Term
What is the BITest for asthma?
What is the MATest
with symptoms?
Without symptoms?
What other test should be done?
and what are the results for all of them |
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Definition
BIT: Peak expiatory flow or arterial blood gas
Pulm Function test shows obstruction results
without symptoms greater >20 decrease in FEV1 with histamine or Methacholine |
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Term
| What are the 6 steps of chronic management of Asthma? |
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Definition
1. SABA (short acting beta agonist
2. ICS (inhaled cortical steroids)
3. LABA ( Long acting Beta agonist
4. Increase doses
5. Omalizumab
6. Oral cortical steroids |
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Term
What are the three main Leukotriene modifiers/ inhibitors?
what are the SE of some of these drugs?
When are they used |
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Definition
Montelukast
Zafirleukast- is hepatotoxic and ass with churg-strauss syndrome
Zileuton
used as alternatives to ICSteroids |
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Term
What are the drugs that inhibit mast cell mediator release and eosinophil recruitment?
when are these used?
what are the Adverse effects of Inhaled Cortical steroids? |
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Definition
Cromolyn and nedocromil
dysphonia and oral candidiasis |
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Term
what is the next best step in acute asthma exasterbations?
what next
when is magnesium used? |
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Definition
Ox, Albuterol, bolus Steroids
If pt does not responds and worsens perform an endotrachial intubation.
Magnesium used in acute exacerbations not responsive to albuterol tx while waiting for cortical steroids to take effect
Epinephrine injections are no more effective than albuterol |
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Term
| What is the BIT and MATest and results of COPD? |
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Definition
BIT: CXR shows
increased Anterior-Posterior (AP) diameter and
Air Trapping flattens diaphragms
MAT: PFT decreased FEV1/FVC ratio and increased TLC due to increase in residual volume |
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Term
| What is the BIT and MATest and results of COPD? |
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Definition
BIT: CXR shows
increased Anterior-Posterior (AP) diameter and
Air Trapping flattens diaphragms
MAT: PFT decreased FEV1/FVC ratio and increased TLC due to increase in residual volume |
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Term
What are the treatments that lower mortality and delays the progression of COPD? x3
What Treatments are to improve symptoms? (x5) |
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Definition
Smoking cessation, Oxygen therapy, Influenza and pneumoccal vaccinations
1.Albuterol,
2.then Anticholinergic agents like tiotropium, ipratropium
3. Steroids
then 4. LABA 5. pulmonary rehabilitation |
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Term
when all medical therapy for COPD is insufficient what is the next best step?
What are the the anticholinergic agents used in COPD |
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Definition
Refer for transplantation
tiotropium, ipratropium |
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Term
| What is the treatment for Acute Exacerbations of chronic bronchitis? |
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Definition
Same for Acute asthma but with Antibiotics:
first line antibiotics are:
Macrolides, Cepholosporins, Amox, Quinolones |
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Term
| What are the Criteria for oxygen used in COPD? |
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Definition
pO2 below 55mmHg or Saturation bellow 88%
if RHF S&S are present pO2 60mmhg, or sat below 90% |
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Term
what is the single most common cause of bronchiectasis?
What are the main S&S of this? |
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Definition
Cystic fibrosis but there are other causes like Infection, Immunodef, Foreign body,....
Recurrent episodes of very high vol purulent sputum, Hemoptysis can occur. Dyspnea and weezing in 75% of cases |
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Term
What is the BIT for Bronchiectasis?
What is the MAT?
what are the results for both? |
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Definition
BIT: Xray showing 1) dialated thickened bronchi 2. Some with "tram tracks"
it is impossible to diagnose bronchiectasis without an imaging study of the lung such as CT Scan (MAT)
it shows widening of the bronchi |
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Term
| What is the treatment for Bronchiectasis? x4 |
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Definition
1. cupping and clapping of chest
2. Treat infection episodes
3. Rotate antibiotics, 1 weekly each month
4. Surgical resection of focal leasions may be indicated. |
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Term
what has recurrent episodes of brown flecked sputum and transient infiltrates on cxr?
What is the treatment? |
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Definition
Allergic bronchopulmonary aspergillosis
Oral steroids and Itraconazole |
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Term
what is the most accurate test for CF?
What is the treatment |
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Definition
increased sweat chloride test
Genotyping is unreliable
xray should be done
tx: routine antibiotics,
inhaled recombinant human DNAase- breaks up masssive amounts of DNA in mucus that clogs up airways
INhaled bronchodialators
Vaccinations
Lung transplant |
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Term
What is the best initial step in all lung leasions?
