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Internal Medicine - MCCQE 1 > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

What is the criteria for long term home oxygen therapy in patients with COPD?

A

Po2 <55mmhg or So2 <88%
or
pt with right heart failure, cor pulmonale Po2 >59mmhg or So2 <89%

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2
Q

What are the normal physiologic pulmonary changes in pregnancy?

A

Decreased (TLC, residual volume and functional residual capacity);
Increased (minute ventilation due to increased tidal volume)
Unchanged (Vital capacity and FEV1)

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3
Q

what effect does system glucocorticoids have on leukocytes?

A

increased leukocytosis with neutrophilic predominance whereas decrease in lymphocytic and eosinophilic counts

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4
Q

What is MOA of theophylline and its toxicity?

A

It is a phosphodiesterase inhibitor. It has a narrow therapeutic index. Toxicity involves CNS (headaches, insomnia, seizures), GI (nausea, vomiting) and cardiac (arrhythmia). Metabolized by cytochrome oxidase system in liver. Inhibited by medication, infections or underlying diseases. Next best step is to measure serum Theophylline levels.

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5
Q

What does patient with acute asthma exacerbation usually have?

A

hyperventilation resulting in decreased PaC02, low pH and respiratory alkalosis

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6
Q

What signals impending respiratory failure in acute asthma exacerbation?

A

normal or rising PaC02 indicating fatigued respiratory accessory muscles suggesting impending respiratory failure. probably need intubation

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7
Q

How can oxygen supplement in patients with advanced COPD worsen hypercapnia?

A

Increased dead space perfusion causing V/Q mismatch; Decreased affinity of oxyhemoglobin for CO2; decreased respiratory drive and reduced minute ventilation

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8
Q

How to diagnose and treat patients with alpha 1 antitrypsin?

A

Diagnose by measuring serum levels of AAT and treatment is with IV supplementation with human AAT

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9
Q

What factors can provide mortality benefit in patients with COPD?

A

Smoking cessation; Long term home O2 therapy; lung reduction surgery

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10
Q

What is NSAID exacerbated respiratory disease (AERD)?

A

non-IgE, non-immunologic rxn that occurs when COX inhibitors (eg, aspirin, other NSAIDs) promotes imbalanced production of leukotrienes over prostaglandins. Leukotriene&raquo_space;> prostaglandins

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11
Q

Worsening of hyponatremia after the infusion of normal saline in patient with pneumonia? What pathology is it?

A

SIADH resulting hypotonic hyponatermia in euvolemic patient

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12
Q

What is the second most common cause of Primary adrenal insufficiency worldwide?

A

PAI due to miliary TB causing infectious adrenalitis

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13
Q

What is Light criteria?

A

Protein(lung)/Protein(serum) >0.5;
LDH(lung)/LDH(serum) >0.6;
Pleural fluid LDH >2/3 of normal serum LDH

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14
Q

What is CURB-65?

A

Confusion; urea >20mg/dL; Respiration >30/min; BP (Sys <90 or Diastole <60); Age >65

0-1 points = outpatient tx
1-2 points = Admit
>3 points = ICU

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15
Q

What is the recommended therapy for outpatient CAP?

A

Healthy patient: Amoxicillin or doxycycline

Comorbidities: fluoroquinolone or Beta-lactam + macrolide

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16
Q

What is the recommended therapy for hospitalized (non-ICU) CAP?

A

Beta-lactam+macrolide or Flouroquinolone

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17
Q

What is the recommended therapy for hospitalized (ICU) CAP?

A

Beta-lactam+Macrolide
or
Beta-lactam+Fluoroquinolone

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18
Q

how to diagnose chronic pulmonary aspergillosis?

A
  1. > 3 months of sxs (B type sxs, cough)
  2. Cavitary lesion with or without aspergilloma
  3. positive aspergillus IgG serology
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19
Q

What is the most important part of the CAP diagnosis?

A

Chest X ray; The diagnosis of CAP requires the presence of lobar, interstitial, cavitary infiltrate of chest imaging. Sputum and blood cultures are typically not required in the outpatient setting as empiric oral antibiotics are almost always curative.

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20
Q

What is the next best step when pleural effusion is suspected or diagnosed?

A

Diagnostic thoracentesis, a minimally invasive bed-side procedure.
*Except in patients with CHF where a trial of diuretic is warranted.

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21
Q

Which hypertensive medication needs to be used with caution in patients with hypoxemia?

A

Nitroprusside - use with caution in COPD patient as they have hypoxemia due to pulmonary vasoconstriction. Nitroprusside is a vasodilator and will worsen hypoxemia by interfering in physiologic vasoconstriction and worsening V/Q mismatching.

22
Q

What is the volume status in SIADH?

A

Euvolemic hyponatremia

23
Q

What are the effects of positive pressure ventilation in cardiogenic pulmonary pressure?

A

Decreases the Left Ventricular preload and afterload to promote LV diastolic filling and systolic ejection, decreasing pulmonary congestion and enhancing oxygen delivery.

24
Q

What is bronchiolitis obliterans?

A

relentless fibrosis of the bronchioles that results in severe and irreversible airflow obstruction and obliteration of the terminal bronchioles. Commonly seen in lung and bone marrow transplantation. CXR shows hyperlucency of the lungs while VQ scans show classic moth-eaten appearance.

25
Q

What are the 4 steps and their Tx in asthma?

A

Step 1 is Intermittent and Tx is Albulerol INH.
Step 2 is mild persistent and Tx is SABA, ICS.
Step 3 is mod persistent and Tx is SABA, ICS+LABA.
Step 4-5 is severe and Tx is SABA, ICS+LABA and PO steroid

26
Q

Tracheal deviation + absent breath sounds + hypotension and JVD =???

