Respiratory 2 2

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What does the term 'blue bloater' describe?: Chronic bronchitis - these patients have chronic cough and peripheral edema secondary to cor pulmonale. They do not appear short of breath and do not feel oxygen deprived
What is the definition of chronic bronchitis?: Chronic bronchitis is characterized by a productive cough on most mornings for three or more consecutive months for two or more consecutive years?
Who does the term pink puffers describe?: Patients with emphysema who will have pursed lipped breathing. They generally feel short of breath and constantly feel as if they are not getting enough oxygen
What are two general mechanisms that can increase dead space and result in hypoxemia and hypercapnia?: Over ventilation
-Emphysema
-Excessive peak
Under perfusion
-Pulmonary embolus
-Low cardiac output
What is the most common cause of a spontaneous pneumothorax?: The most common cause of a spontaneous pneumothorax is the rupture of a emphysematous bleb
What is the crunching sign heard with each heart beat over the precordium in patients with mediastinal emphysema?: Hamman sign
CEA is not specific only for malignant conditions, what non-malignant conditions are associated with elevations of the CEA?: Emphysema, ulcerative colitis, cirrhosis, cholecystitis, and benign breast disease can be associated with elevations of the CEA
What are the three criteria used for use of antibiotics in patient with COPD?: Increased dyspnea
Increased sputum production
Purulent sputum
What are the 3 classifications of bronchodilators drugs used with COPD?: Methylxanthines (theophylline)
Beta-adrenergic agonists
Anticholinergic agents (atrovent will compete with ach at its receptors)
Which type of COPD is characterized by thin patients with no signs of cor pulmonale, minimal to no cough, hyperinflated lungs with decreased vascular markings, and increased total lung capacity?: Pink Puffer
What are 4 chest radiograph findings in patients with COPD?: Low flat diaphragm
Increased retrosternal air space
Elongated, narrow heart shadow
Bullae
Describe the typical physical exam findings in a patient with COPD?: Increased AP diameter
Barrel shaped chest
Decreased vocal fremitus
Diminished breath sounds
Prolonged expiratory signs
Accessory muscle use with expiration
Engorgement of neck veins on expiration
Increased secret
What is the most common etiology of pneumothorax related to lung disease?: COPD
What are the physical exam findings to note when examining a patient with chronic cough?: Mucus production, oropharynx erythema, cobblestoning (Post nasal drip)
Stridor (upper airway pathology)
Wheezing (Asthma, COPD)
Crackles (Pneumonia, interstitial lung disease, CHF)
What are the primary clinical uses of albuterol?: Of euros primarily used to treat asthma, bronchospasm, and COPD
What is the most common extrathoracic form of TB and how often does it occur?: Renal tuberculosis is the most common extrathoracic tuberculosis and it occurs in 3-4% of patients with TB
How often is Addison's disease associated with tuberculosis?: Approximately 15% of patients with Addison's disease have had destruction of their adrenal glands related to tuberculosis infection
What is the most common clinical form of tuberculosis?: Reactivation tuberculosis is the most common clinical form of TB
Which infection is suggested by an exudative pleural fluid with >90% lymphocytes?: Tuberculosis
What is BCG?: BCG (Bacillus Calmette-Guerin) is a live attenuated strain of mycobacterium bovis used in some countries for tuberculosis vaccination as well as for management of superficial bladder cancer
Describe idiopathic pulmonary fibrosis (Hamman-Rich syndrome)?: Immune complex mediated interstitial lung disease with progressive fibrosis of the alveolar wall
Which interstitial lung disease is characterized by presence of asbestos particles and pulmonary fibrosis?: Asbetosis
List four causes of restrictive cardiomyopathy?: Endocardial fibroelastosis
Endomyocardial fibrosis
Amyloidosis
Sarcoidosis
Which restrictive lung diseases characterized by:, epithelial granulomas containing microscopic Schaumann and asteroid bodies, bilateral hilar lymphadenopathy, erythema nodosum, Bell's palsy, and hypercalcemia?: Sarcoidosis
What is the prognosis of sarcoidosis (non caseating granulomas)?: 30-50% spontaneously remit
