Pulmonary Tx And Tests Flashcards
0
Q
How do you tx mild intermittent asthma?
A
PRN rescue inhaler (albuterol)
1
Q
How do you diagnose asthma?
A
ABG - mild hypoxia and resp. Alk
Spirometry: must have 10% decrease in FEV1/FVC ratio
Methacoline challenge test
2
Q
How do you define mild intermittent asthma?
A
Less than 2 days a week
Less than 2 nights a month
FEV1 over 80%
3
Q
How do you define mild persistent asthma?
A
More than twice a week
More than two nights per month
FEV1 > 80%
4
Q
How do you treat mild persistent asthma?
A
Low dose ICS (beclomethasone or prednisone)+ albuterol
5
Q
What is moderate persistent asthma?
A
Daily
More than 1 night per week
FEV1 between 60-80
6
Q
What is the tx for moderate persistent asthma?
A
Low-medium dose ICS + long acting B2 agonist ( salmeterol)
And albuterol for rescue
7
Q
What is severe persistent?
A
Continual
FEV1 is less than 60%
8
Q
What is the tx for severe persistent?
A
High dose ICS+ LABA+ albuterol
Possible PO corticosteroids
9
Q
What is the tx for acute asthma?
A
Oxygen Ipratropium bromide Systemic corticosteroids B2 agonists Magnesium if severe
10
Q
What is the treatment for carbon monoxide poisoning?
A
100% oxygen
11
Q
When do you incubate a patient with a severe asthma exacerbation?
A
When pao2 is less than 50 and PCO2 is greater than 50
12
Q
What is cromolyn useful for?
A
Prophylaxis for exercise induced asthma
13
Q
How do you treat cyanide poisoning?
A
Nitrites to oxidize iron to ferric iron and make methemoglobin which binds cyanide.
Then use thiosulfate to bind this cyanide to form thiocyanate to be excreted by the kidneys.
14
Q
What is the tx of methemoglobin?
A
Methylene blue and vit C
15
Q
What should you do to diagnose bronchiectasis?
A
High resolution CT - dilated airways and ballooned cysts
16
Q
What does a CXR show for bronchiectasis?
A
Peri bronchial cuffing, tram lines, increased pulm vascular marking
17
Q
What is the tx for bronchiectasis?
A
Antibiotics
Physiotherapy
Lobectomy or transplant
18
Q
What is the tx of an acute exacerbation of COPD?
A
Same as asthma + antibiotics: Oxygen Anticholinergic B2 agonists IV or inhaled corticosteroids Antibiotics
19
Q
What can be used to tx severe acute exacerbations of COPD?
A
BiPAP
20
Q
When should you do a gram stain and sputum culture?
A
Fever
Infiltrates on CXR
Productive cough
21
Q
How do you manage COPD long term?
A
Smoking cessation B2 agonists Anticholinergics (tiotropium) ICS or systemic corticosteroids Give pneumococcal and flu vaccines
22
Q
When should supplemental oxygen be given for COPD?
A
When PaO2 is less than 55 SaO2 less than 89% Hematocrit greater than 55% Cor pulmonale Pulmonary HTN Nocturnal hypoxia
23
Q
What is the diagnostic criteria of chronic bronchitis?
A
Productive cough for 3 months per year for 2 consecutive years
24
What are the only 2 interventions proven to improve survival in patients with COPD?
Smoking cessation
| Oxygen titrated to over 90% for only 15 hours per day
25
How do you diagnose restrictive lung disease?
CXR: reticular, nodular, ground glass, honey-combing (late stage)
PFTs: decreased TLC, TVC, DLCO and normal FEV1/FVC
26
What is done to confirm diagnosis of IPF?
Surgical bx - shows fibrosis and inflammation
27
What should be done to determine etiology of restrictive lung disease?
Serum markers of connective tissue diseases
28
What does asbestosis look like on CXR?
