Pulmonology Flashcards Preview

Medicine Clerkship > Pulmonology > Flashcards

Flashcards in Pulmonology Deck (53):
1

Categories for intermittent asthma

2

Categories for intermittent asthma

3

Categories for mild persistent asthma

>1x/day daytime,

4

Categories for moderate persistent asthma

>1x/day daytime, >1x/week nighttime. FEV/FVC = 60-80. ICS, LABA, SABA

5

Categories for severe persistent asthma

>1/day daytime, Frequent nighttime symptoms

6

How to treat refractory asthma?

PO steroids.

7

Are leukotriene antagonists effective for asthma.

Yup about the same as LABA in efficacy

8

How to treat asthma exacerbation?

S/S asthma? Keep SPO2>92, take PEFR, give duonebs q30min x3.

9

When to send patient home after asthma exacerbation?

No wheezing. PEFR>90, Sx relief

10

When to send a patient to ICU during asthma exacerbation?

Wheezing, no lung sounds, PEFR

11

Features of emphysema?

AP diameter, pink puffer, pursed lips, prolonged expiratory phase. Co2 retention. No hypoxia

12

Features of emphysema?

AP diameter, pink puffer, pursed lips, prolonged expiratory phase.

13

Categories for mild persistent asthma

>1x/day daytime,

14

Categories for moderate persistent asthma

>1x/day daytime, >1x/week nighttime. FEV/FVC = 60-80. ICS, LABA, SABA

15

Categories for severe persistent asthma

>1/day daytime, Frequent nighttime symptoms

16

How to treat refractory asthma?

PO steroids.

17

Are leukotriene antagonists effective for asthma.

Yup about the same as LABA in efficacy

18

When to send COPD patient to wards

In between. Give scheduled nebs, PO steroids. ABX; doxycycline.

19

When to send patient home after asthma exacerbation?

No wheezing. PEFR>90, Sx relief

20

When to send a patient to ICU during asthma exacerbation?

Wheezing, no lung sounds, PEFR

21

When to send a patient to the wards during asthma exacerbation

PEFR >50 but less than 90. Will receive scheduled nebs, IV/PO steroids as tolerated

22

Features of emphysema?

AP diameter, pink puffer, pursed lips, prolonged expiratory phase.

23

Features of chronic bronchitis/

Hypoxia, pulmonary constriction. Pulmonary hypertension, RH failure, edema. Copious mucous

24

How to dx emphysema?

PFT with decreased FEV/FVC ratio, no change with bronchodilator, no provocation with methacholine. CXR is nonspecific but shows hyperinflation, flat diaphragm

25

How to treat COPD

Corticosteroids
O2 Start with pa02

26

How to work up COPD exacerbation?

S/s COPD exacerbation? CXR, EKG, ABG.
Then give duonebs q30x3 with a goal spo2 of 88-92.

27

When to move COPD patient to ICU?

If severe acidosis.

28

When to send COPD patient home?

If stable, give doxycycline or fluoroquinolone.

29

When to send COPD patient to wards

In between. Give scheduled nebs, PO steroids. ABX; doxycycline.

30

Sxs of lung cancer?

Fever, weightloss, hemoptysis

31

PFTs for muscle weakness

Like restrictive pattern but residual volume is huge.

32

If lung mass is peripheral and high risk, how to work up?

Percutaneous ct guided biopsy

33

If lung mass is central and high risk how to work up?

Bronch or EBUS

34

Ph of transudate, exudate, empyema?

Transudate = 7.45-7.55
Exudate = 7.3-7.4
Empyema

35

How to work up pleural effusion

Get upright and lateral decubitus images. If it doesn't layer, then loculated. If 1cm ask if CHF, if CHF, then diurese. If not, do a thoracentesis and test for transudate or exudate.

36

How to work up pulmonary nodule?

Get a CT scan, if lesion is

37

Small cell carcinoma

Central, lots of paraneoplastic syndromes like ACTH, ADH, Lambert eaton syndrome. Treat with chemo

38

Squamous cell carcinoma

Central, can cause PTHrP and hypercalcemia, caused by smoking.

39

Adenocarcinoma

peripheral mass, no paraneoplastic syndrome

40

Carcinoid

Fluishing, diarrhea, LH fibrosis. Get 5HIAA to assess

41

PFTs for interstitial lung disease

Decreased FEV1, very decreased FVC so ratio increased or normal.

42

PFTs for muscle weakness

Like restrictive pattern but residual volume is huge.

43

What causes exudates, what causes transudates?

Exudates= malignancy, pneumonia, TB
Transudates = CHF, nephrosis, gastrosis, cirrhosis

44

How to distinguish pleural exudate vs transudate

Light's criteria:

Exudate if LDH >2/3 ULN
LDHf/LDHs >.6
Protein F/ Protein S >.5

45

Ph of transudate, exudate, empyema?

Transudate = 7.45-7.55
Exudate = 7.3-7.4
Empyema

46

How to work up pleural effusion

Get upright and lateral decubitus images. If it doesn't layer, then loculated. If 1cm ask if CHF, if CHF, then diurese. If not, do a thoracentesis and test for transudate or exudate.

47

ARDS

Noncardiogenic pulmonary edema. O2 is diffusion limited, CO2 is perfusion limited.

48

How does a patient get ARDS?

Gram negative sepsis, TRALI, near drowning.

49

How to diagnose ARDS?

CXR- bilateral fluffy infiltrates.

50

PCWP and LV function in ARDS vs CHF?

PCWP normal in ards, same with Lv function
In CHF, PCWP increased, LV function decreased.

51

How to distinguish ARDS from CHF with lab values

BNP

52

How to treat ARDS

Fix underlying disease, add steroids.
PEEP ventilation with decreased tidal volume

53

ABG in PE?

Decreased PaO2, decreased PaCO2 (due to perfusion limited diffusion), so pH increases