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)
Epoprostenol is a prostacyclin analog that also can treat
pulmonary HTN
Lungs are ___ in PE
CLEAR
CXR will most likely be normal too
ABG in PE will show
increased A-a gradient and mild respiratory ALKALOSIS
Right heart strain + Hypotension =
Thrombolytics treatment indicated (PE)
-Heparin
The gold standard for PE diagnosis is
CT angio (95% specific and sensitive)
The best use for D-dimer testing is in a patient with
very low probability of PE but you still want to rule it out
Keep an eye out for questions about PE that have
CONTRAINDICATIONS TO ANTICOAGULATION! (i.e. hematomas, brain bleeds, etc)
Patients who are hemodynamically unstable (hypotensive) and have a PE should receive
thrombolytics!
Thoracentesis fluid show (alsos high protein and high LDH. What is it?
Cancer or infection
Thoracentesis fluid shows low protein and low LDH, what is it?
Congestive failure
What tests should be ordered on pleural fluid?
Gram stain/culture Acid-fast stain Total protein (also order serum) LDH (also order serum) pH Glucose Cell count w/ diff Triglycerides
A kinda badass solution to recurrent pleural effusion that can’t be corrected is
Pleurodesis, or use of talcum powder or bleomycin to cause the pleura to stick to the chest wall. Life Hack!
Central sleep apnea is treated by
avoiding alcohol and sedatives
Acetazolamide is an inhibitor of ___ an enzyme needed to reabsorb ___ that has been filtered in the glomerulus
carbonic anhydrase; bicarb
-results in respiratory acidosis which can help drive respiration
Asthma + brown mucous plugs + peripheral eosinophilia and elevated IgE =
allergic bronchopulmonary aspergillosis (ABPA)
Treat ABPA with
oral steroids, NOT inhaled steroids!
for refractory disease, you can use itraconazole
Do not treat ARDS with
steroids
What does PEEP do?
It keeps the alveoli open! More surface area available for gas exchange!
Wedge pressure will only be high in
cardiogenic shock (it will be low in hypovolemia and septic shock)
Cardiac output on Pulm artery catheterization will only be high in cases of
septic shock (low in hypovolemia and cardiogenic shock)
The respiratory fluoroquinolones are
levofloxacin and moxiflocacin
used for outpatient pneumonia (as are macrolides)
Inpatient pneumonia should be treated with
Ceftriaxone and azitrhomycin OR a fluoroquinolone as a single agent
Ventilator associated pneumonia should be treated with
Imipenem or meropenem, pip/tazo, cefepime
gentamicin
AND vancomycin or linezolid
What is an adverse effect of pyrizanimide for TB?
Hyperuricemia (gout!)
Adverse effect of ethambutol for TB?
Optic neuritis
PPD is positive at 5mm in people who are
close contacts
steroid users
HIV-positive
PPD is positive at 10mm in people who are
homeless, immigrants, prisoners, alcoholics, healthcare workers, and other high risk groups
PPD is positive at 15mm for
Everyone with no other risks
