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ABIM Pulmonary Boards - Jackie > Obstructive Lung Dz > Flashcards

Obstructive Lung Dz Flashcards

1
Q

Indications for bronchial thermoplasty and contraindications

A
  • Stable severe asthma on optimal medical therapy (at least ICS-LABA) with poor control.
  • No trials in those with >3 exacerbations/year, FEV1 <60% pred, or chronic sinus disease.

Contraindications:
1. Active implantable electronic device
2. Acute myocardial infarction <6 weeks ago
3. Prior BT
4. Coagulopathy
5. Allergies to anesthestics for BT

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2
Q

Indications for antibiotics in COPD exacerbation

A

increased dyspnea, sputum volume and sputum purulence

Also if severe exacerbation needing invasive or noninvasive MV

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3
Q

Dynamic extrathoracic obstruction on flow volume loop

A
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4
Q

Dynamic intrathoracic obstruction on flow volume loop

A
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5
Q

Fixed upper air way obstruction on flow volume loop

A
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6
Q

Indication for O2 therapy in COPD

A

PaO2 </=55 or SaO2 </=88%
OR
PaO2 </= 59 or SaO2 </=89% AND
- EKG with signs of cor pulmonale
- HCT >55
- Evidence of RH failure
OR
Exercise desat to </=88% and documented improvement with O2

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7
Q

Indication for NIV for COPD

A

GOLD Stage 4 w/ PaCO2 >/= 52 and pH>7.35

Should initiate 2-4 weeks after discharge for acute exacerbation

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8
Q

Goal of NIV for COPD

A

decrease PaCO2 by >= 20% from baseline or <48

Improved 1 year mortality

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9
Q

Who has survival benefit from lung volume reduction surgery?

A

Upper lobe predominant emphysema and low baseline exercise capacity

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10
Q

Most common risk of endobronchial valve insertion

A

Pneumothorax 20-30%

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11
Q

ICS/LAMA/LABA benefit

A

In pt with hx frequent or severe exacerbations
improves lung function, symptoms, health status, reduces exacerbation, all cause mortality

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12
Q

How to best predict COPD related hospitalizations and mortality on PFTs?

A

FEV1/FVC <0.7 more accurate than LLN

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13
Q

treatment of hereditary angioedema

A

Icatibant (bradykinin receptor antagonist)
Replacement of plasma-derived C1 inhibitor
Ecallantide (inactivation of plasma kallikrein)

ppx with plasma derived C1 inhibitor, lanadelumab, plasma kallikrein

Steroids not effective

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14
Q

Most common cause of nonCF bronchiectasis

A

Post infectious
Idiopathic

Immunodeficiency
ABPA
PCD
CTD/RA
Chronic aspiration
yellow nail syndrome

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15
Q

When is allergen immunotherapy not recommended for pt with asthma?

A

if asthma is uncontrolled - risk of bronchospasm
Pregnancy
Unstable CV disease
concurrent treatment with beta blocker

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16
Q

Effect of allergen immunotherapy for asthma

A

very minimal benefit for asthma outcomes

If mild to mod asthma controlled on ICS then can reduce asthma symptoms

No known effect on exacerbations

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17
Q

Definition of bronchial atresia

A

focal obliteration of lobar, segmental or subsegmental bronchus complicated by mucous impaction and/or air trapping distal to atretic bronchus

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18
Q

Which segment is frequently affected by bronchial atresia

A

left upper lobe

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19
Q

DDx for Perihilar tubular lesion and hyperinflation

A

Congenital lobar emphysema
AVM
intralobar pulm sequestration
Bronchogenic cyst
mucoid impaction

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20
Q

Imaging findings for AVM

A

tubular lesion that enhances with contrast
No bronchial obs, hyperluciency or hyperinflation

21
Q

Gene that determines azithromycin resistance in M. abscessus complex?

A

erm(41) gene

22
Q

rpoB gene mutation can lead to what resistance?

A

rifampin

23
Q

rrs gene mutation leads to which resistance

A

Aminoglycosides

Only in those w/ lots of exposure to amikacin or other AG

24
Q

embB leads to what kind of drug resistance in M abscessus?

A

ethambutol

25
Q

Effect of flu vaccine for pts with COPD?

A

reduces # exac and flu hospitalization frequency

26
Q

Goal VO2 max for lobectomy?

