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DSE > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

Decision to hospitalize for pneumonia

A 
Confusion
Uremia (BUN > 7mmol/L)
Resp rate greater than or equal to 30
BP <90 systolic/less than or equal to 60 diastolic
Age greater than or equal to 65
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2
Q

Empirical abx recommendations in pneumonia for previously healthy pts with no abx use in prior 3 mos

A

Azithromycin 500 mg PO x1 dose then 250 mg PO q24h x4 days OR
Clarithromycin 500 mg PO BID or clarithro ER 1 gm PO q24h x 7days OR
Doxycycline 100 mg PO BID 5-7 days

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3
Q

Empirical abx recommendations in pneumonia for comorbidities

A

Levo 750 mg PO q24h x 5 days

Amoxicillin-clavulanate 1000/62.5 mg 2 tabs PO BID

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4
Q

What is considered a comorbidity for pneumonia tx?

A 
Chronic heart, lung, liver, renal dz
DM
Alcoholism
CA
Asplenia
Immunosuppression
Recent abx use
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5
Q

Empirical abx recommendations in pneumonia for areas with high rate (>25%) macrolide-resistant S. pneumoniae

A

Choose alternative

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6
Q

What are suggestive findings of an “atypical” pneumonia?

A

No clinical or laboratory features reliable distinguish from typical
Little sputum
Not “consolidating” (CXR, ausculatation)
Poor response to beta-lactams

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7
Q

Mild, intermittent asthma

A

Day sx 2x/wk
Night sx 2x/mo or less
Lungs fine between attacks

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8
Q

Mild, persistent asthma

A

Day sx 2+/wk
Night sx 2+/mo
Interfere with daily activities

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9
Q

Moderate, persistent asthma

A

Day sx daily
Night sx 1+/wk
Interfere with daily activities

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10
Q

Severe, persistent asthma

A

Day sx daily
Night sx frequent
Daily activities limited

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11
Q

What is the maximum amount of usage for a SABA?

A

No more than 3-4 times/day

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12
Q

Step 1 asthma tx

A

For intermittent asthma

SABA

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13
Q

Step 2 asthma tx

A

For mild persistent asthma
SABA
Low-dose ICS
Alternatives: Sustained-release theophylline or cromone or leukotriene modifier

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14
Q

Step 3 asthma tx

A 
For moderate persistent asthma
SABA
Low-to-medium dose ICS + LABA
Alternatives:
Medium-dose ICS + sustained-release theophylline OR
Medium-dose ICS + LABA OR
High-dose ICS OR
Medium-dose ICS + leukotriene modifier
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15
Q

Step 4 asthma tx

A 
For severe persistent asthma
High-dose ICS + one or more of the following, if needed:
Sustained-release theophylline
Leukotriene modifier
LABA
Oral glucocorticosteroid
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16
Q

Presentation of controlled asthma

A

Nl physical activity
SABA use < 4x/wk
Daytime sx < 4 days/wk
Nighttime sx <1 night/wk

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17
Q

Presentation of uncontrolled asthma

A

Some interruption with activities
SABA use 4 or more x/wk
Daytime sx 4 or more days/wk
Nighttime sx 1 or more nights/wk

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18
Q

Presentation of dangerously uncontrolled asthma

A 
Difficulty talking
Reliever inhaler does work as usual OR
Relief lasts < 2hrs
Daytime sx all the time
Nighttime sx every night
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19
Q

Examples of SABAs

A

Salbutamol

Fenoterol

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20
Q

Examples of anticholinergics for asthma

A

Ipratropium bromide

Tiotropium

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21
Q

Examples of LABAs for asthma

A

Formoterol

Salmeterol

22
Q

Examples of ICS

A

Ciclesonide
Beclomethasone
Budesonide
Fluticasone

23
Q

Common sx in pts with pulmonary embolism

A 
Dyspnea
Chest pain (pleuritic mmore common than non-pleuritic)
Apprehension
Hemoptysis
Sweating/diaphoresis
Syncope
Palpitations
Wheezing
Leg pain
Leg swelling
24
Q

Work up for PE

A 
Well's score:
1.5 pts for major surgery within 4 wks
3.0 alternative dx less likely
1.5 tachycardia
Score of 2-6= moderate probability
Then, order D-dimer and/or CT chest
CBC
CMP
ABGs
CXR once stable
25
Q

Tx of PE

A

Thrombolytics rarely used. Consider IV heparin if surgery is a possibility or severe renal failure
Heparin- initial bolus based on wt, followed by an infusion, until aPTT at goal
Warfarin initiated and titrated until maintaining INR of 2-3 and then continued for at least 3-6 mos
Supportive care with IV fluids, oxygen, nutrition
Pts are discharged once stable with INR >2

26
Q

Outpatient tx of PE

A

LMWH > IV heparin
Once-daily > twice-daily
Choice between fondaparinux and LMWH should be based on cost, availability, and familiarity of use

27
Q

What are alternative to warfarin for prophylaxis and tx of PE?