Linear opacities in lung bases
Interstitial fibrosis
Calcified pleural plaques
29
What does anthracosis look like on CXR?
Small nodular opacities in upper lung zones
30
What does silicosis look like on CXR?
Small nodular opacities in upper lung zones with eggshell calcifications
31
What does berylliosis look like on CXR?
Sarcoidosis: hilar adenopathy, diffuse infiltration, noncaseating granulomas
32
What is the tx for berylliosis?
Chronic steroid usage
33
What is seen on CXR of chronic hypersensitivity pneumonitis?
Upper lobe fibrosis
34
What is the tx of ABPA.
Corticosteroids
| Amphotericin B
35
How do you diagnose ABPA?
CXR: pulm infiltrates
CBC: peripheral eosinophilia
36
What is the first step in hypoxemia?
Administer oxygen
37
How do you investigate hypoxemia?
CXR
ABG
Calculate A-a gradient
38
How do you treat hypoxia if PaCO2 is increased?
Hyperventilation
39
What does it mean if A-a gradient is increased and PO2 is not fixable with oxygen?
```
Shunting is going on:
Alveolar collapse
Pulm edema
Intracardiac shunt
PE
```
40
How do you increase oxygenation using a mechanical ventilator?
Increase FiO2
| Increase PEEP
41
How do you increase ventilation with a mechanical ventilator?
Increase RR
| Increase tidal volume
42
What are the diagnostic criteria for ARDS?
Bilateral pulm infiltrates n CXR
Acute onset respiratory failure (decreased PO2)
PaO2/FiO2 ratio less than 200
PCWP less than 18
43
What is the tx for ARDS?
Mechanical ventilation with low tidal volumes
| PEEP to recruit alveoli
44
What is the oxygenation goal in ARDS?
```
PaO2 greater than 60
OR
SaO2 greater than 90
OR
FiO2 less than 0.6
```
45
What is the definition of pulmonary HTN?
Mean pulmonary arterial pressure of greater than 25
46
What is the criteria for pulmonary mechanics for extubation from mechanical ventilation?
```
Vital capacity greater than 10-15 ml/kg
Minute ventilation greater than 10L/min
Spontaneous RR below 33 BPm
Lung compliance greater than 100 mL/cm water
Negative inspiratory force less than 25
```
47
What does vital capacity need to be for extubation?
Greater than 10-15 mL/kg
48
What does resting minute ventilation need to be for extubation?
Greater than 10 L/min
49
What should spontaneous RR be for extubation?
Less than 33
50
What should lung compliance be for extubation?
Greater than 100 ml/cm of water
51
What should negative inspiratory force be for extubation?
Less than -25 cm of water
52
What should the A-a gradient be for extubation?
Less than 300-500 mmHg
53
What should the shunt fraction for extubation be?
Less than 15%
54
What should PO2 on 40% FiO2 be for extubation?
Greater than 70
55
What should PCO2 be for extubation?
Less than 45 mmHg
56
What is the tx for pulmonary HTN?
Supplemental O2
Anticoag
Vasodilators
Diuretics if RHF present
57
What is the best test for PE?
Ct angiogram with contrast
58
What is seen on ECG of PE?
Right heart strain with S wave in lead I
Q wave in lead 3
t wave inverted in lead III
59
What test would you do find the origin of the clot?
US of LE
60
What test would you do to rule out a PE.
D-dimer
61
What is the tx of an acute PE?
Bolus of heparin followed by LMWH
| Thrombolysis ONLY if massive, causing RHF and hemodynamic instability
62
What is the chronic tx after a PE?
Warfarin or LMWH for 6 months
63
When is thrombolysis indicated?
Massive DVT
| PE causing RHF and hemodynamic instability
64
What is the most effective DVT prophylaxis?
Early ambulation
65
If you suspect sarcoidosis, what is the best next step for diagnosis?
