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Pulmonology > Midterm > Flashcards

Midterm Flashcards

1
Q

Asthma early-phase response

A
  • peaks 30-60 minutes after exposure
  • subsides 30-90 minutes later
  • primary cause is bronchospasm
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2
Q

asthma late-phase response

A
  • primary cause is inflammation
  • histamine and other mediators set up self sustaining cycle
  • air trapping and lung hyperinflation occurs
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3
Q

asthma signs and symptoms

A
  • episodic wheezing
  • dyspnea (most common)
  • chest tightness
  • cough
  • frequently worse at night
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4
Q

asthma physical exam red flags

A
  • fatigue
  • diaphoresis
  • cyanosis
  • no wheezing
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5
Q

Intermittent asthma

A
  • symptoms: less than or equal to 2 days/week
  • night awakenings: less than or equal to 2/month
  • use of SABA: less than or equal to 2 days/week
  • ADL interference: none
  • FEV1: >80% predicted
  • FEV1/FVC: normal
  • treatment: step 1
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6
Q

mild persistent asthma

A
  • symptoms: >2 days/week but not daily
  • night awakenings: 3-4/month
  • SABA use: >2/week but not daily and no more than 1/day
  • ADL interference: minor
  • FEV1: >80% predicted
  • FEV1/FVC: normal
  • treatment: step 2
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7
Q

moderate persistent asthma

A
  • symptoms: daily
  • night awakenings: >1/week, but not nightly
  • SABA use: daily
  • ADL interference: some limitation
  • FEV1: >60% but <80% predicted
  • FEV1/FVC: reduced 5%
  • treatment: step 3
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8
Q

severe persistent asthma

A
  • symptoms: throughout the day
  • night awakenings: often 7/week
  • SABA use: several times per day
  • ADL interference: extreme limitation
  • FEV1: <60% predicted
  • FEV1/FVC: reduced >5%
  • treatment: step 4 or 5
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9
Q

obstructive lung disease examples

A

COPD
asthma
bronchiectasis
cystic fibrosis

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10
Q

restrictive lung disease examples

A

interstitial lung disease
chest wall abnormalities
obesity
ALS

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11
Q

obstructive PFT

A
  • FEV1: reduced
  • TLC: normal or increased
  • FEV1/FVC: reduced
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12
Q

restrictive PFT

A

FEV1: normal or reduced
TLC: reduced
FEV1/FVC: normal or increased

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13
Q

inspiratory capacity

A

inspiratory reserve volume and tidal volume

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14
Q

functional residual capacity

A

expiratory reserve volume and residual volume

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15
Q

vital capacity

A

inspiratory reserve volume, tidal volume, and expiratory reserve volume

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16
Q

PFT reversible obstruction definition

A

increase of 12% or more and 200mL increase in FEV1 or FVC

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17
Q

bronchoprovocation

A
  • methacholine challenge
  • mannitol challenge
  • exercise testing
  • not recommended if FEV1 is <70% predicted
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18
Q

5 components of asthma management

A
  1. assess control and severity
  2. severe versus uncontrolled
  3. appropriate pharmacology
  4. address modifiable risk factors and environmental concerns
  5. self management and education
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19
Q

LABA

A
  • indicated for bronchodilation maintenance

- helps with nocturnal symptoms

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20
Q

short acting anticholinergic

A
  • reduces vagal tone of the airway

- useful for severe exacerbation when combined with SABA

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21
Q

long acting muscarinic agent

A
  • reduces vagal tone of the airway
  • works well in COPD
  • slow onset of action 60-90 minutes
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22
Q

inhaled corticosteroids

A
  • suppress acute and chronic airway inflammation
  • inhibit inflammatory cell migration
  • block late phase reaction
  • first line maintenance therapy for persistent asthma
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23
Q

leukotriene receptor antagonist

A
  • decreases airway smooth muscle activity
  • decreases mucus production
  • used in long term control but with variable effect
  • alternative to ICS in mild persistent
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24
Q

