123) Define sleep apnea?
124) Tx for obstructive sleep apnea?
125) Tx for central sleep apnea?
126) Dx of sleep apnea?
127) ABGs in ARDS?
128) Swan Ganz catheter findings in ARDS?
129) Tx for ARDS?
130) Mortality rates for ARDS?
131) Most common cause of thrombophilia?
132) Pts at inc risk for post op venous thromboembolism?
133) EKG changes of pulmonary embolism?
134) First test when PE is suspected?
135) Gold stand to dx PE?
136) Gold stand to dx DVT?
137) Pts w/ PE who donít req angiogram for dx?
138) Tx for PE?
139) Tx for PE pts who r hemodynamically unstable? If contraindicated?
140) Tx for hemodynamically stable PE pt w/contraindication to anticoagulation or recurrent PE on anticoagulant?
141) Tx for pregnant pt w/PE or DVT?
142) Epidemiology of silicosis?
143) Epidemiology of asbestosis?
144) Epidemiology of coal minerís lung?
145) PFT pattern of pneumoconiosis?
146) Most common CA associated w/ asbestosis?
147) Dx of asbestosis?
148) Main difference b/w asbestosis & acute silicosis?
149) How to evaluate silicosis associated w/TB?
150) CXR findings of asbestosis?
151) CXR findings of silicosis?
152) CXR findings of coal minerís lung (CWP)?
153) Associated immunolgoical abn in CWP?
154) What is Caplan synd?
155) What is Lofgren synd?
156) What is Heerfordt-Waldenstrom synd?
157) Lab findings of sarcoidosis?
158) Definitive dx of sarcoidosis?
159) Px of sarcoidosis?
160) In which sarcoidosis pt, steroids r mandatory for tx?
161) 55 yr male w/exercise intolerance over 6 mos. No significant past hx. Over past wk, he gets dyspnea on walking across room. Never smoked. RR 24, JVD 8cm, coarse crackles, clubbing, trace pedal edema (both legs), CXR: diffuse reticular disease. Dx? Tx?
162) Etiology of bronchiectasis (permanent dilation of small-med bronchi)?
163) Best non-invasive test for bronchiectasis?
164) Tx for bronchiectasis?
165) When are IV antibiotics (aminoglycosides, ceftazidime, or quinolones) used in bronchiectasis?
166) When is surgical tx considered in bronciectasis?
167) What % of smokers develops COPD?
168) What % of COPD pts are smokers?
169) Dx test of choice for COPD?
170) First line tx for COPD?
171) Second line tx for COPD?
172) 2 modalities that decease mortality in COPD pt?
173) COPD + cor pulmonale will benefit from home O2 tx?
174) When are antibiotics used in COPD?
175) First line tx for acute exacerbation of COPD?
176) Best predictor of survival in COPD?
177) When is dyspnea at rest noted?
178) When is dyspnea on exercise noted?
179) Vaccine for COPD pt?
180) Which B agonist used for nocturnal & exercise induced asthma?
181) Asthmatic pt w/HD in whom B agonist & theophylline may be dangerous so what tx?
182) Tx of choice for spontaneous atelectasis?
183) What 3 criteria have to be present for transudative effusion?
184) How to proceed in low risk pt w/ pulmonary nodule?
185) How to proceed in high-risk pt w/ pulmonary nodule?
186) How to maintain O2 content (O2 to vital organs) in critically ill pt?
187) Formula for alveolar-arterial gradient (useful in assessment of oxygenation)?
188) 60 yr male w/chronic bronchitis develop persist diarrhea, what acid base disorder?
189) Markedly obese 24 yr male, what acid base disorder?
190) 14 yr female w/ severe asthmatic attack, what acid base disorder?
191) 56 yr female w/ chronic bronchitis is started on diuretic tx for peripheral edema resulting in 3kg wt loss, what acid base disorder?


Ans
123) Cessation of airflow >10 sec at least 10-15x/hr during sleep. Day time somnolence
124) Wt loss & CPAP (as floppy airway but adequate ventilation)
125) Acetazolamide, progesterone & supplemental O2
126) Polysomnography
127) Dec PaO2, N or inc PaCo2
128) N C.O. & capillary wedge press, inc pulm art press
129) Tx underlying dis, PEEP & permissive hypercapnea
130) 70%
131) Factor V leiden
132) >40 yrs w/hx of DVT or prior PE, pts w/ extensive pelvic or abd surg for malignant dis or maj orthopedic surg of lower limbs
133) S1 Q3 T3 (R axis deviation, deep S in lead 1, Q waves in lead 3, inverted T waves in lead 3) w/nonspecific RV strain pattern, sinus tachycardia
134) V/Q scan
135) Angiogram
136) Venogram
137) Pts w/ high probability V/Q scan & high or intermediate clinical suspicion for PE should be treated. Any pt w/ abn V/Q scan and +DVT by US should also be treated.
