Pulmonology Flashcards
best initial test in acute asthma exacerbation?
PEF or ABG
What is the most accurate diagnostic test for asthma when the patient is asymptomatic?
20% decrease in FEV1 with use of methacholine or histamine as they provoke bronchoconstriction and an increase in bronchial secretions
What is the best indication of the severity of an asthma exacerbation?
Respiratory Rate (pulse ox will not show hypoxia until point of resp failure) (O2 sat can be maintained >90% by hyperventilating)
how to quantify severity of asthma attack?
PEF
ABG
Treatment for asthma exacerbation
oxygen
albuterol
steroids
Mag (only in acute severe episodes not responsive to albuterol)
Best initial test to diagnose COPD
chest x-ray
why is their an increase in TLC in COPD
increase in residual volume
how do you define full reversibility to bronchodilators in obstructive airway disease?
> 12% or 200ml increase in FEV1
CBC findings and EKG findings that might be seen with COPD
CBC: increase in hct from chronic hypoxia
EKG: right atrial hypertrophy and right ventricular hypertrophy. afib. MAT
most effective symptomatic therapy in COPD?
tiotropium, ipratropium
when all medical therapy is insufficient for COPD, what do you do?
refer for transplant
single most common cause of bronchiectasis?
cystic fibrosis
key to the diagnosis of bronchiectasis?
recurrent episodes of very high volume purulent sputum production.
can have hemoptysis weight loss anemia of chronic disease crackles dyskinetic cilia syndrome
best initial test and most accurate test to diagnose bronchiectasis?
high-resolution CT scan
Treatment for bronchiectasis
specific microbio diagnosis is preffered since mycobacterium avium intracellulare can be found
chest physiotherapy
rotate antibiotics
Asthmatic patient with recurrent episodes of brown-flecked sputum and transient infiltrates on c-xray
allergic bronchopul aspergillosis
treatment for ABPA?
Oral steroids for severe cases (inhaled dont work)
Itraconazole for recurrent episodes
PFTS for CF?
mixed obstructive and restrictive. and decreased diffusing capacity for CO
COPD pneumonia pathogen?
H.flu
Recent viral infection -> pneumonia. pathogen?
S. aureus
Hoarseness and pneumonia?
Chlamydia pneumonia
animals at time of giving birth. vets. farmers. type of pneumonia?
coxiella burnetii
when can you consider a sputum gram stain “adequate”?
more than 25 wbcs and fewer than 10 epithelial cells
Diagnostic test for PCP pneumo?
bronchoalveolar lavage
diagnostic test for coxiella burnetti?
rising serology titers
legionella diagnostic test
urine antigen, culture on charcoal-yeast extract
treatment for pneumonia in a prev healthy, no comorbidity, mild symptoms, no abx in past 3 months?
azithromycin or clarithromycin or doxycycline
treatment for pneumo if patient has comorbidities or abx in past 3 months?
levofloxacin or moxiflox
single factor reasons to hospitalize a patient with pneumonia?
- hypoxia
- hypotension
- resp > 30, PO2<60, pH <7.35
- BUN > 30, Na <130, gluc > 250
- HR > 125
- confusion
- temp > 104
- Age > 65 or other comorbidities
CURB 65`
(0-1 point = home) 2 or more = admit confusion uremia resp distress BP low age >65
dangerous side effect of imipenem?
can cause seizures. cleared renally
best abx for lung abscess coverage?
clinda or penicillin
if you get negative sputum stain for PCP testing, what should u do next?
bronchoscopy
If LDH is normal, can the pneumonia be due to PCP?
on the test- do NOT answer PCP
how do you define severe PCP pneumonia? what should you add for coverage?
PO2 <70 or A-a gradient >35
add steroid
If bactrim is not acceptible for PCP treatment use?
clinda and primaquine- (also contraindicated in G6PD)
or
pentamidine
If there is a rash or neutropenia from TMP-SMX in prophylactic treatment of PCP - use?
atovaquone or dapsone-> (also contraindicated in G6PD)
all of TB drugs cause hepatotoxicity. but do not stop them unless transaminases rise to - ?
3-5X upper limit of normal
when are steroids helpful in TB?
reduce risk of constrictive pericarditis in those with pericardial involvement. decrease neuro comp with TB meningitis.
pyrazinamide and streptomycin are contraindicated in?
pregnant patients
SE of pyrazinamide
hyperuricemia
If first PPD is negative in a patient with first time screen?
Need another test to rule out false-negative
Does previous BCG vaccine have any effect on recommendations for positive PPD?
NO- still must take isoniazid for 9 months
when you have a high suspicion for malignancy of a solitary pulm lesion- what should u do?
resect it. dont biopsy (high chance of false negative)
bronchoalveolar lavage shows an elevated level of helper cells in?
sarcoidosis
drug of choice for sarcoid?
prednisone
Cxray in PE usually show? most common abnormality?
(usually normal in PE)
atelectasis, wedge shaped infarct
most common EKG abnormality seen for PE?
tachy, nonspecific ST changes
most common wrong answer “the most common PE EKG findings”?
S1Q3T3
when should V/Q be first diagnostic test for PE?
pregnancy
when is direct thrombin inhibitor the answer for PE?
HIT (fondaparinux can be used)
Is ASA ever the answer for PE?
no
Treatment of idiopathic Pulm htn?
prostacyclin analogues: (PA vasodilators): epoprostenol, treprostinil
endothelin antagonist: bosentan
phosphodiesterase inhibitor: sildenafil
