Pulmonology Flashcards
Asthma is confirmed with an increase FEV1 of ___ after inhaled bronchodilators
> 12 percent
Best initial therapies for asthma exacerbation are
Inhaled bronchodilators (albuterol) Bolus of steroids (methyl prednisolone) Inhaled ipratropium Oxygen Magnesium
Persistent respiratory acidosis is an indication
intubation and mechanical ventilation
___ are never to be used alone in asthma!
Long-acting beta agonists (aka salmeterol or formeterol)
Non acute asthma order of medications:
inhaled bronchodilator (albuterol)
Inhaled steroid
Inhaled long acting beta agonist
Oral steroid as last resort
Ipratropium and tiotropium act by ___ so they are useful in COPD
inhibiting muscarinic receptors on respiratory mucosae (drying up goblet cells and decreasing mucus)
For COPD patient with mild respiratory acidosis, answer ___ or ___ and move clock forward half hour. This could spare the patient from intubation
CPAP or BiPAP
Labs to do in outpatient setting of COPD include
CBC EKG CMP ABG CXR
The PFT values that will be increased in COPD are
total lung capacity and residual volume
Two vaccines that are important for COPD patients are
pneumococcal 13 to start then 23 a year later and influenza
Only send patient home with long-term home oxygen if PO2 is < ___ or sats are less than ___
55; 88
What two interventions lower mortality in COPD?
Smoking cessation
Continuous home oxygen therapy
COPD = BICARBONATE ____
INCREASE
this is because chronic respiratory acidosis increases the new bicarbonate generation at the distal tubule of the kidney
High volume of sputum, fever, hemoptysis =
Bronchiectasis
What UTI antibiotic is associated with lung fibrosis?
Nitrofurantoin
What will EKG show in interstitial lung disease?
pulmonary hypertension
right atrial and right ventricular hypertrophy
FEV1/FVC ratio will be ___ in ILD
normal or increased
The only form of ILD that definitely responds to steroids is ___ because it is a granulomatous disease
berylliosis (electronics factory)
What two meds slow the progression of idiopathic pulmonary fibrosis?
Pirfenidone and nintedanib
Unlike ILD, there are systemic findings in
BOOP/COP (Bronchiolitis obliterans organizing pneumonia or cryptogenic organizing pneumonia)
-also, no occupational exposure in history
Physical findings in pulmonary hypertension include
Loud P2
Tricuspid regurgitation
Right ventricular heave
Raynaud’s Phenomenon
Diagnose pulmonary hypertension with
Transthoracic echocardiogram (TTE) -shows RVH and big right atrium
Most accurate test for pulmonary HTN is
right heart catheterization (Swan-Ganz catheterization ) with increased pulmonary artery pressure
Treat pulmonary HTN with
bosentan, ambrisentan, or macitentan (endothelin inhibitors)
