Pulmonology and Critical Care Medicine Flashcards
(109 cards)
1
Q
What lung disease presents in patients between 50 to 70 years old, greater than 6 months duration, dry cough, dyspnea on exertion, velcro-like crackles, clubbing, honeycombing changes on HRCT scan?
A
Idiopathic Pulmonary Fibrosis
2
Q
How does one diagnosis chronic thromboembolic pulmonary hypertension?
A
V/Q scan
3
Q
Severe Asthma therapy that targets type 2 inflammation, what drug is this?
A
Mepolizumab (Nucala)
IL-5 inhibitor, decreases eosinophils
4
Q
A patient has sepsis, how does fluid resuscitation work?
What is the lactate level?
A
1st hour, 30 cc/kg LR given, ideally
Lactate above 2 if there is an active infection
5
Q
par
What is a good NIF number?
A
-20
6
Q
What is a good RSBI number?
What is the formula?
A
less than 105
RSBI = RR (Breaths per minute) / Tidal Volume (L)
Denominator should be example (0.450)
7
Q
Chronic Thromboembolic Pulmonary HTN what treatment should be what?
A
AC and Surgery
8
Q
What is the only Chronic Thromboembolic Pulmonary HTN medication if no surgery will be done?
A
Riociguat, soluble guanylate cyclase, primary receptor of nitric oxide
9
Q
Patients with Chronic Thromboembolic Pulmonary HTN, what is needed to rule out Pulmonary HTN?
A
V/Q scan, CTA not as sensitive
RHC and Pulmonary Angiography should be avoided in patients with a normal V/Q scan
10
Q
Pulmonary: Pre-flight, what testing should be done before?
A
Resting Pulse Oximetry
11
Q
Nitric Oxide Fraction looks at what?
A
Non-invasive measurement of eosinophils
12
Q
Severe temperatures below what number require internal rewarming methods?
A
Below 82.4 F
13
Q
How should active rewarming temperatures be taken?
A
Esophageal Probe
14
Q
If Pulmonary HTN is diagnosed on echo, what is the confirmatory test?
A
Right Heart Cath
15
Q
Group 1 Pulmonary HTN can be given what if a RHC shows improvement with nitric oxide?
A
Nifedipine
16
Q
What medication may be given in mild to moderate Pulmonary Artery Hypertension without vasoreactivity?
A
Sildenafil
17
Q
If a patient has COPD Gold criteria E, patient is already on LABA-LAMA-ICS, what is the next best step?
A
Roflumilast, PDE-4 inhibitor
18
Q
COPD Gold group A is what treatment?
A
Bronchodilator (SAMA as needed)
19
Q
COPD Gold group B is what treatment?
A
LAMA+LABA, Anoro Ellipta, other opitions
20
Q
COPD Gold group E is what treatment?
A
LABA+LAMA+ICS, Trelegy Ellipta or Breztri
21
Q
COPD Gold group E, what lab value is looked at to evaluate if a patient should have ICS as well?
A
Eosinophils > 300
22
Q
Dyspnea when hurrying or walking up a slight hill is what GOLD group?
A
GOLD group A
23
Q
Walks slower than people of the same age because of dyspnea or has to stop for breath when walking at own pace is what GOLD group?
A
GOLD group B
24
Q
2 or more moderate COPD exacerbations is what?
A
Gold Group E
25
Montelukast can have what side effect?
Depression, black box warning
26
When determining Lung Cancer staging, what size should the nodules be before a scan shows any benefit?
Greater than 8mm
27
If a CT chest shows a stable nodule after 6 months, when should the follow up CT scans be done?
Every 2 years for 5 years
28
Before an apical Lung mass can be removed, what should be done?
CT Chest Scan
29
Velcro like crackles at both lung bases, what is this, think autoimmune?
Idiopathic Pulmonary Fibrosis
30
Idiopathic Pulmonary Fibrosis, what two medications can be given?
Pirfenidone and Ninedanib
31
PE in pregnancy, what could treat this problem?
Low Molecular Weight Heparin
32
A patient's asthma response to steroids can be seen with what?
Fractional Exhaled Nitric Oxide
33
The most common form of exudative effusions is what?
Infection and Malignancy
34
An exudate effusion that has a triglyceride level above 110 and primarily lymphocytic is what?
Sample color is white
Chylothorax
Lymphoma can cause
35
An inflammatory effusion from what has a low pH (<7.2), low glucose (40), an elevated LDH, what is this?
Inflammatory Effusion
36
An incidental ground glass lesion 6mm or larger, when found, will have a CT scan repeat in 6-12 months. Afterwards, how often?
Every 2 years for 5 years
37
Ethylene Glycol and Methanol poisoning should be treated with what?
Fomepizole or the ethanol
38
Ethylene Glycol poisoning and end organ damage, what should be done?
