Awesome Review

Question 1

First Step to determine obstructive or restrictive disease?

Answer 1

Total Lung Capacity

After maximal inhalation

Question 2

PFT ratio to determine obstructive?

Answer 2

FEV1/FVC

Question 3

Positive Broncodilator challenge to diagnose asthma?

Answer 3

Increase of FEV1 of 12% or increase of 200 mL

Question 4

What causes fixed extra thoracic obstruction?
Draw it
Diagnosis

Answer 4

Tumor and Tracheal stenosis

Dx- Bronchoscopy

Question 5

What causes dynamic extrathoracic obstruction?
Draw it
Diagnosis

Answer 5

Epiglottis and vocal cord dysfunction
Blunted inhalation, air coming in sucks
Dx- indirect laryngoscopy

Question 6

What is DLCO in PE?

What is DLCO in CO poisoning?

Answer 6

Low

Normal

Question 7

If you want to wean down ICS when treating asthma, what to give?

Answer 7

Leukotriene Modifiers

Question 8

When to give Omalizumab?

Answer 8

Serum IgE 30-700
Evidence of allergies of perennial aeroallergen
Eosinophilia

Question 9

What are new IL 5 antagonist monoclonal antibodies to treat eosinophilic asthma?

Answer 9

Reslizumab and Mepolizumab

Question 10

Dx Allergic Bronchopulmonary Aspergillosis

Answer 10

+ skin test to Aspergillus
Increased IgE and peripheral eosinophilia
Brown mucus plugs
CXR- transient infiltrate, pleural thickening, atelectasis, proximal bronchiectasis

Question 11

CXR difference btwn Chronic Eosinophilic PNA and Acute Eosinophilic PNA?

Answer 11

Chronic- peripheral infiltrate

Acute- center infiltrate/ground glass

Question 12

Tx Alveolar Proteinosis

Answer 12

Whole Lung Lavage bc Shitty macrophages cause build up of surfactant in lung

Question 13

If severe COPD on SABA, LABA, LA-anticholinergic, and pulm rehab, what’s next?

Answer 13

Roflumifast/Daliresp
Phosphodiesterase 4 inhibitor
Contraindicated in Liver Impairment

Question 14

When do you need home oxygen in COPD?

Answer 14

PaO2 88%

Or Hct >55%

Question 15

What can you do for upper lobe emphysema when FEV1 less than 50% but greater than 20%?
If less than 20%?

Answer 15

Lung Volume Reduction decreases mortality

Lung transplant if FEV1

Question 16

Dx Dyskinetic Cilia Syndrome (aka Kartagener’s syndrome)

Answer 16

Screen- sperm motility

Confirm- testicular biopsy or biopsy of bronchi or sinus

Question 17

Features of Dyskinetic Cilia Syndrome

Answer 17

Bronchiectasis
Sinusitis
Infertility!
Situs inversus

Question 18

Leading bacteria that increases mortality in cystic fibrosis

Answer 18

Cepacia Burkholderia

Treat with Bactrim

Question 19

Treat severe Bronchiectasis with bleed

Answer 19

Bronchial artery embolization

Question 20

What is IgE and eosinophilia in hypersensitivity pneumonitis?

Answer 20

NORMAL

Question 21

Does LABA change mortality in COPD?

Answer 21

NO

Question 22

What do you think of -Bilateral Basal Bullous Cyst

Answer 22

Thinks alpha 1 antitrypsin deficiency

Check Serum alpha 1 antitrypsin level

Question 23

What is DLCO in Broncholitis Obliterans?

Answer 23

NORMAL

Question 24

What is DLCO in Cryptogenic Organizing Pneumonia? What is treatment?

Answer 24

Decreased DLCO
Crackles everywhere!!
Steroids

Question 25

Treat Stage 1 Sarcoidosis

Answer 25

None, 60-90% will remit Stage 1 only has hilar adenopathy No lung involvement

Question 26

Features of Lymphangioleiomyatosis

Answer 26

Premenopausal Spontaneous pneumothorax Diffuse thin walled cysts Tx- Sirolimus

Question 27

Features of Pulmonary Hypertension

Answer 27

``` At rest- 25 mmHg During exercise- 30 mmHg Normal PCWP Parasternal Heave Large JVP Widened/Split S2 RV failure ```

Question 28

Findings on Echo for Pulmonary Hypertension

Answer 28

Dilation and hyper trophy of right ventricle Tricuspid regurgitation Bulging of septum into left ventricle

Question 29

While diagnosing Pulmonary Hypertension with right heart cath and patient responds to vasodilator challenge? What do you do?

Answer 29

Treat with Nifedipine and Diltiazem

Question 30

Tx Pulmonary Arterial Hypertension | Mild Disease

Answer 30

PP5 inhibitors | Sildenafil and tadalafinil

Question 31

Txt Pulmonary Arterial Hypertension | Moderate disease with some limitation on physical activity

Answer 31

IV Epoprostenol

Question 32

Tx Pulmonary Arterial Hypertension | Severe and Hypotensive

Answer 32

Inhaled Iloprost

Question 33

Which types of Pulmonary Hypertension require anti coagulation?

Answer 33

Type 1 and 4

Question 34

How long do you anticoagulate after knee replacement, hip replacement, or acute orthopedic fracture?

Answer 34

4 weeks!!!

Question 35

Tx large DVT, like iliofemoral DVT

Answer 35

Thrombolytic!!

Question 36

If thrombus in popliteal vein, what's next?

Answer 36

Follow up Doppler in 2 weeks to see if there is extension. If there is extension beyond knee- anticoagulate

Question 37

Patient on anticoagulation for DVT but started bleeding. Frack, now what?

Answer 37

ASA 325 mg

Question 38

MC of PNA in COPD and DM

Answer 38

Moraxella catarhalis

Question 39

Dx: post Tussive vomiting and subconjunctival hemorrhage

Answer 39

Bordatella pertussis

Question 40

Treat bacterial sinusitis

Answer 40

If fever, pain or sx >7 days Augmentin

Question 41

Centor Criteria

Answer 41

1. Fever 2. Exudates 3. Anterior cervical LAD 4. No cough If you fulfill all 4 criteria, give Amoxicillin

Question 42

``` Dx- Hot Potato Voice Dysphagia Drooling Tonsils touching each other Uvula deviated ```

Answer 42

Peritonsillar abscess

Question 43

Treatment of Lung Abscess

Answer 43

PCN & Clindamycin

Question 44

Severe Influenza treatment

Answer 44

IV Zanamivir

Question 45

If PPD + and negative CXR what's next?

Answer 45

INH for 9 months | If unable to tolerate due to liver dysfunction, rifampin for 4 months

Question 46

Pleural Fluid finding in TB

Answer 46

Fluid adenosine deaminase test

Question 47

Dx Hepatopulmonary syndrome

Answer 47

TTE with micro bubble studies

Question 48

Dx Obesity Hypoventilation Syndrome

Answer 48

PaCO2 > 45

Question 49

Increased neutrophils in BAL

Answer 49

Idiopathic Pulmonary Fibrosis

Question 50

Increased Lymphocytes in BAL 1. CD 4 > CD8 2. CD 8 > CD 4

Answer 50

Sarcoidosis is more CD4 | Hypersensitivity Pneumonitis is more CD 8