Pulmonology Test Flashcards
(111 cards)
1
Q
Acute inflammation of the trachea and bronchi (pathology)
A
Acute bronchitis
2
Q
MCC of acute bronchitis
A
Viral agent
3
Q
Acute bronchitis tx
A
Symptomatic tx to control cough, discomfort, and fever
4
Q
Acute inflammation of the terminal bronchioles (pathology)
A
Acute broncholitis
5
Q
Population in which acute broncholitis is MC
A
Infants and children
6
Q
MC cause of acute broncholitis
A
RSV or Adenovirus
7
Q
Acute broncholitis - how are CXR’s different between children and adults?
A
- Children: resembles patchy pneumonia
- Adults: looks like ground glass densities (looks fuzzy)
8
Q
You see “ground glass” densities on CXR. What’s in your differential based solely on that finding?
A
- Acute broncholitis in adults
- Interstitial lung disease (Diffuse parenchymal lung disease)
9
Q
TX for acute broncholitis
A
Supportive treatment
10
Q
Acute infection of the supraglottis with viral or bacterial pathogen (pathology)
A
Acute epiglottitis
11
Q
MC Cause of acute epiglottitis?
A
HIB (but rare now with the HIB vaccine)
12
Q
Child presents with severe odynophagia, muffled voice, and they’re drooling. You check their tonsils and the back of their throat and find nothing. What should you suspect?
A
Epiglottitis
13
Q
“Thumb print sign” on x-ray is related to what pathology?
A
Epiglottitis
14
Q
MCC of croup
A
Parainfluenza (flu-like) viruses
15
Q
Acute inflammatory disease of the larynx, accompanied by barking cough and stridor
A
Croup
16
Q
X-ray sign with croup
A
- Steeple sign
- From narrowing supraglottic narrowing secondary to edema
17
Q
Pertussis causative agent
A
Bordetella pertussis (Gram negative bacteria)
18
Q
How do you transmit Pertussis?
A
Via respiratory droplets
19
Q
3 stages of Pertussis
A
- Catarrhal stage
- Paroxysmal stage
- Convalescent stage
20
Q
Patient presents with rapid, consecutive coughs followed by a deep, high-pitched inspiration. What stage of what disease state are they in?
A
-The paroxysmal stage (the 2nd stage) of Pertussis (AKA “Whooping cough”)
21
Q
If suspicious of Pertussis (Whooping cough), on what agar should you use to plate a sputum sample?
A
Bordet-Gengou agar
22
Q
Antibiotics used for Pertussis (Whooping cough)
A
Macrolides (Erythromycin, Azithromycin, Clarithromycin)
23
Q
MCC of classic CA pneumonia
A
Strep pneumoniae
24
Q
Rust colored sputum is associated with what organism and what pathology?
A
- Strep pneumoniae
- pneumonia
25
Currant jelly sputum is associated with what organism and what pathology?
- Klebsiella
| - Pneumonia
26
Organism that will likely be responsible for pneumonia in alcoholics
Klebsiella
27
DOC family for classic CAP not requiring hospitalization in a young, otherwise healthy patient
Macrolide (Clarithromycin, Azithromycin, or Erythromycin)
28
DOC family for classic CAP not requiring hospitalization in an older patient with comorbidities
Doxycycline or Fleouroquinalone (Levofloxacin)
29
Treatment for classic CAP requiring hospitalization
- Extended spectrum beta lactam (PCN or cephalosporin) plus a Macrolide (Like Ceftriaxone IV with Azithromycin)
- Extended spectrum beta lactam (PCN or cephalosporin) plus a Flouroquinalone (Like Ceftriaxone IV with Levofloxacin)
30
MCC of atypical CAP
Mycoplasma pneumonia (or chlamydia, legionella, viruses)
31
What's the likely causative agent of an atypical pneumonia in a patient who may have consumed contaminated water?
