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Flashcards in Respiratory Deck (147):
1

oral temperature in patient breathing fast

inaccurate

2

asthma epidemiology

INCREASING
- incidence
- prevalence
- hospital admissions

3

best initial test in acute asthma exacerbation

PEF and ABG's

4

CXR in asthma

NORMAL

5

most accurate diagnosis of asthma

PFTs

6

when patient is asymptomatic and want to diagnose asthma

methacholine challenge test

7

CBC asthma

increase eosinophils

8

other random dx of asthma

skin testing and IgE levels

9

STEP 1 asthma tx

saba

10

STEP 2 asthma tx

+ low dose ICS or (cromolyn, theo, LTRA)

11

step 3 asthma tx

+ LABA
OR
INCREASE dose of ICS

12

step 4 asthma tx

saba + MAX dose ICS + LABA

13

step 5 asthma tx

+ omalizumab

14

step 6 asthma tx

ORAL steroids

15

adverse effects with zafirlukast

churg strauss

16

adverse effects with inhaled steroids

DYSPHONIA and oral candidiasis

17

anticholinergics in asthma

unknown use

18

best indication of asthma severity

RESPIRATORY RATE

19

PEF mainly based on....

HEIGHT, age
NOT weight

20

tx acute asthma exacerbation

- O2
- albuterol
- steroids
- epinephrine
- magnesium
- ICU--> resp acidosis-- intubation

21

acute asthma best....

epinephrine> albuterol> magneseium

22

best initial tests for dx COPD

CHEST XR: increase AP diameter and flat diaphragm

23

DLCO in COPD

decrease in emphysema
NOT in chronic bronchitis

24

reversibility- complete

bronchodilator response greater than 12% increase and 200mL increase in FEV1

25

dx of COPD

ABG: increase CO2, decrease O2
CBC: increase Hct
EKG: RA/RV hypertrophy and a.fib or MAT
ECHO: RA/RV hypertrophy and pulmonary HTN

26

MAT in COPD

multifocal atrial tachycardia

27

improving mortality in COPD

smoking cessation
O2 tx
influenza and pneumococcal vaccine

28

O2 use in COPD

O2 less than 55/ sat less than 88%

with pulmonary HTN/ high Hct/ cardiomyopathy:
O2 less than 60/ sat less than 90%

29

anticholinergics in COPD

YESS ARE EFFECTIVE-- no change in mortality

30

asthmatic not controlled with saba

ICS

31

COPD not controlled with saba

anticholinergic--> ICS

32

when medical tx fails in COPD

refer for transplantation

33

antibiotics for acute COPD exacerbation

macrolides: azithomycin, clarithromycin
cephalosporins: cefuroxime, cefixime, cefaclor, ceftibuten
co-amox
quinolones: levofloxacin, moxifloxacin, gemifloxacin

34

second line antibiotics in COPD

doxycycline
TMP/SMX

35

diagnosis of bronchiectasis

HRCT***** only way to diagnose

36

tx of bronchiectasis

physio
antibiotics-- as infection comes: INHALED cold ones, rotate 1 weekly antibiotics
surgical resection if focal

37

steroids for ABPA

ORAL not inhaled (since inhaled cannot get a big enough dose to be effective)

38

COPD with pneumonia

haemophilus influ

39

diabetic or alcoholic with pneumonia

klebsiella

40

poor dentition or aspiration pneumonia

anaerobes

41

hoarseness pneumonia

chalmydophila pneumoniae

42

animals at the time of giving birth pneumonia

coxiella burnetti

43

rigors in pneumonia

sign of bacteremia

44

chest pain in pneumonia

pleuritic-- PG's

45

foul smelling sputum pneumonia

anaerobes

46

dry cough, not severe,
bullous myringitis

mycoplasma pneumonia

47

dry pneumonia/ non productive

mycoplasma
viruses
coxiella
pneumocystis
chalmydia

48

best diagnosis for pneumonia

CXR, sputum cultures= USELESS-- since often cannot detect organism

49

first chest X ray for pneumonia

can be falsely negative in 10-20% of cases

50

sputum grain stain adequate if....

