pulmonology Flashcards
what is the presentation of asthma
- cough
- chest tightness
- SOB
- difficulty breathing
- signs of atopy
what are triggers for asthma
- virus
- allergies
- stress
- exercise
- weather
how do you diagnose asthma
spirometry
what is the diagnostic criteria for asthma
- 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
generalized treatment for asthma
start with ICS and SABA then you can add LABA later
what are the classifications for asthma
- 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
How do you differentiate well controlled, not well controlled, and very poorly controlled asthma
- 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
what are examples of SABAs
- albuterol
- levalbuterol
SE: tachycardia, anxiety, shakiness
what are examples of ICS’s
- budesonide
- Fluticasone
- beclometasome
- mometasome
preferred meds for long term asthma control. can cause thrush so rinse mouth
when are systemic corticosteroids used
acute asthma attacks not responding to inhaled meds
what are examples of LABA’s
- Salmetorol
- formeterol
- arformeterol
when is nebulized epinephrine used in asthma
for severe asthma attacks
what is the most important part of treatment of status asthmaticus
protect the airway; close watch and intubate if patient is decompensating.
MCC of acute bronchitis
viral
s/s of bronchitis
-cough
-wheezing
-SOB
-dyspnea
-fatigue
-rhonchi that clears with cough
diagnosis of bronchitis
clinical
treatment of bronchitis
reassurance and symptomatic
Emphysema vs Chronic Bronchitis
2 types of COPD
what are the 3 cardinal symptoms of COPD
- cough
- dyspnea
- sputum production
What is the diagnostic criteria for COPD
- FVC > 80% with FEV₁/FVC < 0.7
- OR
- FVC < 80% with TLC >80%
How do you stage COPD
Gold Staging
what is the treatment for COPD
- Group E: LABA/LAMA
- Group B: LABA
- Group A: LABA/LAMA
What are indications for adding a ICS in COPD managament
- Hx of hospitalizations secondary to exacerbation
- > 2 exacerbations in a year
- blood eosinophils >300
- Hx of concomonit asthma
What are contraindications for ICS use in COPD
- repeated pneumonia
- blood eosinophils <100
- hx of mycobacteria infection
MC etiology of pneumonia
strep pneumo
s/s of pneumonia
- fever
- shaking chills
- SOB
- purulent cough
- CP
- crackles
diagnosis of pneumonia
CXR
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
what are the characteristics of a solitary pulmonary nodule
- <3cm
- isolated round opacity
most are benign
what would radiology show for a solitary pulmonary nodule
- CXR: popcorn calcification
- CT areas of altering fat/calcifications
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
what portion of the lung is more likely to be malignant
upper lobe
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
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
what are the symptoms associated with pancoast tumor
- shoulder pain (brachial plexus)
- horners syndrome
- atrophy of hand muscles
what is a pancoast tumor
tumor in the apex of the lung causing compression of surrounding structures
what population is at risk for a false negative PET scan
diabetics because PET scan measures glucose metabolism
what biopsy modality is reccomended for peripherally located lung tumors
transthoracic percutaneous fine-needle aspiration with CT guidance
what biopsy modality is preferred for centrally located lung tumors
endobronchial US bronchoscopy
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”
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
what is the MC form of lung cancer in NON smokers
adenocarcinoma
but this is still more common in smokers than non smokers
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
what is a bronchial carcinoid tumor
rare cancer developes in bronchi and rarely metastasizes
MC before age 60. no link to smoking.
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
what is the diagnostic for bronchial carcinoid tumors
bronchoscopy showing pink/purple tumor that bleeds significantly on biopsy
what is the treatment for bronchial carcinoid tumors
surgical excision
to avoid tumor bleeding and airway obstruction
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.
there is also a mixed version where absent ventilatory effort precedes upper airway obstruction
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
what lab findings may be present in obstructive sleep apnea?
erythrocytosis
what diagnostics are used to diagnose sleep apnea
- overnight pulse oximetry (high rule OUT value)
- polysomnogrophy
what is the treatment for obstructive sleep apnea
- Weight loss
- nasal cPAP
- surgical repair
what is the MOA of nicotine in the body
- stimulates nicotinic cholinergic receptors in the brain
- triggers dopamine and epinephrine release
causes tolerance and upregulation of nicotinic (acetylcholine) receptors
what are the s/s of nicotine withdrawal
- irritability
- insomnia
- increased appetite
- weight gain
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)
what is the MOA of bupropion
- blocks dopamine and NE reuptake
- antagonizes nicotinic cholinergic receptors
what are the SE of bupropion
- insomnia
- agitation
- dry mouth
- headache
- seizure
what is the MOA of chantix (varenicline)
- partial agonist of nicotinic cholinergic receptors
- AKA decreases withdrawal and blocks “reward” from nicotine
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
5mm positives for TB skin test
-HIV
-recent contact with TB
-CXR findings that suggest TB
-organ transplant
-immunosuppressed
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
15mm positives for TB skin test
no risk factors
s/s of tuberculosis
-fever
-chills
-night sweats
-weight loss
-cough
-hemoptysis
-chest pain
-fatigue
diagnosis of TB
sputum culture
treatment of latent TB
Isoniazid for 9 months
Treatment of active TB
Isoniazid
Rifampin
Ethambutol
Pyrazinamide
