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USMLE HY notes > Pulmonalogy Finals > Flashcards

Pulmonalogy Finals Flashcards

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USMLE® Step 1 flashcards
1
Q

What are the 2 main medication that can trigger asthma attack?

A
  • Beta-blockers- mainly non selective
  • Aspirin

non selective BB- Carvidelol, labetalol, propanolol

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2
Q

Which IL and WBC we will see in Type II inflammation in asthma pt?

A

IL-4,5,13
IgE + eosinophils

trough TH2

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3
Q

Dgx of Asthma

A

clinical Dgx
קליניקה מתאימה + הפרעה חסימתית הפיכה בספירומטריה

FEV1 / FVC < 80%

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4
Q

What is the definition of reversible obstuction in asthma?

by spirometry criteria

A

FEV1 elecation in 200ml + 12%
15 min after bronchodilators / few weeks after Tx start with steroids

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5
Q

What is positive metacholine test?

A

decrease in FEV1 in 20% after low dose of metacholine < 400 mkg

if negetive- definitly not asthma
if positive- might asthma or other

and after bronchodilaters we will want to see improvment at least in 200ml + 12% in FEV1

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6
Q

How we can tell if a pt have type II inflammation asthma?

A

Exhaled NO
indication for eosinophilic inflammation

does not use to Dgx asthma

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7
Q

when we will hospitelized asthma pt?

A

when PEFR (FEV1) < 60% or persistent severe tachypnea for 4-6 hours

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8
Q

Option of Tx in acute exacervation of asthma

A

SABA + IV /PO steroids + consider adding sulfate Mg IV and LTRA

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9
Q

which type of tx are added to acute asthma on hospital

A
  • NIPPV
  • Oxygen + helium
  • Abx- only when signs of infection
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10
Q

Which type of medication is given in all levels of chronic asthma

whats the reliever

A

Low dose ICS / Formoterol (LABA that start in 15 min)

Reliever that replace SABA

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11
Q

What is the Tx for stage II asthma

A

permenent tx with low dose ICS + reliever

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12
Q

What is the Tx for Stage III-IV-V at chronic asthma

A

eleveted doses of ICS:
III- med. doses
IV- high dose
V- add LAMA

in all add LTM (luekotrient modifier) / and or LAMA (mainly in step 5 LAMA)

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13
Q

When we will give biological therapy for asthma pt?

A

severe cases
שלא הצליחו להיות מאוזנים על הטיפול במינונים גבוהים
step 6

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14
Q

Why we never give LABA alone and only with steroids

A

LABA alone is a/w increase risk of mortalitiy

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15
Q

suffix of beta-agonist

A

Terol / Tamol

like salbutamol, albuterol = ventoline

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16
Q

Suffix of muscarine antagonist

A

Ium

like ipartorpium

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17
Q

ICS options

A

Budesonide / Fluticasone

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18
Q

in Which type of medication can we use in the following situations:

  1. Aspirin- exacerbated respiratoy disease
  2. Exercise induce bronchoconstiction
  3. alternate theapry to ICS for step II in kids

and what is effectivness compared to ICS or bronchodilators?

A

Montelucast
anti-leukotrient

effectivness in improving lung function and reduce excer.
anti-leukotrients < Bronchodilators < ICS

ICS is the most effective

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19
Q

Which biologic medication can be given to Asthma

A
  1. Omalizumab- anti IgE
  2. Mepo/Resli/Benralizumab- anti IL-5, IL-5R
  3. Dupilumab- antil L-4/13

אמא אומרת מי פה הורס לי? זה הבן הרע המסומם (dope)

ema omeret mepo resli? ze benra dope.

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20
Q

When we will give Omalizumab

A

severe asthma + IgE > 30 + ellergy

SC every 2/4 weeks

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21
Q

When we will give anti IL5/IL5R

Mepo o-resli? ze h-ben ra

mipolizumab / reslizumab / Benralizumab

A

Severe Asthma + Eosinophils > 300

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22
Q

Which biological medication can be gevin for severe uncontrole asthma with FeNO 20-25

A

Dupilumab

can lead to paradoxial eosinophila

anti-IL4/13

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23
Q

Triaf of Aspirin Excaerbated respiratory disease

A
  • Asthma
  • nasal polyps
  • Chronic sinusitis

Tx- Montelukostat / other biological Tx for IL5 or 4

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24
Q

What blood results will see in Allergic broncopulmonary Aspergilossis (ABPA)

abd what is the Tx?

A

IgE > 1000
Eosinophils > 500
Skin test- positive for aspergillus
specific IgG + IgE aspergillus Ab.

mainly in immunodepressents with COPD / Asthma

**Tx- Oral steroids + Voriconazole/ Itraconazole **

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25
Q

How we Dgx COPD by pulmonary tests spirometry?

