Term
| what is the indication in asthma to start controller therapy |
|
Definition
| use of reliever therapy for 3 and over times a week |
|
|
Term
| in asthma if the addition of ICS as controller therapy is not enough, what to do? |
|
Definition
| add LABA (in combination inhaler) |
|
|
Term
| when should you add oral theophylline to the management of asthma? |
|
Definition
| In patients with severe asthma and when there is irreversible airway narrowing |
|
|
Term
| if the addition of theophylline and anticholinergics is not enough to relieve symptoms of asthma, what is next? |
|
Definition
|
|
Term
| if oral corticosteroids don't do the job (asthma), what do you add? |
|
Definition
|
|
Term
| when is prophylactic intubation indicated in acute asthma, which anaesthetic may be added |
|
Definition
when the PCO2 is normal or rises
halothane |
|
|
Term
| what are the components of acute asthma treatment, by order from first to last |
|
Definition
| SABA, anticholinergics, aminophylline, magnesium sulfate |
|
|
Term
| what is a test for ICS compliance in the treatment of asthma |
|
Definition
| suppression of plasma cortisol and the expected concentration of prednisone/prednisolone in the plasma |
|
|
Term
| 15 drugs that may precipitate hypersensitivity pneumonitis |
|
Definition
| Amiodarone, bleomycin, efavirenz, gemcitabine, hydralazine, hydroxyurea, isoniazid, methotrexate, paclitaxel, penicillin, procarbazine, propranolol, riluzole, sirolimus, sulfasalazine |
|
|
Term
| what is an important part of the diagnosis of hypersensitivity pneumonitis |
|
Definition
| Examination for serum precipitins against suspected antigens |
|
|
Term
| eosinophils are not elevated in cases of hypersensitivity pneumonitis |
|
Definition
|
|
Term
| what is the definitive diagnosis of hypersensitivity pneumonia? |
|
Definition
| in the setting of history and serum percipitins, CT is diagnostic with ground glass (CXR shows nothing in the acute phase) |
|
|
Term
| when are glucosteroids used in the treatment of hypersensitivity pneumonitis |
|
Definition
| sub-acute and chronic cases - when disease persists over more than a few days |
|
|
Term
| which are associated both to lung cancer and mesotheliomas, smoking or asbestos |
|
Definition
| asbestos, smoking is not assoaciated with mesotheliomas |
|
|
Term
| which organism is associated with CAP in the setting of Stay in hotel or on cruise ship in previous 2 weeks |
|
Definition
|
|
Term
| 5 organisms associated with CAP in the alcoholic |
|
Definition
| Streptococcus pneumoniae, oral anaerobes, Klebsiella pneumoniae, Acinetobacter spp., Mycobacterium tuberculosis |
|
|
Term
| 6 organisms associated with CAP in the smoker or COPDist |
|
Definition
Haemophilus influenzae, Pseudomonas aeruginosa, Legionella spp.,
S. pneumoniae, Moraxella catarrhalis, Chlamydia pneumoniae |
|
|
Term
| 3 organisms associated with CAP in patients with structural lung disease such as bronchoectasis |
|
Definition
| P. aeruginosa, Burkholderia cepacia, Staphylococcus aureus |
|
|
Term
| 3 additional diagnostic test (besides the obvious ones) that can help identify a specific organism and narrow the antibiotic coverage |
|
Definition
| antigen test in urine (legionella, pneumococc), PCR, serology |
|
|
Term
| how do you interpret the curb65 pneumonia severity scor |
|
Definition
| Patients with a score of 0, among whom the 30-day mortality rate is 1.5%, can be treated outside the hospital. With a score of 2, the 30-day mortality rate is 9.2%, and patients should be admitted to the hospital. Among patients with scores of 3, mortality rates are 22% overall; these patients may require admission to an ICU |
|
|
Term
| what is another pneumonia severity score besides curb65? |
|
Definition
| pneumonia severity index - 20 variables |
|
|
Term
| mechanisms of pneumococcal resistance to penicillin |
|
Definition
| low-affinity penicillin-binding proteins |
|
|
Term
| mechanisms of pneumococcal resistance to macrolides |
|
Definition
1. Target-site modification is caused by ribosomal methylation in 23S rRNA
2. The efflux mechanism |
|
|
Term
| mechanism of pneumococc resistance to fluoroquinolones? |
|
Definition
| Changes can occur in one or both target sites (topoisomerases II and IV |
|
|
Term
| what are considered strep pneumoniae mutli drug resistance (MDR) species |
|
Definition
| Isolates resistant to drugs from three or more antimicrobial classes with different mechanisms of action |
|
|
Term
| what is the most significant risk factor for the development of antibiotic resistance? |
|
Definition
