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Success on Step 2 > Pulmonolgy > Flashcards

Pulmonolgy Flashcards

1
Q

What are the important settings of a ventilator?

A

TV
RR
FiO2
PEEP

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2
Q

Tidal volume and respiratory rate are used to control?

A

Ventilation= RR xTV

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2
Q

FiO2 and positive expiatory pressure are used to control?

A

Oxygenation

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3
Q

When do we consider weaning a patient off ventilation?

A

When they can maintain good oxygenation with and FiO2 between 40-50%. when the PEEP is < 5cm. The patient should not be making excessive secretions. Mental status is good, and the patient is hemodynamically stable.

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4
Q

What is the purpose of BiPAP

A

It provide positive pressure on inspiration and on expiration.

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5
Q

What is a spontaneous breathing trial?

A

It is similar to the function of BiPAP. There is positive pressure on inspiration and expiration, but the TV and RR are controlled by the patient. Whether the patient is ready to be weaned of ventilator support is determined by the rapid shallow breathing index.

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6
Q

What RSBI is considered appropriate to wean a patient off ventilation?

A

<105

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7
Q

All patients on mechanical ventilation should be started on what prophylactic therapy?

A

proton pump inhibitors to prevent ulcer formation

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8
Q

What is dead space?

A

Ventilation is good but perfusion is bad. A good example is PE.

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9
Q

What types of shunts are there?

A

Physiological shunts: poor ventilation good perfusion. Obstrutction of the bronchi.
Anatomic shunts allow blood to bypass the pulmonary system (think Eisenmeger, pulmonary AV malformations)

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10
Q

What type of shunt is resistant to oxygen therapy?

A

anatomic shunts, physiologic shunts can partially be corrected with oxygen.

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11
Q

What is ARDS?

A

Is usually a complication of drowning or sepsis, burns, pancreatitis that results in activation of proteases and cytokines that can cause fluid leakage into the alveolar space.

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12
Q

What long-term consequence of ARDS?

A

pulmonary fibrosis

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13
Q

What is the common finding of ARDS on chest X-ray?

A

Bilateral infiltrates present on chest X-ray

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14
Q

True or False. If a patient has a PCWP >18 they are capable of having ARDS?

A

False, remember that ARDS is not a cardiogenic process so if the PCWP is > 18 the disease presentation is not ARDS.

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15
Q

What is the treatment for ARDS?

A

Positive pressure ventilation (usually mechanical intubation) and treatment of the underlying cause of ARDS.

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16
Q

If a patient has unexplained pulmonary symptoms and has a history of smoking or occupational exposure what is the next best step in diagnosis?

A

Spirometry, which will help to differentiate between restrictive and obstructive lung diseases.

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17
Q

What happens to the FVC in restrictive lung disease?

A

Decreases

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18
Q

What happens to the FEV1 in restrictive lung diseases?

A

Decreases

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19
Q

What happens to the FEV/FVC rations in restrictive lung disease?

A

Increases >0.8

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20
Q

What happens to the FEV in obstructive lung disease?

A

Decreases

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21
Q

What happens to the FEV/FVC ratio in obstructive lung disease?

A

Decreases <0.8

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22
Q

What happens to the FRC in obstructive lung disease?

A

It increases, mainly because the residual volume is increasing.

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23
Q

What happens to the FRC in restrictive lung disease?

A

it decreases

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24
Q

___ is a disorder of hyperactive airways?

A

Asthma

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25
Q

What are the two types of asthma?

A

Allergic and intrinsic

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26
Q

What is intrinsic asthma?

A

Usually precipitated by weather changes or exercise not usually precipitated by an allergen.

27
Q

True or False. Upon introduction of a bronchodilator asthma is a reversible airway obstruction?

A

True,

28
Q

What is the definitive diagnosis of asthma?

A

PFT

29
Q

What is the stepwise management of uncontrolled asthma?

A

PRN albuterol, inhaled steroids, LABA, oral steroids

30
Q

What is the treatment for a patient with an acute asthma exacerbation?

A

Oxygen, SABA and SAMA

31
Q

What are important vaccinations to consider in patients who have recent asthma exacerbations?

A

Flu and PCV

32
Q

What is the strongest risk factor for COPD.

A

Smoking

33
Q

What happens to the DCLO in a patient with emphysema?

A

It goes down. Remember that there is a airway component and a lung parenchymal component to emphysema.

34
Q

What happens to the DCLO in a patient with COPD?

A

It’s normal

35
Q

What factors reduced the risk of mortality in COPD patients?

A

Smoking cessation and home oxygen for patients with an oxygen saturation <88% at baseline.

36
Q

What is the treatment for acute COPD exacerbation?

