UW3 (12 Pulm) Flashcards
Asthma diagnostic testing
- PFT results? Test & result?
- Active symptom
- Inactive symptom
Active
FEV1 ↓ / FEV1 / FVC ↓
1) Bronchodilator
2) FEV1 ↑ > 15%
Inactive
PFT = n
1) Methacholine
2) FEV1 ↓ > 20%
Post Op Hypoxemia
Diagnosis?
1) Immediate / Stridor
2) Immediate / R↓ / Tv↓
3) Early / Wheeze
4) 1-5d / Fever / WBC ↑
5) 2-5d / Cough ↓
6) > 3d / Chest pain / HR ↑
1) Airway obst/edema
2) Residual anesthesia
3) Bronchospacm
4) Pneumonia
5) Atelectasis
6) PE
Pneumonia (recurrent / persistent)
Diagnostic? 2
1) CT – r/o neoplasm & obstruction
2) Flexible bronchoscopy
Inspiratory stridor
Barking cough
Hoarseness
- Diagnosis?
- Treatment? 3
Croup
1) Humidifier
2) Steroids
3) Epinephrine neb
Chronic cough
Diagnosis?
1) SOB + Stridor
2) Hoarseness
3) Rhinorrhea / Cobblestone @ oropharynx
4) Reflex w/ meals
5) Chest tightness / Triggers
1) TracheoMalacia
2) Laryngeal Nodule
3) Post nasal drip
4) GERD
5) Asthma
Solid Pulmonary Nodule
- Diagnostic criteria? 4
- Malignancy factor?
- Diagnostic? 3
- Management?
- No Lymphadenopathy
- Round opacity
- < 3cm
- Surrounded by Pul parenchyma
Malignancy factor • Size > 2cm • Old age • Female • Smoker • FH lung cancer • Upper lobe nodule • Spiculation
- XR chest
- Compare with prior image
- CT if worsening
- Nodule < 0.6cm = no FU
- Nodule > 0.8cm + Malignancy = Biopsy, Surgical excision, VATS, PET
Post Op pulmonary complication risk? 4
- COPD
- Smoking
- Sleep Apnea
- HF
Cystic Fibrosis
Diagnostic criteria?
Sweat chloride test ⊕x2
Test for each disease
1) SCID (infectious diarrhea)
2) CGD = Bacterial & fungal infection @ skin / resp
3) CVID = Recurrent infection, bronchiectasis, constipation
1) Adenosine Deaminase ↓
2) DihydroRhodamine 123
3) Ig
Ventilator Pneumonia
Management? 2
1) Respiratory culture
2) Empiric therapy
Asthma exacerbation (treatment)
- PEP/FEV1 > 40%? 3
- PEP/FEV1 < 40%? 2
- Severe? 3
- PEP/FEV1 > 40%
- SABA x3
- Steroids PO
- O2
- PEP/FEV1 < 40% (add)
- Iptratropium inh
- Steroid IV
- Severe (add)
- MgSo4
- Terbutaline / Epinephrine
- Intubation / Vent
Asthma
- Treatment response indication & FU
- Good?
- Incomplete?
- Severe?
- PEF > 70 > 1h + No distress
- Stop SABA & Steroid PO
- PEF 40-70 / Persistent symptom
- Admit
- PEF < 40 / pCO2 > 42 / Worsening
- ICU = Intubation / Vent
Transient Tachypnea NewBorn
- XR chest findings?
- Treatment?
- Course?
- Hyperinflation / Flat diaphgram
- Mild cardiomegaly
- Vascular markings
- Fluid @ fissure
- Pleural effusion
• Support / O2
- Resolve < 72h
- No long term complication
COPD
Poor prognosis?
• FEV1 < 40%
Post Op Atelectasis
- X-ray finding?
- Treatment? 3
• XR chest: Linear opacity @ L+R lung base
- CPAP
- Chest PT
- Suction
Bronchiolitis
- Precaution?
- Support care? 3
- Contact
- Droplet
- IVF
- Nasal bulb suction
- Humidifiers
Lung Cancer
Screening indication? 3
• LD CT chest
- Age 55-80
- 30+ ppy
- Current smoker / Quit < 15y
Allergic BronchoPulmonary Aspergillosis
- Lab results? 4
- XR chest findings?
- CT findings?
- Treatment? 3
- Aspergillous IgE + IgG
- IgE ↑ > 417
- Eosinophilia > 500
- Aspergillous skin test ⊕
- Bronchiectasis
- Bronchial wall thickening
• Central bronchiectasis
1) Steroid
2) Itraconazole
3) Voriconazole
COPD
Antibiotic indication
- (2+/3)
- Sputum purulence ↑
- Sputum volume ↑
- Dyspnea
- Mech Vent
PE
1) EKG finding?
2) PE finding?
1) New RBBB
2) Tricuspid regurgitation
Organ donor preservation method? 2
- IVF
* Desmopressin
OSA (children)
- Cause?
- Management?
- Hypertrophy @ adenoid / Tonsil
* Tonsillectomy / Adenoidectomy
Pulmonary Contusion
- Complication? 2
- XR chest finding?
- Admission criteria? & management?
- Respiratory distress
- Hypoxemia
- Irregular & local opacification
- Admission @ symptoms
- Monitor 24-48h
- Pain control
- Chest PT & suction
- O2 / Vent
Post Extubation Stridor (prevention)
Steroids before extubation
Breathing pause
Diagnosis
1) Pause 5-10 sec?
2) Pause > 20s
1) Periodic breathing
2) Apnea of prematurity
Acute Bronchitis
Management? 5
1) XR if pneumonia symptom
2) NSAID / Acetaminophen
3) Bronchodilator
4) No antibiotics
5) If chronic (cough > 3m in 2y) do PFT
Pulmonary Embolism
Mortality association? 7
- sBP < 90
- HR > 110
- R > 30
- T < 86 ℉
- O2 sat < 90% AMS
- Confusion
- Age > 80
PE management
1) Anticoag
2) IVC
3) Thrombolytic
4) Embolectomy
1) Everyone / Unless CI to anticoag
2) Contraindication to ant-coag
3) ↑ mortality / Bleed risk ↓ / BP < 90
4) Shock
Imminent death
Failed thrombolytic
tPA @ Pulmonary Embolism
- Indications? 4
- Contraindication? 4
- Unstable
- RV dysfunction
- Large clot
- R dardiac thrombous
- IC neoplasm
- Prior hemorrhage
- Active bleed
- Recent head trauma
Pulmonary Nodule
Benign indication?
Calcification • Popcorn • Concentric • Laminated • Central • Diffuse • Homogeneous
