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MTBs Step 2CK > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

CF inheritance? mutation?

A

AR mut in CFTR gene

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2
Q

MC initial presentation of CF?

A

meconium ileus

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3
Q

Sx of CF

A

meconium ileus, FTT, Rectal Prolapse, Persistent cough, infertility(absent vas def), allergic bronchopulmonary aspergillosis, persistant cough, pancreatitis n shit like DM, hernia, amenorrhea, delayed puberty, RVH, portal HTN

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4
Q

Ivacaftor(VX-770)

A

first drug approved to tx CF = restores some function to the CF protein

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5
Q

3 things you can do for a CF patient that will IMPROVE SURVIVAL?

A

ibuprofen to reduce inflammation, Azithromycin to slow the rate of decline of FEV, abx during exacerbations

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6
Q

what is asthma?

A

REVERSIBLE airway obstruction

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7
Q

drugs that can worsen asthma?

A

ASA, NSAIDS, BB

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8
Q

+methacholine challenge test

A

> 20% decrease in FEV1 after methacholine = dx of asthm

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9
Q

FEV, FVC, FEV/FVC, TLC & RV changes in asthma

A

decreased FEV(major), decreased FVC, FEV/FVC, Increased TLC & RV

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10
Q

tx of asthma exacerbation?

A

Inhaled bronchodilators(albuterol), steroid bolus, inhaled ipratropium, oxygen and magnesium

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11
Q

so person has asthma. what do you start them on?

A

SABA

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12
Q

when do you up their medication from SABA

A

> 2d/w or >2n/m then add ICS!

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13
Q

when do you up their medication from SABA + ICS?

A

daily or >1n/w then add LABA

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14
Q

when do you up their medication from SABA + ICS + LABA?

A

frequent shit! just up the dosage of all

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15
Q

tx of acute COPD exacerbation

A

just like asthma! = albuterol,opratropium, steroids bolus, oxygen

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16
Q

what are the only 2 interventions that will decrease mortality and delay disease progression in COPD?

A

smoking cessation and long term home O2 use

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17
Q

when shoudl a pt with COPD be put on home O2?

A

PO2 <55% or O2 sat is <90%

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18
Q

what type of pt would you see A1AT def in?

A

<40, nonsmoker

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19
Q

sx of A1AT def

A

COPD on CXR, Low albumin, elevated prothombin due to liver cirrhosis, low A1AT

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20
Q

tx of A1AT def?

A

infusion with A1AT

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21
Q

Bronchiectasis

presentation/

A

anatomic defect resulting in profound dilation of bronchi = often due to multiple infections or CF.

sx: episodes of lung infections + HIGH(cups) volume of sputum, hemoptysis and fever, Tram tracking on CXR,

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22
Q

tx of bronchiectasis

A

chest physiotherapy = cupping and clapping, rotation abx to avoid resistance

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23
Q

Allergic bronchopulomonary aspergillosis(ABPA)

SX?

A

HSR to fungal antigens that colonize the bronchial tree

sx: cough up brownish mucous plugs with recurrent infections, peripheral eosinophilia, elevated IgE, cough, wheezing, hemoptysis and bronchiectasis

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24
Q

tx of Allergic bronchopulomonary aspergillosis(ABPA)

A

ORAL corticosteroids + Itraconazole

*cant use inhaled wont get past mucous plugs T.T

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25
Q

MCC of bronchiectasis?

A

CF

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26
Q

MCC of CAP

A

pneumococcus

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27
Q

MCC of HAP

A

gram - bacilli

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28
Q

when should you think pneumonia over bronchiectasis?

A

pneumo: tachycardia, tachypenia, hypotension

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29
Q

Empyema + criteria

A

infected pleural effusion that acts like abscess and only improves wiht drainage.

  • LDH >60% of serum
  • Protein >50% of serum
  • pH <7.2, +gram stain or culture
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30
Q

which has a productive cough? lobar or intersitial pneumo?

