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PULMO Flashcards

1
Q

Flow loops:

Diff bet COPD & BA?

A

DLCO dec in COPD, (N) or inc in BA

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2
Q

Flow loops:

Diff bet intra & extrathoracic obstruction?

A

DLCO is dec in intrathoracic, (N) in extrathoracic

RV dec in intrathoracic, inc in extrathoracic

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3
Q

Flow loops:

What differentiates obstructive fr restrictive?

A

TLC

Inc in obstructive, dec in restrictive

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4
Q

When to use leukotriene modifiers?

A

Add on for mild/mod/severe asthma

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5
Q

Criteria for intermittent asthma?

A

daytime sx

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6
Q

Tx for mild persistent asthma

A

Low dose inhaled steroid

Or leukotriene modifier Or cromolyn

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7
Q

Mech of cromolyn

A

Mast cell stabilizer

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8
Q

Tx for moderate persistent asthma

A

Med dose steroids + LABA

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9
Q

Criteria for mod persistent asthma

A

Daytime sx daily, night sx weekly

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10
Q

Anti-IgE for asthma

A

Omalizumab

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11
Q

What can dec freq of exacerbation in asthma?

A

Tiotropium

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12
Q

Flow of meds in exercise-induced asthma?

A

B agonist - cromolyn - inhaled steroids/montelukast

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13
Q

Sx similar to asthma, PFT (n), methacholine challenge neg

A

Non-asthamatic eosinophilic bronchitis

Check sputum for eos

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14
Q

For ASA-sensitive asthma, what to use?

A

D/C asa, avoid nsaids

May use montelukast, codeine based analgesics

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15
Q

Byssinosis

A

Allergy to cotton dust

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16
Q

Pathology in alveolar proteinosis

A

Defective macrophages causing build up

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17
Q

Dxtic in alveolar proteinosis

A

BAL showing tan colored fluid

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18
Q

Tx in alveolar proteinosis

A

Whole lung lavage

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19
Q

Eosinophilic pneumonia presentation

A

Sob, fever, cough

BAL shows eosinophils

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20
Q

CXR in acute vs chronic eosinophilic pneumonia

A

Acute: ground glass
Chronic: very peripheral infiltrates

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21
Q

Tx of eosinophilic pneumonia

A

Steroids

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22
Q

Dx of ABPA

A

(Allergic)
Type 1 hypersensitivity rxn
Serum igE, IgM

(Bronchopulmonary)
Brown mucus plugs
Migratory infiltrates

(Aspergillosis)
skin testing pos for aspergillus

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23
Q

Tx of ABPA

A

Steroids

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24
Q

Asthma + vasculitis

A

Churg-strauss

Tx: steroids

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25
Q

Loeffler’s syndrome cause & tx

A

Strongyloides infxn

Tx: thiebendazole

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26
Q

Hypersensitivity pneumonitis findings?

A

Type 3-4 hypersensitivity
BAL NO EOSINOPHILS, lymphocytic, CD 8 > CD4
CXR groundglass

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27
Q

Lung reduction surgery for COPD

A

Fev1

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28
Q

Lung transplant in COPD

A

Fev1

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29
Q

COPD going for flight

A

Maintain paO2 > 70

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30
Q

Criteria for O2 in COPD

A

Pao2 55

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31
Q

Copd w/ fev1

A

Roflumilast

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32
Q

What has shown to dec exacerbations in copd?

A

Abx for 5 days every 8 weeks (azithro, moxi)

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33
Q

GOLD criteria for COPD

A

Fev1 > 80 – mild

Fev1 55 – very severe

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34
Q

Tx per stage of copd

A

Mild - b agonist prn
Mod - tiotropium +/- salmeterol
Severe - steroids
Very severe- O2

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35
Q

Treatment for high altitude sickness/pulmonary edema

A

Descent
Dexamethasone

Prophy: acetazolamide

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36
Q

What vaccine has been shown to dec mortality in copd

A

Influenza

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37
Q

Extensive bilateral basal bullous emphysema in young px, what to check?

A

Alpha 1 anti-trypsin

38
Q

Young px w/ apical bullous changes

A

Check for custic fibrosis

39
Q

Kartagener’s syndrome

A

Dyskinetic cilia syndrome

Beonchiectasis, situs inversus, infertility, sinusitis

Screen: sperm motility test

Confirm: testicular or bronchial biopsy

40
Q

Treatment of cystic fibrosis

A

Chest PT, antibiotics (topical ti tamycin spray) bronchodilators, human ribonuclease (to dec viscosity of sputum)

41
Q

Which abx has shown to reduce decline in lung fxn in cf?

