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internal medicine mb step 2 > plum > Flashcards

plum Flashcards

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1
Q

what is associated with asthma name 5 symptoms and signs

A 
nasal polyps 
worse at night 
sensitivity to aspirin 
eczema or atopic dermatitis 
increased expiratory phase
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2
Q

what is a the best initial test in acute Asthma excerabation

A

peak expiratory flow

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3
Q

what can Asthma exclusively present as

A

cough

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4
Q

what is most accurate test to diagnose Asthma in a patient and what parameter would you assess

A

PFT and diagnosis with
decrease FEV1/FVC
decrease FEV1
decrease FVC

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5
Q

asthma

if you patients PFT shows to be symptomatic what is next and how will it show to conclusive with asthma

A

normal pft
give patient metacholine
measures FEV1 decreases more than 20% diagnostic for asthma

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6
Q

asthma

if patient is symptomatic what diagnostic drug would administer and what will the PFT show

A

Albuterol increase 12% or 200 FEV1

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7
Q

what drug should never be used alone in asthma or cold

A

LABA must be with ics

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8
Q

asthma

define as intermittent mild, moderate, sever and explain the step up method of therapy

A

intermitten
s/s day <2x/week or Night <2x/mo FEV1 80%
- tx short acting beta albuterol as needed
Mild
s/s > 2x/week but <1x /day or Night < 1x/ week FEV1 80% SABA and ICS

moderate
s/s >1x/day or >1x/wk FEV1 61x/day or frequent FEV1< 60%
tx increase dose of drugs or increase only ICS

Refractory
oral steroids

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9
Q

best initial drug for long term control ASTHMA

A

ICS

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10
Q

what test best quantify asthma exacerbation

A 
PEF ( from patients normal PEF)
ABG for (A-a) gradient
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11
Q

First steps in managing Asthma Exacerbation

A

Oxgen
Albuterol -nebulizer
prednisone IV ( takes 4 hours to work)
ipratropium

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12
Q

SPO2 is kept at in Asthma

A

equal or greater than 90%

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13
Q

asthma

how to you quantify if the patient gets better
what is your next step

A

no wheezing
no increase O2 demand
PEF > 70%
Tx–> send home mediator dose Albuterol and oral steroids

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14
Q

Asthma patient no change after treatment for exacerbation what next step

A

send to wards
IV steroids
Mediator dose inhaler Albuterol

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15
Q

asthma

S/S of patient getting worse

A

increasing CO2 or normalizing CO2 patient should be hyperventilating blowing off CO2 –> shows patients is getting week and entering respiratory failure
decrease lung sounds–. Patient is tiring
PEF< 50%
increase 02 demand

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16
Q

salvage therapy asthma exacerbation

A

MG- relieve bronchospasm - pt not responses to albuterol while waiting for steroids

epinephrine last resort

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17
Q

what test helps to differentiate asthma and COPD

A

bronchodilator test

or metacholine challenge both positive in asthma

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18
Q

asthma

what is a the treatment for a patient not responding exacerbation treatment and is rapidly declining

A

TX send ICU, mechanical intubation and ventilation

IV steroid and continuous nebulizer albuterol

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19
Q

COPD chest x ray findings

A

increase AP diameter
flattened diaphragm
long narrow heart shadow

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20
Q

COPD

most accurate diagnostic test and findings

A

PFT
FEV1/FVC ration <70 %
decrease FEV1 and decrease FVC
increase TLC because of increase RV