| use of a specific antibiotic within the previous 3 months |
|
|
Term
| what is the empirical treatment of CAP in the outpatient settings in a patient that was Previously healthy and no antibiotics in past 3 months |
|
Definition
| a macrolide or doxycycline |
|
|
Term
| what is the empirical treatment of CAP in the outpatient settings in a patient with Comorbidities or antibiotics in past 3 months |
|
Definition
| a fluoroquinolone or [a beta lactam + a macrolide] |
|
|
Term
| what should be the empirical treatment of CAP if a fluoroquinolone was used in the previous 3 months |
|
Definition
| a macrolide and vice versa |
|
|
Term
| what is the empirical treatment of CAP in the inpatient non-ICU setting |
|
Definition
| fluoroquinolone or [macrolide + beta lactam] |
|
|
Term
| what is the treatment of CAP in the setting of the ICU? |
|
Definition
|
|
Term
| what is the treatment of bacteremic pneumococcal pneumonia? |
|
Definition
| strictly comination therapy: macrolide and beta lactam (not monotherapy) |
|
|
Term
| what is the duration of treatment for uncomplicated CAP |
|
Definition
|
|
Term
| patients who with cap who remain hypotensive despite adequate fluids.... |
|
Definition
| may have adrenal insufficiency and benefit from glucosteroids |
|
|
Term
| 3 organisms that may cause abscess in CAP |
|
Definition
| CA-MRSA, P. aeruginosa, or (rarely) S. pneumoniae |
|
|
Term
| when tapping a pleural effusion, which 4 findings are indicative of the need to perform complete drainage of the fluid? |
|
Definition
| a pH of <7, a glucose level of <2.2 mmol/L, and a lactate dehydrogenase concentration of >1000 U/L or if bacteria are seen or cultured |
|
|
Term
| when should follow up CXR be done in a patiet discharged after CAP |
|
Definition
|
|
Term
| what is the rate of ventilator associated pneumonia in the ICU |
|
Definition
| 10% of all patients and 70% of patients ventilated for over a month |
|
|
Term
| Application of clinical criteria consistently results in overdiagnosis of VAP, largely because of three common findings in at-risk patients: (1) tracheal colonization (2) multiple alternative causes of radiographic infiltrates in mechanically ventilated patients, and (3) the high frequency of other sources of fever in critically ill patients. therefore, what are 2 approaches to the diagnosis of VAP/ |
|
Definition
1. different threshold numbers of bacteria needed to confirm diagnosis depending on the site of sample - distinguish colonization from true infection
2. The Clinical Pulmonary Infection Score - points for fever, CXR findings, Tracheal aspirate, oxygenation and leukocytosis that add up to give the risk of true VAP
equal specificity |
|
|
Term
| empirical treatment of ventilator acquired pneumonia depends on whether the patient has risk factors for MDR species or not. it should be remembered that VAP has lower incidence of atypical pathogens |
|
Definition
no risk of MDR - monotherapy with Ceftriaxone, fluoroquinolone, Ampicillin/sulbactam or Ertapenem
risk of MDR - triple therapy (two directed at P. aeruginosa and one at MRSA): 1. A b-lactam, 2. gentamycin, amikacin or ciprofloxacin, 3. An agent active against gram-positive bacterial pathogens - vancomycin or linezolid |
|
|
Term
| which pathogens are less common in hospital acquired pneumonia in respect to ventilator acquired pneumonia? and which are more common |
|
Definition
| MDR are less common where as anaerobes are more common |
|
|
Term
| 2 organisms most commonly implicated in bronchoectasis |
|
Definition
| Haemophilus influenzae and P. aeruginosa |
|
|
Term
| the term putrid abscess applies to which pathogen involved |
|
Definition
|
|
Term
| what is a common pathogen in pulmonary abscess in the immunocompromised host |
|
Definition
|
|
Term
| what is a sign in pulmonary abscess indicative of anaerobes as the causative agents |
|
Definition
| putrid-smelling sputum due to the organisms' production of short-chain fatty acids, such as butyric or succinic acid |
|
|
Term
| Infections caused by anaerobic bacteria should usually be treated with.... |
|
Definition
| clindamycin or b-lactam/b-lactamase inhibitor combination |
|
|
Term
| Lung abscess due to S. aureus is usually treated with |
|
Definition
|
|
Term
| treatment of pulmonary abscess d/t aerobic gram negative bacteria such as klebsiella pneumonia or pseudomonas aeruginosa |
|
Definition
| Carbapenems or -lactams are frequently combined with aminoglycosides |
|
|
Term
| 3 indications for surgical treatment of pulmonary abscess |
|
Definition
