respiratory

Question 1

asthma soundbite

Answer 1

a reactive airway disease characterized by an obstructive pattern with hyper-responsiveness and inflammation

Question 2

in asthma what drugs are good to use and what to be avoided

Answer 2

bronchodilation - prop, ketamine, sevo, and isoflurane
histamine release avoided - meperidine, morphine
avoid beta blockers as they can cause bronchoconstriction
cautious with Nsaids and other cox inhibitirs

Question 3

what is samters triad

Answer 3

nasal polyps, asa sensitivity, asthma

Question 4

what is methacholine?

Answer 4

non-selective muscarinic receptor agonist that acts on smooth muscle to induce bronchospasm

Question 5

cystic fibrosis soundbite

Answer 5

autosomal recessive disease that alters chloride and water transport which prevents sodium reabsorption by epithelial cells, and can impact respiratory, GI, and reproductive system
CFTR gene

Question 6

cystic fibrosis diagnosis

Answer 6

sweat chloride concentration over 60 mEq/L
with
1)lung disease (obstructive, mucus plugging)
2) pancreatic insufficiency
3) CF in a first degree relative

Question 7

pre-op eval for CF patient

Answer 7

1) rule out infection
2) do chest physio
3) BMP, lfts, cxr
4) beta agonist pre-op
5) ketamine contraindicated because of increased secretions

Question 8

COPD soundbite

Answer 8

irreversible obstructive lung disease with either bronchitis or emphysema.

Question 9

how to classify COPD based on PFTs and treatment

Answer 9

all copd have reduced FEV1/FVC (less than 70% predicted)
-mild (1) - greater than 80% FEV1 - short acting bronchodilator
-moderate (2) - 50-79% FEV1 - long acting bronchodilator and anticholinergics (salmeterol, formoterol, bambuterol, /atroven, Spiriva, Combivent)
-severe (3) - 30-49% FEV1 - inhaled steroid
-very severe (4) less than 30% FEV1 - oxygen

Question 10

pre op/peri opcopd

Answer 10

local or hospital?
optimize with pulmonolgist
smoking cessation
ekg
cxr
chest physio
avoid nitrous (like CF)
allow down to 88% - oxygen deprivation drive.

Question 11

pulmonary embolism soundbite

Answer 11

complete or partial blockage of pulmonary arterial vasculature leading to ventilation-perfusion mismatch

Question 12

what criteria to predict pe? and components?

Answer 12

wells criteria
clinica s/s of dvt
high suspicion of pe as the diagnosis
hr greater than 100
surgery within one month or immobility for 3 d
hx of PE or DVT
malignancy
hemoptysis

Question 13

tx for PE

Answer 13

large - thrombectomy or fibrinolysis (TPA?)
smaller tx with heparin and bridge to warfarin or other oral anticoagulants

Question 14

when to anticoagulant for life with PE

Answer 14

massive PE
recurrent DVT
unprovoked PEE
malignancies