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Pneumo/gastro c’est bow > Asthma/COPD/Bronchiect/ILD > Flashcards

Asthma/COPD/Bronchiect/ILD Flashcards

1
Q

4 most common sx of bronchiectasis ?

A
  • cough with sputum and/or hemoptysis
  • dyspnea and fatigue
  • rhinosinusitis
  • thoracic pain
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2
Q

According to GINA 2023, what is the new preferred reliever for asthma ?

A

ICS-Formoterol PRN
No more SABA only tx as reliever

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3
Q

Asthma : when can you offer stepping down therapy ?

A

If pt has sx control for 2 months and low risk of exacerbations consider stepping down therapy

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4
Q

Asthma : when is LTRA appropriate as initial controller ?

A

If pt unwilling / intolerant of ICS
Still less effective than ICS at preventing exacerbations

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5
Q

Asthma : when is LTRA most effective ?
Name 3 situations.

A

ASA exacerbated asthma
Exercise induced sx
Allergic rhinitis

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6
Q

Asthma-COPD overlap : how do you treat ? What is the first line?

A

Treat like asthma, LABA-ICS combo first line
For refractory sx : add LAMA to the combo

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7
Q

Bronchiectasis exacerbation : ATB guided by sensitivity ?

A

no evidence to show antibiotics guided by sensitivity results improves outcomes

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8
Q

Bronchiectasis exacerbation : how do you manage major hemoptysis ?

A

IV antimicrobials
Tranexamic acid
Comsider embolization as first line

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9
Q

Brown sputum with casts + fever : dx ?

A

ABPA

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10
Q

COPD : definition of HIGH RISK for AECOPD ?

A

Defined as 2 or more severe exacerbations in the past year or 1 or more requiring hospitalization

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11
Q

COPD : tx based on dyspnea scale or lung function ?

A

Tx based on subjective level of dyspnea and rate of exacerbations

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12
Q

COPD tx if low sx burden ?
(CAT <10 or mMRC ≤ 1, LOW AECOPD risk)

A

LAMA or LABA monotherapy
Has to have LOW AECOPD risk and FEV1 ≥ 80%

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13
Q

COPD tx if MODERATE sx ?
(CAT ≥ 10, mMRC ≥ 2, LOW AECOPD risk)

A
  • LAMA/LABA dual
  • Then step up to LAMA/LABA/ICS
  • If has asthma can also use ICS/LABA
    Has to be LOW AECOPD risk
    FEV1 < 80
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14
Q

COPD tx if sx moderate to severe ?
(CAT ≥ 10, mMRC ≥ 2 but HIGH AECOPD risk)

A

LAMA/LABA/ICS
No stepping down
FEV1 < 80

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15
Q

Criteria for lung transplant referral in ILD disease ?

A

Criteria for referral : FVC <80%, DLCO <40%, need oxygen, ‘failed’ pharmacotherapy

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16
Q

Does IPF patients require bx ?

A

Most do not

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17
Q

Drug induced ILD : what rx ? what tx ?

A

MTX, amiodarone, nitrofurantoin, bleomycin, vaping
Tx is corticosteroids

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18
Q

Dyspnea in advanced COPD : anxiolytic and antidepressant ?

A

Recommend against
OK for oral but not nebulized opioids

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19
Q

Dyspnea in advanced COPD, what is recommended?

A
  • Oral but NOT nebulized opioids
  • Neuromuscular electrical muscle stimulation
  • Chest wall vibration
  • Walking aids
  • Pursed lip breathing
  • Continuou O2 for hypoxemic COPD : reduce mortality and may reduce dyspnea but little benefit on QOL
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20
Q

Exercise induced asthma : tx ?

A

Salbutamol pre exercise, if insufficient then LTRA pre exercise, if still insufficient try regular ICS

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21
Q

For patient with Sampter’s Triad (ASA allergy, asthma, nasal polyps) whose asthma is not well controlled on low dose ICS – would you add LTRA or increase ICS dose?

A

LTRA

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22
Q

How can we differentiate RADS from Vocal Cord Dysfunction that might also be triggered by irritants?

A

Clinical scenario
some RADS may have a normal spirometry but virtually all will have abnormal metacholine challenge

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23
Q

How do you diagnose COPD ?

