Pulmonology Flashcards
Categories for intermittent asthma
Categories for intermittent asthma
Categories for mild persistent asthma
> 1x/day daytime,
Categories for moderate persistent asthma
> 1x/day daytime, >1x/week nighttime. FEV/FVC = 60-80. ICS, LABA, SABA
Categories for severe persistent asthma
> 1/day daytime, Frequent nighttime symptoms
How to treat refractory asthma?
PO steroids.
Are leukotriene antagonists effective for asthma.
Yup about the same as LABA in efficacy
How to treat asthma exacerbation?
S/S asthma? Keep SPO2>92, take PEFR, give duonebs q30min x3.
When to send patient home after asthma exacerbation?
No wheezing. PEFR>90, Sx relief
When to send a patient to ICU during asthma exacerbation?
Wheezing, no lung sounds, PEFR
Features of emphysema?
AP diameter, pink puffer, pursed lips, prolonged expiratory phase. Co2 retention. No hypoxia
Features of emphysema?
AP diameter, pink puffer, pursed lips, prolonged expiratory phase.
Categories for mild persistent asthma
> 1x/day daytime,
Categories for moderate persistent asthma
> 1x/day daytime, >1x/week nighttime. FEV/FVC = 60-80. ICS, LABA, SABA
Categories for severe persistent asthma
> 1/day daytime, Frequent nighttime symptoms
How to treat refractory asthma?
PO steroids.
Are leukotriene antagonists effective for asthma.
Yup about the same as LABA in efficacy
When to send COPD patient to wards
In between. Give scheduled nebs, PO steroids. ABX; doxycycline.
When to send patient home after asthma exacerbation?
No wheezing. PEFR>90, Sx relief
When to send a patient to ICU during asthma exacerbation?
Wheezing, no lung sounds, PEFR
When to send a patient to the wards during asthma exacerbation
PEFR >50 but less than 90. Will receive scheduled nebs, IV/PO steroids as tolerated
Features of emphysema?
AP diameter, pink puffer, pursed lips, prolonged expiratory phase.
Features of chronic bronchitis/
Hypoxia, pulmonary constriction. Pulmonary hypertension, RH failure, edema. Copious mucous
How to dx emphysema?
PFT with decreased FEV/FVC ratio, no change with bronchodilator, no provocation with methacholine. CXR is nonspecific but shows hyperinflation, flat diaphragm
How to treat COPD
Corticosteroids
O2 Start with pa02
How to work up COPD exacerbation?
S/s COPD exacerbation? CXR, EKG, ABG.
Then give duonebs q30x3 with a goal spo2 of 88-92.
When to move COPD patient to ICU?
If severe acidosis.
When to send COPD patient home?
If stable, give doxycycline or fluoroquinolone.
When to send COPD patient to wards
In between. Give scheduled nebs, PO steroids. ABX; doxycycline.
Sxs of lung cancer?
Fever, weightloss, hemoptysis
PFTs for muscle weakness
Like restrictive pattern but residual volume is huge.
If lung mass is peripheral and high risk, how to work up?
Percutaneous ct guided biopsy
If lung mass is central and high risk how to work up?
Bronch or EBUS
Ph of transudate, exudate, empyema?
Transudate = 7.45-7.55
Exudate = 7.3-7.4
Empyema
How to work up pleural effusion
Get upright and lateral decubitus images. If it doesn’t layer, then loculated. If 1cm ask if CHF, if CHF, then diurese. If not, do a thoracentesis and test for transudate or exudate.
How to work up pulmonary nodule?
Get a CT scan, if lesion is
Small cell carcinoma
Central, lots of paraneoplastic syndromes like ACTH, ADH, Lambert eaton syndrome. Treat with chemo
Squamous cell carcinoma
Central, can cause PTHrP and hypercalcemia, caused by smoking.
Adenocarcinoma
peripheral mass, no paraneoplastic syndrome
Carcinoid
Fluishing, diarrhea, LH fibrosis. Get 5HIAA to assess
PFTs for interstitial lung disease
Decreased FEV1, very decreased FVC so ratio increased or normal.
PFTs for muscle weakness
Like restrictive pattern but residual volume is huge.
What causes exudates, what causes transudates?
Exudates= malignancy, pneumonia, TB Transudates = CHF, nephrosis, gastrosis, cirrhosis
How to distinguish pleural exudate vs transudate
Light’s criteria:
Exudate if LDH >2/3 ULN
LDHf/LDHs >.6
Protein F/ Protein S >.5
Ph of transudate, exudate, empyema?
Transudate = 7.45-7.55
Exudate = 7.3-7.4
Empyema
How to work up pleural effusion
Get upright and lateral decubitus images. If it doesn’t layer, then loculated. If 1cm ask if CHF, if CHF, then diurese. If not, do a thoracentesis and test for transudate or exudate.
ARDS
Noncardiogenic pulmonary edema. O2 is diffusion limited, CO2 is perfusion limited.
How does a patient get ARDS?
Gram negative sepsis, TRALI, near drowning.
How to diagnose ARDS?
CXR- bilateral fluffy infiltrates.
PCWP and LV function in ARDS vs CHF?
PCWP normal in ards, same with Lv function
In CHF, PCWP increased, LV function decreased.
How to distinguish ARDS from CHF with lab values
BNP
How to treat ARDS
Fix underlying disease, add steroids.
PEEP ventilation with decreased tidal volume
ABG in PE?
Decreased PaO2, decreased PaCO2 (due to perfusion limited diffusion), so pH increases
