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PULMONOLOGY Flashcards

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1
Q

Top Causes of Chronic Cough

A

Upper Airway Cough Syndrome
Asthma
PTB
GERD

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2
Q

How to diagnose asthma?

A

History of variable symptoms
FEV1/FVC < 0.75-0.80
Reversibility Criteria
- reduced FEV1 that increases by >12% and by at least 200ml post bronchodilator or after 4 weeks on steroid trial
- decrease in FEV1 by 20% with metacholine or histamine

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3
Q

Asthma Hallmark

A

Airway hyperresponsiveness

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4
Q

Major risk factor for asthma

A

Atopy

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5
Q

Most common allergen

A

dust mite

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6
Q

Most accurate test in diagnosing asthma

A

Pulmonary Function Test or Spirometry

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7
Q

How long should cough be to be considered CHRONIC?

A

> 8 weeks

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8
Q

Most accurate test in asymptomatic patient

A

Metacholine/histamine stimulation test

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9
Q

First Line of treatment for asthma

A

INHALED CORTICOSTEROIDS

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10
Q

Patient has been having DAILY symptoms of asthma and gets awaken at least once a week by it. What will you give?

A

Medium dose maintenance

ICS formoterol

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11
Q

Patient has asthma symptoms MOST DAYS and at least once a week awakens with asthma. What will you give?

A

Low dose maintenance

ICS Formoterol

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12
Q

ACUTE SEVERE ASTHMA.What will you give?

A

SABA

Salbutamol q15 3x then q4

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13
Q

SABA

A

salbutamol
Albuterol
Terbutaline

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14
Q

LABA

A

Salmeterol
Formoterol
Indacaterol

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15
Q

Anti-IgE

A

Omalizumab

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16
Q

Asthma drugs safe for pregnant

A

SABA, ICS, THEOPHYLLINE

PREDNISONE

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17
Q

Most accurate test for COPD

A

Pulmonary Function Test

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18
Q

Most common risk factor COPD

A

Smoking

OTHERS

  • airway hyperresponsiveness
  • infections
  • ambient air pollution
  • smoking exposure
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19
Q

