Pulmonology Flashcards
(134 cards)
1
Q
confirms diagnosis of asthma
A
Spirometry
2
Q
First line tx for BA
A
Inhaled Corticosteroid
3
Q
Pathophysio of BA
A
Airway hyperresponsiveness
4
Q
Chronic cugh
A
> 8 weeks
5
Q
M/C chroic cough, non smoker, normal XRay
A
Post Nasal Drip
Asthma
GERD
6
Q
Major risk factor for asthma
A
Atopy
7
Q
M/C Allergens to trigger Asthma
A
Dermatophagoides
8
Q
Worse art Night
A
Bronchial Asthma
9
Q
Quantify expiratory airway obstruction
A
Simple spirometry
10
Q
Determines reactive airway disease
A
Metachollne/ Histamine
11
Q
Criteria BA by spirometry
A
Reduced FEV1/FVC <0.7
Reduced FEV1 that inc by >12% and by at least 200 mg from baseline post bronchodilator
Reduced FEV1 that inc by >12% and by at least 200 mg from baseline 4 weeks after steroid trial
12
Q
When to start ICS
A
> 2 symptoms/ month
1 waking for asthma/ month
Asthma symptoms + risk for exacerbations
13
Q
When to step up ICS
A
Persistence 2-3 mos
14
Q
When to step down
A
Maintained for 3 mos
15
Q
Asthma relievers
A
SABA
SAMA
Metylxanthine
16
Q
Asthma Controllers
A
Inhaled CS Systemic Steroids LABA Leukotriene modifying agents Cromolyn Anti Ige
17
Q
Indication for impending O2 failure
A
Normal or rising CO2
18
Q
Exercise Induced asthma
A
Leukotrienes/ Bronchodilators Prior
19
Q
Older, Smoker, Barrel Chest, Expiratory wheezes
A
COPD
20
Q
Best initial test for COPD
A
CXR
21
Q
Best diagnostic test during acute exacerbation
A
ABG
22
Q
Target Organ Saturation COPD
A
> 90%
23
Q
Most common risk factor COPD
A
Tobacco Smoking
24
Q
Hallmark COPD
A
Airflow obstruciton
25
Confirms airway limitation in COPD
FEV1/FVC <0.7
26
COPD Manif
```
Dyspnea
Chronic cough
Chronic sputum
Barrel Chest
Quiet Chest
Hyperresonance
Tripod position
Right Sided Heart Failure - Cor pulmonale
```
27
Definitive COPD diagnostic
FEV1/FVC <0.7
28
GOLD 1
>80
29
GOLD 2
>50-<80
30
GOLD 3
>30-<50
31
GOLD 4
<30
32
Dyspnea Rating
```
0 not troubled
1 level ground slight hill
2 slower similar age
3 100 m
4 leave the house
```
33
3 interventions COPD
Smoking cessation
O2 therapy
Lung volume reduction
34
When to start supplemental O2 in COPD
pO2 <55/ sat <88
| pO2 <60/ sat <90
35
For moderate to severe exacerbations
Roflumilast
36
5As to quit smoking
```
Ask
Advice
Assess
Assist
Arrange
```
37
COPD Exacerbation
Dyspnea
Cough
Change in Sputum
38
Bacteria in COPD exacebration
S. pneumoniae
H. influenzae
M. catarrhalis
39
Non Invasive Positive Pressure Ventilation
Respiratory acidosis
Severe dyspnea
Persistent hypoxemia
40
Antibiotics given in COPD
Azithromycin
41
Adequate sputum sample
> 25 neutrophils
| < 10 squamous EC
42
Urinary Antigen for CAP
Pneumococcal and Legionella
43
CURB 65
```
Confusion
Urea/ BUN >30
RR >30
BP >90/<60
65 yo
```
44
Low Risk CAP Tx
Amoxixcillin - no co morbids
| Co Amox - stable co morbids
45
Moderate Risk
Ampi Sul/ Ceftri + Levoflox/ Moxiflox (same with high Risk)
46
High Risk with Risk for Pseudomonas
Pip Taz + Genta/ Amika
47
Resolution Time
1 week Fever
4 weeks Sputum
6 weeks Cough
6 mos normal
Normal XRay 4-12 weeks
Leukocytosis 2-4 days
48
Most accurate test CAP
Chest CT
49
DOC Lung Abscess
Clindamycin
50
CD4 <200
Pneumocytsis Pneumonia
51
Gold Standard for Pneumocystis Pneumonia
Bronchial Alveolar Lavage
52
DOC Pneumocystis Pneumnia
TMP/SMX
53
Best initial test PTB
XRay + Sputum AFB
54
Most infectious form of TB
Cavitary and Laryngeal
55
Primary TB
Children
Ghons Focus
Middle and Lower Lung
56
Post Primary
Adult
Reactivation
Apical and Posterior
57
Presumptive TB
Cough of 2 weeks
Contact with Known TB + Cough
CXR -> + TB
58
Dilated vessel in cavity -> Hemptysis
Rasmusens Aneurysm
59
Gold Standard TB dx
TB Culture
60
Gene XPert
Initial Test
Smear Neg TB but with + X Ray
Presumptive Drug resistant TB (Rifampin)
61
>10 mm TST, but neg symptoms and X Ray
Latent TB
62
DSSM
Primary Diagnostic Method
| 2 sputum specimen 1 hr apart; at least 1 +
63
Most Hepatotoxic anti TB
Pyrazinimide
| *All TB Drugs are hepatotoxic
64
Peripheral Neuropathy
Isoniazid
| Antidote : Vit B6
65
Autoimmune thromocytopenia
Rifampin
66
Most common extrapulmonary TB
TB Lymphadenitis
67
Potts Disease
Lower Thoracid Upper Lumbar
68
Gold Standard for TB Meningitis Dx
CSF Culture
69
Choroidal Tubercle in eyes
Miliary TB
70
Dysepnea, Absent BS, Dullness of Percussion at Base of Lung
Pleural Effusion
