C-Wa's IM Magic

Question 1

Drug toxicity the leads to restrictive lung disease

Answer 1

bleomycin
busulfan
amiodarone
methotrexate

Question 2

Interstitial lung diseases PFTs

Answer 2

Restricted lung expansion–> ↓ lung volumes (↓ FVC and TLC)

PFTs: FEV1/FVC ratio ≥ 80%

Question 3

Poor breathing mechanics vs Interstitial lung diseases

Answer 3

Interstitial lung diseases: pulmonary ↓ diffusing capacity, ↑ A-a gradient

Question 4

What is the state of equilibrium of the lung on spirometry

Answer 4

Function Residual volume

Question 5

Diffusing capacity for CO

Answer 5

Diffusion of CO
normal > 80%
determines parenchymal disease

would change if alveolar surface area is down or membrane is thickened

Question 6

What would ↑ Diffusing capacity for CO

Answer 6

alveolar hemorrhage
polycythemia
interstial edema

Question 7

what will decrease Diffusing capacity for CO (↓ DLCO)

Answer 7

emphysema
pulm htn
anemia
pneumonia

Question 8

Flow volume loops- Loop shifts to the left

Answer 8

Obstructive

Obstructive lung volumes > normal (↑ TLC, ↑ FRC, ↑ RV)

Question 9

Flow volume loops- Loop shifts to the right

Answer 9

Restrictive

restrictive lung volumes < normal

Question 10

Associated with shipbuilding, roofing, plumbing.

Answer 10

Asbestosis

Affects lower lobes

Risk of bronchogenic carcinoma > risk of mesothelioma.

Question 11

Silicosis

Answer 11

Macrophages respond to silica–> release fibrogenic factors–> fibrosis.

Silica disrupts phagolysosomes –> impair macrophages–> ↑ susceptibility to TB.

Question 12

Pneumoconioses

Answer 12

Coal workers’ pneumoconiosis, silicosis, and asbestosis

–> ↑ risk of cor pulmonale, cancer, and Caplan syndrome (RA and pneumoconioses with intrapulmonary nodules).

Question 13

_________ are pathognomonic of asbestosis.

Answer 13

“Ivory white,” calcified, supradiaphragmatic and pleural plaques

Question 14

Acute respiratory distress syndrome results in formation of ________ on biopsy

Answer 14

intra-alveolar hyaline membranes

Question 15

Central sleep apnea

Answer 15

No respiratory effort due to CNS injury/toxicity, HF, opioids.

Question 16

Samter’s triad

Answer 16

asthma, recurrent sinus disease with nasal polyps, and a sensitivity to aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs).

Question 17

chylothorax

Answer 17

Due to thoracic duct injury from trauma or malignancy. Milky appearing fluid; ↑ triglycerides.

Question 18

Transudate

Answer 18

↓ protein content. Due to ↑ hydrostatic pressure (eg, HF)

or

↓ oncotic pressure (eg, nephrotic syndrome, cirrhosis).

Question 19

Exudate

Answer 19

↑ protein content, cloudy. Due to malignancy, pneumonia, collagen vascular disease, trauma
(occurs in states of ↑ vascular permeability). Must be drained due to risk of infection.

Question 20

chlorpheniramine is?

Answer 20

First generation Antihistamines

Question 21

Second generation Antihistamines

Answer 21

Names usually end in “ -ADINE.”

ex: Loratadine, fexofenadine, desloratadine, cetirizine.

Far less sedating than 1st generation because of ↓ entry into CNS.

Question 22

If a patient is on a LABA, they must also __________?

Answer 22

LABA must be used with inhaled steroids

Black box warning

ex: Salmeterol, formoterol

Question 23

Salmeterol, formoterol s/e

Answer 23

tremor and arrhythmia.

Question 24

Blocks leukotriene receptors (CysLT1).

Answer 24

Antileukotrienes: Montelukast, zafirlukast

Especially good for aspirin-induced asthma.

Question 25

Omalizumab

Answer 25

Anti-IgE monoclonal therapy for allergic asthma resistant to inhaled steroids and long-acting β2-agonists

binds IgE and blocks binding to FcεRI.

Question 26

Ipratropium

Answer 26

Ipratropium is short
Tiotropium is long acting.

competitively blocks muscarinic receptors

prevents bronchoconstriction

Question 27

Methacholine

Answer 27

Muscarinic receptor (M3) agonist.

Used in bronchial challenge test to help diagnose asthma.

Question 28

Theophylline

Answer 28

causes bronchodilation
by inhibiting phosphodiesterase –> ↑ cAMP

Usage is limited because of narrow therapeutic index
(cardiotoxicity, neurotoxicity)

Blocks actions of adenosine.

Question 29

Idiopathic pulmonary fibrosis

Answer 29

repeated cycles of lung injury and healing with ↑ collagen deposition (restrictive)

“honeycomb” lung appearance and digital clubbing

Question 30

bilateral hilar LAD
noncaseating granuloma
↑ ACE and Ca2+

Answer 30

Sarcoidosis

Question 31

Bronchiectasis

Answer 31

Chronic necrotizing infection of bronchi–> permanently dilated airways, purulent
sputum, recurrent infections, hemoptysis, digital clubbing.

Asc. w/ bronchial obstruction, poor ciliary motility

(eg, smoking, Kartagener
syndrome, CF, bronchopulmonary aspergillosis)

Question 32

Hypoxia vs Hypoxemia

Answer 32

Hypoxia = ↓ O2 delivery to tissue

Hypoxemia = ↓Pao2

Question 33

Hypoxemia (↓ Pao2)

Answer 33

Normal A-a gradient

• High altitude
• Hypoventilation (eg, opioid use)

↑ A-a gradient

• V˙/Q˙ mismatch
• Diffusion limitation (eg, fibrosis)
• Right-to-left shunt

Question 34

V˙/Q˙= 0

Answer 34

0= “oirway” obstruction (shunt).

100% O2 does not improve Pao2 (eg, foreign body aspiration).

Question 35

V˙ /Q˙ = ∞

Answer 35

∞= blood flow obstruction

100% O2 improves Pao2 (eg, PE).

Question 36

Only things that decreas COPD mortality

Answer 36

• smoking cessation

* 02 when indicated

Question 37

What is a COPD exacerbation?

Answer 37

acute worsening of resp symptoms that requires additional therapy