A

FEV1 / FVC < 0.7
w/o reversability after bronchodilators

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26
Q

what are the 5 stages of GOLD criteria for COPD

by spirometry

A

I- mild FEV1 > 80%
II- FEV1 ~ 50-79%
III- FEV1 ~ 30-49%
IV- FEV1 < 30%

in all we will see FEV1/ FVC < 0.7

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27
Q

Tx for Acute excer. of COPD

A
  1. SAMA + SAMA
  2. **Abx- **fluroquinolone, amoxi/clavinulate
  3. **Systemic Steroids- ** perdnisone for 5-10 days (unhospitelized pt) / IV in-hospitel
  4. Oxygen - O2% > 90%
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28
Q

acute excercabation

When we will use ventilention mechine in COPD pt?

A

NIPPV&raquo_space; Pco2 > 45
רק במטופל יציב, שיכול לשתף פעולה ובהכרה מלאה, ללא השמנה קיצונית, כוויות משמעותיות
הנשמה פולשנית- במצוקה נשימתית ניכרת למרות טיפול, חמצת נשימתית קשה, מצב הכרה ירוד . % תמותה בהנשמה 17-30%

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29
Q

What is the indications of O2 supplement in chronic COPD pt

A

restring O2% < 88%
or
< 89% + PAH, RHF, aretrocytosis

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30
Q

What are the 2 C/I for Lung volume reduction surgery in COPD?

A
  1. DLCO < 20%
  2. FEV1 < 20% + diffuse emphysema on CT

high risk of mortality in surgery

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31
Q

Tx for COPD

A
  • LAMA
  • LABA
  • LAMA+ LABA- most beneficial fromeach medicaiton alone
  • ICS- will never be given alone in COPD(must LABA/ LAMA)

all reduce excer. + improve symptoms

recall- in Asthma - LABA is never alone. alwyas with ICS
in COPD- ICS is never alone

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32
Q

מהם היתרונות שנמצאו במחקרים על שיקום ריאות

A
  • משפר איכות חיים
  • דיספניאה ויכולת ביצוע מאמצים
  • מפחית תדירות אשפוזים
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33
Q

Which advaence medications can be given to COPD who not respond to other medication?

A

Roflumilast- PDE4i, mainly for COPD severe + chronic bronchitis. GI symptoms common
Azytromycin- anti microbial + anti-inflammatory. lower excer reccurence, non smokers does not depend on pulmonary infection

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34
Q

Which type of vaculitis is in correlation of alpha1-AT deficieny

A

GPA (wegner)
alpha1-AT inhibit PR3 perodixase

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35
Q

Tx for alpha1- AT deficinecy?

and what is the indication

A

alpha1 -AT augmentation therapy
given the enzyme IV once a week

only for severe loss < 11 + pulmonary disease

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36
Q

What are the 3 light criteria?

Exudate vs transudate

A
  • Protien serum/effusion > 0.5
  • LDH serum/ effusion > 0.6
  • LDH in effusion > 2/3 of upper normal limit

only need one to determine exudate

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37
Q

How many % Light criteria mistakely recognize Transudate as exudate?

and how can we overcome this problem?

A

25% of times

measure gradient
protein in serum - protein in effusion if > 3.1 = Transudate

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38
Q

Which levels of BNP in pleural effusion is diagnostic for CHF

A

BNP > 1500

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39
Q

What are the 3 main causes of Transudate?

A
  1. CHF- not need to pancture unless- unilateral/ a-symmetric / fever or pain / Tx for CHF does not improve effusion
  2. Chirrosis- mainly in right side
  3. Nephrotic syndrome- part of anasarca
40
Q

Tx for para-pneumonic effusion

indication for Therapuetic thoracentesis

A

thick of pleural effusion > 1 cm = Therapuetic thoracentesis

הנוזל מרחק את הריאה מקיר בית החזה במעל 1 ס”מ

41
Q

What are the indication of complicated para-pneumonic effusion

A
  1. pus = empyema
  2. positive culture
  3. glucose < 60
  4. PH < 7.2
  5. septations

1 is the most importent 5 the least

empyema = collection of pus in pleural cavity

42
Q

What is the steps in Tx of complicated para-pneumonic effusion?

A

1.insert chest tube
2.if not working- insert trough the chest tube fibrinolytic medication like- DNAse
3.Thoracoscopy

steps

  1. pus = empyema
  2. positive culture
  3. glucose < 60
  4. PH < 7.2
  5. septations

בספר רשום קודם כל לחזור על ניקור טיפולי ואז להתקדם לנקז בשאלות משחזורים ישר נקז

43
Q

most common cause of Exudate
and second most common cause

A
  1. Para-pneuomonic
  2. Malignancy- lungs/ Breast / lymphoma
44
Q

a man present with dyspnea which is not proportional for is pleural effusion.

what might be the cause

A

Malignancy

45
Q

What is the only cause a/q mesotholioma?

