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2020 ABIM Awesome Review > Pulmonary Disease 9% > Flashcards

Pulmonary Disease 9% Flashcards

1
Q

Obstructive dz (dilated)

A

COPD, Bronchiectasis

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2
Q

Obstructive (constricted)

A

Asthma

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3
Q

Intrathoracic Restrictive (constricted)

A

Fibrosis, Sarcoidosis, pneumoconiosis

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4
Q

Extrathoracic Restrictive

A

Chest Cage: kyphosis, spondylitis, obesity.

neuromuscular: (M.gravis, GB syndorme, muscular dystrophy

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5
Q

Normal FEV1/FVC

A

> 80%

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6
Q

Obstructive dz FEV1/FVC

A

<80%

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7
Q

Restrictive dz FEV1/FVC

A

> 80%

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8
Q

COPD

A
  • dec FEV1,
  • dec FEV1/FVC ( <80%),
  • inc TLC, (#1..first thing you look at, best test restrict vs obstruct)
  • dec DLCO, (#2..2nd thing you look at)
  • inc RV
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9
Q

Asthma

A
  • dec FEV1,
  • dec FEV1/FVC,
  • inc TLC,
  • normal/increased DLCO, **
  • inc RV
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10
Q

Restrictive intrathoracic

A
  • dec FEV1,
  • nl FEV1/FVC,
  • dec TLC,
  • dec DLCO, **
  • dec RV **
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11
Q

Restrictive extrathoracic

A
  • dec FEV 1,
  • nl FEV1/FVC,
  • dec TLC,
  • nl DLCO, **
  • inc RV **
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12
Q

best test restrictive vs obstructive

A

TLC

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13
Q

DLCO 140% predicted, normal FEV1/FVC and TLC. most likely finding of …

A

alveolar hemorrhage

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14
Q

Inc DLCO

A

CHF, MS, ASD/VSD, PDA, polycythemia, asthma, squatting, exercise, alveolar hemorrhage.

any reason for increased blood to pulmonary vasculature.

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15
Q

Dec DLCO

A

COPD, restrictive lung dz, PE, PHTN, anemia, standing, valsalva.

anything impeding the flow of blood in thoracic cavity

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16
Q

Normal DLCO

A

asthma, CO poisoning

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17
Q

Fixed extrathoracic

A

tumors/tracheal stenosis….. both inspiratory (bottom) and expiratory (top) loops blunted….. confirm w/ bronch

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18
Q

Dynamic extra-thoracic obstruction

A

epiglottis, Vocal cord dysfxn (inspiratory - bottom loops blunted) … confirm w/ laryngoscopy.

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19
Q

Dynamic intra-thoracic obstruction

A

intrathoracic tracheomalacia - exhalatory (upper) loop blunted

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20
Q

Asthma

A
  • Paroxysmal
  • Inflammatory
  • Nonspecific reactive airway disease.

reactive to: dust, viral infection, cold or exercise, occupasional allergens: isocyanates (urethane paint), cotton dust (byssinosis), wood dust (cedar or oak), metal workers.

  • usually present with a combination of symptoms.
  • chronic cough –> SOB –> wheeze.
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21
Q

If pt has asthmatic symptoms (cough, SOB, wheeze)… what is the next diagnistic step?

A

PFT’s show –> obstructive changes with reversible broncospasm - responding to bronchodilators by increasing FEV1 by about 12%), then asthma is diagnosed.
- if no obst, but clinical suspicion is high, then methacholine challenge test to provoke bronchospasm and should respond to bronchodilator by about 12% increase in FEV1

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22
Q

Young man h/o asthma acute asthmatic attack treated with albuterol nebs - f/u now PFT will show

A

Obstructive defect (still has asthma dx)

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23
Q

35yo M paroxysmal non-prod cough >6months - no ohther sx - spirometry normal, no improvement with anti-histamine/cough meds

A

methacholine challenge test r/o asthma

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24
Q

woman in car factory SOB at work, worse at end of day, better at home, cxr normal

A

check peak flow at work AND home ** sen but not spec

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25
Q

Best way to tx patient with asthma

A

remove offending agent (PPI do not inc or dec sx of asthma)

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26
Q

Pt with asthma/eczema moves to new apt, asthma worse - with rug

A

remove rug, get plastic wraps for mattress, pillow etc

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27
Q

Asthma therapy: Intermittent (<2/wk, sx day, <2/mth sx night, FEV1>80%) tx?

A

no daily meds, rescue SABA

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28
Q

Asthma therapy: mild persistent (>2/wk, 2/month, FEV1 >80%)

A
  1. low dose ICS,
  2. cromolyn,
  3. leukotriene,
  4. theophylline
    they will tempt you with LABA
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29
Q

Asthma therapy: Moderate persistent - daily sx, >5/month at night, FEV1 60-80

A
  1. low - med dose ICS +

2. LABA (no beta without inh steroid)

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30
Q

Severe persistent (sx continuous, freq at night, FEV1<60)

A
  1. high dose inh steroid +
  2. PO steroids with attempts to wean

high dose inhaled steroids have been associated with increased risk of pneumonia.

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31
Q

Leukotriene modifiers may be effective treatment for…

A
  1. mild persistent
  2. allow dose reduction of inhaled glucocorticoids in moderate and severe persistent asthma
  3. ASA-sensitive asthma
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32
Q

Pt w/ Vasomotor rhinitis, nasal polyps develops asthma. allergy to NSAIDS. dx?

A

dx: ASA sensitive asthma
tx: d/c asthma, start leukotriene inhib (monteleukast)

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33
Q

Pt with ASA sensitivity asthma. you can use

A

codeine based analgesic, sodium or choline slicylates, NO COX1 NSAIDS

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34
Q

Pt with shoulder pain takes ibuprofen - coupel hours later with SOB/wheezing

A

NSAID induced broncospasm

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35
Q

Pt w/ asthma on mild-mod dose of inhaled steroids with incomplete response. wtd?

A

start PO theophylline

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36
Q

50yo post viral URI several weeks ago with persistent cough, inc’d at night with chest tightness, no heartburn, recent neg cardiac w/u - PFT with mild obstruction - wtd

A

methacoline challenge test -

dx: post viral hypersensitivity - tx with inhaled steroid (budesonide once a day)

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37
Q

Mainstay maintenance therapy for asthma

A

inhaled steroids

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38
Q

30yo F non-prod cough for several months, no heart burn tob or wheeze, PFT normal, methacholine neg - wtf

A

check sputum for eosinophils - (non-asthmatic eosinophillic bronchitis)

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39
Q

Pt with athma on beta agonist still with wheeze

A

add inhaled steroid

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40
Q

Pt with severe asthma exacerbation hospitalized with iv steroid and beta agonist - upon d/c wtd

A

switch to tapering dose of oral steroid -> start inhaled steroid, beta agonist PRN

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41
Q

In addition to reduction of acute/chronic asthma sx what do inhaled steroids do?

