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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
Q

where is small cell located

A

central

*** smokers

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26
Q

non small cell lung CA

-types

A

squamous cell— central mass
-can lead to hypercalcemia thru paraneoplastic syndrome

adenocarcinoma— MC—peripheral mass— assoc with smoking + asbestos

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27
Q

which lung CA cannot be tx with surgery

A

small cell

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28
Q

tx for croup

A

antipyretics, hydration, humidified air (or oxygen), nebulized racemic epinephrine (only if signs of distress), and corticosteroids (dexamethasone

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29
Q

diagnosis for sleep apnea

A

polysomnography= GS

>15 events/hr + apena are + findings

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30
Q

tx for OSA

A
  1. LFM– lose weight**,exervise, decr ETOH, etc
  2. cpap
  3. very severe or refractory— uvulopalatopharyngoplasty— UPPP
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31
Q

MCC for CAP

  • young adults
  • COPD
  • overall
  • infants
  • mc viral in adults

others

A

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

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32
Q

GI s/s + high fever + produtive cough + malaise

A

legionella pneumoina

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33
Q

pnma prevention

A

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

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34
Q

tx for CAP outpatient

  • w/o and w/ comorbids
  • smoker
A

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

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35
Q

smoking causes what in bladder

A

transitional cell carcinoma

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36
Q

smoking cessation
-tx— first line.. which is most efficacious
second line

A
  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
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37
Q

Mantoux test results POS test:
>5 mm
>10 mm
>15 mm

A

> 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
Q

PPD + and CXR negative– type of TB and tx

A

Latent TB

Isoniazid for 9 MO + B6 to prevent neuropathy

39
Q

PPD+ and CXR+

type of TB and tx

A

Active TB

QUAD TX–RIPE x8 weeks and then RI for 16 weeks

Rifampin 
Isoniazid 
Pyrazinamide 
Ethambutol 
****all are hepatoxic
40
Q

SE of the RIPE drugs

A

Rifampin— red-organe urine, hepatitis

Isoniazid— peripheral neuropathy– B6 or pyridoxine given to prevent

Pyraziamide—hyperurecemia–gout

Ethambutol– optic neuritis, red-green blindness

41
Q

prophylaxis for household members around a TB+ patient

A

isoniazid for 1 yr

42
Q

acute sinusitis

  • mcc
  • how to tel b/w bacterial and viral
  • chronic define timing
A

VIRAL
s/s < 7 days
-over 7 days + bilateral purulent discharge from nose=bacterial— strep pneumo, h. influ, m. cata

chronic= > 12 weeks

43
Q

dx for chronic sinusitis

-GS?

A

XR— plainview— waters view

GS= CT

44
Q

tx for acute bacterial sinusitis

A

**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
Q

tx for chronic sinusitis

A

3 weeks long duration tx

-augmentin
pcn allergic= clindamycin

46
Q

single or multiple small shallow ulcers with yellow-gray fibrinoid center with red halo

  • what is it
  • dx
  • tx
A

apthos ulcer

**only do biopsy if lasting > 3 wks

tx=viscous lido

47
Q

chronic inflammation of eyelid margins

A

blepharitis

48
Q

blepharitis

-causes

A

seborrhea, staph or strep

**dysfunction of meibomian glands

49
Q

anterior blepharitis

-affect?

A

eyelid skin
eyelashes

**staph, or seborhhea

50
Q

posterior blepharitis

A

inflamm of meibomian glands— can be infectious or caused by glandular dysfunction

51
Q

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

A

blepharitis

52
Q

tx for blepharitis

A

warm compress
daily lid wash with baby shampoo
lid massge to express gland

refractory:
topical abx—Azithromcin, Erythromycin, Bacitrain

53
Q

painless otorrhea, brown/yellow discharge with a strong odor

*hearing loss

A

cholesteatoma

**hearing loss is on affected side— conductive

54
Q

tx for cholesteatoma in office

A

remove with silver nitrate sticks

topical Ciprofloxacin and Dexamethasoe drops or PO cipro or Bactrim

55
Q

MC virus causing conjucntiitis

A

adenovirus

56
Q

mc bacteria conjuncitivits

A

staph aureus

57
Q

s/s for viral conjunctivitis

A

BILATERAL
FB sensation
clear watery dsx

enlarged preauricular lymph node

58
Q

s/s for bacterial conjunctiitis

A

unilateral at first– but then can spread

eye glued shut

59
Q

opthalmia neonatorum

A

gonococcal infection of neonate within 2-5 days delivery

** mc chlamydia if > days s/s develop

60
Q

tx for bacterial conjuncitiits

A

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
Q

tx for allergic conjuncitivitis

A

epinastine (Elestat)
azelastine (Optivar)
Emedastine difumarate (Emadine)
Levocabastine (Livostin)

62
Q

Sudden onset of eye pain, photophobia, tearing, foreign body sensation, blurring of vision, and/or conjunctival injection

A

corneal abrasion

63
Q

corneal abrasion

  • RF
  • diagnosis
A

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
Q

tear drop shape pupil— what to order next

A

CT and emergent optho consult

65
Q

corneal ulcer aka?

A

ulcerative keratitis

66
Q

corneal ulcer

-causes

A

inflammatory or infective dz of cornea—->disruption of epithelial layer and corneal stroma

67
Q

FB sensation with increased tear production, sensitivity to light,
+ PAIN and eye redness

A

corneal ulcer

68
Q

dendritic lesions seen on slit lamp and fluro staining

A

herpes simplex keratitis

69
Q

corneal ulcer tx

  • small ulcer
  • herpes
  • fungal
  • pain
  • avoid what drug?
A

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
Q

white spot on the surface of the cornea that stains with fluoscene

A

corneal ulcer

71
Q

which vit deficiency can be assoc with corneal ulcer

72
Q

inflammation of the nasolacrimal duct or nasolacrimal gland

A

dacroadenitis

73
Q

dacroadenitis

A

rapid onset
unilateral severe pain, redness and pressure

in the SUPRATEMPORAL region—- above the top eyelid

74
Q

Dacrocystitis

A

infectious obstruction of nasolacrimal duct
rapid onset
unilateral, severe pain, redness and EPIPHORA– overflow of tears

INFRAMEDIAL REGION

MC staph aureus

75
Q

excessive tears, blurry vision, inflammation to medial canthal of lower lid

A

dacrocystitis

76
Q

dacrocystitis

  • dx
  • tx
A

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

***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
Q

Eversion of eyelid— turning outward

  • define
  • tx
A

ectropion

tx— tear supplements, ocular lurbicants– surgery=definitive

78
Q

Inversion of eyelid—- eyelid turning inward

  • define
  • tx
A

entropion

tx— tear supplements, ocular lurbicants– surgery=definitive

79
Q

palsy of which CN can cause ectropion

A

CN VII— facial nerve

80
Q

what can you use to help vasoconstrict nares during epistaxis

A

Oxymetazoline aka Afrin +/- lidocaine

can also try topical sympathomimetics like Phenylephrine

81
Q

packing the nose for >72 hrs and/or pt is immunocomp, what else do we give

A

Augmentin or Cefuroxime prophylaxis

82
Q

severe eye pain, HA, N/V

A

acute narrow angle closure glaucoma

83
Q

gradual peripheral vision loss

84
Q

central vision loss

85
Q

injected conjunctiva, steamy cornea, and fixed dilated pupil,

A

acute glaucoma

86
Q

tx for acute glaucoma

A

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
Q

tx for chronic glaucoma

A
  1. Lanatoprost, Tafluprost or Timolol drops
88
Q

painful, warm, swollen red lump on eyelid

89
Q

hard non-tender mass on eyelid

90
Q

blood in anterior chamber seen with penlight

91
Q

tx for hyphema

A

**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

EORs (15 decks)

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