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step 2 ck pulmonology > p1 > Flashcards

p1 Flashcards

1
Q

preop management of COPD?

A

smoking cessation(4-6) wk prior to surgery decreases post-op pulmonary complications(pneumonia and RF) significantly even if small cigarette consumption.

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2
Q

Long-term oxygen therapy in COPD?

A

Given if resting O2 saturation <88%

have mortality benefit

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3
Q

what about preop corticosteroid, methylxanthine, and antibiotic?

A

No benefit

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4
Q

future and approach of a patient with RLD?

A 
Decreased VC
Normal or increased FEV1/FVC ratio
First, do DLCO
If normal--CW abnormality and RM weakness
if decreased --ILD
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5
Q

Cause for CW abnormality and RM weakness?

A 
CW abnormality
Obesity hypoventilation syndrome
Scoliosis
           RM weakness
Myasthenia gravis
ALS
Polio
Gulian barre syndrome
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6
Q

ILD future?

A

Progressive dry cough, fatigue, and dyspnea
Crackles, clubbing
Imaging shows peripheral reticular opacities with traction bronchiectasis +/– “honeycomb” appearance of the lung (advanced disease).
Histologic pattern: usual interstitial pneumonia.

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7
Q

cause of ILD?

A

Dust
Drug
Radiation
Systemic CTD

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8
Q

Dust?

A

Asbestos
Beryllium
Silicon
Coal worker pneumoconiosis

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9
Q

Drug?

A 
Amiodarone
Bleomycin
Nitrofurantoin
Methotrexate
Busulfan
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10
Q

Systemic CTD?

A

RA
Scleroderma
Sjögrens syndrome

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11
Q

Pathophysiology of ILD?

A

May involve multiple cycles of lung injury-
inflammation, and fibrosis.
Fibrosis affects the airway, alveoli, and interstitium

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12
Q

Pulmonary HTN symptom?

A

Progressive dyspnea, fatigue, and weakness
Exertional angina and syncope due to Dec RVO
Abdominal pain and distension

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13
Q

Physical examination?

A

left the parasternal lift and RV heave
Loud P2 and right side s3
pansystolic murmur due to TR
RSHF sign

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14
Q

Classification?

A

primary PHTN
due to LSHF
due to chronic lung disease(ILD

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15
Q

Normal FVC and FVC1/FVC ratio?

A

FVC:80-120%
FVC1/FVC ratio–>80%
In COPD ratio usualy <70

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16
Q

GERD and asthma?

A

GERD–microaspiration–bronchial hyperactivity and increase vagal tone.
Asma exacerbation during the night and after a meal
Treat with PPI

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17
Q

Normal pH range?

A

7.35 to 7.45

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18
Q

Normal values for PaCO2?

A

are usually 35-45 mmHg.

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19
Q

Partial pressure of oxygen (PaO2)?

A

75 to 100 millimeters

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20
Q

PE and (A-a) oxygen gradient?

A

increase due to VQ mismatch

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21
Q

(A-a) oxygen gradient?

A
  • 2.5 + 0.21xage
  • Patient age/4 + 4
  • Between 5–14 inage < 40
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22
Q

How to calculate PA02?

A

150-PaCO2/0.8

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23
Q

Exercise-induced asthma pathophysiology?

A

High volume gas and cold air entery—mast cell degranulation–bronchospasm

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24
Q

Management?

A

Beta agonist-10-15 min prior exercise(first line), should be used in whom require less than daily
Antilukatrine agent 15-20 min before exercise–second line, not tolerate beta-blocker
Both can be used together in the case of high performing athletes
Antiukatrine and steroid for patient daily exercise practice

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25
Q

trigger of anaphylaxis?

A

FOOD
DRUG
INSECT STING

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26
Q

CM?

A

hypotension, tachycardia, and tissue edema
strider,horsnesnes and bronchospasm
Urticarial rash, pruritis, and flushing
nausea, vomiting, and abdominal pain

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27
Q

management?

A 
intramuscular epinephrine
airway management and resuscitation
adjuvant therapy(antihistamin and glucocorticoid)
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28
Q

How to differentiate asthma fromCOPD?

A

spirometry plus bronchodilator therapy
asthma –reversible
COPD –not reversible/partially reversible

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29
Q

Old patient with lower lobe infiltration?

A

CAP due to S.pnumonia

If cavity–Lung abscess due to anaerobes(associated foul-smelling sputum, dysphagia and common in alcoholic)

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30
Q

Assist-Control (AC) mode?

A

Most common methods of mechanical ventilation in the intensive care unit
AC ventilation is a volume-cycled mode of ventilation.
It works by setting a fixed Tidal Volume (VT) that the ventilator will deliver at set intervals of time or when the patient initiates a breath.

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31
Q

How much TV should be adjusted?

A

6ml/kg

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32
Q

Bird fancier lung and farmer’s lung?

