Pulmonary Step3
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Created by:
drperkins on July 26, 2009
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87 terms
Terms | Definitions |
|---|---|
 SOB c expiratory wheezes | asthma |
| most important features of severe asthma exacerbation | hyperventilation, inc rr, dec in peak flow, hypoxia, resp acidosis, possible absence of wheezing |
| Test for unclear asthma | PFT before and after inhales bronchodilators (inc FEV1 of >12%) |
| Test for asthma in asymptomatic pt | methacholine stim testing (dec in FEV1 = asthma) |
| Best initial tx for asthma pts | albuterol (no max dose), bolus of steroid (methyl prednisilone- takes 4-6 hrs), inhaled ipratropium, O2 |
| Asthma pt c resp acidosis c/CO2 retention | should be placed in ICU if resp acid persistent intubate and mech vent |
| Tx that have NO benefit in acute asthma exacerbation | theophyline, cromolyn nedocromil, montelukast, inhaled corticosteroids, omalizumab, salmeterol and long acting beta aonists, epinephrine sq, terbutaline |
| Tx of asthma in nonacute pts | inhaled bronchodilator, if not controlled ad chronic controller (inhaled steroid), in no help add long acting B-agonist (salmeterol), oral steroids used in last resort (due to SE) |
| Alt long-term controller med in pt c extensive allergies | cromolyn or nedocromil |
| Alt long-term controller med in pt c atopic dz | monteleukast |
| Alt long-term controller med in pt c COPD | tiotroprium, ipratropium |
| Alt long-term controller med in pt c high IgE levels | omalizumab (anti-IgE ABs) |
| chronic cough c sputum prod for >3mos @ least 2 str8 yrs | COPD |
| Acute episodes of SOB should be treated c | O2, ABG,CXR, albuterol, ipratropium, bolus of steroids (methyl prednisilone), phys exam, |
| Acute episodes of SOB c fever sputum and new infiltrate on CXR | add ceftriaxone and azithromycin for CAP |
| COPD pts often have chronic what | CO2 retention |
| When do you intubate a COPD pt | when there is a worsening drop in pH indicative of worsening resp acidosis |
| COPD physical findings | barrel-shaped chest, clubbing of fingers, edema |
| COPD lab test | EKG, CXR, CBC (inc hct), Chem7(inc bicarb),ABG (to assess CO2 retention) |
| PFT findings in COPD | dec FEV1, FVC, FEV1/FVC ratio, DLCO; Inc TLC and RV |
| Chronic med tx of COPD | tiotropium, ipratropium inhaler, albuterol inhaler, pneumococcal vac, influenza vac, smoking cessation, long term home O2 |
| when do you give home O2 in COPD pts | if pO2 <55 or O2 sat is < 88% |
| Genetic disorder that presents c combo of cirrhosis and COPD | alpha 1 antitrypsin def |
| sudden onset of SOB and clear lungs in pts c risk of DVT | PE |
| CXR in PE | normal |
| EKG in PE | sinus tachyc, MC abnorm (nonspecific S-T waves changes) |
| ABG in PE | hypoxia c inc A-a gradient and mild resp alkalosis |
| Confirm test for PE | Spiral CT (test of choice if CXR is abnorm), V/Q scan (CXR MUST be normal to be accurate), LE dopplers (excellent if pos), D-dimer (test in pts c low prob of PE in whom you want a single test to exclude PE) |
| Single most accurate test for PE | angiography (biggest prob is invasive) |
| TX of PE | heparin & O2 (standard of care), warfarin (used >6mo after heparin), venous interruption filter (placed in all pts c CI to anticoagulation), Thrombolytics (used in pts who are unstable) |
| Best initial test of pleural effusion | CXR (decubitus film c pt lying on one side; chest CT might add a bit more detail to CXR |
| Most accurate test of pleural effusion | thoracentesis |
| Lab findings for exudate (infex, cancer, inflam d/o) | protein level HIGH (>50% of serum level); LDH HIGH (>60% of serum level) |
| Lab findings for transudate (CHF) | protein level LOW (<50% serum level); LDH LOW (<60 %of serum level) |
| Test to order on pleural effusions | gram stain & cx, acid-fast stain, total protein, LDH, glucose, Cell ct/diff, triglycerides, pH |
| Tx of small Pleural effusion | small ones do not need tx but can use diuretics |
| tx of large pleural effusion | chest tube for drainage |
