Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Step 2 CK > Pulm > Flashcards

Pulm Flashcards

1
Q

What are main causes of acute asthma exacerbations

A 
Allergens
Infection, Cold air
Exercise
Aspirin, NSAIDs, BBs
GERD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Extrinsic vs Intrinsic Asthma severity

A

Extrinsic is better (ie. has precipitants)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Most likely associations w/ Asthma

A 
Sx worse at night
Nasal polyps and sensitivity to aspirin
Pulsus paradoxus
Eczema or atopic dermatitis
Increased length of expiratory phase
Increased use of accessory muscles
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Best initial test for acute exacerbation of asthma

A

Peak expiratory flow or ABG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Why do CXR in asthma

A

Exclude PN or other chest etiology for sx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Most accurate Dx test in asthma

A

PFTs

  • ↓FEV1/FVC
  • ↓FEV1, ↓FVC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Most accurate test in asymptomatic asthma

A

20% decrease in FEV1 w/ use of methacholine or histamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

PFTs in asthma

A

↓ FEV1/FVC
↓ FEV1, ↓ FVC
↑ FEV1 of >20% and 200ml w/ use of albuterol
↓ FEV1 of >20% w/ use of methacholine or histamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Additional tests in asthma

A

CBC - increased eosinophils
Skin test for allergens
IgE for allergic etiology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Protocol for chronic asthma management

A
  1. SABA
    • ICS
    • LABA or Increase ICS dose
  4. Increase ICS dose to max
    • Omalizumab
    • Oral steroids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Drug that works best in childhood and exercise-induced PPx

A

Cromolyn and Nedocromil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Drug used to help pts ween off steroids

A

Montelukast
Zafirlukast
Zileuton

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Steroid AEs

A 
Osteoporosis
Cataracts
Adrenal suppression and fat distribution
Hyperlipidemia, hyperglycemia, acne, hirsuitism
Thinning of skin, striae, easy bruising
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Vaccines for all asthmatics

A

Influenxae

Pneumococcal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Best indicator for severity of disease in asthma

A

Respiratory rate (severe SOB = 34)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Quantification of severe SOB

A

Decreased PEF

ABG w/ increased A-a

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Rx acute asthma exacerbation

A

O2
Albuterol
Steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Best initial therapy for acute asthma exacerbation

A

O2 w/ SABA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Drug of last resort in acute asthma exacerbation

A

Epi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What to do if there is no response to therapy in acute asthma exacerbation

A

Intubation in ICU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is NOT effective in acute asthma exacerbation

A 
Theophylline
Cromolyn, Nedocromil
LT modifiers
Omalizumab
Salmeterol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is Mg good for in acute asthma exacerbation

A

Non-responsive to albuterol while waiting for steroids to start working

Relieve bronchospasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is COPD

A

SOB from lung destruction due to loss of elastic recoil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Why are steroids ineffective in chronic COPD

A

Non-inflammatory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Major PFT findings in COPD

A

↓ FEV1, FVC

↑ TLC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

MCC COPD

A

Tobacco smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

When to suspect A1AT def causing COPD

A

Young
Non smoker
Transaminitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Common presentation of COPD

A

SOB
Barrel chest
Cachexia (emphysema)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Best initial test for COPD

A

CXR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

CXR findings in COPD

A

Increased AP diameter

Flattened diaphragm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Most accurate test for COPD

A

PFTs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

PFTs in COPD

A 
↓ FEV1, FVC, FEV1/FVC
↑ TLC
↓ DLCO (emphysema)
Incomplete improvement w/ albuterol
Not much effect after methacholine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Response to bronchodilators in COPD

A

Little to full reversibility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is full reversibility in COPD

A

> 12% increase and 200mL increase in FEV1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

ABG findings in acute exacerbation of COPD

A

Increased pO2
Hypoxia
Respiratory acidosis if no compensation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What increases survival in COPD