A

reduction of progressive loss of lung fxn in adults and increased symptom free days

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42
Q

Pt with asthma on albuterol prn with nocturnal awakening with sx of asthma best medcation

A

start with inhaled steroids -> THEN add long acting beta agonist

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43
Q

increased mortality in asthma related to…

A

inc FEV1 responsiveness

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44
Q

Pt with asthma p/w acute exacerbation - ABG 7.46/34/70/94% - pt receives neb tx with albut, after 3rd tx pt with BS b/l but decreased - now RR>30, HR 130, ABG 7.38/46/70/92% wtd

A

INTUBATE PT

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45
Q

oxygenation goal in asthma

A

PaO2>60, SaO2>90%

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46
Q

Pt with asthma being treated with b2 agonist, inhaled steroid, montelukast still has sx, removes carpet/rug, no cat - SERUM IgE high - wtd?

A

add omalizumab (anti-IgE ab)

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47
Q

Asthmatic on b2 agonist prn, inhaled triamcinolone, almeterol and monteleukast - still with frequent exacerbation, does not like to go on logn term oral steroids - wtd

A

start tiotropium (spiriva)

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48
Q

Chronic cough

A

upper airway cough syndorme (post nasal drip), asthma, GERD, chronic bronchitis, ACEi, non asthamatic eosinophilic bronchitis*

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49
Q

Exercise induced asthma

A

sx peak 10-15 after stopping exc, resove in 30 min mainly in cold weather - Dx with excercise challenge test in cold air (drop FEV1 by 10-12%)

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50
Q

Exercise induced asthma tx

A

short-acting B2 agonist 30 min prior to excercise - if no effect then add cromyln Na+ …ppx = TID

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51
Q

If exercise induced asthma SOB on cromoyln

A

add inhaled steroids and monteleukast (3rd line)

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52
Q

Pt moves to minnesota (cold weather) - SOB in cold

A

start B agonist inhaler

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53
Q

Mechaism of cromyln Na+

A

mast cell stabilization (dec histamine release)

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54
Q

Pt with exercise induced asthma started on albuterol inhaler also wakes up at night 3x/wk to use albuterol inhaler… wtd?

A

start inhaled steroid + LABA

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55
Q

Allergic Bronco Pulmonary Asergillosis (ABPA)

A

colonization of upper airway with aspergillus i asthmatics - intense immed hypersensitive type rxn - inc IgE, +skin rxn to aspergillus Ag, serology +IgM, IgE, +eos, +brownish mucous plugs - > migratory pulm infiltrates (eos PNA)

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56
Q

pt with steroid dependent asthma p/w cough, wheezing BROWN mucous plugs - WBC: 15% eos, IgE>2000, CXR b/l infiltrates - steroids recently decreased - has parakeet

A

Allergic Broncopulm aspirgillosis (ABPA)
- incr eosinophils, incr IgE
Tx: incr steroids

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57
Q

Hypersensitivity pneumonitis

A

neg eos, normal IgE

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58
Q

Allergic angiitis of churg stauss

A

+eos, normal IgE

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59
Q

Loeffler’s syndrome (pulm eosinophilia)

A

+eos, inc IgE

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60
Q

Fungal ball in cavity ASX

A

monitor

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61
Q

Fungal ball in cavity with severe hemoptysis

A

surgery

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62
Q

Hypersensitivity Pneumonitis

A

farmer’s lung - fever, chills dyspnea after work everyday, works in grian elevator, pet bird (bird fancier’s lung), methotrexate or nitrofurantoin or works with A/C units

tx: remove the offending agent

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63
Q

Etio - hypersensitivity pneumonitis

A

inhaling organic dust with thermophilic actinomycetes - CXR GROUND GLASS APPEARANCE WITH NO EOSINOPHILS, +serum AB - BAL: CD8>CD4 (opposite of sarcoidosis –> LY,PHOCYTOSIS.)

remove offending agents, +steroids

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64
Q

Pt with dog, cat, 2 parakeets and pigeon - cough, progressive SOB, CXR reveals INTERSTITIAL/ALVEOLAR infiltrates (ground glass) - WBC no EOS - PFT restrictive

A

hypersensitivity pneumonitis (bird fancier lung)

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65
Q

70yo M chills, fever, non prod cough, pleuritis CP - recent acute pharygitis - received PCN/Amp w/o improvemnt - CXR with RLL infiltrate - BCtx neg, myoplasma,legionella ab neg - Dx?

A

Chlamydia pneumoniae

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66
Q

Psittacosis

A

disease asx in birds - complement fixation and serology useful in dx

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67
Q

Pt with asthma on fluticasone inhaler/oral steroids - montelukast added, oral steroids tapered down - pw cough, sob, wk righ thand/foot - 25% eos, IgE elevated - cxr bilateral dense pneumonic infiltrates

A

allergic angiitis/Churg strauss pneumonitis - tx with steroids

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68
Q

Latin american pw asthma, recent immigrant - recurrent cough despite B2 agonists - eos 20%, round infiltrates on CXR - ANCA neg, ANA neg

A

Loeffler’s syndrome - strongyloides infxn - tx with thiabendazole

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69
Q

35yo non-smoker F pw cough, no sputum, wheezing, nighttime sweats - h/o asthma - b/l crackles on exam - PPD neg, high eos in sputum high ESR

A

chronic eos PNA - long term steroid treatment

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70
Q

35yo construction worker p/w SOB, no wheeze, no CP, no hemoptysis no exp to toxic fumes - b/l crackles - diffuse opacities/GG - bronch with copius tan fluid - alveolar proteinosis

A

whole lung lavage - defective macrophages causing buildup of surfactant in lungs

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71
Q

COPD

A

dx: h/o chronic smoking dec FEV1/FVC<0.70

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72
Q

COPD Spirometry determines?