A

Oxygen, SABA and anti-muscarinic, corticosteroid, and anti-biotic (macrolide)

37
Q

What is the best predicitor of prognosis for pulmonary disease?

A

FEV1

38
Q

A patient that is 30 year old with no smoking history presents to the ED with severe shortness of breath. LFT’s are slightly elevated. What is the likely diagnosis?

A

Alpha 1 anti-trypsin

39
Q

What is the most common cause of COPD exacerbations?

A

Infections

40
Q

What are the most common infectious organisms to cause a COPD exacerbation?

A

Strep. P
H. In
Moraxella Cat.

41
Q

What are the etiologies for chronic dry cough?

A

A GAP; Ace inhibitors, GERD, asthma, and post-nasal drip.

42
Q

What is the pathophysiology behind coughs with ACE inhibitors?

A

bradykinins are elevated, due to the breakdown of bradykinins this is also the pathophysiology for angioedema

43
Q

A patient with chronic cough and sore throat and hoarse voice probably is probably suffering from chronic cough due to?

A

GERD

44
Q

What is the difference between Kartagener’s syndrome and Cystic fibrosis.

A

While both can cause infertiility remember that situs inversus is typial for Kartageners

45
Q

PE presentation of atelectasis?

A

Dullness to percussion, decreased breath sounds +/- tracheal deviation.

46
Q

What is the first step in diagnosis of a patient with a solitary nodule?

A

Always see if you can get an older CXR or CT for comparison

47
Q

A solitary lung nodule ____ always needs to be biopsied?

A

3cm

48
Q

What is the next step of diagnosis of a pulmonary nodule after comparing with a previous chest X-ray?

A

Get a CT scan to determine the characteristics of the nodule (regular/irregular/lamellar/calcification/homogenous/ground glass)

49
Q

If a pulmonary nodule is centrally located how do you obtain the biopsy?

A

US guided trans-bronchial biopsy

50
Q

If a pulmonary nodule is peripherally located how do we obtain a biopsy?

A

CT guided peripheral biopsy

51
Q

A patient presents to your office with lid lag and miosis, pain in the ulnar nerver , and hoarse voice what is the diagnosis?

A

Horner’s syndrome, due to a superior sulcus tumor or pancoast tumor

52
Q

A patient presents with swelling face neck, arms with distended collaterals.

A

Superior vena cava syndrome

53
Q

What are common tumors of the anterior mediatstinum?

A

AT&T: Anterior, Thyroid, Teratoma, ad thymoma

54
Q

What are common tumors of the middle mediastinum?

A

pneumonic CML: lymph nodes and cysts

55
Q

What are common tumors in the posterior mediatstinum?

A

PEN: esophageal cancers, neural tumors (schwannomas, neurofibromas, neuroblastomas)

56
Q

What are the physcial exam findings for a patient with pleural effusion?

A

Dullness to percussion, decreased breath sounds, and decreased tactile fremitus. On CXR and pleural effusion may look like blunting of the costophrenic angles

57
Q

What is the next step in management of a patient with unilateral pleural effusions?

A

Thoracocentesis, cytology

58
Q

What is Factor V leiden?

A

Mutation in the gene encoding for the upregulation of Va (which converts X -> II) and less so the anti-coagulant for V.

59
Q

What are the absolute contraindications to anti-coagulation?

A

Bleeding disorder, history of hemorrhagic stroke, and platelet count < 25,000

60
Q

What are DOAC’s

A

Direct oral anti-coagulants, which include apixaban, rivaroxaban, edoxaban. Rememeber the X in the name indicates the drug directly inhibits factor 10 .

61
Q

A patient with inadequate oxygenation should increase FiO2 or PEEP pressure initially?

A

Always try PEEP first, one because this expands the alveoli to optiize gas exchange, but increasing the FIo2 increases the risk for oxygen toxicity. If the oxygenation does not improve after adjusting PEEP then increase the FiO2.

62
Q

What is the next step in managment for a patient with hemoptysis?

A

Identify if the patient is stable? If they are then a CT scan can be done to locate the source of bleeding. If not ABC’s and bronchscopy to locate the source, if bronchoscopy is not successful then arteriogram to locate the source of bleeding.

63
Q

When would we be inclined to place a tracheostomy versus circothyroidotomy?

A

We place a trach for those patients that require chronic breathing support versus circothyroidotomy is for those patients who only need acute respiratory support.

64
Q

98% of patients with cystic fibrosis have a missing _______ in males ?

A

vas deferens

65
Q

Why would you prefer to use Amoxicillin over ampicillin?

A

Amoxicillin, covers gram (+) organisms and gram (-) including H.In, E.coli, and salmonella. It also can be given in the oral form

66
Q
A

Success on Step 2 (14 decks)

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