ABIM Pulmonary flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

COPD spirometric criterion

Persistent airflow obstruction is defined by a post-bronchodilator FEV1/FVC ratio below 0.70, confirming COPD in a patient with compatible symptoms and exposure history.

Asthmatic bronchodilator response

A reversible airway obstruction is defined as an increase in FEV1 of at least 12 percent and at least 200 mL after inhaling a short-acting bronchodilator.

Alpha-1 antitrypsin deficiency clues

Consider testing in early-onset emphysema, basilar-predominant disease, family history, or unexplained liver disease; serum alpha-1 antitrypsin level is the initial test.

COPD oxygen target

In COPD patients at risk for hypercapnia, titrate supplemental oxygen to a saturation of 88 to 92 percent to avoid worsening carbon dioxide retention.

Usual interstitial pneumonia pattern

High-resolution CT shows peripheral, basal-predominant reticulation, honeycombing, and traction bronchiectasis with minimal ground-glass opacity; this pattern supports a diagnosis of idiopathic pulmonary fibrosis.

IPF disease-slowing drugs

Nintedanib and pirfenidone slow the rate of forced vital capacity decline in idiopathic pulmonary fibrosis; immunosuppressive regimens are harmful and should not be used.

Sarcoidosis BAL finding

Bronchoalveolar lavage often shows a CD4 to CD8 ratio greater than 3.5, supporting sarcoidosis, although the diagnosis requires compatible clinical, radiographic, and histologic findings.

Massive pulmonary embolism

Pulmonary embolism with sustained hypotension or shock is massive; treat with systemic thrombolysis or surgical or catheter embolectomy rather than anticoagulation alone.

CTEPH screening test

Chronic thromboembolic pulmonary hypertension should be evaluated with a ventilation-perfusion scan, which is more sensitive than CT pulmonary angiography for detecting chronic thromboembolic disease.

Pulmonary arterial hypertension definition

Pulmonary arterial hypertension requires mean pulmonary artery pressure above 20 mm Hg, pulmonary vascular resistance at least 3 Wood units, and pulmonary artery wedge pressure 15 mm Hg or less.

Berlin ARDS oxygenation categories

ARDS is mild at a PaO2/FiO2 ratio of 200 to 300, moderate at 100 to 200, and severe below 100, all measured with positive end-expiratory pressure at least 5 cm H2O.

Lung-protective ventilation

Use tidal volume of 6 mL per kg predicted body weight and target plateau pressure of 30 cm H2O or less to reduce mortality in acute respiratory distress syndrome.

NIV for COPD exacerbation

Noninvasive ventilation reduces intubation and mortality in COPD exacerbation with respiratory acidosis, typically when pH is 7.25 to 7.35 and hypercapnia is present.

Obstructive sleep apnea criterion

Obstructive sleep apnea is diagnosed when the apnea-hypopnea index is at least 5 with compatible symptoms, or at least 15 regardless of symptoms.

Obesity hypoventilation syndrome

Obesity hypoventilation syndrome is defined by body mass index at least 30, awake PaCO2 above 45 mm Hg, and sleep-disordered breathing after excluding other causes of hypoventilation.

Adaptive servo-ventilation caution

Adaptive servo-ventilation is contraindicated in patients with heart failure and ejection fraction 45 percent or less because it increases mortality in central sleep apnea.

Latent tuberculosis treatment

Preferred regimens for latent tuberculosis include four months of daily rifampin or nine months of daily isoniazid; alternatives depend on resistance, age, and liver disease.

Pneumocystis prophylaxis threshold

Start trimethoprim-sulfamethoxazole prophylaxis for Pneumocystis jirovecii when CD4 count falls below 200 cells per microliter in HIV infection.

Empyema pleural fluid

Pleural fluid that is frank pus, or has pH below 7.20, glucose below 60 mg/dL, or LDH above 1000 IU/L, indicates empyema and requires drainage.

CURB-65 variables

CURB-65 scores confusion, urea above 7 mmol/L, respiratory rate at least 30, blood pressure low, and age 65 or older to stratify community-acquired pneumonia.

SCLC paraneoplastic syndrome

Small cell lung cancer commonly causes SIADH with hyponatremia and, less often, Cushing syndrome from ectopic ACTH; squamous cell carcinoma more often causes hypercalcemia.

EGFR inhibitor indication

Advanced non-small cell lung cancer with an activating EGFR mutation is treated with an EGFR tyrosine kinase inhibitor such as osimertinib, which improves response and survival.

Solitary pulmonary nodule follow-up

For a solid nodule 6 to 8 mm in a low-risk patient, guidelines recommend initial follow-up CT at 6 to 12 months, with subsequent intervals based on stability.

Light criteria exudate

Pleural fluid is an exudate if protein ratio exceeds 0.5, LDH ratio exceeds 0.6, or pleural LDH exceeds two-thirds the upper limit of normal serum LDH.

Tension pneumothorax management

Tension pneumothorax is a clinical diagnosis requiring immediate needle decompression followed by tube thoracostomy; do not delay for chest radiography.

Chylothorax laboratory finding

Pleural fluid triglyceride above 110 mg/dL supports chylothorax, usually from thoracic duct disruption by trauma, surgery, lymphoma, or malignancy.

Asbestosis radiographic features

Asbestosis causes lower-lobe-predominant interstitial fibrosis and often pleural plaques; it increases risk of mesothelioma and lung cancer, with a long latency.

Silicosis classic pattern

Silicosis produces upper-lobe-predominant nodules and eggshell calcification of hilar lymph nodes; it also increases susceptibility to tuberculosis.

Beryllium sensitization test

Beryllium lymphocyte proliferation testing supports chronic beryllium disease, which causes noncaseating granulomas and interstitial lung disease in exposed workers.

ALS noninvasive ventilation

Noninvasive ventilation improves survival and quality of life in amyotrophic lateral sclerosis when forced vital capacity falls below 50 percent or nocturnal hypoventilation develops.

Myasthenic crisis respiratory failure

Myasthenic crisis causes neuromuscular respiratory failure with weak cough and falling vital capacity; treat with plasma exchange or intravenous immunoglobulin and avoid aminoglycosides.

Kyphoscoliosis pulmonary function

Severe kyphoscoliosis produces restrictive physiology with reduced vital capacity and total lung capacity, often with preserved DLCO until late disease.