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310 Cards in this Set
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Q001. What is the most important determinant of the amount of oxygen delivery to tissues?
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A001. Hemoglobin
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Q002. Dx:; A married couple comes to the hospital complaining of "flu- like" symptoms including HA, N/V and disorientation. The wife thinks they caught the virus from a neighbor when they borrowed his home generator.
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A002. Carbon Monoxide Poisoning
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Q003. Equation for Arterial Oxygen content
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A003. 0.0031(PaO2) + 1.38(Hb x SaO2) = Art O2 content
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Q004. Definition:; Due to perfusion of poorly ventilated alveoli or due to alveoli not being perfused. What does it respond to?
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A004. V/Q mismatch; responds to:; supplemental Oxygen; (ex: COPD, CHF, PE, asthma, etc)
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Q005. What is a Right-to-Left shunt in the lungs do to?
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A005. Perfusion of a non-ventilated lung
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Q006. Describe Anemia's effect on hypoxia
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A006. Anemia = decreased Hb; low Hb causes a decrease in O2 carrying capacity:; Normal PaO2; Decreased PvO2
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Q007. When does a Low inspired O2 occur?
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A007. High-altitude
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Q008. What does not cause cyanosis or discoloration until it reaches toxic levels, where the patient will present with "cherry red" lips and nails?
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A008. Carbon Monoxide poisoning
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Q009. Definition:; Gas exchange compromise due to problem with alveolar interface; (ex: interstitial lung Dz)
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A009. Diffusion defect
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Q010. With what neuromuscular disorders does Hypoventilation occur?; (3)
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A010. Myasthenia gravis;; ALS;; Guillain-Barre
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Q011. What does an increased Fremitus suggest?
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A011. Consolidation of the lung
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Q012. What does an decreased Fremitus suggest?; (2)
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A012. Air or fluid in the chest; (Pneumothorax or PE); or; Overexpansion of the lung
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Q013. What does a "Dull" percussion represent?
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A013. Increased density; (increased fluid in the lungs)
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Q014. What does "hyperresonant" refer to with percussion?
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A014. Decreased density and more air; (ex: emphysema)
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Q015. Lung Auscultation definition:; Crackle (rale)
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A015. Excessive airway secretions; (Pneumonia, pulm edema, bronchitis)
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Q016. Lung Auscultation definition:; Wheeze
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A016. Rapid airflow through obstructed airway; (Asthma, bronchitis)
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Q017. Lung Auscultation definition:; Pleural Rub
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A017. Inflammation of the pleura; (Pneumonia, pulmonary infarction)
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Q018. What is it called if you ask the patient to say "eee" and it is heard as "aaa"?; What does it dx?; (2)
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A018. Egophony; Consolidation;; Compressed lung above a Pleural Effusion
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Q019. Definition:; A transudate or exudate in the lung
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A019. Pleural effusion
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Q020. What are (2) physiologic causes of Transudate pleural effusions?; (3) Dx illnesses
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A020. Causes:; Increased Hydrostatic Pressure;; Decreased Oncotic Pressure; From:; CHF;; Cirrhosis;; Nephrosis
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Q021. What is the physiologic cause of Exudate pleural effusions?; (3) Dx illnesses
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A021. Cause:; Increased Capillary permeability; From:; Tumor;; Infection;; Trauma
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Q022. What must be present to consider the pleural fluid an exudate?; (3 criteria--only one must be present)
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A022. 1. Ratio of Pleural to Serum Protein > 0.5; 2. Ratio of Pleural to Serum LDH > 0.6; 3. Pleural fluid LDH > 2/3 upper normal limit
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Q023. When is the pleural effusion considered Parapneumonic?; (2)
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A023. 1. Exudative Pleural fluid Leukocyte count > 10,000 with high PMNs; 2. Empyema
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Q024. Definition:; Pus in the pleural space; Lab criteria?
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A024. Empyema; (WBC > 100,000)
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Q025. What Dx Pleural effusions always require a chest tube?; (3)*
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A025. Pleural Effusion Line:; Positive Cultures;; Empyema;; Loculated Effusion
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Q026. What are the causes of gross blood in the pleural fluid?; (4)*
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A026. blood: A PTT; Aortic Dissection:; Pulmonary Infarction;; Tumor;; Trauma
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Q027. What are the causes of low glucose in the pleural fluid?; (4)*
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A027. Glucose is a TREaT:; Tumor;; Rheumatoid Arthritis;; Empyema;; TB
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Q028. What are the causes of high amylase in the pleural fluid?; (4)*
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A028. Amy(lase) is PRETty:; Pancreatitis;; Renal failure;; Esophageal rupture;; Tumor
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Q029. Device that measures the rate at which the lung changes during forceful breathing?
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A029. Spirometry
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Q030. Definition:; when the patient inhales normally, then exhales as rapidly and completely as possible that is recorded on Spirometry
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A030. Forced Vital Capacity; (FVC)
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Q031. Spirometry Normal values:; 1. FEV1; 2. FVC; 3. FEV1/FVC
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A031. Normals:; FEV1 = > 80%; FVC = > 80%; FEV1/FVC = > 0.7
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Q032. Values indicating Obstructive lung disease:; 1. FEV1; 2. FVC; 3. FEV1/FVC; 4. Lung volume
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A032. FEV1 = DECREASED; FVC = normal or Decreased; FEV1/FVC < 0.7; Lung volume = normal or decreased
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Q033. Values indicating Restrictive lung disease:; 1. FEV1; 2. FVC; 3. FEV1/FVC; 4. Lung volume
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A033. FEV1 = normal or Decreased; FVC = DECREASED; FEV1/FVC > 0.7; Lung volumes = Always DECREASED
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Q034. What are the (3) different types of Restrictive lung defects?
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A034. Interstitial Lung Dz (fibrosis);; Neuromuscular Dz (ALS, MG);; Chest Wall disorders (obesity, kyphosis)
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Q035. What does the Obstructive defect look like on Spirogram?
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A035. "swoopie"
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Q036. What does the Restrictive defect look like on Spirogram?
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A036. Tall and thin
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Q037. *When is a Bronchoscopy the most accurate test?; (2); Only test more accurate?
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A037. 1. Infections such as TB or Pneumocystis; 2. Centrally located Abscess or Tumor; More accurate:; Open Lung Biopsy
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Q038. Dx:; an epileptic, febrile patient with cough for the last several weeks, weight loss and malodorus sputum; unusual finding in upper lung lobe on CXR; Most accurate test?
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A038. Lung Abscess; test:; Lung Biopsy
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Q039. Most accurate diagnostic test of any pulmonary bacterial infection?
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A039. Gram Stain of the Sputum
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Q040. Dx:; patient has a fever, cough and shortness of breath. There are crackles and consolidation over a lung lobe. First test?; Most accurate Dx test?