| failure to respond to medical management, suspected neoplasm, and hemorrhage. Failure to respond to antibiotics is usually due to an obstructed bronchus and an extremely large abscess (>6 cm in diameter) or to infection involving relatively resistant bacteria, such as P. aeruginosa. The usual procedure is lobectomy. An alternative intervention that is becoming popular is percutaneous drainage under CT guidance |
|
|
Term
| what % of patients with CF presents within the first 24 hrs of their lives with miconium ileus |
|
Definition
|
|
Term
| what % of patients with CF are diagnosed only after the age of 18? |
|
Definition
|
|
Term
| what is the incidence of chronic sinusitis and nasal polyps in children with CF? |
|
Definition
|
|
Term
| 2 organisms which are usually recovered from lung secretions early in the disease of newly diagnosed CF patients |
|
Definition
| Haemophilus influenzae and S. aureus |
|
|
Term
| 2 organisms which are usually recovered from lung secretions thereafter in CF patients? |
|
Definition
| pseudomonas aeruginosa, burkholderia cepecia |
|
|
Term
| The first lung-function abnormalities in CF children |
|
Definition
| increased ratios of residual volume to total lung capacity |
|
|
Term
| The earliest chest x-ray change in CF lungs |
|
Definition
|
|
Term
| what is a diagnosis in CF that might confuse the physician with appendicitis? |
|
Definition
| distal intestinal obstruction syndrome (DIOS) |
|
|
Term
|
Definition
| infertility and delayed puberty |
|
|
Term
| 4 components to the diagnosis of CF |
|
Definition
| combination of clinical criteria and abnormal CFTR function as documented by sweat tests, nasal PD measurements, and CFTR mutation analysis |
|
|
Term
| 2 antiobiotic treatments that are given prophylactically to older patients with CF? |
|
Definition
| inhaled aminoglycosides and azythromycin |
|
|
Term
| what % of patients with CF end up suffering end stage liver disease |
|
Definition
|
|
Term
| what generalization can be made about the PaO2 of patients with COPD? |
|
Definition
| it stays normal up until FEV1 levels drop under 50% of predicted |
|
|
Term
| An elevation of arterial level of carbon dioxide (PaCO2) is not expected until the FEV1 |
|
Definition
| is less than 25% of predicted |
|
|
Term
| pulmonary hypertension in COPD is usually correlated with... |
|
Definition
|
|
Term
| 3 most presenting symptoms in COPD |
|
Definition
| cough, sputum production, and exertional dyspnea |
|
|
Term
| exertional dyspnea is typically elicited by which physical exertion in patients with COPD |
|
Definition
| Activities involving significant arm work, particularly at or above shoulder level |
|
|
Term
| what is a physical sign in the way advanced COPDers breath? |
|
Definition
| paradoxical inward movement of the rib cage with inspiration (Hoover's sign), the result of alteration of the vector of diaphragmatic contraction on the rib cage as a result of chronic hyperinflation |
|
|
Term
| what classification is used to assess the severity (and prognosis) of COPD |
|
Definition
| multifactorial index incorporating airflow obstruction, exercise performance, dyspnea, and body mass index is a better predictor of mortality rate than pulmonary function alone |
|
|
Term
| what is a screening test for alpha1antitrypsin undertaken in all patients with COPD and asthma |
|
Definition
| Measurement of the serum alpha1AT |
|
|
Term
| what is the definitive test to assure the presence of emphysema in COPD |
|
Definition
| CT showing bullae, paucity of parenchymal markings, or hyperlucency |
|
|
Term
| what is the definitive test to assure the presence of emphysema in COPD |
|
Definition
| CT showing bullae, paucity of parenchymal markings, or hyperlucency |
|
|
Term
| what are the only 3 therapies that have an effect on the natural history of COPD |
|
Definition
smoking cessation
oxygen therapy in chronically hypoxemic patients
lung volume reduction surgery in selected patients with emphysema |
|
|
Term
| which patients should be offered pharmacotherpeutic aid to quit smoking |
|
Definition
| all adult, nonpregnant smokers considering quitting be offered pharmacotherapy |
|
|
Term
| 7 CIs for lung volume reduction surgery as a treatment for COPD |
|
Definition
significant pleural disease
pulmonary artery systolic pressure >45
extreme deconditioning
congestive heart failure, or other severe comorbid conditions
FEV1 <20%
diffusely distributed emphysema on CT
diffusing capacity of lung for carbon monoxide (DLCO) <20% (emphysema) |
|
|
Term
| what are the indications that must be met in order to be eligible for lung transplantation |
|
Definition
