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FM 3 Flashcards

1
Q

increased TLC, RV, FRC

A

obstructive— COPD, asthma

***hyperinflation

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2
Q

Decreased TLC, RV, FVC

A

restrictive

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3
Q

Asthma

-diagnosis, how to confirm, best way to assess exacerbation

A

H&P, PE findings

CONFIRM diagnosis is w/ PFT– need to stop bronchodilators before test—will show obstructive pattern– decreased FEV1/FVC

best way to assess exacerbation is peak expiratory flow rate

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4
Q

samters triad

A

ASA allg
nasal polyps
asthma

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5
Q

atopic triad

A

eczema
allergic rhinitis
asthma

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6
Q

symptoms <2 times per week, nightitme symptoms 1-2x/month. use of SABA <2days / week

A

intermittent asthma

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7
Q

symps >2x/week, nightime symptoms 3-4x/month, use of SABA >2 days/week

A

mild persistent asthma

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8
Q

daily symptoms, nightime symptoms > or eqaul to 5 times per month, daily use of SABA

A

mod persistnet asthma

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9
Q

continous symptoms with daily night-time awakenings, SABA several times per day

A

severe persistent asthma

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10
Q

asthma diagnosis: Greater than ____% increase in FEV1 after bronchodilator therapy

A

12

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11
Q

tx for:

-mild intermittent

A

SABA PRN

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12
Q

tx mild persistnet asthma

A

low dose ICS daily and SABA PRN

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13
Q

moderate persistent asthma tx

A

low-dose ICS + LABA daily
OR if that doesnt work

medium dose ICS + LABA daily

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14
Q

severe persistent asthma tx

A

high dose ICS + LABA daily
then if that doesnt work

High dose ICS + LABA + PO steroids daily

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15
Q

list the step wise appraoch for asthma tx

A
  1. SABA prn
  2. low dose ICS daily
  3. low dose ICS + LABA
  4. medium dose ICS + LABA
  5. high dose ICS + LABA
  6. high dose ICS + LABA + PO steroids daily
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16
Q

list short acting beta agonists

A

albuterol

levalbuterol

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17
Q

define bronchitis

-etiologies

A

cough >5 days with (MC) or w/o sputum production lasting 2-3 weeks
+/- HA, low grade fever, sore throat

etiologies
MC=viral— adenovirus MC, rhinovirus, RSV, influenza, corona,
bacterial causes= mycoplasma, bordetella pertusis

**if there is HIGH FEVER AND LOTS OF SPUTUM, TACHYCARDIC, TACHYPNIC— consider pnemonia and get CXR

tx=supportive–

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18
Q

COPD

  • define
  • diagnosis–gold standard
  • labs and why
  • tx—- WHATS THE ONLY TX TO REDCE MORTALITY
A

chronic cough that is productive occuring on most days of 3 months of the year for at least 2 or more consecutive yrs w/o defined acute cause

DX

  • GS—- PFTs—–> show V/Q mismatch and FEV1/FVC ration less than 0.7
  • CXR— only used to r/o pneumonia or pneumothorax… can also be useful in exacerbation

LABS
-incr hgb and hematocrit bc of the chronic hypoxic state

TX
1st step: quit smoking and give pneumococcal vaccine
2. bronchodilators—- anticholinergics, beta ags, corticosteroids
3. OXYGEN IS THE ONLY THERAPY TO REDUCE MORTALITY and quiting smoking
4. alpha 1 anti tyrpsin def— lung transplant only tx
5. azithromycin can be helpful in exacerbations/inflammation

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19
Q

lung cancer screening gudielines

A

low dose CT in those aged 50-80 with a 20+ pack year hx and currently smoking OR have quit in the last 15 yrs

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20
Q

minimal cough, thin, barrel chest, quiet lungs

A

emphysema

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21
Q

criteria for home oxygen for COPD pt

A
  1. Pa02 55 mm hg
  2. 02 sat <88% at rest or exercise
  3. pa02 55-59 + polycythemia or cor pulmonale
  4. nocturnal hypoxemia—– CPAP
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22
Q

