pulmonology

Question 1

3 components of asthma

Answer 1

1.obstruction of airflow
2.bronchial hyperreactivity
3.inflammation
It is a disease of chronic inflammation leading to airway narrowing and increased mucous prod

Question 2

Strongest predisposing factor to asthma

Answer 2

atopy

atopy tirad= wheeze, eczema, seasonal rhinitis

Question 3

Stage 1 of asthma- mild intermittent

Answer 3

Daytime asthma sxs occur 2 or fewer days/week
2 or fewer nocturnal awakening/month
use SABA fear then 2x/week
no interference w/ normal activity
FEV1>80%
FEV1/FVC is normal
use only oral steroids 1 time or less/year

TX-SABA (albuterol)-PRN

Question 4

Stage 2- mild persistent

Answer 4

Daytime sx >2x a week
3-4 nocturnal awakenings/month
use SABA >2x/ week
minor limitation in activity
FeV1>80%
FEV1/FVC is normal
2 or more oral uses

TX-
SABA
either inhaled steroid (low dose) OR cromolyn/nedocromil or can do leukotriene inhibitor

Question 5

Stage 3 moderate persistent

Answer 5

Daily sxs
nocturnal awakenings at least once a week
daily need of saba
some limitation of activity
FEV1 is between 60-80%
FEV1/FVC-reduced by 5%
same for oral steroids

TX-
SABA (albuterol) prn
either Inhaled steroid (med dose) OR inhaled steroid (low-med dose) AND long acting Beta agonist
if needed can use inhaled steroid (med-high) dose AND long acting beta agonist

Question 6

4- severe persistent

Answer 6

asthma sxs throughout day
nocturnal awakenings nightly
SABA several times a day
limited physical activity
FEV1 5%

TX-
SABA
Inhaled steroid (high dose) AND long acting beta agonist AND oral steroids

Question 7

Bronchiectasis definition

Answer 7

abnormal, permanent dilation of the bronchi and destruction of bronchial walls. can be congenital (cystic fibrosis) or acquired from recurrent infxns or tumor
results from bronchial injury subsequent to severe infxn and/or inflammation
cystic fibrosis causes 50% of cases

Question 8

sxs of bronchiectasis

Answer 8

foul smelling sputum, hemoptysis, chronic cough, and recurrent pneumonia
chest crackles and clubbing

Question 9

comparison of emphysema and bronchitis

Answer 9

Emphesema bronchitis
exertional dyspnea mild dyspnea
cough is rare chronic prod cough
quiet lungs noisy lungs (wheeze and rhochi)
no peipheral edema edema
thin; weight loss overweight; cyanotic

Question 10

emphysema

Answer 10

airspaces enlarged as a consequence of destruction of alveolar septae

Question 11

bronchitis

Answer 11

characterized by a chronic cough that is productive of phlegm occurring most days for 3 months of the year for 2 or more consecutive years w/out otherwise acute cause

Question 12

idiopathic pulmonary fibrosis

Answer 12

most common diagnosis among pts w/ interstitial lung disease

sxs- dry cough, exertional dyspnea, fatigue, malaise, clubbing, crackles

Question 13

sarcoidosis

Answer 13

multi organ disease of idiopathic cause. characterized by noncaseating granulomatous inflammation in affected organs.
90% have lung involvement
sxs- cough, dyspnea (insidious onset), chest discomfort, may present w/ fever, malaise
Tx- steroids

Question 14

ARDS

Answer 14

underlying problem is increased permeability o fthe alveolar capillary membranes, which leads to development of protein rich pulmonary edema
clinical fxs- rapid onset of dyspnea, tachypnea, frothy pink or red sputum, crackles, cyanotic
denotes acute hyperemic respiratory failure following a systemic or pulmonary insult w/out evidence of heart failure.

Question 15

pulmonary func test

Answer 15

Increases in TLC, FRC, and RV may occur as a result of obstructive disease
Reduction in VC, TLC, FRC, and RV result from restrictive disease

Question 16

5 causes of hypoxemia

Answer 16

high altitude
alterations in diffusion
hypoventilation
shunting
V/Q mismatch

Question 17

A-a gradient

Answer 17

Helps to determine if there are problems on either side of the basement membrane in the pulmonary circulation

Question 18

ARDS characterized by

Answer 18

bilateral, widespread pulmonary infiltrates, normal pulmonary capillary wedge pressure
rapid onset of profound dyspnea that occurs 12-24 hours after initiating event. labored breathing, tacypnea, crackles are noted

Question 19

“Restriction” in lung disorders always means a decrease in lung volume (FVC)

Answer 19

true

Question 20

interstitial lung disease

Answer 20

insidious onset of progressive dyspnea and nonproductive chronic cough
septal thickening
tachypnea, small lung volume, bibasilar rales, and right heart failure w/ adnaved disease

Question 21

most common lung cancer spreads

Answer 21

breast, colon, prostate, bladder

Question 22

lung cancer is most common death from a cancer

Answer 22

true

Question 23

clinical presentation of cancer

Answer 23

centrally located lesions (cough, hemoptysis, wheezing, atalectasis)
peripheral located lesions- (pain due to pleural or chest wall invasion)
with metastasis- bone pain, back pain, difficulty breathing , HA, seizures, mental changes, weight loss, fevers,

Question 24

90% of lung cancer spread to lungs

Answer 24

true

Question 25

most common comp of lung cancer

Answer 25

dysphagia, hoarsness, horners syndrome, pleural effusion, tapanade, svc syndrome, pancoast syndrome

Question 26

pancoast

Answer 26

shoulder pain radiating down arm ulnar distribution

Question 27

work up of cancer pt

Answer 27

history and physical
cxr
labs-cbc,cmp
biopsy