| tx of large recurrant pleural effusion | pleurodesis (infusion of irritant agent (bleomycin/talc to elim pleural space) |
| tx of large recurrant pleural effusion if initial tx fails | decortication (stripping off pleura from the lung) |
| Sudden severe resp failure syndrome | ARDS |
| What can bring about ARDS | sepsis, trauma, shock, infex, pancreatitis, burns |
| Dx for ARDS | CXR (diffuse patchy bilateral infiltrates), pO2/FIO2 < 200, normal wedge pressure |
| Tx of ARDS | vent support c low tidal vol, PEEP, prone position of body, diuretics and ionotrope (dobutamine), transfer pt to ICU |
| Swan-Ganz catheter: hypovolemia | CO: low; wedge pressure: low; SVR: high |
| Swan-Ganz catheter: cardiogenic shock | CO: low; wedge pressure: high; SVR: high |
| Swan-Ganz catheter: septic shock | CO: high; wedge pressure: low; SVR; very low |
| fever cough sputum prod | pneumonia |
| MCC of CAP | pneumococcus |
| MCC of hospital acquired | gram neg bacilli |
| Tx of outpt pneumo | macrolides (azithromycin, clarithromycin, doxycycline) or resp FQ (levofloxicin, gatifloxicin, moxifloxicin) |
| Tx of inpt pneumo | ceftriaxone & azithromycin; FQ (single agent) |
| Tx of vent-assoc pneumo | imipenem or meropenem, pipercillin/tazobactam or cefepime; Gentamycin and either vancomycin or linezolid |
| Specific Assoc c pneumo: recent viral syn | staphylococcus |
| Specific Assoc c pneumo: ETOH | Klebsiella |
| Specific Assoc c pneumo:GI symp & confusion | Legionella |
| Specific Assoc c pneumo:young, healthy pts | Mycoplasma |
| Specific Assoc c pneumo:animals | Coxiella burneti |
| Specific Assoc c pneumo: Az construction workes | Coccidiomycosis |
| Specific Assoc c pneumo: HIV c CD4 < 200 | PCP |
| fever cough sputum wt loss night sweats | TB |
| Dx for TB | CXR, sputum cx |
| Tx for TB | Isoniazid (6mo), Rifampin (6mo), Pyrizinamide (stop after 2mo), Ethmabutol (stop after 2mo) |
| When should TB tx stopped early | when liver transaminases is 5x the upper limit of normal |
| Latent TB is pos @ 5mm in pts who | close contacts to TB pts, steroid users, HIV pos |
| Latent TB is pos @ 10mm in pts who | homeless, immigrants, health care workers, ETOH, prisoners |
| Latent TB is pos @ 15mm in pts who | pts c no risk factors |
| If TB is pos in latent person | CXR, sputum stain (if CXR is abnormal), full dose 4-drug tx (if stain is pos) |
| What drug can be used alone to tx TB | Isoniazid |
| Criteria for mild intermittent asthma | asthma attack </= to 2x/wk or noct awakening </= 2x/mo |
| Criteria for mild persistent asthma | asthma attack >2x/wk but not daily or noct awakening >2x/mo |
| Criteria for mod persistent asthma | asthma attack daily but relief btw attacks c/B2 agonist or >1 noct awakening/wk |
| Criteria for sev persistent asthma | asthma attack c/continous symptoms c noct awakening freq (4-5x/wk) |
| Tx for mild intermittent asthma | short acting B2 agonist (albuterol) |
| Tx for mild persistent asthma | Daily inhaled LOW dose corticosteroid & B2 agonist |
| Tx for mod persistent asthma | Daily inhaled HIGH dose corticosteroid & Long acting B2 agonist (salmetrol) & short acting B2 agonist |
| Tx for sev persistent asthma | Oral corticosteroid & HIGH dose inhaled corticosteroid c/long acting B2 & short acting B2prn |
| PFT findings for bronchitis | FEV1/FVC dec, NO change c/albuterol, DLCO normal |
| PFT findings for COPD | FEV1/FVC dec, NO change c/albuterol, DLCO low |
| Tx for mild dz of CF | macrolides, tmp/smx, or ciprofloxacin |
| Tx for doc Pseudomonas or S. aureus in CF pts | pipercillin + tobramycin or ceftazidime |
| Tx in CF pts that have resistant pathogens | inhaled tobramycin |
| Abnormal perm enlargement of air spaces distal to term bronchiole c destruction | emphysema |
| tx of status asthmaticus | intubation, iv corticosteroids, ipratropium, albuterol |
| Tx of CF mild dz | ciprofloxacin + aerosolized Tobramycin |
| Tx of CF severe dz | IV tobramycin + ticarcillin or ceftazidime or imepenem |
| Tx of small cell ca | cisplatin + etoposide |
| Tx of non small cell ca | sx if CI: cisplatin + rad tx |
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