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step 2 ck pulmonology > P2 > Flashcards

P2 Flashcards

1
Q

Indication for continuous home O2 treatment in case of COPD?

A

1) Pa02=<55 and O2 saturation =<88 %

2) Pao2=<59 and o2 saturation= <89 % inpatient with the symptom of RSHF, Corpulmonala, and HCT>55%

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2
Q

Target and duration?

A

The target is to make o2 saturation >90, at rest, normal walking, and sleep.
Should be given for more than >15 hr/day

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3
Q

Sign of impending RF inpatient with Acute asthma exacerbation and COPD?

A

Elevated or normal PaCo2 despite hypoxia–Indicate respiratory fatigue
Marked decrease breath sound
Absent wheezing
Decrease mental status
Marked hypoxia with cyanosis
NB: This is an indication for ET intubation

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4
Q

Asthma exacerbation management?

A

Depend on severity?

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5
Q

Mild?

A

SABA

INO2

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6
Q

sever?

A

SABA
Systemic corticosteroid
Ipratropium bromide
No response with the above three-drug within 1 Hr give one dose of IV MGSO4.

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7
Q

Pulmonary embolism symptom?

A

Acute dyspnea and pleuritic chest pain–66-73%
Tachypnea–70%
Tachycardia-30 %
Low grade fever–<15%

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8
Q

Classic fingding of ECG in PE?

A

Prominent S wave in V1
Q wave on lead V3
Inverted T waves in lead V3

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9
Q

factor associated with poor outcome in PE?

A

Low O2 saturation

Atrial fibrillation

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10
Q

RV effect of massive PE?

A

Decrease LV preload that dec CO and increase wall stress in –R.Ventricular decrease O2 supply and increase O2 demand respectiveley–RV ischemia/infarction–shock,bradycardia,arrythemia,RV hypokinesis sparing apex and RVF

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11
Q

The initial criteria for extubation readiness?

A

PH>7.25
Adequate oxygenation with minimal suport(FiO2 <40% and PEEP<=5mm)
Intact inspiratory effort and sufficient mental status to protect the airway

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12
Q

What to do next to patient who fulfill above criterion?

A

Spontanous breathing trial

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13
Q

whay and how to do Spontanous breathing trial?

A

Short term risk of RF require intubation
Keep the ETT there
Turn off all respiratory support
See by making patient to breath by himself for 1-2 Hr

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14
Q

When to extubate?

A

Maintain normal ABG

Normal RSBI

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15
Q

RSBI?

A

Rapid shallow breathing index
RR to TV(in L) ratio
Should not be above 105

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16
Q

When we reduce TV in MV patients?

A

When there is respiratory alkalosis

Reduce the risk of barotrauma-If given mere than Recommended (Normal:7-8 ml/kg)

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17
Q

when we extubate w/o SBT?

A

When we intubate for elective surgery

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18
Q

When and why we do tracheostomy in an intubated patients?

A

Intubation >7-10 day

Prolonged intubation–Larengial and tracheal damage—-tracheal stenosis

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19
Q

Normal ABG in adults?

A 
PH--7.35-7.45
PO2--60-100
PaCo2--35-45
HCO3--22-26
Sao2--95--100
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20
Q

Peak airway pressure?

A

Airway pressure measured at end of delivery of TV

Important for a patient on MV

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21
Q

How to calculate PAP?

A

Resistive presure + platu pressure
RP–flow rate + airway R
PP–Lung elatic pressure + PEEP

LEP–1/conpliance
When breathing stooped–RP equal to 0 as aresult PAP equal to platu pressure

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22
Q

Peak Pressure (Peak)?

A

This is the summation of pressure generated by the ventilator to overcome airway (ETT and bronchus) resistance and alveolar resistance to attain peak inspiratory flow and to deliver desired tidal volume.

Peak inspiratory pressure is typically 12 mm Hg. It is best if ventilation is adjusted according to the arterial or end-tidal carbon dioxide tensions.

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23
Q

Cause of elevated peak pressure?

A

Depend on the value of plateau pressure

Asses plateau pressure by making the patient pause breathing after inspiring TV–Wich makes RP zero.

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24
Q

If plateau pressure is normal?

A 
Disease with increased airway resistance. 
Airway obstruction
Bronchospasm
Secretions or plugging
Increased inspiratory flow rate
coughing
biting on ETT.
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25
Q

If there is an increase in PP?