A

With spirometry : post bronchodilatator FEV1/FVC < 0.7

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24
Q

How do you differentiate severe from uncontrolled asthma ?

A

Severe asthma suggested by patient medications
Uncontrolled asthma indicated by CTS 2021 asthma control criteria

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25
Q

How do you grade the severity of airflow limitation in COPD ?

A

In pts w/ post-bronchodilator FEV1/FVC <0.70:
• Mild: FEV1 > 80% predicted
• Moderate: 50% < FEV1 < 80% predicted
• Severe30% < FEV1 < 50% predicted
• Very Severe: FEV1 < 30% predicted

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26
Q

How do you manage bronchiectasis exacerbation ?

A
  • Obtain sputum cultures
  • Empiric antimicrobials, covering organisms previously grown if knoww, generally 14 days especially if PsA colonzed
  • IV ATB if unwell / resistance…
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27
Q

How do you start tx for asthma according to CTS 2021 ? 2 steps.

A

1) Well controlled ?
NO : daily ICS + PRN SABA
YES : go to 2)

2) Risk of severe exacerbation ?
YES : daily ICS preferred or PRN bud/form
NO : PRN bud/form or PRN SABA

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28
Q

How do you treat IPF exacerbation ?

A

Consider high dose corticosteroids (1g/d x 3 -> 1mg/kg po daily) and empiric antimicrobials

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29
Q

How should you initiate pharmacologic tx for smoking cessation in COPD pts ?

A

Treat everyone with varenicline +/- nicotine patch even if they are not ready to quit
Varenicline superior to nicotine patch alone

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30
Q

How to recognize the name of LABA pumps ?

A

LABA : B2 agoniste a longue durée d’action
FINIT EN -TEROL
Formotérol, indacatérol, salmétérol

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31
Q

How to recognize the name of LAMA pumps ?

A

LAMA : anticholinergiques longue action
FINIT EN -IUM
Glycopyrronium, tiotropium, umeclidinium…

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32
Q

If serious exacerbation requiring hospital / ICU in past year : criteria for severe or uncontrolled asthma ?

A

Uncontrolled

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33
Q

If you have severe asthma and high IgE + allergies : what tx ?

A

Think about omalizumab (anti IgE)

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34
Q

ILD : what investigations ?

A
  • ALL : ANA, RF, anti CCP
    +/- more serology if clinically indicated
  • HRCT chest
  • PFTs +/- 6MWT +/- home ox assessment
  • Can send precipitating antibodies for some known antigens for HP
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35
Q

In which situation does pulmonary rehabilitation increase survival ?

A

Increased survival compared with usual care < 4 weeks post AECOPD
And minimize exacerbations if started following < 4w AECOPD

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36
Q

Indicated in maintenance tx of COPD : influenza vaccine ?

A

YES all COPD annually

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37
Q

Indicated in maintenance tx of COPD : pneumococcal vaccine ?

A

YES, all COPD > 65, significant comorbid conditions and all those with FEV1 < 40

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38
Q

Indicated in maintenance tx of COPD : shingrix vaccine ?

A

YES for adults with COPD ≥ 50 y

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39
Q

Indicated in maintenance tx of COPD : TdAP pertussis vaccine ?

A

YES if not received in adolescence

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40
Q

IPF acute exacerbation definition ?

A

Worsening dyspnea, hypoxemia with new diffuse bilateral ground glass on CT
R/O infection/PE/HF

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41
Q

Is purulence sensitive for the need of ATB in AECOPD ?

A

YES 95% sensitivity and 52% specificity for high bacterial load

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42
Q

Link between IPF and smoking ?

A

Many have a smoking history

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43
Q

Non IPF ILD CTD associated : what presentation and tx ?

A

Varity of imaging
MMF preferred, short term steroids, AZA, RTX
TOCI for scleroderma

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44
Q

Non IPF ILD hypersensitivity pneumonitis : cause, presentation and tx ?

A

Organic exposures (moulds, birds…)
Upper lobe predominant + precipitant antibodies to antigen
Tx : avoid antigen, steroid, sometimes MMF or AZA

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45
Q

Non IPF ILD pneumoconioses, what cause / presentation and tx ?

