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Pulm Flashcards

1
Q

Main difference between asthma and COPD

A

reversibility

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2
Q

How to take temp in asthma exacerbation

A

not orally– mouth breathing cools thermometer

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3
Q

Associations with asthma

A

atopy, obesity

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4
Q

Asthma patients are worst at _____, sensitize to ___.

A

Worst at night, sensitive to ASA

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5
Q

PE findings in asthma

A

wheezes and *prolonged expiratory phase

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6
Q

Asthma:
best initial test
most accurate test
best test for asx patient

A

Peak flow- initial
Accurate- PFTs
Asx- FEV1 decrease with methacholine (challenge)

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7
Q

PFT finding in asthma

A

FEV1/FVC low, reversible with albuterol

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8
Q

How should PFTS be affected by methacholine and albuterol in asthma?

A

FEV1 ^ 12% with albuterol

FEV1 down 20% with methacholine)

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9
Q

What is methacholine?

A

acetylcholine– increases secretions

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10
Q

Appropriate asthma treatment (stepwise)

A

1) SABA
2) SABA + ICS
3) SABA + ICS + LABA
4) “” but ^ dose/ strength of ICS
5) SABA+ ICS + LABA + Omalizumab
6) SABA + ICS + LABA + Omalizumab + OCS

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11
Q

Common combined inhalers:

A

bronchodilator
inhaled corticosteroid

(Advair and symbicort are both LABA + ICS)

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12
Q

What are some of the low dose inhaled steroids?

A
  • beclomethasone
  • budesonide
  • fluticasone
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13
Q

What are the two SABAs?

A

albuterol/levalbuterol
pirbuterol

*LABAs are others ending in erol

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14
Q

Metabolic effects of oral steroids

A
  • ^glucose
  • ^lipids
  • osteoporosis
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15
Q

Which of the asthma meds should never be used first/ alone?

A

LABAs

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16
Q

Role of anticholinergics in asthma?

A

not. none. They are for COPD

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17
Q

Special vaccines for asthmatics

A

all get pneumo and influenza. Gotta do it.

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18
Q

Best clinical indication of asthma severity

A

RR

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19
Q

Treatment of asthma exacerbation

A

O2
bolus of IV steroids
albuterol nebs
**No epi. Bad news.

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20
Q

Alternative to albuterol in asthma attack when albuterol not effective

A

mag

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21
Q

COPD- effect on TLC and DLCO

A

increased TLC– hyperinflation

decreased DLCO- destruction

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22
Q

Young nonsmoker with COPD has

A

a1at mutation

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23
Q

CBC change in COPD

A

high hct from chronic hypoxia

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24
Q

EKG findings in COPD

A

RAE (tall P wave V1); RVH; MAT

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25
Q

What improves mortality in COPD

A

O2; smoking cessation; vaccines

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26
Q

When to give supplemental O2?

A

60/90 pO2/sat with right heart disease, high HCT etc… 55/88 if otherwise healthy

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27
Q

Medications for COPD

A

1) SABA PRN
2) SABA PRN + anticholinergic
3) SABA PRN + antichol + ICS
4) transplant

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28
Q

How is COPDE treated differently than asthma?

A

add abx

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29
Q

Drugs for COPDE/asthma exacerbation

A

albuterol nebs, O2, IVCS

+ abx for COPDE

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30
Q

Options for Abx in COPDE

A

1) macrolides
2) augmentin
3) quinolones
4) 2nd gen ceph

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31
Q

What the hell is bronchiectasis anyways?

A

chronic dilation of large bronchi…permanent anatomic abnormality (esp common with CF/ repeated infections)

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32
Q

Clinical clue to bronchiectasis

A

recurrent large volume sputum production (due to large bronchi that allow pooling of secretions)

so coughing shit up all day errday

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33
Q

How to dx bronchiectasis

A

tram tracks on high rest chest CT

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34
Q

Px treatment for bronchiectasis

A

cupping and clapping (chest phys therapy)

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35
Q

ABPA what is it?

A

Allergic Bronchopulmonary Aspergillosis

allergy patient… gets exposed to aspergillus/fungus and has hypersensitivity dx

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36
Q

Clinical clues to ABPA:

A

brown flecked sputum

transient infiltrates on CXR

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37
Q

Treatment of ABPA

A

oral steroids (not inhaled)

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38
Q

Principal pathophys of CF

A

thick sputum, no mucus clearance, bacteria takes shop

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39
Q

Sinus finding in CF

A

nasal polyps

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40
Q

GI assc with CF

A
  • recurrent pancreatitis/ no pancreatic digestive enzymes
  • meconium ileus
  • biliary colic
  • instestinal obstruction
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41
Q

GU involvement in CF

A

-azospermia
-20% missing vas
-altered menstrual cycle
-mucus blocks sperm through cervix
(all infertile)

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42
Q

Best test for CF

A

increased sweat chloride

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43
Q

CF PFT findings

A

mixed obstructive and restrictive

low TLC, DLCO, TLC

44
Q

Treatment options for CF

A
  • inhaled aminoglycosides, rhDNase, and SABA
  • vaccines
  • ivactafor (some patients)
  • transplant
45
Q

Bug causing pneumonia in vet/farmer/animal birth

46
Q

Bug causing pneumonia in contaminated water/ heating and cooling etc

47
Q

Bug assc with DM and alcoholism (causing PNA)

A

klebsiella

48
Q

Dull percussion in PNA=

49
Q

PNA assc with:
currant jelly sputum
rotten egg sputum
CNS symptoms

A

Klebsiella- currant jelly
rotten egg- anerobes
CNS-listeria

50
Q

Infections with dry cough + bilateral interstitial infiltrates

A 
mycoplasma 
coxiella
pneumocystis 
virus 
chlamydia
51
Q

Empyema findings on thoracentesis

A 
LDH more than 60% serum
Protein more than 50% serum
White count more than 1000
pH less than 7.2 
(any of these)
52
Q

What are the respiratory FQs

53
Q

Outpatient treatment of CAP

A

macrolide or doxy unless sickly/recent abx then FQ

54
Q

Inpatient treatment of CAP

A

etither ceftriaxone + macrolide or FQ

55
Q

Two factors that are in isolations reasons to admit PNA patient

A

hypoxia

hypotension

56
Q

What are CURB65 criteria for admission?

A 
C-confusion
U-uremia 
R-respiratory distress
B-BP low 
65+ 
2+ points admit
57
Q

How long between 13 and 23 valent PNA vaccines

A

6-12 months

58
Q

Reasons to give PNA vaccine early

A 
asplenia 
hematologic cx 
immunosupressions (steroids, DM, HIV, alcohol)
CSF leak, cochlear implant 
heart, liver, kidney, lung disease
59
Q

Bugs at risk in HAP and main difference in treatment

A

ecoli and pseudomonas —> cannot use macrolides

60
Q

Treatments for HAP

A

cefepime/ceftaz, pip tazo, or carbapenems

61
Q

What are the antipseudomonal blactams

A

ceftaz, cefepime
piptazo
carbapenems

62
Q

Treatment of VAP

A

3 agents

antipseudomonal B lactam + vanc or linezolid + FQ or AG

63
Q

Why no dapto for lungs?

A

inactivated by surfactant

64
Q

Imipenem ADR

65
Q

Lung Abscess:
key sx
dx
tx

A

foul sputum
lung bx
clinda or penicillin

66
Q

CD4 count where patients get PCP

A

200 or less

67
Q

Lab test clue to PCP

A

LDH levels always elevated

68
Q

1st line tx for PCP

69
Q

Alternatives to Bactrim for px and tx of PCP if patient has contraindication

A

px: atovaquone or dapsone (not in G6PD
tx: clinda + primaquine (not in G6PD) or pentamidine

70
Q

At what CD4 is px given for the first time in AIDs?

71
Q

What is never a good test for TB in symptomatic patient?

A

PPD –> instead do sputum culture x 3

72
Q

Standard empiric treatment for active TB

A

RIPE x 2 months –> RI x 4 months

6 months total

73
Q

When to stop TB meds

A

transaminases 3-5x ULN

74
Q

Who is considered PPD + at 5mm or more?

When are others +?

A

5mm: steroids/transplant, HIV, close contact, xray
10 mm: other risks (healthcare, prison etc)
15 mm: no risks

75
Q

Which RIPE drug causes hyperuricemia?

A

pyrazinamide

76
Q

Treatment for first time +PPD

A

9 months isoniazid even if had BCG vaccine

77
Q

“Malignant” features in lung nodule:

A

40+ enlarging or 2+cm; smoker; spikulated; adenopathy; etc.

78
Q

What to do when solitary nodule has many malignant features

79
Q

What to do for “grey area” nodules?

A

bronch/biopsy in most; can also do PET, sputum cytology, VATS

80
Q

What to do for low risk lesions?

A

surveillance

81
Q

PE findings for pulmonary fibrosis

A

dyspnea, crackles, P2, clubbing

82
Q

Dx of pulm fibrosis

A

CXR –> CT –> bx

83
Q

EKG/ echo findings in pulm fibrosis

A

RVH –> PHTN

84
Q

Bx finding in berylliosis

A

granulomas

85
Q

PFT findings in pulmonary fibrosis

A

normal FEV1/FVC ratio; decreased DLCO

86
Q

Treatment for pulm fibrosis

87
Q

Oddball systemic findings assc with sarcoid

A
  • facial palsy
  • parotid gland hypertrophy
  • heart block
  • uveitis
  • CNS changes
88
Q

CXR clue in sarcoid

A

hilar lymphadenopathy

89
Q

PFTs in sarcoid have what pattern?

A

restrictive

90
Q

Labs in Sarcoid

A

high ACE, calciuria, calcemia

91
Q

Treatment of sarcoid

A

steroids only if symptomatic

92
Q

CXR, EKG, ABG findings in PE

A

clear lungs/ wedge infarct, sinus tach, respiratory alkalosis

93
Q

Appropriate imaging for PE

A

spiral CT unless pregnant then VQ scan

94
Q

What test is avoided in case of PE due to mortality

A

angiography

95
Q

Appropriate treatment for thromboembolism

A

heparin –> warfarin to INR of 2-3

96
Q

Alternative to heparin for TE

A

fonduparinox

97
Q

When is IVC ok?

A

absolute CI to heparin
recurrent emboli on heparin/warfarin
RV dysfunction

98
Q

When are thrombolytics appropriate for TE?

A

unstable/ acute RV dysfunction

99
Q

Heart sounds assc with PHTN

A
  • wide split S2
  • loud P2
  • TR/PR possible
100
Q

Definition of PHTN

A

PA pressures above 25/8

101
Q

Treatment of idiopathic HTN

A
  • prostacyclin analog (tenol/tinil/prost)
  • endothelin antag (sentan)
  • PDEi (sildenafil)
102
Q

Cure for PHTN

A

lung transplantation

103
Q

Sleep apnea + increased bicarb=

A

obesity hypoventilation syndrome

104
Q

Causes of ARDS

A
  • sepsis/aspiration
  • contusion/ trauma
  • drowning
  • pancreatitis
  • burns
105
Q

ARDS definition

A

pO2/FIO2 below 300

106
Q

Vent settings for ARDS

A 
high PEEP 
low TV (6) and plateau pressure less than (30)

Step 2 CK (8 decks)

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