Pulm Clin Med Review

What classification of asthma is the following

• Symptoms < 2 days per week

• Rescue medication < 2 days per week

• Nighttime symptoms < 2 times per month

• FEV > 80% predicted

• FEV1/FVC Normal

Intermitent Asthma

What classification of asthma is the following

• Symptoms < 2 days per week

• Rescue medication > 2 days per week

• Nighttime symptoms 3-4 times per month

• FEV > 80% predicted

• FEV1/FVC Normal

Mild Asthma

What classification of asthma is the following

• Daily symptoms

• Rescue Medication Daily

• Nighttime symptoms > 1 time per week

• FEV1 > 60% but < 80% Predicted

• FEV1/FVC Reduced 5%

Moderate Asthma

What classification of asthma is the following

• Continual Symptoms

• Rescue Medication Several times per day

• Nighttime symptoms often > 7 times per week

• FEV1 < 60% Predicted

• FEV1/FVC Reduced > 5%

Severe Asthma

What white blood cell with be elevated in patients with asthma

Eosinophil

If someone has a predisposed PFT and shows no improvement on a bronchodilator, what might the patient have

COPD

What commonly causes recurrent lung infections of bronchiectasis in patients with cystic fibrosis

Pseudomonas Aeruginosa

What does the sweat chloride test used for

Diagnose cystic fibrosis

35 year old patient has chest x-ray that shows emphysemic changes. What is this indicative of?

Alpha 1 Antitrypsin deficiency (b/c shes young)

ICS use can cause what condition in the mouth

Oropharyngeal candidas

What is the most common cause of COPD

Smoking

Chronic Bronchitis and emphysema fall under this umbrella term

COPD

What does this refer to

• Sarcoidosis

• Silicosis

• Asbestosis

• Coal Worker’s Pneumoconiosis (Black lung disease)

• Idiopathic Fibrosing Interstitial Pneumonia (Pulmonary fibrosis)

Restrictive Lung Diseases

On radiographic imaging, you see a visible pleural line (white line) with no lung marking peripheral to it. What does the patient have?

Pneumothorax

On radiographic imaging, you see that the heart and great vessels are shifted. What does the patient likely have?

Tension pneumothorax

What does this CXR reading indicate

• Pleural plaques (MC lower lobes)

• “Honeycomb lung” – irregular linear opacities

• “Shaggy heart sign”

  • Indistinct heart borders

  • Ground glass appearance of lung fields

Mesothelioma (associated with asbestosis) (-the image is specifically asbestosis, but she said mesothelioma can appear similar)

What does this PFT Restrictive Pattern refer to

PFT Restrictive Pattern

• FVC ↓

• FEV1 ↓ or normal

• FEV1/FVC ratio normal

• Total Lung capacity ↓

Interstitial Lung Disease (ILD), Sarcoidosis, and Silicosis,

What does this refer to

Restrictive Pattern

• FVC ↓

• FEV1 ↓ or normal

• FEV1/FVC ratio normal or ↑

• Total Lung capacity ↓

• Lung volumes ↓

Asbestosis

What test is used to determine which type of IDL the patient has

High resolution CT Scan

What pulmonary finding do you expect to find in sarcoidosis

Normal

What does this refer to

• Productive cough x 3 months in each of 2 successive years in a patient in whom other causes (such as bronchiectasis) have been excluded

Chronic Bronchitis

What does this refer to

• Cyanosis

• Nasal flaring

• Grunting

• Apnea/dyspnea

• Retractions

• Tachypnea (RR>60 breaths/minute)

• Tachycardia (HR>160 beats/minute)

Signs and Symptoms of Infant Respiratory Distress Syndrome

What does this refer to

• Dilation and destruction of alveoli

Emphysema

What does this chest x-ray finding indicate

• Flattened diaphragm

• Panacinar emphysema

• Hyperinflatation

• Elongated heart

Alpha 1 Antitrypsin Deficiency

What do you need to monitor for a patient with TB

BUN and creatinine

What does this refer

• CHF, Cirrhosis of the liver, renal failure, pulmonary failure

Causes of transudative pleural effusion

What does this refer to

• Cloudy fluid with protein, WBCs, platelet, and plasma

• May have RBC but it would have blood streaking

Characteristics of Exudative Effusion

What is the CC of a patient who has pleural effusion

SOB

How many mL of pleural effusion must be present to be seen on a PA view x-ray

250 mL

How many mL of pleural effusion must be present to be seen on a lateral view x-ray

50 mL

How many mL of pleural effusion is usually present in a symptomatic patient

300 mL

What does this refer to

• Pocket of pus due to infection

Empyema

If a pneumothorax causes a shift in the heart and mediastinum what is the dx? Can it be seen on a chest x-ray?

Tension pneumothorax and yes

What activity should be avoided after pneumothorax

Scuba diving

Sarcoidosis and pulmonary fibrosis are examples of…..

Restrictive lung disease

Patient has chronic lung disease and you are getting a CBC, what value do you expect to be elevated?

