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respiratory > UW 2 > Flashcards

UW 2 Flashcards

1
Q

Invasive aspergiolsis - risk factors

A

immune

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2
Q

invasive aspergillosis - findings

A
  1. triad of fever, chest pain, hemoptysis
  2. pulm nodules with halo
  3. positive cultures
  4. positive cell wall biomarkers (galactomannan, betal D glucam
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3
Q

invasive aspergillosis -management

A

voriconazole +/- caspofungin

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4
Q

chronic pulmonary aspergilosis - risk factors

A

lung disease/damage (cavitary TB)

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5
Q

chronic pulm aspergilosis - findings

A
  1. more than 3 months: weight loss, hemoptysis, fatique
  2. cavitary lesion +/- funfus ball
  3. positive aspergillus IgG seology)
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6
Q

Chronic pulm aspergilosis - management

A

resect aspergilloma (if possible)

  1. azole (vorizonazole)
  2. embolization (if severe hemoptysis)
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7
Q

tumors of the mediastinum - location

A

anterior: thymoma, thyroid, teratoma, lymphoma
middle: bronchogenic cysts
posterior: neurogenic, esoph leiomyomas

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8
Q

hospitalized vs ventilator acquired pneumonia - definition

A

hosptial: 48 or more hours after admission
ventilator: 48 or more hours after intubation

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9
Q

Acute exacerbation of COPD - management

A
  1. O2 (target 88-92)
  2. inhaled bronchodilators
  3. systemic glucocrticoids (β2 or anticholinerg)
  4. antibiotics if at least 2 of dyspnea, more frequent cough, change in colore or volume of sputum)
  5. oselramivir if evidence of flu
  6. noninvasive (+) pressure ventilation
  7. intubation
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10
Q

pulm nodule sorrounded by ground glass

A

invasive aspergilosis (halo sign)

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11
Q

causes of obstructive pattern (and their DLCO)

A

asthma: normal/increaed
emphysema: decreasd
chronic bronchitis: normal

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12
Q

causes of increased DLCO

A
  1. asthma
  2. morbit obesity
  3. polycythemia
  4. pulm hemorrhage
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13
Q

increased PCWP is an indicator of

A

LA pressure

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14
Q

lung problems - PCWP?

A

not affected

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15
Q

asbesotis exposure - when develop disease

A

after 20 years of initial exposure

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16
Q

aspiration syndromes - types and mechansim

A

pneumonia: parenchyma infection, anaerobes microves
pnemonitis: parenchyma infl, aspiration of gastric acid

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17
Q

aspiration syndrome - types and clinical features

A
  1. pnemonia: daus after aspiration, fever, cough, sputum. CXR infiltrates, can progress to abscess
  2. pneumonitis: hours after event, from asymptomatic to resp distress, CXR infiltrates (1 or both lower lobes)
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18
Q

aspiration syndrome - types and management

A

pneumonia: clindamycin or b lactam + lactamase inh
pneumonitis: supportive (no antibiotics)

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19
Q

negative pressure pulm edema

A

when a atient has upper airway obstruction that results in large negative intrathoracic pressure (due to inspiration against obstruction)

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20
Q

the 3 MCC of clubbing

A
  1. Lung ca
  2. Cystic fibrosis
  3. R –> L cardiac shunts
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21
Q

Clubbing in COPD

A

copd does not cause

if there is, search for ca

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22
Q

TB endemic areas

A

Mexico, philippnes, china, vietnam, india, Dominican Republic, Haiti

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23
Q

management of PE if more than 4 wells

A

first antigoagulant, and after diagnostic tests

24
Q

classic ECG in PE

A

prominent S in lead I, Q in lead III, and inverted T in head III (S1Q3T3)

25
Q

management after Wells criteria

A
  1. PE likley –> CT pulm angiography –> if (-) is excluded, if (+) is confirmed
  2. PE unlikely –> D dimers –>: if more more than 500 –> CT pulm angiography, if less excluded
26
Q

Modified Wells criteria

A
  • 3 points: Clinical signs of DVT, alternate diagnosis is less likley
  • 1.5 points: previous PE or DVT, herat rate more than 100, Recent surgery or immobilazation
  • 1 point: hemoptyisis, cancer
    MORE THAN 4 –> LIKELY
    4 OR LESS –> UNLIKELY
27
Q

fat embolism - time after event

A

12-78 h

28
Q

pulm contusion - symptoms can be worsen by

A

fluid overvolume

29
Q

COPD indications for O2 at home

A
  1. resting PaO2 55 or lower
  2. SaO2: 88 or less
  3. Those with RHF or HCT higher than 55 should be started if Pao2 lower than 60 or Sao2 lower than 90
30
Q

the 3 MCC of chronic cough are

A
  1. upper airway cough syndrome (postnasal drip_
  2. asthma
  3. GERD
31
Q

POSTNASAL SYNDROME

A

caused by rhinosinus conditions including allergic, perennial nonallergic and vasomotor rhinitis –> mechanical stimulation of cough reflex
treatment: chlorpheniramine

