Pulmonology Flashcards
Asthma Diagnosis
- improvement in FEV1 by ___% after bronchodilator
- Decrease in FEV1 by ___% after metacholine challenge
- DLCO: Increased to unchanged for mild-moderate, low for severe asthma
12, 20
Acute management of Asthma
1) Nebulized Ipatropium/Albuterol
2) _________
3) Magnesium
4) Intubate if worsening respiratory acidosis
Methylprednisone
Backbone of asthma management ______
Steroids
SABA, Steroid inhaler, LABA + Steroid inhaler
LABA substitute: Theophylline, Cromolyn, Leukotriene (Montelukast)
Salvage asthma therapy includes
1) Oral steroids
2) ________ (IL-5 Inhibitor)
3) ________ (Anti IgE)
4) Bronchial Thermoplasty
Mepolizumab
Omalizumab
Loud P2 sound is a sign of ______
Pulmonary hypertension
Backbone of COPD management_____
SABA/LABA
SABA –> LABA—> LABA+Steroid /LAMA (tiotropium)
For OSA, apnea defined as greater than ______ seconds
10
_____ is a treatment for OSA, causes a metabolic acidosis which produces respiratory drive
Acetazolamide (causes bicarb leeching at level of renal tubule, resulting in acidosis)
_____ is a treatment for central OSA, CNS respiratory stimulant
Medroxyprogesterone
A1 antitrypsin results in _____ emphysema
pan-acinar
____, ____, ____ drugs associated with pulmonary fibrosis
Bacterim, nitrofurantoin, bleomycin
ILD 2 treatment philosophies
1) Steroids for acute flare, transition to _____
2) Cyclophosphamide
3) Next generation medication _______, nintedanib
AZT
Pirfenidone
_____ is like an ILD flare , fevers/chills, cough, myalgia
Most accurate biopsy
BOOP , Lung biopsy
Because BOOP is a flare, it will respond to steroids, standard ILD mostly does not
Extra pulmonary manifestations of ______ include, uveitis, 7th nerve palsy, erythema nodosum, restrictive cardiomyopathy, ACE, CD4:CD8 ratio, non-caseating granuloma,
Tx: ______
Sarcoid
Steroids
Most accurate test for pulmonary HTN diagnosis_____
R heart cath: swan ganz
Chronic therapies for primary pulmonary hypertension
1) Bosentan
2) _______
3) Riociguat
Epoprostenol, Selexipag (prostacyclin agonist)
Treatment for chronic thrombo-embolic PE______
Riociguat
30% of PE originate in pelvic veins, wont be visualized on DVT scan LE
Most accurate test for PE______
Angiogram, although never done
T/F : PPI increases risk of HAP
True, natural defense against bacterial organisms suppressed
______ pneumonia associated with farm exposure, birth of an animal
Coxiella
Standard of care for TB is ____ months of RIPE
6 months
Standard of care for TB is ____ months of RIPE
6 months
____ is a side effect of ethambutol, _____ is a side effect of Pyrazinamide
optic neuritis, hyper uricemia
PPD Cutoff
1) Normal Person: _____mm
2) At Risk Groups (nurse, physician, jail)____mm
3) HIV(+)/Steroid/TNF_____
15mm
10mm
5mm
Latent TB Treatment
1) Isoniazid monotherapy ______
Even if BCG vaccine with positive skin test, treat the patient as normally would
9 months
____ is a serious, bronchioectasis like pneumonia common among atopy/asthma patients treated with ______
ABPA, oral steroids + itraconazole; never use inhaled steroids
People with HIV and _____ are at risk of MAC pneumonia
COPD
Dx: requires serial sputum (+) not just 1, and clinical symptoms
Tx: Azithromycin/Rifampin/Ethambutol
_____ is a MAC species causing cavitary lung lesions
Kansaii
_____ is a skin, soft tissue version of MAC, que: colonized denta lines
Abscessus, Fortuitum
For asthma, you see a patient with the following what would you add on :
1) High peripheral eosinophils (IL-5) _____
2) High peripheral IgE______
3) COPD____
mepolizumab
Omalizumab
Tiotropium (anti muscarinic: anti secretion, pro dilation)
The caveats to VQ scan
1) ______
2) ______
Have to have a normal CXR before doing it
A high probability result dosent mean anything, 15% may still have PE
The caveats to VQ scan
1) ______
2) ______
Have to have a normal CXR before doing it
A high probability result dosent mean anything, 15% may still have PE
Treatment of hemodynamically unstable PE_______
Thrombolysis
Treatment of hemodynamically unstable PE_______
Thrombolysis
Urine tests for pneumonia ____, _____
Pneumococcus, legionella
RIPE: Rifampin, Isoniazid (6 months), Pyrazinamide, Ethambutol (2 months), stop if liver enzymes>____times the limit
5
T/F TB during pregnancy requires >6 months treatment
True
A more rapid growing mycobacterium species that my cause cavitary lesions in a immunodeficiency-competent host_____
M. Kansaii