A

lobar

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31
Q

name the pneumonia associated with…

diarrhea, HA, confusion

A

legionella

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32
Q

name the pneumonia associated with…

Bacteremia

A

Strep. Pneumo

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33
Q

name the pneumonia associated with…

current jelly sputumm hemoptysis

A

klebsiella

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34
Q

name the pneumonia associated with…

rotten egg smell

A

anaerobes

35
Q

name the pneumonia associated with…

dry cough, bullous myringitis

A

mycoplasma pneumo

36
Q

name the pneumonia associated with…

CD4<200

A

PCP

37
Q

tx of outpatient pneumonia

A

azithromycin, or clarithromycin OR moxifloxacin

38
Q

tx of HAP

A

Vanc + pip/tazo; or ceftazidine, cefipime, TMP/SMX = point being u need pseudomonas coverage

39
Q

TX of inpatient pneumonia

A

ceftriaxone + azithromycin or moxifloxacin

40
Q

bug that causes pneumo that presents with…

recent viral illness

A

staph

41
Q

bug that causes pneumo that presents with…

alcoholic/DM

A

klebsiella

42
Q

bug that causes pneumo that presents with…

young healthy patients

A

mycoplasma or chalymidia pneumo

43
Q

bug that causes pneumo that presents with…

persons present at the birth of an animla, vets, farmers

A

coxiella burnetii

44
Q

bug that causes pneumo that presents with…

arizona construction workers

A

coccidioidomycosis

45
Q

bug that causes pneumo that presents with…

COPD

A

H. influenza

46
Q

bug that causes pneumo that presents with…

poor dentition

A

anaerobes

47
Q

bug that causes pneumo that presents with…

ppl who fucking love birds

A

chalymdia psittaci

48
Q

What is interstitial lung disease(ILD)

A

inflammation or fibrosis of interalveolar septum causing impaired gas exchange and increase in lung stiffness(restritive lung dz)

49
Q

Dz associated with….

ship yard workers, insulators and pipe fitters

A

asbestosis

50
Q

Dz associated with….

glass workers, mining, sandblasting, brickyards

A

silicosis

51
Q

Dz associated with….

coal worker

A

coal works pneumonoconiosis

52
Q

Dz associated with….

cotton

A

byssinosis

53
Q

Dz associated with….

electronics, ceramics, fluorescent lights

A

berylliosis **has granulomas!!!!

54
Q

Dz associated with….

mercury

A

pulmonary fibrosis

55
Q

drugs that can cause interstital lung dz?

A

bleomycin, busulfan, amiodarone, methylsergide, nitrofuratonin, cyclophosphamide, etc

56
Q

Classic presentation of ILD?

A

SOB with Dry nonproductive cough and chronic hypoxia

PE: dry, rales, loud P2(sx of pulmonary HTN), clubbing

57
Q

Hypersensitivity Pneumonitis

cause? tx?

A

fever, dyspnea, severe cough within 4-6 hr of exposure to antigen!

cause: feathers, MAI, hay, compost, A/C
tx: avoid + steroids

58
Q

DX of ILD?

A
  1. CXR 2. CT, PFT or Bx

**need to do EKG to look for RV hypertrophy due to pulmonary HTN

59
Q

PFT in ILD?

FEV, FVC, FEV/FVC, TLC, RV, DLCO

A

FEV, FVC, TLC, RV, DLCO = decrease

FEV/FVC = increased

60
Q

why do an EKG for ILD?

A

looking for RV hypertrophy due to pulmonary hypertrophy

61
Q

TX of ILD?

