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STEP 3 > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

What are the features of severe asthma exacerbation?

A

hyperventilation, decrease peak flow, hypoxia, respiratory acidosis, absence of wheezing

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2
Q

What confirms a diagnosis of asthma?

A

Increase in FEV1 of > 12%

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3
Q

What is the best way to diagnose reactive airway disease in asymptomatic patient?

A

Methacholine challenge test- looks for a decrease in FEV1 after methylcholine (acetylcholine) is given

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4
Q

What is the best initial therapy for asthma?

A 
Bronchodilators(albuterol)
bolus of steroid
Inhaled ipratropium
oxygen
Mg
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5
Q

All patients with SOB should receive…?

A

Oxygen, oximeter, CXR, ABG

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6
Q

If patient is in respiratory acidosis with CO2 retention, what should they receive?

A

ICU, persistent acidosis is an indication for intubation and MV

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7
Q

What is the best initial therapy for non-acute asthma?

A

inhaled bronchodilator; if patient is not a controlled asthmatic, add inhaled steroid; if both the above are not cutting it, add long acting inhaled beta-agonist(salmeterol or formeterol)

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8
Q

How does COPD present?

A

long term smoker with increasing SOB and decreased exercise tolerance

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9
Q

What should you order with acute exacerbations of COPD?

A

oxygen, ABG, CXR, albuterol, ipratropium, bolus steroids, chest/heart/extremity/neuro exam
- if fever, sputum, new infiltrate add ceftriaxone and azithromycin for pneumonia

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10
Q

What do you find in the following lab tests with COPD patients?
EKG, CXR, CBC, Chemistry

A

EKG- R axis deviation, RVH, RAH
CXR- Flattening of diaphragm
CBC- increased hematocrit
Chemistry- increased HCO3

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11
Q

What are the PFT findings in COPD?

FEV1, FVC, FEV1/FVC, TLC, RV, DLCO

A 
FEV1- decrease
FVC- decrease
FEV1/FVC- decrease
TLC- increase
RV- increase
DLCO- decrease
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12
Q

What is the chronic therapy for COPD?

A

Ipratropium inhaler, albuterol inhaler, pneumococcal vaccine, influenza vaccine, smoking cessation, long term home oxygen (pO2< 88%)

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13
Q

What lowers mortality in COPD?

A

smoking cessation and home O2

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14
Q

How does alpha-1 antitrypsin deficiency present?

A

Young, nonsmoker, cirrhosis, COPD

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15
Q

What is the treatment for alpha-1 antitrypsin deficiency?

A

alpha-1 antitrypsin infusion

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16
Q

What is the most accurate diagnostic test for bronchiectasis?

A

High resolution CT scan of the chest

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17
Q

What is the treatment for bronchiectasis?

A

Chest physiotherapy, rotating antibiotics

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18
Q

What are the PFT values with Interstitial Lung Disease?

FEV1, FVC, FEV1/FVC, TLC, RV, DLCO

A 
FEV1- decrease
FVC- decrease
FEV1/FVC- normal/decrease
TLC- decrease
RV- decrease
DLCO- decrease
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19
Q

What is the presentation of sarcoidosis?

A

Black woman under 40, cough, SOB, fatigue

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20
Q

What is the best initial test for sarcoidosis?

A

CXR shows enlarged lymph nodes

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21
Q

What is the most accurate diagnosis for sarcoidosis?

A

lung/lymph node biposy showing noncaseating granuloma

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22
Q

What is the best therapy for sarcoidosis?

A

Steroids

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23
Q

Pulmonary hypertension can occur in the following conditions….

A

MS, COPD, Polycythemia Vera, Chronic Pulmonary Emboli, Interstitial Lung disease

24
Q

What is the best initial test for pulmonary HTN?

A

TTE

25
Q

What is the most accurate test for pulmonary HTN?

A

right heart catheterization aka Swan-Ganz(shows increased pulmonary artery pressure)

26
Q

What is the treatment for pulmonary HTN?