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A040. Bacterial Pneumonia (MCC Strep); first test: CXR; most accurate: Gram Stain of Sputum
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Q041. What causes interstitial infiltrates?; (4)
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A041. causes:; Viral Pneumonia;; PCP;; Mycoplasma;; Legionella
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Q042. Most accurate test for:; Interstitial Lung Infiltrates caused by PCP
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A042. Bronchoalveolar Lavage; (also Increased LDH)
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Q043. *Most accurate test for:; Interstitial Lung Infiltrates caused by Legionella
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A043. Urine Antigen testing
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Q044. *Most accurate test for:; Interstitial Lung Infiltrates caused by Mycoplasma or Chlamydia
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A044. Serology Antibody titers
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Q045. What is the MC etiology of a Pleural Effusion?; (2); Most accurate test?
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A045. etiology:; 1. CHF; 2. Pneumonia; test: Thoracentesis for fluid analysis
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Q046. What is the best test to tell the difference b/t Obstructive and Restrictive lung disease?
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A046. Flow-Volume Loop
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Q047. *When is a Pulmonary Function Test the most accurate Dx Test?; What part of the test is most accurate in Dx?
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A047. Distinguish b/t Obstructive and Restrictive lung disease; most accurate part:; FEV/FVC ratio
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Q048. Dx:; African-American female with cough, dyspnea, chest pain and bilateral hilar lymphadenopathy. First test?; Most accurate Dx test?
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A048. Sarcoidosis; first test: ACE levels (increased); most accurate: Noncaseating Granuloma on Biopsy
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Q049. Dx:; a young non-smoker with emphysema and liver disease; First test?
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A049. Alpha-1-Antitrypsin Deficiency (low levels); First test: serum A1A levels
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Q050. *When is Performing an ABG the best answer?; (3)
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A050. 1. COPD; 2. possible Respiratory Acidosis; 3. Low serum Bicarb (possible severe Met acidosis)
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Q051. Dx:; chronic respiratory problems, cough, SOB, fat malabsorption, vitamin deficiency, sterile. Blood gas reveals hypoxemia. Best test?
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A051. Cystic Fibrosis; best test: Sweat Chloride; (Pilocarpine is given and Na + Cl is measured in the sweat)
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Q052. (3) Typical Sx of Pneumonia
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A052. Fever;; Cough with sputum;; Pleurtic Chest pain
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Q053. (4) Physical Exam findings with Pneumonia
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A053. Dullness to Percussion;; Rales (Crackles);; Egophany;; Tactile Fremitus in consolidated segment
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Q054. Bug Dx:; 27-yo patient has pneumonia, bullous myringitis and a chest film that looks worse then expected
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A054. Mycoplasma Pneumonia
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Q055. If a patient comes to the ER with consolidation and pleural effusion on CXR, what is the most important test to determine admission / Tx?
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A055. Thoracentesis
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Q056. Bug Dx:; patient with HIV who has a CD-4 count of 52 does not take antiretroviral meds or TMP-SMX, is hypoxic on room air, and has a diffuse bilateral infiltrate on chest film
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A056. PCP; (Pneumocystis Carinii Pneumonia)
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Q057. Bug Dx:; Elderly man presents with pneumonia, GI Sx, bradycardia, and hypoN
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A057. Legionella
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Q058. Pneumonia Bug Dx:; Currant Jelly sputum
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A058. Klebsiella
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Q059. Pneumonia Bug Dx:; Rusty sputum
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A059. Pneumococcus
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Q060. Pneumonia Bug Dx:; patient develops a post-influenza pneumonia
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A060. Pneumococcus
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Q061. Pneumonia Bug Dx:; Buldging fissure on CXR
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A061. Klebsiella
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Q062. Pneumonia Bug Dx:; No bacteria on sputum gram stain culture; (2)
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A062. Legionella; Mycoplasma
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Q063. Pneumonia Bug Dx:; signs of pneumonia and Serum LDH is high
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A063. PCP
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Q064. MC Community Acquired, typical pneumonia; (2)
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A064. S. pneumoniae; H. Influenzae
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Q065. MC Community Acquired, atypical pneumonia; (3)*
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A065. Community Lung Mess:; Chlamydia pneumoniae;; Legionella;; Mycoplasma
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Q066. MC Hospital Acquired pneumonia; (3)
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A066. Pseudomonas aeruginosa;; S. aureus;; Enteric organisms (E. coli)
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Q067. What is the MCC of pneumonia (bugs) in the HIV patients as the CD-4 count decreases to the following numbers; (in order of occurrence)*:; 1. < 500; 2. < 200; 3. < 200; 4. < 200; 5. < 50; 6. < 50
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A067. The Pneumonia HIV Causes Are Count-based:; 1. TB (500); 2. PCP (200); 3. Histoplasma (200); 4. Cryptococcus (200); 5. Avium (mycoplasma) (50); 6. CMV (50)
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Q068. MCC of pneumonia in the immunocompromised host with Neutropenia; (4)*
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A068. Pseudomonas;; Enterobacteriaceae;; S. Aureus;; Aspergillus
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Q069. MCC of pneumonia in the immunocompromised host with sickle cell or a splenectomy
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A069. Encapsulated organisms
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Q070. MCC of pneumonia in the immunocompromised host with chronic Steroid use; (2)
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A070. TB;; Nocardia
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Q071. MCC of pneumonia in Alcoholics; (4)
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A071. S. pneumoniae;; H. Influenzae;; Klebsiella;; TB
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Q072. Pneumonia Bug Dx:; Small gram negative rod with a halo on gram stain
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A072. H. Influenzae
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Q073. CXR pneumonia findings:; Upper lobe; (2)
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A073. TB;; Klebsiella
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Q074. CXR pneumonia findings:; small cavities w/o air-fluid levels
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A074. TB; (Mycobacterium)
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Q075. CXR pneumonia findings:; Large cavities with air-fluid levels that do not culture; (2)
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A075. Coccidioidomycosis;; Nocardia
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Q076. CXR pneumonia findings:; Diffuse Bilateral Infiltrates; (2)
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A076. PCP;; Mycoplasma
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Q077. Definition:; Idiopathic Eosinophilic Pneumonia
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A077. Loeffler's pneumonia
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Q078. Pneumonia bugs causing "Relative Bradycardia"; (slower then expected HR for Temp, but above 60bpm); (3)
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A078. Legionella;; Salmonella;; Chlamydia Psittaci
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Q079. What drug prevents respiratory failure and improves survival in PCP pneumonia patients?; Criteria for when it is given?; (2)
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A079. Steroids; give: A-a gradient > 35, PaO2 < 75
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Q080. Drug of choice for:; Any Community Acquired Pneumonia with no risk factors
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A080. Macrolide; (Erythromycin, Azithromycin)
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Q081. Drug of choice for:; Any Community Acquired Pneumonia with risk factors; (CHF, DM, etc); (2)
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A081. 1. Macrolide + 2nd generation Cephalosporin; 2. FQ (Extended-spectum)
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Q082. Drug of choice for:; Any Hospital Acquired Pneumonia; (2)
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A082. 1. Cefixime; 2. Piperacillin-tazobactam; [both for Pseudomonas coverage]
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Q083. Drug of choice for:; Any Immunocompromised patient with Pneumonia
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A083. TMP-SMX; [for PCP coverage]
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Q084. Dx:; Productive cough, night sweats, hemoptysis, anorexia, weight loss, chest pain, fever, chills
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A084. TB
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Q085. (3) Dx tests for TB
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A085. Positive PPD;; Granuloma in upper lobes of lung;; Acid-fast bacilli on sputum
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Q086. How is latent TB treated?
