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USMLE HY notes > Pulmonalogy Finals > Flashcards

Pulmonalogy Finals Flashcards

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1
Q

What are the 2 main medication that can trigger asthma attack?

A
  • Beta-blockers- mainly non selective
  • Aspirin

non selective BB- Carvidelol, labetalol, propanolol

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2
Q

Which IL and WBC we will see in Type II inflammation in asthma pt?

A

IL-4,5,13
IgE + eosinophils

trough TH2

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3
Q

Dgx of Asthma

A

clinical Dgx
קליניקה מתאימה + הפרעה חסימתית הפיכה בספירומטריה

FEV1 / FVC < 80%

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4
Q

What is the definition of reversible obstuction in asthma?

by spirometry criteria

A

FEV1 elecation in 200ml + 12%
15 min after bronchodilators / few weeks after Tx start with steroids

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5
Q

What is positive metacholine test?

A

decrease in FEV1 in 20% after low dose of metacholine < 400 mkg

if negetive- definitly not asthma
if positive- might asthma or other

and after bronchodilaters we will want to see improvment at least in 200ml + 12% in FEV1

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6
Q

How we can tell if a pt have type II inflammation asthma?

A

Exhaled NO
indication for eosinophilic inflammation

does not use to Dgx asthma

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7
Q

when we will hospitelized asthma pt?

A

when PEFR (FEV1) < 60% or persistent severe tachypnea for 4-6 hours

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8
Q

Option of Tx in acute exacervation of asthma

A

SABA + IV /PO steroids + consider adding sulfate Mg IV and LTRA

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9
Q

which type of tx are added to acute asthma on hospital

A
  • NIPPV
  • Oxygen + helium
  • Abx- only when signs of infection
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10
Q

Which type of medication is given in all levels of chronic asthma

whats the reliever

A

Low dose ICS / Formoterol (LABA that start in 15 min)

Reliever that replace SABA

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11
Q

What is the Tx for stage II asthma

A

permenent tx with low dose ICS + reliever

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12
Q

What is the Tx for Stage III-IV-V at chronic asthma

A

eleveted doses of ICS:
III- med. doses
IV- high dose
V- add LAMA

in all add LTM (luekotrient modifier) / and or LAMA (mainly in step 5 LAMA)

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13
Q

When we will give biological therapy for asthma pt?

A

severe cases
שלא הצליחו להיות מאוזנים על הטיפול במינונים גבוהים
step 6

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14
Q

Why we never give LABA alone and only with steroids

A

LABA alone is a/w increase risk of mortalitiy

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15
Q

suffix of beta-agonist

A

Terol / Tamol

like salbutamol, albuterol = ventoline

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16
Q

Suffix of muscarine antagonist

A

Ium

like ipartorpium

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17
Q

ICS options

A

Budesonide / Fluticasone

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18
Q

in Which type of medication can we use in the following situations:

  1. Aspirin- exacerbated respiratoy disease
  2. Exercise induce bronchoconstiction
  3. alternate theapry to ICS for step II in kids

and what is effectivness compared to ICS or bronchodilators?

A

Montelucast
anti-leukotrient

effectivness in improving lung function and reduce excer.
anti-leukotrients < Bronchodilators < ICS

ICS is the most effective

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19
Q

Which biologic medication can be given to Asthma

A
  1. Omalizumab- anti IgE
  2. Mepo/Resli/Benralizumab- anti IL-5, IL-5R
  3. Dupilumab- antil L-4/13

אמא אומרת מי פה הורס לי? זה הבן הרע המסומם (dope)

ema omeret mepo resli? ze benra dope.

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20
Q

When we will give Omalizumab

A

severe asthma + IgE > 30 + ellergy

SC every 2/4 weeks

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21
Q

When we will give anti IL5/IL5R

Mepo o-resli? ze h-ben ra

mipolizumab / reslizumab / Benralizumab

A

Severe Asthma + Eosinophils > 300

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22
Q

Which biological medication can be gevin for severe uncontrole asthma with FeNO 20-25

A

Dupilumab

can lead to paradoxial eosinophila

anti-IL4/13

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23
Q

Triaf of Aspirin Excaerbated respiratory disease

A
  • Asthma
  • nasal polyps
  • Chronic sinusitis

Tx- Montelukostat / other biological Tx for IL5 or 4

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24
Q

What blood results will see in Allergic broncopulmonary Aspergilossis (ABPA)

abd what is the Tx?

A

IgE > 1000
Eosinophils > 500
Skin test- positive for aspergillus
specific IgG + IgE aspergillus Ab.

mainly in immunodepressents with COPD / Asthma

**Tx- Oral steroids + Voriconazole/ Itraconazole **

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25
How we Dgx COPD by pulmonary tests spirometry?
FEV1 / FVC < 0.7 w/o reversability after bronchodilators
26
what are the 5 stages of **GOLD criteria for COPD** | by spirometry
I- mild FEV1 > 80% II- FEV1 ~ 50-79% III- FEV1 ~ 30-49% IV- FEV1 < 30% | in all we will see FEV1/ FVC < 0.7
27
Tx for Acute excer. of COPD
1. **SAMA + SAMA** 2. **Abx- **fluroquinolone, amoxi/clavinulate 3. **Systemic Steroids- ** perdnisone for 5-10 days (unhospitelized pt) / IV in-hospitel 4. **Oxygen** - O2% > 90%
28
# acute excercabation When we will use ventilention mechine in COPD pt?
**NIPPV** >> Pco2 > 45 רק במטופל יציב, שיכול לשתף פעולה ובהכרה מלאה, ללא השמנה קיצונית, כוויות משמעותיות **הנשמה פולשנית**- במצוקה נשימתית ניכרת למרות טיפול, חמצת נשימתית קשה, מצב הכרה ירוד . % תמותה בהנשמה 17-30%
29
What is the indications of O2 supplement in chronic COPD pt
restring O2% < 88% or < 89% + PAH, RHF, aretrocytosis
30
What are the 2 C/I for Lung volume reduction surgery in COPD?
1. DLCO < 20% 2. FEV1 < 20% + diffuse emphysema on CT | high risk of mortality in surgery
31
Tx for COPD
* **LAMA** * **LABA** * **LAMA+ LABA-** most beneficial fromeach medicaiton alone * **ICS**- will never be given alone in COPD(must LABA/ LAMA) | all reduce excer. + improve symptoms ## Footnote recall- in Asthma - LABA is never alone. alwyas with ICS in COPD- ICS is never alone
32
מהם היתרונות שנמצאו במחקרים על שיקום ריאות
* משפר איכות חיים * דיספניאה ויכולת ביצוע מאמצים * מפחית תדירות אשפוזים
33
Which advaence medications can be given to COPD who not respond to other medication?
**Roflumilast-** PDE4i, mainly for COPD severe + chronic bronchitis. GI symptoms common **Azytromycin-** anti microbial + anti-inflammatory. **lower excer reccurence, non smokers does not depend on pulmonary infection**
34
Which type of vaculitis is in correlation of alpha1-AT deficieny
GPA (wegner) alpha1-AT inhibit PR3 perodixase
35
Tx for alpha1- AT deficinecy? | and what is the indication
**alpha1 -AT augmentation therapy** given the enzyme IV once a week **only for severe loss < 11 + pulmonary disease**
36
What are the 3 light criteria? | Exudate vs transudate
* Protien serum/effusion > 0.5 * LDH serum/ effusion > 0.6 * LDH in effusion > 2/3 of upper normal limit **only need one to determine exudate**
37
How many % Light criteria mistakely recognize Transudate as exudate? | and how can we overcome this problem?
**25% of times** **measure gradient** protein in serum - protein in effusion if > 3.1 = **Transudate**
38
Which levels of BNP in pleural effusion is diagnostic for CHF
**BNP > 1500**
39
What are the 3 main causes of Transudate?
1. **CHF-** not need to pancture unless- unilateral/ a-symmetric / fever or pain / Tx for CHF does not improve effusion 2. **Chirrosis-** mainly in right side 3. **Nephrotic syndrome-** part of anasarca
40
Tx for para-pneumonic effusion | indication for **Therapuetic thoracentesis**
thick of pleural effusion > 1 cm = **Therapuetic thoracentesis** | הנוזל מרחק את הריאה מקיר בית החזה במעל 1 ס"מ
41
What are the indication of complicated para-pneumonic effusion
1. pus = empyema 2. positive culture 3. glucose < 60 4. PH < 7.2 5. septations | 1 is the most importent 5 the least ## Footnote empyema = collection of pus in pleural cavity
42
What is the steps in Tx of complicated para-pneumonic effusion?
1.insert chest tube 2.if not working- insert trough the chest tube fibrinolytic medication like- DNAse 3.Thoracoscopy | steps ## Footnote 1. pus = empyema 2. positive culture 3. glucose < 60 4. PH < 7.2 5. septations **בספר רשום קודם כל לחזור על ניקור טיפולי ואז להתקדם לנקז בשאלות משחזורים ישר נקז**
43
most common cause of Exudate and second most common cause
