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clin med > Pulm > Flashcards

Pulm Flashcards

1
Q

spirometry

A

Measures flow rate and volume in inhalation and exhalation

Measures respiratory capacity

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2
Q

FEV1 baries based on

A

gender, age, height, ethnicity

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3
Q

sx asthma

A

vary, seasonal/allergies, wheezing, cough, breathlessness, chest tightness/discomfort

allergies and nasal polyps, accessory muscle use, hyperexpansion of chest and hunched shoulders, tachycardic, pulsus paradoxus, wheezing, long expiration

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4
Q

asthma

A

Spirometry will show obstructive pattern with bronchodilator (BD) response (witches hat)
Allergy testing, chest xray and bronchial provocation

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5
Q

intermittent asthma meds

A

No daily meds just SABA PRN

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6
Q

mild persistent asthma meds

A

Low dose inhaled steroid. If that does not work, then use a leukotriene modifier such as theophylline

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7
Q

moderate persistent asthma meds

A

Low dose inhaled steroid and LABA or medium dose inhaled steroid. If that does not work, give low dose inhaled steroid and leukotriene modifier such as theophylline

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8
Q

severe persistent asthma meds

A

High dose inhaled steroid and LABA

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9
Q

acute management asthma meds

A

immediate SABA (albuterol). If no complete response within 20 minutes, five 3 more SABA trmts in within 1 hour. If still no response, give oral or IV corticosteroids. If it is still not working, admit pt

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10
Q

emerency asthma meds

A

give Epi

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11
Q

what vassines should asthma pts get

A

influenza, pertussis, and pneumonia

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12
Q

copd?

A

Chronic bronchitis + emphysema that leads to a fixed airway obstruction

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13
Q

copd complications

A

Resp. Infections (bronchitis and pneumonia)
Heart failure (hard to get air in lungs? Hard to get blood too)
Cardiac ischemia

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14
Q

ss copd

A

Daily productive cough 3 months or more for at least 2 yrs, high HgB, rhonchi, wheezing, peripheral edema, CXR hyperinflation and flat diaphragm, ABG and SpO2 are lower, Inc CO2 leads to respiratory acidosis and they compensate by metabolic alkalosis

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15
Q

dx copd

A

Spirometry- concave witches hat pattern
Peak expiratory flow is NOT a criteria like asthma
DLCO
CXR- hyperinflated and flat diaphragm on emphysema
CBC
Oximetry
ABG
Serum alpha 1 antitrypsin in pts under 45

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16
Q

trmt copd

A

Inhaled ipratropium (SAMA) with or without albuterol (SABA)
LABA or LAMA
Oral theophylline if not responsive to other meds
Lung transplant, lung reduction volume, bullectomy

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17
Q

copd exacerbation

A

IV ATB such as macrolides (azithromycin) in patient

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18
Q

emergency copd

A

breathing trmt with SAMA/SABA like albuterol and ipratropium, CPAP, BiPAP, intubation, vent support

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19
Q

copd vaccines?

A

Get flu and pneumonia vaccines

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20
Q

CF triad sx

A

COPD
Pancreatic exocrine insufficiency
High sweat electrolyte concentrations

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21
Q

Bacterial pneumonia caused by staph aureus then pseudomonas aeruginosa (not in many other conditions). Pseudomonas aeruginosa is impossible to get rid of

A

cf

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22
Q

dx cf

A

sweat chloride test

if ng get dna test- 7q

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23
Q

cf trmt

A

Minimize airway reactivity and infections

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24
Q

MC bacteria in bronchiectasis sputum are

A

H influenzae, pseudomonas aeruginosa, and strep pneumoniae

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25
Q

Sx bronchiectasis

A

dyspnea, wheezing, chest pain, crackles, productive cough

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26
Q

dx bronchiectasis

A

XCR- dilated airways and mucus plugging

CT- airway changes

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27
Q

MC of the interstitial lung diseases

A

Idiopathic pulmonary fibrosis/ Idiopathic interstitial pneumonia

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28
Q

Idiopathic pulmonary fibrosis/ Idiopathic interstitial pneumonia is a dx of____

A

exclusion

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29
Q

Idiopathic pulmonary fibrosis/ Idiopathic interstitial pneumonia sx

A

Hypoxemia, inspiratory crackles, tachypnea

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30
Q

Idiopathic pulmonary fibrosis/ Idiopathic interstitial pneumonia dx

A

1st a Physical exam
2nd High resolution thin cut (HRTC) CT chest shows interstitial reticular linear changes and possible honeycombing
3rd Bloodwork to r/o rheum markers
4th Special studies
Bronchoalveolar lavage- r/o infections and malignancies
Transbronchial biopsy- r/o sarcoidosis, malignancy, TB
Surgical open lung biopsy- gold standard, but it’s riskier

