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2020 > Resp > Flashcards

Resp Flashcards

1
Q

Cut offs for positive, borderline, and negative methacholine challenge test?

A

Methacholine Challenge – look for drop in FEV1 by 20%
– PC20 <4mg/mL = POSITIVE
– PC20 4-16 = borderline
– PC20 >16 = negative

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2
Q

Cut offs for positive asthma exercise challenge test?

A

Fall in FEV1 of >10% and >200mL from baseline

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3
Q

Features of severe asthma.

How does this definition vary from uncontrolled asthma?

A

Asthma requiring treatment with high dose ICS + 2nd controller for previous year, or oral steroids for 50% of the year, to prevent it from becoming uncontrolled, or uncontrolled despite this therapy

Uncontrolled asthma is usually due to noncompliance, poor puffer technique etc.

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4
Q

Work up for severe asthma?

A
  • Total IgE
  • Peripheral eosinophil count
  • Sputum eosinophils and FeNO where available
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5
Q

Name 3 classes of biologics used to treat severe asthma

A
  1. Anti-IgE (Omalizumab) use for + IgE levels.
  2. IL-5 (mepolizumab, resilzumab, benralizumab)
  3. IL-4/IL-13 (Dupilumab)
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6
Q

Samter’s triad, what is the best treatment for this special population?

A

ASA exacerbated respiratory disease
(samter’s triad= asthma, nasal polyps,ASAa/NSAID sensitivity)
Tx: avoid ASA/NSAIDs, can treat like normal but usually good response to LTRA, desensitize to ASA if needed

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7
Q

Features and treatment of EGPA?

A

Eosinophilic granulomatosis with polyangiitis (EGPA/Churg Strauss)
– Asthma, eosinophilia, granulomatous vasculitis (cardiac, sinusitis, allergic rhinitis, transient pulmonary infiltrates, purpura, neurologic, GI)
–30-60% have positive p-anca
– Tx: prednisone, cyclophosphamide if severe disease

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8
Q

ABPA treatment?

A

Prednisone +/- itraconazole

Usually high total IgE and Aspergillis specific IgE

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9
Q

How long can symptoms of RADS last?

A

Reactive airways dysfunction syndrome (RADS)
Classic is chlorine spill
lasts > 3 months, treat like asthma exacerbation

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10
Q

Severity of Airflow Limitation in COPD based on FEV1?

A
  • Mild: FEV1 > 80% predicted
  • Moderate: 50% < FEV1 < 80% predicted
  • Severe30% < FEV1 < 50% predicted
  • Very Severe: FEV1 < 30% predicted
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11
Q

Non-pharm mgmt that improves mortality in COPD

A
  1. smoking cessation
  2. pulmonary rehab
  3. supplemental oxygen
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12
Q

Parameters to qualify for supplemental O2

A 
severe hypoxemia (PaO2<55 mmHg),  (SaO2 <= 88%)
 or
–  PaO2 = <60 with:
•  Cor pulmonale
•  Pulmonary hypertension
 •  Persistent erythrocytosis
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13
Q

Options for treatment for Dyspnea in end stage COPD

A

– oral (but not nebulized) opioids (Grade 2C)
– neuromuscular electrical muscle stimulation (Grade 2B)
– chest wall vibration (Grade 2B)
– walking aids (Grade 2B)
– pursed-lip breathing (Gr 2B)
– continuous oxygen therapy for hypoxemic COPD patients reduces mortality, and may reduce dyspnea

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14
Q

Benefits of steroid use in AECOPD Tx?

A

– Faster recovery time
– Increased FEV1
– Reduce length of stay

Give for 5-7 days, no not exceed 7

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15
Q

Indications for NIV in COPD?

A
  • pH ≤7.35 with pC02 ≥ 45
  • severe dyspnea (impending respiratory failure)
  • persistent hypoxemia despite supp oxygen

Can also be considered as a long-term treatment strategy in chronic hypercapnia (suggested PCO2≥52) and
history of hospitalization with acute respiratory failure

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16
Q

Interventions that definitely decreased risk of AE in COPD

A

Grade 1 recommendations:
– Annual flu vaccine
– Pulm Rehab (if RECENT exacerbation <4 weeks ago)
– Education and Case Management
– Inhaled pharmacotherapy [CTS 2017 update]
• LAMA > LABA monotherapy, LAMA/LABA > LABA/ICS (discussed in latest 2019 CTS guideline)

17
Q

What test would you send to work-up Primary Ciliary Dyskinesia?

A

nasal nitric oxide

18
Q

Radiographic features of UIP

A
  • Reticular changes
  • Subpleural, basal predominant
  • Honeycombing
  • Absence of GGO, nodules, cysts, mosiac attenuation
19
Q

Nephrotic syndrome, exudative or transudative pleural fluid?

