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27 Flashcards

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1
Q

Bronchial thermoplasty criteria

A
  1. frequent intermittent or continuous oral steroids
  2. FEV1 >50%
  3. No life-threatening exacerbation in the past and <3 per year
  4. Willing to accept asthma exacerbation
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2
Q

Bronchial thermoplasty benefits

A
  1. Trend toward improved quality of life at 1 year

2. No difference in symptoms or PFTs

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3
Q

pulmonary neuroendocrine cells (PNECs) action

A

Airway chemoreceptors inducing vasoconstriction via serotonin secretion in response to hypoxia

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4
Q

Amiodarone associated pulmonary diseases

A 
Interstitial pneumonia
ARDS
Organizing pneumonia
DAH
Pulmonary nodules (solitary or multiple)
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5
Q

Drugs that cause eosinophilic pleural effusion

A

Warfarin, PTU, nitrofurantoin

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6
Q

What will increase expiratory flow rate

A 
Stiff lungs:
pulmonary edema
pneumothorax
pleural effusion
parenchymal lung disease
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7
Q

What will decrease expiratory flow rate

A

Airway obstruction

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8
Q

Amiodarone associated pulmonary diseases risk factors

A

Dosage >400 mg/day
Duration of therapy >2 months
Age >60
Preexisting lung disease, surgery, contrast administration

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9
Q

Amiodarone toxicity on BAL

A 
Foamy macrophages (also in organizing pneumonia and aspiration)
Eosinophilia (evidence of hypersensitivity)
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10
Q

Grade 1 FEV1

A

> 80%

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11
Q

Grade 2 FEV1

A

50-79%

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12
Q

Grade 3 FEV1

A

30-49%

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13
Q

Grade 4 FEV1

A

<30%

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14
Q

DAH BAL findings

A

> 20% hemosidorin laden macrophages

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15
Q

Hydrogen sulfide poisoning

A

Rotten egg odor
Common cause of inhalation toxic exposure in petroleum industry
Can cause temporary or permanent dysfunction to multiple organ systems

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16
Q

Carbon monoxide poisoning symptoms

A 
Headache
Fatigue
Dizziness
Drowsiness
Nausea
Prolonged exposure: vomiting, confusion, LOC
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17
Q

Toluene diisocyanate symptoms

A

Skin and lung sensitization; can cause asthma, lung damage

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18
Q

Toluene diisocyanate found in

A

Adhesives and paints

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19
Q

Cadmium poisoning

A

Long term exposure: cancer and/or toxicity in multiple organs; emphysema

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20
Q

Dupilumab MOA

A

directed at the a-subunit of IL-4 receptor which can modulate signaling for IL-4 and IL-13

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21
Q

IL-4 and IL-13

A

Important role in IgE synthesis, mucous secretion, and eosinophil recruitment

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22
Q

Omalizumab MOA

A

Targets free IgE, preventing it from binding to receptors on mast cells, eosinophils, and basophils

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23
Q

When to use Dupilumab

A

Add-on maintenance therapy for oral corticosteroid dependent asthma, regardless of phenotype

