PPPs Flashcards
Define COPD and what is the MC RF
What is the only genetic dz linked to COPD
Irreversible airway obstruction d/t loss of elastic recoil and inc airway resistance
Smoking
Alpha-1 antitrypsin deficiency
Define Emphysema
What are the 3 types of emphysema
What is the hallmark of emphysema
Enlarged terminal airspace (distal to terminal bronchioles)
Centrilobar: smoking
Panacinar: a-1 antitrypsin
Paraseptal: Spot Pneumos
Dyspnea
How is emphysema Dz
Define Chronic Bronchitis
What is the MC etiology
PFT: irreversible restrictive pattern w/ FEV1/FVC <70%
Productive cough x 3mon x 2yrs
Smoking
What are the 3 cardinal Sxs of chronic bronchitis
How is Chronic Bronchitis Dx
? arrhythmia is seen in these Pts
Chronic cough, Sputum, Dyspnea
PFT: FEV1/FVC <70% w/ dec FVC
MAT: >100bpm w/ 3 different P-wave morphologies; Tx- Verapamil
What lab result differs Chronic Bronchitis from Emphysema
Most important step in Pt management along w/ ? vaccines
When is O2 supplementation needed
Inc H/H w/ resp acidosis
Cessation, Pneumococcal/Influenza
PaO2 >55,
SpO2 88% or less
Cor Pulmonale
Emphysema
Chronic bronchitis
Dyspnea- MC Sx Hyperinflated lunged/flat diaphragm Hyperresonance Matched V/Q defect Hypoxic
Productive cough- hallmark Rales, Rhonchi, Wheeze Resp acidosis w/ inc H/H V/Q mistmatch Hypercapnea
What ABX classes are used during COPD exacerbations
How are Pts Tx by GOLD Class
Macrolide: Azith/Clarith-romycin
Cephalosporin
Augmentin
Fluroquinolones
A: SABA (Albuterol) or SAMA (Ipratropium)
B: LAMA>BA (Tiotropium>Sal/For-meterol)
C: LAMA (Tiotropium)
D: LAMA+LABA or LABA+inhaled GCSS
COPD Gold Stages
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Why doe COPD Pts develop P-HTN and Cor Pulmonale
Define Bronchiectassis
What is the MCC and what infections are Pts vulnerable to
Hypoxic constriction inc R-sided atrial pressures
Permanent dilation of bronchials
CF w/ Pseudomonas infections;
Non-CF: HFlu
How is CF Dx and w/ ? two findings
What are the three components of Asthma
What is the strongest RF
CT: tram-track and signet ring sign
Airway hyperactivity
Bronchoconstriction
Inflammation
Atopy
Define Samter’s Triad
Define Atopic Triad
How is Asthma Dx
ASA, Rhinosinusitis, Polyps
Asthma Dermatitis Rhinitis
PFT: reversed obstruction w/ dec FEV1/FVC
How is Asthma Dx via bronchoprovocation test
How is an exacerbation best assessed
What criteria are needed for discharge after exacerbation
Methacholine challenge: 20% or more dec of FEV1 followed by bronchodilator challenge w/ FEV1 inc 12% or more
Peak expiratory flow rate
PEFR >70% or >15% improvement
What would ABG show during asthmatic exacerbation
Asthmatic categories w/ Txs
Resp alkalosis
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Define Sarcoidosis
What do Pts present w/
What lab results would be seen
Idiopathic, multi-system inflammatory granulomatous dz
Lupus pernia- most specific
Erythema Nadosum (classic)
Dry cough
Hyper ACE, Ca, Vit D
Define Lofgren Syndrome seen w/ Sarcoidosis
What is the best initial test and what would be seen
Polyarthralgias w/ fever
Erythema Nadosum
Bilateral hilar adenopathy
CXR:
1: BHL w/out pulm Sxs
2: BHL w/ ILDz
3: ILDz only
4: fibrosis w/ restrictive dz
What is the most accurate Dx method for sarcoidosis
How are these Pts Tx
What meds can be used for cutaneous manifestations
Tissue biopsy: non-caseating granulomas
PO CCS
Methotrexate, Hydroxychloroquine
What are two poor prognostic factors for Sarcoidosis
MCC of typical pneumonia and CAP
What would be seen on PE for this MC
Lupus pernio, Interstitial lung Dz
Strep pneumo
Tactile fremitus
Egophony
Dull w/ percussion
How does pneumonia d/t Strep Pneumo appear
What would be seen on lab results
What is the 2nd MCC of CAP
Chills/Rigors w/ rusty (blood-tinged) sputum
Gram-pos diplococci
H-Influ: Gram-neg rod in ImmComp or Pts w/ Pulm Dzs
Pneumonia d/t Staph A is commonly seen after ? and causes ?
What stain pattern does this have
? microbe causes pneumonia in alcoholics
Influenza, HAP
Clustered gram-pos cocci
Klebsiella: purple (currant jelly) sputum w/ cavitary lesions on CXR;
Gram-neg rods
? is the MCC of Atypical pneumonia
What two non-pulm manifestations can this cause
How is this MC Dx
Mycoplasma pneu.
Bullous myringitis
Cold Autoimmune Hemolytic Anemia
CXR:
Reticulonodular pattern, PCR (test of choice)- cold agglutinins
What ABX are used for pneumonia Tx
What class of ABX is this naturally resistant to
How is Legionella Dx and Tx
Azith/Clarith-romycin, Doxy
Lacks cell wall= B-lactams
PCR > Urine Ag;
Azith/Clarith-romycin or Levofloxacin
How is aspiration induced pneumonia Tx
How is the need to admit pneumonia Pt determined
? additional PE finding suggests aspiration pneumonia
IV Amp-Sulbactam, PO Augmentin
CURB65:
Confusion Uremia >30 Resp >29 BP <90/<60, Age >65
Foul smelling sputum d/t accumulation in R-lower lobe
How is Histoplasmosis transmitted
This can also be an AIDS defining illness if CD4 is below ?
How is this Dx
Bird/bat droppings in Mississippi/Ohio River Valley
150/<
Sputum culture > PCR
Inc ALK-P, LDH w/ pancytopenia
How is Histoplasmosis Tx
? is the MC opportunistic infection of HIV
How do Pts present w/ this MC
Mild/Mod: Itraconazole
Sev: Amphotericin
P jirovecii
Dyspnea/dec O2 sat w/ exertion
How is P jirovecii pneumonia Dx
Pg 131
