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Internal Medicine > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

diff PFTs

A
  1. static lung compartments (TLC,RV ,VC)
  2. air movement ( FEV1/FVC , FEF25-75%)
  3. alveolar memb permeability (DLco)
  4. methacholine challenge test
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2
Q

what is the abnorml value for lung vol / flow rates

A

<80% : abnormal

> 120%: air trapping

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3
Q

diff bw FEV1/FVC and FEF25-75%

A

both measure airflow under dynamic condn

FEF usually detects obstructive ds earlier.

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4
Q

obstructive ds + decreased DLco

A

emphysema

DLco diff from ch bronchitis, asthma , bronchiectasis

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5
Q

restrictive pattern + dec DLco

A

interstial lung ds / intrapulmonary restriction

not extrapulmonary cause

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6
Q

when is methacholine challenge test said to be positive

A

dec from baseline FEV1 of 20% or more

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7
Q

increased DLco in___

A

pulmonary haemorrhage eg: good pasteur

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8
Q

bronchodilator reversibility test used to distinguish

A

nonreversible obs from reversible obs lung ds

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9
Q

flattened flow vol loop on top and bottom indicates

A

fixed airway obstruction:eg tracheal stenosis after prolonged intubation

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10
Q

flow vol loop in dynamic extrathoracic airway obstruction

A

obstruction occurs mostly with inspiration while exp is normal

flattened only on bottom

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11
Q

Do2 (oxygen delivery) depends on

A

Do2=CO × (1.34 ×Hb ×HbSat) + 0.0031 ×Pao2

depends less on Pao2(minimal change on giving 100% o2)

main: CO and Hb

dont memorise formula

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12
Q

alveolar - arterial gradient formula

A

PAo2 - pao2

150 - (1.25 x PaCO2) - PaO2

valid if breathing room air

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13
Q

severe hypoxemia but normal gradient

A

dec in RR as in opiod overdose and resp centre depression

high altitude

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14
Q

what is the first step after finding out a pul nodule in chest xray

A

look for prior xray

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15
Q

if no prior chest xray available ..what to do?

A

consider whether the patients is high/low risk

high: >50, smoking
- resection amd biopsy

low: < 35 , nonsmoking, calcified
- Cxray/ CT every 3 mths ×2yrs

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16
Q

why is bronchoscopy not a good option for diagnosing a case of a pul nodule on chest xray

A

not reach peripheral lesions

mislabel 10% of central cancers by finding only nonspecific inflammatory changes

performed blindly

specimen obtained cam be limited

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17
Q

in which cases it is rasonable to observe pleural effusion without performing thoracocentesis

A

CHF

viral pleurisy

recent abdominal/ thoracic surgery

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18
Q

light criteria for pleural effusion

A
  1. LDH
  2. LDH effusion/serum ratio
  3. protein effusion/ serum ratio

values
200
0.6
0.5

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19
Q

eg of condtion causing exudate and transudate

A

pulmonary embolism

clinical significance: patient has transudative effusion but no apparent cause…consider PE

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20
Q

is thoracocentsis necessaary in parapneumonic effusion?

A

YES(treatment ll be diff. in un/complicated effusion)

to rule out complicated parapneumonic effusion ( possibility of progressing to empyema)

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21
Q

what is the diff in the Rx of un/complicated parapneumonic effusion

A

uncomplicated: antibiotics alone
complicated: chest tube drainage

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22
Q

haemorrhagic pleural effusion seen in

A

meaothelioma

metastatic lung / breast ca

pul thromboembolism with infarction

trauma

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23
Q

lymphocytic predominant pleural effusion seen in

A

tuberculosis

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24
Q

most senistive amd specific test for pleural TB

A

biopsy

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25
Q

thoracocentesis should always be done under guidance of USG

A

yes

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26
Q

Rx of acute exacerbation of asthma

A
  1. oxygen
  2. short acting beta2 agonist(albuterol)
  3. anticholinergics( less eff, take time to act)
  4. inhaled steroid spur ( for 7 - 14 days)
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27
Q

which is the most imp medication in Rx of acute excerbation of asthma

A

short acting beta 2 agonist - like albuterol

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28
Q

which is the most imp medication in chronic Rx of asthma

A

inhaled steroids

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29
Q

mostvimp side effects of inhaled steroids

A

oral candidiasis

bad taste

so wash mouth

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30
Q

how to treat nocturnal asthma

A

long acting beta agonist

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31
Q

when is chromolyn / nedocromil used?

