First Aid Pulmonary

Question 1

clinical signs of asthma?

Answer 1

1. cough
2. episodic wheezing
3. accessory muscle use
4. dec breath signs, low O2 sat at late stage

Question 2

treatments for COPD?

Answer 2

COPD

Corticosteroids
Oxygen (goal: 88 - 92%)
Prevention
Dilators (b2 agonists, anticholinergic)

Question 3

clinical symptoms of COPD exacerbation?

Answer 3

wheezing, cough, sputum

Question 4

treatments for COPD exacerbation?

Answer 4

antibiotics (doxy, azithromycin)
bronchodilator (albuterol, ipratropium)
steroids (PO: prednisone, IV: methylprednisone)

Question 5

6 meds for asthma exacerbations

Answer 5

ASTHMA

albuterol
steroids
theophylline
humidified O2
magnesium
anticholinergics

Question 6

5 etiologies for obstructive lung dz?

Answer 6

ABCT

Asthma
Bronchiectasis
Cystic fibrosis/COPD
Tracheal or bronchial obstruction

Question 7

the 1st step of management for pt suspicious of asthma

Answer 7

PFT

Question 8

what is the next step of normal PFT from pt suspicious of asthma?

Answer 8

methacholine challenge test

Question 9

if a pt suspicious of asthma has dec PFT, what is the next step?

Answer 9

give albuterol to reverse the symptoms

Question 10

what other med must be given to asthma pt with long acting b2 agonist?

Answer 10

corticosteroids

Question 11

how do you define severe asthma?

Answer 11

FEV1

Question 12

treatments for severe asthma?

Answer 12

high dose inhaled corticosteroids + long acting inhaled beta 2 agonists

Question 13

what are the light’s criteria for plueral effusion?

Answer 13

1. pleural protein/serum protein > 0.5
2. pleural LDH/serum LDH > 0.6
3. pleural fluid LDH: more than 2/3 the upper limit of normal serum LDH

*an effusion is exudate if any of the above criteria is met.

Question 14

clinical hallmarks of theophylline toxicity?

Answer 14

nausea, vomiting, headahce, anxiety, diarrhea, and cardiac arrhythmia

Question 15

treatments for complicated parapneumonic effusions/empyemas?

Answer 15

chest tube drainage in addition to antibiotic therapy or pleurodesis

Question 16

3 bugs that cause COPD exacerbations?

Answer 16

Haemophilus influenza
Moraxella
Strep pneumoniae

Question 17

CHADSVASc for anticoagulants?

Answer 17

C: CHF
H: HTN
A: age more than 75
D: DM
S: Stroke or hx of TIA
V: Vascular dz (PAD, MI)
A: age > 65
Sc: Sex --> female

more than 2, give anticoagulant

Question 18

define sleep apnea

Answer 18

2’ to disturbances in breathing during sleep that lead to excessive daytime somnolence and sleep disruption

Question 19

define acute respiratory distress syndrome?

Answer 19

1. hypoxemia
2. dec lung compliance
3. noncardiogenic pulmonary edema
4. PaCO2/FiO2 ratio less than 300

Question 20

pathogenesis of ARDS?

Answer 20

endothelial injury

Question 21

causes of ARDS?

Answer 21

sepsis, pneumonia, aspiration, multiple blood transfusions, inhaled/ingested toxins, and trauma

Question 22

what are the 4 diagnosis criteria for ARDS?

Answer 22

1. acute onset (less than 1 week) of resp distress
2. PaO2/FiO2 5 cm H2O
3. bilateral pulmonary infiltrate on CXR
4. resp failure not completely explained by heart failure

Question 23

treatment for ARDS?

Answer 23

1. mechanical ventilation with low tidal volume (4-6 cc/kg) to minimize ventilator induced lung injury
2. use PEEP to recruit collapsed alveoli

Question 24

what are the goals of PaO2 and SaO2 for treating ARDS?

Answer 24

55 mmHg, 88%

Question 25

medications for acute exacerbation?

Answer 25

inhaled beta 2 agonist (albuterol) and anticholinergics (ipratropium), inhaled corticosteroids, antibiotics

Question 26

3 childhood paths associated with asthma?

Answer 26

1. multiple episodes of croup 2. URI with dyspnea 3. Eczema

Question 27

3 causes for transudative pleural effusion?

Answer 27

1. CHF 2. Cirrhosis 3. Nephrotic syndrome

Question 28

7 causes for exudative pleural effusion?

Answer 28

1. Pneumonia 2. TB 3. Malignancy 4. PE 5. Collagen vascular dz (rheumatoid arthritis, SLE) 6. Pancreatitis 7. Trauma

Question 29

clinical definition of emphysema?

Answer 29

productive cough > 3 months X 2 yrs

Question 30

clinical definition of chronic bronchitis?

Answer 30

terminal airway destruction and dilation

Question 31

treatment for tension pneumothorax?

Answer 31

1. needle decompression | 2. chest tube placement

Question 32

most common cause of 1' spontaneous pneumothorax?

Answer 32

rupture of subpleural apical blebs

Question 33

best initial treatment approach for spontaneous pneumothorax?

Answer 33

observation with supplemental oxygen

Question 34

what is a common precursor to acute resp distress syndrome?

Answer 34

pancreatitis

Question 35

what is the next best step of management of pts suspecting of acute lung transplant rejection?

Answer 35

lung biopsy to rule out infection such as CMV

Question 36

clinical characteristics of asthma exacerbation?

Answer 36

1. tachypnea 2. tachycardia 3. diminished breath sounds

Question 37

in a very severe asthma, will you hear wheezing?

Answer 37

no, b/c the air movement is so limited

Question 38

treatments for severe asthma exacerbation whose FEV1 is less than 50% predicted?

Answer 38

1. high dose beta agonist 2. anticholinergic nebulizer every 20 min for 1 hr continuously 3. systemic corticosteroid and oxygen to achieve O2 sat at least 90%

Question 39

in what groups of ppl is an area of induration 10 mm or greater is considered a positive PPD for tuberculosis?

Answer 39

1. health care workers 2. homeless 3. residents in developing countries 4. chronic illness pt

Question 40

image findings of asbestosis?

Answer 40

linear opacities at lung bases and interstitial fibrosis

Question 41

image findings of silicosis?

Answer 41

eggshell calcification

Question 42

what dz risk are you at with silicosis?

Answer 42

inc risk of TB

Question 43

which pneumoconioses requires chronic corticosteroid treatment?

Answer 43

berylliosis

Question 44

paraneoplastic symptoms of large cell carcinoma?

Answer 44

inc beta hCG --> gynecomastia and milky nipple discharge