Clinical Aspects of Pulmonary Diseases

Question 1

2 main mechanisms leading to sensation of dyspnea

Answer 1

Impaired ventilatory mechanics (airway/muscle wall pathologies)
Increase in respiratory drive (pulmonary parenchymal/cardiac/pregnancy pathologies)

Question 2

Patients with what DOE SX should be transferred to an acute care setting (3)

Answer 2

Tachypnea
Accessory muscle use
Conversational dyspnea

Question 3

MRC Dyspnea Scale (1-5)

Answer 3

1 Only breathless during exercise
2 SOB when hurrying on level ground or walking up a slight hill
3 Walks slower than most and will stop after a mile, or after 15 minutes at their own pace
4 Stops for breath after walking approx. 100 yds or a few minutes
5 Too breathless to leave the house

Question 4

Acute dyspnea develops how quickly?

Answer 4

Over mins to a day

Question 5

What are some cardiovascular causes of acute dyspnea? (2)

Answer 5

Decreased LV function

Increased pulmonary capillary pressures

Question 6

1st diagnostic tool for someone presenting with DOE

Answer 6

CXR

Question 7

Chronic dyspnea is dyspnea for…

Answer 7

Over 1 mo

Question 8

Acute cough is a cough for…

Subacute couch is for…

Answer 8

Less than 3 wks

3-8 wks

Question 9

Clinical criteria for Dx of flu is:

Answer 9

Temp > 37.7 C (100 F)

At least one of: cough, pharyngitis, rhinorrhea.

Question 10

When is antiviral therapy indicated for patients with a flu infection? When should it be started?

Answer 10

Hospitalized pts. and those with severe, complicated or progressive illness.
Within first 2 days SX onset.

Question 11

When should chemoprophylaxis be given for the flu?

Answer 11

Only pts. living in assisted-living facilities during an influenza outbreak, people with increased risk for flu infection and contact with people who recently had the infection, or unvaccinated healthcare workers in close contact with others.

Question 12

Drugs of choice for H1N1 flu

Answer 12

Oseltamivir

Zanamivir

Question 13

What are some non-viral causes of acute bronchitis?

Answer 13

B. pertussis
Mycoplasma pneumonia
Chlamydia pneumonia

Question 14

What does not have an effect on the outcome of acute bronchitis?

What is the exception?

Answer 14

ABX

Pertussis, but it is hard to identify if a pt. has it. Should only treat if the doctor believes clinically they have Pertussis (>2 wks of cough w/o cause or whoop, paroxysms, etc.)

Question 15

Dx standard for recovery of bacteria in culture is…

Answer 15

PCR

Question 16

Chronic cough is cough for…

Answer 16

> 8 wks

Question 17

Cessation of what should be recommended for 4 wks before additional workup for chronic cough?

Answer 17

Smoking

ACE-inhibitors

Question 18

Upper airway cough syndrome (UACS) is best treated with:

Chronic or acute cough?

If pts. don’t respond to this therapy, what should be done next?

Answer 18

Non-sedating anti-histamines
Decongestants

Chronic cough

Sinus CT

Question 19

Cough-variant asthma is suggested by:

If Dx is uncertain, what should be done next?

When might cough-variant asthma receive max benefit from therapy?

Answer 19

Airway hyperresponsiveness and confirmed when cough resolves w/ asthma meds

Bronchoprovacation test (if negative, then 100% r/o).

6-8 wks

Question 20

Most common mechanism for GERD-caused aspiration:

Answer 20

Vagally mediated distal esophageal-tracheobronchial reflex

Question 21

Best test for GERD is…

But what is recommended first instead?

How long might it take for SX to improve?

Answer 21

24-hr esophageal pH monitoring

Give a PPI ans see if SX resolve

3 mo

Question 22

Non-asthmatic eosinophilia bronchitis is considered when…

What is it?

What is the Tx?

Answer 22

Normal CXR/CT, normal spiro, and negative methacholine test.

Chronic cough by presence of airway eosinophilia and improvement with Tx.

Steroids and avoidance of allergens

Question 23

Cryptogenic hemoptysis is…

Answer 23

Hemoptysis of unknown origin

Should be considered after detailed workup

30% of hemoptysis cases

Question 24

Massive hemoptysis =

What should be done urgently?

Answer 24

> 200 mL/day

Bronch and bronchial a. embolization because of increased risk of asphyxiation (need airway support)

Question 25

How long does it take for ARDS to occur post inciting cause?

Answer 25

3-5 days

Question 26

Aside from the common manifestations of ARDS, what should prompt “immediate action”?

Answer 26

Presence of hypercapnia along with tachypnea

Question 27

CXR findings for ARDS

Answer 27

BL airspace opacities

Question 28

Exudative stage of ARDS

What dominates the clinical picture at this stage?

Answer 28

Alveolar-capillary barrier loses its ability to limit passage of fluids and debris and leads to accumulation of proteinaceous pulmonary edema.

Shunting and hypoxemia

Question 29

Proliferative stage of ARDS

Answer 29

Type 1 (epithelium) and 2 (surfactant) pneumocytes proliferate with fibrosis.

Question 30

What 3 infections may present similar to ARDS?

Answer 30

Pneumocystis jirovecii
Pneumonitis secondary to viral infection
Severe bacterial community-acquired pneumonia

Question 31

What can be given for ARDS?

What does not help much?

Answer 31

Surfactant therapy
Inhaled NO
Lisofylline
Ketoconozole
PDE inhibitors
Activated protein C 

Steroids

Question 32

Extracorporeal membrane oxygenation (ECMO) has the advantage of…

Answer 32

Supporting hypoxemia w/o potentially injurious ventilator settings

Question 33

If a patient is needing high O2 by day 7 or presentation may suggest…

Answer 33

A protracted ICU course at increased risk for long-term ventilatory dependency in ARDS

Question 34

GOLD criteria for COPD (I-IV)

Answer 34

I (Mild) - FEV1/FVC < 70%; FEV1 > 80%. With or without chronic sx.

II (Moderate) - FEV1/FVC < 70%; FEV1 > 50%. With or without chronic sx.

III (Severe) - FEV1/FVC <70%; 30% < FEV1 <50% predicted. With or without chronic sx.

IV (very severe) - grade II with chronic respiratory failure

Question 35

6 min walk is used for…

Answer 35

Evaluating risk of admit and long-term prognosis of COPD