A

Caused by inorganic exposures YEARS AGO
Variety of imaging patterns
Support care and transplant

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46
Q

Non IPF ILD with upper lobe predominant pattern : what dx ?

A

Hypersensitivity pneumonitis

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47
Q

Pregnancy and asthma : what is the usual evolution ?

A

Rule of thirds (1/3 better, 1/3 worse, 1/3 same), exacerbations more common, increased risk of pre eclampsia, preterm, low birth weight, treat as you would anyone else

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48
Q

Pregnancy and asthma : what tx ?

A

DO NOT stop ICS, most evidence for budesonide
DO NOT withhold oral steroids if exacerbating

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49
Q

Radiological pattern of IPF ?

A

UIP : usual interstitial pneumonia

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50
Q

When is oxygen indicated in ILD ?

A

Indicated if
- Resting hypoxemia (same criteria as COPD)
- Exertional hypoxemia (sat < 88%) WITH improved walk distance or dyspnea on supplemental oxygen

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51
Q

Seasonal allergic asthma: what tx ?

A

start ICs immediately when sx commence and continue for four weeks after relevant pollen season ends

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52
Q

Should you give ATB for asthma exacerbation ?

A

Not recommended

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53
Q

Should you give theophylline for asthma exacerbation ?

A

Not recommended

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54
Q

Spiriva : which pump ?

A

LAMA

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55
Q

What are the antibodies in EGPA ?

A

P ANCA in 30-60%

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56
Q

What are the diagnosis criteria for ABPA ?

A

ARTEPICS
Asthma + skin test positive + eosinophilia + high IgE + central bronchiectasis…

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57
Q

What are the five asthma mimics or asthma plus syndromes ?

A
  • Bronchiectasis including cystic fibrosis
  • EGPA/Churg Strauss
  • Vocal cord dysfunction
  • ABPA (aspergillose chronique)
  • Exercise induced bronchoconstriction
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58
Q

What are the grade 1 recommendations that prevent acute exacerbations in COPD ?
Name 4 points.

A
  • Annual flu vaccine
  • Pulm rehab (if RECENT exacerbation < 4 w ago)
  • Education and case management
  • Inhaled pharmacotx

Also suggested Gr2C:
- Pneumococcal vaccination
- Smoking cessation (reduces mortality and CV events)

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59
Q

What are the mainstays of tx for bronchiectasis ?

A
  • Airway clearance with active cycle of breathing
  • Mucoactive agents : hypertonic saline
  • Antimicrobials
  • Bronchodilator
  • Pulmonary rehab (if fctionally limited by dyspnea mMRC ≥ 1)
  • Vaccins
  • Supplemental oxygen (same criteria as for COPD)
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60
Q

What are the most common causes of bronchiectasis ?

A

Post infectious and idiopathic (accounting for 50% of cases)

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61
Q

What are the three grades of severity for AECOPD ?

A

Mild : no change in medications
Moderate : ATB +/- oral steroid
Severe : hospitalization / ED visit

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62
Q

What are the three ICS/LABA pumps containing formoterol ?

A

Symbicort budesonide/formoterol
Zenhale mometasone/formoterol
Fostair beclomethasone/formoterol

63
Q

What are the two anti fibrotic medications in IPF ?

A
  • Nintendanib : trend to reduced mortality
  • Pirfenidone : improved survival
64
Q

What is a severe asthma exacerbation ?

A

Any 1 of :
- Requiring systemic steroids
- ED visit
- Hospital admission
Mild exacerbation is 0/3 above criteria

65
Q

What is a UIP pattern ?

A
  • Reticular changes
  • Subpleural / basal predominant
  • Honeycombing
  • Absence of inconsistent features which are : cysts, mosaic attenuation, micronodules, nodules, consolidation, distribution peribronchovascular/perilymphatic/upper or mid lung
66
Q

What is in symbicort ?

A

Budesonide formoterol

67
Q

What is superior between LABA-ICS and LTRA-ICS ?

A

LABA-ICS

68
Q

What is the 1 year mortality after AECOPD ?

A

Around 30%
Lose additional 8ml/year of FEV1 with exacerbation

69
Q

What is the black box warning concerning LTRA ?

