Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

STEP 2 by day > 5 May (pulmonary) > Flashcards

5 May (pulmonary) Flashcards

1
Q

How is an ekg different and the same between pericarditis and MI?

A

MI has specific ST elevations

Pericarditis has diffuse ST elevations and also PR depression which is not present in MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

H/P findings in pericarditis

A

Pleuritic chest pain
Pain improves with leaning forward
Friction rub
Pulsus paradoxus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Complication of pericarditis

A

Chronic constrictive pericarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Tx for pericarditis

A

Treat underlying condition
Large effusions require pericardiocentesis
NSAIDS for pain and inflammation
Colchicine to prevent reocurrence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What heart condition will show equal pressures in all chambers of the heart? Most common causes of this condition?

A

Chronic constrictive pericarditis

Radiation or heart surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When is a pericardial effusion exudative?

A

Neoplasm
TB
Fibrotic disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Beck’s triad

A

Hypotension, distant heart sounds, distended neck veins

Think of cardiac tamponade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the lung volumes frequently measured and calculated?

A 
Start with volumes which are used to calculate capacities
Inspiratory reserve volume
Tidal volume
Expiratory reserve volume
Residual volume

Functional insp. capacity = TV+IRV
Functional reserve capacity = ERV+RV
Functional vital capacity = IRV+TV+ERV
Total lung capacity = IRV+TV+ERV+RV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How is FEV1/FVC different between obstructive and restrictive diseases?

A

Less than 80% in obstructive

Normal or elevated in restrictive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

In obstructive and restrictive lung diseases, how is TLC affected?

A

Obstructive: Inc
Restrictive: Dec

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

In obstructive and restrictive lung diseases, how is FVC affected?

A

Obstructive: Dec
Restrictive: Dec

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

In obstructive and restrictive lung diseases, how is RV affected?

A

Obstructive: Inc
Restrictive: Dec

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

In obstructive and restrictive lung diseases, how is FRC affected?

A

Obstructive: Inc
Restrictive: Dec

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

In obstructive and restrictive lung diseases, how is FEV1 affected?

A

Obstructive: Dec
Restrictive: Dec

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is a normal A-a gradient and what increases it? When are false normals seen?

A

Normal 5-15 mmHg
Increased in PE, pulmonary edema, R-L shunts
False normal can be seen in hypoventilation or high altitude (these decrease alveolar values)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is normal PaCO2?

A

35-45

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is normal bicarb?

A

22-28

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Normal PaO2?

A

90-100

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Patient has throat and nasal irritation, rhinorrhea, nonproductive cough, slight fever. Dx? Tx?

A

Likely a common cold caused by rhinovirus, adenovirus, coronavirus
Treat: rest, analgesia, treat symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Patient presents with sore throat, LAD, nasal congestion, fever, red and swollen pharynx with tonsillar exudates. Dx? Cause? Tx? Complications?

A

Likely Pharyngitis
Caused by Group A Strep or Cold viruses
Presence of tonsillar exudates more common in bacterial
Labs: throat culture, rapid strep
Tx: generally self limited, Beta-lactams like penicillin, amoxicillin to reduce infection time
Complications: rheumatic heart disease in 3% if not treated, post-streptococcal glomerulonephritis (unaffected by treatment)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Pt has difficulty opening mouth and swallowing, has sore throat and tonsillar exudates with deviated uvula, high fever, and ear pain. Dx? Cause? Tx? Complications?

A

Tonsillitis with possible peritonsilar abscess
Spread Strep infection from pharyngitis into palatine tonsils
Tx similar to strep throat
Complications: airway compromise, if abscess forms need IV antibiotics and ID and tonsillectomy after resolution to prevent recurrence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Pt has arthralgias, myalgias, sore throat, nasal congestion, nonproductive cough, N/V/D, high fevers, and LAD. Dx? Labs? Tx?

A

Viral influenza
Labs: rapid antigen immunoassay, PCR
Tx: treat symptoms, fluid intake, resolves in few days, oseltamivir or zanamivir can shorted course, annual vaccination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Most common causes of acute sinusitis?

A

Strep pneumo
Haemophilus influenza
Moraxella catarrhalis
Or viral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Most likely cause of chronic sinusitis?

