Term
| If a test question is asking restrictive or obstructive dz and you aren't sure, guess ____ |
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Definition
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Term
| Asthma and COPD are both restrictive/obstructive dz? |
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Definition
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Term
Definitions: PFTs
1) Total amount of air exhaled after maximal inspiration
2) Total volume of exhaled air in 1 sec
3) Normal FEV1/FVC ratio? |
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Definition
1) Forced vital capacity (FCV)
2) FVC1
3) 75-85% |
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Term
| How often to do PFTs for asthma and COPD? |
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Definition
asthma- q1-2 years
COPD: at least yearly |
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Term
| What to know about ABG analysis |
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Definition
1) Question prompt will typically clue you to respiratory or metabolic problem
2) Look at pH: if <7.35 = acidotic. If >7.45 = alkalotic |
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Term
ABG analysis:
1) caused by any process which decreases the ability of the lungs to exchange CO2 for O2, so Co2 builds up. Ex: COPD, asthma CHF< pneumonia
2) Caused by any process that increases respiratory rate (hyperventilation from fever, anxiety, mecchanical overventilation or PE) because CO2 is being blown off too quickly
3) Caused by any process that increases the acumulation of acids or decreases the amount of bicarb - DKA, renal failure
4) caused by any process that decreases acid or increases bicarb such as prolonged vomiting |
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Definition
1) respiratory acidosis
2) Respiratory alkalosis
3) metabolic acidosis
4) metabolic alkalosis |
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Term
| #1 cause of childhood hospitalization in Us |
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Definition
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Term
Asthma classifications
Intermittent
Mild persistent
Moderate persistent
severe persistetn |
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Definition
Intermittent: sx <2x/ wk and night time symptoms <2 days/month
Mild persistent: sx >2x/wk but <1/d and nighttime symptoms >2x/month
Moderate persistent: daily daytime symptoms, exacerbation >2x/wk, nighttime symptoms >1x/month AND some decline in lung function testing
severe persistent: continual daytime symptoms with limited physical activity, frequent exacerbations, and frequent noctunral symptoms AND decline in lung function |
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Term
| General asthma treatment algorithm |
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Definition
1) albuterol (SABA)
2) ICS +/- LABA
3) LABA (if you haven't already) - formoterol or salmeterol
4) Leukotriene modifier (monteleukast)
5) oral steroids for exacerbations
NEVER USE LABA w/o ICS |
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Term
| Asthma diagnostic workup in stable vs unstable pt |
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Definition
Stable:
PFTs before and after albuterol
Asthma = FEV1/FvC <70% and improved by albuterol
bronchoprovocation testing, if positive, indicates asthma (adminstration of methacholine)
Unstable pt: peak flow only (FEV1)
O2 sat, +/- ABGs |
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Term
| Non-medication strategies that should be initiated in all asthma pts (4) |
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Definition
1) remove offending agents - cat dander, tobacco smoke, etc
2) create asthma action plan
3) creat asthma control test (quick way to monitor control)
4) flu and both pneuomococcal vaccines |
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Term
COPD dx eval:
1) spirometry findings
2) CXR findings |
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Definition
1) Spirometry: FEV1/FVC <70 that DOES NOT imporve w/ albuterol
2) CXR: parenchymal bullae or blebs are pathognomonic. hyperinflation is common |
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Term
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Definition
1) albuterol (SAbA) or ipratroprium (sama) or combination (combivent)
2) LAMA (tiotropium) or LABA (salmeterol, formoterol) OR both
3) Add ICS
4) O2 (refer)
In COPD, CAN use LABA without ICS |
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Term
| multisystem autosomal recessive disorder that leads to abnormalities in membrane chloride channel (CFTR) which leads to altered chloride transport and water flux across epitheliasl cells. Ultimately causes progressive ung disease that leads to death. |
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Definition
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Term
| Extrapulmonary symptoms of CF |
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Definition
meconium ileus (virtually pathognomonic)
infant failure to thrive
pancreatic insufficiency/steatorrhea
infertility (men > women) |
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Term
| Most common lung pathogen in CF infections |
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Definition
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Term
CF:
1) diagnostic evaluation
2) Treatment |
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Definition
Eval:
1) Newborn screening (90-95% false positive rate)
2) Quantitative pilocarpine sweat test - positive if increased sodium and chloride levels
2) Tx: refer |
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Term
| Most common cuase of cancer related death in both sexes in US |
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Definition
| bronchgenic carcinoma (lung cancer) |
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Term
| Lung cancer screening recommendations |
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Definition
Low dose chest CT for patients 55-80 y/o who have smoked >30 pack years and either continue to smoke or have quit within the past 15 years.