A

Increased suicidality in adolescents and adults

70
Q

What is the clinical presentation of ABPA ?

A
  • Exclusively seen in either asthma or CF
  • Have recurrent exacerbations, fever, brown sputum with casts
  • Criteria ARTEPICS
71
Q

What is the definition of LOW risk of AECOPD ?

A

≤ 1 moderation exacerbation in last year
(rx abx or pred, no ED/hospit)

72
Q

What is the definition of severe asthma ?

A
  • Requiring high dose ICS + 2nd controller for the previous year
  • Oral steroids for 50% of the year to maintain control (or remaining uncontrolled)
73
Q

What is the difference between occupational asthma and work exacerbated asthma ?

A

Occupational : asthma caused by exposure to irritants at work
Work exacerbated : pre existing asthma worse at work

74
Q

What is the difference between sensitizer induced asthma and irritant induced asthma ?

A

Sensitizer : long term exposure
Irritant : one specific high level exposure (RADS)
Acute form of irritant induced asthma with ++ sx following a single high dose exposure to vapors/gas/fumes, lasts > 3months, treat like asthma exacerbation

75
Q

What is the dose and length of prednisone in AECOPD?

A

40mg/d for 5-7 days
Faster recovery time and increased FEV1

76
Q

What is the effect of steroids on AECOPD ?

A

Shorten recovery and hospitalization duration

77
Q

What is the epidemiology of IPF?

A

Most common IIP (idiopathic interstitial pneumonias)
M>F, 6th or 7th decade (rare < 50)
Many have smoking history

78
Q

What is the IPF tx ?

A
  • Quit smoking
  • O2 PRN and pulmonary rehab
  • Vaccines
  • Antifibrotic medications reduce decline in FVC by 50% : nintendanib or pirfenidone
79
Q

What is the name of budesonide formoterol ?

A

Symbicort

80
Q

What is the name of mometasone/formoterol ?

A

Zenhale

81
Q

What is the outcome of Asthma-COPD overlap compared to COPD ?

A

Worse outcomes than COPD or asthma alone

82
Q

What is the presentation of vocal cord dysfunction ?

A

Abrupt onset inspiratory stridor, may be misdiagnosed as asthma
Dx via laryngoscopy with adduction of the vocal cords upon inspiration
Rx: education, speech therapy, treat GERD

83
Q

What is the prognosis of IPF exacerbation ?

A

Generally 50% in hospital mortality

84
Q

What is the track 1 preferred tx plan for asthma ?

A

STEP 1+2 : PRN low dose ICD formoterol
STEP 3: low dose maintenance ICS formoterol
STEP 4: medium dose maintenance ICD formoterol
STEP 5: refer for phenotypic assessment +/- LAMA …

85
Q

What is the treatment of severe asthma ?

A
  • LAMA / tiotropium mist inhaler if uncontrolled despite ICS/LABA (at least medium dose)
  • Macrolides
  • Biologics
  • Low dose oral corticosteroids
  • Bronchial thermoplasty
86
Q

What is the tx of ABPA ?

A

Prednisone +/- itraconazole

87
Q

What is the tx of AECOPD ?

A
  • Supplemental oxygen
  • Short acting BD with long acting BD initiated ASAP prior to discharge
  • Steroids x 5-7j
  • ATB if indicated x 5-7j
  • NIV
88
Q

What is the work up of bronchiectasis ?

A
  • For ABPA : blood count, total IgE, sensitization to aspergillus (IgE specific antibodies or skin prick)
  • Serum immunoglobulins
  • Test for CF (sweat test) and primary ciliary dyskinesia (nasal nitric oxide)
  • Sputum cultures

CONSIDER: RF, anti CCP, ANA, ANCA, alpha 1 antitrypsin, HIV, videofluoroscopic swallow study

89
Q

What is the work up of severe asthma ?
Name 4 points.

A
  • Total IgE
  • Peripheral eosino count
    > 0.3 : consider non asthma causes including stronglyoides before steroids
    > 1.5 : consider investigate for conditions such as EGPA
  • Sputum eosinophils and FeNO
  • Consider screening for adrenal insufficiency if on maintenance oral corticosteroid or high dose ICS-LABA
90
Q

What is the tx of vocal cord dysfunction ?