Legionella
32
Preferred family of antibiotics for atypical CAP
Macrolides (Azithromycin, Erythromycin, Clarithromycin)
33
Likely causative agent in nosocomial pneumonia in an intubated patient or in a patient in the ICU
Pseudomonas
34
Two MC causes of nosocomial pneumonia
MRSA or pseudomonas
35
Treatment choice for nosocomial pneumonia with mild symptoms
2nd/3rd gen Cephalosporin (like Rocephin) and a Macrolide
36
Treatment choice for nosocomial pneumonia in a patient in the ICU or intubated
- Aminoglycoside (Streptomycin, Gentamicin, etc.) OR Flouoquinalone (Levofloxacin)
- AND an Antipseudomonal beta lactam (PCN, Cephalosporin, or Aztreonam)
- Add Vancomycin if MRSA is suspected
37
Likely causative agent of pneumonia in HIV patient
Pneumocystic jiroveci
38
What tool do we use to help us decide if pneumonia patient needs to be hospitalized?
PORT Score
39
Rare, aggressive manifestation of TB
Miliary TB
40
Inability to react to PPD test because of immunosuppression
Anergy
41
Isoniazid (INH) adverse effects
- Hepatitis
| - Peripheral neuropathy
42
Rifampin (RIF) adverse effects
- Hepatitis
- Flu-like symptoms
- Orange body fluid
43
Which TB treatment is contraindicated in pregnancy?
Streptomycin
44
Ethambutol (EMB) adverse effects
Optic neuritis (red-green vision loss)
45
Which types of bronchogenic carcinoma tend to originate centrally?
- Squamous cell carcinoma
| - Small cell
46
Which types of bronchogenic carcinoma tend to be located more peripherally?
- Adenocarcinoma
| - Large cell carcinoma (although this can also be located more centrally)
47
Which type of lung cancer may present as a cavitary lesion?
Large cell carcinoma
48
Two subtypes of large cell carcinoma
Giant and clear cell
49
Horner's syndrome consists of what?
- Enophthalmos
- Ptosis
- Miosis
- Ipsilateral anhydrosis
50
What type of tumor can cause Horner's syndrome?
Pancoast tumor
51
System used to stage non-small cell lung cancer
TMN
- T: tumor
- M: metastasis
- N: nodal involvement
52
2 classifications of small cell lung cancer
- Limited
| - Extensive
53
Pancoast tumors are one of what two "types" of tumor?
- Large cell
| - Or adenocarcinoma
54
Tumor of the lung's superior sulcus
Pancoast tumor
55
Imaging studies good for looking for Pancoast tumor
CT/MRI
56
How can you distinguish pleuritis from costochondritis?
-Costochondritis pain will be reproducible with pressure or palpation
57
Effusion caused by an increased production of fluid, with normal capillaries
Transudative
58
Type of effusion caused by fluid leaking through abnormal capillary walls, or from decreased lymphatic clearance
Exudative effusion
59
What labs would be significant in distinguishing a transudative effusion from an exudative effusion?
For an EXUDATIVE effusion:
- Pleural protein to serum protein ratio will be > 0.5
- Pleural LDH to serum LDH ration will be > 0.6
60
What changes in percussion and tactile fremitus will be observed with a pleural effusioN?
- Dullness to percussion
| - Decreased tactile fremitus
61
Procedure that drains a pleural effusion
Pleurodesis
62
Procedure that will likely be performed to drain a pleural effusion of pus
Tube thoracostomy
63
When a patient presents with a pneumothorax, what measurement will guide our treatment? (Either conservative wait-and-see treatment or insertion of a chest tube)
- If the pneumothorax is < 15%, conservative treatment
| - If the pneumothorax is > 15%, chest tube placement
64
Procedure indicated in patients with recurrent pneumothoracies
Pleurodesis (fusion of the pleura to obliterate the pleural space)
65
Where do we perform (anatomically) a needle thoracostomy?
2nd ICS, MCL
66
Primary tumors of the mesothelial cells arising from the surface lining of the pleura (pathology)
Mesothelioma
67
Inflammation and fibrosis of interalveolar septum or capillary endothelial cells (pathology)
Interstitial lung disease (diffuse parenchymal lung disease)
68
Most common diagnosis among patients with interstitial lung disease
Idiopathic fibrosing interstitial pneumonia
69
Systemic, inflammatory, multisystem disease of unknown cause with granulomatous inflammation of the lung in 90% of patients (pathology)
Sarcoidosis
70
Is sarcoidosis obstructive or restrictive?