A 
Pneumonia
Pneumothorax
Pulmonary edema
Atelectasis
Right mainstem bronchus intubation
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26
Q

Treatment lists and their benefit In COPD?

A

Long term supplemental O2–Increase survival(the only management that increases survival)
Influenza Vaccination–Decrease exacerbation
Beta 2 agonist–Central to management
Systemic steroid: Acute exacerbation
Periodic phlebotomy: When a patient has polycythemia symptom(usually occur when HCT >65%)
Mucoactive agent(acetylcysteine)–Pt with mucous plugging
Prophylactic Ab: rarely used but show a decrease in acute exacerbation.

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27
Q

Long term systemic corticosteroid in COPD?

A

Not recommended B/C of side effects and increase mortality.

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28
Q

Common causes of chronic cogh?

A

upper airway cough syndrome(postnatal drip)
asthma
GERD

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29
Q

UACS feaucher?

A

Also called postnasal drip
Is due to mechanical(due to discharge) stimulant cough reflex in the upper airway
Diagnosis confirmed by improvement to first-generation antihistamine( Block H1 receptors–anti-inflammatory and block histamine release from mast cell –Decrease secretion(a major mechanism)

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30
Q

a side effect of o2 treatment in patients with COPD?

A

CO2 retention by 3 mechanism due to increase Po2

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31
Q

Mechanism?

A

Vasodilation — V/Q mismach
Haldal effect on hemoglobin—Decrease Co2 affinity of HgB
Decrease RR–Deacrese minute ventilation

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32
Q

Benefits of pulmonary vasoconstriction in COPD?

A

Decrease B/F to Hypoventlated area –Correct the V/Q mismatch(prevent Co2 retention and hypoxia due to V/Q mismach)

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33
Q

symptoms?

A 
Decrease LOC(Due to a reduction of aspartate and glutamate and increment of GABA and Glutamine)
Seizure due to reflex cerebral vasodilation
Acidosis
34
Q

Prevention and management?

A

Target o2 saturation b/n 90-93 and pao2 b/n 60-70

Put on MV if have sever acidosis and decrease LOC

35
Q

OSA feaucher?

A

Obesity
HTN
Day time drowsiness
Diagnose with polysomnography

36
Q

Typical feather of bronchiectasis due to CF from other causes?

A

Crackle and infiltration in the upper lobe

37
Q

Sign and symptoms of ankylosing spondylitis?

A

Low back pain improves with exercise and worsens at night
Hip or buttock pain
Limited chest expansion and spinal mobility(PFT–show restrictive lung pattern with normal or increase RV/FRC due to chest wall stiffness)
Enthesitis
Systemic symptoms
Acute anterior uvitis

38
Q

How to differentiate RLD from lung fibrosis from chest wall stiffness on PFT?

A

In the case of CWS the RV/FRC will be normal or high but low in the case of ILD.

39
Q

Cough related to ACE inhibitors?

A

Mainley stary whithin weeks of start/increament of drug dose
Occur upto 20% of patient
Is due to increasing level of inflammatory mediators(bradikinin,substance P ,thromboxane and prostaglandine)–bronchial irritation and constriction

40
Q

Aproch to plural effusion?

A

Do diagnostic thoracyntesis whether you suspect or not.

41
Q

treatment of non allergic rhenitis?

A

Mild:Intranasal antihistamin and corticosteroids
sever:combination

42
Q

Sinus X-Ray indication in sinusitis?

A

lpersistent symptom–chronic sinusitis

43
Q

CXR feather of PE?

A

Wage shaped infarction(shallow wedge-shaped opacity in the periphery of the lung with its base against the pleural surface)
Unilateral plural effusion

44
Q

Aproch to hyponatremia(<275meq/l)

A

Cheek blood volume status

Cheek urine osmolarity

45
Q

If hypovolemic do Una?

A

Una>40–renal loss(Diuretic,PAI)

Una<40–nonrenal(vomiting,diharoa ,DHN)

46
Q

If normovolumic check Uosm?

A

Uosm>100-SIADH

Uosm<100-Psychogenic polydipsia, beer potomania

47
Q

Beer potomania?

A

It is described as the excessive intake of alcohol, particularly beer, together with a poor dietary solute intake that leads to fatigue, dizziness, and muscular weakness.

48
Q

Hypervolemic?

A

CHF
Nephrotic syndrome
Hepatic failure

49
Q

PCP endocrine complication?

A

SIADH

worsen by normal saline

50
Q

How NS worsen it?

