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Pulmonology > Pugging > Flashcards

Pugging Flashcards

1
Q

Stage T1

A

T1a: <2 cm
T1b: >2 cm to 3 cm

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2
Q

Stage T2

A

T2a: > 3-5 cm
T2b: > 5-7 cm
- Involve main bronchus, >2cm from carina

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3
Q

Stage T3

A
  • Tumor > 7 cm
  • Main bronchus <2cm from carina
  • Invasion (phrenic n, parietal pericardium, chest wall, diaphragm)
  • Additional tumor nodules in same lobe
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4
Q

Stage T4

A
  • Invasion of important structures (trachea, SVC, aorta, recurrent lar. n, esophagus
  • Ipsilateral nodules, in different lobe
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5
Q

Stage N1

A

Ipsilateral hilar

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6
Q

Stage N2

A

Ipsilteral

  • Mediastinal
  • Subcarinal
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7
Q

N3

A
  • Contralateral

- Supravlavicular

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8
Q

Stage M1

A 
Metastases
M1a: 
- Contralateral lung
- Pleura
- Pericardium
M1b:
- Distant
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9
Q

Surgical resection stage

A

Up to IIIA

  • T4 N0-1 M0
  • T3 N1 M0
  • T1-3 N2 M0
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10
Q

Surgery options

A
  • Lobectomy
  • Bilobectomy
  • Pulmonectomy
  • Atypical resection (Wedge resection?)
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11
Q

Performance status grading

A

ECOG

- 0-2 good for treatment (?)

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12
Q

Chemotherapy SCLC first line

A

Stage I-III:
Cisplatin/carboplatin+etoposide
- 6 cycles
- Thoracic radiation after 3rd (~50Gy)

Stage IV:
- 4-6 cycles

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13
Q

Chemotherapy SCLC second line

A
  • Topotecan OR

- Epirubicine-Cyclophosphamide-Vincristine (4 cycles)

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14
Q

NSCLC adjuvant chemo stage

A

IB to IIIA

- After surgery

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15
Q

NSCLC neoadjuvant chemotherapy

A

Before surgery

  • Make it resectable
  • E.g stage IIIA
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16
Q

NSCLC palliative chemotherapy stage

A

Stage IIIB-IV

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17
Q

NSCLC chemotherapy

Stage IIIB-IV palliative, or stage IB-IIIA neoadj/adj

A

Cisplatin or Carboplatin
+
Gemcitabin/Docetaxel/Pemetrexed

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18
Q

NSCLC second/third line chemotherapy

A
  • Chemo: Docetaxel or pemetrexed monotherapy

- Targeted therapy: EGFR blockers

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19
Q

Molecular targeted therapy in IIIB and IV adenocc

A

1) VEGF antagonist (angiogenesis): Bevacizumab
- With first line chemo

2) EGFR antagonists (tyrosine kinase)
Gefitinib or Erlotinib
- Monotherapy

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20
Q

Radiation therapy

A

High energy X-rays

  • External radiation
  • Endoluminal brachytherapy
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21
Q

Light’s criteria (pleural fluid is exudate if)

A

1) Pleural fluid protein / serum protein is > 0.5
2) Pleural fluid LDH / serum LDH is >0.6
3) Pleural fluid LDH > 2/3 of the upper limits of normal serum LDH (>266iu/L)

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22
Q

Protein level and LDH level that suggests effusion is exudate

A

Protein > 30g/L

LDH > 200 iu/L

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23
Q

Epidemiology of TBC

A

1) Leading infectious cause of morbidity and mortality
2) 1/3 of population infected
3) 2-3 millions die per year

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24
Q

Treatment TBC

A 
Rifampin: 600 mg/day 
Isoniazide: 300 mg/day
Pyrazinamide: 1.5 g/day
Ethambutol: 2.0 g/day
*all per os (streptomycin is i.v)
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25
Q

2nd line antiTBC drugs

A
  • Streptomycin
  • Ethambutol
  • Paraaminosalicylic acid (PAS)
  • Fluoroquinolones (levofloxacin)
  • Cycloserine
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26
Q

Causative agents community acquired pneumonia

A

1) Strep pneumo
2-3) M. Pneumo, Chlamydophila pneumoniae
4-5) H. Infl, Klebsiella pn
6) Viruses

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27
Q

Causative agents nosocomial pneumoniae

A

1) Enterobacteriaceae (E.coli)
2) Pseudomonas
3) Staph aureus
4) Acinetobacter spp
5) H. infl

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28
Q

Fine crackels (rales, crepitations)

A
  • Discontinuous
  • Similar to wood burning
  • Both phases of resp
  • Early insp+exp: chr. Bronchitis
  • Late insp: pneumonia, CHF, atelectasis
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29
Q

