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3rd Year (Step 2) > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

Main diff. between Asthma & COPD?

A

Asthma is a reversible OLD, COPD isn’t

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2
Q

Best initial test in acute asthma exacerbation?

A

Peak Expiratory Flow (PEF) or Arterial Blood Gas (ABG)

- peak flow can be used by the patient to determine function

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3
Q

CXR appearance in asthma pt?

A

Normal or hyper-inflated

used in asthma dx to r/o pneumonia, pneumothorax, or CHF if case unclear

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4
Q

Most accurate Dx test for Asthma?

A

PFTs

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5
Q

PFTs in between asthma exacerbations?

A

Normal

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6
Q

Provocation testing for asthma?

A

Methacholine (or Histamine) should cause >20% decrease in FEV1

  • used when pt is asymptomatic, since ABG & PFTs are only useful in acute exacerbation
  • Methacholine = synthetic Acetylcholine

(Methacholine & Histamine cause bronchoconstriction & increase bronchial secretions)

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7
Q

Inhaled Steroids – adverse effects?

A
  • Dysphonia (voice impairment)

- Oral Candidiasis

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8
Q

Zafirlukast - AEs?

A
  • Hepatotoxicity

- Churg-Strauss Syndrome

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9
Q

Cromolyn MOA?

A

Inhibits mast cell mediator release & eosinophil recruitment

alt. long-term control agent to low-dose inhaled corticosteroids — 1st added Tx to asthma after albuterol inhaler

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10
Q

Nedocromil MOA?

A

Inhibits mast cell mediator release & eosinophil recruitment

alt. long-term control agent to low-dose inhaled corticosteroids — 1st added Tx to asthma after albuterol inhaler

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11
Q

Omalizumab MOA?

A

IgE-inhibitor

inhibits their binding to mast cells & basophils

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12
Q

How do you quantify severity of asthma?

A
  • Decreased PEF
  • ABG w/ increased A-a gradient

If pt is acutely SOB, use RR as indication of severity (if increased)

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13
Q

Systemic Corticosteroids – AEs?

A
  • Osteoporosis
  • Cataracts
  • Adrenal suppression & fat redistribution
  • Hyperlipidemia, Hyperglycemia, Acne, & Hirsuitism
  • Thinning of skin, striae, & easy bruising

(harsh, therefore try to not give these)

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14
Q

All asthma patients receive what 2 vaccines?

A

Influenza & Pneumococcal

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15
Q

Acute asthma exacerbation – what do you give?

A
  • Oxygen
  • Albuterol
  • Steroids (take 4-6 hrs to work)
  • Ipratropium or Magnesium can be used if multiple rounds of Albuterol not helping, while waiting for steroid to kick in
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16
Q

COPD: best initial test & most accurate diagnostic test?

A

Best initial = CXR

Most accurate Dx = PFT

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17
Q

Potential abnormal CBC findings in COPD patients?

A

Increased hematocrit from chronic hypoxia

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18
Q

Potential abnormal EKG findings in COPD patients?

A
  • Right atrial & ventricular hypertrophy

- A. fib or multifocal atrial tachycardia (MAT)

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19
Q

Potential abnormal Echo findings in COPD patients?

A
  • Right atrial & ventricular hypertrophy

- Pulmonary HTN

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20
Q

COPD Tx that improves mortality?

A
  • Smoking cessation
  • O2 Tx if pO2<=88%
  • Influenza & Pneumococcal vaccinations
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21
Q

COPD Tx that improves symptoms but not mortality?

A
  • SABAs (albuterol)
  • *- Anti-Cholinergic agents - inhaled (Tiotropium; Ipratropium)** these are most effective
  • Steroids (IV or PO methylprednisolone for acute exacerbation of COPD)
  • LABAs (salmeterol)
  • Pulmonary rehabilitation

**AECOPD Meds MOA:
Inhaled bronchodilators: albuterol, ipratropium
IV/PO anti-inflammatories: glucocorticoids (methylprednisolone)

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22
Q

Asthmatics not controlled w/ albuterol get what next?

A

Inhaled steroid

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23
Q

COPD pts not controlled w/ albuterol get what next?

A

Anticholinergic (Tiotropium, Ipratropium)

next –> inhaled steroid

24
Q

Antibiotics to use in acute exacerbation of chronic bronchitis?

A
  • Macrolides: Azithromycin, Clarithromycin
  • Cephalosporins: Cefuroxime, Cefixime, Cefaclor, Ceftibuten
  • Amoxicillin/Clavulanic Acid (Augmentin)
  • Quinolones: Levofloxacin, Moxifloxacin, Gemifloxacin

(covering: Strep pneumonia, H. influenzae, & Moraxella catarrhalis)

25
Q

Viruses cause mose acute exacerbations of COPD, but just in case, which bacterias do you wanna cover w/ ABX?

A
  • Strep pneumonia
  • H. influenzae
  • Moraxella catarrhalis
26
Q

Bronchiectasis - permanent or reversible?

A

Permanent anatomic abnormality due to chronic dilation of the large bronchi
(from multiple infections usually)

27
Q

Differences btwn Bronchiectasis & Chronic Bronchitis?

