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Master the Boards > Respiratory > Flashcards

Respiratory Flashcards

1
Q

oral temperature in patient breathing fast

A

inaccurate

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2
Q

asthma epidemiology

A

INCREASING

  • incidence
  • prevalence
  • hospital admissions
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3
Q

best initial test in acute asthma exacerbation

A

PEF and ABG’s

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4
Q

CXR in asthma

A

NORMAL

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5
Q

most accurate diagnosis of asthma

A

PFTs

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6
Q

when patient is asymptomatic and want to diagnose asthma

A

methacholine challenge test

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7
Q

CBC asthma

A

increase eosinophils

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8
Q

other random dx of asthma

A

skin testing and IgE levels

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9
Q

STEP 1 asthma tx

A

saba

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10
Q

STEP 2 asthma tx

A

+ low dose ICS or (cromolyn, theo, LTRA)

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11
Q

step 3 asthma tx

A

+ LABA
OR
INCREASE dose of ICS

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12
Q

step 4 asthma tx

A

saba + MAX dose ICS + LABA

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13
Q

step 5 asthma tx

A

+ omalizumab

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14
Q

step 6 asthma tx

A

ORAL steroids

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15
Q

adverse effects with zafirlukast

A

churg strauss

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16
Q

adverse effects with inhaled steroids

A

DYSPHONIA and oral candidiasis

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17
Q

anticholinergics in asthma

A

unknown use

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18
Q

best indication of asthma severity

A

RESPIRATORY RATE

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19
Q

PEF mainly based on….

A

HEIGHT, age

NOT weight

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20
Q

tx acute asthma exacerbation

A
  • O2
  • albuterol
  • steroids
  • epinephrine
  • magnesium
  • ICU–> resp acidosis– intubation
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21
Q

acute asthma best….

A

epinephrine> albuterol> magneseium

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22
Q

best initial tests for dx COPD

A

CHEST XR: increase AP diameter and flat diaphragm

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23
Q

DLCO in COPD

A

decrease in emphysema

NOT in chronic bronchitis

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24
Q

reversibility- complete

A

bronchodilator response greater than 12% increase and 200mL increase in FEV1

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25
Q

dx of COPD

A

ABG: increase CO2, decrease O2
CBC: increase Hct
EKG: RA/RV hypertrophy and a.fib or MAT
ECHO: RA/RV hypertrophy and pulmonary HTN

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26
Q

MAT in COPD

A

multifocal atrial tachycardia

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27
Q

improving mortality in COPD

A

smoking cessation
O2 tx
influenza and pneumococcal vaccine

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28
Q

O2 use in COPD

A

O2 less than 55/ sat less than 88%

with pulmonary HTN/ high Hct/ cardiomyopathy:
O2 less than 60/ sat less than 90%

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29
Q

anticholinergics in COPD

A

YESS ARE EFFECTIVE– no change in mortality

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30
Q

asthmatic not controlled with saba

A

ICS

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31
Q

COPD not controlled with saba

A

anticholinergic–> ICS

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32
Q

when medical tx fails in COPD

A

refer for transplantation

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33
Q

antibiotics for acute COPD exacerbation

A

macrolides: azithomycin, clarithromycin
cephalosporins: cefuroxime, cefixime, cefaclor, ceftibuten
co-amox
quinolones: levofloxacin, moxifloxacin, gemifloxacin

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34
Q

second line antibiotics in COPD

A

doxycycline

TMP/SMX

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35
Q

diagnosis of bronchiectasis

A

HRCT***** only way to diagnose

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36
Q

tx of bronchiectasis

A

physio
antibiotics– as infection comes: INHALED cold ones, rotate 1 weekly antibiotics
surgical resection if focal

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37
Q

steroids for ABPA

A

ORAL not inhaled (since inhaled cannot get a big enough dose to be effective)

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38
Q

COPD with pneumonia

A

haemophilus influ

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39
Q

diabetic or alcoholic with pneumonia

A

klebsiella

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40
Q

poor dentition or aspiration pneumonia

A

anaerobes

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41
Q

hoarseness pneumonia

A

chalmydophila pneumoniae

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42
Q

animals at the time of giving birth pneumonia

A

coxiella burnetti

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43
Q

rigors in pneumonia

A

sign of bacteremia

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44
Q

chest pain in pneumonia

A

pleuritic– PG’s

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45
Q

foul smelling sputum pneumonia

A

anaerobes

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46
Q

dry cough, not severe,

bullous myringitis

A

mycoplasma pneumonia

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47
Q

dry pneumonia/ non productive

A 
mycoplasma 
viruses
coxiella
pneumocystis
chalmydia
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48
Q

best diagnosis for pneumonia

A

CXR, sputum cultures= USELESS– since often cannot detect organism

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49
Q

first chest X ray for pneumonia

A

can be falsely negative in 10-20% of cases

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50
Q

sputum grain stain adequate if….

A
  • more than 25 WBC’s

- fewer than 10 epithelial cells

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51
Q

blood cultures for pneumonia

A

positive in 5-15% cases of CAP– esp with s. pneumonia

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52
Q

dx of pneumonia from hx/exam alone?

A

NNNNOOOOOO

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53
Q

tests done in pneumonia with severe disease, and unknown aetiology, or not responding to tx

A
  1. thoracocentesis
  2. empyema
  3. bronchoscopy
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54
Q

thoracocentesis in pneumonia

A
  • pleural effusion analysis

- or if empyema

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55
Q

empyema in pneumonia

A

LDH above 60%
protein above 50% of serum level
WCC above 1000
pH less than 7.2

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56
Q

bronchoscopy in CAP

A

RARE– in ICU

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57
Q

dx of mycoplasma pneumonia

A
  • PCR
  • cold agglutinins
  • serology
  • culture special media
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58
Q

dx chlamydophila pneumoniae

A
  • rising serologic titers
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59
Q

dx legionella

A
  • urine antigen

- culture on charcoal yeast extract

60
Q

dx chlamydia pstiacci or coxiella

A
  • rising serologic titers
61
Q

dx PCP

62
Q

treatment CAP based on….

A

SEVERITY OF DISEASE more nb than the cause

63
Q

outpatient tx CAP

A

previously health or no antibiotics in past 3 months and mild symptoms
= MACROLIDE or DOXYCYCLINE

comorbidities or antibiotics in past 3 months
= LEVOFLOXACIN or MOXIFLOXACIN

64
Q

inpatient tx CAP

A

LEVOFLOXACIN or MOXIFLOXACIN
or
CEFTRIAXONE + AZITHROMYCIN

65
Q

single factors= reason to hospitalize a patient

A

HYPOxia

HYPOtension

66
Q

CURB-65

A

confusion
Urea: BUN above 30, sodium less than 130, glucose above 250
Resp rate: above 30, pO2 less than 60, pH less than 7.35
BP: bp below 90mmHg

pulse above 125/minute
temperature above 104 farenheit
age: older than 65, or comorbifities: cancer, COPD, CHF, renal failure, liver disease

67
Q

empyema tx

A

placement of chest tube for suction

68
Q

HCW need PCV vaccine?

69
Q

tx of HAP

A

antipseudomonal cephalosporin: cefepime, ceftazidime
OR
antipseudomonal penicillin: piperacillin/tazo
OR
carbapenems: mero/imi/doripenem

70
Q

dx of VAP, easiest/least accurate–> dangerous/most accurate

A
  1. tracheal aspirate
  2. BAL
  3. protected brush specimen
  4. video-assisted thoracoscopy
  5. open lung biopsy
71
Q

tx of VAP

A

3 different drugs:

  1. antipseudomonal beta lactam= tx of HAP
  2. second antipseudomonal:
    - gentamicin/tobramycin/amikacin
    - ciprofloxacin or levofloxacin
  3. MRSA
    - vancomycin
    - linezolid
72
Q

daptomycin for lungs?

A

NOOOOO, since inactivated by surfactant

73
Q

culturing endotracheal tube

A

contamination

74
Q

aspiration pneumonia

A

lying flat, upper lobes

75
Q

sputum culture for lung abscess

A

NOOOpe, because has anaerobes anyways

76
Q

tx of lung abscess

A

clindamycin or penicillin

77
Q

PCP always has elevated

78
Q

negative sputum stain, best diagnostic test…

A

BRONCHOSCOPY

79
Q

tx PCP and prophylaxis

80
Q

severe PCP

A

pO2 less than 70

A-a gradient above 35

81
Q

what tx for severe PCP

A

ADD STEROIDS – decreases mortality

82
Q

toxicity from TMP/SMX switch to

A

clindamycin + primaquine
OR
pentamidine

83
Q

when to start PCP prophylaxis

A

CD4 less than 200

84
Q

rash or neutropenia from TMP/SMX prophylaxis give….

A

atovaquone
OR
dapsone (not if G6PD)

85
Q

CD4 below 50, what additional prophylaxis

A

ATYPICAL mycobacteria– azithromycin

86
Q

when to stop prophylaxis of PCP

A

when CD4 greater than 200 for several months

87
Q

dx of TB must include…

A
  1. clear risk factor
  2. cavity CXR
  3. positive smear (done 3 times)
88
Q

when to use ripE (ethambutol)

A

when beginning tx and know that it is SENSITIVE to ALL TB meds

89
Q

side effect of pyrazinamide

A

hyperuricemia

90
Q

ethabutol, mgmt adjustments

A

decrease dose in renal failure

91
Q

how to decrease risk of TB constrictive pericarditis

92
Q

pregnant patients, antibiotic for TB they shouldn’t receive

A

PYRAZINAMIDE

side note: cannot also receive streptomycin

93
Q

once the PPD test is positive….

A

it will always be positive in the future

94
Q

BCG and PPD

A

has no effect on recomendations

95
Q

PPD positive whether or not had BCG

A

MUST take INH 9mos

96
Q

benign solitary nodule

A
  • less than 30
  • no change in size
  • nonsmoker
  • smooth borders
  • less than 1 cm
  • normal lung
  • no adenopatthy
  • dense, central calcification
  • normal PET scan
97
Q

malignant solitary nodule

A
  • older than 40
  • enlarging
  • smoker
  • spiculated
  • large great than 2 cm
  • atelectasis
  • yes adenopathy
  • sparse, eccentric calcification
  • abnormal PET scan
98
Q

what to do if nodule is enlarging

99
Q

for high probability lesions best answer

100
Q

intermediate probability lesions

A

BRONCHOSCOPY- central

or TRANSTHORACIC NEEDLE BX- peripheral

101
Q

sputum cytology positive, next appropriate mgmt

A

RESECTION– since highly specific

102
Q

most common adverse effect of transthoracic bx

A

pneumothorax

103
Q

PET scan for lung cancer

A

content of lesion is malignant, most accurate if lesion GREATER THAN 1cm

104
Q

VATS

A

MOST specific MOST sensitive

105
Q

byssinosis

106
Q

bagassosis

A

moldy sugar cane

107
Q

best test for ILD

108
Q

DLCO ILD

109
Q

dx of sarcoidosis, best initial test

A

CXR– HILAR ADENOPATHY

110
Q

most accurate dx of sarcoidosis

111
Q

additional things for dx of sarcoidosis

A

ACE elevated
hypercalcemia
hypercalciuria
PFT–ILD

112
Q

HY– BAL in sarcoidosis

A

ELEVATED helper cells

113
Q

CXR PE

A

NORMAL usually

114
Q

most common CXR abnormalitiy PE

A

ATELECTASIS

115
Q

most common EKG finding for PE

A

nonspecific ST-T wave changes

116
Q

ABG in PE– highly suggestive

A

hypoxia

resp alkalosis

117
Q

when hx and initial labs very suggestive of PE….

A

START TREATMENT

118
Q

gold std dx of PE

A

spiral ct SCAN

119
Q

V/Q scan low probability

A

15% can have a clot

120
Q

V/Q scan high probability

A

15% won’t have a clot

121
Q

V/Q first only in

122
Q

D-DIMER

A

screening– sensitivity

not specific

123
Q

positive D-dimer

A

doesn’t mean anything

124
Q

negative D-dimer

A

EXCLUDES PE

125
Q

for VQ to have any accuracy must have

A

normal CXR

126
Q

abnormal CXR PE

127
Q

LL Doppler study

A

good test if ? V/Q and ? spiral CT

128
Q

angiography in PE

A

NOOOOOO RARELY done

129
Q

IVC filter

A

contraindications to anticoagulants
recurent emboli on therapeutic warfarin
RV dysfunction- enlarged RV– could have embolus

130
Q

HIT alternative in PE

A

fondaprinaux

131
Q

thrombolytics in PE

A

hemodynamically unstable

acute RV dysfunction

132
Q

best initial tests in pulmonary HTN

A

CXR/ CT: narrowing/pruning of distal vessels

133
Q

most accurate test in pulmonary HTN

A

R heart or swan ganz catheter

134
Q

EKG in pulmonary HTN

A

RA/RV hypertrophy and R axis deviation

135
Q

ECHO in pulmonary HTN

A

RA/RV hypertrophy, doppler estimates pulmonary artery pressure

136
Q

only cure for pulmonary HTN

A

LUNG TRANSPLANT

137
Q

sleep apnea and increased bicarb

A

OBESITY/HYPOVENTILATION SYNDROME

138
Q

most accurate test OSA

A

polysomnography (sleep study)

139
Q

tx of osa

A

weight loss

CPAP

140
Q

CT ARDS

A

air bronchograms

141
Q

ARDS definition

A

p02/FI02 below 300

142
Q

moderately severe ARDS

A

p02/FI02 below 200

143
Q

severe ARDS

A

p02/FI02 below 100

144
Q

calculation: p02= 70, FI02=50% oxygen

A

70/0.5= 140

145
Q

before starting treatment with PEEP

A

DECREASE FI02 (since above 50% FI02 is toxic to lungs)

146
Q

tx of ARDS

A

6ml per kg of tidal volume
STEROIDS NOT BENEFICIAL
Tx underlying cause

147
Q

maintain plateau pressure for ARDS

A

less than 30cm of water

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