Awesome Review Flashcards
First Step to determine obstructive or restrictive disease?
Total Lung Capacity
After maximal inhalation
PFT ratio to determine obstructive?
FEV1/FVC
Positive Broncodilator challenge to diagnose asthma?
Increase of FEV1 of 12% or increase of 200 mL
What causes fixed extra thoracic obstruction?
Draw it
Diagnosis
Tumor and Tracheal stenosis
Dx- Bronchoscopy
What causes dynamic extrathoracic obstruction?
Draw it
Diagnosis
Epiglottis and vocal cord dysfunction
Blunted inhalation, air coming in sucks
Dx- indirect laryngoscopy
What is DLCO in PE?
What is DLCO in CO poisoning?
Low
Normal
If you want to wean down ICS when treating asthma, what to give?
Leukotriene Modifiers
When to give Omalizumab?
Serum IgE 30-700
Evidence of allergies of perennial aeroallergen
Eosinophilia
What are new IL 5 antagonist monoclonal antibodies to treat eosinophilic asthma?
Reslizumab and Mepolizumab
Dx Allergic Bronchopulmonary Aspergillosis
+ skin test to Aspergillus
Increased IgE and peripheral eosinophilia
Brown mucus plugs
CXR- transient infiltrate, pleural thickening, atelectasis, proximal bronchiectasis
CXR difference btwn Chronic Eosinophilic PNA and Acute Eosinophilic PNA?
Chronic- peripheral infiltrate
Acute- center infiltrate/ground glass
Tx Alveolar Proteinosis
Whole Lung Lavage bc Shitty macrophages cause build up of surfactant in lung
If severe COPD on SABA, LABA, LA-anticholinergic, and pulm rehab, what’s next?
Roflumifast/Daliresp
Phosphodiesterase 4 inhibitor
Contraindicated in Liver Impairment
When do you need home oxygen in COPD?
PaO2 88%
Or Hct >55%
What can you do for upper lobe emphysema when FEV1 less than 50% but greater than 20%?
If less than 20%?
Lung Volume Reduction decreases mortality
Lung transplant if FEV1
Dx Dyskinetic Cilia Syndrome (aka Kartagener’s syndrome)
Screen- sperm motility
Confirm- testicular biopsy or biopsy of bronchi or sinus
Features of Dyskinetic Cilia Syndrome
Bronchiectasis
Sinusitis
Infertility!
Situs inversus
Leading bacteria that increases mortality in cystic fibrosis
Cepacia Burkholderia
Treat with Bactrim
Treat severe Bronchiectasis with bleed
Bronchial artery embolization
What is IgE and eosinophilia in hypersensitivity pneumonitis?
NORMAL
Does LABA change mortality in COPD?
NO
What do you think of -Bilateral Basal Bullous Cyst
Thinks alpha 1 antitrypsin deficiency
Check Serum alpha 1 antitrypsin level
What is DLCO in Broncholitis Obliterans?
NORMAL
What is DLCO in Cryptogenic Organizing Pneumonia? What is treatment?
Decreased DLCO
Crackles everywhere!!
Steroids
Treat Stage 1 Sarcoidosis
None, 60-90% will remit
Stage 1 only has hilar adenopathy
No lung involvement
Features of Lymphangioleiomyatosis
Premenopausal
Spontaneous pneumothorax
Diffuse thin walled cysts
Tx- Sirolimus
Features of Pulmonary Hypertension
At rest- 25 mmHg During exercise- 30 mmHg Normal PCWP Parasternal Heave Large JVP Widened/Split S2 RV failure
Findings on Echo for Pulmonary Hypertension
Dilation and hyper trophy of right ventricle
Tricuspid regurgitation
Bulging of septum into left ventricle
While diagnosing Pulmonary Hypertension with right heart cath and patient responds to vasodilator challenge? What do you do?
Treat with Nifedipine and Diltiazem
Tx Pulmonary Arterial Hypertension
Mild Disease
PP5 inhibitors
Sildenafil and tadalafinil
Txt Pulmonary Arterial Hypertension
Moderate disease with some limitation on physical activity
IV Epoprostenol
Tx Pulmonary Arterial Hypertension
Severe and Hypotensive
Inhaled Iloprost
Which types of Pulmonary Hypertension require anti coagulation?
Type 1 and 4
How long do you anticoagulate after knee replacement, hip replacement, or acute orthopedic fracture?
4 weeks!!!
Tx large DVT, like iliofemoral DVT
Thrombolytic!!
If thrombus in popliteal vein, what’s next?
Follow up Doppler in 2 weeks to see if there is extension. If there is extension beyond knee- anticoagulate
Patient on anticoagulation for DVT but started bleeding. Frack, now what?
ASA 325 mg
MC of PNA in COPD and DM
Moraxella catarhalis
Dx: post Tussive vomiting and subconjunctival hemorrhage
Bordatella pertussis
Treat bacterial sinusitis
If fever, pain or sx >7 days
Augmentin
Centor Criteria
- Fever
- Exudates
- Anterior cervical LAD
- No cough
If you fulfill all 4 criteria, give Amoxicillin
Dx- Hot Potato Voice Dysphagia Drooling Tonsils touching each other Uvula deviated
Peritonsillar abscess
Treatment of Lung Abscess
PCN & Clindamycin
Severe Influenza treatment
IV Zanamivir
If PPD + and negative CXR what’s next?
INH for 9 months
If unable to tolerate due to liver dysfunction, rifampin for 4 months
Pleural Fluid finding in TB
Fluid adenosine deaminase test
Dx Hepatopulmonary syndrome
TTE with micro bubble studies
Dx Obesity Hypoventilation Syndrome
PaCO2 > 45
Increased neutrophils in BAL
Idiopathic Pulmonary Fibrosis
Increased Lymphocytes in BAL
- CD 4 > CD8
- CD 8 > CD 4
Sarcoidosis is more CD4
Hypersensitivity Pneumonitis is more CD 8