A

Chronic is more than 3 months
Obstruction, anaerobic infection
DM patients at risk for mucormycosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Sinusitis treatment

A

Amoxicillin for 2 weeks in acute cases and 6-12 weeks in chronic.
Surgical correction of obstruction may be necessary

26
Q

How might bronchitis present differently than a cold?

A

Usually a progression from a cold

Cough will become productive, wheezing may start, tight breath sounds, otherwise same symptoms as a cold

27
Q

How is bronchitis treated?

A

Most cases are viral and support is only treatment
In patients with higher risk of bacterial infection (elderly, smokers, other lung conditions present) can give antibiotics like fluoroquinolones, tetracycline, erythromicin

28
Q

H/P findings for pneumonia?

A

Pleuritic chest pain, fevers, chills, night sweats, dyspnea, decrease breath sounds, wheezing, rales, dullness to percussion, egophony, tachypnea

29
Q

Who gets admitted when they have pneumonia?

A

Elderly, multiple comorbidities, significant lab abnormalities, multilobar involvement, signs of sepsis

30
Q

What is the WBC like for pneumonia of different causes?

A

Viral has slight increase in WBC, whereas bacterial and fungal are significant

31
Q

What are the most common causes of pneumonia in adults and kids?

A

Kids: viral
Adults: Strep. pneumoniae

32
Q

Which cause of pneumonia is more common in COPD and has a slower onset?

A

H. influenzae

33
Q

Which cause of pneumonia tends to be nosocomial and in immune compromised and tends to form abscesses?

A

Staph. aureus

34
Q

Which cause of pneumonia is common in alcoholics and patients at risk for aspiration and has currant jelly sputum?

A

Klebsiella pneumoniae

35
Q

Which cause of pneumonia is most common in pt’s with CF?

A

Pseudomonas aeruginosa

36
Q

Which cause of pneumonia is most common in neonates and infants?

A

Group B Strep.

37
Q

Which cause of pneumonia is common in young adults and has a positive cold agglutinin test?

A

Mycoplasma pneumonias

38
Q

Which cause of pneumonia is associated with aerosolized water and has slow onset of Sx and includes N/D, confusion, or ataxia?

A

Legionella pneumophila

39
Q

What are the fungal causes of pneumonia and who gets them?

A

Coccidioidomycosis from SW USA
Histoplasmosis from caves
Blastomycosis from Central America

Pneumocystis jirovecii in HIV patients

40
Q

What are the 4 drugs used for TB? What is the treatment protocol?

A

Isoniazid, rifampin, pyrazinamide, ethambutol
Do all four initially then just the first two for 6 months
Sputum culture monthly to assess treatment
Supplement with vitamin B6 to prevent peripheral neuritis from isoniazid

41
Q

For community acquired and nosocomial pneumonias, how do the different types of bacterias compare?

A

CAP tends to be gram (+) and nosocomial tends to be g(-)

42
Q

What should be done if a patient has a positive PPD for the first time?

A

Must followup with CXR

If asymptomatic, but likely exposure, treat with isoniazid for 9 months (or other regimens)

43
Q

Positive PPD criteria

A

5mm for immune compromised, HIV, known exposure, signs of TB on CXR
10mm for all those at increased risk: homeless, healthcare workers, immigrants, IVDA, chronically ill, incarcerated
15mm always considered positive

44
Q

Describe ARDS in general

A

Acute respiratory failure caused by sepsis, trauma, near-drowning, drugs, aspiration, shock, lung infection
Has refractory hypoxemia, decreased lung compliance, edema and infiltrates and carries high mortality rate

45
Q

What are the labs, imaging, treatment for ARDS?

A

ABG shows respiratory alkalosis
CXR shows bilateral pulmonary edema and infiltrates
Treat includes ICU with mechanical ventilation and treatment of underlying condition. PEEP needed on ventilator. Keep fluid levels low to prevent edema.

46
Q

What are the causes of ARDS?

A

A: aspiration, acute pancreatitis, air or amniotic embolism
R: radiation
D: drug overdose, diffuse lung disease, DIC, drowning
S: shock, sepsis, smoke inhalation

47
Q

What are the primary signs and symptoms on H/P for a patient with asthma?