A

Bronchiectasis - Chronic cough is ass’d w/ larger volume of sputum (>100ml/day), recurrent fever, hemoptysis, & Pseudomonas infection
- also may see anemia of CD, weight loss, crackles on lung exam

Chronic bronchitis pts usually have same chronic cough, but w/ non purulent expectoration

28
Q

Most common cause of bronchiectasis?

A 
Cystic Fibrosis 
(accounts for half of cases)
29
Q

Bronchiectasis – best initial test & most accurate Dx test?

A

Best initial = CXR

Most accurate Dx = High-resolution CT scan

30
Q

Most likely Dx?

Asthmatic pt w/ recurrent episodes of brown-flecked sputum & transient infiltrates on CXR.

A

Allergic Bronchopulmonary Aspergillosis

  • may also have cough, wheezing, hemoptysis, & sometimes bronchiectasis may occur

Dx: look for peripheral eosinophilia, inc’d serum IgE levels, & serum antibodies to aspergillus

31
Q

Describe Sweat Chloride Test for CF

A
  • Pilocarpine increases ACh levels, which increases sweat production
  • Sweat Cl- >60mEq/L = CF dx
32
Q

Typical organisms in sputum culture of CF pts?

A
  • Nontypable H. influenzae
  • Pseudomonas aeruginosa
  • Staph aureus
  • Burkholderia cepacia
33
Q

ABX Tx that is almost exclusive to CF pts?

A

Inhaled Aminoglycosides

34
Q

CAP organism ass’d w/ COPD?

A

H. influenzae

35
Q

CAP organism ass’d w/ recent viral infection (influenza)?

A

Staph aureus

36
Q

CAP organism ass’d w/ Diabetes?

A

Klebsiella pneumoniae

also w/ alcoholics

37
Q

CAP organism ass’d w/ poor dentition/aspiration?

A

Anaerobes

38
Q

CAP organism ass’d w/ young, healthy patients?

A

Mycoplasma pneumoniae

39
Q

CAP organism ass’d w/ hoarseness?

A

Chlamydophila pneumoniae

40
Q

CAP organism ass’d w/ contaminated H2O sources, AC, vent systems?

A

Legionella

41
Q

CAP organism ass’d w/ birds?

A

Chlamydia psittaci

42
Q

CAP organism ass’d w/ animals @ the time of giving birth (vets, farmers)?

A

Coxiella burnetii

43
Q

Main ways to distinguish pneumonia from bronchitis?

A

Dyspnea, high fever, & abnormal CXR

44
Q

CAP organism ass’d w/ hemoptysis from necrotizing disease?

A

Klebsiella

currant jelly sputum

45
Q

CAP organism ass’d w/ foul smelling sputum, “rotten eggs”?

A

Anaerobes

46
Q

CAP organism ass’d w/ dry cough, rarely severe, bullous myringitis?

A

Mycoplasma pneumoniae

47
Q

CAP organism ass’d w/ GI symptoms (abdominal pain, diarrhea)?

A

Legionella

48
Q

CAP organism ass’d w/ CNS symptoms (headache, confusion)?

A

Legionella

49
Q

What is meant by “atypical pneumonia”?

A

Refers to an organism that is not visible on gram stain & not culturable on standard blood agar

  • Mycoplasma
  • Chlamydophila
  • Legionella
  • Coxiella
  • Viruses
50
Q

Organisms causing CAP w/ “dry” or non-productive cough?

A
  • Mycoplasma
  • Viruses
  • Coxiella
  • Pneumocystis
  • Chlamydia
51
Q

CAP organisms that cause bilateral interstitial infiltrates on CXR?

A
  • Mycoplasma
  • Viruses
  • Coxiella
  • Pneumocystis
  • Chlamydia

**same ones that cause dry, non-prod cough*

52
Q

Main causes of exudates?

A

Infection & Cancer

53
Q

Etiology diff. in HCAP vs. CAP

A

HCAP has much higher incidence of Gram-negative bacilli (E. coli or Pseudomonas)

54
Q

HCAP Tx vs. CAP?

A

CAP:
O/P = Azithromycin or Clarithromycin if healthy & no recent ABX, but Fluoroquinolone if comorbidities or recent ABX use (past 3 months)
I/P = Fluoroquinolone or Ceftriaxone + Azithromycin

HCAP:
- Antipseudomonal cephalosporin (Cefepime or Ceftazidime)
- Antipseudomonal penicillin (Piperacillin/tazobactam)
or
- Carbapenems (Imipenem, Meropenem, Doripenem)

55
Q

1st & 2nd most common AEs of TMP/SMX?

A
  1. Rash

2. Bone marrow suppression

56
Q

How to determine if patient w/ CAP needs outpatient treatment vs. inpatient admit vs. ICU?

A 
CURB-65:  
Confusion,
Uremia (BUN>20),
Respirations > 30/min,
BP  65

> 2 points gets admitted, > 4 points goes to ICU

57
Q

Exudative edema causes

A

Infection (pneumonia, TB), malignancy, pulmonary embolus, connective tissue disease, iatrogenic

3rd Year (Step 2) (44 decks)

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