A

Severity of disease

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73
Q

Gold Criteria Mild COPD stageI

A

FEV1/FVC <70%, +FEV1 >80 …………………. tx = SABA prn, albuterol +/- ipratropium (SAMA(atrovent*)

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74
Q

Gold Criteria Mod COPD stageII

A

FEV1/FVC <70%, FEV1 < 80% …………. tx = SABA prn plus LABA (tiotropium(LAMA(spiriva)) +/-salmeterol (LABA(Serevent))+/- rehab

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75
Q

Gold Criteria Severe COPD stage III

A

FEV1 <50%, …….SABA, LABA + ICS (LABA/ICS combos: symbacort, advair, dulera, breo)

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76
Q

Gold Criteria very severe COPD stage IV

A

FEV1<30 %- use long term O2 therapy at least 15hrs/day. consider sx

… stage 4 w/ acute exacerbation should be treated like CAP

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77
Q

Major risk factor for COPD

A

Smoking

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78
Q

Main tx for COPD

A

bronchodil, antichol, supp O2 SaO2>90%

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79
Q

Therapy survival benefit for COPD

A

O2 supp at least 15hrs/day

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80
Q

Pt with COPD hypoxia on O2 therapy, PO2 signficantly improves - cause of low PO2 is…

A

V/Q mismatch

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81
Q

Bronchodilators do what for COPD

A

reduce hyperinflation, dec RV, improve sx and exc tolerance - DO NOT IMPROVE MORTALITY

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82
Q

Tiotropium is better than Ipratropium

A

True. reduces exacerbations, hospitalizations, lung hyperinflations. improves exercise tolerance. works by blocking muscarinic receptors. more potent than SABA. Superior to Salmeterol at 6 months.

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83
Q

Side effect of salmeterol/tioproprium

A

dry mouth

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84
Q

Pt with COPD, +tob - best way to preserve lung fxn

A

quit smoking

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85
Q

Inc’d mortality in COPD

A

decreased free fat mass. not bmi

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86
Q

Criteria for starting O2 on COPD pt

A
  1. PaO2 <55mmHg or O2 sat of 88%. PaO2<59mmHg or O2 sat >88% with evidence of Cor pulmonale, 3. erythrocytosis (Hct>55%)*
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87
Q

Role of inhaled steroids COPD

A

decrease exacerbations

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88
Q

Adv COPD pt Pulm rehab

A

DOES NOT improve FEV1, does NOT dec mortality, does improve sx, QOL, dec exacerbations, reduced dynamic hyperinflation, reduced healthcare utilization

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89
Q

Pulm rehab doesn’t work, still low exc tol, ABG 7.42, PO2 62, pCO2 48 - FEV120, b/l upper lobe emphysema

A

lung volume reduction surgery*

if FEV1 < 20 –> lung transplant (improved QOL, decreased mortality, improved increased BMI, decreased dyspnea)

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90
Q

Pt gets sick everytime he goes up a mountain to ski. He wants to go back next year…. what is he best advcie for prevention?

A

acetazolamide 24-48hours prior… watch out for syncope from decr BP.

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91
Q

Pt goes to colorado for skiing, on top of the mountain at 8000ft, he gets dyspnea and develops pulmonary edema. Paramedics start O2.. what is the most immediate step.??

A

bring him down to lower altitude……. pulm edema = leading cause of death with altitude sickenss - h/a, n/v/fatigue, dizzines PLUS SOB - 8000 to 12000 ft - tx descent, dexamethalazone, prev with acetazolamide or nifedipine

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92
Q

Thophylline decrease clearance by…

A

CHF, Liver dz, hypoxia, fever, cipro, erythro, OCP

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93
Q

Young woman h/o asthma on multiple meds and OCP c/o n/v - tachycardia/tremors . this is most likely related to her use of …

A

theophylline . OCP incr theophylline level which can cause MAT

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94
Q

COPD with Po2 60 pCO2 50 - exacerbation of COPD - PO2 55 and pCO2 60 - refuses intubation

A

BIPAP

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95
Q

50yo COPD p/w SOB,cough - awake but in severe distress, using accessory muslces - pCO2= 74, pO2= 50, pH= 7.18, HR 120, RR 36, BP =100/68. wtd?

A

intubate, mech ventillation……..

indications to intubate pt? pH<7.25, RR>35, HR>120. (positive secretions if close to criteria, hemoptysis counts.)

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96
Q

Mortality reduction COPD pt

A

flu vaccine

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97
Q

30yo M extensive bullous emphysema, CXR: b/l basal bullous cysts. which test would you do

A

check serum alpha 1 antitrypsin level

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98
Q

58yo F recurrent cough, foul smelling yellow sputum with hemoptysis, h/o PNA >1 yr ago - CXR: prominent cystic spaces in RLL, streaking opacites in the direction of bronchial tree( tram lines). dx? confirm?

A

dx bronchiectasis, confirm w/ high res CT scan. TIP = h/o PNA in the past

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99
Q

Bronchiectasis/sinusitis, infertiility, sinus inversus

A

Bronchiectasis/sinusitis, infertiility, sinus inversus…….

Dx Dyskinetic cilia syndrome/ Kartagener’s syndrome.
Screen by: inhaled nitric oxide test. Confirm by: bx of bronchi or sinus with video electron microscopy

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100
Q

22yo M recurrent PNA, bronchitis since childhood, no allergy or GERD, IgG electrophoresis nl, unable to have children. exam: slender body habitus and polyp in nose. clubbing (+), CXR:apical bullous changes. wtd next?

A

check sweat chloride. >60 = positive

dx : cystic fibrosis, inc’d ris kof endobronchial infxn with pseduomonas, staph, strep Pneum

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101
Q

Cystic Fibrosis tx?

A
  1. chest PT, abx (anti pseudom, topical tobramycin spray **, inhaled hypertonic saline, bronchodilators., 2. decrease sputum viscosity by human ribonuclease
  2. Treatment of severe bronchiectassis w/ bleed —> bronch artery embolization
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102
Q

Reduce decline in lung fxn with CF patient colonized with pseudomonas

A

Azithromycin (anti-inflamm effect)

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103
Q

35yo non-smoker, h/o RA, no asthma/allergies - p/w cough/dyspnea on exertion, recent viral URI. exam: JVD 6cms, no wheeze, CXR normal - PFT = severe obstruction w/ FEV1/FVC 0.6. DLCO 82%. No change after bronchodilator. alpha antitrypsin level normal

A

Bronchioitis obliterans - can occur after RA, carcinoid tumor, lung transplant

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104
Q

35yo F s/p radiation tx for breast CA p/w SOB, diffuse insp crackles - PaO2 52, PCO2 30, PFT dec DLCO, no response to abx

A

cryptogenic organizing PNA - dec DLCO, bx rapidly progressive organizing PNA or acute interstitial PNA - tx STEROIDS

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105
Q

Interstitial lung dz

A 
sarcoid
idiopathic Pulm Fibrosis
hypersensitivity pneumonitis
COP
Allergic bronchopulm aspergillosis
lyphogioleiomyomatosis
Churg strauss
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106
Q

