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Pulmonary Flashcards

1
Q

What is Samter’s Triad?

A

Asthma + Nasal Polyps + ASA/NSAID allergy

*Associated with atopic dermatitis

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2
Q

Extrinsic causes of asthma are allergen-induced. Intrinsic causes include:

A
  • Infection (viral/URI)
  • Meds: BBs, ASA, NSAIDs, ACEI
  • Exercise
  • Emotional
  • Cold air
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3
Q

The classic triad of asthma is:

A
  1. Dyspnea
  2. Wheezing
  3. Cough- esp. at night
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4
Q

PE of asthma reveals…

A

Prolonged expiration with wheeze, hyperresonance, decreased breath sounds, increased HR and RR.

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5
Q

The gold standard for diagnosing asthma is:

A

Pulmonary function test- reversible obstruction

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6
Q

The best way to assess asthma exacerbation severity in the ED is through a _____ test.

A

Peak expiratory flow rate (PEFR)

*If PEFR > 15% initial value (before treatment) then pt is responding appropriately to treatment

**If pulse ox < 90% you are in respiratory distress!

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7
Q

Asthma medications for acute exacerbations…

A
  1. Beta-2 Agonists: BEST!
    - Albuterol. Nebulizers used in ED
  2. Anticholinergics: Central bronchodilator, best in 1st hour
    - Tiotropium (Spiriva) and Ipratropium (Atrovent)
  3. Corticosteroids: ALL but mild exacerbations should leave with short course of PO steroids (3-5 days)
    - Prednisone, Methylprednisolone, Prednisolone
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8
Q

What are some examples of ICS used for asthma?

A
  • Beclomethasone- Qvar
  • Budesonide- Pulmicort
  • Fluticasone- Flovent
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9
Q

If persistent asthma is NOT controlled by ICS you can add a LABA.

What are some examples of LABAs?

A
  • Salmeterol

* and other “terols”

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10
Q

What are some ICS/SABA combos?

A
  • Symbicort (Budesonide/Formoterol)

- Advair (Fluticasone/Salmeterol)

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11
Q

Leukotriene Modifiers/Receptor Antagonists (LTRA) are useful in asthmatics w/ allergic rhinitis/ASA induced asthma. PROPHYLAXIS ONLY.

What are some examples?

A
  • Montelukast- Singulair

- Zafirlukast- Accolate

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12
Q

For classification of asthma severity see p. 40!

A

DO IT FOR THE CHARTS

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13
Q

Acute bronchitis is MC caused by ____ (bacteria/viruses).

A

Viruses

-Adenovirus, Parainfluenza, Influenza, Etc.

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14
Q

What are the signs and symptoms of acute bronchitis?

A

COUGH!!

+/- productive, +/- 1-3 weeks

-Symptoms similar to PNA- HA, myalgias, fever, sore throat, substernal discomfort, expiratory rhonchi/wheezes

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15
Q

How is acute bronchitis treated?

A

-Fluids + rest +/- bronchodilators +/- antitussives in adults

+/- ABX in elderly, COPD, immunocompromised, cough > 7-10 days

-COPD patients- 1st line treatment is 2nd generation Cephalosporin, 2nd line= macrolide or TMP/SMX

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16
Q

____ is the only genetic disease linked to COPD.

A

a-1 antitrypsin deficiency (in patient’s less than 40 years)

*a-1 antitrypsin protects elastin in lungs from damage by WBCs

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17
Q

Abnormal, permanent enlargement of terminal airspaces is known as ______.

A

Emphysema

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18
Q

Productive cough x 3+ months for at least 2 consecutive years is diagnostic of _____.

A

Chronic bronchitis

*chronic airway inflammation–> hypersecretion of mucus, airway narrowing, increased airway resistance

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19
Q

_____ is the MC symptom of emphysema.

*Along w/ accessory muscle use, tachypnea, long expiratory mild cough

A

Dyspnea

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20
Q

Respiratory ______ (acidosis/alkalosis) is associated with emphysema.

A

Alkalosis

*can get acidosis in acute exacerbations

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21
Q

Patients with emphysema have ____ (mild/severe) hypoxemia and often ____ (low, nml, elevated) CO2 levels.

A

Mild hypoxemia and normal CO2

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22
Q

Productive cough is a hallmark of _____.

A

Chronic bronchitis

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23
Q

S/s of Cor Pulmonale may be seen with chronic bronchitis. What is cor pulmonale?

A

Abnormal enlargement of right side of heart, peripheral edema, cyanosis

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24
Q

Respiratory ______ (acidosis/alkalosis) is associated with Chronic Bronchitis.

