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Boards > Pulm 2 > Flashcards

Pulm 2 Flashcards

1
Q

Step up therapy in Asthma

A

SABA –> low-dose ICS-LABA –> medium-dose ICS-LABA –> medium to high dose ICS-LABA + LAMA –> high dose ICS–LABA + oral steroids

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2
Q

P to F calculation

A

Suppose the pO2 is 90mmHg on 40% oxygen (FIO2 = .40). The P/F ratio = 90 divided by .40 = 225.

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3
Q

P to F interpretation

A

P/F ratio <300 = acute lung injury or mild ARDS
<200 = moderate ARDS
<100 = severe ARDS

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4
Q

Obstructive, restrictive, and fixed airway obstruction on flow volume loop

A

See image online

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5
Q

obstructive lung disease diagnosis PFTs

A

FEV1/FVC less than 70%

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6
Q

treatment of allergic bronchopulmonary aspergillosis

A
  • steroids

- antifungals

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7
Q

allergic bronchopulmonary aspergillosis clinical features

A

Josh using a huge inhaler + walls made out of asparagus + eosinophil chandelier/aspergillus fumigatus infection can complicate asthma + elevate IgE.

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8
Q

Rhinitis medicamentosa is…

A

overuse of nasal decongestants

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9
Q

Management of eczema not responding to topical steroids

A
  • topical calcineurin inhibitors (tacrolimus, pimecrolimus)

- dupilumab

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10
Q

treatment of C1 esterase inhibitor deficiency

A
  • bradykinin antagonist

- kallikrein inhibitor

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11
Q

Type 1 drug allergy mechanism + presentation

A
  • IgE mediated

- Immediate (anaphylaxis)

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12
Q

Type 2 drug allergy mechanism + presentation

A
  • antibody mediated

- hemolysis

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13
Q

Type 3 drug allergy mechanism + presentation

A
  • immune complex mediated

- serum sickness

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14
Q

Type 4 drug allergy mechanism + presentation

A
  • T-cell mediated, delayed

- Contact dermatitis, maculopapular drug rash

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15
Q

treatment of morbilloform rash

A
  • topical steroids (systemic steroids if necessary)
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16
Q

Treatment of fixed drug eruption

A
  • self limiting so should resolve on its own

- if not, topical steroid

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17
Q

RSBI calculation

A

TV (in liters) over RR

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18
Q

Goal RSBI

A

less than 105

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19
Q

Proper ET tube position in women and men

A

20-21 cm in women

22-23 in men

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20
Q

management of patient with reduced breath sounds following intubation

A
  • reposition ET tube (likely intubated right mainstream, which is common due to more vertical orientation)
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21
Q

How to differentiate tension pneumo from right mainstem intubation

A
  • tension pneumo = tympany on percussion + tracheal deviation + acute cardiovascular collapse (BP will rapidly drop)
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22
Q

Criteria for extubation

A

1) RSBI less than 105
2) Normal mental status, following commands
3) Few secretions + strong cough
* absent upper airway lesions

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23
Q

When do patients on vent need to be considered for tracheostomy?

A

2 weeks roughly

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24
Q

Management of failed SBT

A
  • place on assist control

- continue daily SBTs

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25
Q

RSBI calculation

A

RR over TV (**expressed in liters)

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26
Q

Cardiac index in hypovolemic shock vs. cardiogenic shock

A
  • slightly reduced in hypovolemic

- substantially reduced in cardiogenic

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27
Q

Wedge pressure in hypovolemic shock vs. cardiogenic shock

A
  • decreased in hypovolemic, increased in cardiogenic shock
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28
Q

Mean RA pressure

A

4

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29
Q

Mean wedge pressure

A

9

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30
Q

Mean cardiac index

A

2.8-4.2

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31
Q

Mean SVR

A

1,150

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32
Q

Other goals of ARDS management

A
  • low plateau pressure (less than 30)

- early administration of paralytics

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33
Q

ARDS criteria

A
  • bilateral lung opacities + *no signs of cardiac failure or fluid overload
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34
Q

Management of respiratory failure after extubation

A

Reintubate immediately

Unless COPD –> then can trial BiPaP

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35
Q

Treatment of respiratory impairment in ankylosing spondylitis

A
  • pulmonary rehab

- noninvasive positive pressure ventilation

36
Q

Physical exam for ankylosing spondylitis

A

Test for chest expansion

37
Q

Treatment of acute asthma attack

A
  • inhaled beta agonist
  • O2
  • IV steroids or PO if able to tolerate
38
Q

Discharge meds following admission for acute asthma exacerbation

A
  • short course of oral steroids (no need to taper if used for less than 3 weeks since adrenal axis suppression won’t occur)
  • inhaled corticosteroid (one hospitalization is an indication for maintenance steroids)
39
Q

Management of patient with pleural effusion + spiculated nodule concerning for cancer with negative thora cytology

A
  • Repeat thora with cytology (initial has low sensitivity but 3 separate thora’s can detect up to 90% of malignant effusions because you remove the older degenerated cells with first thora)
40
Q

Indication for pulmonary rehab in COPD

A

Category B-D disease

41
Q

COPD step up therapy

A

B = SABA PRN + LAMA or LABA
C = SABA + LAMA IF frequent COPD exacerbations – LABA + ICS
D = SABA + LAMA + LABA
IF frequent exacerbations ICS

42
Q

COPD step up therapy (in general)

A

1) Add LAMA or LABA
2) Add ICS
3) LAMA + LABA + ICS (triple therapy)
* ICS is not the preferred treatment of COPD patients

43
Q

How is step up therapy determined in COPD?