Bx of lymph node or transbronchial/VAT for lung bx
| Will show noncaseating granulomas
66
What are the CXR findings in sarcoidosis?
LAD
| Lung nodules
67
What is the tx for sarcoidosis?
Corticosteroids
68
When is an IVC filter indicated?
If patient has documented DVT and can't be anticoagulated
| If patient gets recurrent emboli while on anticoag
69
What is Light's criteria?
Pleural protein to serum protein ratio greater than 0.5
Pleural LDH to serum LDH ratio greater than 0.6
Pleural fluid LDH in the upper 2/3 of normal serum LDH
70
How do you diagnose a pleural effusion?
CXR will show costophrenic angle blunting
71
How should you assess if there is loculation in the effusion?
Do a lateral decubitus CXR view
72
When is a thoracentesis indicated?
With new effusion greater than 1 cm in decubitus view
73
What is the treatment for a complicated parapneumonic effusion or empyema?
Chest tube drainage and antibiotic therapy
74
What is the tx of tension pneumothorax?
Immediate needle decompression at 2nd intercostal space midclavicular line
Then chest tube placement
75
What can be used for small pneumothoraces to help them resolve spontaneously?
Supplemental oxygen
76
What is considered a small pneumothorax?
Less than 2 cm of air on CXR
77
What is the tx of large sx pneumothorax?
Chest tube placement
78
What are the criteria for benign lung nodules?
```
Age less than 35
Smooth margins
Popcorn calcification
Uniform
Central
No change
Nonsmoker
Less than 2 cm
```
79
What is the tx for a nodule at high risk for malignancy?
Surgical resection
80
What is the protocol for low risk nodules?
CXR q 3 months for 1 year
| Then CXR q 6 months for a year
81
How do you diagnose a lung cancer?
CXR or CT
82
How do you get a bx of a peripheral lesion?
CT guided FNA
83
How do you get a bx of a central lesion?
Bronchoscopy
84
What is the treatment for SCLC?
Unresectable
| Chemo and radiation
85
What is tx for NSCLC?
Surgical resection if early stage
| Chemo and radiation
86
What chemo drug can be used to treat NSCLC?
Cetuximab = anti EGFR Ab
87
What is the best next step after detecting a lung lesion on CXR?
Compare with previous CXR
| If new or changed --> bx
88
What is the chemo used for non small cell lung cancer?
Cisplatin with etoposide and doctaxel
| Carboplatin with paclitaxel
89
How do you diagnose bronchiectasis?
High resolution CT
90
What do all patients require after bronchiectasis is confirmed?
Sputum analysis for bacteria and mycobacterium
91
How do you treat empyema with a thick pleural peel?
Surgery (decortication)
92
What should be added to the tx of a severe asthma exacerbation?
Ipratropium
| IV steroids
93
What is recommended for severe asthma exacerbation that does not resolve after 1 hour of therapy?
MgSO4
94
What is the tx for inpatient community acquired PNA?
Levofloxacin
95
What can be used for outpatient tx of community acquired PNA?
Doxycycline or azithromycin
96
Who should be hospitalized for pneumonia?
```
Patients over 65 with comorbidities
Immunosuppressed
Malignancy
Unstable vitals
Signs of respiratory failure
Altered mental status
Multilobular involvement
```
97
What is the best next step in diagnosing the cause of recurrent pneumonia in the same part of the lung?
CT scan
98
How do you diagnose for pulmonale?
Right heart cath showing increased pulmonary artery pressure, RV end diastolic pressure, central venous pressure
99
What is the treatment of cor pulmonale?
Oxygen
Diuretics
IV inotropes
100
What is the step in management for a solitary pulmonary nodule after you have compared with a previous CXR?
CT scan of chest
101
What is the tx for patients with COPD exacerbation despite medical management?
Noninvasive positive pressure ventilation
102
When should patients with COPD exacerbation be intubated?
After failing a 2 hour trial of NPPV?
