Internal Medicine Shelf Review: Pulmonology

Front 1

What do CXR findings of opacification, consolidation, air bronchograms" indicate?

Back 1

Pneumonia

Front 2

What condition should be suspected with a CXR showing hyperlucent lung fields with a flattened diaphragm?

Back 2

COPD

Front 3

What condition should be suspected if CXR shows the heart > 50% AP diameter, cephilization, Kerly B lines, and interstitial edema?"

Back 3

CHF (cardiomegaly)

Front 4

What condition should be suspected if CXR findings show a cavity containing an air fluid level?

Back 4

Lung abscess (⇒ anaerobes)

Front 5

What condition should be suspected if CXR findings show an upper lobe cavitation +/- hilar adenopathy?

Back 5

TB

Front 6

What condition should be suspected if CXR findings show a thickened peritracheal stripe and splayed carina bifurcation

Back 6

- Left atrial enlargement
- Mediastinal lymphadenopathy (cancer)

Front 7

When is thoracentesis indicated with pleural effusion?

Back 7

>1 cm fluid on lateral decubitus film

Front 8

What conditions are likely to cause a transudative pleural effusion?

Back 8

- CHF
- Nephrotic syndrome
- Cirrhosis

Front 9

What condition is likely to cause a transudative pleural effusion with low glucose?

Back 9

Rheumatoid arthritis

Front 10

What condition is likely to cause a transudative pleural effusion with high lymphocytes?

Back 10

Tuberculosis

Front 11

What condition is likely to cause a transudative, bloody pleural effusion wi

Back 11

- Malignancy
- PE

Front 12

What is Light's criteria for transudative pleural effusions?

Back 12

All three of the following:
- LDH <200
- LDH (effusion) / serum < 0.6
- Protein (effusion) serum < 0.5

Front 13

What conditions are likely to cause an exudative pleural effusion?

Back 13

- Parapneumonic syndromes (cancer, etc.)

Front 14

What qualifies a transudative effusion as "complicated?"


What is indicated for this condition?

Back 14

- (+) Gram stain or Cx
- pH < 7.2
- Glucose < 60


Insert chest tube for drainage

Front 15

What are the common causes of ARDS?

Back 15

- Sepsis
- Gastric aspiration
- Trauma
- Low perfusion
- Pancreatitis

Front 16

How is the Dx of ARDS made?

Back 16

- PaO2 / FiO2 < 200 (<300: acute lung injury)
- Bilateral alveolar infiltrates on CXR
- PCWP < 18

Front 17

How is ARDS treated?

Back 17

Mechanical ventilation (O2) w/ PEEP

Front 18

To what degree must FEV1 improve with a bronchodilator challenge to merit the Dx of asthma?

Back 18

>12%

Front 19

What is the criteria for COPD Dx?

Back 19

- Productive cough
- > 3 months
- > 2 consecutive years

Front 20

What are Tx options for COPD?

Back 20

1. Ipratropium, tiotropium
2. β-agonists
3. Theophylline

Front 21

What are the indications to start O2 therapy in a patient with COPD?

Back 21

- PaO2 < 55%
- SpO2 < 88% (cor pulmonale, then <59%)

Front 22

What are Dx criteria for COPD exacerbation?

Back 22

- Change in sputum
- Increasing dyspnea

Front 23

What is the best prognostic indicator in COPD?

Back 23

FEV1

Front 24

Why is the goal for COPD an SpO2 of 94-95% instead of 100%?

Back 24

COPD patients retain CO2; hypoxia is the only drive for respiration

Front 25

What are the important vaccinations for COPD patients?

Back 25

- Pneumococcal w/ 5 year booster
- Influenza yearly

Front 26

What can new-onset clubbing in a COPD patient indicate?

Back 26

Hypertrophic osteoarthropathy (cancer)

Front 27

What are the Sx and Tx associated with the following:
- Mild-intermittent asthma

Back 27

Sx:
- Sx 2x/week N
- Normal PFTs


Tx: Albuterol

Front 28

What are the Sx and Tx associated with the following:
- Moderate-intermittent asthma

Back 28

Sx:
- Sx > 4x/week
- Nighttime cough 2x month
- Normal PFTs


Tx:
- Albuterol + inhaled corticosteroids

Front 29

What are the Sx and Tx associated with the following:
- Moderate-consistent asthma

Back 29

Sx:
- Daily Sx
- Night cough 2x/week
- FEV1 60-80%


Tx:
- Albuterol + inhaled corticosteroids + long-acting β-agonist (salmeterol)

Front 30

What are the Sx and Tx associated with the following:
- Severe asthma

Back 30

Sx:
- Daily Sx
- Nighttime cough 4x/week
- FEV1 < 60%


Tx:
- Albuterol + inhaled corticosteroids + long-acting β agonist + LTE-inhibitor / PO steroids

Front 31

How is an asthma exacerbation treated?

Back 31

- Inhaled albuterol
- PO/IV steroids

Front 32

What must be monitored carefully during an asthma exacerbation?

Back 32

PCO2:
- Should be low
- Normalizing PCO2 = respiratory failure and impending intubation


Peak flow

Front 33

What condition can present as 1 cm eggshell calcified nodules in the upper lobes of the lung?

Back 33

Silicosis

Front 34

What is important to address in patients with silicosis?

Back 34

Yearly TB test

Front 35

What condition can present as a reticulonodular process in the lower lobes of the lung w/ pleural plaques?

Back 35

Asbestosis

Front 36

What condition can present as patchy, lower lobe infiltrates?

Back 36

Hypersensitivity pneumonitis (farmer's lung)

Front 37

What condition can present as hilar lymphadenopathy, ↑ACE, and erythema nodosum?

Back 37

Sarcoidosis

Front 38

What is an important referral to make when treating a patient with sarcoidosis?

Back 38

Opthalmology:
- Uveitis conjunctivitis in 25%

Front 39

How is sarcoidosis diagnosed?

Back 39

Biopsy

Front 40

How is sarcoidosis treated?

Back 40

Steroids

Front 41

What are characteristics of benign lung nodules?


What can these indicate?

Back 41

Popcorn calcification:
- Hamartoma

Concentric calcification:
- Old granuloma

<3 cm

Well-circumscribed

Front 42

What are characteristics of malignant lung nodules?

Back 42

- > 3 cm
- Eccentric calcification

Front 43

What are the most common sites of metastasis for adenocarcinoma of the lung?

Back 43

- Bone
- Liver
- Brain
- Adrenals

Front 44

What is a characteristic quality of pleural effusions caused by adenocarcinoma of the lung?

Back 44

Exudative effusion w/ high hyaluronidase