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PAS 531 > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

Acute respiratory failure

A

Respiratory dysfunction resulting in abnormalities of oxygenation ofr ventilation severe enough to threaten vital organs

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2
Q

What blood gas paO2 level is it considered ARF

A

<60

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3
Q

What PCO2 level is considered ARF

A

> 50

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4
Q

What all is included in an arterial blood gas (ABG)

A

pH
PaO2
PaCO2
HCO3

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5
Q

Normal blood pH

A

7.35-7.45

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6
Q

Normal PaO2

A

80-100

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7
Q

Normal PaCO2

A

35-45

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8
Q

Normal HCO3

A

22-26

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9
Q

How to shorthand ABG

A

pH/pCO2/pO2/HCO3

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10
Q

Symptoms and signs of acute respiratory failure

A

Hypoxemic or hypercapnic
DYSPNEA
HEADACHE
Cyanosis
Restlessness
Confusion
Tachypnea

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11
Q

What to give someone that is hypoxemic

A

Nasal cannula 1-3 liters
Then Venturi mask

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12
Q

Number one step in treating patient in respiratory distress

A

Get an ABG

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13
Q

Hypoxemic and hypercapnic causes

A

Airway disorders (asthma, COPD, obstruction)
Pulmonary edema (ARDS, left heart dysfunction, acute leg injury)
Lung disorder (pneumonia, interstitial lung disease, aspiration, lung contusion)
Pulmonary vasculature problems
Chest wall, diaphragm, and pleural disorders (rib fracture, pneumothrax, pleural effusion, flail chest)
Neuromuscular problems
CNS problem
Increased CO2 production

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14
Q

ARF diagnosis

A

Stabilize aireay
ABG
CPK to check for rhabdo
Toxicology
BMP
CMP

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15
Q

Common findings in pts with hypercapnia

A

History of sedative use
History of COPD
Obesity
Snoring
Postop

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16
Q

ARF BIPAP

A

8-12 cm H2O inspiratory pressure (pushing O2 in)
3-5 cm H2O expiratory pressure (pulling CO2 out)

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17
Q

CPAP vs BiPAP

A

BIPAP changes pressure to help with inspiration and expiration (higher pressure during inspiration).
CPAP has the same constant pressure

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18
Q

BIPAP contraindications

A

AMS
Throwing up
Upper airway obstruction
Moderate to severe ARDS

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19
Q

Ventilator

A

Maintains airway
Ensures adequate alveolar ventilation
Might be done through tracheal intubation (noninvasive positive pressure ventilation

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20
Q

Noninvasive positive pressure ventilation (NIPPV)

A

Full facemask or nasal mask for COPD with hypercapnic respiratory.
Pt must be able to protect and maintain patency of airway, handle own secretions, tolerate mask apparatus
Uses BIPAP-like changes in pressure

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21
Q

Tracheal intubation indications in ARF

A

Hypoxemia even with supplemental oxygen
Upper airway obstruction
Impaired airway obstruction
Inability to clear secretions
Respiratory acidosis
BIPAP and NIPPV doesn’t work

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22
Q

Meds to give before intubation for ARF

A

Etomidate or ketamine

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23
Q

Tidal volume

A

Quantity of gas delivered with each breath

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24
Q

Positive end-expiratory pressure (PEEP)

A

Prevents lungs from collapsing after exhaling

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25
Q

Pressure support

A

Suppport provided by ventilator in breathing
Normally 5-8

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26
Q

Inspiratory time

A

Period over ventilator delivers a breath

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27
Q

Fraction of inspired oxygen (FiO2)

A

Fraction of inhaled air that is O2
We increase it on ventilator when can’t get pts O2 levels up

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28
Q

Peak inspiratory pressure

A

Highest pressure in lungs during inspiration

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29
Q

Two most common primary control variables on ventilator

A

Volume
Pressure

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30
Q

Complications often caused by ventilator

A

Barotrauma
Volutrauma
Acute respiratory alkalosis
Hypotension
Ventilator associated pneumonia

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31
Q

What to do when pt is in respiratory failure but an endotracheal tube can’t be placed

A

Cricothyrotomy (going through cricothyroid cartilage into airway

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32
Q

ARF caused by opioid overdose treatment

A

Nalaxone (narcan)

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33
Q

ARF caused by benzo overdose treatment

A

Flumazenil (romazicon)

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34
Q

pCO2 of pregnant

A

30-32

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35
Q

Acute respiratory distress syndrome (ARDS)

A

Causes severe diff breathing.
Usually happens in people already critically ill or major injuries

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36
Q

ARDS diagnosis

A

NONCARDIAC PULMONARY EDEMA
Resp failure within one week of known clinical insult
New bilateral radiographic pulm opacities that aren’t PE, atelectasis, or nodules
Resp failure not explained by HF or volume overload.
Impaired O2 with PaO2 to FiO2 ratio less than 300mmHg and PEEP >5cm H20

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37
Q

What determines severity of ARDS

A

PaO2/FiO2 ratio
Mild: 201-300
Moderate 101-200
Severe <100

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38
Q

Acute lung injury

A

Used to describe pts wht hypoxemia (PaO2/FiO2=201-300)
(Mild ARDS)

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39
Q

ARDS risk factors

A

Sepsis
Aspiration
Pneumonia
Trauma
Blood transfusion
Lung and stem cell transplantation
Pancreatitis
Drug OD
Alcoholism
Genetics
Tobacco

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40
Q

Pulmonary causes of ARDS

A

Pneumonia
Aspiration og gastric contents
Pulmonary contusion
Inhalation injury
Fat emboli

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41
Q

Non-pulmonary causes of ARDS

A

Sepsis
Trauma
Drug OD
Pancreatitis
Cardiopulm bypass

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42
Q

ARDS pathophys

A

Damage to capillary endothelium
Protein escapes from vascular space
Fluid shift into interstitium (third spacing)
Edema with proteinaceous fluid
Loss of surfactant
All this causes impaired gas exchange, decrease lung compliance, and pulmonary HTN

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43
Q

ARDS symptoms

A

Dyspnea
Increased O2 requirement
Cough, wheeze
Chest pain
Hemoptysis (blood spit)
Confusion, resp distress, cyanosis, diaphresis

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44
Q

ARDS physical exam findings

A

Tachypnea, tachycardia
Raised JVP, crackles, S3/S4 gallop
Dullness to percussion, egophony , enlarged lymph nodes
Check skin turgor an d mucus membranes for volume status

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45
Q

ARDS imaging

A

CXR shows bilateral diffuse alveolar opacities with dependent atelectasis and usually bronchograms
Chest CT shows widspread patchy opacities (ground glass)

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46
Q

ARDS labs

A

ABG shows hypoxemia
Acute respiratory alkalosis
Pneumonia or sepsis may have elevated WBC
BNP <100

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47
Q

ARDS EKG

A

Maybe arrhythmias or ST changes

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48
Q

ARDS common complication

A

Organ failure (Kidney, liver, gut, CNS, Cardiovascular)

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49
Q

ARDS treatment

A

Treat underlying cause
Mechanical ventilation
Low tidal volume (4-6 ml/kg) to avoid volutrauma (lung overdistension)
Prostacyclin
Nitric oxide
PDE4 inhibitors

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50
Q

ARDS supportive care

A

Sedation
Hemodynamic monitoring
Nutritional support
Fluid management
Prone positioning

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51
Q

Normal setting for CPAP

A

5cm H2O

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52
Q

Maximium setting of CPAP

A

20cm H2O

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53
Q

Transudates

A

Clear fluid low in protein and cell content

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54
Q

Exudates

A

Cloudy fluid high in protein and cell content

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55
Q

Pleural effusion causes

A

Increased production of fluid with nromal capillaries (transudative)
Increased production of fluid with abdnormal capillary permeability (exudates)
Decreased lymphatic clearance from pleural space (exudates)
Infection in pleural space (empyema)
Bleeding in pleural space (hemothorax)

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56
Q

Pleural effusion treatment options

A

Thoracentesis (drain)
Observe
Diuretics

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57
Q

Pleural effusions symptoms and signs

A

Dysnpnea
Cough
Chest pain
Physical findings usually absent in small ones
Dullness to percussion
Atelectasis may cause bronchial breath sounds adn egophony above effusion
Pleural friction rub

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58
Q

Empyema

A

Purulent fluid drained from some pleural effusion.
pH<7.2
Glucose<40
Positive Gram stain

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59
Q

Chylothorax

A

Lymph causing pleural effusion
TG>100

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60
Q

Hemorrhagic pleural effusion

A

Mixture of blood and pleural fluid

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61
Q

Hemothorax

A

Presence of gross blood on pleural space

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62
Q

Lab findings that show pleural fluid is exudative

A

Pleural fluid protein to serum protein ratio >0.5
Pleural fluid LDH to serum LDH ratio >0.6
Pleural fluid LDH >2/3 upper limit of normal serum LDH
If none of these are met, that means its transudative

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63
Q

Thorocostomy

A

Putting in a chest tube

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64
Q

Thorocotomy

A

Opening the chest

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65
Q

Transudates pH

A

7.4-7.55

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66
Q

Most common transudative effusion

A

Heart failure

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67
Q

Most common bacterial exudative effusion

A

Bacterial pneumonia and cancer

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68
Q

What does elevated amylase in pleural fluid suggest

A

Pancreatitis
Pancreatic pseudocyst
Adenocarcinoma of lung or pancreas
Esophageal rupture

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69
Q

TB pleural effusiion findings

A

Adenosine deaminase
Interferon-gamma
Granulomatous inflammation in 60% of pts

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70
Q

Paramalignant effusino

A

Efussion in pt with cancer when repeated attempts to identify tumor cells in pleural fluid or pleura but continues to be nondiagnostic but there is a solid tumor somewhere.
No evidence of cancer but you know there’s malignancy

