pulmonary with Kelly Flashcards Preview

Boards > pulmonary with Kelly > Flashcards

Flashcards in pulmonary with Kelly Deck (43):
1

Ominous signs in asthma

paradoxical chest/abd movement

inability to maintain recombancy

absent breath sounds

cyanosis

2

Asthma

thick causes plugging

the epitheial basement membrane gets thick

3

What PFTs are important in Asthma

Pulmonary Function Tests:

peak flows at home

FEV1, FVC, FEF

4

What level FEV1 is less than what ____% of predicted requires admission?

less than 30% of predicted, admit

5

If you treat an asthmatic in the ER for an hour and their FEV1 doesn't increase to at least 40% of predicted, what should you do?  

admit

6

CXR of asthmatic shows

hyperinflation

7

steps wise approach to outpatient management of asthma

1)  SABA: short acting beta adrenergic (albuterol, rescue and before you exercise)

2)  inhaled corticosteroids (pulmicort) (this helps prevent chronic changes that the inflammation causes, not for symptoms, daily maintenance, wash out your mouth)

3) SABA for symptom breakthrough, albuterol (rescue inhaler)

4) LABA long acting beta adrenergic, salmeterol.  NOT rescue inhalers.   

*5) anticholinergic *On the test, atrovent IS used in asthma for secretions

*6) antiluekotriane: monolukast

 

8

inpatient mangement of asthma 

inhaled: alupent/albuterol (proventil) are sympathomimetics

corticosteroids: methylprednisone IV (in the hospital)

parenteral (IV) sympathomimetics: SQ epi

anticholingergic to dry secretions: atrovent

9

status asthmaticus

severe acute asthma, unremitting, poorly controlled, life threatening

10

Asthma, COPD, emphysema, chronic bronchitis

are they obstructive or restrictive?

obstructive

11

How long do you have to have productive cough for dx of chronic bronchitis?

3 consecutive months for two consecutive years

12

Emphysema is characterized by:

mild clear sputum

barrel chest

old 

thin

increased lung capacity

alveoli abnormal permanent enlargement

13

CXR for chronic bronchitis

hyperinflation

possible bulea or blebs

normal AP diameter

14

COPD CXR

flattened diaghragm

15

PFTs for restrictive:

TLC total lung capacity

RV remaining volumes after maximal expiration

FRC functional residual capacaity

in restrictive disease all these are low

restrictive disease: pulmonary fibrosis, pulmonary sarcoidosis (connective tissue where it shouldn't be)

acute: ARDS, PNA, 

16

If you see extrapulmonary TB you should consider

HIV

17

Definitive diagnostic test for TB

culture x3

18

TB CXR

honeycomb appearance R upper lobe

upper lobes

19

4 differentials for night sweats

menopause

TB 

HIV/AIDS

endocarditis

lymphoma

20

acronym for TB meds

they are ripe for treatment

Rifampin

INH isoniazid (monitor LFTs)

Pyrazinamide

ethambutal (changes red/green color perception, and visual acuity)

21

If you are treating pulmonary TB, how often do you get cultures?

every week for first 6 weeks

then monthly until cultures are negative

22

If you have positive cultures after three months of TB treatment consider

drug resistance

23

Patient with HIV gets treated for TB for how long?

9 months

24

TB treatment lasts a total of how many months?

6 months

*9 months for HIV

25

Most common organism with CAP?

strep pneumoniae

26

Lung consolidation is PNA, you can't clear the ronchi with a caugh

lung consolidation

27

Treatment for CAP, consider two things:

how old they are (60)

if they have been on abx recently

28

CAP in healthy <60, not been on ABX

azythromycin (macrolide)

*new black blox warning for QT prolongation

29

If CAP patient with other commorbidities and  >65 y/o. 

levaquin

-floxacins

(flouroquinalones)

30

CAP >65 not doing well on levaquin, now admit 

ADD A BETALACTAM

start on betalactam

cextriaxone

unasyn

cefetaxime

plus

continue outpatient (levaquin)

31

If you admit CAP

betalactam +

azithromycin or levaquin

 

*if PCN allergic hold betalactam and give

aztreonam

32

Most common causitive organisms in HAP?

 

strep + staph (gram positive)

H flu (gram negative)

 

 

33

What is the most common caustive agent in VAP?

pseudomnas

*treat with antipseudamonal beta lactam

*zosyn, cefepime, imipenem

34

Thoracentesis with colored fluid, high protein, high LDH 

exudates

pressure problem*

due to inflammation (lupus)

infection (TB/PNA)

malignancy

 

 

35

Thoracentesis clear, normal protein, normal LDH

transudates

heart failure, liver failure

36

In the elderly, does the vital capacity increase or decrease?

it decreases because of increased residual volume increases

37

What is the only mid-diastolic murmur?

mitral stenosis

38

Acute L sided HF what heart sound?

S3

39

CXR for CHF

kerley B lines

(increased interstitial markings)

40

What drug is used to treat HTN in pregnancy, can also be used to treat parkinsons?

central alpha 2 agonist

methyldopa

41

Papilledema

swelling of the optic disk with blurred margins

*found in HTN emergency

42

Oral drugs in HTN urgency

clonidine

captopril

loop durectics

43