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67 Cards in this Set

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