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Family Medicine EOR > pulmonology > Flashcards

pulmonology Flashcards

(66 cards)

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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
MC etiology of pneumonia
strep pneumo
26
s/s of pneumonia
* fever * shaking chills * SOB * purulent cough * CP * crackles
27
diagnosis of pneumonia
CXR
28
treatment of pneumonia
* 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
what are the characteristics of a solitary pulmonary nodule
* <3cm * isolated round opacity | most are benign
30
what would radiology show for a solitary pulmonary nodule
* CXR: popcorn calcification * CT areas of altering fat/calcifications
31
what are the 4 types of lung cancers | say whether they present centrally or peripherally
* Small Cell Carcinoma - presents centrally * Squamous Cell Carcinoma - presents centrally * Adenocarcinoma - present peripherally * Large Cell Cancer - anywhere but often more peripheral
32
what portion of the lung is more likely to be malignant
upper lobe
33
what features make a solitary pulmonary nodule more likely to be malignant
* in the upper lobes * subsolid (ground glass = bad) * ill defined, lobular, or spiculated. (NOT smooth) * growth on serial imaging * stippled or eccentric pattern
34
what is the screening reccomendation for lung cancer
* 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
what are the symptoms associated with pancoast tumor
* shoulder pain (brachial plexus) * horners syndrome * atrophy of hand muscles
36
what is a pancoast tumor
tumor in the apex of the lung causing compression of surrounding structures
37
what population is at risk for a false negative PET scan
diabetics because PET scan measures glucose metabolism
38
what biopsy modality is reccomended for peripherally located lung tumors
transthoracic percutaneous fine-needle aspiration with CT guidance
39
what biopsy modality is preferred for centrally located lung tumors
endobronchial US bronchoscopy
40
what are the 4 classifications of lung cancer
* small cell lung cancer * squamous cell carcinoma * adenocarcinoma * large cell carcinoma | 2-4 are all “non small cell lung cancer”
41
what are the characteristics of small cell lung cancer
* rare in non-smokers * bronchi (centrally located) * presents as large hilar mass w bulky mediastinal LAD
42
what is the MC form of lung cancer in NON smokers
adenocarcinoma | but this is still more common in smokers than non smokers
43
what is the treatment of lung cancer
stage 1: surgery +/- radiation stage 2 and 3: surgery + chemo +/-radiation stage 4: chemo +/- palliative radiation and surgery
44
what is a bronchial carcinoid tumor
rare cancer developes in bronchi and rarely metastasizes | MC before age 60. no link to smoking.
45
what is the clinical presentation of bronchial carcinoid tumor
hemoptysis wheezing recurrent pneumonia carcinoid syndrome (flushing, diarrhea, wheezing, hypotension) | carcinoid syndrome is rare but i know itll be on there
46
what is the diagnostic for bronchial carcinoid tumors
bronchoscopy showing pink/purple tumor that bleeds significantly on biopsy
47
what is the treatment for bronchial carcinoid tumors
surgical excision to avoid tumor bleeding and airway obstruction
48
what is the difference between central and obstructive sleep apnea
* 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. ## Footnote there is also a mixed version where absent ventilatory effort precedes upper airway obstruction
49
what physical exam findings might you see in obstructive sleep apnea
HTN Cor Pulmonale Sleepy appearance Narrowed oropharynx Nasal obstruction Nasal twang to speech “Bull neck” appearance
50
what lab findings may be present in obstructive sleep apnea?
erythrocytosis
51
what diagnostics are used to diagnose sleep apnea
* overnight pulse oximetry (high rule OUT value) * polysomnogrophy
52
what is the treatment for obstructive sleep apnea
* Weight loss * nasal cPAP * surgical repair
53
what is the MOA of nicotine in the body
* stimulates nicotinic cholinergic receptors in the brain * triggers dopamine and epinephrine release ## Footnote causes tolerance and upregulation of nicotinic (acetylcholine) receptors
54
what are the s/s of nicotine withdrawal
* irritability * insomnia * increased appetite * weight gain
55
what are the nicotine metabolites
* continine (16 hours in serum, several weeks in urine) * anabasine (present in tobacco/vapes but not in nicotine replacement or second hand smoke)
56
what is the MOA of bupropion
* blocks dopamine and NE reuptake * antagonizes nicotinic cholinergic receptors
57
what are the SE of bupropion
* insomnia * agitation * dry mouth * headache * seizure
58
what is the MOA of chantix (varenicline)
* partial agonist of nicotinic cholinergic receptors * AKA decreases withdrawal and blocks “reward” from nicotine
59
what are the 5 A’s
* 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
5mm positives for TB skin test
-HIV -recent contact with TB -CXR findings that suggest TB -organ transplant -immunosuppressed
61
10mm positives for TB skin test
-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
15mm positives for TB skin test
no risk factors
63
s/s of tuberculosis
-fever -chills -night sweats -weight loss -cough -hemoptysis -chest pain -fatigue
64
diagnosis of TB
sputum culture
65
treatment of latent TB
Isoniazid for 9 months
66
Treatment of active TB
Isoniazid Rifampin Ethambutol Pyrazinamide

Family Medicine EOR (17 decks)

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