Pulmonology Flashcards
(114 cards)
1
Q
ipf
capenumonia
copd
plural effusion
asthma
aspregella
A
2
Q
A
3
Q
What are the key spirometric and lung volume changes in obstructive pulmonary diseases⁉️
A
- 🫁 Obstructive diseases (e.g. COPD, asthma):
✅ ↓ FEV₁
✅ ↓ FEV₁/FVC
✅ ↑ RV, FRC, TLC (air trapping)
✅ Normal lung compliance (↑ in emphysema)
✅ ↓ DLCO in emphysema, ↑ DLCO in asthma
DLCO = diffusion capacity of carbon monoxide
4
Q
What are the hallmark findings of restrictive pulmonary diseases⁉️
A
🫁 Restrictive diseases (e.g. IPF, obesity, neuromuscular disorders):
✅ ↓ TLC, RV, FRC
✅ Normal or ↑ FEV₁/FVC
✅ ↓ DLCO if parenchymal (e.g. fibrosis)
✅ Normal DLCO if non-parenchymal (e.g. obesity)
✅ ↓ Lung compliance in intrinsic causes (e.g. fibrosis)
DLCO:diffusion capacity of carbon monoxideوidiopathic pulm fibrosis (IPF
5
Q
A
6
Q
Which test is required to confirm a restrictive ventilatory defect⁉️
A
🧪 Body plethysmography
✅ Measures absolute lung volumes including TLC and RV
➡️ Needed to diagnose true restriction (↓ TLC)
7
Q
What is the utility of DLCO in lung function testing⁉️
A
🌬️ DLCO = diffusion capacity of carbon monoxide
* ✅ ↓ in:
* Pulmonary fibrosis
* Emphysema
* Pulmonary hypertension
* ✅ ↑ in:
* Asthma
* Polycythemia
* Pulmonary hemorrhage
8
Q
How does lung compliance differ in emphysema vs pulmonary fibrosis⁉️
A
- 📉 Compliance curves:
✅↑ Compliance in emphysema
✅ ↓ Compliance in fibrosis
9
Q
What are the typical spirometry and diffusion findings in idiopathic pulmonary fibrosis (IPF)⁉️
A
- 🫁 IPF lung function test results:
✅ Low lung volumes (↓ TLC, RV, FRC)
✅ Normal or ↑ FEV1/FVC ratio (restrictive pattern)
✅ ↓ DLCO (impaired diffusion due to parenchymal damage)
10
Q
What clinical signs and symptoms are characteristic of idiopathic pulmonary fibrosis (IPF)⁉️
A
- 🩺 Key features:
✅ Progressive dyspnea (over months)
✅Dry cough
✅ Inspiratory “velcro” crackles
✅ More common in adult smokers
11
Q
How is restriction diagnosed in pulmonary function testing⁉️
A
📉 Restriction is confirmed by:
✅ ↓ TLC on plethysmography
➡️ Spirometry alone is not sufficient for diagnosing restriction
12
Q
Which conditions show low DLCO but normal lung volumes and flows⁉️
A
🧬 Suggestive of pulmonary vascular disease:
* ✅ Pulmonary embolism
* ✅ Pulmonary hypertension
13
Q
How does emphysema differ from IPF in lung function tests⁉️
idiopathic pulmonary fibrosis (IPF)
A
-
Emphysema:
✅ ↓ DLCO
✅ Obstructive pattern (↓ FEV1/FVC)
✅ ↑ lung volumes due to air trapping - ⛔ Unlike IPF, FVC is not reduced and lung volumes are increased
14
Q
What are the main mechanisms of pathogenesis in community-acquired pneumonia (CAP)⁉️
A
🦠 Mechanisms include:
✅ Microaspiration (most common)
✅ Inhalation of pathogens
✅ Direct mucosal dispersion
➡️ Aspiration pneumonia accounts for 5–15% of CAP cases
15
Q
What are key **risk factors **for CAP⁉️
A
⚠️ Risk factors:
* Alcoholism
* asthma
* immunosuppression
* institutionalization
age >70
* ➕ Specific risk associations:
* Pneumococcus → dementia, smoking
* CA-MRSA → post-viral, skin colonization
* Pseudomonas → structural lung disease (e.g. CF)
* Legionella → diabetes, HIV, recent travel/cruise
16
Q
What are the common clinical features of CAP⁉️
A
🩺 Symptoms include:
✅ Fever, chills, sweats, dry or productive cough