| <65 years; have severe disability despite maximal medical therapy; and be free of comorbid conditions such as liver, renal, or cardiac disease |
|
|
Term
| which 2 interventions have been proven to reduce the frequency of COPD exacerbations |
|
Definition
| inhaled glucocorticoids and influenza vaccine |
|
|
Term
| 5 factors that impact the decision to hospitalize a patient with COPD exacerbation |
|
Definition
| respiratory acidosis and hypercarbia, significant hypoxemia, or severe underlying disease or those whose living situation is not conducive to careful observation and the delivery of prescribed treatment |
|
|
Term
| when should patients with COPD exacerbation have an arterial blood-gas measurement |
|
Definition
| advanced COPD, those with a history of hypercarbia, those with mental status changes (confusion, sleepiness), or those in significant distress |
|
|
Term
| when should patients with COPD exacerbation be given a CXR? |
|
Definition
| severe underlying COPD, who are in moderate or severe distress or those with focal findings |
|
|
Term
| what is the role of Abx in the management of COPD exacerbations |
|
Definition
Most practitioners treat patients with moderate or severe exacerbations with antibiotics, even in the absence of data implicating a specific pathogen
b lactam + macrolide |
|
|
Term
| what is the role of glucocorticoids in the mgmt of COPD exacerbation |
|
Definition
reduce the length of stay, hasten recovery, and reduce the chance of subsequent exacerbation or relapse for a period of up to 6 months
oral prednisolone or its equivalent for a period of 10–14 days |
|
|
Term
| what is the indication for non-invasive positive pressure ventilation (NIPPV) in COPD exacerbation |
|
Definition
| PaCO2 >45 mmHg - respiratory failure |
|
|
Term
| what is a manifestation of rheumatoid arthritis that is more common in males |
|
Definition
| Interstitial lung disease |
|
|
Term
| Diagnostic finding of Bronchoalveolar Lavage in Pulmonary Langerhans cell histiocytosis (ILD) |
|
Definition
| electron microscopy demonstrating Birbeck granule in lavaged macrophage |
|
|
Term
| Diagnostic finding of Bronchoalveolar Lavage in Diffuse alveolar damage or drug toxicity (ILD) |
|
Definition
| Atypical hyperplastic type II pneumocytes |
|
|
Term
| Diagnostic finding of Bronchoalveolar Lavage in Organizing pneumonia (ILD) |
|
Definition
| Foamy macrophages, decreased CD4:CD8 ratio |
|
|
Term
| Diagnostic finding of Bronchoalveolar Lavage in Hypersensitivity pneumonitis (ILD) |
|
Definition
| Marked lymphocytosis (>50% |
|
|
Term
| Diagnostic finding of Bronchoalveolar Lavage in Eosinophilia (ILD) |
|
Definition
| Lymphocytosis; CD4:CD8 ratio >3.5 most specific of diagnosis |
|
|
Term
| what is and important confirmatory test before initiating therapy for ILD |
|
Definition
|
|
Term
| Glucocorticoid therapy is recommended for symptomatic ILD - which 9 diseases specifically |
|
Definition
| eosinophilic pneumonias, COP, CTD, sarcoidosis, hypersensitivity pneumonitis, acute inorganic dust exposures, acute radiation pneumonitis, DAH, and drug-induced ILD |
|
|
Term
| in which ILD glucocorticoids are recommended for both the acute and chronic stages |
|
Definition
|
|
Term
| which interstitial lung diseases has a distinctly poor response to therapy and a bad prognosis |
|
Definition
| idiopathic pulmonary fibrosis |
|
|
Term
| there is no treatment for idiopathic pulmonary fibrosis |
|
Definition
|
|
Term
| which ILD is most common in women who have never smoked |
|
Definition
| nonspecific interstitial pneumonia |
|
|
Term
| CT of idiopathic pulmonary fibrosis |
|
Definition
| developing diffuse ground-glass abnormality and/or consolidation superimposed on a background reticular or honeycomb pattern |
|
|
Term
| CT of nonspecific interstitial pneumonia |
|
Definition
| bilateral, subpleural ground-glass opacities - no honeycombing |
|
|
Term
| what is the treatment and prognosis of nonspecific interstitial pneumonia |
|
Definition
| glucocorticosteroids + azathioprine |
|
|
Term
what is the pathology of acute interstitial pneumonia (hamman-rich syndrome)
what is seen on CXR |
|
Definition
diffuse alveolar damage
Diffuse, bilateral, air-space opacification |
|
|
Term
| how is the Dx of acute interstitial pneumonia made? |
|
Definition
| clinical syndrome of idiopathic ARDS and pathologic confirmation of organizing diffuse alveolar damage |
|
|
Term
| what is the prognosis of acute interstitial pneumonia? |
|
Definition
The mortality rate is high (>60%), with most patients dying within 6 months of presentation.
