Pulmonary Flashcards
COPD Path: Pt: Dx: Tx:
Path: Loss of elastic recoil + increased airway resistance
Emphysema: abnormal, permanent enlargement of terminal airspaces
Chronic Bronchitis: productive cough >/=3m x2 consecutive years
Pt:
E: dyspnea, accessory muscle use, tachypnea, prolonged exhalation
CB: productive cough, rale/rhonchi/wheeze, cor pulmonale
Dx:
GS: spirometry: obstruction -> dec FEV1, FVC and FEV1/FVC<70%
moderate-severe exacerbation FEV1<50%
CXR/CT scan: flattened diaphragm, dec/inc vascular markings, +/- bullae, inc AP diameter, enlarged right heart border
EKG: cor pulmonale, a-fib/a-flutter, mutifocal atrial tachycardia
Tx:
- Smoking cessation
- Bronchodilators: anticholinergic + beta agonist
- inhaled corticosteroids
- Oxygen -> ONLY medical therapy proven to decrease mortality
- Prevent exacerbations-> smoking cessation, pneumonia/influenza vaccines, pulmonary rehab
GOLD staging criteria + tx
I: Mild FEV1>/=80%
tx: short acting bronchodilators; vaccinations
II: Moderate FEV1 50-70%
tx: above + long acting bronchodilator
III: Severe FEV1 30-50%
tx: above + pulmonary rehab, steroids if increased exacerbations
IV: Very severe FEV1<30%, cor pulmonale, respiratory failure, heart failure
tx: above + oxygen therapy
Tobacco dependence
Pt:
Tx:
Pt: restless, anxiety, irritability, sleep abnormalities, depression, nicotine craving
Tx:
Counseling and support therapy, cognitive behavioral therapy
Nicotine tapering therapy: gum, nasal sprays, transdermal patches, inhaler, lozenges
Bupropion: often used in combo w/ nicotine tapering
Varenicline (Chantix): blocks nicotine receptors, reducing nicotine activity
A patient receiving quadruple drug therapy for active tuberculosis develops pain and paresthesias in his fingers and toes. What is the most likely agent responsible for these symptoms?
Ethambutol
Obstructive Sleep Apnea Path Pt Dx Tx Complications
Path: pharynx collapse
Pt: obese w/ hx of allergies,
c/o apneic episodes while sleeping, snoring and daytime sleepiness
PE:enlarged tonsils
Dx: sleep study (polysomnography)
Screen: STOP BANG 3+-> refer to sleep study
snoring, tiredness, observed stop breathing, blood pressure, BMI>35, Age>50, neck circumference>40cm, gender (male)
Tx: weight loss, CPAP
Complications:
pulmonary hypertension
cor pulmonale (right ventricular hypertrophy)
Mild intermittent asthma
Dx
Tx
of sx:
Days: 2 day/week
Nights: 2 days/month
FEV1: 80%
Tx: beta-2 agonist prn inhaled corticosteroid (low dose)
Mild persistent asthma
Dx
Tx
of sx:
Days: >2 days/week
Nights: 3-4 days/month
FEV1: 80%
Tx: beta-2 agonist prn
inhaled corticosteroid (low dose) + LABA OR inhaled corticosteroid (medium dose dose)
Moderate persistent asthma
Dx
Tx
of sx:
Days: daily
Nights: 5 days/month
FEV1: 60-80%
Tx: beta-2 agonist prn
inhaled corticosteroid (medium dose) + LABA
and/or leukotriene receptor antagonist
Severe persistent asthma
Dx
Tx
of sx:
Days: continual
Nights: frequent
FEV1: =60%
Tx: beta-2 agonist prn inhaled corticosteroid (high dose) + LABA and/or leukotriene receptor antagonist oral corticosteroid omalizumab
Lung cancer Path: Screening: Pt: Dx: Tx:
Path:
85% non-small cell: adenocarcinoma (MC), large cell, squamous
15% small cell (strong correlation to smoking)
Screening: Age 55-77, No sxs of lung cancer
>30 pack year smoking history
Current smoker or quit within the past 15yrs
Pt: cough, dyspnea, hemoptysis, weight loss
Dx: CXR and CT Sputum cytology- for central lesions Bronchoscopy- for central lesions Pleural fluid analysis Trans-thoracic needle biopsy Mediastinoscopy
Tx:
Non-small cell: surgical intervention first line
Small cell: chemo and radiation
Pneumonia Path: Dx: Tx: Complication
Path:
CAP: strep pneumonia
COPD: H flu, M cat
Hospital: pseudomonas, MRSA
Dx: CXR, PE findings
Tx:
Out pt: Macrolide or doxycycline
Fluoroquinolone if comorbid conditions/recent abx use
In pt: B lactam + macrolide, Broad spectrum fluoroquinolone
Aspiration: Clinda, Metronidazole, Augmentin
Complication-> MC cause of lung abscess
Tx: Clinda
Tuberculosis Path: Pt: Dx: Tx:
Path: mycobacterium tuberculosis
Pt: chronic productive cough, hemoptysis, fever, chills, weight loss, high risk for TB (HIV, DM, IVDA, ETOHics, malignancy)
Dx:
Gold standard: AFB cultures x3 days
PPD:
>/=5mm: HIV + or immunosuppressed,
close contacts of pts with active TB, CXR consistent with old healed TB (calcified granuloma)
>/=10mm: All other high-risk populations/high prevalence populations, Recent conversion = inc induration by >10mm in the past 2 yrs
>/=15mm: Everyone else (no known risk factors for TB)
Tx: Isoniazid + rifampin + pyrazinamide + ethambutol
Admission to hospital pneumonia
CURB-65 Confusion Urea >7 RR >/=30 BP: SBP=90 OR DBP =60 65 years or older 0-1: low risk, consider home tx 2: probably admission vs close out pt monitoring 3-5: admission, manage as severe
Active TB treatment which causes paresthesias:
color blindness:
GI side effects:
increase LFTs:
paresthesias: Isoniazid
color blindness: Ethambutol
GI side effects: Pyrazinamide
increase LFTs: Rifampin
