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family med > Pulm > Flashcards

Pulm Flashcards

1
Q

Diagnosis of Asthma

A

spirometry
-> decrease FEV1/FVC ratio <80%
Bronchodilator response
-> greater than 12% increase in FEV1 after SABA
Bronchoprovocation
->hyperresponsiveness = >20% decrease in FEV1 after methacholine challenge

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2
Q

night time cough + hyperresonance to percussion + eosinophil containing suptum should make you think of?

A

Asthma, IgE mediated type hypersensitive.
Hyper-resonance to percussion occurs because there is air trapping.

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3
Q

Atopic triad

A

1)asthma
2) allergic rhinitis
3) eczema

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4
Q

Samter’s triad

A

asthma, nasal polyps, ASA sensitivity.

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5
Q

how does the methacholine challenge test work?

A

Methacholine is a muscarinic agonist that causes bronchoconstriction in the lungs. Should a greater than >20 decrease in FEV1

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6
Q

Why is SAMA (short-acting muscarinic antagonist) contraindicated in myasthenia gravis?

A

Because in Myasthenia gravis the immune system attacks the acetylcholine receptors at the neuromuscular junction.

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7
Q

What can be used in life threatening exacerbation or severe excerbation asthma with no improvement 1 hour after intensive bronchodilator therapy.

A

IV magnesium

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8
Q

What is a common side-effect of short-acting beta-agonists?

A

Tachycardia because it is systemically absorbed and acts on the beta 1 receptors in the heart.

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9
Q

What is SAMA (short-acting muscarinic antagonist)

A

Ipratropium is a SAMA it blocks the constricting action of acetylcholine at the muscarinic receptor = bronchodilator and decrease mucus secretion. Can be added to SABA to treat severe asthma excerbations.

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10
Q

T/F: LABA (long-acting beta agonist) such as salmeterol and formoterol can be used as monotherapy to treat asthma.

A

False. LABA should always be used with a ICS to address both the inflammation and bronchoconstriction of the airway . If LABA is used alone can lead to asthma related death.

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11
Q

Name some Inhaled corticosteriods

A

Fluticasone
budesonide
Beclomethasone
Note: high dose can cause adrenal supression & oral candidiaisis

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12
Q

What is the best medication to use for exercise-induced asthma & aspirin induced asthma?

A

Leukotriene receptos antagonist such as montelukast or Zafirlukast
associated with increased aggression, hallucinations and depression

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13
Q

Which medication can be used to treat high levels of IgE medicated bronchospasms

A

Anti-IgE monoclonoal antibody (omalizumab)
associated with anaphylaxis

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14
Q

What is the step-wise treatment for asthma?

A

step 1: SABA
Step 2: add low dose ICS
Step 3: add moderate dose ICS OR low dose ICS + LABA
Step 4: Moderate dose ICS + LABA
Step 5: high dose ICS + LABA
Step 6: add oral steriod + HIGH dose ICs + LABA

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15
Q

What are the risk factors for COPD?

A

Smoking MCC
Alpha-1 antitrypsin deficiency ( alpha 1 antitrypsin protects the elastin in the lungs. deficiency = break down of elastin = damage).
Smoking increase the production of elastase = break down of elastin.

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16
Q

The Ghon complex of tuberculosis is a combination of hilar lymphadenopathy and a______ on chest X-ray.

A

ghon focus

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17
Q

Mycobacterium tuberculosis is transmitted via _______________ from the respiratory tract.

A

airbrone droplets

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18
Q

__________Mycobacterium tuberculosis infection affects the middle to lower lung segments.

A

Primary Mycobacterium tuberculosis infection affects the middle to lower lung segments.

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19
Q

A hilar lymphadenopathy with a peripheral granulomatous lesion in the middle or lower lung lobes which can calcify is diagnosti

A

primary tuberculosis

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20
Q

____________is a second-line anti-tuberculous drug that can cause ototoxicity and nephrotoxicity.

A

Streptomycin

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21
Q

The interferon-γ release assay for tuberculosis is usually (positive/negative) if a patient has had previous immunization.

A

The interferon-γ release assay for tuberculosis is usually (positive/negative) negative if a patient has had previous immunization.

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22
Q

_________is an anti-tuberculous drug that can sometimes cause optic neuropathy

A

Ethambutol

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23
Q

The anti-tuberculous drug ___________________ can cause a benign red-orange discoloration of body fluids like tears and urine.

A

rifampin

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24
Q

A fibrocaseous cavitary lesion on chest X-ray is seen in (primary/secondary) tuberculosis.

A

A fibrocaseous cavitary lesion on chest X-ray is seen in secondary tuberculosis.

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25
Q

rifampin, _____________ , pyrazinamide, and ethambutol are the four antimycobacterial drugs used to treat tuberculosis.

