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IM Board Review > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

Positive bronchial (meta choline) challenge is : if FEV1 falls by ___ or more from the baseline value, the test is considered positive.

A

20%, good NPV for asthma, but can be positive also for COPD

A positive bronchodilator response is increase by 12%

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2
Q

Treatment of aspirin exacerbated asthma/respiratory disease_____

A

Prednisone

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3
Q

The diagnostic criteria of _________are debated but include the presence of asthma, elevated IgE levels, positive skin tests to Aspergillus antigens, increased pulmonary Aspergillus-specific IgE and IgG levels, and either central bronchiectasis or infiltrates

A

ABPA

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4
Q

_____ vs asthma

A

Vocal cord dysfunction should be considered in the differential diagnosis of asthma, particularly if patients complain of prominent inspiratory breathlessness, with throat tightness or voice dysfunction during attacks

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5
Q

Asthma stepwise model
1) Level 1: SABA as needed (Albuterol)
2) Level 2: low dose ICS steroid + SABA as needed (Albuterol)
3) Level 3: ______ + low dose ICS
4) Level 4: medium ICS /LABA or LAMA
5) Level 5:
6) Level 6: High dose ICS/LABA + ____

A

LABA (formoterol), can also do Low dose ICS/LAMA (Tiotropium)

High dose ICS LABA/LAMA, SABA as needed

Systemic prednisone, plus adjuvant omalizumab (Ige), Mepolizumab (IL-5) etc

*backbone started is low dose steroid inhaler
*Although expensive, omalizumab reduces emergency department visits and may be cost-effective in eligible patients with moderate to severe atopic asthma not well controlled with other therapies.

Bronchial thermoplasty is a radiofrequency airway treatment administered using bronchoscopy that can reduce exacerbations and improve quality of life. Candidates are patients with an FEV1 above 60% and severe asthma that is poorly controlled despite high-dose inhaled glucocorticoid/LABA combination therapy.

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6
Q

Asthma management during pregnancy____________

A

Continue as normal

*The risks to the fetus of untreated asthma are significantly greater than the risks of asthma medications.

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7
Q

Biggest risk factor for COPD________________

A

Smoking

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8
Q

An α1-antitrypsin level should be obtained in patients with COPD under the age of ___who have a strong family history of COPD or who are without identifiable COPD risk factors.

A

45

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9
Q

Backbone of COPD therapy______

A

SABA –> LABA/LAMA, glucorticoid is asthma backbone

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10
Q

In patients with severe COPD and frequent exacerbations, ______ has been shown to decrease COPD exacerbations

A

chronic macrolide therapy (azithromycin)

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11
Q

Lung volume reduction surgery improves quality of life and survival for patients with upper-lobe predominant emphysema and significant exercise limitations.

A
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12
Q

Sinusitis + Gastro + Pulm symptoms is hinting at ____

A

CF

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13
Q

A characteristic radiographic finding of the emphysema associated with _______ is bullous changes most prominent at the bases, which are not present in this patient.

A

a1 antitrypsin deficiency

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14
Q

American Thoracic Society guidelines recommend screening all patients with____ with an antinuclear antibody (ANA), rheumatoid factor, and anti-cyclic citrullinated peptide antibodie

A

Restrictive lung disease DPLD

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15
Q

Best test for diagnosis pulm sarcoid_____

A

Bronchoscopy

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16
Q

Respiratory bronchiolitis–associated interstitial lung disease is found in _____

A

Active smokers, smokers can get both restrictive and obstructive lung disease

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17
Q

First line therapy for connective tissues disease (Systemic sclerosis: CREST) associated restrictive lung disease____

A

As a result, mycophenolate mofetil is considered first-line therapy for those with progressive DPLD and systemic sclerosis

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18
Q

Medications associated with restrictive lung disease
1)Amiodarone
2)________
3)Nitrofurantoin
3)________
4)_______

A

MTX, bleomycin, busulfan

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19
Q

Treatment of radiation pneumonitis_____

A

Treatment of severe forms of radiation pneumonitis typically is glucocorticoids, whereas observation may be appropriate for those with mild disease.

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20
Q

IPF Treatments
1)Anti fibroblast_____

A

Pirfenidone, nintedanib, specifically if UIP pattern

21
Q

Disease in smokers
1) COPD
2) Respiratory Bronchiolitis associated interstitial lung disease
3)__________________

A

Classic IPF with UIP pattern

Respiratory bronchiolitis–associated interstitial lung disease is used to describe disease in active smokers who have imaging findings of centrilobular micronodules with a pathologic finding of respiratory bronchiolitis on biopsy. - image findings are key

Autoimmune lung disease does not typically follow UIP pattern, it would be NSIP (non specific interstitial pneumonia)

22
Q

Sarcoid associated syndromes
1)Hilar lymphadenopathy, polyarthralgia, erythema nodosum, fever ________
2)Anterior uveitis, parotiditis, facial nerve palsy (Cranial-Bulbar symptoms)_________

