Respiratory Flashcards
1
Q
oral temperature in patient breathing fast
A
inaccurate
2
Q
asthma epidemiology
A
INCREASING
- incidence
- prevalence
- hospital admissions
3
Q
best initial test in acute asthma exacerbation
A
PEF and ABG’s
4
Q
CXR in asthma
A
NORMAL
5
Q
most accurate diagnosis of asthma
A
PFTs
6
Q
when patient is asymptomatic and want to diagnose asthma
A
methacholine challenge test
7
Q
CBC asthma
A
increase eosinophils
8
Q
other random dx of asthma
A
skin testing and IgE levels
9
Q
STEP 1 asthma tx
A
saba
10
Q
STEP 2 asthma tx
A
+ low dose ICS or (cromolyn, theo, LTRA)
11
Q
step 3 asthma tx
A
+ LABA
OR
INCREASE dose of ICS
12
Q
step 4 asthma tx
A
saba + MAX dose ICS + LABA
13
Q
step 5 asthma tx
A
+ omalizumab
14
Q
step 6 asthma tx
A
ORAL steroids
15
Q
adverse effects with zafirlukast
A
churg strauss
16
Q
adverse effects with inhaled steroids
A
DYSPHONIA and oral candidiasis
17
Q
anticholinergics in asthma
A
unknown use
18
Q
best indication of asthma severity
A
RESPIRATORY RATE
19
Q
PEF mainly based on….
A
HEIGHT, age
NOT weight
20
Q
tx acute asthma exacerbation
A
- O2
- albuterol
- steroids
- epinephrine
- magnesium
- ICU–> resp acidosis– intubation
21
Q
acute asthma best….
A
epinephrine> albuterol> magneseium
22
Q
best initial tests for dx COPD
A
CHEST XR: increase AP diameter and flat diaphragm
23
Q
DLCO in COPD
A
decrease in emphysema
NOT in chronic bronchitis
24
Q
reversibility- complete
A
bronchodilator response greater than 12% increase and 200mL increase in FEV1
25
dx of COPD
ABG: increase CO2, decrease O2
CBC: increase Hct
EKG: RA/RV hypertrophy and a.fib or MAT
ECHO: RA/RV hypertrophy and pulmonary HTN
26
MAT in COPD
multifocal atrial tachycardia
27
improving mortality in COPD
smoking cessation
O2 tx
influenza and pneumococcal vaccine
28
O2 use in COPD
O2 less than 55/ sat less than 88%
with pulmonary HTN/ high Hct/ cardiomyopathy:
O2 less than 60/ sat less than 90%
29
anticholinergics in COPD
YESS ARE EFFECTIVE-- no change in mortality
30
asthmatic not controlled with saba
ICS
31
COPD not controlled with saba
anticholinergic--> ICS
32
when medical tx fails in COPD
refer for transplantation
33
antibiotics for acute COPD exacerbation
macrolides: azithomycin, clarithromycin
cephalosporins: cefuroxime, cefixime, cefaclor, ceftibuten
co-amox
quinolones: levofloxacin, moxifloxacin, gemifloxacin
34
second line antibiotics in COPD
doxycycline
| TMP/SMX
35
diagnosis of bronchiectasis
HRCT***** only way to diagnose
36
tx of bronchiectasis
physio
antibiotics-- as infection comes: INHALED cold ones, rotate 1 weekly antibiotics
surgical resection if focal
37
steroids for ABPA
ORAL not inhaled (since inhaled cannot get a big enough dose to be effective)
38
COPD with pneumonia
haemophilus influ
39
diabetic or alcoholic with pneumonia
klebsiella
40
poor dentition or aspiration pneumonia
anaerobes
41
hoarseness pneumonia
chalmydophila pneumoniae
42
animals at the time of giving birth pneumonia
coxiella burnetti
43
rigors in pneumonia
sign of bacteremia
44
chest pain in pneumonia
pleuritic-- PG's
45
foul smelling sputum pneumonia
anaerobes
46
dry cough, not severe,
| bullous myringitis
mycoplasma pneumonia
47
dry pneumonia/ non productive
```
mycoplasma
viruses
coxiella
pneumocystis
chalmydia
```
48
best diagnosis for pneumonia
CXR, sputum cultures= USELESS-- since often cannot detect organism
49
first chest X ray for pneumonia
can be falsely negative in 10-20% of cases
50
sputum grain stain adequate if....