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31
Q

Idiopathic pulmonary fibrosis/ Idiopathic interstitial pneumonia trmt

A

high dose steroids

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32
Q

UIP- usual interstitial pneumonia (a type of IPF)

A

progressive scarring of the lungs

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33
Q

UIP- usual interstitial pneumonia (a type of IPF) trmt

A

steroids, Antifibrotic and immunosuppressive modulators Not responsive
Only definitive trmt is a long transplant

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34
Q

Idiopathic pulmonary fibrosis/ Idiopathic interstitial pneumonia can be caused by this medicine

A

amiodarone

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35
Q

pts taking amiodarone should get this frequently

A

pft

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36
Q

Pneumoconiosis sx

A

Sx: weak, pale, cyanotic, rhonchi, wheezing, crackles/rales (heard on inspiration), pleural friction rub

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37
Q

Pneumoconiosis dx

A

PFT- restrictive
DLCO- reduced diffusion
CXR- linear/reticular interstitial marlins in the lower and mid lung fields and calcified thickening along the chest wall/diaphragm, ground glass appearance
Note: lung biopsy not needed

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38
Q

Pneumoconiosis trmt

A

supplemental O2

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39
Q

Lung cancer and mesothelioma are huge concerns!

A

pneumonicosis

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40
Q

sarcoidosis?

A

Inflammatory disease with noncaseating granulomas

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41
Q

sarcoidosis cause

A

Unknown cause possibly propionibacter acnes

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42
Q

Mc in nordic population

A

sarcoidosis

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43
Q

sarcoidosis sx

A

Multisystem- need 2+ organs to dx

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44
Q

sarcoidosis dx

A

XCR- shows micronodular interstitial densities and nodular granulomatous changes
Chest CT- nodules and mediastinal hilar adenopathy

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45
Q

sarcoidosis trmt

A

Single organ: topical therapy

Multi-organ: oral steroids

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46
Q

sarcoidosis pts must have this test done

A

ophthalmic

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47
Q

pe ss

A

Ss: Sudden onset dyspnea, hypoxemia, tachycardia, light headed

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48
Q

pe dx

A

CXR normal
Chest CT with contrast (angio/spiral ct) shows small arterial emboli
VQ scan- old standard before CT, used only if pt has dye allergy
Serum D dimer should be positive
Ekg should be normal, but if you see S1Q3T3, it’s most likely PE

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49
Q

pe trmt with rhf and hypotension

A

thrombolysis or thrombectomy

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50
Q

pe trmt with normal r ventricle function

A

anticoagulation
Heparin drip
Anticoagulation for 6 months (or 3 if only DVT)

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51
Q

sx pulm htn

A

Sx: dyspnea, chest pain, fatigue, peripheral edema, syncope

52
Q

dx pulm htn

A

Measure right heart pressure by echocardiogram, swann-ganz catheter, right heart catheterization (gold std)

53
Q

Classification of pulmonary HTN

A

WHO group 1- idiopathic, younger pts, more females than males
WHO group 2- from left heart disease
WHO group 3- from lung disease or hypoxemia
WHO group 4- secondary to chronic thromboembolism
WHO group 5- from blood disorders, systemic disorders, and metabolic disorders, miscellaneous

54
Q

WHO group 1 pulm htn trmt

A

PDE 5 inhibitor (phosphodiesterase) (sildenafil)
Endothelin receptor antagonists (bosentan, ambrisentan)
cGMP stimulator/vasodilator
Prostaglandin- relax arterial smooth muscles

55
Q

cor pulmonale

A

RV systolic and diastolic failure from lung disease or pulmonary CV disease

56
Q

MCC from tobacco and exposure to heating/cooking fuel

A

cor pulmonale

57
Q

cor pulmonale ss

A

Lower extremity edema, inc abdominal girth, dyspnea on exertion, inspiratory crackles, pulsatile liver with ascites, JVD, high serum Cr, abnormal liver function, albuminuria, paracentesis (clear straw colored fluid, a transudate), tachycardia with RAD (enlarged right heart), worsening renal failure

58
Q

dx cor pulmonale

A

EKG shows: RVH, RV and RA dilated, tricuspid regurgitation, RVSP 100 mmHg normal is 12-25)

59
Q

trmt cor pulmonale

A

IV diuretics, supplemental O2, Digoxin (inotrope)

