Pulmonology Flashcards
How do you diagnose Asthma?
History and PFT tests that improve after using bronchodilator:
FEV1 >15% and Peak expiration flow rate >20%
What is considered intermittent asthma?
Treatment?
Most mild form of asthma Daytime sxs: < or = 2 days/wk Nighttime sxs: < or = 2 times/mo Use of inhaler: < or = 2 days/wk Interfering in nl activity: No Lung Function: FEV1 >80% of predicted; FEV1/FVC nl SABA (Albuterol)
What is considered mild persistent asthma?
Treatment?
Day Sxs: > 2 days/wk
Night Sxs: 3-4 times/mo
Use of rescue med: > 2 days per week, not daily and not more than once per day.
Normal activity: minor limitations
Lung function: FEV1>80% predicted; FEV1/FVC normal
Adding a low dose inhaled corticosteroid: fluticasone
What is considered moderate persistent asthma?
Treatment?
What if still sxs?
Day Sxs: daily
Night Sxs: > once per week, not daily
Use of rescue med: daily
Activities: some limits
Lung Function: FEV1> 60%, but <80%; FEV1/FVC reduced 5%
Treatment: low dose inhaled corticosteroid (fluticasone) + LABA (Salmeterol).
Change ICS to medium dosed + LABA
What is considered severe persistent asthma?
Treatment?
If doesn’t work?
Daily sxs: throughout day
Night sxs: > 7x/wk
Use of inhaler: several times/day
Activities: extreme limitation
Lung Function: FEV1 <60%; FEV1/FVC reduced>5%
Treatment: High dose inhaled corticosteroid + LABA (Salmeterol).
High dose ICS + LABA + oral corticosteroid
What is affected with a PE?
What is Virchow’s Triad(cause of PE)?
What is the CXR finding with a PE?
Right side of heart: obstructing heart flow. MC emboli are coming from legs.
Injury, stasis, hypercoagulability.
Normal CXR.
What are some paraneoplastic syndromes seen with Small Cell Lung Cancer?
- Superior vena cava obstruction(blood can’t get down from head)–torturous veins on neck & hands ; death imminent.
- Hoerner’s Syndrome: ptosis, miosis (pupil constriction)
- Lambert-Eaton: weakness
- SIADH: hyponatremia, seizures (Na screwed up)
- Cushings(tumor secretes steroids): round fancies, buffalo hump
- Dermatomyositis: muscle breaks down, purple rash on face and hands.
- Clubbing: large convex nails; smoker that gets clubbing think lung cancer
What is found with Squamous Cell Lung Cancer as part of the paraneoplastic syndrome?
Hypercalcemia: constipated, irritable bowel, kidney stones.
Caused by tumor secreting hormone.
What med if given to asthmatic can kill them?
BB: this is also called a Beta antagonist.
Asthmatics need Beta Agonist to relax muscles in the airways
What happens with COPD?
What is considered the blue bloater?
What is the pink puffer?
Lungs get big, but don’t work. Increased TLC, but airflow obstruction.
Blue Bloater: Chronic bronchitis(is the mucus part). Blue Bloater is use to chronic low O2 and higher CO2 levels; lung vessels constrict, stenose and scar up.
Pink Puffer: Emphysema destroys alveoli, and patient looks emaciated and cachectic.
What is ARDS (Acute Respiratory Distress Syndrome)?
What is seen on CXR?
DXic criteria?
Tx?
Acute lung failure usually from sepsis. Pulmonary edema with a normal size heart.
Kerly B lines and diffuse infiltrates.
Dx: hypoxia (paO2 <60mmHg); no evidence of CHF; diffuse infiltrates.
Supportive tx only.
What is the MCC of acute bronchitis?
In patient with bronchitis sxs, when do you order a CXR?
Rhinovirus.
Fever, age >75, smoker, immunosuppressive
What is the most consistent sx in primary TB?
How to determine if mantoux test is positive in: healthy person with low likelihood of dz; healthcare workers or in high risk settings; HIV, close contacts, immunocompromised.
Fever.
Mantoux test +: healthy low risk = >/= 15 mm induration; healthcare worker or high risk = >/+ 10 mm; HIV etc: >/= 5mm
Describe exudative pleural effusion and cause?
Thick, gunky and needs to come out. Malignancy(lung cancer) and empyema(can develop after pneumonia)are causes.
What is transudative pleural effusion? Causes?
Thin watery fluid that doesn’t need to be taken out. Caused by CHF, Cirrhosis, PE.
Treat with medications.
What is restrictive lung disease? Type of lung disease?
Signs on exam
Signs on CXR
Treatment
Lung expansion is restricted, so it is Difficult to fill lungs with air and decreases ability of oxygen to diffuse.
Dry Crackles.
Honeycomb lung.
Supportive and O2.
What is the disease the affects the lung and causes pancreatitis in a young person?
What organs are affected?
Cystic Fibrosis.
Affects the lungs the most, then pancreas, kidney, liver, intestine.
What is a diffuse lung injury that is caused by something else: another process or systemic disease?
ARDS
Addition of what med can improve airflow and reduce their need for hospitalization in acute severe asthma?
IV magnesium
What is the condition that has abnormal dilation and destruction of alveoli either from inherited or acquired means?
What is the diagnostic test of choice?
Bronchiectasis is from Cystic Fibrosis or chronic infection.
CT.
What is the treatment for a lung abscess?
Clindamycin or Amox-Clav
What does restrictive Lung disease cause in systemic arterial blood gas values?
Respiratory Alkalosis: stiffness of lungs, hyperventilation, decreased O2 diffusion.
What does pulmonary function testing show in idiopathic pulmonary fibrosis(idiopathic fibrosing interstitial pneumonia)
Restricted pattern: normal to increased FEV1/FVC
Decreased carbon monoxide diffusing capacity.
What is the MCC of clubbing? Do you see clubbing in COPD patients? Other causes of clubbing?
Lung cancer. No, think lung cancer or look for other reason. Hypertrophic osteoarthropathy is found in patients when clubbing is due to lung cancer: causes pain in shoulders, knees, ankles, wrists elbows.
Interstitial pulmonary fibrosis, lung abscess, CHF