- more than 25 WBC's
| - fewer than 10 epithelial cells
51
blood cultures for pneumonia
positive in 5-15% cases of CAP-- esp with s. pneumonia
52
dx of pneumonia from hx/exam alone?
NNNNOOOOOO
53
tests done in pneumonia with severe disease, and unknown aetiology, or not responding to tx
1. thoracocentesis
2. empyema
3. bronchoscopy
54
thoracocentesis in pneumonia
- pleural effusion analysis
| - or if empyema
55
empyema in pneumonia
LDH above 60%
protein above 50% of serum level
WCC above 1000
pH less than 7.2
56
bronchoscopy in CAP
RARE-- in ICU
57
dx of mycoplasma pneumonia
- PCR
- cold agglutinins
- serology
- culture special media
58
dx chlamydophila pneumoniae
- rising serologic titers
59
dx legionella
- urine antigen
| - culture on charcoal yeast extract
60
dx chlamydia pstiacci or coxiella
- rising serologic titers
61
dx PCP
- BAL
62
treatment CAP based on....
SEVERITY OF DISEASE more nb than the cause
63
outpatient tx CAP
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
inpatient tx CAP
LEVOFLOXACIN or MOXIFLOXACIN
or
CEFTRIAXONE + AZITHROMYCIN
65
single factors= reason to hospitalize a patient
HYPOxia
HYPOtension
66
CURB-65
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
empyema tx
placement of chest tube for suction
68
HCW need PCV vaccine?
NOOOOPE
69
tx of HAP
antipseudomonal cephalosporin: cefepime, ceftazidime
OR
antipseudomonal penicillin: piperacillin/tazo
OR
carbapenems: mero/imi/doripenem
70
dx of VAP, easiest/least accurate--> dangerous/most accurate
1. tracheal aspirate
2. BAL
3. protected brush specimen
4. video-assisted thoracoscopy
5. open lung biopsy
71
tx of VAP
3 different drugs:
1. antipseudomonal beta lactam= tx of HAP
2. second antipseudomonal:
- gentamicin/tobramycin/amikacin
- ciprofloxacin or levofloxacin
3. MRSA
- vancomycin
- linezolid
72
daptomycin for lungs?
NOOOOO, since inactivated by surfactant
73
culturing endotracheal tube
contamination
74
aspiration pneumonia
lying flat, upper lobes
75
sputum culture for lung abscess
NOOOpe, because has anaerobes anyways
76
tx of lung abscess
clindamycin or penicillin
77
PCP always has elevated
LDH
78
negative sputum stain, best diagnostic test...
BRONCHOSCOPY
79
tx PCP and prophylaxis
TMP/SMX
80
severe PCP
pO2 less than 70
| A-a gradient above 35
81
what tx for severe PCP
ADD STEROIDS -- decreases mortality
82
toxicity from TMP/SMX switch to
clindamycin + primaquine
OR
pentamidine
83
when to start PCP prophylaxis
CD4 less than 200
84
rash or neutropenia from TMP/SMX prophylaxis give....
atovaquone
OR
dapsone (not if G6PD)
85
CD4 below 50, what additional prophylaxis
ATYPICAL mycobacteria-- azithromycin
86
when to stop prophylaxis of PCP
when CD4 greater than 200 for several months
87
dx of TB must include...