A

Tension pneumothorax; emergent needle decompression required

27
Q

What are the highlights of management of COPD exacerbation?

A

Short acting bronchodilator therapy (Albuterol and ipratropium), systemic corticosterioids, antibtiotic therapy and oxygen therapy to achieve PaO2 >60mmhg and SaO2 88%-92%

28
Q

When are antibiotics indicated in patients with COPD?

A

Indicated in patients at least in 2 of the following: 1) dyspnea 2) sputum production 3) sputum purulence

29
Q

Episodic throat tightness, shortness of breath, choking sensation, and coughing?

A

Vocal cord dysfunction diagnosed with fiberoptic laryngoscopy and treatment with speech therapy, breathing techniques and reassurance.

30
Q

What is absorption atelectasis?

A

also called denitrogenation atelectasis is due to loss of partial pressure of nitrogen within the lungs. It happens when supplement oxygen supply slowly washes or pushes out the nitrogen within the alveoli which normally helps keep them open.

31
Q

In which case does BiPAP provides mortality and morbidity benefit?

A

In cases where there is respiratory acidosis, impending respiratory failure, or progressive fatigue due to increased work of breathing. For example, COPD exacerbation.
BiPAP is deleterious in the treatment of cases with respiratory failure such as ARDS, pneumothorax, or sepsis.

32
Q

What is next best site for biopsy in sarcoidosis when the presentation is atypical and no granulomas are present on the peripheral lymph nodes or skin lesions?

A

Perform biopsy of intrathoracic lymph nodes or lungs i.e Mediastinal and hilar lymph node biopsy using the transbronchial needle aspiration

33
Q

When is the home oxygen therapy for COPD is recommended?

A

PaO2 <55mmHg or SaO2 <88%

34
Q

What does spirometry for vocal cord dysfunction or glottic or epiglottic obstruction looks like?

A

Normal expiratory loop with flattened inspiratory loop

35
Q

Multisystem necrotizing granulomatous inflammation presenting with respiratory and renal involvement?

A

Granulomatous with Polyangitis aka Wegner granulomatosis

Positive C-ANCA - “Charles Wegner with Anca”

36
Q

Churg-Strauss Syndrome?

A

Allergic granulomatous angiitis with asthma, paranasal sinusitis and rapidly progressive glomerulonephritis. Eosinophilia is common. Positive P-ANCA

37
Q

What should be obtained as the primary test to establish patient with asthma?

A

Spirometry

38
Q

What is the most appropriate discharge instruction for patient suffered from acute opioid intoxication?

A

referring to family physician for review

39
Q

What is Goodpasture syndrome?

A

anti-glomerular basement antibody syndrome that causes acute glomerulonephritis and pulmonary hemorrhage. It is type II hypersensitivity inflammation.

40
Q

Which medications are used as monotherapy for the treatment of asthma?

A

Inhaled Glucocorticoids or leukotriene receptor antagonist

41
Q

What is the next best step after giving O2 in patient with carbon monoxide toxicity?

A

Next step is to evaluate the level of carboxyhemoglobin.

More than 60% level of HbCO is considered very severe and it is fatal and need hyperbaric O2 treatment.

42
Q

What is the initial management of COPD?

A

Starting on long-acting bronchodilators, LAMA (Long acting muscarinic ANTagonist) or LABA (Long acting beta AGONIST)

43
Q

What is the initial steps in the management of spontaneous pneumothorax in COPD patient?

A

Oxygen supplement via nasal cannula and next best step will be chest tube placement.

44
Q

Sudden increase in shortness of breath, unilateral decreased breath sounds on auscultation and hyperresonance to percussion in a patient with COPD hx is suggestive of what?

A

Spontaneous pneumothorax

45
Q

What is high altitude illness?

A

Decrease in inspired O2 when there is ascent >2500 m resulting in Decrease in PaO2. Sxs of hypoxemia such as n/v, headaches, dizziness. Hyperventilation as a compensatory mechanism increases the PaO2 but PaCO2 decrease resulting in Respiratory alkalosis. Rise in PaO2 due to hyperventilation reaches its limit due to feedback inhibition due to rising pH.

46
Q

How is Acetazolamide helps in the treatment of high altitude sickness?

A

Carbonic anhydrase inhibitor. It blocks reabsorption of NaHCO3 in the proximal tube to increase excretion of HCO3- and promptly assist in the metabolic compensation for respiratory alkalosis.

47
Q

PAH in systemic sclerosis is due to what?

A

Intimal smooth muscle hyperplasia of the pulmonary arteries; normal FEV1 and FEV1/FVC ratio.

48
Q

When to quit active smoking pre operative to avoid post op pulmonary complications?

A

> 4-8 weeks pre-operative

49
Q

What is the common side effect of ACE inhibitors?

A

Chronic non-productive cough due to increased circulating levels of kinins, substance P, thromboxane, and prostaglandins.

50
Q

What is the approach to patient with suspected pulmonary embolism?

A

Stablize the patient with IV access and O2, then access the patient for CI to anticoagulations. Contraindicated patients go through diagnostic test such as CT pulmonary angio and if Positive then IVC filter. If there is no contraindication, then access PE clinical suspicion in patient with Wells criteria. If PE likely then start IV heparin. If PE unlikely, then confirm it with diagnostic tools (also confirm it in PE likely patient). If yes then start or continue with IV heparin. If no, then stop it.

51
Q

What is modified Wells criteria?

A

[+3 points each for clinical signs of DVT or alternative diagnosis less likely than PE];
[+1.5 points each for HR>100, previous DVT or PE, recent surgery or immobilization];
[+1 point each for hemoptysis or cancer]

PE likely >4
PE unlikely <4

Internal Medicine - MCCQE 1 (13 decks)

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