Restrictive
71
TX of sarcoidosis
- Oral corticosteroids are first line
- Methotrexate
- Lung transplant
72
Chronic fibrotic lung disease caused by inhalation of various dusts (Asbestos, silica, coal) (Pathology?)
Pneumoconiosis
73
What is "Hampton's Hump" on CXR associated with?
PE
74
What "rule" do we use to help rule out the possibility of a PE?
PERC (Pulmonary Embolism Rule out Criteria)
75
What is "Westermark's Sign" on CXR associated with?
Pulmonary embolism
76
Will patients with a PE be acidotic or alkalotic? Why?
Alkalotic from hypervntilation
77
Only available definitive medicinal treatment for PE
Thrombolysis with Streptokinase, Alteplase, etc.
78
Treatment for PE when thrombolytic therapy is absolutely contraindicated
Embolectomy
79
Patient population in whom primary PHTN tends to occur?
Young and middle-aged women
80
What might a CBC reveal in a patient with PHTN? Why?
- Polycythemia
| - From chronic hypoxemia causing increased RBC production
81
Pulmonary vasodilator drug
Epoprostenol
82
Most common cause of cor pulmonale
COPD
83
3 components of asthma as an obstructive disease
- Airway hyper-responsiveness
- Inflammation
- Allergic/Immunologic-mediated
84
What will CXR of asthmatic patient show?
- Hyperinflation
| - Increased rib spacing
85
FEV1/FVC value indicative of obstructive disease
< 75%
86
What value should asthmatics test for every morning to make sure they're well-controlled?
Peak Expiratory Flow
87
What change in FEV1 is considered a positive bronchial provocation test?
Decrease in FEV1 by at least 20%
88
Type of asthma that's unrelated to allergens
Idiosyncratic (intrinsic) asthma
89
Lung functions defining intermittent asthma
- FEV1 > 80%
- Less than 20% variability
- FEV1/FVC is normal
90
Lung functions defining mild persistent asthma
- FEV1 > 80%
- 20-30% variability
- FEV1/FVC is normal
91
Lung functions defining moderate persistent asthma
- FEV1 60-80%
- > 30% variability
- FEV1/FVC is reduced by 5%
92
Lung functions defining severe persistent asthma
- FEV1 < 60%
- > 30% variability
- FEV1/FVC reduced by > 5%
93
How is FEV1 affected in obstructive disease?
Decreased
94
How is FVC affected in obstructive disease?
Decreased
95
How is FEV1/FVC affected in obstructive disease?
Decreased
96
How is PEF affected in obstructive disease?
Decreased
97
How is TLC affected in obstructive disease?
Increased (air-trapping)
98
How is RV affected in obstructive disease?
Increased (air-trapping)
99
TOC for acute symptoms in asthma?
Fast-acting beta agonists
100
TOC for bronchospasms in patients on beta-blockers or with COPD
Anticholinergic
101
Preferred agents for long-term control of asthma?
Long-acting corticosteroids
102
Indicated for maintenance therapy of mild-moderate asthma, or for exercised-induced asthma prophylaxis
Mediator inhibitors
103
Green zone for asthmatics (PEF value)
PEF > 80%
104
Yellow zone for asthmatics (PEF value)
PEF 50-80%
105
Red zone for asthmatics (PEF value)
PEF < 50%
106
"Mild" COPD FEV1 value
60-80% of predicted
107
"Moderate" COPD FEV1 value
40-59% of predicted
108
"Severe" COPD FEV1 value
< 40% of predicted
109
What cause of COPD should you be suspicious of if you have COPD in a patient < 40 yo?
Alpha-1 antitrypsin deficiency
110
Mainstay of drug therapy for COPD patients
Bronchodilators
111
Abnormal dilation of the bronchi resulting from inflammation and permanent destructive changes in the elastic and muscular layers of the bronchial walls
Bronchiectasis
