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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
Horner's syndrome
Miosis Ptosis Anhidrosis
26
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
27
Treatment of lung cancer?
NSCLC--> surgical resection +/- chemo and radiation SCLC --> Chemo is mainstay Prognosis --> 5 yr survival is 15%
28
Mesothelioma
Pleural based mass
29
Influenza treatment
Supportive Zanamavir Osaltamivir
30
COPD exacerbation treatment
Oxygen is critical Albuterol / ipratropium inhaler or neb
31
CAP Typical pathogens
Strep pneumo H. Flu M. Cat
32
CAP Atypical pathogens
Legionella mycoplasma pneumoniae Chlamydia pneumoniae
33
CAP pearls for strep pneumo
Single rigor pleurisy / pleural effusions "Rust colored" sputum
34
CAP pearls for H flu
Pt has COPD too
35
CAP Pearls for M cat
None
36
CAP pearls for Legionella pneumophilia
Fever Hyponatremia Diarrhea Aerosolized water - cruise ship Sicker than CXR looks
37
CAP pearls for mycoplasma pneumoniae
Cough Similar to bronchitis but feel sick for weeks Walking PNA
38
CAP treatment outpt
Doxycycline Macrolides like Azithromycin FQ like levofloxicin
39
CAP treatment for inpt
Ceftriaxone plus Azithromycin | Allergy: Respiratory FQ
40
How long to treat PNA ?
Pneumococcal PNA : 72 hrs Atypical PNA : 2-3 weeks
41
H. Flu gram stain for CAP
"Pleomorphic"
42
"Pleural plaquing"
Mesothelioma
43
"Pleural based mass"
Pneumoconiosis
44
Tuberculosis
Need to review high points later
45
MAC
Common in AIDS pts with CD4
46
Sarcoidosis
High ACE Hypercalcemia from high calcitriol CXR : bilateral perihilar lymphadenopathy Biopsy : **noncaseating granulomas****
47
Idiopathic pulmonary fibrosis
Velcro crackles "Ground glass" "Honey-combing" Restrictive PFTs
48
Quick eyeball pleural fluid results and protein is
Transudative : protein
49
Most common cause of transudative effusion ?
Heart failure in 90%
50
Most common cause of exudative effusion?
PNA - treat the underlying condition
51
Exudative effusion associated with malignancy -- what cancer?
Commonly lung or breast cancer
52
Most common cause of pneumothorax
Primary PTX: tall thin M smoker Secondary PTX: COPD
53
When does a pneumothorax get a chest tube?
If > 15-20%, require chest tube decompression
54
DVT diagnosis
"Screening test" -- Venous US "Gold standard" - venography (even though clinically we don't do this, bc use US, this is the "definitive test")
55
CXR findings for PE EKG finding
Westermarks sign Hamptons hum S1Q3T3
56
PE diagnosis ?
NOT V/Q Gold standard is pulmonary angiography** (although clinically would not do this ever)
57
Cor pulmonale
Right heart failure due to lung disease
58
OSA definition
Apnea greater than 10 seconds and occurs > 7-10x / hr
59
Pulmonary HTN definition
Pulm artery pressure > 25 on right heart cath
60
Asthma
Episodic wheezing Largely REVERSIBLE airway obstruction Chronic inflammatory condition
61
Types of non-small cell lung cancer
Squamous cell carcinoma, adenocarcinoma, and large cell carcinoma are all subtypes of non-small cell lung cancer
62
Most common lung cancer
Non-Small Cell Lung Cancer. About 85% of lung cancers are non-small cell lung cancers.
63
Types of lung cancer
``` Non-small cell 85%- subtypes: adeno (MC), squamous, large cell Small cell (15%) - no subtype (smokers, grows fast) ```
64
Noncaseating granuloma
Sarcoidosis
65
If local pleural disease, like PNA or malignancy, would you expect a Exudative or transudative effusion ?
Exudative
66
DOC for uncomplicated COPD
Doxycycline Tmp-SMX Cefuroxime
67
DOC for complicated COPD
Amoxicillin / clavulanate Or Levofloxicin
68
DOC for typical CAP outpt
Doxy Azithromycin Levofloxicin
69
DOC if covering for atypical PNA
Ceftriaxone + Azithromycin Or Levofloxicin

PANRE (21 decks)

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