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ABIM > Pulmonary 2 > Flashcards

Pulmonary 2 Flashcards

1
Q

Pt presents with SOB, fatigue, Edema, Murmur and NORMAL PFTs and DECREASE DLCO. Dx?

A

Pulmonary HTN

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2
Q

Pt s/p CABG presents with SOB with Exertion. He Desaturates in supine position.
CXR shows Left Hemidiaphragm.
There is a drop in FVC with supine position.
Dx?
What is the best test to diagnose this condition?

A

Unilateral Diaphragmatic Paralysis (due to phrenic nerve injury after cardiac surgery.)

Sniff Test using Fluoroscopy

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3
Q

Next step in management with a patient with COPD exacerbation who is not responding to bronchodilators, steroids and antibiotics?

When would you intubate?

A

BIPAP (Noninvasive positive pressure ventilation)

pH < 7.1 OR no improvement after BIPAP

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4
Q

What ratio helps determine successful intubation?

A

RSBI (Rapid Shallow Breathing Index) RR/ tidal volume < 105

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5
Q

Chronic rhinosinusitis with Polyposis, Asthma and Ingestion of Aspirin leading to Asthma exacerbation? Dx? Rx?

A

Aspirin Exacerbated Respiratory Disease.

Singulair

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6
Q

In obstructive lung disease what will be the FEV1?

FEV/1/FVC?

FVC?

A
  1. Decreased
  2. Decreased
  3. Normal to Decreased
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7
Q

In Restrictive Lung Disease what will be the FEV1?

FEV1/FVC?

FVC?

A
  1. Decreased
  2. Normal to Increased (FVC is way lower)
  3. Decreased
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8
Q

Proper Management to Prevent VAP?

A

Oral care and Semi-recumbent positioning

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9
Q

Management of COPD:

  1. Minimal Symptoms <1 exacerbation?
  2. Moderate to severe < 1 exacerbation?
  3. Minimal symptoms > 2 exacerbations?
  4. Moderate to severe > 2 exacerbations?
A
  1. SABA prn
  2. SABA prn + LAMA+/- LABA
  3. SABA prn + LAMA and for frequent exacerbations LABA +/- ICS
  4. SABA prn + LAMA + LABA +/- ICS
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10
Q

Pt presents with 4-6 weeks occasional subjective fever, mild SOB, intermittent cough, right sided chest pain, smoked daily, construction worker, LDH 256. CXR shows right sided effusion and pleural thickening. Dx?

A

BAPE (Benign Asbestos-Related-Pleural-Effusions. Can happen 10-15 years post-exposure.

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11
Q

Pt presents with nonproductive Cough, SOB, JVD, No improvement with lasix, CXR shows Interstitial Markings and Decreased lung volumes?

Dx?

Test?

A

IPF

High Resolution CT (honeycombing, cystic changes and traction bronchiectasis.

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12
Q

What is the best test to do when you suspect a PE in critically ill and hemodynamically unstable patient?

A

Bedside transthoracic Echo (quickest) to check for RV disfunction.

If noted immediate thrombolytics are warranted.

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13
Q

What type of acid base disturbance is associated with hepatic cirrhosis?

A

Respiratory Alkalosis due to Increased minute ventilation due to Increased Estrogen and Progesterone (Happens in Pregnancy too)

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14
Q

Difference in Pleural Fluid from Rheumatoid effusions vs. Empyema?

A

Rheumatoid effusions have cell count < 5,000 and predominantly lymphocytic. (INFLAMMATORY)

Empyema have cell counts 50,000 and predominantly Neutrophilic. (BACTERIAL)

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15
Q

1 Next step in management for a complicated parapenumonic effusion? (ph < 7.20, low glucose level on PF) ?

  1. Managed for an uncomplicated effusion?
A
  1. Immediate Chest tube placement
  2. Will drain by itself with Antibiotics
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16
Q

Pt presents with worsening SOB over the last 6 months. An echo shows moderate RIGHT Ventricular dilation and Hypokinesis as well as Increased Flow velocities through the tricuspid valve.

