Card Set Information
What is DLCO?
DLCO measures ability of lungs to transfer gas into red blood cels.
Low in conditions characterized by barriers to diffusion: Interstitial edema, interstitial infiltrates, tissue fibrosis, or emphsema.
What is a methacholine challenge test
It induces bronchocnstriction, even when patient is asymptomatic and spirometry is normal.
Methacholine = Non-selective muscarinic receptor agonist
Neuromuscular causes of respiratory fialure
ALS or Myasthenia gravis (auto antibodies against postsynaptic ACh receptors)
opposite of orthopnea. Better breathing when lying down.
Dyspnea, platypnea, hypoxemia in setting of chronic liver disease. Can have clubbing and cyanosis.
Vocal cord dysfunction
Throat or neck discomfort, wheezing, stridor.
Difficult to differentiate from asthma, but patients do not respond to usual asthma therapy.
O2 Sat is typically normal.
Laryngoscopy with sx patient can reveal adduction of vocal cords during inspiration.
Symptoms and signs of pulmonary arterial hypertension
Loud P2, fixed split S2, pulmonic flow murmur, TR.
CXR usually nL at first, then shows enlargement of pulmonary arteries, RA, RV.
Lactate Dehydrogenase (LDH) in pleural effusions
The higher it goes, the more likely it is an exudate rather than a transudate. Usually cut-offi s 200-300.
In an empyema it is freq. >1000
Indications for chest tube drainage
ph < 7.20
Glucose < 60
LDH > 1000
Positive Gram Stain/Cx
PE findings w/ pleural effusion
Blocks sound transmission between lung and chest wall
percussion is dull
Tactile vocal fremitus is diminished
breath sounds diminished
Tuberculous pleural effusion
Tuberculous pleural effusion typically presents with a lymphocyte-predominant effusion.
Also longer course than typical bacterial pneumonia case.
Blockage of thoracic duct (which is left-sided). Malignancy is most common cause. Trauma second.
Triglycerides > 50 mg/dL
Respiratory acidosis in asthma exacerbation
Indicate impending respiratory failure.
Long-acting anticholinergic drugs?
Used in COPD, their role in management of asthma is not defined
Antibiotics in COPD
For moderate to severe CPOD exacerbations,
Use levofloxacin (Fluroquinolone)
or 3rd generation cephalosporin with a Macrolide
Difference between ipratropium and tiotropium
Anticholinergics for COPD
Ipratropium = Short-Acting
Should not be combidned.
Cryptogenic organizing pneumonia
Interstitial Lung disease
COP is often acute or subacute,
doesn't respond to abx.
Alveolar opacification that migrates on serial exams
Idiopathic Pulmonary Fibrosis (IPF)
Prolonged course interstitial lung disease.
Reticular pattern on CXR w or w/o opacities.
Lung findings of sarcoidosis
Most commonly 3rd decade presentation.
90% have lung involvement
: Hilar lymphadenopathy
reticular pattern in upper lung zone
Restrictive lung pattern.
Antibody test for systemic sclerosis/scleroderma
anti-topoisomerase / anti-Scl-70
Restrictive lung disease
Drug-induced lung toxicity versus acute eosinophilic pneumonitis
Acute eosinophilic pneumonitis = a few days
Drug-induced lung toxicity = sub acute
Both cause eosinophilia
When can you d/c heparin when moving to warfarin for DVT prophylaxis
2 INRs > 2 at least 24 hours apart.
Medial and Lateral Epicondylitis
Lateral Epicondylitis is more common (tennis elbow)
Medial Epicondylitis = Golf's elbow.
Diagnosis a meniscal tear
Twisting injury of the foot with weith-bearing followed by severe pain, swelling (over hrs).
McMurray Test (flexing hip and knee and abducting or adducting knee while extending).
Focal tenderness on upper inner tibia, about 5cm distal to medial articular line of the knee.
Pseudogout = Positive, rhomboidal crystals
Gout = Negative, Needle-shaped crystals
DIP and PIP boney enlargements in OA
PIP - Bouchard nodes
DIP = Heberden nodes
Chronic pain at base of dominant thumb
Suggestive of OA
de Quervain tenosynovitis
Inflammation of abductor pollics longus and extensor pollicis brevis tendons.
Pain on distal aspect of radial styloid.
Pain on flexing thumb into palm, closing fingers over thumb, and bending wrist in ulnar direction
Leukocyte count in septic arthritis
Usually greater than 50,000 and PMN predominance
<2000 leukocyte count is nL in joint.
Cardinal X-Ray feature of RA
Erosions in proximal joints
Parvovirus B19 and arthritis
Parvovirus B19 infection in adults may induce an acute RF postive oligo or polyarthritis.
Most adult pts. with Parvo B19 infection also develop rash, but rearely slapped cheek rash of childhood.
Contraindication for first-line use of MTX?
Use hydroxychloroquine first in this case.
Rare infection syndrome cased by Tropheryma whippelii.
Arthritis --> Migratory and chronic.
Also called progressive systemic sclerosis
Widespread skin involvement
Early visceral involvement
Assoc. w/ anti-Scl-70 Ab (Anti-DNA topoisomerase I antibody)
Immune-mediated widespread noncaseating granulomas and elevated serum ACE levels.
Gammaglobulinemia (Low antibodies)
Assoc. w/ RF and HLA-B27
Ankylosing Spondylitis --> Spine and sacroiliac jts, uveitis, AR
Reactive (Can't see, can't pee, can't climb a tree) after shigella, salmonella, yersina, campylobacter, chlamydia.
Anti-Ro and anti-La
Seen in patients w/ anti-TNF-alpha drugs
Usually spares renal and neurologic symptoms.
D/C offending agent.
Anti-HTN drug of choice in patients with lupus nephritis
ACE inhibitors, because help control proteinuria.
distinguishing rosacea from SLE malar rash
Rosacea does not spare nasolabial fold
Treatment for Raynaud phenomenon
Nonglomerular renal vessels vasculitis associated with HTN, kidney insufficiency, proteinuria, hematuria.
Granulomatosis with polyangitis
A vasculitis. Necrotizing granulomatous vasculitis affecting small arteries and veins.
Effects nose, sinuses, lungs, and kidneys.