--> has led to 20% decrease in mortality rate |
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Term
Types of lung cancer:
1) non-small cell. typically arises in peripheral location as a nodule or mass. more common in pt w/ underlying lung disease like COPD
2) non-small cell cancer that arises in central location. often bleeds, causing persistent cough, hemoptysis, recorruent penumonia.
3) AKA "oat cell carcinoma" - imaging typically reveals hilar mass |
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Definition
1) Adenocarcinoma
2) Squamous cell carcinoma
3) small cell |
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Term
| caused from intratoracic spread of a lung cancer- causes horners syndrome, rib destruction, and brachial plexopathy (bc it typically occurs in the apex of the lung) |
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Definition
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Term
Two paraneoplastic syndromes associated with lung cancer:
1) associated with squamous cell carcinomas. probably due to bony mets or production of PTHrP
2) associated wtih small cell cancer. due to ectopic production of anti-diurection hormones which leads to a decreased renal clearance of free water and subsequently a drop in serum sodium |
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Definition
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Term
| Most common secondary bacterial pneumonia associated with flu? |
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Definition
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Term
| 4 high risk groups when it comes to flu |
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Definition
1) young and old
2) cardiovascular disease
3) immunocompromised
4) morbidly obese |
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Term
Acute bronchitis:
1) How to differentiate viral vs bacterial?
2) How to differentiate from flu or pnuemonia?
3) how to differentiate from URI
4) when to do cxr
5) tx |
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Definition
1) viral (90% of cases) typically associated with nasal symptoms
2) fever should make you think flu or pneumonia
3) cannot be distinguished from URI in first few days. bronchitis is suggested if cough present for >5d
4) do CXR if sbnormal vitals or pulmonary exam fidnings
5) Tx: NOT abx. Do supportive care, cough suppressants. |
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Term
| Acute bronchitis in a COPD patient is typically caused by what organism? tx? |
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Definition
h. flu
tx: doxy, cefuroxime, or augmentin PLUS 5d of prednisone (longer courses no longer recommended) |
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Term
CAP:
1) most common organism in general population
2) most common organism in COPD
2) 3 atypical organisms
3) Think legionella when?
4) think mycoplasma when? |
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Definition
1) strep pneumoniae "gram positive diplococci"
2) H. Flu "gram neg bacillus"
2) Atypicals: legionella, mycoplasma, chlamydophila pneumoniae
3) Think legionella when prompt says pt has been aroudn a water source (hotel air conditioning, shower head). pt will typically have GI symptoms too (diarrhea), high fever, and appears much more ill than their evaluation would predict
4) Think mycoplasma when child or young adult presents w/ cough and extrapulmonary symptoms like joint pain and bullous myringitis |
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Term
| When a prompt discusses gram neg diplococci, think what two bacteria? |
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Definition
| M. catarrhalis and N. gonorrhea |
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Term
| CAP treatment outpt vs inpt |
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Definition
outpt:
doxy, azithromycin, or levaquin
inpt:
ceftriaxone + azithromycin
levaquin if B lactam allergy |
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Term
| Azithromycin is no longer suggested for routine use. what are some of its indications? |
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Definition
-CAP (but choose doxy if that's an option)
-H. pylori
-shigella (kids), campylobacter
-pertussis
-gonorrhea/chlamydia |
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Term
Common microscopy terms and their causative organisms:
1) Gram pos diplococci
2) gram neg diplococci
3) acid fast bacillus
4) gram + cocci in clusters
5) gram neg rods
6) spirochetes
7) positively birfringent crystals
8) needle shaped, negatively birefringent crystals
9) Caseating granulomas
10) non-caseating granuloma |
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Definition
1) gram pos diplo: Strep pneumo
2) gram neg diplo: N. gonorrhea, M. catarrhalis
3) acid fast bacillus: TB
4) gram + clusters: staph aureus
5) gram neg rods: e. coli and basically all diarrhea illnesses (shigella, salmonella, campylobacter, etc)
6) spirochetes: lyme, syphilis
7) positively birefringent: CPPD
8) needle shaped, neg birefringent: gout
9) caseating granulomas: TB
10) non-caseating granuloma: sarcoid |
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Term
Special types of TB:
1) skeletal (esp spine) lesions
2) progressive, widely disseminated hematogenous TB. may use term "buckshot" on imaging |
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Definition
1) Pott's disease
2) miliary TB |
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Term
TB skin testing:
1) + in immunosuppressed pt?