mast cell stabilizers

A
  • prevent bronchoconstriction
  • for prevention and maintenance
  • trial of 6-8 weeks needed before effectiveness known
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25
Q

methylxanthines

A
  • causes bronchodilation
  • suppresses response of airway to stimuli
  • 2nd/3rd line treatment for moderate to severe
  • can cause toxicity and drug interactions
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26
Q

step 1 treatment

A

SABA

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27
Q

step 2 treatment

A
  • low dose ICS

- SABA

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28
Q

step 3 treatment

A

-low dose ICS and LABA combo

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29
Q

step 4 treatment

A

-medium dose ICS and LABA

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30
Q

step 5 treatment

A

medium to high dose ICS/LABA and LAMA

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31
Q

asthma exacerbation treatment

A

BIOMES

Beta agonists
Ipratropium (and IV access)
Oxygen
Mag
Epinephrine
Steroids
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32
Q

emphysema

A
  • permanent enlargement of airspace due to alveolar destruction
  • increased CO2 retention
  • pursed lip breathing
  • thin with barrel chest
  • accessory muscle use
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33
Q

chronic bronchitis

A
  • extensive bronchial mucus
  • daily productive cough for 3 consecutive months
  • cyanotic/dusky
  • hypoxic
  • digital clubbing
  • exertional dyspnea
  • accessory muscle use
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34
Q

COPD causes

A
  • smoking #1
  • occupational dust/chemicals
  • air pollution
  • genetic factors
  • Hx allergies and recurrent bronchitis
  • alpha1 antitrypsin deficiency
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35
Q

pack year

A

(# packs/day) x (# years)

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36
Q

COPD GOLD 1

A
  • mild

- FEV1 greater than or equal to 80% predicted

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37
Q

COPD GOLD 2

A

-moderate

FEV1: 50-80% predicted

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38
Q

COPD GOLD 3

A

-severe

FEV1 30-50% predicted

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39
Q

COPD GOLD 4

A

-very severe

FEV1: <30% predicted

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40
Q

COPD group A treatment

A
  • 0-1 moderate exacerbation but no admission
  • mMRC 0-1
  • CAT <10

bronchodilator

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41
Q

COPD group B treatment

A
  • 0-1 moderate exacerbation but no admission
  • mMRC 2 or more
  • CAT 10 or more

LABA or LAMA

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42
Q

COPD group C treatment

A
  • 2 or more moderate exacerbation or 1 or more exacerbation with admission
  • mMRC 0-1
  • CAT <10

LAMA

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43
Q

COPD group D treatment

A
  • 2 or more moderate exacerbation or 1 or more exacerbation with admission
  • mMRC 2 or more
  • CAT 10 or more

LAMA
LAMA + LABA (highly symptomatic CAT>20)
ICS + LABA (eos >300)

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44
Q

COPD treatment steroids

A
  • inhaled reduce exacerbation frequency in combination with LABA
  • not responsive to oral steroids but a subset of steroid responsive may warrant a trial
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45
Q

COPD treatment antibiotics

A
  • azithromycin as prophylaxis for exacerbation and anti-inflammatory
  • macrolide (azithromycin)
  • amoxicillin clavulanate
  • trimethoprim sulfamethoxazole
  • fluoroquinolones (ciprofloxacin)
  • doxycycline
46
Q

