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Internal Medicine Mnemonics > Pulmonology > Flashcards

Flashcards in Pulmonology Deck (102):
1

Areas of gas exchange in the respiratory tract

Respiratory bronchiole

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4 basic lung volumes

Inspiratory Reserve Volume (IRV)

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Amount of air inhaled /exhaled with each normal breath

TV (~0.5L)

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Amount of air remaining in the lungs after full exhalation

RV (maintains oxygenation between breaths)

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Maximum amount of air that one can inhale/exhale

Vital Capacity (IRV + TV + ERV)

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Anatomic dead space volume

Area with no gas exchange from nose to terminal bronchiole (~150mL)

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Physiologic dead space volume

Anatomic dead space volume + alveolar dead space volume

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Alveolar Ventilation per minute

Respiratory Rate x (TV - Physiologic Dead Space Volume)

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Minute Respiratory Volume

TV x RR

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Stimulates central chemoreceptors in the medulla

Carbon Dioxide (as CSF +)

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Lung Zones

Zone 1 (no blood flow)

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Increase in the following factors would cause shift to the right of the O2-Hgb dissociation curve (unloading of O2 from Hgb)

Mnemonic: CADET face RIGHT: CO2, Acidosis, 2,3-DPG, Exercise, Temperature

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Increase in the following factors would cause shift to the left of the O2-Hgb dissociation curve (increased binding of O2 to Hgb)

Carbon monoxide, fetal hemoglobin

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Percentage of blood that gives up oxygen as it passes through the tissue capillaries

Utilization coefficient (25% at rest, 75-85% during exercise)

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Central control of inspiration; sends inspiratory ramp signals

Dorsal respiratory group (DRG) of the medulla

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Central control of both inspiration and expiration; sends overdrive mechanism in exercise

Ventral respiratory group (VRG) of the medulla

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Limits inspiration and increases respiratory rate

Pneumotaxic center of the pons

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Stimulates the inspiration and decreases the respiratory rate

Apneustic center of the pons

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Receptors in the ventral medulla that is stimulated by CSF H+ from blood CO2; adapts within 1-2 days

Central chemoreceptors

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Receptors in carotid bodies (CN IX) and aortic bodies (CN X); activated when PO2 < 70 mmHg and to a lesser extent, CO2

Peripheral chemoreceptors

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Reversibility in asthma (spirometry)

>12% and 200mL increase in FEV1: 15 minutes after an inhaled short-acting B2-agonist; or

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Physiologic abnormality of asthma

Airway hyperresponsiveness

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Pathogenesis behind asthma

Imbalance favoring TH2 production over TH1 -> increases IL-1, IL-5 -> increased eosinophils

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Putative mediators of asthma

SRS-A (made up of leukotrienes C4, D4, E4)

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Whorls of shed epithelium in mucus plugs in asthma

Curschmann?s Spirals

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Crystalloid made up of eosinophil membrane protein seen in both asthma & amoebiasis

Charcot-Leyden Crystals

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Predominant key cell involved in asthma

None

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Characteristic feature of asthmatic airways

Eosinophil infiltration

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Most common triggers of acute severe asthma exacerbations

URTI: rhinovirus, respiratory syncytial virus (RSV), coronavirus

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Mechanism of exercise-induced asthma (EIA)

Hyperventilation

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EIA is best prevented by regular treatment with

Inhaled corticosteroids (ICS)

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Confirms airflow limitation with a reduced FEV1, FEV1/FVC ratio, and PEF

Spirometry

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Confirms diurnal variation in airflow obstruction

Measurements of PEF twice daily

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Primary action of B2-agonists

Relax smooth-muscle cells of all airways, where they act as functional antagonists

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Most common side effect of anticholinergics

Dry mouth

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Most common side effects of theophylline

Nausea, vomiting, headaches

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Most effective controllers for asthma

ICS

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Indicates the need for regular controller therapy

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Most common reason for poor control of asthma

--------------

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Drugs that are safe for asthma in pregnancy

-----------

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Most common pathogenesis of pneumonia

Aspiration

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Most common etiology of community-acquired pneumonia

Streptococcus pneumoniae

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Most common etiology of atypical pneumonia

Mycoplasma pneumonia

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Most common cause of nosocomial pneumonia and pneumonia in cystic fibrosis patients

Pseudomonas aeruginosa

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Most common viral cause of atypical pneumonia and bronchitis in children

Respiratory Syncytial Virus (RSV)

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Main purpose of the sputum gram stain

Ensure suitability of sample for culture

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To be adequate for culture, a sputum sample must have

>25 neutrophils; and

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Most frequently isolated pathogen in blood cultures of community-acquired pneumonia

Streptococcus pneumoniae

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Irreversible airway dilation that involves the lung in either a diffuse or focal manner

Bronchiectasis

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Most common form of bronchiectasis

Cylindrical or tubular

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Most cited mechanism for infectious bronchiectasis

Vicious cycle hypothesis

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Most common clinical presentation

