MKSAP - Respiratory Flashcards
Hydropneumothorax pathogenesis?
Imaging findings?
Bleb rupture causes lung to collapse toward hilum.
Bleeding from rupture produces flat-line junction between the air and fluid at the base of hemithorax
Signs that respiratory failure is due to neuromuscular problem?
- Increased RV/TLC ratio (also seen in obstructive disorders)
- Normal FEV1/FVC ratio
- Low maximal respiratory pressures
- Normal DLCO
Tuberculosis effusion – typical duration of symptoms? Type of effusion? WBCs in effusion? Diagnose by?
Subacute duration of symptoms (weeks to months); exudative with lymphocytes; diagnose with pleural biopsy
Nebulizer therapy for asthma reserved for which patients?
Patients who cannot use a metered dose inhaler appropriately
Treatment of the patient with COPD exacerbation?
- Oral or intravenous corticosteroids
- Albuterol/ipratropium (Short acting bronchodilators)
- Supplemental oxygen
- Levofloxacin or macrolide + ceftriaxone
Suitable candidates for noninvasive positive-pressure ventilation? Contraindications?
Respiration rate >25
PH under 7.35
PCO2 over 45
Contraindications: impending respiratory arrest, cardiovascular instability, altered mental status, I aspiration risk, extreme obesity
Patient with COPD – goal oxygen saturation?
90%
COPD – consider lung volume reduction surgery when? transplantation when?
- Predominantly upper lobe disease with limited exercise performance after rehabilitation
- FEV1 between 20% to 35%
- DLCO greater than 20
- PCO2 >50
- Both FEV1 and DCLO <20
Complications of untreated obstructive sleep apnea?
Pulmonary artery hypertension, a true fibrillation, heart failure, treatment resistant hypertension
Findings and Cushing’s syndrome?
Hypertension, muscle weakness, bruises, diabetes, osteoporosis
Findings in drug-induced long toxicity? Well known cause?
Fatigue, fever, cough, eosinophilia. Amiodarone
Acute eosinophilic pneumonitis?
Rapidly progressive illness associated with
- fever
- sputum production
- eosinophilia
- peripherally distributed lung infiltrate
Patient with suspected PE (Well’s score > 4) – test?
- CT angiogram
2. In patient with elevated creatinine: ventilation/perfusion scan
Patient with previously well-controlled asthma who experiences unstable asthma after respiratory infection – treatment?
If unstable asthma persists?
Short course of oral steroids
Long acting beta agonist
Causes of low DLCO?
- Barriers to diffusion (Edema, infiltrates, fibrosis)
2. Loss of lung tissue (emphysema)
Exam Signs of pulmonary artery hypertension?
- loud P2
- Fixed split S2
- Tricuspid regurgitation
- JVD
Physical exam findings in atrial septal defect?
- Fixed split of S2
2. Right ventricular Heave
Symptoms of vocal cord dysfunction? Test?
- Wheezing, Strider
- No response to asthma therapy. 3. Decreased lung volumes
- normal unsaturation
Laryngoscopy
Pulmonary function tests in PAH? Early diagnostic test?
isolated decreased DLCO with normal airflow and lung volumes
Echo to r/o heart problems
When is chest tube drainage needed for pleural effusion?
- Loculated
- PH under 7.2
- Glucose under 60
- LDH over 1000
Indications for video assisted thorascopic surgery?
Empyema not drained soon enough leading to loculations that need to be surgically removed
Consider chylothorax if effusion studies show?
Triglycerides >110
Signs of respiratory failure?
Pulse ox < 75
Respiration rate >30
heart rate > 120
Adjust criteria for home oxygen patients with COPD with these comorbidities?
Cor pulmonale, pulmonary hypertension, right heart failure
When to give a COPD patient inhaled corticosteroids?
Lung function <50%
Rule out alpha-1 anti-trypsin deficiency when?
Patient <45 years old with bilateral basilar emphysema
Factors which increased BNP? Factors which decrease BNP?
Renal failure, old age, female sex
Obesity
Typical cryptogenic organizing pneumonia patient?
Non-smoker with acute to subacute development of respiratory symptoms and opacification on CXR
DVT prophylaxis in hospitalized, medically ill patients?
In patients with renal impairment?
In HIT?
Heparin, LMWH, fondaparinux
Adjusted dose of LMWH,
Direct thrombin inhibitors
