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Pulm Flashcards

1
Q

COPD: what decreases mortality

A
  • stop smoking

- oxygen therapy: resting pO2

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2
Q

COPD: improves symptoms, but not mortality

A
  • SABA
  • Anticholinergic**
  • Steroids
  • LABA
  • Pulm rehabilitation
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3
Q

COPD: Treatment for acute exacerbation

A
  • ABX: macrolides, Cephalo, Amox/clav, Quinolones
  • Bronchodilators
  • Corticosteroids
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4
Q

COPD: tests to workup of acute exacerbation

A
  • O2
  • ABG: hypoxia, hypercapnea
  • CXR: exclude PNA
  • CBC: leukocytosis
  • Chem8: electrolyte abn
  • EKG exclude A-Fib
  • Theophylline levels: can drop [macrolide]
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5
Q

ABPA: treatment

Allergic Bronchopulmonary Aspergillosis

A
  • Oral steroids (inhaled steroids are NOT effective)

- Itraconazole orally for recurrent episodes

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6
Q

ABPA: Diagnostic tests

Allergic Bronchopulmonary Aspergillosis

A
  • Peripheral eosinophilia
  • Skin test re-activity to aspergillus antigens
  • Precipitating Antibodies to aspergillus on blood test
  • Elevated serum IgE levels
  • Pulm infiltrates on CXR or CT
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7
Q

ABPA: Most likely patient has… PMH, S/S

Allergic Bronchopulmonary Aspergillosis

A 
asthmatic pt
recurrent episodes brown-flecked sputum 
transient infiltrates on CXR 
cough
wheezing
hemoptysis 
sometimes bronchiectasis
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8
Q

asthma: diagnostic tests

A
  • ABG (best initial test)
  • PEF (best initial test)
  • CXR (normal, but r/o infection)
  • PFT: FEV1/FVC (most accurate test)
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9
Q

Asthma: PFT findings

A
  • decreased FEV1, FVC and ratio of FEV1/FVC
  • albuterol –> increase FEV1 by 12%+ and 200mL
  • methacholine –> decrease FEV1 by 20%+
  • increase in DLCO
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10
Q

Asthma: treatment

A

1) SABA (intermittent, 2days/week, 3-4x night/mo)
3) LABA or increase in ICS dose (mod persistent, daily sx, >1 night/wk)
4) increase in ICS dose in addition to LABA and SABA
5) Omalizumab (if increased IgE level)
6) Oral CS prednisone taper

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11
Q

Acute Asthma Exacerbation: diagnostic tests

A
  • PEF
  • ABG with increased A-a gradient
  • CXR: infection?
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12
Q

Acute Asthma Exacerbation: treatment

A
  • oxygen
  • albuterol
  • steroids
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13
Q

CF: treatment

A
  • ABX
  • rhDNase
  • albuterol
  • vaccinations: PNA and flu
  • lung transplant
  • Invacaftor
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14
Q

PNA: infections with dry cough

A
  • Mycoplasma
  • Viruses
  • Coxiella
  • PCP
  • Chlamydia
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15
Q

PNA: indication for hospital admission

A

CURB 65

  • Confusion
  • Uremia: BUN >20
  • RR >30
  • BP (hypotension)
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16
Q

exudate vs transudate

A

Exudate

  • LDH >200
  • LDH ratio of pleura/serum > 60%
  • Protein ratio of pleura/serum >50%
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17
Q

Ventillator-Associated PNA: diagnostic tests

A
  • tracheal aspirate
  • BAL
  • Protected brush specimen
  • Video-assisted thoracoscopy (VAT)
  • open lung biopsy
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18
Q

Ventillator-Associated PNA: treatment

A
  • combine 3 different drugs
    1) cephalosporin, PCN, or carbapenem (the C’s)
    2) aminoglycoside or fluoroquinolone
    3) MRSA: vanc or linezolid
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19
Q

PCP: diagnostic tests

A

-best initial: CXR or ABG
-most accurate: BAL
-sputum stain for PCP
positive= no further tests needed, reached Dx
negative= bronchoscopy is “best diagnostic test” –> look in there and see what’s going on

A normal LDH means PCP is NOT THE DIAGNOSIS. LDH is ALWAYS elevated in PCP

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20
Q

PCP: severe

A

pO2 below 70 or A-a >35
add steroids to TMP/SMX

if toxicity from TMP/SMX switch treatment to:

  • Clinda and primaquine (can’t use primaquine in G6PD)
  • OR pentamidine
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21
Q

RFs for TB

A
  • Recent immigrant (past 5yrs)
  • Prisoners
  • HIV+
  • Healthcare worker
  • Close contact with someone with TB
  • Steroid use
  • Hematologic malignancy
  • Alcoholic
  • DM
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22
Q

TB: diagnosis and treatment

A

-CXR = best initial test
-Pleural biopsy = most accurate
-sputum stain
must be (-) x3 to r/o TB
positive –> 6mo therapy: 2 mo RIPE + 4mo RI

23
Q

TB: treatment

A

-sputum stain
must be (-) x3 to r/o TB
positive –> 2 mo RIPE + 4mo RI

continue treatment >6mo if

  • osteomyelitis
  • miliary TB
  • meningitis
  • Pregnancy or any other time pyrazinamide not used
24
Q

TB: S/E treatment meds

A
  • Rifampin –> red pee –> benign
  • Isoniazid –> peripheral neuropathy prevent w pyridoxine
  • Pyrazinamide –> hyperuricemia –> no Rx unless symptoms
  • Ethambutol –> optic neuritis/color vision–> decrease dose in renal failure

All meds cause hepatoxicity, do not stop until AST/ALT rise 3-5x ULN

25
Q

TB: PPD reading >5mm positive in..

