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Pulm Flashcards

1
Q

Main difference between asthma and COPD

A

reversibility

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2
Q

How to take temp in asthma exacerbation

A

not orally– mouth breathing cools thermometer

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3
Q

Associations with asthma

A

atopy, obesity

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4
Q

Asthma patients are worst at _____, sensitize to ___.

A

Worst at night, sensitive to ASA

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5
Q

PE findings in asthma

A

wheezes and *prolonged expiratory phase

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6
Q

Asthma:
best initial test
most accurate test
best test for asx patient

A

Peak flow- initial
Accurate- PFTs
Asx- FEV1 decrease with methacholine (challenge)

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7
Q

PFT finding in asthma

A

FEV1/FVC low, reversible with albuterol

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8
Q

How should PFTS be affected by methacholine and albuterol in asthma?

A

FEV1 ^ 12% with albuterol

FEV1 down 20% with methacholine)

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9
Q

What is methacholine?

A

acetylcholine– increases secretions

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10
Q

Appropriate asthma treatment (stepwise)

A

1) SABA
2) SABA + ICS
3) SABA + ICS + LABA
4) “” but ^ dose/ strength of ICS
5) SABA+ ICS + LABA + Omalizumab
6) SABA + ICS + LABA + Omalizumab + OCS

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11
Q

Common combined inhalers:

A

bronchodilator
inhaled corticosteroid

(Advair and symbicort are both LABA + ICS)

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12
Q

What are some of the low dose inhaled steroids?

A
  • beclomethasone
  • budesonide
  • fluticasone
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13
Q

What are the two SABAs?

A

albuterol/levalbuterol
pirbuterol

*LABAs are others ending in erol

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14
Q

Metabolic effects of oral steroids

A
  • ^glucose
  • ^lipids
  • osteoporosis
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15
Q

Which of the asthma meds should never be used first/ alone?

A

LABAs

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16
Q

Role of anticholinergics in asthma?

A

not. none. They are for COPD

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17
Q

Special vaccines for asthmatics

A

all get pneumo and influenza. Gotta do it.

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18
Q

Best clinical indication of asthma severity

A

RR

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19
Q

Treatment of asthma exacerbation

A

O2
bolus of IV steroids
albuterol nebs
**No epi. Bad news.

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20
Q

Alternative to albuterol in asthma attack when albuterol not effective

A

mag

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21
Q

COPD- effect on TLC and DLCO

A

increased TLC– hyperinflation

decreased DLCO- destruction

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22
Q

Young nonsmoker with COPD has

A

a1at mutation

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23
Q

CBC change in COPD

A

high hct from chronic hypoxia

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24
Q

EKG findings in COPD

A

RAE (tall P wave V1); RVH; MAT

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25
What improves mortality in COPD
O2; smoking cessation; vaccines
26
When to give supplemental O2?
60/90 pO2/sat with right heart disease, high HCT etc... 55/88 if otherwise healthy
27
Medications for COPD
1) SABA PRN 2) SABA PRN + anticholinergic 3) SABA PRN + antichol + ICS 4) transplant
28
How is COPDE treated differently than asthma?
add abx
29
Drugs for COPDE/asthma exacerbation
albuterol nebs, O2, IVCS | + abx for COPDE
30
Options for Abx in COPDE
1) macrolides 2) augmentin 3) quinolones 4) 2nd gen ceph
31
What the hell is bronchiectasis anyways?
chronic dilation of large bronchi...permanent anatomic abnormality (esp common with CF/ repeated infections)
32
Clinical clue to bronchiectasis
recurrent large volume sputum production (due to large bronchi that allow pooling of secretions) so coughing shit up all day errday
33
How to dx bronchiectasis
tram tracks on high rest chest CT
34
Px treatment for bronchiectasis
cupping and clapping (chest phys therapy)
35
ABPA what is it?
Allergic Bronchopulmonary Aspergillosis | allergy patient... gets exposed to aspergillus/fungus and has hypersensitivity dx
36
Clinical clues to ABPA:
brown flecked sputum | transient infiltrates on CXR
37
Treatment of ABPA
oral steroids (not inhaled)
38
Principal pathophys of CF
thick sputum, no mucus clearance, bacteria takes shop
39
Sinus finding in CF
nasal polyps
40
GI assc with CF
- recurrent pancreatitis/ no pancreatic digestive enzymes - meconium ileus - biliary colic - instestinal obstruction
41
GU involvement in CF
-azospermia -20% missing vas -altered menstrual cycle -mucus blocks sperm through cervix (all infertile)
42
Best test for CF
increased sweat chloride
43
CF PFT findings
mixed obstructive and restrictive | low TLC, DLCO, TLC
44
Treatment options for CF
- inhaled aminoglycosides, rhDNase, and SABA - vaccines - ivactafor (some patients) - transplant
45
Bug causing pneumonia in vet/farmer/animal birth
coxiella
46
Bug causing pneumonia in contaminated water/ heating and cooling etc
listeria
47
Bug assc with DM and alcoholism (causing PNA)
klebsiella
48
Dull percussion in PNA=
effusion
49
PNA assc with: currant jelly sputum rotten egg sputum CNS symptoms
Klebsiella- currant jelly rotten egg- anerobes CNS-listeria
50
Infections with dry cough + bilateral interstitial infiltrates
``` mycoplasma coxiella pneumocystis virus chlamydia ```
51
Empyema findings on thoracentesis
``` LDH more than 60% serum Protein more than 50% serum White count more than 1000 pH less than 7.2 (any of these) ```
52
What are the respiratory FQs
levo moxi
53
Outpatient treatment of CAP
macrolide or doxy unless sickly/recent abx then FQ
54
Inpatient treatment of CAP
etither ceftriaxone + macrolide or FQ
55
Two factors that are in isolations reasons to admit PNA patient
hypoxia | hypotension
56
What are CURB65 criteria for admission?
``` C-confusion U-uremia R-respiratory distress B-BP low 65+ 2+ points admit ```
57
How long between 13 and 23 valent PNA vaccines
6-12 months
58
Reasons to give PNA vaccine early
``` asplenia hematologic cx immunosupressions (steroids, DM, HIV, alcohol) CSF leak, cochlear implant heart, liver, kidney, lung disease ```
59
Bugs at risk in HAP and main difference in treatment
ecoli and pseudomonas ---> cannot use macrolides
60
Treatments for HAP
cefepime/ceftaz, pip tazo, or carbapenems
61
What are the antipseudomonal blactams
ceftaz, cefepime piptazo carbapenems
62
Treatment of VAP
3 agents | antipseudomonal B lactam + vanc or linezolid + FQ or AG
63
Why no dapto for lungs?
inactivated by surfactant
64
Imipenem ADR
seizures
65
Lung Abscess: key sx dx tx
foul sputum lung bx clinda or penicillin
66
CD4 count where patients get PCP
200 or less
67
Lab test clue to PCP
LDH levels always elevated
68
1st line tx for PCP
Bactrim
69
Alternatives to Bactrim for px and tx of PCP if patient has contraindication
px: atovaquone or dapsone (not in G6PD tx: clinda + primaquine (not in G6PD) or pentamidine
70
At what CD4 is px given for the first time in AIDs?
200
71
What is never a good test for TB in symptomatic patient?
PPD --> instead do sputum culture x 3
72
Standard empiric treatment for active TB
RIPE x 2 months --> RI x 4 months | 6 months total
73
When to stop TB meds
transaminases 3-5x ULN
74
Who is considered PPD + at 5mm or more? | When are others +?
5mm: steroids/transplant, HIV, close contact, xray 10 mm: other risks (healthcare, prison etc) 15 mm: no risks
75
Which RIPE drug causes hyperuricemia?
pyrazinamide
76
Treatment for first time +PPD
9 months isoniazid even if had BCG vaccine
77
"Malignant" features in lung nodule:
40+ enlarging or 2+cm; smoker; spikulated; adenopathy; etc.
78
What to do when solitary nodule has many malignant features
remove
79
What to do for "grey area" nodules?
bronch/biopsy in most; can also do PET, sputum cytology, VATS
80
What to do for low risk lesions?
surveillance
81
PE findings for pulmonary fibrosis
dyspnea, crackles, P2, clubbing
82
Dx of pulm fibrosis
CXR --> CT --> bx
83
EKG/ echo findings in pulm fibrosis
RVH --> PHTN
84
Bx finding in berylliosis
granulomas
85
PFT findings in pulmonary fibrosis
normal FEV1/FVC ratio; decreased DLCO
86
Treatment for pulm fibrosis
steroids
87
Oddball systemic findings assc with sarcoid
- facial palsy - parotid gland hypertrophy - heart block - uveitis - CNS changes
88
CXR clue in sarcoid
hilar lymphadenopathy
89
PFTs in sarcoid have what pattern?
restrictive
90
Labs in Sarcoid
high ACE, calciuria, calcemia
91
Treatment of sarcoid
steroids only if symptomatic
92
CXR, EKG, ABG findings in PE
clear lungs/ wedge infarct, sinus tach, respiratory alkalosis
93
Appropriate imaging for PE
spiral CT unless pregnant then VQ scan
94
What test is avoided in case of PE due to mortality
angiography
95
Appropriate treatment for thromboembolism
heparin --> warfarin to INR of 2-3
96
Alternative to heparin for TE
fonduparinox
97
When is IVC ok?
absolute CI to heparin recurrent emboli on heparin/warfarin RV dysfunction
98
When are thrombolytics appropriate for TE?
unstable/ acute RV dysfunction
99
Heart sounds assc with PHTN
- wide split S2 - loud P2 - TR/PR possible
100
Definition of PHTN
PA pressures above 25/8
101
Treatment of idiopathic HTN
- prostacyclin analog (tenol/tinil/prost) - endothelin antag (sentan) - PDEi (sildenafil)
102
Cure for PHTN
lung transplantation
103
Sleep apnea + increased bicarb=
obesity hypoventilation syndrome
104
Causes of ARDS
- sepsis/aspiration - contusion/ trauma - drowning - pancreatitis - burns
105
ARDS definition
pO2/FIO2 below 300
106
Vent settings for ARDS
``` high PEEP low TV (6) and plateau pressure less than (30) ```

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