Resp Flashcards
1
Q
PE in pneumothorax
A
No tactile fremitus
Hypertesonance percussion
Decreased breath sound on affected side
Tracheal deviation away from side
2
Q
Dx of pneumothorax
A
CXR
3
Q
Most effective Rx in sleep apnea?
A
CPAP
4
Q
Population of hyperventilation syndrome
A
Young women
5
Q
Sx of hyperventilation
A
Tachypnea Hyperpnoea (deep breath) Atypical chest pain Tachycardia \+/- carpopedal spasm
Gas:
Resp alkalosis
6
Q
Bronchitis vs bronchiactesis sputum
A
Bronchitis > mucoid sputum
Bronchiactsis > purulent malodorous sputum
7
Q
Rx of pneumothorax <20%
A
Outpatient observation
CXR in 24-48 hr
Or
Oxygen + observe
8
Q
Tests done for sarcoidosis patients
A
Slit lamp Pulmonary function test Serum Ca ECG ACE level
9
Q
Sleep apnea associations
A
HTN
10
Q
Differentiate bronchitis from emphysema by PFT?
A
Single diffusion capacity DLCO.
11
Q
Most effective measure in COPD?
A
Smoking cessation
12
Q
What Rx measure improves mortality / survival in COPD
A
Supplemental O2
13
Q
If asthma isn’t controlled with inhaled SABA?
A
Add low dose ICS > increasing dose of SABA
14
Q
Good pasture’s classic?
A
Acute glomerulonephritis
Pulmonary hemorrhage
Following URTI
15
Q
Cause of glumeruonephritis in goodpasture
A
Anti-GBM antibodies > complement activation > tissue damage.
16
Q
CXR in asbestosis
A
Lower > upper lobe
Fibrosis w/ linear streaking (early)
Cyst & honeycombing (late)
IMP > plural & diaphragmatic calcification
17
Q
Cancer with asbestosis
A
Bronchogenic Ca
Mesothelioma
18
Q
When does SABA work?
A
Work in 5 minutes for 4-6 HR.
19
Q
Inhaled CS before SABA improves delivery?
A
False
20
Q
Which is better in asthma oral Beta agonists or inhaled SABA
A
Inhaled
21
Q
Exercise induced bronchoconstriction classic
A
10% decrease in FEV1 with exercise.
High-ventilation sports > track, skiing
Winter sports
22
Q
Dx exercise induced bronchocostriction.
A
Trial with albutrol inhaler.
23
Q
Best way to Dx COPD?
A
Spirometer FEV1/FVC < 70% - 80%
24
Q
Is clubbing a sign of COPD?
A
No
25
Guidelines for pulmonary nodule.
```
Suspicious:
1. Size < 8 mm
2. Ground glass appearance
3. Irregular borders
4. Double size in 1 mo - 1 yr
5. Hx of Ca
6. Smoker
=> biopsy.
```
Non suspicious:
Repeat CT in 6-8 mo
26
Rx of tension pneumothorax
Needle at 2nd intercostal space > chest tube > CXR.
27
Contraindications to thrombolytics?
```
Eye / CNS surgery in 2 wk
Brain tumor
Brain vascular disease
Stroke < 2 mo
Active bleeding
Hypotension
```
28
When does rapidly progressive silicosis develop?
6 months of exposure.
29
Benefit of BiPAP in acute COPD
Improves ventilation
Delay intubation
Improves mortality / morbidity.
30
Rx of acute chronic bronchitis.
SABA
Anti cholinergic
Steroids (oral / IV)
31
Resp side effect of nitrofurantoin?
If used > 6 mo
| Restrictive pulmonary fibrosis
32
Risk of tension pneumothorax
Patient on +ve mechanical ventilation.
33
Step after pulmonary function test?
