Brainscape's Knowledge GenomeTM

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


See full index

issues and policy > pulm > Flashcards

pulm Flashcards

1
Q

S and S of asthma

A 
respiratory distress at rest
diaphoresis
RR over 28
pulse >110
pulsus paradoxus >12- unique feature of asthma 
hyperressonance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

astuma ominous signs

A 
fatigue
paradoxical chest or ab movment
absent breath sounds
can be recumbant
cyanosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

asthma labs

A

slight wbc elevation withh eosinophilla
initially resp acidosis with mild hypoxemia on ABG
HYPERCAPNEA IS AN OMINOUS FINDING
A PC02 >45MMMHG INDICATES AN EMERGENCY
A NORMAL PCO2 (35-45) IS A VERY SICK PATIENT
chest x-ray is only useful to rule out other conditions

would show hyperinflation

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

asthma PFT

A

hospitilazation with initial FEV-1 is <30% predicted or dose not increase by at least 40% after one hour of vigorous therapy
hospialization is reccomended if peak flow is <60L/min ainitiallly and doesn to improve to >50% predicted after 1 hour of treatment.

general improvment in FVC or FEV1 of 15% or FEF 25-75 of 25% after inhailed bronchodialator

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

outpatient management of asthma -

A

short acting B2 adrenergic agonist (albuterol, for symptom releife before exercise

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

Short acting B2 adrenergic agonist

A

albuteral or proventil step one

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

step 2 daily maintenance with inhaled corticosteroids

A

budesonide (pulmicort) triacinolone (amacort

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

side effects of step 2 inhaled corticosteroids

A

(rinse mouth) candidal infection of oropharynx, dry mouth, sore throat,

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

step 3 asthma

A

short acting b2 adrenergic agonist - albuterol, proventil for symptom breakthrough

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

if symptoms persist beyond step 3 then

A

increase corticosteroid dose or add LONG acting b2 adrenergic agonist (salmeterol (servent) or ipratropium bro- arovent -good for lots of secretions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

useful for chronic asthma

A

antileukotryines- singulair

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

Inpatient managment of asthma

A

02 at 2-3 L
mild to mod- abg not necessary, if sa02 is over 90%
abg for less than 90%
hydration oral or IV

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

inhaled sympathomimetics

A

alupent (0.3cc in 5% soutions) in 2.2 ml nss q 30-60mins
proventil,
proventil or ventolin inhaled

corticosteroids
methlprednisolone 60-125mg IV x1 and then 20mg q 4or 6 untill attack is broken

can use parenteral sympathomimetics in pts who cant do po
can also use anticholonergic (atrovent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

black box on leukotryins and LABA

A

dont take in acute attack singular or salmeterol

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

Status asthmaticus def

A

severe acute asthma presenting in an unremitting, poorly responsive, life thereatening manner,

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

status asthmaticus management

A

02
D51/2 ns
inhaled and pareneral sympathomimetics- alupent or proventil or ventolin
methylpred-60-125IV or hydroortisone 300iv now
consider atrovent- 2-6puffs q4-6 anticholinergic
continous pulse ox
freq ABG
tube if necessary

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

Chronic bronchitis

A

characterized by excessive bronchial mucous and is manifested by productive cough for 3months or more in at least tow consecutive years

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

Emphysema

A

abnormal, permanent enlargement of the alveoli

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

emphysema symptoms

A 
progressive constant dyspnea
onset of symptms after 50 
min clear sputum
thin
increase in chest AP diameter
hyperressonant precussion
normal hematocrit
increased total lung capacity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

chronic bronchitis symptoms

A 
intermittant mild to mod dypsnea
symptoms onset after age 35
COPIUS PURULENT SPUTEM PRODUCTION
stocky body habitus
normal chest AP diameter
bulla blebs on cxr
hyperinfation on cxr
HEMATOCRIT INCREASED
hypercapnea hypoxia on ABG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

COPD fev and volume stuff

A

FEV is down but TLC< FRC and RV may be up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

COPD management outpatint

A

stop smoking
aovind irritants
postural drainage
INHALED IPRATROPIUM BROMIDE (ATROVENT) OR SYMPATHOMIMETICS (PROVENTIL, VENTOLIN)MAINSTAY OF THERAPY

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

COPD inpatient

A

02 at 1-2L per min or 24-28% on venti mask
pharmacologic progression as with asthma
purluent sputem gets abx for 7-10 days

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

copd inpaitient ABX

A

ampicilin or amox- 500mg four times per day
doxy 100mg bid or
bactrim DS 1 tab BID

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

TB def

A

systemic disease caused by M Tuberculosis. Pulm disease, is the most common clinical presentation, othe sites of involvment include lymphatics, denitourinary, bone, meningies, perotoneum and heart

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

TB most at risk

A

crowded living conditions, the institutionalized, HIV +, those with DM, chronic renal players, malignancy, malnutrition and the immunosuppressed.

