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OME > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

Status asthmaticus

A

Medical emergency: An extremely severe asthma attack

Severe dyspnea accesory muscle use
Absent lung sounds

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2
Q

DX of asthma

A

PFTs: Dec FEV1 / FEV
reversed with bronchodialators

Methacholine challenge if normal at time of test

Not for DX but likely to have eosinophilia / allergen skin testing / atopy

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3
Q

FOr excrcise induced asthma with known triggers, you can use :

A

Cromolyn sulfate
or
Nedocromil

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4
Q

When someone arrives to ED with likely asthma exacerbation, how do you work them up?

Treatment?

What to do after treatment?

If refractory or severe?

When to intubate?

A 
PE 
BMP (CO2 retention) 
ABG 
PEFR (Peak expiratoryy flow rate) 
CXR (to rule out other causes of dyspnia)

O2
Duonebs (Albuterol / ipratropium)
Corticosteroids

Repeat after initial tx:
BMP (CO2 retention)
ABG
PEFR
Sats
If refractory or severe: 
Racemic Epi
nebs
SubQ epi
IV mag

Intubate if:
Rising CO2 Decreasing pH
absence of lung sounds

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5
Q

In ER, after you treat asthma, what to do with them

A

after 3 hours of neb tx:

No imp- ICU
Total imp - home
anywhere inbetween gets admitted (steroids and nebs)

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6
Q

Classification of asthma

A

Intermittent:
<2/wk <2/month

Mild persistant:
>2/wk >2/month

Moderate persisitant:
Daily >1 / wk
*Start seeing drops below 80% of FEV1

Severe
Daily Daily

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7
Q

Treatment for each classification of asthma

A

Intermittant - SABA

Mild persistant - ICS

Moderate Persistant - LABA OR Leukotriene inhib

Severe persistant - inc ICS dose

Refractory - PO steroids

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8
Q

Stats of COPD

A

20% of smokers get COPD but 90%of COPDers were smokers

Genetic (alpha 1) and environmental factors influence the disease

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9
Q

Chronic Bronchitis Definition

A

productive cough >3 months of two consectutive years

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10
Q

Sequllae of COPD

A 
Cliliary loss
Inc mucouse 
Smooth muscle hypertrphy (narrowning) 
Loss of elasticity 
*Inc pulmonary htn
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11
Q

RF for COPD

Presentation of COPDer (lots)

Labs

CXR

A

Smoking (40 Pyear
Age >45

Chronic cough
Smoker
Cyanosis (blue) 
Edema / RHF / 
Clubbing
air trapping / barrel chest 
pursed lips/ prolonged exp 
Weight loss*
accesory muscle use*

Labs -
ABG:
Low 02
high CO2

PFT: dec FEV1, Dec FEV1/FVC

CBC inc RBCs.

RAD/RVH in ECG from core pulmonale

CXR
Flattened diaphragm
translucent lung fliedls

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12
Q

COPDER acronym

A

an aconym to recall all treatments and goals for COPD patient

C corticosteroids - no change in mortality UNLESS infection

O oxygen (saves life)

P prevention (pneumovax Q5yr, flu shot, smoking cessation) savesl lifes

D dialation

E - skip

R - rehab - excercise - increases tolerance. no change in mortality

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13
Q

Profession of COPD treatments

A

First line:
SABA
LAMA (ipro / tio)
02 as needed

Steroids - IV or PO depending on severity

Intubate / ventilate

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14
Q

COPD exacerbation

SIgns

A

Signs: drop in CO2 or inc in cough prod

O2 (dont stress dec in hypoxic drive here)

Duonebs (ipra / alb)

IV steroids (no taper is req for COPD)

ABX if purulent sputum* / if sputum increased.

  • amoxicillin
  • TMPSMX
  • Doxy
  • Azithro
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15
Q

VIrchows Triad

A

Venous Stasis
Hypercoagulable State
Endothelial Damage

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16
Q

RF for PE

A 
Stasis
Recent Surgery 
Hypercoagulable disorder
-Cancer
-OCP
-genetic dx
17
Q

THere are no valves in deep veins!

A

WOW

Usually in popliteal or femoral veins

18
Q

How does even a small clot cause dyspnia in PE?

How are large clots different than small ones on workup?

What will ABG look like on PE?

A

Small clot will release platelet derived mediators that cause lung wide inflamation - fluid will leak around alveoli.

Larger clots will cause right heart strain

ABG - CO2 can be blown off, but O2 cant exchange.

Low O2, normal CO2

19
Q

Presentation of PE

A

SOB
Tachypnia
Tachycardia
Leuritic CP

Clear chest XR*
One leg with larger circumference

20
Q

Wells Criteria

SCores

Score interpretation - what tests to do

What if cant get CTA?

A

Helps decide what type of test to do and how to treat it.

Clinical signs and sxs of DVT 3

DVT is first or equally likely 3

HR>100 1.5

Immob / surg in last three days 1.5

Prev DVT/PE 1.5

Hemoptysis 1

Cancer in last 6 months 1

Score interpretation:
4 or under - D dimer
5 or more - CTA

No CTA? (renal dz) get VQ scan

21
Q

TX of PE

How long for heparin bridge

alternate adv/ disadv

If massive

A

Heparin to warfarin
or
NOAC (no reversal, BID but no monitoring)

TPA if massive

22
Q

HIT from heparin

A

low platelets
7 days of first exposure, 3 days on repeat

draw HIT panel
stop hep, give argatroban

23
Q

Overview of Transudate vs exudate

Unlateral vs Bilat?

A

Transudate - dec oncotic P vs inc hydrostatic P
-usu bilateral

Exudate - stuff in space is drawing fluid
-usu unulat

24
Q 
Puleural effusion
Presentation 
Dx 
Next step for analysis
When you can do throacentesis
A

Presentation
SOB
Pleuritic CP

DX
CXR - blunting of costovertebral angle, (needs 250cc)

Then get recumabnt Xray - will see if loculated.

If free moving and above 1cm from chest wall to fluid level, can do thoracentesis.

25
Q

Lights criteria

A

Criteria for analizing thoracentesis fluid. transudate vs exudate

“Fluid comes first”
(Extracted / serum)

it is an exudate IF:
fLDH/sLDH > 0.6
fProt/sProt > 0.5
LDH >2/3 upper limit of normal * (200)

If it is an Exudate, must get Glucose, amylase, Cel count, cultre, gram stain, AFB / TB antigen, RF, CCP, ANA

26
Q

If loculated and not free flowing on recumbant X ray?

A

Consult surg for possible VATS vs TPA vs thorocotomy

27
Q

If CHF and plural effusion….

A

Skip tap, and diuresis

28
Q

DDX for Transudate

DDX for Exudate

A 
Transudate
Inc hydrostatic
-CHF 
Dec Oncotic
-Nephrosis, Cirrhosis, Gastrosis

Exudate

  • Malignancy
  • PNA
  • TB
29
Q

Screening for lung cancer

A

Annual low dose CT scan is inidcated for indivuduals who:

Quit less than 15 years prior

55-85

Have a 30pack year hx

30
Q

If a pulmonary nodule is found:

Next step

If Stable?

If unstable?

A

Next step - compare old

If no change in two years, it is stable

If Stable? - nothing

If unstable? - serial CT scans to monitor

  • Sometimes if it looks bad (size, surface, smoke, self =age - may get bx immediately
31
Q

Ways of getting BX of lung tissue

A

Bonchoscopy / EBUS

Percutaneous CT BX

VATS if in the middle

Thoracentisis if effusion

32
Q

Lung cancer presentation

A

Fever
hemoptysis
weight loss

33
Q

ARDS

Overview

Exam

DX (difinitive)

TX

A

Pulmonary edema caused by increased permiability of capiliarties.

Exam
Pt will be hypoxic
SOB / Cough / Crackles
(looks like CHF with normal heart fucntion)

Difinitive DX - Capilary wedge pressure

TX - PEEP

34
Q

DDX of ARDS

A

GNR septicemia
burns
TRALI (transfusion related acute lung injury)
drowning

OME (11 decks)

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