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71
Q

How much fluid must be present on standard upright CXR to be visible

A

175-200 ml

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72
Q

How much fluid must be present on lateral CXR to be seen

A

50 mL

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73
Q

How much fluid must be present to be seen on on CT scan

A

10 mL

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74
Q

Pleurvac

A

Drains pleural effusion.
Helps reestablish normal neg pressure
Facilitates lung re-expansion
Prevents air and fluid from reentering chest cavity

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75
Q

Malignant pleural effusion treatment

A

Thoracenesis if symptomatic
If fluid remains, place indwelling catheter pt can access at home

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76
Q

Simple/uncomplicated pleural effusion

A

Free flowing sterile exudates of modest size resolved quickly with abx

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77
Q

Complicated pleural effusion

A

Larger
More inflammatory stimuli (low glucose, low pH, loculation)

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78
Q

Hemothorax treatment

A

Close observation for small and asymptomatic
Drain existing blood clots
Keep track of bleeding
Reduce risk of fibrothorax
Permit getting edges close together to reduce hemorrhage

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79
Q

Three categories of pneumothorax

A

Spontaneous (primary or secondary)
Traumatic
Iatrogenic

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80
Q

Primary spontaneous pneumothorax

A

Occur in the absence of underlying lung disease

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81
Q

Secondary spontaneous pneumothorax

A

Complication of preexisting pulmonary disease

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82
Q

Tension pneumothorax causes

A

Trauma
Infection
CPR
Pressure of pleural space excedes alveolar vanous pressures

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83
Q

Tension pneumothorax signs and symptoms

A

Increased JVP
Systemic HTN
Pulsus paradoxus
Tachycardia
Mediastinal/tracheal shift

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84
Q

Tension pneumothorax treatment

A

IMMEDIATE needle decompressions in 2 intercostal space at midclavicular line

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85
Q

Pneumothorax treatment

A

Chest tube
Very small ones can resolve spontaneously

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86
Q

Indications for sthoroscopy or open thoracotomy

A

REcurrence of spontaneous pneumothorax
Bilateral pneumothorax
Failure of tube thoracosotomy for first episode

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87
Q

Pleuritis

A

Localized, sharp, fleeting pain from acute pleural inflammation

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88
Q

Pleuritis causes

A

Viral respiratory infections
Pneumonia
Pleural effusion
Pleural thickenin
Air in pleural space
Simple rib fractures

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89
Q

Pleuritis treatment

A

Treat underlying disease
Analgesis and anti-inflammatory meds for pain

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90
Q

Pneumonitis

A

Inflammatin of lung tissue
Usually noninfectious
Inflammation makes it hard for gas exchange in aveoli

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91
Q

Pneumonia

A

Type of pneumonitis
INfection causes inflammation.
Infection causes alveoli to fill with purulence and can become solid
Bacterial, fungal, viral, aspiration pneumonia

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92
Q

Types of pneumonitis

A

Aspiration (aspiration pneumonia)
Hydrocarbon (lipoid pneumonia)
Hypersensitivity
Radiation
Vaping

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93
Q

Acute aspiration of gastric contents

A

One of the most common causes of ARDS
The more acidic the material, the greater the degree of chemical pneumonitis

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94
Q

Signs and symptoms of acute aspiration event

A

HYPOXEMIA (first)
Cough
Wheezing
Fever
Tachypnea
Patchy alveolar opacities on radiograph
Leukocytosis

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95
Q

Acute aspiration of gastric contents treatment

A

O2
Maintain aireway
Use rebreather mask
Fluids to avoid hypotension but careful bc pulm edema
No antibiotics unlesss aspiration pneumonia develops (usually 2-3 days after aspiration in 1/4 of pts)

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96
Q

Chronic aspiration of gastric contents

A

Achalasia
Esophageal stricture
GERD
Systemic sclerosis (scleroderma)
Esophageal carcinoma
Esophagitis

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97
Q

GERD

A

Relaxation of tone of the lower esophageal sphincter allows reflux of gastric contents into esophagus and can eventually cause aspiration

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98
Q

Things other than GERD that relax lower esophageal sphincter

A

Cig smoking
Alcohol
Caffeine
Theophylline

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99
Q

Pulmonary disorders linked to GERD

A

Asthma
Chronic cough
Bronchiectasis
Pulmonary fibrosis

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100
Q

Modified Barium Swallow study

A

Looking to see how pt is swallowing solids or liquids.
Have them drink something with barium and can watch it through floroscopy.
Watches oral, pharyngeal, and upper esophagus

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101
Q

Aspiration pneumonia

A

Infection caused by less virulent bacteria usually found in upper airways or stomach

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102
Q

Aspiration pneumonia clinical presentation

A

Depends on what causes it
Cough
Purulent sputum
Dyspnea
Fever
NOT rigors or chills

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103
Q

Hospital acquired aspiration pneumonia

A

Staph aureus
Sputum has putrid odor
Infectious process is faster in infections with anaerobes

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104
Q

Aspiration pneumonia labs

A

Blood cultures
Sputum gram stain and culture
Respiratory viral panel
Urine streptococcal antigen testing
Sputum or urine Legionella testing

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105
Q

Procalcitonin

A

Elevated with bacterial infections, not viral infections

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106
Q

Aspiration pneumonia imaging

A

CXR may be negative early on
Can be caught early on CT

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107
Q

Aspiration pneumonia treatment

A

Antibiotics
5 days for community acquired aspiration pneumonia
7 days for hospital acquired aspiration pneumonia

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108
Q

Café Coronary

A

Sudden death by obstruction of upper airway by food
Associated with elderly, dental problems, babies
Associated with sedative drugs and alcohol
Need heimlich maneuver

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109
Q

What chronic conditions can be caused by rentention of aspirated foreign body in tracheobronchial tree

A

Atelectasis
Post-obstructive hyperinflation
Acute and recurrent pneumonia
Bronchiectasis
Lung abscess

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110
Q

Best diagnostic test for retention of aspirated foreign body

A

CXR DO THIS FIRST (two views)

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111
Q

Retention of aspirated foreign body treatment

A

Bronchoscopy
Remove

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112
Q

Aspiration of inert material

A

Soil, sand, rock, etc (no chemicals)
Can cause asphyxia if amount aspirated is massive and cough is impaired.
Need suction if this is the case

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113
Q

Hydrocarbon pneumonitis

A

Aspiration of toxic materials into lungs (usually gasoline) usually causing pneumonia.
As soon as gas gets into mouth you cough increasing risk of aspiration
Lungs injured from vomiting gas

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114
Q

Hydrocarbon pneumonitis treatment

A

Supportive
Lung protected from repeated aspiration with CUFFED endotracheal tube

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115
Q

Lipoid pneumonia

A

Chronic syndrome related to repeated aspiration of oily materials.
Occurs in elderly with impaired swollowing

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116
Q

Lipoid pneumonia signs and symptms

A

Patchy opacities
Lipid-laden macrophages in expectorated (coughed up) sputum

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117
Q

Hypersensitivity pneumonitis cause

A

AKA extrinsic allergic alveolitis
Exposure to iinhaled organic antigens leads to acute illness
(moldy stuff, sawdust, deetergents)

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118
Q

Hypersensitivity pneumonitis signs in imaging

A

Interstitial infiltrates of lymphocytes and plasmacells with noncaseating granulomas in interstitial and air spaces
Can be acute, chronic, recurrent

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119
Q

Hypersensitivity physical exam findings

A

Tachypnea
Crackles
Midinspiratory squeeks (chirping or squawks)
Digital clubbing

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120
Q

Initial imaging of Hypersensitivity of pneumonitis

A

CT scan of chest

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121
Q

What is used to stage functional lung damage in hypersensitivity pneumonia

A

PFTs

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122
Q

Hypersensitivity pneumonitis labs

A

IgG

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123
Q

Acute radiation pneumonitis

A

AKA radiation induced lung injury
Occurs in people that have had radiation for treatment of lung, breast, or hematologic malignancies

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124
Q

How long does it take symptoms of acute radiation pneumonitis to start

A

4-12 weeks after irradiation

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125
Q

How long does it take for symptoms of late or fibrotic radiation pneumonitis to star

A

6-12 months after radiation

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126
Q

Acute radiation pneumonitis symptoms

A

Nonproductive cough
Dyspnea
Fever
Chest pain
Malaise and weight loss

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127
Q

Acute radiation pneumonitis physical exam

A

Crackles or pleural rub
DUllness to percussion
Skin erythema may outline radiation port
Tachypnea, cyanosis, HTN

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128
Q

Acute radiation pneumonitis diagnosis

A

Chest CT preferred
PFTs to rule out COPD flare up or interstitial process
Tidal volume and total lung capacity lowered.
O2 may be low
Bronchoscopy to see infection, bleeding, malignancy

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129
Q

Acute radiation pneumonitis treatment

A

Glucocorticoids (no benefit with pts with established fibrosis)
Prednisone

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130
Q

Medication toxicities

A

Asthma with beta blockers, NSAIDs, and nebulized drugs
Pulmonary edema with beta blockers

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131
Q

Ecigarette or vaping product use associated lung injury (EVALI)

A

Acute lng injury with actue fibrinous pneumonitis, diffuse alveolar damage, or organizing pneumonia

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132
Q

EVALI symptoms

A

SOB
Cough
Chest pain
Hemoptsis
Fever and chills
NVD
Abd pain

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133
Q

EVALI physical exam

A

Fever
Tachycardia
Tachypnea
Hypoxemia
Progression to respiratory failure common

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134
Q

EVALI labs to get

A

CBC
BUN/Cr
Check LFTs if pt has GI symptoms

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135
Q

EVALI imaging

A

Diffuse bilateral opacities
Ground glass
Sometimes subpleural

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136
Q

EVALI treatment

A

Hospitalization if bad.
Emi[iric antibiotics
Maybe antiviral

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137
Q

SARS-CoV-2 pathophys

A

occurs due to development of prolonged inflammatory cascade clled cytokine storm
Uncontrold amplication of IL- leads to multiorgan failure and death

