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American Board of Internal Medicine COPY > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

Define Light’s Criteria

A

Transudate:

  1. Pleural protein / Serum Protein LESS than 0.5
  2. Pleural LDH / serum LDH LESS than 0.6
  3. Pleural LDH LESS than 2/3 ULN
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2
Q

What spirometry value suggests obstruction?

A

FEV1/FVC less 70%

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3
Q

What spirometry value suggests REVERSIBLE airways?

A
  1. Increase 12% of either FEV1 or FVC

2. Increase 200 mL baseline

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4
Q

What suggests Restrictive Lung Disease?

A

Equal reductions in FEV1 and FVC

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5
Q
  1. What do Flow-Volume Loops identify?
  2. Describe these flows:
    a. COPD
    b. Asthma
    c. Tracheal Stenosis
A
  1. They localize anatomic airway obstruction
  2. a. “Scooped-out”, no change w/ bronchodilators
    b. “Scooped-out”, improve w/ bronchodilators
    c. Flattened both expiration and inspiration
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6
Q
  1. When spirometry/lung volumes are AB-normal and DLCO low, consider _ (3).
  2. When spirometry/lung volumes are normal and:
    a. Low DLCO
    b. High DLCO
A
  1. a. COPD
    b. Pulmonary Fibrosis
    c. Bronchiectasis
  2. a. Pulmonary vascular disease
    b. Hemorrhage, L-to-R shunt, polycythemia
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7
Q

Define these Asthma Classifications:

  1. Intermittent
  2. Mild persistent
  3. Moderate persistent
  4. Severe persistent
A
  1. Intermittent:
    a. Day < 2/week
    b. Night < 2/month
    c. FEV1>80
  2. Mild persistent:
    a. Day > 2/week, less than daily
    b. Night > 2/month
    c. FEV1>80
  3. Moderate persistent:
    a. Daily
    b. Night >1/week
    c. FEV1 60-80
  4. Severe persistent:
    a. Continual
    b. Night frequent
    c. FEV1 <60
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8
Q

What drugs should be avoided with Theophylline (3)?

A
  1. Fluorquinolones
  2. Macrolides
  3. Azole antifungals
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9
Q

What are treatment options for Exercise-Induced Asthma when:

  1. Infrequent (3)
  2. Frequent more than 2/week (2)
A
  1. a. Albuterol
    b. Cromolyn Sodium**
    c. Nedocromil**

**Mast cell stabilizers

  1. a. Montelukast
    b. Zafirlukast
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10
Q

List some historical clues which would prompt testing for alpha1-antitrypsin (6)?

A
  1. Age less 45
  2. No risk for COPD
  3. FHx AAT deficiency
  4. Basilar lung predominant emphysema
  5. Liver disease
  6. Necrotizing panniculitis
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11
Q

Describe COPD stages (4) and their treatment

A

All have FEV1/FVC less 70%

I (mild): FEV1 greater 80% predicted
TX: SABA or anticholinergic

II (moderate): FEV1 less 80% predicated (50%)
TX: LABA and anticholinergic
TX: Pulmonary rehab

III (severe): FEV1 less 50% predicated (30%)
TX: Add ICS

IV (very severe): FEV1 less 30% predicated (50%)
TX: Surgery and oxygen

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12
Q

What are indications for daylong oxygen therapy for COPD (4)?

A
  1. PO2 less 55 mmHg
  2. PO2 between 55-60 with signs
  3. Nocturnal oxygen less 88%
  4. Ambulating oxygen less 88%
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13
Q
  1. What does clubbing suggest (3)?

2. What does it NOT suggest (1)?

A
  1. a. Bronchiectasis
    b. R-to-L shunt
    c. Malignancy
  2. NOT COPD
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14
Q

List causes of Transudative Pleural Effusions (3 increased hydrostatic, 4 decreased oncotic)

A

Increase hydrostatic pressure

  1. CHF
  2. Constrictive pericarditis
  3. SVC syndrome

Decreased oncotic pressure

  1. Ascites
  2. Nephrotic syndrome
  3. Hypoalbuminemia
  4. Peritoneal dialysis
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15
Q

List causes of Exudative Pleural Effusions (5)

A
  1. Infection
  2. Neoplasm
  3. Collagen vascular disorders
  4. Pulmonary infarction
  5. Hemothorax
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16
Q

What pleural effusion features suggest empyema, thus require chest tube (4)?

A
  1. pH 7.2
  2. Pleural glucose less 50% plasma glucose
  3. LDH more than 1,000
  4. Positive gram stain
17
Q

What is the different between Primary and Secondary Pneumothorax?