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A086. INH daily for 9 months; (or Rifampin for 4 if in contact with INH-resistant TB)
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Q087. How is Active TB treated?
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A087. RIPE for 2 months:; Rifampin; INH, Pyrazinamide; Ethambutol; followed with 4 months of:; INH and Rifampin
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Q088. How is tx of TB different with pregnant pt?
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A088. No pyrazamide; (other med ok)
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Q089. Toxicity of INH; (2)*
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A089. INH: Infects Neuro and Hepatic:; Neruopathy;; Seizures;; Hepatitis
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Q090. Dx:; patient brought by ambulance in status epilepticus. Patient says only medical history is TB; How is it treated?
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A090. INH toxicity; Tx: Pyridoxine
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Q091. Toxicity of Rifampin; (2)
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A091. Induces P450; Gives Red-orange secretions; (tears, urine, sweat, etc)
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Q092. Toxicity of Ethambutol
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A092. Optic neuritis and impaired color vision
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Q093. Risk factors for DVT.
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A093. stasis; endothelial injury; hypercoagulability; (Virchow's triad)
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Q094. Criteria for exudative effusion.
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A094. pleural/serum protein > 0.5; pleural/serum LDH > 0.6
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Q095. Causes of exudative effusion.
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A095. Think of leaky capillaries. Malignancy; TB; bacterial or viral infection; pulmonary embolism with infarct; pancreatitis
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Q096. Causes of transudative effusion.
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A096. Think of intact capillarie. CHF; liver or kidney disease; protein-losing enteropathy
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Q097. Normalizing PCO2 in a patient having an asthma exacerbation may indicate?
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A097. Fatigue & impending respiratory failure
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Q098. dyspnea; lateral hilar lymphadenopathy on CXR; noncaseating granulomas; increased ACE; hypercalcemia
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A098. Sarcoidosis
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Q099. PFT showing decreased FEV1/FVC.
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A099. Obstructive pulmonary disease (e.g. asthma)
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Q100. PFT showing increased FEV1/FVC.
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A100. Restrictive pulmonary disease
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Q101. Honeycomb pattern on CXR. Diagnosis?; Treatment?
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A101. Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help.
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Q102. Treatment for SVC syndrome.
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A102. Radiation
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Q103. Treatment for mild, persistent asthma.
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A103. Inhaled beta-agonists & inhaled corticosteroids
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Q104. Acid-base disorder in pulmonary embolism.
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A104. Hypoxia & hypocarbia
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Q105. Non-small cell lung cancer (NSCLC) associated with hypercalcemia.
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A105. Squamous cell carcinoma
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Q106. Lung cancer associated with SIADH.
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A106. Small cell lung cancer (SCLC)
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Q107. Lung cancer highly related to cigarette
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A107. Small cell lung cancer (SCLC)
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Q108. A tall white male presents with acute shortness of breath. Diagnosis?; Treatment?
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A108. Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful.
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Q109. Treatment of tension pneumothorax.
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A109. Immediate needle thoracostomy
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Q110. Characteristics favoring carcinoma in an isolated pulmonary nodule.
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A110. Age > 45-50 yrs; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
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Q111. Hypoxemia & pulmonary edema with normal pulmonary capillary wedge pressure.
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A111. ARDS
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Q112. Increased risk of what infection with silicosis?
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A112. Mycobacterium tuberculosis
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Q113. Causes of hypoxemia.
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A113. right-to-left shunt; hypoventilation; low inspired O2 tension; diffusion defect; V/Q mismatch
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Q114. Classic CXR findings for pulmonary edema
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A114. cardiomegaly; prominent pulmonary vessels; Kerley B lines; "bat's wing" appearance of hilar shadows; perivascular & peribronchial cuffing
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Q115. pulmonary function tests
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A115. spirometry (mechanical ventilation); Dlco (gas exchange); methacholine challenge test (bronchial hyperreactivity); TLC
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Q116. restrictive pattern
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A116. FEV1/FVC > 80%
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Q117. obstructive pattern
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A117. FEV1/FVC < 80%; seen in emphysema, chronic bronchitis, asthma, bronchiectasis
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Q118. Decreased DLco
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A118. if FEV1/FVC < 80% suggests emphysema; if FEV1/FVC > 80% suggests interstitial lung disease or mild left heart failure
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Q119. Increased DLco
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A119. suggests hemorrhage such as in Goodpasture
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Q120. methacholine test
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A120. bronchoprovocation in patients with cough or wheezing who have normal pulmonary function tests, for possible asthma; do basal and postprovocation spirometry; positive test if baseline FEV1 decreased >20%
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Q121. A-a gradient formula
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A121. 150 - (1.25 x PaCO2) - PaO2 normal: 5-15mmHg;; increases with age and all forms of hypoxemia except hypoventilation and high altitude
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Q122. solitary pulmonary nodule
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A122. 1/3 are malignant; first step in management is looking for previous image study; if none available then consider if patient is high or low risk for cancer; low risk nonsmoker <35 --> x-ray every 3 months for 2 years, if no growth stop follow-up; high risk smoker >50 --> open-lung biopsy and removal due to cancer risk
