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MKSAP - Internal > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

most important lab test in evaluation of respiratory compromise?

A

arterial blood gas measurement

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2
Q

hallmark of acute respiratory failure

A

rise in PCO2 accompanied by drop in pH

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3
Q

what PFTs establish the diagnosis of COPD (vs asthma)

A

postbronchodilator FEV1 < 80% and FEV1/FVC < 0.70

low DLco

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4
Q

when is DLco low in a patient?

A

conditions w/ barriers to diffusion (interstitial edema, interstitial infiltrates, tissue fibrosis) OR loss of lung tissue (emphysema)

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5
Q

pulmonary embolism on PFTs

A

no change in spirometry or lung volumes

decreased DLco

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6
Q

cough variant asthma

A

episodic cough and chest tightness, worse after respiratory infections

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7
Q

provocative concentration 20

A

methacholine dose that leads to 20% decrease in FEV1 in a challenge test; if < 4 mg/ml diagnosis is asthma; > 16 mg/ml is normal

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8
Q

FP results on methacholine challenge can be due to

A 
allergic rhinitis
COPD
heart failure
cystic fibrosis
bronchitis
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9
Q

when is methacholine challenge test useful?

A

in evaluating pts w/ suspected asthma who have episodic symptoms and normal baseline spirometry

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10
Q

PFTs in pt with neuromuscular respiratory failure

A

increased RV/TLC ratio
normal FEV1/FVC ratio
low maximum respiratory pressures
normal DLco

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11
Q

increased RV/TLC ratio can be seen in..

A

obstructive disorders

neuromuscular disorders

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12
Q

main CF of hepatopulmonary syndrome

A

dyspnea, platypnea (worse when sitting up), orthodeoxia (fall in PP of O2 when upright), hypoxemia in setting of chronic liver disease, normal CXR

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13
Q

characteristic findings in pt with severe aortic stenosis

A 
narrow pulse pressure
delayed, diminished carotid upstroke
sustained apical impulse
late peaking systolic ejection murmur radiating to carotids
S4
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14
Q

characteristics findings in pt with ASD

A

fixed splitting of s2/ RV heave
atrial arrhythmias
pulmonary midsystolic flow murmur OR tricuspid diastolic flow rumble

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15
Q

radiographic changes in spontaneous pneumothorax

A

loss of normal lung markings in periphery

well-defined visceral pleural line

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16
Q

vocal cord dysfunction - symptoms

A

difficult to tell apart from asthma

  • throat/neck discomfort
  • wheezing/stridor
  • anxiety
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17
Q

diagnostic test of choice in suspected vocal cord dysfunction

A
  1. laryngoscopy - reveals adduction of vocal cords during inspiration
  2. flow-volume loops - inspiratory loop is flattened due to narrowing of airway at level of vocal cords during inspiration
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18
Q

most common pulmonary manifestation in patient with systemic sclerosis

A

pulmonary arterial hypertension

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19
Q

physical signs of pulmonary arterial HTN

A

loud P2, fixed split S2
pulmonic flow murmur
tricuspid regurgitation

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20
Q

PFTs in pulmonary arterial HTN

A

isolated decreased DLco

normal airflow and lung volumes

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21
Q

presence of which two findings points towards interstitial lung disease?

A

late inspiratory crackles

lung volumes < 80% predicted

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22
Q

what diagnostic test should be done in suspected pulmonary artery HTN

A

echocardiography

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23
Q

what features of pleural effusion make it more likely that it should be treated with chest tube drainage vs. antibiotics alone (7)

A
  • assoc w/ pneumonia
  • presence of loculated fluid
  • pH < 7.2
  • glucose level < 60
  • LDH > 1000 IU/L
  • positive gram stain or culture
  • presence of gross pus in pleural space
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24
Q

when is a CT scan ordered with pleural effusion?

A
  • to detect very small effusions
  • to determine thickness of pleural lining
  • to distinguish empyema from lung abscess
  • to detect underlying malignancy
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25
Q

lung auscultation findings in pleural effusion

A

dullness on percussion
diminished tactile fremitus
absent breath sounds over effusion

26
Q

lung auscultation findings in lobar pneumonia

A

dullness on percussion
reduced breath sounds
increased tactile fremitis

27
Q

lung auscultation findings in pneumothorax

A

decreased breath sounds

hyperresonance on percussion

28
Q

pt presents with predominantly lymphocytic pale yellow pleural effusion (> 80% lymphocytes)

A

consider primary TB

- do pleural biopsy to evaluate

29
Q

dx. chylothorax

A

milky pleural fluid
pleural fluid TG conc. > 110 mg/dL
low pleural fluid cholesterol conc

30
Q

MCC of chylothorax

A

cancer
trauma
others: pulmonary TB, chronic mediastinal infection, sarcoidosis, lymphangioleoimyomatosis, radiation fibrosis

31
Q

in pt. with acute asthma exacerbation what does a normal or slightly elevated PCO2 mean?