A

Rx: education, behavior modification, speech therapy, treat GERD

91
Q

What medication should you NOT give to treat IPF ?

A
  • Do not give PPI for purpose of improving resp outcomes (just Rx if indicated for usual GI reasons)
  • No role for corticosteroids or immunosuppression in IPF AS INCREASED MORTALITY
92
Q

What non pharm management improve survival in COPD ?

A

Smoking cessation
Pulmonary rehabilitation
Supplemental oxygen (in severe resting hypoxemia)

93
Q

What should you expect on PFTs of pts with bronchiectasis ?

A

Obstruction

94
Q

When does BIPAP show a mortality benefit in COPD ?

A

In AECOPD : significant mortality benefit and reduction in intubation rate
IN COPD : reduction in hospital re admission and some trials showing mortality benefit

95
Q

When is BIPAP/NIV indicated in AECOPD ?

A

Recommended (GOLD 2023) if any of:
- pH ≤ 7.35 with PaCO2 ≥ 45
- Severe dyspnea (impending respiratory failure)
- Persistent hypoxemia despite supplemental oxygen

96
Q

When is lung transplant indicated in COPD ?

A
  • Bode score 7-10 and 1 of
    1) hospitalized with COPD with pCO2 >50
    2) pulmonary hypertension/cor pulmonale despite supp oxygen
    3) FEV1 <20% with DLCO <20%
97
Q

When is lung volume reduction surgery indicated in COPD ?

A

Increased survival in severe emphysema with upper lobe predominant disease and low post rehabilitation exercise capacity
Bullectomy may be considered if large bulla

98
Q

When is macrolide indicated in COPD tx ?

A

Add to LAMA/LABA/ICS if continues to exacerbate, will lower AECOPD if :
- Mod to high sx burden
- HIGH AECOPD risk
- FEV1 < 80

99
Q

When is NIV indicated for COPD at home?

A

Chronic NIV if severe COPD on home oxygen and chronic hypercapnia PaCO2 ≥ 52
Reduction hospital re-admission and some trials showing MORTALIY benefit

100
Q

When is roflumilast or N-acetylcystein indicated in COPD ?

A

In addition to LAMA/LABA/ICS if:
- Mod to high sx
- HIGH AECOPD risk
- FEV1 < 80
**Chronic bronchitis necessary
Recommend against if low sx or low AECOPD risk

101
Q

When is theophylline indicated in COPD ?

A

Recommend against

102
Q

When should ATB be given in AECOPD ?

A
  • If presence of three cardinal sx
  • or TWO of the following if increased purulence is one of them
  • or if pt requires ventilation
  1. Increase in dyspnea
  2. Increase in sputum volume
  3. Increase in sputum purulence
103
Q

When should long term oxygen therapy be offered in COPD ?

A

If severe hypoxemia (PaO2 < 55) or PaO2 < 60 and
- bilateral ankle edema
- cor pulmonale
- Hct > 56%

104
Q

When should you add macrolides in asthma ?

A

For severe asthma despite ICS/LABA
May decrease frequency of exacerbations

105
Q

When should you consider transplant in bronchiectasis tx ?

A

If poor lung function and one of : massive hemoptysis, severe PH, ICU admissions or respiratory failure requiring NIV

106
Q

When should you do CT thorax in COPD assessment ?

A

IF
- Lung cancer screening criteria
- Frequent exacerbations (R/O bronchiectasis or atypical infection), sx out of proportion of lung fxn testing
- Lung volume reduction surgery might be helpful (FEV1 < 45% and significant gas trapping)

107
Q

When should you give azithromycin in bronchiectasis ?

A

Mainstay of treatment, use if recurrent exacerbations
Can use with or without PsA colonization but rule out NTM

108
Q

When should you give LABA monotherapy in asthma ?

A

Never as increased risk of death

109
Q

When should you prescribe omalizumab in asthma ?

A

Allergic asthma with IgE 30-700, sensitive to at least 1 allergen, severe despite high dose ICS and one other controller

110
Q

When should you suspect ACO : asthma COPD overlap ?

