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Final Exam Prep > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

S/s of asthma, workup, and treatment

A

S/S:bronchoconstriction and dry, plugging of airway with mucus, Respiratory alkalosis
Respiratory distress at rest, can’t finish sentences, use of accessory muscles
Pulses paradoxes and hyperresonance to percussion*
Bad signs: inability to breathe, paradoxical chest and abdominal movement, cyanosis, no breath sounds, tired*

Workup: Obstructive disease
i. PFTs will show obstructive, FEV1 will be less than predicted
ii. Hospitalization is recommended if PFTs do not improve with bronchodilator
f. CXR will show hyperinflation***

Treatment: i. SABA (albuterol)
1. Works by stimulating enzymes that convert ATP to cAMP, releases bronchial smooth muscles***
2. 1st drug for SOB in ED
ii. LABA
iii. SAMA (ipotropium)
1. Anticholinergic
iv. LAMA
v. LABA/ICS (symbicort, advair)
vi. LABA/LAMA/ICS (Trilogy)

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2
Q

TB S/S, labs, s/s, treatment

A

a. Asymptomatic typically
b. Weight loss, low grade fever, night sweats, dry cough to productive cough
c. Labs:
i. Culture x3
ii. AFB are presumptive of active
iii. Small homogenous infiltrate (honeycomb in the upper right lobe)
iv. PPD only shows exposure (15mm of reaction, 10mm for healthcare workers or high risks, 5mm for HIV)
d. Exposure: 6months of INH
e. Treatment
i. RIPE
ii. Rifampin, INH, Pyrisidomide, Ethambutol (test for red/green color perception)
iii. Someone will be on regimen for 6 months
iv. If HIV positive 9month treatment
v. Meds are hepatotoxic (needs weekly LFTs)
f. Must report to health department
g. Consider hospitalization if patient is noncompliant
h. Those who live with TB positive patient, testing the family
1st

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3
Q

Port pneumonia score

A

b. PORT score
i. How bad the pneumonia will be
ii. 1-2 outpatient
iii. 3- 24 hr admit
iv. 4- inpatient
v. 5 – ICU

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4
Q

Outpatient CAP treatment

A

Outpatient CAP
i. Low (s.pna) : Amoxicillan or Doxycycline or a Macrolides (if not resistant)
ii. Mod to high (S.pna + MDR) : (Amoxicillan or Cefpodoxime) + (macrolide OR doxy) OR mono therapy w/ resp fluroqiuinolone

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5
Q

HAP treatment

A
  1. No risk, no factors for MRSA: Monotherapy with zosyn OR Cefepime OR levofloxacin OR carbapenem
  2. Low risk with factors for MRSA : (Zosyn OR Cefepime OR Levofloxacin OR Cipro OR carbapenem) + Vanco or linezolid
  3. High risk OR IVABX within the past 90 days: TWO (Zosyn OR Cefepime OR Levo OR carbapenem) + Vanco or linezolid
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6
Q

Inpatient CAP treatment

A

i. Non-severe: B lactam(ceftriaxone) + macrolides or fluroquinolone (levofloxacin or moxi)
ii. Severe: B lactam +IV floroquinolone or macrolides
2. Pseudomonas: Merrem
3. MRSA: Vanco or linezolid

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7
Q

VAP treatment

A

MRSA Coverage: Vanco or linezolid
Antipseudomonal BETA LACTAMS: Zosyn OR Cefepime OR Carbapenems
Antipseudomonal NON BETA LACTAMS: Fluroquinolone, Gentamycin OR tobramycin OR Polymixin B

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8
Q

What is the A-a gradient

A

PAO2 -PaO2 larger the difference = pathology hindering transfer of O2 into capillaries
>15 means parenchymal diseae

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9
Q

PFTs for obstructive vs Restrictive

A

Obstructive: <80%
Restrictive Normal 80-100

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10
Q

Normal lung percussion vs asthma/COPD, bone, gastric

A

Normal: Resonance
Hyperresonance: Asthma or COPD
Tympani: Gastric
Dull: Bone

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11
Q

Where are the most important allergens encountered in asthma

A

Indoors

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12
Q

What is a s/s that is present in asthma but not COPD

A

Pulsus paradoxus >12

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13
Q

Ominous signs in asthma exacerbation

A

Fatigue, absent breath sounds, paradoxical chest/abdomen movement, inability to maintain recumbency, cyanosis

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14
Q

Is asthma obstructive or restrictive

A

Obstructive

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15
Q

Obstructive vs restrictive airway disease

A

Obstructive: can’t get air out
Restrictive: can’t get air in

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16
Q

What is the initial ABG in respiratory distress

A

Respiratory alkalosis

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17
Q

SABA MOA and examples

A

Stimulating enzymes that covert adenosine triphosphate into cAMP which relaxes beronchial smooth muscles
Albuterol, levalbuterol