Persistent cough with production of thick sputum

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Imaging modality of choice for confirming bronchiectasis

Chest CT

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First step in diagnostic approach to pleural effusion

Determine whether the effusion is an exudate or a transudate

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Leading causes of transudative pleural effusion

LV failure and cirrhosis

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Leading causes of exudative pleural effusion

Bacterial pneumonia, malignancy, viral infection, pulmonary embolism

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Most common cause of chylous pleural effusion

Malignancy

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Three tumors that cause ~75% of all pleural effusions

Lung carcimona, breast carcimona, lymphoma

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Benign ovarian tumors producing ascites and pleural effusion

Meigs' Syndrome

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The only symptom that can be attributed to the malignant pleural effusion itself

Dyspnea

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Condition most commonly overlooked in the differential diagnosis of a patient with undiagnosed effusion

Pulmonary embolism

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Most common cause of chylothorax

Trauma (most frequently, thoracic surgery)

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Treatment choice for most cases of chylothorax

Insertion of a chest tube plus administration of octreotide

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Population at risk for spontaneous pneumothorax

Tall, thin men 20-40 y/o, smoker

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Ipsilateral tracheal deviation

Tracheal deviation in spontaneous pneumothorax

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Contralateral tracheal deviation

Tracheal deviation in tension pneumothorax

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Coexistence of unexplained excessive daytime sleepiness with at least five obstructed breathing events (apnea or hypopnea) per hour of sleep

Obstructive sleep apnea

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Breathing pauses lasting >10 seconds

Apnea

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>10 second events where ventilation is reduced by at least 50% from the previous baseline

Hypopnea

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First step in evaluating a mediastinal mass

Place it in one of the three mediastinal components

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Most common lesions in anterior mediastinum

Mnemonic: Terrible T?s!

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Most common lesions in middle mediastinum

Vascular masses, Lymphadenopathy from metastases or granulomatous disease, Pleuropericardial and bronchogenic cysts

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Most common masses in the posterior mediastinum

Neurogenic tumors, Meningocoelesm Meningomyelocoeles, Gastroenteric cysts, Esophageal diverticula

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First step in evaluating a mediastinal mass

Place it in one of the three mediastinal components

75

Most common lesions in anterior mediastinum

Mnemonic: Terrible T?s!

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Most common lesions in middle mediastinum

Vascular masses, Lymphadenopathy from metastases or granulomatous disease, Pleuropericardial and bronchogenic cysts

77

Most common masses in the posterior mediastinum

Neurogenic tumors, Meningocoelesm Meningomyelocoeles, Gastroenteric cysts, Esophageal diverticula

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One of the three major cardiovascular causes of death, along with MI and stroke

Venous thromboembolism

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Causes of pulmonary embolism

Fat, foreign body, air, DVT, bone marrow, ambiotic fluid, tumor

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Population at risk for pulmonary embolism

Patients with preexisting heart/lung disease (occurs in lower lobes)

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Usual cause of death from pulmonary embolism

Progressive right HF

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Most frequent history in DVT

Cramp in the lower calf that persists and worsens for several days

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Most frequent history in PE

Unexplained breathlessness

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Classic signs of PE

Tachycardia, low-grade fever, neck vein distension

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Most frequent symptom of PE

Dyspnea

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Most frequent sign of PE

Tachypnea

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Useful rule-out test: >95% of patients with normal levels (<500 ng/ml) do not have PE

Quantitative plasma D-dimer ELISA

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Most frequently cited ECG abnormality in PE (in addition to sinus tachycardia)

S1 Q3 T3 Sign (specific but insensitive)

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Most common ECG abnormality in PE

T-wave inversion leads V1 to V4

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Principal imaging test for the diagnosis of PE

Chest CT scan with IV contrast

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Second-line diagnostic test for PE, used mostly for patients who cannot tolerate IV contrast

Lung scanning

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Best known indirect sign of PE on transthoracic echo

McConnell's sign: hypokinesis of the RV free wall with normal motion of RV apex

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Definite diagnostic test for PE, used mostly for patients who cannot tolerate IV contrast PE which visualizes an intraluminal filling defect in more than one projection

Lung scanning

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Foundation for successful treatment of DVT and PE

Anticoagulation

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Massive pulmonary embolism

Systemic arterial hypotension with usually anatomically widespread thromboembolism

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Moderate to large pulmonary embolism

RV hypokinesis with normal systemic arterial pressure

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Small to moderate pulmonary embolism

Normal RV function and normal systemic arterial pressure (excellent prognosis with adequate anticoagulation)

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Definition of ARDS

Acute onset (<24 hours), Bilateral patchy airspace disease, Absence of of left atrial hypertension (PCWP < 18 mmHg), Profound shunt physiology

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Top 3 causes of ARDS

Gram-negative sepsis, gastric aspiration, severe trauma

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Short-term morphology of ARDS

Waxy hyaline membranes

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Long-term morphology of ARDS

Intra-alveolar fibrosis

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Histologic manifestation of ARDS

Diffuse alveolar damage