Dx?

What will the spirometry show?

A

Pulmonary HTN will Show Normal FEV1, and FEV1/FVC ratio.
The TLC may be decreased.

There is also decreased DLCO.

17
Q

Management of an Asplenic patient who presents with Fever?

A

Abx + Go to Urgent Care.

18
Q

Pt reports with SOB and Wheezing after Paint exposure in the work place.
Pulmonary function test are normal.

Dx?

What test is important to establish diagnosis?

A

Reactive Airway Dysfunction Syndrome

Methacholine challenge test to diagnose Asthma.

19
Q

What is the next best test when a Heart Failure patients Pleural Effusion may meet Exudative Effusion Criteria after Diuresis?

A

Calculate Serum Effusion Albumin gradient > 1.2

20
Q

Next step in management of a patient with radiographic evidence of ABPA?

A

Skin prick test
Elevated IgE levels and Aspergillus
antibodies.

21
Q

Pt with restrictive lung chest wall disease pectus excavatum, ankylosing spondylitis and obesity can benefit from what ?

What are the contraindications to BIPAP?

A
  1. BIPAP
  2. Impending Arrest
  3. Severe Acidosis
  4. Other failing Organs
  5. Uncooperative
  6. Cant Clear secretions
  7. Mechanical issues (Esophageal anastomosis, FACIAL surgery)
22
Q
  1. Which Parapneumonic Effusions require Thoracentesis?

2. Management of NON-Complicated Parapneumonic Effusions?

A
  1. Complicated ones (Positive Gram Stain & Culture, LOW PH and LOW Glucose)
                      OR

Large ones (> 10mm). Also if pt not improving with Abx.

  1. Non complicated just Require Serial Imaging. (Negative Gram stain etc, Or < 10 mm)
23
Q

Pt presents with Dyspnea, Fatigue and Pulmonary Artery Pressure > 60 mmHg.
Her Echo is normal.
CT shows no abnormalities.
She had hx of PE 3 years ago.
She does not have any OSA Symptoms.
Had a hx of smoking but has Normal PFTs.

Next Step in Management?

A

V/Q Scan to evaluate for Chronic Thromboembolic Pulmonary Hypertension.

24
Q

10 Minutes after Bronchoscope a man becomes Cyanotic with Myoclonic Jerks.
ABG is normal
02 sat is normal
However patient remains Tachynpneic and Doesn’t improve.
Dx? Rx?

A

Methemoglobinemia due to Anesthetic.

Pulse Ox measures light absorbance between Oxy and Deoxyhemoglobin.
Need a Co-Oximeter to measure Methemoglobin.

Treatment is Methylene Blue.

25
Q

Pt presents who is a NON-Smoker with Fever, Cough, Shortness of Breath over the last 4 months.
Reports Night Sweats and Weight-loss.
CXR shows bilateral pleural based dense infiltrates involving upper and lower lobes SPARING Central and Peri-hilar lung regions ?

What is the difference between Chronic an Acute?

When does Asbestosis Present? (Commonly confused with the two)

Rx?

A

Eosinophilic Pneumonia.

Test: Bronchoalverolar lavage >25% Eosinophils.
Peripheral Eosinophils > 6%.

Acute associated with smokers (Develop Hypoxic Respiratory Failure.) It is a rapid course.

Chronic is associated with NON-SMOKERS.
More Insidious course with lots of Relapse.

Remember Asbestosis will present 20-30 years AFTER EXPOSURE.

Rx with steroids (IV Acute, Oral Chronic) 3 month treatment with gradual taper.

26
Q

Difference between Silicosios and Asbestosis.

A

Silicosis : Occurs outdoors (Rocks, Coal mining). They have BILATERAL Interstitial infiltrates in the Upper Lung Fields.

Occurs in Plumber, Electricians, Carpentors, janitors (Buildings)
They have Pleural Plaques

ABIM (45 decks)

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