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CanQB > Resp > Flashcards

Resp Flashcards

1
Q

PE in pneumothorax

A

No tactile fremitus
Hypertesonance percussion
Decreased breath sound on affected side
Tracheal deviation away from side

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2
Q

Dx of pneumothorax

A

CXR

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3
Q

Most effective Rx in sleep apnea?

A

CPAP

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4
Q

Population of hyperventilation syndrome

A

Young women

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5
Q

Sx of hyperventilation

A 
Tachypnea 
Hyperpnoea (deep breath)
Atypical chest pain 
Tachycardia 
\+/- carpopedal spasm

Gas:
Resp alkalosis

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6
Q

Bronchitis vs bronchiactesis sputum

A

Bronchitis > mucoid sputum

Bronchiactsis > purulent malodorous sputum

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7
Q

Rx of pneumothorax <20%

A

Outpatient observation
CXR in 24-48 hr

Or
Oxygen + observe

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8
Q

Tests done for sarcoidosis patients

A 
Slit lamp
Pulmonary function test 
Serum Ca
ECG
ACE level
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9
Q

Sleep apnea associations

A

HTN

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10
Q

Differentiate bronchitis from emphysema by PFT?

A

Single diffusion capacity DLCO.

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11
Q

Most effective measure in COPD?

A

Smoking cessation

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12
Q

What Rx measure improves mortality / survival in COPD

A

Supplemental O2

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13
Q

If asthma isn’t controlled with inhaled SABA?

A

Add low dose ICS > increasing dose of SABA

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14
Q

Good pasture’s classic?

A

Acute glomerulonephritis
Pulmonary hemorrhage
Following URTI

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15
Q

Cause of glumeruonephritis in goodpasture

A

Anti-GBM antibodies > complement activation > tissue damage.

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16
Q

CXR in asbestosis

A

Lower > upper lobe
Fibrosis w/ linear streaking (early)
Cyst & honeycombing (late)
IMP > plural & diaphragmatic calcification

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17
Q

Cancer with asbestosis

A

Bronchogenic Ca

Mesothelioma

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18
Q

When does SABA work?

A

Work in 5 minutes for 4-6 HR.

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19
Q

Inhaled CS before SABA improves delivery?

A

False

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20
Q

Which is better in asthma oral Beta agonists or inhaled SABA

A

Inhaled

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21
Q

Exercise induced bronchoconstriction classic

A

10% decrease in FEV1 with exercise.
High-ventilation sports > track, skiing
Winter sports

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22
Q

Dx exercise induced bronchocostriction.

A

Trial with albutrol inhaler.

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23
Q

Best way to Dx COPD?

A

Spirometer FEV1/FVC < 70% - 80%

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24
Q

Is clubbing a sign of COPD?

A

No

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25
Q

Guidelines for pulmonary nodule.

A 
Suspicious: 
1. Size < 8 mm 
2. Ground glass appearance 
3. Irregular borders 
4. Double size in 1 mo - 1 yr
5. Hx of Ca
6. Smoker 
=> biopsy.

Non suspicious:
Repeat CT in 6-8 mo

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26
Q

Rx of tension pneumothorax

A

Needle at 2nd intercostal space > chest tube > CXR.

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27
Q

Contraindications to thrombolytics?

A 
Eye / CNS surgery in 2 wk
Brain tumor 
Brain vascular disease 
Stroke < 2 mo 
Active bleeding 
Hypotension
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28
Q

When does rapidly progressive silicosis develop?

A

6 months of exposure.

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29
Q

Benefit of BiPAP in acute COPD

A

Improves ventilation
Delay intubation
Improves mortality / morbidity.

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30
Q

Rx of acute chronic bronchitis.

A

SABA
Anti cholinergic
Steroids (oral / IV)

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31
Q

Resp side effect of nitrofurantoin?

A

If used > 6 mo

Restrictive pulmonary fibrosis

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32
Q

Risk of tension pneumothorax

A

Patient on +ve mechanical ventilation.

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33
Q

Step after pulmonary function test?

A

Full pulmonary test for static lung volume

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34
Q

COPD ventilation setting

A 
Volume assist 
Rate: 10-12
TV: 8mL/kg
PEEP 0-5 cm H2O
Hgb sat: 92%
Peak flow 75-90 L/min
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35
Q

Gold standard Dx in PE?

A

CT Angio

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36
Q

Hypersensitivity pneumonitis cause

A

Inhaled organic dust

E.g mold

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37
Q

Hypersensitivity pneumonitis classic

A

4-8 hrs after exposure > chill, cough, SOB worsen with time

Symptoms resolve then recur suddenly with repeated exposure.

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38
Q

CXR and labs in hypersensitivity pneumonitis

A

CXR = normal
PFT = restrictive
High ESR
High IgG

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39
Q

Idiopathic pulmonary fibrosis classic

A

Gradual Sx
Dry cough
Clubbing
Fine bilateral crackles (Velcro crackles)

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40
Q

Causes of transudate pulmonary effusion

A

CHF
Cirrhosis
Low albumin
Nephrotic syndrome has

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41
Q

Causes of exudative plural effusion.

A 
Pneumonia 
Malignancy 
PE
Viral infection 
TB
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42
Q

What’s central sleep apnea

A

Cessation of airflow 10 seconds without resp effort result in unstable resp control center

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43
Q

What worsens central sleep apnea

A
  1. Low CO2: high altitude, cheyne-stroke

2. Slow circulation: CHF

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44
Q

Role of sedatives in central sleep apnea

A

Helpful

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45
Q

Indication of sever apnea?

A

Apnea-hypopnea index > 29

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46
Q

1st line Rx in sever sleep apnea?

A

CPAP

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47
Q

Acute resp alkalosis acid-base labs

A

PH > 7.45
O2 normal
CO2 < 40

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48
Q

Anaerobic lung abscess classic

A

Risk of aspiration
Productive cough + fever
Poor dental hygiene
Bad mouth odor + sputum odor.

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49
Q

CBC changes in COPD? Why?

A

Increased RBC mass + erythropoietin

=> low O2 stimulates bone marrow => secondary polycythemia

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50
Q

What’s pulsus paradoxus? What does it indicate?

A

10 mmHg decrease in SBP on inspiration

Asthma

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51
Q

How to assess severity of asthma attack?

A
  1. Mild:
    O2 > 94%
    PEF 70% expected
  2. Moderate:
    O2 < 90
    PEF < 40% expected
    Pulsus pardoxus
  3. Sever:
    PEF < 25% expected
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52
Q

Rx of acute asthma attack?

A

Inhaled SABA
Prednisolone (oral / IV)

O2 supplement given if O2 < 90%

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53
Q

Def of sleep apnea

A

> 5 obstructive events / hr

Daytime sleepiness

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54
Q

Sleep apnea association

A

Obesity
Older age
MEN
HTN

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55
Q

Overflow fecal incontinence classic

A

Common in institutionalized elderly due to constipation meds.

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56
Q

Cause of reduced storage fecal incontinence

A

IBD

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57
Q

Hereditary theombophilia

A 
Factor V Leiden
Prothrombin 20210A
Protein C
Protein S
Antithrombin deficiency
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58
Q

Most common hereditary thrombophilia

A

Factor V Leiden

59
Q

Rx of PE

A

Heparin 3-7 days
Warfarin 6 months
INR 2-3

60
Q

When to use tPA in PE

A

Patient with low BP

61
Q

Role of anti-thrombin in PE?

A

Prophylaxis pre or post op

62
Q

What does flat inspiratory loop indicate

A

Extra-thoracic pulmonary obstruction

63
Q

What to r/o in asthma not responsive to Rx?

A

Vocal cord dysfunction

64
Q

Vocal cord dysfunction classic

A

Episodic tightness of throat
SOB
Choking sensation
Cough

65
Q

Dx vocal cord dysfunction

A

Fiber optic laryngoscope

=> paradoxical inspiratory movement +/- expiratory partial closure of cords.

66
Q

Rx of vocal cord dysfunction

A

Speech therapy

Breathing techniques

67
Q

Cause of vocal cord dysfunction

A 
Occupational exposure (glutaraldehyde + chloride in swimmers) 
Psychological stress
68
Q

Rx of sarcoidosis limited to hilar lymphadenopathy

A

Observation

69
Q

Role of Na cromolyn in asthma attack

A

No role

Used in prophylaxis.

70
Q

Blood gases in PE

A

High A-a gradient
PH > 7.45
CO2 < 40
O2 low

Resp alkalosis

71
Q

Sarcoidosis Rx

A

Observation
Prednisolone (1st)
MTX (2nd)

72
Q

Garland’s triad

A

Sarcoidosis

  1. Bilateral hilar LN
  2. rt paratracheal LN
73
Q

Stages of sarcoidosis

A

0: normal CXR
1: lymphadenopathy
2: LN + lung disease
3: lung disease only
4: fibrosis.

74
Q

Cause of silicosis

A

Crystalline-free silica inhalation form cement.

75
Q

Causes of resp alkalosis

A

Fever
Low O2
Salicylate
Tachypnea

76
Q

Spirometer in asthma

A

Reduced FEV1

Reduced FEV1/FVC

77
Q

Restrictive pattern on spirometer

A

Low FVC
Low FEV1 < 70%
Normal or high FEV1/FVC

78
Q

Drugs cause pulmonary fibrosis

A

Amiodrone
Amphotericin B
Acebutolol
Carbamazepine

79
Q

Investigations of dysphagia

A

Barium swallow

Manometer and

80
Q

Which is more effective in acute COPD:

Albuterol or levalbuterol?

A

Same

81
Q

Which is better during acute COPD oral or IV steroids

A

Same.

82
Q

MCC of chronic cough (order)

A
  1. Upper airway cough = Postnasal drip
  2. Asthma
  3. GERD
83
Q

Rx steps in acute asthma

A
  1. SABA
  2. Systemic steroids
  3. Ipratropium
  4. Admit if no response in 4-6 hrs.
84
Q

Dx bronchiectesis

A

HRCT

85
Q

CXR in bronchiectasis

A

PeriBronchial thickening (tram track)

Increased vascular markings

86
Q

Period of cough in acute bronchitis

A

20 days (> 2wk)

87
Q

MCC of acute bronchitis

A

Viral infection

88
Q

Purulent sputum in acute bronchitis indicates?

A

Airway desquamation

89
Q

MCC of 2ry spontaneous pneumothorax

A

COPD

90
Q

Pleuropulomnary nocardiosis classic

A

In immunocompromised
Sx: night sweat, fever, cough.
CXR: multiple infiltrates.

No response to pneumonia Rx

91
Q

Dx nocardia?

A

Modified AFB => fire-faraco stain.

Weakly positive on AFB

92
Q

Rx of nocardia

A

Sulfonamides => sulfasalazine or TMP/SMX

93
Q

Pneumocystis vs nocardia?

A

Both give same finding
Stain:
Pneumocystis doesn’t stain AFB, stains silver.

Nocardia is weakly positive in AFB + stains w/ fite-faraco

94
Q

Rx of coccidioides immits

A

Ketoconazole

95
Q

1st step in tension pneumothorax

A

Needle Thoracentesis

Then chest tube.

96
Q

Red flags in hiccups

A

> 2 days

Waking patient from sleep

97
Q

Military TB on CXR

A

Diffuse small nodules

98
Q

ECG finding in PE

A

S1Q3T3

99
Q

McGinn-White sign

A

S1Q3T3 on ECG

Indicates Rt heart strain

100
Q

High mountain sickness classic

A 
8-96 HR of arrival
Headache 
Poor sleep
N/V
Anorexia
101
Q

Rx acute mountain sickness

A

Prevention = slow ascent, high carb diet or acetazolamide.

1- Slow descent
Oxygen
Hydration

2- Hyperbaric chamber

3- Acetazolamide
Dexamethasone

102
Q

What’s acetazolamide

A

Carbonic anhydrase inhibitor

Cuz metabolic acidosis via loss of HCO3

103
Q

Rx of acute COPD

A 
ABC
O2
Bronchodilator neb
Systemic steroids (IV soulmedrol)
Abx: doxy, TMP/SMZ, amoxi/clavu
104
Q

Causes of increased A-a

A

Alveolar collapse (atelectasis)

Pneumonia
PE

Intracardiac shunt
Vascular shunt

Asthma
COPD
ILD

Pulmonary vascular Dz

105
Q

Spirometer in vocal cord dysfunction

A

Flat inspiratory flow volume loop

Normal exploratory

106
Q

Exposure to asbestosis

A

Ship yards

107
Q

Asbestosis Classic

A

Dyspnea
Dry cough
Basal velcro crackles

108
Q

PFT in asbestosis

A

Restrictive

109
Q

CXR of adenocarcinoma

A

Peripheral lung nodules

110
Q

Mesothelioma on CXR

A

Obliteration of diaphragm

Modular thickening of pleura

Sheet like encasement of pleura.

111
Q

Drugs contraindicated w/ mountain sickness

A

Diuretics

BB

112
Q

Major issue w/ CPAP in sleep apnea

A

Compliance

113
Q

Spirometer value affected by age?

A

FEV1/FVC
Increased Functional residual capacity

Low vital capacity

Normal total lung capacity

114
Q

T/F: spirometer doesn’t measure airway dimensions

A

T

115
Q

What’s antifreeze

A

Ethylene glycol

116
Q

Ethylene glycol ingestion causes what?

A

Metabolic acidosis.

117
Q

Corticosteroids for COPD

A

No effect on mortality

Reduce exacerbation

No risk of cataract or fracture

Risk of candida

118
Q

Feature of malignant pulmonary nodule

A 
> 10mm
Irregular borders 
Ground glass 
No calcification or eccentric calcification 
Double in 1 mo - 1 year
119
Q

ARDS Rx

A

Oxygen (mask or ventilator)

120
Q

Lights criteria (transudate vs exudate)

A

Fluid/serum ratio of protein + LDH

LDH fluid/serum > 0.6
Protein fluid/serum > 0.5

=> exudate

121
Q

MCC of hemoptysis

A

Lower RTI

122
Q

ILD vs bronchiactsis if clubbing present?

A 
ILD = fine crackles 
Bronchiactsis = coarse
123
Q

Lung abscess CXR

A

Cavity w/ necrotic debris

124
Q

MCC of aspiration lung abscess

A

Post op from aspiration

125
Q

Rx of lung abscess

A

Clindamycin

126
Q

Pleuritic rub in PE indicates?

A

Pleural infarction

127
Q

Pleural effusion classic

A

Decreased breath sounds
Decreased fremitus
Dull percussion
Tracheal deviation to opposite site.

128
Q

Bronchiotis obliterans seen w/?

A

Lung + BM transplant

129
Q

Bronchiolitis obliterans CXR

A

Hyperlucency

130
Q

V/Q scan in bronchiactsis obliterans

A

Moth-eaten

131
Q

PFT in bronchiolitis obliterans

A

Low FEV1

Normal DLCO

132
Q

Stages of CO toxicity

A

HbCO < 20%
Headache, dizziness, blurry vision.

HbCO 20-40%
Confusion, syncope, chest pain, rhabdomyolysis

HbCO 41-60%
Arrhythmia, low BP, MI, seizure

HbCO >60%
Death

133
Q

CO toxicity Rx

A

Stop exposure
Oxygen (non-rebreather)
CarboxyHgb level.

134
Q

Decide level of CO toxicity

A

Carboxy-Hgb level

135
Q

When to use hyperbaric oxygen in CO toxicity

A

Moderate to sever control

Carboxy-Hgb > 20%

136
Q

Drug contraindicated in asthma? Why

A

Non selective BB

Cause constriction

137
Q

Palliative Rx for patients on death rattle?

A

Anti cholinergic to decrease secretions

E.g. Glycopyrrolate

138
Q

Rx pulmonary edema

A
  1. Preload reducers:
    Diuretics = furosemide
  2. Morphine:
    Rx cardiac pulmonary edema
    To decrease catecholamines + SVR.
  3. After load reducers:
    Nitroprusside (pre + after load)
    Enalapril (after load, SV, CO)
139
Q

Theophylline toxicity classic

A 
When > 20 mcg/ml 
High HR 
N/V + diarrhea 
Irritability, restlessness 
Agitated maniac behavior 
Thirst 
Muscle twitch
140
Q

Use of peak flow in asthma

A

Monitor not Dx

141
Q

Rx of cardiac pulmonary edema

A

ABC
1. Preload reduction
Nitroglycerin (most effective)

  1. After load
    ACEI
  2. +/- inotropic support
142
Q

Rx of status asthmaticus

A

SABA
Hydration
IV steroids
+/- intubation

143
Q

Which is better in acute asthma meter dose inhaler or nebulizer? Why?

A

Inhalers

  1. Greater improvement in peak flow rate
  2. Better blood gases
  3. Lower cost, hospital stay.
  4. Lower relapse.
  5. No difference in hospital admission rate.

CanQB (16 decks)

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