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Q123. transudative pleural effusion
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A123. Decreased hydrostatic pressure or decreased oncotic pressure; usually bilateral and equal; low LDH and proteins in fluid and serum (200, 0.6, 0.5); need all three values for diagnosis, else exudate
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Q124. exudative pleural effusion
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A124. due to local process; usually unilateral; need further investigation; high LDH and proteins in fluid and serum (200, 0.6, 0.5); don't need all three values high to make diagnosis
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Q125. transudative causes of pleural effusion
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A125. heart failure; nephrotic syndrome; liver disease; pulmonary embolism; atelectasis
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Q126. exudative causes of pleural effusion
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A126. pneumonia; cancer (lung, breast or lymphoma); pulmonary embolism; drug-induced; pancreatitis; TB; RA; SLE
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Q127. transudative pleural effusion with no apparent cause
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A127. consider pulmonary embolism which can be either transudative or exudative
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Q128. indications of thoracocentesis
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A128. any new and unexplained pleural effusion --> rule out empyema; decubitus x-ray --> <1cm free-flowing fluid --> minimal risk; if non-free fluid need ultrasound guidance
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Q129. malignant pleural effusions
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A129. due mostly to breast cancer, lung cancer and lymphoma; send thoracocentesis fluid for cytologic exam also
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Q130. hemorrhagic pleural effusion
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A130. seen in mesothelioma, metastatic lung or breast cancer, pulmonary embolism with infarction and trauma
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Q131. lymphocytic-predominant pleural effusions
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A131. suggests TB due to tuberculin hypersensitivity; check increased adenosine deaminase and positive PCR for TB; acid-fast and culture of fluid are only positive in 30%
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Q132. respiratory compromise and distress
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A132. presents with shortness of breath, dyspnea, tachypnea (>30) and associated symptoms such as agitation, confusion or decreased consciousness
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Q133. evaluation of respiratory distress
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A133. ensure patent airway; focus on quickness of onset and associated symptoms; most important lab test is arterial blood gases then B- natriuretic peptide and chest x-ray
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Q134. acute respiratory distress with fever, cough or sputum
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A134. suggests infectious etiology
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Q135. acute respiratory distress without systemic symptoms
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A135. suggests airway obstruction, cardiac disease or thromboembolism
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Q136. chronic respiratory distress
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A136. suggests interstitial lung disease or COPD
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Q137. common lung physical exam findings
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A137. diffuse wheezing --> asthma; localized wheezing --> foreign object; rales --> pneumonia, interstitial disease, heart failure; dull percussion --> pneumonia or atelectasis; normal exam --> pneumocystis jirovecci, central respiratory problems
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Q138. B-natriuretic peptide in acute dyspnea
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A138. elevation is sensitive for heart failure but can also be elevated in cor pulmonale and acute right ventricular failure (thromboembolism)
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Q139. chest x-ray without parenchymal infiltrates in acute dyspnea
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A139. suggests thromboembolism; central respiratory depression; neuromuscular disease; upper airway obstruction
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Q140. chest x-ray hyperinflation in acute dyspnea
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A140. suggests asthma and COPD
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Q141. chest x-ray with focal infiltrates in acute dyspnea
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A141. suggests bacterial, viral or fungal pneumonia, aspiration or pulmonary hemorrhage
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Q142. chest x-ray with diffuse edema in acute dyspnea
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A142. suggests heart failure or ARDS
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Q143. ICU indications in respiratory failure
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A143. persistent hypoxemia --> hospitalization; ICU indications -->; need for mechanical ventilation; close monitoring; increasing oxygen demand; continuous nursing
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Q144. indications for intubation and/or mechanical ventilation
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A144. respiratory acidosis and hypercapnia in asthmatic patient; upper airway injury (burns, laryngeal edema, trauma); neurologic airway depression (often with loss of gag and cough reflexes)
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Q145. respiratory distress in hospitalized patients
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A145. inpatient who develops dyspnea, tachypnea and/or hypoxemia should raise possibility of pulmonary embolism or aspiration
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Q146. types of asthma
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A146. intrinsic (50%) is secondary to nonimmunologic stimuli (infections, irritating inhalants, cold air and emotional);; extrinsic (20%) due to allergens
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Q147. asthma stimuli
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A147. infections (RSV, rhinovirus),; drugs (aspirin/NSAIDs, coloring agents, betablockers),; allergens,; cold air,; emotions
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Q148. asthma presentation
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A148. tachypnea,; tachycardia,; diffuse wheezing,; use of accessory muscles,; diminished breath sounds,; hyperresonance,; intercostal retractions
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Q149. asthma poor prognosis factors
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A149. fatigue; diaphoresis; pulsus paradoxus; inaudible breath sounds; decreased wheezing; cyanosis; bradycardia
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Q150. asthma diagnosis
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A150. initial tests for acute attacks --> decreased PaCO2, increased pH, normal or decreased PaO2; severe attack -->decreased PaO2, increased PaCO2, decreased pH; chest x-ray to rule out infection as cause; spirometry --> obstructive pattern that reverses with beta agonist (FEV1 reverses by 12%); methacholine test --> decreased FEV1/FVC of 20%
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Q151. acute asthma management
