Obstructive disease

Question 1

7 types of asthma:

Answer 1

Extrinsic asthma

Intrinsic asthma

Exercise induced asthma

Triad asthma

Cough-variant asthma

Occupational asthma

Refractory asthma

Question 2

When does extrinsic asthma usually onset and what are its triggers?

Answer 2

Usually in childhood, triggered by exposure to inhaled allergen

Question 3

When does intrinsic asthma usually onset and what are its triggers?

Answer 3

Usually in adulthood, triggered by viral infections or other nonspecific irritants

Question 4

What is a strong risk factor for intrinsic asthma?

Answer 4

Obesity, particularly in women

Question 5

What is the triad of “triad asthma?”

Answer 5

Asthma

Nasal polyps

Aspirin sensitivity

Question 6

Temporal pattern of occupational asthma:

Answer 6

“Monday morning” symptoms as sx’s abate over weekend.

Better in AM, worse in PM

Question 7

6 causes of refractory asthma:

Answer 7

Chronic allergen exposure

Beta-blockers

ASA-containing drugs

Mucocutaneous fungal infections

Allergic bronchopulmonary aspergillosis

Churg-strauss vasculitis

Question 8

Frequency cut-off for “persistent” or “intermittent”asthma:

Answer 8

> 2 episodes per week

Question 9

Stepwise therapy for mild intermittent asthma:

Answer 9

Short-acting bronchodilator as needed

Question 10

Stepwise therapy for mild persistent asthma:

Answer 10

low/medium inhaled corticosteroids + SABA

Question 11

Stepwise therapy for moderate persistent asthma:

Answer 11

High inhaled corticosteroid, LABA, SABA

Question 12

When to consider step-down therapy for asthma:

Answer 12

If well-controlled symptoms for 3 months

Question 13

Acute asthma attack treatment:

Answer 13

Nebs q20minutes x3 doses

60 - 120 mg steroids q6h if no relief

Question 14

Indications for hospitalization for asthma attack:

Answer 14

• Peak flow < 40% of baseline after 4-6 hrs of treatment
• Persistent hypoxemia
• Hypercapnia
• Altered sensorium
• Hx of prior near fatal asthma attacks

Question 15

Definition of chronic bronchitis:

Answer 15

Daily sputum production for >3 months/year for 2 consecutive years

Question 16

Four risk factors for developing COPD in smokers:

Answer 16

• Airway reactivity
• Family history of COPD
• Childhood lung dz
• Occupational dust exposures

Question 17

What is the BODE index?

Answer 17

Body mass index (low is bad)

Obstructive defect (severe is bad)

Dyspnea (severe is bad)

Exercise tolerance (on 6 MWT)

Question 18

What is the earliest abnormality seen on spirometry for COPD?

Answer 18

Decreased maximal flow at low lung volumes seen on flow-volume loops

Question 19

Stepwise approach for COPD treatment:

Answer 19

Mild - Short acting bronchodilators

Moderate - Long acting bronchodilators, ICS

Severe - long-term oxygen + above

Very severe - LVRS, transplant

Question 20

Benefit of exercise rehab in COPD:

Answer 20

Improves exercise function, no effect on lung function

Question 21

Benefit of oxygen for hypoxemic patients with COPD:

Answer 21

Improves long-term survival in pts with hypoxemia

Question 22

Indications for chronic oxygen in COPD:

Answer 22

PaO2 < 55 or SpO2 < 89% in usual health

OR

PaO2 < 60 or SpO2 < 90% if cor pulmonale or neurocognitive impairment

Question 23

Bullectomy indications:

Answer 23

For single bulla occupying 1/2 of hemithorax

Question 24

Lung transplant candidate criteria for COPD:

Answer 24

FEV1 < 20%

Age younger than 60-65 yo

Good social support

Question 25

Maximum beneficial steroid course length in COPD exacerbation:

Answer 25

2 weeks

Question 26

Inheritance pattern of A1AT deficiency

Answer 26

Autosomal recessive

Question 27

3 most common alleles of A1AT deficiency

Answer 27

M: normal

S: intermediate

Z: marked decrease

Null: absent

Question 28

Phenotypes and associated problems with A1AT mutations:

Answer 28

M, MS, MZ: No increased risk

SZ: mildly increased risk

ZZ: increased risk of emphysema, 10% also liver disease

Question 29

Causes of bronchiolitis obliterans:

Answer 29

Connective tissue diseases, e.g. RA

Organ transplantation

Inhalation of toxic fumes

Viral infections

Neuroendocrine cell hyperplasia

Idiopathic

Question 30

Treatment for bronchiolitis obliterans:

Answer 30

Immunosuppressive drugs but often not useful

Macrolides if post-transplant

Question 31

Radiographic features of ABPA:

Answer 31

“Gloved finger” on CT or CXR from dilated central airways

Recurrent pulmonary infiltrates

Perihilar evanescent oval shadows on CXR from mucoid impactions