A

Asbestosis

aorund 80% of pt with Hx of exposure

No connection to smoking

46
Q

in PE, which type of pleural effusion we expect?

A

almost always Exudative

47
Q

What define Pleural effusion as reasult of TB?

A

mainly in primary TB
lympocytes dominant
Marker of TB in effusion- high ADA or INF-y

Tx as pulmonary TB- RIPE

48
Q

What is the Tx for Chylothorax?

how we Dgx?

A

Dgx
CT + lymphangiogram
+
TG > 110 in effusion
Tx
Chest tube + octerotide

להמנע מניקוז ממושך של הנוזל- סיכון לתת תזונה ופגיעה חיסונית.

49
Q

2 main reason for Chylothorax?

A

mediastinal Tumor
Traume

affect the thoracic duct

50
Q

What is the cheracteristics of RA pleural effusion?

A

Exudate + monocytes + PNM + low glucose

most common extra articular in RA- pleural disease

51
Q

low glucose in pleural effusion (exudate) can seen in 3 main situations

A
  1. bacterial infeciton
  2. Malignancy
  3. RA
52
Q

Primary spontanous pneumothorax

cause and treatment

A

cause&raquo_space; epical bulb
mainly in tall think males
Tx
simple aspiration&raquo_space; Stapling of bulb and Pleural abrasion

ננסה אספירציה, לא עובד נעשה סטמפלינג והדבקה של הפלאורות

if reccurent episode- jsut spaling + pleural abrasion

53
Q

Main cause of Secondary spontaneous pneumothorax and Tx

A

COPD
Emergency- always chest tube
if candidate for surgery- Stapling of bulb and Pleural abrasion
if not candidate- Pleurodesis

54
Q

when most tension pneumothorax occurs?

Tx?

A

mainly during ventilation / CPR

Tx
Needle&raquo_space; Chest tube

High PIP

55
Q

what is the Hallmark of obstuctive disorder (in spiromytry)

A

FEV1/FVC < 0.7

56
Q

What is the hallmark in sirometry of restrictive disease

A

FEV1/FVC < 80% or normal

*also TLC < 80%

57
Q

What is the meaning of DLCO when its low and normal?

A

DLCO normal- no problem in lung tissue- extra pulmonary cause
DLCO low- ILD

58
Q

What are the main causes of extra-pulmonary restrictive disease

A

Neuromascular
polio
MG
ALS
Stractural
Scolicosis shape of spine
Morbid obesity

59
Q

Which type of extra-pulmoanry restrictive disoder we will see only low FRC when RV + TLC are normal

A

Stractural
Scolicosis shape of spine
Morbid obesity

60
Q

When we will see normal FRC (passive volume)
but low TLC and high RV

A

Neuromascular
polio
MG
ALS

all the volume that requires muscles will be low

61
Q

When we see normal spirometry and isolated low DLCO

A

PAH
anemia

62
Q

which type of disease can cause low DLCO

A
  • ILD
  • anemia
  • PAH
  • PE
  • emphyzema
  • lung resection
63
Q

Which drugs a/w ILD

A

Bleomycin, busulfan
Amiodaron
MTX
RTX
AZA
anti-TNF
Nitrofurantoin

64
Q

which type of ILD is a/w smoking, the pathological process is fibrosis (and not inflammation) , will present around age > 40, with clubbing, and progressive dyspnea + dry cough?

A

Idiopathic pulmonary fibrosis

65
Q

What can we hear in IPF?

A

קרפיטציות אינספירטוריות שנשמעות כמו Velcro

66
Q

Dgx of IPF?

A

clinical presentation + typical HCRT

no biopsy is needed

67
Q

Tx for IPF?

A

Nintedanib + pirfenidone

נינתן דה פירבנידון (פיברוזיס אנד דונ)

מאטות הדרדרות בתפקודי הריאות ויתכן שמשפרות השרדות

68
Q

Which type of Tx if not recommended of IPF

A

Steroids and immunosupresive- increase morbidity and mortality

69
Q

Cryptogenic Orginizing pneumonia

presentation
HRCT
Tx

A

presentation
Flu like disease, but prolong
HCRT- Sub-pleural patches consolidations
Tx- Steroids (prolong use)

70
Q

Acute eoshinophilic pnuemonia

true or false:
1. present in elderly males
2. present with fiver, dyspnea
3. respond to Abx
4. treatment with Abx
5. Dgx by BAL with eosinophils > 25%

A
  1. present in elderly males- False- young males 20-40
  2. present with fiver, dyspnea - true
  3. respond to Abx- false
  4. treatment with Abx- false- with Steroids
  5. Dgx by BAL with eosinophils > 25%- true

Steroids- great prognosis.