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138
Q

SARs Cov-2 symptoms and signs

A

Many asymptomatic
Symptoms start 2-14 days after exposure
Cough
Fever
Chills/rigors
Myalgias
Dyspnea

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139
Q

SARS CoV-2 lab findings

A

Neutrophillia
Absolute lymphtocytosis
Increased LDH
Increased LFT
Elevated D-dimer
Elevated fibrin
Platelet counts usually neffected

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140
Q

SARS CoV-2 imaging

A

Diffuse ground glass opacities and/or multilobular infultrates that often turn into consolidation.
May appear on CXR or CT scan

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141
Q

SARS-CoV-2 complications

A

ARDS
Pulmonary embolus
HF
Myocarditis
Acute coronary syndrome
Sudden death
Stroke
Encehphalopathy

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142
Q

Multisystem inflammatory syndrome

A

Complication of SARS COV-2 in kids
Mimmics kawasaki

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143
Q

SARS COV-2 treatment

A

Usually mild and require no treatment
Early course antivirals
Later cytokine storm phase needs anti-inflammatory
Remdisivir

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144
Q

Remdisivir

A

used to treat SARS COV-2

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145
Q

When to admit someone with SARS CoV-2

A

Respiratory failure and ARDS
High risk category

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146
Q

COVID-19 outpatient treatment

A

Nirmatrelvir/Ritonavir (paxlovid)
Oral tablets taken over 5 days

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147
Q

Respiratory Syncytial Virus (RSV)

A

Paramyxovirus that causes annual outbreaks during winter
Happens in wet months outside of US
Leading cause of hospitalization in children
Causes upper and lower respiratory tract infections in adults

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148
Q

RSV symptoms

A

Bronchiolitis
Fever
Tachypnea
Wheezing
APNEA is common presenting symptom
Lung hyperinflation causing decreased gas exchange
Pulmonary hemorrhage

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149
Q

Most common cause of acute lower respiratory infection and otitis media

A

RSV

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150
Q

RSV lab diagnosis

A

ELISA
Imunoflluorescent
PCR

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151
Q

RSV treatment

A

Supportive (hydration, humidification, ventilatory support)
Ribavirin
Plavizumab for infants
NO bronchodilators or corticosteroids

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152
Q

CDC recomendations for RSV vaccine

A

60 yrs and older
50-59 with underlying conditions
INfants and young children
Pregnant (32-36 weeks sep-jan)

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153
Q

Human Metapneumovirus clinical presentation

A

Muld upper respiratory infection or severe lower respiratory tract infection with bronchiolitis, croup (barking seal), pneumonia

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154
Q

Human metapneumovirus treatment

A

Ribavirin for lung transplant pts

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155
Q

Human metapneumovirus diagnosis

A

PCR

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156
Q

Human parainfluenza virus

A

Most common in children
HIPIV-1 causes croup
HPIV-2 causes croup
HPIV-3 causes bronchiolitis and pneumonia
HPIV-4 causes less frequently reported pathogen

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157
Q

Human parainfluenza virus diagnosis

A

ELISA
Immunofluorescence
PCR
Culture

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158
Q

Nipah virus

A

Southeast asia
Fruit bat is natural host
Pigs, cows, human transmission
Causes acute encephalitis with high fatlity raes
Rspiratory symptoms
Cranial nereve palsies, encephalopathy, dystonia

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159
Q

Nipah virus diagnosis

A

ELISA
PCR

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160
Q

Three types of seasonal influenza

A

Type A (human, swine, horse, bird)
Type B (humans)
Type C (humans) more mild

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161
Q

Seasonal influenza signs and symptoms

A

Asymptomatic
Fever
Chills
Headache
malaise
Myalgias
Confusion in elderly
Resp symptoms
GI symptoms (usually in children with type B)
Lymph node enlargement

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162
Q

Seasonal influenza diagnosis

A

Positive rapid flu test
PCR

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163
Q

People at high risk of hospitalization from seasonal influenza

A

Astma pts
Nursing home
>65y/o
Obese
Underlying conditions
Immune deficiency
Pregnancy

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164
Q

Seasonal flu complications

A

Pneumococcal pneumonia
Staphylococcal pneumonia
Necrosis of respiratory epithelium
Increased adherence of bacteria to infected cells
Ciliary dysfunction

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165
Q

Reye syndrome

A

Giving aspirin to child causes hepatic failure and encephalopathy.

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166
Q

Seasonal influenza treatment

A

Supportive
-mivir
Baloxavir (causes diarrhea and bronchitis)

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167
Q

Who should get flu vaccine

A

Everyone over 6 months old with no contraindications

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168
Q

Types of flu vaccine

A

Inactivated
Recombinant
Live attenuated

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169
Q

Flu vaccine contraindication

A

Past severe allergic reaction.
Wait until healthy

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170
Q

When to admit someone with seasonal influenza

A

Pneumonia
Decreased O2
Changes in mental status
Consider with pregnancy

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171
Q

Avian influenza

A

Zoonotic influenza
Comes from birds (chickens)
Can get from eating or handling chickens
H5, H7, H9

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172
Q

H5N1 or H7N9 avian influenza symptoms

A

Fever
Lower respiratory (cough, dyspnea)
Upper respiratory symptoms less common

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173
Q

Avian influenza signs ans symptomc

A

Conjunctivitis (H7)
Encephalopathy
Seizure
Liver impairment
Prolonged febrile states
General malaise
Resp failure, multiorgan dysfunction, septic shock is usual cause of death

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174
Q

Avian influenza diagnosis

A

RT-PCR
Need to test within 7 days of onset

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175
Q

Avian influenza treatment

A

-mivir

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176
Q

Severe acute respiratory syndrome (SARS)

A

Caused by coronavirus
Natural reservoir is horseshoe bat

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177
Q

SARS symptoms and sign

A

Atypical pneumonia
Affects persons in all age groups
Ranges from asymptomatic to severe respiratory illness
Incubation 2-7 days
Can be spread for 10 days
Fever
Chills
Cough
SOB
Rales
Rhonchi
Diarrhea
Delerium in elderly

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178
Q

SARS lab findings

A

Leukopenia
Low DIC
High ALT and CPK
O2 <95 with pulmonary infiltrates

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179
Q

SARS diagnosis

A

RT-PCR usually negative in first week of illness
Serum serologies

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180
Q

SARS complications

A

ARDS with bilateral consolidations (requires intubation and ventilaion)

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181
Q

SARS treatment

A

Supportive
Lopinaver/rotinavir
Ribavirin
Interferon
IVIG
Systemic corticosteroids

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182
Q

Middle eastern respiratory syndrome-coronavirus (MERS-CoV)

A

Get it from cammels in saudi arabia

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183
Q

MERS-CoV signs and symptoms

A

Acute respiratory syndrome
Fever
Chills
GI symptoms

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184
Q

MERS-CoV lab findings

A

Thrombocytopenia
Lymphopenia
Lymphocytosis
High LDH, AST, ALT

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185
Q

MERS-CoV imaging

A

CXR with increased bronchovascular markings, patchy infiltrates, opacities, pleural effusions, ground glass, consolidation

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186
Q

MERS-CoV diagnosis

A

Rt-PCR
Serum serologies
Test lower respiratory tract specimens and sputum

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187
Q

MERS CoV case definition

A

Fever
Pneumonia or ARDS
History of travel to arabian peninsula 14 days before symptoms
Faster respiratory failure than SARS

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188
Q

MERS-CoV treatment

A

Respiratory support
No vaccine
Interferons
Ribavirin
Lopinavir-ritonavir
Mycophenolate mofetil

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189
Q

Adenovirus symptoms and signs

A

Worse in native americans
Chronic lung disease
Hepatitis Hemorrhagic cysts

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190
Q

Adenovirus diagnosis

A

Fluorescence immunoassay
PCR

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191
Q

Adenovirus imaging

A

Multifocal consolidation or ground glass opacity without airway inflammatory findings on chest CT

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192
Q

Adenovirus treatmen

A

Ribavirin or cidofovir in immunocompromised
IVIG

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193
Q

Acute bronchitis

A

Lower respiratory tract infection causing inflammation in large airways

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194
Q

Acute bronchitis pathophys

A

epithelial infection of bronchitis to inflammation and thickening of bronchial and tracheal mucosaI decreasing airflow and bronchial hyperrresponsiveness

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195
Q

Acute bronchitis signs and symptoms

A

Wheezing or mild dyspnea with cough
Hemoptysis
Fever is rare

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196
Q

Ronchi

A

Usually clears with coughing

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197
Q

Acute bronchitis imaging

A

Don’t need imaging

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198
Q

Acute bronchitis treatment

A

Nonpharm: throat lozenges, hot tea, stop smoking
Pharm: Dextrometorphan, Guaifenesin if >2 y/o

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199
Q

Pulmonary embolism (PE) presentation

A

Dyspnea
Chest pain
Hemoptysis
Syncope
Tachypnea
Tachycardia
Hypoxia

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200
Q

Pulmonary embolism (Pulmonary venous thromboembolism) cause

A

Deep vein thrombus

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201
Q

Superficial vein

A

Closer to skin
Smaller
Tend to move blood more slowly bc no muscle near

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202
Q

Deep veins of lower extremities examples

A

Anterior tibial
Posterier tibial
Peroneal
Femoral veins

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203
Q

Superficial veins in lower extremities examples

A

Great sephenous vein
Small (short) saphenous vein

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204
Q

Where do pulmonary embolisms usually come from

A

Iliac, femoral, and popliteal veins
DVTs below popliteal or superficial veins don’t usually get to pulm circulation

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205
Q

Substances that can embolize to pulmonary circulation

A

Fat (long bone fractures)
Septic emboli (acute inefective endocarditis)

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206
Q

Risk factors for PE that are risk factors from thrombus formation

A

Virchow triad
1. Venous stasis
2. INjury to vessel wall
3. Hypercoagulability

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207
Q

Common cause of hypercoagulability

A

WHite people
Resistance to activated protein C (Factor V Leiden)

