1.4 Pulmunology Flashcards
what does the PFT in asthma show
↓ FEV1/FVC (both decrease)
↑ TLC
↑ RV
Reversibility with albuterol: ↑ FEV1 > 12%
Bronchial hyperresposiveness: ↓ FEV1 >20% (methacoline)
what diagnostic tool do you use ot test for asthma in a patient that is asymptomatic?
methocoline bronquial hyperresponsiveness
↓ FEV1 >20%
adverse effect of ICS
dysphonia
oral candidiasis
adverse effects of zafirlukast
hepatotoxicity
Chrug-Strauss Syndrome
what vaccines are given in all asthma and COPD patients?
influenza
pneumococcal
severe asthma exacerbation (LAB)
PEF: decreased
ABG: increased A-a
when is magnesium used in an acute asthma flare?
after several rounds of albuterol do not work (waiting for the corticosteroids to begin to work)
shortness of breath, young, non-smoker
most likely cause?
anpha-1 antitrypsin deficiency
treatment of COPS that decreases mortality
when to use them
- smoking cessation
- oxygen therapy
- pO2 <55 / sat <88%
- pO2 <60 / sat <90%
- pulm HTN
- High HCT
- cardiomyopathy
Most common/resistant organisms that infect CF patients?
nontypable H. influenzae
Pseudomonas aerruginosa
Staph. aureus
Burkhorlderia capacia
pneumonia that is accompanied by a dry (nonproductive) cough
- virus
- pneumocystis
- mycoplasma
- coxiella
- chlamydia
what is the best initial test for all respiratory infections?
chest x-ray
organisms that cause atypical pneumonia
mycoplasma
chalmydophila
legionella
coxiella
viruses
criteria for empyema
LDH >60% of serum
Protein >50% of serum
WBC >1000
pH <7.2
+ gram stain/culture / frank pus
🌟 reasons to hospitalize a patient with pnemonia
CURB 65
Confusion
Uremia
Respiratory distress
BP low
Age > 65
empiric therapy for CAP
macrolides
comorbidities or ATB in past 3 months: flouroquinolones
inpatient treatment: IV flouroquinolones
/ ceftriaxone+ azithromycin
empiric therapy for HAP
antipseudomonal drugs (gram-eg bacilli)
cefepime, ceftazidime
piperaciline/tazobactam
imipenem, meropenem
why can’t you use daptomycin in the lung
inactivated by surfactant
adverse effect of imipenem
at toxicity levels can cause seizures
excreted by kidney, kidney failure = toxicity
risks for large-volume aspiration
stroke with loss of gag reflex
seizures
intoxication
endotracheal intubation
in what part of the lungs does aspiration pneumonia happen
upper lobe when lying flat
🚩 pt with AIDS presenting dyspnea, dry couch and fever
pneumocystis pneumonia
P. jiroveci
most common adverse effects of TMP/SMP
rash
bone marrow supression
🚩 bite cells
what drug is contraindicated
G6PDH deficiency
primaquine, dapsone
TB risk factors
immigrants (past 5 yrs)
healthcare provider
prisoners
close contacts with TB
alcoholics
HIV
hematologic malignancy
DM
in what cases is the tx for tuberculosis extended >6m?
- osteomyelitis
- miliary tb
- meningitis
- pregnancy
- cavitary lesions
what drugs are contraindicated for a pregnant woman with TB?
pyrazinamide and streptomycin
lunch cancer screening indications
30 pack-year tobacco history
age >55
chest CT
🚩 velcro sounding crackles
interstitial lung disease (pulm. fibrosis)
🚩 hiliar adenopathy on chest x-ray in a healthy african american woman
Sarcoidosis
🚩 Dyspnea, normal chest x-ray, hypoxia with respiratory alkalosis
pulmonary embolism
when should you treat PE with IVC filter
- contraindication to the use of anticoagulants
- recurrent emboli (while on therapy)
- right ventricular dysfunction
when should you tret a patient with PE with thrombolytics
- hemodynamically unstable
- acute right ventricle dysfunction
what is the treatment in a patient with PE that has heparin-induced thrombocytopenia?
fondaparinux