Fomepizole and Dialysis
39
Neutropenic fever, antibiotics can be stopped when?
Full course for antibiotics or absolute neutrophil count is above 500, whichever is longest. Patient should also be afebrile.
40
Spontaneous primary pneumothorax prevention in a patient with a risk occupation, is what?
Recurrence Prevention (pleurodesis)
41
Aspiration Pneumonitis, improve after 24 hours, what can be done if on abx?
Can stop antibiotics
42
COPD with thick purulent sputum, P. Aeruginosa history, what is the best antibiotic to give?
Ciprofloxacin, not azithyromycin
43
COPD and does not improve with albuterol, what should be given?
FInhaled Fluticasone Propionate-Salmeterol (LABA-LAMA)
44
Thermal injury 2/2 fire, patient has some oral swelling, oxygenating well, what procedure does the patient need?
Patient needs to have a Bronchoscopy
45
Low risk patient with a 6 mm nodule, what is the follow up CT scan advice?
No further follow up
46
What is the first test for a chronic PE?
V/Q scan
47
What meds can help modify the ALS disease?
riluzole, edaravone
48
Leukocytosis with an initial neutrophil predominance and elevated IgE, what is this associated with?
Acute Eosinophilic Pneumonia
Usually with new or restarted smoking history
consistent with a Hypersensitivity reaction
49
What respiratory treatment will improve mortality with ALS?
Non-invasive Ventilation (BiPAP)
50
Cystic fibrosis has pancreatitis, chronic liver disease, and pulmonary symptoms, what will a chest xray show?
Cavitation, Bronchiectasis with GI symptoms, steatorrhea, diarrhea, or abdominal pain
51
Pulmonary Hypertension group #1 is due to what?
Idiopathic, hertiable
52
Pulmonary Hypertension group #2 is due to what?
Left Heart Disease
53
Pulmonary Hypertension group #3 is due to what?
Lung Disease
54
Pulmonary Hypertension group #4 is due to what?
How is this caused?
Chronic Thromboembolic PH
clots become scared into the wall, clots are scared into the wall
| Can have corrective surgery, most likely lifelong Anticoagulation
55
Pulmonary Hypertension group #5 is due to what?
Multifactorial
56
What is anti-P/Q-type voltage-gated calcium channel antibodies? What disease may this be?
Lambert Eaton Myasthenic syndrome
57
What is the first medication to start with Lambert Eaton?
Pyridostigmine
58
Incidental finding in the patient's middle mediastinum, what is the most likely finding?
Bronchogenic Cyst
59
What Pneumonia Vaccine should be given if no previous vaccine has been given, under the age of 65 with risk factors?
PCV 20
60
If Patient has PCV 15 vaccine given, what vaccine should be given one year later?
PCV 23
61
Common variable immunodeficiency, what are these people at risk of obtaining? (think cancer)
Risk of Lymphoma
62
What are CVID (common variable immunodeficiency disease) patients, pulmonary wise, at risk of obtaining? What will the CT scan show?
Bronchiectasis, tram track bronchi, can see a Signet ring
63
Patients with non-small cell lung cancer Stage I and II, what is the next best step?
Surgery and Adjuvant Chemotherapy (cisplatin based therapy)
64
Patient has a PFT done, FEV1/FVC increase from 10-12% with bronchodilator, what could that be?
Asthma
65
Patient has aspiration concerns, what is the test of choice?
CT chest with contrast, Contrast can help outline the abscess
66
For COPD patients, what medication should be done before romflumilast and Azithyromycin?
LAMA, LABA, and ICS
67
Anti synthetase Syndrome has what positive antibody?
Myositis, arthritis, an ILD can occur
anti-Histidyl-transfer RNA synthetase antibodies (Very similar to Polymyositis)
Patient may not have all three (Myositis, arthritis, and ILD)
68
Post primary TB, what should be done if the patient has respiratory issues and is symptommatic?
Sputum Cx and acid fast bacilli
69
May Turner Syndrome is another name for iliac vein compression syndrome. Where is the compression?
Right Common Iliac Artery and 5th Lumbar Vertebrae. Will do Antiplatelet and compression stocking
70
What is a common Pneumocosis that can make TB worse?
Silicosis
71
What medication is contraindicated in active TB and Gout?
Pyrazinamide
72
What is central sleep apnea, via mechanism?
Loss of Brainstem central respiratory generator output precipitating airflow pauses and subsequent hyperventilation with low PCO2
73
What vaccine is recommended in COPD patients? Not PCV
Herpes Zoster, over the age of 50, two doses 2-6 months apart
74
Elevated cholesterol of what number in the pleural fluid gives a pertinent diagnosis?
Cholesterol above 200
75
Triglyceride level higher than what may indicate the patient has a chylothorax?
Above 110
76
What is Loeffler Syndrome?
