Pulmonology Flashcards
Classification of asthma 2
Intermittent and persistent
Presistent-Mild,Moderate,severe
Quid asthma intermittent and RX
Symptom< ou egal 2f par semaine nightime awakening, 2f month use B2 agonist 2f par semaine
RX:Albuterol
Quid asthma Mild persistent and RX
Symptom>2 f par semaine,3 a 4 nightime awakening/month
Rx albuterol + inhaled corticosteroid
Quid asthma moderate persistent and RX
daily symptom,weekly nightime awakening,FEV 60-80
SABA+inhaled corticisteroid +long acting B2 agonist
Quid severe asthma and RX
daily symptoms,frequent nightime awakening,FEV<60
Same as Astma moderate +prednisone oral
Organ involved in wegener 3
Upper and lower respitatory
renal involvement
Renal involvement in wegener
rapidly progressive glomerulonephritis
Rx of wegener
corticosteroids
COPD and acute respiratory distress
Rule out secondary pneumothorax
Physiopato seconary pneumothorax in COPD
blebs rupture
quid Blebs
dilated apical alveoli
Dx of Blebs
CT scan
Management of acute exacerbation of COPD
NPPV,decreases Mortality
Cause of recurrent pneumonia involving same lung area(4)
Alcohol use,GERD,seizures,brochial stenosis
Community acquired Pneumonia with skin involvement
Mycoplasma Pneumoniae
Bugs causing Atypical pneumonia(4)
Mycoplasma P,Legionelle P,Chlamidya P,Coxiella and influenza
Disease causing granulomatous inflammation(2)….
TB,sarcoidosis
Dx confirmatory of Sarcoidosis
Biopsy by brochoscopy or by mediatinoscopy
Recurrent Pneumonia in smoker
Bronchogenic carcinoma
Pulmonary disease with high A-a gradient(2)….
PCP,PE
Causof recurrent pneumonia involving different sites of the lung(3)
Sinopulmonary disease
immunodeficiency
Nonn infectious cause,vasculitis
Cause of sinopulmonary disease reccurente(2)
Cystic fibrosis
immotile cilia
Rx CAP for inpatient
Levofloxacin
Rx CAP for out patient(2)
Azythromycin
Dox
Dx of pulmonary HT(2)
Prominent pulmonary arteries
Enlarged right heart
Physiopatho ARDS in acute pancreatitis
Phospholipase A2 causes inflammation in lung and destroys surfactant
quid Pancoast tumor
Non small cell carcinoma
Findings in Pancoast Tumor(5)
Shoulder Pain Horner's syndrome C8-T2 involvement weight loss supra clavicular lymph node
Manif for c8-t2 involvement(3)
Paresthesie 4e et 5e doigt,bras et face ant avant-bras
Pneumonia et digestive symptom or hyponatremia or neurologic problem
Legionella
dx of legionella(2)
antigen in urine or charcoal agar
Rx of legionella(2)
Quinolone or macrolide(Azytromycin or levofloxacin)
Why b2 agonists causes hypokaliemia
they drive k+ into cells
Manif of HypoK+(3)
Mx weakness
arythmia
EKG changes
Why shock in massive PE
RV dilation
Septum is pushed towards left ventricle
Low ejection fraction—shock
Epidemio of histoplasmosis(2)
Missisipi,Ohio river
Link with guano
Pulmonary nodule in non smoker
rule out histoplasmosis
Quid of respiratory acidosis(3)
Low PH45
Normal HCO3- 22-28
cause of respiratory acidosis
Hypoventilation
Main indication of BAL(2)
PCP
Malignancy
Indication for inferior vena cava filter placement(3)
contrindication to anticoagulant
HIT
DVT on heparin
Manif of Theophyline toxicity(2)
Neurologic
Palpitation
Metabolism of theophyline
Cytochrome P450
drug inhibiting CP450
Cimetidine clarythromycin ciprofloxacin erythromycin verapamil
FEV% in Obstructive disease
<70
FEV% in restrictive disease
> 70
Restrictive disease with low DLCO
Intersticial disease
Restrictive disease with normal DLCO
Mx chest weakness
Bug causing pneumonia in alcoholics
Klebsiella
Quid Friedlander Pneumoniae(2)
Jelly sputum
Klebsiella
Bugs causing empyema(3)
Strep Pneumo
Staph aureus
Klebsiella
Quid Empyema
Pus in pleural space
Rx of empyema(2)
drainage
antibiotics
Most common site of Wegener
Upper respiratory tract
Wegener Quid(4)
Upper respiratory tract involvement
Lower respiratory tract involvement
Renal involvement
Ulcer in leg
rx for Wegener
cyclophosphamide
PH fluid for empyema
<7,2
Acute productive cough with no fever and wheezing and sore throat
acute bronchitis
Rx of acute bronchitis
Supportive care
sleep apnea syndrome management
weight reduction
avoid supine position
avoid alcohol and sedatives
Therapeutic INR
2-3
indication of endotracheal intubation in asthma
Normal or High PCO2
Bad prognosis in asthma acute exacerbation
Normal or High PCO2
First measure in hypersensitivity pneumonitis
avoid antigen exposure
Two forms of hypersensitivity pneumonitis(2)
Bird fancier’s Lung
farmer’s Lung
Pneumonia linked with cruise
Legionella
PE and renal failure :RX
unfractionnated heparin
abnormal GFR
<30/ml/mn/1,73m2
Dx of adult astma
Increase FEV% after administration of bronchodilator
COPD exacerbation management(4)
Albuterol
ipratopium
antibiotics
corticosteroids
Management of exercice induced astma
Short acting agonist 20 mn before exercising
Light criteria(4)
Protein pleural fluid/protein serum >0.5
LDH pleural fluid/LDH serum>0,6
LDH pleural fluid>2/3 upper limit LDH serum
Favor exsudate
Management of solitary nodule in non smoker <40 ans
serial chest xray to see if mass is incresing in volume
Prognosis of solitary nodule in nonsmoker
stable during 2 years ,no cancer
Indication of home oxygen in COPD(3)
Pa0255 si Pao2<60
PH of pleura transudate
7,4-7,55
PH of pleural exsudate
7,30-7,45
Quid of flail chest
> / 3 ribs adjacent ruptured in two places
Rx
Positive pressure ventilation
Risk of flail chest
Paradoxical respiration
Co2 Narcosis Manif(2)
Seizure
cardiac problem
Risk for co2 narcosis
patient with acute or chronic respiratory failure treated with high o2 flow
Best site to biopsy for wegener
nasopharynx
Anapath wegener(2)
Medium and small size arteries involvement
granulomatous inflammation
PCO2 value in secondary pneumothorax causing by COPD
Normal 33-45
PCO2 value in acute exacerbation causing by COPD
High
2e cause of reccurent pneumoniae involving same site
Local anatomic brochial obstruction
Lofgren syndrome(4)
Adenonopathie hilaire
erythema nodosum
fever
polyarthritis migratory
disease with lofgren syndrome
sarcoidosis
Biopsy findings in sarcoidosis
Non caseating granuloma
cause of bronchial obstruction(3)
Bronchial stenosis
ca(bronchogenic carcinoma or carcinoisd tumor)
foreign body
In reccurrent pneumonia test to do and why
Chest CT
to rule out bronchial obstruction
Seizures and respiratory
seizures can cause apnea and hypoventilation
Workup of PVCP pneumonia(3)
Chest xray
Sputum induction by hypertonic saline
BAL si sputum induction fails
Quid of bronchodilator challenge in obstructive pulmonary disease
Si FEV% increases:asthma
No change:COPD
Triad of wegener
Systemic vasculitis
Upper and lower respiratory tract infection
renal impairment
Rx of severe asthma exacerbation(4)
SABA
Ipratopium
corticisteroid
si no improvement intubation
Rx for mild to moderate asthma exacerbation(2)
SABA
No Improvement corticosteroids
Confirmatory test for legionella(2)
Charcoal agar
or Urine antigen testing
When to initiate warfarin in DVT
when PTT>1,5 or 2 fois la normale
Inchronic respiratory acidosis ,link between PCO2 et HCO3
each 10 mm de hg of PCO2,HCO3- increases 0f 3,5
Exsudate physio patho
Increase capillary permeability
Transudate physio patho
Increase hydrostatic pressure
Decrease oncotic pressure
Centrally located nodule work up
Broncoscopy for Biopsy
peripherically located nodule
CT guided Biopsy
Measure to decrease mortality in COPD (3)
Home 02
stop smoking
lung reduction surgery