A

isoniazid

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26
Q

___________ is an agent that is co-administered with isoniazid to decrease the chance of a peripheral neuropathy or sideroblastic anemia developing

A

Pyridoxine (B6)

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27
Q

______ is the name given to tuberculous arthritis and osteomyelitis of the spine.

A

Pott Disease

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28
Q

Mycobacterium tuberculosis is a mycobacterial species that thrives in high oxygen environments, flourishes in the apex of the lung during_

A

Reactivation

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29
Q

_________is an anti-tuberculous drug that can cause hyperuricemia and thus increase the chance for gout in susceptible patients.

A

Pyrazinamide

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30
Q

Which drug is used to treat latent TB?

A

Isoniazide + pyridoxine (B6)

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31
Q

What is used to treat active or primary TB?

A

RIPE for 2 months
Rifampin
Isoniazide
Pyrazinamide
Ethambutol

Then
Rifampin + Isoniazide for an additional 4 months.

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32
Q

Extrapulmonary tuberculosis sites

A

Kidneys are the most common site
Meningitis
Vertebral Tuberculosis
Peri-carditis

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33
Q

TB diagonsis

A

pulmonary sputum or bronchoalveolar lavage get acid-fast culture.

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34
Q

Target SpO2 for COPD

A

88-92%

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35
Q

3 cardinal symptoms of acute excerbation of COPD

A

1) worsening dyspnea
2) increase severity/frequency of cough
3) increased volume purulence of sputum

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36
Q

Emphysema what is

A

Permanent enlargement & destruction of terminal airspace making it hard to get air out

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37
Q

Emphysema presentation

A

Dyspnea is the most common CC
prolonged expiration
use of accessory muscles

decreased tactile fremitus (decreased vibration due to increased air in the lungs)
hyper-resonance

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38
Q

Chrontic bronchitis what is it?

A

productive cough >/=3months for 2+ consecutive years

39
Q

Severe v/q mismatch in chronic bronchitis can stimulate

A

severe V/Q mismatch results in hypoxemia & hypercapnia leading to erythopoieses

40
Q

Chronic productive cough is the most common presentation of

A

Chronic bronchitis

41
Q

FEV1/FVC ratio of <70% indicates?

A

obstruction commonly seen in COPD

42
Q

What is FVC & FEV1

A

FVC (forced vital capacity) is the max amount of air forcibly exhales from lungs after max inhalation
FEV1: the volume of air exhaled during the 1st second of the forced exhalation.

43
Q

In treating COPD groups B & E what medications should be given?

A

Group B: LABA (salmeterol) + LAMA (Tiotropium)
Group E: LABA (salmeterol) + LAMA (Tiotropium) +/- ICS if blood eos >/= 300

44
Q

What is used to treat patient that falls into Group A of COPD

A

bronchodilators such as SAMA (Ipratropium) Or SABA (albuterol)

45
Q

How should an acute COPD excarbation be managed ?

A

1) SABA +/- SAMA
2) systemic glucocorticoid steroids (prednisone)
3) Abx (macrolide, FQ) if 2+ cardinal sxs changed.
4) Oxygen therapy target SpO2 88-92%

46
Q

People with COPD should get what vaccines yearly?

A

Influenza & pneumococcal vaccine

47
Q

COPD is associated with

A

1) MAT
2) Cor pulmonale

48
Q

What is acute bronchitis

A

Inflammation of the upper bronchi and trachea following and upper respiratory tract infection

49
Q

What is the most common cause of acute bronchitis?

A

adenovirus

50
Q

Most common presentation of acute bronchitis

A

persistent cough (+/-) sputum 1-3 weeks

51
Q

What is community acquired pneumonia?

A

infection of one or both of the lungs outside the hospital or within 48 hours of hospital admission

52
Q

Hospital aqcuired pneumonia

A

infection acquired>48 hours after admission.
Often caused by Pseudomonas aeruginosa or MRSA

53
Q

Typical Community acquire pnemonia is caused by which pathogens

A

1) strep pneumoniae (mcc)
2) Haemophilus influenzae
3) Moraxella catarrhalis
4) Klebsiella pneumoniae
5) Staphylococcus aureus

54
Q

Atypical CAP (walking pneumonia) is caused by which pathogens?

A

Mycoplasma penumoniae (MCC)
Chlamydophila pneumoniae
Legionella spp.

55
Q

What are the presentations of typical CAP?

A

acute fever, cough +/- sputum, dyspena

56
Q

What are the physical exam findings of typical CAP?

A

evidence of consolidation: increased tactile fremitus, egophony, dullness to percussion

Crackles, tachypnea & tachycardia

57
Q

What are the presentations of atypical CAP?