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24
Q

When to use Omalizumab

A 
- positive skin test 
or 
- in intro reactivity to a perennial aeroallergen 
And
- IgE of 30-700
>12 years old
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25
When to use Mepolizumab
Add on in asthma | Eosinophil level >150 cells
26
When to use Reslizumab
Add on in asthma | Eosinophil level >400 cells
27
Mepolizumab and Reslizumab MOA
Directed against IL-5
28
Thoracic splenosis when does it occur
After left hemidiaphragmatic injury and splenic rupture | Usually 20 year interval
29
When is methylene blue indicated
Methemoglobin >30%
30
Methylene blue dosing
1-2mg/kg over 5 minutes
31
When will methylene blue lead to methemoglobinemia
Dose >15mg/kg | Patients with G-6-PD deficiency
32
Respiratory system compliance
Tv divided by the inflating pressure (Plateau pressure minus PEEP)
33
How to measure perfusion pressure of the abdomen?
MAP - intra-abdominal pressure
34
What intra-abdominal pressure is low
When MAP - intra-abdominal pressure is <60
35
Roflumilast MOA
Increases intracellular cAMP which inhibits PDE-4 leading to decreased inflammation
36
Roflumilast SE
N/V Weight loss Psychiatric reactions
37
NIV criteria in COPD
NIV use during hospitalization and remain hypoxemic and hypercarbic (PaCO2 > 52), 2 weeks after discharge
38
Which immunologic mechanism is measured by Quantiferon Gold
Delayed hypersensitivity
39
Granulomatosis with polyangiitis maintenance immunotherapy
Azathioprine Methotrexate Rituximab
40
Protective effect on asthma (conversion from Th2)
IFN-gamma IL-12 IL-18
41
Asthma Th2 interleukins leading to disease
``` IL-4 IL-5 IL-9 IL-13 IL-17 IL-25 ```
42
Neutrophilic asthma TH
TH 17
43
Pro-inflammatory cytokines that enhance asthma
IL-1B IL-6 TNF-a TSLP
44
Where do leukotrienes in asthma come from
Action of 5-LO on arachidonic acid
45
Leukotrienes important in asthma
LTC4 | LTD4
46
Common leukotrienes LTC4 and LTD4 receptor
CysLT1
47
IL-5 action in asthma
Differentiation and maturation of eosinophils
48
IL-13 action in asthma
Recruitment of eosinophils into the airway
49
IL-4 and IL-13 action in asthma
IgE production by B-cells
50
IgE action
Activates mast cells and basophils which produce leukotrienes that recruit and activate eosinophils
51
Indirect bronchial challenge testing
Exercise Hypertonic saline Mannitol
52
How dose indirect bronchial challenge with exercise/hypertonic saline/mannitol work?
Increased osmolarity of airway surface leads to mediator release from mast cells or basophils
53
Direct action on smooth muscle to provoke asthma
Methacoline challange
54
Direct stimulation of sensory nerve endings in asthma
Sulfur dioxide Bradykinin Allergens
55
Indirect vs direct stimulation test for asthma
More specific but less sensitive | Best choice when exercise bronchospasm is the question
56
Exhaled nitric oxide of >35 parts per billion associated with
eosinophilic airway inflammation Risk of asthma exacerbation Non-adherence to inhaled steroids
57
Exhaled nitric oxide use
Can predict response to inhaled steroids and anti-IgE therapy (anti IL-4, 5 and 13)
58
Exercise induced asthma diagnosis
15% decrease in FEV1 after exercise
59
What is elevated in aspirin exacerbated respiratory disease
Blood eosinophils and serum IgG4 subclass levels, persistent airway inflammation
60
How can you test for aspirin exacerbated respiratory disease?
Can check urine leukotrienes after challenge
61
What ACT score means asthma control?
>20
62
What ACT score asthma poorly controlled?
<15
63
Intermittent asthma definition
Symptoms <2d/week Nighttime awakening <2x/month SABA use <2x/week Normal FEV1
64
Mild persistent asthma definition
Symptoms >2d/week but not daily Nighttime awakening 3-4x/month SABA use >2x/week but not daily Normal FEV1
65
Moderate persistent asthma definition
Symptoms daily Nighttime awakening >1x/week SABA use daily FEV1 >60% but <80%
66
Severe persistent asthma definition
Symptoms throughout the day Nighttime awakening nightly SABA use throughout the day FEV1 <60%
67
Do inhaled steroids prevent airway remodeling?
No
68
