MKSAP 10-11

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Jastrzembski
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209084
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MKSAP 10-11
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2013-03-24 23:01:33
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Pulm Rheum
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  1. What is DLCO?
    DLCO measures ability of lungs to transfer gas into red blood cels.

    Low in conditions characterized by barriers to diffusion: Interstitial edema, interstitial infiltrates, tissue fibrosis, or emphsema.
  2. What is a methacholine challenge test
    It induces bronchocnstriction, even when patient is asymptomatic and spirometry is normal.

    Methacholine = Non-selective muscarinic receptor agonist
  3. Neuromuscular causes of respiratory fialure
    ALS or Myasthenia gravis (auto antibodies against postsynaptic ACh receptors)
  4. Platypnea
    opposite of orthopnea. Better breathing when lying down.
  5. Hepatopulmonary Syndrome
    Dyspnea, platypnea, hypoxemia in setting of chronic liver disease. Can have clubbing and cyanosis.
  6. Vocal cord dysfunction
    • Throat or neck discomfort, wheezing, stridor.
    • Difficult to differentiate from asthma, but patients do not respond to usual asthma therapy.
    • O2 Sat is typically normal.

    Laryngoscopy with sx patient can reveal adduction of vocal cords during inspiration.
  7. Symptoms and signs of pulmonary arterial hypertension
    Loud P2, fixed split S2, pulmonic flow murmur, TR.

    CXR usually nL at first, then shows enlargement of pulmonary arteries, RA, RV.
  8. Lactate Dehydrogenase (LDH) in pleural effusions
    • The higher it goes, the more likely it is an exudate rather than a transudate. Usually cut-offi s 200-300.
    • In an empyema it is freq. >1000
  9. Indications for chest tube drainage
    • ph < 7.20
    • Glucose < 60
    • LDH > 1000
    • Positive Gram Stain/Cx
  10. PE findings w/ pleural effusion
    • Blocks sound transmission between lung and chest wall
    • percussion is dull
    • Tactile vocal fremitus is diminished
    • breath sounds diminished
  11. Tuberculous pleural effusion
    • Tuberculous pleural effusion typically presents with a lymphocyte-predominant effusion.
    • Also longer course than typical bacterial pneumonia case.
  12. Chylothorax
    • Blockage of thoracic duct (which is left-sided). Malignancy is most common cause. Trauma second.
    • Triglycerides > 50 mg/dL
  13. Respiratory acidosis in asthma exacerbation
    Indicate impending respiratory failure.
  14. Long-acting anticholinergic drugs?
    Used in COPD, their role in management of asthma is not defined
  15. Antibiotics in COPD
    • For moderate to severe CPOD exacerbations,
    • Use levofloxacin (Fluroquinolone)
    • or 3rd generation cephalosporin with a Macrolide
  16. Difference between ipratropium and tiotropium
    • Anticholinergics for COPD
    • Ipratropium = Short-Acting
    • Tiotropium= Long-acting
    • Should not be combidned.
  17. Cryptogenic organizing pneumonia
    • Interstitial Lung disease
    • COP is often acute or subacute,
    • doesn't respond to abx.
    • Alveolar opacification that migrates on serial exams
  18. Idiopathic Pulmonary Fibrosis (IPF)
    • Prolonged course interstitial lung disease.
    • Reticular pattern on CXR w or w/o opacities.
  19. Lung findings of sarcoidosis
    • Most commonly 3rd decade presentation.
    • 90% have lung involvement
    • CXR: Hilar lymphadenopathy
    • reticular pattern in upper lung zone
    • Restrictive lung pattern.
  20. Antibody test for systemic sclerosis/scleroderma
    • anti-topoisomerase / anti-Scl-70
    • Restrictive lung disease
  21. Drug-induced lung toxicity versus acute eosinophilic pneumonitis
    • Acute eosinophilic pneumonitis = a few days
    • Drug-induced lung toxicity = sub acute
    • Both cause eosinophilia
  22. When can you d/c heparin when moving to warfarin for DVT prophylaxis
    • 5 days.
    • 2 INRs > 2 at least 24 hours apart.
  23. Medial and Lateral Epicondylitis
    • Lateral Epicondylitis is more common (tennis elbow)
    • Medial Epicondylitis = Golf's elbow.
  24. Diagnosis a meniscal tear
    Twisting injury of the foot with weith-bearing followed by severe pain, swelling (over hrs).

