Pulmonary Flashcards
1
Q
Symptoms worse at night, nasal polyps, sensitivity to aspirin
A
asthma
2
Q
best initial test in acute asthma exacerbation
A
PEF or ABG
3
Q
most accurate test for asthma
A
PFTs
4
Q
characteristic PFTs in asthma
A
Decreased FEV1 (more so), decreased FVC, and decreased FEV1/FVC, increased DLCO
5
Q
result of albuterol challenge in asthma
A
increased FEV1 >12% or 200 ml
6
Q
result of methacholine challenge in asthma
A
Decreased FEV1 >20%
7
Q
increased IgE in asthma is associated with
A
allergic bronchopulmonary aspergillosis
8
Q
tx of asthma
A
inhaled SABA (albuterol)
9
Q
tx of asthma if albuterol is insufficient
A
add low dose corticosteroid
10
Q
tx if IgE positive asthma
A
omalizumab
11
Q
if SABA and corticosteroid are insufficient to treat asthma then
A
add LABA and/or increase corticosteroid
12
Q
if all other medical therapies are ineffective in asthma then
A
add oral steroids (prednisone)
13
Q
adverse effects of systemic steroids
A
osteoporosis, cataracts, adrenal suppression and fat redistribution, Hyperlipidemia, hyperglycemia, acne, hirsuitism, thinning of skin, striae, easy bruising
14
Q
adverse effects of inhaled steroids
A
dysphonia, oral candidiasis
15
Q
indicators of severity in acute asthma attack
A
RR, decreased PEF, ABG with increased Aa gradient
16
Q
asthma predisposes to
A
pneumothorax
17
Q
tx of acute asthma exacerbation
A
oxygen, albuterol, steroids
18
Q
most common cause of COPD
A
tobacco, destroys elastin
19
Q
COPD in young non smoker
A
alpha 1 antitrypsin deficiency
20
Q
best initial test for COPD
A
x ray (increased AP, flattened diaphragm)
21
Q
most accurate test for COPD
A
PFT
22
Q
characteristic PFTs in COPD
A
↓ FEV1, ↓ FVC, ↓ FEV1/FVC (<70%)
↑TLC (↑ residual volume)
↓ DLCO (emphysema, not chronic bronchitis)
23
Q
CBC finding in COPD
A
increased hematocrit
24
Q
cardiac findings in COPD
A
RA, RV hypertrophy, A fib or MAT, pulmonary HTN
25
when do you give oxygen in COPD
If pO2 <90%
26
tx that decrease mortality in COPD
smoking cessation, influenza and pneumoccocal vaccines, oxygen
27
tx if COPD not controlled with albuterol
inhaled anticholinergics (tiotropium, ipratropium) → inhaled steroid
28
Most common cause of acute exacerbations of chronic bronchitis
infections
29
most common cause of bronchiectasis
cystic fibrosis
30
Recurrent episodes of very high volume purulent sputum production, dyspnea, and wheezing
bronchiectasis
31
best initial test for bronchiectasis
x ray (tram tracks)
32
most accurate test for bronchiectasis
CT
33
tx for bronchiectasis
chest physiotherapy (cupping, clapping), rotate antibiotics (1 weekly each mo)
34
population that gets allergic bronchopulmonary aspergillosis
Almost exclusively in asthmastics with atopic disorders
35
Recurrent episodes of brown flacked sputum and transient infiltrates of x ray
allergic bronchopulmonary aspergillosis
36
tx of allergic bronchopulmonary aspergillosis
```
oral steroids (prednisone) if severe. Inhaled steroids are NOT effective
Itraconazole for recurrent episodes
```
37
tx for cystic fibrosis
antibiotics, inhaled recombinant human deoxyribonuclease, albuterol, pneumococcal and influenza vacccines
38
organism: CAP in COPD
H influenza
39
organism: CAP after recent viral infection
staph aureus
40
organism: CAP in alcoholic or diabetic
klebsiella
41
Currant jelly sputum, hemoptysis from necrotizing disease
klebsiella
42
organism: CAP with poor dentition
anaerobes
43
Foul smelling sputum “rotten eggs”
anaerobes
44
orgnaism: CAP in young healthy adult
mycoplasma pneumoniae
45
Dry cough, rarely severe, bullous myringitis
mycoplasma pneumoniae
46
dx of mycoplasma pneumoniae
PCR, cold agglutins, serology, special culture media
47
organism: CAP with horseness
chlamydia pneumoniae
48
dx of chlamydia pneumoniae
rising serologic titers
49
organism: CAP from ventillation
legionella
50
organism: CAP with GI (abdominal pain, diarrhea), or CNS (HA, confusion)
legionella
51
dx or legionella
urine antigen, culture on charcoal-yeast extract
52
organism: CAP with bird exposure
chlamydia psittaci
53
dx of chlamydia psittaci
rising serologic titers
54
organism: CAP with birthing animal exposure
coxiella burnetti
55
dx of coxiella burnetii
rising serologic titers
56
dx of PCP
bronchoalverolar lavage
57
best initial test in CAP
x ray
58
organisms in CAP, bilateral intersitital infiltrates, with dry productive cough
Mycoplasma, viruses, coxiella, PCP, chlamydia
59
next step in all new pleural effusions
thoracentesis
60
LDH >60%, protein >50%, WBC >1000, or pH <7.2
exudate = infection or CA = empyema
61
outpatient CAP tx in Previously healthy or no antibiotics for past 3mo and mild symptoms
Macrolide (azithromycin or clarithromycin) OR doxycycline
62
outpatient CAP tx in Comorbidities or antibiotics in past 3 mo
Fluoroquinolones (levofloxacin or moxifloxacin)
63
in patient CAP tx
Fluoroquinolones (levofloxacin or moxifloxacin) OR ceftriaxone and azithromycin
64
rule for hospitalization in pneumonia
if >2: CURBS65 = confusion, uremia, respiratory distress, BP low, age >65
65
tx of hospital acquired pneumonia
antipseudomonal cephalosporins (cefepime or ceftazidime) or antipseduomonal penicillin (piperacillin/tazobactam) or carbapenems (imipenem, meropenem, or doripenem)
66
most accurate test for ventilator associated pneumonia
open lung biopsy
67
tx for ventilator associated pneumonia
```
Antipseudomonal beta lactam:
antipseudomonal cephalosporins (cefepime or ceftazidime) or antipseduomonal penicillin (piperacillin/tazobactam) or carbapenems (imipenem, meropenem, or doripenem)
AND
Second antipseudomonal agent:
Aminoglycoside (gentamicin, tobramycin, or amikacin) or fluoroquinolone (ciprofloxacin or levofloxacin)
AND
MRSA agent:
Vanco or linezolid
```
68
adverse effect of imipenem
seizures
69
which lobe: aspiration pneumonia when lying flat
upper lobe
70
best initial test for lung abscess
x ray
71
most accurate test for lung abscess
CT
72
tx for lung abscess
clindamycin or penicillin
73
best initial test for PCP
x ray or ABG
74
most accurate test for PCP
bronchoalverolar lavage
75
what is always elevated in PCP
LDH
76
negative sputum stain in PCP, next best dx test?
bronchoscopy
77
best initial tx for PCP
TMP/SMX
78
prophylactic tx for PCP when TMP/SMZ causes rash
atovaquone or dapsone
79
dapsone contraindicated in
G6PD deficiency
80
primaquine contraindicated in
G6PD deficiency
81
tx of PCP when TMP/SMX is toxic
clindamycin and primaquine or pentamidine
82
what do you add to tx of PCP in severe disease
steroids
83
best initial test for TB
x ray
84
test to exclude TB
sputum stain and culture for acid fast bacilli x3
85
most accurate test for TB
pleural biopsy
86
tx for TB
RIPE (rifampin, isoniazid, pyrazinamide, ethambutol)
| RIPE for 2 mo, then d/c ethambutol and pyrazinamide. Continue rifampin and isoniazid for 4 more mo = 6 mo total
87
if pericardial involvement of TB meningitis add what to tx
glucocorticoids
88
adverse effects of rifampin
red color to secretions (benign)
89
adverse effects of isoniazid
peripheral neuropathy (use pyridoxine to prevent)
90
adverse effects of pyrazinamide
hyperuricemia, only tx if symptomatic.
91
adverse effects of ethambutol
optic neuritis/color vision – decrease dose in renal failure
92
which TB drug is contraindicated in pregnancy
pyrazinamide
93
positive PPD in high risk
>5
94
positive PPD in medium risk
>10
95
positive PPD in no risk
>15
96
next step when positive PPD
x ray and 9 mo of isoniazid, even if prior BCG
97
what test is equivalent to PPD and has no cross reaction with BCG
Interferon gamma release assay (IGRA)
98
management of lung nodule with intermediate probability of malignancy
bronchoscopy for central lesions, transthoracic biopsy for peripheral lesions
99
most common adverse effect of transthoracic biopsy
pneumothorax
100
causative drugs of interstitial lung disease
bleomycin, busulfan, amiodarone, methylsergide, nitrofurantoin, cyclophosphamide
101
byssinosis d/t
cotton
102
bagassosis d/t
moldy sugar cane
103
best initial test for interstitial lung disese
x ray
104
most accurate test for interstitial lung disease
lung biopsy
105
characteristic PFTs in interstitial lung disease
restrictive disease. FEV1/FVC is normal, DLCO decreased
106
tx for interstitial lung disease
prednisone
107
best initial test for sarcoidosis
x ray
108
most accurate test for sarcoidosis
lymph node biopsy
109
bronchoalverolar lavage in sarcoidosis shows
helper cells
110
tx for sarcoidosis
prednisone
111
what is elevated in sarcoidosis
ACE - granulomas make Vit D
112
most common finding on x ray in PE
atelectasis
113
most common finding on EKG in PE
non specific ST/T wave changes
114
most common finding on ABG in PE
hypoxia and respiratory alkalosis (high pH, low pCO2)
115
best initial test for PE
x ray, EKG, ABG
116
if x ray abnormal and suspect PE then next dx test?
spiral CT
117
V/Q is superior to spiral CT for PE when
pregnancy
118
most accurate test for PE
angiography
119
adverse effects of angiography for PE
allergy, renal toxicity, and death
120
best initial tx for PE
heparin and warfarin (INR 2-3)
121
alternative tx to heparin in PE
fondaprinux
122
hampton hump and westermark sign suggest
PE
123
when do you use thrombolytics for PE
when hemodynamically unstable or acute RV dysfunction
124
when are direct acting thrombin inhibitors (argatroban, lepirudin) used in PE
after HIT
125
pulmonary HTN is
>25/8
126
best initial tests for pulmonary HTN
x ray and CT
127
most accurate test for pulmonary HTN
swan ganz cath
128
prostacyclin analogue tx for pulmonary HTN
epoprostenol, treprostinil, iloprost, beraprost
129
endothelin antagonist tx for pulmonary HTN
bosentan
130
phosphodiesterase inhibitor tx for pulmonary HTN
sildenafil
131
what slows progression of pulmonary HTN
oxygen
132
only cure for pulmonary HTN
lung transplant
133
x ray findings in ARDS
white out with air bronchograms
134
ARDS definition
pO2/FIO2 <300
135
tx of ARDS
mechanical ventilation with 6ml/kg tidal volume
136
if FIO2 >50% in ARDS then
add PEEP and Maintain plateau pressure <30cm of water
137
are steroids beneficial in ARDS
no
