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Pulmonary Flashcards

1
Q

Pulmonary Embolism classic triad

A
  1. Dyspnea
  2. Pleuritic CP
  3. Hemoptysis
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2
Q

What is the MC predisposing condition in PE?

A

Factor V Leiden

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3
Q

Gold standard diagnostic in PE

A

CT Pulmonary Angio

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4
Q

Lab findings in PE

A
  1. Leukocytosis
  2. Elevated ESR
  3. Elevated AST
  4. Elevated Troponin
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5
Q

What is the MC EKG finding in PE

A

Sinus Tachycardia + Nonspecific ST/T changes

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6
Q

What is the most specific EKG finding in PE, but rare

A

S1Q3T3

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7
Q

What is the MC CXR finding in PE?

A

Normal CXR

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8
Q

Rare CXR findings in PE

A
  1. Westmark’s Sign

2. Hamptons Hump: Wedge shaped infiltrate

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9
Q

What are the CI’s to LMWH (SQ injections)

A
  1. Renal failure: Cr >2

2. Thrombocytopenia

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10
Q

What is a SE to Unfractionated Heparin

A

Heparin Induced Thrombocytopenia (HIT)

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11
Q

What is the antidote to Unfractionated Heparin

A

Protamine sulfate

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12
Q

If you start a patient on Warfarin, what must you make sure you do?

A

Overlap with Heparin for @ least 5 days and INR 2-3 for @ least 24 hrs

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13
Q

Treatment options in a HEMODYNAMICALLY STABLE pt with a PE

A
  1. IV UFH or SQ LMWH
  2. PO Warfarin or NOAC x 3 mos
  3. IVC filter if anticoagulation CI
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14
Q

Treatment options in a HEMODYNAMICALLY UNSTABLE pt with a PE

A
  1. Thromobolytic tx

2. Embolectomy

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15
Q

Define empyema

A

Grossly purulent /turublent effusion

Direct infection of pleural space

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16
Q

Define Parapnuemonic

A

Noninfected pleural effusion 2ry to bacterial pneumonia

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17
Q

What is the MCC of Transudate Pleural Effusion? 2nd and 3rd?

A

CHF=MC
Nephrotic Syndrome
Cirrhosis

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18
Q

What is the cause of Exudate Pleural Effusion?

A

Infection/Inflammation= Pneumonia

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19
Q

Lung physical exam findings in pleural effusion

A
  1. Decreased BS
  2. Dullness to percussion
  3. Decreased tactile fremitus
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20
Q

What CXR view is the best for detecting small effusions? CXR findings?

A

Lateral decubitus

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21
Q

PA/Lateral CXR findings in pleural effusion

A

Blunting of costophrenic angle, + menisci sign

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22
Q

What is the TOC in pleural effusions?

A

Thoracentesis

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23
Q

Describe the lung exam findings in spontaneous pneumothorax

A
  1. Hyperressonance to percussion

2. Decreased fremitus, decreased BS

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24
Q

Describe the lung exam findings in tension pneumothorax

A
  1. JVP
  2. Hypotension
  3. Pulsus Paradoxus
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25
When would it be appropriate to observe a pneumothorax? How long is observation? f/u tx?
Small Primary Spontaneous Pneumothorax= <15-20% of hemothorax diameter Observe for 6 hrs and repeat CXR
26
Tension Pneumothorax treatment
Needle aspiration + Chest tube placement
27
Define Acute Respiratory Distress Syndrome (ARDS)
Life threatening acute hyperemic respiratory failure-->organ failure from prolonged hypoxemia
28
Who does ARDS MCly develop in? What is the MCC?
Critically ill | Sepsis=MCC
29
What diagnostic finding is the hallmark of ARDS?
Severe refractory hypoxemia | = PaO2/FIO2 ratio <200 that is not responsive to 100% O2
30
CXR findings in ARDS
B/L Pulmonary infiltrates
31
What is the Pulmonary Capillary Wedge Pressure (PCWP) in ARDs?
Low/Normal | PCWP= <18 mmHg
32
ARDS treatment
1. CPAP | 2. Positive End Expiratory Pressure (PEEP)
33
What is the MCC of Primary Pulmonary HTN? Who is it the MC in?
Idiopathic | Middle-aged or young women
34
What is the gene defect in Primary Pulmonary HTN?
BMPR2
35
What is the MCC of Secondary Pulmonary HTN?
COPD
36
Heart sound findings in Pulmonary HTN
1. Accentuated S2 2. Systolic Ejection click 3. Pulmonary Regurgitation
37
EKG findings in Pulmonary HTN
Cor Pulmonale=RVH, RAD, RBBB, Right atrial enlargement
38
Lab findings in Pulmonary HTN
Polycythemia + Elevated Hct
39
What is the definitive dx of pulmonary HTN? Findings?
Rigt Sided Heart Cath: Mean Pulmonary Arterial Pressure= >25 mmHG (normal @ rest <20)
40
What is 1st line tx in Primary Pulmonary HTN?
Calcium Channel blocker
41
What is the MC Viral cause of bronchitis?
Adenovirus
42
What is the only bacterial cause of bronchitis that requires treatment?
Bordetella Pertussis
43
List symptomatic treatment options in bronchitis
1. Antitussives: Codeine, Robitussion (dextromethorphan) 2. Bronchodilators: Albuterol 3. Expectorants/Mucolytics: Mucinex ( Guaifenesin) 4. Decongestants: Sudafed (Pseduoephedrine), Afrin nasal spray
44
Correctly identify the pneumonia described below: Green sputum 2nd MCC of CAP Increased with underlying lung dz
H. Influenza
45
Correctly identify the pneumonia described below: Bullous Myringitis URI sx's Reticulondular pattern on CXR
Micoplasma Pneumoniae (walking pneumonia)
46
Correctly identify the pneumonia described below: Hyponatremia GI sx's: N/V, watery diarrhea Elevated LFT's
Legionella Pneumophilia
47
Correctly identify the pneumonia described below: Often seen after viral illness, especially influenza
S. Aureus
48
Correctly identify the pneumonia described below: Cavitary lesions "currant jelly sputum": blood tinged, thick, mucoid
Klebsiella
49
Correctly identify the pneumonia described below: RLL Cavitary Consolidation Cough w/ foul smelling purulent sputum
Anareobes
50
What is the MC viral cause of pneumonia in infants/small children
RSV & Parainfluenza
51
What is the MC viral cause of pneumonia in adults
Influenza | 2ry bacterial pneumonia=common
52
What is the MC opportunistic pneumonia infection in pt's with AIDs? CDC count of what?
Pneumocystis jirovecii | CDC <200
53
Pneumocystis jirovecii si/sx's
1. Hypoxia 2. Elevate LDH* 3. Pleuritic CP
54
What is unique about the urine antigen test in pneumonia?
Can use this even after starting abx: S. pneumo, Legionella
55
what does Procalcitonin help determine in pneumonia?
Bacterial vs. Viral | Response to treatment
56
CURB score of __ requires hospital admission
2
57
CURB score of ___ you should assess for ICU admission
3-5
58
CAP Outpatient abx treatment in a pt with NO comorbid conditions or recent abx use
Macrolide (Azithromyicin) or Doxycycline x5 days
59
CAP Outpatient abx treatment in a pt WITH comorbid conditions or recent abx use
Resp. Fluoroquinolone: Levaquin
60
CAP Inpatient abx treatment
B Lactam (Ceftriaxone, Unasyn) + Macrolide or Doxycycline
61
Aspiration pneumonia abx treatment
Clindamycin Metronidazole Augmentin
62
PCP abx treatment
Bactrim x 21 days
63
What is considered gold standard in the dx of asthma?
Spirometry/PFT's
64
What FEV1/FVC ratio is considered obstructive dz?
<70%
65
What is considered a normal value for FEV1?
>80%
66
An FEV1 increase of __ Bronchodilator (Albuterol) challenge test of is considered diagnostic of asthma
Increase of >12%
67
What medications should asthma patients avoid?
ASA & NSAIDs
68
What is 1st line tx in acute asthma exacerbation? What else can be used?
Short-acting B2 agonist: Albuterol= 1st line | Anticholinergics/Antimuscarinics: Ipratroprium, Tiotropium
69
What should all asthma exacerbations be discharged home with?
Course of steroids: Prednisone
70
What is the drug of choice in long term, persistent chronic maintenance of asthma?
ICS: Fluticasone, Beclomethasone, Budenoside
71
List ICS + LABA examples used in asthma
Symbicort: Budenoside + Formoterol | Advair Diskus: Fluticasone + Salmeterol
72
What would you recommend prescribing in asthmatics with allergic rhinitis/ASA induced asthma?
LTRA: Montelukast (Singulair)
73
Acute asthma exacerbation treatment
SABA (Albuterol) + Ipratropium Combo for nebulization IV steroids or Oral glucocorticoids

Emergency Med (10 decks)

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