Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Step 2 CK > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

Explain 2 stage testing.

A

If pt has never had PPD done before then the 2nd PPD is indicated w/in 1-2 weeks if the first test was negative to rule out falsely negative result. If second test negative then pt is truly negative. If second test is positive then pt is truly positive and the first test was falsely negative.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the alternative screening tool for pts who have the BCG vaccine?

A

Can do Inteferon Gmma Release assay which has no reactivity to BCG. However if pts have positive PPD due to BCG they must take isoniazid for 9 months No matter what!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the best initial test of Asthma? Most accurate test?

A

Best initial test depends on severity of asthma. If pt is having severe symptoms then ABG right away. If not then Peak Expiratory Flow. PFTs Most accuartate (Decrease in FEV1 more than FVC, Decrease FEV1/FVC ratio, Normal DLCO) If pt has no symptoms you can do Methacholine challenge test. Skin testing to identify specific allergens. IgE levels elevated.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

State the for steps in treatment of Asthma 1-6.

A
  1. Short acting B 2. Lows dose ICS 3. Long acting B or increase ICS 4. High dose, leukotriene antagonist, long acting beta and short acting beta 5. Omalizumab 6. Oral Prednisone when all else fails.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Name the common oragnisms causing COPD exacerbation? Best initial test for COPD. Most accurate test?

A

S. pneumonia and H. influenza. CXR (increased AP diatmeter, flat diaphram) need to rule PNA to exclude diagnosis and as a cause of the exacerbation. Most accurate test is PFT (Decrease FEV1 more than FVC, Decrease in DLCO - emphysema, Normal in Bronchitis type.) EKG will show MAT(p waves of different sizes) or AFib due to R atrial dilation and RVH.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Name the different treatment steps for Chronic COPD.

A

Smoking cessation 02 therapy ( 2 things that decrease mortality) if p02 < 55 mmhg and sat < 88% or p02 < 60 mmg hg and sat <90% for R heart failure. 1. Beta 2 + anticholinergics (tiotropium or iotropium) Betas are not first line because pts usually have underlying heart disease 2. Theophylline (check abx.) Pulmonary rehab. When all else fails lung transplant.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Initial Management and treatment of Acute on Chronic Exacerbation of COPD.

A

CXR. Get ABG if severe. Always check levels of theophylline if pt is on that, CBC, ECG. Rx: 1. 02 2. beta 2/ipatropium (Combivent/Symbicort), 3. IV or PO steroids (Solumedrol) (determine if they can swallow Oral tabs) and 4. Azithromycin. Educate on smoking cessation if pt is still smoking.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Initial Management and treatment of Acute Exacerbation of asthma?

A

CXR and CBC to r/o infection causing the exacerbation. O2, Albuterol Neb, ICS.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Pt presents with reccurent pulmonary infections, sinsuitis, nasal polyps, meconium ileus, biliary cirrhosis, malabsorption, pancreatic insufficiency, steatorrhea, reccurent pancreatitis and gastro intestinal obstruction. Dx? Etiology? Most accurate test? Rx?

A

CF (AR CFTR gene mutations damage chloride and water transport across the apical surface of epithelial cells in exocrine glands. This leads to thick mucus. CXR. Sweat chloride test is most accurate. Rx: 1. Inhaled aminoglycosides and inhaled rH-deoxyribonuclease ( helps to break up the mucous) 3. Albuterol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q
  1. How do CF pts develop Diabetes? 2. Common complicaiton for boys with CF? 3. Common complication of boys and girls with CF?
A
  1. Do to recurrent pancreatitis leading to beta cell destruction. 2. Subinfertility (Azoserpmia, cant migrate to vas deferans due to thick secretions) 3. Chronic Rhinosinusitis.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Name the cause of PNA: 1. Recent viral syndrome 2. Alcoholics 3. GI symptoms+ confusion 4. Young, healthy pts 5. Person present at birth of an animal 6. Arizona Construction workers 7. HIV CD44 < 200

A
  1. S. Aureus 2. Klebsiella 3. Legionella 4. Mycoplasma 5. Coxiella burnetii 6. Coccidioiomycosis 7. PCP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Purpose of thoracentesis in pneumonia.

A

If pleural effusion is present we want to analyze the fluid for the presence of empyema which is infection pleural effusion. Effusions can be Exudative ( caused by infection or cancer: this meets lights criteria :increased vascular permeability) or transdutative( increased PCWP (left heart failure) or decrease oncontic pressure does not meet lights criteria). Lights criteria: 1. pleural protein/serum protein >0.5 ( pleural protein greater than 50% of serum 2. Pleural LDH/Serum LDH > 0.6 (pleural LDH is greater than 60% of the serum) 3. Pleural LDH fluid >2/3 the upper limit of the serum. Will show LDH 300s.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Name the specific diagnostic test for these organisms. Mycoplasma, Legionella, PCP (Pneumocystis)

A
  1. PCR and cold agglutins. 2. Urine antigen or Chorcal- yeast extract 3. BAL(Bronchoalveolar Lavage) For the other atypicals you can check serology (antibody titers)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Best initial test for PCP? Most accurate test? Rx? PCP prophylaxis?