71
Best initial Diagnostic Test for PE
CXR PA - L
72
Most accurate test
UTZ guided thoracintesis
73
Exudative PE
Measure the serum and pleural fluid protein
74
Transudative effusion measurement
Serum - PF protein gradient: >31 g/L or 3.1 g/dL
75
M/C Cause of pleural effusion
LV Heart Failure
76
M/C Cause of exudative pleural effusion (PH)
TB
77
2nd most common cause of exudative PE
Malignancy
78
Lights Criteria
PF/Serum Protein >0.5
PF/Serum LDH > 0.6
PF LDH > 2/3 upper normal serum limit
79
Light Criteria Met
Exudative
80
M/C cause of Malignant Pleural Effusion
Lung CA
81
Bilateral PE in the absence of Cardiomegaly
Malignancy
82
Chylothorax
Milky gross appearance
Fat content > 400 mg/dl
Chylomicrons seen
83
Most common cause of Chylothorax
Lymphoma
84
Rupture of subpleural bleb
Pneumothorax
85
Diminished breath sounds, hyperresonance
Peumothorax
86
Best initial test for pneumothorax
CXR
87
Most appropriate tx for Pneumothroax
Chest tube thoraccostomy
88
Occurs without antecedent trauma to the thorax
Spontaneous pneumothorax - Smoking m/c cause
89
Pneumothorax, absence of underlying lung disease
Primary Pneumothorax - M/C Smoking
90
MC cause of Secondary pneumothorax
COPD
91
Pneumothorax, trachea away
Tension pneumothorax
92
CXR Pneumothorax
Partial lung collapse on side of pneumothorax
93
Non tension pneumothorax X Ray
Trachea/ mediastinum unchanged, will shift towards affected side
94
Preferred insertion site for tube thoracostomy
4th or 5th ICS Anterior Axillary line
95
Tx Primary Spontaneous Pneumothorax
Simple Aspiration
96
Tx Secondary Spontaneous Pneumothorax
Tube Thoracostomy
97
Tx Traumatic Pneumothorax
Supplemental O2 + Aspiration
98
Respi Failure Type I
Acute Hypoxemic
99
Respi Failure Type II
Hyperbaric
100
Respi Failure Type III
Atelectasis
101
Repi Failure Type IV
Hypoperfusion
102
Hypercarbia corrected by
Increasing RR and TV
103
Hypoxemia corrected by
Increasing FiO2 and PEEP
104
Severe dyspnea of sudden onset, hypoxemia, diffuse pulmonary inflitrates
ARDS
105
Mechanical ventilator strategy that improved survuval
Low Tidal Volume
106
ARDS Criteria
Berlin Criteria
107
Berlin Criteria
Acute onset: Within 1 week
Ratio: PaO2/FiaO2
Diffuse Bilateral alveolar or interstitial infiltrates
Swan Ganz Wedge Pressure <18 mmHg
108
Severity of ARDS
PaO2/FiO2: 200-300 - MILD
PaO2/FiO2: 100-200 - MODERATE
PaO2/FiO2: <100 - SEVERE
109
MV management in ARDS
Low Tidal Volume 6 mL/kg
| High PEEP 12-15 mmHg
110
Early muscular blockade in ARDS
Cistatracurium besylate
111
Hypotension, HR 140, Elavated JVP, Bilateral Crackles
Cardiogenic Shock
112
3 components of shock state
Systemic Arterial Hypotension - SBP <90 MAP <70 with Tachycardia
Tissue Hypoperfusion
Hyperlactatetemia >1.5
113
First choice fluid for circulatory shock
Crystalloid 300-500 mL in 30 mins
114
First choice vasopressor for Circulatory Shock
Norepinephrine
115
Inotropic of choice for Circulatory shock
Dobutamine
116
Approach for Circulatory Shock
O2
Fluid
Vasoconstrictors
Inotropics
117
VIP Rule
Ventilate Infuse Pump
118
Most serious complication of fluid ifusion
Pulmonary Edema
119
Best Initial Test Legionnaires disease
Urine Antigen Test
120
Onset is midlife, symptoms slow and progressive, exposure to engine smoke
COPD
121
Childhood onset, symptoms worse at night, history of atopy
Asthma
122
Restrictive ventilatory defect on spirometry with pulmonary edema and cardiomegaly
Congestive HF
123
Large volume purulent sputum, bronchial dilatation and wall thickening
Bronchiectasis
124
Young non smoker, history of RHEUMATOID arthritis, seen after lung and bone marrow TRANSPLANT
Obliterative bronciolitis
125
Chronic sinusitis, diffuse small centrilobar nodule opacities
Bronchiectasis
126
Ship Building/Tile/ Brick making, Calcified Pleural Plaques
Asbestosis
127
Mining, Stone cutting, sand blasting, EGG Shell calcification
Silicosis
128
Alloys, aerospace, nuclear, fluorescent bulbs
Berryliosisc
129
Cotton
Byssiniosis
130
Coal
Coal workers pneumoconiosis
131
Motorvehicular Accident, No breath sounds
Tension Pneumothorax
132
Most urgent step tension pneumothorax
Large bore needle - 2nd anterior IC space
133
Confirms diagnosis
Rush of air
134
P THORAX
```
Pleuritic Pain
Tracheal Deviation
Hyperresonance
Onset Sudden
Reduced BS
Absent Fremitus
XRay - collapsed lung
```