A

need to intubate and mechanically ventilate the pt –> sign of impending respiratory failure

32
Q

indications for intubation and mechanical ventilation in pts with acute asthma attack

A
  1. respiratory acidosis
  2. hypoxemia
  3. fatigue
33
Q

what do you give a pt. who developed unstable asthma disease after respiratory tract infection?

A

short course of oral steroids

34
Q

nebulizer therapy at home in asthma management should be reserved for who?

A

pts who cannot use MDI properly

35
Q

what do you do if your asthma patient becomes pregnant?

A

if asthma is well-controlled, keep her on the same regimen (SABA and inhaled corticosteroids are safe in pregnancy)

36
Q

what do you give next to a patient with persistent asthma not well controlled by low-mod dose inhaled corticosteroids?

A

add long acting B-agonist

37
Q

when do you consider theophylline and/or leukotriene antagonists in tx. of asthma?

A

in pts who remain symptomatic despite addition of long-acting B agonist to corticosteroids therapy

38
Q

main reason why pts with asthma do not respond well to specific asthma therapy

A

poor inhaler technique

39
Q

Tx. of acute exacerbation of COPD

A

oral or IV steroids
short acting B2 agonist/anticholinergic
antibiotics

40
Q

what antibiotics are used in acute COPD?

A

fluoroquinolone OR

third generation cephalosporin + macrolide

41
Q

criteria for Rx continuing oxygen therapy in COPD patients

A
  1. PO2 < 55 mmHg OR
  2. O2 sat < 88% w/ wo hypercapnia
  3. pts with symptoms of pulm HTN, cor pulmonale, RHF or Hct > 56%
42
Q

when do you use methylxanthines in COPD pts?

A

only after long-acting bronchodilators have been tried

43
Q

what two therapies improve survival among COPD pts?

A

continuous O2 therapy

smoking cessation

44
Q

when should you consider inhaled corticosteroid therapy in COPD pt?

A

pt whose lung function is < 50%
pts with severe/ frequent exacerbations
(esp. beneficial when combined with LABA)

45
Q

suitable COPD candidates for NPPV

A
  • pts with moderate-severe dyspnea
  • use of accessory respiratory muscles
  • RR > 25/min
  • pH < 7.35 w/ PCO2 > 45 mmHg
46
Q

C/I to NPPV

A 
impending respiratory arrest
cardiovascular instability
altered mental status
high aspiration risk
production of copious secretions
extreme obesity
surgery, trauma
deformity of upper airway or face
47
Q

what do you Rx. for a pt with COPD on maximal medical treatment?

A

pulmonary rehabilitation

48
Q

when do you consider lung transplant in COPD pts?

A
  1. pts who are hospitalized w/ COPD exacerbation complicated by hypercapnia
  2. pts with FEV1 < 20% and either homogenous dz on HRCT or DLCO < 20%
49
Q

ideal candidate for lung reduction surgery

A
  1. predominantly upper lobe disease
  2. FEV1 bw 20-35% predicted
  3. DLco > 20% predicted
  4. hyperinflation
  5. no significant comorbidities
50
Q

what test do you need to do in a pt that presents with early onset COPD, esp. emphysema involving the lung bases?

A

a1-antitrypsin level

51
Q

diagnostic test to demonstrate sleep apnea

A

polysomnography and arterial blood gases

52
Q

how do you diagnose obesity-hypoventilation syndrome?

A

alveolar hypoventilation (PaCO2 > 45) in absence other known causes

53
Q

pt presents with subacute respiratory symptoms resembling respiratory tract infection but unresponsive to antibiotics; CXR shows bilateral alveolar-filling opacities - dx?

A

cryptogenic organizing pneumonia

54
Q

key radiographic feature of COP

A

tendency for COP opacities to “migrate” or involve different areas of the lung on serial examinations

55
Q

most specific CXR finding in asbestosis

A

bilateral partially calcified pleural plaques

56
Q

next best test in someone suspected of having diffuse parenchymal lung disease i.e. pt with CT disease and respiratory symptoms

A

high resolution CT scan

57
Q

drug-induced lung toxicity

A

presents as hypersensitivity reaction with symptoms of fatigue, low grade fever, cough and peripheral eosinophilia

58
Q

what drug(s) should be used for venous thromboembolism prophylaxis in hospitalized, medically ill patients?

A

unfractionated heparin
LMWH
fondaparinoux - C/I in renal impairment

59
Q

uses of lepirudin (direct thrombin inhibitor)

A

when a patient has heparin-induced thrombocytopenia

60
Q

what test do you do in someone w/ suspected PE, with elevated creatinine (i.e. kidney disease)

A

V/Q scan

- avoid CT angiography due to contrast

61
Q

how do you treat DVT?

A

therapeutic heparin and warfarin

  • heparin for atleast 5 days
  • warfarin only once INR > 2.0 for 24 hrs

MKSAP - Internal (11 decks)

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