PULMO

Question 1

Interleukin that has a critical role in regulating eosinophils

Answer 1

IL-5

Question 2

Induces airway hyperresponsiveness, mucus hypersecretion, and goblet cell metaplasia

Answer 2

IL 13

Question 3

Cholinergic agonist inhaled in increqsing concentrations; most commonly used for provocative challenge test

Answer 3

Metacholine

Question 4

A (+) metacholine provocative challenge test is defined as

Answer 4

20% drop in FEV1 (PD20) is calculated with a valuenog <400ug indicative of airway reactivity

Question 5

Hallmark of asthma; acute narrowing response of the airways in reaction to agents that do not elicit airway responses in non-affected individuals or an excess narrowing response to inhaled agents

Answer 5

Airway hyperresponsiveness

Question 6

Goals of Asthma therapy

Answer 6

1. Reduction in symptom frequency to =/<2 times a week
2. Reduction in night time awakenings to =/<2 times a month
3. Reduction of reliever use to =/<2 times a week (except before exercise)
4. No more than 1 exacerbation/year
5. Optimization of lung function
6. Maintenance of normal daily activities
7. Satisfaction with asthma care with minimal or no SE of tx

Question 7

Patients at greater risk for asthma mortality

Answer 7

1. Hx of ICU admission for asthma
2. Hx of intubation for asthma
3. Illicit drug use
4. Depression
5. New dx
6. =/>2 ER unit visits in past 6 months
7. Severe psychosocial problems
8. Lower SES
9. On daily prednisone prior to admission

Question 8

Transudative pleural effusion

Answer 8

Congestive heart failure
Cirrhosis
Nephrotic syndrome
Peritoneal dialysis
SVC obstruction
Myxedema
Urinothorax

Question 9

Criteria for exudate

Answer 9

PF/serum protein >0.5
PF/serum LDH >0.6
PF LDH >2/3 upper normal serum limit

Question 10

Most commom cause of pleural effusion

Answer 10

LVHF

Question 11

Factors indicating the likely need for a procedure more invasive than thoracentesis

Answer 11

In increasing order of importance
1. Loculated pleural fluid
2. Pleural fluid pH <7.20
3. Pleural fluid glucose <3.3 mmol/L (<60 mg/dl)
4. Positive gram stain or culture of pleural fluid
5. Presence kf gross pus in pleural space

Question 12

3 tumors that cause 75% of all malignant pleural effusions

Answer 12

Lung carcinoma
Breast carcinoma
Lymphoma

Question 13

Occurs when thr thoracic duct is disrupted and chyle accumulates in the pleural space

Answer 13

Chylothorax

Question 14

Most common cause of chylothorax

Answer 14

Trauma (mowt commonly from thoracic surgery); may also result from tumors in the mediastinum

Question 15

Triglyceride level finding in thoracentesis of chylothorax

Answer 15

Milky fluid; TG level >1.2 mmol/L (110 mg/dL)

Question 16

TOC for chylothorax

Answer 16

Chest tube insertiom + octreotide

If it fails: percutaneous transabdominal thoracic duct blockage

Alt: ligation of thoracic duct

Question 17

Most common etiology og undiagnosed exudative pleural effusion

Answer 17

Viral related effusion

Question 18

Elevated pleural fluid amylase is most consistent with

Answer 18

Esopahgeal rupture or pancreatic disease

Question 19

Dx of hemothorax based on the ff:

Answer 19

Dx thoracentesis: bloody pleural fluid - hct should be obtained (more than half of that in peripheral blood)

Question 20

Indication for urgent thoracotomy/thoracoscopy/angiographic coil embolization in hemothorax

Answer 20

Pleural hemorrhage >200 ml/h

Question 21

Etiologies of exudative PF that presents w/ glucose of <60 mg/dl

Answer 21

Malignancy
Bacterial infections
RA