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Flashcards in MKSAP - Respiratory Deck (29):
0

Signs that respiratory failure is due to neuromuscular problem?

1. Increased RV/TLC ratio (also seen in obstructive disorders)
2. Normal FEV1/FVC ratio
3. Low maximal respiratory pressures
4. Normal DLCO

1

Hydropneumothorax pathogenesis?

Imaging findings?

Bleb rupture causes lung to collapse toward hilum.

Bleeding from rupture produces flat-line junction between the air and fluid at the base of hemithorax

2

Tuberculosis effusion – typical duration of symptoms? Type of effusion? WBCs in effusion? Diagnose by?

Subacute duration of symptoms (weeks to months); exudative with lymphocytes; diagnose with pleural biopsy

4

Nebulizer therapy for asthma reserved for which patients?

Patients who cannot use a metered dose inhaler appropriately

5

Treatment of the patient with COPD exacerbation?

1. Oral or intravenous corticosteroids
2. Albuterol/ipratropium (Short acting bronchodilators)
3. Supplemental oxygen
4. Levofloxacin or macrolide + ceftriaxone

6

Suitable candidates for noninvasive positive-pressure ventilation? Contraindications?

Respiration rate >25
PH under 7.35
PCO2 over 45

Contraindications: impending respiratory arrest, cardiovascular instability, altered mental status, I aspiration risk, extreme obesity

7

Patient with COPD – goal oxygen saturation?

90%

8

COPD – consider lung volume reduction surgery when? transplantation when?

1. Predominantly upper lobe disease with limited exercise performance after rehabilitation
2. FEV1 between 20% to 35%
3. DLCO greater than 20

1. PCO2 >50
2. Both FEV1 and DCLO <20

9

Complications of untreated obstructive sleep apnea?

Pulmonary artery hypertension, a true fibrillation, heart failure, treatment resistant hypertension

10

Findings and Cushing's syndrome?

Hypertension, muscle weakness, bruises, diabetes, osteoporosis

11

Findings in drug-induced long toxicity? Well known cause?

Fatigue, fever, cough, eosinophilia. Amiodarone

12

Acute eosinophilic pneumonitis?

Rapidly progressive illness associated with
1. fever
2. sputum production
3. eosinophilia
4. peripherally distributed lung infiltrate

13

Patient with suspected PE (Well's score > 4) – test?

1. CT angiogram
2. In patient with elevated creatinine: ventilation/perfusion scan

16

Patient with previously well-controlled asthma who experiences unstable asthma after respiratory infection – treatment?

If unstable asthma persists?

Short course of oral steroids

Long acting beta agonist

17

Causes of low DLCO?

1. Barriers to diffusion (Edema, infiltrates, fibrosis)
2. Loss of lung tissue (emphysema)

18

Exam Signs of pulmonary artery hypertension?

1. loud P2
2. Fixed split S2
3. Tricuspid regurgitation
4. JVD

19

Physical exam findings in atrial septal defect?

1. Fixed split of S2
2. Right ventricular Heave

20

Symptoms of vocal cord dysfunction? Test?

1. Wheezing, Strider
2. No response to asthma therapy. 3. Decreased lung volumes
4. normal unsaturation

Laryngoscopy

21

Pulmonary function tests in PAH? Early diagnostic test?

isolated decreased DLCO with normal airflow and lung volumes

Echo to r/o heart problems

22

When is chest tube drainage needed for pleural effusion?

1. Loculated
2. PH under 7.2
3. Glucose under 60
4. LDH over 1000

23

Indications for video assisted thorascopic surgery?

Empyema not drained soon enough leading to loculations that need to be surgically removed

24

Consider chylothorax if effusion studies show?

Triglycerides >110

25

Signs of respiratory failure?

Pulse ox < 75
Respiration rate >30
heart rate > 120

26

Adjust criteria for home oxygen patients with COPD with these comorbidities?

Cor pulmonale, pulmonary hypertension, right heart failure

27

When to give a COPD patient inhaled corticosteroids?

Lung function <50%

28

Rule out alpha-1 anti-trypsin deficiency when?

Patient <45 years old with bilateral basilar emphysema

29

Factors which increased BNP? Factors which decrease BNP?

Renal failure, old age, female sex

Obesity

30

Typical cryptogenic organizing pneumonia patient?

Non-smoker with acute to subacute development of respiratory symptoms and opacification on CXR

31

DVT prophylaxis in hospitalized, medically ill patients?

In patients with renal impairment?

In HIT?

Heparin, LMWH, fondaparinux

Adjusted dose of LMWH,

Direct thrombin inhibitors

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