Hemoglobin and hematocrit

What illness may cause elevated leukocytes

Pneumonia or chronic illness (can be a sign of glycemia or leukemia)

What device is used to help monitor asthma, not diagnose

Peak expiratory flow

What does this refer to

• __________ is a standardized method that compares serum and pleural protein and LDH concentrations to differentiate exudative from transudative effusion

Light’s criteria

Light’s criteria is 100% sensitive for diagnosing ________ fluid

Exudative

What does this refer to

• Steriling Law with increased hydrostatic pressure or decreased plasma oncotic pressure

Transudative effusion

After an initial PFT, you give a patient with asthma albuterol and repeat the PFT. What do you expect the PFT to do?

Improve

After an initial PFT, you give a patient with asthma albuterol and repeat the PFT. What percent do you expect the PFT to improve by?

12%

What is the purpose of gold standard guideline for COPD

To characterize COPD and determine appropiate treatment

What does this refer to

• Located in the parietal space

• Nearly always associated with pneumonia

Empyema pus

What specific apparatus can be used in the prevention of occupation or environmental exposure

N95

What does this refer to

• Absestos

• Silica (sandblasting)

• Coal-mining (Black lung)

• Smoke (fire-fighters)

Occupational exposures

What is used to determine if the patient needs an anticoagulant?

CHA2DS2-VASc score

According to CHA2DS2-VASc score you need to give a patient an anticoagulant. What would you give them?

Warfarin/Eliquis

If a patient in on an ACEI, what electrolyte should you check routinely

Potassium (causes hypekalemia)

Lung disease over a prolonged period of time can cause what type of heart issue

Cor pulmonale (right heart failure)

You know your patient had lung disease, but are now concerted about their heart, what test are you ordering?

Echocardiogram

What does this refer to

• A predictive value that determines the risk of a patient having another MI in the next 14 days

TIMI Score (thrombolysis in myocardial infarction)

What does this refer to

• Age

• 3 or more risk factors for CAD

• Known CAD

• Aspirin in the past 7 days

• Severe Angina

• ST segment changes

• Increased cardiac biomarkers

TIMI 7 risk factors

What does this refer to

• Dyspnea with exercising

• Diaphoresis

• Dizziness

• Nausea

• Syncope

Symptoms that are angina equivalent

What is the treatment for bad aortic regurgitation

Valve replacement

What are the 3 cardiac risk equivalent

CAD, PAD, and diabetes

Exudate is confirmed by presenting with at least one of the following criteria. Give me the criteria

• Pleural fluid protein/serum protein ratio >0.5

• Pleural lactate dehydrogenase (LDH)/serum LDH ratio >0.6

• Pleural fluid LDH > two-thirds the upper limits of the laboratory’s normal serum LDH

What does this refer to

• Mid to late peaking murmur at the right upper sternal border with diminished A2 and decreased carotid upstroke

Aortic stenosis

What does this refer to

• Early, soft decrescendo diastolic murmur at the right upper sternal border best heard leaning forward after expiration

Aortic regurgitation

What does this refer to

• Low-pitched, soft rumbling mid to late diastolic murmur heard at the apex; could be associated with a mitral valve opening snap

Mitral stenosis

What does this refer to

• Blowing systolic murmur at the apex radiating to the sternal border, axilla, or back

Mitral regurgitation

What does this refer to

• FEV1:FVC < 70% (↓)

• FEV1 < 80% (↓)

• FVC > 80% (normal)

• TLC Normal/Increased

• RV Normal/Increased (emphysema is reduced)

• DLCO Normal (asthma, chronic bronchitis) + reduced (pulmonary fibrosis)

Obstructive lung disease

What does this refer to

• FEV1:FVC >70% (normal)

• FEV1 Variable

• FVC < 80% (↓)

• TLC < 80% (↓)

• RV ↓ (parenchymal)

• DLCO Normal (Chest wall/neuromuscular) + reduced (emphysema + other cystic lung disease)

Restrictive lung disease

What does this refer to

• FEV1:FVC < 70% (↓)

• FEV1 < 80% (↓)

• FVC < 80% (↓)

• TLC Variable

• RV variable

Mixed lung disease

What does this refer to

ABG readings:

• Cause: hypoventilation (COPD, sedation, neuromuscular disease)

• pH: ↓

• PaCO2: ↑

Respiratory acidosis

What does this refer to

• ABG readings:

• Cause: hyperventilation (anxiety, PE, pain)

• pH: ↑

• PaCO2: ↓

Respiratory alkalosis

What does this refer to

• ABG readings:

• pH: ↓

• HCO₃⁻: ↓

Metabolic acidosis

What normal value does this refer to

• 7.35-7.45

pH

What normal value does this refer to

• 35-45

PaCO2

What normal value does this refer to

• 22-26

HCO3

What’s the answer

• pH = 7.23

• PCO2 = 54

• HCO3 = 22

Respiratory acidosis, no compensation

Whats the answer

• pH = 7.38

• PCO2 = 59

• HCO3 = 34

Respiratory acidosis, fully compensated

What is the answer

• pH = 7.28

• PCO2 = 41

• HCO3 = 19

Metabolic acidosis, no compensation

What does this refer to

• pH = 7.30

• PCO2 = 50

• HCO3 = 29

Partially compensated respiratory acidosis

What does the top box refer to

Intermitent

What does the second box refer to

Mild persistent

What does the third box refer to

Moderate persistant

What does the fourth box refer to

Severe persistant

Describe the chamber size that can cause an S4 sound in diastolic HF?

Small chamber (hypertrophy)

Which abnormal heart sound is heard with diastolic HF?

S4