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Step 3- Pulmonary

Jaimie Shah Step 3 cards Inglés 79 fichas

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  1. 1signs of severe asthma exacerbationHyperventilation/increased RR, decreased Peak flow, Hypoxia, Resp acidosis (as resp muscles fatigue), possible absence of wheezing
  2. 2Asthma on PFTthis is done before and after bronchodilators, should see an increase of FEV1>12% at baseline
  3. 3best initial test to see if an asymptomatic patient has asthma?Methacholine challenge test
  4. 4what should all patient with SOB recieveO2, pulse ox, CXR, ABG
  5. 5initial tx of asthmaalbuterol, steroids, ipratropium, O2, Magnesium and send to ICU if starts to retain CO2
  6. 6Non acute asthma medicationsalbuterol, inhlated steroids, long acting beta agonist, oral steroids as a last result
  7. 7tx exercise induced asthmainhaled bronchodilator prior to exercise
  8. 8PFT in COPDdecreased FEV1, FVC, FEV1/FVC , increased TLC due to air trapping, residual volume, and decrease DLCO due to destruction of lung interstitum
  9. 9long term care of COPD patientsipratropium, long acting beta agonist, albuterol, Pnemoccoccal vaccine, flu vaccine, Smoking cessation, Home O2 if PO2<55 or O2 sat<88
  10. 10what reduces mortality in COPD patientssmoking cessation and home O2
  11. 11alpha 1 antitrypsin defpresents with COPD and Cirrhosis usu <40yo and nonsmoker and has bullae at bases of lung
  12. 12alpha 1 antitrypsin def dxCXR, blood tests indicate liver dz, alpha-1 antitrypsin levels are low, genetic testing
  13. 13alpha 1 antitrypsin def txalpha-1 antitrypsin infusion
  14. 14Bronchiectasis causecaused by anatomic defect of lungs usually from infection in childhood where there is profound dilation of bronchi
  15. 15bronchiectasis presentationchronic resolving and recurring episodes of lung infection, high volume of sputum, Hemoptysis and fever
  16. 16bronchiectasis dx and txCXR (tram tracking), most accurate test is CT; tx: no cure so treat infection, chest PT, rotating abx
  17. 17Abx that cause ILDBactrim and macrobid
  18. 18Cause of ILD with AsbestosAsbestosis
  19. 19Cause of ILD in glassworker, mining, sandblasting, brickyardsSilicosis
  20. 20ILD in a coal workerCoal worker pneumoconiosis
  21. 21ILD in cotton workersByssinosis
  22. 22ILD in electronics, ceramics, fluorescent, light bulbsBerylliosis
  23. 23ILD associated with mercuryPulmonary fibrosis
  24. 24ILD physical exam findingsVelcro rales, Loud P2 due to pulm HTN, clubbing (no fever or systemic findings unless PNA or bronchitis)
  25. 25ILD dx testingCXR, CT, EKG will show RA and RV enlargement, Lung bx, PFT
  26. 26PFT in ILDlow FEV1, FVC, increased FEV1/FVC ratio, decreased TLC, residual vol, DLCO
  27. 27most common lung cancer in asbestosislung cancer not mesothelioma
  28. 28Tx of ILDno spp tx, if inflammatory on bx can try steroids (really only berylliosis responds to steroids); there is def no therapy for silicosis, mercury fibrosis, asbestosis, or byssinosis
  29. 29BOOPrare bronchiolitis or inflammation of the small airways with a chronic alveolitis of uknown origin
  30. 30BOOP presentationsimilar to ILD but more acute over weeks to months, cough, rales, SOB, fever, malaise and myalgias, no occupational exposure in history
  31. 31BOOP dx and txCXR, CT, most accurate is open lung bx; tx is steroids
  32. 32difference between ILD and BOOPBOOP- has myalgias and malaise and fever, present over days to weeks, patchy infiltrates and steroids are effective; ILD- no fever, no myalgias, six mos, interstitial infiltrates, rarely responds to steroids
  33. 33Sarcoidosis presentationAA woman under 40, cough, SOB, fatigue, weeks to months, rales on PE, Uveitits, CN 7 involvement, Lupus pernio, erythema nodosum, RCM, Renal and liver dz w/o symps, Hypercalcemia
  34. 34Dx test of sarcoidosis and txbest initial test is CXR, Most accurate test is lung or lymph node bx, Ca/ACE levels elevated but not spp., BAL w/ increased helper cells; best tx is steroids
  35. 35Secondary causes of pulm HTNMS, COPD, Polycythemia vera, chronic pulm emboli, ILD
  36. 36PE of pulm HTNloud P2, TR, RV heave, Raynaud's
  37. 37Dx testing of Pulm HTNTTE, EKG, most accurate test is R heart cath with increased pulm artery pressure
  38. 38Tx of pulm HTNother than treating the cause and if idiopathic: bosentan (endothelin inhibitor), Epoprostenol/treprostinil (prostacyclin analog), CCB, Sildenafil (inhibits phosphodiesterase)
  39. 39RF of DVTimmobility, malignancy, trauma, surgery esp joint replacement, thrombophilia (factor 5, lupus anticoag, pro C and S def)
  40. 40dx test for PECXR, EKG, ABG