A

Type of Hypersensitivity pneumonitis due to exposure of bird dropping and mold respectively.

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33
Q

clinical manifestation?

A

cough, fever, malaise, and breathlessness after 4-6 hr of antigen exposure.
If chronic–restrictive lung disease

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34
Q

CXR?

A

Ground-glass opacity/heaviness on CXR.

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35
Q

pathophysiology?

A

chronic inflammation–lung fibrosis

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36
Q

management?

A

Avoid exposure

Systemic corticosteroid–severe manifestation and acute exacerbation

37
Q

myasthenic crisis CM?

A

Increase generalized or oropharyngeal paralysis

respiratory insuficieny

38
Q

precipitating factor?

A

Infection and surgery
Pregnancy or childbirth
tapering corticosteroid
medication(aminoglycoside,fluoroquinolone,BB and CCB)

39
Q

management?

A

intubation if deteriorating respiratory status(impeding RF)

plasmapheresis, IV Ig, and corticosteroid

40
Q

impeding RF sign?

A

tachypnea
shallow breath
respiratory muscle paralysis
choking

41
Q

alpha 1 antitrypsin deficiency?

A

Family history of COPD and Liver disease
COPD
Smoking exacerbates
Minimal LFT abnormality

42
Q

Diagnosis?

A

Serum A1A level
Pulmonary spirometry
Liver function test

43
Q

for a patient who presents with subacute/chronic cough

w/o apparent cause and absent parenchymal lesion what first to do?

A

Emperic 1st generation antihistamin
Combined antihistamines and decongestants
If not respond for 3-4 wk– Immaging

44
Q

Atelectasis feutcher?

A

Decrease/absent BS
Decrease TF
Dullness on percussion
The trachea will deviate to the side of the lesion?

45
Q

What is a solitary lung nodule?

A

round opaque
<=3 CM
normal surrounding lung parenchyma
no LDP, surrounding PE and athelectasis

46
Q

How we approach if it is found on routine x-Ray?

A

ask for previous X-ray >2 years back–If the same-No further test but patient have not/changed size CT

47
Q

After CT?

A

Depend on the presence of malignancy fetcher (low density, large, onion skin calcification and speculated border)
Also consider CM suggesting of malignancy(age >40, smoking, previous malignancy, and weight loss)

48
Q

no malignancy future?

A

serial CT follow-Up

49
Q

Borderline?

A

Biopsy

PET

50
Q

malignancy future?

A

Surgical excision

51
Q

cause of recurrent pneumonia?

A

depend on region involvement

52
Q

On the same field?

A 
Local airway obstruction due to intrinsic(tumor, bronchiectasis) or extrinsic cause(tumor or LDP)
Recurrent aspiration(alcohol,drug,GERD,dysphagia and seizure)
If the patient has a risk of Ca do CT
53
Q

On different religions?

A

Immunosuppression
sinopulmonary disease(ISS and CF)
Non-Infectious(Vasculitis, BOOP)

54
Q

Location of aspiration pneumonia in supine?

A

posterior segment of UL

the upper segment of LL

55
Q

How stroke is a risk?

A

cause dysphagia and impaired cough reflex

56
Q

Good pasture syndrome CM

A

 Renal—nephritic syndrome

 Pulmonary—Cough, SOB, and hemoptysis

57
Q

Pathophysiology?

A

Ab against alpha 3 type chain of collagen type 4 in BM of glomeruli and alveoli

58
Q

Diagnosis of pneumonia requires?

A

 CXR

 CM have sensitivity < 50%

59
Q

Cause of acidosis in seizure patients?

A

 Prolonged muscle contraction—LA—M.Acidosis

 Aspiration/muscle spasm—hypoventilation –R.Acidosis

60
Q

Acid-base disturbance in PE?

A

 Hypoxia/V/Q mismatch—Hypervantlasion-R.Alkalosis

61
Q

CM of asbestosis?

A

 Develop prolonged asbestos exposure(e,g shipyard, mining)
 Develop after 20 years of exposure
 Dyspnea, Clubbing, and inspiratory crackle
 Increase the risk of L, Ca, and mesothelioma
plural plaqe in CXR

62
Q

Imaging (CXR) other diagnosis modality?

A

 Lower lob infiltration
 Plural plaque
 Spirometer show a restrictive pattern
 Decrease DLCO

63
Q

Pulmonary embolism cardiac catheterization evidence?

A

 Elevated RA pressure
 Elevated pulmonary artery pressure
 Normal or low capillary wage pressure

64
Q

Cardiac tamponed finding in cardiac catheterization?

A

 Increase with equalization of RA, PA, and PCW pressure

65
Q

Archnodinic acid metabolism?

A

 First PLA2m metabolize membrane PL to AA

AA metabolize to leukotriene and prostaglandin and thromboxane by LOX and COX respectively

66
Q

Function?