1. clear risk factor
2. cavity CXR
3. positive smear (done 3 times)
88
when to use ripE (ethambutol)
when beginning tx and know that it is SENSITIVE to ALL TB meds
89
side effect of pyrazinamide
hyperuricemia
90
ethabutol, mgmt adjustments
decrease dose in renal failure
91
how to decrease risk of TB constrictive pericarditis
STEROIDS
92
pregnant patients, antibiotic for TB they shouldn't receive
PYRAZINAMIDE
| side note: cannot also receive streptomycin
93
once the PPD test is positive....
it will always be positive in the future
94
BCG and PPD
has no effect on recomendations
95
PPD positive whether or not had BCG
MUST take INH 9mos
96
benign solitary nodule
- 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
malignant solitary nodule
- older than 40
- enlarging
- smoker
- spiculated
- large great than 2 cm
- atelectasis
- yes adenopathy
- sparse, eccentric calcification
- abnormal PET scan
98
what to do if nodule is enlarging
BIOPSY
99
for high probability lesions best answer
RESECTION
100
intermediate probability lesions
BRONCHOSCOPY- central
| or TRANSTHORACIC NEEDLE BX- peripheral
101
sputum cytology positive, next appropriate mgmt
RESECTION-- since highly specific
102
most common adverse effect of transthoracic bx
pneumothorax
103
PET scan for lung cancer
content of lesion is malignant, most accurate if lesion GREATER THAN 1cm
104
VATS
MOST specific MOST sensitive
105
byssinosis
cotton
106
bagassosis
moldy sugar cane
107
best test for ILD
HRCT
108
DLCO ILD
DECREASED
109
dx of sarcoidosis, best initial test
CXR-- HILAR ADENOPATHY
110
most accurate dx of sarcoidosis
bx
111
additional things for dx of sarcoidosis
ACE elevated
hypercalcemia
hypercalciuria
PFT--ILD
112
HY-- BAL in sarcoidosis
ELEVATED helper cells
113
CXR PE
NORMAL usually
114
most common CXR abnormalitiy PE
ATELECTASIS
115
most common EKG finding for PE
nonspecific ST-T wave changes
116
ABG in PE-- highly suggestive
hypoxia
| resp alkalosis
117
when hx and initial labs very suggestive of PE....
START TREATMENT
118
gold std dx of PE
spiral ct SCAN
119
V/Q scan low probability
15% can have a clot
120
V/Q scan high probability
15% won't have a clot
121
V/Q first only in
pregnancy
122
D-DIMER
screening-- sensitivity
| not specific
123
positive D-dimer
doesn't mean anything
124
negative D-dimer
EXCLUDES PE
125
for VQ to have any accuracy must have
normal CXR
126
abnormal CXR PE
do CT
127
LL Doppler study
good test if ? V/Q and ? spiral CT
128
angiography in PE
NOOOOOO RARELY done
129
IVC filter
contraindications to anticoagulants
recurent emboli on therapeutic warfarin
RV dysfunction- enlarged RV-- could have embolus
130
HIT alternative in PE
fondaprinaux
131
thrombolytics in PE
hemodynamically unstable
| acute RV dysfunction
132
best initial tests in pulmonary HTN
CXR/ CT: narrowing/pruning of distal vessels
133
most accurate test in pulmonary HTN
R heart or swan ganz catheter
134
EKG in pulmonary HTN
RA/RV hypertrophy and R axis deviation
135
ECHO in pulmonary HTN
RA/RV hypertrophy, doppler estimates pulmonary artery pressure
136
only cure for pulmonary HTN
LUNG TRANSPLANT
137
sleep apnea and increased bicarb
OBESITY/HYPOVENTILATION SYNDROME
138
most accurate test OSA
polysomnography (sleep study)
139
tx of osa
weight loss
| CPAP
140
CT ARDS
air bronchograms
141
ARDS definition
p02/FI02 below 300
142
moderately severe ARDS
p02/FI02 below 200
143
severe ARDS
p02/FI02 below 100
144
calculation: p02= 70, FI02=50% oxygen
70/0.5= 140
145
before starting treatment with PEEP
DECREASE FI02 (since above 50% FI02 is toxic to lungs)
146
tx of ARDS
6ml per kg of tidal volume
STEROIDS NOT BENEFICIAL
Tx underlying cause
147
maintain plateau pressure for ARDS
less than 30cm of water
