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55 Cards in this Set
- Front
- Back
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What is the normal A-a gradient? What causes false-normal and increased gradient?
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Normal: 5-15
False normal: Hyperventilation, high altitude Increased: PE, pulmonary edema, R to L shunts |
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Which antibiotics are used to treat pharyngitis?
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If streptococcal, Beta lactams
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Which organisms cause sinusitis (4) and what is the treatment?
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Viral
Strep pneumoniae H. influenza Moraxella catarrhalis Treatment: Amoxicillin |
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First and most accurate tests for acute asthma exacerbation
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First - Peak expiratory flow or ABG
Accurate - PFTs (decreased FEV1 with methacoline; can't do when patient is actively SOB) |
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What determines the severity of an asthma exacerbation (2)?
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Decreased PEF (FVC normalized to height and age)
ABG with increased A-a gradient |
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Beclomethasone, fluticasone - drug class and side effects
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Inhaled corticosteroids
Side effects: Dysphonia Oral candidiasis |
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Side effects of systemic corticosteroids (6)
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Osteoporosis
Cataracts Hyperglycemia, hyperlipidemia Adrenal suppression Fat redistribution, acne, hirsutism Thin skin, striae, easy bruising |
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Initial treatment for acute asthma exacerbation
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Oxygen
Albuterol Steroid bolus |
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First and most accurate tests for COPD
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First - CXR (increased AP diameter, air trapping, flattened diaphragm)
Most accurate - PFT (Increased TLC, decreased DLCO) |
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EKG and echocardiogram findings in COPD
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EKG
Right atrial and ventricular hypertrophy Afib or MAT Echo Right atrial and ventricular hypertrophy Pulmonary HTN |
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Treatment for COPD that improves mortality and disease progression (3)
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Smoking cessation
Oxygen therapy if pO2 <55 or O2 sat < 88% (pO2 cutoff is 60 in patients with pulmonary HTN, high HCT, or cardiomyopathy) Influenza and pneomococcal vaccines |
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Treatment for COPD that only improves symptoms (5)
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*Anticholinergics (ipratropium)
Short acting beta agonist (albuterol) Inhaled steroids Long acting beta agonists (salmeterol) Pulmonary rehab |
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Pink puffer vs. blue bloater
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Pink puffers: Emphysema because of pursed-lip breathing, dyspnea, and barrel chest
Blue bloaters: Chronic bronchitis bc cor pulmonale causes cyanosis and peripheral edema |
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Which pneumonias present with dry cough and what are the CXR results?
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Viral
Mycoplasma Pneumocystis jirovecci Chlamidophila CXR=bilateral interstitial infiltrates |
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Empiric treatments for pneumonia
Healthy patients, no abx for 3 mos Comorbidities, or abx within 3 mos Inpatient |
Healthy patients, no abx for 3 mos: Macrolide (mycin) or doxycycline
Comorbidities, or abx within 3 mos Inpatient: Respiratory fluoroquinolon (floxacin) or ceftriaxone and azithromycin |
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Exudate vs. transudate in pleural effusion
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Transudate: CHF, hypoalbumin (cirrhosis), kidney disease
Exudate: Infection, cancer, PE, vasculitis - Protein fluid:serum > 0.5 - LDH fluid:serum > 0.6 - Pleural fluid LDH > 1.5 times upper limit of normal pH<7.2 and glucose <60 - Complicated parapneumatic, rheumatic disease, drug-induced lupus, TB, cancer |
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Criteria for hospital admission in patient w/ pneumonia
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CURB65
Confusion Uremia Respiratory distress BP low Age >65 |
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Combination therapy for TB
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RIPE
Rifampin Isoniazid Pyrazinamide Ethambutol |
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Most accurate test for CF
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Chloride sweat test
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Treatment for allergic bronchopulmonary aspergillosis
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Oral steroids (not inhaled), can use itraconazole for recurrent episodes
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Treatment for hospital acquired pneumonia
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Piperacillin/tazobactam
Carbapenems Cephalosporins |
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Treatment for aspiration pneumonia (3)
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Combine 3:
First drug: - Piperacillin/tazobactam -Carbapenem -Cephalosporin Second drug: -Aminoglycoside -Fluoroquinolone (cipro- or levo-floxacin) Third drug: -Vancomycin or linezolid |
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How to test for TB in a patient with symptoms or abnormal CXR
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Sputum acid fast stain (PPD and CXR not helpful)
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What are the blood cell changes with glucocorticoids
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Increased neutrophils - increasing release from bone marrow and mobilizing the marginated pool
(eosinophils and lymphocytes are decreased) |
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Symptoms of theophylline toxicity
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CNS - Headache, insomnia, seizures
GI - Nausea, vomiting |
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Aspirin sensitivity syndrome
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Nasal polyps, episodic bronchoconstriction
Pseudo-allergic reaction Treatment: Leukotriene receptor antagonist (Zifirlukast, ziluteon) |
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Pancoast syndrome
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Tumor at lung apex compresses the brachial plexus, causing shoulder pain radiating to the arm in an ulnar distribution
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Treatment for ARDS
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Mechanical ventilation with low tidal volume, FiO2<40%, and PEEP
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Causes of ARDS
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ARDS
Aspiration, acute pancreatitis, air or amniotic embolism Radiation Drug overdose, diffuse lung disease, drowning Shock, sepsis, smoke inhalation |
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Most common type of lung cancer in non-smokers
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Adenocarcinoma
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SVC synrdrome
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Obstruction of venous return to SVC, causing head swelling and CNS symptoms
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H/P of goodpasture's disease
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Hemoptysis
Renal disease |
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Diagnosis and treatment of Goodpasture's
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Dx: Renal biopsy shoing linear anti-GBM IgG
Treatment: Plasmapheresis, corticosteroids, immunosupression |
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Most common adverse effect of inhaled corticosteroids
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Oral candidiasis (thrush)
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Most common cancer associated with asbestosis
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Bronchogenic carcinoma (next is mesothelioma)
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Unique finding on imaging in asbestosis vs. other restrictive lung diseases
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Pleural plaques/linear fibrosis
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Most common source of PE
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Proximal deep leg veins - Iliac, femoral, popliteal
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H/P of sarcoidosis
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Dyspnea, dry cough with dry rales on exam
Bilteral hilar lymphadenopathy and diffuse interstitial infiltrates Erythema nodosum Uveitis |
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Initial and most accurate test for sarcoidosis
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Initial - CXR
Most accurate - lymph node biopsy showing non-caseating granulomas (also have high ACE levels) |
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Treatment for sarcoidosis
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Prednisone (if symptomatic)
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New onset left vs. right BBB?
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New RBBB = Pulmonary embolism
LBBB = MI |
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What condition presents with pleural based wedge shaped density of chest CT?
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Pulmonary embolism
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This chart -->
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Definitive diagnostic test and treatment for legionella
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Urine antigen testing or culture on charcoal agar
Treatment: Macrolide or fluoroquinolone |
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Initial diagnostic tests for PE (3) and their findings
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CXR - Usually normal, wedge shaped pleural infart or infarction of one lobe
EKG - Most common is non-specific ST-T wave changes, usually accompanied by sinus tachycardia ABG - High pH, low PCO2 |
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Presentation of restrictive lung disease
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Dyspnea on exertion
Fine rales or crackles Loud P2 Clubbing |
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Initial and most accurate test for interstitial lung disease
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Initial - CXR
Most accurate - lung biopsy |
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Treatment for acute PE
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Start warfarin and heparin, d/c heparin after 5 days if INR is therapeutic (2-3), then continue warfarin for 6 mos for 1st time clot, lifetime if second episode
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What are the only 2 causes of hypoxemia that does not correct with supplemental oxygen?
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Shunt (Intracardiac or ARDS)
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What are the values of FEV1 and FEV1/FVC ratio:
Normal? Obstructive disease? Restrictive disease? |
Normal:
Between 80 and 120 Obstructive - FEV1: Decreased FEV1/FVC: Decreased Restrictive - FEV1: Decreased FEV1/FVC: Normal or increased |
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Which lung cancer is associated with PTHrp
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Squamous cell carcinoma
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Yellowish exudative pleural effusion with lots of lymphocytes, very high protein and glucose levels only slightly below blood glucose
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Tuberculosis
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Purulent exudative pleural effusion with very low glucose and lots of neutrophils
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empyema
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What does the ABG show in COPD vs. CHF
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COPD: Respiratory acidosis with low PO2 and high PCO2
CHF: Respiratory alkalosis with low PO2 and low PCO2 |
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What is the difference between malingering and factitious disorder?
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Malingering want secondary gain
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