Respiratory Flashcards
What is the medical management of mild persistent asthma?
A low-dose inhaled corticosteroid daily, along with a short-acting inhaled β-agonist as needed
What asthma medication should not be used as monotherapy due to safety concerns?
Because of the risk of asthma exacerbation or asthma-related death, the FDA has added a warning against the use of long-acting β2-agonists as monotherapy. Inhaled corticosteroids, leukotriene-receptor antagonists, short-acting β2-agonists, and mast-cell stabilizers are approved and accepted for both monotherapy and combination therapy in the management of asthma.
What is the recommended treatment in a patient with an acute COPD exacerbation?
Oxygen, bronchodilators, systemic corticosteroids, and antibiotics (most often caused by a superimposed infection)
What is the management of acute COPD exacerbations?
Antibiotic use in moderately or severely ill patients with a COPD exacerbation reduces the risk of treatment failure or death, and may also help patients with mild exacerbations. Brief courses of systemic corticosteroids shorten hospital stays and decrease treatment failures. Studies have not shown a difference between oral and intravenous corticosteroids. Inhaled corticosteroids are not helpful in the management of an acute exacerbation.
What are the benefits of using an albuterol MDI with spacer over a nebulizer in the setting of acute asthma exacerbation?
Compared to nebulizers, MDIs with spacers have been shown to lower pulse rates, provide greater improvement in peak-flow rates, lead to greater improvement in arterial blood gases, and decrease required albuterol doses. They have also been shown to lower costs, shorten emergency department stays, and significantly lower relapse rates at 2 and 3 weeks compared to nebulizers. There is no difference in hospital admission rates.
What does the vocal cord dysfunction flow-volume loop look like?
Flattening of the inspiratory portion of the flow-volume loop, but a normal expiratory phase
What are signs a pulmonary nodule may be malignant on a chest radiograph?
A size >10 mm, an irregular border, a “ground glass” appearance, either no calcification or an eccentric calcification, and a doubling time of 1 month to 1 year
What test should be performed on all patients suspected of asthma before diagnosis is made?
The American Academy of Asthma, Allergy, and Immunology recommends that asthma not be diagnosed
or treated without spirometry. Once the diagnosis is confirmed, treatment should commence with a
short-acting beta-agonist as needed, followed by stepwise treatment based on the severity of asthma.
How long should patients take oral steroids following a COPD exacerbation?
5 days
What is first line treatment for patients with CO poisoning?
Normobaric O2
What is the guideline for lung cancer screening?
The USPSTF recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in adults 55–80 years of age who have a 30-pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have lung surgery.
What are the main side effects of inhaled corticosteroids?
Candidal infection of the oropharynx, hoarseness, and an increased risk of developing pneumonia.
For an acute asthma attack if a short-acting beta-agonist is insufficient to control symptoms, what is the next therapy that should be tried?
An oral corticosteroid (short course)
What is the management of ARDS?
Early recognition and prompt treatment with intubation and mechanical ventilation is necessary to improve chances for survival. Patients with ARDS should be started at lower tidal volumes (6 mL/kg) instead of the traditional volumes (10–15 mL/kg). These patients also often require higher positive end-expiratory pressure (PEEP) settings. Fluid management should be conservative to allow for optimal cardiorespiratory and renal function and to avoid fluid overload.
What PFT results are indicative of a restrictive disease process?
Reduced FVC and an increased or normal FEV1/FVC ratio
