Step 3- Pulmonary

Frage	Antworten
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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	Erstellt von Jaimie Shah vor etwa 11 Jahre