A

Smoking cessation

O2 (when pO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

When to give O2 in COPD when they also have pulm HTN, high HCT or cardiomyopathy

A

pO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Symptomatic rx in COPD

A 
SABA
Anticholinergics
Steroids (good in acute)
LABA
Pulm rehab
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

When to give theophylline in COPD

A

When all else fails

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Rx when all medical therapy is insufficient for COPD

A

Transplantation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Rx acute exacerbation of chronic bronchitis

A

Same as acute asthma exacerbations

Plus ABX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What do ABX need to cover in AECB

A

Strep pneumo, H. flu, M. catarrhalis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What ABX are given in AECB

A

Macrolides
Cepalosporins
Augmentin
Quinolones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is bronchiectasis

A

Chronic dilation of large bronchi

Permanent anatomic abnormality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

MCC bronchiectasis

A

CF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Other causes of bronchiectasis

A 
Infection
Panhypogammaglobulinemia
Foreign body/tumors
Aspergillosis
Collagen vascular disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Pathognomonic w/ bronchiectasis

A

Purulent foul smelling cough/sputum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

PE and lab findings in bronchiectasis

A 
Hemoptysis
Wt loss
AOCD
Crackles
Dyskinetic cilia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Best initial test in bronchiectasis

A

CXR showing dilated thickened bronchi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Most accurate test in bronchiectasis

A

High resolution CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Only way to determine specific bacterial etiology of bronchiectasis

A

Sputum Cx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Rx bronchiectasis

A

Chest physio and postural drainage
Treat each infection episode
Rotate ABX 1 weekly each month
Surgical resection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Who gets allergic bronchopulmonary aspergillosis (ABPA)

A

Asthma

Hx atopic disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What to look for in ABPA

A

Asthmatic w/ recurrent brown-flecked sputum

Transient infiltrates on CXR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Dx tests for ABPA

A 
Peripheral eosinophilia
Skin test reactivity
Aspergillus Abs
Elevated IgE
Infiltrates on CXR, CT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Rx ABPA

A

Oral prednisone

Itraconazole if reccurent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What is CF

A

AR mutation in chloride transport gene (CFTR)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

MCC death in CF

A

Lung disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What to look for in CF

A

Young adult
Chronic lung disease
Recurrent infections
Sinus pain and polyps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

GI features of CF

A 
Meconium ileus
Pancreatic insufficiency - steatorrhea, vit ADEK malabsorption
Recurrent pancreatitis
Distal intestinal obstruction
Biliary cirrhosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

GU features of CF

A

Men - Azoospermia, missing vas deferens

Women - Infertile 2/2 thickening of cervical mucus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Most accurate test for CF

A

Sweat chloride test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

ABG in CF

A

Hypoxemia

Resp acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Which cells in the pancreas are spared in CF

A

Beta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Sputum Cx in CF may show

A

H. flu
Pseudomonas
S. aureus
Burkholderia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Rx CF

A 
Routine ABX (same ones as bronchiectasis)
Recombinant human deoxyribonuclease
Inhaled bronchodilators
Pneumococcal and flu vax
Lung transplant in severe disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What is CAP

A

PN before or within 48hrs of hospitalization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

MCC CAP

A

Strep pneumo - REGARDLESS of comorbidities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

CAP association w/ COPD

A

H. flu

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

CAP association w/ recent viral illness

A

S. aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

CAP association w/ alcoholism/DM

A

Klebsiella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

CAP association w/ poor dentition or aspiration

A

Anaerobes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

CAP association w/ young healthy pts

A

Mycoplasma pneumoniae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

CAP association w/ hoarseness

A

Chlamydophila

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

CAP association w/ contaminated water sources, AC, ventilation

A

Legionella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

CAP association w/ birds

A

Chlamydia psittaci

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

CAP association w/ animals at time of birth, vets, farmers

A

Coxiella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Common findings in all PN

A

Fever
Cough
Dyspnea
Dullness to percussion if effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Features of severe PN