Full pulmonary test for static lung volume
34
COPD ventilation setting
```
Volume assist
Rate: 10-12
TV: 8mL/kg
PEEP 0-5 cm H2O
Hgb sat: 92%
Peak flow 75-90 L/min
```
35
Gold standard Dx in PE?
CT Angio
36
Hypersensitivity pneumonitis cause
Inhaled organic dust
| E.g mold
37
Hypersensitivity pneumonitis classic
4-8 hrs after exposure > chill, cough, SOB worsen with time
| Symptoms resolve then recur suddenly with repeated exposure.
38
CXR and labs in hypersensitivity pneumonitis
CXR = normal
PFT = restrictive
High ESR
High IgG
39
Idiopathic pulmonary fibrosis classic
Gradual Sx
Dry cough
Clubbing
Fine bilateral crackles (Velcro crackles)
40
Causes of transudate pulmonary effusion
CHF
Cirrhosis
Low albumin
Nephrotic syndrome has
41
Causes of exudative plural effusion.
```
Pneumonia
Malignancy
PE
Viral infection
TB
```
42
What's central sleep apnea
Cessation of airflow 10 seconds without resp effort result in unstable resp control center
43
What worsens central sleep apnea
1. Low CO2: high altitude, cheyne-stroke
| 2. Slow circulation: CHF
44
Role of sedatives in central sleep apnea
Helpful
45
Indication of sever apnea?
Apnea-hypopnea index > 29
46
1st line Rx in sever sleep apnea?
CPAP
47
Acute resp alkalosis acid-base labs
PH > 7.45
O2 normal
CO2 < 40
48
Anaerobic lung abscess classic
Risk of aspiration
Productive cough + fever
Poor dental hygiene
Bad mouth odor + sputum odor.
49
CBC changes in COPD? Why?
Increased RBC mass + erythropoietin
=> low O2 stimulates bone marrow => secondary polycythemia
50
What's pulsus paradoxus? What does it indicate?
10 mmHg decrease in SBP on inspiration
Asthma
51
How to assess severity of asthma attack?
1. Mild:
O2 > 94%
PEF 70% expected
2. Moderate:
O2 < 90
PEF < 40% expected
Pulsus pardoxus
3. Sever:
PEF < 25% expected
52
Rx of acute asthma attack?
Inhaled SABA
Prednisolone (oral / IV)
O2 supplement given if O2 < 90%
53
Def of sleep apnea
> 5 obstructive events / hr
| Daytime sleepiness
54
Sleep apnea association
Obesity
Older age
MEN
HTN
55
Overflow fecal incontinence classic
Common in institutionalized elderly due to constipation meds.
56
Cause of reduced storage fecal incontinence
IBD
57
Hereditary theombophilia
```
Factor V Leiden
Prothrombin 20210A
Protein C
Protein S
Antithrombin deficiency
```
58
Most common hereditary thrombophilia
Factor V Leiden
59
Rx of PE
Heparin 3-7 days
Warfarin 6 months
INR 2-3
60
When to use tPA in PE
Patient with low BP
61
Role of anti-thrombin in PE?
Prophylaxis pre or post op
62
What does flat inspiratory loop indicate
Extra-thoracic pulmonary obstruction
63
What to r/o in asthma not responsive to Rx?
Vocal cord dysfunction
64
Vocal cord dysfunction classic
Episodic tightness of throat
SOB
Choking sensation
Cough
65
Dx vocal cord dysfunction
Fiber optic laryngoscope
=> paradoxical inspiratory movement +/- expiratory partial closure of cords.
66
Rx of vocal cord dysfunction
Speech therapy
| Breathing techniques
67
Cause of vocal cord dysfunction
```
Occupational exposure (glutaraldehyde + chloride in swimmers)
Psychological stress
```
68
Rx of sarcoidosis limited to hilar lymphadenopathy
Observation
69
Role of Na cromolyn in asthma attack
No role
| Used in prophylaxis.
