PANCE Pulmonary 8/13/20 Flashcards
what are the three components of samters triad 3
- asthma
- nasal polyp
- asa allergy
what are the three components of asthma 3
- airway hyper reacticity
- bronchosonstriction
- inflammation
what is the classic traid of asthma 3
- dyspnea
- wheezing
- cough
what does the physical examination of the lung display 3 asthma
- prolonged expiration
- wheezing
- hyperresonance
what is the gold standard for the Dx of asthma
PFT
what is the best way to determine the severity of an asthma exacerbation
peak expiatory flow rate
what are the three asthma admission criteria 3
- PEFR > 50%
- ER visit within the last 3 days
- post treatment failure
what is the frequency of nighttime awakenings on the chart Per ?
per month
what is the FEV-1 for severe asthma
< 60%
what is the FEV-1 for moderate asthma
60-80%
what is the #1 RF for COPD
smoking
if someone < 40 years old has COPD what might you think about
alpha one antitripsan
pick puffer is associated with what pathology
emphasema
what is the most importnat factor is the prognosis of COPD
- FEV1
what cardiac electrical abnormality is associated with COPD
Multi focal atrial tachycardia
what cardiac (non electrical) pathology is COPD associated with
R sided HF
what is the most importent step in managing COPD
smoking cessation
what are the best 2 meds to manage COPD
- ipratriprium (atrovent)
- albuterol (proventil)
what two COPD groups get O 2
- O2 < 88%
2. cor pulmonalale
what pathology:
“ irreversible bronchial dialtaion 2nd dary to trans mural inflammation”
bronchietacsis
what are the MC causes of infections with CF
psudomonas
daily thick cough in a younger person what are you thinking
CF
what is the MC cause of massive hemoptyosis
bronchietacasis
what is the best study for dx of bronchietacasis
high resolution CT
what is the tx for mac (1+1)
clarithromycin + ethambutol
what is your got to abx for psudomonas
cipro
what are the three areas effected by CF
GI
pulmonary
infertility
non caseating granuloma formation in the lungs
sarcoidosis
what is an odd pathology that may happen with sarcoidosis
blindless
what skin condition can happen with sarcoidisis
erythema nodosum
what is pathopneumonic for sarcoid
Lupus perino
what type of disease is sarcoidosis (obstructive or restrictive)
restrictive
what lab value will be elevated with sarcoid
ace
“exaggerated T cell response with granuloma formation”
sarcoid
what are the 3 tx options for sarcoid
observation
oral steroids
hydroxychloraqiun
what 4 pathologies are associated with erythema nodosum and 1 medication class
- TB
- Cocci
- Sarcoidosis
- IBS
- OCP
how do you tx IPF
lung transplant
what environmental lung disease is associated with
mining and quary work
slicosis
what environmental lung disease is associated with
egg shell calfifications in the upper portion of the lungs
silicosis
what environmental lung disease is associated with
- electronics
- arospace
- light bulbs
berylliosis
what environmental lung disease is associated with
- cotton exposures
byssinosis
what area of the lung does asbestosis affect
lower lobe
what area of the lung does the lung plura affect
lung lining
what enviormental lung disease is known as the “monday fever”
byssinosis
hypersensitivity pneumonitis from nitrogen dioxide gas exposure from plant matter
silo filler disease
what is unique about tietze syndrome
tietze syndrome has swelling
what pleural effusion type is infectious
excutative
what is the MC cause of transudadtive plural effusion
CHF
what are the three components of lights criteria 3
> LDH >.6
LDH 2/3
protein .5
how to treat plural effusion 2
- thoracocentesis
- chest tube
what is the best position for a CXR
lateral decubitius
for a tension pneumonia what direction are the vesicles pulled
to the opposite side
what are the three treatments for a penumothroax
- observation
- chest tube
- needle aspiration (2ns ICS MCL)
how do you dx a pulmonary nodule
transthoracic needle aspiration
bronchoscopy
what type of tumors may secrete serotonin ACTH ADH melanocyte
bronchial carcinoid tumor
“pink purple well vascularized central tumor”
bronchial carcinoid tumor
bronchial carcinoid tumor tx 2
octreotide
resection
what are the two types of bronchiogenic carcinoma
- non small cell
- small cell (oat)
what are the 3 types of non small cell bronchiogenic carcinoma
- adenocarcinoma (peripherial)
- squamous (central)
- large cell (anaplastic)
what are the tx for the two types of bronchogenic carcinoma
- non small cell
surgical resection - small cell (oat)
chemo, radiation
what is the triad for a PE
- dyspnea
- plutitic chest pain
- hemoptyosis
what are the 2 bests tests for PE
- helical CT
- pulmonary angiography
“a normal CXR in the setting of hypoxia is highly suspicious of ?”
