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Pulmonology (Current) Flashcards

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1
Q

Risk factors for Sarcoidosis

A
  • African American
  • Females
  • Northern Europeans
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2
Q

Symptoms of Sarcoidosis

A
  • Dry (nonproductive) cough
  • Skin: erythema nodosum, lupus pernio
  • Parotid gland enlargement
  • Anterior Uveitis
  • Restrictive cardiomyopathy
  • Diabetes Insipidus
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3
Q

What is Lofgren Syndrome in regards to sarcoidosis?

A

-Erythema nodosum + bilateral hilar LAD + polyarthralgias with fever

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4
Q

Best initial test and what does it show for sarcoidosis

A

-Bilateral hilar LAD on CXR

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5
Q

What kind of pattern is on a PFT for Sarcoidosis?

A

Restrictive pattern: normal or increased FEV1/FVC, normal or decreased FVC

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6
Q

What is the most accurate diagnostic for sarcoidosis?

A

Tissue Biopsy: noncaseating granulomas

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7
Q

What is one other lab that is significant in sarcoidosis?

A

Increased ACE levels

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8
Q

If the patient is symptomatic and has sarcoidosis, what is the first line treatment?

A

Oral corticosteroids

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9
Q

What is a pleural effusion?

A

Abnormal accumulation of fluid in the pleural space

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10
Q

Physical exam findings of a pleural effusion

A
  • Dullness to percussion
  • Decreased fremitus
  • Decreased breath sounds
  • Dyspnea, pleuritic chest pain, cough
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11
Q

Lateral decubitus chest radiographs are the best type of radiographs to get to evaluate for a pleural effusion. What do you see?

A

Blunting of the costophrenic angles (meniscus sign)

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12
Q

What is the gold standard diagnostic for pleural effusion?

A

Thoracocentesis

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13
Q

What are the factors of Light’s Criteria? If any of the three are present, it is an exudate cause?

A
  • Pleural fluid protein: serum protein > 0.5
  • Pleural fluid LDH: serum LDH > 0.6
  • Pleural fluid LDH: > 2/3 of the upper limit of normal LDH
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14
Q

When do you perform a chest tube for the fluid drainage?

A 
If empyema (pleural fluid pH < 7.2, glucose < 40, or positive gram stain)
-May inject with streptokinase to facilitate breakup of loculations
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15
Q

Symptoms of a pneumothorax

A
  • Hyperresonance to percussion
  • Decreased fremitus
  • Decreased breath sounds over affected area
  • Unequal respiratory expansion
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16
Q

Initial test of choice for a pneumothorax

A

Chest radiograph (expiratory upright view preferred)

  • Companion lines
  • Decreased peripheral markings
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17
Q

Primary spontaneous pneumothorax:
Secondary spontaneous pneumothorax:
Tension pneumothorax:
Traumatic pneumothorax:

A

Primary: no underlying lung disease
Secondary: underlying lung disease
Tension: positive air pressure pushes trachea and heart to contralateral side
Traumatic: Car accident, subclavian line placement

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18
Q

Stable secondary spontaneous pneumothorax treatment

A

Chest tube or catheter thoracotomy + hospitalization

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19
Q

Tension Pneumothorax treatment

A

-Needle aspiration followed by chest tube thoracostomy

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20
Q

Patient education following a pneumothorax

A

-Avoid pressure changes for a minimum of 2 weeks (high altitudes, smoking, scuba diving, etc.)

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21
Q

Strongest risk factor for sleep apnea

A

Obesity

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22
Q

First line diagnostic test for sleep apnea

A

In-laboratory polysomnography (15 or more events per hour)

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23
Q

Treatment for sleep apnea

A
  • Behavioral changes including weight loss, no alcohol, changes in sleep positioning
  • CPAP (mainstay)
  • Tracheostomy is definitive treatment
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24
Q

What is the first-line in prevention of meconium aspiration?

A

Prevention of post-term delivery (> 41 weeks) via labor induction and prevention of fetal hypoxia