However, those who recover often have substantial improvement in lung function. |
|
|
Term
| CXR of cryptogenic organizing pneumonia |
|
Definition
| bilateral, patchy, or diffuse alveolar opacities in the presence of normal lung volume |
|
|
Term
| what is the usual cause of death from PE? |
|
Definition
| progressive right heart failure |
|
|
Term
| For patients who have DVT, the most common history |
|
Definition
| a cramp in the lower calf that persists for several days and becomes more uncomfortable as time progresses |
|
|
Term
| the likelihood of DVT/PE determines the workup |
|
Definition
|
|
Term
what are the variables in the scoring of DVT likelihood? 8 for and 1 against
High-Likelihood Score Is 3 or Greater |
|
Definition
Active cancer
Paralysis, paresis, or recent cast
Bedridden for >3 days; major surgery <12 weeks
Tenderness along distribution of deep veins
Entire leg swelling
Unilateral calf swelling >3 cm
Pitting edema
Collateral superficial nonvaricose veins
Alternative diagnosis at least as likely as DVT -2 |
|
|
Term
| 7 variables in the likelihood score of PE - High Clinical Likelihood of PE if Point Score Exceeds 4 |
|
Definition
Signs and symptoms of DVT 3.0
Alternative diagnosis less likely than PE 3.0
Heart rate >100/min 1.5
Immobilization >3 days; surgery within 4 weeks 1.5
Prior PE or DVT 1.5
Hemoptysis 1.0
Cancer 1.0 |
|
|
Term
| besides PE, d-dimer also rises in patients with which conditions |
|
Definition
| myocardial infarction, pneumonia, sepsis, cancer, and the postoperative state and those in the second or third trimester of pregnancy |
|
|
Term
| d-dimer is not a good test in hospitalized patients, when should it be used? |
|
Definition
| where PE is unlikely (high NPV, very sensitive) and no other cause for high d-dimer |
|
|
Term
| what is a specific sign of PE on ECG |
|
Definition
| S1Q3T3 sign: an S wave in lead I, a Q wave in lead III, and an inverted T wave in lead III |
|
|
Term
| what is a very common finding on ECG of PE |
|
Definition
| T wave inversions in leads V1-4 |
|
|
Term
| 4 possible findings in CXR of PE (one which is mutually exclusive) |
|
Definition
| normal or nearly normal chest x-ray often occurs in PE. Well-established abnormalities include focal oligemia (Westermark's sign), a peripheral wedged-shaped density above the diaphragm (Hampton's hump), and an enlarged right descending pulmonary artery (Palla's sign). |
|
|
Term
| lung scanning is the second line diagnostic tool for PE. what does it consist? |
|
Definition
| perfusion and ventilation scan. abnormal perfusion with normal ventilation is indicative of PE |
|
|
Term
| TTE usually shows nothing in PE, but there is an indirect finding that is indicative |
|
Definition
| McConnell's sign: hypokinesis of the RV free wall with normal motion of the RV apex |
|
|
Term
| what is the order of imaging done in PE, considering each step is non-diagnostic and indicates further workup? |
|
Definition
| CT, lung scanning, venous ultrasound, MRA, TEE, angiography |
|
|
Term
| before commencing treatment for PE, what should be done? |
|
Definition
| risk stratification - low risk get secondary prevention (anticoagulation or IVC filter) and high risk get primary therapy (thrombolysis or embolectomy) |
|
|
Term
| 4 findings that render a patient with PE, high risk |
|
Definition
| hemodynamically unstable, RV hypokinesis on echo, RV enlargement on chest CT, and troponin elevation |
|
|
Term
| 4 conditions considered as provoking of DVT/PE. what is the duration of anticoagulation in these cases? |
|
Definition
surgery, trauma, estrogen exposure, indwelling central venous catheter or pacemaker
3-6 months |
|
|
Term
| which situation is considered non-provoking of DVT/PE? |
|
Definition
|
|
Term
| 3 indications for IVC filter placement in DVT/PE? |
|
Definition
(1) active bleeding that precludes anticoagulation
(2) recurrent venous thrombosis despite intensive anticoagulation
(3) patients with right heart failure who are not candidates for fibrinolysis and prophylaxis |
|
|
Term
| what is the indication for fibrinolysis in PE |
|
Definition
|
|
Term
| what is the management of Chronic thromboembolic pulmonary hypertension which develops d/t acute PE |
|
Definition
follow up with echo at 6 months to see if pressure has normalized.
