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FINAL Flashcards

1
Q

asthma

A

-hypertrophy of bronchial smooth muscle
-plugging of small airways
-genetics (IgE) and environment
-atopic/allergic/extrinsic- younger
-nonatopic/nonallergic/intrinsic- older -> stress, exercise, anxiety, air, sickness
-type 2 inflammation- atopic dermatitis, nasal polyps

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2
Q

asthma reseribility

A

-FEV1/FVC ratio reduced (<90%)
-reversibility- increase of ≥ 12% and 200 ml in FEV1

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3
Q

asthma medication

A

-IgE Mediated Asthma- Omalizumab (Xolair)

-Eosinophilic Mediated Asthma (IL-5):
-Benralizumab (Fasenra)
-Mepolizumab (Nucala)
-Reslizumab (Cinqair)

-Mixed Eosinophilic and Allergic:
-Dupilumab (IL-4,13)
-Tezepelumab (TSLP)

-Methylxanthines- Theophylline

-biologics

-LAMA- tiotropium- option for >6yo

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4
Q

peak expiratory flow (PEF) meters

A

->20% change in a day -> uncontrolled
-<200 value -> severe obstruction
-moderate to severe:
-every morning and night
-before meds
-after exacerbation

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5
Q

severe asthma attack

A

-<40% PEF or FEV1 -> severe attack
-beta agonist + anticholinergic every 20 mins or for 1 hour
-O2 therapy
-systemic corticosteroids

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6
Q

COPD

A

-sedentary- few symptoms
-chronic
-acute exacerbation
-distant heart sounds
-depressed diaphragm
-can lead to cor pulmonale
-FEV1/FVC < 70%

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7
Q

mMRC scale

A
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8
Q

COPD tx + exacerbation

A

-resting O2 <88% -> O2 therapy
-alpha 1 antritrypsin
-lung transplant
-bilateral resection
-endobronchial valve
-bullectomy

-exacerbation (50%):
-augmentin
-doxy
-bactrim

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9
Q

bronchiectasis

A

-cytokines -> mucociliary + cartilaginous -> decrease V
-impaired drainage, obstruction, immunodeficiency
-copious amounts of purulent smelly sputum
-hemoptysis
-dyspnea and wheezing/crackles
-pseudomonas/MRSA is common
-obstructive

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10
Q

bronchiectasis dx

A

-immunoglobulins
-sputum- pseudomonas
-alpha 1 deficiency
-sweat test- cystic fibrosis
-PFTs
-x-ray- dilated and thickened bronchi -> tram tracks
-honey combing- cystic bronchiectasis
-bronchoscopy to R/O hemoptysis, obstruction, removal of secretion
-DX- CT*
-ring shadows, tree in bud
-cysts - grapes

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11
Q

bronchiectasis tx

A

-according to sputum culture
-multiple prior exacerbation and no sputum culture -> fluoroquinolone
-recurrent (2-3/year)- macrolide
-bronchodilator
-glucocorticosteroid
-resection if remaining part of lung is good

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12
Q

bronchiectasis complications

A

-hemoptysis -> massive may require embolization of bronchial arteries or surgical resection
-cor pulmonale
-amyloidosis
-abscesses at distant sites

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13
Q

cystic fibrosis

A

-increase mucus viscosity
-pancreatitis, infertility, gall stones
-Hyperresonance to percussion
-Apical crackles
-Sinus tenderness, purulent nasal secretions, nasal polyps
-Mixed obstructive and restrictive pattern

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14
Q

cystic fibrosis dx

A

-1. Clinical symptoms consistent with CF in at least one organ system
-2. Evidence of CFTR dysfunction:
-Elevated sweat chloride >60 mmol/L
OR
-genetic testing- Presence of 2 disease-causing mutations in CFTR
-Abnormal nasal potential difference (used if sweat chloride neg)

-PFTs, ABGs
-sputum- MRSA, p. aeruginosa
-bronchiectasis
-interstitial markings

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15
Q

cystic fibrosis tx

A

-pancreatic enzymes replacement
-CFTR modulators
-VEST, PEP
-Inhaled recombinant human deoxyribonuclease (rhDNase) *cleaves extracellular DNA in sputum
-azithromycin with chronic
-lung transplant- def tx

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16
Q

pleural effusion labs

A

-hemothorax- Hct/SHct >.5
-exudate- protein/Sprotein >.5, LDL/SLDL >.6, OR LDL > 2/3rds of normal
-transudates- glucose=Sglucose, pH 7.4-7.55, <1000 WBC

