Pulm 1

Front 1

What is pathology of centrilobular emphysema? Who gets it? where in lungs?

Back 1

i)destroys RB (prox acini) w/little change in distal acini. ii)smokers iii)upper lobe

Front 2

what is path of panlobular emphysema? Who gets it? Where in lungs?

Back 2

i)prox and distal acini ii)a1AT def iii)lung bases

Front 3

What is defn of chronic bronchitis? Of emphysema?

Back 3

i)CB: clinical dx; chronic cough w/sputum for 3 mo/year for 2 years. ii)pathologic dx; permanent enlargement distal to TB due to destruction of alveolar walls

Front 4

what is a risk factor for COPD besides smoking, A1AT, and environment

Back 4

asthma

Front 5

What is pathogenesis of CB?

Back 5

i)excess mucus production narrowing airways; inflamm and scarred airways, enlarged mucus glands, smooth m hyperplasia

Front 6

What is pathogenesis of emphysema? How does smoking affect it?

Back 6

i)alveolar walls destroyed b/c excess elastase or relative def a1AT and PMNs and macros release elastase (inhibited by a1AT). ii)smoke: incr PMNs and macros; inhibits a1AT

Front 7

What is definitive test for COPD? What are 2 other tests? What is CXR good for?

Back 7

i)PFT: obstruction=decr FEV1 and decr FEV1/FVC (FEV1: 50% is severe). Get incr TLC, RV, FRC b/c air trapped. Decr VC ii)CXR and a1AT genetics. iii)r/o pneumonia/pneumothorax. If severe, get hyperinflation, flattened diaphragm, enlarged retrosternal space.

Front 8

what are signs of COPD? x3

Back 8

i)decr FEV ii)auscult: end exp wheezes on forced expiration; decr breath sounds; insp crackles. iii)hyperressonance on percussion

Front 9

What is most imp intervention in COPD? What are drugs that can be used? x3

Back 9

i)smoking cessation ii)B2 agonist; anticholinergic (ipratropium): slower onset but last longer; steroids (decr inflamm)

Front 10

What do you give for acute exacerbation in COPD?

Back 10

1st: B agon/anticholin->systemic steroids and ABX. Give O2 to keep O2>90%. Use Noninvasive PPV to help in acute exacerbations. Intubate and mech ventilate if these don't stabilizeDon't give B block in acute COPD or asthma exacerbations.

Front 11

What are secondary treatment options besides drugs for COPD? x3

Back 11

i)O2 therapy: improves survival and quality of life in COPD and hypoxemia. It will decr pulm HTN and cor pulmonale b/c hypoxemia leads to that; need ABG to determine need for O2. ii)vaccinate against Strep pneum iii)SX: resect or xplant

Front 12

What are criteria for cntinuous or intermittent long term O2 therapy in COPD? x2

Back 12

i)PaO2 55 mmHg or O2 sat<88%. ii)OR, PaO2 55-59+polycythemia or cor pulm

Front 13

What is the order of operations for treating COPD?

Back 13

i)mild to mod: MDI (metered dose inhaler) of anticholin and/or B agonists and steroids. ii)severe: add continuous O2 TX (if hypoxemic) and pulm rehab.

Front 14

What are complications of COPD? x3

Back 14

i)acute exacerbation: most common cause is infection, cardiac dz. ii)secondary polycythemia: response to chronic hypoxemia. iii)pulm HTN and cor pulm

Front 15

What is the triad for asthma?

Back 15

i)airway inflamm ii)airway hyperresponsiveness iii)reversible airflow obstruction

Front 16

What is diff b/w extrinsic and intrinsic asthma?

Back 16

i)extrinsic: atopic patients IgE to environmental Ags; ass'n w/eczema and hay fever. ii)intrinsic: not atopic or environmental triggers

Front 17

What are clinical features of asthma? x4. When do they occur? When are they worst

Back 17

i)wheezing ii)cough iii)chest tightness iv)SOB. v)Occurs w/in 30 in of exposure vi)worst at night

Front 18

What is DDX of wheezing besides asthma? x4

Back 18

i)CHF: edema of airways and congestion of bronchial mucosa. ii)COPD: inflamed airways may be narrowed or bronchospasm iii)cardiomyopathies, pericardial dz: edema around bronchi iv)lung cancer: obstructed airway

Front 19

What drugs can be used for asthma? x4

Back 19

i)B agonist ii)steroids iii)montelukast-leukotriene iv)cromolyn

Front 20

What is long term B agonist good for? x2 What does corticosteroids have an effect on? x2 What side effect do inhaled steroids cause? x3

Back 20

i)night time sxs; exercise induced asthma ii)decrease hyperresponsiveness; decr number of exacerbations iii)oral thrush; sore throat; hoarseness

Front 21

What is tx for acute severe asthma exacerbation x4

Back 21

i)B agonist ii)steroids iii)O2 iv)Abx if infection suspected...intubate if resp failure

Front 22

What are complications of asthma? x3

Back 22

i)status asthmaticus: no response to std meds ii)acute resp failure iii)pneumothorax, atelectasis, pneumomediastinum

Front 23

What is triad of ASA sensitive asthma? What should you avoid?

