Pulmonology Flashcards Preview

USMLE Step 3 MTB > Pulmonology > Flashcards

Flashcards in Pulmonology Deck (164)
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1

- SOB
- expiratory wheezing

asthma

2

- hyperventilation/increased RR
- decrease in peak flow
- hypoxia
- respiratory acidosis
- possible absence of wheezing

SEVERE asthma exacerbation

3

if asthma diagnosis is unclear

PFT before and after inhaled bronchodilators

4

asthma and reactive airway disease are CONFIRMED with what finding on PFT?

INCREASE in FEV1 of greater than 12%

5

ALL patients with SOB should receive the following

- oxygen
- continuous oximeter
- CXR
- ABG

6

best INITIAL treatment for asthma exacerbation

- inhaled bronchodilator (albuterol); no maximum dose
- steroid bolus (methylprednisolone)
- inhaled ipratropium (ACh receptor antagonist)
- oxygen
- magnesium

7

when should an asthma patient be placed in the ICU?

respiratory acidosis with CO2 retention

8

what is the indication for intubation and mechanical ventilation in asthma?

PERSISTENT respiratory acidosis

9

best INITIAL treatment for nonacute asthma

inhaled bronchodilator (albuterol)

10

if asthma patient is not controlled on inhaled bronchodilator (albuterol)

inhaled steroid

11

if patient is STILL not controlled on inhaled bronchodilator (albuterol), and inhaled steroids

inhaled long-acting beta agonist (LABA) (salmeterol, or formoterol)

12

alternate long-term controller medications besides inhaled steroids: extrinsic allergies, such as hay fever

cromolyn

13

alternate long-term controller medications besides inhaled steroids: atopic disease

montelukast

14

alternate long-term controller medications besides inhaled steroids: COPD

- tiotropium
- ipratropium

15

alternate long-term controller medications besides inhaled steroids: high IgE levels, no control with cromolyn

omalizumab (anti-IgE Ab)

16

last resort for uncontrolled nonacute asthma (if still not controlled on SABA, inhaled steroids, and LABA)

PO steroids (many adverse effects)

17

treatment for exercise-induced asthma

inhaled bronchodilator BEFORE exercise

18

- long-term smoker
- increasing SOB
- decreasing exercise tolerance

COPD

19

treatment for acute exacerbation of COPD

- oxygen (NOT TOO MUCH)
- ABG
- CXR
- inhaled albuterol
- inhaled ipratropium
- steroid bolus (methylprednisolone)

20

what should be added in treatment for acute exacerbation of COPD, if fever, sputum, and/or new infiltrate is present on CXR?

ceftriaxone and azithromycin for CAP

21

management of COPD with mild respiratory acidosis

BiPAP or CPAP

22

COPD physical examination findings

- barrel-shaped chest
- clubbing of fingers
- increased AP diameter mf chest
- loud P2 heart sound (pulmonary HTN)
- edema (blood backing up d/t pulmonary HTN)

23

EKG findings in COPD

- right axis deviation (RAD)
- right ventricular hypertrophy (RVH)
- right atrial hypertrophy (RAH)

24

CXR findings in COPD

- flattening of diaphragm
- elongated heart
- substernal air trapping

25

CBC findings in COPD

- increased hematocrit (sign of chronic hypoxia)
- microcytic

26

chemistry finding in COPD

increased serum bicarbonate

27

mechanism of right heart enlargement in COPD

hypoxia = capillary constriction in lungs = diffuse vasoconstriction = increased pressure in RV and RA

28

expected PFT results in COPD

- decreased FEV1
- decreased FVC (loss of elastic recoil of lung)
- decreased FEV1/FVC ratio
- increased TLC (d/t air trapping)
- increased residual volume (RV)
- decreased diffusion capacity lung carbon monoxide (DLCO) (destruction of lung interstitium

29

chronic treatment for COPD

- tiotropium/ipratropium
- albuterol
- pneumococcal vaccine
- influenza vaccine
- smoking cessation
- long-term home O2

30

when is home oxygen indicated in COPD?

- pO2 less than 55
- oxygen saturation less than 88%