1Retrictive lung disease will have a FEV1/FVC=
0.75
2Obstructive lung disease with have a FEV1/FVC=
less than 0.7
3How is RV effected with restrictive lung disease?
decreased
4What is tidal volume?
it is the amount you breath in and out normally at rest
5What is vital capacity?
it is a forceful inhalation
a forceful exhilation plus normal tidal volume
6What is inspiratory capacity?
the most air you can breath in
7What is expiratory capacity?
the most you can breath out
8What is a normal FEV1/FVC?
0.8
9Before PFT testing when should you stop eating food?
two hours
10How long before PFT testing should you stop smoking?
one hour before
11How long before PFT testing should you stop exercising?
30 minutes
12How long before PFT testing should you stop drinking?
four hours before
13What are four other things you should not do for PFT testing?
do not wear tight form fitting clothes
may need to remove loose dentures
should wait at least 1 month post MI
bring a list of meds
14A blood clot in on e of the deep venous structures is
DVT
15A blood clot in an artery of the lung is
PE
16Term that encompasses both a DVT and the PE
venous thromboembolism
17What are some predisposing factors for a PE?
cancer
obesity
cigarette smoking
systemic arterial hypertension
COPD
CKD
long air travel
estrogen containing contraceptives
pregnancy
HRT
surgery
trauma
18What is virchow's triad? What does it indicate?
venous stasis
hypercoagulability
endothelial injury
pertains to thrombus formation
19Ptt is evaluation what?
how well heparin is working
20PT is on which pathway?
extrinsinc pathway
21D dimer is more sensitive or specific?
it is more sensitive
22What are the classic findings of S1, Q3 and T3 on an EKG of a patient with a PE?
prominent S wave in lead I
prominent Q wave in lead III
Inverted T wave in lead III
23What is the gold standard for diagnosing a PE?
chest CT with IV contrast
24What is used for imaging if a DVT is suspected?
ultrasound
25You have a pregnant patient who is SOB, a D dimer is ordered which comes back positive which scan would you do to r/o a PE?
VQ scan
26For treatment of a PE which strategy is used the least often?
strategy 1 which involves parenteral UFH or LMWH and then transition to oral warfarin
27When is an inferior vena cava filter indicated?
bleeding that precludes anticoagulation
recurrent DVT despite anticoagulation therapy
28Vena cava filters increase or decrease DVT rate? what about PE rate?
increases DVT rate but decreases PE rate
29What are two other surgical options for PE treatment?
pulmonary embolectomy
pulmonary thromboendarterectomy
30Is the EKG more sensitive or specific?
specific meaning that if you have these classic findings it is definetely a PE but you may not have these findings with all PEs
31What are some characteristics of small cell carcinoma
early hematogenous spread
does not respond to resection
aggresive course
median survival 6-18 weeks
32What are some characteristics of non small cell carcinoma
all other groups
slower spread
possible cure in early stages
resection and chemo responsive
33What does T stand for in the TNM staging system?
size and location of primary tumor
34What does the N stand for in the TNM staging system?
presence and location of nodal metastasis
35What does the M stand for in the TNM staging system?
presence or absence of distant metastasis
36Why does lung cancer have such a poor prognosis?
less than 25% of newly detected lung CA in stage I
37Why is lung cancer caught so late?
symptoms do not present until after stage IIIA/B or IV
38Endobronchial mets are more common in which 5 cancers?
cervical
colon
breast
malignant melanoma
renal cell
39Patient has a less than 3 cm isolated, rounded opacity surrounded by normal lung on their chest x ray. There is no infiltrate, atelectasis or adenopathy. What could it possibly be?
benign coin lesion
40A majority of patients with solitary pulmonary nodules are asymptomatic or symptomatic?
asymptomatic
41What is RV systolic and diastolic failure resulting from pulmonary disease and associated with hypoxia?
cor pulmonale
42Group 2 is pulmonary hypertension from?
left sided heart failure
43Group 3 is pulmonary hypertension due to?
the lungs
44Group 4 classification is pulmonary hypertension due to?
pulmonary obstruction
45Group 5 classification is pulmonary hypertension due to?
random things
46When will an EKG for pulmonary hypertension be abnormal and what might you see?
when the dz is advanced
right axis deviation
47When are PFTs useful for diagnosing pulmonary hypertension?
if they are in group 3
48What is the gold standard for diagnosing pulmonary hypertension?
right sided cardiac catheterization
49What are the 3 main pathways for pulmonary hypertension treatment?
nitric oxide
endothelin
prostacyclin
50What is the most common form of ILD of unknown cause?
idiopathic pulmonary fibrosis
51Idiopathic pulmonary firbosis is more common in...
men over 50
hx of smoking/environmental exposure
52How does cyptogenic organizing pneumonia patients present and what is the common age range?
