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step 2 ck pulmonology > p3 > Flashcards

p3 Flashcards

1
Q

Normal PFT value?

A

FEV1>80%
FEV1/FVC ratio >70%
FVC > 80%

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2
Q

D/t asthma from COPD?

A

In asthma FEV1 improvement usually >12%

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3
Q

mechanism of hypoxia in pneumonia?

A

Alveoli filled with debris–right to left shunting–severe V/Q mismatch —Hypoxia

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4
Q

cause of diffuse alveolar hypoventilation?

A

a factor that causes a decrease in TV and RR

  • –NM blockage
  • —Narcotic overdose
  • —Co2 narcosis in COPD
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5
Q

reduced PiO2 fetcher?

A

High altitude
Normal A-a gradient
correct with suplemental o2
Low PCO2

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6
Q

hypoventilation feture?

A

CNS depression and morbid obesity
Normal A-a gradient
correct with suplemental o2
high CO2

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7
Q

diffeusion limitation?

A

ILD and emphysema
High A-a gradient
correct with suplemental o2
normal PCO2

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8
Q

V/Q mismatch?

A

small PE and lobar pneumonia
High A-a gradient
correct with suplemental o2
normal or low O2

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9
Q

Large intrapulmonary shunt?

A

Diffuse pulmonary edema and Diffuse pnumonia
High A-a gradient
Not correct with suplemental o2

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10
Q

Large dead space ventilation?

A

massive PE and Intracardiac shunt
High A-a gradient
Not correct with suplemental o2

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11
Q

Hyperthrophic osteoartherophaty?

A

Digital clubing

Artheritis commonly affect wrist and hand

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12
Q

Hypherthrophic pulmonary osteoartherophaty?

A

Subset of HOA but it occur due to underling lung disease

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13
Q

Acute bronchitis etiology?

A

Preceding respiratory illness (90% viral)

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14
Q

symptom and sign?

A

Cough of 5 days -3 week duration(+/-sputum, mostly yellow/purulent and sometimes can be blood tingled))
Absent systematic symptom
Wheezing/rhonchi(clear with coughing), chest wall tenderness

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15
Q

Diagnosis and managment?

A

Clinical diagnosis
CXR needed when pnumonia suspected
Symptomatic treatment(NSAID and bronchodilator)

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16
Q

PFT in pulmonary htn?

A

TLC-Normal
FEV1/FVC–Normal
DLCO–Decreased

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17
Q

tracheal narowing and ulceration are typical finding in?

A

graneulomatous polyangitis

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18
Q

aproch to PE?

A

If likeley in wales criteria–start imidiateley anticoagulant
If not unlikely in wells criterion do diagnostic test before starting anticoagulant

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19
Q

a condition associated with Clubing?

A 
Intrapulmonary malignancy
Empyema and lung abscess
Bronchiectasis
Cystic fibrosis
Chronic cavitary lesion
IPF
Asbestosis
Pulmonary AVM
cyanotic congenital disease
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20
Q

pathophisiology?

A

Megakaryocytes escape the lesioned lung–traped in finger nainl–produce VEGF and PDGF–smoth muscle proliferation

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21
Q

presence of clubing in COPD patients?

A

suspect ocult malignancy

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22
Q

acide base disturbance in acute COPD exacerbation?

A

Respiratory acidosis

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23
Q

Histoplasma capsulatum?

A 
MW/SE(missisipi and ohio river vali
Bat or bird droping
Subacute fever,cogh and mailase
CXR:mediasternal/hailar LDP with liliary and reticulonodular infilitrasion
Urine /blood antigen
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24
Q

Histoplasmosis(also including other fungal pneumonia) x-ray feather?

A

Lobar infiltration

hilar lymphadenopathy

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25
Q

Adenocarcinoma fetcher?

A

Irregular nodule on CXR in the periphery
50% patient non-smoker
Chest pain and pleural effusion due to Ca dissimination.
Cough and hemoptysis(as tumor grow)
Other risk factors: second-hand smoking, environmental carcinogen, oncogenic virus, CLD, and px radiation or chemotherapy

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26
Q

Pheripherial pulse in septic shock?