20-30% remain stable
30% demonstrate progression
When is calcium supplementation contraindicated?: Hypercalciuria
Nephrolithiasis
Sarcoidosis
Hyperparathyroidism
Which syndrome is characterized by arthralgias, erythema nodosum, bilateral hilar lymphadenopathy, in a patient with sarcoidosis?: Lofgren's syndrome
What is the mechanism of hypercalcemia and sarcoidosis?: Elevated levels of 1,25-dihydroxyvitamin D (calcitriol) produced by macrophages in the granulomas leads to increased calcium absorption in the intestine resulting in hypercalciuria and at times hypercalcemia
What is the most specific skin finding in sarcoidosis?: Lupus pernio
What is Besnier-Boeck disease?: Besnier-Boeck disease is another name for Sarcoidosis
Why is the ACE level generally done?: The ACE level is often elevated in patients with sarcoidosis
How often will patients with stage I sarcoidosis have an elevated ACE level?: Approximately 67%
How often will patients with stage 2 sarcoidosis have an elevated ACE level?: Approximately 88%
How often will patients with stage 3 sarcoidosis have an elevated ACE level?: Approximately 95%
In this disease interstitial pneumonitis and glomerulonephritis are secondary to anti-glomerular basement membrane antibodies?: Goodpasture's syndrome
Which disease is characterized by glomerulonephritis, pulmonary hemorrhage, and is associated with antiglomerular basement membrane?: Goodpasture's disease
What routine laboratory and imaging studies should be performed on a patient presenting with hemoptysis?: ABG
PT/PTT, CBC
Sputum cytology
Urinalysis to look for red cells or casts in the urine (Goodpastureâ€™s syndrome, Wegenerâ€™s granulomatosis)
CXR
TB skin test
How often will patients with anti-glomerular basement membrane antibodies (Goodpasture's syndrome) also have a positive C-ANCA and Wegener's granulomatosis?: Approximately 10-20% of patients with Goodpasture's syndrome also have Wegener's granulomatosis. It is rare that patients with Wegener's granulomatosis will also have Goodpasture's syndrome
What disease is associated with C-ANCA: Wegener's granulomatosis
Wegener's granulomatous disease is a systemic illness of unknown cause possibly due to hypersensitivity reaction of unknown antigens. List four histopathologic features of Wegener's granulomatosis?: Necrotizing granulomas in the upper and lower respiratory tract
Necrotizing vasculitits involving both arteries and veins
Glomerulonephritis
ANCA (antineutrophil cytoplasmic antibody) has high sensitivity and specificity
What is the most common lung vasculitis?: Wegener's granulomatosis
A patient presents with anemia, leukocytosis, bloody nasal discharge, pulmonary disease, glomerulonephritis, and cranial neuritis. What is the most likely diagnosis?: Wegener's granulomatosis
What is the systemic vasculitis known to most commonly involve the respiratory tract and kidneys?: Wegener's granulomatosis
How often does Wegener's granulomatosis only involve the respiratory tract?: Approximately 25% of cases are said to be limited only to the respiratory tract
What is C-ANCA?: C-ANCA is a blood test finding associated with Wegener's granulomatosis and stands for cytoplasmic anti-nuclear cytoplasmic antibody
What are the renal manifestations of Wegener's granulomatosis?: Patients with renal involvement will commonly develop acute renal failure, proteinuria, hematuria, and red cell casts in the urine
What type of cardiovascular manifestations to Wegener's granulomatosis can develop?: Cardiovascular manifestations include pericarditis, conduction system dysfunction, and cardiomyopathy
What are the potential neurological manifestations of Wegener's granulomatosis?: The neurologic manifestations of Wegener's granulomatosis include cranial neuropthy, hearing loss, mononeuritis muliplex, and CNS lesions
What are the potential ophthalmic complications of Wegener's granulomatosis?: Wegener's granulomatosis can be associated with corneal ulceration, proptosis, retinal vasculitis, episcleritis, uveitis, and optic neuropathy
What are the most common presenting symptoms of patients with Wegener's granulomatosis?: Patients commonly present with rhinorrhea, bloody nasal discharge, arthralgias, sinus pain, myalgias, mouth ulcers, and nasal ulcers
What are some of the potential chest radiograph findings in patients with Wegener's granulomatosis?: Patients with Wegener's granulomatosis can present with chest radiographs demonstrating infiltrates, nodules, or areas of cavitation
