Pulmonary Clin Med Buzz Words Flashcards
Recent sepsis
ARDS
PaO2/FiO2 <300
ARDS
Brown mucus plugs
Allergic bronchopulmonary aspergillosis
Central bronchiectasis on CXR
Allergic bronchopulmonary aspergillosis
Young patient (<45 YO) with COPD
Alpha-1-Antitrypsin deficiency
Atopic dermatitis
Asthma
Allergic rhinitis
Asthma
Chronic cough + sputum + dyspnea
Bronchitis
Cobblestoning
Post-nasal drip
Barking cough
Croup
Steeple sign
Croup
Drooling
Epiglottitis
Epiglottitis TX
Secure airway in OR first!
Empiric ceftriazone and rifampin for close contacts
Velcro rales
Idiopathic Pulmonary Fibrosis
Honeycombing + reticular opacities
Idiopathic pulmonary fibrosis
Drugs that can cause IPF symptoms
bleomycin (chemo)
nitrofurantoin (used for UTIs)
amiodarone (used for a-fib)
methotrextate (used in auto-immune disorders)
Post-tussive emesis
Pertussis
Most contagious phase of pertussis
Catarrhal stage
Eggshell calcifications
Silicosis
Malignant mesothelioma
Asbestosis
Rheumatoid arthritis symptoms + respiratory symptoms
Caplan syndrome, coal exposure
Mosaic attenuation
Hypersensitivity pneumonitis
Black female patient 20-60 YO
Probably sarcoidosis because med school is racist
Non-caseating granulomas
Sarcoidosis
Bilateral adenopathy
Sarcoidosis
Ruptured or paralyzed diaphragm
Absolute contraindication for thoracentisis
Diagnostic criteria for ARDS that excludes cardiac causes
Capillary wedge pressure <18 mmHg
Tx for ARDS
Mechanical ventilation with low TV and PEEP
Restrict fluids/use diuretics
Tx underlying cause
Care for psych concerns after
Diagnostic lab for aspergillosis
Elevated IgE (>1000)
Tx for allergic bronchopulmonary aspergillosis
Long-term oral prednisone (month - years)
How to dx Alpha-1-Antitrypsin deficiency
PFT with obstructive pattern
CXR showing changes at lung bases
*Genetic screening
Low serum [AAT]
3 components of asthma pathophys
Airway hyperreactivity
Bronchoconstriction
Inflammation
Among asthma/copd meds, what cannot be used alone?
Never use LABA (ex: salmeterol) alone in asthma
Tx for bronchiolitis?
Supportive, but admit if severe.
Prevention for RSV?
Preterm infants who are less than 1 YO at start of RSV season
BPD patients for 1st year of life
BPD patients for 2nd year of life if still requiring meds 6 months before RSV season
Infants with congenital heart disease
^^ Treat all of these guys with palivizumab
Most common etiological agent of acute bronchitis?
Influenza A/B, parainfluenza, coronavirus, rhinovirus, RSV
Mnemonic: PRICR
What happens to the compliance in an infant without sufficient surfactant?
Becomes less compliant
Tx BPD?
Exogenous surfactant;
Corticosteroids;
Mechanical ventilation with small TV and PEEP
What are some meds that can be used for a COPD exacerbation?
Azithromycin (for anti-inflammatory properties)
Prednisone 5 days
Roflumilast
COPD control meds, in order from mild to most severe
Start with albuterol (SABA) PRN
Add tiotropium (LAMA)
Progress to ICS/LABA combo (Symbicort, Advair)
Progress to Trelegy - combo ICS/LABA/LAMA
What meds can be used to control bothersome acute cough symptoms?
Dexomethorfan
Benzonatate
What meds should be considered with chronic cough with evidence of cobblestoning of the airway?
PND can be treated with topical steroids (flonase) and antihistamines
Consider abx if bacterial sinusitis is present
What is the most common etiological agent of croup?
Parainfluenza (influenza a/b tends to be more severe but more rare)
What meds should be considered in croup?
Dexamethasone; blow-by O2; humidified air.
If in SEVERE respiratory distress, consider racemic epinephrine.
What gene is mutated in CF and what is it’s location?
CFTR gene on the long arm of chromosome 7.
What drug is used in CF when channels are being biosynthesized but have troubles with maturation?
Ivacaftor
Tx of cystic fibrosis?
Bronchodilators PRN Dornase alfa (breaks up DNA in mucus) Hypertonic saline Chest vest Oral corticosteroids High-dose ibuprofen Azithromycin Ivacaftor
What are the most common etiologic agents of epiglottitis?
HiB in unvaccinated kids
Other Haemophilus spp, S. penumo, or S aureus in vaccinated kids
What is the narrowest region of an infant’s airway?
Subglottic region
What is the tx for chronic IPF?
Nintedanib (suppresses tyrosine kinase = slows repair cascade to reduce scarring)
Pirfenidone (supresses fibrosis by slowing TGF-B pathway
What is influenza myositis, who does it primarily affect, and how is it diagnosed?
Complication of flu, associated with influenza B
Usually affects school-age Boys
Causes Bilateral calf pain
Confirm with measurement of creatinine kinase
Aside from clinically, how do you dx pertussis?
PCR of nasopharyngeal swab showing lymphocytosis w/in first 2 weeks
Tx of pertussis?
Early azithromycin
Supportive care
Prevention of pertussis?
DTaP at: 2 mo 4 mo 6 mo 1.5 YO 4-5 YO
and with every pregnancy!
Patient presents with dullness to percussion, decreased fremitus, and decreased breath sounds. Possible dx?
Pleural effusion.
Patient presents with dullness to percusion, increased fremitus, bronchial breath sounds, and egophony. Possible dx?
PNA
Patient presents with hyper-resonant percussion, decreased fremitus, and decreased breath sounds. Possible dx?
Pneumothorax or obstructive disorder
Light’s Criteria
Excessive protein in pleural fluid (>.5 ratio)
Excessive LDH in pleural fluid (>.6 ratio)
LDH > 2/3 upper limit of normal serum LDH
Any of above is exudate
Otherwise, it is transudate
Most likely cause of transudate
CHF
Tx for CAP in patient with no co-morbidities
Doxycycline OR Amoxocillin OR If S. pneumo resistance <25%, azithromycin
Tx for CAP in patient with co-morbidities
Levofloxacin OR Augmentin + azithromycin OR doxy OR High-dose amox + azithro OR doxy
What are the classic risk factors for a PE?
Virchow’s triad:
Damage (trauma, infection, inflammation)
Stasis (immobilization, surgery, sitting >4 hr)
Hypercoagulability (including use of oral contraceptives, pregnancy, smoking, or familial causes)
Dx of PE?
CT angiography; D-dimer
CXR will likely be normal
EKG should be done
Split of S2 may indicate what?
Pulmonary hypertension
How is pulmonary HTN diagnosed?
Catheterization is gold standard but echo is more reasonable
What are the 4 classifications of pulmonary HTN?
- idiopathic
- caused by left-heart dz
- caused by chronic pulm dz (COPD)
- caused by thromboembolic dz
Tx of pulmonary HTN?
Ca+ channel blockers; heart/lung transplant
Tx for sarcoidosis?
Methotrexate; rituximab
You’re about to do a thoracentesis. Where do you aim?
Over 5th rib and don’t take more than 1.5 L max
What is a positive TB skin test result for a patient with HIV?
5+ mm
What is a positive TB skin test result for a healthcare worker or recent immigrant?
10+ mm