A

Azithromycin

42
Q

T/F surgical resection is required for massive hemoptysis in pxs w/ cf

A

F

Bronchial artery embolization

43
Q

(N) BAL

44
Q

BAL:

CD8 > CD4

A

Hypersensitivity pneumonitis

45
Q

BAL:

CD4 > CD8

A

Sarcoidosis

46
Q

BAL with eosinophils

A

Hypersensitivity pneumonitis

47
Q

BAL with inclusion bodies

48
Q

BAL with foamy lamellar inclusions

A

Amiodarone

49
Q

Stain for PCP

A

Silver methanamine

50
Q

REMEMBER CT SCREENING GUIDELINES FOR PULMO NODULES

51
Q

Def of apnea & OSA

A

Apnea: no breath > 10 secs
OSA: >10 apneic episodes/ hr

52
Q

Dxtic & tx of OSA

A

Dx: polysomnography

Tx: CPAP

53
Q

Tx of rhinitis medicamentosa

54
Q

Obesity + chronic resp failure (hypercarbia, hypoxemia)

A

Obesity hypoventilation syndrome

55
Q

Tx for narcolepsy

A

Methylphenidate
Modafenil
Sodium oxybate (for cataplexy)

56
Q

Indication for steroids in ILD

A 
CNS involvement
Eye involvement
Severe disfigurement
Myocardial involvement
Progressive pulmo dse
Persistent hypercalcemia
57
Q

Stages of Sarcoidosis

A

I- hilar adenopathy
II- adenopathy + infiltrates
III- infiltrates alone

58
Q

When to treat sarcoid

A

Only if symptomatic

59
Q

Findings in IPF

A 
Sx > 6mos
No cause
Honeycombing in lung
BAL: inc neutrophils
Circulating immunocomplexes
60
Q

Lung involvement in asbestos vs silicosis

A

Upper: silicosis
Lower: asbestosis

61
Q

Associations in asbestos vs silicosis

A

Asbestos: mesothelioma, bronchogenic CA

Silicosis: TB

62
Q

CXR findings in asbestos vs silicosis

A

Asbestos: pleural or diaphragmatic plaques
Silicosis: eggshell calcification w/ hilar LN

63
Q

Berrylliosis?

A

Meral workers

Will also show noncaseating granulomas

64
Q

BAL: langerhans or giant cells

A

Histiocytosis X

65
Q

Drugs w/c cause hypersensitivity pneumonitis

A

MTX, nitrofurantoin, rituximab

66
Q

Classification of pulmo HTN

A 
I- idiopathic
II- 2ndary to cardiac dse
III- 2ndary to pulmo dse
IV- chronic thromboembolic 
V- others
67
Q

Which classes of pulmo HTN do you treat w: warfarin?

A

Class I and IV

68
Q

Mainstay of tx in pulmo HTN

69
Q

Dxtic for pulmo HTN

A

Echo then R heart cath w/ vasodilator studies

70
Q

Normal PAP

A

25/15 with mean of 14 mmHg at rest

71
Q

Dx of pulmo HTN

A

PAP > 25 at rest > 30 on exertion

72
Q

If px w/ pulmo HTN does not respond to vasodilators?

A

Mild sx: sildenafil, tadafil, bosentan
Mod sx: + IV prostacyclin
Severe sx: Inhaled iloprost

73
Q

Tx for pulmo HTN responsive to vasodilators

A

Nifedipine, diltiazem

74
Q

V/Q scan finding for PE

A

2 or more segmental defects without matching ventilation defect

Subsegmental defects or matched defects are indeterminate - check for DVT

75
Q

Leading cause of death in CF

A

Burkholderia cepacia

Tx: bactrim

76
Q

Indication for thrombolysis

A

Massive PE

Large DVT

77
Q

Petecchiae over the chest, sudden SOB

A

Fat embolism

78
Q

Px with dvt on warfarin has bleeding, what to do?

A

D/c warfarin and give asa 325 mg

79
Q

Acute ortho fx are receive dvt prophylaxis for how long?

80
Q

HCAP definition

A 
Px w/in 90 days post hospitalization
W/in 30 days of wound care
NH
Chemo
Dialysis
81
Q

Most common cause of pneumonia

A

Strep pneumonia

82
Q

Common pathogen of pneumonia in young adults (w/ bullous myringitis, erythema multiforme)

A

Mycoplasma

Dx: serum IgM, cold agglutinins
Tx: macrolide

83
Q

Good sputum sample

A

Epithelial cells 25

84
Q

How long is legionella pneumonia treated

A

2 wks w/ macrolide +/- rifampin

85
Q

Common pathogen in neutropenic

A

Strep, staph, pseudomonas, aspergillus

86
Q

CURB 65

A

Confusion, BUN > 19, RR > 30, BP

87
Q

Common pneumonia pathogen in COPD/DM

A

Haemophilus

88
Q

Outbreak of influenza in nursing home

A

Oseltamivir x 2 wks + vaccine

If no vaccine, oseltamivir x 6 wks

89
Q

Ppd + at 5mm

A

Hiv
Organ transplant
On steroids (pred > 15mg x 3 mos)
Px w/ recent active TB contact

90
Q

PPD + CXR + but no sx, what to do?

A

Induce sputum afb

91
Q

Ppd pos, cxr neg

A

Inh x 9 mos
Rifampicin x 4 mos
Inh 900 mg + rifampentine 900 mg weekly x 3 mos

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