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208
Q

PE physiologic effects

A

Physical obstruction of vascular beds
Vasoconstriction
Thrombus occlusion greater than 20-25%
Vascular obstruction causing hypoxemia
Reflex bronchoconstiction promotes wheezing and increased work of breathing

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209
Q

PE pathophys

A

Usually multiple with lower lobes involved more commonly than upper lobes

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210
Q

Saddle PE

A

Located at bifurcation of main pulmonary artery

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211
Q

PE signs and smptoms

A

Dyspnea
Pain on ispiration
Cough
Wheezing
Anginal pain
RR>16
Tachycardic
S4
Temp
Homans sign
S3
Cyanosis

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212
Q

Symptom of massive PE

A

Syncope and obstructive shock with circulatory collapse (saddle embolus)

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213
Q

PE EKG

A

S1Q3T3 pattern bc of right heart dysfunction
Nonspecific ST and T wave changes
New RBB
Right axis deviation
Tachycardic

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214
Q

PE labs

A

Alkalosis bc hyperventilation
Elevated D-dimers
Troponin and BNP elevated
CBC and coagulation studies

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215
Q

PE imaging

A

Helical CT-PA scan GOLD STANDARD
CXR needed to rule out stuff and could see Westermark sign or Hampton hump
Pulmonary CT angiography
V/Q can be used if CT-PA can’t be used bc of contrast
Echocardiogram
Venous ultrasound to check for DVT

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216
Q

Westermark sign

A

PE CXR finding
Decreased vasularization of lung periphery causes sharp cut off of pulmonary vessls with avascular marksings ins egmental distribution distal to PE

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217
Q

Hampton hump

A

PE CXR finding
Wedge or dome shaped, pleural based opacification in periphery of lung

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218
Q

High risk PEs

A

Massive
SBP<90mmHg or a drop in over 40mmHg for longer than 15 minutes

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219
Q

Intermediate risk PEs

A

Submassive PE
Hemodynamically stable but strainsof right ventricular dysfunction seen in imaging or in troponin/BNP

220
Q

Low risk PEs

A

Normotension without signs of right ventricular dysfunction

221
Q

PE treatment

A

Unfractioned heparin
LMW heparin
DOACs
IVC filter
Catheter directed thrombolysis via angiography
Surgical embolectomy

222
Q

IVC filter

A

Used to treat recurrent PE
Stops clot from entering RA

223
Q

Thrombolytic therapy

A

Streptokinase, urokinase, recombinant tissue plasminogen cativator.
Increases plasmin levels and directly lyse intravascular thrombi accelerating resolution of thrombi
IV

224
Q

PE treatment in pregnant

A

Low molecular weight heparin (Lovenox) (-parin) bc doesn’t cross placenta

225
Q

PE treatment for people with malignancy

A

LMWH (lovenox) (-parin)
Apixiban (DOAC)

226
Q

PE prophylaxis drugs

A

DOAC
Warfarin
Unfractioned heparin

227
Q

Pulmonary HTN diagnosis value

A

Pulmonary arterial pressure of 20 mmHg

228
Q

Pulmonary HTN clinical presentation

A

Dyspnea, fatigue, chest pain, syncope on exertion
Split S2 with loud pulmonary component
Tricuspid regurgitation murmur
Systolic ejection click
RV hypertrophy
Elevated RV systolic pressure
JVD
Hepatomegaly
Lower extremity edema

229
Q

Normal pulmonary artery systolic pressure

A

15-30 mmHg

230
Q

Groups of pulmonary HTN

A

Group 1 primary
Group 2 PVH from Left heart disease
Group 3 PHTN due to lung disease or hypoxemia
Grop 4 PHTN due to pulmonary obstruction
Group 5 PHTN secondary to unclear or multifactorial mechanisms

231
Q

Group 1 pulmonary arterial hypertenson causes

A

Diseases that localize directly to pulmonary arteries leading to structural changes, smooth muscle hypertrophy, endothall dysfunction.
Idiopathic
Heritable
Drug induced
Portal HTN
HIV
Connective tissue disorders
Congenital heart disease
Schistosomiasis

232
Q

Group 1 pulmonary HTN diagnosis

A

Mean pulm arterial pressure of 20 mmHg
Wedge pressure of 14mmHg or less.
Pulmonary vascular resistance of 2 Wood units or moreGrou

233
Q

Group 2 pulmonary HTN

A

Caused by left heart disease
Includes LV systolic or diastolic dysfunction and valvular heart disease

234
Q

Group 3 pulmonary HTN

A

Caused by lund disease or hypoxemia

235
Q

Group 4 pulmonary HTN

A

Caused by pulmonary obstruction
Includes chronic thromboembolic pulmonary HTN, sarcoma, metasttic alignancies, congenital pulmonary artery stenosis.

236
Q

Group 5 pulmonary HTN

A

Secondary to unclear multifactorial mechanisms like hematoligic, systemic, metabolic, and other orders

237
Q

Pulmonary HTN lab findings

A

BNP may be elevated
Check liver
EKG normal except in bad cases RV hypertrophy, right axis deviation, RA enlargement, right BBB

238
Q

Pulmonary HTN imaging

A

Pulm arteries enlarged on CXR and CT
RV and RA enlargement seen
CT good to find cause in group 3
Echocardiogram with bubble study (does not diagnose pulmonary HTN)
V/Q
CT-PA

239
Q

Group 2 pulmonary HTN treatment

A

Decrease pulmonary venous rpessure
Diuretics

240
Q

Group 3 pulmonary HTN treatment

A

Assessed for hypoxemia
Give O2 if needed
Focus on supportive care in COPD

241
Q

Group 4 pulmonary HTN treatment

A

Long term anticoagulation
Undergo thromboendoarterectomy if able and have surgicallly accessible lesions

242
Q

Cor pulmonale signs and symptoms

A

Chronic productive cough
Exertional dyspnea
Wheezing
Fatigue
Cyanosis
JVD
Dependent edema
Low cardiac output and reduced LV filling, preload, and stroke volume

243
Q

Cor pulmonale treatment

A

Oxygen
Sodium restriction
Diuretics
Ionotropic agents

244
Q

Alveolar hemorrhage syndromes

A

Alveolar infiltrates on chest radiograph
Dyspnea
Anemia
Hemoptysis
Rapid clearing of diffuse lung infultrates within 2 days
Lavage aliquots progressivel more hemorrhage in bronchoalveolar lavage bronchoscopy

245
Q

Alveolar hemorrhage syndrome cause

A

Anti-basement membrane antibody disease
Granulomatosi with plyangiitis
Systemic necrotizing vasculitis
Lupus
Coagulopathy
Mitral stenosis
Necrotizing pulonary infection
Drugs
Idiopathic pulmonary hemosiderosis

246
Q

Good pasture syndrome

A

Idiopathic recurrent alveolar hemorrhage
Mediated by antiglomerular basement membrane antibodies

247
Q

Good pasture syndrome symptoms

A

HEMOPTYSIS
Dyspna, cough, hypoxemia, diffuse bilateral infultrates

248
Q

Pulmonary edema causes

A

Acute MI
Ischemia
Exacerbation of HF
Acute severe hypertension
Acute kidney injury
Acute volume overload of LV
Mitral stenosis
High salt intake

249
Q

Pulmonary edema clinical findings

A

Dyspnea
Pink frothy sputum
Diaphoresis
Cyanosis
Rales

250
Q

Pulmonary edema imaging

A

CXR has blurriness of vascular outlines
INcreased interstitial markings
Butterfly pattern alveolar edema
enlarged heart maybe

251
Q

Pulmonary edema teatment

A

O2
IV Morphine
IV Diuretic
Nitrate
IV Nesirtide

252
Q

What lab to meaasure when on a heparin drip

A

aPTT (activated partial thromboplastin time)

253
Q

Anticoagulation for pre-MI cath lab

A

Start unfractionated heparin (IV)
Leave on ASA/Plavix if alreadyy on it
Hold Warfarin and DOACs

254
Q

Meds post MI cath lab

A

Dual antiplatelet therapy (like ASA+Plavix)
Off fractionated heparin now

255
Q

Indications of low molecular weight heparin

A

DVT prophylaxis in hospital
DVT/PE initially while bridging pt to daily oral anticoagulant

256
Q

DVT prophylaxis for low risk pts

A

Compression stockings

257
Q

What do we need to check when someone is on warfarin

A

PT/INR (prothrombin time/international normalized ratio

258
Q

Prothrombin time

A

Measures activity of extrinsic and common pathways of coagulation.
Measures prothrombin (factor II) and factors I, V, VII, X

259
Q

International normalized ratio (INR)

A

Value we base changes ot warfar on.
Normla is 1
Goal is 2-3

260
Q

What to do if PT is elevated on warfarin

A

Give vitamin K.
Could mean wrong dosage, vitamin K deficiency, or liver disease

261
Q

What to do if INR is 3-5

A

Lower dose or omit dose
Monitor more frequently

262
Q

What to do if INR is betweeen 5-9

A

Hold next 1-2 doses
Monitor more frequently and

263
Q

Pneumonia

A

Infection that inflames alveoli in one or both lungs.
Can be viral, bacterial, or fungal

264
Q

Pneumonia pathway

A

Failure of protective mechanisms–>
Infiltration–>
Inflammation–>
Hypoxia

265
Q

Bronchopneumonia

A

Affects lungs in patches around bronchi or bronchioles instead of whole lobe.
Much more common than lobar.
Usually bacterial

266
Q

Lobar pneumonia

A

Fills up the lobe
Usually bacterial

267
Q

Interstitial pneumonia

A

Involves areas between alveoli
Progressive scaring
Mostly viral or atypical

268
Q

Nosocomical pneumonia

A

Acquired in hospital/nursing home
occurs >48 hrs after admission.

