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Flashcards in Pulmonary Deck (36)
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1
Q

autosomal recessive inherited d/o defective chloride transport leads to buildup of mucous in lungs, pancreas, liver, intestines, & repro tract

A

cystic fibrosis

2
Q

how is cystic fibrosis diagnosed

A

sweat chloride test >60mmol/L on 2 occasions; pilocarpine (cholinergic)

3
Q

what would you expect to find on a CXR c/ CF

A

hyperinflated, c/ bronchiectasis (prox/medial airway dilation, lack of tapering & thick walls “Tram Track” appearance; pulm art dil- “signet ring sign”

4
Q

young pt c/ bronchiectasis, pancreatic insufficiency, growth delay and infertility

A

classic CF

5
Q

what clinical manifestations would you expect to find in the lungs and 2/2 pancreatic insufficiency in a CF pt

A

recurrent resp infx (pseudomonas, staph aureus) productive cough, chest pain, dyspnea, chronic sinusitis; dec fat absorb, steatorrhea (bulky, pale, foul smelling stool) fat soluble vit deficiency

6
Q

what you you expect to find on PFT with an obstructive dz like CF

A

dec flow and inc volume; dec FEV1 and dec FEV1/FVC

7
Q

chronic multisys inflamm granulomatous dsrdr affecting lungs, skin lymph nodes, eyes

A

sarcoidosis

8
Q

what are the most common sx 2/2 granulomas taking up space and disrupting fxn in sarcoidosis

A

dry cough dyspnea, chest pain, hilar lymphadenopathy, erythema nodosum, LUPUS PERINO, parotid enlargement, uveitis, myocardial arrhythmias, rheum, neuro

9
Q

what would you expect to see on bx with sarcoidosis

A

noncaseating (no central clearing) granulomas

10
Q

what would you expect to see on CXR c/ sarcoidosis

A

bilat HILAR lymphadenopathy, R paratracheal, interstitial lung dz, reticular opacities, fine ground glass, eggshell nodal calcifications

11
Q

would you expect a obstructive or restrictive pattern c/ sarcoidosis

A

restrictive pattern- norm or inc FEV1/FVC; dec lung vol, VC, RV, FRC, TLC

12
Q

how do you manage CF

A

bronchodil, mucolytics, abx, decongestants, replace pancreatic enzymes, supplement A,D,E,K, transplant

13
Q

if you wanted to rule out ifx (TB) in sarcoid what could you do

A

bronchiolar lavage- inc CD4: dec CD8

14
Q

what would you expect to see on labs c/ sarcoid

A

inc ACE, hypercalciuria, eosinophilia, cutaneous anergy (diminished skin allergy test)

15
Q

how do you manage sarcoid

A

oral corticosteroids, methotrexate, NSAIDs

16
Q

if you see hyperlucent lower lung fields on CXR what would be on your DDx

A

alpha 1 antitrypsan deficiency

17
Q

what is alpha 1 antitrypsan deficiency ass c/

A

liver dz, and genetic RF for COPD

18
Q

chronic progressive interstitial scarring (fibrosis) from persistent inflamm, loss of pulm fxn c/ restrictive component unknown cause M 40-50yrs

A

idiopathic pulmonary fibrosis

19
Q

what would you expect to find on exam c/ IPF

A

fine bibasilar insp crackles, clubbing of fingernails

20
Q

what would you expect to see on CXR c/ IPF

A

diffuse reticular opacities (honeycombing) ground glass opacities

21
Q

is IPF obstructive or restrictive

A

restrictive -dec lung vol (TLC, RV) norm FEV1/FVC

22
Q

what are some other names for pulmonary vasculitis

A

granulomatosis c/ polyangitis, wegner granulomatosis

23
Q

what is the classic triad c/ pulmonary vasculitis

A

upper and lower resp tract dz, glomerulonephritis

24
Q

stone/pottery worker c/ DOE, cough and small nodular opacities in upper lobes and eggshell calcifications of hilar and mediastinal nodes

A

silicosis

25
Q

cotton/textile worker c/ dyspnea, wheeze, cough, chest tightness- sx improve as week progresses

A

byssinosis

26
Q

coal mine, small upper lobe nodules, hyperinflation of lower lobes resembles emphysema, massive progressive fibrosis+ RA

A

coal workers pneumocoinosis

27
Q

construction, renovation old buildings, insulation, pleural plaques, interstitial fibrosis (honeycomb lung) lower lobes, dry velcro crackles, streaking at lung bases, ferriginous body

A

asbestosis

28
Q

generalized lung inflamm of alveoli & resp bronchioles 2/2 organic antigens

A

hypersensitivity pneumonitis

29
Q

what would you expect on CXR c/ hypersensitivity pneumonitis

A

small nodular densities sparing apices and bases

30
Q

what meds are 1st line for persistent asthma

A

inhaled corticosteroids (beclomethasone, fluticasone, triamcinolone) don’t affect s.m. target inflamm, dec cap perm, inhibit leukotriene release, red hyperresponse

31
Q

what are some common ADE of inhaled corticosteroids and how prevent

A

candidiasis, hoarse voice, local immune suppression, nose bleed, sore throat; swish and spit

32
Q

should you use mast cell stabilizers (cromolyn) for acute attack

A

no- blocks initiation, good for pretreatment of allergen or exercise induced bronchoconstriction

33
Q

what are some common ADE of Beta agonists

A

tachycardia, hyperglycemia, hypokalemia, hypomagnesemia, tremor

34
Q

what are the long acting B agonists

A

salmeterol, xenafoate, formeterol - should not be used alone ;should+ ICS

35
Q

if you have asthma and COPD what kind of inhaled bronchodilator would be best

A

anticholinergic- ipratropium, tiotropium

36
Q

what are some ADE of leukotriene receptor antagonists -

A

inc liver enzymes, inc warfarin effects