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pulmonary Flashcards

1
Q

pt with increased RR, hyperresounane upon assessment as well as pulses paradoxes , what do you suspect

A

asthma

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2
Q

pulsus paradoxus

A

seen in asthma
SBP decreases with inhalation

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3
Q

hyperresonance

A

air trapping
asthma / COPD

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4
Q

when is hospitalization recommended for asthma

A

FEV1 does not improve after bronchodilator
peak flow <60/liters/min or does not improve after treatment

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5
Q

expected finding of asthma in chest xray

A

hyperinflation

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6
Q

stepwise approach for managing asthma

A

step 1 - SABA (albuterol, levalbuterol)
Step 2 - ICS *budesonide, fluticasone, triamcinolone)
Step 3- ICS + LABA (salmeterol,)
step 4- medium ICS + LABA
step 5 - high dose ICS + LABA

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7
Q

how does levalbuterol work

A

by stimulating enzymes that convert adenosine triphosphate to cyclic-3, cAMP, which in turns relaxes bronchial smooth muscle

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8
Q

what is advair

A

fluticasone + salmeterol (LABA)

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9
Q

what is symbicort

A

formoterol + budesonide (LABA)

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10
Q

if a pt does not respond to SABA and ICS what other medication may you administer

A

magnesium sulfate

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11
Q

55 y/o female with progressive cough complains of clear sputum and has an increased chest A-P diameter , what do you suscpect

A

emphysema

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12
Q

40 y/o female presents with copious purulent sputum and mild dyspnea, xray reveals hyperinflation and normal AP diameter -what do you supect

A

chronic bronchitis

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13
Q

normal FEV1

A

70

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14
Q

typical FEV1 of COPD

A

low , below 70 due to reduced expiratory airflow

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15
Q

normal TLC
FRC
RV

A

TLC - 4000-11000
FRC - (functional residual capacity) -1.7-3.5L
RV (residual volume) -1-1.2L

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16
Q

what are the FRC and RV of a COPD

A

increased

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17
Q

what test is definitive diagnosis of TB

A

culture of M. tuberculosis x 3

small homogeneous infiltrate in upper lobe by XRAY

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18
Q

TB medication regimen

A

RIPE

r- rifampin
I- isoniazid
p - pyrazinamide
e - ethambutol

if isolate proves susceptible to INH and RIF then fourth drug may be dropped

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19
Q

tx time of TB in HIV

A

9 months

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20
Q

tx time for healthy person with TB

A

three drugs 2 months, then 4 more months of INH and RIF

21
Q

what test do you monitor weekly when under going TB tx

A

liver function studies

22
Q

what should people be tested for if taking ethambutol

A

red -green color perception

23
Q

most common agent of CAP

A

strep. pneumoniae

24
Q

postive TB test for HIV infected perison

25
Q

postive TB test for immigrants or health care workers

26
Q

postive TB test for general population

27
Q

screening tool to predict morbidity and mortality in patients with CAP

A

PORT score
patient outcomes research team /pneumonia severity index (PSI)

28
Q

how many categories make up PORT score

A

twenty - (-10 for women)

29
Q

what class of PORT requires ICU

A

> 130, Class V, high risk mortality

30
Q

pt has PORT score of III what should you do for admission

A

brief inpatient, score 71-90 low risk

31
Q

pt has PORT score of <70, how should you manage

A

outpatient , class I-II

32
Q

CURB-65 Criteria

A

score for pneumoia
C-confusion
U- BUN >19
RR - RR >=30
SBP - SBP<90 DBP <60
Age- >=65

low risk - 0-1 (go home)
moderate risk - 2 *brief inpatient
high risk - >=3 Hospital admission

33
Q

VAP medication mtg

A

Vanco + Zosyn OR Cefepime or Meropenem + levofloxacin/cipro

34
Q

s/s of pneumothorax

A

hyperresonance on affected side
diminished breath sounds affected side
mediastinal shift toward unaffected side

35
Q

tx for sarcoidosis

A

corticosteroid

36
Q

s/s of sarcoidosis

A

progressive dyspnea even with oxygen
nonproductive cough
rales / velcro crackles

37
Q

chest tube placement for pneumothorax

A

4th/5th ICS , mid axillary line

38
Q

most common cause of VAP

A

pseudomonases

39
Q

leading cause of in hospital death

40
Q

test to dx PE in stable patients

41
Q

vent changes for ARDS

A

decrease TV 4-6 ml/kg IBW

42
Q

what do you order for PE when VQ is indeterminate

A

pulmonary angiography

43
Q

this vent setting has preset TV and number of breaths

A

assist control

44
Q

these diseases are characterized by reduced volumes ( low TLC, FRC, RV)

A

restrictive disease- morbid obesity, sarcoidosis, pulmonary fibrosis

45
Q

exudate fluid has waht

A

one or more:
fluid protein to serumm protein >0/5
LDH ratio >0/6
LDH > 2/3 upper limit of normal serum LDH

46
Q

you see localized infiltrate of right middle lobe, what do you suspect

A

aspiration pneumonia

47
Q

how do you manage pulmonary shunting on vent

A

Increase PEEP

48
Q

how is pulmonary htn dx

49
Q

how is pulmonary HTN confirmed

A

right heart Cath

Review (16 decks)

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