Respirology

Question 1

Indications for home O2

Answer 1

PaO2 55%

Titrate PaO2 to 60-65% (spO2 > 90)
Home O2 for 15 hr/day, only for non-smokers
Shown to reduce complications of chronic hypoxia and increased daily activities independence

Question 2

Vaccinations in pts with COPD

Answer 2

Flu vaccine yearly

Pneumococcal vaccine at least once and repeated in 5-10 years

Question 3

COPD to consider when determining pharmacotherapy

Answer 3

• Symptoms (MRDC scale 0-1, >2)
• # exacerbations (2/year)
• Gold class (1-2 or 3-4)

Question 4

LAAC what does it improve

Answer 4

-lung function (debatable)
-decreased symptoms (dyspnea)
-decreased exacerbations
-improves exercise tolerance
?mortality

Question 5

LABA what does it improve

Answer 5

• lung function
• decreases symptoms (dyspnea)
• decreases exacerbations
• no effect on mortality OR exercise tolerance

Question 6

LAAC and LABA what does it improve

Answer 6

• improvement in health status
• may improve lung function(some studies for, some against)
• does not reduce frequency or severity of exacerbations

Question 7

Addition of ICS to to LABA benefits

TORCH study

Answer 7

• Decreased # exacerbations (NNT 4 for exacerbation/year; counterbalanced by increased risk of pneumonia associated with ICS NNH 17)
• Improvement in PFT
• improve symptoms
• Trend twds decreasing mortality

Question 8

Benefit of quitting smoking for COPDer

Answer 8

Low evidence for preventing exacerbations

-outstanding in improving COPD prognosis, slowing lung function decline, improvement QOL and symptoms

Question 9

Benefit of pulmonary rehab for COPDer

Answer 9

• For pts with mod-very severe COPD provided within 4 weeks of exacerbation
• can prevent exacerbations
• improve symptoms/QOL, exercise tolerance

Question 10

Definition of asthma

Answer 10

Increase of FEV or FVC >12% or > 200 cc

Question 11

Abnormal DLCO

Question 12

Normal FEV1

Answer 12

lower limit of normal if 80%

Question 13

Air trapping

Answer 13

Definition TLC > 120% predicted

Question 14

Fixed upper airway obstruction characteristic pattern on Flow volume loop

Answer 14

Flattening of both inspiratory and expiratory limbs of flow volume loop

Question 15

Variable intrathoracic obstruction results in what feature on flow volume loop

Answer 15

Flattening of expiratory limb (top)

Example could be carcinoid tumor of bronchus

Question 16

Variable extrathoracic obstruction results in what feature on flow volume loop

Answer 16

Flattening of inspiratory limb (bottom)

Examples could be thyroid tumor

Question 17

Restrictive lung disease definition

Answer 17

FEV1/FVC normal or increased

TLC

Question 18

Restrictive lung disease differential

Answer 18

Think PAINT
Pleural
-trapped lung
-pleural scarring
-large pleural effusion
-chronic empyema
-asbestosis

Alveolar

• edema
• hemorrhage

Interstitial
-ILD including IPF, NSIP, COP

Neuromuscular
-Myasthenia Gravis/ALS myopathy

Thoracic/extrathoracic

• Obesity
• Kyphoscoliosis
• Ascites