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pulmonary with Kelly Flashcards

1
Q

Ominous signs in asthma

A

paradoxical chest/abd movement

inability to maintain recombancy

absent breath sounds

cyanosis

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2
Q

Asthma

A

thick causes plugging

the epitheial basement membrane gets thick

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3
Q

What PFTs are important in Asthma

A

Pulmonary Function Tests:

peak flows at home

FEV1, FVC, FEF

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4
Q

What level FEV1 is less than what ____% of predicted requires admission?

A

less than 30% of predicted, admit

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5
Q

If you treat an asthmatic in the ER for an hour and their FEV1 doesn’t increase to at least 40% of predicted, what should you do?

A

admit

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6
Q

CXR of asthmatic shows

A

hyperinflation

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7
Q

steps wise approach to outpatient management of asthma

A

1) SABA: short acting beta adrenergic (albuterol, rescue and before you exercise)
2) inhaled corticosteroids (pulmicort) (this helps prevent chronic changes that the inflammation causes, not for symptoms, daily maintenance, wash out your mouth)
3) SABA for symptom breakthrough, albuterol (rescue inhaler)
4) LABA long acting beta adrenergic, salmeterol. NOT rescue inhalers.

*5) anticholinergic *On the test, atrovent IS used in asthma for secretions

*6) antiluekotriane: monolukast

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8
Q

inpatient mangement of asthma

A

inhaled: alupent/albuterol (proventil) are sympathomimetics
corticosteroids: methylprednisone IV (in the hospital)

parenteral (IV) sympathomimetics: SQ epi

anticholingergic to dry secretions: atrovent

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9
Q

status asthmaticus

A

severe acute asthma, unremitting, poorly controlled, life threatening

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10
Q

Asthma, COPD, emphysema, chronic bronchitis

are they obstructive or restrictive?

A

obstructive

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11
Q

How long do you have to have productive cough for dx of chronic bronchitis?

A

3 consecutive months for two consecutive years

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12
Q

Emphysema is characterized by:

A

mild clear sputum

barrel chest

old

thin

increased lung capacity

alveoli abnormal permanent enlargement

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13
Q

CXR for chronic bronchitis

A

hyperinflation

possible bulea or blebs

normal AP diameter

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14
Q

COPD CXR

A

flattened diaghragm

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15
Q

PFTs for restrictive:

TLC total lung capacity

RV remaining volumes after maximal expiration

FRC functional residual capacaity

A

in restrictive disease all these are low

restrictive disease: pulmonary fibrosis, pulmonary sarcoidosis (connective tissue where it shouldn’t be)

acute: ARDS, PNA,

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16
Q

If you see extrapulmonary TB you should consider

A

HIV

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17
Q

Definitive diagnostic test for TB

A

culture x3

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18
Q

TB CXR

A

honeycomb appearance R upper lobe

upper lobes

19
Q

4 differentials for night sweats

A

menopause

TB

HIV/AIDS

endocarditis

lymphoma

20
Q

acronym for TB meds

they are ripe for treatment

A

Rifampin

INH isoniazid (monitor LFTs)

Pyrazinamide

ethambutal (changes red/green color perception, and visual acuity)

21
Q

If you are treating pulmonary TB, how often do you get cultures?

A

every week for first 6 weeks

then monthly until cultures are negative

22
Q

If you have positive cultures after three months of TB treatment consider

A

drug resistance

23
Q

Patient with HIV gets treated for TB for how long?

A

9 months

24
Q

TB treatment lasts a total of how many months?

A

6 months

*9 months for HIV

25
Q

Most common organism with CAP?

A

strep pneumoniae

26
Q

Lung consolidation is PNA, you can’t clear the ronchi with a caugh

A

lung consolidation

27
Q

Treatment for CAP, consider two things:

A

how old they are (60)

if they have been on abx recently

28
Q

CAP in healthy <60, not been on ABX

A

azythromycin (macrolide)

*new black blox warning for QT prolongation

29
Q

If CAP patient with other commorbidities and >65 y/o.

A

levaquin

-floxacins

(flouroquinalones)

30
Q

CAP >65 not doing well on levaquin, now admit

A

ADD A BETALACTAM

start on betalactam

cextriaxone

unasyn

cefetaxime

plus

continue outpatient (levaquin)

31
Q

If you admit CAP

A

betalactam +

azithromycin or levaquin

*if PCN allergic hold betalactam and give

aztreonam

32
Q

Most common causitive organisms in HAP?

A

strep + staph (gram positive)

H flu (gram negative)

33
Q

What is the most common caustive agent in VAP?

A

pseudomnas

*treat with antipseudamonal beta lactam

*zosyn, cefepime, imipenem

34
Q

Thoracentesis with colored fluid, high protein, high LDH

A

exudates

pressure problem*

due to inflammation (lupus)

infection (TB/PNA)

malignancy

35
Q

Thoracentesis clear, normal protein, normal LDH

A

transudates

heart failure, liver failure

36
Q

In the elderly, does the vital capacity increase or decrease?

A

it decreases because of increased residual volume increases

37
Q

What is the only mid-diastolic murmur?

A

mitral stenosis

38
Q

Acute L sided HF what heart sound?

A

S3

39
Q

CXR for CHF

A

kerley B lines

(increased interstitial markings)

40
Q

What drug is used to treat HTN in pregnancy, can also be used to treat parkinsons?

A

central alpha 2 agonist

methyldopa

41
Q

Papilledema

A

swelling of the optic disk with blurred margins

*found in HTN emergency

42
Q

Oral drugs in HTN urgency

A

clonidine

captopril

loop durectics

43
Q
A

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