A

gradual onset of HA, malaise, low-grade fever +/- sore throat, dry non productive cough

URI sxs

physical exam normal

58
Q

CXR finding for typical pneumonia

A

Lobar consolidations

59
Q

CXR findings for atypical pneumonia

A

interstitial infiltrates

60
Q

Strep pneumoniae CAP assoications

A

Most common cause of CAP
-> Gram-positive cocci
-> rust color/blood-tinged sputum
-> common in young adults, post influenza

61
Q

Haemophillus influenza CAP assoications

A

2nd most common cause of CAP
common in COPD & Elderly
-> Gram negative rod

61
Q

Kiebsiella pneumoniae CAP assoications

A

Common in alcoholics & diabetics, aspiration (affects upper lobe) & abscess formation
Gram neg rod
Current jelly sputum

62
Q

Staphylococcus aureus CAP assoications

A

Most commonly develops after the flu (post influenza)
associated with elderly, IVDU, immunocompromised

Gram + in clusters

salmon colored sputum

Bilateral lobe pneumonia

63
Q

Mycoplasma pneumoniae CAP assoications

A

Most common cause of atypical pneumoniae
associated with young health people living in close quarters such as college, military

64
Q

Legionella CAP assoications

A

transmission via aerosolized contaminated water
Nausea vomiting
hyponatremia
elevated Liver enzymes

65
Q

CURB 65

A

Confusion
U: BUN
Respiratory
B: SBP <90 or DBP<60
65: >/= age 65

66
Q

Pneumocystis pneumonia is caused by

A

pneumocystis jirovecii, aids defining illness in patient with CD4 count <200

67
Q

Pneumocystis pneumonia treatment

A

Bactrim

68
Q

Treatment for CAP outpatient

A

Macrolide or doxy

69
Q

CAP inpatient treatment

A

beta lactam (ceftrixaone) + macrolide

70
Q

Hospital aquired pnuemonia treatment

A

antipseudomonal beta lactam: piperacillin-tazobactam (Zosyn), imipenem

vancoymcin or linezolid if MRSA

71
Q

The most common type of lung cancer is

A

adenocarcinoma

associated with asbestos exposure. MC seen in non-smokers

Peripheral located

72
Q

Non small cell carcinoma includes

A

adenocarcinoma
squamous cell carcinoma
Large cell carcinoma

73
Q

Squamous cell carcinoma

A

centrally located
associated w
1) pancoast syndrome (arm/ shoulder pain)
2)honrner’s syndrome (miosis, ptosis & anhidrosis)

hypercalcemia

74
Q

Large cell carcinoma

A

very aggressive
doubles in sie quickly
peripherally located
associated with gynecomastia

75
Q

Carcinoids tumors

A

slow growing centrally located
secrete serotonin, histamine & bradykinin

most commonly affects the GI tract, lungs 2nd common site

76
Q

Small cell lung cancer

A

Very aggressive
centrally location, Mets at presentation

77
Q

Small cell lung cancer is associated with

A

Cushing syndrome
SIADH
Lambert-eaton (proximal muscle weakness that improves with continued use)

78
Q

Small cell lung caner treatment

A

chemo +/- radiation

79
Q

Non small cell lung cancer

A

surgery +/- chemo and radiation

80
Q

What are the 2 types of sleep apnea?

A

Obstructive sleep apea: decreased air flow due to upper airway obstruction. Most common type.

Central sleep apnea: when the breathing repeatedly stop and start during sleep

81
Q

What are the risk factors for obstructive sleep apnea?

A

obesity (neck circumference >40cm)

alcohol or drug use before bed can cause increased snoring but not sleep apnea.

82
Q

What does STOP-BANG stands for?

A

it is used to diagnose sleep apnea

Snoring
Tired (daytime sleepiness
Observed pnea
Pressure (HTN)
BMI >35
Age >50
Neck >43
Gender: male

83
Q

complication of of sleep apnea

A

pulmonary HTN/cor pulmonale

84
Q

treatment for tobacco use

A

Chantix
wellbutrin (bupropion)

85
Q

Lung cancer screening

A

annual screening, 50-80 years old with a hx of smoking (20 yr pack hx, currently smoking or quit within past 15 years) -> low dose computed tomography

86
Q

AAA screening

A

abdominal ultrasound to screen for abdominal aortic aneurysm in men 65-75 years when they have any smoking history

87
Q

Bone density scan

A

screen for osteoporosis in women at average risk starting at age 65 years

88
Q

Fecal immunochemical test

A

colorectal cancer screening 50–75 years old annual for anyone who does not want to do a colonoscopy

89
Q

Which smoking cessation medication is contraindiacted in patient with a history of seizure

A

bupropion lowers the seizure threshold and so is contraindicated in patients with a history of seizures

90
Q

What is the most effection treation for smoking cessation

A

Varecniline

91
Q

Recommened pneumococcal vaccine for all patient >65 yrs old and who have never received the vax in the past

A

PCV15 or PCV20
if PCV 15 is given, a dose of pneumococcal polysaccharide vaccine (PPSV23) should be administered 1 year later.

92
Q

Which pneumococcal vaccine is used in ped population

A

PCV13

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