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18
Q

LABA examples

A

Salmeterol
Formoterol
Oldaterol

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19
Q

SAMA example

A

Ipratropium (atrovent)

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20
Q

LAMA examples

A

Tiotropium bromide (Spiriva)

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21
Q

ICS examples

A

Budesonide/formoterol (symbicort)
Fluticasone/salmeterol (advair)

22
Q

What do you give asthma patients that are not responding to treatment

A

Mag sulfate IV

23
Q

Indications for epinepherine

A

Stridor and respiratory distress d/t anaphylaxis

24
Q

Status Asthmaticus treatment

A

Poorly responsive asthmatic attack
O2, D51/2 NSS, Methylprednisolone or hydrocortisone IV IMMEDIATELY

25
Q

What is the difference between chronic bronchitis and Emphysema

A

CB: excessive secretion of bronchial mucus for at least 3 months per year for 2 years
E: Abnormal enlargement of alveoli

26
Q

What is the difference in S/S of Chronic Bronchitis vs Emphysema

A

CB: Copious purulent secretions, stocky, obese, normal AP chest
E: Mild clear sputum, thin, wasted, increased chest AP

27
Q

What are the two major causes of COPD

A

Smoking and alpha 1 antitrypsin deficiency

28
Q

What is the diagnostic for COPD

A

Post bronchodilator FEV1/FVC <0.7

29
Q

Differentiate between Category A, B, and E COPD tx

A

A: no-1 mod exacerbation that does not require hospitalization per year, CAT <10, Tx: Bronchodilator
B: No or 1 exacerbation that does not require hospitalization per year, CAT >10, TX: LABA and LAMA
E: >2 moderate exacerbations OR >1 leading to hospitalization, TX: LABA and LAMA (add ICS if eosinophils >300)

30
Q

What is the most common cause of pneumonia

A

Strep pneumonia

31
Q

CURB 65 criteria

A

PNA treatment
Confusion, BUN >19, RR >30, SBP <90, DBP <60, Age >65
Low: 0-1, outpatient
Moderate: 2, consider brief hospitalization
High: >3, Hospitalization consider ICU

32
Q

When is HAP suspected

A

> 48 hours after admission

33
Q

What organisms are common in HAP

A

Staph, Strep, and H. Influenza treatment

34
Q

When is VAP considered and what is the most common causative organism

A

48-72 hours post intubation
Pseudomonas

35
Q

What is a VAP prevention absolute mandate

A

HOB >30

36
Q

S/s of pneumothorax and treatment

A

S/S: Hyper resonance on the affected side, diminished breath sounds on the effected side, mediastinal shift toward the unaffected side.
TX: Emergency needle thoracostomy (2nd ICS, midclavicular line), chest tube for non-emergency 4th or 5th ICS mid axillary line

37
Q

What is Sarcoidosis the s/s, labs, tx

A

Granulomas of the lungs
S/s: progressive dyspnea and Rales (velcro)
Labs: Bronchoscopy
Tx: Steroids

38
Q

What is the hallmark feature of ARDS

A

Refractory hypoxemia w/ bilateral infiltrates

39
Q

ARDS managment

A

Intubation
TV 4-6mls/kg of IBW
PEEP 10
16 hours prone

40
Q

What are the Berlin detentions for the 3 categories of ARDS

A

<300: mild lung injury
<200 Moderate
<100 Severe

41
Q

Absolute contraindication to extubation

A

Vasopressor for BP

42
Q

Describe an exudative pleural effusion findings

A

Two or More
Protein >0.5
LDH >0.6
LDH is great her than upper limit of serum LDH
Serum total protein >3

43
Q

What is a side effect of Ethambutol

A

Red/green color blindness

44
Q

How does viral PNA appear on CXR

A

Bilateral infiltrates

45
Q

O2 dissociation curve

A

To the left: higher affinity
To the right: lower affinity

46
Q

What is the difference in percussion of CB and emphysema

A

CB: normal
Emphysema: hyper-resonance

47
Q

Bacterial pneumonia signs on a CXR

A

Lobular infiltrates

48
Q

CXR results for aspiration pneumonia

A

Diffuse involvement

49
Q

5 step Asthma guideline treatment

A

Step 1/2: symptoms that last <4-5 days /week, Low dose ICS/fometerol PRN
Step 3: Symptoms most days or waking >1/week, Low dose maintenance ICS/fometerol
Step 4: Daily symptoms waking >1/week, medium maintenance dose ICS fometerol
Step 5: Persistent symptoms and exacerbations, ADD LAMA, high dose maintenance ICS-Fometerol

50
Q

How to treat a psedomonas infection

A

Zosyn or carbapenem OR cefepime plus fluroquinolone

Final Exam Prep (19 decks)

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