound is heard clearly. What do you suspect?
Consolidation
184
A patient undergoes thoracentesis for a large right pleural effusion. The fluid is noted to be bloody. What is the suspected etiology?
Malignancy or pulmonary infarct
185
A 60 year smoker presents to your office with hemoptysis. On chest X-ray you see a large central solitary tumor. What type of lung cancer do you suspect?
Squamous cell carcinoma
186
What is the most common cause of a transudative pleural effusion?
Congestive heart failure
187
Which lung cancer is commonly found incidentally in non-smokers in the peripheral lung fields?
Adenocarcinoma
188
What are two types of lung cancer commonly associated with smoking?
Squamous cell carcinoma and small cell carcinoma
189
What type of cancer is suspected in a patient who has cutaneous flushing, diarrhea, wheezing and low blood pressure?
Carcinoid tumor with metastasis
190
You note an isolated 1 cm pulmonary nodule with a ground glass appearance on a chest X-ray. What do you suspect?
Lung cancer
191
What is considered a positive PPD result in patient with HIV?
5 mm or greater (Note: measure the wheal not the redness)
192
What vitamin supplement can help prevent peripheral neuropathy in a patient taking isoniazid?
Pyridoxine (Vitamin B6)
193
Which tuberculosis medication can cause red orange urine?
Rifampin
194
Which tuberculosis medication can cause optic neuritis?
Ethambutol
195
Which tuberculosis medication can lead to peripheral neuropathy?
Isoniazid (INH)
196
What is the recommended treatment for PJP if the patient is allergic to sulfa drugs?
Pentamidine
197
Which of the fungal pneumonias is most likely to lead to meningitis in an immunocompromised patient?
Cryptococcus
198
What medication is used to treat Histoplasma capsulatum pneumonia?
Amphotericin B
199
While living in the Mississippi River Valley, you treat a 15 year old boy with a cough. Chest X-ray reveals bilateral hilar adenopathy. What is the suspected etiology?
Histoplasma capsulatum
200
Hantavirus is acquired through what vector?
Dried rodent feces
201
What pneumonia is associated with positive cold agglutinins?
Mycoplasma pneumonia (aka walking pneumonia)
202
Aspiration pneumonia in alcoholics and nursing home patients is most commonly caused by what organism?
Klebsiella pneumonia
203
A patient in the ICU on a ventilator develops hypotension and rapidly goes into septic shock. What is the suspected etiology?
Pseudomonas aeruginosa
204
Which pneumonia is associated with diarrhea, very high fevers, and hyponatremia?
Legionella pneumonia
205
An 18 year old post flu returns to your office with fever and productive sputum. Chest x-ray demonstrates a large infiltrate. What is the suspected etiology?
Staphylococcus aureus
206
An outbreak of flu like symptoms associated with nausea and diarrhea occurs in a group of military recruits in boot camp. You suspect what etiology?
Adenovirus
207
What pneumonia is commonly associated with patients that are post splenectomy?
Streptococcus pneumonia
208
What is the most common cause of viral pneumonia?
Influenza
209
What x-ray findings are expected in a patient with cystic fibrosis?
Dilated thickened airways or plate like atelectasis
210
Bronchiectasis is commonly associated with what genetic disease?
Cystic fibrosis
211
A “steeple sign” seen on chest x-ray is associated with what condition?
Croup
212
A premature delivery of an infant before 30 weeks gestation is treated with corticosteroids and exogenous surfactant to prevent what complication?
Infant respiratory distress syndrome
213
A child presents to the hospital with pertussis and is placed on a macrolide antibiotic. What is the gold standard testing used to diagnose the pertussis?
Nasopharyngeal secretions remains the current
214
A school age child presents with a cough and is suspected of having croup. What is the etiology of the disease?
Parainfluenza virus
215
What is the most likely causative organism in a patient with epiglottitis?
Haemophilus influenza type B
216
A child in the ER is in acute respiratory distress, he is leaning forward and drooling. What is the expected finding on the lateral x-ray of the neck?
Thumb print sign
217
A 14 month old has a runny nose, fever and wheezing. She states she thought it was a cold but now the child is short of breath. What is the suspected etiology?
Respiratory Syncytial Virus (RSV)
