Pulmonary Flashcards

1
Q

Most important imaging study for diagnosis of Interstitial Lung Disease?

A

High-Resolution CT (1-2mm cuts of lung tissue)

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2
Q

Interstitial Lung Disease shows a ___ pattern on PFTs

A

Restrictive

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3
Q

Change to TLC in Interstitial Lung Disease?

A

Low

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4
Q

Change to FVC in Interstitial Lung Disease?

A

Low

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5
Q

Change to RV in Interstitial Lung Disease?

A

Low

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6
Q

Change to DCLO in Interstitial Lung Disease?

A

Low

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7
Q

Change to FEV1/FVC in Interstitial Lung Disease?

A

NML

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8
Q

3 conditions that show mixed obstructive and restrictive patterns of lung disease?

A

Sarcoidosis, Lymphangioleiomyomatosis, Eosinophilic granuloma

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9
Q

Pattern of asbestos-related ILD on CXR?

A

Involvement of lower lung fields

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10
Q

Pattern of silicosis-related ILD on CXR?

A

Hilar egg-shell Ca2+

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11
Q

Pattern of sarcoidosis-related ILD on CXR?

A

Bilateral hilar predominance

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12
Q

Pattern of lymphangioleiomyomatosis-related ILD on CXR?

A

Pneumothorax in premenopausal female

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13
Q

What is the most common work-related illness?

A

Pulmonary disease

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14
Q

4 types of inorganic dust that cause interstitial lung disease?

A

Silicosis, Coal worker’ pneumoconiosis, Berylliosis, Asbestosis

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15
Q

1 type of organic dust that cause interstitial lung disease?

A

Cotton duct

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16
Q

Alternate name for cotton/flax dust?

A

Byssinosis

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17
Q

Clinical presentation for Byssinosis?

A

Symptoms present M-F, Absent S-Su

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18
Q

Best treatment for Byssinosis?

A

Exposure avoidance

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19
Q

Image of eggshell calcifications seen on XR in silicosis?

A
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20
Q

If patient with silicosis presents with fever – diagnosis?

A

Silicone-TB

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21
Q

If patient with silicosis presents with fever – next step of workup?

A

Silicone-TB

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22
Q

What is the cutoff value for PPD in Silicone-TB?

A

10mm

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23
Q

5 occupations that have increased risk of silicosis exposure?

A

Construction, mining, ceramics, sandblasting, masonry

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24
Q

3 aspects of clinical presentation for Caplan Syndrome?

A

Coal-worker’s pneumoconiosis, RA, Lung nodules

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25
Q

Change to lung in setting of coal-worker’s pneumoconiosis?

A

Anthracosis … black patches in lung

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26
Q

What accounts for anthracosis (black patches in lung) in setting of coal-worker’s pneumoconiosis?

A

Carbon-ingesting macrophages

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27
Q

Berylliosis mimics which condition?

A

Granulomatous sarcoidosis

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28
Q

Which portion of lung is affected by berylliosis?

A

Upper lung + Hilar lymphadenopathy

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29
Q

3 exposures that increase risk for developing berylliosis?

A

Fluorescent light bulbs, Aerospace, Electronics

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30
Q

Best treatment for berylliosis?

A

Corticosteroids

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31
Q

Best test for diagnosing berylliosis?

A

Beryllium lymphocyte transformation test … (not serum berylliosis level)

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32
Q

Which type of immune response mediates berylliosis?

A

Cell-mediated

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33
Q

Patient with asbestos exposure is most likely to develop which type of CA?

A

Squamous cell + Adenocarcinoma (NOT mesothelioma)

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34
Q

Ferruginous bodies seen in asbestos exposure will stain (+) for …

A

Prussian blue

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35
Q

3 asbestos-related pleural diseases?

A

Pleural plaques, Pleural effusion, Mesothelioma

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36
Q

What is definition of asbestosis (compared to pleural plaques)?

A

Asbestosis = ILD in lung bases

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37
Q

Characteristic of pleural effusion in setting of asbestos exposure?

A

Hemorrhagic

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38
Q

Prognosis of pleural effusion in setting of asbestos exposure?

A

Benign

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39
Q

Prognosis of mesothelioma in setting of asbestos exposure?