50-60
they have cough, dyspnea, fever, fatigue
commonly mistaken for pneumonia
53What can cryptogenic organizing pneumona be secondary to?
underlying CTD
medications
malignancy
54What might a CT show in cryptogenic organizing pneumonia?
patchy subpleural consolidative opacities
ground-class opacities
subpleural sparing
55In pleural effusion, what are some mechanisms of fluid accumulation?
increased drainage of fluid into space
increased production of fluid by cells in space
decreased drainage out of space
56Which medications can trigger ILD?
methotrexate
nitrofurantoin
amiodarone
neoplastic agents
tumor-necrosis factor alpha blocking agents
57What disorder is connected to ILD?
connective tissue disorders
58What are two other factors associated with ILD?
malignancy
asthma/allergic rhinitis
59What is the strongest risk factor in IPF?
Close family relative with IPF
60What do you not want to give a patient with IPF?
immunosuppresants
61What indicates a poor prognosis on CT for ILDs?
honeycombing
62Plueral rub is more often heard on?
inspiration
63sharp pain that is aggrevated by deep breating or coughing is characteristic of
pleuritic pain
64What might you hear when percussing and auscultating when a patient has a pleural effusion?
dullness w/ percussion and decreased breath sounds over the effusion
65What is the normal level of fluid in the pleural space?
5-15 mL
66What absorbs pleural fluid?
parietal pleural lymphatics
67With what conditions might you see transudative pleural effusion?
heart failure
nephrotic syndrome
hepatic cirrhosis
68Exudative pleural effusion occurs with
inflammation of the pleura
malignancy
infection
trauma
pulmonary infarction
pulmonary embolism
69What is the lights criteria for exudative fluid?
ratio of pleural fluid to serum protein >0.5
ratio of pleural fluid serum LDH >0.6
pleural fluid LDH > 2.3rd of the upper limits of normal serum LDH
70
Tall thin boys and men ages 10-30 are most often to have which type of pneumothorax?
primary spontaneous
71Secondary spontaneous pneumothorax is seen in..
preexisting pulmonary disease
72Adult onset asthma is associated with?
ASA sensitive asthma
eosinophilic asthma
occupational asthma
73Which age is asthma often diagnosed by?
7
74What are characteristic triggers of asthma?
exercise
viral URI
inhaled allergens
75Pain with asthma is rarely described as ?
sharp
76Which medications will worsen asthma and COPD and should not be given?
beta blockers
77What is a major risk factor for developing asthma?
personal or family hx of atopy
78What are some exam findings for asthma
nasal polyps
pale swollen cobblestone appearance posterior pharynx
atopic dermatits
79What is are some pharmocological treatment for asthma?
systemic corticosteroids
inhaled corticosteroids
anticholinergics
Beta 2 agonists
80Do you need to taper short term used of OCS?
no but need to taper long term and do bone density scan
81What is the mainstay treatment for all phases of asthma?
SABA PRN
82Chemical pneumonitis is often caused by?
gastric fluid
83What is a big predisposure to aspiration pneumonia?
reduced levels of consciousness
84What are some things that can compromise your cough reflex and glottic closure putting you at risk for aspiration pneumonia?
sedating meds
ETOH
seizures
85In order to get chemical pneumonitis how much gastric contents need to be aspiirated?
70 mL
86Which type of pneumonitis is seen with intubation and extubation?
chemical aspirations
87What is a common complication of pneumonia?
empyema
88What are some risk factors for empyema?
aspiration
poor dental hygiene
ETOH abuse
IV drug use
89Aside from pneumonia, with what other conditions can an empyema present from?
esophogeal rupture
blunt of penetrating chest trauma
liver abscess
cervical or thoracic spin infection
90What is the most common bacteria causing empyema?