Sarcoid - indications for steroids

A

progressive pulm dz, eye involvement, CNS involvement, myocardial involvement, persistent hyperCA, disfiguring lesions

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107
Q

24yo F fever, pain, swelling both ankles (erythema nodsum - tender erythematous nodules - wtd

A

CXR r/o sarcoid - bil hilar LAD - no tx, adenopathy +parenchymal infiltrate - steroids if symptoms, diffuse infiltrates - no adenopathy - steroids if symptom

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108
Q

26yo F f/weakness, tenderness over legs - erythematous lesions, CXR b/l mediastinal adnopathy with infiltrates

A

BAL T4/T8 4:1, start steroids if eye involved, TB bx for non-caseating granulomas

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109
Q

All following elevated in sarcoidosis

A

Calcium in serum/urine, ACE, helper T cells

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110
Q

Idiopathic Pulm Fibrosis

A

insidous onset dry cough, gradual progressive dypsnea, cyanosis, clubbing, CXR diffuse infiltrative progess, reticular opacities, ground glass, honeycombing, PFT FEV1 low, FEV/FVC normal DLCO dec, BAL inc neutrophil
Tx: supportive care, O2 PRN, pneumovax, flu shot +- steroids

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111
Q

Asbestosis

A

Chronic exp x 10yr, lower lobe fibrosis, PFT - RESTRICTIVE patter - a/w mesothelioma, broncogenic CA, Pleural/diaphragm calcified plaques (no lung impairment)

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112
Q

Silicosis

A

chronic exp x 20 yrs (sandblasting, granite cutting) - upper lobe fibrosis with inc’d MTB incidence
EGG SHELL Calcifications with hilar LAD

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113
Q

58yo M SOB< CP, reporducible on palpation, 15lb wt loss over couple months, asbesthos exp - used to smoke, no BS in L base - pleural effusion L

A

mesothelioma/bronchogenic CA

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114
Q

Berylliosis

A 
metal workers (computers, aerospace, electronics/lights b4 1950's) - can cause tracheobonchitis
Bx - non-caseating granuloma
A/w lung Ca
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115
Q

Male smoker with SOB, progressive - honeycomb on chest xray interstitial upper lung fields - PFT restrictive - BAL - langerhans cells (giant cells - also on bx

A

Langerhan cell granuloma/esoinophilic grnauloma/histiocytosis x
c/b - PTX
Tx: quit tobacco

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116
Q

Premenopausal woman on OCP with sudden SOB, CXR with PTX, honey comb appearance on CXR with CHYLOUS EFFUSION

A

lymphangioleiomyomatosis

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117
Q

Consequences of hyopxemia

A

pulm HTN, secondary erythrocytosis, exc intolerance, impaired mental fxn, precip sleep apena

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118
Q

COPD dx with pulm HTN - etiology?

A

hypoxia

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119
Q

Tx for pulm HTN pt with COPD

A

O2 tx keep SaO2 90-95%

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120
Q

Pulm arterial HTN

A

Idiopathic, hertiable, drug (Fen,fen), conn tissue d/o, HIV, portal HTN, congential heart dz

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121
Q

Pulm HTN from LH dz

A

systolic/diastolic dysfxn - valvular dz

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122
Q

Pulm HTN from lung dz/hypoxia

A

COPD, ILD, mixed restr/obst, chronic high altitude

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123
Q

Chronic throboembolic pulm HTN

A

PE of prox or distal pulm vasc

dx V/Q scan

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124
Q

Pulm HTN unclear mech

A

hematologist, sarcoid, langerhans, lymphagioleiomyomatosis, met d/o, tumor infiltration

125
Q

Pulm pressures

A

normal 25/15 - RVH (RAD, tall Rwave V1/2, split loud second heart snd - lous P2

126
Q

Pt with near syncope, SOB< SQ calcification, split 2nd heart dound, JVP, pedal edema

A

TTE

127
Q

Pt with telangiectasias and SOB, h/o syncope, JVP 10cm, loud P2, pansystolic murmur L sternal border - echo with RV dilation and mod TR wtc

A

RHC with vasodilator testing

128
Q

45yo F h/o PE 4ya tx’d with a/c with SOB, loud P2 EKG with RAD and P pulmonale - echo RV dil - next dx step?

A

r/o CTEPH - V/Q scan

129
Q

Pt with +v/Q scan - wtd?

A

eval for thromboembolectomy

130
Q

If pt with RHC responds to vasodilators?

A

start nifedipine or diltiazem

131
Q

If pt with RHC with NO response to vasodilators?

A

Mild dz - sildenafil, tadafil, bosentan
Mod dz to severe (limits on physical activity) - IV epoprosterol + sildenafil
Severe dz and hypotensive - inhaled Iloprost

132
Q

Maintenance tx pulm HTN

A

Coumadin

133
Q

Pulm Embolism

A

usually from DVT (mostly above Knee - sudden onset SOB, tachypnea, pleuritic CP, pre/syncope, hemoptysis, loud P2, split 2nd heart sound, CXR normal - S1Q3T3, A-a gradient >20 if hyperventilating PO2 may be normal - taxoifen, OCP, nephrotic syndrome, breast CA, protein C/S def, long flight or drive

134
Q

V/Q scan

A

Normal - no PE
2 or > seg or larger defect with no matching ventil def - > +PE, treat
sugseg perfusion defects or matching ventillation and perfusion deficets or single large defect - PE low or intermed - check for DVT - tx if postive if ng then pulm angiogram

135
Q

Tx for PE

A

LMW or heparin 7-10 days - then coumadin for 3-6 months

136
Q

High clinical suspicion

A

start tx before confirmation

137
Q

Best test r/o low prob PE

A

D-dimer (if neg no PE)

138
Q

Best test r/o mod to high prob PE

A

V/Q scan

139
Q

Best test dx chronic PE

A

V/Q scan

140
Q

Contraindications to A/C

A

neursx, eye sx, open prostatectomy

141
Q

Indication for thrombolytics

A

acute massive PE with hypotension - large DVT (Iliofemoral DVT)

142
Q

Indication for IVC filter

A

If another PE pt may die, contraindication to A/C - emboli post A/C

143
Q

52yo M midl CHF is a/w sudden onset of SOB and right sided pleuritic pain on furosemide and digozin - CXR with cardiomegaly - split 2nd heart snd HR 100 - V/Q scan showed small subsegmental match/unmatched deficits - contrast scan lower extrem neg wtd?