A

Symptom severity (dyspnea while walking uphill, on level surface OR COPD assessment Test score)

44
Q

Evidence for long-term home oxygen therapy in COD

A
  • improves QOL + mortality benefit
45
Q

Indication for O2 therapy in COPD

A

1) Resting O2 sat less than 88%

2) Resting O2 sat less than 89% + right-sided heart failure or erythrocytosis

46
Q

Diagnosis of OHS

A

ABG showing daytime hypercapnia (PaCO2 over 45) and hypoxemia (PaO2 less than 70)

47
Q

What is nocturnal oximetry used for?

A

OSA diagnosis

48
Q

What is a chylothorax?

A
  • effusion with milky-white appearance caused by thoracic duct obstruction (often from bulky lymphadenopathy from lymphoma)
49
Q

First step in management of suspected massive PE

A

IF Hemodynamic instability + high probability of PE –> **bedside TTE before CT-PE
- IF RV dysfunction on TTE, give lytics

50
Q

Nodule size warranting additional management

A

Greater than 0.8 cm

51
Q

Next step after intermediate probability VQ scan

A

lower extremity US (intermediate probability VQ scan is nondiagnostic and you need more info for risk-benefit analysis)

52
Q

PFTs of OHS

A
  • Restrictive physiology with normal DLCO
53
Q

Normal FEV1

A

greater than 80% (of predicted)

54
Q

Normal FEV1 to FVC ratio

A

greater than 70%

55
Q

Normal FVC

A

greater than 80% (of predicted)

56
Q

FEV1 to FVC ratio in restrictive lung disease

A

Normal to *increased

57
Q

Evidence for conversative fluid management in ARDS

A

Reduced ventilator-free days

58
Q

Acute bronchitis clinical features

A
  • typically following viral URI (that goes lower)
  • persistent cough (bronchospasm from transient airway obstruction and hyperactive airways) + no systemic infectious symptoms + wheezing or rhonchi
  • with or without purulent sputum
59
Q

Treatment of acute bronchitis

A
  • inhaled beta-2 agonists (relieve bronchial obstruction)

* NO antibiotics (not infectious)

60
Q

Causes of fixed upper airway obstruction

A
  • obstructive substernal goiter (these extend through thoracic inlet into thoracic cavity and may not be visible on exam. patient may be euthyroid)
  • tracheal stenosis
  • not tracheomalacia (dynamic obstruction)
61
Q

COPD patients who need workup prior to flying

A

O2 sat of less than 95% on room air + RF’s (FEV1 less than 50%, moderate to severe pHTN)

62
Q

COPD patients who need supplemental O2 during flights

A

Resting SpO2 less than 92%

*If on oxygen at home, increase by 1-2L from baseline

63
Q

Permissive hypercapnia goal

A

Maintain pH above 7.2

64
Q

Management of negative rapid flu antigen in patient with high pretest for flu

A
  • still give treatment (low sensitivity of rapid antigen test)
65
Q

Clinical features of Reactive airway dysfunction syndrome (RADS)

A
  • similar to asthma + following exposure to inhaled irritant (chlorine, ammonia, paint, diesel, bleach)
66
Q

Reactive airway dysfunction syndrome diagnosis

A

same as asthma (methacholine challenge)

67
Q

Reactive airway dysfunction syndrome treatment

A
  • inhaled steroids
68
Q

Spirometry in pulmonary HTN

A
  • NORMAL, but reduced DLCO
69
Q

What is auto-peep?

A
  • air remaining in the lungs due to incomplete expiration in ventilated patients (this causes alveolar distension and increases risk for ventilator-associated lung injury)
70
Q

How to reduce auto-PEEP

A
  • reduce minute ventilation
  • increase expiratory time
  • treat airway obstruction
71
Q

Clinical features of malignant pleural effusions + correlation of PH to malignant cell burden

A
  • exudative
  • lymphocyte predominant
  • low pH is associated with high sensitivity of fluid cytology, whereas high pH is associated with low fluid cytology sensitivity
72
Q

Next step after patient passes SBT

A

IF underlying lung disease –> always extubatne to noninvasive ventilation

73
Q

management of dyspnea in end-stage lung disease

74
Q

best variable for differentiating asthma from obstructive lung disease

A
  • reversibility of airway obstruction (not history of smoking)
75
Q

Eosinophilic pneumonia clinical + imaging features

A
  • similar to TB (fever, cough, weight loss)

- bilateral pleural-based opacities sparing perihilar and central lung regions

76
Q

Chest imaging with asbestosis

A
  • bilateral multi nodular or reticular opacities + pleural plaques
77
Q

Indication for hospice in COPD

A
  • end-stage disease with disabling dyspnea at rest
78
Q

Contraindications to lung volume reduction surgery

A
  • high-risk patients with FEV1 less than 20% or DLCO less than 20% (increased mortality)
79
Q

Presentation of pleuritis

A
  • typically preceding viral infection (viral pleuritis but can have other causes)
  • pain worse with movement (breathing, coughing)
80
Q

Treatment of pleuritis

81
Q

Aspirin exacerbated respiratory disease clinical features

A

chronic rhino sinusitis + polyposis + asthma + aspirin *OR NSAID sensitivity
(ingestion of NSAID or asthma causes asthma attack)

82
Q

Treatment of aspirin exacerbated respiratory disease

A
  • **leukotriene receptor antagonist (montelukast, zafirlukast)
  • avoid NSAIDs
83
Q

CF presentation

A
  • chronic respiratory tract infections
  • upper lobe bronchiectasis
  • pancreatitis
  • absence of vas deferens
84
Q

Most common causes of candidemia

A
  • central lines
  • TPN
  • immunocompromised
85
Q

Management of candidemia

A
  • catheter removal

- echinocandin anti fungal

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