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PANRE > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

Drug induced asthma

A

17 yo kid takes aspirin

Can be also beta-blocker, ACEi, NSAIDs

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2
Q

Asthma classifications

A

Intermittent

Mild persistent

Moderate persistent

Severe persistent

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3
Q

Intermittent asthma

Definition

Tx

A

Daytime sxs > 2/ week

Nocturnal sxs , FEV1>80%

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4
Q

Mild persistent asthma

Definition

Tx

A

Daytime sxs > 2/ week, >2/ month, but 80%

Tx:

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5
Q

Moderate persistent asthma

Definition

Tx

A

Daytime daily sxs with daily beta-agonist use
Nocturnal sxs > 1/week
FEV1 > 60%- 80%

Tx:

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6
Q

Severe persistent asthma

Definition

Tx

A

Continual Daytime sxs with daily beta-agonist use
Nocturnal sxs frequent
FEV1

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7
Q

Peak Flow

A

Bedside FEV1

3 attempts and average it

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8
Q

Asthma diagnostic evaluation

A

Step 1: spirometry before and after short acting bronchodilator therapy
FEV1

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9
Q

Asthma treatment

A

Routine rescue med:
—albuterol !!
Maintenance : inhaled corticosteroids for persistent asthma
—budesonide
—fluticasone
Add on maintenance : inhaled long acting beta adrenergic (LABA)
—Salmeterol

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10
Q

Asthma related to allergy –additional treatment

A

Montelukast

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11
Q

COPD physical exam

A

Increased AP diameter

Decreased tactile fremitus

Hyperresonance

Decreased breath sounds

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12
Q

COPD diagnosis

A

CXR +/- CT

Perenchymal Bullae and blebs

PFTs for staging

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13
Q

Stages of COPD

A

I– mild , FEV1> 80% predicted
II– mod, FEV1 50-79%
III– severe, FEV1 30-49%
IV– very severe, FEV1

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14
Q

COPD treatment

A 
Bronchodilators are mainstay!!
Short acting rescue agent 
----beta2 agonist + anticholinergic 
      -- albuterol + ipratropium 
Long acting maintenance agent : 
----long acting anticholinergics 
       -- tiotropium
----long acting beta2 agonist 
       -- salmeterol
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15
Q

Most common cause of bronchiectasis

A

Cystic fibrosis

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16
Q

1 cancer related death

A

Lung cancer

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17
Q

When to SCREEN for lung cancer ??

A

Age 55-75 if smoked > 30 pack years and are still smoking or quit within 15 years

This is standard of care and is frequently not done!!!!

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18
Q

2 classifications of lung cancer

A

Non small cell lung cancer

Small cell lung cancer

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19
Q

Where is adenocarcinoma??

A

Peripheral nodule or mass

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20
Q

Where is squamous cell carcinoma ?

A

Endobronchial mass

Persistent cough, hemoptysis, recurrent PNA

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21
Q

Where makes you think of Large cell carcinoma ?

A

Mass with Peripheral location

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22
Q

Where makes you think of Small cell lung cancer ?

A

Hilar mass

“Oat cell”

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23
Q

How does the word HASSLE make you remember location of lung cancers?

A

HASSLE

AL are on periphery of word
Adeno
Large cell

SS are in the middle
Squamous
SSC

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24
Q

What is a Pancoast Tumor ?

A

Fast growing lung cancer with:
Horner’s syndrome (miosis,ptosis,anhidrosis)

Rib destruction

Brachial plexopathy – hand muscle atrophy, pain, weakness

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25
Q

Horner’s syndrome

A

Miosis

Ptosis

Anhidrosis

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26
Q

Paraneoplastic syndromes associated with lung cancer ??

A

Hypercalcemia — SCC

SIADH — SCLC
Outside production of ADH causing decreased renal clearance of free water with a subsequent decrease in sodium

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27
Q

Treatment of lung cancer?