A
  • HIV+
  • Glucocorticoid user
  • Abn calcifications on CXR
  • organ transplant
  • Close contact with TB person
26
Q

TB: PPD reading > 10mm positive in..

A
  • recent immigrant (past 5yrs)
  • prisoners
  • healthcare workers
  • close contact TB person
  • hematologic malignancy, alcoholic, DM
27
Q

TB: PPD reading > 15 mm positive in..

A

people with NO risk factors

28
Q

TB: treatment for +PPD or +IGRA

A

exclude active TB with CXR

-9mo isoniazid (use B6 to prevent periph neuropathy)

29
Q

Pulmonary fibrosis: causes

A
  • idiopathic
  • radiation
  • drugs: bleomycin, busulfan, amiodarone, methylsergide, nitrofurantoin, cyclophosphamide
30
Q

Pneumoconioses: cotton

A

byssinosis

31
Q

Pneumoconioses: electronic manufacture

A

berylliosis

Most likely to respond to steroid treatment

32
Q

Pneumoconioses: moldy sugar cane

A

bagassosis

33
Q

Pneumoconioses: shipyard

A

asbestosis

34
Q

Pneumoconioses: sandblasting, rock mining, tunneling

A

silicosis

35
Q

PE: when do you use IVC filter?

A
  • can’t use anticoagulants
  • recurrent emboli while on heparin or warfarin (2-3)
  • RV dysfunction with enlarged RV on Echo: next emboli might kill the person
36
Q

PE: when to use thrombolytics

A

-hemodynamically unstable

37
Q

PE: when to use direct-acting thrombin inhibitors (argatroban, lepirudin)

A

-Heparin-induced thrombocytopenia

38
Q

A-a gradient formula

A

PAO2 = 150 - pCO2/0.8
PAO2 - PaO2 = (150 - pCO2/0.8) - PaO2 82 year
normal is

39
Q

normal blood gas

A

7.4 pH/ 40 CO2/ 90 O2 / 100% sat

40
Q

PE: initial tests

A

ABG: hypoxemia, increased A-a gradient, normal in healthy young patients

CXR: normal, effusion, Westermark sign, Hampton hump

EKG: sinus tachycadia, S1Q3T3

41
Q

PE: specific tests

A

Spiral CT: may miss small peripheral PEs

V/Q Scan: perfusion defect, normal ventilation

Angiogram: gold standard

DVT: Doppler U/S, venogram, MRI

D-dimer: sensitive, rule out, ELISA

42
Q

Fat embolism: triad

A
  1. Acute dyspnea
  2. Petechiae: neck and axilla
  3. Confusion

occurs 3-4days after long bone fractures
Rx = supportive, no anticoagulation

43
Q

ARDS: definition

A

-pO2/FiO2 (mild 300-200, moderate 200-100, severe

44
Q

Squamous CA: types

A

PTH-rP = PTH related peptide

Hypercalcemia

45
Q

Small Cell CA: types

A

Para-neoplastic

  • SIADH –> ADH –> save water
  • Cushing syndrome –> ACTH
  • Lambert-Eaton Syndrome –> antibody against pre-synaptic Ca2+ channels causing muscle weakness
46
Q

CAP treatment

A

Outpatient
-healthy = macrolide or doxycycline
-comorbids = fluoroquinolone
beta-lactam + macrolide

Inpatient (non-ICU)

  • Fluoroquinolone OR
  • Beta-lactam + macrolide

Inpatient (ICU)

  • Beta-lactam + macrolide (IV)
  • Beta-lactam + fluoroquinolone
47
Q

atypical PNA: organisms

A 
Mycoplasma
Chlamydophilia
Legionella
Coxiella
Viruses

not visible on gram stain, not culturable on standard blood agar

48
Q

Pulmonary embolism: symptoms

A 
sudden onset
pleuritic chest pain
dyspnea
tachypnea 
tachycardia
hypoxemia
49
Q

Causes of exudate

A
  • Infection: TB
  • Autoimmune: RA
  • Neoplasm: sarcoidosis, lymphoma

all of these increase capillary permeability –> protein and LDH passes into pleural fluid

50
Q

TMP/SMX S/E and alternative meds

A

S/E: rash, bone marrow suppression

alternate meds: atovaquone or dapsone (can’t use dapsone in G6PD)

51
Q

When does a patient require oxygen?

A

-pO2 55%, OSA with hypoxia at night or cardiomyopathy –>

pO2

52
Q

Hypertrophic Osteoarthropathy (HOA)

A
  • digital clubbing
  • sudden-onset arthropathy (wrist, hand joints)
  • Hypertrophic pulmonary osteoarthropathy (HPOA) is a subset of HOA where clubbing/arthropathy 2/2 underlying lung dx: lung CA, TB, bronchiectasis, emphysema
53
Q

Conditions associated with digital clubbing

A
  • Intrathoracic neoplasms: bronchogenic CA, metastatic CA, malignant mesothelioma, lymphoma
  • Intrathoracic suppurative Dx: lung abscess, empyema, bronchiectasis, CF, chronic cavitary lesions
  • Lung Dx: idiopathic pulm fibrosis, asbestosis, pulm a-v malformations
  • CV Dx: cyanotic congential heart dx
54
Q

Modified Wells Criteria

A

Score 3pts

  • Clinical signs DVT
  • Alternate diagnosis less likely than PE

Score 1.5pts

  • previous DVT/PE
  • HR > 100
  • Recent surgery (3days)

Score 1pts

  • Hemoptysis
  • Cancer

total Score
4 PE likely

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