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Maddy - CPR II - some pharm > Hubbard DSAs > Flashcards

Hubbard DSAs Flashcards

1
Q

describe grades 1-5 on the MRC dyspnea scale

A

1: not troubled by breathlessness except on strenuous exercise
2: SOB when hurrying on the level or when walking up slight hill
3: walks slower than most people on the level, stops after a mile, stops after 15 mins walking at own page
4: stops for breath after walking 100 yards or after few minutes on level ground
5: too breathless to leave the house or breathless when undressing

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2
Q

in TNM staging for tumors, what does T1 mean

A

tumor <2cm w/o extraparenchymal extension

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3
Q

T2 in TNM staging

A

tumor >2cm but not more than 4cm w/o extraparenchymal extension

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4
Q

T3 in TNM staging

A

tumor >4cm and/or having extraparenchymal extension

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5
Q

T4a in TNM staging

A

tumor invades skin, mandible, ear canal, and or fascial nerve

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6
Q

T4b in TNM staging

A

tumor invades skull base and/or pterygoid plates and/or encases carotid artery

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7
Q

N0 in TNM staging

A

no regional LN mets

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8
Q

N1 in TNM staging

A

mets in a single, ipsilateral LN <3cm

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9
Q

N2a in TNM staging

A

mets in a single ipsilateral LN >3 but less than 6cm

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10
Q

N2b in TNM staging

A

mets in multiple ipsilateral LN >6cm

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11
Q

N2c in TNM staging

A

mets in bilateral or contralateral LN, none >6cm

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12
Q

N3 in TNM staging

A

mets in LN >cm

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13
Q

stage 1 non-small cell lung CA:

  • definition
  • tx
  • prognosis
A

tumor surrounded by lung or pleura, <2cm from carina

  • surgery, adjuvant chemotharpy if needed
  • 60-70% survival
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14
Q

stage 2 non-small cell lung CA:

  • definition
  • tx
  • prognosis
A

locally advanced dz w/o mediastinal involvement

  • surgery and adjuvant chemotherapy
  • 40-50% survival
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15
Q

stage 3 non-small cell lung CA:

  • definition
  • tx
  • prognosis
A

mediastinal involvement, or 2 separate tumor nodules in same lobe w/o involvement

  • combine modalities of chemo, radiation, surgery
  • 5-20% survival
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16
Q

stage 4 non-small cell lung CA:

  • definition
  • tx
  • prognosis
A

metastatic

  • chemo
  • median survival 7 months
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17
Q

GOLD staging 1

A

Mild
- FEV1/FVC <70%

  • FEV1 >80% of predicted
  • w/ or w/o chronic sx (cough, sputum)
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18
Q

GOLD staging 2

A

Moderate
- FEV1/FVC <70%

  • FEV1 b/w 50%-80% of predicted
  • w/ or w/o chronic sx (cough, sputum)
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19
Q

GOLD staging 3

A

Severe
- FEV1/FVC <70%

  • FEV1 b/w 30%-50% of predicted
  • w/ or w/o chronic sx (couch, sputum)
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20
Q

GOLD staging 4

A

Very Severe
- FEV1/FVC <70%

  • FEV1 <30% of predicted
  • chronic respiratory failure
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21
Q

Tx for GOLD staging 1

A

short acting bronchodilator

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22
Q

Tx for GOLD staging 2

A

add regular tx w/ one or more long-acting bronchodilators, add pulmonary rehab

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23
Q

Tx for GOLD staging 3

A

add inhaled corticosteroid if repeated exacerbations

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24
Q

Tx for GOLD staging 4

A

add long-term oxygen therapy if chronic respiratory failure, consider surgical tx

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25
Q

ddx for predominantly basal infiltrates on CXR

A

IPF, asbestosis, NSIP

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26
Q

ddx for predominantly upper lobe infiltrates on CXR

A

hypersensitivity pneumonitis, sarvoidosis, silicosis

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27
Q

ddx for peripheral infiltrates on CXR

A

IPF, chronic eosinophilic pneumonia, cryptogenic organizing pneumonia

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28
Q

ddx for central infiltrates on CXR

A

sarcoidosis, pulmonary alveolar proteinosis

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29
Q

ddx for mosaic attenuation on CXR

A

small airway disease (hypersensitivity pneumonitis, respiratory bronchiolitis-associated interstitial lung dz)

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30
Q

what does the epworth sleepiness scale measure

A

assesses the level of somnolence during daytime activity to help determine the need for diagnostic testing for sleep disorders.

31
Q

purpose of STOP-BANG questionnaire

A

high sensitivity and negative predictive value, par ticularly for moderate or severe sleep apnea

32
Q

AHI > 5 confirms what

A

OSA

33
Q

ratio of pleural fluid to serum protein <0.5

A

transudative pleural effusion

34
Q

ratio of pleural fluid to serum protein >0.5

A

exudative pleural effusion

35
Q

ratio of pleural fluid LDH to serum LDH <0.6

A

transudative pleural effusion

36
Q

ratio of pleural fluid LDH to serum LDH >0.6

A

exudative pleural effusion

37
Q

pleural fluid LDH <2/3 upper limit of normal for serum

A

transudative pleural effusion

38
Q

pleural fluid LDH >2/3 upper limit normal for serum

A

exudative pleural effusion

39
Q

borders, contents, and lesions of anterior mediastinum

A
  • sternum –> anteriorly to pericardium and posteriorly to brachiocephalic vessels
  • thymus gland, anterior mediastinal LNs, internal mammary a. and v.
  • thymomas
  • lymphomas
  • teratomas
  • thyroid masses
40
Q

contents and lesions of middle mediastinum

A
  • heart, aorta, venae cavae, brachiocephalic a. and vs, phrenic nerves, trachea
  • vascular masses, LN enlargement, pleuropericardial and bronchogenic cysts
41
Q

contents and lesions of posterior mediastinum

A
  • descending thoracic aorta, esophagus, thoracic duct, azygos and hemiazygos veins. mediastinal LNs
  • neurogenic tumors
  • meningocele, meningomyelocele
  • gastroenteric cysts
  • esophageal diverticula
42
Q

what bacteria are the following patients most likely to get in community acquired pneumonia:

  • pts in extended care facilities or w/ comorbidities
  • alcoholics
  • pts w/ structural lung dzs
  • aspiration
A

extended care/comorbidities: gram negative

alcoholics: klebsiella

structural lung dzs: pseudomonas aeruginosa

aspiration: gram negative and anaerobic

43
Q

what is the CURB-65 criteria

A

used to identify high risk patients w/ pneumonia

  • Confusion
  • blood urea nitrogen
  • respiration rate
  • systolic blood pressure
  • age > 65
  • *pts who meet two criteria are admitted to the hospital
  • **3 criteria –> ICU
44
Q

antibiotic therapy for Inpatient PNA pts w/ aspiration

A

clindamycin

b-lactam/b-lactamase inhibitor

45
Q

antibiotic therapy for inpatient PNA pts w/o aspiration

A

quinolone or combo of B-lactam + macrolide or doxy

46
Q

antibiotic therapy for outpatient PNA pts w/o chronic dz

A

macrolide or doxy

47
Q

antibiotic therapy to outpatient PNA pts w/ cardiopulm dz

A

quinolone or combo B-lactam + macrolide or doxy

48
Q

empiric outpatient antibiotc therapy for PNA in previously healthy patient

A

macrolid

49
Q

antibiotic therapy for suspected ventilator acquired pneumonia in pts w/o risk

A

ceftriaxone or levofloxacin

50
Q

antibiotic therapy for suspected ventilator acquired pneumonia in pts w/ risk factors

A

antipseudomonal agent + vanco

51
Q

group 1 pulmonary hypertension

A

pulmonary arterial hypertension (PAH)

  • idiopathic
  • resting mPAP > 25mmHg
  • PCWP <15
  • drug and toxin-induced
  • associated w/ CT disease, HIV, portal HTN, etc
52
Q

group 2 pulmonary hypertension

A

secondary left heart disease

  • resting mPAP > 25mmHg w/ underlying lung dz
  • systolic and diastolic dysfunction
  • valvular dz
53
Q

group 3 pulmonary hypertension

A

secondary lung disease and/or hypoxia

  • mPAP >25 mmHg
  • COPD
  • interstitial lung dz
  • sleep disordered breathing
54
Q

group 4 pulmonary hypertension

A

chronic thromboembolic pulmonary HTN

55
Q

group 5 pulmonary hypertension

A

secondary unclear or multifactorial causes

  • hematologic disorders
  • systemic disorders
  • metabolic disorders
56
Q

CXR of TB patient

A

lesions in apical posterior segments of upper lung and superior segments of lower lobe

57
Q

can IGRA distinguish b/w latent and active forms of TB

A

no

58
Q

clinical triad of fat embolism

A

hypoxemia
neurologic abnormalities
petechial rash

59
Q

tx for fat embolism

A

supportive care

60
Q

organisms causing adult supraglottitis

A
  • h. influenzae
  • pneumococci
  • group a strep
  • s. aureus
  • s. viridans
61
Q

most important approach to evaluate airway obstruction

A

CT

62
Q

virchow’s triad

A

hypercoagulability of blood
vessel wall injury
stasis of blood

63
Q

homan sign

A

pain in calf on forced dorsiflexion of the foot (DVT pts, although it is a nonspecific and nonsensitive test for DVT)

64
Q

wells criteria for DVT

A
  • active cancer +1
  • bedridden recently or recent major surgery +1
  • calf swelling >3cm +1
  • collateral superficial veins +1
  • entire leg swollen +1
  • pitting edema, confined to symptomatic leg +1
  • paralysis, paresis, or recent plaster immobilization of LE +1
  • previous DVT +1
  • alternative dx more likely -2
65
Q

wells criteria PE

A
  • sx of DVT +3
  • alternative dx less likely +3
  • HR > 100 +1.5
  • immobilization > 3 days or surgery in last 4 weeks +1.5
  • previous PE or DVT +1.5
  • hemoptysis +1
  • active cancer +1
66
Q

assessment of wells score for PE

A

high: >6
moderate: 2-6
low: <2

PE likely: >4
PE unlikely < or = 4

67
Q

process after getting a wells score of 0

A

proceed to d-dimer

  • negative: rule out DVT
  • positive: go to US
  • –negative: rule out DVT
  • –positive: strongly consider anticoags
68
Q

process after getting a wells score of 1-2

A

proceed to high-sensitivity d-dimer

  • negative: rule out DVT
  • positive: go to US
  • –negative: rule out DVT
  • –positive: strongly consider anticoags
69
Q

wells score of 3 or higher means

A

DVT is likely (17-35% chance)

70
Q

westermark sign

A

seen on CXR in PE patients

- lack of vascularity distal to an embolus

71
Q

positive D-dimer means

A

high likelihood for DVT

72
Q

in patients with low probability of a PE, a normal d-dimer means

A

rules out DVT

73
Q

in what PE patients is thrombolytic therapy considered

A

pts w/ extensive thrombosis

- MAY be effective in pts w/ circulatory shock due to PE

Maddy - CPR II - some pharm (18 decks)

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