A

Malignant

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40
Q

Incidence of mesothelioma is affected by ___, but unaffected by ___

A

Asbestos exposure, Smoking

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41
Q

Best method of diagnosing mesothelioma?

A

Open pleural biopsy (DON’T do FNB … may seed the lungs/pleura)

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42
Q

Pathogen associated with Hypersensitivity PNA due to moldy hay?

A

Thermophilic actinomyces

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43
Q

Which lab value is ABSENT in Hypersensitivity PNA?

A

Eosinophilia

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44
Q

Most common cause of death in ARDS?

A

Sepsis, Organ failure

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45
Q

Cardiac output in Hypovolemic Shock?

A

Decreased

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46
Q

Wedge pressure in Hypovolemic Shock?

A

Decreased

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47
Q

SVR in Hypovolemic Shock?

A

Increased

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48
Q

Cardiac output in Cardiogenic Shock?

A

Decreased

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49
Q

Wedge pressure in Cardiogenic Shock?

A

Increased

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50
Q

SVR in Cardiogenic Shock?

A

Increased

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51
Q

Cardiac output in Septic Shock?

A

Increased

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52
Q

Wedge pressure in Septic Shock?

A

NML

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53
Q

SVR in Septic Shock?

A

Decreased

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54
Q

Tidal volume of ___ mL/kg is associated with decreased mortality

A

6

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55
Q

Patient in ICU after septic shock; Recently removed from ventilator; HGB now is 7.9 – at what point should patients in ICU receive blood transfusion?

A

HGB < 7.0

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56
Q

What are 2 exceptions to rule that ICU should not receive blood transfusion until HGB < 7.0?

A

Active bleeding; Unstable CAD

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57
Q

ICU admission for COPD exacerbation is associated with ___ year mortality

A

1

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58
Q

Appropriate duration of oral/IV corticosteroids in COPD exacerbation?

A

2 weeks

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59
Q

Pulmonary arterial pressure that indicates pulmonary HTN?

A

Pulmonary arterial systolic pressure > 35 mmHg

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60
Q

Etiology of secondary pulmonary HTN?

A

Vasoconstriction secondary to COPD, chronic hypoxia, OSA; Scleroderma

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61
Q

Etiology of pulmonary HTN in setting of Scleroderma?

A

Proliferation of intimal smooth muscle cells

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62
Q

Diagnostic test for Pulmonary HTN?

A

R heart catheterization

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63
Q

Best treatment for Pulmonary HTN?

A

CCBs, Lung transplantation

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64
Q

2 tools for diagnosis of PE?

A

V/Q scan, Helical CT

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65
Q

Hallmark EKG sign associated with PE?

A

S1-Q3-T3

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66
Q

What accounts for appearance of S1Q3T3 in setting of PE?

A

R heart strain

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67
Q

Most common finding on chest examination in setting of PE?

A

Clear breath sounds

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68
Q

Which of the following is NOT a risk factor for DVT – female, advanced age, trauma, recent surgery, homocystinuria?

A

Female … pregnancy = yes, OCP = yes … but NML women have no increased risk

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69
Q

Is knee surgery OR hip surgery considered a greater risk factor for DVT?

A

Knee surgery

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70
Q

Best DVT prophylaxis for CA patients?

A

LMWH

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71
Q

Best treatment for superficial thrombophlebitis?

A

Not heparin … NSAIDs, rest

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72
Q

2 serious symptoms associated with altitude mountain sickness?

A

Cerebral edema, Pulmonary edema

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73
Q

3 DOCs for altitude mountain sickness?

A

Furosemide, Nifedipine, Dexamethasone

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74
Q

DOC for prevention of altitude mountain sickness?

A

Acetazolamide

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75
Q

Structure of Streptococcus pneumoniae on Gram stain?

A

Gram (+) lancet-shaped diplococci

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76
Q

Clinical presentation of PNA due to Klebsiella?

A

Currant jelly sputum

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77
Q

Pathogen responsible for PNA + cattle/sheep exposure?

A

Q fever, coxsiella

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78
Q

Pathogen responsible for PNA + bird exposure?

A

Chlamydia psittacosis

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79
Q

Pathogen responsible for PNA + hunters?

