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cardio and pulm > LA pulm 2 > Flashcards

LA pulm 2 Flashcards

asthma, influenza, pneumonia, TB

1
Q

Samter’s triad

A

(aspirin exacerbated resp ds): asthma, chronic rhinosinusitis with nasal polyps, sensitivity to aspirin/or NSAIDs

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2
Q

3 component of asthma

A

bronchoconstriction, airway hyper-reactivity, inflammation

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3
Q

atopic triad

A

pts with condition are likely to develop one or 2 of the other: asthma, atopic dermatitis(eczema), and allergic rhinitis

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4
Q

extrinsic asthma trigger is Ig___

A

EEEEEEEEEEEEEEEEEE

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5
Q

PE with asthma

A

prolong expiration with wheezing, hyperresonance to percussion, decreased breath sounds, tachycardia/tachypnea

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6
Q

classic asthma triad s/s

A

dyspnea, wheezing, and cough especially at night

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7
Q

severe asthma and status asthmaticus

A

inability to speak full sentences, tripod, SILENT chest, altered mental status

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8
Q

bronchoprovocation to test asthma

A

methacholine challenge >20% decrease on FEV1 followed by bronchodilator challenge (increase of FEV1 >12%) expected

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9
Q

best and most objective way to assess exacerabation severity and pat response to treatment

A

peak expiratory flow rate, discharge if PEFR>70% or PERF>15% initial attempt

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10
Q

ABG in asthma

A

usually not ordered. repiratory alkalosis expected from tachypnea.

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11
Q

FEV1 in 4 levels of asthma

A

over 80% in intermittent and mild
60-80% in moderate
under 60% in severe

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12
Q

ratio if 4 levels of asthma

A

nml in intermittent and mild
5% reduction in moderate
>5% in severe

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13
Q

tx for intermittent asthma

A

inhaled SABA as needed

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14
Q

tx for mild asthma

A

inhaled corticosteroid plus inhaled SABA as needed

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15
Q

tx for moderate asthma

A

low dose ICS plus LABA or

(increase ICS to medium dose or leukotrine modifier)

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16
Q

tx for severe asthma

A

high dose ICS plus LABA

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17
Q

MOA of theophylline

A

bronchodilator that improves respiratory muscle endurance

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18
Q

what decreases theophylline levels

A

smoking

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19
Q

what drug is NOT used in acute asthma exacerbations

A

theophylline, LABA(salmeterol)

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20
Q

theophylline toxicity

A

arrhythmias and seizures

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21
Q

omalizumab

A

IgE antibody. for severe asthma

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22
Q

drug for allergic rhinitis/aspirin induced asthma

A

Leukotriene modifier: montelukast

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23
Q

what has been associated with churg-strauss syndrome

A

zafirulkast, leukotriene modifier

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24
Q

name anticholinergic

A

ipratropium, quick acting

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25
Q

name long acting ICS

A

beclomethasone, flunisolide, triamcinolone

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26
Q

name LABA

A

salmeterol(sometimes with fluticasone), formoterol(with bodesonide),

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27
Q

name mast cell modifiers

A

long acting,cromolyn, nedocromil

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28
Q

what drug is used only for prophylaxis

A

cromolyn, mast cell modifier

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29
Q

what med for chronic maintenance for asthma

A

long acting ICS, beclomethasone, flunisolide, triamcinolone

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30
Q

SABA is a bronchodilator that works ____

A

peripherally

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31
Q

what med is useful in the first hour

A

anticholinergic, ipratropium

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32
Q

what med decreses relapse and reverses the late pathophysiology

A

prednisone,

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33
Q

when to use a LABA

A

if persistant asthma is not controlled with ICS alone

34
Q

antivirals for who with the flu

A

hospitalized or high risk of complications, over 65 yo

35
Q

main s/s for flu

A

abrupt onset ha, fever/chills, malaise, URI, myalgias of legs and lower back

36
Q

neuraminidase inhibitor for flu

A

oseltamivir if initiated with 48 hours of symptom onset. good for type a and b

37
Q

contraindication to zanamir

A

egg allergy

38
Q

amantadine and rimantadine for flu

A

only for influenza a. high level of resistance.

39
Q

when to start flu vaccine

A

6 months and older

40
Q

attenuated flu vaccine for what ages

A

2-49 yo

41
Q

contraindications to flu vaccines

A

guillain-barre syndrome within 6 weeks after previous flu shot, high fever, infants under 6 months

42
Q

contraindications to attenuated flu vaccine

A

immunocompromised pts and their close contacts, PG, adults 50 and over, got other vaccine within 48 hours

43
Q

rusty blood tinged sputum; gm + diplococci

A

strep pneumonia

44
Q

1st and 2nd most common cause of CAP

A
  1. strep pneumo
  2. h. flu
45
Q

purple colored sputum

A

klebsiella

46
Q

pneumonia, chronic alcoholism

A

klebsiella

47
Q

most common cause of atypical walking pneumonia

A

mycoplasma

48
Q

pneumonia of young and healthy pts

A

mycoplasma

49
Q

pneumonia with high incidence of hyponatremia and increased LFTs

A

legionella

50
Q

pneumonia with complications of SJS, cold autoimmune hemolytic anemia

A

mycoplasmic

51
Q

foul smelling sputum, rotten eggs

A

aspiration pneumonia; anaerobes

52
Q

soil containing bat and bird droppings in Mississippi and Ohio rivers

A

histoplasmosis

53
Q

name 3 atypical pneumonias

A

mycoplasma, chlamydia, legionella

54
Q

rigors

A

strep pneumo

55
Q

most common in right lower lobe of lung

A

aspiration pneumonia

56
Q

CXR: reticulonodular pattern

A

mycoplasma

57
Q

prominent GI sx: watery diarrhea

A

legionella

58
Q

CXR: cavitary lesions hallmark

A

klebsiella

59
Q

dx test for atypical pneumonias

A

PCR

60
Q

which pneumonia lacks a cell wall

A

mycoplasma so naturally resistant to beta lactams

61
Q

first line tx for aspiration pneumonia

A

ampicillin/sulbactram or augmentin

62
Q

what pneumonia can mimick TB

A

histoplasmosis

63
Q

histoplasmosis most specific test

A

cultures.

antigen testing via sputum or urine high specific too

64
Q

PCP pneumonia rf CD4 amount

A

under 200

65
Q

PCP pneumonia sx triad

A

dyspnea on exertion, fever, non productive cough

66
Q

oxygen desaturation with ambulation

A

PCP pneumonia

67
Q

CXR: diffuse bilateral interstitial infiltrates

A

PCP pneumonia

68
Q

labs in PCP pneumonia

A

increased LDH and beta D glucan

69
Q

increased LDH and beta D glucan

A

labs in PCP pneumonia

70
Q

direct fluorescent antibody staining done for what

A

PCP pneumonia sputum from bronchoavleolar lavage

71
Q

orange colored urine/tears

A

rifampin

72
Q

SE of peripheral neuropathy

A

isoniazid, give B6 and
ethambutol

73
Q

SE photosensitivity dermatologic rash, hepatitis, hyperuricemia

A

pyrazinamide

74
Q

SE of optic neuritis

A

ethambutol

75
Q

SE of ototoxicity and nephrotoxicity

A

strepomycin; alternative for ethambutol

76
Q

tx of latent TB infection

A

INH and pyroxidine, vit B6 for 9 months

77
Q

tx of active TB infection

A

all 4 drugs x 2 months, then rifampin and isoniazid for 2 months

78
Q

test for TB with a pt that had a BCG vaccine in the past

A

interferon gamma release assay

79
Q

CXR of reactivation and primary TB

A

reactivation is apical/upper lobe fibrocavitary disease
and primary TB is middle/lower lobe consolidation

80
Q

anergy

A

false neg PPD test due to sarcoidosis or HIV

cardio and pulm (22 decks)

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