How frequently to step down asthma therapy?
Every 6-8 weeks
69
Zileuton in asthma
5-LO agent
70
What works on the CysLT1 receptor in asthma?
Montelukast Zafirlukast Pranlukast
71
Asthma, skin rash, pulmonary infiltrates and peripheral eosinophilia
EGPA (churg Strauss)
72
Therapeutic window for theophilline
8-12 ug/dL
73
Theophilline toxicity symptoms
``` Tremors Palpitations N/V Arrhythmia Seizures Death ```
74
What decreases with omalizumab use
Decreased exacerbation | Minimal effect on lung function
75
IL-5 in asthma
eosinophil maturation, activation, and recruitment
76
Benralizumab MOA
Tags onto IL-5 receptor
77
Alpha 1 antitrypsin deficiency mutation in what gene?
SERPINA1
78
What is Alpha 1 at deficiency?
An imbalance between neutrophil elastase in the lung (which destroys elastin) and the elastase inhibitor alpha-1 antitrypsin (which protects against proteolytic degradation)
79
UPLIFT trial
Tiotropium exacerbation reduced
80
TORCH trial
LABA/ICS associated with a reduced COPD exacerbation, trend towards improved survival Higher incidence of PNA using ICS
81
Benefits of pulmonary rehab
Reduced hospital admission Reduced mortality Improved quality of life Improved exercise capacity
82
What does NIPPV in COPD do?
If PaCO2 >52 at baseline, if dropped to <48 post hospitalization can improve survival
83
Focal Bronchiectasis
Mechanical obstruction Congenital bronchial atresia Necrotizing PNA
84
How to reduced viscosity of secretions in CF?
Dornase alpha | Hypertonic saline
85
Anti-Inflammatory therapy in CF
Azithromycin IF colonized with Pseud | High dose ibuprofen in 6-17 yo ONLY
86
Diagnosis of OHS
BMI >30 | Diurnal pCO2 >45
87
What are the primary lymphocytes involved in pathogenesis of COPD?
CD8+ cytotoxic T cells
88
When measuring volume response in intubated patients, what must be present?
``` Passive (paralyzed) In sinus rhythm Vt of at least 8mL/kg predicted body weight Abdominal pressure <12 HR/RR of >3.6 ```
89
What is reduced on PFTs in obesity?
ERV and FRC
90
How to differentiate work exacerbated VS occupational asthma
Lack of change in sputum eosinophil count after being away from work and unchanged airway hyper-responsiveness
91
Centrilobular nodules and tree in bud in a clustered pattern
Suggestive of mycobacterial, fungal, bacterial infection
92
Tree in bud in a diffuse distribution
Suggestive of panbronchiolitis, viral infection, cystic fibrosis
93
Centrilobular nodules without tree in bud diseases
Subacute hypersensitivity pneumonitis Respiratory bronchiolitis (RB-ILD) Lymphocytic interstitial pneumonitis (LIP) Early Langerhans
94
Perilymphatic nodules location
Subpleural and peribronchovascular and along the interlobular septa, usually upper lobe predominant
95
Perilymphatic nodules diseases
Sarcoidosis Carcinomatosis Silicosis
96
Random nodules location
Random but mostly lower lobe predominant, sub pleural
97
Random nodules diseases
Hematogenous spread, malignancy, miliary PNA
98
Bronchiolitis obliterans CT chest
Clear CT with mosaic is on end-expirations imaging c/w air trapping; bronchiectasis may develop
99
Bronchilolitis obliterans definition
Airflow limitation in the absence of other etiologies but without confirmatory pathology; decrease in FEV1 > FVC on 2 spirometries 3 weeks apart
100
Bronchiolitis obliterans treatment
Azithromycin for minimum 3 months and check spirometry after
101
Risk of pulmonary edema at what altitude
>8000 feet or 2500 meters
102
BODE index - B
BMI >21 vs <21
103
BODE index - O
Obstruction, FEV1 | 0 = >65% then go down by 15%
104
BODE index - D
``` Dyspnea based on mMRC 0 = mMRC 0 or 1 1 = mMRC 2 2 = mMRC 3 3 = mMRC 4 ```
105
BODE index - E
Exercise in 6 minutes | 0 = >350 feet then go down by 100 feet
106
BODE 4 year survival 0-2
80%
107
BODE 4 year survival 3-4
67%
108
BODE 4 year survival 5-6
57%
109
BODE 4 year survival 7-10
17%
110
mMRC 0
Dyspnea only with strenuous activity
111
mMRC 1
Dyspnea with hurrying or slight hill
112
mMRC 2
Walks slower than ppl own age
113
mMRC 3
Stops after 100 yards
114
mMRC 4
Too dyspneic to leave the house

My Pulmonary Boards (6 decks)

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