60
Q

Meniscus sign on CXR

A

pleural effusion

61
Q

milky pleural effusion that clears with spinning

A

cells

62
Q

milky pleural effusion that does not clear with spinning

A

lipids- chylothorax

63
Q

pleural effusion: Hematocrit > 50%

A

hemothorax

64
Q

pleural effusion Hematocrit 1- 50%

A

cancer

65
Q

richard lights criteria is for

A

pleural effusion

66
Q

trmt open pneumothorax

A

cover it mechanically

67
Q

sx pneumothorax

A

Hypotension, tachycardia, rise in airway pressure, no breath sounds on affected side, percussion on affected side, trachea deviation, hyperexpanded chest

68
Q

small asymptomatic < 15% pneumothorax trmt

A

observe it to see if it can resolve itself

69
Q

large but <30% width pneumothorax trmt

A

thoracentesis or pleural catheter

70
Q

large >30% width pneumothorax trmt

A

tube thoracostomy

71
Q

after 2nd pneumo trmt

A

pleurodesis

72
Q

pneumo trmt in field

A

needle throacostomy

73
Q

pneumo trmt in hospital

A

chest tube

74
Q

Fleischners society criteria- interprets

A

pulmonary nodules

75
Q

Pulmonary nodules dx

A

MUST get chest CT +/- PET scan

76
Q

Acute respiratory distress syndrome ARDS?

A

Fluid builds up in the alveoli/parenchyma of the lungs from leaky vessels
Alveoli collapse and impair O2 exchange

77
Q

causes Acute respiratory distress syndrome ARDS ?

A

sepsis, toxic inhalation, severe pneumonia, head/chest trauma

78
Q

sx Acute respiratory distress syndrome ARDS

A

Worsening SOB and resp failure; looks like heart failure but involves the periphery many times; lag from when it occurs until when you develop sx
Labored rapid breathing, low bp, fatigue, hypoxia
General criteria:
Resp sx within 1 wk of incident
CXR shows Bilateral opacities/fluid (pulm edema)
Resp failure not explained by CHF or fluid overload
Oxygenation impairment

79
Q

dx ards

A

CXR shows Bilateral opacities/fluid (pulm edema)

80
Q

Hyaline membrane disease (HMD) or neonatal respiratory distress syndrome (RDS) is due to

A

not enough surfactant in babies lungs

81
Q

Will worsen in the first 48-72 hours, but improves with trmt

A

HMD

82
Q

epiglottitis cause

A

HiB (MC), streptococci, staph aureus

83
Q

risk factors Croup/ Laryngotracheobronchitis

A

Recurrent URI
Upper abnormalities such as stenosis and strictures
GERD
Intubation issues

84
Q

MCC Croup/ Laryngotracheobronchitis

A

Parainfluenza virus 1 is the MCC

85
Q

____ can occur secondarily in Croup/ Laryngotracheobronchitis

A

bacterial infection

86
Q

sx Croup/ Laryngotracheobronchitis

A

Gradual, nasal irritation, congestion, fever, hoarseness, barking/seal cough, striador

87
Q

dx Croup/ Laryngotracheobronchitis

A 
Neck x ray- Steeple sign
CBC if you think a bacteria caused it
Westly croup severity scoring system- determines trmt
Mild- 2 or less
Moderate- 3 to 7
Severe- 8+
88
Q

trmt Croup/ Laryngotracheobronchitis

A

Mild: home, supportive, hydration, humidity
Moderate: support, ER, steroids, bronchodilators, admit to hospital
Severe: ER, admit, aggressive

89
Q

Excessive lacrimation and conjunctival injection are important early clinical findings

A

catarrhal phase of pertussis

90
Q

Hallmark sx- paroxysmal cough

A

paroxysmal phase pertussis

91
Q

dx pertussis

A 
Cough less than 2 wks?
Culture and PCR
Cough 2-4 wks?
PCR only (bc culture sensitivity declines)
Cough 4+ wks?
Only serology
92
Q

trmt pertussis

A

Most ppl fight this off without ATB (azithromycin/zithromax) within 6 wks
Catarrhal phase- ATB (azithromycin/zithromax) can decrease duration and cough, but it’s hard to catch in this phase
You can treat with ATB later, but it will only prevent the infection from spreading to others
Hydration, mucolytics, control airway

93
Q

9th MC illness in outpt

A

acute bronchitis

94
Q

MCC acute bronchitis

A

flu

95
Q

sx acute bronchitis

A

Last 5-7 days
Productive or nonproductive cough that lasts over 5 days
Infection may go aways, but inflammation does not so the cough won’t go away

96
Q

trmt acute bronchitis

A

Cough suppressants, antipyretics, SABA, steroids, atb if sputum is present

Treat the inflammation to treat the disease. You’ll need more than 1 medication to do so or else the disease will “bounce back”. If you don’t treat the disease, pts think they have the worst cold ever or a bad case of bronchitis

97
Q

bronchiolitis?