70
Blood gases in PE
High A-a gradient
PH > 7.45
CO2 < 40
O2 low
Resp alkalosis
71
Sarcoidosis Rx
Observation
Prednisolone (1st)
MTX (2nd)
72
Garland's triad
Sarcoidosis
1. Bilateral hilar LN
2. rt paratracheal LN
73
Stages of sarcoidosis
0: normal CXR
1: lymphadenopathy
2: LN + lung disease
3: lung disease only
4: fibrosis.
74
Cause of silicosis
Crystalline-free silica inhalation form cement.
75
Causes of resp alkalosis
Fever
Low O2
Salicylate
Tachypnea
76
Spirometer in asthma
Reduced FEV1
| Reduced FEV1/FVC
77
Restrictive pattern on spirometer
Low FVC
Low FEV1 < 70%
Normal or high FEV1/FVC
78
Drugs cause pulmonary fibrosis
Amiodrone
Amphotericin B
Acebutolol
Carbamazepine
79
Investigations of dysphagia
Barium swallow
| Manometer and
80
Which is more effective in acute COPD:
| Albuterol or levalbuterol?
Same
81
Which is better during acute COPD oral or IV steroids
Same.
82
MCC of chronic cough (order)
1. Upper airway cough = Postnasal drip
2. Asthma
3. GERD
83
Rx steps in acute asthma
1. SABA
2. Systemic steroids
3. Ipratropium
4. Admit if no response in 4-6 hrs.
84
Dx bronchiectesis
HRCT
85
CXR in bronchiectasis
PeriBronchial thickening (tram track)
Increased vascular markings
86
Period of cough in acute bronchitis
20 days (> 2wk)
87
MCC of acute bronchitis
Viral infection
88
Purulent sputum in acute bronchitis indicates?
Airway desquamation
89
MCC of 2ry spontaneous pneumothorax
COPD
90
Pleuropulomnary nocardiosis classic
In immunocompromised
Sx: night sweat, fever, cough.
CXR: multiple infiltrates.
No response to pneumonia Rx
91
Dx nocardia?
Modified AFB => fire-faraco stain.
Weakly positive on AFB
92
Rx of nocardia
Sulfonamides => sulfasalazine or TMP/SMX
93
Pneumocystis vs nocardia?
Both give same finding
Stain:
Pneumocystis doesn't stain AFB, stains silver.
Nocardia is weakly positive in AFB + stains w/ fite-faraco
94
Rx of coccidioides immits
Ketoconazole
95
1st step in tension pneumothorax
Needle Thoracentesis
| Then chest tube.
96
Red flags in hiccups
> 2 days
| Waking patient from sleep
97
Military TB on CXR
Diffuse small nodules
98
ECG finding in PE
S1Q3T3
99
McGinn-White sign
S1Q3T3 on ECG
| Indicates Rt heart strain
100
High mountain sickness classic
```
8-96 HR of arrival
Headache
Poor sleep
N/V
Anorexia
```
101
Rx acute mountain sickness
Prevention = slow ascent, high carb diet or acetazolamide.
1- Slow descent
Oxygen
Hydration
2- Hyperbaric chamber
3- Acetazolamide
Dexamethasone
102
What's acetazolamide
Carbonic anhydrase inhibitor
Cuz metabolic acidosis via loss of HCO3
103
Rx of acute COPD
```
ABC
O2
Bronchodilator neb
Systemic steroids (IV soulmedrol)
Abx: doxy, TMP/SMZ, amoxi/clavu
```
104
Causes of increased A-a
Alveolar collapse (atelectasis)
Pneumonia
PE
Intracardiac shunt
Vascular shunt
Asthma
COPD
ILD
Pulmonary vascular Dz
105
Spirometer in vocal cord dysfunction
Flat inspiratory flow volume loop
| Normal exploratory
106
Exposure to asbestosis
Ship yards
107
Asbestosis Classic
Dyspnea
Dry cough
Basal velcro crackles
108
PFT in asbestosis
Restrictive
109
CXR of adenocarcinoma
Peripheral lung nodules
110
Mesothelioma on CXR
Obliteration of diaphragm
Modular thickening of pleura
Sheet like encasement of pleura.