71
Q

when I say Framer lung or bird / chicken workers

you say?

A

Hypersensetivity pneumonitis

In this type of ILd must search for the reason!

72
Q

Most common reason for Bronchoectasis?

A

|Reccurent infections

Bronchoactasis- non-reversabile dilation of airways

73
Q

Bronchoactasis:
upper lobe causes
lower lobe causes
middle lobes
central airways

A
  • upper lobe causes- CF, radiations
  • lower lobe causes- reccurent aspirations (like in scleroderma- esophagus dismotility)
  • middle lobes- MAC, kartenger (Primary cilliary dyskinesia)
  • central airways- ABPA (aspergillosis)
74
Q

Which bugs ar the most common etiology for bronchoectasis?

A

Hemophilus and pseudomonas

75
Q

Clinical presentation of Bronchoectasis

A

שיעול פרודקטיבי עם כיח סמיך +ייתכן המופטזיס

can progress to cor-pulmonale and secondary amyloidosis

76
Q

Imaging of choice for Broncheacatsis and what we will see?

A

CT
Singet ring sing (airway X 1.5 from the near Blood vessel)
thickness of airway/ small to medium

77
Q

Main reasons for Bronchoectasis

A

CF
Kartenger (PCD)
aspergillos
smoking
obstuction by tumor

78
Q

Which test must have taken when there are Focal bronchoectasis?

A

Bronchoscopia
rule out obstruction - tumor / foreign body

make sense beacuse its not a diffusal process

79
Q

Empiric Tx in excerbation of broncheoctasis?

A

empiric cover for H.influenza + psuedomonas
Flueroquinolones- like levofloxacin

for 7-10 days

80
Q

Tx for broncheoctasis with Hemophilus specific or non TB mycobacteria- mainly MAC

A

H. influenza- augmentin
NTM (must grow in 2 different cultures)- macrolide, rifampin, ethembutol

81
Q

Tx for ABPA (aspergillus)

A

Steroids + long term on Itraconazole

82
Q

Tx for Broncheoctasis with Hypergamaglobulinemia

A

IVIG

83
Q

Main different between Central to Obstructive sleep apnea

A

Central- w/o breating effort
Obstructive- theres a breathing effort

84
Q

Dgx of OSA?

obstructvie Sleep apnea

A

עייפות במהלך היום / תסמיני הפרעות לילות בשינה (נחירות וכאלה)
+
AHI ≥ 5
או
AHI ≥ 15

(AHI) is an index used to indicate the severity of sleep apnea. It is represented by the number of apnea and hypopnea events per hour of sleep

85
Q

sleep apnea

What is the definiton of episode of apnea?

A

at least 10 seconds with apnea / hypopnea (decrease > 30% in flow)

86
Q

Risk factor for OSA?

A

obesity - 40-60%
Males

87
Q

Complication of OSA?

A
  • Resistance HTN- Tx with CPAP
  • risk for CV disease- stroke, DM, CHF, arrytmihas

*do not cause Cor-pulmonale

HTN- w/o reduce in 10% in night

88
Q

first line Tx in OSA?

A
  • lifestyle change
  • CPAP- first line
  • התקנים אוראליים- מי שלא סובל סי-פאפ
  • ניתוח של דרכי אוויר עליונות- פחול יעיל מ-CPAP
89
Q

Cheye stokes breathing is a/w?

A

Central apnea
mainly in CHF and stroke

CPAP is not helping here!

could also be seen in: CNS- encephalitis
polio/ ALS
drugs, Severe kyposcolicosis

opiods, high pressure CPAP, hypoxia (high altitude)

90
Q

nocosomial disease

What we will see in
* Coal mine lungs
* and Brilium?

A

Caol mine- upper airways, small round nodoles
Berilum- look like sarcoidosis

91
Q

Eggshell pattern is a/w

A

Silicosis

mainly upper lung

92
Q

Silicosis is a/w increase risk to which type of pulmonary infection and lung cancer?

A

TB
bronchogenic carcinoma

93
Q

What is the imaging findings see on asbestosis?

A

pleural plaques, some are calcified, somtimes with effusion.

mainly effect the lower lobe

94
Q

True or false

Asbestosis have a synergestic affect with smoking

A

ture

means high risk for all type of cancers

95
Q

In asbestosis, which type of cancer is a/q higher risk?

A

Bronchogenic carcinoma = most high risk

Mesothelioma- less but asbest exposure is the only risk factor known for this type of cancer

USMLE HY notes (34 decks)

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