A

Tularemia

80
Q

Pathogen responsible for PNA + homosexuality?

A

PCP

81
Q

Pathogen responsible for PNA + nursing home?

A

Klebsiella

82
Q

Pathogen responsible for PNA + ETOH?

A

Klebsiella

83
Q

Pathogen responsible for PNA + aspiration, poor dental hygiene?

A

Anaerobes

84
Q

Pathogen responsible for PNA + cystic fibrosis?

A

Pseudomonas

85
Q

Pathogen responsible for PNA + post-influenza infection?

A

Staph aureus

86
Q

Pathogen responsible for PNA + neonate?

A

GBS

87
Q

3 most common pathogens responsible for atypical PNA?

A

Mycoplasma, Leigonella, Chlamydia

88
Q

2 pathogens causing PNA that are diagnosed with urinary antigen?

A

Leigonella, Histoplasmosis

89
Q

Subtype of lung adenocarcinoma that causes peripheral lung CA in non-smoker females?

A

Bronchoalveolar Carcinoma

90
Q

Next step of workup for patient with suspected Pancoast Tumor?

A

CT needle-guided biopsy

91
Q

Nerve roots of ulnar nerve?

A

C8-T1

92
Q

Paraneoplastic syndrome associated with lung adenocarcinoma?

A

Hypertrophic osteoarthropathy

93
Q

Paraneoplastic syndrome associated with large cell lung CA?

A

Gynecomastia

94
Q

Appearance of small cell lung CA on CXR?

A

Centrally-located … near hilum

95
Q

3 Paraneoplastic syndromes associated with small cell lung CA?

A

SIADH, Eaton-Lambert Syndrome, Cushing Syndrome

96
Q

Best treatment for brain metastasis?

A

Surgical resection + whole brain XRT

97
Q

Treatment of choice for idiopathic interstitial PNA?

A

Corticosteroids

98
Q

Which medication can induce Bronchiolitis Obliterans Organizing Pneumonia (BOOP)?

A

Penicillamine

99
Q

Diagnostic test for sarcoidosis?

A

Bronchoscopy with bonchial wall biopsy … looking for non-caseating granulomas

100
Q

Biopsy shows caseating granulomas … diagnosis?

A

TB

101
Q

___ is a condition that mimics sarcoidosis?

A

Beryllosis

102
Q

Indication for steroid treatment of sarcoidosis?

A

Other organ involvement; Hypercalcemia; Neurosarcoidosis

103
Q

Clinical presentation of neurosarcoidosis?

A

CN VII involvement

104
Q

Patient presents with hilar LAD, polyarthralgia (especially involving ankle), erythema nodosum – diagnosis?

A

Lofgren Syndrome … variant of sarcoidosis

105
Q

Patient presents with lytic bone lesions, diabetes insipidus, exophthalmos – diagnosis?

A

Hand-Schuller-Christian Syndrome

106
Q

Which test confirms diagnosis of Hand-Schuller-Christian Syndrome?

A

Lung biopsy that shows Langerhans cells

107
Q

Treatment for Systemic Langerhans cell granulomatosis?

A

2-chlorodeoxyadenosine (2-CDA)

108
Q

Additional condition that is treated with 2-CDA?

A

Hairy cell leukemia

109
Q

Most common cause of chylothorax?

A

Lymphoma

110
Q

Lung condition that may result in chylous pleura effusions?

A

Lymphangiomyomatosis (LAM)

111
Q

Best treatment for Churg-Strauss Disease?

A

Corticosteroids, Cyclophosphamide

112
Q

Medication that might induce Churg-Strauss Disease?

A

Leukotriene receptor antagonist

113
Q

Alternate name for Acute Eosinophilic PNA?

A

Loeffler Syndrome

114
Q

2 lab results seen in setting of Loeffler Syndrome?

A

Eosinophils in blood + sputum

115
Q

Clinical presentation of aspergilloma?

A

Massive hemoptysis

116
Q

Best treatment of aspergilloma?

A

Surgical removal

117
Q

Appearance of aspergilloma on CXR?

A

Fungal ball

118
Q

Clinical presentation of invasive pulmonary aspergillosis?

