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Pulmonology Flashcards

(99 cards)

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1
Q

diff PFTs

A
  1. static lung compartments (TLC,RV ,VC)
  2. air movement ( FEV1/FVC , FEF25-75%)
  3. alveolar memb permeability (DLco)
  4. methacholine challenge test
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2
Q

what is the abnorml value for lung vol / flow rates

A

<80% : abnormal

> 120%: air trapping

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3
Q

diff bw FEV1/FVC and FEF25-75%

A

both measure airflow under dynamic condn

FEF usually detects obstructive ds earlier.

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4
Q

obstructive ds + decreased DLco

A

emphysema

DLco diff from ch bronchitis, asthma , bronchiectasis

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5
Q

restrictive pattern + dec DLco

A

interstial lung ds / intrapulmonary restriction

not extrapulmonary cause

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6
Q

when is methacholine challenge test said to be positive

A

dec from baseline FEV1 of 20% or more

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7
Q

increased DLco in___

A

pulmonary haemorrhage eg: good pasteur

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8
Q

bronchodilator reversibility test used to distinguish

A

nonreversible obs from reversible obs lung ds

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9
Q

flattened flow vol loop on top and bottom indicates

A

fixed airway obstruction:eg tracheal stenosis after prolonged intubation

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10
Q

flow vol loop in dynamic extrathoracic airway obstruction

A

obstruction occurs mostly with inspiration while exp is normal

flattened only on bottom

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11
Q

Do2 (oxygen delivery) depends on

A

Do2=CO × (1.34 ×Hb ×HbSat) + 0.0031 ×Pao2

depends less on Pao2(minimal change on giving 100% o2)

main: CO and Hb

dont memorise formula

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12
Q

alveolar - arterial gradient formula

A

PAo2 - pao2

150 - (1.25 x PaCO2) - PaO2

valid if breathing room air

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13
Q

severe hypoxemia but normal gradient

A

dec in RR as in opiod overdose and resp centre depression

high altitude

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14
Q

what is the first step after finding out a pul nodule in chest xray

A

look for prior xray

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15
Q

if no prior chest xray available ..what to do?

A

consider whether the patients is high/low risk

high: >50, smoking
- resection amd biopsy

low: < 35 , nonsmoking, calcified
- Cxray/ CT every 3 mths ×2yrs

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16
Q

why is bronchoscopy not a good option for diagnosing a case of a pul nodule on chest xray

A

not reach peripheral lesions

mislabel 10% of central cancers by finding only nonspecific inflammatory changes

performed blindly

specimen obtained cam be limited

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17
Q

in which cases it is rasonable to observe pleural effusion without performing thoracocentesis

A

CHF

viral pleurisy

recent abdominal/ thoracic surgery

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18
Q

light criteria for pleural effusion

A
  1. LDH
  2. LDH effusion/serum ratio
  3. protein effusion/ serum ratio

values
200
0.6
0.5

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19
Q

eg of condtion causing exudate and transudate

A

pulmonary embolism

clinical significance: patient has transudative effusion but no apparent cause…consider PE

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20
Q

is thoracocentsis necessaary in parapneumonic effusion?

A

YES(treatment ll be diff. in un/complicated effusion)

to rule out complicated parapneumonic effusion ( possibility of progressing to empyema)