✅ Dyspnea, pleuritic chest pain, GI symptoms, fatigue
17
Q
What are the physical exam findings in CAP⁉️
A
📉 Findings include:
✅ Increased respiratory rate
✅ Crackles, bronchial breath sounds
✅ Increased or decreased fremitus
✅ Dullness to percussion (e.g. pleural fluid)
18
Q
What pathogens are common by site of care in CAP⁉️
A
-
Outpatient:
* Strep pneumo
* Mycoplasma
* H. flu
* Chlamydia pneumo
* viruses -
Hospitalized (non-ICU):
* Add Legionella
* gram negatives -
ICU:
* S. aureus
* Legionella
* gram negatives
* H. flu
* respiratory viruses
19
Q
What is the empiric outpatient treatment for CAP without comorbidities⁉️
A
💊 Outpatient, low risk:
* ✅ Amoxicillin + macrolide/doxycycline
* ✅ Or doxycycline or macrolide alone
20
Q
What is the empiric outpatient treatment for CAP with comorbidities or Abx risk⁉️
A
💊 Outpatient, high risk:
* ✅ Amoxicillin-clavulanate or cephalosporin
➕** Macrolide/doxycycline or respiratory fluoroquinolone**
21
Q
What is the empiric inpatient treatment for non-severe CAP⁉️
A
✅β-lactam + macrolide
✅ Or respiratory fluoroquinolone
22
Q
What is the empiric inpatient treatment for severe CAP⁉️
A
- ✅ β-lactam + macrolide
✅ Or β-lactam + respiratory fluoroquinolone
23
Q
When should MRSA or Pseudomonas coverage be added in CAP⁉️
A
🧪 Add if risk factors present:
✅ MRSA ➡️ add vancomycin or linezolid
✅ Pseudomonas ➡️ add Zosyn, cefepime, meropenem, etc.
24
Q
How is site of care determined in CAP (outpatient vs hospitalization vs ICU)⁉️
A
📊 Use CURB-65 or PSI:
* Confusion
* Urea >7
* RR ≥30
* BP low
* Age ≥65
➡️ Score ≥2 → consider hospitalization
➡️ ≥3 → may need ICU
25
What are warning signs requiring hospitalization in CAP⁉️
🚩 Hospitalize if:
✅ **Can’t maintain oral intake**
✅ **Confusion or poor oxygenation**
✅ **Room air O2 saturation <92%**
26
What should be done if a CAP patient **fails to improve after 3 days⁉️**
🔍 **Reassess the diagnosis**:
✅ Repeat CXR or CT
✅ Consider **bronchoscopy**
✅ Check for **complications** (abscess, empyema, resistant bug)
27
When should **pneumonia** be **reassessed** for **treatment failure**⁉️
🕒 **After 72 hours of antibiotic treatment without improvement**
➡️ Prompt **clinical re-evaluation is necessary**
28
What are common **causes** of **pneumonia treatment failure despite antibiotics⁉️**
🚩 Main causes include:
✅ **Antibiotic resistance**
✅ **Incorrect antibiotic choice** (e.g., not covering the pathogen)
✅ **Complications** (e.g., lung abscess, empyema)
✅ **Mimics** (e.g., PE, pulmonary edema, hypersensitivity pneumonitis)
29
What is a **parapneumonic effusion** and **how is it diagnosed**⁉️
🫁 Parapneumonic effusion = **pleural effusion secondary to pneumonia**
✅ Can be associated with:
* **Lung abscess**
* **Bronchiectasis**
✅ Diagnosis: **Chest radiograph (CXR**)
30
What is the recommended step if a **pneumonia patient shows no improvement after 72 hours** of antibiotic therapy⁉️
* 🕒 **Reevaluate the patient**
✅ Consider **complications** (e.g., empyema, abscess)
✅ Order a **chest X-ray to assess for pleural effusion**
31
What is **the most important risk factor** for developing COPD⁉️
🚬 **Smoking**
✅ Risk increases with **intensity and early-life exposure**
32
What **occupational exposures** increase the risk of COPD⁉️
✅ **Coal mining**
✅ **Cotton textile industry**
➡️ Act as **amplifiers** of smoking-related risk
33
Why should beta-blockers be **used cautiously** in COPD patients⁉️
🛑 **Non-selective beta-blockers**(e.g., **carvedilol**) can **worsen bronchoconstriction**
✅ **Cardioselective β1-blockers** (e.g., metoprolol) are **safer in COPD when needed**
34
How does **asthma** contribute to **COPD** development⁉️
🌬️ **Airway hyperresponsiveness in asthma**
✅ In smokers, this leads to **greater airflow obstruction**
➡️ **Asthma** + **smoking** = **higher COPD risk**
35
What **childhood condition** has been linked to **increased COPD risk**⁉️
👶 **Childhood pneumonia**
✅ Associated with **long-term lung function impairment**
36
What **genetic condition** is a known contributor to **early-onset COPD**⁉️
* 🧬 **α1-antitrypsin (α1AT) deficiency**
✅ Leads to **early emphysema**, especially in **non-smokers**
37
Do **adult respiratory infections** cause COPD⁉️
⛔ **No** strong evidence for causing COPD
✅ But they are a **major trigger of COPD exacerbations**
38
What are the **major risk factors** for developing chronic obstructive pulmonary disease (COPD)⁉️
1. 🚬 **Smoking** (most important; risk depends on intensity & timing)
2. 🏭 **Occupational exposures** (e.g. coal mining, cotton textile)
3. 🌬️ **Asthma** (airway hyperresponsiveness + smoking)
4. 👶 **Childhood pneumonia** (linked to long-term lung damage)
5. 🧬 **Genetic predisposition** (e.g. α1-antitrypsin deficiency)
39
What is the **diagnostic spirometric criterion** for COPD⁉️
* 📉 **FEV1/FVC < 70%** after bronchodilator use
✅ Confirms persistent airflow limitation
➡️ **Irreversible** with bronchodilators
* ↑ lung volumes (air trapping)
40
What **lung volume changes** are expected in **COPD with emphysema⁉️**
🫁 Due to **hyperinflation** and **loss of elastic recoil:**
✅ ↑ Total Lung Capacity (TLC)
✅ ↑ Residual Volume (RV)
✅ ↑ Functional Residual Capacity (FRC)
✅ ↓ Diffusing Capacity of the Lungs for CO (DLCO)
41
42
What are the **hallmark symptoms** and signs of COPD⁉️
* 🩺 Symptoms:
✅ **Chronic cough**, **sputum** production, **exertional dyspnea**
* Exam findings:
✅ **Wheezing**, **prolonged expiration**
43
What are common **ECG findings** in COPD⁉️
📉 Signs of **right heart strain:**
✅ **Right ventricular hypertrophy**
✅ **P-pulmonale**
✅ **Right axis deviation**
44
What is the **GOLD classification** system for COPD severity⁉️
🟨 **Based on FEV1 (% predicted):**
* GOLD 1: >80%
* GOLD 2: 50–80%
* GOLD 3: 30–50%
* GOLD 4: < 30%
45
What are key **X-ray findings** in COPD⁉️
🩻 Radiographic signs include:
✅ **Hyperinflated lungs** (>10 posterior ribs)
✅ **Flattened diaphragms**
✅ **Narrow mediastinum**
46
What is the **first-line pharmacologic** therapy for **stable COPD**⁉️
💊 **Bronchodilators**:
✅ **Antimuscarinics** (**LAMA**)
✅ **Beta-2 agonists** (**LABA/SABA**)
➡️ Add **ICS**, **roflumilast**, or **oxygen** as disease progresses
47
How is **stable** COPD **pharmacologic treatment** grouped⁉️
💊 By symptoms & exacerbations:
* **Group A**: 0–1 exacerbation, few symptoms → **Bronchodilator**
* **Group B**: 0–1 exacerbation, many symptoms → **LABA or LAMA**
* **Group C**: ≥2 exacerbations or ≥1 hospitalization, few symptoms → **LAMA**
* **Group D**: Same exacerbation risk, many symptoms → **LAMA + LABA or ICS + LABA**
48
What defines a **COPD exacerbation⁉️**
⚠️ Acute worsening of:
✅ **Shortness of breath**
✅ **Sputum production**
✅ **Cough severity**
49
What is the **treatment for COPD exacerbation**⁉️
💊 Includes:
✅ **Short-acting β₂-agonists** (albuterol)
✅ **Anticholinergics** (ipratropium)
✅ **Systemic corticosteroids**
✅ **Antibiotics** (if moderate-severe)
✅ **Supplemental oxygen**
50
When is **non-invasive ventilation** indicated in COPD and contraindications⁉️
🫁 Use NIPPV if:
✅ **Respiratory failure with PaCO₂ > 45 mmHg**
🚫 **Contraindicated** if: **mental status issues**, **facial trauma**, **inability to clear secretions**.
51
Which **interventions improve** COPD prognosis⁉️
Only therapies shown to improve survival:
✅ **Smoking cessation**
✅ Ox**ygen therapy if SaO₂ <88%**
✅ **Lung volume reduction surgery** (emphysema)
✅ **Triple inhaled therapy** in selected patients
52
How is **follow-up pharmacologic** therapy **adjusted in stable COPD**⁉️
📊 Based on **dominant symptom:**
* **Dyspnea**: LAMA or LABA → LAMA+LABA → add ICS
* **Exacerbations**: LAMA or LABA → LAMA+LABA → add ICS
➡️ **Roflumilast** if FEV1<50% + chronic bronchitis
➡️ **Macrolide** if former smoker
53
Is **Carvedilol** preferred for patients with COPD⁉️
🛑**NO**, Carvedilol is a **non-selective beta-blocker**, which can **exacerbate bronchoconstriction**
54
What is **Pneumocystis pneumonia** (PCP), and who is **most at risk⁉️**
🦠 PCP is an **interstitial pneumonia** caused by **Pneumocystis jirovecii**
* Highest risk in **HIV-infected patients with CD4+ < 200/μL**
✅ Especially if not on **ART** or **PCP** prophylaxis
55
What are the **clinical features** of PCP⁉️
🩺 Symptoms:
* **Acute/subacutedyspnea**
* **fever**
* **nonproductive cough**
* ➡️ May progress to respiratory failure and death if untreated
56
What are the **typical imaging** **findings** in PCP⁉️
🩻 **Chest X-ray**:
✅ Diffuse **bilateral**, **perihilar**, **interstitial infiltrates**
🖥️ **High-resolution CT:**
✅ **Diffuse ground-glass opacities **(in nearly all cases)
57
What is the **first-line antibiotic treatment** for Pneumocystis pneumonia (PCP)⁉️
* 💊 **Trimethoprim-sulfamethoxazole (TMP-SMX)**
✅ Standard of care for both treatment and prophylaxis of PCP
✅ Given IV or PO for **21 days**
58
What are **alternative** antibiotic regimens for PCP in **TMP-SMX intolerance**⁉️
* ✅ **IV pentamidine**
* ✅ **Clindamycin + primaquine**
* ✅ **Atovaquone**
59
When are **adjunctive corticosteroids** indicated in PCP⁉️
🧪 Indicated in **moderate to severe PCP:**
✅ **PaO₂ < 70 mmHg** (on room air)
✅ Or **A–a gradient ≥ 35 mmHg**
➡️ Reduces mortality and respiratory complications
60
What **causes** **pleural effusion** to form⁉️
💧Pleural fluid accumulates when **fluid formation exceeds absorption**
➡️ Causes: **increased production** or **impaired drainage**
61
What **physical exam findings** suggest pleural effusion⁉️
🩺 Classic findings:
🔴 **Dullness** to percussion
🔵 **Decreased fremitus** on palpation
🔵 **Decreased breath sounds** on auscultation
62
What **imaging modalities** help **confirm** pleural effusion⁉️
🖥️ Diagnosis by:
✅ **Ultrasound** (fluid in pleural space)
✅ **Chest X-ray** (blunting of costophrenic angle)
✅ **CT scan**(more precise localization)
63
What are **Light’s criteria** for **distinguishing exudate from transudate⁉️**
📊 Fluid is **exudate** if ≥1 of the following:
* Effusion protein/serum protein > 0.5
* Effusion LDH/serum LDH > 0.6
* Effusion LDH > 2/3 upper normal serum limit
⚠️ If **none** are met → **transudate**
64
What are the common **causes** of **transudative** vs **exudative** effusions⁉️
* 🔹 **Transudates**:
CHF (most common), cirrhosis, nephrotic syndrome, constrictive pericarditis
* 🔸 **Exudates**:
Infections, malignancy, PE, autoimmune diseases (SLE, RA), TB, GI diseases
65
What are the **key features** and **diagnostic findings** of **chylothorax**⁉️
🩸 Chylothorax = **accumulation of chyle (lymphatic fluid) in pleural space**
🚩 Most common cause: **Trauma or thoracic surgery**
🔬 Thoracentesis findings:
* **Milky fluid**
* **Triglyceride level >110 mg/dL** (1.2 mmol/L)
📸 Chest X-ray: large pleural effusion
⚠️ Often caused by **mediastinal tumors** or ** ** to thoracic duct
66
What is a **chylothorax** ⁉️
🩸 Chylothorax = **pleural effusion** caused by **disruption of the thoracic duct**,
➡️ leading to **accumulation of chyle** (lymphatic fluid) in the **pleural space**
67
What is the **most common cause** of chylothorax⁉️
**Trauma,**
most commonly **due to thoracic surgery,**
➡️ leading to disruption of the thoracic duct and leakage of chyle into the pleural space
68
What are the **strongest indicators** that a **pleural effusion** is **empyema**⁉️
* 🧪 In decreasing strength:
1. **Visible pus**
2. **Positive Gram stain**/culture
3. **Glucose < 60 mg/dL**
4. **pH < 7.20**
5. **Loculated effusion**
➕ **LDH >1000 U/L** also suggests empyema
69
How is empyema **treated**⁉️
🚨 Requires **complete drainage**
✅ **Chest tube or video-assisted thoracoscopy**
70
What are features of **pleural effusion** due to **malignancy**⁉️
* 🧬 Most common **exudative** cause after infection
* ✅ Diagnosed by **cytology**
* ✅ Features: **Exudate**, **low glucose**
* ➡️ Common malignancies: **Lung**, **breast**, **lymphoma**
71
How is pleural effusion **initially diagnosed** and evaluated⁉️
🩻 Initial detection via **chest X-ray or ultrasound**
✅ If **effusion >1 cm** → perform **thoracentesis**
➡️ **Evaluate fluid via Light's criteria**
72
How does **pleural fluid glucose** help narrow the **differential diagnosis**⁉️
* 🧪 **Glucose < 60 mg/dL:**
✅ Think **malignancy**, **bacterial infection**, **rheumatoid pleuritis**
* 🧪 **Glucose > 60 mg/dL:**
✅ Suggests **pulmonary embolism** or **tuberculosis**
73
What is **the next best step** when **exudate is confirmed** and **glucose is >60 mg/dL⁉️**
🧾 **CT chest scan**
✅ Helps assess for **PE or TB**which are more likely in this context
74
When is **echocardiography** **preferred over CT** in pleural effusion evaluation⁉️
If **transudate** is confirmed and **CHF** is **suspected** → perform **echocardiography**
75
What **diagnostic procedure** is appropriate for **suspected malignant** pleural disease (e.g. mesothelioma)⁉️
🧬 **Pleural biopsy**
✅ Used when **cytology** **is inconclusive** and suspicion for malignancy is high
76
What is the **definition** of asthma⁉️
* 🫁 Asthma is a **chronic obstructive lung disease**
* characterized by:
✅ **Airway hyperresponsiveness**
✅ **Variable airflow obstruction** (often reversible)
* 💡 Triggered by **allergens**, **irritants**, **infections**, or **environmental exposures**
77
What are the **hallmark features** of **asthma pathophysiology**⁉️
🌀 **Airway hyperresponsiveness**
🌬️ Variable **airflow obstruction (reversible)**
78
How is **asthma diagnosed** using **spirometry**⁉️
A:
📉 **Decreased FEV1/FVC and FEV1**
✅ **Reversibility with SABA: FEV1 ↑ by >12% and >200 mL**
✅ **Methacholine test**: **↓ FEV1 by 20% confirms diagnosis**
79
What are the signs of an **acute asthma attack⁉️**
* 🚨 Symptoms: **Chest tightness**, **wheezing**, **dyspnea**
* 🩺 Signs: **Tachycardia**, **hyperventilation**
* 🧪 ABG: **Low PaCO₂** due to hyperventilation; later normal/high = BAD
80
How is an **acute asthma** **attack treated**⁉️
💊 **Oxygen**
💊 **High-dose SABA**
💊 **Nebulized anticholinergics**
💊 **Systemic corticosteroids**
⚠️ Severe: **Magnesium sulfate, aminophylline**
🛑 Prophylactic intubation if PCO₂ normalizes or rises
81
What are the **5 key indicators of poorly controlled asthma**⁉️
⚠️ Daytime symptoms >2/week
⚠️ Activity limitation
⚠️ Nocturnal symptoms
⚠️ Need for reliever >2/week
⚠️ FEV1 < 80%
82
How are **asthma patients classified** and what is the **cornerstone of their treatment**⁉️
* 📊 Asthma patients are classified into “**treatment steps**” based on:
1. Symptom frequency
2. Severity of exacerbations
3. Response to previous treatments
✅ **All patients should receive ICS-LABA inhalers, regardless of step**
➡️ **Inhaled corticosteroid** + **long-acting beta agonist** (ICS-LABA) is the **cornerstone of asthma therapy**
83
What is the **stepwise treatment** for asthma (Step 1 to Step 6)⁉️
➡️ **Step 1**: As-needed **LABA**+**ICS** or **SABA**
➡️ **Step 2**: **ICS low dose**
➡️ **Step 3**: **ICS medium dose** + **LABA**
➡️ **Step 4**: **ICS high dose** + **LABA**
➡️ **Step 5-6:** **Add-on** LAMA / anti-IgE / IL-5 + consider **oral steroids**
84
What does **GINA recommend** as the preferred reliever **for all steps** of asthma management⁉️
✅ **Low-dose ICS-formoterol(LABA)** is the **preferred reliever at all steps**, even in **mild** or **intermittent** asthma
* 🧠 This strategy reduces:
Exacerbations
Need for systemic steroids
Reliance on SABA alone (which may mask worsening inflammation)
85
86
Why is **oral corticosteroid (OCS) use inappropriate for long-term asthma control**⁉️
* 🚫 Long-term OCS use is not appropriate **due to significant adverse effects**
* ✅ Reserved for **severe, refractory cases**
* ➡️ **Step down** to** ICS-LABA** if possible and reassess response
87
What makes **ICS** a **critical component of asthma therapy**⁉️
💊 Inhaled corticosteroids (ICS) **reduce**:
✅ **Airway inflammation**
✅ **Asthma exacerbations**
✅ **Mortality risk**
⚠️ LABA must **never** be used without ICS in asthma
88
What is the role of **LABA/LAMA** **combinations** in asthma management⁉️
* 🟡 LABA/LAMA may be added at **Step 5** for persistent symptoms
* ⚠️ Not a replacement for **ICS**
* ➡️ Consider in patients not responsive to ICS-LABA
89
What are **three asthma-associated syndromes** to remember⁉️
1️⃣ **Aspirin-sensitive asthma**: asthma + nasal polyps
2️⃣ **ABPA**: asthma + pulmonary infiltrates + allergic Aspergillus rxn
3️⃣ **Churg-Strauss (EGPA**): asthma + eosinophilia + vasculitis
90
91
What is the next step in treatment for **uncontrolled asthma** on **low-dose ICS** with frequent symptoms and reliever use⁉️