Other than C-ANCA, what are some other common laboratory manifestations of Wegener's granulomatosis?: Wegener's granulomatosis can be associated with thrombocytosis, leukocytosis, anemia, and an elevated sed rate
How is the diagnosis of Wegener's granulomatosis confirmed?: The diagnosis of Wegener's granulomatosis is made with a biopsy of affected tissue. This may be done with biopsy of the nasopharynx, lung, or kidney
Can the diagnosis of Wegener's granulomatosis be made with only a positive C-ANCA?: In general, tissue biopsy is needed to make the diagnosis of Wegener's granulomatosis
What is the most common initial treatment for Wegener's granulomatosis?: There are many ways to treat Wegener's granulomatosis, however the initial treatment often involves the combination of cyclophosphamide and corticosteroids
What is busulfan lung?: Seen after long term therapy with busulfan, it is characterized by bronchopulmonary dysplasia with diffuse interstitial pulmonary fibrosis
What is the other name for Hamman-Rich syndrome?: Idiopathic pulmonary fibrosis
Which focal pulmonary fibrosis occurs first in the upper lobes with enlargement of the hilar lymph nodes and is characterized by multiple egg shell calcifications?: Silicosis
What are the three most common findings of Horner's syndrome?: Ptosis (drooping of eyelid)
Miosis (pupil constriction)
Anhidrosis (decreased sweating associated with redness)
What is the term used for a tumor at the apex of the lung or superior sulcus which may involve brachial plexus, sympathetic ganglion, vertebral bodies, leading to pain, upper extremity weakness, and Horner's syndrome?: Pancoast tumor
What is the common cause of Horner's syndrome?: Horner's syndrome is often associated with pancoast tumors of the lung and is characterized by ptosis, miosis, and anhidrosis. Is occurs secondary to paralysis of the cervical sympathetic nerves
What are the four original criteria for pancoast tumor?: Arm/shoulder pain
Horner's syndrome
Destruction of bone
Atrophy of hand muscles
What are the three components of Horner's syndrome?: Ptosis, miosis, and anhidrosis
List 5 types of paraneoplastic syndromes?: Metabolic
Neuromuscular
Skeletal
Dermatologic
Vascular
List three metabolic paraneoplastic syndromes?: Cushings
SIADH
Hypercalcemia
What are the paraneoplastic syndromes commonly associated with small cell lung cancer?: SIADH
Hypercalcemia
Ectopic ACTH
Eaton-Lambert syndrome
What type of paraneoplastic syndromes are most commonly associated with gastric carcinoma?: Paraneoplastic syndromes of the skin such as acanthosis nigricans, circinate erythema, pemphigoid, and dermatomyositis are the most common types of paraneoplastic syndromes associated with gastric carcinoma.
What are the syndromes that are associated with tumors but which may affect distant parts of the body. They may be caused by hormones released from the endocrinologically active tumors or may be of uncertain etiology?: Paraneoplastic syndromes
What are the typical findings of hepatocellular carcinoma?: Hepatocellular carcinoma is responsible for 3/4 of primary malignant liver tumors. It is associated with a history of cirrhosis and is characterized by dull RUQ pain, hepatomegaly, abdominal mass, paraneoplastic syndromes, and an increased AFP
What are the 4 most common types of lung cancer?: Adenocarcinoma
Squamous cell carcinoma
Large cell
Small cell
Which cancer is commonly associated with hypercalcemia secondary to parathyroid hormone related protein (PTHRP)?: Squamous cell carcinoma of the lung
Squamous cell carcinoma of the lungs has characteristic slow growth and late metastasis. List the location of squamous cell carcinoma of the lungs?: -2/3 pf squamous cell carcinomas present at the hilus of the lung, but they may also present as a pancoast tumor
Hypertrophic pulmonary osteoarthropathy is most often associated with squamous cell carcinoma of the lung. What are four associated findings?: Deep burning pain in the distal extremeties
Clubbing of fingers and toes
Periositis of the long bones
Occasional polyarthritis
What is the most common pulmonary malignancy associated with hypercalcemia?: Squamous cell carcinoma of the lung
What is the number one cause of painless immobile neck mass in adults?: Malignancy (most commonly squamous cell carcinoma)
