Im Shelf/step 2 - Pulmonary

Front 1

Type of emphysema - most common
Smokers
Destruction limited to respiratory bronchioles with little change in distal acini
Predilection for upper lung zones

Back 1

CENTRILOBULAR

Front 2

Type of emphysema - in patients with alpha 1 anti trypsin defficiency
Destruction involves both proximal and distal acini
Predilection for lung bases

Back 2

PANLOBULAR

Front 3

Chronic bronchitis- diagnosis criteria

Back 3

Chronic productive cough for at least 3 months for at least 2 consecutive years

Front 4

Emphysema diagnostic criteria

Back 4

Permanent enlargement of air spaces distal to terminal bronchioles due to destruction of alveolar walls

Front 5

In airway obstruction what happens to FEV1, TLC

Back 5

FEV1 - decreased
TLC - normal or increased

Front 6

What is the definitive diagnostic test for COPD

Back 6

PFT

Front 7

In COPD

what happens to

- FEV1, FEV1/FVC ratio
- TLC, RV, FRC
- VC

Back 7

FEV1, FEV1/FVC ratio decreased
TLC, RV, FRC increased
VC decreased

Front 8

In restrictive disease

What happens to
-FEV1
-FEV1/FVC
-Peak expiratory flow rate
- RV
- TLC
- VC

Back 8

FEV1 - normal or slightly low
FEV1/FVC - normal or high
Peak expiratory flow rate - normal
RV - low, normal, or high
TLC - LOW
VC - LOW

Front 9

If peak expiratory flow is < 350 - what should you do next and what does it indicate

Back 9

PFT next - good screening test for obstruction

Front 10

CXR in COPD (2)

Back 10

- Hyperinflation, flattened diaphragm, enlarged retrosternal space
- Diminished vascular markings

Front 11

Clinical monitoring of COPD patients (3)

Back 11

FEV1 - HIGHEST predictive value

Pulse ox

Exercise tolerance

Front 12

What is the most important intervention in COPD patients

Back 12

SMOKING CESSATION - quitting does NOT result in complete reversal, prolongs survival rate but doesnt reduce it to level of someone who never smoked

Front 13

Most efficacious than either agent alone in bronchodilation, also helps with compliance

Back 13

ALBUTEROL + IPRATROPIUM BROMIDE

Front 14

Treatment of COPD - reserved for patients whose symptoms are not controlled by bronchodilators

Back 14

Inhaled corticosteroids (budesonide, fluticasone)

Front 15

Which drug is contraindicated in acute COPD or asthma exacerbation

Back 15

BETA BLOCKERS

Front 16

Give _ in COPD and add _ and _ for acute exacerbation

Back 16

Bronchodilators (beta2 agonists, anti cholinergics or both)

Steroids or abx

Front 17

Criteria for continuous or intermittent long term oxygen therapy in COPD

Back 17

PaO2 55 mm Hg OR O2 saturation < 88% either at rest or during exercise OR PaO2 55-59 with polycythemia/cor pulmonale

ABOVE must be consistent findings despite optimal medical therapy

Front 18

SHOWN TO IMPROVE SURVIVAL AND QUALITY OF LIFE in patients with hypoxemia and COPD

Back 18

OXYGEN THERAPY

Front 19

Treatment of acute exacerbation of COPD

Back 19

CXR
Beta 2 agonist + anticholinergic inhaler
Systemic corticosteroids
Abx
Supplemental O2
NPPV

Front 20

Most common causes of acute exacerbation of COPD (3)

Back 20

Infection
Non compliance
Cardiac disease

Front 21

Name compensatory response to chronic hypoxemia

Back 21

Secondary polycythemia (HCT > 55)

Front 22

Complication that can occur in patients with severe long standing COPD who have chronic hypoxemia

Back 22

Pulmonary HTN and cor pulmonale

Front 23

Name triad of asthma pathogenesis

Back 23

Airway inflammation
Airway hyperresponsiveness
Reversible airflow obstruction

Front 24

Extrinsic vs intrinsic asthma

Back 24

Extrinsic = Environmental triggers

Intrinsic = not related to environmental triggers

Front 25

What on physical exam in patients with acute asthma is a sign of impending respiratory failure

Back 25

Paradoxic movement of abdomen and diaphragm on inspiration

Front 26

In an acute setting what is the quickest diagnosis of asthma

Back 26

Peak flow measurement

Front 27

If CO2 level in asthma patient is normal or high what does it mean

Back 27

Patient hyperventilates - low PaCO2 level, patient not hyperventilating - PaCO2 normal or high - patient is decompensating (due to fatigue), intubation may be required

Front 28

Complications of asthma

Back 28

Status asthmaticus - doesnt respond to standard medications

Acute respiratory failure - respiratory muscle fatigue

Pneumothorax, atelectasis, pneumomediastinum

Front 29

Main goal in treating bronchiectasis

Back 29

Prevent complications of pneumonia and hemoptysis

Front 30

Bronchiectasis

What is the diagnostic test of choice

What PFT show

Back 30

CT

PFT = obstructive pattern

Front 31

Which lung cancer has LOWEST relationship with smoking

Back 31

ADENOCARCINOMA

Front 32

30% of all lung cancers, usually central, cavitation on CXR

Back 32

Squamous cell carcinoma

Front 33

35% of all lung cancer, MOST common type, often peripheral, pleural involvement in 20% of cases, less closely associated with smoking than other types, can be associated with pulmonary scars/fibrosis

Back 33

Adenocarcinoma

Front 34

5-10% of all lung cancers, usually peripheral

Back 34

Large cell carcinoma

Front 35

SIADH is usually seen with what type of cancer

Back 35

Small cell