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IM > PULMONOLOGY > Flashcards

PULMONOLOGY Flashcards

1
Q

Top Causes of Chronic Cough

A

Upper Airway Cough Syndrome
Asthma
PTB
GERD

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2
Q

How to diagnose asthma?

A

History of variable symptoms
FEV1/FVC < 0.75-0.80
Reversibility Criteria
- reduced FEV1 that increases by >12% and by at least 200ml post bronchodilator or after 4 weeks on steroid trial
- decrease in FEV1 by 20% with metacholine or histamine

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3
Q

Asthma Hallmark

A

Airway hyperresponsiveness

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4
Q

Major risk factor for asthma

A

Atopy

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5
Q

Most common allergen

A

dust mite

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6
Q

Most accurate test in diagnosing asthma

A

Pulmonary Function Test or Spirometry

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7
Q

How long should cough be to be considered CHRONIC?

A

> 8 weeks

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8
Q

Most accurate test in asymptomatic patient

A

Metacholine/histamine stimulation test

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9
Q

First Line of treatment for asthma

A

INHALED CORTICOSTEROIDS

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10
Q

Patient has been having DAILY symptoms of asthma and gets awaken at least once a week by it. What will you give?

A

Medium dose maintenance

ICS formoterol

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11
Q

Patient has asthma symptoms MOST DAYS and at least once a week awakens with asthma. What will you give?

A

Low dose maintenance

ICS Formoterol

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12
Q

ACUTE SEVERE ASTHMA.What will you give?

A

SABA

Salbutamol q15 3x then q4

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13
Q

SABA

A

salbutamol
Albuterol
Terbutaline

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14
Q

LABA

A

Salmeterol
Formoterol
Indacaterol

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15
Q

Anti-IgE

A

Omalizumab

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16
Q

Asthma drugs safe for pregnant

A

SABA, ICS, THEOPHYLLINE

PREDNISONE

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17
Q

Most accurate test for COPD

A

Pulmonary Function Test

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18
Q

Most common risk factor COPD

A

Smoking

OTHERS

  • airway hyperresponsiveness
  • infections
  • ambient air pollution
  • smoking exposure
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19
Q

Classic Symptoms of COPD

A

dyspnea
chronic cough
chronic sputum production

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20
Q

COPD HALLMARK

A

airflow obstruction

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21
Q

Spirometry criteria for COPD

A

FEV1/FVC ratio < 0.7

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22
Q

Lung Pattern: Restrictive

A

Restrictive=Right

Smaller and displaced to the right
decreased volume

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23
Q

GOLD CLASSIFICATION

A

1 - FEV1>=80%
2 - FEV1 50-79%
3 - FEV1 30-49%
4 - FEV1 < 30%

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24
Q

3 Interventions demonstrated to improve survival in COPD

A

smoking cessation
O2 therapy
Lung volume reduction

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25
Q

When to start supplemental O2?

A

PO2<55 or sat <88% at room air

PO2<60 AND with signs of pulmonary HTN/erythrocytosis

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26
Q

Pharmacotherapy for smoking cessation (3)

A

Nicotine, Bupropion, Varenicline

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27
Q

5As in Smoking Cessation therapy

A 
Ask
Advise
Assess
Assist
Arrange
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28
Q

Acute COPD exacerbation treatment

A 
immediate nebulization + bronchodilators
Antibiotics
Glucocorticoids (Prednisone)
NIPPV
Intubation
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29
Q

Most common cause of CAP

A

Streptococcus pneumoniae

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30
Q

CAP in a patient staying on a cruise ship for 2 weeks. Etiology?

A

Legionella

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31
Q

Patients with stroke, dementia, decreased consciousness developed CAP. Etiology?

A

Anaerobes, Gram (-) enteric bacteria

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32
Q

Patient with recent antibiotic use, malnutrition, steroid use, bronchiectasis developed CAP. Etiology?

A

Pseudomonas

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33
Q

Best initial test for CAP

A

CXR

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34
Q

Moderate Risk CAP

A 
Presence of the following:
RR >=30
PR >=125
T>=40C or <=36C
SBP <90 OR DBP <=60
Altered mental status
Suspected aspiration
Unstable co-morbid conditions
CXR: Multilobar Pleural Effusion, Abscess
35
Q

HIGH RISK CA

A

Severe sepsis/shock

Need for mechanical ventilation

36
Q

CURB65

A 
Confusion
Urea > 7mmol/L
RR >=30
BP SBP <=90 or DBP <=60
Age >65

0-1 low risk
2 Admit vs OPD
3-5 Admit

37
Q

Instances wherein CXR could be normal in CAP

A

pancytopenia, severe dehydration

38
Q

Clinical Findings CAP

A

cough, fever, tachypnea, tachycardia, pulmonary crackles

39
Q

DOC for CAP LR no comorbids

A

AMOXICILLIN

40
Q

TX CAP LR STABLE COMORBID

A

B-Lactam, BLIC (Coamox, Sultamicillin) or 2nd Gen (Cefu) with or without extended macrolides (azithro)

41
Q

TX CAP MR

A

IV non antipseudomonal B-Lactam (Ampicillin, Sulbactam, Ceftriaxone, Ertapenem) PLUS either Extended Macrolide or Respiratory FQ (Levo, Moxifloxacin)

42
Q

TX CAP HR W/O RISK FOR PSEUDOMONAS

A

IV non antipseudomonal B-Lactam (Ampicillin, Sulbactam, Ceftriaxone, Ertapenem) PLUS either Extended Macrolide or Respiratory FQ (Levo, Moxifloxacin)

43
Q

TX CAP HR W/ PSEUDOMONAS RISK

A

IV antipneumococcal/ antipseudomonal B-Lactam (PipTazo, Cefepime, Meropenem, Imipenem-Cilastatin) PLUS either Extended Macrolide or Aminoglycosides (Gentamicin, Amikacin)

OR

IV antipneumococcal + antipseudomonal B-Lactam (BLIC, cephalosporins, carbapenem) PLUS IV ciprofloxacin or IV levifloxacin

44
Q

Drugs vs MRSA

A

I AM your Last Shot at Victory.