1. Para-pneuomonic 2. Malignancy- lungs/ Breast / lymphoma
44
a man present with dyspnea which is not proportional for is pleural effusion. what might be the cause
Malignancy
45
What is the only cause a/q mesotholioma?
**Asbestosis** aorund 80% of pt with Hx of exposure | **No connection to smoking**
46
in PE, which type of pleural effusion we expect?
**almost always Exudative**
47
What define Pleural effusion as reasult of TB?
mainly in primary TB lympocytes dominant **Marker of TB in effusion-** high ADA or INF-y **Tx as pulmonary TB- RIPE**
48
What is the Tx for Chylothorax? how we Dgx?
**Dgx** CT + lymphangiogram + TG > 110 in effusion **Tx** Chest tube + octerotide ## Footnote להמנע מניקוז ממושך של הנוזל- סיכון לתת תזונה ופגיעה חיסונית.
49
2 main reason for Chylothorax?
mediastinal Tumor Traume affect the thoracic duct
50
What is the cheracteristics of RA pleural effusion?
**Exudate + monocytes + PNM + low glucose** ## Footnote most common extra articular in RA- pleural disease
51
low glucose in pleural effusion (exudate) can seen in 3 main situations
1. bacterial infeciton 2. Malignancy 3. RA
52
Primary spontanous pneumothorax cause and treatment
cause >> epical bulb mainly in tall think males **Tx** simple aspiration >> Stapling of bulb and Pleural abrasion | ננסה אספירציה, לא עובד נעשה סטמפלינג והדבקה של הפלאורות ## Footnote **if reccurent episode- jsut spaling + pleural abrasion**
53
Main cause of Secondary spontaneous pneumothorax and Tx
**COPD** Emergency- **always chest tube** **if candidate for surgery-** Stapling of bulb and Pleural abrasion **if not candidate-** Pleurodesis
54
when most tension pneumothorax occurs? Tx?
**mainly during ventilation / CPR** **Tx** Needle >> Chest tube | High PIP
55
what is the Hallmark of obstuctive disorder (in spiromytry)
**FEV1/FVC < 0.7**
56
What is the hallmark in sirometry of restrictive disease
FEV1/FVC < 80% or normal *also TLC < 80%
57
What is the meaning of DLCO when its low and normal?
DLCO normal- no problem in lung tissue- extra pulmonary cause DLCO low- **ILD**
58
What are the main causes of extra-pulmonary restrictive disease
**Neuromascular** polio MG ALS **Stractural** Scolicosis shape of spine Morbid obesity
59
Which type of extra-pulmoanry restrictive disoder we will see only **low FRC** when RV + TLC are normal
**Stractural** Scolicosis shape of spine Morbid obesity
60
When we will see normal FRC (passive volume) but low TLC and high RV
**Neuromascular** polio MG ALS | all the volume that requires muscles will be low
61
When we see normal spirometry and isolated low DLCO
PAH anemia
62
which type of disease can cause low DLCO
* ILD * anemia * PAH * PE * emphyzema * lung resection
63
Which drugs a/w ILD
**Bleomycin**, busulfan **Amiodaron** **MTX** RTX AZA anti-TNF **Nitrofurantoin**
64
which type of ILD is a/w smoking, the pathological process is fibrosis (and not inflammation) , will present around age > 40, with clubbing, and progressive dyspnea + dry cough?
**Idiopathic pulmonary fibrosis**
65
What can we hear in IPF?
קרפיטציות אינספירטוריות שנשמעות כמו Velcro
66
Dgx of IPF?
clinical presentation + typical HCRT no biopsy is needed
67
Tx for IPF?
**Nintedanib + pirfenidone** | נינתן דה פירבנידון (פיברוזיס אנד דונ) ## Footnote מאטות הדרדרות בתפקודי הריאות ויתכן שמשפרות השרדות
68
Which type of Tx if **not** recommended of IPF
Steroids and immunosupresive- increase morbidity and mortality
69
**Cryptogenic Orginizing pneumonia** presentation HRCT Tx
**presentation** Flu like disease, but prolong HCRT- **Sub-pleural patches consolidations** **Tx-** Steroids (prolong use)
70
Acute eoshinophilic pnuemonia true or false: 1. present in elderly males 2. present with fiver, dyspnea 3. respond to Abx 4. treatment with Abx 5. Dgx by BAL with eosinophils > 25%
1. present in elderly males- **False- young males 20-40** 2. present with fiver, dyspnea - **true** 3. respond to Abx- **false** 4. treatment with Abx- **false- with Steroids** 5. Dgx by BAL with eosinophils > 25%- **true** ## Footnote Steroids- great prognosis.