A

CT angiogram

144
Q

44yo M multiple pelvic hip fx and undergoes hip replacemnt - two days after surgery fever, mental confusion and sob - chest xray and diffuse pulm infiltrates - pO2 44 , pCO2 30mm, pH 7.48 EKG wiith sinus tach - inubated and transferred to ICU - dx?

A

Non cardiogenic pulm edema due to fat emboli

145
Q

Tx for non-cardiogenic pulm edema 2/2 fat emboli

A

No A/C no steroids

146
Q

Post delivery patient becomes hypotensive and SOB

A

amnitotic fluid embolism

147
Q

Pt with sudden onset SOB< tachy, hypoxeia and inc’d A-a gradient

A

V/Q scan

148
Q

Pulm HTN, SOB, tachy, echo with RV strain -

A

V/Q scan

149
Q

Pt with SOB, tachy cardia, echo RV strain - V/Q scan with 2 large deficits normal ventillation

A

Anticoagulation

150
Q

Pulm HTN, SOB, tachy, V/Q scan 3 defects 2 matched with ventillaory defects one with unmatched defciit - lower extrem US neg

A

pulm angiogram

151
Q

Pulm HTN with SOB, V/Q with 2 large unmatched defects, hypotensive

A

T-PA

152
Q

DVT

A

D-dimer good neg predictive value
If D-dimer + further w/u needed
Infection good predictor for DVT
LMWH dec’s DVT but not mortality

153
Q

Pt with unprovoked DVT 5 months ago now in ED with bleed, coumadin stopped -> wtd?

A

ASA 325

154
Q

DVT ppx

A

High risk - Knee replacement, Total hip - ppx LMWH 4 weeks or warfarin or fondaparinex

155
Q

DVT ppx with elev Cr

A

unfractionated hep, ext pneumatic compression, early mobilization

156
Q

Pt with DVT started on A/C with swelling of leg, 2 months later leg swells again - wtd?

A

below knee compression stocking

157
Q

Elderly pt with colon CA 2ya p/w swelling of leg

A

check LE US (high risk patient)

158
Q

45yo p/w swellinig/pain in right leg - wtd?

A

D-dimer (low risk pt)

159
Q

Hospital Aquired PNA

A

leading cause of death among hospital aquired infections - 48hr or more after admission

160
Q

Ventilator Associated PNA

A

within 48 to 72hrs after intubation

161
Q

Healthcare associated PNA

A

pt either hospitalized w/in 90 days of infxn, resided in NH, chemotx or wound care within 30 days of infxn or attends a hosptial or HD clinic

162
Q

Pt with cholecystitis s/p chole develops PNA

A

48hr imipenum +aminoglycoside

163
Q

Strep Pneumo

A

MCC of PNA

164
Q

Myoplasma

A

PNA in yound adults

165
Q

H flu/M catarrhalis

A

COPD/DM pts

166
Q

Legionella

A

cool damp places/water coolers

167
Q

Pseduomonas

A

nosocomial, neutropenics

168
Q

Klebsiella

A

alcoholics, NH residents

169
Q

Mixed flora

A

cavities, lung abscess

170
Q

Good sputum sample

A

25WBCs

171
Q

pt with cough/yellow expectoration pas 2 days low grade tempHR 84 BP ok lungs with few rales

A

over the counter anti-tussives

172
Q

Pt with URI sx >2wks tx’d with doxycycline w/o improvement - inc’d cough with post-cough vomiting - exam with SUBCONJ HEMORRHAGE -> organism?

A

sputum PCR for bordetella

173
Q

Pt with PNA tx’d with Ctx/azithro x 5 days then changed t PO meds - on abx fells better - continues to have cough, 6 wks later opacity persists - dx?

A

underlying malignancy or bronchial carcinoid

174
Q

Pt with recurrent PNA - CT chest fibrosis in Lt lower lobe area - etiology?

A

post obstructive PNA

175
Q

40yo pt with hemoptysis and streaks blood x 3 weeks - 4lb wt loss, cough, CXR normal - management?

A

bronchoscopy

176
Q

25yo p/w purulent nasal discharge, HA for past 2 days, cough+, tx with?

A

decongestants, analgesics

177
Q

Bacterial sinusitis

A

< 7 days have bacterial sinusitis - No abx unless sx > 7 days or have fever/pain - no routine CT for dx

178
Q

22yo M with c/o purulent nasal d/c for 3 days and temp 101 with maxillary pain wtd?

A

abx - amox-clavulanate (augmentin)

179
Q

40yo sore throat and h/a x 3 days - grandchild with cold - 99 deg with pharyngeal erythema, anterior cervical LAD

A

rapid strep test - confirm with throat ctx

180
Q

Centor criteria for strep

A

fever, no cough, tonsillar exudate, cervical LAD
0-1 no abx or throat ctx
2-3 throat ctx - tx if +
4 or 5 tx empirically with abx

181
Q

pt with runny/blocked nose, itchy eyes, sore throat - swelling below eyes, coblestone pharynx no LAD dx?

A

allergic rhinitis

182
Q

Nasal congestion/rhinorrhea for several months, h/o allergies usually controlled with decongestants and antihitamines - using OTD meds and getting worse - red edematous mucousa of nares

A

rhinitis medicamentosa - rebound congestion from vasoconstrictors - stop vasoconstrictors start intranasal steroids

183
Q

24yo hot potato voice, fever, unable to swallow, drooling - tonsils touching each other, dev of uvula

A

peritonsillar abscess (Quincy)

184
Q

pt with sore throat few day sand severe pain when moves neck, pain on swallowing - brawny edema of hypopharynx and tenderness of palpation of SCM - dx?

A

internal jugular vein thrombosis (Lemierre’s dz)

185
Q

DM pt with fever from NH, no teeth CXR RL consoldiation - best empirc abx?

A

newer fluoroquinolone (strep pneumo) - if worsens still febrile and hypotensive then resistant - start vanco or linezolid

186
Q

alcoholic pt with cough/red currant jelly sputum - g neg bacilli with capsure, cxr bulging fissure dx?