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25
What is pulmonary hypertension defined as?
Elevated mean arterial pressure > 20 mmHg with a pulmonary vascular resistance > 3 Wood units
26
What is on physical exam of a patient with pulmonary hypertension?
- Accentuated S2 - Signs of right heart failure: increased JVP, peripheral edema, ascites - Pulmonary regurgitation, right ventricular heave - Dyspnea, fatigue, chest pain, weakness
27
On a chest radiograph for pulmonary hypertension, you see enlarged pulmonary arteries and signs of right sided heart failure. However, what is the definitive diagnostic for pulmonary HTN?
-Right heart catheterization: elevated pulmonary artery pressure, RV pressure
28
On a CBC for pulmonary HTN, what is seen?
Polycythemia (high # of RBC) | Increased hematocrit
29
If primary pulmonary HTN (idiopathic in cause), what is the treatment?
- Vasoreactivity trial with Nitric Oxide, IV Adenosine, or CCB - -If vasoreactive: CCB first line - -Prostacyclins (Iloprost) - -PD5-inhibitors (Tadalafi)
30
What is the definitive treatment for pulmonary HTN?
Heart-lung transplant
31
Acute Respiratory Distress Syndrome develops in who?
Critically ill patients (Gram-negative sepsis) Severe Trauma Near Drowning Severe Pancreatitis
32
What does chest radiographs for acute respiratory distress syndrome classically show?
-Bilateral diffuse pulmonary infiltrates that spare costophrenic angles
33
With right heart catheterization, what is diagnostic for ARDS?
Pulmonary capillary wedge pressure < 18 mm Hg
34
Treatment for ARDS
Noninvasive or mechanical ventilation + treat underlying cause
35
What is the difference between costochondritis and Tietze Syndrome?
Costochondritis: reproducible chest wall tenderness without palpable edema Tietze Syndrome: reproducible chest wall tenderness with palpable edema
36
What is the treatment for costochrondritis and Tietze Syndrome?
NSAIDs
37
Parrot Fever (Psittacosis) is an infection with _______ that is due to exposure of ______
Chlamydia Psittaci Infected birds
38
Treatment for Psittacosis
Tetracyclines
39
Risk Factors for Berylliosis
-Aerospace, electronics, ceramics, tool and dye manufacturing, jewelry making
40
What is Berrylium?
Alloyed with nickel, aluminum, and copper so people working in those industries are at increased exposure
41
Treatment for Berylliosis
Corticosteroids, oxygen | -Methotrexate if corticosteroids fail
42
Risk factors for Silicosis
-Quarry work, sandblasting with granite, slate, quartz, pottery makers, coal mining
43
Silicosis greatly increases the risk for _____
Tuberculosis
44
What is seen on chest radiographs with silicosis
- Multiple, small round nodular opacities primarily in upper lobes - Eggshell calcifications of hilar and mediastinal nodes
45
Definitive diagnostic for silicosis
Lung biopsy
46
What is Caplan Syndrome?
Coal worker's pneumoconiosis + Rheumatoid Arthritis
47
What does a chest radiograph for coal worker's pneumoconiosis show?
Small nodules in upper lung with hyperinflation of lower lobes in obstructive pattern
48
Treatment for Coal Worker's Pneumoconiosis
Supportive
49
Risk factors for a PE
-Virchow's Triad: hyper coagulability, stasis, intimal damage
50
Symptoms of a PE
- Tachypnea (most common sign) - Tachycardia - Dyspnea (most common symptom) - Pleuritic chest pain - Hemoptysis
51
What is highly suspicious of a PE?
Normal chest xray in the setting of hypoxia
52
What does an ECG show for a PE?
Nonspecific ST/T changes and sinus tachycardia | -S1Q3T3 (deep wide S in lead I; both isolated Q and T wave inversion in III)
53
When is a D-dimer helpful in PE?
Only if negative and low suspicion for PE
54
What is the best initial test to confirm the presence of a PE?
Helical (Spiral) CT angiography
55
A V/Q scan is performed when patients cannot undergo a CT. Who are these people?
Pregnancy | Increased creatinine
56
Gold standard and definitive diagnostic for PE
Pulmonary angiography
57
An IVC filter is indicated in stable 3 patients:
- Anticoagulation contraindicated (recent bleed, bleeding disorder) - Anticoagulation unsuccessful - RV dysfunction seen on echocardiogram (next embolus can be fatal)
58
If the patient is hemodynamically stable, treatment for PE is
-Anticoagulation (first line): Heparin bridge plus Warfarin or novel oral anticoagulant (Dabigatran, Rivaroxaban, Apixaban, Edoxaban)
59
If the patient is hemodynamically unstable (SBP < 90, acute RV dysfunction), what is the treatment for a PE?
Thrombolysis (LMWH) | Thromectomy or embolectomy
60
PE prophylaxis is warranted in patients undergoing surgery with prolonged immobilization, pregnant women, or history of DVT/PE. What are the recommendations?
- Early ambulation ( < 40, minor procedures) - Elastic stockings, compression devices - LMWH (orthopedic surgery, trauma)
61
The Wells' Criteria for DVT. Explain
3 points added for: Clinical signs and symptoms of DVT, PE is #1 diagnosis 1.5 points for: HR > 100, Immobilization at least 3 days or surgery in past 4 weeks, previous DVT or PE 1 point: hemoptysis, malignant with treatment in past 6 months Low probability: < 2 points = D-dimer Moderate: 2-6 points = CTA or D-dimer High: > 6 = CTA
62
What is the antidote for LMWH and UFH?
Protamine Sulfate

PANCE/EOC (63 decks)

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