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A151. O2; metered inhaled beta agonists --> albuterol/salbutamol, terbutaline; salmeterol is long-lasting for nocturnal variant; catecholamines may be used but not routinely; aminophylline and theophyline have modest potency and are not routine; anticholinergics (ipratropium) if heart disease (slow onset, medium potency)
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Q152. chronic asthma management
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A152. acute exacerbations: systemic prednisone 10-14 days along with inhaled albuterol;; inhaled corticosteroids are first line maintenance;; cromolyn is first line maintenance in children and prophylaxis in adults;; zileuton, zafirlukast, mmonteleukast for severe asthma resistant to maximum doses of inhaled steroids
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Q153. mild asthma definition and treatment
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A153. symptoms ~2 days/week and rare night symptoms; FEV1 is normal; no long-term control needed only inhaled beta agonists for attacks
|
|
Q154. moderate asthma definition and treatment
|
A154. symptoms on most days and at least 5 nights/month with FEV1 60-80%; treat with daily inhaled steroids (also cromolyn specially in children); maybe also salmeterol
|
|
Q155. severe asthma definition and treatment
|
A155. daily symptoms, frequent night symptoms and hospital emergencies with FEV1 <60%;; daily inhaled steroids, daily inhaled salmeterol along with antileukotriene drug and possibly low-dose oral steroid
|
|
Q156. physical exam in emphysema
|
A156. distant breath sounds; pink skin; thin; barrel chest; accessory muscles; symptoms of right heart failure and clubbing
|
|
Q157. physical exam in chronic bronchitis
|
A157. rhonchi and wheezes; signs of cyanosis; weight gain; symptoms of right heart failure and clubbing
|
|
Q158. chest x-ray findings in COPD
|
A158. chronic bronchitis --> increased pulmonary markings; emphysema --> bilateral hyperinflantion, diaphragm flattening, small heart size, increase in retrosternal space
|
|
Q159. COPD diagnosis
|
A159. decreased FEV1/FVC; FEF 25-75; increased RV and TLC; emphysema has decreased DLco and chronic bronchitis has normal DLco; FEV1/FVC after bronchodilation will stay the same
|
|
Q160. COPD complications
|
A160. hypoxemia with nocturnal desaturation; secondary erythrocytosis; cor pulmonale; chronic ventilatory failure; CO2 retention
|
|
Q161. maintenance treatment for COPD
|
A161. first-line --> ipratropium via metered inhaler;; inhaled beta agonists can be used concomitantly;; inhaled corticosteroids are not used in COPD;; if above fails --> theophylline (watch for cytochrome inhibitors and inducers)
|
|
Q162. only treatment that reduces mortality in COPD
|
A162. home O2 supplementation and smoking cessation; home oxygen for hypoxemia (PaO2<55mmHg or saturation <88%); pneumococcal vaccine every 5 years, influenza vaccine yearly and haemophilus vaccine if unvaccinated
|
|
Q163. COPD exacerbation general management
|
A163. 1) measure O2 saturation (pulse oximetry); 2) arterial blood gases; 3) chest x-ray; 4) check theophylline levels; 5) CBC and ECG; 6) hospital admission if significant hypercapnia or hypoxemia; 7) consider intubation and mechanical ventilation; 8) specific treament; spirometry is NOT done or useful in exacerbation
|
|
Q164. COPD exacerbation specific treatment
|
A164. 1) O2 supplementation; 2) inhaled bronchodilators and anticholinergics concomitantly; 3) IV or oral prednisone for 2 weeks; 4) antibiotics despite normal x-ray; 5) council on smoking cessation; 6) teach optimal use of MDI; no benefit in IV theophylline and avoid opiates and sedatives
|
|
Q165. bronchiectasis etiology
|
A165. secondary to recurrent pneumonias, TB, fungal or abscess; cystic fibrosis, immotile cilia syndrome (50% Kartagener)
|
|
Q166. bronchiectasis presentation
|
A166. suspect in anyone with; chronic cough; foul-smelling sputum; hemoptysis; recurrent pulmonary infections; sinusitis; immune deficiencies; presents with purulent copious sputum, wheezes, crackles and history of recurrent pneumonias (specially gram- and pseudomonas)
|
|
Q167. bronchiectasis diagnosis
|
A167. early chest x-ray may be normal or severe cases show 1- 2cm cysts and crowding of bronchi;; chest CT is best noninvasive test
|
|
Q168. bronchiectasis treatment
|
A168. bronchodilators, chest physical therapy, postural drainage, rotating gram- antibiotics; surgery in cases of localized bronchiectasis or massive hemoptysis; yearly influenza vaccine and pneumococcal vaccine with booster at 5 years
|
|
Q169. bronchiectasis complications
|
A169. massive hemoptysis,; amyloidosis,; cor pulmonale,; visceral abscesses
|
|
Q170. interstitial lung disease general presentation
|
A170. exertional dyspnea; nonproductive cough; crackles; pulmonary hypertension; clubbing; restrictive pattern
|
|
Q171. interstitial lung diseases
|
A171. idiopathic pulmonary fibrosis; sarcoidosis; pneumoconiosis --> asbestosis, silicosis, coal pneumoconiosis
|
|
Q172. idiopathic pulmonary fibrosis presentation
|
A172. exercise intolerance, dyspnea, coarse crackles
|
|
Q173. idiopathic pulmonary fibrosis diagnosis
|
A173. reticular or reticulonodular pattern on chest x-ray; restrictive pattern on PFTs; increased macrophages on bronchoalveolar lavage (nonspecific)
|
|
Q174. idiopathic pulmonary fibrosis treatment
|
A174. steroids with or without azathioprine works in 20%;; the rest develop fatal lung disease
|
|
Q175. idiopathic pulmonary fibrosis prognosis
|
A175. 20-40% 5-year survival;; best prognostic factor is response to steroids as evidenced in PFTs
|
|
Q176. sarcoidosis presentation
|
A176. "GRAIN"; gammaglubilinemia; rheumatoid arthritis; ACE increase; interstitial fibrosis; non-casseating granuloma; hilar and left paratracheal adenopathy; hypercalcemia due to vitamin activation by macrophages; uveitis/conjunctivitis in >25%; chest x-ray findings; restrictive or normal PFTs
|
|
Q177. chest x-ray findings in sarcoidosis
|
A177. four stages found (not progressive); bilateral hilar adenopathy; hilar adenopathy with reticulonodular parenchyma; reticulonodular parenchyma alone; honeycombing of bilateral lung fields with fibrosis
|
|
Q178. sarcoidosis diagnosis
|
A178. biopsy of affected tissue showing noncasseating granulomas;; all patients should have ophthalmologic exam
|
|
Q179. sarcoidosis prognosis
|
A179. 80% remain stable or spontaneously resolves;; 20% progress to organ compromise
|
|
Q180. sarcoidosis treatment
|
A180. no treatment is effective; if organ compromise may use trial of high-dose steroids; if uveitis, CNS involvement or hypercalcemia --> steroids are mandatory
|
|
Q181. pneumoconiosis general presentation
|
A181. dyspnea,; shortness of breath,; cough,; sputum,; cor pulmonale,; clubbing,; restrictive pattern,; decreased DLco,; hypoxemia with increased A-a
|
|
Q182. ocupations associated with asbestosis
|
A182. mining,; milling,; foundry work,; shipyards,; pipes,; break linings,; insulation,; boilers;; history of exposure necessary for Dx
|
|
Q183. asbestosis x-ray findings
|
A183. diffuse or local pleural thickening,; pleural plaques,; calcifications near diaphragm,; pleural effusions,; lower lobe interstitial infiltrate
|
|
Q184. asbestosis associated cancers
|
A184. lung adenocarcinoma or SCC; pleural mesothelioma is less common
|
|
Q185. asbestosis diagnosis
|
A185. history of exposure + lung biopsy showing barbell-shaped asbestos fibers
|
|
Q186. asbestosis treatment
|
A186. no effective treatment;; must stop smoking due 75x increased risk of cancer
|
|
Q187. ocupations associated with silicosis
|
A187. mining,; quarrying,; tunneling,; glass and pottery making,; sandblasting
|
|
Q188. silicosis x-ray findings
|
A188. 1-10mm nodules throughout the lungs, most prominent in upper lobes; in progressive massive fibrosis nodules are >10mm and coalesce
|
|
Q189. silicosis diagnosis
|
A189. history of exposure + lung biopsy showing silica particles; pathologic lesion is the hyaline nodule
|
|
Q190. silicosis treatment
|
A190. no effective treatment; should have yearly PPD test and if >10mm --> INH prophylaxis for 9 months
|
|
