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PULM > PCM REVIEW > Flashcards

PCM REVIEW Flashcards

1
Q

what percentage of US adults smoke?

A

21%

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2
Q

how many people start smoking by age 18?

A

80%

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3
Q

how many deaths annually can be attributed to smoking?

A

1 in 5

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4
Q

what is the leading preventable cause of death in the US?

A

smoking

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5
Q

if you tell someone to quit at each visit you can raise the quit rate by______________

A

30%

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6
Q

what are the 5 A’s?

A
  1. ask about tobacco use
  2. advise to quit
  3. assess willingness to try
  4. assist in quit attempt
  5. arrange followup
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7
Q

what are the 5 stages of change?

A 
precontemplative
contemplative
preparation
action
maintenance
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8
Q

what percent of people who try to quit on their own are smoking within 30 days?

A

80%

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9
Q

what percentage of smokers quit successfully annually?

A

3%

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10
Q

how is cognitive therapy involved in smoking cesation?

A

helps smokers combat addiction, craving triggers, stress/environmental cues and withdrawal sings

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11
Q

what happens to quit rates when counseling is combined with pharmacotherapy?

A

quit rates double

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12
Q

how does varenicline work?

A

partial agonist at the alpha4beta2 nicotinich ACh receptor

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13
Q

which antismoking drug is the most effective alone?

A

varenicline

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14
Q

what are notable adverse effects of varenicline and buproprion?

A

psychiatric adverse effects

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15
Q

how does buproprion work?

A

NE and dopamine re-uptake inhibitor (decreases cravings and withdrawal symptoms while interactin with pathways underlying addiction)

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16
Q

rank the smoking cessation drugs from best to worst>

A

Varenicline>buproprion>nicotine replacement

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17
Q

what is a notable side effect of clonidine?

A

rebound htn

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18
Q

how does mecamylamine work?

A

nicotine antagonist (ganglionic blocker) data shows that mecamylamine + nicotine is better than nicotine alone

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19
Q

how does clonidine work?

A

blocks cravings, anxiety, restlessness, tension and hunger

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20
Q

how does naltrexone work?

A

opiate antagonist (DOESNT WORK)

21
Q

what pts shouldnt get mecamylamine?

A

coronary or renal insufficiency, glaucoma, uremia

22
Q

who is supposed to get the flu shot?

A

pts 6 months and older

23
Q

what are the 2 kinds of flu shot?

A
  1. shot is inactivated killed virus

2. nasal spray is live attenuated virus (only for healthy people 5-49 yrs)

24
Q

how many strains does each vaccine have?

A

3

25
Q

adults get which pneumococcal vaccine?

A

23 valent inactivated vaccine

26
Q

kids get which pneumococcal vaccine?

A

7 valent conjugate vaccine

27
Q

bronchial breath sounds + egophony triples the likelihood of what?

A

pneumonia in pt with fever and cough

28
Q

the algorithms for cough are indicated for what patients?

A

15 yrs and older

29
Q

upper airway cough syndrome (UACS) is also known as what?

A

post-nasal drip

30
Q

pts with pneumonia and risk factors for lung cancer should have a follow up CXR around when?

A

6-12 wks

  • assure resolution
  • avoid missing a lung cancer hidden by infiltrates
31
Q

what kind of things cause a subacute cough?

A

usually subacute

-pertussis

32
Q

post-tussive vomiting and paroxysmla cough in a subacute setting are sugestive of what?

A

pertussis

33
Q

how do you treat pertussis?

A

erythromycin

34
Q

if you have a chronic cough and you’ve done a good hx and physical what else do you need to order?

A

CXR

35
Q

if you have a pt where the history, physical, and CXR are normal, what are 4 possible causes?

A

smoking
ACE-inhibitor
GERD
Asthma

36
Q

do you have to evaluate a change in chronic cough if the pt is a smoker?

A

YES

37
Q

True or False: all that wheezes is asthma

A

FALSE

38
Q

how do you diagnose asthma?

A

clinical based on multiple findings in hx (no specific test )

39
Q

asthma is easily recognized when it presents with what?

A

intermittent wheezing

40
Q

what should be high on your ddx if your pt has: wheezing, dyspnea, cough, chest tightness

A

asthma

41
Q

what are some findings in asthma with high likelihood ratios?

A

nocturnal dyspnea

wheezing and exertional dyspnea

42
Q

what are the key points to diagnosing asthma?

A

episodic symptoms of airflow obstruction
reversibility of airflow obstruction
exclusion of other likely diseases

43
Q

how do you know if you should hospitalize an asthmatic patient?

A

pts w/ an exacerbation and 1 of the following:

  • hx of sudden severe exacerbations
  • prior admission to ICU
  • recent ER visit
  • use of 2 or more canisters of beta2agonist in last month
44
Q

what can the physical exam tell you about a pt with asthma?

A

not much, generally a poor marker of the severity of disease

45
Q

what 2 pieces of info are the most important for making admission decisions?

A
  1. spirometry

2. hx of the pt’s prior exacerbations

46
Q

a succinct and complete __________________ should always be included in oral presentations and written histories and physicals in the respective assessment sections

A

illness script

47
Q

what is the purpose of an illness script?

A
  1. facilitate diagnostic thinking
  2. better communicate your conclusions to others
  3. give others insight into your diagnostic reasoning
48
Q

define a likelihood ratio

A

(probability of a finding in pt w/ disease) / (probability of same finding in pt w/o disease)

PULM (14 decks)

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