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Pulm Flashcards

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1
Q

COPD: what decreases mortality

A
  • stop smoking

- oxygen therapy: resting pO2

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2
Q

COPD: improves symptoms, but not mortality

A
  • SABA
  • Anticholinergic**
  • Steroids
  • LABA
  • Pulm rehabilitation
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3
Q

COPD: Treatment for acute exacerbation

A
  • ABX: macrolides, Cephalo, Amox/clav, Quinolones
  • Bronchodilators
  • Corticosteroids
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4
Q

COPD: tests to workup of acute exacerbation

A
  • O2
  • ABG: hypoxia, hypercapnea
  • CXR: exclude PNA
  • CBC: leukocytosis
  • Chem8: electrolyte abn
  • EKG exclude A-Fib
  • Theophylline levels: can drop [macrolide]
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5
Q

ABPA: treatment

Allergic Bronchopulmonary Aspergillosis

A
  • Oral steroids (inhaled steroids are NOT effective)

- Itraconazole orally for recurrent episodes

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6
Q

ABPA: Diagnostic tests

Allergic Bronchopulmonary Aspergillosis

A
  • Peripheral eosinophilia
  • Skin test re-activity to aspergillus antigens
  • Precipitating Antibodies to aspergillus on blood test
  • Elevated serum IgE levels
  • Pulm infiltrates on CXR or CT
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7
Q

ABPA: Most likely patient has… PMH, S/S

Allergic Bronchopulmonary Aspergillosis

A 
asthmatic pt
recurrent episodes brown-flecked sputum 
transient infiltrates on CXR 
cough
wheezing
hemoptysis 
sometimes bronchiectasis
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8
Q

asthma: diagnostic tests

A
  • ABG (best initial test)
  • PEF (best initial test)
  • CXR (normal, but r/o infection)
  • PFT: FEV1/FVC (most accurate test)
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9
Q

Asthma: PFT findings

A
  • decreased FEV1, FVC and ratio of FEV1/FVC
  • albuterol –> increase FEV1 by 12%+ and 200mL
  • methacholine –> decrease FEV1 by 20%+
  • increase in DLCO
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10
Q

Asthma: treatment

A

1) SABA (intermittent, 2days/week, 3-4x night/mo)
3) LABA or increase in ICS dose (mod persistent, daily sx, >1 night/wk)
4) increase in ICS dose in addition to LABA and SABA
5) Omalizumab (if increased IgE level)
6) Oral CS prednisone taper

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11
Q

Acute Asthma Exacerbation: diagnostic tests

A
  • PEF
  • ABG with increased A-a gradient
  • CXR: infection?
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12
Q

Acute Asthma Exacerbation: treatment

A
  • oxygen
  • albuterol
  • steroids
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13
Q

CF: treatment

A
  • ABX
  • rhDNase
  • albuterol
  • vaccinations: PNA and flu
  • lung transplant
  • Invacaftor
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14
Q

PNA: infections with dry cough

A
  • Mycoplasma
  • Viruses
  • Coxiella
  • PCP
  • Chlamydia
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15
Q

PNA: indication for hospital admission

A

CURB 65

  • Confusion
  • Uremia: BUN >20
  • RR >30
  • BP (hypotension)
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16
Q

exudate vs transudate

A

Exudate

  • LDH >200
  • LDH ratio of pleura/serum > 60%
  • Protein ratio of pleura/serum >50%
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17
Q

Ventillator-Associated PNA: diagnostic tests

A
  • tracheal aspirate
  • BAL
  • Protected brush specimen
  • Video-assisted thoracoscopy (VAT)
  • open lung biopsy
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18
Q

Ventillator-Associated PNA: treatment

A
  • combine 3 different drugs
    1) cephalosporin, PCN, or carbapenem (the C’s)
    2) aminoglycoside or fluoroquinolone
    3) MRSA: vanc or linezolid
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19
Q

PCP: diagnostic tests

A

-best initial: CXR or ABG
-most accurate: BAL
-sputum stain for PCP
positive= no further tests needed, reached Dx
negative= bronchoscopy is “best diagnostic test” –> look in there and see what’s going on

A normal LDH means PCP is NOT THE DIAGNOSIS. LDH is ALWAYS elevated in PCP

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20
Q

PCP: severe

A

pO2 below 70 or A-a >35
add steroids to TMP/SMX

if toxicity from TMP/SMX switch treatment to:

  • Clinda and primaquine (can’t use primaquine in G6PD)
  • OR pentamidine
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21
Q

RFs for TB

A
  • Recent immigrant (past 5yrs)
  • Prisoners
  • HIV+
  • Healthcare worker
  • Close contact with someone with TB
  • Steroid use
  • Hematologic malignancy
  • Alcoholic
  • DM
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22
Q

TB: diagnosis and treatment

Study These Flashcards
A

-CXR = best initial test
-Pleural biopsy = most accurate
-sputum stain
must be (-) x3 to r/o TB
positive –> 6mo therapy: 2 mo RIPE + 4mo RI

23
Q

TB: treatment

Study These Flashcards
A

-sputum stain
must be (-) x3 to r/o TB
positive –> 2 mo RIPE + 4mo RI

continue treatment >6mo if

  • osteomyelitis
  • miliary TB
  • meningitis
  • Pregnancy or any other time pyrazinamide not used
24
Q

TB: S/E treatment meds

Study These Flashcards
A
  • Rifampin –> red pee –> benign
  • Isoniazid –> peripheral neuropathy prevent w pyridoxine
  • Pyrazinamide –> hyperuricemia –> no Rx unless symptoms
  • Ethambutol –> optic neuritis/color vision–> decrease dose in renal failure

All meds cause hepatoxicity, do not stop until AST/ALT rise 3-5x ULN

25
TB: PPD reading >5mm positive in..
- HIV+ - Glucocorticoid user - Abn calcifications on CXR - organ transplant - Close contact with TB person
26
TB: PPD reading > 10mm positive in..
- recent immigrant (past 5yrs) - prisoners - healthcare workers - close contact TB person - hematologic malignancy, alcoholic, DM
27
TB: PPD reading > 15 mm positive in..
people with NO risk factors
28
TB: treatment for +PPD or +IGRA
exclude active TB with CXR | -9mo isoniazid (use B6 to prevent periph neuropathy)
29
Pulmonary fibrosis: causes
- idiopathic - radiation - drugs: bleomycin, busulfan, amiodarone, methylsergide, nitrofurantoin, cyclophosphamide
30
Pneumoconioses: cotton
byssinosis
31
Pneumoconioses: electronic manufacture
berylliosis | Most likely to respond to steroid treatment
32
Pneumoconioses: moldy sugar cane
bagassosis
33
Pneumoconioses: shipyard
asbestosis
34
Pneumoconioses: sandblasting, rock mining, tunneling
silicosis
35
PE: when do you use IVC filter?
- can't use anticoagulants - recurrent emboli while on heparin or warfarin (2-3) - RV dysfunction with enlarged RV on Echo: next emboli might kill the person
36
PE: when to use thrombolytics
-hemodynamically unstable
37
PE: when to use direct-acting thrombin inhibitors (argatroban, lepirudin)
-Heparin-induced thrombocytopenia
38
A-a gradient formula
PAO2 = 150 - pCO2/0.8 PAO2 - PaO2 = (150 - pCO2/0.8) - PaO2 82 year normal is
39
normal blood gas
7.4 pH/ 40 CO2/ 90 O2 / 100% sat
40
PE: initial tests
ABG: hypoxemia, increased A-a gradient, normal in healthy young patients CXR: normal, effusion, Westermark sign, Hampton hump EKG: sinus tachycadia, S1Q3T3
41
PE: specific tests
Spiral CT: may miss small peripheral PEs V/Q Scan: perfusion defect, normal ventilation Angiogram: gold standard DVT: Doppler U/S, venogram, MRI D-dimer: sensitive, rule out, ELISA
42
Fat embolism: triad
1. Acute dyspnea 2. Petechiae: neck and axilla 3. Confusion occurs 3-4days after long bone fractures Rx = supportive, no anticoagulation
43
ARDS: definition
-pO2/FiO2 (mild 300-200, moderate 200-100, severe
44
Squamous CA: types
PTH-rP = PTH related peptide | Hypercalcemia
45
Small Cell CA: types
Para-neoplastic - SIADH --> ADH --> save water - Cushing syndrome --> ACTH - Lambert-Eaton Syndrome --> antibody against pre-synaptic Ca2+ channels causing muscle weakness
46
CAP treatment
Outpatient -healthy = macrolide or doxycycline -comorbids = fluoroquinolone beta-lactam + macrolide Inpatient (non-ICU) - Fluoroquinolone OR - Beta-lactam + macrolide Inpatient (ICU) - Beta-lactam + macrolide (IV) - Beta-lactam + fluoroquinolone
47
atypical PNA: organisms
``` Mycoplasma Chlamydophilia Legionella Coxiella Viruses ``` not visible on gram stain, not culturable on standard blood agar
48
Pulmonary embolism: symptoms
``` sudden onset pleuritic chest pain dyspnea tachypnea tachycardia hypoxemia ```
49
Causes of exudate
- Infection: TB - Autoimmune: RA - Neoplasm: sarcoidosis, lymphoma all of these increase capillary permeability --> protein and LDH passes into pleural fluid
50
TMP/SMX S/E and alternative meds
S/E: rash, bone marrow suppression alternate meds: atovaquone or dapsone (can't use dapsone in G6PD)
51
When does a patient require oxygen?
-pO2 55%, OSA with hypoxia at night or cardiomyopathy --> | pO2
52
Hypertrophic Osteoarthropathy (HOA)
- digital clubbing - sudden-onset arthropathy (wrist, hand joints) - Hypertrophic pulmonary osteoarthropathy (HPOA) is a subset of HOA where clubbing/arthropathy 2/2 underlying lung dx: lung CA, TB, bronchiectasis, emphysema
53
Conditions associated with digital clubbing
- Intrathoracic neoplasms: bronchogenic CA, metastatic CA, malignant mesothelioma, lymphoma - Intrathoracic suppurative Dx: lung abscess, empyema, bronchiectasis, CF, chronic cavitary lesions - Lung Dx: idiopathic pulm fibrosis, asbestosis, pulm a-v malformations - CV Dx: cyanotic congential heart dx
54
Modified Wells Criteria
Score 3pts - Clinical signs DVT - Alternate diagnosis less likely than PE Score 1.5pts - previous DVT/PE - HR > 100 - Recent surgery (3days) Score 1pts - Hemoptysis - Cancer total Score 4 PE likely

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