Q191. Lofgren syndrome
|
A191. acute sarcoidosis presentation with erythema nodosum, arthritis, hilar adenopathy
|
|
Q192. Heefordt-Waldenstrom syndrome
|
A192. acute sarcoidosis presentation with fever,; parotid enlargement,; uveitis and facial palsy
|
|
Q193. Caplan syndrome
|
A193. rheumatoid nodules in periphery of lung,; rheumatoid arthritis and coexisting pneumoconiosis (usually CWP)
|
|
Q194. coal worker's pneumoconiosis x-ray findings
|
A194. small round parenchymal densities; usually in upper half of lungs; progressive massive fibrosis has 1cm densities in whole lung
|
|
Q195. coal worker's pneumoconiosis immunologic findings
|
A195. increased IgA,; increased IgG,; increased C3, ANA and rheumatoid factor
|
|
Q196. pulmonary embolus site of origin
|
A196. most are from above-the-knee deep veins which result from distal deep vein thrombosis;; in patients with catheters it can originate from upper limb, subclavian and internal jugular veins
|
|
Q197. criteria for high-risk pulmonary embolism patients
|
A197. recent surgery (specially orthopedic, knee replacement has 70% risk);; cancer history (prostate, breast, pelvic, abdominal);; immobilized patients;; acquired thrombophilia (lupus anticoagulant, nephrotic syndrome);; oral contraceptives;; inherited thrombophilia (factor V Leiden, protein C/S deficiency, antithrombin III deficiency);; pregnancy;; need 1 risk factor and consistent signs and symptoms for high-risk label
|
|
Q198. signs and symptoms consistent with pulmonary embolism
|
A198. sudden onset of dyspnea,; tachypnea,; thigh/calf swelling,; pleuritic chest pain,; hemoptysis,; tachycardia,; increased P2
|
|
Q199. when to consider pulmonary embolism
|
A199. all patients with dyspnea and normal chest x-ray
|
|
Q200. nonspecific routine tests for dyspnea; may suggest PE
|
A200. arterial blood gases show hypoxemia with increased A-a; chest x-ray (normal in PE); ECG (to exclude others) shows S1, Q3, T3, tachycardia
|
|
Q201. specific tests for pulmonary embolism
|
A201. best initial test is spiral CT scan;; V/Q scan (if normal excludes PE);; angiogram is gold standard
|
|
Q202. deep venous thrombosis specific tests
|
A202. best initial test is compression or duplex ultrasound;; venogram is rarely done;; MRI
|
|
Q203. tests for DVT and PE
|
A203. D-dimer is most sensitive;; can only exclude thromboembolism if normal levels; may also be high in surgery, infection, trauma, pregnancy and DIC; normal D-dimer and CT scan rule out thromboembolism in 98% of low-risk patients
|
|
Q204. tests results that exclude pulmonary embolism
|
A204. normal CT + normal D-dimer in low-risk patients; normal CT + normal doppler in low-risk patients; V/Q scan is completely normal
|
|
Q205. generalities of pulmonary embolism diagnosis
|
A205. all patients should be on heparin during diagnosis and imaging;; if PE is suspected start CT scan right after chest x-ray;; if all tests are negative but it's high-risk patient --> angiogram;; normal CT + normal D-dimer or doppler excludes PE in low- risk patients
|
|
Q206. pulmonary embolism treatment
|
A206. 1) O2; 2) start heparin before confirmation and during work-up; 3) concomitant warfarin; 4) if hemodynamically unstable or massive PE --> thrombolytics (tPa, streptokinase)
|
|
Q207. heparin considerations in pulmonary embolism
|
A207. if LMWH then no need to follow PTT and less chance of heparin-induced thrombocytopenia; HIT is associated with more thrombotic events, not bleeding diathesis, and is treated with new anticoagulants (argatroban, lepirudin); start heparin immediately
|
|
Q208. warfarin considerations in pulmonary embolism
|
A208. monitor PT; titrate to INR of 2-3; skin necrosis can occur if protein C deficiency already present; contraindicated in pregnancy (use LMWH 6 months instead)
|
|
Q209. contraindications of anticoagulation therapy in PE
|
A209. contraindicated in patients with recent neurosurgery or eye surgery; use inferior vena cava filter instead
|
|
Q210. post thrombotic syndrome
|
A210. pain; edema; hyperpigmentation; skin ulceration in 2/3 of PE patients; compression stockings can prevent it
|
|
Q211. fat embolism
|
A211. acute dyspnea, petechiae in neck or axilla, confusion,; 3 days after long bone fracture or after CPR;; no anticoagulation necessary
|
|
Q212. ARDS etiology
|
A212. sepsis; trauma; DIC; Goodpasture; SLE; drug overdose; toxin inhalation; drowning
|
|
Q213. ARDS presentation
|
A213. dyspnea,; tachypnea,; diffuse rales and ronchi
|
|
Q214. ARDS diagnosis
|
A214. chest x-ray --> diffuse interstitial or alveolar infiltrates; ABGs --> decreased PaO2, increased PaCO2; Swan-Ganz --> normal cardiac output and capillary wedge pressure but increased pulmonary artery pressure
|
|
Q215. ARDS treatment
|
A215. treat underlying cause;; mechanical ventilation with positive end-expiratory pressure
|
|
Q216. ARDS prognosis
|
A216. 70% mortality
|
|
Q217. sleep apnea
|
A217. cessation of airflow >10s at least 10-15/hour of sleep + daytime somnolence; confirm with polysomnography; treat obstructive with weight loss and nasal continuous positive airway pressure (CPAP); treat central with acetazolamide, progesterone and O2
|
|
Q218. lung cancer etiology
|
A218. 90% of cases are directly related to cigarette smoke;; nonsmokers develop adenocarcinoma;; all lung cancers are associated with smoking;; active smokers have 10x greater risk;; 40 pack-year history increases risk 60-70x;; asbestos increases risk 75x
|
|
Q219. types of lung cancer
|
A219. most common is adenocarcinoma (40%);; squamous cell carcinoma,; small cell and large cell
|
|
Q220. centrally located lung cancers
|
A220. squamous cell and small cell
|
|
Q221. peripheral located lung cancers
|
A221. adenocarcinoma and large cell
|
|
Q222. lung cancer paraneoplastic syndromes
|
A222. SCC --> hypercalcemia (PTH-like peptide); small cell --> SIADH and Eaton-Lambert
|
|
Q223. lung cancer metastasis
|
A223. SCC --> direct extension to hilar node and mediastinum; small cell and adenocarcinoma --> liver, adrenals, brain, bones
|
|
Q224. lung cancer presentation
|
A224. cough; weight loss; dyspnea; hemoptysis; chest pain; recurrent pneumonic processes; hoarseness
|
|
Q225. lung cancer diagnosis
|
A225. sputum cytology (specially SCC); bronchoscopy for centrally located lesions; needle aspiration biopsy if highly suspicious and nonspecific bronchoscopy findings or peripheral lesion
|
|
Q226. symptoms of unresectable lung cancer
|
A226. weight loss >10%; bone pain; extrathoracic metastasis; CNS symptoms; SVC syndrome; hoarseness; contralateral mediastinal adenopathy
|
|
Q227. lung cancer treatment
|
A227. resectable small cell --> VP16 (etoposide, platinum);; resectable non-small --> CAP (cyclo, adriamycin, platinum) and radio
|
|
Q228. lung cancer prognosis
|
A228. 5-8% 5-year survival; after resection of SCC --> 30-35%; after resection of large-cell and adeno --> 25%
|
|
Q229. atelectasis etiology
|
A229. most common is postsurgery;; also mucuous plug, foreign body or tumor
|
|
Q230. atelectasis presentation
|
A230. tachycardia,; dyspnea,; fever,; hypoxemia
|
|
Q231. atelectasis diagnosis
|
A231. ipsilateral trachea deviation --> upper lobe; mediastinal deviation --> massive atelectasis; elevation of hemidiaphragm --> lower lobe; atelectatic lobe looks denser, consolidated and smaller than normal contralateral lobe
|
|
Q232. What muscles are responsible for inspiration during exercise?
|
A232. external intercostals; scalenes,; sternocleidomastoid,
|
|
Q233. What muscles are responsible for expiration during exercise?
|
A233. Internal intercostals,; rectus abdominis,; transversus abdominis,; internal and external obliques
|
|
Q234. What ratio indicates fetal lung maturity?
|
A234. lecithin: sphingomyelin > 2.0
|
|
Q235. What is deficiency in neonatal respiratory distress syndrome?
|
A235. dipalmitoyl phosphatidylcholine (lecithin)
|
|
Q236. How do ACE inhibitors cause cough?
|
A236. Normally ATII inactivates bradykinin;; when blocked, kallikrein is unopposed --> activates bradykinin --> cough and angioedema
|
|
Q237. Where are ACE and kallikrein synthesized?
|
A237. In the lungs
|
|
Q238. What is the formula for collapsing pressure?