Wheeze

A
  • Continous
  • High or low pitched
  • Narrowing of airways
  • Insp: stiff stenosis, tumor, foreign body, scarring
  • Exp: bronchiolar disease (eg asthma)
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30
Q

Rhonchi

A

«Low pitched wheeze»

  • Continous
  • Insp and exp
  • Often clear after cough
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31
Q

Pleural rubs

A
  • Discontinous or continous
  • Creaking sound (gå på kram snø)
  • Insp and exp (whenever chest moves)
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32
Q

Blood gas pneumonia

A
  • Hypoxemia
  • Hypocapnia
  • Alkalosis
33
Q

Diagnosis pneumonia

A
  • Sputum from lower airw
  • Protected brush specimen
  • BAL
  • Serology: mycopl, chlam, legionella
  • Urinary Ag test: Legionella
  • M. Tub: Mantoux, direct Koch, culture, PCR, Quantoferon test
34
Q

PORT

A 
«Pneumonia outcome research team» points
- Show risk of pneumonia pts
- I-V
- PORT increase w/ age, comorbidities, severity of symptoms
- Lethality 
I-III~0.x% (treat at home, AB po)
IV~10% (hospital, AB iv)
V~30% (ICU, AB iv)
35
Q

Empirical AB treatment PORT I

A

Amoxicillin-clavulanic acid
OR
Macrolides (Klacid, Sumamed)

36
Q

Empirical AB treatment PORT II-III

A

Amoxocillin-clavulanic acid
AND
Macrolides (Klacid, Sumamed) or
Fluoroquinolones (levofloxacin, moxi)

37
Q

Empirical AB treatment PORT III-IV (hospital, iv)

A

Amoxicillin-clavulanic acid or cephalosporins (ceftriaxone, cefotaxime)

AND

Macrolides (Klacid, sumamed) or Levofloxacin

38
Q

Empirical AB treatment PORT IV-V (hospital, iv)

A

Cephalosporins (ceftriaxone, cefotaxime) or
Imipenem or Meropenem or
Piperacillin-tasobactam

AND

Macrolides (klacid, sumamed) or
Levofloxacin or
Aminoglycocide

39
Q

Supportive treatment pneumonia

A
  • O2
  • Fluid, electrolytes
  • Antipyretics
  • Insulin
  • Antiarrhytmic
  • Anticoag (heparin)
  • Low dose steroid (antifibrogen)
  • Bronchodilator
40
Q

Normal values FEV1, FVC, ratio

A

FEV1: 4 L
FVC: 5 L
Ratio: 0.8 (<0.7 indicates obstructive disease)

41
Q

Assesment of COPD symptoms

A
  • COPD assessment test (CAT)

- mMRC Breathlessness scale/questionaire (modified british medical research council) - grade 0-4

42
Q

Classification of severity of airflow limitation in COPD

A 
Based on post-SABA FEV1
- GOLD 1: FEV1 = 80 %
- GOLD 2: FEV1 = 50-80%
- GOLD 3: FEV1 = 30-50%
- GOLD 4: FEV1 < 30% predicted
Mild, moderate, severe, very severe
43
Q

Assessment of COPD

A
  • Symptoms (CAT, mMRC)
  • Airflow limitation (GOLD 1-4)
  • Risk of exacerbations (2 or more within last year, or FEV1<50% are high risk)
44
Q

Medications COPD

A
  • SABA/LABA
  • SAMA/LAMA
  • Methylxanthines
  • Inhaled/systemic corticosteroids
  • Phosphodiesterase-4 inhibitors (roflumilast)
45
Q

Therapeutic recommendations for COPD medication

A
  • Gr A: Bronchodilator
  • Gr B: LABA or LAMA => both
  • Gr C: LAMA => both
  • Gr D: LABA+LAMA => both+ICS
46
Q

Type I and II respiratory failure

A

I: Hypoxemic

  • PaO2<60mmHg on 60 % oxygen
  • Oxygenation failure

II: Hypercapnic

  • PaCO2>45mmHg and pH<7.35
  • Ventilatory failure
47
Q

Zubrod scale (performance state of patient)

A

0: Normal activity
1: Can walk, but need support
2: In bed close to 50% of time
3: In bed >50% of daytime
4: Bed-ridden

48
Q

Asthma definition

A

1) Chronic inflammatory
2) Wheeze, cough, dyspnea
3) Airflow limitation
4) Airflow hyperresponsiveness

