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Flashcards in Resp Deck (143):
1

PE in pneumothorax

No tactile fremitus
Hypertesonance percussion
Decreased breath sound on affected side
Tracheal deviation away from side

2

Dx of pneumothorax

CXR

3

Most effective Rx in sleep apnea?

CPAP

4

Population of hyperventilation syndrome

Young women

5

Sx of hyperventilation

Tachypnea
Hyperpnoea (deep breath)
Atypical chest pain
Tachycardia
+/- carpopedal spasm

Gas:
Resp alkalosis

6

Bronchitis vs bronchiactesis sputum

Bronchitis > mucoid sputum


Bronchiactsis > purulent malodorous sputum

7

Rx of pneumothorax <20%

Outpatient observation
CXR in 24-48 hr

Or
Oxygen + observe

8

Tests done for sarcoidosis patients

Slit lamp
Pulmonary function test
Serum Ca
ECG
ACE level

9

Sleep apnea associations

HTN

10

Differentiate bronchitis from emphysema by PFT?

Single diffusion capacity DLCO.

11

Most effective measure in COPD?

Smoking cessation

12

What Rx measure improves mortality / survival in COPD

Supplemental O2

13

If asthma isn't controlled with inhaled SABA?

Add low dose ICS > increasing dose of SABA

14

Good pasture's classic?

Acute glomerulonephritis
Pulmonary hemorrhage
Following URTI

15

Cause of glumeruonephritis in goodpasture

Anti-GBM antibodies > complement activation > tissue damage.

16

CXR in asbestosis

Lower > upper lobe
Fibrosis w/ linear streaking (early)
Cyst & honeycombing (late)
IMP > plural & diaphragmatic calcification

17

Cancer with asbestosis

Bronchogenic Ca
Mesothelioma

18

When does SABA work?

Work in 5 minutes for 4-6 HR.

19

Inhaled CS before SABA improves delivery?

False

20

Which is better in asthma oral Beta agonists or inhaled SABA

Inhaled

21

Exercise induced bronchoconstriction classic

10% decrease in FEV1 with exercise.
High-ventilation sports > track, skiing
Winter sports

22

Dx exercise induced bronchocostriction.

Trial with albutrol inhaler.

23

Best way to Dx COPD?

Spirometer FEV1/FVC < 70% - 80%

24

Is clubbing a sign of COPD?

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.