A

Acidosis

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25
Patients with chronic bronchitis have ____ (mild/severe) hypoxemia and ____ (low, nml, elevated) CO2 levels.
Severe, Elevated CO2
26
What is the gold standard for diagnosing COPD?
PFTs/Spirometry *FEV1 is an important factor in prognosis and mortality. FEV1 < 1L= increased mortality
27
_____ (Increased/Decreased) vascular markings are seen with Emphysema while _____ (increased/decreased) vascular markings are seen with Chronic Bronchitis.
Decreased vascular markings= Emphysema Increased vascular markings= Chronic Bronchitis (w/ enlarged right heart border)
28
Cor pulmonale is suggestive of what chronic conditions?
Pulmonary HTN--> RVH, RAE, right axis deviation, and Rside HF
29
Bronchodilators are a mainstay of treatment for COPD. Especially _____ (class of med) + _____ (class of med).
Anticholinergics + B2 agonists
30
What are some popular anticholinergics used with COPD?
1. Tiotropium (Spiriva)- inhaled long-acting | 2. Ipratropium (Atrovent)
31
FYI
SABA relax muscle bands after they are already tight Anticholinergics prevent the bands from tightening
32
Anticholinergics preferred over SABA in COPD!
Anticholinergics are CI in BPH and Glaucoma
33
Common Beta2 agonists for COPD are:
Albuterol, Terbutaline; Salmeterol (long-acting) *CI in patients with severe CAD, caution in patients with DM (HYPERglycemia), hyperthyroidism
34
ICS NOT USED AS MONOTHERAPY IN PATIENTS WITH COPD!!
May be added to LABA *S/E- thrush, infxns, osteoporosis, hyperglycemia, fluid retention, and renal calculi
35
____ is the only medical therapy shown to decrease mortality!
O2 | decreases pulmonary HTN by decreasing hypoxia-mediated pulmonary vasoconstriction
36
____ (specific abx) has been shown to have anti-inflammatory properties in the lung.
Azithromycin
37
GOLD Classification: all stages- FEV1/FVC <70%
Gold I: Mild: FEV1 >80% predicted GOLD II: Mod: FEV1 50-79% GOLD III: Severe: FEV1 30-50% GOLD IV: Very Severe: Cor pulmonale, resp. failure, HF, FEV1 < 30%
38
Know COPD risk stratification chart
p. 42
39
The MC cause of CAP is _____.
Strep pneumo
40
2nd MC cause of CAP, esp w/ patient populations including: COPD, EtOH abuse, DM, kids, <6y, and elderly is _____.
H flu
41
____ PNA is especially common in elderly, smokers, and immunodeficient.
Legionella
42
____ PNA is seen in severe EtOHics. See cavitary lesions on CXR.
Klebsiella
43
Histoplasma capsulatum is found most often in the Mississippi and Ohio river valleys and is associated with soil containing _____.
Bird and bat droppings
44
HAP occurs after ____ hours of admission in hospital.
48 hours
45
Signs and Symptoms of typical PNA include:
Sudden fever, productive cough (purulent sputum), pleuritic CP, rigors, tachyHR, tachyRR *Elderly or confused patients may not have resp s/s, fever, or inc. WBC; may have AMS, depressed mental fxn
46
R upper lobe is associated with ____ PNA and R lower lobe is associated with ____ PNA.
Upper- Klebsiella Lower- Anaerobes
47
1st line treatment for CAP, Outpt:
Macrolide or Doxy (FQ if comorbids, recent ABX) *Macrolides used: Clarithro, Azithro
48
1st line treatment for CAP, Inpt:
Beta lactam + Macrolide (or Doxy) OR broad spectrum FQ
49
1st line treatment for CAP, ICU:
Beta lactam + Macrolide OR broad spectrum FQ
50
1st line treatment for HAP:
- Anti-pseudomonal AG or FQ - Suspect MRSA: add vanc or linezolid - Suspect legionella: add Levofloxacin or Azithro - Suspect PCP: add Bactrim +/- steroids - If beta-lactam allergy: FQ +/- Clinda, aztreonam, AG
51
1st line treatment for Aspiration (anaerobes):
Clinda or Flagyl or Augmentin
52
What are some anti-pseudomonal beta lactams?
Zosyn (piperacillin/tazobactam), Cefepime, Imipenem, Meropenum, Ceftazidime
53
Respiratory FQs used:
Levofloxacin, Moxifloxacin, Gemifloxacin
54
A granuloma is a collection of macrophages produced in response to inflammation or infxn by foreign substance.
Just FYI
55
Health care workers, immigrants from high-prevalence areas, homeless, and the immunodeficient (HIV, DM, IVDA, ETOHics, malignancy) are all at high risk for what pulmonary infxn?
Tuberculosis
56
Primary TB is the outcome of the initial infxn and is usually self-limiting
FYI *90% control initial primary infxn via granuloma formation- becomes a chronic, LATENT, infxn
57