Back 23

i)nasal polyps, ASA, asthma. ii)NSAIDs b/c can get systemic rxn

Front 24

What is precipitant of bronchiectasis? x2 What happens?x2

Back 24

i)infection in patient w/airway obstruction; b) impaired defense or drainage. ii)a)permanent, abnl dilation and destruction of bronchial walls b)cilia are damaged

Front 25

What are causes of bronchiectasis?x4

Back 25

i)CF ii)infection iii)humoral immunodef (abnl lung defense) iv)airway obstruction

Front 26

What is longterm tx of mod asthma? severe?

Back 26

i)mod: daily inhaled steroid OR cromolyn, methylxanthine, or antileukotriene. ii)high dose steroid OR long acting B agonist OR methylxanthine and PO steroid

Front 27

What are clinical features of bronchiectasis? x4

Back 27

i)chronic cough w/lots of mucopurulent smelly sputum. ii)dyspnea iii)hemoptysis: rupture BV near bronchial wall iv)recurrent pneumonia

Front 28

How to DX bronchiectasis? x3

Back 28

i)PFTs: obstructive ii)CT scan is study of choice iii)CXR nonsp but abnl. iv)bronchoscopy sometimes

Front 29

What is TX of bronchiectasis x4

Back 29

i)Abx for acute exacerbations: signalled by changed sputum, fever, CP ii)bronchial hygiene: a)hydration b)drainage of mucus c)bronchodilators

Front 30

What is main goal of TX of bronchiectasis? x2

Back 30

i)prevent hemoptysis ii)prevent pneumonia

Front 31

What is clinical features of CF? x3

Back 31

i)obstructive lung dz pattern ii)pancreatitis iii)recurrent lung infection (pseudomonas)

Front 32

How to treat CF? x4

Back 32

i)annual flu vaccine ii)Abx for lung infection iii)iatro pancreatic enzymes iv)fat soluble vit supplements

Front 33

What are 2 kinds of lung cancers? Which is more common? Why imp to differentiate?

Back 33

i)Small cell: 25% ii)NSCLC: 75% (ADC, large cell, sq cell, bronchoalveolar). iii)treatment is diff

Front 34

Which cancer has lowest ass'n w/smoking? What are 2 risk factors?

Back 34

i)ADC ii)a)radon b)COPD (independent of smoking)

Front 35

How are the 2 kinds of CA staged?

Back 35

i)NSCLC: TNM ii)SCLC: a)ltd: chest + supraclav nodes (no cervical or axillary). b)extensive: outside of ltd

Front 36

What are local clinical features of lung cancer and which one shows these the most? x5

Back 36

i)hemoptysis ii)obstruction iii)wheezing iv)cough v)dyspnea

Front 37

What are Sxs of local invasion in lung cancer? x6

Back 37

i)phrenic nerve palsy ii)hoarseness (Recurrent laryngeal) iii)Pancoast iv)Horner's v)malig effusion vi)SVC syndrome

Front 38

What does SVC syndrome present as? x4

Back 38

i)facial fullness; ii)facial and arm edema; dilated veins over ant chest, face, arms; JVD

Front 39

What local invasive/paraneoplastic sxs is SCLC ass'd w/? x4 Sq CC? x4

Back 39

i)Eaton Lambert; SVC; SIADH; ACTH secretion ii)SqCC: Pancoast; PTH pr; long bone pain

Front 40

What nerves does Pancoast affect? What are the sxs? x3

Back 40

i)C8 and T1-2. ii)a)pain in arm b)weakness in arm b/c brachial plexus c)Horner's ass'n

Front 41

What is clinical pic of Eaton Lambert Syndrome x3

Back 41

i)paresthesias ii)decr DTR iii)prox muscle weakness/fatigability

Front 42

What tests should be performed for lung cancer DX? x3 How are each imp?

Back 42

i)CXR: most imp radio study for DX: if stable for 2 years, benign. ii)CT scan: for staging (see mets and mediastinal lympadenopathy). iii)Needle BX: SCLC vs NSCLC

Front 43

What kind of lesion is bronchoscopy and cyto exam of sputum for?

Back 43

i)for central lesions. Bronchoscope can't go past 2ndary br of bronchial tree

Front 44

What is the treatment for NSCLC and SCLC?

Back 44

i)NSCLC: a)SX*, but if mets outside chest, no SX. b)Rads c)chemo uncertain. ii)SCLC: a)chemo* b)rads: only for ltd dz

Front 45

What is most common cause of mediastinal mass? What is most common according to location? x2 for each

Back 45

i)metastatic CA (esp lung). ii)a)ant: thyroid, teratogenic tumor b)Middle: lung Ca; lymphoma c)posterior: neurogenic; esophageal mass

Front 46

What are clinical features of mediastinal mass? x5

Back 46

i)cough (compressed bronchi/trachea) ii)CP iii)dysphagia iv)SVC syndrome v)compression of nerves (hoarse, Horners, hemidiaphragm paralysis via phrenic)

Front 47

How to DX mediastinal mass? If benign, what to do?

Back 47

i)CT ii)if asympto and benign: observe