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17
Q

pleural effusion tx

A

-pleurodesis
-thoracocentesis
-indwelling pleural catheter

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18
Q

parapneumonic pleural effusion

A

-exudate
-uncomplicated
-complicated- depends on provider -> if glu is <60 or pH < 7.3 -> drain
-empyema- gram+ or culture -> drained and antibiotics
-complicated and empyema -> loculation common -> fibrinolytics (steptokinase and urokinase)

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19
Q

pneumothorax

A

-spontaneous or traumatic
-spontaneous- primary (no disease); secondary (lung ds)
-traumatic- trauma
-EKG changes that mimic MI
-supine- deep sulcus
-complication- subcutaneous emphysema

20
Q

respiratory alkalosis vs acidosis

A

-alkalosis- pneumothorax, PE, anxiety, pain, hypoxemia
-acidosis- sleep apnea, obesity, hypoventilation syndrome, COPD, asthma

21
Q

pneumothorax tx

A

-can resolve on own if minor
-spontaneous primary- needle decompression with small catheter+small chest tube -> imaging every 24 hrs
-2ndary, large, tension, severe- needle decompression and large test tube
-thoracoscopy or open thoracotomy- recurrent, bilateral, bullectomy required, tx failure

22
Q

PE and DVT risk facotrs

A

-venous stasis- low mobility, high central venous pressure, hyperviscosity
-injury to vessel- surgery, trauma, prior thrombus
-hypercoagulability- genetics, meds, disease

23
Q

pulmonary embolism

A

-usually multiple in lower lobes
-infarction, abnormal gas exchange, right ventricular strain
-pleuritic pain
-hypotension is a bad sign
-EKG- 70%
-<500 d-dimer- sensitive
-westermarks sign- prominent central pulmonary artery with local oligemia
-hamptons hump- infarct
-angiography- intraluminal filling defect in more than 1 projection, abrupt arterial cutoff, asymmetry (especially segmental oligemia)

24
Q

PE tx

A

-O2 sat > 90%
STABLE
-low risk, nonmassive- empiric anticoagulation
-high risk, nonmassive/anticoagulation contraindicated- IVC filter
-moderate risk, nonmassive- case by case
-moderate risk, submassive- anticoagulate and monitor for thrombolytics
UNSTABLE
-thrombolytics (streptokinase and urokinase) and anticoagulate
-embolectomy

-anticoagulation - LMW (fondaparinux) or oral factor Xa inhibitors or direct thrombin inhibitors- rivaroxaban/apixaban

-3 months for 1st reversible risk
-12 months for 1st idiopathic
-6/12 months-forever- for irreversible risk or recurrent