A

Apixaban
Dabigatran
Rivaroxaban
Edoxaban

28
Q

F/u after PE tx- First thromboembolic event occurring in the setting of reversible RFs, such as immbobilization, surgery, or trauma

A

Warfarin therapy for at least 3 mos up to 6 mos

29
Q

F/u after PE tx- pts who have PE and preexisting irreversible RFs, such as deficiency of antithrombin III, protein S and C, factor V Leiden mutation, or the presence of antiphospholipid antibodies

A

Long-term anticoagulation

30
Q

F/u after PE tx if recurrent thrombosis despite treatments?

A

Vena Cava filter

31
Q

What is the preferred initial phase regimen for TB?

A

Combo of isoniazid, ethambutol, and pyrazinamide

32
Q

What should be done after the initial regimen for TB?

A

Tx is specific to the sputum culture results. Pt needs to be quarantined from the public and immune compromised until no longer contagious
Continue isolation until sputum smears are neg for 3 consecutive determinations (usually after 2-4 wks of tx)

33
Q

Stage 1 COPD

A

Mild COPD

80% nl lung function

34
Q

Stage 2 COPD

A

Moderate COPD

50-80% nl lung function

35
Q

Stage 3 COPD

A

Severe COPD
Typically involves severe restraint of respiration, tininess of breath, and frequently COPD exacerbations
30-50% nl lung function

36
Q

Stage 4 COPD

A

Very severe COPD
Become very severe and risky, thus decreases the QOL with vital COPD exacerbations
Lung function FEV1 levels might be lower than 30%

37
Q

Tx of mild COPD

A

Active reduction of risk factor(s): influenza vaccine

SABA PRN

38
Q

Tx of moderate COPD

A

Influenza vaccine
SABA PRN
One or more LABAs PRN
Pulmonary rehab

39
Q

Tx of severe COPD

A 
Influenza vaccine
SABA PRN
One or more LABAs PRN
Pulmonary rehab
ICS if repeated exacerbations
40
Q

Tx of very severe COPD

A 
Influenza vaccine
SABA PRN
One or more LABAs PRN
Pulmonary rehab
ICS if repeated exacerbations
Add long-term O2 if chronic respiratory failure
Consider surgical treatments
41
Q

Specific treatments of COPD and doses

A

Albuterol: 2 puffs q4-6h prn
Advair: one puff every 12 hrs
Albuterol/ipratropium: 2 puffs q8h
Quit smoking!

42
Q

Pathophys of ARDS

A

Necrosis
Tissue destruction
Influx of leukocytes
Dilatation of blood vessels

43
Q

Tx of ARDS

A

Treat the underlying condition, along with supportive care, mechanical ventilation, and conservative fluid management. Antibiotic therapy that is broad enough to cover suspected pathogens is essential

44
Q

Mortality rates of ARDS

A

30-40%

45
Q

Acute bronchitis

A

Inflammation of the bronchial tubes (bronchi) from the trachea into the small airways for <3 wks. Most occur in fall and winter

46
Q

Etiology of acute bronchitis

A

90% is caused from viral infections or irritation of bronchial tubes and NOT from bacterial infections.

47
Q

MC organisms of acute bronchitis

A

Parainfluenza
RSV
Coronavirus
Influenza A or B

48
Q

Prognosis of acute bronchitis

A

Almost always self-limited in individuals who are otherwise healthy

49
Q

Complications of acute bronchitis

A

10%: bacterial superinfection

PNA in 5% of chronic bronchitis pts, reactive airway dz

50
Q

Prevention of acute bronchitis

A

Quit smoking
Avoid inhaling chemicals or other irritants that may harm your lungs
Steer clear of infection
Wash your hands

51
Q

S/sx of acute bronchitis

A 
Cough
Sputum production
Fever- usually only with flu
Sore throat
Nasal congestion
HA 
Fatigue
Rare- N/V/D
52
Q

PE of acute bronchitis

A

Fever- rare and usually a sign of influenza- R/o pneumonia
General malaise
Mild injection of posterior pharynx and nares
Diffuse wheezes, high-pitched continuous sounds or nl lung sounds

DSE (14 decks)

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