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67 Cards in this Set
- Front
- Back
two measurements most often used in PFTs
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FEV1 and FVC
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FEV1/FVC ratio that indicates obstruction
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<70%
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FVC that suggests restrction
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<80%
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define hypoxia
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room air O2 sats <88% or PaO2 <55mmHg on ABG
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causes of hypoxia
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VQ mismatch, hypoventilation, decreased diffusion, high altitude, shunt
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These hypoxic conditions present with increased A-a gradient
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VQ mismatch, decreased diffusion, shunt physiology
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this hypoxic condition doesn't respond to O2 supplementation
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shunts
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these hypoxic conditions are associated with a very low DLCO
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decreased diffusion (interstitial or parenchymal liung diseases)
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treatment goals for hypoxic conditions
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O2 to maintain saturation >90% or PaO2 >60 mmHg
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most common cause of bronchiolitis (infants to 1 year old)
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RSV
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diagnosis of bronchiolitis
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hyperinflation on CXR, flattening of diaphragms, mild interstitial infiltrates; RSV with ELISA or fluorescent antibody test
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treatment of bronchiolitis
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supplemental O2, albuterol, ribavirin if severe RSV infection or with underlying cardiac / pulmo problems
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most common genetic disease in US among Caucasians
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CF
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transmission of CF
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aurosomal-recessive
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symptoms of CF
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recurrent pulmo infections, sinusitis, bronchiectasis, infertility or pancreatic insufficiency
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presentation of CF in infants
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meconium ileus or intussusception
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diagnosis of CF
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sweat chloride test (>60 mEq/L) confirmed on two different days
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treatment of CF
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nutritional, chest PT, bronchodilators, pancreatic enzymes, mucolytics (DNase) stool softeners
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antibiotic prophylaxis in CF?
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chronic and chronic intermittent oral antibiotics with azithro or inhaled tobramycin may be beneficial
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classic triad of atopy
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eczema, wheezing, seasonal rhinitis
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definitive diagnosis of asthma
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demonstration of obstruction on PFTs - reversibility with bronchodilators
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define reversibility in asthma
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with bronchodilators, increase in FEV1 or FVC by 12% and 200ml
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what to monitor in asthma treatment
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peak flows
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mainstay of treatment for COPD
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beta agonists and anticholinergics (albuterol and ipratropium)
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when to start O2 therapy in COPD
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O2 sats <88% or PaO2 <55mmHg; PaO2 55-60 + evidence of cor pulmonale; desaturations <88% during exercises or at night
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vaccinations for COPD patients
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yearly influenza and at least once for pneumococcal pneumonia
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define COPD in acute exacerbation
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increasing dyspnea or a change in cough or sputum production
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O2 sat goals in COPD
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90-95%
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what empiric antibiotics to start for COPD IAE
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to cover for strep, H influenza and moraxella (amox, TMP-SMZ, doxycycline, azithromycin, clarithromycin)
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when is thoracentesis indicated in pleural effusion
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if >10mm thick or about 100 ml
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indications for chest tube in pleural effusions
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pleural WBC >100,000 or frank pus; glucose <40 or pH <7.0
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cellular differential in pleural fluid shows lymphocytes, differentials?
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TB, sarcoid, malignancy
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cellular differential in pleural fluid shows PMNs, differentials?
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empyema, PE
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cellular differential in pleural fluid shows eosinophils, differentials?
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bleeding, pneumothoax
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what pH is complicated effusion or empyema
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<7.2
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diagnostic of chylothorax
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TG >150
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when is a chest tube insertion indicated in a pneumothorax?
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if >30%
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pharmacologic treatment of pneumothorax
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O2 fupplementation, morphine, NSAIDs
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differential for SOB / chest pain
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pneumothorax, MI, PE, dissection
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diagnostics for suspected tension pneumothorax
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none. don't wait for imaging, insert needle to decmopress, then insert chest tube
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PE findings in pulmonary embolism
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tachypnea, tachycardia, cyanosis, loud P2 or S2, increased JVP, signs of R-sided HF
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ABG fidnings in PE
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primary respiratory alkalosis, increased A-a gradient
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most common CXR findings in PE
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normal
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wedge-shaped infarct in CXR of patients with PE
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Hampton's hump
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oligemia in affected lobe seen in CXR of patients with PE
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Westermark's sign
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ECG findings in PE
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S in lead I, Q in lead III, T inversion in lead III
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gold standard for diagnosis of PE
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pulmonary angiography
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describe diagnostic approach to pulmo embo
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first do a VQ scan, if high prob, treat, if normal exclude. if intermediate, test for DVT; if positive treat, if negative do pulmo arteriogram or noninvasive test for DVT, if positive treat, if negative, excluded
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treatment of VTE
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IV heparin or LMWS, transition to warfarin with goal of INR of 2.0 to 3.0
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large central PEs adn hypotension or shock, treatment?
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administer tPA along with heparin
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duration of treatment for VTE
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first even with reversible or time-limited factors - 3-6 months; if with chronic risk factors - lifelong anticoagulation
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PaO2 / FiO2 ratio in ARDS
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<200
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diagnostic findings in ARDS
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diffuse bilateral pulmo infiltrates with pulmo edema on CXR without evidence of volume overload (normal PCWP)
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define a solitary pulmonary nodule
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radiodense lesion on chest imaging that is <3 cm in diameter, not associated with infiltrates, adenopathy or atelectasis
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risk factors for malignancy in solitary pulmonary nodules
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size >2cm, spiculation, upper lobe location, in patients who are smokers >30 y/o or with prior diagnosis of CA
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diagnosis / treatment of SPN
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examine old X-rays, lesions with >1 malig feature - do high resolution CT
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SPN, imaging shows probably malignancy; next step?
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biopsy via bronchoscopy, needle aspiration or VATS
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SPN, imaging shows probably not malignancy; next step?
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serial CXR every 3 months for 1 year then every 6 months for 1 year
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idiopathic illness characterized by formation of noncaseating granulomas in various organs
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sarcoidosis
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treatment of sarcoidosis
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systemic corticosteroids
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typical PE findings in OSA
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obese, hypertensive, large neck circumference, retrognathia, large tonsils, peripheral edema if severe
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gold standard for diagnosis of OSA
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overnight polysomnography or sleep study
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diagnostic of OSA
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AHI >5 (apnea-hypopnea index) or the number of apneas / hypopneas per hour of sleep
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most effective treatment of OSA
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CPAP
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treatments for OSA
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weight loss, CPAP, surgery
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surgical treatment of OSA
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uvulopalatopharyngoplasty or UPPP
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how effective is UPPP?
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40-50%
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