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21
Q

what is the diff in the Rx of un/complicated parapneumonic effusion

A

uncomplicated: antibiotics alone
complicated: chest tube drainage

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22
Q

haemorrhagic pleural effusion seen in

A

meaothelioma

metastatic lung / breast ca

pul thromboembolism with infarction

trauma

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23
Q

lymphocytic predominant pleural effusion seen in

A

tuberculosis

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24
Q

most senistive amd specific test for pleural TB

A

biopsy

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25
thoracocentesis should always be done under guidance of USG
yes
26
Rx of acute exacerbation of asthma
1. oxygen 2. short acting beta2 agonist(albuterol) 3. anticholinergics( less eff, take time to act) 4. inhaled steroid spur ( for 7 - 14 days)
27
which is the most imp medication in Rx of acute excerbation of asthma
short acting beta 2 agonist - like albuterol
28
which is the most imp medication in chronic Rx of asthma
inhaled steroids
29
mostvimp side effects of inhaled steroids
oral candidiasis bad taste so wash mouth
30
how to treat nocturnal asthma
long acting beta agonist
31
when is chromolyn / nedocromil used?
not to be used in acute excerbation: may even proke attack. used in childhood asthma which is mild and where steroids should be avoided. adulthood asthma does not benefit much since it is severe....but can be used in exercise (mild) induced asthma
32
when is LTs antagonists used in asthma
used in steroid dep asthmatics(chronic oral steroid users ) to minimize steroid use or stop its use dur to side effects
33
what is the difference bw COPD and asthma
COPD:: nonreversible noninflammatory condition inflammation only during excerbation Rx
34
what are the types of ventilation
noninvasive: supports breathing without the need for intubation invasive: (mechanical) follows endotracheal intubation
35
types of nonivasive ventilation
bilevel positive airway pressure:positive pressure at alternating levels(higher for insp and lower for expiration) continuous positivr airway pressure: air pressure on a continuous basis ( airways continuously open)
36
BiPAP used in
COPD acute resp failure( pneumonia, status asthmaticus) chronic resp failure
37
CPAP used in
obstructive sleep apnoea CHF with pul edema near drowning other resp distress
38
invasive ventilation includes
positive end exp pressure
39
pattern of obs in asthma
episodic pattern . .with interspersed normal airway tone.
40
cause of obs in asthma
mucosal inflammation muscle constriction hypersecretion
41
2 types of asthma
INTRINSIC/ IDIOSYNCRATIC/ NONALLERGIC: secondry to nonimmunologic stimuli like infection, irritating inhalant, cold air , exercise , emoional upset EXTRINSIC/ALLERGIC /ATOPIC: precipitated by allergens. sp IgE are present other symp like rhinits, utricaria , eczema
42
MCC of asthmatic excerbation
resp infections ( MC: viruses)
43
samster`s triad
athma nasal polyposis(causing reccurent sinus ds) sensitivity to aspirin and nsaids
44
variants of asthma
nocturnal cough exercise induced
45
why is chest x ray done in asthma
to R/O acute infection of lung
46
Dx of asthma
obstructive pattern that reverses with bronchodilation if normal PFTs : do methacholine test - decrease in FEV1 and FEF25- 75 of 20%
47
MC side effect of beta agonist
tremors
48
SABA and LABA
SABA salbutamol/albuterol terbutaline LABA salmeterol formeterol
49
beta agoinsts should be used in caution in
``` CVD hypothytoidism DM htn coronary insufficiency ```
50
moa of amino/theophylline
not used routinely modest bronchodilation IMPROVING CONTRACTILITY OF DIAPHRAGM AS WELL AS OTHER RESPIRATORY MUSCLES
51
status of anticholinergics in asthma
ADVANTAGE used in patients with heart ds DISADVANTAGE significant time to achieve max bronchodilation (-90 min) medium potency
52
should routine Antibiotic Rx in acute excerbation of asthma be given
no, not proved only in patients with symptoms ( purulent sputum ) and chest xray findings ( infilterates) consistent wih bacterial pneumonia
53
use of systemic steroids in asthma
in severe asthma following status asthmaticus( initially i.v. then orally for 10 - 14 days)
54
when is LABA used?
persistant asthma nocturnal symptoms
55
when is LT modifiers used in astham
for severe asthma resistant to max doses of inhaled steroid AND as a last resort before using chronic systemic steroids
56
status of MAST cell stabilizers in asthma
cromolyn ,nedocromil - chronic asthma especially in children - allergic / exercise induced
57
diff categories of asthma
