Pulmonolgy

Question 1

What are the important settings of a ventilator?

Answer 1

TV
RR
FiO2
PEEP

Question 2

Tidal volume and respiratory rate are used to control?

Answer 2

Ventilation= RR xTV

Question 2

FiO2 and positive expiatory pressure are used to control?

Answer 2

Oxygenation

Question 3

When do we consider weaning a patient off ventilation?

Answer 3

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.

Question 4

What is the purpose of BiPAP

Answer 4

It provide positive pressure on inspiration and on expiration.

Question 5

What is a spontaneous breathing trial?

Answer 5

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.

Question 6

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

Answer 6

<105

Question 7

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

Answer 7

proton pump inhibitors to prevent ulcer formation

Question 8

What is dead space?

Answer 8

Part of the lungs that cannot partake in gas exchange. A good example is pulmonary embolism because you have good ventilation, but because f reduced blood flow there can be no gas exchange.

Question 9

What types of shunts are there?

Answer 9

There are physiological shunts that when there is poor perfusion the vasculature of the pulmonary system constricts so that blood may be shunted to well ventilated portions of the lung. Anatomic shunts allow blood to bypass the pulmonary system (think Eisenmeger, pulmonary AV malformations)

Question 10

What type of shunt is resistant to oxygen therapy?

Answer 10

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

Question 11

What is ARDS?

Answer 11

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.

Question 12

What long-term consequence of ARDS?

Answer 12

pulmonary fibrosis

Question 13

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

Answer 13

Bilateral infiltrates present on chest X-ray

Question 14

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

Answer 14

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

Question 15

What is the treatment for ARDS?

Answer 15

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

Question 16

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

Answer 16

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

Question 17

What happens to the FVC in restrictive lung disease?

Answer 17

Decreases

Question 18

What happens to the FEV1 in restrictive lung diseases?

Answer 18

Decreases

Question 19

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

Answer 19

Increases >0.8

Question 20

What happens to the FEV in obstructive lung disease?

Answer 20

Decreases

Question 21

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

Answer 21

Decreases <0.8

Question 22

What happens to the FRC in obstructive lung disease?

Answer 22

It increases, mainly because the residual volume is increasing.

Question 23

What happens to the FRC in restrictive lung disease?

Answer 23

it decreases

Question 24

___ is a disorder of hyperactive airways?

Answer 24

Asthma

Question 25

What are the two types of asthma?

Answer 25

Allergic and intrinsic

Question 26

What is intrinsic asthma?

Answer 26

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

Question 27

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

Answer 27

True,

Question 28

What is the definitive diagnosis of asthma?

Answer 28

PFT

Question 29

What is the stepwise management of uncontrolled asthma?

Answer 29

PRN albuterol, inhaled steroids, LABA, oral steroids

Question 30

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

Answer 30

Oxygen, SABA and SAMA

Question 31

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

Answer 31

Flu and PCV

Question 32

What is the strongest risk factor for COPD.

Answer 32

Smoking

Question 33

What happens to the DCLO in a patient with emphysema?

Answer 33

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

Question 34

What happens to the DCLO in a patient with COPD?

Answer 34

It’s normal

Question 35

What factors reduced the risk of mortality in COPD patients?

Answer 35

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

Question 36

What is the treatment for acute COPD exacerbation?

Answer 36

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

Question 37

What is the best predicitor of prognosis?

Answer 37

FEV1

Question 38

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?

Answer 38

Alpha 1 anti-trypsin