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21
Q

DCLO in asthma and in COPD

A

asthma normal or increase

COPD decreased

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22
Q

S/S of COPD exacerbation

A

increase CO2
compensatory increase in HCO3
hypoxia

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23
Q

EKG for COPD

A

RV an RA hypertrophy

MAT and atrial fibrillation

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24
Q

what treatment improves mortality and delays progression

A

smoking cessation and

at home oxygen treatment

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25
O2 indication COPD
``` PO2< 55% SAT<88% OR PO2<66% or SAT ,90% with : pulmonary HTN, high HCT, or cardiomyopathy, S/S right sided heart failure ```
26
what vaccination should both COPD and Asthma patients receive
influenzas | pneumoccal
27
best prognostic factor for COPD
FEV1
28
treatment method for COPD step up | all medical therapy fails
1. SABA 2 SABA + long acting muscarinic blocker (tioropium, ipratropium) 3. SABA +LAMA+LABA 4. SABA+LAMA+LABA+ICS 5. SABA+LAMA+LABA+ICS+ THEOPHYLLINE 6. SABA+LAMA+LABA+ICS+ THEOPHYLLINE+ ORAL CORTICOSTEROIDS 7. lung transplant
29
Bactertia that cause pneumonia in COPD patients
strep.pneuo H. influenza M. cataorrhalis
30
COPD exacerbation drugs | 02
Albuterol ipratropium steroids antibiotics
31
antibiotic of choice COPD
macroclides: azithromycin, clarithromycin (warfirn) cephalosporin: cefuroxime , cefixime, cefaclor amoxicllin/calvuanlic acid quinolones Alternative doxycycline
32
COPD exacerbation management AFTER TREATMENT improving no change worsening +s/s
1. improving --> send home PO steroids, MDI inhaler 2. no change --> PO steroids nebulizer inhalers 3. worse--> ICU increase CO2, decrease lung sounds IV steroids, continuous nebulizer, intubate
33
most common cause of bronchiectasis
cystic fibrosis
34
COPD patient with catrostophic worsening of s/s
pneumothorax
35
etiology bronchiectasis
``` cystic fibrosis tb pneumonia immune deficiency + panhypogammaglobunemia ABPA, dyskinetic cilia syndrome collagen vascular disease like Rh ```
36
S/S of bronchiectasis
``` high volume purulent sputum hemopytosis--> bc rupture of blood vessels can present as emergency - greatest complication foul smelling sputum resistance to antibiotic treatment recurren persistant pneumonia ```
37
bronchiectasis best initial test | most accurate and diagnostic test
chest x ray - dilated thickened bronchi not diagnostic | resolution ct most accurate and diagnostic
38
BRONCHIECTASIS treatment methods
``` chest physiotherapy (cupping clapping) + postural drainage => dislodge plugged up bronchi ``` treat each infections episode as they arise , same antibiotic as COPD specific microbiologic diagnosis preferred- sputum culture
39
signs of superimposed infection on bronchiectasis
fever, chest pain, changed in quality an quantity of sputum
40
community acquired pneumonia | is defined as
pneumonia occurring before hospitalization or within 40 hours of hospitalization
41
most common cause of CAP
strepococcus pneumonia
42
best initial test for all pneumonia
chest x ray
43
Tests for pneumonia in admitted patients triage
1. chest x ray 2. CBC and differentials, BUN, creatinine, glucose, electrolytes and ) O2 stat 3. 2 pretreatment blood culture 4. sputum gram stain (all patients) and culture of sputum (hospitalized pt) 5. start antibiotics broad spectrum
44
typical pneumonia causes and presentation | atypical pneumonia and presentation
``` strep pneumo kielbsella staph areus anerobic, gram negative rods h. influenza lobar consolidtion ``` ``` interstitial infiltrates mycoplasma CMV RSV legionella coxeilla chlamydia pneumonia+ psitacci ```
45
Pneumonia previously healthy no antibiotics for the last 3 months and no comorbities (outpatient
azithromycin or clarithromycin (warfin) | or doxycycline
46
Pneumonia out patient comorbidities and antibiotics last 3 months
levofloxacin or moxifloxacin
47
Pneumonia in patient treatment
levofloxacin or moxifloxacin (respiratory floroquinlones | or ceftatriaxone or azithromycin
48
Pnemonia reasons to hospitlize
hypotension <90 mmhg RR >30 or P02 <60 mmhg or pH< 7.35 pulse >125pm confusion, comorbities COPD, CHF, renal failure , liver failure temp >104 BUN >30 Na< 130 mml/L , glucose >250 mg/dl
49
hospital aquired pneumonia | definiton
occurs 48 Hours after admission | or 90 days within hospitalization
50
most common cause of HAP
gram negative bacteria | pseudomonas or e.coli
51
HAP management
therapy centred around therapy for gam negative bacilli antipseudomonal cephalosporins --> 1. cefepime, or ceftazidime 2. antipseudomonal penicillin : pipercillin/tazobactam 3. carbapenem: imipenem, meropenem, or doripenem pipercillin and ticarcillin always used with betalactamase inhibitor
52
ventilator associated pneumonia pathophysiology name 3 S/S
``` no mucociliary clearance, no cough and postive peep prevents fever and or rising abc new filtrate on chest x ray purulent secretions coming form the tracheal tube ```
53
how to culture VAP pneumonia
BAL | bronchoaveolar lavage--> bronchoscope passed into lungs
54
VAP Pneumonia drug treatment regimen
``` 3 drug combo 1.Cephalosporin (ceftazidime or cefepime) OR penicillin (piperacillin/tazobactam) OR carbapenem (imipenem) 2. Aminoglycoside OR fluoroquinolone 3. Vancomycin OR linezolid ``` change initial therapy when identified
55
which drug is inactivated by surfactant
daptomycin
56
lung abscess etiology
