Pulmonary Flashcards
Drug induced asthma
17 yo kid takes aspirin
Can be also beta-blocker, ACEi, NSAIDs
Asthma classifications
Intermittent
Mild persistent
Moderate persistent
Severe persistent
Intermittent asthma
Definition
Tx
Daytime sxs > 2/ week
Nocturnal sxs , FEV1>80%
Mild persistent asthma
Definition
Tx
Daytime sxs > 2/ week, >2/ month, but 80%
Tx:
Moderate persistent asthma
Definition
Tx
Daytime daily sxs with daily beta-agonist use
Nocturnal sxs > 1/week
FEV1 > 60%- 80%
Tx:
Severe persistent asthma
Definition
Tx
Continual Daytime sxs with daily beta-agonist use
Nocturnal sxs frequent
FEV1
Peak Flow
Bedside FEV1
3 attempts and average it
Asthma diagnostic evaluation
Step 1: spirometry before and after short acting bronchodilator therapy
FEV1
Asthma treatment
Routine rescue med:
—albuterol !!
Maintenance : inhaled corticosteroids for persistent asthma
—budesonide
—fluticasone
Add on maintenance : inhaled long acting beta adrenergic (LABA)
—Salmeterol
Asthma related to allergy –additional treatment
Montelukast
COPD physical exam
Increased AP diameter
Decreased tactile fremitus
Hyperresonance
Decreased breath sounds
COPD diagnosis
CXR +/- CT
Perenchymal Bullae and blebs
PFTs for staging
Stages of COPD
I– mild , FEV1> 80% predicted
II– mod, FEV1 50-79%
III– severe, FEV1 30-49%
IV– very severe, FEV1
COPD treatment
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
Most common cause of bronchiectasis
Cystic fibrosis
1 cancer related death
Lung cancer
When to SCREEN for lung cancer ??
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!!!!
2 classifications of lung cancer
Non small cell lung cancer
Small cell lung cancer
Where is adenocarcinoma??
Peripheral nodule or mass
Where is squamous cell carcinoma ?
Endobronchial mass
Persistent cough, hemoptysis, recurrent PNA
Where makes you think of Large cell carcinoma ?
Mass with Peripheral location
Where makes you think of Small cell lung cancer ?
Hilar mass
“Oat cell”
How does the word HASSLE make you remember location of lung cancers?
HASSLE
AL are on periphery of word
Adeno
Large cell
SS are in the middle
Squamous
SSC
What is a Pancoast Tumor ?
Fast growing lung cancer with:
Horner’s syndrome (miosis,ptosis,anhidrosis)
Rib destruction
Brachial plexopathy – hand muscle atrophy, pain, weakness
Horner’s syndrome
Miosis
Ptosis
Anhidrosis
Paraneoplastic syndromes associated with lung cancer ??
Hypercalcemia — SCC
SIADH — SCLC
Outside production of ADH causing decreased renal clearance of free water with a subsequent decrease in sodium
Treatment of lung cancer?
NSCLC–> surgical resection +/- chemo and radiation
SCLC –> Chemo is mainstay
Prognosis –> 5 yr survival is 15%