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MTBs Step 2CK > Pulmonary > Flashcards

Pulmonary Flashcards

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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
MCC of bronchiectasis?
CF
26
MCC of CAP
pneumococcus
27
MCC of HAP
gram - bacilli
28
when should you think pneumonia over bronchiectasis?
pneumo: tachycardia, tachypenia, hypotension
29
Empyema + criteria
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
30
which has a productive cough? lobar or intersitial pneumo?
lobar
31
name the pneumonia associated with... | diarrhea, HA, confusion
legionella
32
name the pneumonia associated with... | Bacteremia
Strep. Pneumo
33
name the pneumonia associated with... | current jelly sputumm hemoptysis
klebsiella
34
name the pneumonia associated with... | rotten egg smell
anaerobes
35
name the pneumonia associated with... | dry cough, bullous myringitis
mycoplasma pneumo
36
name the pneumonia associated with... | CD4<200
PCP
37
tx of outpatient pneumonia
azithromycin, or clarithromycin OR moxifloxacin
38
tx of HAP
Vanc + pip/tazo; or ceftazidine, cefipime, TMP/SMX = point being u need pseudomonas coverage
39
TX of inpatient pneumonia
ceftriaxone + azithromycin or moxifloxacin
40
bug that causes pneumo that presents with... | recent viral illness
staph
41
bug that causes pneumo that presents with... | alcoholic/DM
klebsiella
42
bug that causes pneumo that presents with... | young healthy patients
mycoplasma or chalymidia pneumo
43
bug that causes pneumo that presents with... | persons present at the birth of an animla, vets, farmers
coxiella burnetii
44
bug that causes pneumo that presents with... | arizona construction workers
coccidioidomycosis
45
bug that causes pneumo that presents with... | COPD
H. influenza
46
bug that causes pneumo that presents with... | poor dentition
anaerobes
47
bug that causes pneumo that presents with... | ppl who fucking love birds
chalymdia psittaci
48
What is interstitial lung disease(ILD)
inflammation or fibrosis of interalveolar septum causing impaired gas exchange and increase in lung stiffness(restritive lung dz)
49
Dz associated with.... | ship yard workers, insulators and pipe fitters
asbestosis
50
Dz associated with.... | glass workers, mining, sandblasting, brickyards
silicosis
51
Dz associated with.... | coal worker
coal works pneumonoconiosis
52
Dz associated with.... | cotton
byssinosis
53
Dz associated with.... | electronics, ceramics, fluorescent lights
berylliosis **has granulomas!!!!
54
Dz associated with.... | mercury
pulmonary fibrosis
55
drugs that can cause interstital lung dz?
bleomycin, busulfan, amiodarone, methylsergide, nitrofuratonin, cyclophosphamide, etc
56
Classic presentation of ILD?
SOB with Dry nonproductive cough and chronic hypoxia PE: dry, rales, loud P2(sx of pulmonary HTN), clubbing
57
Hypersensitivity Pneumonitis | cause? tx?
fever, dyspnea, severe cough within 4-6 hr of exposure to antigen! cause: feathers, MAI, hay, compost, A/C tx: avoid + steroids
58
DX of ILD?
1. CXR 2. CT, PFT or Bx **need to do EKG to look for RV hypertrophy due to pulmonary HTN
59
PFT in ILD? | FEV, FVC, FEV/FVC, TLC, RV, DLCO
FEV, FVC, TLC, RV, DLCO = decrease | FEV/FVC = increased
60
why do an EKG for ILD?
looking for RV hypertrophy due to pulmonary hypertrophy
61
TX of ILD?
1. steroids 2. Azathioprine 3. cyclophosphamide
62
whats Sarcoidosis
idiopathic inflammatory condition involving infiltration of non-caseating granulomas thought out the body. MC in AA women
63
sx of sarcoidosis
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
best initial test for sarcoidosis? most accurate test?
initial CXR, accurate = bx of lymph node
65
tx of sarcoidosis
steroids ONLY IF SYMPTOMATIC = if hilar lymphadenpathy but not symptomatic leave alone
66
Normal pulmonary vascular values: | systolic, diastolic and MAP
Systolic: 25mmHg Diastolic: 8mmHg MAP: 15mmHg
67
sx of pulmonary HTN
Loud P2, Tricuspid reguritation, RV heave, raynauds phenomenon, wide split S2
68
SAAG calculations & meaning...
(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
Allergic Bronchopulmonary Aspergillosis(ABPA) | sx?
*asthmatic pt with worsening asthma(cough, wheezing) w/brown mucous plugs(hemoptysis), peripheral eosinophila and elevated IgE and central bronchiectasis,
70
Allergic Bronchopulmonary Aspergillosis(ABPA) | dx?
aspergillus skin testing, meansing IgE, ABPA ab's
71
Allergic Bronchopulmonary Aspergillosis(ABPA) | tx?
ORAL steroids and if refractory Itraconazole
72
dx of Acute Respiratory Distress Syndrome?
CXR shows white out, normal wedge pressure, pO2/FiO2 <200.
73
tx of ARDS
ventilation w/low tidal volume of <6mL/kg, PEEP, prone, diruetics, positive inotropes(doubutamine), ICU
74
TX of TB
4 for 2: INH, Rifamp, pyrazina, etham for 2 months THEN 2 for 4: INH + Rifampin for an additonal 4 months
75
PPD + but CXR - ?
9m of INH
76
side fx of INH
hepatotoxic, peripheral neuropathy = pyridoxine
77
side fx of Rifampin
red/orange colored body fluids = benign
78
side fx of pyrazinamide
hyperuricemia = NSAID + Colchine
79
side fx of Ethambutol
optic neuritis = decrease dose
80
how do you check someon for TB who has had the BCG vaccine?
INF y release assay = IGRA
81
Acute Bronchitis | sx?
*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
Acute Bronchitis | tx?
NSAIDs + Bronchodilators
83
Why do you get yellow/purulent sputum and blood with acute bronchitis?
* Yellow/purulent Sputum = epithelium sloathing not infection * Blood = inflammation due to epithelial damage

MTBs Step 2CK (20 decks)

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