A

klebsiella PNA - 3rd gen cephalosporin (ceftx) + amminoglycoside

187
Q

If above pt worse (etoh abuse with red currant jelly)

A

ESBL - start impipenum or meropenum

188
Q

S/E flurouinolone

A

inc QTC -> ventricular arrythmia

189
Q

elerly woman floroquinolone s/e

A

tendon rupture

190
Q

which abx have hypoglycemia s/e

A

Levofloxacin

191
Q

CAP tx period

A

1 week

192
Q

HAP pseudomonas tx period

A

2 weeks

193
Q

Pt with PNA - early ambulation leads to…

A

early d/c from hospital

194
Q

65yo DM pt with PNA tx’d with abx - wtd prior to d/c

A

23 valent pneumococcal vaccine

195
Q

Pt wit LLL PNA tx with Abx with persistent fever, elev WBC for 2 weeks, CXR still with infiltrates

A

CT scan r/o lung abscess or empyema

196
Q

Fever, cough, DIARRHEA, mental confusion, pulm infiltrated, DEC SODIUM, inc BUN

A

legionella - urine legionella Ag -> macrolide +- rifampin x 2 weeks

197
Q

AIDs pt with sudden onset SOB, hypoxic on ABG, PTX on CXR - chest tube inserted - wtd

A

PCP tx (bactrim + steroids)

198
Q

Acute ill pt with PNA and intubated - lancet shaped diplococci - WBC 15, 103 deg - tx’d with PCN - 2 days later still temp, wbc 11, greenish secretions from ET tube grows pseduonas

A

continue PCN

199
Q

PNA temp 103, WBC 17K tx’d with fluroquinolone - 3 days later WBC 11K - unchanged lobar infiltrate - WTD?

A

no further testing - continue to tx

200
Q

Pt a/w RL pna - temp 102, WBC 16, started on Ceftx, next day BCtx growing PCN sensitive srep pneumo, - pt changed to PCN - on 5th day shows growth of MRSA (contaminent)

A

continue PCN

201
Q

Pt with recent Seizure -3 days later UL infiltrate - organism?

A

Peptostreptococcus

202
Q

Pt with Sz 1 month ago now with fever, foul smelling sputum, CXR cavity with fluid level, sputum shows mixed flora dx?

A

Lung abscess -> PCN with clindamycin - several days later no fever, same cavity but fluid decreases, WBC dec -> continue abx

203
Q

25yo with ear ache fever cough - inflammed typanic membrane with hemmorhage - CXR patchy infiltrate

A

Myoplasma -> tx macrolide (erythromycin)

204
Q

35yo non-smoker with gradual onset cough few weeks - WBC < 5, Epith 25/cm2 CXR b/l infiltrates -> tx?

A

Macrolide

205
Q

50yo COPD, acute onset of cough, rusty sputum, fever, chills LLL consolidation dx?

A

Strep pneumo - macrolid+ceftx

206
Q

Common pathogens in neutropenics

A

Pseudomonas, aspergillus, staph, strep

207
Q

CURB65

A 
Confusion
bUn>19
RR>30
sBP65
0-low risk - home tx
1 - outpt tx
2 short inpt, clsoely supervised outpt
3 severe PNA - hospitalize consider ICU
4 or 5 - ICU tx/intubation
208
Q

55yo COPD SOB, cough, sputum white-> green, low temp scattered rhonci - organism?

A

H.Flu non-typable

209
Q

50yo farmer 3 month cough, inc dyspnea, skin lesion on nose with pleurtic CP -> CXR alveolar/fibronodular infiltrates

A

Blastomycosis (thick walled infiltrates)

210
Q

22yo F OCP 3 days fever, pleuritic CP, non prod cough/fatigue CXR clear

A

Pleurodyna 2/2 coxsackie virus - sx therapy

211
Q

Pt with URI 3 wks ago - fatigue, inc JVD echo EF 20% - cause?

A

coxsackie B3 virus

212
Q

Pt from southwest - arizona, NM, texas with fever and LUNG infiltrates, thin walled cavity on CXR

A

Cocoidomycosis - thin walled - self limited or fluconazole -> systemic -> Amphotericin B

213
Q

Influenaza season

A 
NOv to march - f/cough/myalgia - vaccine any age > 6 months
Tx Oseltamivir (tamiflu), zanamivir
214
Q

Influenza outbreak in NH tx?

A

vaccine+tamiflu(oseltamivir x 2 weeks - if no vaccine then oseltamivir/amantadine x 6 weeks

215
Q

Pt post influenza more prone to…

A

staph PNA

216
Q

Which flu med NOT with asthma/COPD

A

zanamivir (or BB, adenosine, dihydropyridine)

217
Q

Female pt with UTI on nitrofurantoin - SOB/fever, crepitice over lung fields with ground glass

A

Dx nitrofurantoin rxn

218
Q

PPD

A

> 5mm - HIV, rec TB contact, old CXR TB scar, organ tx, prednisone >15mg/day at least 3 months, anti TNF, rituximab
10mm - HC workers, etoh, homeless, foreign born, NH resdients, dz with high risk of TB, IVDA, silicosis, DM, CRF gastrectomy, chemo, lymophoma, leukemia, malnutrition

219
Q

PPT+ wtd?

A

CXR

220
Q

CXR small patch fibronodular opacity no cough -

A

induce sputum AFB

221
Q

CXR neg after +PPD

A

tx with INH x 9 months

222
Q

alternate to INH with liver enzyme elevation or HCV

A

rifampin x 4 monthsbest

223
Q

best tx pt PPD+ (compliance wise)

A

INH 900/rifampin 900 weekly x 3 months (direct observed therapy)

224
Q

Multidrug resistant TB - asymptomatic roommate PPD 5mm CXR neg - wtz?

A

PZA/ethambutol for 6 months or PZA+quinolone (levoq/moxiflox) x 6 months

225
Q

Nurse (filipino with PPC x 20mm) BCG in childhood

A

CXR if neg begin INH and B6 (if 10 or less check gamma IFN if + active TB tx

226
Q

Ukrain resident PPD 10mm BCG in chilhood CXR neg

A

check IFN gamma

227
Q

Pt on INH/B6 - 3 moths on tx now tired and nausea x 2 days

A

d/c INH, check AST/ALT, bilirubin check (liver failure) stat

228
Q

Best Screen latent TB

A

Gamma IFN

229
Q

What is good about gamma IFN vs PPD

A

decrease confounding with BCG

230
Q

Inner city pt, PPD+, CXR+ started on rif, inh, pza, ethambutol isolated until 3 afb neg still ctx + 1 later wtd

A

continue 4 meds x 1 more month

231
Q

Pt dx with pulm MTB - homelss lives in shelter periodically wtd?

A

INH/rifampin/pza/ethambutol x 2 weeks then inh/rif, pza ethambutol twice wekly x 6 weeks then inh/rfampin twic weekly x 4 months

232
Q

Pt from E eurobe/asia with pleural effusion - tap done neg for AFB - wtd?

A

needs VATs pleural bx

233
Q

Management of MTB resistant to INH - what drug improves outcome?

A

Fluoroquinolone

234
Q

Homeless pt with RUL infiltrate and pleural effusion wtd?

A

airborn isolation

235
Q

Pleural effusion lytes criteria

A

transudate 3g tot protein, fluid/serum protein ratio >0.5, total LDH >200, fluid serum LDH ratio >0.6

236
Q

Causes Transudate effusion

A

CHF, Nephrosis, cirrhosis, hypothyroid

237
Q

Causes Excudate effusion

A

neoplasm, infection, inflammation (RA, SLE, Pancreatitis), esophageal perforation (gastrograffin), dresslers syndrome (post cardiac sx)

238
Q

Mesolthelioma/malignance with bloody effusion

A

chylous eff >115 TGA->trauma, mediastinal lymphoma/lymphangioeiomyomatosis
pseudochylous like in TB, Rh arth
Gluc 80-TB, gluc 60-CA, Gluc 30-Rh arthritis

239
Q

54yo with pleural effusion dx tap reveals fluid serus <0.6 cause of pleural effusion?

A

Cirrhosis

240
Q

Rh arthritis pt with recurrent effusions after repeated taps wtd?

A

tub thoracostomy and sclerosing agent

241
Q

Pleural fluid with glucose o29 - cause?

A

Rh arthritis (<30)

242
Q

55yo M s/p CABG 4 weeks ago p/w fever, dyspnea, non-productive cough, pleuritic CP - pericardial rub - ESR 68, WBC 10, cardiomegaly with b/l basal atelectasis and small pelural effusion - ABG PO2 80, PCO2 34 pH 7.45 - tap done 350cc removed - protein ratio >0.5, LDH ratio >0.6 - V/Q scan with several matched defects - dx?

A

Post cardiotomy syndrome (dressler’s)

243
Q

25yo athlete SOB while sprinting with pleuritic CP - BS dec on R side - hyperresonance on percussion

A

spontaneous PTX -> chest tube insertion

if recurs pleurodysis

244
Q

When to tap parapneumonic effusion

A

If effusion >10mm on lat decubitus CXR, PNA not responding to abx, frank empyema needing chest tube, loculated fluid needs thoractomy

245
Q

Pt with PNA continues to spike temp on Abx, cxr with pleural effusion, protein >3g, LDH rat>0.6, chest tube placed, 72hrs later pt still febrile - loculation on chest CT

A

VATS (surgery c/s)

246
Q

Chest physical exam

A

Pleural effusion -> dull percussion, dec BF, Fremoitus absent
Pneumonia ->dull percussion-> bronchial BS, in fremitus
PTX - hyper percussion, dec BS, inc frem

247
Q

Best way to diff PTX from pleural eff o PE

A

percussion (hyper on PTX)

248
Q

Pt with SOB - exam dec BS on left, inc vocal frem on L - dx?

A

L side consolidation (PNA)

249
Q

Pt a/w SOB, CXR lower lobe infiltrate and pleural effusion, temp 102.5, HR 110, pleural tap exudative fluid - next day pt worse and more hypoxic with PO2 of 52, CXR complete whiteout of left side - trachea not deviated - dx?

A

L hemithroax consolidation - needs intubation

250
Q

Pt with PNA, large consolidation on LL, abg while lying on L side 54, while lying on R side 65 - cause?

A

intrapulmonary shunting 2/2 PNA

251
Q

Pt with cryptogenic cirrhosis with ascites and pedal edema, SOB on sitting or standing up - pulse ox 92% lying down, sitting 82% DLCO 70% - etiology?

A

intrapulm R to L shunt (hepatopulm syndrome (orthodeoxyia see every 4 beat bubble in LA on bubble study in TTE)

252
Q

Sleep Apnea

A

Apnea - no breathing for 10 seconds - >10/h - sleep apnea syndrome

253
Q

increased snoring prevents good sleep causing sleepiness?

A

T

254
Q

Hypoxemia causes daytime sleepiness in OSA

A

F

255
Q

hypoventilation at right leading to recurrent arousals leas to daytime sleepiness

A

T

256
Q

Nighttime alkalosis leads to daytime sleepiness

A

F

257
Q

OSA pt with apnea hypopnea index >30 has?

A

inc’d mortality

258
Q

Sleep Apnea definitioin

A

> 95% obstructive, snoring, wakes up with h/a, distrubed sleep, neck >17 inches, neuropsych manifestations, somnolence, accidents, firing, high risk for MI/CVA/HTN
Dx with polysomnography - r/o treatable cuase - enlarged tonsils, tumor, hypothyroid
Tx no sedation, no etoh, protriptylin e9mild), mod sleep apnea nasal cpap, , uvulopalatopharygoplasty works 50% of time

259
Q

45yo pt with lethargy, BMI 41, HTN, lift in R parasternal area, panniculus, edema, echo with TR - wtd?

A

sleep study - etiology of leg edema - pulm HTN from RHF

260
Q

Secondary HTN cause in pt with obestiy

A

OSA

261
Q

Cause of HTN in pt with OSA

A

inc’d sodium retention

262
Q

Tx for OSA

A

improved quality of life, cogn fxn, daytiem sleepiness, HTN, dec mortality

263
Q

Pt with difficult to tx HTN on 4 meds with OSA - best management?

A

renal denervation

264
Q

22yo BMI 24 tx herself for allergic rhinitis with OTC meds for past few days now unable to sleep well and tired during day dx?

A

Rhinitis medicamentosa - tx - d/c meds start steroids

265
Q

45yo F BMI 35 p/w DOE - JVD, FEV1/FVC 0.7, mild edema, RVH on echo, no valvular lesions - PCO2 55, PO2 58

A

dx Obesity hypoventillationi syndrome->pulm HTN

266
Q

Why do ppl with severe obesity have PCO2 elevation?

A

hypoventillation - check sleep study

267
Q

48yo M dx with OSA - sleepy during day, c/o fatigue, Leg edema, TFT nromal - most appropriate Tx

A

nasal CPAP

268
Q

Pt with daytime sleepiness, mod musc wk at onlet of sleep gets hallucinations - brother with similar episodes

A

narcolepsy (autoimmune dz) - tx with modafinil (expensive) or methyphenidate or sodium oxybate)

269
Q

Elderly pt with gradual onset SOB, daytime sleepiness, pedal edema and rales - breaths funny at night and doesn’t breath several seconds - BMI 28, EF 30% - most likely cause of daytime sleepiness?