49
Q

Asthma classification

A

1) Severity
- Intermittent, mild-, moderate-, severe persistent

2) Control level
- Controlled, partly controlled, uncontrolled

3) Etiology
- Extrinsic, intrinsic

50
Q

PEF (abbreviation+unit+normal+asthma)

A 
Peak expiratory flow
(L/min)
- Normal range: 400-600 L/min
- Asthmatics: 200-400 L/min
- Daily PEF variability >20% suggest asthma
51
Q

Inhaled corticosteroids (3)

A

1) Beclomethasone
2) Budesonide
3) Fluticasone

52
Q

Leukotriene modifiers

A
  • 5-LO inh: Zileuton

- CysLT1 antag: Montelukast, Zafirlukast, Pranlukast

53
Q

Anti-IgE

A

Omalizumab

54
Q

Valve used in pleural suction (ptx)

A

Heimlich valve

55
Q

Methods for pleural biopsy (4)

A

1) Closed needle biopsy (Cope-Ramel needle)
2) CT guided core biopsy
3) Medical thoracoscopy
4) Surgical biopsy (VATS, open surgical biopsy)

56
Q

Treatment malignant pleural mesothelioma

A

Radio+chemo (pemetrexed+cisplatin)

  • Poor effect, poor prog
  • Survival ~12 months
57
Q

Pleurodesis

A

Fusion of visceral and parietal pleura

- For pleural effusion

58
Q

Other word for pleural tapping of fluid

A

Thoracocentesis

59
Q

Sclerosing agents used for pleurodesis (3-4) + SEs (2)

A

1) Talc
2-3) Doxycycline, Tetracycline
4) Bleomycin
SEs: chest pain, fever

60
Q

Sleep study

A

Polysomnography (PSG)

61
Q

Sleep state scoring

A

EEG
EMG (electronyography)
EOG (electrooculography)

62
Q

Sleep apnea «types» (3)

A

1) Obstructive sleep apnea
2) Central sleep apnea
3) Sleep related hypoventilation syndromes

63
Q

Diagnostic criterias sleep apnea (OSAS) («3»)

A

1) Excessive daytime sleepiness (EDS)

2) 2 or more:
a. Airflow cessations (apneas) during sleep
b. Repetitive awakenings during night
c. Bad sleep quality
d. Impaired memory and learning skills

3) At least 5 apnea/hypopnea per hour during polysomnography (AHI>5)

64
Q

AHI + scale

A

Apnea-Hyponea index
= «average no. of apneic and hyponeic episodes per 1 hour of sleep»

AHI 5-15: Mild disorder
AHI 15-30: Moderate
AHI >30: Severe

65
Q

Asthma treatment protocol (step 1-5)

A

1) SABA as needed
2) Add Low-dose ICS
3) Add LABA
4) Medium/high-dose ICS + LABA (and/or LT modifier, theophylline)
5) Add Oral glucocorticoids and/or Anti-IgE (Omalizumab)

66
Q

COPD treatment protocol (facebook)

A

Step

1) SABA, SAMA
2) LABA, LAMA
3) Depends on exacerbation frequency
- High: Corticosteroids
- Low: don’t give

67
Q

Pleura on US

A

Highly echogenic

68
Q

Bone metastases on US

A

Hypoechoic

69
Q

Pleural effusion on US

A
  • Transudates: anechoic
  • Exudates: can be complex, septated or echogenic
  • Malignant: often anechoic
70
Q

Pneumothorax on US

A
  • Absence of normal lung sliding
  • Loss of comet-tail artefacts
  • Exaggerated horizontal reverberation artefacts
71
Q

Lung/pleural tumor on US

A

Hypoechoic with posterior acoustic enhancement

72
Q

Atypical mycobacteria examples (5)

A

1) M. Avium Complex (MAC)
2) M. Kansasii (Kansas)
3) M. Malmoense (Malmö)
4) M. Abscessus
5) M. Xenopi

73
Q

Examples SABAs (3)

A
  • Fenoterol
  • Salbutamol
  • Terbutaline
74
Q

Examples LABAs (3)

A
  • Salmeterol
  • Formoterol
  • Olodaterol
75
Q

Examples SAMAs (2) and LAMAs (2)

A

SAMA: Ipratropium & Oxitropium

LAMA: Tiotropium & Glycopyrronium

76
Q

Methylxanthine example + disadvantage

A

Thiophylline

- Narrow TI

77
Q

Phosphodiesterase 4 inhibitor

A

Roflumilast

- COPD

78
Q

Triple therapy COPD

A

LABA
LAMA
ICS

79
Q

Comorbidities COPD

A

1) Lung cancer
2) Cardiovascular
3) Osteoporosis
4) Depressiob/anxiety
5) Sleep apnea
6) GERD

Pulmonology (1 decks)

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