A

Occurs in AIDS when CD4 count < 200. 1. CXR, ABG show hypoxia and increase A-a gradient 2. BAL most accurate. Sputum is quite specific. If sputum stain is negative then next is bronchoscopy . Rx: Bactrim. If toxicity to bactrim then Clindamycin and Primaquine (Contraindicated in G6PD) or Pentamidine. Prophylaxis: Bactrim if neutropenia or rash develop then Atovaquone or Dapsone (also contrainidcated in G6PD.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Give 5 Classifications of Pulmonary HTN.

A
  1. Idiopathic Aterial pulmonary HTN 2. Increase venous black flow from left heart failure 3. Hypoxic vasocontriction 2/2 COPD 4. Chronic PE 5. Unclear etiology
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Pt placed on ventilator and develops new onset fever cough purulent secretions and new infiltrate found on CXR. Dx? Test? Most accurate? Rx?

A

VAP (Mechanical ventilation interferes with mucocilary clearance of the respiratory tract such as ability to cough) Test: Tracheal aspirate, BAL, Protected Brush specimen, Video Assisted Thoroscopy. Open lung biopsy is most accurate. Rx: Ceftazdime/Cefipime/Ceftriaxone + gentamicin+ vancomycin!!

18
Q

Complication of PEEP?

A

Barotrauma: tension pneumothorax. Needle thorocostomy and chest tube placement.

19
Q

Rheumatoid arthritis, pneumoconiosis, lung nodules, increase IgA, IgG, C3 and ANA. Dx?

A

Caplan syndrome associated with Coal Miners Lung/Cool worker’s pneumoconiosis.

21
Q

When you discover a new SPN in a young non smoker. What is the next step in management?

A

Get the previous CXR. If new, CT scan to assess whether its spiculated, >2.3 cm. Then from this you decide if want further intervention. Most likely benign in this patient so just follow with serial CTs.

22
Q

When discover a new SPN n a old male smoker that was not there previous on CXR.

A

Next step is CT scan to see if the lesions can be biopsied by bronchoscopy (central lesions) or percutaneous CT-guided biopsy for peripheral lesions. It is important to do this so you will not cause a pneumothorax.

22
Q

Next step in management when a pt presents with recurrent pneumonia.

A

After doing a CXR and they still are not clinically better the next step is CT scan to assess for an obstruction, fistula, empyema. If the CT scan is negative then the next step is Bronchoscopy.

22
Q

Pt presents with SOB, fatigue, CP, wide splitting S2 from pulmonary HTN with loud P2 or tricupsid and pulmonary valve regurgitation. Best initial test? Most accurate test? Rx?

A

This is pulmoary HTN. CXR and CT. Right heart/ Swanz-ganz catheter most accurate shows elevate pulmonary arterial pressures. Correct underlying condition. Idiopathic Rx: Phosphodiesterase ihibitors, Prostacyclin analogues Epoprostenol, Any prost drug, Bosentan.

23
Q

Pt presents with obesity, bull neck, loud snoring, daytime somnolence, depression, HA in AM, HTN. Dx? What is the cause of HA. Most accurate test? Rx?

A

Obstructive sleep apnea. HA caused by the increase hypercabnia upon waking. Polysomnography (sleep study) Weight loss and avoid alcohol. CPAP. Last line is uvuloplatopharyngoplasty.

24
Q

Best initial test for Active TB? Accurate? Rx?

A

CXR. AFB stain and culture on 3 separate occasions. RIPE therapy 6 months. (After 2 months, stop Ethambutol (Optic neuritis) and Pyarzinamide (hyperurecemia), Continue Rifampin (Red secretions) and Isoniazid (AST/ALT,neuropathy) for 4 more months.

25
Q

PDD: When is induration considered alarming > 5 mm an issue? 10mm> , >15mm?

A
  1. Immunocomprised (HIV and steroid) and Close Contacts with active TB 2. Immigrants, healthcare workers, prisoners, 3. Everybody
26
Q

Pt presents with reccurent pulmonary infections, sinsuitis, nasal polyps, meconium ileus, biliary cirrhosis, malabsorption, pancreatic insufficiency, steatorrhea, reccurent pancreatitis and gastro intestinal obstruction. Dx? Etiology? Most accurate test? Rx?

A

CF (AR CFTR gene mutations damage chloride and water transport across the apical surface of epithelial cells in exocrine glands. This leads to thick mucus. CXR. Sweat chloride test is most accurate. Rx: 1. Inhaled aminoglycosides and inhaled rH-deoxyribonuclease ( helps to break up the mucous) 3. Albuterol

27
Q
  1. How do CF pts develop Diabetes? 2. Common complicaiton for boys with CF? 3. Common complication of boys and girls with CF?
A
  1. Do to recurrent pancreatitis leading to beta cell destruction. 2. Subinfertility (Azoserpmia, cant migrate to vas deferans due to thick secretions) 3. Chronic Rhinosinusitis.
28
Q

Name the association for each pathogen: 1. Haemophilus Influenzae 2. S. aureus 3. Klebsiella pneumonia 4. Anaerobes 5. Mycoplasma pneumonia 6. Chlamydia pneumonia 7. Legionella 8. Chlamydia psittaci 9. Coxiella burnetti.