A

not to be used in acute excerbation: may even proke attack.

used in childhood asthma which is mild and where steroids should be avoided.

adulthood asthma does not benefit much since it is severe….but can be used in exercise (mild) induced asthma

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32
Q

when is LTs antagonists used in asthma

A

used in steroid dep asthmatics(chronic oral steroid users ) to minimize steroid use or stop its use dur to side effects

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33
Q

what is the difference bw COPD and asthma

A

COPD::
nonreversible

noninflammatory condition

inflammation only during excerbation

Rx

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34
Q

what are the types of ventilation

A

noninvasive: supports breathing without the need for intubation
invasive: (mechanical) follows endotracheal intubation

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35
Q

types of nonivasive ventilation

A

bilevel positive airway pressure:positive pressure at alternating levels(higher for insp and lower for expiration)

continuous positivr airway pressure: air pressure on a continuous basis ( airways continuously open)

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36
Q

BiPAP used in

A

COPD

acute resp failure( pneumonia, status asthmaticus)

chronic resp failure

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37
Q

CPAP used in

A

obstructive sleep apnoea

CHF with pul edema

near drowning

other resp distress

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38
Q

invasive ventilation includes

A

positive end exp pressure

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39
Q

pattern of obs in asthma

A

episodic pattern . .with interspersed normal airway tone.

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40
Q

cause of obs in asthma

A

mucosal inflammation

muscle constriction

hypersecretion

41
Q

2 types of asthma

A

INTRINSIC/ IDIOSYNCRATIC/ NONALLERGIC:

secondry to nonimmunologic stimuli like infection, irritating inhalant, cold air , exercise , emoional upset

EXTRINSIC/ALLERGIC /ATOPIC:

precipitated by allergens.

sp IgE are present

other symp like rhinits, utricaria , eczema

42
Q

MCC of asthmatic excerbation

A

resp infections ( MC: viruses)

43
Q

samster`s triad

A

athma

nasal polyposis(causing reccurent sinus ds)

sensitivity to aspirin and nsaids

44
Q

variants of asthma

A

nocturnal cough

exercise induced

45
Q

why is chest x ray done in asthma

A

to R/O acute infection of lung

46
Q

Dx of asthma

A

obstructive pattern that reverses with bronchodilation

if normal PFTs : do methacholine test - decrease in FEV1 and FEF25- 75 of 20%

47
Q

MC side effect of beta agonist

A

tremors

48
Q

SABA and LABA

A

SABA
salbutamol/albuterol
terbutaline

LABA
salmeterol
formeterol

49
Q

beta agoinsts should be used in caution in

A 
CVD
hypothytoidism
DM
htn
coronary insufficiency
50
Q

moa of amino/theophylline

A

not used routinely

modest bronchodilation

IMPROVING CONTRACTILITY OF DIAPHRAGM AS WELL AS OTHER RESPIRATORY MUSCLES

51
Q

status of anticholinergics in asthma

A

ADVANTAGE
used in patients with heart ds

DISADVANTAGE
significant time to achieve max bronchodilation (-90 min)

medium potency

52
Q

should routine Antibiotic Rx in acute excerbation of asthma be given

A

no, not proved

only in patients with symptoms ( purulent sputum ) and chest xray findings ( infilterates) consistent wih bacterial pneumonia

53
Q

use of systemic steroids in asthma

A

in severe asthma

following status asthmaticus( initially i.v. then orally for 10 - 14 days)

54
Q

when is LABA used?

A

persistant asthma

nocturnal symptoms

55
Q

when is LT modifiers used in astham

A

for severe asthma resistant to max doses of inhaled steroid

AND

as a last resort before using chronic systemic steroids

56
Q

status of MAST cell stabilizers in asthma

A

cromolyn ,nedocromil

  • chronic asthma especially in children
  • allergic / exercise induced
57
Q

diff categories of asthma

A

MILD INTERMITTANT
symptoms 2x/wk
nighttime symp <2x/ mth

MILD PERSISTANT
symptoms 3-6x/wk
nighttime symp 3-4x/mth

MODERATE PERSISTANT
symptoms everyday
nighttime symptoms >5x/wk

SEVERE PERSISTANT
symptoms everyday
nighttime symp frequently

58
Q

Dx of ABPA

A

sputum: fungus , eosinophils
blood: eosino, IgE, specific aspergillus Ab

skin test: but does not differentiate bw ABPA and simple allergy to aspergillus

59
Q

Rx of ABPA

A

corticosteroids

60
Q

chronic bronchitis

A

productive cough for most days of a 3 month period for atleast 2 consecutive yrs

61
Q

pathognomic differentiating finding on PFTs bw COPD and asthma

A

COPD :irreversible

62
Q

cause of obstruction in empysema

A

decrease in recoil

63
Q

cause of obstruction in ch bronchitis

A

mainly increase in airway resisitance

64
Q

chest x ray finding in emphysema

A

hyperinflation of bilateral lung fields

diaphragm flattening

small heart

inc retrosternal space

65
Q

chest x ray finding in ch bronchitis

A

increased pul markings

66
Q

Dc of COPD

A

PFTs

67
Q

increase in CO2 occurs __ in ch bronchitis and ___ in emphysema

A

early

late

68
Q

Rx of stable phase of COPD

A

anticholinergics (first choice)

can be given synergistically with beta agonist

theophylline

inhaled steroids( very severe case)