PE
management of stable PE
- anticoag
- IVC filter
managemnet of unstable PE
- thrombolytic tx
- embolectomy tx
what are the 2 classic (not common) CXR findings for a PE
- watermark sign
- hamptoms hump
what are the 4 types of pulmonary HTN
- idiopathic
- due to left heart disease
- due to COPD
- due to PE
what do you see on a CBC for pulm HTN 1
polycytemia with increased hematocrit
what do you see on an EKG for pulm HTN 1
right axis deviation
how do you dx pulm htn definitive 1
right heart cath
how do you tx pulm HTN 1
CCB
how do you dx mycoplasm pna on a gram stain
lacks cell wall
what is the MC cause of cap
strep penumo
what is the MC cause of viral pna in kids
- RSV
- parainfluenza
what pna is associated with HIV
PJP
MC cause of viral PNA in adults
influenza
what is gram (-) rods cause of of pna
psudomonas
what lobe for aspiration pna
right lower
what is the only pathology that has increased tacitile fermitis
PNA
what lobe for klebsiella
right upper
CAP tx 2
azithro OR doxcy
HAP tx 2
Zosyzn + Levofloxacin
when does someone get PPSV 23
> 65 years old
do you need PCV 13
no
“caseating granuloma”
TB
are people with latent TB contagious
no
how long after a TB infection is someones PPD +
2-4 weeks
are people with reactivated TB contagious
yes
what is the gold standard to dx TB
acid fast bacillious
how do you TX TB
Rifampin
Isoniazid
Pyrazinimide
Ethambutol
what is the SE of rifampin 2
thrombocytopenia
orange sweat
what is the SE of isoniazid 2
hepatitis
peripheral nephropathy
(Give B6)
what is a SE of ethambutol
optic neuritis
“diffuse millet seeds”
milliary TB
what lobes for primary TB
lower
acute inflammation of trachea and bronchi
acute bronchitis
what is the MC cause of acute bronchitis
adenovirus
acute bronchitis tx
supportive
how do you tx pertussis
macrolides (erythromyocyin)
what phase of pertussis has a cough
paroxysmal
” post coughing emesis”
wooping cough (pertissis)
what is the CBC for pertussis
- lymphocytosis
how do you dx pertussis
- PCR via nasal pharangeal swab
what is the main pathogen for bronchiolitis
RSV
what causes acute epiglottis
HIB
“thumb sign”
acute epiglottis
what are the 3 D’s
drooling
dysphagia
distress
what are the two tx’s for epiglottitis
support the airway
ceftriaxone
what pathology do you not want to use a tongue depressor with
epiglottitis
“barking cough” Seal like
croup
laryngotracheitis
croup
what two pediatric respiratory pathologies is stridor associated with
- croup
- epiglottitis
- croup tx
dexamethasone
what influenza is more severe
A
abrupt onset of myalgia what are you thinking
influenza
what is the medication oseltamir used for
flu
who should not get the intranasal flu vaccination 2
> 50
prego
how do you dx forign body aspiration
bronchoscopy
what is the MC cause of ARDS
sepsis
hypoexia with 100% o2
ARDS
on a chest X ray with ARDS what will you see
- white out pattern that will spare the costophenic angles
how do you tx ARDS
PEEP
what is a polysomnography
sleep study
How to you tx OSA
CPAP
mild asthma tx 2
SABA + Low ICS
mod asthma tx 3
SABA + Low ICS + LABA
severe asthma tx 3
SABA + High ICS + LABA
what is the gold standard for COPD dx
PFT
cornerstone of tx for bronchiectasis
bacrium
aspiration pneumo tx
clinda
CAP ICU tx
ceftriaxone + levo
L heart boarder what lobe
L lingular
steeple sign
croup