A
  1. steroids
  2. Azathioprine
  3. cyclophosphamide
62
Q

whats Sarcoidosis

A

idiopathic inflammatory condition involving infiltration of non-caseating granulomas thought out the body. MC in AA women

63
Q

sx of sarcoidosis

A

Eye: uveitis(burning, itching, tearing)
neural: 7th CN probs
Skin: lupus pernio(purple rash of face), Erythema Nodosum(itchy, painful on legs and ankles)
Cardiac: restrictive cardiomyopathy
RENAL & HEPATIC: OFTEN ASYMPTOMATIC (lean more tword amyloidosis if you see this)
Hypercalcemia: excess VitD from granulomas causes this
Bilateral hilar lymphadenopathy, Liver & spleen enlargement,

64
Q

best initial test for sarcoidosis? most accurate test?

A

initial CXR, accurate = bx of lymph node

65
Q

tx of sarcoidosis

A

steroids ONLY IF SYMPTOMATIC = if hilar lymphadenpathy but not symptomatic leave alone

66
Q

Normal pulmonary vascular values:

systolic, diastolic and MAP

A

Systolic: 25mmHg
Diastolic: 8mmHg
MAP: 15mmHg

67
Q

sx of pulmonary HTN

A

Loud P2, Tricuspid reguritation, RV heave, raynauds phenomenon, wide split S2

68
Q

SAAG calculations & meaning…

A

(SAAG = serum albumin - ascites albumin);

SAAG = albumin concentration of serum - albumin concentration of ascitic fluid.

SAAG > 1.1;
Ascites is due to an imbalance between hydrostatic and oncotic pressures;(portal HTN)
• Chronic liver disease.
• Massive hepatic metastases.
• CHF.
• Portal-vein Thrombosis.
SAAG < 1.1;
Ascites is due to protein leakage;
• Nephrotic syndrome.
• Tuberculosis.
• Malignancy, (e.g., ovarian cancer).
• Pancreatic ascites.
• Biliary ascites.
• Serositis.
• Bowel obstruction or infarction.
• Peritoneal Carcinomatosis.
69
Q

Allergic Bronchopulmonary Aspergillosis(ABPA)

sx?

A

*asthmatic pt with worsening asthma(cough, wheezing) w/brown mucous plugs(hemoptysis), peripheral eosinophila and elevated IgE and central bronchiectasis,

70
Q

Allergic Bronchopulmonary Aspergillosis(ABPA)

dx?

A

aspergillus skin testing, meansing IgE, ABPA ab’s

71
Q

Allergic Bronchopulmonary Aspergillosis(ABPA)

tx?

A

ORAL steroids and if refractory Itraconazole

72
Q

dx of Acute Respiratory Distress Syndrome?

A

CXR shows white out, normal wedge pressure, pO2/FiO2 <200.

73
Q

tx of ARDS

A

ventilation w/low tidal volume of <6mL/kg, PEEP, prone, diruetics, positive inotropes(doubutamine), ICU

74
Q

TX of TB

A

4 for 2: INH, Rifamp, pyrazina, etham for 2 months THEN 2 for 4: INH + Rifampin for an additonal 4 months

75
Q

PPD + but CXR - ?

A

9m of INH

76
Q

side fx of INH

A

hepatotoxic, peripheral neuropathy = pyridoxine

77
Q

side fx of Rifampin

A

red/orange colored body fluids = benign

78
Q

side fx of pyrazinamide

A

hyperuricemia = NSAID + Colchine

79
Q

side fx of Ethambutol

A

optic neuritis = decrease dose

80
Q

how do you check someon for TB who has had the BCG vaccine?

A

INF y release assay = IGRA

81
Q

Acute Bronchitis

sx?

A

*nonsmoking patient with recent URI & persistant cough + production of yellow, blood tinged sputum.
SX:
- >5 days w/cough yellow/bloody sputum
- No fever, chill or pneumona on CXR present(lungs clear)
- Wheezing or rhonchi

82
Q

Acute Bronchitis

tx?

A

NSAIDs + Bronchodilators

83
Q

Why do you get yellow/purulent sputum and blood with acute bronchitis?

A
  • Yellow/purulent Sputum = epithelium sloathing not infection
  • Blood = inflammation due to epithelial damage

MTBs Step 2CK (20 decks)

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