- more than 25 WBC's
- fewer than 10 epithelial cells

51

blood cultures for pneumonia

positive in 5-15% cases of CAP-- esp with s. pneumonia

52

dx of pneumonia from hx/exam alone?

NNNNOOOOOO

53

tests done in pneumonia with severe disease, and unknown aetiology, or not responding to tx

1. thoracocentesis
2. empyema
3. bronchoscopy

54

thoracocentesis in pneumonia

- pleural effusion analysis
- or if empyema

55

empyema in pneumonia

LDH above 60%
protein above 50% of serum level
WCC above 1000
pH less than 7.2

56

bronchoscopy in CAP

RARE-- in ICU

57

dx of mycoplasma pneumonia

- PCR
- cold agglutinins
- serology
- culture special media

58

dx chlamydophila pneumoniae

- rising serologic titers

59

dx legionella

- urine antigen
- culture on charcoal yeast extract

60

dx chlamydia pstiacci or coxiella

- rising serologic titers

61

dx PCP

- BAL

62

treatment CAP based on....

SEVERITY OF DISEASE more nb than the cause

63

outpatient tx CAP

previously health or no antibiotics in past 3 months and mild symptoms
= MACROLIDE or DOXYCYCLINE

comorbidities or antibiotics in past 3 months
= LEVOFLOXACIN or MOXIFLOXACIN

64

inpatient tx CAP

LEVOFLOXACIN or MOXIFLOXACIN
or
CEFTRIAXONE + AZITHROMYCIN

65

single factors= reason to hospitalize a patient

HYPOxia

HYPOtension

66

CURB-65

confusion
Urea: BUN above 30, sodium less than 130, glucose above 250
Resp rate: above 30, pO2 less than 60, pH less than 7.35
BP: bp below 90mmHg

pulse above 125/minute
temperature above 104 farenheit
age: older than 65, or comorbifities: cancer, COPD, CHF, renal failure, liver disease

67

empyema tx

placement of chest tube for suction

68

HCW need PCV vaccine?

NOOOOPE

69

tx of HAP

antipseudomonal cephalosporin: cefepime, ceftazidime
OR
antipseudomonal penicillin: piperacillin/tazo
OR
carbapenems: mero/imi/doripenem

70

dx of VAP, easiest/least accurate--> dangerous/most accurate

1. tracheal aspirate
2. BAL
3. protected brush specimen
4. video-assisted thoracoscopy
5. open lung biopsy

71

tx of VAP

3 different drugs:
1. antipseudomonal beta lactam= tx of HAP
2. second antipseudomonal:
- gentamicin/tobramycin/amikacin
- ciprofloxacin or levofloxacin
3. MRSA
- vancomycin
- linezolid

72

daptomycin for lungs?

NOOOOO, since inactivated by surfactant

73

culturing endotracheal tube

contamination

74

aspiration pneumonia

lying flat, upper lobes

75

sputum culture for lung abscess

NOOOpe, because has anaerobes anyways

76

tx of lung abscess

clindamycin or penicillin

77

PCP always has elevated

LDH

78

negative sputum stain, best diagnostic test...

BRONCHOSCOPY

79

tx PCP and prophylaxis

TMP/SMX

80

severe PCP

pO2 less than 70
A-a gradient above 35

81

what tx for severe PCP

ADD STEROIDS -- decreases mortality

82

toxicity from TMP/SMX switch to

clindamycin + primaquine
OR
pentamidine

83

when to start PCP prophylaxis

CD4 less than 200

84

rash or neutropenia from TMP/SMX prophylaxis give....

atovaquone
OR
dapsone (not if G6PD)

85

CD4 below 50, what additional prophylaxis

ATYPICAL mycobacteria-- azithromycin

86

when to stop prophylaxis of PCP

when CD4 greater than 200 for several months

87

dx of TB must include...

