STEP 2 Pulmonary

zomovefa's version from 2018-07-09 06:52


Question Answer
Pulmonary function tests reasonsDx obstructive vs restrictive, Disease severity pre-op, Post treatment evaluation
Methacholine challenge testNormal PFTs pts get one to find out if pt has asthma, Positive test->20% decrease
Bronchodilator reversibilityGive b agonist -> if pt sx decrease then asthma if not then COPD
Fixed obstruction in lung flow volume loopLung tumor, tracheal stenosis
Oxygen delivery most important factors are?CO & hemoglobin
A-a gradientAlveoli & arterial difference in oxygen -> 5-15 normal -> 15+ pulmonary embolism or diffusion problem -> -5 think of respiratory depression
Pulmonary nodules management1. Look at old xray first 2 Low risk or high risk(smoker,40+yrs old) 3.
Pulmonary nodules low risk vs High risk?Follow up with chest x-ray Q 3 months for 2 years VS Open lung biopsy and remove nodule
Pleural effusion in lungs, what is the first thing to do?Tap the fluid to see what it is -> Thoracentesis
Thoracentesis?Ultrasound guided now a days
Pleural effusion exudate management?Further workup -> Treat the cause cancer, infection, collagen disease, PE, TB-> LDH-200+, LDH EFFUSION/SERUM-0.6+, LDH protein effusion/serum- 0.5+
Pleural effusion transudate management?CHF, Nephrotic, liver disease low protein / Systemic issue
Pulmonary embolism cause what kind of pleural effusion?Both transudate and exudate effusion
Parapneumonic effusion?Bacterial Pneumonia -> S.pneumo
Hemorrhagic effusionTrauma, Cancer
Lymphocytic exudative effusionPleural TB
Corticosteroids takes how long to act?24hrs
Asthma conceptsReversibility, Episodic, History of early onset, Most common causes -> Viral Infections, Drugs such as beta antagonists, Exercise
What drugs to avoid in asthma pts?Aspirin or NSAIDS
Nocturnal coughGERD, Post nasal drip, Asthma
Asthma acute dx?ABG, Chest xray(any sort of effusions or infections), Pulse oximeter
Asthma chronic dx?PFTs to confirm diagnosis, Methacholine challenge(If PFT is normal), Peripheral esoinophilia
Asthma acute tx?Oxygen, Beta agonists-short acting, Albuterol, SteroidSpurt (Iv first then oral )
Asthma Chronic tx?Daily inhaled steroids(candida,long term cataracts -> wash mouth after use), Beta agonists as needed
Long acting beta agonists in asthma?When short term or steroids do not work in the setting of nocturnal asthma -> Salmaterol
Long acting beta agonists contraindicated in?Acute asthma and to be used alone (used with steroids)
Asthma worse prognosis?Acidemia or high pco2
Emphysema & chronic bronchitis VS AsthmaPermanent non reversible with no inflammation VS Reversible with inflammation
Facial plethora sx in COPD pt is due toChronic hypoxia leading to High epo production -> secondary ploycythemia
COPD PT testingChest xray -> hyperinflated lungs, flattened diaphragm, slender heart / ABG -> Hypercapnia, hypoxemia / Labs -> Polycythemia
COPD Chronic Management?Anticholinergic-. Ipratropium(bronchodilator), Beta agonists -> Avoid acting long acting ones / Theophyline ONLY if tx is no sufficient
COPD Increase survivalStop smoking, Home 02 supplementation, Vaccines ->Influenza, Pneumococcal, H.Influenza
COPD Acute management?90% O2 supplementation , Bronchodilators, Systemic corticosteroids, Antibiotics despite normal xray -> Macrolides, cephalosporins, fluoroquinolones
Bronchiectasis dxChest xray, High resolution CT(BEST non-invasive test)
Bronchiectasis tx ACUTEAntibiotics
Bronchiectasis tx CHRONICBronchodilators, Chest physical therapy, Postural drainage, Antibiotics, Vaccinations, Surgery of localized disease
Cephalosporins do not coverPseudomonas
Interstitial Lung diseaseChronic iNflammation -> Fibrosis Of interstitium, Gas exchange is disrupted, Hypoxemia,
Restrictive with normal DLcoObesity or Kyphoscoliosis, Myasthenia gravis
Sarcoidosis nodules calledErythema nodosum -> bilateral hilar adenopathy -> goes away on its own -> non caseating(crohns) -> uvetitis ->
Pneumoconiosis most importantPositive exposure 20-30 yrs after,Biopsy mandatory, Classic Interstitial lung disease
Silicosis vs AsbestosisUpper lung infiltration(risk for TB) VS Lower lung(risk for Cancer)
Chest xray normal in PE becasuePE is in vessels NOT lung parenchyma
PE dxCat scan of Pulmonary vein
DVT below kneeLow risk
DVT above kneeHigh risk
Superficial femoral vein DVT same asDistal DVT
DVT riskSurgery, Cancer, Contraceptives, Economy class syndrome, Lupus, Nephrotic syndrome, Factor V leiden