A

 LT C4E4D4—Bronchoconstriction and increase vascular permeability, inflammatory
 B4—chemotaxis and inflammatory
 TXA2 and PGD2—bronchospasm and inflammatory
 PGE2 and PGI2
 Bronchodilator and vasodilation, anti-inflammatory

67
Q

Did aspirin exacerbate respiratory disease(AERD) CM?

A

 Constellation of morbid obesity, chronic rhinosinusitis, nasal polyposis, or urticarial with AERD
 Non-IGE mediated pseudo drug allergic reaction
 Patient present with the asthmatic symptom, sinusitis symptom, and facial flushing after 30min-3 Hr of aspirin ingestion
 Is due to an imbalance of pro-inflammatory leukotrienes and anti-inflammatory prostaglandins

68
Q

Management?

A

 Management chronic sinusitis and asthma
 Avoidance of NSAID
 Desensitize if NSAID is necessary
 Anti-leukotriene for respiratory and sinus symptom

69
Q

The most common diagnostic criteria of anaphylaxis?

A

 Acute illness involving skin

 Respiratory or CVS compromise

70
Q

A drug that exacerbates anaphylaxis?

A

 NSAID and beta-blocker

 By increasing non-immunologic mast cell degranulation and unopposed alpha effect

71
Q

CM of pneumothorax?

A

 Hyper resonant lung
 Decrease air entry
 Decrease TF
 Hypotension/shock— impairing RV preload due to media sternal venous obstruction

72
Q

Positive end-expiration MV mechanism, benefit, and complication?

A

 Provide above AP pressure at end of expiration
 Prevent alveolar collapse, increase FRC and decrease work of breathing
 Alveolar injury, pneumothorax, and hypotension

73
Q

Cause of atelectasis in MV patient?

A

 Mucus plugging
 A shift of the ETT to one bronchus thus the other will be atelectatic
–Normally the ET tube should be 2-4 CM above carina

74
Q

How do ET intubation, bronchoscopy, and endoscopy, and NGT increase the risk of aspiration pneumonia?

A

 Blocking epiglottis closure

75
Q

Bacteriology profile of AP?

A

 Mixed aerobic, anaerobic, G+ and G- rods and streptococcus

76
Q

S/E of inhaled corticosteroid?

A

 In both high and low dose—MC oral thrush

 High dose-Cushing

77
Q

Bronchiectasis signs and symptoms?

A

Cough with daily mucopurulent sputum production
Rhinosinusitis, dyspnea, and hemoptysis
Crackles and wheezing
suspect specially in non smoker patient with chronic cough

78
Q

pathophysiology?

A

Infectious insult with impaired clearance

79
Q

Etiology?

A 
airway obstruction
rheumatic disease(RA and Sjogren)
chronic or prior infection(aspergillosis and TB)
immunodeficiency (hypogammaglobulinemia)
congenital(CF and alpha 1 antitrypsin defriciency)
80
Q

Evaluation?

A

HRCT for initial diagnosis
Immunoglobulin quantification
CF testing
Sputum culture and pulmonary function testing

81
Q

Symptom of B-agonist S/E?

A
  • Hypokalemia related (increase cellular k uptake)—weakness, arrhythmia, and ECG change
  • Tremor
  • Headache
  • Palpitation
82
Q

Drug induced lung injury future?

A
  • Present acutely as hypersensitivity pneumonitis or chronic ILD
  • Fever, dry cough and SOB
  • Mid lung and lower lung interstitial infiltration with unilateral effusion
  • Leukocytosis and eosinophilia
83
Q

Granulomatosis with polyangiitis(wegners) CM?

A

 Arthralgia, fever, Weight loss, and fatigue
 Sinusitis, otitis media, and saddle nose deformity
 Bloody or purulent nasal discharge and hearing loss
 Lung nodule and cavitation
 Dyspnea, cough, and hemoptysis
 Rapidly progressive granulomatosis
Livedo reticularis and skin ulceration

84
Q

Diagnosis?

A

 ANCA—PR3(70)-C-ANCA and MPO(20)-P-ANCA
 Leukocytoclastic vasculitis in skin biopsy
 Pausini glomerulonephritis in renal biopsy
 Granulomatous vasculitis in lung biopsy

85
Q

Management?

A

Corticosteroid and immunomodulator

86
Q

feucher of bronchiectasis?

A

Cough and mucopurulent sputum production
Rhinosinusitis, dyspnea, and hemoptysis
Crackles and wheezing

87
Q

risk factors?

A 
Airway obstruction
Rheumatic disease(RA and sjhorgen), toxic inhalation
Chronic and prior infection(aspergillosis and Tb)
Immunodeficiency(hypoglobulinimia)
Congenital(CF and alphal1 antitrypsin deficiency)
88
Q

Evaluation?

A

High-resolution CT
imunoglobulin quantification
CF testing and sputum culture
PFT

step 2 ck pulmonology (4 decks)

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