COPD treatment when hospitalized

A
  • oxygen
  • broad spectrum antibiotics (levofloxacin, ceftriaxone, piperacillin tazobactam)
  • usually nebulizers/IV steroids
47
Q

community acquired pneumonia

A
  • streptococcus pneumonia most common cause
  • right middle lobe most common site
  • x-ray gold standard for diagnosis
48
Q

atypical pneumonia

A
  • mycoplasma pneumoniae most common (walking pneumonia) with CXR bilateral patchy infiltrate
  • pneumocystis jiroveci in HIV positive
49
Q

tools to admit pneumonia patient

A
  • PORT score to assess outpatient CAP Tx

- CURB score for admission decision

50
Q

hospital acquired pneumonia

A

develops 48 hours after admission

51
Q

ventilator associated pneumonia

A

develops 48 hours after intubation

52
Q

viral pneumonia

A
  • flu like
  • patchy infiltrates on CXR
  • most common in kids
53
Q

strep pneumonia

A
  • red-brown rusty sputum
  • lobar
  • gram + diplococci
54
Q

H influenzae pneumonia

A
  • COPD patients

- small gram - rods

55
Q

klebsiella pneumonia

A
  • alcoholics, aspiration
  • currant jelly sputum
  • encapsulated gram - rod
56
Q

staph pneumonia

A
  • pink salmon colored sputum
  • often nosocomial
  • gram + cocci in cluster
57
Q

mycoplasma pneumonia

A
  • young adults

- CXR looks worse than patient

58
Q

pseudomonas pneumonia

A

ICU
immunocompromised
CF patients

59
Q

legionella pneumonia

A
  • air conditioners

- GI and CNS symptoms that start later

60
Q

pneumocystitis jiroveci

A
  • HIV patients
  • white out CXR
  • Tx with bactrim
61
Q

TB pneumonia

A

fever, night sweats, weight loss, bloody sputum

62
Q

pH normal

A

7.35 - 7.45

63
Q

PaCO2 normal

A

35 - 45

64
Q

HCO3 normal

A

22 - 26

65
Q

PaO2 normal

A

> 80

66
Q

SaO2 normal

A

> 95

67
Q

acidosis causes

A

increased CO2

decreased HCO3

68
Q

alkalosis causes

A

decreased CO2

increased HCO3

69
Q

respiratory acidosis

A

decreased pH

increased pCO2

70
Q

respiratory acidosis with compensation

A

decreased pH

increased HCO3

71
Q

metabolic acidosis

A

decreased pH

decreased HCO3

72
Q

metabolic acidosis with compensation

A

decreased pH

decreased pCO2

73
Q

respiratory alkalosis

A

increased pH

decreased pCO2

74
Q

respiratory alkalosis with compensation

A

increased pH

decreased HCO3

75
Q

metabolic alkalosis

A

increased pH

increased HCO3

76
Q

metabolic alkalosis with compensation

A

increased pH

increased pCO2

77
Q

anion gap calculation

A

Na - (HCO3 + Cl)

78
Q

decreased anion gap Dx

A

hypoalbumenemia
hyponatremia
monoclonal protein

79
Q

elevated anion gap Dx

A

MUDPILERS

methanol
uremia
DKA
propylene glycol
isoniazid intoxication
lactic acidosis
ethanol
rhabdo
salicylates
80
Q

respiratory acidosis causes

A
  • head trauma
  • airway obstruction
  • pneumonia
  • decreased surface area
81
Q

respiratory alkalosis causes

A
  • hyperventilation

- ascent to high altitude

82
Q

acute bronchitis

A
  • self limiting inflammation of the tracheobronchial tree due to upper airway infection
  • lots of coughing that can last 5 days to 2 weeks (8 weeks not unheard of)
83
Q

acute bronchitis symptoms

A
  • coughing
  • fever is unusual
  • wheezing may occur secondary
  • 50% have purulent sputum
  • important to rule out pneumonia
84
Q

acute bronchitis cause

A
  • 85% are caused by a virus

- influenza, coronavirus, rhinovirus, RSV

85
Q

acute bronchitis with bacterial cause

A
  • can occur in patients with tracheostomy or intubated
  • mycoplasma pneumoniae
  • chlamydia sp.
  • bordetella pertussis
86
Q

acute bronchitis signs

A
  • pharyngeal erythema
  • no parenchymal consolidation
  • CXR non specific
87
Q

