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Medicine Clerkship > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

Categories for intermittent asthma

A
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2
Q

Categories for intermittent asthma

A
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3
Q

Categories for mild persistent asthma

A

> 1x/day daytime,

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4
Q

Categories for moderate persistent asthma

A

> 1x/day daytime, >1x/week nighttime. FEV/FVC = 60-80. ICS, LABA, SABA

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5
Q

Categories for severe persistent asthma

A

> 1/day daytime, Frequent nighttime symptoms

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6
Q

How to treat refractory asthma?

A

PO steroids.

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7
Q

Are leukotriene antagonists effective for asthma.

A

Yup about the same as LABA in efficacy

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8
Q

How to treat asthma exacerbation?

A

S/S asthma? Keep SPO2>92, take PEFR, give duonebs q30min x3.

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9
Q

When to send patient home after asthma exacerbation?

A

No wheezing. PEFR>90, Sx relief

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10
Q

When to send a patient to ICU during asthma exacerbation?

A

Wheezing, no lung sounds, PEFR

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11
Q

Features of emphysema?

A

AP diameter, pink puffer, pursed lips, prolonged expiratory phase. Co2 retention. No hypoxia

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12
Q

Features of emphysema?

A

AP diameter, pink puffer, pursed lips, prolonged expiratory phase.

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13
Q

Categories for mild persistent asthma

A

> 1x/day daytime,

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14
Q

Categories for moderate persistent asthma

A

> 1x/day daytime, >1x/week nighttime. FEV/FVC = 60-80. ICS, LABA, SABA

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15
Q

Categories for severe persistent asthma

A

> 1/day daytime, Frequent nighttime symptoms

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16
Q

How to treat refractory asthma?

A

PO steroids.

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17
Q

Are leukotriene antagonists effective for asthma.

A

Yup about the same as LABA in efficacy

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18
Q

When to send COPD patient to wards

A

In between. Give scheduled nebs, PO steroids. ABX; doxycycline.

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19
Q

When to send patient home after asthma exacerbation?

A

No wheezing. PEFR>90, Sx relief

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20
Q

When to send a patient to ICU during asthma exacerbation?

A

Wheezing, no lung sounds, PEFR

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21
Q

When to send a patient to the wards during asthma exacerbation

A

PEFR >50 but less than 90. Will receive scheduled nebs, IV/PO steroids as tolerated

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22
Q

Features of emphysema?

A

AP diameter, pink puffer, pursed lips, prolonged expiratory phase.

23
Q

Features of chronic bronchitis/

A

Hypoxia, pulmonary constriction. Pulmonary hypertension, RH failure, edema. Copious mucous

24
Q

How to dx emphysema?

A

PFT with decreased FEV/FVC ratio, no change with bronchodilator, no provocation with methacholine. CXR is nonspecific but shows hyperinflation, flat diaphragm

25
Q

How to treat COPD

A

Corticosteroids

O2 Start with pa02

26
Q

How to work up COPD exacerbation?

A

S/s COPD exacerbation? CXR, EKG, ABG.

Then give duonebs q30x3 with a goal spo2 of 88-92.

27
Q

When to move COPD patient to ICU?

A

If severe acidosis.

28
Q

When to send COPD patient home?

A

If stable, give doxycycline or fluoroquinolone.

29
Q

When to send COPD patient to wards

A

In between. Give scheduled nebs, PO steroids. ABX; doxycycline.

30
Q

Sxs of lung cancer?

A

Fever, weightloss, hemoptysis

31
Q

PFTs for muscle weakness

A

Like restrictive pattern but residual volume is huge.

32
Q

If lung mass is peripheral and high risk, how to work up?

A

Percutaneous ct guided biopsy

33
Q

If lung mass is central and high risk how to work up?

A

Bronch or EBUS

34
Q

Ph of transudate, exudate, empyema?

A

Transudate = 7.45-7.55
Exudate = 7.3-7.4
Empyema

35
Q

How to work up pleural effusion

A

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.

36
Q

How to work up pulmonary nodule?

A

Get a CT scan, if lesion is

37
Q

Small cell carcinoma

A

Central, lots of paraneoplastic syndromes like ACTH, ADH, Lambert eaton syndrome. Treat with chemo

38
Q

Squamous cell carcinoma

A

Central, can cause PTHrP and hypercalcemia, caused by smoking.

39
Q

Adenocarcinoma

A

peripheral mass, no paraneoplastic syndrome

40
Q

Carcinoid

A

Fluishing, diarrhea, LH fibrosis. Get 5HIAA to assess

41
Q

PFTs for interstitial lung disease

A

Decreased FEV1, very decreased FVC so ratio increased or normal.

42
Q

PFTs for muscle weakness

A

Like restrictive pattern but residual volume is huge.

43
Q

What causes exudates, what causes transudates?

A 
Exudates= malignancy, pneumonia, TB
Transudates = CHF, nephrosis, gastrosis, cirrhosis
44
Q

How to distinguish pleural exudate vs transudate

A

Light’s criteria:

Exudate if LDH >2/3 ULN
LDHf/LDHs >.6
Protein F/ Protein S >.5

45
Q

Ph of transudate, exudate, empyema?

A

Transudate = 7.45-7.55
Exudate = 7.3-7.4
Empyema

46
Q

How to work up pleural effusion

A

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.

47
Q

ARDS

A

Noncardiogenic pulmonary edema. O2 is diffusion limited, CO2 is perfusion limited.

48
Q

How does a patient get ARDS?

A

Gram negative sepsis, TRALI, near drowning.

49
Q

How to diagnose ARDS?

A

CXR- bilateral fluffy infiltrates.

50
Q

PCWP and LV function in ARDS vs CHF?

A

PCWP normal in ards, same with Lv function

In CHF, PCWP increased, LV function decreased.

51
Q

How to distinguish ARDS from CHF with lab values

A

BNP

52
Q

How to treat ARDS

A

Fix underlying disease, add steroids.

PEEP ventilation with decreased tidal volume

53
Q

ABG in PE?

A

Decreased PaO2, decreased PaCO2 (due to perfusion limited diffusion), so pH increases

Medicine Clerkship (12 decks)

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