What is the most common genetic alteration involved in malignancy?: Mutations in the p53 gene account for >50% of genetic alterations in cancer
What is the most common genetic alteration known in human cancer?: The most common alteration is a mutation or deletion of the P53 gene on the long arm of chromosome 17
What is the common chromosomal abnormality of hereditary retinoblastoma?: Deletion of the q14 segment of chromosome 13
Which disease is characterized by a hypersensitivity reaction to Aspergillus seen most often in people with a history of asthma and atopy. It commonly presents with fever, myalgia, and a chest radiograph with migratory infiltrates?: Allergic bronchopulmonary aspergillosis
Which syndrome is caused by a vasculitis of the small arteries and characterized by eosinophilia, asthma, and necrotizing vascuitis with extravascular eosinophil granulomas. The lung is often involved and the ANCA is + in approximately 70% of patients?: Churg-Strauss syndrome
Does ACE inhibitor associated cough occur more often in patients with asthma?: No
Has atenolol been associated with exacerbation of asthma?: Atenolol is associated with exacerbation of asthma
What type of bacteria are gram-positive cocci that grow in chains and are catalase negative?: Streptoccus pneumoniae
What is the most common complication of pneumococcal pneumonia?: Empyema is the most common complication of pneumococcal pneumonia (2% occurrence)
Compare chest radiograph findings of early versus late aspiration pneumonia?: Early --fluffy infiltrate
Late --Pneumonia, ARDS
What are the two main causes of SIADH?: Lung- (small cell lung cancer, pneumonia, increased PEEP)
CNS- (trauma, CVA, anesthesia, morphine)
Which bacteria is most associated with the development of cold agglutinins?: Myocplasma pneumonia
What type of cold agglutinins can develop with mycoplasma pneumoniae infections?: Myocplasma pneumonia generally is associated with an IgM anti-I
What is the most common cause of bacterial meningitis?: Streptococcus pneumoniae
List five causes of nodular or cavitary pneumonia?: Cryptococcus
Norcardia
Bacterial lung abcess
Neoplasm
Aspergillus
Which organisms most commonly cause nosocomial pneumonia?: Gram negative organisms (Pseudomonas, Klebsiella, E. coli, Enterobacter)
What are the common presenting findings in patients with Legionella?: Purulent sputum
Gram stain without organisms
Failure to respond to conventional abx
Temperature-pulse dissociation with rapidly progressive pneumonia
Hyponatremia
Who is at the greatest risk of developing Klebsiella pneumonia outside the hospital setting?: Alcoholics
What is the most common cause of a focal infiltrate on a chest radiograph?: Bacterial pneumonia
What is the most common cause of bacterial pneumonia?: Streptococcus pneumoniae is the most common bacterial pneumonia and accounts for approximately 85% of cases
What is the most common cause of ventilator associated pneumonia in patients on the ventilator at least 5 days?: More than 60% of pneumonias will be seconadary to gram negative bacteria
What is the most common cause of pneumonia in patients on the ventilator 4 days or less?: More than 50% of pneumonias in this setting will be secondary to Staph aureus, Strep pneumonia, or H. influenza
What is the syndrome of recurrent pneumonia or collapse of the right middle lobe of the lung assocated with bronchial obstruction because of lymphadenopathy?: Brock syndrome
Do patients with pneumocystic pneumonia have elevations of the CEA?: Yes
What are the relative indications of an unresectable lung cancer?: Distant spread
Persistent pleural effusion
SVC obstruction
Supraclavicular or contralateral mediastinal positive node
Recurrent laryngeal nerve involvement
Tracheal wall involvement
Main stem bronchus involvement <2cm from carina
What are the three most common causes of malignant pleural effusions?: Lung cancer (35%)
Breast cancer (25%)
Lymphoma (10%)
What are the two most important mechanisms in the development of malignant pleural effusions?: Increased capillary permeability secondary to tumor related inflammation,
Lymphatic obstruction
What are the three criteria of exudative pleural effusions?: Pleural fluid protein/Serum protein ratio>0.5
Pleural fluid LDH/Serum LDH ratio>0.6
Pleural fluid LDH > 2/3 the upper limit for serum

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