patients with dyspnea are eligible for pulmonary thromboendarterectomy |
|
|
Term
| what is the first step of determining the cause of a pleural effusion? |
|
Definition
determining whether it is transudate or exudate. exudate need a further workup - 3 findings:
1. PF/serum protein >0.5
2. PF/serum LDH >0.6
3. PF LDH > 2/3 of upper normal serum limit |
|
|
Term
| once pleural effusion determined to be exudate, which 7 tests should be done on the pleural fluid |
|
Definition
| glucose, amylase, cytology, differential count, marker for TB, culture and stain |
|
|
Term
| 3 possible causes of pleural effusion if amylase is elevated? |
|
Definition
esophageal rupture
malignancy
pancreatic pleural effusion |
|
|
Term
| possible causes of pleural effusion if glucose<60? |
|
Definition
malignancy
bacterial infection
rheumatoid pleuritis |
|
|
Term
| if non of the tests done on the pleural fluid yield a diagnosis, what is the next step? |
|
Definition
| spiral CT for PE and if also non-yielding perform Bx |
|
|
Term
| when the pleural fluid is thought to be transudative according to the suspected etiology, but the initial tests on the PF elicits positive criteria for exudate, what do you do to determine nature of PF? |
|
Definition
| use absolute measures of protein in pleural fluid and serum. if protein in serum exceeds that in PF by more than 3.1 g/dL than PF is thought to be transudate |
|
|
Term
| what is the MCC of pleural effusion |
|
Definition
|
|
Term
| 3 situations where thoracocentesis should be preformed on a patients with pleural effusion and known heart failure |
|
Definition
| the effusions are not bilateral and comparable in size, if the patient is febrile, or if the patient has pleuritic chest pain |
|
|
Term
| when should parapneumonic effusion be treated with therapeutic thoracocentesis? |
|
Definition
| If the free fluid separates the lung from the chest wall by >10 mm |
|
|
Term
| in parapneumonic effusion, Factors indicating the likely need for a procedure more invasive than a thoracentesis (in increasing order of importance) include the following |
|
Definition
Loculated pleural fluid
Pleural fluid pH <7.20
Pleural fluid glucose <3.3 mmol/L (<60 mg/dL)
Positive Gram stain or culture of the pleural fluid
Presence of gross pus in the pleural space |
|
|
Term
| in parapneumonic effusion, if the fluid cannot be completely removed with the therapeutic thoracentesis |
|
Definition
| chest tube and instilling fibrinolytic agents |
|
|
Term
| which 3 malignacies are responsible for 75% of malignant pleural effusions? |
|
Definition
| lung carcinoma, breast carcinoma, and lymphoma |
|
|
Term
| if a pleural effusion is suspected to be malignant but thoracocentesis doesn't yield signs of malignancy, what are 2 possible steps? |
|
Definition
| thoracoscopy and US guided needle bx |
|
|
Term
| what should be done in a patient with a malignant pleural effusion who has proven to benefit from therapeutic thoracocentesis/ |
|
Definition
| gain access to the affected pleural space with a tube/catheter and instill doxycycline which has sclerosing properties |
|
|
Term
| what test is preformed on pleural fluid suspected of being bloody |
|
Definition
| If the hematocrit is more than one-half of that in the peripheral blood, the patient is considered to have a hemothorax |
|
|
Term
| what is a treatment option for patients with hypoventilation d/t a high cervical spine lesion or decreased respiratory drive |
|
Definition
| phrenic nerve or diaphragm pacing |
|
|
Term
| definition of obesity hypoventilation syndrome OHS (usually OSA) |
|
Definition
| body mass index (BMI) 30 kg/m2, sleep-disordered breathing and chronic daytime alveolar hypoventilation, defined as PaCO2 45 mmHg, and PaO2 < 70 mmHg in the absence of other known causes of hypercapnia |
|
|
Term
|
Definition
| congenital central hypoventilation syndrome |
|
|
Term
| most common causes of lung transplantation by descending order of occurence |
|
Definition
| COPD, IPF, CF, a1-antitrypsin deficiency emphysema, idiopathic pulmonary arterial hypertension |
|
|
Term
| what is the BODE index to measure the severity of COPD |
|
Definition
| BMI, airflow Obstruction, Dyspnea, Exercise capacity |
|
|
Term
| what is the indication to refer a patient with COPD to consider lung transplantation |
|
Definition
|
|
Term
| 4 indications for lung transplantation in COPD |
|
Definition
BODE index 7–10
Hospitalization for exacerbation, with PaCO2 >50 mmHg
Pulmonary hypertension or cor pulmonale despite oxygen therapy
FEV1<20% with either DLCO <20% or diffuse emphysema |
|
|
Term
| 5 indications to refer a patient with CF/bronchietasis to a lung transplant center |
|
Definition
FEV1<30% or rapidly declining FEV1
Hospitalization in ICU for exacerbation
Increasing frequency of exacerbations
Refractory or recurrent pneumothorax
Recurrent hemoptysis not controlled by bronchial artery embolization |
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Term
| 3 indications for lung transplantation in CF/bronchiectasis |
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Definition
Oxygen-dependent respiratory failure
Hypercapnia
Pulmonary hypertension |
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Term
| what is the indication to refer a patient to a lung transplant center in idiopathic pulmonary fibrosis |
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Definition
| Pathologic or radiographic evidence of UIP regardless of vital capacity |
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Term
| 4 indications for lung transplantation in idiopathic pulmonary fibrosis |
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Definition
Pathologic or radiographic evidence of UIP
and
any of the following criteria
DLCO <39%
Decrement in FVC 10% during 6 months of follow-up
Decrease in SpO2 below 88% during a 6-min walk test
Honeycombing on HRCT (fibrosis score >2) |
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Term
| 2 indications for refferal to a lung transplant center with idiopathic pulmonary arterial hypertension |