25
pulmonary HTN
-mild >25, moderate > 30, severe > 45 -chest pain, fatigue, dyspnea, syncope -S2 splitting -idiopathic/primary- RHF -> low CO -secondary- presents as underlying ds
26
pulmonary HTN dx
-polycythemia -EKG- right axis deviation, RV hypertrophy/strain, RA enlargement -CT/CXR- R and L main and lobar pulmonary artery dilation and pulmonary outflow tract enlargement -DEF DX- right heart cath
27
pulmonary HTN tx
-idiopathic/primary- anticoagulation, O2 therapy, diuretics -secondary- O2, anticoagulation, polycythemia tx, cor pulmonale tx -PAH- vasodilators: -prostacyclines- epopros, treprost, iloprost -PDE-5- sildenafil, tadalafil -endothelial- bosentan, ambrisentan, macitentan -CCB
28
cor pulmonale
-caused by hypoxemia, pulm HTN, COPD, pulmonary fibrosis -same S&S as pulm HTN -polycythemia, low O2 -EKG- RBBB, SVT, right axis deviation -echo -DEF DX- right heart cath -tx- treat what caused it, O2, diuretic therapy, diet
29
sleep apnea
-upper airway is smaller than normal due to fat, bone structure, genetics -inspiratory ds -nocturia -males > 17; females > 16 neck size -rule out arrythmia -proteinuria, polycythemia -apnea hypopnea index (AHI) -epworth sleepiness scale -inspire tx- <32 BMI
30
epworth sleepiness scale
-0 = Would never doze -1 = Slight chance of dozing -2 = Moderate chance of dozing -3 = High chance of dozing -during the day: -Sitting and reading -Watching television -Sitting inactive in a public place (theater, meeting) -Lying down to rest in the afternoon when circumstances allow -Sitting and talking to someone -Sitting quietly after lunch without alcohol -In a car, while stopped for a few minutes in traffic
31
obesity hypoventilation
->45 CO2, >30 BMI -upper airway obstruction -restrictive chest -blunted central respiratory drive -pulmonary HTN -dx of exclusion -respiratory acidosis with metabolic alkalosis compensation -CPAP
32
ARDS
-sepsis, trauma, gastric aspiration -must R/O heart failure -> <18 pressure with cath -PaO2/FIO2 ratio <300 -bilateral widespread whiteout on x-ray -> no pleural effusion -FROTHY RED/PINK SPUTUM -DIFFUSE CRACKLES -no response to O2
33
ARDs imaging
-CXR- progresses overtime -bilateral white out -diffuse or patchy -spares the angles -no pleural effusions -air bronchograms- 80%
34
ARDs tx
-lowest PEEP -keep above O2 55, SO2 88% -tx underling cause -get FIO2 under 60% -> 40% is safe -minimal fluids -> can cause HF
35
pulmonary aspiration
-esophageal dysfunction, AMS -Aspiration of Inert Material -Aspiration of Toxic Material -“Café Coronary”- food -Retention of Aspirated FB- recurrent pneumonia, bronchiectasis, abscess, hyperinflation -> bronchoscopy for dx and tx -Chronic Aspiration of Gastric Contents- zenker, ppi, H2, metaclopramide -Acute Aspiration of Gastric contents- copious or very acidic -> chemical pneumonitis -> <2.5 -> ARDS
36
Aspiration of Toxic Material
-Clinically evident pneumonia -Hydrocarbon pneumonitis: aspiration of ingested petroleum distillates: -Gasoline, kerosene, furniture polish -Lung injury: mainly from vomiting and aspiration -Symptoms: vomiting, coughing, respiratory distress, cyanosis, fever -CXR: may initially be normal or near-normal but may significantly progress over the next 12 hours. -Patchy airspace consolidation, particularly in the lower lobes, especially the medial basal segments -Therapy is supportive -right side mc for aspiration
37
intermediate probability nodule
-bx- transthoracic needle aspiration or bronchoscopy -PET scan -sputum- squamous -VATs
38
fleischner society risk scale
39
carcinoid tumors
-<60 -slow growing -rarely metastasize -in the bronchi -hemoptysis, cough, wheeze -central -pedunculated or sessile -carcinoid syndrome- flushing, diarrhea, hypotension, wheezing -bronchoscopy- dx -Octreotide scintigraphy, Dotatate PET/CT* -neuroendocrine
40
bronchogenic: NSCLC
-squamous cell- central, bronchial hypercalcemia, hemoptysis, sputum -MC- adenocarcinoma- BAC- peripheral - can look like pneumonia -large cell carcinoma- peripheral or central, grow fast, can be resected and cleared if caught early
41
SCLC
-begins centrally -mediastinal adenopathy -submucosal -neuroendocrine -> paraneoplastic syndromes: -cushings, SIADH, peripheral neuropathy, myasthenia, cerebellar degeneration -limited (contained within 1 lung) and extensive (outside 1 lung area)
42
lung cancer complications
-SVC- plethera, headache, AMS -pancoasts- apical tumor pushing on brachial plexus and cervical sympathetic -> horners + shoulder pain -> unilateral anhidrosis, miosis, ptosis
43
lung cancer work up
-bx -thoracentesis- fluid cytology -FNA- outside nodes - tissue bx -bronchoscopy -transthoracic needle bx with CT -VATs- high risk -Tumor markers: PDL1, ALK gene, EGFR gene -MRI of brain -PET of abdomen -radionuclide bone scan -V/Q- assess for surgery
44
lung cancer tx
-immunotherapy- NSCLC- PD-1 (nivo and pemb) or PDL-1 (mezo and durv) -SCLC: -limited- resect if isolated and no metastasis/spread -extensive- chemo -> if responding -> radiation
45
metastatic lung cancer
-via pulmonary artery usually -kidney, colon, cervix, metastatic melanoma, breast -multiple spherical bilateral -symptoms uncommon- same-> usually primary tumor symptoms -lower lung MC -bx if cant find primary tumor -tx primary tumor and lung symptoms -resection if SOLITARY and primary tumor is controlled, low risk, no other metastasis -resection contraindicated if metastatic melanoma or pleural involvement
46
blue bloater, pink puffer

Pulmonology (19 decks)

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