269
Q

Most common bacterial causes of pneumonia

A

STREP PNEUMO
H. influenza
Staph aureus
Moraxella catarrhalis

270
Q

Legionella (Legionnaire’s disease)

A

Reportable pneumonia
Bad in immunocompromised

271
Q

Typical Pneumonia symptoms

A

SOB
Pleuritic chest pain
Fever
Cough (productive or nonproductive)
Dyspnea
Fatigue
GI
Headache

272
Q

Atypical pneumonia symptoms

A

Nonproductive cough
Scanty sputum
Fatigue
Malaise
Headache

273
Q

Pneumonia physical exam findings

A

Tachypnea
Tachycardia
Hypoxemia
Hypotension
Hyperthermia
Accessory muscle use
Dullness to percussion
Craakles/bronchial breath sounds
Enhanced tactile fremitus
Egophony
Bronchial breath sounds

274
Q

Best imaging for pneumonia

A

AP and lateral CXR is gold standard
CT if CXR not diagnositic
UA for legionella

275
Q

Indications for thoracentesis in pneumonia

A

Effusion >10mm

276
Q

Bronchoscopy indications in pneumonia

A

INconclusive CT scan
Suspected mass

277
Q

Labs needed in pneumonia

A

CBC with differential
Procalcitonin
2 sets of blood or sputum culture

278
Q

Pneumonia treatment for healthy <65 yo with no comorbidities or risk factors for MRSA or P aeruginosa

A

Amoxicillin 1000 mg TID 5 days
or Doxycyclin 100mg BID 5 days
or Macrolide (-mycin) for 5 days

279
Q

Pneumonia treatment for someone with comorbidities (CHF, CKD, liver disease, T2DM, EtOH, immunosuppression) or recent antibiotic use

A

COombo therapy
Macrolide (-mycin) or doxycycline with amoxixillin/clavulanic acid or 3rd gen cephalosoprin

280
Q

Doxycycline adverse effects

A

Can’t use in pregnant

281
Q

Macrolide adverse effects

A

Prolong QT interval

282
Q

Fluoroquinolone adverse effects

A

Prolong QT interval
Tendon rupture
C. diff colitis

283
Q

Outpatient community acquired pneumonia treatment

A

Abx for At least 5 days continue until afebrile for 48 hours
Acetaminophen and NSAIDs for pain
Guaifenesin (mucinex)

284
Q

PSI risk stratification

A

Risk I: 0 points outpatient oral abx
Risk II: 1-70 points outpatient oral abx
RIsk III: 71-90 observation admission
Risk IV: 91-130 hospital admission
RIsk V: >130 hospital admission

285
Q

Inpatient community acquired pneumonia abx treatment

A

Combo of beta-lactam and macrolide.
Will be IV at start
Add vancomycin or linezolid if MRSA suspected
Use combo of antipseudomonal beta-lactam and fluoroquinolone if Pseudomonas expected

286
Q

Additional inpatient community acquired pneumonia treatment

A

Pulmonary exercise
SUpplemental hygene
Prone positioning
Maybe mechanical ventilation

287
Q

Hospital acquired pneumonia treatment

A

Abx for at least 7 days

288
Q

Prevnar 13`

A

S. pneumo vaccine for all children younger than 2 yo

289
Q

Pneumovax 23

A

S. pneumo vaccine for those over 65 yo

290
Q

Most common cause of community acquired pneumonia

A

S. pneumonia

291
Q

S. pneumoniae pneumonia symptoms

A

Abrupt onset
Sever rigor
Rusty sputum
Fever
Bronchial breath sounds in early stages

292
Q

S. pneumoniae pneumonia imaging

A

CXR with lobar infiltrates, air bronchograms

293
Q

H. flu pneumonia

A

G- Coccobaciillus
Common in COPD and smokers

294
Q

H. flu pneumonia imaging

A

CXR lobar patchy infiltrates

295
Q

Staph aureus pneumonia

A

Usually from preceding flu infection.
Infect multiple lobes of lungs quickly

296
Q

Staph aureus pneumonia imaging

A

CXR shows cavitary lung lesions that mimic TB

297
Q

MSSA pneumonia treatment

A

Cephalexin, dicloxacillin, Trimethoprim/sulfamethoxazole
IVV nafcillin or cafazoline

298
Q

MRSA pneumonia treatment

A

IV vancomycin, linezolid, cefaroline, or daptomycin

299
Q

Staph aureus pneumonia complications

A

Lung abscess
Pneumothorax
Empyema

300
Q

Moraxella catarrhalis pneumonia

A

Gram negative diplococci
Usually in upper respiratory

301
Q

Mycoplasma pneumoniae

A

Young kids
Bullous myringitis
Papular rash or erythema multiform

302
Q

Mycoplasma pneuomniae treatment

A

Azithromycin
Doxycycline
Levofloxacin
Moxifloxacin

303
Q

Chlamydophila pneumonia

A

Children and overcrowded
CXR nonspecific
PCR needed

304
Q

Clamydophila pneumonia treatment

A

Macrolinde
Tetracycline
Resp fluoroquinolone

305
Q

Legionella pneumophila pneumonia symptoms

306
Q

Legionella pnemophilia pneumonia imaging

A

CXR lbar pneumonia
Can form cavities in immunocompromised

307
Q

Legionella pneumophila treatment

A

Levofloxacin
Azithromycin
Doxycycline

308
Q

Klebsiella pneumonia

A

Gram negative rods
Associated with aspiration
Currant jelly colored sputum

309
Q

Chlamiydophila psittaci

A

Birds
Pneumonia
Tetracyclines or macrolide

310
Q

Coxiella burnetti

A

Q fever
farm animals
Pneuomnia

311
Q

Microaerophilic bacteria anaerobes (aspiration pneumonia)

A

Usually in pts with poor oral hygeine
Usually in right lower lobe

312
Q

What usually causes pneumonia in cystic fibrosis pts

A

Pseudomonas

313
Q

Histoplasmosis pathophys

A

IN soil with berd or bat droppings.
Spores inhaled then engulfed by macrophages in alveolar space causing granuloma formation

314
Q

Histoplasmosis epidemiology

A

North american fungus
Usually seen in chicken coops, farms, caves

315
Q

Histoplasmosis clinical findings

A

Erythema nodosum
Erythema multiform
Pericarditis

316
Q

Histoplasmosis diagnosis

A

CXR with patchy infiltrates
Reticulonodular pattern
Fungal culture
Antigen assay

317
Q

Histoplasmosis treatment

A

Itraconazole
Amphotericin. B only for extremely ill

318
Q

Blastomycosis pathophys

A

Inhale spores and immune system inhibits conversion of spores into pathogenic yeast form (thermal dimorphism).

319
Q

Blastomycosis epidemiology

A

Immunocompetent men
Major soil disruption in endemic ariesa
Drainage systems
Warm, moist soil in he woods

320
Q

Blastomycosis clinical findings

A

Cough fever dyspnea pleuritic chest pain
Prurulent sputum, pleurisy
Fever, chills, weight loss
Ulcers (look like squamous cell carcinoma)
Osteomyelitis
Epididymitis
CNS involvement

321
Q

Blastomycosis diagnosis

A

Failed trial of abx
CXR
Fungal culture
Antigen assay

322
Q

Blastomycosis treatment

A

Itraconazole
Amphotericin in immunocompromised

323
Q

Coccidioidmycosis Pathophys

A

Inhale spores.
Spores evade immune system and enarge into spherules that make endospores

324
Q

Coccidioidomycosis epidemiology

A

Southwest US
Dry climates

325
Q

Coccidioidomycosis clinical findings

A

Meningitis
Erythema nodosum
Erythema multiform
Fever, night sweats, weight loss, fatigue, arthralgia

326
Q

Coccidioidomycosis diagnosis

A

CXR with patchy infiltrates, lobar consolidation, hilar adenopathy, diffuse, reticulonodular pattern, interstitial fluid
Serologic enzyme immunoassay
Antigen assay

327
Q

Coccidioidmycosis treatment

A

Fluconazole or itraconazole
Amphotreicin B for severe

328
Q

Aspergilosis

A

Allergic reaction to fungus in pts with asthma and CHF

329
Q

Aspergillosis pathophys

A

Inhale spores
Toxins inhibit phagocytes and T cell function
Very bad in immunocompromised

330
Q

Allergic aspergillosis clinical fidings

A

Bronchopulmonary
Rhinosinusitis
Hypersensitivity
Mucoid impaction
Acute asthma exacerbation with bronchial obstruction

331
Q

Chronic aspergillosis clincial findings

A

Cavitary, fibrosing, necrotizing
Aspergilloma
Weight loss, productive cough
SOB
Fatigue

332
Q

Invasive aspergillosis clinical findings

A

Sinusitis
Tracheobronchitis
Progressive, acute
Fever, chest pain, hemoptysis

333
Q

Aspergillosis extrapulmonary clinical findings

A

Cutaneous infiltration
Endocarditis
Endophthalmitis
Cutaneous lesions
Branin abscess
Hemorhagic infarction

334
Q

Aspergillosis imaging

A

CXR shows aspergilloma
Lung nodule

335
Q

Allergic aspergillosis diagnosis

A

Asthma, cystic fibrosis
Elevated IgE
Elevate IgG
Pulmonary opacities on CXR

336
Q

Chronic aspergillosis diagnosis

A

Presence of cavitation on CXR (one large or two small)
Fever, weight loss, fatigue, cough, sputum, hemoptysis, SOB (three of those for more than 3 months)

337
Q

INvasive aspergilllosis diagnosis

A

Fungal culture

338
Q

Aspergillosis treatment

A

Itraconazole
Prednisone taper over months
Voriconazole for invasive

339
Q

Pneumocystis pneumonia epidemiology

A

Opportunistic infection in immunocompromised
Common in HIV/AIDS

340
Q

Pneumocystis pathophys

A

Proliferates in alveoli tissue causing alveolar damage

341
Q

Pneumocystis clinical findings

A

acute pneumonia in immunosuppressed pt..
Potential to progress to ARDS

342
Q

Pneumocystis imaging

A

CXR showing diffuse bilateral interstitial infiltrates
Chest CT showing ground glass opacities

343
Q

Pneumocystis diagnosis

A

Pathogen identification with sputum o r bronchoalveolar lavage.
Stain wright giems
Can’t be cultureed
PCR

344
Q

Pneumocystis treatment

A

Trimethoprim-sulfamethoxazole (bactrim)

345
Q

Obstructive lung disease characteristics

A

Narrowing of lower airway
Bronchoconstriction ]
Inflammation
Mucous production
Alveolar damage
Air trapping

346
Q

Restrictive lung disease characteristics

A

Decreased lung compliance
Fibrosis
Infiltration

347
Q

Hemoptysis

A

Coughing up blood

348
Q

Spirometry

A

Measures volume of air exhaled at poins during forceful complete expiration
Records:
FVC (forced vital capacity)
FEV1 (forced expiratory in one second)
FEV1/FVC ratio

349
Q

Normal FVC/FV1 ratio

350
Q

Obstructive pulmonary disorder spirometry

A

Decreased FV1
Decreased FVC
FEV1/FVC <80%

351
Q

Restrictive pulmonary spirometry

A

Normal or decreased FEV1
Decreased FVC and TLC
FEV1/FVC normal (>80%)

352
Q

Obstructive pulmonary disorder examples

A

Asthma
Emphysema
Chronic bronchitis
COPD

353
Q

Pre and post Bronchodilator spirometry

A

Identifies reversible vs irreversible obstructive lung disease
Positive test shoes increase >10% in FEV1 or FVC (reversible)

354
Q

Bronchoprovocation

A

Used if spirometry alone was not diagnostic.
Stimulus (methacholine) administered to assess airway constriction, hyperresponsiveness via spirometry
Positive test is FEV1 decline >20% and PD20<200

355
Q

PD20

A

Provocation dose.
Dose of methacholine that causes significant drop in FEV1 >20%

356
Q

Flow volume loop

A

Graphs out pattern of breath

357
Q

Obstructive volume loop

A

scooped out

358
Q

Restrictive volume loop

A

Reduced overall volume

359
Q

Asthma

A

Reversible obstructive variable inflammatory airway disorder

360
Q

Asthma pathophys

A

Airways narrow excessively in response to stimuli
Caysed by release of IgE, mast cells, leukotrientes, histamine, eosinophils obstructing airway
Goblet cell hyperplasia
Over time causing hypertrophy (remodeling)

361
Q

Asthma risk factors

A

FAM HISTORY
Atopic triad (atopy)
NSAID allergy

362
Q

Atopic triad

A

Eczema (atopic dermatitis)
Allergic rhinitis
Asthma

363
Q

Asthma clinical presentation

A

Wheeze
Cough
Dyspnea
Could have silent chest in exacerbation

364
Q

Asthma supporting physical exam findings

A

Allergic shiners
Morgan-Dennie lines
Allergic crease (salute)
Nasal drainage
Boggy turbinates
Nasal polyps
Atopic dermatitis
AMS shows resp distress
Tripod

365
Q

Asthma vital signs

A

Tachycardic
Tachypnic
Hypoxic
Pulsus paradoxus (>10mmHg fall in systolic blood pressure during inspiration)

366
Q

Asthma diagnostic

A

Pulmonary function testsd (spirometry with or without bronchodilation, DLCO, lung volumes)
Spirometry best initial test

367
Q

DLCO in asthma

A

Normal or increased

368
Q

DLCO in emphysema

369
Q

Lung volume in obstructive disease

A

Increased TLC suggest hyperinflation
Increased compliance
Increased RV suggests air trapping

370
Q

Lung volume in restrictive disease

A

TLC is less than 80% what was expected

371
Q

Asthma Peak expiratory flow rate test

A

> 20% increased in PEF after treatment showing that it is reversible

372
Q

Asthma treatment for 6-11 y/o

A

Stepwise
1: Low dose ICS when SABA taken
2: Daily low dose ICS
3: Low dose ICS-LA A or medium dose ICS or very low dose ICS
4: Medium dose ICS-LABA or low dose ICS and refer to expert
5: Refer for phenotypic assessment and maybe higher dose ICS LABA or add-on therapy

373
Q

Asthma treatment for adult

A

1-2 (symptoms less than 4-5 days/week): As needed low dose ICS-formoterol as needed
3 (symptoms most days or walking asthma once/week): Low dose ICS-formoterol daily
4 (daily symptoms or walking asthma once/week and low lung function): Medium dose daily ICS
5: add on LAMA and refer for assessment of phenotype and consider high dose ICS

374
Q

Long acting Beta 2 agonists (LABA)

A

Asthma first line reliever in GINA
Bronchodilation starting at 15 mins and lasting up to 12 hours
Decreases exacerbations
Not monotherapy
Ex. formoterol, salmeterol

375
Q

Short acting beta 2 agonist

A

Asthma second line reliever in GINA
First line in NAEPP
Onset in 5 mins and lasts up to 6 hrs
ex. albuterol
Overuse can cause increased exacerbations

376
Q

Leukotriene receptor antagonists

A

-lukast
Long term controller for add on therapy in asthma not well controlled by ICS

377
Q

Long acting muscarinic antagonist (LAMA)

A

Used in step 5 Gina asthma with ICS
Tiotropium

378
Q

Monoclonal antibody agents

A

-zumab
Used in step 5 GINA asthma

379
Q

Omalizumab

A

Humanized monoclonal antibody blocks IgE from binding in asthma
Used in asthma with blood eosinophilia >260

380
Q

Dupilumab

A

Anti-IL4 agent used in asthma
Givn to pt with severe eosinophilic asthma >150 and 6 yrs or older

381
Q

Exercise induced asthma treatment ad adverse effects

A

SABA prior to exercise
Muscel tremor
Tachycardia
Hypokalemia
Restlessness

382
Q

Mild asthma exacerbation treatment

A

PEF is 50-80% personal best
Administer SABA by nebulizer
Titrate oxygen to >92
Prednisone 40mg PO x 7 days
Want to get PEFR>80% personal best

383
Q

Severe asthma exacerbation treatment

A

PEF is <50% personal best
Administer nebulized SABA and maybe ipatropium
Titrate O2>92
IV methlyprednisolone
Mag sulfate IV in life threatening
Want PEFR>80% personal best

384
Q

Oral corticosteroid indications in asthma

A

Severe, not well controlled asthma presentation, asthma, exacerbation
Short term use for acute exacerbations

385
Q

COPD

A

Chronic obstructive pulmonary disease
Irriversible
Includes emphysema and chronic bronchitis

386
Q

COPD Risk factors

A

Smoking
Coal
Biomass fuel cooking
Alpha-1 antitrypsin deficiency

387
Q

COPD pathyphys

A

Inflammation of airway
Alveolar wall destruction leading to airway collapse
Fibrosis narrowing airway
Mucus gland hyperplasia
Vasoconstriction of pulmonary artery causing arterial HTN, hypoxemia, hypercapnia

388
Q

Centriacinar COPD

A

Most common
Usually in upper lobes of smokers

389
Q

Panacinar COPD

A

Associated with ALpha-q antitrypsin dficiency
Effects lower lung zones and exacerbated by smoking

390
Q

Paraseptal COPD

A

Found near pleura and septum of lungs often adjacent to areaas of fibrosis or scaring

391
Q

Irregular COPD

A

LEss common and can happen anywhere in lungs

392
Q

COPD symptoms

A

Dyspnea
Chronic cough
Sputum production
Wheezing
Fatigue
Pink puffers and blue bloaters

393
Q

Alpha antitryspin-1 deficiency treatment

A

IV alpha 1 antitrypsin
Lung transplant is the definitive treatment

394
Q

Emphysema pathophys

A

Loss of alveolar walls causing enlargement of air
Resistance of blood flow due to capillary loss
Loss of elastic recoil
Airway collapse makes expiration active process
Hyperinflation leading to air trapping and flattening of diaphragm

395
Q

Emphysema symptoms

A

Dyspnea
Exertion usually first sign
Chronic cough
Fatigue

396
Q

Emphysema physical exam findings

A

Pink sometimes or cyanotic
Usually noncyanotic at rest
Barrel chest
Hyperresonant to percussion bc hyperinflation
Decreased breath sounds
Expiratory wheezing

397
Q

Chronic bronchitis pathophys

A

Chronic inflammation leads to mucous gland hyperplasia, goblet cell mucous production, dysfunctional cilia, infiltration of neutrophils and CD8 T cells
Increased susceptibility to infection

398
Q

Chronic bronchitis symptom

A

Chronic cough
Sputum production
Dyspnea

399
Q

Chronic bronchitis physical exam

A

Blue bloaters from cyanosis (hypoxia)

400
Q

COPD diagnosis

A

Spirometry is GOLD (scooped out graph)
Post bronchodilator shows irreversible
FEV1 and FVC lowered
FEV1/FVC<80%
RV, TLC, and FRC increased
Emphysema has low DLCO
6 min walk test and get O2 sat

401
Q

Emphysema (COPD) CXR

A

Decreased lung markings
Large bullae
Flattened diaphragm from hyperinflation

402
Q

COPD ECG changes

A

Tachycardic with 3 different P wave morphologies (multifocal) is main one
Could also show low amplitude, right axis deviation, right atrial enlargement, RBBB

403
Q

COPD CBC

A

Increaesd HGB, HCT, chronic hypoxia
More in chronic bronchitis
Elevated eosinophils

404
Q

COPD ABG

A

Respiratory acidossi
Decreased pH
Increased pCO2 from CO2 from rentention in lungs
Hypercapnia

405
Q

Severity of airflow obstruction GOLD criteria

A

GOLD 1: Mild FEV1>80
GOLD 2: Moderate FEV1 50-80
GOLD 3: Severe FEV1 30-50
GOLD 4: Very severe FEV1 <30

406
Q

COPD GOLD group A

A

mMrc 0-1
CAT <10
0-1 exacerbations/yr

407
Q

COPD GOLD group A treatment

A

LABA daily (aformoterol, formeterol, salmeterol)
LAMA alternative
SABA for acute breathlessness

