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PULMO Flashcards

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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
Loeffler's syndrome cause & tx
Strongyloides infxn Tx: thiebendazole
26
Hypersensitivity pneumonitis findings?
Type 3-4 hypersensitivity BAL NO EOSINOPHILS, lymphocytic, CD 8 > CD4 CXR groundglass
27
Lung reduction surgery for COPD
Fev1
28
Lung transplant in COPD
Fev1
29
COPD going for flight
Maintain paO2 > 70
30
Criteria for O2 in COPD
Pao2 55
31
Copd w/ fev1
Roflumilast
32
What has shown to dec exacerbations in copd?
Abx for 5 days every 8 weeks (azithro, moxi)
33
GOLD criteria for COPD
Fev1 > 80 -- mild | Fev1 55 -- very severe
34
Tx per stage of copd
Mild - b agonist prn Mod - tiotropium +/- salmeterol Severe - steroids Very severe- O2
35
Treatment for high altitude sickness/pulmonary edema
Descent Dexamethasone Prophy: acetazolamide
36
What vaccine has been shown to dec mortality in copd
Influenza
37
Extensive bilateral basal bullous emphysema in young px, what to check?
Alpha 1 anti-trypsin
38
Young px w/ apical bullous changes
Check for custic fibrosis
39
Kartagener's syndrome
Dyskinetic cilia syndrome Beonchiectasis, situs inversus, infertility, sinusitis Screen: sperm motility test Confirm: testicular or bronchial biopsy
40
Treatment of cystic fibrosis
Chest PT, antibiotics (topical ti tamycin spray) bronchodilators, human ribonuclease (to dec viscosity of sputum)
41
Which abx has shown to reduce decline in lung fxn in cf?
Azithromycin
42
T/F surgical resection is required for massive hemoptysis in pxs w/ cf
F Bronchial artery embolization
43
(N) BAL
44
BAL: | CD8 > CD4
Hypersensitivity pneumonitis
45
BAL: | CD4 > CD8
Sarcoidosis
46
BAL with eosinophils
Hypersensitivity pneumonitis
47
BAL with inclusion bodies
CMV
48
BAL with foamy lamellar inclusions
Amiodarone
49
Stain for PCP
Silver methanamine
50
REMEMBER CT SCREENING GUIDELINES FOR PULMO NODULES
***
51
Def of apnea & OSA
Apnea: no breath > 10 secs OSA: >10 apneic episodes/ hr
52
Dxtic & tx of OSA
Dx: polysomnography Tx: CPAP
53
Tx of rhinitis medicamentosa
Steroids
54
Obesity + chronic resp failure (hypercarbia, hypoxemia)
Obesity hypoventilation syndrome
55
Tx for narcolepsy
Methylphenidate Modafenil Sodium oxybate (for cataplexy)
56
Indication for steroids in ILD
``` CNS involvement Eye involvement Severe disfigurement Myocardial involvement Progressive pulmo dse Persistent hypercalcemia ```
57
Stages of Sarcoidosis
I- hilar adenopathy II- adenopathy + infiltrates III- infiltrates alone
58
When to treat sarcoid
Only if symptomatic
59
Findings in IPF
``` Sx > 6mos No cause Honeycombing in lung BAL: inc neutrophils Circulating immunocomplexes ```
60
Lung involvement in asbestos vs silicosis
Upper: silicosis Lower: asbestosis
61
Associations in asbestos vs silicosis
Asbestos: mesothelioma, bronchogenic CA Silicosis: TB
62
CXR findings in asbestos vs silicosis
Asbestos: pleural or diaphragmatic plaques Silicosis: eggshell calcification w/ hilar LN
63
Berrylliosis?
Meral workers | Will also show noncaseating granulomas
64
BAL: langerhans or giant cells
Histiocytosis X
65
Drugs w/c cause hypersensitivity pneumonitis
MTX, nitrofurantoin, rituximab
66
Classification of pulmo HTN
``` I- idiopathic II- 2ndary to cardiac dse III- 2ndary to pulmo dse IV- chronic thromboembolic V- others ```
67
Which classes of pulmo HTN do you treat w: warfarin?
Class I and IV
68
Mainstay of tx in pulmo HTN
Warfarin
69
Dxtic for pulmo HTN
Echo then R heart cath w/ vasodilator studies
70
Normal PAP
25/15 with mean of 14 mmHg at rest
71
Dx of pulmo HTN
PAP > 25 at rest > 30 on exertion
72
If px w/ pulmo HTN does not respond to vasodilators?
Mild sx: sildenafil, tadafil, bosentan Mod sx: + IV prostacyclin Severe sx: Inhaled iloprost
73
Tx for pulmo HTN responsive to vasodilators
Nifedipine, diltiazem
74
V/Q scan finding for PE
2 or more segmental defects without matching ventilation defect Subsegmental defects or matched defects are indeterminate - check for DVT
75
Leading cause of death in CF
Burkholderia cepacia Tx: bactrim
76
Indication for thrombolysis
Massive PE | Large DVT
77
Petecchiae over the chest, sudden SOB
Fat embolism
78
Px with dvt on warfarin has bleeding, what to do?
D/c warfarin and give asa 325 mg
79
Acute ortho fx are receive dvt prophylaxis for how long?
4-6 wks
80
HCAP definition
``` Px w/in 90 days post hospitalization W/in 30 days of wound care NH Chemo Dialysis ```
81
Most common cause of pneumonia
Strep pneumonia
82
Common pathogen of pneumonia in young adults (w/ bullous myringitis, erythema multiforme)
Mycoplasma Dx: serum IgM, cold agglutinins Tx: macrolide
83
Good sputum sample
Epithelial cells 25
84
How long is legionella pneumonia treated
2 wks w/ macrolide +/- rifampin
85
Common pathogen in neutropenic
Strep, staph, pseudomonas, aspergillus
86
CURB 65
Confusion, BUN > 19, RR > 30, BP
87
Common pneumonia pathogen in COPD/DM
Haemophilus
88
Outbreak of influenza in nursing home
Oseltamivir x 2 wks + vaccine If no vaccine, oseltamivir x 6 wks
89
Ppd + at 5mm
Hiv Organ transplant On steroids (pred > 15mg x 3 mos) Px w/ recent active TB contact
90
PPD + CXR + but no sx, what to do?
Induce sputum afb
91
Ppd pos, cxr neg
Inh x 9 mos Rifampicin x 4 mos Inh 900 mg + rifampentine 900 mg weekly x 3 mos

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