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Step 2 High Yield > Pulmonary Tx And Tests > Flashcards

Pulmonary Tx And Tests Flashcards

0
Q

How do you tx mild intermittent asthma?

A

PRN rescue inhaler (albuterol)

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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

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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%

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3
Q

How do you define mild persistent asthma?

A

More than twice a week
More than two nights per month
FEV1 > 80%

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4
Q

How do you treat mild persistent asthma?

A

Low dose ICS (beclomethasone or prednisone)+ albuterol

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5
Q

What is moderate persistent asthma?

A

Daily
More than 1 night per week
FEV1 between 60-80

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6
Q

What is the tx for moderate persistent asthma?

A

Low-medium dose ICS + long acting B2 agonist ( salmeterol)

And albuterol for rescue

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7
Q

What is severe persistent?

A

Continual

FEV1 is less than 60%

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8
Q

What is the tx for severe persistent?

A

High dose ICS+ LABA+ albuterol

Possible PO corticosteroids

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9
Q

What is the tx for acute asthma?

A 
Oxygen
Ipratropium bromide
Systemic corticosteroids 
B2 agonists
Magnesium if severe
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10
Q

What is the treatment for carbon monoxide poisoning?

A

100% oxygen

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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

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12
Q

What is cromolyn useful for?

A

Prophylaxis for exercise induced asthma

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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.

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14
Q

What is the tx of methemoglobin?

A

Methylene blue and vit C

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15
Q

What should you do to diagnose bronchiectasis?

A

High resolution CT - dilated airways and ballooned cysts

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16
Q

What does a CXR show for bronchiectasis?

A

Peri bronchial cuffing, tram lines, increased pulm vascular marking

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17
Q

What is the tx for bronchiectasis?

A

Antibiotics
Physiotherapy
Lobectomy or transplant

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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
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19
Q

What can be used to tx severe acute exacerbations of COPD?

A

BiPAP

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20
Q

When should you do a gram stain and sputum culture?

A

Fever
Infiltrates on CXR
Productive cough

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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
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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
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23
Q

What is the diagnostic criteria of chronic bronchitis?

A

Productive cough for 3 months per year for 2 consecutive years

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24
Q

What are the only 2 interventions proven to improve survival in patients with COPD?

A

Smoking cessation

Oxygen titrated to over 90% for only 15 hours per day

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25
Q

How do you diagnose restrictive lung disease?

A

CXR: reticular, nodular, ground glass, honey-combing (late stage)
PFTs: decreased TLC, TVC, DLCO and normal FEV1/FVC

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26
Q

What is done to confirm diagnosis of IPF?

A

Surgical bx - shows fibrosis and inflammation

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27
Q

What should be done to determine etiology of restrictive lung disease?

A

Serum markers of connective tissue diseases

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28
Q

What does asbestosis look like on CXR?

A

Linear opacities in lung bases
Interstitial fibrosis
Calcified pleural plaques

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29
Q

What does anthracosis look like on CXR?

A

Small nodular opacities in upper lung zones

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30
Q

What does silicosis look like on CXR?

A

Small nodular opacities in upper lung zones with eggshell calcifications

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31
Q

What does berylliosis look like on CXR?

A

Sarcoidosis: hilar adenopathy, diffuse infiltration, noncaseating granulomas

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32
Q

What is the tx for berylliosis?

A

Chronic steroid usage

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33
Q

What is seen on CXR of chronic hypersensitivity pneumonitis?

A

Upper lobe fibrosis

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34
Q

What is the tx of ABPA.

A

Corticosteroids

Amphotericin B

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35
Q

How do you diagnose ABPA?

A

CXR: pulm infiltrates
CBC: peripheral eosinophilia

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36
Q

What is the first step in hypoxemia?

A

Administer oxygen

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37
Q

How do you investigate hypoxemia?

A

CXR
ABG
Calculate A-a gradient

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38
Q

How do you treat hypoxia if PaCO2 is increased?

A

Hyperventilation

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39
Q

What does it mean if A-a gradient is increased and PO2 is not fixable with oxygen?

A 
Shunting is going on:
Alveolar collapse
Pulm edema
Intracardiac shunt 
PE
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40
Q

How do you increase oxygenation using a mechanical ventilator?

A

Increase FiO2

Increase PEEP

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41
Q

How do you increase ventilation with a mechanical ventilator?

A

Increase RR

Increase tidal volume

42
Q

What are the diagnostic criteria for ARDS?

A

Bilateral pulm infiltrates n CXR
Acute onset respiratory failure (decreased PO2)
PaO2/FiO2 ratio less than 200
PCWP less than 18

43
Q

What is the tx for ARDS?

A

Mechanical ventilation with low tidal volumes

PEEP to recruit alveoli

44
Q

What is the oxygenation goal in ARDS?

A 
PaO2 greater than 60 
OR
SaO2 greater than 90
OR
FiO2 less than 0.6
45
Q

What is the definition of pulmonary HTN?

A

Mean pulmonary arterial pressure of greater than 25

46
Q

What is the criteria for pulmonary mechanics for extubation from mechanical ventilation?

A 
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
Q

What does vital capacity need to be for extubation?

A

Greater than 10-15 mL/kg

48
Q

What does resting minute ventilation need to be for extubation?

A

Greater than 10 L/min

49
Q

What should spontaneous RR be for extubation?

A

Less than 33

50
Q

What should lung compliance be for extubation?

A

Greater than 100 ml/cm of water

51
Q

What should negative inspiratory force be for extubation?

A

Less than -25 cm of water

52
Q

What should the A-a gradient be for extubation?