408
Q

COPD GOLD group B

A

mMRC>1
CAT>9
0-1 exacerbations/yr

409
Q

COPD GOLD group B treatment

A

LAMA+LABA dual bronchodilator daily (umeclidinium/vilanterol)
SABA PRN for acute breathlessness

410
Q

COPD GOLD Group E

A

> 1 exacerbations/yr

410
Q

COPD GOLD Group E treatment

A

LAMA+LABA daily
SABA PRN for acute breathlessness
Refer to pulmonary rehab
If have hospitalizations or eosinophils >300 add ICS

411
Q

Refractory Gold E COPD

A

Continuous exacerbations while on LABA+LAMA+ICS
Give roflumilast in chronic bronchitis with FEV1<50
Give Dupilumab if eosinophills >300
Give azithromycin in bbronchiectasis or recurrent bacterial infections in nonsmoker

412
Q

Toflumilast

A

PDE4 inhibitor
Givee pt with chronic bronchitis with FEV1<50 refractory COPD with LABA+LAMA+ICS
Antiinflammatory

413
Q

Dupilumab

A

Monoclonal antibody that blocks shared receptor in IL-4 and IL-13 (antiinflammatory)
Give to pts with eosinophils >300 with recurrent COPD on LAMA+LABA+ICS

414
Q

Azithromycin in COPD

A

Macrolide with antiinflammatory properties
Give in refractory COPD with LABA+LAMA+ICS with bronchiectasis or recurrent bacterial infections in nonsmoker

415
Q

What is the only treatment that lowers mortality in COPD

A

Oxygen therapy

416
Q

When to refer COPD pt

A

Onset before 40 yo
Two or more exacerbations per year
Rapidly progressive
Symptoms disproportionate to severity of airflow obstruction

417
Q

Triggers for COPD exacerbation

A

Respiratory infections
Pollution
Pulmonary embolism

418
Q

When to admit someone having COPD exacerbation

A

FEV1<50%
New symptoms
Signs of respiratory distress
Hemodynamic instability

419
Q

COPD bronchodilator treatment

A

Mild: SABA: albuterol or levalbuterol
Moderate/severe: SABA+ SAMA: ipratropium+albuterol

420
Q

COPD steroid treatment

A

Indicated for moderate to severe exacerbations
Prednisone
Methylprednisolone

421
Q

When to give antipseudomonas abx for COPD

A

Previous psudomonas infection
FEV1<30
Abx use in last 3 months
CHronic glucocorticoid treatment

422
Q

Restrictive lung disease pathophys

A

Decreased lung distensibility–>
Compromised lung expansion–>
Reduced lung volumes

423
Q

Interstitial lung disease

A

Destruction of lung parenchyma
Infiltrates
Toxins

424
Q

Extraparynchymal conditions that cause restrictive lung disease

A

Scoliosis
Kyphosis
Neuromuscular causes
Marked obesity

425
Q

Interstitial lung disease examples

A

Idiopathic pulmonary fibrosis (IPF)
Silicosis
Asbestosis
Coal worker’s pneumoconiosis
Sarcoidosis

426
Q

Interstitial lung disease symptoms

A

Progressive DOE
Persisitent nonproductive cough

427
Q

Interstitial lung disease labs

A

CMP for hepatic or renal involvement
CBC for anemia, polycythemia, eosinophilia
UA
Rheumatic labs(Antinuclear antibody, rheumatoid factor, anticyclic citrullinated peptide)
HIV test

428
Q

Idiopathic pulmonary fibrosis

A

Restrictive lung disease usually in 60-70 yo

429
Q

Idiopathic pulmonary fibrosis risks

A

Smoking
Dusts
Agent orange
GERD maybe

430
Q

Idiopathic pumonary fibrosis physical exam findings

A

Bibasilar crackles

431
Q

Idiopathic pulmonary fibrosis clinical manifestation

A

Gradual DOE and nonproductive cough over months.

432
Q

Idiopathic pulmonary fibrosis testing and imaging

A

Pulmonary function testing (PFT) to see restrictive pattern and severity
CXR with increased reticular markings and ground glass opacities (not diagnostic)
CT to congirm presence and see distribution (diagnostic)
Possible biopsy

433
Q

Diagnosis of idiopathic pulmonary fibrosis without biopsy

A

Pt>60yo AND
insidious cough AND
Diffuse patchy fibrosis with pleural based honeycombing on CT AND
Other potential causes ruled out

434
Q

Gold standard biopsy for idiopathic pulmmonary fibrosis

A

Open procedure using video assisted thoracoscopic surgery (VATS)
Diagnostic on its own

435
Q

Mild idiopathic pulmonary fibrosis

A

Asymptomatic or mild nonproductive cough and DOE
<10% lung parenchyma involvement
PFT normal or mild reductions

436
Q

Moderate idiopathic pulmonary fibrosis

A

DOE with some activity maybe needing O2
Nonproductive cough
Mild-moderate PFT changes
20-30% lung parenchyma involvement and honeycombing of 5%

437
Q

Advanced idiopathic pulmonary fibrosis

A

DOE with little activity
O2
Extensive honeycombing
pFT moderate to severe FCV reduction

438
Q

Idiopathic pulmonary fibrosis treatment

A

Referral to pulmonologist
No cure
Antifibrotic meds help (nintedanib, pirfenidone)
Supplemental O2 as needed
Lung transplant is definitive treatment (usually die in 5.2 years)

439
Q

Silicosis

A

Restrictive
Chronic fibrotic lung disease caused by inhalation of inorganic dusts.
Usually work with rocks/mining

440
Q

Silicosis imaging

A

CXR diffuse nodular opacities, egg shell calcification
Often found in upper lungs

441
Q

Asbestosis

A

Caused by inhaled asbestos fibers
Can be asymptomatic or severe. symptomatic life-shortening disorders.
Usually found in people that work in shipyards, construction, insulation

442
Q

Asbestosis imaging

A

CXR diffuse nodular opacities
Pleural calcifications
Honeycombing CT
CT is best

443
Q

Asbestosis symptoms

A

Progressive dyspnea
Clubbing
Cyanosis
Inspiratory crackles

444
Q

Asbestosis diagnosis

A

PFTs show restrictive dysfunction adn reduced diffusing capacity
CT images
Ferruginous body (asbestos body) in tissue

445
Q

Asbestosis treatment

A

No treatment

446
Q

Coal worker’s pneumoconiosis

A

Restrictive lung disease caused by inhaling coal dust

447
Q

Coal worker’s pneumoconiosis imaging

A

2-5 mm opacities of upper lung

448
Q

Coal worker’s pneumoconiosis symptoms

A

Cough
SOB
Chest tightness
Black sputum
Hypoxemia

449
Q

COal worker’s pneumoconiosis diagnosis

A

Mostly history (work in coal)
Smoking makes it worse

450
Q

Coal worker’s pneumoconosis treatment

A

O2
Inhalers
Pulmonary rehab
Transplant in severe

451
Q

Sarcoidosis

A

Restrictive lung disease
Usually in african americans and northern europeans 30-40yo

452
Q

Sarcoidosis symptoms

A

Parotid gland enlargement
Malaise
Fever
Dyspnea
Erythema nodosum and lupus pernio
Iritis
Peripheral neuropathy
Arthritis
Cardiomyopathy

453
Q

Sarcoidosis imaging

A

CXR Bilateral hilar and right paratracheal lymphadenopathy

454
Q

Sarcoidosis labs

A

ACE levels elevated
Leukopenia
Elevated ESR
Hypercalcemia
Hypercalciuria

455
Q

Sarcoidosis diagnosis

A

NONCASEATING GRANULOMAS in flexible bronchoscopy and biopsy
BAL fluid high CD4/CD8 ratio
Opthalmology exam

456
Q

Sarcoidosis treatment

A

Oral corticosteroids (prednisone 1mg/kg/day)
Long term therapy
Immunosuppressive therapy (methotrexate, azathioprine, infliximab

457
Q

Small cell carcinoma

A

Lung cancer
Early widespread metastasis
Most common in heavy smokers
Centrally located
Dark blue cells with rosette formation
Associated with Lambert Eaton syndrome, SIADH, Cushing syndrome

458
Q

Adenocarcinoma

A

Most common lung cancer
Minimally invasive or in situ
Usually in peripheral location
Neoplastic gland formation

459
Q

Squamous cell carcinoma

A

Lung cancer
Usually arises in mucous membrane of proximal bronchi
Strongly associated with smoking
Centrally located cavitary lesions
Widened mediastinum
Causes hypercalcemia

460
Q

Large cell undifferentiated carcinoma

A

Rare lung cancer
Rapidly growing in peripheral lung tissue

461
Q

Lung cancer risk factors

A

Smoking
Radon
Air pollution
Asbestos
Family history

462
Q

Lung cancer symptoms

A

Asymptomatic
Cough
Hemoptysis
Dyspnea
Hoarseness
Pleural effusion
Weight loss

463
Q

Lung cancer diagnosis

A

CXR
CT
Biopsy

464
Q

Occult stage of cancer

A

Cancer cells picked up in mucus but tumor not found

465
Q

Stage 0 cancer

A

Very small tumor
Canccer cells haven’t spread (in situ)