1. clear risk factor
2. cavity CXR
3. positive smear (done 3 times)

88

when to use ripE (ethambutol)

when beginning tx and know that it is SENSITIVE to ALL TB meds

89

side effect of pyrazinamide

hyperuricemia

90

ethabutol, mgmt adjustments

decrease dose in renal failure

91

how to decrease risk of TB constrictive pericarditis

STEROIDS

92

pregnant patients, antibiotic for TB they shouldn't receive

PYRAZINAMIDE
(side note: cannot also receive streptomycin)

93

once the PPD test is positive....

it will always be positive in the future

94

BCG and PPD

has no effect on recomendations

95

PPD positive whether or not had BCG

MUST take INH 9mos

96

benign solitary nodule

- less than 30
- no change in size
- nonsmoker
- smooth borders
- less than 1 cm
- normal lung
- no adenopatthy
- dense, central calcification
- normal PET scan

97

malignant solitary nodule

- older than 40
- enlarging
- smoker
- spiculated
- large great than 2 cm
- atelectasis
- yes adenopathy
- sparse, eccentric calcification
- abnormal PET scan

98

what to do if nodule is enlarging

BIOPSY

99

for high probability lesions best answer

RESECTION

100

intermediate probability lesions

BRONCHOSCOPY- central
or TRANSTHORACIC NEEDLE BX- peripheral

101

sputum cytology positive, next appropriate mgmt

RESECTION-- since highly specific

102

most common adverse effect of transthoracic bx

pneumothorax

103

PET scan for lung cancer

content of lesion is malignant, most accurate if lesion GREATER THAN 1cm

104

VATS

MOST specific MOST sensitive

105

byssinosis

cotton

106

bagassosis

moldy sugar cane

107

best test for ILD

HRCT

108

DLCO ILD

DECREASED

109

dx of sarcoidosis, best initial test

CXR-- HILAR ADENOPATHY

110

most accurate dx of sarcoidosis

bx

111

additional things for dx of sarcoidosis

ACE elevated
hypercalcemia
hypercalciuria
PFT--ILD

112

HY-- BAL in sarcoidosis

ELEVATED helper cells

113

CXR PE

NORMAL usually

114

most common CXR abnormalitiy PE

ATELECTASIS

115

most common EKG finding for PE

nonspecific ST-T wave changes

116

ABG in PE-- highly suggestive

hypoxia
resp alkalosis

117

when hx and initial labs very suggestive of PE....

START TREATMENT

118

gold std dx of PE

spiral ct SCAN

119

V/Q scan low probability

15% can have a clot

120

V/Q scan high probability

15% won't have a clot

121

V/Q first only in

pregnancy

122

D-DIMER

screening-- sensitivity
not specific

123

positive D-dimer

doesn't mean anything

124

negative D-dimer

EXCLUDES PE

125

for VQ to have any accuracy must have

normal CXR

126

abnormal CXR PE

do CT

127

LL Doppler study

good test if ? V/Q and ? spiral CT

128

angiography in PE

NOOOOOO RARELY done

129

IVC filter

contraindications to anticoagulants
recurent emboli on therapeutic warfarin
RV dysfunction- enlarged RV-- could have embolus

130

HIT alternative in PE

fondaprinaux

131

thrombolytics in PE

hemodynamically unstable
acute RV dysfunction

132

best initial tests in pulmonary HTN

CXR/ CT: narrowing/pruning of distal vessels

133

most accurate test in pulmonary HTN

R heart or swan ganz catheter

134

EKG in pulmonary HTN

RA/RV hypertrophy and R axis deviation

135

ECHO in pulmonary HTN

RA/RV hypertrophy, doppler estimates pulmonary artery pressure

136

only cure for pulmonary HTN

LUNG TRANSPLANT

137

sleep apnea and increased bicarb

OBESITY/HYPOVENTILATION SYNDROME

138

most accurate test OSA

polysomnography (sleep study)

139

tx of osa

weight loss
CPAP

140

CT ARDS

air bronchograms

141

ARDS definition

p02/FI02 below 300

142

moderately severe ARDS

p02/FI02 below 200

143

severe ARDS

p02/FI02 below 100

144

calculation: p02= 70, FI02=50% oxygen

70/0.5= 140

145

before starting treatment with PEEP

DECREASE FI02 (since above 50% FI02 is toxic to lungs)

146

tx of ARDS

6ml per kg of tidal volume
STEROIDS NOT BENEFICIAL
Tx underlying cause

147

maintain plateau pressure for ARDS

less than 30cm of water