PANCE - pulm review

Question 1

when is the newborn screen for CF done

Answer 1

24-48 hrs after 1st feed

ALL neonates w meconium ileus should be evaluated

Question 2

tx for CF

Answer 2

clear airway secretions:
- chest physiotherapy
- HYPER-tonic saline

dornase alpha:
- mucolytic

ivacaftor:
- CFTR modulator that increases chloride transport

pancreatic enzyme replacement and fat soluble vitamins

Question 3

patho of chronic bronchitis

Answer 3

overproduction and hypersecretion of mucus by goblet cells

Question 4

definition of chronic bronchitis

Answer 4

chronic productive cough for at least 3 mo out of the yr for at least 2 consecutive yrs

Question 5

what is the DLCL in chronic bronchitis

Answer 5

NORMAL DLCL
*how to differentiate from emphysema

Question 6

what is the DLCL in emphysema

Answer 6

DECREASED DLCL

Question 7

how to dx chronic bronchitis

Answer 7

PFT
- decreased FEV1/FVC <70%
- NORMAL DLCL

Question 8

hemoglobin in chronic bronchitis

Answer 8

increased hemoglobin and hematocrit
-due to chronic hypoxia

Question 9

2 things that improve mortality rate in COPD

Answer 9

oxygen therapy and smoking cessation

Question 10

only use oxygen in COPD IF

Answer 10

O2 sat is < 88%

OR

PaO2 < 55%

Question 11

COPD Group A definition

Answer 11

minimal symptoms and infreq exacerbations

tx: SABA

Question 12

COPD Group B definition

Answer 12

more severe symptoms, but infreq exacerbations

tx:
SABA + LABA (salmeterol)
or
SABA + LAMA (tiotropium)
*LAMA’s are preferred

Question 13

COPD Group C definition

Answer 13

minimal symptoms, but freq exacerbations

tx: same as group B
SABA + LAMA
or
SABA + LABA

Question 14

COPD Group D definition

Answer 14

severe symptoms and freq exacerbations

tx:
SABA + LABA + LAMA
or
SABA + LABA + inhaled CS

Question 15

acute COPD exacerbation tx

Answer 15

macrolides (azithro)

SABA + ipratropium as breathing tx

Question 16

emphysema patho

Answer 16

enlarged air spaces due to alveolar septae destruction

*structural changes occur distal to terminal bronchioles

Question 17

centrilobular emphysema

Answer 17

MC in smokes

affects UPPER lobes

Question 18

panacinar emphysema

Answer 18

MC in alpha-1 antitrypsin def

affects LOWER lobes

*A1 sauce in the PAN

Question 19

CXR findings in emphysema

Answer 19

• flattened diaphragm
• bullae > 1cm
• hyperinflation
• small-thin heart

Question 20

ABG of PE

Answer 20

respiratory alkalosis

Question 21

what is the westermark sign or hampton hump

Answer 21

triangular or rounded pleural based infiltrate adjacent to hilum

seen in PE

Question 22

tx of PE

Answer 22

anticoagulation for 3 mo MINIMUM

heparin, followed by rivaroxaban after acute phase

Question 23

CXR findings of asbestosis

Answer 23

• interstitial fibrosis
• pleural thickening
• calcified pleural plaques* (on diaphragm or lateral chest wall)

Question 24

CXR findings of silicosis

Answer 24

• calcification of hilar nodes
  “eggshell calcifications”

Question 25

how to dx pneumoconiosis

Answer 25

PFT
- restrictive pattern w reduced diffusing capacity
*FEV1/FVC >80% or decreased FVC

Question 26

CT findings for idiopathic pulmonary fibrosis

Answer 26

• diffuse patchy fibrosis w pleural based honeycombing
• ground glass opacities on fine reticular pattern

Question 27

tx for idiopathic pulmonary fibrosis

Answer 27

antifibrotic drugs:
- pirfenidone
- nintedanib

oxygen therapy

lung transplant

Question 28

patho of sarcoidosis

Answer 28

systemic granulomatous dz characterized by NON-caseating granulomas

Question 29

lupus pernio is pathognomonic for what condition

Answer 29

sarcoidosis

violaceous plaques on cheeks, nose, and eyes