71
when I say Framer lung or bird / chicken workers you say?
**Hypersensetivity pneumonitis** | **In this type of ILd must search for the reason!**
72
Most common reason for Bronchoectasis?
**|Reccurent infections** ## Footnote Bronchoactasis- non-reversabile dilation of airways
73
Bronchoactasis: upper lobe causes lower lobe causes middle lobes central airways
* **upper lobe causes-** CF, radiations * **lower lobe causes**- reccurent aspirations (like in scleroderma- esophagus dismotility) * **middle lobes**- MAC, kartenger (Primary cilliary dyskinesia) * **central airways-** ABPA (aspergillosis)
74
Which bugs ar the most common etiology for bronchoectasis?
**Hemophilus and pseudomonas**
75
Clinical presentation of Bronchoectasis
שיעול פרודקטיבי עם כיח סמיך +ייתכן המופטזיס ## Footnote can progress to cor-pulmonale and secondary amyloidosis
76
Imaging of choice for Broncheacatsis and what we will see?
**CT** Singet ring sing (airway X 1.5 from the near Blood vessel) thickness of airway/ small to medium
77
Main reasons for Bronchoectasis
CF Kartenger (PCD) aspergillos smoking obstuction by tumor
78
Which test must have taken when there are **Focal bronchoectasis?**
**Bronchoscopia** rule out obstruction - tumor / foreign body ## Footnote make sense beacuse its not a diffusal process
79
Empiric Tx in excerbation of broncheoctasis?
**empiric cover for H.influenza + psuedomonas** Flueroquinolones- like levofloxacin for 7-10 days
80
Tx for broncheoctasis with Hemophilus specific or non TB mycobacteria- mainly MAC
H. influenza- augmentin NTM (must grow in 2 different cultures)- macrolide, rifampin, ethembutol
81
Tx for ABPA (aspergillus)
Steroids + long term on Itraconazole
82
Tx for Broncheoctasis with Hypergamaglobulinemia
IVIG
83
Main different between Central to Obstructive sleep apnea
**Central-** w/o breating effort **Obstructive-** theres a breathing effort
84
Dgx of OSA? ## Footnote obstructvie Sleep apnea
עייפות במהלך היום / תסמיני הפרעות לילות בשינה (נחירות וכאלה) + AHI ≥ 5 **או** AHI ≥ 15 ## Footnote (AHI) is an index used to indicate the severity of sleep apnea. It is represented by the number of apnea and hypopnea events per hour of sleep
85
# sleep apnea What is the definiton of episode of apnea?
at least 10 seconds with apnea / hypopnea (decrease > 30% in flow)
86
Risk factor for OSA?
obesity - 40-60% Males
87
Complication of OSA?
* **Resistance HTN-** Tx with CPAP * **risk for CV disease-** stroke, DM, CHF, arrytmihas *do not cause Cor-pulmonale ## Footnote HTN- w/o reduce in 10% in night
88
first line Tx in OSA?
* lifestyle change * CPAP- **first line** * התקנים אוראליים- מי שלא סובל סי-פאפ * ניתוח של דרכי אוויר עליונות- פחול יעיל מ-CPAP
89
Cheye stokes breathing is a/w?
**Central apnea** mainly in CHF and stroke | CPAP is not helping here! ## Footnote could also be seen in: CNS- encephalitis polio/ ALS drugs, Severe kyposcolicosis **opiods, high pressure CPAP, hypoxia (high altitude)**
90
# nocosomial disease What we will see in * Coal mine lungs * and Brilium?
Caol mine- upper airways, small round nodoles Berilum- look like sarcoidosis
91
Eggshell pattern is a/w
Silicosis | mainly upper lung
92
Silicosis is a/w increase risk to which type of pulmonary infection and lung cancer?
TB bronchogenic carcinoma
93
What is the imaging findings see on asbestosis?
**pleural plaques**, some are calcified, somtimes with effusion. mainly effect the lower lobe
94
True or false Asbestosis have a synergestic affect with smoking
**ture** means high risk for all type of cancers
95
In asbestosis, which type of cancer is a/q higher risk?
**Bronchogenic carcinoma** = most high risk **Mesothelioma**- less but asbest exposure is the only risk factor known for this type of cancer

USMLE HY notes (34 decks)

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