MILD INTERMITTANT symptoms 2x/wk nighttime symp <2x/ mth MILD PERSISTANT symptoms 3-6x/wk nighttime symp 3-4x/mth MODERATE PERSISTANT symptoms everyday nighttime symptoms >5x/wk SEVERE PERSISTANT symptoms everyday nighttime symp frequently
58
Dx of ABPA
sputum: fungus , eosinophils blood: eosino, IgE, specific aspergillus Ab skin test: but does not differentiate bw ABPA and simple allergy to aspergillus
59
Rx of ABPA
corticosteroids
60
chronic bronchitis
productive cough for most days of a 3 month period for atleast 2 consecutive yrs
61
pathognomic differentiating finding on PFTs bw COPD and asthma
COPD :irreversible
62
cause of obstruction in empysema
decrease in recoil
63
cause of obstruction in ch bronchitis
mainly increase in airway resisitance
64
chest x ray finding in emphysema
hyperinflation of bilateral lung fields diaphragm flattening small heart inc retrosternal space
65
chest x ray finding in ch bronchitis
increased pul markings
66
Dc of COPD
PFTs
67
increase in CO2 occurs __ in ch bronchitis and ___ in emphysema
early late
68
Rx of stable phase of COPD
anticholinergics (first choice) can be given synergistically with beta agonist theophylline inhaled steroids( very severe case)
69
why are beta agonists not the first cgoice
COPD patients have underlying heart ds and tachycardia. beta agonist can ppt heart failure
70
drugs that increase theophylline levels
FQs clarithromycin H2 blockers certain beta blockers CCBs
71
drugs that decrease theophylline levels ( due to increased clearance)
rifampin dilantin phenobarbital SMOKING
72
only interventions that can decrease the mortality in COPD
home oxygen smoking cessation
73
when should home oxygen therapy be instituted in COPD patients
PaO2 <55 mm Hg PaO2 <59 mm Hg if cor pulmonale is present
74
MCC of COPD acute excerbation
viral lung infections
75
specific treatment for acute excerbation of COPD
oxygen( till 90%) inhaled bronchodilators: ipratropium + albuterol systemic corticosteroids for 2 wks ( inhaled not given) antibiotics no benefit of i.v. theophylline but if the patient was using give it now also beacause abrupt discontinuation may worsen symptoms avoid opiates and sedatives postural drainage stop smoking how to use MDI
76
which is the commonest micro org seen in bronchiectasis
pseudomonas
77
tram traking and signet ring sign in chest xray is seen in
bronchiectasis
78
rotating antibiotics concept is used in
bronchiectasis (patirnts should be Rx with antibiotics when sputum production increases or they have mild symptoms. chronic prophylaxis is not recomended)
79
sirgical therpy in bronchiectasis is useful in case of __
localised bronchiectasis
80
reticular / reticulonodular pattern in Chest X ray seen in
intertitial lung disease
81
drug used in IPF
pirfenidone ( antifibroti effects)
82
what are the dermatologic manifestations in sarcoidosis
lupis pernio( ch raised purplish indurated lesion of skin found on face) erythema nodosum non scarring alopecia papules
83
LÖFGREN SYNDROME
distinct sarcoid syn with acite presentation includes eryhtema nodosum , arthritis , hilar adenopathy.
84
HEERFORDT WALDENSTROM SYNDROME
distinct sarcoid syndrome wih acute presentation fever parotid enlargement uveitis facial palsy
85
if a patient is asymptomatic amd has BILATERAL HIALR ADENOPATHY on routine chest XRay ... assume this to be
sarcoidoisis and follow with imaging
86
definitive diagnosis of sarcoidosis is via
BIOPSY
87
when are steroids used in sarcoidosis
in the setting of organ impairment: uveitis CNS heart hypercalcemia
88
sarcoidosis and ACE levels
60% show rise in ACE levels ACE levels should not be used to diagnose sarcoidosis but can br used to follow the course of ds
89
can u have raised PTT and still have bleeding
yes ..in antiphospholipid Ab syndrome (anticardiolipin Ab syn/ lupus anticoagulant)
90
factor V leidd3n deficiency seen in which races
european decent
91
presentation of fat embolism
TRIAD : acute dyspnea , petechiae ( neck and axilla & confusion)...H/O trauma
92
findings in ARDS
dysnoea , crackles & rhonchi , hypoxemia +/- hypercapnoea , white out chest xray , elevated pul pressure
93
Rx of fat embolism
supportive( not heparin or anticoagulation)
94
one of the major complication / end result of sleep apnoea
right sided heart failure
95
best diagnostic test for sleep apnoea
polysomnography
96
imp lab findings in sleep apnoea
ABG- O2 dec and CO2 inc & RAISED BICARBONATE
97
Rx of sleep apnoea
OBSTRUCTIVE :weight loss , CPAP , surgery .CENTRAL: acetazolamide/ progesterone (breathe faster)
98
diff be central and obs sleep apnoea
no muscle retractions in central sleep apnoea during polysomnography
99
causes of atelectasis
post op ( lack of insp/ cough), foreign body ,tumor , pneumothorax

Internal Medicine (9 decks)

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