69
Q

why are beta agonists not the first cgoice

A

COPD patients have underlying heart ds and tachycardia.

beta agonist can ppt heart failure

70
Q

drugs that increase theophylline levels

A

FQs

clarithromycin

H2 blockers

certain beta blockers

CCBs

71
Q

drugs that decrease theophylline levels ( due to increased clearance)

A

rifampin

dilantin

phenobarbital

SMOKING

72
Q

only interventions that can decrease the mortality in COPD

A

home oxygen

smoking cessation

73
Q

when should home oxygen therapy be instituted in COPD patients

A

PaO2 <55 mm Hg

PaO2 <59 mm Hg if cor pulmonale is present

74
Q

MCC of COPD acute excerbation

A

viral lung infections

75
Q

specific treatment for acute excerbation of COPD

A

oxygen( till 90%)

inhaled bronchodilators: ipratropium + albuterol

systemic corticosteroids for 2 wks ( inhaled not given)

antibiotics

no benefit of i.v. theophylline but if the patient was using give it now also beacause abrupt discontinuation may worsen symptoms

avoid opiates and sedatives

postural drainage

stop smoking

how to use MDI

76
Q

which is the commonest micro org seen in bronchiectasis

A

pseudomonas

77
Q

tram traking and signet ring sign in chest xray is seen in

A

bronchiectasis

78
Q

rotating antibiotics concept is used in

A

bronchiectasis

(patirnts should be Rx with antibiotics when sputum production increases or they have mild symptoms.

chronic prophylaxis is not recomended)

79
Q

sirgical therpy in bronchiectasis is useful in case of __

A

localised bronchiectasis

80
Q

reticular / reticulonodular pattern in Chest X ray seen in

A

intertitial lung disease

81
Q

drug used in IPF

A

pirfenidone ( antifibroti effects)

82
Q

what are the dermatologic manifestations in sarcoidosis

A

lupis pernio( ch raised purplish indurated lesion of skin found on face)

erythema nodosum

non scarring alopecia

papules

83
Q

LÖFGREN SYNDROME

A

distinct sarcoid syn with acite presentation

includes eryhtema nodosum , arthritis , hilar adenopathy.

84
Q

HEERFORDT WALDENSTROM SYNDROME

A

distinct sarcoid syndrome wih acute presentation

fever

parotid enlargement

uveitis

facial palsy

85
Q

if a patient is asymptomatic amd has BILATERAL HIALR ADENOPATHY on routine chest XRay … assume this to be

A

sarcoidoisis and follow with imaging

86
Q

definitive diagnosis of sarcoidosis is via

A

BIOPSY

87
Q

when are steroids used in sarcoidosis

A

in the setting of organ impairment:

uveitis

CNS

heart

hypercalcemia

88
Q

sarcoidosis and ACE levels

A

60% show rise in ACE levels

ACE levels should not be used to diagnose sarcoidosis but can br used to follow the course of ds

89
Q

can u have raised PTT and still have bleeding

A

yes ..in antiphospholipid Ab syndrome (anticardiolipin Ab syn/ lupus anticoagulant)

90
Q

factor V leidd3n deficiency seen in which races

A

european decent

91
Q

presentation of fat embolism

A

TRIAD : acute dyspnea , petechiae ( neck and axilla & confusion)…H/O trauma

92
Q

findings in ARDS

A

dysnoea , crackles & rhonchi , hypoxemia +/- hypercapnoea , white out chest xray , elevated pul pressure

93
Q

Rx of fat embolism

A

supportive( not heparin or anticoagulation)

94
Q

one of the major complication / end result of sleep apnoea

A

right sided heart failure

95
Q

best diagnostic test for sleep apnoea

A

polysomnography

96
Q

imp lab findings in sleep apnoea

A

ABG- O2 dec and CO2 inc & RAISED BICARBONATE

97
Q

Rx of sleep apnoea

A

OBSTRUCTIVE :weight loss , CPAP , surgery .CENTRAL: acetazolamide/ progesterone (breathe faster)

98
Q

diff be central and obs sleep apnoea

A

no muscle retractions in central sleep apnoea during polysomnography

99
Q

causes of atelectasis

A

post op ( lack of insp/ cough), foreign body ,tumor , pneumothorax

Internal Medicine (9 decks)

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