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Family Medicine EOR > pulmonology > Flashcards

pulmonology Flashcards

1
Q

what is the presentation of asthma

A
  • cough
  • chest tightness
  • SOB
  • difficulty breathing
  • signs of atopy
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2
Q

what are triggers for asthma

A
  • virus
  • allergies
  • stress
  • exercise
  • weather
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3
Q

how do you diagnose asthma

A

spirometry

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4
Q

what is the diagnostic criteria for asthma

A
  • Reduced FEV1/FVC of <70%
  • increased FEV1 after bronchodilator by at least 12% and 200mL

for children its FEV1/FVC of 85% and just 12% increase

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5
Q

generalized treatment for asthma

A

start with ICS and SABA then you can add LABA later

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6
Q

what are the classifications for asthma

A
  • mild intermittent: 2 or fewer days per week with no nighttime symptoms
  • mild persistent: 2 or more days per week and nighttime symptoms 3-4 times per month
  • moderate persistent: daily symptoms and nighttime awakening 2 nights per week
  • severe persistent: symptoms throughout the day and nighttime awakenings nightly
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7
Q

How do you differentiate well controlled, not well controlled, and very poorly controlled asthma

A
  • well controlled: symptoms < 2 days per week
  • not well controlled: symptoms > 2 days per week or multiple times a night
  • very poorly controlled: symptoms persist throughout the day
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8
Q

what are examples of SABAs

A
  • albuterol
  • levalbuterol

SE: tachycardia, anxiety, shakiness

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9
Q

what are examples of ICS’s

A
  • budesonide
  • Fluticasone
  • beclometasome
  • mometasome

preferred meds for long term asthma control. can cause thrush so rinse mouth

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10
Q

when are systemic corticosteroids used

A

acute asthma attacks not responding to inhaled meds

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11
Q

what are examples of LABA’s

A
  • Salmetorol
  • formeterol
  • arformeterol
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12
Q

when is nebulized epinephrine used in asthma

A

for severe asthma attacks

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13
Q

what is the most important part of treatment of status asthmaticus

A

protect the airway; close watch and intubate if patient is decompensating.

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14
Q

MCC of acute bronchitis

A

viral

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15
Q

s/s of bronchitis

A

-cough
-wheezing
-SOB
-dyspnea
-fatigue
-rhonchi that clears with cough

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16
Q

diagnosis of bronchitis

A

clinical

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17
Q

treatment of bronchitis

A

reassurance and symptomatic

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18
Q

Emphysema vs Chronic Bronchitis

2 types of COPD

A
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19
Q

what are the 3 cardinal symptoms of COPD

A
  • cough
  • dyspnea
  • sputum production
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20
Q

What is the diagnostic criteria for COPD

A
  • FVC > 80% with FEV₁/FVC < 0.7
  • OR
  • FVC < 80% with TLC >80%
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21
Q

How do you stage COPD

A

Gold Staging

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22
Q

what is the treatment for COPD

A
  • Group E: LABA/LAMA
  • Group B: LABA
  • Group A: LABA/LAMA
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23
Q

What are indications for adding a ICS in COPD managament

A
  • Hx of hospitalizations secondary to exacerbation
  • > 2 exacerbations in a year
  • blood eosinophils >300
  • Hx of concomonit asthma
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24
Q

What are contraindications for ICS use in COPD

A
  • repeated pneumonia
  • blood eosinophils <100
  • hx of mycobacteria infection
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25
Q

MC etiology of pneumonia

A

strep pneumo

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26
Q

s/s of pneumonia

A
  • fever
  • shaking chills
  • SOB
  • purulent cough
  • CP
  • crackles
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27
Q

diagnosis of pneumonia

A

CXR

28
Q

treatment of pneumonia

A
  • outpatient low risk: amoxicillin, doxy, or azithromycin
  • outpatient high risk: rocephin + azithromycin or levaquin
  • inpatient non-ICU: rocephin + azithromycin or levaquin
  • inpatient ICU: rocephin + levaquin
29
Q

what are the characteristics of a solitary pulmonary nodule

A
  • <3cm
  • isolated round opacity

most are benign

30
Q

what would radiology show for a solitary pulmonary nodule

A
  • CXR: popcorn calcification
  • CT areas of altering fat/calcifications
31
Q

what are the 4 types of lung cancers

say whether they present centrally or peripherally

A
  • Small Cell Carcinoma - presents centrally
  • Squamous Cell Carcinoma - presents centrally
  • Adenocarcinoma - present peripherally
  • Large Cell Cancer - anywhere but often more peripheral
32
Q

what portion of the lung is more likely to be malignant

A

upper lobe

33
Q

what features make a solitary pulmonary nodule more likely to be malignant

A
  • in the upper lobes
  • subsolid (ground glass = bad)
  • ill defined, lobular, or spiculated. (NOT smooth)
  • growth on serial imaging
  • stippled or eccentric pattern
34
Q

what is the screening reccomendation for lung cancer

A
  • 50-80 years old in good health
  • currently smokes or quit in the past 15 years
  • at least 20 pack year history
  • access to treatment

screening should be an annual low dose CT scan

35
Q

what are the symptoms associated with pancoast tumor

A
  • shoulder pain (brachial plexus)
  • horners syndrome
  • atrophy of hand muscles
36
Q

what is a pancoast tumor

A

tumor in the apex of the lung causing compression of surrounding structures

37
Q

what population is at risk for a false negative PET scan

A

diabetics because PET scan measures glucose metabolism

38
Q

what biopsy modality is reccomended for peripherally located lung tumors

A

transthoracic percutaneous fine-needle aspiration with CT guidance

39
Q

what biopsy modality is preferred for centrally located lung tumors

A

endobronchial US bronchoscopy

40
Q

what are the 4 classifications of lung cancer

A
  • small cell lung cancer
  • squamous cell carcinoma
  • adenocarcinoma
  • large cell carcinoma

2-4 are all “non small cell lung cancer”

41
Q

what are the characteristics of small cell lung cancer

A
  • rare in non-smokers
  • bronchi (centrally located)
  • presents as large hilar mass w bulky mediastinal LAD
42
Q

what is the MC form of lung cancer in NON smokers

A

adenocarcinoma

but this is still more common in smokers than non smokers

43
Q

what is the treatment of lung cancer

A

stage 1: surgery +/- radiation
stage 2 and 3: surgery + chemo +/-radiation
stage 4: chemo +/- palliative radiation and surgery

44
Q

what is a bronchial carcinoid tumor

A

rare cancer developes in bronchi and rarely metastasizes

MC before age 60. no link to smoking.

45
Q

what is the clinical presentation of bronchial carcinoid tumor

A

hemoptysis
wheezing
recurrent pneumonia
carcinoid syndrome (flushing, diarrhea, wheezing, hypotension)

carcinoid syndrome is rare but i know itll be on there

46
Q

what is the diagnostic for bronchial carcinoid tumors

A

bronchoscopy showing pink/purple tumor that bleeds significantly on biopsy

47
Q

what is the treatment for bronchial carcinoid tumors

A

surgical excision
to avoid tumor bleeding and airway obstruction

48
Q

what is the difference between central and obstructive sleep apnea

A
  • in central there is ABSENT respiratory effort
  • in obstructive there is CONTINUED respiratory effort throughout the event but no airflow due to obstruction of upper airway.

there is also a mixed version where absent ventilatory effort precedes upper airway obstruction

49
Q

what physical exam findings might you see in obstructive sleep apnea

A

HTN
Cor Pulmonale
Sleepy appearance
Narrowed oropharynx
Nasal obstruction
Nasal twang to speech
“Bull neck” appearance

50
Q

what lab findings may be present in obstructive sleep apnea?

A

erythrocytosis

51
Q

what diagnostics are used to diagnose sleep apnea

A
  • overnight pulse oximetry (high rule OUT value)
  • polysomnogrophy
52
Q

what is the treatment for obstructive sleep apnea

A
  • Weight loss
  • nasal cPAP
  • surgical repair
53
Q

what is the MOA of nicotine in the body

A
  • stimulates nicotinic cholinergic receptors in the brain
  • triggers dopamine and epinephrine release

causes tolerance and upregulation of nicotinic (acetylcholine) receptors

54
Q

what are the s/s of nicotine withdrawal

A
  • irritability
  • insomnia
  • increased appetite
  • weight gain
55
Q

what are the nicotine metabolites

A
  • continine (16 hours in serum, several weeks in urine)
  • anabasine (present in tobacco/vapes but not in nicotine replacement or second hand smoke)
56
Q

what is the MOA of bupropion

A
  • blocks dopamine and NE reuptake
  • antagonizes nicotinic cholinergic receptors
57
Q

what are the SE of bupropion

A
  • insomnia
  • agitation
  • dry mouth
  • headache
  • seizure
58
Q

what is the MOA of chantix (varenicline)

A
  • partial agonist of nicotinic cholinergic receptors
  • AKA decreases withdrawal and blocks “reward” from nicotine
59
Q

what are the 5 A’s

A
  • Ask: Identify and document the behavior being targeted
  • Advise: Provide clear, personalized guidance on the risks and benefits of changing the behavior
  • Assess: Evaluate the individual’s readiness to change
  • Assist: Provide resources and support to help the individual change their behavior
  • Arrange: Schedule a follow-up contact to check in on progress
60
Q

5mm positives for TB skin test

A

-HIV
-recent contact with TB
-CXR findings that suggest TB
-organ transplant
-immunosuppressed

61
Q

10mm positives for TB skin test

A

-people who have come from endemic areas
-drug users
-mycobacteriology lab workers
-people who live or work in high risk congregate settings
-certain medical conditions
-children under 5
-infants or children exposed to adults in high risk categories

62
Q

15mm positives for TB skin test

A

no risk factors

63
Q

s/s of tuberculosis

A

-fever
-chills
-night sweats
-weight loss
-cough
-hemoptysis
-chest pain
-fatigue

64
Q

diagnosis of TB

A

sputum culture

65
Q

treatment of latent TB

A

Isoniazid for 9 months

66
Q

Treatment of active TB

A

Isoniazid
Rifampin
Ethambutol
Pyrazinamide

Family Medicine EOR (11 decks)

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