466
Q

Stage I cancer

A

Cancer is in the lung tissue but not lymph nodes

467
Q

Stage II cancer

A

Cancer has spread to lymph nodes near lungs

468
Q

Stage III cancer

A

Cancer has spread to lymph nodes in middle chest

469
Q

Stage IV cancer

A

Cancer has spread widely
Maybe into bones, brain, or liver

470
Q

Small cell lung cancer treatment

A

Chemotherapy

471
Q

Who qualifies for lung cancer screening

A

50-80 yo
20 pack-year history or quit in the last 15 years

472
Q

Most common primary lung cancer

A

Adenocarcinoma

473
Q

Adenocarcinoma symptoms

A

Asymptomatic
cough
dyspnea
hemoptysis
Weight loss

474
Q

Adenocarcinoma treatment

A

Surgery
Chemo

475
Q

Squamous cell carcinoma treatment

A

Surgery
Chemo

476
Q

Large cell carcinoma treatment

A

Surgery
Chemo

477
Q

Small cell carcinoma treatment

A

Chemotherapy and immunotherapy
Usually relapses within months

478
Q

Bronchial carcinod tumor

A

Secrete serotonin, ACTH, ADH, MSH
Slow growing
Slow metastasis

479
Q

Bronchial carcinoid tumor symptoms

A

Asymptomatic
Cough
Hemoptysis
SIADH
Cushing syndrome

480
Q

Carcinoid syndrome

A

Caused by serotonin and histamine release
Diarrhea, flushing tachycardia, hypotension, bronchoconstriction.
5-HIAA in urine

481
Q

Carcinoid syndrome treatment

A

Octreotide

482
Q

Superior sulcus (Pancoast tumor) symptoms

A

Horner syndrome (ipsilateral ptosis with arrowing of palpebral fissure
Shoulder pain
Fushing and sweating
Weakness in arm involved
SUPRACLAVICULAR lymph node enlargement
Weight loss

483
Q

Superior sulcus tumor treatment

A

Chemo
Radiation
Surgery f no metastasis

484
Q

Superior vena cava syndorome

A

Obstruction of blood flow in SVC
Usually tumor but could be medical device
Most common n non-small cell lung cancer

485
Q

Superior vena cava syndrome symptoms

A

Facial swelling or head fullness
Neck swelling
Dyspnea
Resp distress

486
Q

Superior vena cava syndrome physical exam

A

Distention of neck
Edema
Cyansosis

487
Q

Superior vena cava syndrome imaging

A

CXR with mediastinal widening and pleural effusion
CT

488
Q

Superior vena cava syndrome treatment

A

Radiation to treat underlying malignancy
Head elevation and fluid reduction

489
Q

Paraneoplasic syndromes

A

Caused by production of hormones, cytokines, or other substances
Commonly cushings, hypercalcemia, SIADHm, neuropathy

490
Q

Pulmonary nodule

A

> 3cm
Usually infectious granuloma (not cancer)
Could be adenocarcinoma (cancerous)
Usually no symptoms
Get good medical and social history

491
Q

Pulmonary nodule imaging

A

Found on CXR
Get CT
Compare to old CXR and CT
Maybe PET
Biopsy or resection

492
Q

What to do if pulmonary nodule >8mm found

A

Get PET scan
Biopsy or resection

493
Q

What to do if pulmonary nodule <8mm found

A

Get another CT later on

494
Q

Subsolid nodule on CT

A

Ground glass
More likely to be adenocarcinoma than solid

495
Q

At what point does a nodule need no further workup

A

If it is sable for two years with no growth

496
Q

Benign calcification pattersn

A

Central, diffuse, fat, lamellated

497
Q

More worrisome calcifaction patterns

A

Puntuate
Eccentric
amorphous

498
Q

More suspicious characteristics of nodules

A

Spiculated or lobulated borders
Worse in upper lobe

499
Q

Gold standard for pulmonary nodule diagnosis

A

Surgical biopsy and if you need to take it out go ahead and do it at same time

500
Q

A-a gradient

A

PAO2-PaO2
Difference in O2 in alveoli and arteries

501
Q

A-a gradient increased with hypoxemia

A

Shows intrapulmonary cause
Caused by dead space ventilation (pulm embolism) or diffusion disorder (pulm fibrosis) that are fixable with 100% oxygen.
Also caused by shunt (pneumonia) not fixable with 100% oxygen bc problem is blood flow to alveoli

502
Q

A-a gradient normal with hypoxemia

A

Shows extrapulmonary cause
Caused by hypoventilation, low inspired O2 (altitude)
Correctible with 100% oxygen

503
Q

Respiratory alkalosis

A

Hyperventilation
Hypoxemia most commmon cause
Anxiety
Stimulants
Can cause hypocalcemic symptoms (treussau and chvostek)

504
Q

Metabolic compensation for respiratory acidosis

A

HCO3 must increase 3.5 mEq/L for every 10mmHg PaCO2 is increased

505
Q

Metabolic compensation for respiratory alkalosis

A

HCO3 should decrease by 5mEq/L for every 10mmHg decrease in PaCO2

506
Q

Respiratory compensation for metabolic acidosis

A

PaCO2 should decrease by 1.2mmHg fro every 1mEq/L decrease in bicarb

507
Q

Respiratory compensation for metabolic alkalosis

A

PaCO2 should increase by 0.7mmHg for every 1mEq/L increase in HCO3

508
Q

Obstructive sleep apnea

A

Cessation of airflow during sleep with persistent respiratory effort
Most common sleep apnea

509
Q

Central sleep apnea

A

Cessation of airflow bc brain stops sending signals to muscles of respiration
Rare

510
Q

Mixed sleep apnea

A

Apnea that begins as central apnea and ends as obstructive

511
Q

Apnea

A

Drop in airflow of at least 90% lasting longer than 10 seconds

512
Q

Hypopnea

A

Drop in airflow at least 30% lasting longer than 10 seconds

513
Q

Apnea/Hypopnea index

A

Apneas and hypopneas per hour
5 or more diagnostic for sleep apnea of OSA
>30 is severe OSA

514
Q

Sleep apnea risk factors

A

Men
Family history of snoring or OSA
Nasal congestion
Obesity
CHF
Pulm HTN
Kidney disease
Lung disease

515
Q

Sleep apnea clinical presentation

A

Tired
Snoring, choking, gasping during sleep
Morning headaches
Nocturia

516
Q

Sleep apnea physical exam

A

Obesity (BMI>30)
Crowded airway from tonsils, uvula, or other stuff
Large neck (>17 males and >16 females) and/or waist

517
Q

Obesity hypoventilation syndrome

A

Awake alveolar hypoventilation and hypercapnea
Need PAP device

518
Q

First line treatment for sleep apnea in KIDS

A

Tonsillectomy
NOT for adults

519
Q

Epworth sleepiness scale

A

Pt ranks likelyhood of falling asleep in certain scenarios.
10-15 is very sleepy
16-24 needs medical attention

520
Q

STOP-BANG sleepiness scoring

A

Snore
Tired
Observed apnea
Pressure (blood)
BMI
Age
Neck
Gender

521
Q

Best diagnostic test for sleep apnea

A

In-lab polysomnography sleep study
Hooked up head to toe with monitors

522
Q

When to give home sleep apnea test

A

When you think pt has uncomplicated sleep apnea
Shows severity of sleep apnea, O2, position
Box strapped to chest, oximeter on finger, canular under nose.

523
Q

Mild obstructive sleep apnea

A

AHI 5-15 and one or more of these:
Sleepiness, waking up gasping, snoring, HTN, mood problems, Afib, T2DM

524
Q

Severe obstructive sleep apnea

A

AHI>30
Falling asleep during daily activities

525
Q

Obstructive sleep apnea treatment

A

Behavioral modifications
Weight loss (GLP-1 (tirzepetide))
PAP devices
Avoid alcohol
Sleep position
Oral devices for mild

526
Q

What pts usually require higher CPAP pressure

A

Heavier pts with short, thick neck

527
Q

Mycobacterium

A

Aerobic acid fast bacilli
Slow growth
Often acquired through municipal water sources

528
Q

Non-TB mycobacterium presentation

A

Persistent fever and weight loss
Pulm exam usually normal

529
Q

Non-TB mycobacterium treatment

A

Azithromycin
Rifampin
Ethambutol

530
Q

Types of tuberculosis

A

Primary
Primary progressive
Latent
Reactivation

531
Q

Primary TB pathophys

A

Inhale airborne droplet
Bacilli ingested but not destroyed by mø
Pulmonary granulomas formed to isolate infection and regional lymphadenopathy (Ghon complex)
Can be dormant for years

532
Q

Primary progressive TB pathophys

A

Immune response inadequate to contain infections.
Will develop pulmonary symptoms

533
Q

Latent TB pathophys

A

NOT active disease.
Reactivation can occur if immune system impaired (can be triggered by meds)

534
Q

Reactivation TB pathyophys

A

Usually associated with waining immune system.
Lesions usually localized in lung apices due to increased O2 in apices.
Contagious

535
Q

TB clinical findings

A

Very slowly progressive
Fever, malaise, anorexia, weight loss, night sweats
Chronic cough
Malnourished
Cervical lymphadenopathy
Can effect vertebral bodies, adrenals, meninges, GI

536
Q

TB diagnosis

A

Sputum culture or acid fast bacilli

537
Q

Primary TB imaging

A

CXR shows small unilaterla infiltrates.
Hilar and paratracheal lymphadenopathy
Segmental atelectasis
Pleural effusion

538
Q

Reactivated TB imaging

A

Fibrocavitary apical disease
Nodules
Upper and superior segment of lower lobe infiltrates.
Millet seed nodules
Miliary pattern

539
Q

What is measured to find if TB skin test is positive

A

Induration (raised area) not red area 48-72 hrs after test

540
Q

What to do if TB skin test is positve

541
Q

Interferon gamma release assays

A

High sensitivity and specificity for TB
Fewer false positives but more expensive

542
Q

Number one cause for TB treatment failure

A

Nonadherence to medication regimen.
So every person gets case manager to watch them take meds

543
Q

TB treatment

A

4 total months
First 2: isoniazid, rifapentine, pyrazinamide, moxifloxacin
Second 2: isoniazid, rifaapentine, moxifloxacin
No pyrazinamide in pregnant
Drug resistant is different for 6 months
Monthly follow up until sputum and culture negative (should only take 3 months)

544
Q

Latent TB treatment

A

Isoniazid and rifampan 3 months
or
Isoniazid and rifapentine 3 months
or
Isoniazide alone 9 months

PAS 531 (15 decks)

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