Pulmonary Diseases Flashcards
COPD, Pneumonia, URI, Tobacco Use, VTE
2 risk factors for COPD (emphysema + chronic bronchitis)
- Smoking
- Alpha-1 antitrypsin deficiency
How is COPD evaluated?
((emphysema + chronic bronchitis)
PFTs: FEV1/FVC < 0.7
CXR: Hyperinflation, flat diaphragm
ABG: Chronic respiratory acidosis.
What are 3 complications of COPD?
(emphysema + chronic bronchitis)
- Respiratory failure
- Cor pulmonale
- Pneumothorax
What is the most common cause of URI?
Viral: Rhinovirus, coronavirus, influenza.
2 things that improve surviva/mortality in COPD
- oxygen therapy (Only for PaO₂ < 55 mmHg or SpO₂ < 88%)
- smoking cessation
What is the treatment for viral URI?
Supportive care: Decongestants, analgesics, fluids.
A COPD patient presents with respiratory acidosis (pH < 7.35, CO₂ > 50) and hypoxia despite O₂ → tx?
BiPAP
tx of COPD from mild, moderate, severe, to very severe?
- mild: SABA or SAMA
- moderate: LAMA (tiotropium) or LABA (salmeterol)
- severe: LAMA + LABA +/- ICS
- very severe: O2 if hypoxic, lung resection
(LAMA is first line for long-term maintenance)
When should antibiotics be used for URI?
Only for bacterial infections like strep throat (amoxicillin) or bacterial sinusitis.
… = Rescue inhaler for both COPD & asthma
SABA (Albuterol)
When is Roflumilast used in COPD?
PDE-4 inhibitor : severe COPD w/bronchitis & exacerbations
= Add-on for acute COPD exacerbations
SAMA (Ipratropium)
mnemonic: O₂, BAM-S (O₂, Bronchodilators, Antibiotics, Steroids)
What is the mnemonic for smoking cessation medications?
BANS
Bupropion
Acamprosate
Nicotine replacement
Varenicline (Chantix)
…= First-line maintenance therapy for COPD
LAMA (Tiotropium)
$
COPD exacerbations: tx (3)
- O2
- SABA (albuterol) + SAMA (Ipratopium) via nebulizer
- ABX: azithromycin, doxy, amoxicillin-clavulanate
- Prednisone
mnemonic: O₂, BAM-S (O₂, Bronchodilators, Antibiotics, Steroids)
= Add-on for COPD & asthma maintenance, but NEVER use alone in asthma (always pair with ICS!)
LABA (Salmeterol)
What are complications of smoking?
Lung cancer, COPD, CAD, stroke, peripheral arterial disease.
What screening is recommended for smokers?
Low-dose CT for lung cancer (age 50-80, ≥20 pack-years).
What is the most common cause of bacterial pneumonia?
Streptococcus pneumoniae.
How is pneumonia diagnosed?
CXR: Lobar consolidation (typical), interstitial pattern (atypical).
What is the treatment for community-acquired pneumonia?
(inpatient vs. outpatient)
Inpatient: Ceftriaxone + azithromycin OR levofloxacin
Outpatient: Amoxicillin ± macrolide or doxycycline OR levofloxacin
What are 3 MC complications of pneumonia?
- Abscess
- ARDS
- pleural effusion
4 most common microbes that cause Hospital-Acquired Pneumonia (HAP)
- pseudomonas
- MRSA
- Klebsiella
- E.coli
(ventilator-associated pneumonia/VAP is caused by pseudomonas, MRSA and acinetobacter)
How do you know when to admit a patient w/CAP?
CURB-65 ≥2
Microbe that causes CAP + GI symptoms + hyponatremia →
Legionella
When do you vaccinate for pneumonia?
- Infants (<2 yrs): PCV13 (Conjugate) → More immunogenic
- Adults >65 OR Immunocompromised: PPSV23 (Polysaccharide)
- AND YEARLY FLU SHOT!
(high. risk pateitns in between get PPSV23 early)
How is Venous Thromboembolism (VTE) diagnosed?
DVT or PE = VTE just different locations
DVT: Compression ultrasound
PE: CT pulmonary angiography (gold standard)
D-dimer (low probability rule-out).
What is the treatment for VTE?
Anticoagulation: DOACs (apixaban, rivaroxaban) or heparin → warfarin bridge
Thrombolysis if massive PE.
(filter if cannot anticoagulate or recurrent DVT, but filter does NOT replace anticoagulation)
What are 2 MC complications of VTE?
- Chronic thromboembolic pulmonary hypertension
- recurrence
EKG finding for PE
S1Q3T3 (only 20% of cases)
How does a saddle PE cause death
right heart failure
(sudden collapse and shock → Think massive PE or saddle PE!)
What is the next step in management if:
* Wells Score ≤ 4 →
* Wells Score > 4 →
Low probability → Do D-dimer
High probability → Go straight to CTA (skip D-dimer!)
