Pulmonology Flashcards
triggers for asthma
-pollutants
-infection
-cold
-smoke
other conditions often seen with asthma
-eczema
-allergies
What is Samter’s triad
s/s of asthma
-cough
-chest tightness
-SOB
-wheezing
diagnosis of asthma
-children: reduction in either FEV1 or FVC by >12% (85% of predicted)
-adults: reduction in either FEV1 or FVC by >12% AND a minimum of >200mL (70% of predicted)
mild intermittent asthma
-symptoms <2 or fewer days per week
-<2 night awakenings per month
-doesn’t interfere with normal activities
mild persistent asthma
-symptoms >2 times weekly
-3-4 night awakenings per month
-use of SABA more than twice a week
moderate persistent asthma
-daily asthma symptoms
-nighttime awakenings >1/week
-daily need for SABA
severe persistent asthma
-symptoms of asthma throughout the day
-nightly awakenings
-need for SABA multiple times per day
treatment of asthma
-SABA (albuterol, metaproterenol, terbutamine)
-SABA + ICS (budesonide, declomethasone dipropionate)
-SABA + ICS + LABA (salmeterol, fometerol)
causes of bronchitis
typically viral or bacterial
s/s of acute bronchitis
-cough
-substernal pain
-wheezing
-fever
-SOB
treatment of acute bronchitis
-symptomatic treatment
MCC of COPD
smoking
COPD symptoms
-dyspnea
-chronic cough
-sputum production
-wheezing
-chest tightness
COPD vs EMPHYSEMA
diagnosis of COPD
-FEV1 less than 80% predicted
-FEV1/FVC ratio: less than (0.7) 70%
vaccine recommendations for COPD patients
-pneumonia (over 18)
-flu
-COVID
GOLD classification
Gold 1: FEV1: >80 predicted
Gold 2: FEV1: 50-79 predicted
Gold 3: FEV1: 30-49 predicted
Gold 4: FEV1:<30 predicted
ABCD assessment tool
-A: 0-1 exacerbations and CAT <10
-B: 0-1 exacerbations and CAT >10
-C: >2 exacerbations and CAT<10
-D: >2 exacerbations and CAT>10
treatment of COPD
-A: intermittent use of SABA
-B: SABA + LABA or LAMA
-C: SABA + LAMA
-D: SABA + LABA + LAMA
treatment of COPD exacerbation
-increase SABA use
-neb
-oral steroids
-azithromycin, augmentin, or doxy
solid vs subsolid pulmonary nodule
-solid: less likely to be cancer
-subsolid: more likely to be cancer
management of solitary pulmonary nodules
->30mm: resection
-<30mm: determine risk for malignancy
screening criteria for lung cancer
-50-80 years old
-currently smoke or quit in the last 15 years
-20 pack year history
s/s of lung cancer
-cough
-blood tinged sputum
-CP
-SOB
diagnosis of lung cancer
-CT with contrast then biopsy
techniques for biopsy depending on location of tumor
-central: endobronchial
-peripheral: transthoracic
small cell carcinoma
-smokers
-central
adenocarcinoma
-nonsmokers
-peripheral
Most common type of lung cancer-non small cell (adenocarcinoma)
squamous cell carcinoma
-smokers
-central
large cell carcinoma
-peripheral
treatment for NSCLC
-stage 0 and 1: surgery
-stage 2 and 3: surgery + chemo
-stage 4: chemo and palliative surgery or radiation
treatment for SCLC
-limited stage with no mets: surgery + chemo
-limited stage with mets: chemo + radiation
-extensive: chemo
MCC for pneumonia
strep pneumo
Dx of pneumonia
CXR
when do you order sputum cultures for pneumonia?
when hospitalizing
s/s of pneumonia
-cough
-sputum
-fever
-dyspnea
determine if patient needs hospitalized for pneumonia
PSI and CURB65
3-5: hospitalize
4-5: ICU
CURB65
C - Confusion
U - BUN >19
R - RR>30
B - BP <90/60
>65
Any criteria > 2 indicate need for inpatient admission
treatment of pneumonia
-outpt with no comorbidities: amoxicillin + (macrolide or doxy)
if penicillin allergy use a 3rd gen ceph (cefpodoxime)
-outpt with comorbidities: azithromycin + rocephin OR levaquin
-inpatient non ICU: levaquin OR rocephin + azithromycin
-inpatient ICU: rocephin + levaquin OR rocephin + azithromycin
s/s of sleep apnea
-HTN
-sleepy appearance
-bull neck
-right rided HF
diagnosis of sleep apnea
sleep study
polysomnography
tx of sleep apnea
CPAP
s/sx of TB
fever, night sweats, loss of energy/appetite, weight loss
dx of TB
ppd skin test
in what pts is positive >5 mm ppd
-HIV
-contact with TB patient
-immunosuppressed
-xray findings
positive >10 mm ppd
-high risk workers
-people who come to us from areas where TB is common
-comorbidities
-children
positive >15 mm ppd
anyone else
tx of TB
Isoniazid
Rifampin
Pyrazinamide
Ethambutol
Streptomycin