A

Lofgren Syndrome
Heerfordt Syndrome

Tx: Steroids, if PAH lung transplant eval

23
Q

Occupation
1) Upper lobe predominant disease____

A

Silicosis, must also consider TB

24
Q

The most common causes worldwide of lymphocyte-predominant effusions are ________

A

TB and cancer

25
Q

Gold standard for pleural malignancy______

A

Thoroscopy

26
Q

Pulm artery pressure>___ means pulmonary HTN

A

25

27
Q

Autoimmune disease most associated with PAH______

A

Systemic sclerosis/scleroderma

28
Q

___ is a popular treatment for PAH, vasodilators

A

Bosentan

29
Q

Subsolid lung nodules ___ in size should be initially followed up at 6-12 months and then every 2 years for 5 years

A

6-8mm

Any lesion above 3cm is automatically assumed as lung cancer, will need biopsy/staging

30
Q

Tumor markers for lung adenocarcinoma_______

A

ALK, EGFR, ROS1

31
Q

annual lung cancer screening using low-dose CT scan for those who are age_____ have at least a ___pack-year smoking history, and are either current smokers or have quit smoking within the last 15 years.

A

50 - 80
20

32
Q

Carcinoid: It is rare for lung carcinoid tumors to produce and release serotonin and other vasoactive substances into the systemic circulation and be associated with carcinoid syndrome. Surgical resection is often curative, and 10-year survival rates are higher than ____

A

90%

33
Q

Anterior mediastinal masses associated with Terrible T

1________
2) Teratoma
3)Lymphoma
4)Thyroid cancer

A

Thymoma

34
Q

AHI greater than _____ is severe sleep apnea

A

30

35
Q

multiple sleep latency testing (MSLT) is used to diagnose_____

A

narcolepsy

36
Q

maxillomandibular advancement (MMA) is a surgery used to treat severe, treatment refractory____

A

OSA

Traditional soft palatal procedures such as uvulopalatopharyngoplasty are ineffective for treatment of obstructive sleep apnea.

37
Q

medication to stop with central OSA_____

A

Opiates

central OSA associated with HF, Cheyenne Stokes respiration, the answer is always medically optimizing patients

38
Q

. The hallmark of ____ is daytime hypercapnia, defined as a Pco2 greater than 45 mm Hg (5.9 kPa). OSA is usually but not always superimposed.

A

Obesity hypoventilation

39
Q

Symptoms of acute mountain sickness are nonspecific and include headache, fatigue, nausea, and vomiting; disturbed sleep related to high-altitude periodic breathing is common.

A

Cerebral hypoxia due to altitude

Tx: Acetazolamide, dexamethasone, supplemental oxygen

Tx: (Pulm Edema): Supplementary oxygen –> Nifedipine/Sildenafil ; not HF treatments

40
Q

Air travel with lung disease

A

An existing pneumothorax has traditionally been considered a contraindication to flight owing to the potential risk of expansion and tension physiology. Air travel may be safe in the presence of a small postoperative pneumothorax that has been radiographically stable.

In patients who are already on long-term supplemental oxygen, doubling of the flow rate during flight is typically adequate.

41
Q

ICU Nutrition

A

Use of supplemental parenteral nutrition should be considered only after 7 to 10 days of not meeting more than 60% of energy and protein requirements by the enteral route alone.

Unless severe malnutrition

42
Q

________describes a group of symptoms that present in patients after an episode of critical care. The symptoms have been grouped according to the area that they affect (physical impairment, mental health, and cognitive impairments)

A

Post Intensive Care Syndrome

43
Q

A negative clinical examination or chest radiograph does not necessarily rule out community-acquired pneumonia in symptomatic patients, especially in elderly individuals (True/False)

A

True

44
Q

Guillain-Barré syndrome and _______are the most common causes of acute neurologic respiratory failure in the ICU.

A

Mysthenia Gravis

45
Q

NMS vs Serotonin syndrome

A

NMS takes weeks, serotonin syndrome takes hours

46
Q

Fomepizole for isopropyl alcohol ingestion:

A

There is no need to block the action of ADH with fomepizole. Administration of fomepizole would be advised for treatment of methanol or ethylene glycol ingestion, because these alcohols both have toxic metabolites that can lead to blindness, kidney failure, or death. Inhibiting ADH in patients who have ingested isopropyl alcohol only prolongs its elimination.

Classic isopropyl = Osmol gap>10, gap acidosis : 2Na + Gluc/18 + BUN/3

47
Q

Antidote for cyanide poisioning

A

Hydroxocobalamin avidly binds to cyanide to produce cyanocobalamin, which is soluble, nontoxic, and readily excreted. The usual dose is 5 g for an adult. Other antidotes include nitrites (amyl nitrite and sodium nitrite) to induce methemoglobin, which in turn binds cyanide, as well as sodium thiosulfate

Inducing methemoglobinemia in inhalation-injury victims who may also have high levels of carboxyhemoglobin is not safe, so nitrite therapy should be avoided. Of these potential treatment strategies, hydroxocobalamin is the most commonly recommended due to ease and safety of administration.

48
Q

Restrictive lung disease spirometry: FEV1/FVC<70%, TLC below ___

A

80%

IM Board Review (13 decks)

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