2) pt who's had recent contact w/ TB
3) Pt's who've arrived from high TB country, IVDUs, residents and workers of high-congregate settings (prisons, homeless shelters, etc), healthcare workers, kids, and high risk pts due to comborbidities
4) If no risk factors |
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Definition
1) immunosuppressed pt + if induration >5mm
2) recent contact pt + if induration >5mm
3) High risk pts: >10mm
4) no risk factors: >15mm |
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Term
| How to dx active vs latent TB? |
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Definition
Active TB if:
+CXR
sputum culture shows AFB
tissue bx shows caseating granulomas |
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Term
| always check for concomittant ____ in pt's with active TB |
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Definition
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Term
| On pleural fluid analysis, what is the one thing you should pay attention to to determine transudate v exudate |
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Definition
Protein >3g = exudate
Protein <3g = transudate
transudates are more common, generally guess that |
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Term
3 types of exudative pleural effusions
1) cholesterol accumulation. associated with lymphoma and thoracic surgery
2) direct infection of an exudate
3) blood in pleural space from trauma |
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Definition
| chylothorax, empyema, hemothorax |
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Term
| 90% of transudative pleural effusions are from? |
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Definition
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Term
| Tall, thin, male who is otherwise healthy but is a smoker comes in with chest pain and SOB. think? |
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Definition
| primary spontaneous pneumothorax |
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Term
| Most common cause of secondary spontaneous pneumothorax? |
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Definition
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Term
| Most common type of pneumothorax? |
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Definition
| iatrogenic (from thoracentesis, central line placement, CPR, etc) |
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Term
Pneumothorax treatment:
<___% --> rest, O2, supportive tx. f/u xray to ensure resolution
>___% --> decompression. usually chest tube. may need surgery |
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Definition
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Term
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Definition
Infers risk for clot:
hypercoagulable state
venous stasis
endothelial injury |
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Term
| A younger patient presents with DVT. they have a family hx of blood clots as well. what is the most common etiology? |
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Definition
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Term
VTE:
1) what is well's prediction rule for DVT?
2) best screening test
3) Gold standard test (but rarely done) |
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Definition
Well's prediction indications low or high risk DVT
Screening test: commpression US
Gold standard: venography |
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Term
What diagnostic findings in pt w/ DVT indicate PE?
1) EKG
2) CXR
3) ABG
What is the best diagnostic test to get?
What is the gold standard that is rarely done? |
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Definition
1) EKG: new onset sinus tachy, S1Q3T3 is classic finding (indicates strain)
2) CXR: atelectasis, parenchymal infiltrates, pleural effusion. Westermark's sign, Hamptom's hump
3) ABG - resp alkalosis due to hyperventilation
CT Pulmonary Artery is gold standard NOT V/Q scan
but don't do CT in pt's with renal failure or pregnancy
Gold standard: Pulmonary angiography |
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Term
| VTE prevention & treatment |
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Definition
Prevention: early ambulation, pneumatic compression devices, Lovenox
Treatment:
heparin or Lovenox immediately, then transition to warfarin for 3-12 months or oral anticoagulant like rivaroxaban |
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