deck 11 Flashcards
FEV1/FVC threshold for obstructive
70
combivent
albuterol + ipratropium
iptratropium drug class
anticholinergic
iptratropium vs. tiotropium
ipratropium slower acting
drugs best at reducing exacerbations in COPD
anticholinergics
vaccine all COPD patients need
pneumovax
when to give O2
O2 sat below 88 (while ambulating)
When to prescribe ABX for COPD exacerbation
SOB
Increased sputum volume
Increased sputum clearance
Why you use anticholinergics in COPD
- vagal nerve causes bronchoconstriction
- basically bronchodilation
COPD exacerbation treatment
- steroids (pred 40 x 5 days)
- office nebulizer
- ## antibiotics (azithromycin x 5 days), which has been shown to reduce inflammation in airways
asthma categories and inhaler use
severe persistent = several times per day
moderate persistent = daily
mild persistent = more than 2 days per week
intermittent = less than 2 days per week
asthma categories and nighttime symptoms
severe = more moderate = more than 1 a week mild = 3-4/month intermittent = less than 2/month
salmeterol
long acting beta agonist
singular used for…
asthma w/ allergic component
setting of aspergillum infection
prolonged neutropenia
presentation of invasive pulmonary aspergillosis
fever + pleuritic chest pain + hemoptysis
CT scan of invasive aspergillosis
nodules with surrounding ground-glass opacities (“halo sign”)
first step in anaphylaxis management
IM epinephrine
solitary pulmonary nodule CXR algorithm
- if on previous x-ray, monitor with x-rays for 2-3 years then stop if stable.
- if no previous imaging, get chest CT. If benign features –> serial CT. If indeterminate or suspicious for malignancy –> biopsy/PET. If suspicious for malignancy –> surgical excision.
positive bronchodilator response defined as
greater than 12% increase in FEV1
squamous cell carcinoma presentation
- smoking history + hypercalcemia + hilar mass
- usually causes other paraneoplastic syndromes such as ACTH production + SIADH
ABG findings suggestive of CHF
hypoxia, hypocapnia, respiratory alkalosis
causes of recurrent pneumonia
1) lung malignancy
(recurrent pneumonia in the same location of the lung suggests localized airway obstruction, which can lead to impaired bacterial clearance and predisposition to infection. Causes of localized airway obstruction include external bronchial compression due to lymphadenopathy, expanding neoplasm, or vascular anomaly)
increased breath sounds just means
crackles and ego phony present
other name for postnasal drip
upper-airway cough syndrome
upper-airway cough syndrome presentation
- cough following URI + occurring primarily at night + no expectoration
upper-airway cough syndrome treatment
oral 1st generation antihistamine (chlorpheniramine) OR combined antihistamine-decongestant
normal JVP
6-8 cm
what causes cor pulmonale?
1) **COPD
2) ILD
3) pulmonary vascular disease (thromboembolic)
4) OSA
cor pulmonale symptoms
- DOE, fatigue, lethargy
- exertional syncope (due to decreased CO)
- exertion angina (due to increased myocardial demand)
- peripheral edema
- Increased JVP
- Loud S2
- pulsatile liver from congestion
- ascites
cor pulmonale onset
usually gradual but can be sudden (due to sudden increase in pulmonary artery pressure from PE for example)
causes of transudative pleural effusions
CHF
Cirrhosis
nephrotic syndrome
peritoneal dialysis
pathophys of effusion with CHF
- elevated pressure from LV end diastole and LA transmits back to the alveolar capillaries to increase hydrostatic pressure –> fluid movement across visceral pleura into pleural space
exudate characteristics
- Pleural fluid protein/serum protein ratio > 0.5
- pleural fluid LDH/serum LDH greater than 0.6
- pleural fluid LDH greater than 2/3 of upper limit of normal serum LDH
transudate pleural fluid pH
7.40-7.55
exudate pleural fluid pH
7.3-7.45
mass in middle mediastinum is usually
bronchogenic cyst
mass in anterior mediastinum is usually
thymoma
hypertrophic osteoarthropathy
- digital clubbing + sudden-onsets arthropathy (wrist and hands swollen)
- hypertrophic pulmonary osteoarhtropathy is a subset where clubbing and athropathy are attributable to underlying lung disease like lung cancer.
initial management of hyponatremia secondary to SIADH from lung cancer in asymptomatic or mildly symptomatic patient
fluid restriction
kidney’s response to hypercarbia
- increase bicarb retention and decrease chloride reabsorption to create a compensatory metabolic alkalosis.
aspirin-exacerbated respiratory disease (AERD)
- pseudo allergic reaction to NSAIDs
- occur in patients with comobrid asthma, chronic rhino sinusitis with nasal polyposis.
- asthmatic symptoms (cough wheezing, chest tightness) + nasal and ocular symptoms (nasal congestion, rhinorrhea, periorbital edema) and facial flushing
primary therapy for moderate hypothermia
- active external rewarming + warmed IV fluids
- *bradycardia is often refractory to treatment with atropine and cardiac pacing but usually improves with correction of hypothermia
bronchiectasis presentation
1) cough w/ daily production of large amounts of mucopurulent sputum
2) rhino sinusitis, dyspnea, hemoptysis
3) crackles, wheezing
gold standard for diagnosis of bronchiectasis
high-resolution CT (HRCT), which demonstrates bronchial dilation, lack of airway tapering, and bronchial wall thickening.
outpatient empiric abx for CAP
macrolide or doxy (healthy)
fluoroquinolone or beta-lactam + macrolide (comorbidities)
inpatient empiric abx for CAP
IV quinolone OR
IV beta-lactam + macrolide
tool for determining admission for CAP
CURB-65
USPSTF recommendation on AAA screening
1 time abdominal US for men aged 65-75 who have smoked cigarettes
how to determine anticoagulation in CHF patient
CHADS-VASc
management of patients with lone AF – patients with paroxysmal, persistent, or permanent AF with no evidence of cardiopulmonary or structural heart disease
no therapy