A

NSCLC–> surgical resection +/- chemo and radiation

SCLC –> Chemo is mainstay

Prognosis –> 5 yr survival is 15%

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28
Q

Mesothelioma

A

Pleural based mass

29
Q

Influenza treatment

A

Supportive

Zanamavir

Osaltamivir

30
Q

COPD exacerbation treatment

A

Oxygen is critical

Albuterol / ipratropium inhaler or neb

31
Q

CAP

Typical pathogens

A

Strep pneumo
H. Flu
M. Cat

32
Q

CAP

Atypical pathogens

A

Legionella
mycoplasma pneumoniae
Chlamydia pneumoniae

33
Q

CAP pearls for strep pneumo

A

Single rigor
pleurisy / pleural effusions
“Rust colored” sputum

34
Q

CAP pearls for H flu

A

Pt has COPD too

35
Q

CAP Pearls for M cat

36
Q

CAP pearls for Legionella pneumophilia

A

Fever
Hyponatremia
Diarrhea
Aerosolized water - cruise ship

Sicker than CXR looks

37
Q

CAP pearls for mycoplasma pneumoniae

A

Cough
Similar to bronchitis but feel sick for weeks
Walking PNA

38
Q

CAP treatment outpt

A

Doxycycline
Macrolides like Azithromycin
FQ like levofloxicin

39
Q

CAP treatment for inpt

A

Ceftriaxone plus Azithromycin

Allergy: Respiratory FQ

40
Q

How long to treat PNA ?

A

Pneumococcal PNA : 72 hrs

Atypical PNA : 2-3 weeks

41
Q

H. Flu gram stain for CAP

A

“Pleomorphic”

42
Q

“Pleural plaquing”

A

Mesothelioma

43
Q

“Pleural based mass”

A

Pneumoconiosis

44
Q

Tuberculosis

A

Need to review high points later

45
Q

MAC

A

Common in AIDS pts with CD4

46
Q

Sarcoidosis

A

High ACE
Hypercalcemia from high calcitriol

CXR : bilateral perihilar lymphadenopathy

Biopsy : noncaseating granulomas**

47
Q

Idiopathic pulmonary fibrosis

A

Velcro crackles

“Ground glass”

“Honey-combing”

Restrictive PFTs

48
Q

Quick eyeball pleural fluid results and protein is

A

Transudative : protein

49
Q

Most common cause of transudative effusion ?

A

Heart failure in 90%

50
Q

Most common cause of exudative effusion?

A

PNA - treat the underlying condition

51
Q

Exudative effusion associated with malignancy – what cancer?

A

Commonly lung or breast cancer

52
Q

Most common cause of pneumothorax

A

Primary PTX: tall thin M smoker

Secondary PTX: COPD

53
Q

When does a pneumothorax get a chest tube?

A

If > 15-20%, require chest tube decompression

54
Q

DVT diagnosis

A

“Screening test” – Venous US

“Gold standard” - venography (even though clinically we don’t do this, bc use US, this is the “definitive test”)

55
Q

CXR findings for PE

EKG finding

A

Westermarks sign
Hamptons hum

S1Q3T3

56
Q

PE diagnosis ?

A

NOT V/Q

Gold standard is pulmonary angiography** (although clinically would not do this ever)

57
Q

Cor pulmonale

A

Right heart failure due to lung disease

58
Q

OSA definition

A

Apnea greater than 10 seconds and

occurs > 7-10x / hr

59
Q

Pulmonary HTN definition

A

Pulm artery pressure > 25 on right heart cath

60
Q

Asthma

A

Episodic wheezing

Largely REVERSIBLE airway obstruction

Chronic inflammatory condition

61
Q

Types of non-small cell lung cancer

A

Squamous cell carcinoma, adenocarcinoma, and large cell carcinoma are all subtypes of non-small cell lung cancer

62
Q

Most common lung cancer

A

Non-Small Cell Lung Cancer. About 85% of lung cancers are non-small cell lung cancers.

63
Q

Types of lung cancer

A 
Non-small cell 85%- subtypes: adeno (MC), squamous, large cell
Small cell (15%) - no subtype (smokers, grows fast)
64
Q

Noncaseating granuloma

A

Sarcoidosis

65
Q

If local pleural disease, like PNA or malignancy, would you expect a Exudative or transudative effusion ?

66
Q

DOC for uncomplicated COPD

A

Doxycycline
Tmp-SMX
Cefuroxime

67
Q

DOC for complicated COPD

A

Amoxicillin / clavulanate

Or

Levofloxicin

68
Q

DOC for typical CAP outpt

A

Doxy

Azithromycin

Levofloxicin

69
Q

DOC if covering for atypical PNA

A

Ceftriaxone + Azithromycin

Or

Levofloxicin

PANRE (21 decks)

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