A

Primary - normal lung, spontaneous

Secondary - overt lung disease (COPD, PCP…)

18
Q
  1. How are pneumothorax under 2cm treated (2 scenarios)?
  2. When should chest tube be placed?
  3. When should VATS pleurodesis be considered?
A
  1. Less than 2cm
    • Primary: observation
    • Secondary: aspiration if mild and <50yo
      otherwise chest tube
  2. Greater than 3cm, small tubes only
  3. a. Refractory or recurrent PTX
    b. Certain occupations like pilots
19
Q

Contrast Malignant from Benign solitary pulmonary nodules (3 each)

A

Malignant:

  1. Spiculated
  2. Minimal calcification
  3. Intermediate doubling times (30-500 days)

Benign:

  1. Smooth margins
  2. Central laminated calcifications
  3. Doubling times 30-day or none over 2-years
20
Q
  1. Besides erythema nodosum, what are skin finding with Sarcoidosis?
  2. What is a facial finding with Sarcoidosis?
  3. What occupational hazard would cause a Sarcoidosis-like syndrome?
A
  1. Lupus Pernio - violaceous discoloration of the nose, cheek, chin
  2. Parotid enlargement with facial nerve palsy
  3. Beryllium - light bulb factories or semiconductors
21
Q

What is the illness script for Langerhans cell histiocytosis, what is found on HRCT (2) and what is treatment?

A
  1. Young male smoker with recurrent PTX
  2. HRCT with stellate nodules and upper cysts
  3. Treatment is smoking cessation
22
Q
  1. What is prophylaxis for Mountain Sickness?
  2. What is HAPE and treatment?
  3. What is HACE and treatment?
A
  1. Acetazolamide 1-2 days prior
  2. High-Altitude Pulmonary Edema
    TX: Furosemide and Nifedipine
  3. High-Altitude Cerebral Edema
    TX: Dexamethasone
23
Q

What are relative indications for mechanical ventilation (4)?

A
  1. PaO2 < 60 mmHg on FiO2 50%
  2. PaCO2 > 45 mmHg with acidemia
  3. pH less 7.25
  4. RR greater 35
24
Q
  1. What are parameters for measuring pretest probability of DVT?
  2. What are the pretest categories and their diagnostic algorithms (3)?
A 
Mnemonic: C3PO+R2D2
Cancer
Calf diameter increase >3 cm
Collateral superficial veins visible
Pitting oedema -or-
Oedema of the whole leg
\+ (t)enderness of the calf
Recent surgery/immobilization
Recent casting 
Different diagnosis more likely (subtract 2 points)

0 Low - order d-dimer
1-2 Moderate - order V/Q or CT–>if negative US
3 or more High - start therapy then do imaging

25
Q
  1. What pulmonary artery pressure suggests Pulmonary Hypertension?
  2. What is the confirmatory test?
A
  1. PA pressure more than 40 mmHg

2. Right-heart catheterization

26
Q

What test should be done for CHRONIC thromboembolic pulmonary hypertension?

A

V/Q scan

27
Q

What treatment options are used for Pulmonary Hypertension (5)?

A
  1. Warfarin
  2. Oxygen for SaO2 less 90%
  3. Calcium channel blockers if reduction of PAP
  4. Endothelin antagonists, sildenafil…
  5. Lung transplant for NYHA III-IV
28
Q
  1. What is a serologic test for Organophosphate Poisoning?

2. What are treatment options (3)?

A
  1. Acetylcholinesterase levels
    • DON’T WAIT TO TREAT IF CONCERNED
    • Follow during treatment
  2. a. Atropine
    b. Pralidoxime for CNS toxicity
    c. Benzos for convulsions
29
Q

What are key differences between poisoning with:

  1. Methanol (wood alcohol)
  2. Ethylene glycol
  3. Isopropyl alcohol
A
  1. Methanol - visual symptoms
  2. Ethylene glycol - urine oxalate crystals
  3. Isopropryl alcohol - NO ACIDOSIS or AKI
30
Q

What is a drug-treatment for Malignant Hyperthermia?

A

Dantrolene

31
Q

Describe the follow-up for pulmonary nodules based on size and risk factors.

A

Less than 4mm

- No risks: None
- Smoker: 12m

4-6mm

- No risks: 12m
- Smoker: 6-12m then 18-24m

6-8mm

- No risks: 6-12m
- Smoker: 3-6m then 9-12m then 24m

Greater than 8mm

- No risks: Contrast CT, PET, biopsy
- Smoker: Contrast CT, PET, biopsy
32
Q

What type of tumors appear in the __ mediastinum?

  1. Anterior (3)
  2. Middle (3)
  3. Posterior (2)
A
  1. Anterior = thyroid, thymus, lymph
  2. Middle= bronchogenic, pericardial, lymph
  3. Posterior = neural (Schwann), esophageal
33
Q

If a patient presents with suspected ACEI-angioedema, what two medications may not help?

A
  1. Steroids

2. Epinephrine

American Board of Internal Medicine COPY (15 decks)

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