209022
Description
Flashcards by Jaimie Shah, updated more than 1 year ago
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Created by Jaimie Shah
over 10 years ago
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| Question | Answer |
| signs of severe asthma exacerbation | Hyperventilation/increased RR, decreased Peak flow, Hypoxia, Resp acidosis (as resp muscles fatigue), possible absence of wheezing |
| Asthma on PFT | this is done before and after bronchodilators, should see an increase of FEV1>12% at baseline |
| best initial test to see if an asymptomatic patient has asthma? | Methacholine challenge test |
| what should all patient with SOB recieve | O2, pulse ox, CXR, ABG |
| initial tx of asthma | albuterol, steroids, ipratropium, O2, Magnesium and send to ICU if starts to retain CO2 |
| Non acute asthma medications | albuterol, inhlated steroids, long acting beta agonist, oral steroids as a last result |
| tx exercise induced asthma | inhaled bronchodilator prior to exercise |
| PFT in COPD | decreased FEV1, FVC, FEV1/FVC , increased TLC due to air trapping, residual volume, and decrease DLCO due to destruction of lung interstitum |
| long term care of COPD patients | ipratropium, long acting beta agonist, albuterol, Pnemoccoccal vaccine, flu vaccine, Smoking cessation, Home O2 if PO2<55 or O2 sat<88 |
| what reduces mortality in COPD patients | smoking cessation and home O2 |
| alpha 1 antitrypsin def | presents with COPD and Cirrhosis usu <40yo and nonsmoker and has bullae at bases of lung |
| alpha 1 antitrypsin def dx | CXR, blood tests indicate liver dz, alpha-1 antitrypsin levels are low, genetic testing |
| alpha 1 antitrypsin def tx | alpha-1 antitrypsin infusion |
| Bronchiectasis cause | caused by anatomic defect of lungs usually from infection in childhood where there is profound dilation of bronchi |
| bronchiectasis presentation | chronic resolving and recurring episodes of lung infection, high volume of sputum, Hemoptysis and fever |
| bronchiectasis dx and tx | CXR (tram tracking), most accurate test is CT; tx: no cure so treat infection, chest PT, rotating abx |
| Abx that cause ILD | Bactrim and macrobid |
| Cause of ILD with Asbestos | Asbestosis |
| Cause of ILD in glassworker, mining, sandblasting, brickyards | Silicosis |
| ILD in a coal worker | Coal worker pneumoconiosis |
| ILD in cotton workers | Byssinosis |
| ILD in electronics, ceramics, fluorescent, light bulbs | Berylliosis |
| ILD associated with mercury | Pulmonary fibrosis |
| ILD physical exam findings | Velcro rales, Loud P2 due to pulm HTN, clubbing (no fever or systemic findings unless PNA or bronchitis) |
| ILD dx testing | CXR, CT, EKG will show RA and RV enlargement, Lung bx, PFT |
| PFT in ILD | low FEV1, FVC, increased FEV1/FVC ratio, decreased TLC, residual vol, DLCO |
| most common lung cancer in asbestosis | lung cancer not mesothelioma |
| Tx of ILD | no 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 |
| BOOP | rare bronchiolitis or inflammation of the small airways with a chronic alveolitis of uknown origin |
| BOOP presentation | similar to ILD but more acute over weeks to months, cough, rales, SOB, fever, malaise and myalgias, no occupational exposure in history |
| BOOP dx and tx | CXR, CT, most accurate is open lung bx; tx is steroids |
| difference between ILD and BOOP | BOOP- 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 |
| Sarcoidosis presentation | AA 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 |
| Dx test of sarcoidosis and tx | best 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 |
| Secondary causes of pulm HTN | MS, COPD, Polycythemia vera, chronic pulm emboli, ILD |
| PE of pulm HTN | loud P2, TR, RV heave, Raynaud's |
| Dx testing of Pulm HTN | TTE, EKG, most accurate test is R heart cath with increased pulm artery pressure |
| Tx of pulm HTN | other than treating the cause and if idiopathic: bosentan (endothelin inhibitor), Epoprostenol/treprostinil (prostacyclin analog), CCB, Sildenafil (inhibits phosphodiesterase) |