Imipenem
Amikacin
Meropenem
Linezolid
Streptogramins
Vancomycin
45
Q

Only Carbapenem without Pseudomonal activity

46
Q

Reasons for Lack of Response to Tx

A

Resistant pathogen
Sequestered focus
Wrong drug
Correct drug, wrong dose/frequency

47
Q

Most CAP symptoms should have resolved by

A

3 mon.

1wk - fever
4wks - chest pain and sputum production
6wks - cough and breathlessness
3mon - most symptoms resolved
6mon - back to normal

CXR clears in 4-12 wks

48
Q

First evidence of response to treatment

A

Resolution of fever 1wk

Decreasing WBC within 2-4 days

49
Q

Duration of Antibiotics Therapy: MSSA/S. aureus Gram negative enteric/nonenteric

A

7 days

if using Azithromycin - 5 days

50
Q

Duration of Antibiotics Therapy: Pseudomonas or MRSA/MSSA

51
Q

Duration of Antibiotics Therapy: Bacteremic

A

Double the usual

52
Q

Duration of Antibiotics Therapy: Atypical

A

Double the usual

53
Q

Criteria for Discharge

A 
Afebrile
HR normal
RR 16-24
SBP>90
O2 SAT >90%
Functioning GIT
54
Q

Most infectious form of TB

A

Cavitary PTB and Laryngeal PTB

55
Q

MC etiology of hemoptysis worldwide

56
Q

Primary PTB Test

57
Q

Best initial test for TB

A

Gene Xpert MTB/Rif

58
Q

Category I TB Tx

59
Q

Category Ia TB Tx

A

2HRZE/10HR

60
Q

Category II TB TX

A

2HRZES/1HRZE/5HRE

61
Q

Category IIa TX TB

A

2HRZES/1HRZE/9HRE

62
Q

Pathognomonic of Miliary TB in eye exam

A

Choroidal Tubercles

63
Q

Pott’s Disease involves

A

Lower thoracic and upper lumbar spine

64
Q

Gold standard for TB meningitis

A

CSF Culture

65
Q

Most accurate test for Pleural Effusion

66
Q

LIGHTS CRITERIA

A

EXUDATE
>=0.5 PF/SERUM CHON RATIO
>=0.6 PF/SERUM LDH RATIO
>2/3 PF LDH

TRANSUDATE
vice versa

67
Q

TRANSUDATE - Diseases

A

CHF
CIRRHOSIS
NEPHROTIC SYNDROME
PULMONARY EMBOLISM

68
Q

EXUDATE - Diseases

A 
MALIGNANCY
PNEUMONIA
TB
PE
ESOPHAGEAL RUPTURE
COLLAGEN VASCULAR DSE
CHYLOTHORAX/HEMOTHORAX
69
Q

MCC of Pleural Effusion

A

LV Heart Failure

70
Q

Difference between serum-PF protein should be ___ to consider that effusion is TRANSUDATIVE

A

> 31g/L (3.1g/dl)

71
Q

What to consider if PF glucose is <60mg/dL?

A

Malignancy
Bacterial Infections (Empyema)
Rheumatoid Arthritis

72
Q

When to consider invasive procedure in management of Pleural Effusion?

A 
increasing order of importance
loculated pleural fluid
PF PH<7.20
PF Glucose <3.3mmol/L (<60mg/dl)
Positive Gram stain or culture of PF
Presence of grosd pus in pleural space
73
Q

FLUID HCT > 50% IN PLEURA

A

HEMOTHORAX

74
Q

Suggestive of CHYLOTHORAX

A

milky gross appearance
high fat >400mg/dl TAG
with chylomicrons

75
Q

PSEUDOCHYLOTHORAX - DSE

A

TUBERCULOSIS
RA
INADEQUATELY TREATED EMPYEMA
A CHRONIC EXUDATIVE EFFUSION FROM ALMOST ANY CAUSE

76
Q

MC cancer in asbestosis

A

LUNG CANCER

77
Q

patient exposed to mining, sandblasting, quarrying and glass cutting developed egg-shell calcification

78
Q

Majorrisk factors for OSA

A

obesity, male

79
Q

MC complaint in OSA

80
Q

MC daytime symptom OSA

A

excessive sleepiness

81
Q

Gold standard for diagnosis of OSA

A

Overnight Polysomnogram

82
Q

> =30% reduction in airflow for at least 10s during sleep accompanied by either >=3% desat or an arousal

83
Q

management OSA

A

Weight loss, CPAP or BiPAP

84
Q

management Central Apnea

A

avoid alcohol and sedatives

may respond to ACETAZOLAMIDE

IM (9 decks)

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