A

bosentan(endothelial inhibitor), epoprostenol, sildenafil

27
Q

What are the ABG findings for PE?

A

hypoxia with increased A-a gradient

28
Q

How do you confirm PE?

A

CT angio

29
Q

What is d-dimer good for?

A

In patient who has low probability of PE in which you want a single test to exclude PE

30
Q

What is the treatment for PE?

A

heparin
warfarin(6 months)
IVC Filter(in patients who have contraindication to filter)
Thrombolytics(used in hemodynamically unstable patients)

31
Q

What is the best initial test for pleural effusion?

A

CXR

32
Q

What is the most accurate test for pleural effusion?

A

Thoracentesis

33
Q

What tests need to be ordered of pleural fluid?

A

gram stain, culture, Acid fast stain, total protein, LDH, glucose, cell count, triglycerides, pH

34
Q

What is the treatment for pleural effusions?

A

Small- none, may use diuretics
Large- chest tube
- If pleural effusion is large and recurrent- pleurodesis can be done

35
Q

What if the pleuodesis fails, what is the next step?

A

Decortication

36
Q

What are the characteristics of sleep apnea?

A

Obese, daytime somnolence, sever snoring

37
Q

How is sleep apnea diagnosed?

A

Polysomnography(sleep study)- periods >10 seconds of apnea

38
Q

What is the treatment for obstructive sleep apnea?

A

Weight loss, and CPAP/BiPAP; if not effective, can surgically release uvula, palate, pharynx

39
Q

What is the treatment of central sleep apnea?

A

Avoid alcohol/sedatives, acetazolamide

40
Q

What is the treatment for ARDS?

A

Ventilatory support, PEEP, possible diuretics and dobutamine

41
Q

What are the measurements of the following parameters in Hypovolemia?
CO, Wedge Pressure, Systemic Vascular resistance

A

CO- low
WP- low
SVR- high

42
Q

What are the measurements of the following parameters in Cardiogenic Shock?
CO, Wedge Pressure, Systemic Vascular resistance

A

CO- low
WP- high
SVR- high

43
Q

What are the measurements of the following parameters in Septic Shock?
CO, Wedge Pressure, Systemic Vascular resistance

A

CO- high
WP- low
SVR- low

44
Q

What is the bug for community acquired pneumonia?

A

Pneumococcus

45
Q

What is the bug for hospital acquired pneumonia?

A

Gram negative bacilli

46
Q

What is the best initial and most accurate test for pneumonia?

A

CXR, sputum gram stain and culture

47
Q

What else needs to be ordered in cases of pneumonia?

A

Oximeter, O2(if SOB), ABG(if hypoxic)

48
Q

What is the OUTPATIENT treatment for pneumonia?

A

Macrolide (azithyromycin, doxycyline, clarithromycin)

Fluoroquinolone (levofloxacin, moxifloxacin)

49
Q

What is the INPATIENT treatment for pneumonia?

A

Ceftriaxone and azithromycin

Fluoroquinolone

50
Q

What is the treatment for ventilator associated pneumonia?

A

Imipenem, piperacillin/tazobactam, or cefipime
Gentamicin and
Vancomycin

51
Q

What is the best initial test for TB?

A

CXR

52
Q

What is the confirmatory test for TB?

A

sputum AFB and culture

53
Q

What is the treatment for TB once the culture is positive?

A 
RIPE- 
Rifampin- 6 months
Isoniazid- 6 months
Pyrazinamide- 2 months
Ethambutol- 2 months
54
Q

What are the toxicities for TB treatments?

A 
All can lead to liver toxicity
Rifampin- red/orange bodily secretions
Isoniazid- peripheral neuropathy
Pyrazinamide- hyperuricemia
Ethambutol- optic neuritis
55
Q

What are the PPD screening tests?

A

Positive PPD-
5 mm- close contact, steroid users, HIV positive
10 mm- homeless, immigrants, alcoholics, healthcare workers, prisoners
15 mm- those without increased risk

STEP 3 (8 decks)

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