    McMurray Test (flexing hip and knee and abducting or adducting knee while extending).
  25. Anserine bursitis
    Focal tenderness on upper inner tibia, about 5cm distal to medial articular line of the knee.
  26. Birefringence
    • Pseudogout = Positive, rhomboidal crystals
    • Gout = Negative, Needle-shaped crystals
  27. DIP and PIP boney enlargements in OA
    • PIP - Bouchard nodes
    • DIP = Heberden nodes
  28. Chronic pain at base of dominant thumb
    Suggestive of OA
  29. de Quervain tenosynovitis
    Inflammation of abductor pollics longus and extensor pollicis brevis tendons.

    • Pain on distal aspect of radial styloid.
    • Pain on flexing thumb into palm, closing fingers over thumb, and bending wrist in ulnar direction
  30. Leukocyte count in septic arthritis
    Usually greater than 50,000 and PMN predominance

    <2000 leukocyte count is nL in joint.
  31. Cardinal X-Ray feature of RA
    • Erosions in proximal joints
    • Carpal-metacarpal
    • Metacarpal-phalangeal, PIPs,
  32. Parvovirus B19 and arthritis
    • Parvovirus B19 infection in adults may induce an acute RF postive oligo or polyarthritis.
    • Most adult pts. with Parvo B19 infection also develop rash, but rearely slapped cheek rash of childhood.
  33. Contraindication for first-line use of MTX?
    • Alcohol use.
    • Use hydroxychloroquine first in this case.
  34. Whipple Disease
    • Rare infection syndrome cased by Tropheryma whippelii.
    • Arthritis --> Migratory and chronic.
    • Diarrhea
    • Malbsorption
    • CNS
    • Constitiutional Syxs
  35. CREST Syndrome
    • Local scleroderma
    • Calcinosis
    • Raynaud's
    • Esophageal dysmotility
    • Sclerodactyly
    • Telangectasia

    Anti-Centromere Ab
  36. Diffuse Scleroderma
    • Also called progressive systemic sclerosis
    • Widespread skin involvement
    • Rapid progression
    • Early visceral involvement
    • Assoc. w/ anti-Scl-70 Ab (Anti-DNA topoisomerase I antibody)
  37. Sarcoidosis
    • Immune-mediated widespread noncaseating granulomas and elevated serum ACE levels.
    • GRAIN
    • Gammaglobulinemia (Low antibodies)
    • RA
    • ACE increase
    • Interstitial Fibrosis
    • Noncaseating granulomas.
  38. Seronegative spondyloarthopathies
    • Assoc. w/ RF and HLA-B27
    • Psoriatic Arthritis
    • Ankylosing Spondylitis --> Spine and sacroiliac jts, uveitis, AR
    • IBD
    • Reactive (Can't see, can't pee, can't climb a tree) after shigella, salmonella, yersina, campylobacter, chlamydia.
  39. Anti-Ro and anti-La
    Sjögren's Syndrome
  40. Drug-induced lupus
    • Seen in patients w/ anti-TNF-alpha drugs
    • Usually spares renal and neurologic symptoms.
    • D/C offending agent.
    • Add prednisone.
  41. Anti-HTN drug of choice in patients with lupus nephritis
    ACE inhibitors, because help control proteinuria.
  42. distinguishing rosacea from SLE malar rash
    • Rosacea does not spare nasolabial fold
    • SLE does.
  43. Treatment for Raynaud phenomenon
    Amlodipine
  44. Polyarteritis Nodosa
    • Vasculitides
    • Nonglomerular renal vessels vasculitis associated with HTN, kidney insufficiency, proteinuria, hematuria.
  45. Granulomatosis with polyangitis
    • Wegener granulomatosis.
    • A vasculitis. Necrotizing granulomatous vasculitis affecting small arteries and veins.
    • Effects nose, sinuses, lungs, and kidneys.
    • C-ANCA

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