|
A238. 2(tension)/radius; As radius decreases, alveoli are more likely to collapse
|
|
Q239. How is inspiratory capacity calculated?
|
A239. tidal volume + inspiratory reserve capacity
|
|
Q240. Formula for calculated Vd - physiologic dead space
|
A240. tidal volume x (PaCO2-PeCo2)/PaCO2; PaCO2 = arterial PCO2; PeCO2 = expired air CO2
|
|
Q241. At what point in the breath cycle is the tendency for the lungs to collapse equal to the tendency for the chest wall to spring outward?; What is the system pressure at this point?
|
A241. At FRC; System pressure is equal to atmospheric pressure
|
|
Q242. What is the treatment for methemoglobinemia?
|
A242. Methylene blue
|
|
Q243. What is the treatment for cyanide poisoning?
|
A243. Give nitrates to oxidize Hb to metHb --> allows cyt oxidase to function; -> thiosulfate to bind cyanide; -> thiocyanide is renally excreted
|
|
Q244. What is methemoglobin?
|
A244. oxidized form (Fe3+ instead of Fe2+) --> poorer O2 binding
|
|
Q245. What is the effect of carboxyhemoglobin on the oxygen dissociation curve?
|
A245. Left shift (increased affinity for oxygen, decreased unloading)
|
|
Q246. What is the effect of increased metabolic needs on the oxygen dissociation curve?
|
A246. Right shift (increased oxygen unloading)
|
|
Q247. What is the effect of acidemia on the oxygen dissociation curve?
|
A247. Right shift (increased oxygen unloading)
|
|
Q248. What is the effect of alkalemia on the oxygen dissociation curve?
|
A248. Left shift (increased affinity for oxygen, decreased unloading)
|
|
Q249. What is the effect of increased 2,3-DPG on the oxygen dissociation curve?
|
A249. Right shift (increased oxygen unloading)
|
|
Q250. How does the oxygen dissociation curve of fetal Hb differ from adult Hb?
|
A250. Left shift (increased affinity for oxygen, decreased unloading)
|
|
Q251. What is the effect of a decrease in PAO2?
|
A251. Vasoconstriction that shunts blood towards well-ventilated regions of lung
|
|
Q252. How do emphysema and pulmonary fibrosis impact diffusion?
|
A252. Both decrease it. Diffusion is proportional to A(rea)/T(hickness). Emphysema reduces area. Fibrosis increases thickness.
|
|
Q253. What types of gases show perfusion-limited patterns of exchange along pulmonary capillaries?
|
A253. O2 (normally), CO2, N2O. These equilibrate before the end of the capillary. Diffusion can only be increased if blood flow increases.
|
|
Q254. What types of gases show diffusion-limited patterns of exchange along pulmonary capillaries?
|
A254. O2 (in emphysema or fibrosis); CO
|
|
Q255. What is the normal pressure in pulmonary arteries?
|
A255. 10-14 mmHg; >25 mmHg = HTN; >35 mmHg during exercise = HTN
|
|
Q256. What histologic changes are seen as a result of pulmonary HTN?
|
A256. medial thickening, intimal fibrosis, atherosclerosis
|
|
Q257. What causes primary pulmonary HTN?
|
A257. Inactivating mutation in BMPR2 gene (normally inhibits smooth muscle proliferation)
|
|
Q258. What causes secondary pulmonary HTN?
|
A258. COPD,; mitral stenosis; systemic sclerosis; left-to-right shunt; sleep apnea (hypoxic vasoconstrict); high altitude (hypoxic vasoconstrict); recurrent thromboemboli
|
|
Q259. What is the formula for pulmonary vascular resistance?
|
A259. PVR = (Ppulm artery - Pleft atrium)/CO; R = (change in P)/Q; R = (8)(viscosity)(length)/(pi)(radius^4)
|
|
Q260. What is the alveolar gas equation?
|
A260. PAO2 = 150 - (PACO2)/0.8; 150 = PO2 in inspired air; 0.8 = respiratory quotient
|
|
Q261. What is the A-a gradient?; When is it increased?
|
A261. PAO2 - PaO2 = 10-15; Increased in hypoxemia (V/Q mismatch, fibrosis)
|
|
Q262. Where in the lung are ventilation and perfusion greatest?; Where is V/Q = 3?; Where is V/Q = 0.6; Where is V/Q = 1
|
A262. At the bases; At the apices; At the bases; During exercise
|
|
Q263. In what type of V/Q mismatch should 100% O2 be used?
|
A263. Only in physiologic dead space (V>Q) due to blood flow obstruction. Does not help in physiologic shunt (V<Q) due to airway obstruction.
|
|
Q264. In zone 2 of the lung, how to the partial pressures of oxygen in the alveoli, veins, and arteries compare?
|
A264. PA > Pa > Pv
|
|
Q265. What are the 3 forms in which carbon dioxide is transferred from the tissues to the lungs?
|
A265. 1. Bicarbonate, HCO3- (90%); 2. Carbaminohemoglobin, bound to Hb at N terminus (5%), favors T form --> O2 unloading; 3. Dissolved CO2 (5%
|
|
Q266. Pt presents with sudden onset dyspnea, chest pain, and tachycardia. What could be the underlying causes?
|
A266. Embolus (95% from deep leg veins):; Fat (bone fractures, liposuction); Air; Thrombus; Bacteria; Amniotic fluid (--> postpartum DIC); Tumor
|
|
Q267. Pt presents with calf tenderness occurring with foot dorsiflexion. What is wrong?
|
A267. DVT (positive Homan's sign)
|
|
Q268. Pt has productive cough, wheezing, crackles, and cyanosis. What is causing this?
|
A268. Chronic bronchitis ("blue bloater") due to hypertrophy of mucus-secreting glands in bronchioles --> early onset hypoxemia, late-onset dyspnea
|
|
Q269. Pt has dyspnea, decreased breath sounds, tachycardia. What is causing this?
|
A269. Emphysemia ("pink puffer") due to increased elastase activity --> destruction of alveolar walls
|
|
Q270. What type of emphysema is caused by smoking?
|
A270. Centriacinar
|
|
Q271. What type of emphysema is caused by alpha1-antitrypsin deficiency?
|
A271. Pancacinar
|
|
Q272. What type of emphysema is associated with spontaneous pneumothorax in a young male?
|
A272. Paraseptal (cyst/bulla forming)
|
|
Q273. Pt has dyspnea, cough, wheezing, tachypnea, hypoxemia, decreased inspiratory/expiratory ratio
|
A273. Asthma: bronchial hyperresponsiveness --> bronchoconstriction; Smooth muscle hypertrophy, Curschmann's spirals (shed epithelium from mucus plugs)
|
|
Q274. Pt has dilated airways, purulent sputum, recurrent infections, and hemoptyis. What is this called?; What is it caused by?; What infection are they at risk for?
|
A274. Bronchiectasis; CF, Kartagener's, poor ciliary motility; Aspergillosis
|
|
Q275. What are the mechanical causes of restrictive lung disease?