A

Transudative

20
Q

Hypothyroidism, exudative or transudative pleural fluid?

A

Transudative

21
Q

PE, exudative or transudative pleural fluid?

A

Exudative

22
Q

Pancreatitis, exudative or transudative pleural fluid?

A

Exudative

23
Q

When is drainage of a pleural effusion indicated?

A

– drainage of frank pus/cloudy
– positive gram stain or culture
– pH <7.2 (if unavailable use glucose <3.4 mmol/L)
– >50% of hemithorax or loculations on imaging

– if no culture then treat for CAP plus anaerobes (empiric add anaerobic!)
• Usually prolonged antibiotic course (often at least 3 weeks, based on clinical and radiographic response)

24
Q

Size cutoffs for intervention of Pneumothorax?

A

– Small <2cm with minimal signs and symptoms = monitor

– If >2cm or signs and symptoms = needle aspiration +/- chest tube insertion – Surgery if persistent leak

25
Q

Features of Heerfordt’s Syndrome (Sardcoidosis syndrome)

A 
Heerfordt’s Syndrome
 –  Anterior uveitis
–  Parotid enlargement
–  Facial palsy
–  Fever (uveoparotid fever)
26
Q

Indications for treatment of Sarcoidosis?

A
  1. CNS- CN plasy
  2. Ocular- Anterior Uveitis
  3. CVS- heart block, arrhythmia, cardiomyopathy
  4. Resp- pHTN, bothersome symptoms, decrease PFTs
  5. Others: Usually treat liver, hyperCa, severe skin symptoms.
27
Q

Treatment of Sarcoidosis?

A

Erythema Nodosum—>NSAIDS
Pulm, mild, N PFTs—>inhaled ICS
CNS, ocular, CVS–> Pred 20-40mg daily x 3 months, then slow taper over 1 year. If refractory can add MTX

Usually effective but will increase risk of recurrence by 60-70%!

28
Q

Who needs treatment for OSA?

A
  1. Severe OSA
  2. OSA + HTN
  3. Severe symptoms
29
Q

Who should be NOT be allowed to drive with OSA?

A
  1. Severe daytime sleepiness
  2. Crash in last 5 years from falling asleep while driving and has not been on therapy
  3. Non compliant with CPAP.

Compliance= using >4 hours/night x 70% of nights in past 30 days.

30
Q

Definition of pulmonary HTN?

A

mean pulmonary artery pressure >20mmHg and PVR >3WU on right heart catheterization

*everyone now needs a R heart Cath!

31
Q

Isolated reduction in DLCO DDx

A
  1. PHTN
  2. Anemia
  3. Early ILD
  4. Emyphsema
  5. PE
32
Q

Isolated increased DLCO DDx

A

– Pulmonary hemorrhage/polycythemia
– Left sided heart failure

(apparently asthma can cause false positive?)

33
Q

Contraindications to PFTs

A
  1. Hemoptysis
  2. Pneumothorax
  3. Unstable cardiovascular status including recent MI
  4. Aneurysms–thoracic, abdominal or cerebral
  5. Recent eye surgery–eg.Cataracts
  6. Recent thoracic or abdominal surgery
  7. Presence of acute illness that may interfere with test performance
34
Q

Contraindications to Methacholine Challenge

A

– Absolute:
1. Severe airflow limitation FEV1 <50% or <1L
2. Recent MI or Stroke in last 3m
3. Uncontrolled HTN,SBP>200/100
4. Known Aortic Aneurysm
– Relative:
1. Moderate airflow limitation FEV1 <60% o r<1.5L
2. Pregnancy or nursing mothers (category C)
3. Use of cholinesterase inhibitor (myesthenia gravis)

35
Q

Making the diagnosis for asthma, what are the FEV1 cutoffs for spirometry, exercise, methacholine and diurnal variation?

A
  1. Bronchodilator- FEV1 increase>12% AND >200ml
  2. Improvement in lung function with anti-inflammatory treatment x 4 weeks:
    – Improvement in FEV1 by > 12% AND 200mL post BD
  3. Exercise- FEV1 decrease by >10% AND 200ml from baseline
  4. Diurnal PEF- FeV1 variability >10%, excessive variability in twice daily PEF over 2 weeks
  5. Methacholine- FEV1 decrease >20%
36
Q

FEV1 cutoffs for Pnuemonectomy and Lobectomy?

A

FITNESS FOR SURGERY
Pneumonectomy - FEV1 >2L or 80% Predicted
Lobectomy - FEV1>1.5L

37
Q

Benefits of ICS in asthma over SABA?

A
  • ↓Symptoms, Exacerbations, Asthma-Related Hospitalization and Death
  • ↑QOL and ↑ PFT

2020 (13 decks)

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