mc type of lung CA

A

non small cell— 85%

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23
Q

how does small cell lung CA present

A

recurrent pnma

-anorexia, wt loss, wekeanss, cough

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24
Q

list pe finding for horner syndrome

A

unilateral facial anhidrosis, ptosis, miosis

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25
where is small cell located
central *** smokers
26
non small cell lung CA | -types
squamous cell--- central mass -can lead to hypercalcemia thru paraneoplastic syndrome adenocarcinoma--- MC---peripheral mass--- assoc with smoking + asbestos
27
which lung CA cannot be tx with surgery
small cell
28
tx for croup
antipyretics, hydration, humidified air (or oxygen), nebulized racemic epinephrine (only if signs of distress), and corticosteroids (dexamethasone
29
diagnosis for sleep apnea
polysomnography= GS | >15 events/hr + apena are + findings
30
tx for OSA
1. LFM-- lose weight****,exervise, decr ETOH, etc 2. cpap 3. very severe or refractory--- uvulopalatopharyngoplasty--- UPPP
31
MCC for CAP - young adults - COPD - overall - infants - mc viral in adults others
strep pneumoniae overall young adults= mycoplasma ``` OTHERS -haemophlus--- 2nd mc and assoc with COPD -influenzae -mycoplasma pneumoniae -staph aureus -n. meningitiis - m. catarrhalis - ``` INFANTS-- RSV.. virla viral adults--- influenza
32
GI s/s + high fever + produtive cough + malaise
legionella pneumoina
33
pnma prevention
Pneumovax 23-- all adults 65+, adults 18-64 who are smokers or have o ther condiitons that make them high risk PCV or prevnar 13--- vaccine for all kids <2 YO and high risk aduls >65
34
tx for CAP outpatient - w/o and w/ comorbids - smoker
with no comorbidities *amox PO or Doxy or Macrolide (clarithromcin or azithromycin) PO**** 5 days or until afebrile with comorbidities or >65 * beta lactam (amox HD or augmentin) + macrolide PO * respiratory fluoro-- moxifloxacin or levofloxacin Smokers -cefdinir
35
smoking causes what in bladder
transitional cell carcinoma
36
smoking cessation -tx--- first line.. which is most efficacious second line
1. Varenicline (chantix)-- best efficacy bc reduces reward aspect of smoking--quit smoking 1 wk after start 2. Bupropion--- wellbutrin, Zyban---- YES USE IN PREGNANCY 3. Nicotine replacement therapy (NRT)--- rec for inpatient SECOND LINE 1. Nortriptyline and Clonidine * **every pt gets CBT * ***f/u appointment 1-2 wks after treatment start
37
Mantoux test results POS test: >5 mm >10 mm >15 mm
>5 *high risk, immunocomp, steroids/TNF agents, close contact with pt infected >10 * HOSPITALS AND OTHER HEALTHCARE WORKERS * IVDU * recent immigrant * homeless * DM * head/neck CA >15 *no risk factors
38
PPD + and CXR negative-- type of TB and tx
Latent TB Isoniazid for 9 MO + B6 to prevent neuropathy
39
PPD+ and CXR+ | type of TB and tx
Active TB QUAD TX--RIPE x8 weeks and then RI for 16 weeks ``` Rifampin Isoniazid Pyrazinamide Ethambutol ****all are hepatoxic ```
40
SE of the RIPE drugs
Rifampin--- red-organe urine, hepatitis Isoniazid--- peripheral neuropathy-- B6 or pyridoxine given to prevent Pyraziamide---hyperurecemia--gout Ethambutol-- optic neuritis, red-green blindness
41
prophylaxis for household members around a TB+ patient
isoniazid for 1 yr
42
acute sinusitis - mcc - how to tel b/w bacterial and viral - chronic define timing
VIRAL s/s < 7 days -over 7 days + bilateral purulent discharge from nose=bacterial--- strep pneumo, h. influ, m. cata chronic= > 12 weeks
43
dx for chronic sinusitis | -GS?
XR--- plainview--- waters view GS= CT
44
tx for acute bacterial sinusitis
**only given is s/s dont improve >10 days tx=5-7 days long *amox or augmentin PCN allergic= Doxycycline MACROLIDES AND BACTRIM NOT RECCOMENDED FOR EMPIRIC TX BC HIGH RATES OF RESISTANCE FOR STREP PNEUMO kids= amox 10-14 days
45
tx for chronic sinusitis
3 weeks long duration tx -augmentin pcn allergic= clindamycin
46
single or multiple small shallow ulcers with yellow-gray fibrinoid center with red halo - what is it - dx - tx
apthos ulcer **only do biopsy if lasting > 3 wks tx=viscous lido
47
chronic inflammation of eyelid margins
blepharitis
48
blepharitis | -causes
seborrhea, staph or strep | **dysfunction of meibomian glands
49
anterior blepharitis | -affect?
eyelid skin eyelashes **staph, or seborhhea
50
posterior blepharitis
inflamm of meibomian glands--- can be infectious or caused by glandular dysfunction
51
crusting, scaling, red-rimming of eyelide and eyelast flaking, adherent eyelashes, hyperemic lid margins, dandruff-like deposits (scurf) and fibrous scales (collarettes); clear or slightly injected conjunctiva; thick cloudy discharge visible when Meibomian glands obstructed
blepharitis
52
tx for blepharitis
warm compress daily lid wash with baby shampoo lid massge to express gland refractory: topical abx---Azithromcin, Erythromycin, Bacitrain
53
painless otorrhea, brown/yellow discharge with a strong odor | *hearing loss
cholesteatoma | **hearing loss is on affected side--- conductive
54
tx for cholesteatoma in office
remove with silver nitrate sticks | topical Ciprofloxacin and Dexamethasoe drops or PO cipro or Bactrim
55
MC virus causing conjucntiitis
adenovirus
56
mc bacteria conjuncitivits
staph aureus
57
s/s for viral conjunctivitis
BILATERAL FB sensation clear watery dsx enlarged preauricular lymph node
58
s/s for bacterial conjunctiitis
unilateral at first-- but then can spread | eye glued shut
59
opthalmia neonatorum
gonococcal infection of neonate within 2-5 days delivery **** mc chlamydia if > days s/s develop
60
tx for bacterial conjuncitiits
topical gentamycin/tobramycin (Tobrex) ********** contact wearer: topical ciprofloxacin to cover pseudo Erythromycin oinemnt for chlamydia newborns *systemic tetracycline or erythromycin Gonorrhea--- prompt referral + systemic ABX
61
tx for allergic conjuncitivitis
epinastine (Elestat) azelastine (Optivar) Emedastine difumarate (Emadine) Levocabastine (Livostin)
62
Sudden onset of eye pain, photophobia, tearing, foreign body sensation, blurring of vision, and/or conjunctival injection
corneal abrasion
63
corneal abrasion - RF - diagnosis
RF= contacts, occupations where small things fly around DX * prior to lid eversion and staining-- use Proparacaine drops for anesthetic * Flurescein stain--- Abrasion will GLOW green/yellow with slit lamp---- see a +Seidel sign-- leakage of aqueous fluid showing corneal perforation * *NO eye patching
64
tear drop shape pupil--- what to order next
CT and emergent optho consult
65
corneal ulcer aka?
ulcerative keratitis
66
corneal ulcer | -causes
inflammatory or infective dz of cornea---->disruption of epithelial layer and corneal stroma
67
FB sensation with increased tear production, sensitivity to light, + PAIN and eye redness
corneal ulcer
68
dendritic lesions seen on slit lamp and fluro staining
herpes simplex keratitis
69
corneal ulcer tx - small ulcer - herpes - fungal - pain - avoid what drug?
***immediate referrral small= Moxifloxacin***, tobramycin, Cefazolin, drops HSV--Trifluridine***, ganciclovir, Valacyclovir, Acyclovir drops, Fungal--Natamycin**, amphotericin B, Voriconazole drops PAIN= Atropine or Scopolamine AVOID CORTICOSTEROIDS bc they prolong healing time
70
white spot on the surface of the cornea that stains with fluoscene
corneal ulcer
71
which vit deficiency can be assoc with corneal ulcer
A
72
inflammation of the nasolacrimal duct or nasolacrimal gland
dacroadenitis
73
dacroadenitis
rapid onset unilateral severe pain, redness and pressure in the SUPRATEMPORAL region---- above the top eyelid
74
Dacrocystitis
infectious obstruction of nasolacrimal duct rapid onset unilateral, severe pain, redness and EPIPHORA-- overflow of tears INFRAMEDIAL REGION MC staph aureus
75
excessive tears, blurry vision, inflammation to medial canthal of lower lid
dacrocystitis
76
dacrocystitis - dx - tx
DX 1. Schirmer basic secretor test-- tear draininage test 2. Irrigation and probing--help relieve blockage (diagnostic and therapeutic) 3. jones dye test-- looks for anatomical obstruction 4. CT ONLY if orbital cellulitis is suspected tx - ***lacrical massage, dilation, probing, flushing infectious= Topical abx - purulent laacrimal sac--- augmentin PO * if orbital cellulitis--> IV abx and hosp admission----- Ampicillin-Sulbactam, Cefrtri, Moxifloxacin
77
Eversion of eyelid--- turning outward - define - tx
ectropion tx--- tear supplements, ocular lurbicants-- surgery=definitive
78
Inversion of eyelid---- eyelid turning inward - define - tx
entropion tx--- tear supplements, ocular lurbicants-- surgery=definitive
79
palsy of which CN can cause ectropion
CN VII--- facial nerve
80
what can you use to help vasoconstrict nares during epistaxis
Oxymetazoline aka Afrin +/- lidocaine can also try topical sympathomimetics like Phenylephrine
81
packing the nose for >72 hrs and/or pt is immunocomp, what else do we give
Augmentin or Cefuroxime prophylaxis
82
severe eye pain, HA, N/V
acute narrow angle closure glaucoma
83
gradual peripheral vision loss
GLAUCOMA
84
central vision loss
MAC DEGEN
85
injected conjunctiva, steamy cornea, and fixed dilated pupil,
acute glaucoma
86
tx for acute glaucoma
GOAL IS TO DECR IOP IMMEDIATELY 1. Acetazolamide IV first line followed by mannitol or Isosorbide 2. Pilocarpine or timolol 3. Carbonic anhydrase--- Diamox DEFINITIVE= laser peripheral iridotommy
87
tx for chronic glaucoma
1. Lanatoprost, Tafluprost or Timolol drops
88
painful, warm, swollen red lump on eyelid
hordeolum
89
hard non-tender mass on eyelid
chalazion
90
blood in anterior chamber seen with penlight
hyphema
91
tx for hyphema
**blood is reasbored within days-weeks ``` 1 metal eye shield to prevent incr IOP 2. elevate head of bed to 30-40 degrees 3. emergent optho ref 4 ,timolol or brimonidine to decr IOP 5. Atropine or Scopolamine to dilate eyes ```

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