Pulm

Question 1

What is the FEV1/FVC threshold for airflow obstruction

Answer 1

<0.7

Question 2

An increase by what percentage in FEV1 or FVC indicates a reversible airway obstruction?

Answer 2

12% or >200mL from baseline

Question 3

Equal reductions in FEV1 and FVC suggest what?

Answer 3

restrictive lung disease

Question 4

What is the diagnosis?

decreased DLCO and reduced lung volumes

Answer 4

Pulmonary fibrosis

Question 5

What is the diagnosis?

decreased DLCO and normal lung volumes

Answer 5

pulmonary vascular disease or anemia

Question 6

What is the diagnosis?

decreased DLCO and airflow obstruction

Answer 6

COPD, bronchiectasis

Question 7

What is the diagnosis?

increased or normal DLCO and airflow obstruction

Answer 7

asthma

Question 8

What is the diagnosis?

increased DLCO

Answer 8

Pulmonary hemorrhage
L to R shunt
polycythemia

Question 9

What does a normal DLCO in patients with low lung volumes suggest?

Answer 9

obesity!

Question 10

What is CPET testing used for?

Answer 10

unexplained dyspnea
symptoms disporportionate to measured pulmonary function tests
exercise related lung symptoms

Question 11

When use bronchoprovocation testing?

Answer 11

patients with a suggestive clinical history for asthma but normal spirometry, diagnose exercise-induced asthma in patients with dyspnea after exercise but normal spirometry

Question 12

Peripheral eosinophilia, fever and weight loss in a long term smoker - dx?

Answer 12

chronic eosinophilic pneumonia

Dx with bronchoscopy and bx or BAL with high eo count

Question 13

eosinophilia, high serum IgE level and intermittent pulmonary infiltrates - dx?

Answer 13

allergic bronchopulmonary aspergillosis

dx: with positive skin test for aspergillum and IgG and IgE Ab to aspergillus, radiographic opacities in upper lobes

Question 14

Upper airway and sinus disease that precedes difficult to treat asthma, flares with leukotriene inhibitors and steroid tapers - dx?

Answer 14

Eosinophilic granulomatosis with polyangiitis (Churg Strauss)

• can have an elevated p-ANCA
• hallmark of diagnosis is eosinophilic tissue infiltrates

Question 15

Do not administer theophylline with what drug class?

Answer 15

fluoroquinolone or macropodes because can result in theophylline toxicity

Question 16

What drugs should not be used alone in patients with asthma?

Answer 16

LABAs - increased mortality

Question 17

A normal PCO2 in a patient with severe symptomatic asthma indicates what?

Answer 17

impending respiratory failure

Question 18

what diagnosis should be considered for patients with asthma who rapidly improve with intubation?

Answer 18

vocal chord dysfunction

Question 19

How diagnose bronchiectasis?

Answer 19

High res CT

Question 20

What patients are particularly at risk of bronchiolitis obliterates?

Answer 20

patients post lung or stem cell transplant

Question 21

what antibiotics can you use for a mild COPD exacerbation?

Answer 21

tetracycline or bactrim

Question 22

what is the most cost effective way to diagnose workplace asthma

Answer 22

spirometry before and after exposure

high value care

Question 23

do you need a sputum culture in COPD flares?

Answer 23

no doesn’t normally affect mgmt

high value care

Question 24

should you use steroids in sepsis without shock?

Answer 24

no

high value care

Question 25

patient with likely OSA without cardiopulmonary or neuromuscular dz - where the best place for a sleep test?

Answer 25

the patient’s home

high value care

Question 26

What are key features of cyanide poisoning?

Answer 26

Diagnostic clues include lactic acidosis and inappropriately elevated central venous oxyhemoglobin saturation, which manifests as bright red venous blood.

tx: Hydroxocobalamin