A

Necrotizing PNA in immunocompromised patients (neutropenia)

119
Q

Best treatment for invasive pulmonary aspergillosis?

A

Voriconazole

120
Q

Best treatment for allergic bronchopulmonary aspergillosis?

A

Steroids … (not antifungals)

121
Q

Parapneumonic effusion is associated with …

A

Bacterial PNA

122
Q

Most common cause of massive hemothorax pleural effusion?

A

Malignant pleural effusion

123
Q

What type of pleural effusion is associated with rheumatoid pleurisy?

A

Exudative

124
Q

Change to LDH in rheumatoid pleurisy?

A

Increased

125
Q

Change to glucose in rheumatoid pleurisy?

A

Decreased

126
Q

What distinguishes rheumatoid pleurisy from other exudative pleural effusion?

A

Low glucose (without WBCs or signs of infection)

127
Q

2 characteristics of lupus pleuritis?

A

Bilateral, painful

128
Q

Most common cause of chylothorax?

A

Lymphoma

129
Q

Laterality of chylothorax?

A

Unilateral

130
Q

Rare cause of chylothorax?

A

Lymphangioleiomyomatosis

131
Q

Epidemiology of hepatic hydrothorax?

A

ETOH with cirrhosis

132
Q

Hepatic hydrothorax represents a type of ___ pleural effusion

A

Transudative

133
Q

Etiology of hepatic hydrothorax?

A

Hypoalbuminemia

134
Q

Best treatment for hepatic hydrothorax?

A

Salt restriction, diuretics

135
Q

What is NOT a treatment option for hepatic hydrothorax?

A

Chest tube, Thoracentesis … (the effusion accumulates too rapidly)

136
Q

Most common laterality of developing hepatic hydrothorax?

A

R

137
Q

3 criteria for exudative pleural effusion?

A

Pleural fluid protein >2.9, Pleural fluid LDH >60%, Pleural fluid cholesterol >45

138
Q

WBC >1000 in pleural effusion means …

A

Exudate

139
Q

WBC >10,000 in pleural effusion means …

A

Parapneumonic

140
Q

WBC >100,000 in pleural effusion means …

A

Empyema (pus collection)

141
Q

Eosinophils > 10% in pleural effusion means …

A

Drug reaction

142
Q

Lymphocytes > 50% in pleural effusion means …

A

TB or malignancy

143
Q

What are 2 markers for TB?

A

Adenosine deaminase (ADA), IFNg

144
Q

Next step of workup for patient with TB effusion?

A

Pleural biopsy

145
Q

Glucose < 20 in pleural effusion means …

A

RA

146
Q

PMN predominance in pleural effusion means …

A

PNA

147
Q

High amylase in pleural effusion means …

A

Pancreatic fistula

148
Q

High triglycerides (>115) in pleural effusion means …

A

Thoracic duct injury, Lymphangioleiomyomatosis

149
Q

Pleural effusion with (+) ANA, low complement means …

A

SLE

150
Q

Best next step of workup for patient with suspected pleural mesothelioma?

A

Open pleural biopsy

151
Q

What should you NOT do in patient with suspected pleural mesothelioma?

A

Needle biopsy … may seed the needle track

152
Q

First step of workup for patient with pulmonary nodules?

A

Check previous CXR

153
Q

3 conditions that would warrant biopsy of pulmonary nodules?

A

CA, Exposure (asbestos), Smoking

154
Q

Most likely fungal infection – Mississippi, Ohio river valley?

A

Histoplasmosis

155
Q

Most likely fungal infection – Chicago, Midwest?

A

Blastomycosis

156
Q

Most likely fungal infection – California?

A

Coccidioidomycosis

157
Q

Pattern of pulmonary nodule calcification that suggests benign lesion?

A

Popcorn, laminar, central, diffuse

158
Q

Pattern of pulmonary nodule calcification that suggests malignant lesion?

A

Stippled, eccentric

159
Q

Diameter of pulmonary nodule in which probability of CA is low?

A

Diameter < 1.5cm

160
Q

Best treatment for pulmonary nodule in which probability of CA is low?

A

Serial CXR monitoring every 3 months

161
Q

Diameter of pulmonary nodule in which probability of CA is high?

