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PANCE Review > Pulm > Flashcards

Pulm Flashcards

1
Q

CAP

A

Pt hasn’t been hospitalized w/in the last 14 days

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2
Q

CAP pathogen

A 
S. pneumo (MC) 
H. flu
M. cat 
*same as sinusitis & AOM
*Lobar consolidation/ air bronchograms
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3
Q

PE finding for consolidated PNA

A

1) dec chest movements
2) Inc vocal fremitus
3) dull to percussion
4) BS are bronchial (normally vesicular)
5) Vocal resonance (not hyperresonance) is increased
6) Whispering pectoriloquy is present

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4
Q

what tool estimates mortality for patients w/ CAP?

A

PSI/ PORT score

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5
Q

ddx RML and RLL PNA

A

RML can see diaphragm, heart border not seen

RLL “white out” of the lower diaphragm

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6
Q

what tool estimates inpt vs outpt tx of CAP?

A 
CURB 65 
Confusion
Urea (renal dysfun)
RR > 30 
BP < 90 
Age +65
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7
Q

DDx Typical vs Atypical CAP

A

Atypical PNA

  • Legionella- PNA w/ GI sxs and relative low HR (should be tachy! with fever)
  • Patchy infiltrates on CXR
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8
Q

Tx for Legionella

A

Fluoroquinolones

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9
Q

HAP definition

A

PNA 48-72 hrs after admission

New sxs w/in 4 days after d/c

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10
Q

Tx for HAP

A

3 ANTIBIOTICS

1) Pseudomonas (Tobramycin, Ceftazidime)
2) MRSA (Vancomycin)
3) ESBL (amp/sulbactam or pipericillin/tazobactam)

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11
Q

History of travel to….w/ incompetent immune system

1) MS/ OH river valeey
2) Midwest
3) Desert Southwest

A

PNA (FUNGAL)

1) Histoplasmosis
2) Blastomycosis
3) Coccidiomycosis

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12
Q

Prevention of Atelectasis post-op?

A

Incentive spirometry (10-15x day)

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13
Q

When does a ppd get read? What does it tell?

A

48-72 hours
Indicates infection when INDURATED (not active vs latent) …need CXR
Dx made by AFB Sputum (takes 3 wks)

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14
Q

3 TB drugs

A

INH - needs pyridoxine
Rifampin- hepatitis, orange
Ethambutol- optic neuritis

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15
Q

First goal in dx pulmonary nodules

A

1) Comparison films
(Popcorn = always benign)
2) CT scan +3cm

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16
Q

Bronchogenic Carcinoma: CHRONIC cough:
associated findings -
SPHERE of lung CA

A 
SVC compression 
Pancoast tumor (apical)
Horner syndrome
Endocrine 
Recurrent laryngeal n. 
Effusion (Exudative)
17
Q

Lung CA work up

A

CXR
CT Chest
Sputum cytology
Lung Bx

18
Q

TLC in obstructive vs restrictive

A

Obstructive- inc TLC

Restrictive- dec TLC

19
Q

FEV1 in obstructive vs restrictive

A

Obstruction- dec FEV1 (<80%)

Restrictive- nml FEV1

20
Q

Ex’s of restrictive pulm dz’s

A

Primary pulmonary fibrosis
Pneumoconioses
Sarcoidosis

21
Q

Types of Pneumoconiosis

A

1) Asbestosis- ships/ insulation
2) Silicosis- sandblasting
3) Black lung- coal

22
Q

Black Scandinavian/ Norweign with lung problem =

A 
Sarcoidosis 
non caseating granulomas 
Ant/ Post uveitis
Erythema nodosum 
20-40 yo F
23
Q

Hypercalemia
Increased serum ACE
Nodular lesions w/ hilar lymphadenopathy

A

Sarcoidosis

24
Q

Dx Sarcoid

A

Transbronchial biopsy

25
Q

Tx Sarcoid

A

Steroids only for symptoms

26
Q

How much can FEV1 increase with beta agonists when doing PFT’s

A

+12 %

27
Q

1) “intermittent”
2) “Mild persistent”
3) “Mod persistent”
4) “severe persistent”

A

1) SABA
2) SABA + LOW dose inhaled steroid
3) SABA+ HIGH dose inhaled steroid
4) SABA+ HIGH dose inhaled+ PO steroids

28
Q

If you give a LABA (Salmeterol)

A

YOU NEED inhaled steroids

29
Q

Indication for of Mast Cell Stabilizers (Cromolyn) ….

A

1) Cold induced asthma
2) Grandma has a cat

*NEVER for acute asthma; only PREVENTATIVE

30
Q

Chronic Bronchitis Tx

A

Stop smoking
Vaccinate (Flu & Pneumococcal)
Inhalers: Anticholinergics/ SABA/Inhaled Steroids
Home O2

31
Q

COPD Exacerbation

A

O2
DuoNebs
Prednisone PO
Antibiotics (purulence, productive sputum, fever)

32
Q

Emphysema Signs

A 
Pink Skin
Cachectic
Breathing thorough pursed lips
Barrel chest
Dec breath sounds

CXR: bullae

33
Q

Spont PTX

A

Marfans- Tall thin healthy male smoker

COPD-Ruptured bleb

34
Q

PE for pneumothorax

A
  • ipsilateral dec chest wall movement

- ipsilateral dec BS

35
Q

Non-tension pneumo

A

<15% + asymp - WW

+15%- CT w/ water seal

36
Q

Tx for ARDS

A

TREAT underlying dz

37
Q

Dx OSA

A

Polysomnography (sleep study)

PANCE Review (10 decks)

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