A

In the early phase–compensatory high SV–bounding pheripherial pulse.

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27
Q

clinical finding of multifocal atrial tachycardia?

A

Typically asymptomatic
Rapid irregular pulse
>=3 p waveform
HR>100

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28
Q

etiology?

A

exacerbation of pulmonary disease(e.g COPD)
electrolyte disturbance(hypokalemia)
catecholamine surge9e.g surgery,sepsis)

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29
Q

treatment?

A

correct underlying cause

AV blocking drug like verapamil if persistent

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30
Q

pathophysiology?

A

atrial conduction defect due to abnormality in atrium-like enlargement, electrolyte and catecholamine surge

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31
Q

step1 AT?

A

SABA PRN

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32
Q

step2 AT?

A

SABA

Low dose ICS

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33
Q

step3 AT?

A

Low dose ICS

LABA

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34
Q

steep 4?

A

Medium-dose ICS

LABA

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35
Q

step 5?

A

High dose ICS
LABA
Consider omalizumab for a patient with an allergy

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36
Q

step 6?

A

High dose ICS
LABA
Oral corticosteroid
Consider omalizumab for a patient with an allergy

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37
Q

CVS finding in COPD without cor-pulmonary?

A

Mild raising of JVP exacerbate with expiration

Distant heart sound

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38
Q

Why a patient with pneumonia: the hypoxia more pronounced when the patient lies on the side of the lesion?

A

due to gravity more blood goes to the side of the lesion—High perfusion despite low ventilation–V/Q mismatch

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39
Q

when we do a biopsy, PET scan, or surgical excision in a patient with pulmonary mass?

A

Biopsy and PET scan: When there is indeterminate or malignancy suspicion on CT?
Surgical excision: Highley suspicious for malignancy

40
Q

Patient work up with new SPN on CXR?

A

First, do CT

If have no malignant feather do serial CT every 2-3 year.

41
Q

pulmonary auscultation and percussion finding in consolidation?

A

BS: Increased
TF: Increased
P: dullness

42
Q

pulmonary auscultation and percussion finding in PE??

A

S: Decreased
TF: Decreased
P: Dullness

43
Q

pulmonary auscultation and percussion finding in Pneumothorax?

A

BS: Decreased
TF: Decreased
P: Hyperresonant

44
Q

pulmonary auscultation and percussion finding in atelectasis?

A

S: Decreased
TF: Decreased
P: Dullness

45
Q

sarcoidosis menifestation?

A

Tender reddish bumps or patches on the skin.EN
Red and teary eyes or blurred vision.
Swollen and painful joints.
Enlarged and tender lymph glands in the neck, armpits, and groin.
Enlarged lymph glands in the chest and around the lungs.
Hoarse voice.
Pain in the hands, feet, or other bony areas due to the formation of cysts (an abnormal sac-like growth) in bones.
Kidney stone formation.
Enlarged liver.
Development of abnormal or missed heartbeats (arrhythmias), inflammation of the covering of the heart (pericarditis), or heart failure.
Nervous system effects, including hearing loss, meningitis, seizures, or psychiatric disorders (for example, dementia, depression, psychosis).
Facial pulsie,DI and Hypercacemia

46
Q

Plural effusion after px breast ca treatment?

A

cancer dissemination

47
Q

Effect of ACE inhibitors related to cough?

A

decrease metabolism of sub. P and kinin–Increase PG production
They also activate the AA pathway

48
Q

AMS and siezure in a patient with AECOPD?

A 
CO2 retention(do ABG)
may develop despite hypoxia
49
Q

Invasive aspargilosis feaucher?

A

Occur in an immunocompromised patient
Fever, chest pain, and hemoptysis (Triads)
CT fetcher-Nodule with surrounding ground-glass opacity (halo sign)
Diagnosis-serum biomarker for cell wall component and sputum culture
Treatment: IV Voriconazole and eicosanoids for 2 week then prolonged PO Voriconazole
Mortality > 50 %
Acquired inhalational and convert to infectious form and will cause disease in
Immunocompromised patient.

50
Q

Chronic pulmonary aspergillosis?

A

Occur inpatient with cavitary pulmonary lesion
>3 months of cough, wt loss, hemoptysis, and fatigue
Cavitary lesion +/- fungal ball
Iv IG posetiv for aspargilosis
Resect the aspergilloma, azole, and embolization

51
Q

treatment for respiratory acidosis acute respiratory failure n MV patient?

A 
Increase RR(mostly used)
Increase TV(less likely used b/c have high barotrauma risk)
52
Q

How to differentiate uncomplicated(sterile exudate) from Complicated(have bacteria or empyema) exudative PE?

A

Both have fulfilled light criteria but CPE/Empyema have?
PH<7.2
Glucose < 60
Loculated fluid

53
Q

management D/C?

A

CPE:AB + CT drainage
NCPE: Onley Ab

54
Q

PE pleural effusion?

A

Can be exudative and bloody

55
Q

Restrictive LD PFT?

A 
N/D--FEV1
N/D--FVC
D---TLC
D----DCO
N/I--Fev1/FVC ratio
56
Q

diffuse pulmonary hemorrhage (e.g pulmonary vasculitis) PFT?

A

N-FEV1
N–TLC
I—DLCO(B/C of increasing Hg in alveoli)

57
Q

a common manifestation of Superior sulcus tumor?

A

shoulder pain
SVS
weakness and atrophy of interest hand muscle(8th and T1 injury)
pain in medial arm and forearm 4th and 5th digit
SC–LNP
Horner syndrome–CSG injury
Hoarsnesnes–RLN injury

58
Q

Treatment of hyponatremia of SIADH?

A

Fluid restriction +- table salt
Hypertonic saline if sever
Demeclocycline in case of resistance to above management

59
Q

when to consider albumin infusion?

A

Hyponatremia in case of cirrhosis/NS

60
Q

PH of pleural fluid analysis and cause?

A

normal 7.6
T:7.4-7.55
E:7.3-7.4
CE/empyma-<7.3

61
Q

antibiotic indication inAECOPD?

A

> =2cardinal symptom

those require MV

62
Q

OSA and OHS electrolyte disturbance?

A

hypochloremia due to increasing HCO3 absorption

63
Q

OSA and OHS effect in B/P

A

HTN due to SNS activation due to hypoxia

64
Q

what causes OSA?

A

episodic upper airway collapse

65
Q

Cause of tachypnea (Hyperventilation) in A.Astma ex.

Which result in Low Co2 and Respiratory alkalosis

A

Hypoxia
Anxiety
The signal from thoracic neural receptors which are activated by chest expansion and inflammatory mediators like prostaglandin.

66
Q

Having normal/high PaCo2 in hypoxia and Normal/low PH indicates?

A

Impending respiratory failure due to respiratory muscle fatigue and severe air trapping

67
Q

Does the factor indicate the severity of asthma exacerbation?

A

Severe hypoxia (PaO2<60)
Normal or low PH
Normal or high PaCo2
Sever tachypnea and tachycardia

68
Q

Asbestosis complication?

A

Bronchogenic Ca
Plural plaque (Just it is a sign of exposure)
Most commonly Bronchogenic ca to that of other ca (may look as cavity mass)—6x in non 59x in smokers
Mesothelioma (the only identified cause)—Present with massive pleural plaque
Oropharyngeal, laryngeal, esophagus, biliary system, and renal CA

69
Q

Characteristic of fixed upper airway obstruction?

A

Impair both inspiration (more) and expiration

Flatten both the top and bottom of the flow-volume curve

70
Q

What about another respiratory condition that affects a flow-volume curve?

A

COPD and Asthma—scooped out pattern during exhalation
Restrictive lesion—decrease inspiratory length with normal or increase expiratory flow rate relative to the lung volume
Pneumothorax—The same to that of restrictive lung disease

71
Q

CT fetcher of IPF?

A

Interstitial fibrosis
Honeycombing
Traction bronchiectasis

72
Q

Arterial blood gas analysis in IPF?

A

Always have increase (A-a) gradient due to diffusion defect
Decrease CO diffusion capacity
Exertion cause significant hypoxia
Resting Hypoxia and elevated PaCO2 in advanced case(lately)

73
Q

What to do next in a patient with chronic cough with no identified parenchymal lesion in PE, CXR not respond to antihistamine and PPI?

A

Strongly suspect asthma
Do spirometry to assess bronchodilator response and in negative do methacholine challenge test
Alternative;2-4 week of empirical inhaled corticosteroid—if respond consider asthma
In nocturnal case—Do morning peak expiratory flow rate
Do CT if the above tests are normal
Do laryngoscopy and ECG if CT normal

74
Q

When you suspect A1A deficiency strongly?

A

COPD at age <45(normally smoker present 30s and non-smoker present 40s)
Basilar predominant COPD (lucency in lower lung predominantly)
COPD with minima/no smoking
Patient with a history of the unexplained lived disease

75
Q

Diagnosis and management?

A

Serum A1A level

Treat with Iv pooled human A1A

76
Q

Asthma severity grading using symptom?

A 
frequency/SABA usage and nighttime awakening on patients not taking controller therapy?
             Intermittent
             Mild persistent
             Moderate persistent
             Sever persistently
77
Q

Intermittent?

A

S/S:<=2x per week

NTA:<=2x per month

78
Q

Mild persistent?

A

s/s: >2x per week but no Dailey

NTA:3-4x per month

79
Q

Moderate persistent?

A

S/S; Dailey

NTA :> 1x per week but not nightly

80
Q

Sever persistently?

A

S/S: Thought the day

NTA: 4-7 x/weekly

81
Q

Management principles?

A

Avoid triggers
Stop smoking
Fit with exercise
Learn how to use an inhaler
If uncontrolled steep up to 1-2 steep
If control for a 3-month plan to step down
Short course prednisolone in poor control (prevent relapse/hospitalization)
Evaluate using asthma based on an asymptomatic assessment of asthma symptom based on severity (similar to the assessment of asthma severity)

82
Q

Mechanism aids in improving hypoxia and treat respiratory alkalosis inpatient with MV and ARDS?

A

1) Increase Fio2(not more than 60)

2) increase PEEP(as long as norma plateau pressure)–Decrease shunting and improve hypoxia.

83
Q

theophylline toxicity symptom?

A 
CNS stimulation(headache, seizure, and insominia)
GI(nausea and vomiting)
Cardiac toxicity(arrhythmia)
84
Q

MV principle in ARDS?

A

High Fio2
High PEEP
Low TV

85
Q

Pa02 to Fi02 ratio?

A

The amount of Fio2 need to get adequate Pao2
The normal is 400–5000
In ARDS<300mmhg
Used to assess the severity of ARDS

86
Q

Diffuse alveolar hemorrhage sign and symptom?

A 
cough
hemoptysis
fever
drop in heamoglobine
bilateral infiltration
respiratory distress
underline lung injury can cause it like ARDS
other causes can be CTD, RD, and drug
87
Q

Pulmonary edema secondary to fluid overloaded?

A

the patient will have a sign of HF.

88
Q

Low DLCO with obstructive PFT?

A

emphysema

89
Q

Normal DLCO with obstructive PFT?

A

chronic bronchitis

astma

90
Q

Increase DLCO with obstructive PFT?

A

Asthma

91
Q

Low DLCO with restrictive PFT?

A

ILD
sarcoidosis
Asbestosis
Heart failure

92
Q

Normal DLCO with restrictive PFT?

A

MSK deformity

NM blockage

93
Q

Increase DLCO with restrictive PFT?

A

morbid obesity

94
Q

low DLCO with normal PFT?

A

anemia
pulmonary embolism
pulmonary HTN

95
Q

increase DLCO with normal PFT?

A

pulmonary hemorrhage

polycythemia

step 2 ck pulmonology (4 decks)

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