⬆️ **Step-up to combination** **therapy**: **ICS + LABA (e.g. formoterol**)
✅ Improves symptom control
✅ Reduces exacerbation risk
🧠 Based on GINA guidelines stepwise approach
92
What is **Allergic Bronchopulmonary Aspergillosis (ABPA)⁉️**
🦠 ABPA is a **hypersensitivity reaction** to **colonization by Aspergillus species** (not invasive infection)
✅ Occurs **mainly in patients with asthma or cystic fibrosis**
✅ Leads to **chronic airway inflammation**, **eosinophilia**, and **bronchiectasis**
93
What are the key **clinical and diagnostic** features of **Allergic Bronchopulmonary Aspergillosis (ABPA)⁉️**
🦠 Aspergillus hypersensitivity in patients with asthma or bronchiectasis
📍 Key features:
✅ **Recurrent pneumonia** + **asthma-like symptoms**
✅ **Eosinophilia**
✅ **Central** **bronchiectasis**
✅ **Brown mucus plugs**
✅ **Positive skin test** / serum precipitins for Aspergillus
94
When should ABPA be suspected in an asthma patient⁉️
🧠 Suspect ABPA when:
✅ **Asthma is refractory** to conventional treatment
✅ **High IgE** levels and **eosinophilia** are present
✅ Other signs: **Central bronchiectasis**, **brown mucus plugs**
95
What is the **treatment approach** for ABPA⁉️
* 💊 **Systemic corticosteroids**
➕ **Antifungals** (voriconazole or itraconazole)
✅ For persistent or severe cases despite asthma therapy
96
What is **bronchiectasis and what causes** it⁉️
* 🫁 **Bronchiectasis** is the **permanent dilation of bronchi** due to chronic or **recurrent lung infections**, including **recurrent pneumonia**
➡️ Leads to **airway wall damage**, mucus buildup, and persistent inflammation
97
What **life-threatening complication** can occur in patients with chronic bronchiectasis⁉️
1. 🚨 **Massive hemoptysis**
✅ Due to recurrent infections causing **mucosal blood vessel damage**
98
How is **life-threatening hemoptysis in bronchiectasis** **managed**⁉️
* 🚨 **Initial steps**:
✅ **Intubation** and **stabilization**
✅ Identify the **bleeding source**
✅ Position patient with **bleeding lung down** to protect the other lung
* 🩸 **Definitive treatment**:
✅ **Bronchial artery embolization**
✅ **Surgery** (if embolization fails or not feasible)
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What are common **causes** of bronchiectasis⁉️
🔁 Chronic and recurrent lung injury from:
✅ **Recurrent pneumonia**
✅ **Cystic fibrosis**
✅ **Alpha-1 antitrypsin deficiency**
✅ **Hypogammaglobulinemia**
✅ **Immotile cilia syndrome**
✅ **ABPA (Allergic bronchopulmonary aspergillosis)**
✅ **Connective tissue diseases**
✅ **Foreign body/tumor (if localized)**
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What are the **clinical features** of bronchiectasis⁉️
🩺 Key signs/symptoms:
✅ **Chronic productive cough**
✅ **Hemoptysis**
✅ **Dyspnea**
✅ Digital **clubbing**
✅ PFT: **Obstructive pattern**
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Which **bacteria** are commonly **isolated** during **bronchiectasis exacerbations**⁉️
🦠 Common pathogens:
✅ **Pseudomonas aeruginosa**
✅ **Haemophilus influenzae**
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What **imaging** is required in **localized bronchiectasis** to rule out a central cause⁉️
* 📷 **Bronchoscopy**
✅ To rule out foreign body or bronchial tumor if confined to one area
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