pulmonary with Kelly Flashcards
Ominous signs in asthma
paradoxical chest/abd movement
inability to maintain recombancy
absent breath sounds
cyanosis
Asthma
thick causes plugging
the epitheial basement membrane gets thick
What PFTs are important in Asthma
Pulmonary Function Tests:
peak flows at home
FEV1, FVC, FEF
What level FEV1 is less than what ____% of predicted requires admission?
less than 30% of predicted, admit
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?
admit
CXR of asthmatic shows
hyperinflation
steps wise approach to outpatient management of asthma
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
inpatient mangement of asthma
inhaled: alupent/albuterol (proventil) are sympathomimetics
corticosteroids: methylprednisone IV (in the hospital)
parenteral (IV) sympathomimetics: SQ epi
anticholingergic to dry secretions: atrovent
status asthmaticus
severe acute asthma, unremitting, poorly controlled, life threatening
Asthma, COPD, emphysema, chronic bronchitis
are they obstructive or restrictive?
obstructive
How long do you have to have productive cough for dx of chronic bronchitis?
3 consecutive months for two consecutive years
Emphysema is characterized by:
mild clear sputum
barrel chest
old
thin
increased lung capacity
alveoli abnormal permanent enlargement
CXR for chronic bronchitis
hyperinflation
possible bulea or blebs
normal AP diameter
COPD CXR
flattened diaghragm
PFTs for restrictive:
TLC total lung capacity
RV remaining volumes after maximal expiration
FRC functional residual capacaity
in restrictive disease all these are low
restrictive disease: pulmonary fibrosis, pulmonary sarcoidosis (connective tissue where it shouldn’t be)
acute: ARDS, PNA,
If you see extrapulmonary TB you should consider
HIV
Definitive diagnostic test for TB
culture x3
TB CXR
honeycomb appearance R upper lobe
upper lobes
4 differentials for night sweats
menopause
TB
HIV/AIDS
endocarditis
lymphoma
acronym for TB meds
they are ripe for treatment
Rifampin
INH isoniazid (monitor LFTs)
Pyrazinamide
ethambutal (changes red/green color perception, and visual acuity)
If you are treating pulmonary TB, how often do you get cultures?
every week for first 6 weeks
then monthly until cultures are negative
If you have positive cultures after three months of TB treatment consider
drug resistance
Patient with HIV gets treated for TB for how long?
9 months
TB treatment lasts a total of how many months?
6 months
*9 months for HIV
Most common organism with CAP?
strep pneumoniae
Lung consolidation is PNA, you can’t clear the ronchi with a caugh
lung consolidation
Treatment for CAP, consider two things:
how old they are (60)
if they have been on abx recently
CAP in healthy <60, not been on ABX
azythromycin (macrolide)
*new black blox warning for QT prolongation
If CAP patient with other commorbidities and >65 y/o.
levaquin
-floxacins
(flouroquinalones)
CAP >65 not doing well on levaquin, now admit
ADD A BETALACTAM
start on betalactam
cextriaxone
unasyn
cefetaxime
plus
continue outpatient (levaquin)
If you admit CAP
betalactam +
azithromycin or levaquin
*if PCN allergic hold betalactam and give
aztreonam
Most common causitive organisms in HAP?
strep + staph (gram positive)
H flu (gram negative)
What is the most common caustive agent in VAP?
pseudomnas
*treat with antipseudamonal beta lactam
*zosyn, cefepime, imipenem
Thoracentesis with colored fluid, high protein, high LDH
exudates
pressure problem*
due to inflammation (lupus)
infection (TB/PNA)
malignancy
Thoracentesis clear, normal protein, normal LDH
transudates
heart failure, liver failure
In the elderly, does the vital capacity increase or decrease?
it decreases because of increased residual volume increases
What is the only mid-diastolic murmur?
mitral stenosis
Acute L sided HF what heart sound?
S3
CXR for CHF
kerley B lines
(increased interstitial markings)
What drug is used to treat HTN in pregnancy, can also be used to treat parkinsons?
central alpha 2 agonist
methyldopa
Papilledema
swelling of the optic disk with blurred margins
*found in HTN emergency
Oral drugs in HTN urgency
clonidine
captopril
loop durectics