A

Characterized by persistent airflow limitation with several features of both asthma and COPD
Diagnosis requires 3 points :

  1. Diagnosis of COPD given risk factors, history, spirometry
  2. History of asthma (past history/diagnosis, current symptoms consistent, or physiology confirmed /w spirometry)
  3. Spirometry: post-bronchodilator fixed FEV1/FVC <0.7

and supportive but not required:
1. Documentation of bronchodilator improvement of FEV1 by 200ml or 12%
2. sputum eosinophils > 3%
3. Blood eosinophils > 300

111
Q

When should you use colistin or gentamicin in bronchiectasis ?

A

If PsA colonized

112
Q

When should you use DNAse as mucoactive agent in bronchiectasis tx ?

A

Avoid DNAse unless CF

113
Q

When should you use high flow nasal cannula in COPD ?

A

Not currently recommended

114
Q

Which antimicrobials are indicated for bronchiectasis ?

A

Inhaled colistin or gentamicin (if PsA colonized)
Chronic azithromycin if chronic exacerbations (with or without PsA colonization but R/O NTM)

115
Q

Which medication should you avoid in asthma ?

A

NSAIDs and maybe beta blockers

116
Q

What are the two pre requisites for asthma diagnosis ?

A
  1. Hx of variable respiratory sx (vary in time and intensity)
  2. Confirmed variable expiratory airflow limitation

NEED SPIROMETRY

117
Q

What are the specificities of adult onset asthma ?

A

Non-allergic, require higher ICS, rule out occupational asthma

118
Q

What are the specificities of asthma associated with obesity ?

A

Little eosinophilic inflammation

119
Q

What are the 5 ways to demonstrate variability in asthma ?

A

1- Positive bronchodilator reversibility
Improvement in FEV1 by > 12 % AND 200ml post BD 10-15min after 200-400mcg salbutamol
2- Improvement in lung function with anti inflammatory tx x 4 weeks (FEV1 > 12% AND 200mL post BD)
3- Excessive FEV1 variation between visits (>12% and 200cc)
4- Peak Flow variability daily > 10%
(twice daily PEF over 2w)
5- Positive bronchial challenge test or exercise challenge test

120
Q

What to do if you suspect asthma but normal spirometry?

A

Airflow limitation may not be present at the time of initial assessement, REPEAT during times of sx or do metacholine or exercise testing

121
Q

How do you interpret metacholine challenge ?

A

Look for drop in FEV1 by 20 %
PC20 < 4 = +
PC20 4-16 = borderline
PC20 > 16 = negative

122
Q

How do you interpret exercise challenge in asthma ?

A

Fall in FEV1 > 10% and > 200mL from baseline

123
Q

Asthma control : daytime sx ?

A

≤ 2d/week

124
Q

Asthma control : nightime sx ?

A

<1d/w and mild

125
Q

Asthma control : need for a reliever ?

A

≤ 2 doses per week

126
Q

Asthma control : FEV1 or PEF ?

A

≥ 90% of personal best

127
Q

Asthma control : PEF diurnal variation ?

A

<10-15 %

128
Q

Asthma control : sputum eosinophils ?

A

<2-3 %

129
Q

What is the PDEi4 that can be used in COPD ?

A

Roflumilast

130
Q

How can you differentiate occupational asthma from RADS (reactive airway disfunction syndrome)?

A

Occ asthma : latency period, better reversitibility to bronchodilator

RADS : no latency, less reversibility to bronchodilator
Peut se manifester après une seule exposition aigue comme une forte concentration d’agents irritants (chlore, ammoniac, fumée). Sx 24h après l’exposition.

131
Q

What is the presentation du syndrome du larynx irritable ?

A
  • Abdormal closure of the vocal cords usually on inspiration, it can mimic asthma or accompany asthma
  • Temporal association of onset of PVFM and irritant exposure has been described
  • Dx suggestive by presence of dysphonia and abnormal slowing of the inspiratory flow volume loop obtained during routine spirometry or non specific bronchoprovocation challenge
  • Dx confirmed by laryngoscopy
132
Q

VEMS diminué avec ratio VEMS/CVF normal : obstructif ou restrictif ?

