Obstructive Lung Disease

Question 1

Indication for abx in AECOPD patient that is intubated

Answer 1

Routinely give them

Question 2

Frequency of sputum culture in patients with CF

Answer 2

Every 3 months

Question 3

Preferred treatment for new pseudomonas infection in CF

Answer 3

Inhaled tobramycin for 28 days

Question 4

First line therapy for destroyed lung syndrome

Answer 4

Hypertonic saline and chest physiotherapy

Question 5

Biologic for steroid dependent asthma regardless of phenotype

Answer 5

Dupilumab

Question 6

Dupliumab mechanism

Answer 6

Inhibits alpha subunit of IL-4

Question 7

Omalizumab mechanism

Answer 7

Inhibits free IgE

Question 8

Reslizumab mechanism

Answer 8

Monoclonal antibody against IL-5, a cytokine responsible for eosinophil differentiation, activation, and recruitment

Question 9

Mepolizumab mechanism

Answer 9

Monoclonal antibody against IL-5, a cytokine responsible for eosinophil differentiation, activation, and recruitment

Question 10

Indication for mepolizumab

Answer 10

Poorly controlled asthma with eosinophil >150

Question 11

Indication for roflumilast

Answer 11

Chronic bronchitis AND two exacerbations in a year or 1 hospitalization

Question 12

Roflumilast mechanism

Answer 12

PDE-4 inhibitor

Question 13

Criteria for a positive bronchoprovocation test?

Answer 13

> 15% fall in FEV1 with indirect stimulus (mannitol) and >20% fall in FEV1 with direct stimulus (methacholine)

Question 14

Patients excluded in bronchial thermoplasty trials

Answer 14

FEV <60%, <18 years old, sinus disease, >3 exacerbations per year

Question 15

COPD ppulation with greatest supplemental oxygen supplementation

Answer 15

Severe desaturation with activity or desaturation at rest

Question 16

New therapy for attacks of hereditary angioedema

Answer 16

Icatibant

Question 17

Benefit of pulmonary rehab after discharge for AECOPD

Answer 17

Reduction in all cause mortality

Question 18

Benefits of endobronchial valves in COPD

Answer 18

Improved quality of life, improved dyspnea, improved lung function, and reduced exacerbations

Question 19

Most common cause non-CF bronchiectasis

Answer 19

Post-infectious and idiopathic

Question 20

CF bronchiectasis upper or lower lobe predominant?

Answer 20

Upper lobe

Question 21

Non-CF bronchiectasis upper or lower lobe predominant?

Answer 21

Lower lobe

Question 22

Is dornase alpha effective in CF? Non-CF bronchiectasis

Answer 22

Effective on in CF bronchiectasis

Question 23

Test for primary ciliary dyskinesia

Answer 23

Nasal nitric oxide test

Question 24

Contraindications to allergen immunotherapy in asthma management

Answer 24

Poorly controlled asthma, unstable cardiac disease, pregnancy (can continue in preg but can’t start)

Question 25

Benefit of endobronchial valve insertion in COPD

Answer 25

Improved lung function and quality of life that persist after 12 months. No mortality benefit.

Question 26

Most common adverse effect of endobronchial valves

Answer 26

Pneumothorax

Question 27

Gene that confers macrolide resistance in M abscessus infection

Answer 27

erm

Question 28

Gene that confers ethambutol resistance in mycobacterial infection

Answer 28

emb

Question 28

Gene that confers rifampin resistance in mycobacterial infection

Answer 28

rpoB

Question 28

Difference in using FEV1/FVC <70% and using LLN

Answer 28

<0.7 provides discrimination of COPD-related hospitalization and mortality that is more accurate than using the LLN

Question 29

Does a fixed threshold for obstruction diagnosis based on FEV1/FVC lead to over or underdiagnosis?

Answer 29

Over diagnosis

Question 30

How does sensitivity and specificity compare for LLN and <70% for FEV1/FVC?

Answer 30

LLN is more specific. Fixed threshold <70% is more sensitive.

Question 31

Difference in ICS/LABA/LAMA vs LABA/LAMA

Answer 31

ICS/LABA/LAMA has been shown to improve lung function & symptoms, & to reduce exacerbations and all-cause mortality

Question 32

When should NIV be started after AECOPD in patient with hypercapnia?

Answer 32

2 to 4 weeks following discharge.

Question 33

ATS pCO2 cutoff for starting NIV in patients with COPD

Answer 33

> 45

Question 34

Effects of influenza vaccination in COPD

Answer 34

Reduced number of exacerbations and hospitalizations

Question 35

Brensocatib mechanism and use

Answer 35

Inhibitor of DPP1 that reduces neutrophil serine protein activity in patients with non–CF bronchiectasis

Question 36

Major side effects of Brensocatib

Answer 36

Periodontal disease and skin lesions

Question 37

Consequence of de-escalating triple therapy to ICS/LABA in patient with COPD and few exacerbations

Answer 37

Reduced lung function

Question 38

Patients should be checked for ______ if baseline absolute eosinophil count is >300

Answer 38

Strongyloides

Question 39

Treatment for bronchopulmonary sequestration

Answer 39

Surgical resection