What are some qualities of Malignant nodules? |
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Definition
compare the size with old xrays
>40 years old, enlarging, smoker, spiculated, >2 cm, ....... |
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Term
What is the next best step in Hi probability lung nodules?
Intermettent?
what is an adverse effect of this |
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Definition
Resect
Bronchoscopy for central lesions or transthoracic needle biopsy for peripheral lesions
the Adverse effect of the needle biopsy is pneumothorax |
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Term
what is the BITest and results of Pulmonary fibrosis?
More accurate?
MAT?
What does an echo show? |
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Definition
BIT: CXR
high resolution CT showing honeycombing is more accurate
MAT: lung biopsy
Pulmonary HTN, RVH |
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Term
| what is the treatment for interstitial lung disease? |
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Definition
Most types are untreatable
Prednisone can be used if biopsy shows white cell or inflammatory infiltrate?
Berylliosis is most likley to respond to steroids |
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Term
| what is the treatment for interstitial lung disease? |
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Definition
Most types are untreatable
Prednisone can be used if biopsy shows white cell or inflammatory infiltrate?
Berylliosis is most likley to respond to steroids |
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Term
what is very indicative of Sarcoidosis? x4
What is the treatment? |
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Definition
SOB on exertion
African American
Erythema nodosum
lymphadenopathy
Prednisone |
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Term
What is the BIT/results of Sarcroidosis?
MAT&R |
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Definition
CXR showes halar lymphadenopathy
MAT is Lymph node biopsy shoes non caseating granulomas |
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Term
What is the BIT&R for Pulmonary embolism?
What then x3
What is the MAT |
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Definition
Chest xray could show atelectasis, wedge shaped infarction pleural based leasions
Then do Spiral CT and or LE doppler study
If still unconclusive do the MAT which is Angiogram |
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Term
What is the best initial therapy for PE/DVT?
Whin is an IVC filter indicated? |
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Definition
Heparin and Warfarin
Fondaparinux is a alternative to heparin
CI use of anticoag,
Recurrent emboli
RV dysfunction |
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Term
When is Thrombolytics the right answer for PE/DVT?
What is an alternative to heparin? |
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Definition
Hymodynamically unstable pts. ( hypotention and tachycardia)
Acute RV dysfunction
--------------
fondaparinux |
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Term
What are the Adverse effects of angiography? x3
when are direct acting thrombin inhibitors the answer in PE/DVT
what are they? x2 |
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Definition
allergies, renal toxicity, and .5% mortality
In heparin induced thrombocytopenia
argatroban, lepirudin |
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Term
what B/P is considered Pulmonary HTN
what can cause Pulm HTN?
What will be on Auscultation? |
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Definition
>25/>8
Chronic lung diseases, COPD, fibrosis, Hypoxia
Wide S2 splitting |
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Term
what is the BIT&R of Pulmonary HTN x2
What is the MAT&R of HTN? |
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Definition
BIT: xray shows dilation of proximal pulmonary arteries with narrowing or pruning of distal vessels
MAT: R heart or swan-ganz catheter measures blood pressure |
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Term
What is the treatment for pulmonary HTN?
name all the drugs |
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Definition
Correct underlying cause
Idiopathic:
1)prostacyclin analogs: epoprostenol,treprostinil
2 endothelin antagonists: bosentan
3.Phosphodiesterase inhibitors: sidenafil
and o2 slows progression expecially in COPD
lung transplantation is the only curative thing for Idiopathic |
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Term
What is the MAT for Obstructive sleep apnea?
What is the treatment for sleep apnea? |
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Definition
MAT: polysomnography(sleep study)
tx:
1 weight loss,
2continuous positive airway presssure CPAP
3. Surgical widening of airway
4. avoid sedatives
5. oral appliances |
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Term
what is the BIT&R of ARDS?
what is the definition in pO2.FIO2? |
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Definition
BIT: CXR showing bilateral infiltrates that quickly become confluent (white out)
With air bronchograms
pO2/FIO2 ratio below 300 |
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Term
| what is the treatment for ARDS? |
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Definition
Low tidal volume mechanical ventaltation
6mL per kg of tidal volume.
PEEP (positive end expiratory pressure) used with ventalation to try to decrease FI02
maintain the plateau pressure of less than 30 cm of water |
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