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Definition
NYHA functional class III or IV regardless of therapy
Rapidly progressive disease |
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Term
| 5 indication for lung transplantation in patients with idiopathic pulmonary arterial hypertension |
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Definition
Failing therapy with intravenous epoprostenol (or equivalent drug)
Persistent NYHA functional class III or IV on maximal medical therapy
Low (<350 m) or declining 6-min walk test
Cardiac index <2 L/min/m2
Right atrial pressure >15 mmHg |
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Term
| what is the treatment of COPD exacerbation |
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Definition
| in the hospitalized patient: BB, ipratropium and oral GCS |
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Term
| in which disease is it condtraindicated to conceive |
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Definition
| pulmonary artery hypertension |
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Term
| patients with silicosis have an increased risk of which infection? |
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Definition
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Term
| condition where the pulmonary diffusion is over 100% |
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Definition
| pulmonary hemorrhage - RBCs increase diffusion |
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Term
| what is the definition of sub-massive/moderate-to-large PE? and what is the treatment |
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Definition
hypokinesia of RV on echo
fibrinolysis should be considered on an individual basis |
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Term
| what is the only intervention in ARDS known to lower mortality rates |
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Definition
| low Vt mechanical ventilation |
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Term
| when in COPD are anticholinergics used? |
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Definition
| stable disease not in exacerbations |
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Term
| 2 facts about administering oral GCS for the management of acute asthma exacerbation |
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Definition
as good as IV
no need for tapering |
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Term
| which organism is seen more frequently in hospital acquired pneumonia (patients in hospital not ventilated - may be in ICU) vs. ventilator acquired pneumonia |
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Definition
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Term
| FEV1/FVC in emphysema? Maximal Expiratory Pressure? |
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Definition
FEV1/FVC - low
MEP - normal (low in the other component of obstructive disease) |
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Term
| what can be found in the pleural effusion caused by pancreatitis |
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Definition
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Term
| which antibiotic is not suitable for pneumonia |
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Definition
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Term
| leading cause of death in scleroderma |
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Definition
| pulmonary involvement - ILD and PAH |
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Term
| how do you isolate a patient with TB |
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Definition
| negative pressure room air |
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Term
| what is the indication for oxygen therapy at home in COPD? |
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Definition
| resting O2 saturation < 88% or <90% with signs of pulmonary hypertension or right heart failure |
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Term
| what should the treatment of pneumonia in COPD consist |
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Definition
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Term
| COPD doesn't cause clubbing! |
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Definition
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Term
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Definition
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Term
| asthma - mild intermitent? mild persistent, moderate persistent, severe persistent |
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Definition
| mild intermitent - 2/w, night 2/m, FEV1>80%; mild persistent - 6/w, 2/m, FEV1>80; moderate persistent - 7/w, 1/w, FEV1 60-80%; severe persistent FEV1< 60% |
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Term
| what is the indication for preventive treatment in asthma |
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Definition
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Term
| infections that cause bronchoectasia |
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Definition
| TB, adeno, influenza, staph aureus, HIV, klebsiella |
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Term
| causes of bronchiectasia besides infectious |
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Definition
| Ig def, amonia, aspiration, alcohol, heroin, allergy, ABPA, alpha1AT, yellow nail syndrome, kartagener |
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Term
| treatment of bronchiectasia |
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Definition
| resprim/amoxicillin/levofloxacin |
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Term
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Definition
| age 50, flu-like, restrictive, migratory pulmonary opacities, lower lobes, ground glass, granulation tissue on Bx, steroids effective in 2/3 |
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Term