A

Diameter > 2cm

162
Q

Best treatment for pulmonary nodule in which probability of CA is high?

A

Resection

163
Q

When should you add inhaled corticosteroids for patient who has HX of asthma?

A

When patient begins to use of inhaled b agonist every day

164
Q

Value of spacers during use of inhaled corticosteroids for asthma?

A

Decrease AE by decrease amount of drug swallowed each day

165
Q

Indication for short-term oral corticosteroids in asthma?

A

Acute outpatient flare

166
Q

T/F – regular use of inhaled corticosteroids has been shown to improve pulmonary function and reduce mortality in patients with asthma?

A

True

167
Q

Which inhaler is indicated for asthmatic patients with b-blocker induced bronchospasm?

A

Atrovent inhaler

168
Q

DOC for prevention of exercise-induced asthma in children?

A

Cromolyn

169
Q

MOA of cromolyn in prevention of exercise-induced asthma in children?

A

Mast cell stabilizer

170
Q

3 drug interactions associated with theophylline?

A

Increased clearance of phenytoin, phenobarbital, lithium

171
Q

In patients with atypical symptoms of asthma, which step of workup has high NPV to exclude asthma?

A

Methacholine challenge

172
Q

Most common etiology of occupational exposure?

A

Isocyanates (pesticides)

173
Q

Which substance is unlikely to induce asthma?

A

Not silica

174
Q

Is airflow limitation in COPD reversible?

A

Not fully

175
Q

Classic CXR appearance of COPD?

A

Lung hyperinflation

176
Q

T/F – 80% of cigarette smokers do not experience marked airflow obstruction?

A

True

177
Q

Which intervention should not be prescribed for patient with severe COPD that requires admission?

A

Inhaled high-dose corticosteroids … Use ORAL or IV steroids!

178
Q

What is the best prognostic indicator for COPD?

A

FEV1

179
Q

What is the only therapy that has been proven to increase lifespan in patients with COPD?

A

O2

180
Q

Goal O2 sat in patients with COPD?

A

90%

181
Q

Which intervention has been shown to reduce the need for intubation for patients with COPD?

A

Non-invasive mask ventilation

182
Q

What is the preferred method of O2 delivery for patients who are acutely ill and may be at risk for developing hypercapnia?

A

Venturi mask delivery

183
Q

Change to PE seen in asthma?

A

Asthmatic patients usually have NML resting PE

184
Q

Next step of workup to distinguish asthma from COPD in setting of decreased FEV1/FVC?

A

Bronchodilator challenge (b2 agonist)

185
Q

Patient with low FEV1/FVC experiences improvement in FEV1 after bronchodilator challenge – diagnosis?

A

Asthma

186
Q

Patient with low FEV1/FVC experiences NO improvement in FEV1 after bronchodilator challenge – next step of workup?

A

Check DCLO

187
Q

Patient with low FEV1/FVC experiences NO improvement in FEV1 after bronchodilator challenge; DCLO is low – diagnosis?

A

COPD

188
Q

Patient with low FEV1/FVC experiences NO improvement in FEV1 after bronchodilator challenge; DCLO is high – diagnosis?

A

Asthma

189
Q

In patient with low FVC, TLC – what is next step of workup?

A

Check DLCO

190
Q

In patient with low FVC, TLC and low DLCO – what is diagnosis?

A

Interstitial lung disease

191
Q

In patient with low FVC, TLC and NML DLCO – what is diagnosis?

A

Chest wall lesions

192
Q

2 aspects of clinical presentation seen in males with Cystic Fibrosis?

A

Bronchiectasis, Aspermia

193
Q

27 yo male presents with recurrent sinusitis, bronchiectasis, sterility, hearing loss; PE shows heart sounds that are more prominent on R side – diagnosis?

A

Kartagener Syndrome

194
Q

Etiology of Kartagener Syndrome?

A

Defective ciliary function

195
Q

4 organ systems affected by Kartagener Syndrome?

A

Sinuses, Bronchi, Sperm, Organ of Corti

196
Q

Classic CXR finding associated with a1 anti-trypsin?

A

Lower lobe emphysematous bullae

197
Q

Inheritance pattern of a1 anti-trypsin?

A

AR