PULM 1 Flashcards
A patient who has a long standing history of smoking, presents with recurrent PNA in the same place…you suspect lung cancer…
What is the best initial test?
What provided definitive dx?
Best initial test = CT
Definitive dx = Flexible Bronchoscopy BX
What is the current recommendation for LUNG CA screening?
Who do you screen?
What is the Screening modality and how often?
Screen Ages 55-80 yo with > 30 pack years.
+
Currently smoking or quick < 15 years ago.
SCREEN with yearly low dose CT
Despite very HIGH false positive rates for yearly lung CA screen with low dose CT…why should you do it?
20 % relative reduction in mortality.
What is the pathophysiology of ASTHMA?
IgE mast cell mediated bronchoconstriction.
Children with asthma also present with a personal history of family history of what other diseases?
ATOPIC DISEASES “3 AS”
- ASTHMA
- ATOPY (ECZEMA)
- ALLERGY
During a PFT what can you administer to see if there is inducible obstructive airway pattern suggestive of Asthma?
Methacholine challenge.
What are the day symptoms, night symptoms and FEV1 for the following Stages of Asthma?
Intermittent (stage 1)? Persistent Mild (Stage 2) Persistent Moderate (Stae 3) Persistent Severe (Stage 4)
Intermittent:
Day: < 2/wk
Night: < 2/mth
FEV: 80%
Persistent Mild:
Day: > 2/wk but no daily
Night: < 1/ wk
FEV 80%
Persistent Mod:
Day: 1 or more per day
Night: 1 per week or more
FEV 60-80%
Persistent Severe:
Day: 1 or more per day
Night: Frequent
FEV <60%
How do you treat the stages of Asthma?
Intermittent?
MILD?
MOD?
SEVERE?
Intermittent:
- PRN albuterol
MILD:
- PRN Albuterol
- Low dose inhaled corticosteroids (or leukotriene inhib)
MOD:
- Albuterol PRN
- Low dose inhaled corticosteroids (or leukotriene inhib)- Long acting B agonist (Solumedrol)
SEVERE:
- Albuterol PRN
- Low dose inhaled corticosteroids (or leukotriene inhib)
- Long acting B agonist
- Consider ORAL steroids.
Cough-variant asthma presents as non productive cough as predominant symptoms, and can lack the typical wheezing or sob…
What are the 4 hallmark features of cough variant asthma?
HOW do you treat?
- Cough worse at night
- Triggered by exercise
- Triggered by allergens
- Triggered by forced expiration
TRX = Same algorithm as ASTHMA.
What is Exercise induced Bronchoconstriction/Asthma?
How do you DX?
Type of asthma that is triggered by exercise or passage of large amounts of dry cold air.
DX: Bronchoprovocation test during PFT (patients are exposed to methacholine, cold air, histamine and exercise to see asthma can be provoked.
How do you treat exercised induced Asthma?
- Warm up before exercise
- SABA/Albuterol 10-20 min prior to exercise
- Add daily inhaled corticosteroids if using SABA daily.
Inhaled corticosteroids for the treatment of asthma can cause what oral infection?
What is the best TRX?
What are 3 preventative techniques to avoid this infection?
Candida/Oral Thrush
TRX: Nystatin swish and swallow.
Prevention:
- Ensure proper technique
- Spacer
- Rinse after inhaler
When patients with ASTHMA do PFT, you will see normal pattern if not symptomatic. IF patients are symptomatic or you use metacholine challenge…what are the changes you see to FEV1 and FEV1/FCV?
FEV1 (Decreased)
FEV1/FVC < 80% (obstructive pattern)
FEV/FCV of what values suggest obstructive vs restrictive disease?
FEV1/FVC > 110% –> Restrictive
FEV 1/FVC < 80% –> Obstructive
How do you manage a patient who comes to the ED with Mild to Moderate asthma exacerbation?
What do you do in severe asthma with signs of respiratory failure?
MILD-MOD:
- Give them supplemental O2 (spo2> 95% pregnant, >90% non-pregnant)
- Give DuoNebulizers (Albuterol/Ipatroprium)
- Give PO Steroids if incomplete response to Nebs
SEVERE:
- O2
- DUONEBS
- IV STEROIDS
- +/- IV Terbutaline
- +/- Intubation
- ICU