| indications for chest tube in pleural effusion |
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Definition
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Term
| test of choice for massive hemoptysis |
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Definition
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Term
| smokers with a1-antitrypsin def develop COPD young |
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Definition
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Term
| smoking associated with decreased incidence of hypersensitivity pneumonitis but a more aggressive course |
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Definition
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Term
| CBC of hypersensitivity pneumonitis |
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Definition
| neutropenia, leukopenia - no eosinophilia |
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Term
| Pulmonary function studies in all forms of HP may show a restrictive or an obstructive pattern with loss of lung volumes, impaired diffusing capacity, and decreased compliance |
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Definition
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Term
| in acute eosinophilic pneumonia there is no history of pneumonia - there is history of asthma in chronic eosinophilic pneumonia which also has other systemic symptoms |
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Definition
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Term
| what do you need to r/o before determining SIADH in a patient with lung cancer |
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Definition
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Term
| pneumococc is more common in children and the elderly |
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Definition
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Term
| what is absent (suggestive of other Dx) in idiopathic lung disease |
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Definition
| extensive ground-glass abnormality, nodular opacities, upper or midzone predominance |
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Term
| אבחנה מבדלת לתסנין באונה עליונה |
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Definition
• סרקואידוזיס
• שחפת
• PCP
• ABPA
• סיליקיוזיס
• היסטוציטוזיס של תאי לנגרהנס
• פנאומוניה של יתר רגישות –HP |
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Term
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Definition
o במצב אקוטי נראה כמו דלקת ריאות שמופיעה 6-8 שעות לאחר חשיפה לאנטיגן
o צורה כורנית דומה לפיברוזיס ראיתי
o במעבדה עליה במדדי דלקת, Rf ואימונוגלובולינים
o הרבה פעמים נויטרופיליה ולימפופניה
o אאזוניפיליה לא אופינית
o משקעים בסרום כנגד אנטיגנים חשודים היא חלק חשוב מאבחנה, והיא צריכה להעשות בכל חולה עם מחלת ריאות אינטרסטיציאלית-אך צריך עוד דברים כי יש גם באנשים רגילים
o CT ברזולוציה גבוהה היא בדיקת הבחירה ייתכן גרואנד גלאס והוניקומב
o במבחני ריאה יש תבנית רסטרקטיבית וירידה בדיפוזה וייתכן היפוקסמיה במנוחה
o ייתכן לעיתים ברונכוספאזם והיפרריאקטיביות של דרכי אוויר
o BAL –בעיקר לימפוציטים אם כי ייתכן יותר נויטרופלים בזמן אקוטי
o טריאדה מרמזת בביופסיה –ברונכוליטיס מונונוקלארי, תסנין אינטרסטיציאלי של לימפוציטים ותאי פלזמה, וגרנולומות לא גבינתיות |
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Term
| מדרג הטיפול באסתמה כרונית |
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Definition
o מחלה קלה – פחות מ3 ארועי קוצר נשימה בשבוע. רק SABA
o מעל שימוש של 3 פעמים בשבוע בSABA- אז נוסיף ICS במינון נמוך
o אם גם זה לא עוזר- נוסיף גם LABA. ניתן לשקול גם הוספת אנטילויקוטרינים או תיאופילין אך פחות יעיל מLABA
o באסטמה קשה מינון נמוך של תאופילין ואנטיכולינרגים ארוכי טווח
o אם גם לא עובד OCS
o ואם גם זה לא אז אנטיIGE |
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Term
| איך מטפלים בדלקת ריאות במונשמים |
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Definition
| באזיטרומיצין/רוקסימיצין יחד עם צפטריאקסון |
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Term
| • ויאגרה- מעכבי פוספודיאסטרס חמש- אושר לטיפול ל NYHA וו-ווו. משפר סימפטומים. תופעת לוואי הנפוצה ביותר כאבי ראש. אסור לתת יחד עם ניטרטים |
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Definition
| שאר הטיפולים מתאימים לNYHA 3-4 |
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Term
| treatment of COPD exacerbation |
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Definition
Oxygen to target saturation of 90 to 94% and PaO2 of 60-70 mmHg; Venturi mask can be useful for titrating FiO2; High FiO2 usually not needed and can contribute to hypercapnia (high FiO2 requirement should prompt consideration of alternative diagnosis (eg, PE))
Inhaled beta agonist (eg, albuterol 2.5 mg diluted to 3 mL via nebulizer)
Inhaled anticholinergic agent (eg, ipratropium 500 micrograms via nebulizer)
Systemic corticosteroid (eg, methylprednisolone 60 mg IV)
Antibiotic therapy: Levofloxacin (750 mg IV) or alternative based on likely pathogens (including risk of pseudomonas infection) and local patterns of antibiotic resistance |
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Term
| For symptomatic patients with GOLD Stage II, III, or IV COPD, we recommend pulmonary rehabilitation - FEV1<80 |
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Definition
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Term
| indication for pneumococcal vaccination in COPD |
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Definition
| patients who are ≥65 years old, or who are younger than 65 years with a forced expiratory volume in one second (FEV1) less than 40 percent |
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Term
| CIs to performing LVRS in COPD |
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Definition
| forced expiratory volume in one second (FEV1) of 20 percent predicted or less and either a diffusing capacity (DLCO) of 20 percent predicted or less or homogeneous emphysema on chest computed tomography |
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