A

Normal saline administration(water in >water out)–net water retention

51
Q

Serum osmolarity calculation?

A

2x NA+ G + BUN

52
Q

The normal serum osmolality?

A

should range from 275 to 295 mOsm/kg.

53
Q

Psycogenic polydypsia and hyponatremia?

A

ADH suppression

Overwhelmed renal H2O excretion

54
Q

Cause of hyperinflation in COPD?

A

Static and dynamic phenomena

55
Q

Static phenomena?

A

NEW high FRC(created by low alveolar collapsing pressure and decrease CW expansion)

56
Q

Dynamic phenomena?

A

more important

airway resistance–more air retention due to expiratory difficulty

57
Q

Exercise and COPD?

A

Decrease time-lapse b/n respiration due to increase RR to increase MV–Decrease time for expiration–more inflation–Increase work of breathing due to diaphragmatic flattening and respiratory muscle shortening.

58
Q

Acute COPD exacerbation cardinal symptoms?

A

Dyspnea
Cough exacerbation
Change in color or volume of sputum

59
Q

Diagnostic tool?

A

Hyperinflation on CXR

Low O2 and CO2 retention

60
Q

management of AECOPD?

A 
O2(Target 88-92 %)
Inhaled bronchodilator(beta-agonist and anticholinergics)
Systemic glucocorticoid(short course)
Antibiotic if >=2 cardinal symptom
Oseltamivir if evidence of influnza
NPPV-if ventilatory failure
Tracheostomy if NPPV failed
61
Q

Systemic glucocorticoid?

A

5 day of oral prednisolone or IV methylprednisolone
Improve hypoxia, lung function, relapse, hospital stay, and treatment failure.
No mortality benifit

62
Q

Risk factors for ARDS?

A

Infection
Trauma
massive transfusion
acute pancreatitis

63
Q

pathophysiology?

A

fluid and cytokine leakage to alveoli

decrease gas exchange, decrease lunge compliance, and P.HTN.

64
Q

diagnosis?

A

New/worsen RD < 1 week
Bilateral lung opacity(Pulmonary edema)not due to CHF or fluid overload
Hypoxia with Pa02/Fio2 ratio < 300mmhg

65
Q

The formula for calculating FiO2 percentage?

A

. FiO2= 20% + (4 X oxygen liter flow)

66
Q

management?

A

mostly need MV
oxygen delivery
Tx underline cause

67
Q

MV principle in ARDS?

A

LOW TV–prevent baritrauma-decrease mortality

PEEP–prevent alveolar collapse and improve O2 delivery

68
Q

mortality benefiting treatment in COPD?

A

Smoking session–By reducing the rate of FEV1 decline
Long term 02 supplementation inpatient have an indication for LTOT)
Surgery

69
Q

longterm treatment sequale after HL?

A

Cardiac complication
Radiation induced hypothyroidism
Life time 2nd malignancy >30%,mostley occur after 10 year of inithal NHL treatment.

70
Q

Classification of plural effusion?

A

Based on PFA
PF LDH
PF/S protien ratio

71
Q

PF LDH for exudative?

A

1) >2/3 of upper normal serum level(which is 90)

2) PF/S ratio >0.6

72
Q

PF/S protien level for exudative?

A

1)>0.5

73
Q

If plural fluid lymphocyte predominant?

A

TB

74
Q

Obesity hypoventlation syndrome(OHS)?

A

Obesity (BMI>30)
Awake daytime hypercapnia(>45)
No alternative diagnosis

75
Q

workup?

A 
ABG on room air(Hypercapnia with normal A_a gradient
No interesic pulmonary disease on x-ray
Restrictive pattern PFT
Normal TSH
polysomnography(ass.OSA is common)
76
Q

treatment?

A

nocturnal PPV
wight loss
avoidant of sedative medication
respiratory stimulant(Acetazolamide) last resort

77
Q

Other future OHS?

A 
Dyspnea
Polycytemia
Respiratory acidosis with metabolic alkalosis
Pulmonary HTN
Corpulmonale
78
Q

pathophysiology?

A

Low CW and lung cpmpliance-dec TV and TLC and increase airway resistance–persistent nocturnal hypercapnia exacerbated by decrease central chemosensetivity for co2 and renal hco3 los for response of respiratory acidosis.

79
Q

which heparin form is good to use in renal insufficiency?

A

unfracctionate heparine

80
Q

effect of high Fi02>

A

Free radical injurt

athelectasis

step 2 ck pulmonology (4 decks)

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