S. pneumoniae
91Empyema can also be seen with?
mycobacterium/latent TB
92What is the treatment for empyema?
drainage by thoracentesis
tube thoracostomy
93Thoracostomy is preferred for treatment of empyema when
pleural pH is less than 7.2
pleural glucose is less than 40
pleural LDH is greater than 1000
significant extrapleural loculations
94T/F patient with latent TB can transmit to others
false
95T/F active TB can develop from latent TB if not given preventative therapy
true
96What is drug resistant TB resistant to?
isoniazid or rifampin
97What is multi drug TB resistant to?
isoniazide and rifampin and possibly other
98Extensively drug- resistant TB is resistant to
isoniazid, rifampin, floroquinoolones and aminoglycosides
99What is the buzz word for sputum specimens obtained?
acid fast bacilli
100Nucleic acid amplification can detect
M tuberculosis and resistant marks
101What is the definitive diagnosis for TB?
it depens on recovery of M tuberculosis from cultures
102Is the interferon Gamma release assays more specific or sensitive?
it is both
103What does the interferon gamma release assays find?
in vitro assays of CD4+ T cell mediate interferon gamma which is release in response to stimulation by specific M tuberculosis antigens
104Which infectious cause is a common cause of asthma exacerbations in school aged children?
rhinoviruses
105Where doe rhinoviruses typically grow?
in the nares
106What is the most common viral cause of severe lower respiratory tract illness in the elderly and children?
RSV
107Nasopharyngitis is inflammation of the
nares, pharynx, hypopharynx, uvula and tonsils
108If exudate is clear and the patient has watery discharge this likely indicates
a viral infection
109What is withdrawal of the drug after pronlonged use lead to this, an almost addictive need for continuous usage?
rhinitis medicamentosa
110How is rhinitis medicamentosa treated?
cessation of the sprays
topical intranasal corticosteroids-flunisolide 2 sprays BID
intranasal anticholinergic
short tapering course of oral prednisone
111What are some treatment options for sinusitis?
NSAIDS
pseudophedrine
nasal oxymetazoline
112In addition to atbx what else might you prescribe for bacterial sinusitis?
nasonex
113What is the criteria for GABHS?
fever over 38
tender anterior cervical adenopathy
lack of cough
phayngotonsillar exudate
114What is suggestive of monocucleosis?
marked lympadenopathy and white-purple tonsillar exudate
115What is used to diagnose GABHS?
single-swab throat culture or rapid antigen detection testing
116Throat culture is more sensitive or specific
it is both sensitive and specific
117What is the treatment for GABHS?
penicillin
118What is the treatment for GABHS if the patient is allergic?
erythromycin
119Aside from penicllin what other treatment options are there for GABHS?
ceftin
cephalosporins
azithromycin
120Peritonsillar abscess is treated with
augmentin
clindamycin for penecillin allergy
plus steroids
121What other treatment options are available for peritonsillar abscess besides pharmacological?
needle aspiration
I&D
Tonsillectomy
122What are the most common pathogens for acute otitis media?
strep pneumoniae
heamophilus influenzae
strep pyogenes
123Acute otitis media is treated with
amoxicillin or erythromycin
124How does bronchitis present?
starts 1-2 days after URI with gradual onset of cough
125What are the common viruses associated with bronchitis?
influenza A & B
RSV
coronavirus
adenovirus
rhinovirus
126What are the most common bacterial causes of bronchitits?
heamophilus influenzas
strep pneumoniae
127What will you hear on auscultation with bronchitis?
rales
rhonic
expiratory wheeze
128If there is no fever, patient is not tachycardic or tachypneac or hypoxic what is unlikely?
pnumeonia
129Patients with bronchitis can have
mild fever
increase WBC
cough w/ or w/o sputum production
130If you suspect PNA what should you do?
obtain a chest x ray
131Which medication should you avoid with mononucleosis?
amoxicillin
132What are some causes of bronchitis?
airborne irritants
aspiration of irritants
inhaled allergens
infections