| RF of DVT | immobility, malignancy, trauma, surgery esp joint replacement, thrombophilia (factor 5, lupus anticoag, pro C and S def) |
| dx test for PE | CXR, EKG, ABG |
| Confirmatory testing of PE | spiral 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) |
| Tx of PE | Heparin and O2, coumadin for 6mos, IVC filter (if cant be anticoagulated), thrombolytics (if hypotension present) |
| Pleural effusion dx | initially CXR decubitus films, Chest CT, most accurate thoracentesis |
| Exudative fluid characteristics | seen in cancer and infection, Protein level high (>50% of serum level), LDH high (>60% of serum level) |
| send the following on Pleural fluid | gram stain and culture, AF stain, total protein in serum too, LDH in serum too, Glucose, Cell count w/ diff, TG, pH |
| tx of pleural effusions | Diuretics if small and from CHF, Chest tube if larger and exudative, Pleurodesis if recurrent, if pleurodesis fails then decortication |
| Sleep Polysomnography results | looking for periods of >10seconds of apnea; Mild 5-20 periods an hour, severe is >30 periods an hour |
| tx OSA | weight loss, CPAP or BiPAP; if not good surgery to remove uvula, palate and pharynx can be done |
| Tx of central sleep apnea | avoid alcohol and sedative, may respond to acetazolmide (metabolic acidosis will drive breathing), medroxyprogesterone |
| ABPA presentation | asthamatic patient that worsens, cough up brown mucus plugs, peripheral eosinophilia, serum IGE is elevated |
| ABPA dx and tx | Skin testing; measure IGE levels, precipitins, and A. fumigatus spp antibodies; tx- corticosteroids and if refractory dz itraconazole |
| ARDS causes | sudden severe resp failure results in diffuse lung injury due to: sepsis, Aspiration, shock, infection, lung contusion, trauma, toxic inhalation, near drowning, Pacreatits, Burns |
| ARDS dx | CXR-diffuse patchy infiltrates, normal wedge pressure, PO2/FiO2 ratio<200 (room air 0.21) |
| ARDS tx | ventilatory 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 |
| hemodynamic measures in hypovolemia | low CO, Low wedge pressure, High SVR |
| hemodynamic measures in Cardiogenic shock | CO is low, Wedge pressure high, SVR high |
| hemodynamic measures in septic shock | CO high, wedge pressure low, SVR low |
| tx outpatient PNA | Macrolide, fluoroquinolone |
| treat inpatient PNA | ceftriaxone and azithromycin or fluoroquinolone as single agent |
| tx of VA-PNA | Imipenem or meropenem, zosyn or cefepime; gentamicin; and vanc or linezolid |
| PNA cause after recent viral illness | Staph |
| PNA cause in alcoholics | Klebsiella |
| PNA cause with GI symps and confusion | legionella |
| PNA cause in young healthy person | mycoplasma |
| PNA cause in persons persent and birth of an animal | Coxiella brunetii |
| Cause of PNA in arizona Construction workers | Coccidiodomycosis |
| Cause of PNA in HIV with CD4<200 | PCP |
| presentation of VAP | fever, hypoxia, new infiltrate, increasing secretions |
| Most accurate dx of PCP | BAL |
| TB presentation | fever, cough, sputum, weight loss, night sweats. |
| TB dx tests | best intial test is CXR, sputum and acid fast culture done to confirm |
| Tx TB | start on four medications for 6 months: INH (6mo), Rifampin (6 months), Pyrazinamide for 2 months, Ethambutol for 2months. |
| TB medication toxicity | all 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 |
| Following conditions need tx for more than 6 months | osteomyelitis, Meningitis, Miliary TB, Cavitary TB, Pregnancy |
| Screening for TB | use the PPD test and if the test was done a while ago or never tested start with a two step PPD |
| the test for Dx or confirmation of latent TB | Quant gold blood test, there are no false positives with bHGG vaccine |
| Both the PPD and IGA tell us what | neither tell us if there is active disease, they only indicate if positive that there is a 10% lifetime risk of TB |
| what to do if PPD is positive | get a CXR then if abnormal check sputum and if positive start on a 4 drug course |
| when is INH used alone | used 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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