A

Tachy
Hypotension
Tachypnea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Signs of bacteremia

A

Chills and Rigors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Unique presentation of klebsiella PN

A

Current jelly sputum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Unique presentation of Anaerobe PN

A

Rotten egg smelling sputum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Unique presentation of mycoplasma PN

A

Dry cough, rarely severe, bullous myringitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Unique presentation of Legionella PN

A

GI or CNS sx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Unique presentation of pneumocystis PN

A

AIDS w/ CD4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Infections w/ dry cough

A 
Mycoplasma
Viruses
Coxiella
Pneumocystis
Chlamydia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Best initial test for all resp infections

A

CXR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Most accurate test for resp infections

A

Sputum stain and Cx

Much of the time this is negative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Characteristic CXR finding in bacterial PN

A

Right middle lobe infiltrate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Organisms causing B/L infiltrate in CXR

A 
Mycoplasma
Viruses
Coxiella
PCP
Chlamydia
Legionella
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

How do you know sputum gram stain is adequate

A

> 25 WBCs and

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Tests done in severe disease w/ unclear etiology

A

Thoracocentesis
Empyema analysis
Bronchoscopy only in ICU and worsening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Dx test to confirm mycoplasma

A

PCR
Cold agglutinin
Serology
Special cx media

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

Dx test to confirm chlamydophila

A

Rising serology titres

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

Dx test to confirm legionella

A

Urine Ag

Cx on charcoal-yeast extract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

Dx test to confirm chlamydia psittaci

A

Rising serology titres

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Dx test to confirm coxiella

A

Rising serology titres

98
Q

Dx test to confirm PCP

A

BAL

99
Q

Empiric Rx outpatient if previously healthy

A

Macrolide or Doxy

100
Q

Empiric Rx outpatient if comorbidities or ABX in last 3 mos

A

Resp fluoroquinolone

101
Q

Empiric Rx inpatient

A

Resp fluoroquinolone or (Ceftriaxone and Azithromycin)

102
Q

Reasons to hospitalize for PN

A 
Hypotension
Hypoxia
Elevated BUN or Hyponatremia
Tachy, Confusion
Fever
> 65
103
Q

Management of Empyema

A

Drain it

104
Q

CURB65 (2 or more = admission)

A 
Confusion
Uremia
Resp distress
BP low
> 65
105
Q

Features of empyema (Exudate)

A

pH 60% of serum or Protein >50% of serum

106
Q

What causes exudate

A

Infection

Cancer

107
Q

Reasons to give pneumococcal vaccine

A 
>65
Chronic heart, liver, kidney, lung disease
Functional or anatomic asplenia
Blood cancer
Immunosuppression
CSF leak or cochlear implant
108
Q

What is HAP

A

PN >48hrs after admission or after hospitalization within the last 90 days

109
Q

What are the main bugs in HAP

A

E. coli

Pseudomonas

110
Q

What is given for HAP

A 
Antipseudomonal cephalosporins
- Cefepime
- Ceftazidine
Antipseudomonal PCNs
Carbapenems
111
Q

What to look for to suggest VAP

A

Fever with rising white count
New infiltrate
Purulent secretions

112
Q

Dx tests for VAP

A 
Tracheal aspirate
BAL
Protected brush specimen
VAT
Open lung Bx
113
Q

Rx VAP

A 
Antipseudomonal beta lactam
PLUS
Aminoglycoside or fluoroquinolone
PLUS
MRSA agent
114
Q

Imipenem AE

A

Seizures 2/2 renal failure

115
Q

How does large volume aspiration occur

A 
Stroke w/ loss of gag
Seizures
Intoxication
ET tube
Bad teeth
116
Q

When to suspect lung abscess

A

Pt w/ risk factors and weeks of sx

Large volume foul smelling sputum

117
Q

Best initial test for lung abscess

A

CXR

118
Q

Most accurate test for lung abscess

A

Bx - gives microbe

119
Q

Best empiric rx for lung abscess

A

Clindamycin or PCN

120
Q

Presentation of PCP

A

Dry cough and fever in AIDs pt w/ CD4

121
Q

Best initial test for PCP

A

CXR w/ B/L infiltrates

ABG w/ hypoxia and increased A-a

122
Q

Most accurate test in PCP

A

BAL

123
Q

LDH in PCP

A

ALWAYS elevated

124
Q

Next best step w/ negative sputum

A

BAL

125
Q

Best initial therapy for PPx and Rx

A

TMP/SMX

Add steroids if severe

126
Q

TMP/SMX AE

A 
#1 Rash
#2 BM suppression
127
Q

What is severe PCP

A

pO2 35

128
Q

Rx PCP w/ TMP/SMX tox

A

Clinda and primaquin
OR
Pentamidine

129
Q

PCP PPX w/ TMP/SMX tox

A

Atovaquone or dapsone

130
Q

When is dapsone contraindicated

A

G6PD def

131
Q

RFs TB

A 
Immigrant, homeless
Prisoners
HIV
Healthcare
Alcoholics
132
Q

Common features of TB

A

RFs

Fever, weight loss, night sweats, cough, hemoptysis

133
Q

Best initial test for TB

A

CXR

134
Q

Sputum protocol in TB

A

Stain and Cx 3 times

135
Q

Most accurate test for TB

A

Pleural Bx

136
Q

Pt w/ TB RFs and +CXR w/ apical infiltrate

A

Sputum stain and Cx

137
Q

Pt w/ TB positive sputum stain and cx

A

Empiric therapy

138
Q

Initial therapy for TB

A

Rifampin
Isoniazid
Pyrazinamide
Ethambutol

139
Q

Rx protocol in TB

A

RIPE for 2 months

Rifampin and INH for another 4

140
Q

When do you extend TB Rx to 9 months

A

Osteo
Milliary
Meningitis
Pregnancy (and any other time pyrazinamide is contraindicated)

141
Q

All TB meds can cause

A

Hepatotoxicity

142
Q

Rifampin AE

A

Red coloured body secretions

143
Q

INH AE

A

Peripheral neuropathy

Pyridoxine to prevent

144
Q

Pyrazinamide AE

A

Hyperuricemia

145
Q

Ethambutol AE

A

Optic neuritis/Colour vision

Decrease dose in renal failure

146
Q

When to give steroids in TB

A

Reduce risk of constrictive pericarditis and meningitis

147
Q

When to do PPD

A

Asymptomatic pts in RISK GROUPS ONLY

Must have neg CXR

148
Q

When is 5mm induration pertinent

A 
HIV
Steroid users
Close contact to TB person
Abnormal calcifications on CXR
Organ transplant recipients
149
Q

When is 10mm induration pertinent

A 
Immigrant
Prisoner
Healthcare worker
Close contact to TB person
Blood cancer, alcoholics, DM
150
Q

When is 15mm induration pertinent

A

People with no RFs

151
Q

First time PPD protocol

A

2nd test 1-2 weeks later if 1st is negative

152
Q

Reactive PPD next step

A

CXR

153
Q

BCG role in PPD testing

A

Doesn’t matter

154
Q

Pt w/ +PPD and -CXR next step

A

INH for 9 months

155
Q

Qualities of benign pulmonary nodule

A
156
Q

Qualities of malignant pulmonary nodule

A 
>40
Enlarging
Smoker
Spikes
>2cm
Atelectasis
Sparse, eccentric calcification
Abnormal PET
157
Q

