Pulm

Question 1

What constitutes intermittent asthma (#daytime ssx, #nocturnal ssx, FEV1)

Answer 1

• daytime ssx: up to 2x/wk
• nocturnal ssx: up to 2x/mo
• FEV1: >80%

Question 2

What constitutes mild persistent asthma (#daytime ssx, #nocturnal ssx, FEV1)

Answer 2

• daytime ssx: <1/day
• nocturnal ssx: <1/wk
• FEV1: >80%

Question 3

What constitutes mod persistent asthma (#daytime ssx, #nocturnal ssx, FEV1)

Answer 3

• daytime ssx: 1x or more/day
• nocturnal ssx: 1x or more/wk
• FEV1: 60-80%

Question 4

What constitutes severe persistent asthma (#daytime ssx, #nocturnal ssx, FEV1)

Answer 4

• daytime ssx: 1x or more/day
• nocturnal ssx: frequent
• FEV1: <60%

Question 5

What is tx for intermittent asthma?

Answer 5

SABA

Question 6

What is tx for moderate persistent asthma?

Answer 6

SABA + ICS + LABA

Question 7

What is tx for refractory asthma?

Answer 7

SABA + high ICS + LABA + PO steroids

Question 8

What is tx for mild persistent asthma?

Answer 8

SABA + ICS

Question 9

What is tx for severe persistent asthma?

Answer 9

SABA + high ICS + LABA

Question 10

ED –> acute asthma exacerbation –> labwork?

Answer 10

• peak expiratory flow rate

- ABG

Question 11

ED –> acute asthma exacerbation –> tx?

Answer 11

• O2
• albuterol/ipratropium nebulizer
• corticosteroid

Question 12

ED –> acute asthma exacerbation –> refractory –> rescue therapy? why is this used?

Answer 12

• racemic epi nebulizer
• SQ epi
• IV magnesium

To avoid intubation

Question 13

ED –> acute asthma exacerbation –> continuous nebulizer tx –> how long before dispo decision?

Answer 13

3hr

Question 14

which lung cancer is most common in non-smokers?

Answer 14

adenocarcinoma

Question 15

lung adenocarcinoma –> histology

Answer 15

glandular formation -> mucin production

Question 16

sarcoidosis –> lab finding

Answer 16

non-caseating granuloma secrete:

• angiotensin-converting enzyme (ACE) increased
• vitD –> Ca increased

Question 17

sarcoidosis –> tx

Answer 17

steroids

Question 18

68F in ICU –> ventilated on positive pressure –> acutely becomes agitated –> oxy sat drop from 96% to 85%

what condition?

Answer 18

barotrauma from positive pressure ventilation

or

pneumothorax

Question 19

what is Cheyne-Stokes respiration

Answer 19

cycles of apnea followed by hyperpnea

Question 20

very deep breaths at fast rate

type of respiration pattern? seen in what condition?

Answer 20

Kussmaul

metabolic acidosis –> DKA

Question 21

patient initiate breath –> ventilator deliver breath –> backup rate in place if patient fail to initiate breath

what type of ventilation?

Answer 21

assist-control ventilation

Question 22

patient makes no respiratory effort –> what type of ventilation is appropriate for this patient?

Answer 22

controlled mechanical ventilation –> total ventilator dependent setting –> not allow or support spontaneous breaths

Question 23

diffuse parenchymal lung disease –> tx

Answer 23

steroids

Question 24

what are the idiopathic DPLDs? (2)

Answer 24

• acute interstitial pneumonitis (acute <6wk)

- idiopathic pulmonary fibrosis (chronic >6mo)

Question 25

what rheumatologic disorders can lead to pulmonary fibrosis? (3)

Answer 25

- SLE - RA - SS

Question 26

sarcoidosis --> extra-pulmonary manifestations (3)

Answer 26

- heart block - bell's palsy - erythema nodosum

Question 27

shipyard --> what occupational exposure?

Answer 27

asbestos

Question 28

bird fancier --> what type of DPLD?

Answer 28

hypersensitivity pneumonitis

Question 29

silicosis --> CXR findings can look like what other condition?

Answer 29

nodules in upper lung --> TB

Question 30

ssx of DPLD at work --> feel better on weekend/vacation --> ssx come back when return to work what condition?

Answer 30

hypersensitivity pneumonitis

Question 31

sarcoidosis --> diagnosed and treated --> what followup management?

Answer 31

cardiac MRI

Question 32

sarcoidosis --> how dx?

Answer 32

lung bx

Question 33

PE --> tx

Answer 33

- first line: factor Xa inh (rivaroxaban), if no renal dz | - LMWH --> bridge to warfarin

Question 34

PE --> when trt w tPA?

Answer 34

R heart strain + hypotension

Question 35

small cell lung CA --> tx

Answer 35

chemo + rad

Question 36

squamous cell lung cancer --> paraneoplastic synd

Answer 36

PTH-rp --> hyperCa

Question 37

PFT: differentiate emphysema vs chronic bronchitis

Answer 37

diffusion capacity of lung for carbon monoxide (DLCO): - emphysema: decreased - chronic bronchitis: increased

Question 38

Lights criteria for exudate

Answer 38

- LDHf >2/3 ULN - LDHf/LDHs >0.6 - TPf/TPs >0.5

Question 39

pleural effusion --> ADA positive dx?

Answer 39

TB

Question 40

- erythema nodosum - hilar adenopathy - migratory polyarthralgia - fever what condition?

Answer 40

Lofgren's synd (sarcoidosis)