Respiratory 2

Front 1

Choriocarcinoma:

- What is it?

- Symptoms?

- Diagnose how?

Back 1

A metastatic form of gestational trophoblastic disease. It may occur after a molar pregnancy or normal gestation, and the lungs are the most frequent site of metastatic spread.

Suspect choriocarcinoma in any postpartum woman with pulmonary symptoms and multiple nodules on CXR. An elevated beta hCG helps to confirm the diagnosis.

Front 2

Pulmonary TB:

- Presents how?

Back 2

- Productive cough

- Hemoptysis

- Recurrent fevers

- Weight loss

- Imaging reveals upper lobe cavitary lesions

- May be pts from endemic regions w/ subacute or chronic pulmonary complaints

Front 3

Pleural fluid:

- What indicates empyema and need for removal of fluid?

Back 3

pH < 7.2, or glucose < 60 mg/dL

Front 4

How do you treat Legionnaire's pneumonia?

Back 4

- Azithromycin OR

- Levofloxacin

Front 5

Pneumocystitis pneumonia (PCP):

- Seen in who?

- How to work up?

Back 5

- HIV patients, CD4 < 200

- Sputum induction w/ hypertonic saline or BAL (bronchoalveolar lavage).

Front 6

What can you diagnose with Bronchoalveolar lavage?

Back 6

Malignancy and opportunistic infection, such as PCP (pneumocystitis pneumonia).

Front 7

What is the mainstay of symptom management in COPD?

Back 7

Inhaled anti-muscarinic agents such as ipatropium

Front 8

Alpha-1 antitrypsin deficiency seen in what?

Back 8

Pts may have emphysema, a diagnosis common in older smokers, but with this deficiency it presents in younger patients who have never smoked.

Front 9

Common causes of pleural effusions:

- Transudate causes?

- Exudate causes?

Back 9

Transudate:

- CHF

- Cirrhosis

- Nephrotic syndrome

- Peritoneal dialysis

Exudate:

- Infections

- Malignancy

- Connective tissue diseases

- Inflammatory disorders

- Movement of fluid f/ abdomen to pleural space

- Coronary artery bypass

- Pulmonary embolism (usually)****

Front 10

What is normal pleural fluid pH? What is the pH of transudative fluid? exudative?

Back 10

Normal pH is 7.6

Transudative (CHF) is usually 7.4-7.55

Exudative (malignancies, PE) is usually 7.3-7.45

Front 11

High pleural fluid amylase level:

- Usually d/t what?

Back 11

Pancreatitis-associated effusion or esophageal rupture (from saliva).

Front 12

What might you think if you see "pleural plaques" on imaging???

Back 12

Bronchogenic carcinoma from asbestosis

Front 13

Wegener's:

- Define?

- Symptoms?

- Diagnosis?

- Treatment?

Back 13

- Vasculitis affecting small and medium sized arteries

- Gomerulonephrtiis and upper and lower respiratory tract disease

- Diagnose by c-ANCA positive and tissue biopsy

- Treat with high-dose corticosteroids and cytotoxic agents

Front 14

COPD:

- The chronic destruction of alveolar sacs leads to what?

Back 14

The chronic destruction of alveolar sacs leads to the formation of large alveolar blebs (generally in the upper lobes) which can eventually rupture and leak air into the pleural space.

Front 15

Asprin-exacerbated respiratory disease:

- What is it?

- Symptoms?

Back 15

Pseudoallergic reaction that are NOT IgE mediated but typically occur in pts with comorbid asthma, chronic rhino sinusitis with nasal polyposis, or chronic urticaria.

Front 16

Blastomycosis:

- What is it?

- Symptoms?

- Treatment?

Back 16

- A pulmonary fungal infection that is endemic to the Great Lakes, and Mississippi and Ohio River basins.

- Systemic Blastomycosis may cause skin and bone lesions in addition to pulmonary manifestations.

- Broad-based budding yeast grown from the sputum confirm the diagnosis.

- Itraconazole or amphotericin B may be used to treat symptomatic disease.