A
  1. COPD 2. Secondary bacterial pneumonia after influenza 3. Alcoholics and diabetics 4. Poor dentition and aspiration, Alcoholics, Altered Mental Status, Stroke 5.Young and health, military, dorm 6. Young and healthy people with hoarsness. 7. Water contimination, air conditining, aerosolization 8. Birds 9. Farmers, Q fever, Sheep
29
Q

Name the atypical pnuemonias that present with dry cough, interstitial infiltrate and will not be detected on Sputum Stain and Culture.

A

(MCC/PVL) Mycoplasma, Chlymydia, Coxiella/ Pneumocysitis and Viruses. Legionalla doesnt show up on gram stain either but you get productive cough. Must check rising serologic titers to accurately diagnosis these.

30
Q

Purpose of thoracentesis in pneumonia.

A

If pleural effusion is present we want to analyze the fluid for the presence of empyema which is infection pleural effusion. Effusions can be Exudative ( caused by infection or cancer: this meets lights criteria :increased vascular permeability) or transdutative( increased PCWP (left heart failure) or decrease oncontic pressure does not meet lights criteria). Lights criteria: 1. pleural protein/serum protein >0.5 ( pleural protein greater than 50% of serum 2. Pleural LDH/Serum LDH > 0.6 (pleural LDH is greater than 60% of the serum) 3. Pleural LDH fluid >2/3 the upper limit of the serum. Will show LDH 300s.

31
Q

Best initial test for PCP? Most accurate test? Rx? PCP prophylaxis?

A

Occurs in AIDS when CD4 count < 200. 1. CXR (shows bilateral infiltrates), ABG show hypoxia and increase A-a gradient 2. BAL most accurate. Sputum is quite specific. If sputum stain is negative then next is bronchoscopy . Rx: Bactrim + prednisone if p02 < 70. If toxicity to bactrim then Clindamycin and Primaquine (Contraindicated in G6PD) or Pentamidine. Prophylaxis: Bactrim if neutropenia or rash develop then Atovaquone or Dapsone (also contraindicated in G6PD.)

32
Q

Pt placed on ventilator and develops new onset fever cough purulent secretions and new infiltrate found on CXR. Dx? Test? Most accurate? Rx?

A

VAP (Mechanical ventilation interferes with mucocilary clearance of the respiratory tract such as ability to cough) Test: Tracheal aspirate, BAL, Protected Brush specimen, Video Assisted Thoroscopy. Open lung biopsy is most accurate. Rx: Ceftazdime/Cefipime/Ceftriaxone + gentamicin+ vancomycin!!

33
Q

Management for Latent TB 1. Positive PPD (>5, >10, >15mm)and Negative CXR? 2. Positive PPD and Negative AFB x 3? 3. Positive PPD and Positive AFB x 3 - Active Disease?

A
  1. INH + B6 for 9 months for chemoprohylaxis 2. INH + B6 for 9 months 3. 6 months INH (AST/ALT), Pyzarazinamide then drop Rifampin (Red secretions) and Ethambutol (Optic Neuritis) after 2 months. Rifampin and Ethambutol always drop first.
34
Q

Rheumatoid arthritis, pneumoconiosis, lung nodules, increase IgA, IgG, C3 and ANA. Dx?

A

Caplan syndrome associated with Coal Miners Lung/Cool worker’s pneumoconiosis.

35
Q

Pt presents with worsening asthma symptoms, brownish mucous plugs. IGE elevated. Eosinophila present on CBC. Dx? Test? Rx?

A

ABPA (Allergic Bronchopulmonary Aspergillosis). Aspergillous skin testing. IGE levels and A fumigatus specific antibodies. 1. Oral steroids ( mainstay of therapy for ABPA ) 2. Itracanazole for refractory disease.

36
Q

Rx for ARDS?

A

Low tidal volume (6ml per kg), PEEP, Prone positioning, duiretics and dobutamine may help.

37
Q

Rx For CAP, HAP and VAP?

A
  1. Azithromycin/Clarithromycin or Moxi or Levo 2. Azithromycin +Ceftriaxone or Moxi or Levo 3. Meropenem/Zosyn/Cefepime + Vanc/Linezolid + Gentamicin
38
Q

Rx for latent TB I(5 options)?

A
  1. Isoniazid for 9 months. 2. Rifampin for 4 months 3. Rifampin + isoniazid for 4 months. 5. Isoniazid + Rifapentine weekly for 3 months.

Step 2 CK (33 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions