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My Pulmonary Boards > 27 > Flashcards

27 Flashcards

1
Q

Bronchial thermoplasty criteria

A
  1. frequent intermittent or continuous oral steroids
  2. FEV1 >50%
  3. No life-threatening exacerbation in the past and <3 per year
  4. Willing to accept asthma exacerbation
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2
Q

Bronchial thermoplasty benefits

A
  1. Trend toward improved quality of life at 1 year

2. No difference in symptoms or PFTs

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3
Q

pulmonary neuroendocrine cells (PNECs) action

A

Airway chemoreceptors inducing vasoconstriction via serotonin secretion in response to hypoxia

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4
Q

Amiodarone associated pulmonary diseases

A 
Interstitial pneumonia
ARDS
Organizing pneumonia
DAH
Pulmonary nodules (solitary or multiple)
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5
Q

Drugs that cause eosinophilic pleural effusion

A

Warfarin, PTU, nitrofurantoin

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6
Q

What will increase expiratory flow rate

A 
Stiff lungs:
pulmonary edema
pneumothorax
pleural effusion
parenchymal lung disease
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7
Q

What will decrease expiratory flow rate

A

Airway obstruction

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8
Q

Amiodarone associated pulmonary diseases risk factors

A

Dosage >400 mg/day
Duration of therapy >2 months
Age >60
Preexisting lung disease, surgery, contrast administration

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9
Q

Amiodarone toxicity on BAL

A 
Foamy macrophages (also in organizing pneumonia and aspiration)
Eosinophilia (evidence of hypersensitivity)
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10
Q

Grade 1 FEV1

A

> 80%

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11
Q

Grade 2 FEV1

A

50-79%

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12
Q

Grade 3 FEV1

A

30-49%

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13
Q

Grade 4 FEV1

A

<30%

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14
Q

DAH BAL findings

A

> 20% hemosidorin laden macrophages

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15
Q

Hydrogen sulfide poisoning

A

Rotten egg odor
Common cause of inhalation toxic exposure in petroleum industry
Can cause temporary or permanent dysfunction to multiple organ systems

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16
Q

Carbon monoxide poisoning symptoms

A 
Headache
Fatigue
Dizziness
Drowsiness
Nausea
Prolonged exposure: vomiting, confusion, LOC
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17
Q

Toluene diisocyanate symptoms

A

Skin and lung sensitization; can cause asthma, lung damage

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18
Q

Toluene diisocyanate found in

A

Adhesives and paints

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19
Q

Cadmium poisoning

A

Long term exposure: cancer and/or toxicity in multiple organs; emphysema

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20
Q

Dupilumab MOA

A

directed at the a-subunit of IL-4 receptor which can modulate signaling for IL-4 and IL-13

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21
Q

IL-4 and IL-13

A

Important role in IgE synthesis, mucous secretion, and eosinophil recruitment

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22
Q

Omalizumab MOA

A

Targets free IgE, preventing it from binding to receptors on mast cells, eosinophils, and basophils

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23
Q

When to use Dupilumab

A

Add-on maintenance therapy for oral corticosteroid dependent asthma, regardless of phenotype

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24
Q

When to use Omalizumab

A 
- positive skin test 
or 
- in intro reactivity to a perennial aeroallergen 
And
- IgE of 30-700
>12 years old
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25
Q

When to use Mepolizumab

A

Add on in asthma

Eosinophil level >150 cells

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26
Q

When to use Reslizumab

A

Add on in asthma

Eosinophil level >400 cells

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27
Q

Mepolizumab and Reslizumab MOA

A

Directed against IL-5

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28
Q

Thoracic splenosis when does it occur

A

After left hemidiaphragmatic injury and splenic rupture

Usually 20 year interval

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29
Q

When is methylene blue indicated

A

Methemoglobin >30%

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30
Q

Methylene blue dosing

A

1-2mg/kg over 5 minutes

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31
Q

When will methylene blue lead to methemoglobinemia

A

Dose >15mg/kg

Patients with G-6-PD deficiency

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32
Q

Respiratory system compliance

A

Tv divided by the inflating pressure (Plateau pressure minus PEEP)

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33
Q

How to measure perfusion pressure of the abdomen?

A

MAP - intra-abdominal pressure

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34
Q

What intra-abdominal pressure is low

A

When MAP - intra-abdominal pressure is <60

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35
Q

Roflumilast MOA

A

Increases intracellular cAMP which inhibits PDE-4 leading to decreased inflammation

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36
Q

Roflumilast SE

A

N/V
Weight loss
Psychiatric reactions

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37
Q

NIV criteria in COPD

A

NIV use during hospitalization and remain hypoxemic and hypercarbic (PaCO2 > 52), 2 weeks after discharge

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38
Q

Which immunologic mechanism is measured by Quantiferon Gold

A

Delayed hypersensitivity

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39
Q

Granulomatosis with polyangiitis maintenance immunotherapy

A

Azathioprine
Methotrexate
Rituximab

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40
Q

Protective effect on asthma (conversion from Th2)

A

IFN-gamma
IL-12
IL-18

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41
Q

Asthma Th2 interleukins leading to disease

A 
IL-4
IL-5
IL-9
IL-13
IL-17
IL-25
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42
Q

Neutrophilic asthma TH

A

TH 17

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43
Q

Pro-inflammatory cytokines that enhance asthma

A

IL-1B
IL-6
TNF-a
TSLP

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44
Q

Where do leukotrienes in asthma come from

A

Action of 5-LO on arachidonic acid

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45
Q

Leukotrienes important in asthma

A

LTC4

LTD4

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46
Q

Common leukotrienes LTC4 and LTD4 receptor

A

CysLT1

47
Q

IL-5 action in asthma

A

Differentiation and maturation of eosinophils

48
Q

IL-13 action in asthma

A

Recruitment of eosinophils into the airway

49
Q

IL-4 and IL-13 action in asthma

A

IgE production by B-cells

50
Q

IgE action

A

Activates mast cells and basophils which produce leukotrienes that recruit and activate eosinophils

51
Q

Indirect bronchial challenge testing

A

Exercise
Hypertonic saline
Mannitol

52
Q

How dose indirect bronchial challenge with exercise/hypertonic saline/mannitol work?

A

Increased osmolarity of airway surface leads to mediator release from mast cells or basophils

53
Q

Direct action on smooth muscle to provoke asthma

A

Methacoline challange

54
Q

Direct stimulation of sensory nerve endings in asthma

A

Sulfur dioxide
Bradykinin
Allergens

55
Q

Indirect vs direct stimulation test for asthma

A

More specific but less sensitive

Best choice when exercise bronchospasm is the question

56
Q

Exhaled nitric oxide of >35 parts per billion associated with

A

eosinophilic airway inflammation
Risk of asthma exacerbation
Non-adherence to inhaled steroids

57
Q

Exhaled nitric oxide use

A

Can predict response to inhaled steroids and anti-IgE therapy (anti IL-4, 5 and 13)

58
Q

Exercise induced asthma diagnosis

A

15% decrease in FEV1 after exercise

59
Q

What is elevated in aspirin exacerbated respiratory disease

A

Blood eosinophils and serum IgG4 subclass levels, persistent airway inflammation

60
Q

How can you test for aspirin exacerbated respiratory disease?

A

Can check urine leukotrienes after challenge

61
Q

What ACT score means asthma control?

A

> 20

62
Q

What ACT score asthma poorly controlled?

A

<15

63
Q

Intermittent asthma definition

A

Symptoms <2d/week
Nighttime awakening <2x/month
SABA use <2x/week
Normal FEV1

64
Q

Mild persistent asthma definition

A

Symptoms >2d/week but not daily
Nighttime awakening 3-4x/month
SABA use >2x/week but not daily
Normal FEV1

65
Q

Moderate persistent asthma definition

A

Symptoms daily
Nighttime awakening >1x/week
SABA use daily
FEV1 >60% but <80%

66
Q

Severe persistent asthma definition

A

Symptoms throughout the day
Nighttime awakening nightly
SABA use throughout the day
FEV1 <60%

67
Q

Do inhaled steroids prevent airway remodeling?

A

No

68
Q

How frequently to step down asthma therapy?

A

Every 6-8 weeks

69
Q

Zileuton in asthma

A

5-LO agent

70
Q

What works on the CysLT1 receptor in asthma?

A

Montelukast
Zafirlukast
Pranlukast

71
Q

Asthma, skin rash, pulmonary infiltrates and peripheral eosinophilia

A

EGPA (churg Strauss)

72
Q

Therapeutic window for theophilline

A

8-12 ug/dL

73
Q

Theophilline toxicity symptoms

A 
Tremors
Palpitations
N/V
Arrhythmia
Seizures
Death
74
Q

What decreases with omalizumab use

A

Decreased exacerbation

Minimal effect on lung function

75
Q

IL-5 in asthma

A

eosinophil maturation, activation, and recruitment

76
Q

Benralizumab MOA

A

Tags onto IL-5 receptor

77
Q

Alpha 1 antitrypsin deficiency mutation in what gene?

A

SERPINA1

78
Q

What is Alpha 1 at deficiency?

A

An imbalance between neutrophil elastase in the lung (which destroys elastin) and the elastase inhibitor alpha-1 antitrypsin (which protects against proteolytic degradation)

79
Q

UPLIFT trial

A

Tiotropium exacerbation reduced

80
Q

TORCH trial

A

LABA/ICS associated with a reduced COPD exacerbation, trend towards improved survival
Higher incidence of PNA using ICS

81
Q

Benefits of pulmonary rehab

A

Reduced hospital admission
Reduced mortality
Improved quality of life
Improved exercise capacity

82
Q

What does NIPPV in COPD do?

A

If PaCO2 >52 at baseline, if dropped to <48 post hospitalization can improve survival

83
Q

Focal Bronchiectasis

A

Mechanical obstruction
Congenital bronchial atresia
Necrotizing PNA

84
Q

How to reduced viscosity of secretions in CF?

A

Dornase alpha

Hypertonic saline

85
Q

Anti-Inflammatory therapy in CF

A

Azithromycin IF colonized with Pseud

High dose ibuprofen in 6-17 yo ONLY

86
Q

Diagnosis of OHS

A

BMI >30

Diurnal pCO2 >45

87
Q

What are the primary lymphocytes involved in pathogenesis of COPD?

A

CD8+ cytotoxic T cells

88
Q

When measuring volume response in intubated patients, what must be present?

A 
Passive (paralyzed)
In sinus rhythm
Vt of at least 8mL/kg predicted body weight
Abdominal pressure <12
HR/RR of >3.6
89
Q

What is reduced on PFTs in obesity?

A

ERV and FRC

90
Q

How to differentiate work exacerbated VS occupational asthma

A

Lack of change in sputum eosinophil count after being away from work and unchanged airway hyper-responsiveness

91
Q

Centrilobular nodules and tree in bud in a clustered pattern

A

Suggestive of mycobacterial, fungal, bacterial infection

92
Q

Tree in bud in a diffuse distribution

A

Suggestive of panbronchiolitis, viral infection, cystic fibrosis

93
Q

Centrilobular nodules without tree in bud diseases

A

Subacute hypersensitivity pneumonitis
Respiratory bronchiolitis (RB-ILD)
Lymphocytic interstitial pneumonitis (LIP)
Early Langerhans

94
Q

Perilymphatic nodules location

A

Subpleural and peribronchovascular and along the interlobular septa, usually upper lobe predominant

95
Q

Perilymphatic nodules diseases

A

Sarcoidosis
Carcinomatosis
Silicosis

96
Q

Random nodules location

A

Random but mostly lower lobe predominant, sub pleural

97
Q

Random nodules diseases

A

Hematogenous spread, malignancy, miliary PNA

98
Q

Bronchiolitis obliterans CT chest

A

Clear CT with mosaic is on end-expirations imaging c/w air trapping; bronchiectasis may develop

99
Q

Bronchilolitis obliterans definition

A

Airflow limitation in the absence of other etiologies but without confirmatory pathology; decrease in FEV1 > FVC on 2 spirometries 3 weeks apart

100
Q

Bronchiolitis obliterans treatment

A

Azithromycin for minimum 3 months and check spirometry after

101
Q

Risk of pulmonary edema at what altitude

A

> 8000 feet or 2500 meters

102
Q

BODE index - B

A

BMI >21 vs <21

103
Q

BODE index - O

A

Obstruction, FEV1

0 = >65% then go down by 15%

104
Q

BODE index - D

A 
Dyspnea based on mMRC
0 = mMRC 0 or 1
1 = mMRC 2
2 = mMRC 3
3 = mMRC 4
105
Q

BODE index - E

A

Exercise in 6 minutes

0 = >350 feet then go down by 100 feet

106
Q

BODE 4 year survival 0-2

A

80%

107
Q

BODE 4 year survival 3-4

A

67%

108
Q

BODE 4 year survival 5-6

A

57%

109
Q

BODE 4 year survival 7-10

A

17%

110
Q

mMRC 0

A

Dyspnea only with strenuous activity

111
Q

mMRC 1

A

Dyspnea with hurrying or slight hill

112
Q

mMRC 2

A

Walks slower than ppl own age

113
Q

mMRC 3

A

Stops after 100 yards

114
Q

mMRC 4

A

Too dyspneic to leave the house

My Pulmonary Boards (6 decks)

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