A

CHF - cheyne stokes breathing (widening of QRS >120)

270
Q

Pulmonary nodules

A

4-6 low risk f/u CT 12 months if no changes, no f/u, high risk initial CT 6-12 months, then 18-24 months if no changes
6 to 8 - low risk initial CT 6 to 12 months, then 18 to 24 months if no change, high risk initial f/u 3 to 6 months the 9 to 12 adn 24 months if no change
>8mm low risk f/u CT 3,9,24 months, CT, PET and/or bx - same for high risk

271
Q

60yo pt with 1.5cm solitary nodule on CXR wtd first

A

see old CXR

272
Q

53yo with pulm nodule 1.2 cm - last year 0.9cm wtd?

A

resection

273
Q

Bronchoalveolar lavage (BAL)

A

Normal = inc’d PMN
Sarcoid - inc’d lymph CD4>CD8
hypersensitivity Pneumonitis inc’d lymp, CD8>CD4
Eos pNA - peripheral infiltrates - inc’d eos
PJP in HIV - silver metahanamine +
CMV - inclusion bodies
PNA in ARDS - bacteria >10^3
Amiodaraone PNA - foamy witih lamellar inclusions - r/o thyroid issues

274
Q

A pt w/ myasthenia gravis presents w/ weakness w/ vital capacity of < 20ml/kg. Pt is intubated , tx for a wk, extubated and discharged home. He presents 2 weeks later w/ dyspnea. PFTs reveal flattened inspiratory and expiratory flow loops. Most likely dx?

A

subglottic tracheal stenosis.

275
Q

A 22 yo woman presents w/ dyspnea and wheezing. She has been on inhaled beta2 agonists, inhaled steroids and has used intermittent increasing dose of oral steroids for the past year without much symptomatic relief. Exam reveals a puffy face. Bilateral wheezing during inspiration. The inspiration/expiration ratio is 1. Pulse ox is 96% on room air. Most likely dx?

A

vocal cord dysfunction

276
Q

Pt with asthma on albuterol, inhaled ICS. Pt still has symptoms. LABA was added with not much improvement. wtd?

A

dc LABA, begin theophylline PO

277
Q

Pt on ICS + LABA doing well for 3 months –>

A

1/2 dose ICS, cont LABA. If 3 months stable .. then dc ICS

278
Q

Pt w/ asthma on inhaled fluticasone, salmeterol, tiotropium, and prednisone for past 3 years.. You are trying to wean off the steroids , his last asthmatic attack was more than a year ago. Eosinophil count is high. wtd?

A

begin mepolizumab (IL-5 inhib)…. decreases exacerbation and improved FEV1

279
Q

asthma. symptoms <2/wk and <2nights/month =

A

intermittent

280
Q

asthma. no daily meds needed, short acting beta agonist prn =

A

intermittent

281
Q

asthma. >2/wk but < 1/day and >2night/month, low dose inhaled steroid =

A

mild persistent

282
Q

asthma. daily symptoms, >5nights/mnth =

A

moderate persistent

283
Q

asthma. start long acting beta agonist and low to moderate dose inhaled steroid =

A

moderate persistent

284
Q

asthma. continuous symptoms and frequent nocturnal sx

A

severe persistent

285
Q

asthma. high dose inhaled steroids + long acting beta agonist + PO steroids

A

severe persistent

286
Q

asthma. post-viral URI w/ increasing wheezing and dyspnea =

A

exacerbation

287
Q

asthma. nebulization tx with short acting beta agonists –> ipratroprium –> steroids –> IV MgSO4 =

A

exacerbation

288
Q

asthma. leukotriene inhibitors (montelukast) in …

A

mild, moderate, severe persistent.

289
Q

a 20-40 yo male smoker, or recently quit smoking presents with fever, cough, and dyspnea for the past week.Eosinophils 8%. CXR with ground glass appearance. BAL w/ eosiniophils… dx? tx?

A

acute eosinophilic pneumonia, tx: glucocorticoids.

290
Q

Stage 4 COPD (very severe disease) should be treated like

A

CAP w/ abx

291
Q

FEV1 is 65% of predicted and FEV1/FVC ratio of 64%.

A

add long acting anticholinergic

292
Q

FEV1 is 45% of predicted and FEV1/FVC ratio of 55%

A

add inhaled steroid

293
Q

FEV1 is 28% of predicted. SaO2 87% on room air.

A

continuous oxygen

294
Q

pt w/ COPD on albuterol and ipratropium still w wheeze .. wtd?

A

dc ipratropium (SAMA) and begin tiotropium (LAMA)

295
Q

Pt on HCTZ, w/ several exacerbations each year. what has shown to decrease the risk of exacerbations?

A

moxifloxacin for 5 days every 8 weeks or azithromycin 250mg PO qdaily

since hctz, check for electrolyte distrubances

296
Q

Pt w/ COPD on tiotropium, salmeterol and inhaled steroids presents with COPD exacerbation. LAst exacerbation was treated w/ steroids for 5 days and azithromycin for 5 days… wtd?

A

begin roflimulast

297
Q

A COPD pt on tiotroprium, salmeterol and inhaled fluticasone presents with increasing bruising. Her last exacerbation was more than a year ago.. wtd?

has exacerbation 2 months later.

A

dc fluticasone..

start phosphodiesterase 4 inhibitor - roflimulast (daliresp)

298
Q

pt w persistent symptoms, despite adeqate therapy.. wtd?

A

assess adherence to medications

299
Q

Pt w/ COPD w/ acute hypoxemic respiratory failure, non hypercapneic PCO2 norm,. Best managment that has showed decreased intubation and decreased mortality??

A

high flow nasal cannula 100%O2.

300
Q

Pt w/ COPD with acute hypercapneic respiratory failure (PCO2 elevated). Best management that has shown decreased intubation and decreased mortality is…

A

BiPAP

301
Q

Pt w/ COPD w/ hypercapnea. best management ….

A

BiPAP, shown to decrease mortality

302
Q

what is the role of inhaled steroids in COPD

A

decrease exacerbations

303
Q

how long to treate acute exacerbation of COPD with steroids 40mg PO daily??

A

5 days.

304
Q

what is the underlying reason for reduced dyspnea due to decreased respiratory requirement?

A

improved muscle efficiency

305
Q

what is a required component of pulmonary rehab?

A

program of exercise training of muscles of ambulation

306
Q

leading bacteria that increaseds mortality in cystic fibrosis

A

cepacia burkhdorferia.. tx bactrim

307
Q

pulmonary infection or colonization w/ pseudomonas is commn

A

true

308
Q

cystitic fibrosis should be considered in children or young adults with bronchiectasis or hypogammaglobulinemia

A

true

309
Q

surgical resection is requried in most cystic fibrosiss patients presenting with massive hemoptysisis

A

false

2020 ABIM Awesome Review (14 decks)

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