patients with large volume of oral/pharyngeal content with poor dentation not adequately treated stroke with loss of gag reflex seizures intoxication endotracheal intubation foul smelling sputum
57
best initial test diagnosis of lung abscess with and finding on exam most accurate test test for specificitc microbiologic etiology
chest xray - cavity with air fluid level chest CT most accurate micro aetiology lung biopsy by bronchoscopy or transtracheal aspiration
58
lung abscess drugs treatment
clindamycin (anaerobic) | or penicillin until cavity gone
59
young Adult patient with chronic lung disease couch sputum hemopytosis brochietasis wheezing dyspnea , recurrent infections sinus pain nasal pain
cystic fibrosis in young adult
60
pancreatitis in cystic fibrosis
beta cells spread
61
``` infertile man ( azoospermia) missing vas deferens infertile female think cervical mucus altered menstral cycle ```
cystic fibrosis
62
best diagnostic test and parameters for diagnosis | which test is not accurate
increased sweat chloride test pilocarpine increase sweat chloride levels > 60 meq/l diagnostic not accurate CFTR is not accurate b.c to many mutations
63
treatment cystic fibrosis
antibiotic in bronchiectasis - sputum culture is essential to guide therapy 2. inhaled recombinant human deoxyribonucleauses breaks up clogged up air way secreted by neutrophils 3. inhaled bronchodilators ( albuterol) 4. pneumococcal vaccine 5. lung transplant all other treatment failures sever disease 6. ivacaftor increases the activity of CFTR in the 5% of patients who have a specific mutation
64
asthmatic patient with recurrent episodes of brown flecked sputum and transient infiltrates on chest x ray
ABPA
65
APBA etiology most commonly effected patients signs and symptoms
hypersensitive reaction to fungal antigens colonize at bronchial tree *asthma/atopy, hempytosis, bronchiectasis, foul smelling sputum, recurrent chest infection
66
APBA | diagnostic tests
1. Peripheral eosinophilia 2. Skin test reactivity to aspergillus antigens 3. Precipitating antibodies to aspergillus on blood test 4. Elevated serum IgE levels 5. Pulmonary infiltrates on chest x-ray or CT
67
ABPA chest x ray findings
lobar infiltrates- eosinophilic pneumonia | bronchiectatsis
68
APBA
oral steroid prednisone sever cases inhaled steroids not effective itraconazole for recurrent episodes
69
Pneumonia 1. Hemophilus influenzae 2. Staphylococcus aureus 3. Klebsiella pneumoniae 4. Anaerobes 5. Mycoplasma pneumoniae 6. Chlamydophila pneumoniae 7. Legionella 8. Chlamydia psittaci 9. Coxiella burnetii
1. COPD 2. Recent viral infection (influenza) 3. Alcoholism, diabetes 4. Poor dentition, aspiration 5. Young, healthy patients 6. Hoarseness 7. Contaminated water sources, air conditioning, ventilation systems 8. Birds 9. Animals at the time of giving
70
Pleural effusion thoracentsis anatomical location maximum amount of fluid allowed to be removed
midaxillary line above the rib --> to avoid damage to intercostal artery, nerve, intercostal vein 2 interocostal spaces below level of fluid remove max 1 Litre of fluid
71
pneumonia dry not productive cough
atypical pneumonia | less sputum because infects interstial space not alveoli
72
s/s that distinguish pneumonia from bronchitis
Dyspnea, high fever, and an abnormal chest x-ray are the main ways to distinguish pneumonia from bronchiti bronchitis no fever,
73
sputum gram stain "adequate" criteria
> 25 wbc and < less than 10 epithelial cells
74
aspiration pneumonia anatomical location when lying flat
upper lobe
75
stroke patient develops chronic infection with over several weeks with large volume sputum that is foul smelling. Also has several pounds during this time.
lung abscess
76
aids patient with dry cough, dyspnea I exertion, fever, cd4 count <200 /ul 1. what is best initial test and what will the lab finding show 2. name 2 other test that can also be of diagnostic use 3. what is the most accurate diagnostic taste
pneumocystis pneumonia P. Jiroveci 1. chest x ray--> will show bilateral interstitial infiltrates 2. A-a gradient can also be diagnostic alternative to chest x ray -> demonstrates hypoxia (increased A-) gradient Decrease LDH most likely NOT P.J LDH always increased in disease 3. most accurate testis BAL
77
aids patient is diagnosed with pneumocystis pneumonia P. Jiroveci a chest x ray has been performed what is the next best step
sputum stain for pneumocystis pneumonia P. Jiroveci
78
aid patient pneumocystis pneumonia P. Jiroveci is negative for sputum stain what is the next best step
negative sputum test then should be followed with a BAL
79
pneumocystis pneumonia P. Jiroveci 1. best initial therapy for treatment and prophylaxis 2. if patient has toxicity to best treatment what is alternative
1. TMP/SMX 2. clindamycin and primaquine or Pentamidnine
80
1. define sever pneumocystis pneumonia P. Jiroveci 2. what tx is required to decrease mortality 3. how is mild PCP treated and defined
1. pO2 below 70 or an A-a gradient above 35 2. steroids added to tx 3. atovaquone and defined as mild hypoxia
81
patient diagnosed with pneumocystis pneumonia P. Jiroveci being treated with TMP/SMX demonstrate
G6PD bite cells
82
1. Klebsiella pneumoniae 2. Anaerobes 3. Mycoplasma pneumoniae 4. Legionella 5. Pneumocystis
1. 2. Hemoptysis from necrotizing disease, "currant jelly" sputum 3. Foul-smelling sputum, "rotten eggs" 3. Dry cough, rarely severe, bullous myringitis 4.Gastrointestinal symptoms (abdominal pain, diarrhea) or CNS symptoms such as headache and confusion 5. AIDS with <200 CD4 cells

internal medicine mb step 2 (7 decks)

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