A

Less than 300-500 mmHg

53
Q

What should the shunt fraction for extubation be?

A

Less than 15%

54
Q

What should PO2 on 40% FiO2 be for extubation?

A

Greater than 70

55
Q

What should PCO2 be for extubation?

A

Less than 45 mmHg

56
Q

What is the tx for pulmonary HTN?

A

Supplemental O2
Anticoag
Vasodilators
Diuretics if RHF present

57
Q

What is the best test for PE?

A

Ct angiogram with contrast

58
Q

What is seen on ECG of PE?

A

Right heart strain with S wave in lead I
Q wave in lead 3
t wave inverted in lead III

59
Q

What test would you do find the origin of the clot?

A

US of LE

60
Q

What test would you do to rule out a PE.

A

D-dimer

61
Q

What is the tx of an acute PE?

A

Bolus of heparin followed by LMWH

Thrombolysis ONLY if massive, causing RHF and hemodynamic instability

62
Q

What is the chronic tx after a PE?

A

Warfarin or LMWH for 6 months

63
Q

When is thrombolysis indicated?

A

Massive DVT

PE causing RHF and hemodynamic instability

64
Q

What is the most effective DVT prophylaxis?

A

Early ambulation

65
Q

If you suspect sarcoidosis, what is the best next step for diagnosis?

A

Bx of lymph node or transbronchial/VAT for lung bx

Will show noncaseating granulomas

66
Q

What are the CXR findings in sarcoidosis?

A

LAD

Lung nodules

67
Q

What is the tx for sarcoidosis?

A

Corticosteroids

68
Q

When is an IVC filter indicated?

A

If patient has documented DVT and can’t be anticoagulated

If patient gets recurrent emboli while on anticoag

69
Q

What is Light’s criteria?

A

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
Q

How do you diagnose a pleural effusion?

A

CXR will show costophrenic angle blunting

71
Q

How should you assess if there is loculation in the effusion?

A

Do a lateral decubitus CXR view

72
Q

When is a thoracentesis indicated?

A

With new effusion greater than 1 cm in decubitus view

73
Q

What is the treatment for a complicated parapneumonic effusion or empyema?

A

Chest tube drainage and antibiotic therapy

74
Q

What is the tx of tension pneumothorax?

A

Immediate needle decompression at 2nd intercostal space midclavicular line
Then chest tube placement

75
Q

What can be used for small pneumothoraces to help them resolve spontaneously?

A

Supplemental oxygen

76
Q

What is considered a small pneumothorax?

A

Less than 2 cm of air on CXR

77
Q

What is the tx of large sx pneumothorax?

A

Chest tube placement

78
Q

What are the criteria for benign lung nodules?

A 
Age less than 35 
Smooth margins
Popcorn calcification 
Uniform 
Central 
No change 
Nonsmoker
Less than 2 cm
79
Q

What is the tx for a nodule at high risk for malignancy?

A

Surgical resection

80
Q

What is the protocol for low risk nodules?

A

CXR q 3 months for 1 year

Then CXR q 6 months for a year

81
Q

How do you diagnose a lung cancer?

A

CXR or CT

82
Q

How do you get a bx of a peripheral lesion?

A

CT guided FNA

83
Q

How do you get a bx of a central lesion?

A

Bronchoscopy

84
Q

What is the treatment for SCLC?

A

Unresectable

Chemo and radiation

85
Q

What is tx for NSCLC?

A

Surgical resection if early stage

Chemo and radiation

86
Q

What chemo drug can be used to treat NSCLC?

A

Cetuximab = anti EGFR Ab

87
Q

What is the best next step after detecting a lung lesion on CXR?

A

Compare with previous CXR

If new or changed –> bx

88
Q

What is the chemo used for non small cell lung cancer?

A

Cisplatin with etoposide and doctaxel

Carboplatin with paclitaxel

89
Q

How do you diagnose bronchiectasis?

A

High resolution CT

90
Q

What do all patients require after bronchiectasis is confirmed?

A

Sputum analysis for bacteria and mycobacterium

91
Q

How do you treat empyema with a thick pleural peel?

A

Surgery (decortication)

92
Q

What should be added to the tx of a severe asthma exacerbation?

A

Ipratropium

IV steroids

93
Q

What is recommended for severe asthma exacerbation that does not resolve after 1 hour of therapy?

A

MgSO4

94
Q

What is the tx for inpatient community acquired PNA?

A

Levofloxacin

95
Q

What can be used for outpatient tx of community acquired PNA?

A

Doxycycline or azithromycin

96
Q

Who should be hospitalized for pneumonia?

A 
Patients over 65 with comorbidities 
Immunosuppressed
Malignancy
Unstable vitals 
Signs of respiratory failure 
Altered mental status
Multilobular involvement
97
Q

What is the best next step in diagnosing the cause of recurrent pneumonia in the same part of the lung?

A

CT scan

98
Q

How do you diagnose for pulmonale?

A

Right heart cath showing increased pulmonary artery pressure, RV end diastolic pressure, central venous pressure

99
Q

What is the treatment of cor pulmonale?

A

Oxygen
Diuretics
IV inotropes

100
Q

What is the step in management for a solitary pulmonary nodule after you have compared with a previous CXR?

A

CT scan of chest

101
Q

What is the tx for patients with COPD exacerbation despite medical management?

A

Noninvasive positive pressure ventilation

102
Q

When should patients with COPD exacerbation be intubated?

A

After failing a 2 hour trial of NPPV?

Step 2 High Yield (20 decks)

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