|
A275. Muscle - polio, myasthenia gravis; Structural - scoliosis, obesity
|
|
Q276. What are the causes of restrictive lung disease that are attributable to lowered diffusing capacity?
|
A276. ARDS; Neonatal RDS (hyaline membrane dz); Sarcoidosis; Pneumoconioses; Idiopathic pulmonary fibrosis (collagen); Goodpasture's syndrome; Wegener's granulomatosis; Eosinophilic granuloma (histiocytosis X); Drug toxicity (bleomycin, amiodarine, busulfan)
|
|
Q277. Pt presents with cough, dyspnea, morning stiffness, and painful joints. What caused it?; What part of lung is affected?
|
A277. Coal dust (coal miner's lung) --> Caplan syndrome; Upper lobes
|
|
Q278. Sandblaster presents with cough, dyspnea, and "eggshell" calcification of hilar lymph nodes. What caused it?; What part of lung is affected?
|
A278. Silicosis (macrophages respond to silica --> fibrogenesis); may increase susceptibility to TB if macrophages are impaired. Upper lobes
|
|
Q279. Plumber/roofer presents with bronchogenic carcinoma. What caused it?; What part of lung is affected?; What is seen on biopsy?
|
A279. Asbestosis; Lower lobes; "Ivory white" calcified pleural plaques, dumbbell-shaped bodies in macrophages, "ferruginous bodies" on Prussian blue
|
|
Q280. Baby is born before 35 weeks. What is his L:S ratio?; What did his mom have?; How was he delivered?; What congenital heart defect?; Giving 100% O2 does what?; Treatment?
|
A280. L:S < 1.5; maternal diabetes; Cesarean section; low O2 tension --> PDA; 100% O2 --> retinopathy; Give maternal steroids before birth, artificial surfactant, thyroxine
|
|
Q281. Protein-rich fluid in alveoli, hyaline membranes. What caused damage?; What incited this diffuse alveolar damage?
|
A281. Toxic neutrophilic substances OR coagulation cascade OR free radicals; Trauma, sepsis, shock, gastric aspiration, uremia, pancreatitis, amniotic fluid embolism
|
|
Q282. Obese pt who snores, has HTN, is always tired... Has what?; Should do what?; Could die from what?
|
A282. Obstructive sleep apnea (central is no respiratory effort); Get CPAP, lose weight, surgery; Arrhythmia
|
|
Q283. Decreased breath sounds in one area, decreased resonance to percussion, decreased fremitus, tracheal deviation.
|
A283. Bronchial obstruction (ipsilateral to tracheal deviation), e.g. cancer
|
|
Q284. Decreased breath sounds, dullness to percussion, decreased fremitus
|
A284. Pleural effusion
|
|
Q285. Bronchial sounds in one area, dullness to percussion, increased fremitus
|
A285. Lobar pneumonia
|
|
Q286. Decreased breath sounds, hyperresonance to percussion, absent fremitus, tracheal deviation
|
A286. Tension pneumothorax (on contralateral side to tracheal deviation)
|
|
Q287. Pt presents with cough, hemoptysis, decreased breath sounds in one area, wheezing, coin lesions. Possible complications?
|
A287. Lung cancer SPHERE:; Superior vena cava syndrome; Pancoast's tumor; Horner syndrome; Endocrine (paraneoplastic); Recurrent laryngeal symptoms; Effusions (pleural or pericardial)
|
|
Q288. Hx of smoking; Hilar mass arising from bronchus, cavitation, PTHrP production; What would show up on histology?
|
A288. Squamous cell carcinoma
|
|
Q289. Keratin pearls and intracellular bridges
|
A289. Squamous cell carcinoma
|
|
Q290. Clara cells --> type II pneumocytes; multiple densities on chest X-ray
|
A290. Bronchial or bronchioloalveolar Adenocarcinoma
|
|
Q291. Peripheral tumor in site of prior pulmonary inflammation or injury
|
A291. Bronchial adenocarcinoma
|
|
Q292. Peripheral tumor presenting like pneumonia, grows along airways; Can result in hypertrophic osteoarthropathy
|
A292. Bronchioloalveolar adenocarcinoma
|
|
Q293. Most common lung cancer in nonsmokers and females?
|
A293. Bronchial adenocarcinoma
|
|
Q294. Central, aggressive tumor. Associated with ectopic ACTH or ADH, Lambert-Eaton Syndrome (anti-Ca channel Igs)
|
A294. Small (oat) cell carcinoma
|
|
Q295. Poorly differentiated; neuroendocrine Kulchitsky cells (dark blue)
|
A295. Small (oat) cell carcinoma
|
|
Q296. Inoperable but responsive to chemotherapy
|
A296. Small (oat) cell carcinoma
|
|
Q297. Pleomorphic giant cells with leukocyte fragments
|
A297. Large cell carcinoma
|
|
Q298. Peripheral tumor composed of anaplastic cells; unresponsive to chemotherapy; surgically removed
|
A298. Large cell carcinoma
|
|
Q299. Secretes serotonin, can cause flushing, diarrhea, wheezing, salivation
|
A299. Carcinoid tumor
|
|
Q300. Malignancy of the pleura resulting in hemorrhagic pleural effusions and pleural thickening
|
A300. Mesothelioma
|
|
Q301. Psammoma bodies seen on histology
|
A301. Mesothelioma
|
|
Q302. Common sites of lung metastases
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A302. adrenals; brain (seizures); bone (fractures); liver (jaundice, hepatomegaly)
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Q303. Ptosis, miosis, anyhydrosis can be caused by a lung tumor in what location?
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A303. Apex (Pancoast's) --> compresses cervical sympathetic plexus
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Q304. What organisms are usually responsible for lobar pneumonia?; Produce intra-alveolar exudate --> consolidation
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A304. Streptococcus pneumoniae; Klebsiella
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Q305. What organisms are usually responsible for bronchopneumonia?; Inflammatory infiltrates from bronchioles --> alveoli; patchy distribution in >1 lobe
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A305. S. aureus; H. flu; Klebsiella; S. pyogenes
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Q306. What organisms are usually responsible for interstitial pneumonia?; Diffuse patchy infiltrates localized to interstitial areas at alveolar walls; more indolent
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A306. Viruses (RSV, adenovirus); Mycoplasma; Legionella; Chlamydia
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Q307. What situations predispose to lung abscess with S. aureus and anaerobes?
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A307. Bronchial obstruction (e.g. cancer); Aspiration of oropharyngeal contents (e.g. alcoholics, epileptics)
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Q308. Pleural effusion with low protein content is due to...
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A308. (Transudate):; CHF; Nephrotic syndrome; Hepatic cirrhosis; Anything that causes increased hydrostatic or decreased oncotic P
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Q309. Cloudy pleural effusion with high protein content is due to...
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A309. (Exudate - must drain):; Malignancy; Pneumonia; Collagen vascular disease; Infection; Trauma; Anything that causes increased vascular permeability
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Q310. Milky fluid with high triglyceride content is composed of...
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A310. lymphatic fluid (lymphatic effusion)
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