A simple eosinophilic pneumonia/limited illness with fleeting infiltrates
| Can be associated with parasitic infections
77
What is LAM syndrome?
A lung disease that causes spontaneous pneumothorax and chylous effusions, **usually women between 30-40s,** Chest CT will show a cystic disease
78
A young male smoker with the following:
Brownish-purple papules, erythematous papular rash
Bone Pain with Lytic Lesions on Xray
Polyuria
Spontaneous Pneumothorax
Lymphadenopathy
What could this be?
Langerhans's Cell Histiocytosis
XR chest will have thick-walled cysts and Pneumothorax
79
Acute Eosinophilic Pneumonia, has what characteristics?
Young Man who rapidly deteriorates and has to go on a ventilator
80
Chronic Eosinophilic Pneumonia, has what characteristics?
Middle Aged Female with chronic recurrences of an asthma flare
81
What are the histologic markers for Langerhans cell histiocytosis?
CD-1a, S-100, CD 207, and Birbeck Granules
82
Recurrent Pneumonias without eosinophils, what could this be?
Hypersensitivity Pneumonitis
Tx: Antigen avoidance and Steroids
83
Immunocompromised HRCT of Chest that show a surrounding glass infiltrates ("halo sign") or an air-crescent sign or simple consolidation, what is this?
Invasive Pulmonary Aspergillosis
84
How is a REM sleep disorder treated?
| Patient usually has vivid and scary dreams, may be violent, as well
Benzos are #1 usually, low dose clonazepam before bed, cause is unknown
85
What pulmonary disease has daytime hypercapnia and PCO2 > 45?
Obesity Hypoventilation Syndrome
86
Central Sleep Apnea is the loss of repiratory effort for at least how long on PSG?
At least 10 seconds
87
Exercise induced asthma, what is the first line treatment for the patient?
Budesonide (Oral Steroid) and Formoterol ((LABA))
88
Patient has frequent Bronchiectasis exacerbations every year, what is chronic medication to consider starting?
Oral Azithyromycin
89
Cheyne-Stokes Breathing has what?
Rapid-deep breathing and shallow/absent breathing (apnea or hypopnea)
90
What Pulmonary lesion size, greater than what number is concerning for malignancy?
3 cm
91
What lung nodule size should have a repeat CT scan in 6-12 months and then 18-24 months thereafter?
6-8 mm
92
What lung nodule size have a CT scan in 3 months, PET/CT, or tissue sampling?
> 8 mm
93
What is the best asthma treatment regimen? What has been added recently?
ICS plus a beta 2 agonist, eventually LAMA can be added
94
What pulmonary disease state is shown?
Normal PFT
95
What pulmonary disease state is seen
Obstructive PFT, emphysema
96
What pulmonary disease state is seen?
Restrictive Lung Disease
97
In terms of COPD subtypes, what can distinguish between Emphysema and Chronic Bronchitis?
Chronic Bronchitis: DLCO is intact
Emphysema: DLCO is decreased
98
Pleural Fluid with low pH, very low glucose, elevated LDH, and elevated lymphocytes. What could this be?
Rheumatoid Arthritis
99
# A pleural effusion, with the below, what can be found?
Serum Effusion albumin gradient > 1.2
Serum Effusion protein difference > 3.1
Transudative Effusion, should use this ratio if on diuretics, Light's criteria, hold off
100
An ABG pH > 7.35, pCO2 > 45, pO2 < 70, normal DLCO, BMI >30, what does this person most likely have?
Obesity Hypoventilation Syndrome
101
ICS/LABA is formoterol (LABA)-mometasone is good for what disease?
Asthma (Formoterol has a very fast onset)
102
Chronic Respiratory acidosis, what is the compensation ratio with bicarb?
Every 10 paCO2 increase, should increase bicarb by 4
103
Acute Respiratory acidosis, what is the compensation ratio with bicarb and pH?
Every 10 paCO2 should decrease pH by 0.1 and bicarb 1 increase
104
What is the best medication for smoking cessation?
(not e-cigarettes or vaping)
Varenicline (Chantix)
105
A patient appears to have pneumonia on imaging, and he is given antibiotics. No improvement, imaging is shown, what other disease could this be?
Crytogenic Pneumonia, treat with steroids
CT scan has "atoll sign" (reverse halo sign)
FYI: This used to be called BOOP (Bronchiolitis Obliterans Organizing Pneumonia)
106
What PFT is this?
Variable Intrathoracic Obstruction
Causes: Tracheomalacia, no problems with inspiration
107
# What PFT is this?
What is this loop?
Normal, make sure to note which is inspiratory and expiratory
108
What is this loop?
Variable Extrathoracic Obstruction
Causes: unilateral vocal cord dysfunction
109
What is this loop?
Fixed Upper Airway Obstruction
Causes: Tracheal Stenosis, Goitre