138) Continuous heparin (5 days) to prolong PTT to 1.5-2x N, Long term warfarin (on day 1 to inc PT 1.3-1.5x N; baseline for 6 mo)
139) Thrombolytic tx (tPA). If contraind: embolectomy
140) Interrupt IVC Greenfield filter
141) LMWH for 6 mo
142) Workers in mining, quarrying, tunneling, glass & pottery making, sand blasting
143) Asbestos exposure in mining, milling, foundry work, shipyard, asbestos application to pipes, brake linings, insulation and boilers
144) Coal dust exposure (amount), high rank (hardness of coal), high silica content of inhaled dust
145) Restrictive w/dec DLCO, hypoxemia w/inc PAO2-PaO2 gradient
146) Bronchiogenic CA (adeno or squamous cell)
147) Lung biopsy: barbell shaped asbestos fiber
148) In acute silicosis: lung failure in months
149) Yearly PPD (if >10mm: INH pox for 9 mo)
150) Diffuse or local pleural thickenings, pleural plaques & calcifications at diaphragm, pleural effusion common at lower lung fields
151) Nodules (1-10mm) seen thru out lungs (prominent in upp lobes), Rare egg shell calcifications, progressive dis (densities >10mm) in large masses
152) Small round densities in parenchyma (upp half of lung), progressive (densities from 1cm to entire lobe)
153) Inc levels of IgA, IgG, C3, ANA, Rf
154) Rheumatoid nodules in lung periphery in pt w/RA & coexisting pneumoconiosis (usually CWP)
155) Sarcoid synd: Erythema nodosum, arthritis, hilar adenopathy
156) F, parotid enlargement, uveitis & facial palsy
157) Hypercalcemia or hypercalciuria (inc circulation of vit D produced by macrophages), nonspecific inc in ACE (60%), abn in LFT (30%) w/90% symptomatic pt, skin anergy, PFT N or restrictive, uveitis & conjunctivitis (>25%)
158) Biopsy of suspected tissue (non-caseating granuloma)
159) 80% w/lung inv: stable or resolve spontaneously, 20% have progressive dis w/end organ compromise
160) Involvement of CNS, uveitis & hypercalcemia
161) Idiopathic pulmonary fibrosis. Seen in 5th decade, CT: ground glass app. PFT: restrictive. Tx: steroid +/- azathioprine. Px: response to steroids
162) Secondary to repeated pneumonic processes as TB, fungal, lung abscess, and pneumonia (focal bronchiectasis) or when defense mech of lungs are compromised as CF and immotile cilia synd (diffuse b)
163) High resolution chest CT
164) Bronchodilators, chest phys tx, postural drainage, rotating antibiotics (amox, TMP-SMX, amox, amox/clavulanic acid when sputum prod inc or mild sx)
165) If significant sx or pneumonia
166) Localized bronchiectasis w/adequate PFT or massive hemoptysis
167) 10-15%
168) 80-90%
169) PFT (dec FEV1/FVC & FEF 25-75%, inc RV & TLC,
DLCO dec in emphysema & N in chronic bronchitis)
170) Anticholinergic (ipratropium bromide; atrovent)
171) B2 agonist (albuterol, terbutaline, metaproterenol)
172) Home O2 tx & smoking cessation
173) PaO2 < 59mmHg
174) Empirically for acute exacerbation of COPD: cover H inf & pneumococcus
175) Systemic steroids (slowly taper w/in 2 wks)
176) Check FEV1 after bronchiodilator (If inc FEV1: better survival, If faster rate of decline of FEV1: worse px)
177) FEV1 < 25% predicted
178) FEV1 < 50%
179) Pneumococcus/5 yr, Influenza/yr
180) Salmeterol (12hr)
181) Anticholinergic (ipratropium bromide: takes 90 min to bronchodilate, has medium potency)
182) Bronchoscopy w/subsequent removal of mucous plugs
183) LDH effusion<200, LDH E/S<0.6, Protein E/S<0.5
184) <35 yr non-smoker w/calcified nodule (follow w/ CXR/3mo for 2 yr. Stop follow up if after 2 yr, there is no growth
185) >50 yr w/smoking hx & nodule->likely bronchiogenic CA so best dx procedure is open lung biopsy & removal of nodule at the same time
186) Keep Hb & C.O. near normal
187) PAO2 Ė PaO2 gradient= 150-1.25 x PCo2-PaO2 (In N young individual its 5-15 mmHg; increases w/hypoxemia except hypoventilation & increase altitude)
188) Combined chronic resp acidosis & metab acidosis
189) Chronic hypercapnia (chronic resp acidosis or metab acidosis) superimposed on acute resp acidosis
190) Acute resp acidosis
191) Chronic resp acidosis superimposed on metabolic alkalosis