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Family med > deck 11 > Flashcards

deck 11 Flashcards

1
Q

FEV1/FVC threshold for obstructive

A

70

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2
Q

combivent

A

albuterol + ipratropium

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3
Q

iptratropium drug class

A

anticholinergic

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4
Q

iptratropium vs. tiotropium

A

ipratropium slower acting

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5
Q

drugs best at reducing exacerbations in COPD

A

anticholinergics

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6
Q

vaccine all COPD patients need

A

pneumovax

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7
Q

when to give O2

A

O2 sat below 88 (while ambulating)

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8
Q

When to prescribe ABX for COPD exacerbation

A

SOB
Increased sputum volume
Increased sputum clearance

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9
Q

Why you use anticholinergics in COPD

A
  • vagal nerve causes bronchoconstriction

- basically bronchodilation

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10
Q

COPD exacerbation treatment

A
  • steroids (pred 40 x 5 days)
  • office nebulizer
  • ## antibiotics (azithromycin x 5 days), which has been shown to reduce inflammation in airways
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11
Q

asthma categories and inhaler use

A

severe persistent = several times per day
moderate persistent = daily
mild persistent = more than 2 days per week
intermittent = less than 2 days per week

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12
Q

asthma categories and nighttime symptoms

A 
severe = more
moderate = more than 1 a week
mild = 3-4/month
intermittent = less than 2/month
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13
Q

salmeterol

A

long acting beta agonist

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14
Q

singular used for…

A

asthma w/ allergic component

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15
Q

setting of aspergillum infection

A

prolonged neutropenia

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16
Q

presentation of invasive pulmonary aspergillosis

A

fever + pleuritic chest pain + hemoptysis

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17
Q

CT scan of invasive aspergillosis

A

nodules with surrounding ground-glass opacities (“halo sign”)

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18
Q

first step in anaphylaxis management

A

IM epinephrine

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19
Q

solitary pulmonary nodule CXR algorithm

A
  • 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.
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20
Q

positive bronchodilator response defined as

A

greater than 12% increase in FEV1

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21
Q

squamous cell carcinoma presentation

A
  • smoking history + hypercalcemia + hilar mass

- usually causes other paraneoplastic syndromes such as ACTH production + SIADH

22
Q

ABG findings suggestive of CHF

A

hypoxia, hypocapnia, respiratory alkalosis

23
Q

causes of recurrent pneumonia

A

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)

24
Q

increased breath sounds just means

A

crackles and ego phony present

25
Q

other name for postnasal drip

A

upper-airway cough syndrome

26
Q

upper-airway cough syndrome presentation

A
  • cough following URI + occurring primarily at night + no expectoration
27
Q

upper-airway cough syndrome treatment

A

oral 1st generation antihistamine (chlorpheniramine) OR combined antihistamine-decongestant

28
Q

normal JVP

A

6-8 cm

29
Q

what causes cor pulmonale?

A

1) **COPD
2) ILD
3) pulmonary vascular disease (thromboembolic)
4) OSA

30
Q

cor pulmonale symptoms

A
  • 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
31
Q

cor pulmonale onset

A

usually gradual but can be sudden (due to sudden increase in pulmonary artery pressure from PE for example)

32
Q

causes of transudative pleural effusions

A

CHF
Cirrhosis
nephrotic syndrome
peritoneal dialysis

33
Q

pathophys of effusion with CHF

A
  • 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
34
Q

exudate characteristics

A
  • 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
35
Q

transudate pleural fluid pH

A

7.40-7.55

36
Q

exudate pleural fluid pH

A

7.3-7.45

37
Q

mass in middle mediastinum is usually

A

bronchogenic cyst

38
Q

mass in anterior mediastinum is usually

A

thymoma

39
Q

hypertrophic osteoarthropathy

A
  • 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.
40
Q

initial management of hyponatremia secondary to SIADH from lung cancer in asymptomatic or mildly symptomatic patient

A

fluid restriction

41
Q

kidney’s response to hypercarbia

A
  • increase bicarb retention and decrease chloride reabsorption to create a compensatory metabolic alkalosis.
42
Q

aspirin-exacerbated respiratory disease (AERD)

A
  • 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
43
Q

primary therapy for moderate hypothermia

A
  • active external rewarming + warmed IV fluids
  • *bradycardia is often refractory to treatment with atropine and cardiac pacing but usually improves with correction of hypothermia
44
Q

bronchiectasis presentation

A

1) cough w/ daily production of large amounts of mucopurulent sputum
2) rhino sinusitis, dyspnea, hemoptysis
3) crackles, wheezing

45
Q

gold standard for diagnosis of bronchiectasis

A

high-resolution CT (HRCT), which demonstrates bronchial dilation, lack of airway tapering, and bronchial wall thickening.

46
Q

outpatient empiric abx for CAP

A

macrolide or doxy (healthy)

fluoroquinolone or beta-lactam + macrolide (comorbidities)

47
Q

inpatient empiric abx for CAP

A

IV quinolone OR

IV beta-lactam + macrolide

48
Q

tool for determining admission for CAP

A

CURB-65

49
Q

USPSTF recommendation on AAA screening

A

1 time abdominal US for men aged 65-75 who have smoked cigarettes

50
Q

how to determine anticoagulation in CHF patient

A

CHADS-VASc

51
Q

management of patients with lone AF – patients with paroxysmal, persistent, or permanent AF with no evidence of cardiopulmonary or structural heart disease

A

no therapy

Family med (48 decks)

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