A

VO2>20

27
Q

When to prescribe O2 for flying?

A
  • resting SpO2 <92% –>2L
  • SpO2 <84% 6MWT –> get HAST or empiric 2L
  • If <4L O2 baseline then increase 1-2L for flight
  • If on >4L at rest at baseline then dont fly
28
Q

When to get 6MWT prior to a pt flying if suspicious for hypoxia?

A

if SpO2 >95% RA and a mMRC 3 or greater

29
Q

What can cause the PRISm pattern on PFTs

A
  1. Air trapping w or w/o hyperinflation (pseudoresriction)
  2. simple restriction (FVC<LLN)
  3. Nonspecific pattern
  4. complex restriction
30
Q

What are the associated issues with PRISm?

A

increased risk resp symptoms
reduced exercise tolerance
respiratory related hospitalizations
increased mortality

31
Q

What is a nonspecific pattern on PFTs?

A

VC<80%, TLC nl
can be airway hyperresponsiveness, chronic lung dz, obesity , Neuromsk impairment, chest wall restriction, poor testing

32
Q

Initial inhaler for pts with COPD?

A

LAMA/LABA

33
Q

Best treatment for pt with CF and F508del mutation

A

elexacaftor plus tezacaftor plus ivacaftor

34
Q

Placental transmogrification of the lung treatment

A

bronchodilators, ICS, smoking cessation and vaccines.

If that fails then bullectomy

35
Q

Congenital causes of unilateral cystic or bullous lesions

A
  • bronchogenic cysts
  • Congenital lobar emphysema
  • placental transmogrification of the lung
  • Swyer-James-MacLeod syndrome (reduced pulmonary vasculature and alveolar hyperdistention +/- bronchiectasis)
36
Q

CT scan findings of RML and lingular bronchectais in older pt w/o history of pulmonary disease

A

nontuberculous mycobacteria

37
Q

how long can people continue to benefit from long term maintenance PR?

A

24 months

38
Q

CT findings of bronchopulmonary sequestration

A

focal areas of lucency or irregular cystic spaces w or w/o fluid

CT angio can identify the arterial blood supply

39
Q

Most common form of bronchopulmonary sequestration

A

Intralobar sequestrations
Located in posterior basal segment of lower lobe 60%

Presentation: recurrent pneumonia

40
Q

What is the prevalence of undiagnosed COPD in pts >40yo with >10pkyrhx

A

70-78%

41
Q

Effect of deesclation of triple inhaler therapy to LAMA/LABA in non-frequent exac pts with FEV1 40-80% and no asthma

A

Reduction in lung function

No increased AECOPD and no change in QoL or mortality

42
Q

When to continue patient on triple inhaler therapy despite being GOLD B?

A

Blood eos >300
- higher risk of AECOPD
- Greater lung function loss off of ICS

43
Q

When to NOT use ICS in COPD?

A

Recurrent PNA
Eos <100
hx mycobacterial infection

44
Q

Prior to starting augmentation therapy for AAT def what lab?

A

IgA

45
Q

What are some of the adverse effects and contraindications of roflumilast?

A
  • Weight loss
  • Nausea, vomiting, diarrhea
  • Contraindicated moderate-to-severe hepatic impairment (Child-Pugh class B or C)
  • Drug interactions with inducers and inhibitors of CYP 3A4 (inducers: rifampicin and carbamazepine; inhibitors: erythromycin, cimetidine, and protease inhibitors)
46
Q

What are the direct and indirect agents for bronchoprovocation testing and the thresholds for a positive test in each respective category?

A
47
Q

Cystic fibrosis patients with a new pseudomonas aeruginosa should receive what treatment?

A

Inhaled tobramycin solution for 28 days

(Grade A recommendation - CF Foundation Guidelines)

48
Q

Indications for O2 prescription:

A

1) Resting room air Pao2 ≤55 mm Hg or Spo2 ≤88%

2) Resting room air Pao2 56 to 59 mm Hg or Spo2 ≤89% if there is evidence of dependent edema, or cor pulmonale or pulmonary hypertension, or erythrocythemia >56%

3) Exercise desaturation to Spo2 ≤88% and documented improvement of hypoxemia during exercise with oxygen.

ABIM Pulmonary Boards - Jackie (11 decks)

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