A

Virus infects bronchiolar epithelial cells on small bronchi and bronchioles. These infected cells secrete mucus and swell which cause the airways to obstruct and may collapse
Starts as an URI then infects the LRT

98
Q

risk factors bronchiolitis?

A

Children less than 2 yo

Toxic fumes, viral infections, transplant, CT disease

99
Q

mcc bronchiolitis?

A

RSV

100
Q

sx bronchiolitis?

A

Cough, dyspnea, wheezing or crackles, inflammation in airways less than 2mm in diameter
Clinical course
1- viral URI symptoms
2- increased respiratory effort such as nasal flaring, sternal retractions, SOB, tachypnea, wheezing
If severe, you may see, hypoxemia, apnea, acute respiratory failure

101
Q

dx bronchiolitis?

A

Clinical but you’ll see…
PFT- airflow obstruction
CXR- normal

102
Q

trmt bronchiolitis?

A

Healthy: self limited, support
Sick: hydration, ventilation, mucolytics, suctioning, bronchodilators

103
Q

MCC lower respiratory infections in kids less than 1

A

RSV

104
Q

MCC medical admissions in kids under 5

A

RSV

105
Q

Almost all kids have been infected by age 2

A

RSV

106
Q

Dx RSV

A

Isolate virus in HEp-2 cells- ID plaques with syncytium formation
Rapid assay-
nasal swabbing

107
Q

trmt RSV

A

Support
Inhaled bronchodilators- use in kids with asthma or RAD, but NOT routinely
Corticosteroids- use in older children and adults but NOT infants
Ribavirin- can give to infants but not routinely

108
Q

MC mechanism is upper airway colonization by aspirated organisms

A

pneumonia

109
Q

pneumonia?

A

Infection of the parenchyma dt bacteria, viruses, fungi, and parasites

110
Q

cause Community acquired/typical pneumonia?

A

MCC is streptococcus pneumoniae/pneumococcus but H flu and moraxella can also cause it

111
Q

sx Community acquired/typical pneumonia?

A

Rust colored sputum, fever, chills, shaking,

112
Q

dx Community acquired/typical pneumonia?

A

CXR- lobar infiltrates

113
Q

trmt Community acquired/typical pneumonia?

A

In healthy: Macrolide (clarithromycin or azithromycin) or fluoroquinolone (levofloxacin, moxifloxacin)
If hospitalized and not in the ICU: IV beta lactam (cefuroxime, cefotaxime, ceftriaxone, ampicillin-sulbactam) and IV macrolide (erythromycin or azithromycin)
Follow up 3-4 days later. If no response to therapy, get a CXR to r/o bronchogenic carcinoma

114
Q

atypical pneumonia cause

A

Mycoplasma pneumoniae, chlamydia pneumoniae, legionella pneumophila

115
Q

atypical pneumonia dx

A

CXR- bilateral diffuse wispy infiltrates

116
Q

atypical pneumonia trmt

A

beta lactam + antipseudomonal fluoroquinolone or aminoglycoside

117
Q

Hospital acquired/nosocomial pneumonia risk factors

A

Intubation, nasogastric tube feeding, pre existing lung disease, multisystem failure

118
Q

Hospital acquired/nosocomial pneumonia causes

A

Aerobic gram - bacteria like pseudomonas, klebsiella, acinetobacter
Aerobic gram + cocci like staph aureus

119
Q

pneumonia sx

A

Productive cough, fever, pleuritic chest pain, dyspnea, fever, tachycardia, reduced oxygen saturation, rhonchi or rales, dullness to percussion (pulmonary effusion), egophony (from lung consolidation)

120
Q

elderly may have this as their only sx of pneumonia

A

change in mental status

121
Q

if you have diarrhea with your pneumonia, you prob have been infected by this organism

A

leigonella

122
Q

common cause of post influenza pneumonia

A

staph aureus

123
Q

complications pneumonia

A

Bacteremia, parapneumonic pleural effusion, empyema

124
Q

sx active tb

A

Sx: cough * 3 wks, chest pain, hemoptysis, fatigue, weight loss, anorexia, fever, night sweats

125
Q

dx active tb

A

+PPD (purified protein derivative)
CXR- abnormal
Sputum culture- positive

126
Q

trmt tb

A

Long term ATB months - years (don’t need to know specific meds)

127
Q

Determine if tb is latent or active via

A

sputum culture

clin med (35 decks)

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