A

Restrictif

133
Q

When should you administer intrapleural tPA / DNase ?

A

Usually considered as well as placing a 2nd or 3rd chest tube before resorting to VATS.
Exceptions : bronchopleural fistula, significant organization/fibrothorax (excessively thickened pleural on chest CT), unexpandable lung : VATS directly

134
Q

When should you think of silicosis ?

A
  • Travail dans les mines
  • Multiples petites nodules aux lobes superieurs
  • A risque de progression en fibrose massive, de cancer pulmonaire, de tuberculose
    PAS ASSOCIE au mesotheliome
135
Q

Which exposition is linked to mesothelioma ?

A

Asbestos

136
Q

When should you consider an indwelling pleural catheter ?

A

Best suited for shorter survival (ex <2 months) and for patients who prefer outpatient management and a minimally invasive intervention
Can also be used if failed pleurodesis and it does not preclude subsequent pleurodesis

137
Q

Which disease you should think of if pulmonary pseudomonas and s aureus infection ?

A

Cystic fibrosis

138
Q

Which agent is not helpful for smoking cessation ?
Buproprion, varenicline, fluoxetine, nortriprytline

A

Fluoxetine

139
Q

How do you differentiate UIP from NSIP ?

A

Bronchiectasis in both
NO honeycombing in NSIP
NSIP with a verre depoli pattern

140
Q

What is a pleurodesis ?

A

Alternative to IPC or failed IPC
Injection d’un produit irritant dans la cavité pleurale afin de créer des adhérences de la plèvre viscérale ‘a la plèvre pariétale

141
Q

When should you use pleurodesis ?

A

Rapidly recurrent pleural effusion within one month
Suitable for patients with an EXPANDABLE lung who have a resonable survival >2-6 months and/or who prefer a more definitive and rapid procedure (a one and done) that minimzes future interventions

NOT if short survival anticipated like < 2 months

142
Q

When should you suspect a rounded atelectasis ?

A

Subpleural mass, out of which emanates a swirl of vessels and bronchi that curve like a comet tail

143
Q

Comet tail on chest X ray : diagnosis ?

A

Round atelectasis

144
Q

Round atelectasis linked to what exposure ?

A

70% linked to previous asbestos exposure, also been reported in association with pleural tuberculosis

145
Q

Popcorn calcification on chest X ray : diagnosis ?

A

Pulmonary hamartomas

146
Q

What is the clinical presentation of pulmonary hamartoma ?

A

10% benign nodules
Middle age, grow slowly, typically popcorn calcification
Focal areas of fat also possible

147
Q

TB nodule : presentation ?

A

While not pathognomonic, they classically appear as a well-dermacated and fully calcified or centrally calcified nodule
But also frequently present as non calcified nodules… dx via bx / resections as suspected cancer

148
Q

What is the clinical presentation of COP ? On imaging and spirometry.

A

Verre depoli surtout en périphérie
TFR avec pattern restrictif avec DLCO diminué

149
Q

How do you treat COP ?

A
  • If minimally sx and mild : observe
  • If sx : prednisone 0.5-1 mg?kg
  • If stable disease but echec aux cortico : AZA
  • If ICU or rapid disease despite solumedrol : cyclophosphamide
150
Q

Quel DEP nécessaire pour un patient asthmatique pour pouvoir lui donner congé?

A

PEF > 80% predicted : can be discharged

151
Q

How do you treat rheumatoid pleuritis and pleural effusions ?

A

Generally does not require tx as resolve spontaneously or with tx of RA joint disease
Not known wheter anti inflammatory tx of larger rheumatoid effusions will decrease the likelihood of long terme sequelae such as trapped lung/fibrothorax
If sx and does not resolve spontaneously : AINS, corticotx, pleurodese, thoracentese…

152
Q

Recent severe exacerbation with CAT> 10 : what tx for this COPD pt?

A

triple therapy with mortality benefit LAMA/LABA/ICS

153
Q

Which pump combination lowers mortality in COPD ?

A

Triple therapy lowers mortality
Needs to have sx mod to high (CAT ≥ 10, mMRC ≥ 2) ; high AECOPD risk and FEV1 < 80

Pneumo/gastro c’est bow (5 decks)

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