Granulomas become _____ (TB key word)
CASEATING- central necrosis, acidic w/ low O2, making it hostile for TB to grow
58
What populations are at risk for SECONDARY (reactivation) TB?
Elderly, HIV+, steroid use, malignancy
59
Reactivation TB is MC in _____ lobes with cavitary lesions. It is CONTAGIOUS.
Apex/Upper lobes--> more O2 here
60
Signs & Symptoms of active TB are:
- chronic, productive cough w/ pleuritic CP - hemoptysis if advanced - night sweats, fever/chills - fatigue - anorexia/weight loss
61
PE findings for TB?
Signs of consolidation, Rales/rhonchi near apices, dullness
62
___ is used to screen for TB. Look for transverse induration (redness is not a positive)!
PPD * If ≥5mm in at risk pops then it is POSITIVE * *If ≥15mm in persons w/ NO risk factors it is POSITIVE
63
The gold standard test for DX in a person w/ suspected TB is:
Acid-fast Smear & Sputum culture (AFB) *TB r/o after 3- smears
64
____ indicated to exclude active TB.
CXR *Also for yearly screening in pts w/ known positive PPD to r/o active TB
65
The Quantiferon-TB Gold assay is a blood test w/ improved specificity, no reader bias, no booster phenomenon, and NOT affected by prior BCG vaccination.
FYI
66
The initial 4 drug regimen for the treatment of active TB is:
1. Rifampin (RIF) 2. Isoniazid (INH)- take Pyridoxine (B6) w/ this to prevent peripheral neuropathy 3. Pyrazinamide (PZA)- can cause hepatitis and hyperuricemia 4. Ethambutol (EMB)- can cause optic neuritis OR Streptomycin (STM)- Ototoxicity and Nephrotoxicity
67
4 TB drugs are taken for __ months w/ total treatment duration of __ months.
All 4= 2 months (then drop PZA after 2 months, and drop EMB or STM if culture shows sensitivity to both RIF and INH) Total treatment time= 6 months *NOT considered infectious 2 weeks after treatment initiation
68
Treatment of LATENT TB infections reduces risk of reactivation in future. Treatment is:
- Likely INH Sensitive: INH + B6 for 9 months | - HIV+: INH + B6 for 12 months
69
INH prophylaxis is warranted in kids < __ years w/ exposure to contacts w/ active dz.
4
70
____ cancer is the MC cause of cancer deaths; MC 50s-60s
Lung
71
Non Small Cell Carcinoma makes up about 85% of cases. The MC type of NSCC is _____.
Adenocarcinoma (35%)- from mucus glands
72
____ is at type of NSSC that is usually centrally located and is associated with Cavitary lesions, hyperCalcemia, and Pancoast Syndrome (CCP).
Squamous Cell *Pancoast Syndrome- tumors at superior sulcus and shoulder pain, Horner's syndrome (miosis, ptosis, anhidrosis)
73
Small Cell (Oat Cell) Carcinoma is metastatic early! Surgery is usually not a treatment option.
May see Trousseau's Syndrome- vessel inflammation due to blood clots which are recurrent and occur in different locations
74
How is lung cancer diagnosed?
CXR and CT for staging
75
How is lung cancer treated?
NSSC: Surgical resection Small cell: Chemo (+/- radiation)
76
2 types of sleep apnea: Central and Obstructive...
1. Central- reduced CNS resp. drive | 2. Obstructive- physical airway obstruction
77
Signs and Symptoms of sleep apnea...
Snoring, unrestful sleep, nocturnal choking
78
Labwork of someone with OSA may show...
Polycythemia- due to chronic hypoxemia, hypercapnia and hypoxemia on ABGs
79
Surgical corrective options for someone with OSA are:
- Tracheostomy- definitive - Nasal septoplasty - Uvulopalatopharyngoplasty
80
_____ Test assesses level of nicotine dependence. Higher the score= more dependent.
Fagerstrom
81
The most important indicators are ____ and ____.
of ciggs Time to first cigg
82
1st line therapy for nicotine dependence...
1. NRT- patch, gum, lozange, nasal spray (rx), inhaler (rx) 2. Bupropion (Zyban) 3. Varenicline (Chantix) - 2nd line: Nortriptyline and Clonidine
83
____ is best choice of NRT for pregnant women due to ability to dose intermittently.
Gum (NOT patch)
84
Advantage of gum and lozenge is that they _____.
Relieve cravings
85
Oral inhaler and nasal spray are CI in patients with ____.
Severe reactive airway dz
86
Bupropion is CI in what patient populations?
Seizures, hx of anorexia/bulimia, undergoing d/c of ETOH or sedatives
87
Nausea, visual disturbance, insomnia, abnormal dreams, and increased CVD risk and suicide risk are associated with what treatment?
Chantix

Primary Care (12 decks)

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