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

TB s and S

A 
most are asymptomatic 
fatigue, annorhexia
dry cough, progressign to wet with some blood
weight loss and low grade fever
night sweats
28
Q

TB labs

A

DEFINITIVE DIAGNOSIS BY CULTURE OF M TUBERCULOSIS X 3
AFB ssmear are presumptive evidence of active TB
small momogenious infiltrate in Upper lobes on CR
PPD shows exposure but is not diagnositic for active disease

29
Q

TB managemnt

A

local helath department, must be notified

hospitilization is not required

30
Q

TB meds

A

Isoniazid 300mg, rifampin 600mg, pyrazinamide 1.5-2.0 gm and ethambutol 15mg per kg per day initially

if the isolate is succeptable tto INH and RIF than you can drop ethambutol

3 drugs for 2 months, and 4 months of INH and RIF daily

31
Q

TB meds INH

A

nephro toxic

32
Q

TB meds consideration

A

persons iwth HIV should be treated for 9 months

depot injections are available

33
Q

Pulm tb patient monitoring

A

weekly sputum smears and cultures for 6 weeks, and then monthly untill negative cultures, persistant symptoms or cultures should raise suspicion for resistance

34
Q

baseline before TB therapy

A

liver labs, and watch for red-green color acuity in efambutol

35
Q

Chemoprophylaxis and PPD

A

positive PPD of 5mm for an HIV +, contact with a known positive or chest film typical of TB

10mm for immagrants or health care workers

15mm for no in high prevelance groups

36
Q

Pneumonia def

A

lower respirartoy infection, strep pneumonia is the most common etilolgical agent of CAP

37
Q

Pneumonia s and s

A

fever, shaking chills, lung consolidaiton on physical exam, malise and fremitus

38
Q

Pneumonia labs

A 
elevated WBC's 
infiltrates on CXR
GS and culture if indicated
ABG for respiratory faiure
CXR and consider 3 blood cultures
39
Q

CAP in previously healthy pt abx

A

macrolide (mycins) or tetracycline (clclines)

40
Q

CAP in comorbid patints abx

A 
floriquinolone (oxacins) + Amoxicillin/clavulanic acid#
Imipenem/cilastatin#
Imipenem/cilastatin/relebactam.
Ampicillin/flucloxacillin.
Ampicillin/sulbactam (Sultamicillin)
Ceftazidime/avibactam.
Piperacillin/tazobactam.
Ceftolozane/tazobactam
41
Q

Non ICU CAP

A

oxacins or beta lactam + macrolide or tetracycline

42
Q

ICU CAP if P aeruginosa suspected

A

pip/tazo or meropenem or cefepime _ AMG/azithromycin

add vanco if MRSA pnu is suspected

43
Q

ICU PNU - viral

A

still gets abx for secondary bacterial infetion- tamflu if in the first 48 hrs

44
Q

abx for PCN allergy patients

A

aztreonam

45
Q

for pseudomonas PNU use

A

zosyn plus cipro

46
Q

HAP definition

A

pneumona that occurs 48hours or more after aadmission whih was not incubation the time of admission includs VA and HCAP, most common is Staphylcoccus aureus or streptococcus

47
Q

VAP definition

A

pneumona that arisis more than 48-72 hours after endotracheal intubation pseudomonas is most common orginization

48
Q

Penumothorax -

A

gas in the pleural space that raises pleural pressures and can impair respiration, resulting in a “collapsed lung”

49
Q

S and S of pneumothorax

A

chest pain, dypsnea, cough
HYPERROSONANCE ON THE AFFECTED SIDE
diminshed breaht sounds and fremitice on the affected side
mediastinal shift towards the unnafected side in the case of tension
hypotension

50
Q

Pneumothorax labs

A

CHEST X RAY IS DIAGNOSTIC

abg my be indicated

51
Q

pneumothorax management

A

<20% pneumothorax in asymptomatic patinents requires no intervention
chest tube first if available, needle throcostomy

52
Q

needle thoracostomy site

A

2nd intercostal space mid clavicular line

53
Q

chest tube placement site

A

4th or 5th ics Mid axillary

54
Q

PE definition

A

leading cause of inhospital death leads to faillure of left ventricle.

55
Q

PE S AND S

A

usually occur abruptly
unexplained dyspnea and taccy are most common
chest pain, retrosternal or lateralized and pleuritic

56
Q

PE diagnosis

A

spiral CT
vq scan in all clinicallly stable patients
reflexive hyperventilation causes hypercapnea
pulmonary angiography when clinical data and vq scan contradictory or those at great risk from anticoagulation with high probability VQ scan.

57
Q

PE managemtn

A

supplamental 02
IV fluids, for hypotension and reduced Cardiac output
tube for change in mental status
heparin 80u/kg bolus followed by 18u/kg to ptt of 1.5-2x normal, coumadin simultaneus to inr of 2-3

58
Q

finrinolytic therapy for PE

A

for those withh hemodynamic compromise or shock before starting hepairn, PT and PT myst be <2x normal

59
Q

ARDS- management

A

TV 5-7 or 6-8 ml/kg ideal body weight,

peep of 10

60
Q

ARDS

A

refractroy hypoxemia

61
Q

assist control

A

pt can trigger and gets set volume

62
Q

SIMV

A

preset numebr of breaths at preset volume, can take own breath at whatever volume they want

63
Q

FVC

A

volume of gas forcefully expelle from lungs after max inspiration

64
Q

FEV1

A

expelled over 1 second

65
Q

pleural effusion serum protien

A

one or more of the following equals exudate
pleural fluid protein to serim protein ration is >0.5
pleural fluid LDH to serum LDH ration is >0.6
Pleural fluid LDH is greter than 2-3 the upper limit of normal serum LDH (140-280u/L)

transudates have none of these features

66
Q

RML think

A

aspiration PNU

issues and policy (22 decks)

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