Respiratory Disease

Question 1

FEV1/FVC ratio in Obstructive vs Restrictive lung disease

Answer 1

FEV1 is reduced in both. However, the FVC (forced vital capacity) remains normal in obstructive. Therefore the ratio is reduced in Obstructive

Question 2

Asthma classification

• List 4 types
• What is key differentiating factor?
• Common treatment cocktails for each

Answer 2

Question 3

MOA of each med

• Albuterol
• Fluticasone
• Montelukast
• Ipratropium bromide

Answer 3

MOA of each med

• Albuterol = Beta 2 agonist increases cAMP and relaxes bronchial muscle
• Fluticasone = Decrease inflammatory response and mucosal edema
• Montelukast = Leukotriene receptor antagonist decreases bronchoconstriction
• Ipratropium bromide = Blocks cholinergic constriction causing bronchodilation

Question 4

COPD staging

• Based on. . ?
• Common treatment cocktails for each stage?

Answer 4

Question 5

Emphysema genetics

• What protein can be deficient in non-smoking associated emphysema?
• What other organ is affected?
• Age of symptom manifestations?

Answer 5

Alpha 1 antitrypsin

Liver and lung

Age 20-50yrs

Question 6

• Wells criteria score if PE likely
• Wells criteria score if PE unlikely

Answer 6

Wells >4 is likely PE

Question 7

ECG findings with PE

• S1Q3T3
• Heart rate
• New signs of strain on which side of heart

Answer 7

• S1Q3T3 = S wave lead 1, Q wave lead 3, T wave inversion Lead 3
• HR >100
• Right side heart strain

Question 8

Cheynes-Stokes breathing

• Characteristic pattern
• Sign of… (4 conditions)

Answer 8

Cheynes-Stokes breathing

• Alternating deep breaths with apnea

Sign of

• heart failure
• uremia
• drug-induced respiratory depression
• brain dmg

Question 9

Kussmaul respirations

• Characteristic pattern
• Sign of… (1 condition)

Answer 9

• Deep gasping hyperventilation
• Respiratory compensation for metabolic acidosis, most commonly DKA

Question 10

Respiration sounds

• Wheeze
• Stridor
• Rhonchi
• Inspiratory gasp
• Rales/crackles

Answer 10

Respiration sounds

• Wheeze - Asthma, many others
• Stridor - foreign body, epiglottis edema
• Rhonchi - Bronchitis
• Inspiratory gasp - Whooping cough
• Rales/crackles - PNA, CHF