acute bronchitis treatment

A
  • symptomatic: NSAIDs, tylenol
  • OTC cough meds
  • Rx cough meds
88
Q

influenza treatment

A

-antivirals administered if within 48 hours of symptoms onset

89
Q

pertussis

A
  • respiratory tract infection caused by bordetella pertussis
  • consider for cough lasting more than 3 weeks
  • 50% in <2 years old
  • no lasting immunity from vaccine or active infection
90
Q

pertussis catarrhal stage

A
  • 7-10 days
  • insidious onset
  • mild fever
  • hacking cough at night
  • coryza
  • conjunctivitis
91
Q

pertussis paroxysmal stage

A

7-28 days

  • spasmodic rapid coughing
  • followed by inspiratory stridor
92
Q

pertussis convalescent stage

A
  • several months

- decreasing severity and frequency of symptoms

93
Q

pertussis diagnosis

A

nasopharyngeal culture swab = gold standard

94
Q

pertussis treatment

A

-macrolides for all suspected cases
(end in -thromycin)
-prophylaxis for those exposed within 3 weeks

95
Q

bronchiectasis

A
  • disorder of large bronchial with permanent abnormal dilation and destruction of bronchial walls
  • congenital or acquired
  • local or diffuse
96
Q

bronchiectasis causes

A
  • 50% caused by cystic fibrosis
  • lung infections
  • RA
  • localized airway obstruction
97
Q

bronchiectasis clinical findings

A
  • chronic cough with copious purulent sputum
  • hemoptysis
  • pleuritic chest pain
  • 75% dyspnea/wheezing
  • weight loss
  • persistent crackles at lung base
  • digital clubbing = chronic sign
98
Q

bronchiectasis imaging

A

-CT is diagnostic study of choice

99
Q

bronchiectasis treatment

A

Acute

  • antibiotics
  • chest physiotherapy
  • inhaled bronchodilator

cystic fibrosis
-use of aerosolized aminoglycoside

100
Q

RSV

A
  • form of paramyxovirus
  • leading cause of hospitalization of children
  • highly contagious
101
Q

RSV presentation

A 
fever
rapid breathing
cough
possible accessory muscle
runny nose
nasal flaring
102
Q

RSV treatment

A
  • O2
  • hydration
  • treat the fever
  • ribavirin in extreme cases
  • clear nasal passages
103
Q

bronchiolitis

A
  • generic term for inflammatory processes that affect the bronchioles
  • usually caused by RSV
  • most common in under 2
  • clinical diagnosis
104
Q

bronchiolitis treatment

A
  • majority can be discharged

- deep nasal suctioning

105
Q

constrictive bronchiolitis

A
  • common after inhalation injury
  • airflow obstruction on PFT
  • chronic condition
106
Q

croup causes

A
  • parainfluenza most common
  • also RSV and flu
  • bacterial pneumonia may be secondary

children 3-36 months

107
Q

croup clinical findings

A
  • gradual onset of symptoms
  • barking cough
  • hoarse voice
  • inspiratory stridor
  • mild fever
  • often at night
108
Q

croup severity

A

westley croup score

109
Q

croup treatment

A
  • mild: humidified air, antipyretics, fluid
  • moderate: single dose dexamethasone, nebulized Epi
  • severe: repeated nebulized epi with admission if no improvement
  • impending respiratory failure: O2, ICU, scheduled epi, IV steroids
110
Q

epiglottitis

A
  • inflammation of epiglottis and adjacent supraglottic structures
  • in children primarily caused by H. influenza type B, strep, and staph
111
Q

epiglottitis clinical findings

A
  • febrile toxic appearing children with rapid onset
  • dysphagia
  • drooling
  • tripoding
  • hot potato voice
112
Q

epiglottitis treatment

A
  • defer pharyngeal exam
  • stabilize airway
  • draw labs before ABX
  • empiric ABX cefotaxime or ceftriaxone plus clindamycin or vancomycin

Pulmonology (2 decks)

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