Best initial test for all lung lesions

A

Compare to old CXRs

158
Q

Best next step for features of malignant lesions

A

Resect

159
Q

Cytology is positive in pulm nodule, next best step

A

Resect

160
Q

Intermediate probability lesions next best step

A

Central - bronchoscopy

Peripheral - transthoracic Bx

161
Q

MC AE transthoracic bx

A

PTX

162
Q

When is a PET most accurate

A

> 1cm

163
Q

Most sensitive and specific test for pulm nodule

A

VATS

164
Q

What is interstitial lung disease

A

Thickening of interstitial septum of lung between arterial space and alveolus

165
Q

Specific causes of pulmonary fibrosis

A 
Idiopathic
Radiation
Drugs
Vasculitis
Eosinophilic PN
166
Q

Drugs that can cause pulm fibrosis

A 
Bleomycin
Amiodarone
Methylsergide
Nitrofurantoin
Cyclophosphamide
167
Q

Pneumoconiosis in exposure to coal

A

Coal worker’s lung

168
Q

Pneumoconiosis in exposure to sandblasting, rock mining, tunneling

A

Silicosis

169
Q

Pneumoconiosis in exposure to shipyards, pipe fitting, insulators

A

Asbestosis

170
Q

Pneumoconiosis in exposure to cotton

A

Byssinosis

171
Q

Pneumoconiosis in exposure to electronic manufacturing

A

Beryliosis (also aerospace)

172
Q

Pneumoconiosis in exposure to moldy sugar cane

A

Bagassosis

173
Q

Features of coal worker’s lung

A 
Upper
↑ IgA, G
↓ C3
ANA+
Can have RA
174
Q

Features of silicosis

A

Upper

Egg-shell calcification of LNs

175
Q

Features of Asbestosis

A

Lower

Dumbbell shaped

176
Q

Features of all pulm fibrosis

A

Dyspnea worse on exertion
Rales
Loud P2
Clubbing

177
Q

Best initial test for pulm fibrosis

A

CXR

178
Q

Most accurate test for pulm fibrosis

A

Lung Bx

179
Q

What does echo show in pulm fibrosis

A

RVH

Pulm HTN

180
Q

CXR pattern in pulm fibrosis

A

Diffuse reticulonodular pattern

Honeycombing

181
Q

What does Bx show in berylliosis

A

Granulomas

182
Q

When are PFTs used in pulm fibrosis

A

Response to therapy

183
Q

PFTs in pulm fibrosis

A

Decreased everything

Decreased DLCO

184
Q

When can you rx interstitial lung disease

A 
Bx shows WBC infiltration
Use Prednisone (berylliosis responds best)
185
Q

Who gets sarcoidosis

A

Young AA woman

186
Q

Presentation of sarcoidosis

A

SOB on exertion

Erythema nodosum and lymphadenopathy

187
Q

Misc findings in sarcoidosis

A 
Parotid gland enlargement
Facial palsy
Heart block and restrictive cardiomyopathy
CNS sx
Iritis, Uveitis
188
Q

Best initial test in sarcoidosis

A

CXR

189
Q

Most accurate test in sarcoidosis

A

LN Bx

Shows noncaseating granulomas

190
Q

Drug of choice in sarcoidosis

A

Prednisone

191
Q

Where do PEs derive from

A

DVT in leg - 70%

DVT in pelvic vein - 30%

192
Q

Causes of DVTs

A 
Immobility
Surgery
Trauma
Joint replacement
Thrombophilia
Malignancy
Pregnancy
193
Q

Inherited thrombophilia causing DVT

A

Factor V Leiden

194
Q

Aquired thrombophilias

A

Lupus anticoagulant
Nephrotic syndrome
OCPs esp in smokers

195
Q

How does nephrotic syndrome cause DVTs

A

Loss of albumin and Anti-thrombin III

Leads to renal vascular thrombosis

196
Q

Most common findings in PE

A

Sudden SOB w/ clear lungs and normal CXR

197
Q

Best initial tests for PE

A

CXR
EKG
ABG

198
Q

Most accurate test for PE

A

Angiography

199
Q

Mortality rate in angiography

A

0.5%

200
Q

MC finding on CXR for PE

A

Atelectasis

201
Q

Other findings on CXR for PE

A

Wedge infarction
Pleural lesion
Westermark sign

202
Q

MC abnormality on EKG for PE

A

Nonspecific ST-T changes

203
Q

ABG findings in PE

A

Hypoxia and resp alkalosis w/ NL CXR

204
Q

Suspect PE what is next best step

A

Start therapy

Do NOT wait for confirmatory testing (Spiral CT or V/Q)

205
Q

MC confirmatory test for PE

A

Spiral CT

206
Q

When to use V/Q as confirmatory test for PE

A 
Pregnancy (Use as 1st test)
CXR NL (but spiral CT is still better)
207
Q

When is D-dimer the answer for PE test

A

Pretest probability for PE is low

208
Q

LE doppler positive in PE pt, what is the next step

A

No more testing

Heparin then warfarin for 6mos

209
Q

-CT, -V/Q, -LE doppler, now what

A

Stop heparin

210
Q

Angiography AE

A

Allergy
Renal tox
Death

211
Q

Best initial therapy for PE or DVT

A

Heparin (warfarin started at same time)

212
Q

When is IVC filter the rx for PE/DVT

A

Contraindication to anticoagulants
Recurrent emboli while on heparin or therapeutic warfarin
RV dysfunction

213
Q

When are thrombolytics the rx for PE/DVT

A

Hemodynamically unstable

Acute RV dysfinction

214
Q

When are direct acting thrombin inhibitors the rx for PE/DVT

A

HIT

215
Q

When is aspirin the rx for PE/DVT

A

Never

216
Q

What is pulm HTN

A

SBP>25

DBP>8

217
Q

Causes of pulm HTN

A

Idiopathic
Chronic lung disease
- COPD
- Fibrosis

218
Q

Presentation of pulm HTN

A

Dyspnea and fatigue
Syncope
CP
Wide splitting S2, Loud P2

219
Q

Best initial test for pulm HTN

A

CXR and CT

220
Q

Most accurate test for pulm HTN

A

Swan Ganz catheter

221
Q

Rx pulm HTN

A

Treat underlying cause

222
Q

When is idiopathic pulm HTN treated

A

Vascular reactivity

223
Q

Rx idiopathic pulm HTN

A 
Prostacyclin analogues
- Epoprostenol
- Trepostinil
- Iloprost
- Beraprost
Endothelin antagonists
- Bosentan
Phosphodiesterase inhibitors
- Sidenafil
224
Q

Role of O2 in pulm HTN

A

Slowes progression

225
Q

Only cure for pulm HTN

A

Lung transplant

226
Q

MCC OSA

A

Obesity

227
Q

Most accurate test for OSA

A

Sleep study

228
Q

How does OSA have increased bicarb

A

Hypoventilation → Hypoxia, hypercapnea, ↓O2 sat → chronic resp acidosis → compensate w/ increased bicarb

229
Q

Rx OSA

A 
Lose weight
No alcohol
CPAP
Keep tongue out of the way
Uvuloplatopharyngoplasty (LAST RESORT)
230
Q

Picture of ARDS

A

Pt in ICU doing better then rapidly deteriorates w/ a pulmonary edema picture

231
Q

Problem in ARDS

A

Loss of surfactant leading to leaky alveoli that fills w/ fluid

232
Q

Causes of ARDS

A 
Sepsis/aspiration
Contusion/trauma
Near-drowning
Burns or pancreatitis
DIC
233
Q

MCC ARDS

A

G- sepsis by pseudomonas

234
Q

CXR in ARDS

A

B/L infiltrates

White-out

235
Q

pO2/FIO2 ratio in ARDS

A
236
Q

pO2 in ARDS

A
237
Q

FIO2 in ARDS

A
238
Q

Wedge pressure in ARDS

A

NL

239
Q

Does anything reverse ARDS

A

No

240
Q

Best support for ARDS

A

Low tidal volume mechanical ventilation

6mL/kg

241
Q

What is used to decrease FIO2

A

PEEP

Maintain plateau pressure of

Step 2 CK (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions