Pulmonary and critical care med Flashcards
(12 cards)
most helpful test to distinguish COPD and asthma?
spirometry before and after inhaled bronchodilator!!!
- complete reversal in asthma FEV1/FVC >/= 70
- non or partial in COPD
mechanism behind intermittent asthma?
leukocyte induced bronchoconstriction
36 YO primagravida 34 weeks gestation. nitrofurantoin for uti. now SOB, dry cough, 92% sats, crackles at bases bilaterally. heart murmur, 1+ edema of ankles. leukocytosis with eosinophila. serum creatinine normal. raised blood glucose. CXR shows bilateral basilar parenchymal opacities!!!.
most likely cause?
drug induced lung injury!!! -> nitrofurantoin
causes acute hypersensitivity involving lungs and also interstitial lung disease
unilateral pleural effusions and rash can also occur.
NOT peripartum cardiomyopathy -> ankle swelling and murmur notmal in pregnancu. no extra signs like orthopnea
NOT acute interstitial nephritis as creatinine is normal. nasuea and vomiting would be typicall.
chronic cough, history of chronic rhinorrhea. one wee treatment with chloramphenamine improves symptoms. decrease in what is most likely responsible for improvement?
nasal secretions!!!
elimation of nasal discharge and cough with histamines = post nasal drip as cause of cough (upper airway cough syndrome)
other two common causes of chronic cough = asthma, GERD
mechanism behind hypoxia in pneumonia?
V/Q mismatch!!
specifically right to left intraPULMONARY shunting
progressive asthma symptoms -> sore throat morning hoarseness, worsening cough only at night, increased need for albuterol inhaler following meals. next step in management?
add esomeprazole!!!
comobrid GERD is common in patients with asthma and can worsen symptoms.
not stop lisinopril as ace inhibitor related cough occurs during the day as well and not associated with hoarseness
not oral corticosteroids as this is used in asthma exacerbations
recent GI illness (hemoconcentration) + acute onset pleuritic chest pain + hemoptysis. Chest CT scan showin wedge shaped lesion. most likely diagnosis?
pulmonary embolism!!!
wedge shaped infarct - hemoptysis may occur
patient has
1. asthma
2. chronic rhinosinusitis = nasal congestion frontal headaches, nasal polyps
3. NSAID induced respiratory reactions/sensitivity
what is driving the pathogenesis of patients symptoms?
Leukotreine production!!!!
patient has aspirin-exacerbated respiratory disease
when PE is suspected, give IV heparin before you do the CT angio!
findings suggestive of CAP from history and lung auscultation. in outpatient setting. next step in management?
CXR!!! -> required before antibiotics!!
not sputum and gram stain as not done in outpatient and treatment is always empiric antibiotics
patient with asthma. taking ICS-LABA PRN. but having exacerbations 3 times a week? next step in manaegemtn?
step up to ICS-LABA daily!!!!!
after this if daily symptoms of asthma -> step up to Medium dose ICS-LABA
last step is ICS-LABA + LAMA
35 yo woman. 6 months progressive breathlessness. no other symptoms. has raynauds phenomenon. history of gastroesophageal reflux
most likely finding on cardiovascular exam?
right ventricular heave!!!
esophageal dysmotility + raynauds = CREST syndrome likely
pulmonary arterial hypertension is frequently complicated by limited systemic sclerosis!!! -> can lead to right ventricular enlargement!! and right heart failure
other findings could be jugular venous distention, right sided S3 best heard at left lower sternal border NOT S3 at apex on end inspiration (consistent with left ventricular failure), split S2 in pulmonic region due to delayed closure of pulmonary valve
PH - split S2, RV heave, right sided S3 and S4, tricuspid or pulmonic regurg, signs of right HF