111
Drugs contraindicated w/ mountain sickness
Diuretics
| BB
112
Major issue w/ CPAP in sleep apnea
Compliance
113
Spirometer value affected by age?
FEV1/FVC
Increased Functional residual capacity
Low vital capacity
Normal total lung capacity
114
T/F: spirometer doesn't measure airway dimensions
T
115
What's antifreeze
Ethylene glycol
116
Ethylene glycol ingestion causes what?
Metabolic acidosis.
117
Corticosteroids for COPD
No effect on mortality
Reduce exacerbation
No risk of cataract or fracture
Risk of candida
118
Feature of malignant pulmonary nodule
```
> 10mm
Irregular borders
Ground glass
No calcification or eccentric calcification
Double in 1 mo - 1 year
```
119
ARDS Rx
Oxygen (mask or ventilator)
120
Lights criteria (transudate vs exudate)
Fluid/serum ratio of protein + LDH
LDH fluid/serum > 0.6
Protein fluid/serum > 0.5
=> exudate
121
MCC of hemoptysis
Lower RTI
122
ILD vs bronchiactsis if clubbing present?
```
ILD = fine crackles
Bronchiactsis = coarse
```
123
Lung abscess CXR
Cavity w/ necrotic debris
124
MCC of aspiration lung abscess
Post op from aspiration
125
Rx of lung abscess
Clindamycin
126
Pleuritic rub in PE indicates?
Pleural infarction
127
Pleural effusion classic
Decreased breath sounds
Decreased fremitus
Dull percussion
Tracheal deviation to opposite site.
128
Bronchiotis obliterans seen w/?
Lung + BM transplant
129
Bronchiolitis obliterans CXR
Hyperlucency
130
V/Q scan in bronchiactsis obliterans
Moth-eaten
131
PFT in bronchiolitis obliterans
Low FEV1
| Normal DLCO
132
Stages of CO toxicity
HbCO < 20%
Headache, dizziness, blurry vision.
HbCO 20-40%
Confusion, syncope, chest pain, rhabdomyolysis
HbCO 41-60%
Arrhythmia, low BP, MI, seizure
HbCO >60%
Death
133
CO toxicity Rx
Stop exposure
Oxygen (non-rebreather)
CarboxyHgb level.
134
Decide level of CO toxicity
Carboxy-Hgb level
135
When to use hyperbaric oxygen in CO toxicity
Moderate to sever control
| Carboxy-Hgb > 20%
136
Drug contraindicated in asthma? Why
Non selective BB
Cause constriction
137
Palliative Rx for patients on death rattle?
Anti cholinergic to decrease secretions
| E.g. Glycopyrrolate
138
Rx pulmonary edema
1. Preload reducers:
Diuretics = furosemide
2. Morphine:
Rx cardiac pulmonary edema
To decrease catecholamines + SVR.
3. After load reducers:
Nitroprusside (pre + after load)
Enalapril (after load, SV, CO)
139
Theophylline toxicity classic
```
When > 20 mcg/ml
High HR
N/V + diarrhea
Irritability, restlessness
Agitated maniac behavior
Thirst
Muscle twitch
```
140
Use of peak flow in asthma
Monitor not Dx
141
Rx of cardiac pulmonary edema
ABC
1. Preload reduction
Nitroglycerin (most effective)
2. After load
ACEI
3. +/- inotropic support
142
Rx of status asthmaticus
SABA
Hydration
IV steroids
+/- intubation
143
Which is better in acute asthma meter dose inhaler or nebulizer? Why?
Inhalers
1. Greater improvement in peak flow rate
2. Better blood gases
3. Lower cost, hospital stay.
4. Lower relapse.
5. No difference in hospital admission rate.