  41. 41Confirmatory testing of PEspiral CT (high spp), VQ scan (more sensitive-15% with low prob scan still have PE; and 15% with high prob scan dont have PE), LE doppler (sen of 70%), D dimer testing (done in pts with low prob of PE)
  42. 42Tx of PEHeparin and O2, coumadin for 6mos, IVC filter (if cant be anticoagulated), thrombolytics (if hypotension present)
  43. 43Pleural effusion dxinitially CXR decubitus films, Chest CT, most accurate thoracentesis
  44. 44Exudative fluid characteristicsseen in cancer and infection, Protein level high (>50% of serum level), LDH high (>60% of serum level)
  45. 45send the following on Pleural fluidgram stain and culture, AF stain, total protein in serum too, LDH in serum too, Glucose, Cell count w/ diff, TG, pH
  46. 46tx of pleural effusionsDiuretics if small and from CHF, Chest tube if larger and exudative, Pleurodesis if recurrent, if pleurodesis fails then decortication
  47. 47Sleep Polysomnography resultslooking for periods of >10seconds of apnea; Mild 5-20 periods an hour, severe is >30 periods an hour
  48. 48tx OSAweight loss, CPAP or BiPAP; if not good surgery to remove uvula, palate and pharynx can be done
  49. 49Tx of central sleep apneaavoid alcohol and sedative, may respond to acetazolmide (metabolic acidosis will drive breathing), medroxyprogesterone
  50. 50ABPA presentationasthamatic patient that worsens, cough up brown mucus plugs, peripheral eosinophilia, serum IGE is elevated
  51. 51ABPA dx and txSkin testing; measure IGE levels, precipitins, and A. fumigatus spp antibodies; tx- corticosteroids and if refractory dz itraconazole
  52. 52ARDS causessudden severe resp failure results in diffuse lung injury due to: sepsis, Aspiration, shock, infection, lung contusion, trauma, toxic inhalation, near drowning, Pacreatits, Burns
  53. 53ARDS dxCXR-diffuse patchy infiltrates, normal wedge pressure, PO2/FiO2 ratio<200 (room air 0.21)
  54. 54ARDS txventilatory support with low tidal vol (6ml/kg), PEEP to keep alveoli open, Prone positioning, possible diuretics, possible inotropes, put pt in ICU, steroids not effective
  55. 55hemodynamic measures in hypovolemialow CO, Low wedge pressure, High SVR
  56. 56hemodynamic measures in Cardiogenic shockCO is low, Wedge pressure high, SVR high
  57. 57hemodynamic measures in septic shockCO high, wedge pressure low, SVR low
  58. 58tx outpatient PNAMacrolide, fluoroquinolone
  59. 59treat inpatient PNAceftriaxone and azithromycin or fluoroquinolone as single agent
  60. 60tx of VA-PNAImipenem or meropenem, zosyn or cefepime; gentamicin; and vanc or linezolid
  61. 61PNA cause after recent viral illnessStaph
  62. 62PNA cause in alcoholicsKlebsiella
  63. 63PNA cause with GI symps and confusionlegionella
  64. 64PNA cause in young healthy personmycoplasma
  65. 65PNA cause in persons persent and birth of an animalCoxiella brunetii
  66. 66Cause of PNA in arizona Construction workersCoccidiodomycosis
  67. 67Cause of PNA in HIV with CD4<200PCP
  68. 68presentation of VAPfever, hypoxia, new infiltrate, increasing secretions
  69. 69Most accurate dx of PCPBAL
  70. 70TB presentationfever, cough, sputum, weight loss, night sweats.
  71. 71TB dx testsbest intial test is CXR, sputum and acid fast culture done to confirm
  72. 72Tx TBstart on four medications for 6 months: INH (6mo), Rifampin (6 months), Pyrazinamide for 2 months, Ethambutol for 2months.
  73. 73TB medication toxicityall cause liver toxicity and should be stopped if LFTs reach 5x ULN, INH-peripheral neuropathy, Rifampin-orange colored body secretion, Pyrazinamide- hyperuricemia, Ethambutol- optic neuritis
  74. 74Following conditions need tx for more than 6 monthsosteomyelitis, Meningitis, Miliary TB, Cavitary TB, Pregnancy
  75. 75Screening for TBuse the PPD test and if the test was done a while ago or never tested start with a two step PPD
  76. 76the test for Dx or confirmation of latent TBQuant gold blood test, there are no false positives with bHGG vaccine
  77. 77Both the PPD and IGA tell us whatneither tell us if there is active disease, they only indicate if positive that there is a 10% lifetime risk of TB
  78. 78what to do if PPD is positiveget a CXR then if abnormal check sputum and if positive start on a 4 drug course
  79. 79when is INH used aloneused if PPD is positive for 9 mos to lower risk of TB to 1%, but PPD should never be repeated again

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Step 3 cards Fichas sobre Step 3- Pulmonary, creado por Jaimie Shah el 14/09/2013.
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Jaimie Shah
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