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Emergency > 7 - Pulm 2 > Flashcards

7 - Pulm 2 Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Most common PE finding in asthma

A

end expiratory wheezing with prolonged expiration phase

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2
Q

t/f: asthma patients have decreased sputum production and usually cough only during exacerbations

A

false (increased, chronic cough)

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3
Q

What PE findings in asthma indicate more severe disease?

a) tachycardia
b) wheezing
c) tachypnea
d) decreased breath sounds

A

d) decreased breath sounds

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4
Q

What is the most useful test to determine severity of asthma?

A

peak flows

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5
Q

when should you order a CXR for asthma patients?

A

1) patients with status asthmaticus

2) no h/o wheezing

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6
Q

What labs should be ordered in asthma patients? why?

A

1) BMP–monitor K+ for patients uring nebulizers

2) CBC–if suspect infection, (little use in diagnosing asthma)

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7
Q

Patient’s CBC shows left shift after being given steroids in the ED for asthma attack. What should you do?

A

Nothing, this is normal after steroids

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8
Q

Asthma tx:

A

1) corticosteroids

2) bronchodilators

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9
Q

What are the pharmacology mechanisms of bronchodilators?

A

1) Beta agonists
2) anticholinergics
3) Mg

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10
Q

Patients with PFR < ____% need to be admitted, and PFR > _____% can be discharged. (In between is discretionary)

A

40%, 70%

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11
Q

Your 60 year old patient with 40 pack year history comes into the office with a productive cough for the last 3 months, SOB and mild respiratory distress comes into the office. What is the most likely dx?

A

COPD

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12
Q

What are the 2 types of COPD?

A

1) chronic bronchitis

2) emphysema

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13
Q

What is the dx criteria for chronic bronchitis?

A

Productive cough x 3 months of the year x 2 consecutive years.

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14
Q

What is the physiological definition of emphysema?

A

Permanent enlargement of the alveoli without fibrosis

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15
Q

When is pulse ox useful in COPD evaluation?

A

to monitor changes rather than using absolute value

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16
Q

When do you perform an ABG for a COPD pt?

A

severe exacerbation with AMS

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17
Q

On CXR, these 3 findings indicate chronic changes

A

1) hyperinflation (barrel chest)
2) decreased vascular markings
3) small cardiovascular silhouette

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18
Q

On CXR, these 3 findings indicate acute and treatable exacerbation:

A

1) pna
2) pneumothorax
3) tumor

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19
Q

COPD tx options:

A

1) O2 support (NC, CPAP, NRB, intubation) to get > 90% sat
2) steroids
3) bronchodilators
4) Abx, PRN

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20
Q

Name the 2 most common mainstays of bronchodilators used for COPD exacerbation which are used synergistically

A

1) Beta agonist: Albuterol

2) anticholinergic: Ipratropium

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21
Q

What are the most common pathogens responsible for COPD exacerbation?

A

1) strep pna
2) h. flu
3) M. catarrhalis
(same as OM)

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22
Q

What abx are used for COPD exacerbations?

A

1) Azith
2) Doxy
3) 3rd gen Ceph
4) Augmentin
5) Levaquin/Piper/4th ceph for pseudomonas

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23
Q

Your 65 year old male patient presents c/o cough w/ blood tinged sputum, SOB, fever, rigors, and malaise. He c/o night sweats. You r/o TB. What is first on DDx?

A

PNA

24
Q

What is the PE for a PNA patient?

A

rales, dull to percussion, egophony (alveolar). And rhonchi/wheezing (bronchial).

25
Q

How will you dx pna?

A

CXR, blood cx/sputum cx

26
Q

When is it considered health care-associated PNA?

A

1) If pt was hospitalized for 2 days within last 90
2) nursing home residents
3) dialysis pts
4) pts who’ve had IV abx, chemo, or wound care w/in 30 days

27
Q

What are the most common pathogens in nosocomial PNA?

A

1) Pseudomonas
2) Klebsiella
3) Acinetobacter
4) MRSA

28
Q

Which PNA pathogen is a/w GI symptoms?

A

Legionella

29
Q

Which PNA pathogen is most common in CAP?

A

strep pna

30
Q

Which PNA pathogen is most common in alcoholics and diabetics?

A

klebsiella

31
Q

Which PNA pathogen is most common in COPD and immunocompromised pts?

A

h.flu

32
Q

Which PNA pathogen is most common in young healthy people?

A

M. pna

33
Q

a disease in which the normal lung architecture is replaced by a cavity

A

cavitation

34
Q

What PNA pathogens cause cavitation?

A

1) anaerobes
2) staph
3) TB
4) fungal

35
Q

Bilateral interstitial infiltrates that present indolently in patients with CD4<200.

A

Pneumocystis

36
Q

How do you tx pneumocystis?

A

steroids + abx

37
Q

Risk factors for TB

A

1) immunocomp
2) incarcerated
3) homeless

38
Q

What unusual CXR findings is suggestive of TB?

A

upper lobe consolidation and hilar lymphadenopathy

39
Q

How do you determine if PNA severity is great enough to warrant admission, assuming that there is not current hypoxia?

A 
CURB65
Confusion
Urea (BUN>20)
Resp rate > 30
BP < 90
65+ Age
40
Q

What abx do you choose for CAP in simple patient with no comorbidities or recent illnesses?

A

Azith or Clarithro or doxy

41
Q

What abx do you choose for CAP in patient with comorbidities or abx within 3 months?

A

Azith + 3rd Ceph OR Levo

42
Q

What abx for otherwise healthy patient admitted for CAP?

A

Azith+3rd ceph OR Levo

43
Q

Abx for healthy pt admitted for SEVERE CAP?

A

Levo+vanc+3rd ceph

44
Q

What abx for any pt suspected to have HCAP/pseudomonas?

A

4th ceph, or
piper + FQ, or
vanc + aminoglycoside

45
Q

what abx for pneumocystis?

A

bactrim

46
Q

S3 gallop and diminished breath sounds at the lung bases is commonly found in what?

A

CHF with acute pulm edema

47
Q

What labs are helpful in dx’ing CHF with acute pulm edema?

A

1) BNP
2) electrolytes
3) cardiac enzymes

48
Q

tx of CHF and acute pulm edema

A

1) diuretics
2) nitrates (reduce pre/post load)
3) analgesics (also venodilate)
4) CPAP/BiPAP
5) Inotropics for ^ contractility (dopa/dobuta)

49
Q

Time to intubate. What is the sequence???

A

1) prepare
2) preoxygenate
3) paralysis and induction
4) placement and proof
5) post ET management

50
Q

What are some things you need for good preparation?

A

1) O2
2) suction
3) IV access
4) monitors
5) resp therapist
6) equipment
7) position patient

51
Q

Intubation requires 2 types of drugs:

A

1) induction agents

2) paralytics

52
Q

Name the induction agents:

A

1) etomidate
2) propofol
3) Ketamine

53
Q

Name the paralytic agenst:

A

1) succinylcholine

2) vecuronium

54
Q

When would you order a capnography?

A

for proof of intubation success

55
Q

alternatives to intubation

A

1) CPAP/BiPAP
2) laryngo mask airway
3) cricothyrotomy

Emergency (10 decks)

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