A

Dyspnea, wheezing, chest tightness, anxiety, difficulty speaking, prolonged expiratory phase, accessory muscle use, cyanosis, decreased pulse O2

48
Q

During an asthma exacerbation, what might signal an impending respiratory failure requiring additional Beta agonists and supplemental O2 and possibly intubation?

A

Normal CO2 levels during an exacerbation is a bad sign

49
Q

What PFT is used to help classify asthma?

A

Peak Expiratory Flow Rate

50
Q

What is the treatment protocol for asthma exacerbations?

A

Inhaled Beta 2 agonist with IV corticosteroids if symptoms are persistent

51
Q

An asthma patient uses their bronchodilator 3 times a week and wakes up 3 times a month. What level are they at, what PEFR, and what should their maintenance therapy be?

A

Mild persistent
PEFR: more than 20% fluctuations over time
Tx: Inhaled low dose steroid, consider mast cell stabilizer, leukotriene inhibitor, or theophylline

52
Q

An asthma patient has daily symptoms with daily bronchodilator use and wake up at least once a week. What stage, what PEFR, what long term treatment?

A

Moderate persistent
PEFR: 60-80% predicted
Tx: Inhaled low to medium dose steroid with long-acting beta agonist, consider leukotriene inhibitor or theophylline

53
Q

Asthma patient has symptoms 1-2 times weekly and wakes up 1-2 times per month and has symptoms only during exercise. What stage, PEFR, and long term treatment?

A

Mild intermittent
PEFR: over 80%
No daily medications, may use mast cell stabilizers if known trigger

54
Q

Asthma patient has symptoms at rest, wakes multiple times per night and requires multiple meds throughout the day. What stage, PEFR, treatment?

A

Severe
PEFR: varies but rarely above 70%, FEV1 less than 60%
Inhaled high dose steroids with long acting beta agonist, consider systemic steroids

55
Q

Describe chronic bronchitis

A

Obstructive lung disease on continuum with emphysema
Most commonly caused by smoking, but also chronic asthma in rare cases
Pt will have productive cough, recurrent infections, dyspnea, wheezing, rhonchi
Dx: productive cough for 3 months of the year for 2 years
Labs: PFTs show gradually worsening obstructive disease
Tx: tobacco cessation, antibiotics for URI because increased risk for bacterial cause, bronchodilators
Leads to emphysema without tobacco cessation

56
Q

Who are the blue bloaters and pink puffers?

A

Blue bloaters are chronic bronchitis leading to cor pulmonale leading to cyanosis and edema
Pink puffers are emphysema patients that have to breath through pursed lips and have barrel chests and dyspnea

57
Q

What is the pathogenesis of emphysema?

A

Smoking leads to chronic inflammation of the lungs leading to activation of neutrophils and macrophages that release proteolytic enzymes that damage the lung parenchyma leading to enlarging air spaces and reduced capillary beds

58
Q

How does emphysema differ from disease caused by alpha-1 antitrypsin deficiency?

A

Emphysema has centrilobular distribution while the other has panlobular distribution.

59
Q

What do PFT’s show in COPD?

A

Decreased FEV1
Decreased FEV1/FVC ratio
Increased TLC
Decreased PEFR

60
Q

What do ABG’s look like in COPD exacerbation?

A

Decreased O2 and increased CO2

61
Q

When should a home O2 program be started for a COPD patient?

A

O2 sats are less than or equal to 88%, or if symptoms too severe

62
Q

Describe bronchiectasis features, cause, H/P, radiology findings, treatment, complications

A

Permanent dilation of small and medium bronchi due to destruction of elastic components
Secondary to chronic airway obstruction, chronic tobacco use, TB, fungal, severe pneumonia, CF
H/P: copius sputum, persisten and productive cough, hemoptysis, frequent infections, rales, hypoxemia
Radiology: multiple cysts and bronchial crowding, dilation of bronchi on CT with wall cysts
Tx: hydration and sputum removal, chest PT, antibiotics when sputum increases, Beta agonists and steroids, lung resection when hemorrhaging, producing too much sputum, or inviability
Complications: cor pulmonale, massive hemoptysis, abscess formation

STEP 2 by day (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions