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Emergency Med > Pulmonary > Flashcards

Pulmonary Flashcards

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Royal College: Emergency Medicine 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
Q

When would it be appropriate to observe a pneumothorax? How long is observation? f/u tx?

A

Small Primary Spontaneous Pneumothorax= <15-20% of hemothorax diameter
Observe for 6 hrs and repeat CXR

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26
Q

Tension Pneumothorax treatment

A

Needle aspiration + Chest tube placement

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27
Q

Define Acute Respiratory Distress Syndrome (ARDS)

A

Life threatening acute hyperemic respiratory failure–>organ failure from prolonged hypoxemia

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28
Q

Who does ARDS MCly develop in? What is the MCC?

A

Critically ill

Sepsis=MCC

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29
Q

What diagnostic finding is the hallmark of ARDS?

A

Severe refractory hypoxemia

= PaO2/FIO2 ratio <200 that is not responsive to 100% O2

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30
Q

CXR findings in ARDS

A

B/L Pulmonary infiltrates

31
Q

What is the Pulmonary Capillary Wedge Pressure (PCWP) in ARDs?

A

Low/Normal

PCWP= <18 mmHg

32
Q

ARDS treatment

A
  1. CPAP

2. Positive End Expiratory Pressure (PEEP)

33
Q

What is the MCC of Primary Pulmonary HTN? Who is it the MC in?

A

Idiopathic

Middle-aged or young women

34
Q

What is the gene defect in Primary Pulmonary HTN?

A

BMPR2

35
Q

What is the MCC of Secondary Pulmonary HTN?

A

COPD

36
Q

Heart sound findings in Pulmonary HTN

A
  1. Accentuated S2
  2. Systolic Ejection click
  3. Pulmonary Regurgitation
37
Q

EKG findings in Pulmonary HTN

A

Cor Pulmonale=RVH, RAD, RBBB, Right atrial enlargement

38
Q

Lab findings in Pulmonary HTN

A

Polycythemia + Elevated Hct

39
Q

What is the definitive dx of pulmonary HTN? Findings?

A

Rigt Sided Heart Cath: Mean Pulmonary Arterial Pressure= >25 mmHG (normal @ rest <20)

40
Q

What is 1st line tx in Primary Pulmonary HTN?

A

Calcium Channel blocker

41
Q

What is the MC Viral cause of bronchitis?

A

Adenovirus

42
Q

What is the only bacterial cause of bronchitis that requires treatment?

A

Bordetella Pertussis

43
Q

List symptomatic treatment options in bronchitis

A
  1. Antitussives: Codeine, Robitussion (dextromethorphan)
  2. Bronchodilators: Albuterol
  3. Expectorants/Mucolytics: Mucinex ( Guaifenesin)
  4. Decongestants: Sudafed (Pseduoephedrine), Afrin nasal spray
44
Q

Correctly identify the pneumonia described below:

Green sputum
2nd MCC of CAP
Increased with underlying lung dz

A

H. Influenza

45
Q

Correctly identify the pneumonia described below:

Bullous Myringitis
URI sx’s
Reticulondular pattern on CXR

A

Micoplasma Pneumoniae (walking pneumonia)

46
Q

Correctly identify the pneumonia described below:

Hyponatremia
GI sx’s: N/V, watery diarrhea
Elevated LFT’s

A

Legionella Pneumophilia

47
Q

Correctly identify the pneumonia described below:

Often seen after viral illness, especially influenza

A

S. Aureus

48
Q

Correctly identify the pneumonia described below:

Cavitary lesions
“currant jelly sputum”: blood tinged, thick, mucoid

A

Klebsiella

49
Q

Correctly identify the pneumonia described below:

RLL Cavitary Consolidation
Cough w/ foul smelling purulent sputum

A

Anareobes

50
Q

What is the MC viral cause of pneumonia in infants/small children

A

RSV & Parainfluenza

51
Q

What is the MC viral cause of pneumonia in adults

A

Influenza

2ry bacterial pneumonia=common

52
Q

What is the MC opportunistic pneumonia infection in pt’s with AIDs? CDC count of what?

A

Pneumocystis jirovecii

CDC <200

53
Q

Pneumocystis jirovecii si/sx’s

A
  1. Hypoxia
  2. Elevate LDH*
  3. Pleuritic CP
54
Q

What is unique about the urine antigen test in pneumonia?

A

Can use this even after starting abx: S. pneumo, Legionella

55
Q

what does Procalcitonin help determine in pneumonia?

A

Bacterial vs. Viral

Response to treatment

56
Q

CURB score of __ requires hospital admission

A

2

57
Q

CURB score of ___ you should assess for ICU admission

A

3-5

58
Q

CAP Outpatient abx treatment in a pt with NO comorbid conditions or recent abx use

A

Macrolide (Azithromyicin) or Doxycycline x5 days

59
Q

CAP Outpatient abx treatment in a pt WITH comorbid conditions or recent abx use

A

Resp. Fluoroquinolone: Levaquin

60
Q

CAP Inpatient abx treatment

A

B Lactam (Ceftriaxone, Unasyn) + Macrolide or Doxycycline

61
Q

Aspiration pneumonia abx treatment

A

Clindamycin
Metronidazole
Augmentin

62
Q

PCP abx treatment

A

Bactrim x 21 days

63
Q

What is considered gold standard in the dx of asthma?

A

Spirometry/PFT’s

64
Q

What FEV1/FVC ratio is considered obstructive dz?

A

<70%

65
Q

What is considered a normal value for FEV1?

A

> 80%

66
Q

An FEV1 increase of __ Bronchodilator (Albuterol) challenge test of is considered diagnostic of asthma

A

Increase of >12%

67
Q

What medications should asthma patients avoid?

A

ASA & NSAIDs

68
Q

What is 1st line tx in acute asthma exacerbation? What else can be used?

A

Short-acting B2 agonist: Albuterol= 1st line

Anticholinergics/Antimuscarinics: Ipratroprium, Tiotropium

69
Q

What should all asthma exacerbations be discharged home with?

A

Course of steroids: Prednisone

70
Q

What is the drug of choice in long term, persistent chronic maintenance of asthma?

A

ICS: Fluticasone, Beclomethasone, Budenoside

71
Q

List ICS + LABA examples used in asthma

A

Symbicort: Budenoside + Formoterol

Advair Diskus: Fluticasone + Salmeterol

72
Q

What would you recommend prescribing in asthmatics with allergic rhinitis/ASA induced asthma?

A

LTRA: Montelukast (Singulair)

73
Q

Acute asthma exacerbation treatment

A

SABA (Albuterol) + Ipratropium
Combo for nebulization
IV steroids or Oral glucocorticoids

Emergency Med (10 decks)

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