32
Q

COPD exacerbation - when to give antibiotics

A

if 2/3 of:

  1. increaed dyspnea
  2. increased cough (more frequent o sever
  3. sputum production (change in color or volume)
33
Q

anaphylaxis - IV vs IM epinephrine?

A

IM –> if no response –> IV

NO IMMEDIATELY IV DUE TO SE (arrhythmia)

34
Q

the most effective way to differentiate asthma from COPD

A

spirometry before and after administration of a bronchodilator (usually albuterol)

35
Q

COPD - factors that decrease mortality

A
  1. smoking cessation
  2. Long term supplemental 02 decreases mortality if:
    - SpO2 under 88%
    - SpO2 under 89% + RHF or erythrocytosis (HCT more than 55)
36
Q

solitary pulm nodule - definition

A

round opacity up to 2 cm in diameter within and surrounded by pulm parenchyma
by convention: no pleural effusion, adenopathym atelectasis

37
Q

solitary pulm nodule - DDX

A
  1. 1ry lung Ca
  2. Metastatic ca
  3. Benigh infect granulomas (TB, histopl, other fungus)
  4. Benign neolasm (lipomas, hamartomas, fibroma)
  5. vascular (AV malformation)
38
Q

Solitary pulm nodule on routine chest X-ray - management

A

previous chest x-ray:
- stable over 2-3 years –> no further testing
- No previous imaging or possible nodule growth –>
CT:
1. Benign features –> serial CT scans
2. High suspicious for malignancy –> surgery
3. indeterminate or suspicious for malignancy –> biopsy or PET

39
Q

high risk vs low risk for solitary pulm nodule

A

low: smaller than 0.8 cm, younger than 40, never skomed or smoking cessation more than 15 years, smooth margins
high: larger than 2 cm, older than 60, current smoker or cessation less than 5 years before, corona radiata or spiculated margins

40
Q

Causes of recurrent pneumonia

A
  1. involving same region: local airway obstruction, aspiration –> CT
  2. involving different regions of lung: immunoddef, sinopulm disease, noninfectious (Vasculitis, etc)
41
Q

antitryps def - smoking

A

COPD 10 years earlier compare to nonsmoking

42
Q

empiric treatment of CAP

A
  1. outpatient:macrolide or doxycycline (healthy)
    resp quinolone or beta lactam + macrolide (comorbitities)
  2. inpatients: quinolone (IV) or betal lactam + macrolide
  3. ICU: beta lactam + macrolide or quinolne + beta lactam
43
Q

resp quinolones

A

levo-, moxifloxacin

44
Q

CURB-65

A 
Confusion
Urea more than 20
Respiration more than 30
Blood pressure lessthan 90/60
Age 65 or more
45
Q

CURB-65 interpretation

A

0-1: low mortality –> outpatient
1-2 intermediate –> likley inpatient
3-4 urgent inpatient –> possibly ICU if socre more than 4

46
Q

initial drug in stable PE in patient with RF

A 
unfractionated heparin (if severe: GFR lower than 30)
(the others are contraindicated)
47
Q

SIADH - treatment

A

Fluid restrition (best initial) +/- salt tablets
hypertonic (3%)saline for severe
- DEMECLOCYCLINE ONLY IF THE OTHERS FAIL

48
Q

PE - Aa gradient

A

increased

49
Q

anemia - Aa gradient

A

low

50
Q

dead space ventilation?

A

air in non-perfused areas

51
Q

subacute vs chronic cough

A

subacute: 3-8 wks
chronic: more than 8 wks

52
Q

evaluation of subacute or chronic cough

A

evaluate and treat as indicated (stop ACEi, H1 for upper airway cough, OFT for asthma, PPI for GERD) –> if no improvement –> Cest X-ray
- parenchymal disease, purulent sputum, immune, no specific etiology –> chest x-ray

53
Q

atelectasi - PCO2

A

low

54
Q

upper airway obstruction - graph

A

decrease the airflow rate during insipration and expiration –> flattening both the top and bottom of the flow - volume loop

55
Q

FRC in ankylosing spond

A

normal or increased due to fixation of a rib in the inspiratory position

respiratory (27 decks)

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