Classic Symptoms of COPD

A

dyspnea
chronic cough
chronic sputum production

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20
Q

COPD HALLMARK

A

airflow obstruction

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21
Q

Spirometry criteria for COPD

A

FEV1/FVC ratio < 0.7

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22
Q

Lung Pattern: Restrictive

A

Restrictive=Right

Smaller and displaced to the right
decreased volume

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23
Q

GOLD CLASSIFICATION

A

1 - FEV1>=80%
2 - FEV1 50-79%
3 - FEV1 30-49%
4 - FEV1 < 30%

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24
Q

3 Interventions demonstrated to improve survival in COPD

A

smoking cessation
O2 therapy
Lung volume reduction

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25
When to start supplemental O2?
PO2<55 or sat <88% at room air | PO2<60 AND with signs of pulmonary HTN/erythrocytosis
26
Pharmacotherapy for smoking cessation (3)
Nicotine, Bupropion, Varenicline
27
5As in Smoking Cessation therapy
``` Ask Advise Assess Assist Arrange ```
28
Acute COPD exacerbation treatment
``` immediate nebulization + bronchodilators Antibiotics Glucocorticoids (Prednisone) NIPPV Intubation ```
29
Most common cause of CAP
Streptococcus pneumoniae
30
CAP in a patient staying on a cruise ship for 2 weeks. Etiology?
Legionella
31
Patients with stroke, dementia, decreased consciousness developed CAP. Etiology?
Anaerobes, Gram (-) enteric bacteria
32
Patient with recent antibiotic use, malnutrition, steroid use, bronchiectasis developed CAP. Etiology?
Pseudomonas
33
Best initial test for CAP
CXR
34
Moderate Risk CAP
``` Presence of the following: RR >=30 PR >=125 T>=40C or <=36C SBP <90 OR DBP <=60 Altered mental status Suspected aspiration Unstable co-morbid conditions CXR: Multilobar Pleural Effusion, Abscess ```
35
HIGH RISK CA
Severe sepsis/shock | Need for mechanical ventilation
36
CURB65
``` Confusion Urea > 7mmol/L RR >=30 BP SBP <=90 or DBP <=60 Age >65 ``` 0-1 low risk 2 Admit vs OPD 3-5 Admit
37
Instances wherein CXR could be normal in CAP
pancytopenia, severe dehydration
38
Clinical Findings CAP
cough, fever, tachypnea, tachycardia, pulmonary crackles
39
DOC for CAP LR no comorbids
AMOXICILLIN
40
TX CAP LR STABLE COMORBID
B-Lactam, BLIC (Coamox, Sultamicillin) or 2nd Gen (Cefu) with or without extended macrolides (azithro)
41
TX CAP MR
IV non antipseudomonal B-Lactam (Ampicillin, Sulbactam, Ceftriaxone, Ertapenem) PLUS either Extended Macrolide or Respiratory FQ (Levo, Moxifloxacin)
42
TX CAP HR W/O RISK FOR PSEUDOMONAS
IV non antipseudomonal B-Lactam (Ampicillin, Sulbactam, Ceftriaxone, Ertapenem) PLUS either Extended Macrolide or Respiratory FQ (Levo, Moxifloxacin)
43
TX CAP HR W/ PSEUDOMONAS RISK
IV antipneumococcal/ antipseudomonal B-Lactam (PipTazo, Cefepime, Meropenem, Imipenem-Cilastatin) PLUS either Extended Macrolide or Aminoglycosides (Gentamicin, Amikacin) OR IV antipneumococcal + antipseudomonal B-Lactam (BLIC, cephalosporins, carbapenem) PLUS IV ciprofloxacin or IV levifloxacin
44
Drugs vs MRSA
I AM your Last Shot at Victory. ``` Imipenem Amikacin Meropenem Linezolid Streptogramins Vancomycin ```
45
Only Carbapenem without Pseudomonal activity
ERTAPENEM
46
Reasons for Lack of Response to Tx
Resistant pathogen Sequestered focus Wrong drug Correct drug, wrong dose/frequency
47
Most CAP symptoms should have resolved by
3 mon. ``` 1wk - fever 4wks - chest pain and sputum production 6wks - cough and breathlessness 3mon - most symptoms resolved 6mon - back to normal ``` CXR clears in 4-12 wks
48
First evidence of response to treatment
Resolution of fever 1wk | Decreasing WBC within 2-4 days
49
Duration of Antibiotics Therapy: MSSA/S. aureus Gram negative enteric/nonenteric
7 days if using Azithromycin - 5 days
50
Duration of Antibiotics Therapy: Pseudomonas or MRSA/MSSA
14 days
51
Duration of Antibiotics Therapy: Bacteremic
Double the usual
52
Duration of Antibiotics Therapy: Atypical
Double the usual
53
Criteria for Discharge
``` Afebrile HR normal RR 16-24 SBP>90 O2 SAT >90% Functioning GIT ```
54
Most infectious form of TB
Cavitary PTB and Laryngeal PTB
55
MC etiology of hemoptysis worldwide
TB
56
Primary PTB Test
DSSM
57
Best initial test for TB
Gene Xpert MTB/Rif
58
Category I TB Tx
2HRZE/4HR
59
Category Ia TB Tx
2HRZE/10HR
60
Category II TB TX
2HRZES/1HRZE/5HRE
61
Category IIa TX TB
2HRZES/1HRZE/9HRE
62
Pathognomonic of Miliary TB in eye exam
Choroidal Tubercles
63
Pott's Disease involves
Lower thoracic and upper lumbar spine
64
Gold standard for TB meningitis
CSF Culture
65
Most accurate test for Pleural Effusion
UTZ
66
LIGHTS CRITERIA
EXUDATE >=0.5 PF/SERUM CHON RATIO >=0.6 PF/SERUM LDH RATIO >2/3 PF LDH TRANSUDATE vice versa
67
TRANSUDATE - Diseases
CHF CIRRHOSIS NEPHROTIC SYNDROME PULMONARY EMBOLISM
68
EXUDATE - Diseases
``` MALIGNANCY PNEUMONIA TB PE ESOPHAGEAL RUPTURE COLLAGEN VASCULAR DSE CHYLOTHORAX/HEMOTHORAX ```
69
MCC of Pleural Effusion
LV Heart Failure
70
Difference between serum-PF protein should be ___ to consider that effusion is TRANSUDATIVE
>31g/L (3.1g/dl)
71
What to consider if PF glucose is <60mg/dL?
Malignancy Bacterial Infections (Empyema) Rheumatoid Arthritis
72
When to consider invasive procedure in management of Pleural Effusion?
``` increasing order of importance loculated pleural fluid PF PH<7.20 PF Glucose <3.3mmol/L (<60mg/dl) Positive Gram stain or culture of PF Presence of grosd pus in pleural space ```
73
FLUID HCT > 50% IN PLEURA
HEMOTHORAX
74
Suggestive of CHYLOTHORAX
milky gross appearance high fat >400mg/dl TAG with chylomicrons
75
PSEUDOCHYLOTHORAX - DSE
TUBERCULOSIS RA INADEQUATELY TREATED EMPYEMA A CHRONIC EXUDATIVE EFFUSION FROM ALMOST ANY CAUSE
76
MC cancer in asbestosis
LUNG CANCER
77
patient exposed to mining, sandblasting, quarrying and glass cutting developed egg-shell calcification
Silicosis
78
Majorrisk factors for OSA
obesity, male
79
MC complaint in OSA
snoring
80
MC daytime symptom OSA
excessive sleepiness
81
Gold standard for diagnosis of OSA
Overnight Polysomnogram
82
>=30% reduction in airflow for at least 10s during sleep accompanied by either >=3% desat or an arousal
Hypopnea
83
management OSA
Weight loss, CPAP or BiPAP
84
management Central Apnea
avoid alcohol and sedatives | may respond to ACETAZOLAMIDE

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