Pulmonology Flashcards
Asthma if FEV1 increases by?
12%
Given methacoline with increased concentration, stopped when X drops by Y?
FEV1
Drops by 20%
Positive methacholine challenge
> 16 = normal
4- 16 = borderline
1 -4 : mild (+)
<1 : moderate-severe
Admission for asthma:
PEFR <50% predicted, ER visit within 3 days, status asthmaticus, post-treatment failure, AMS
Intermittent asthma: symptoms
2 or less d/wk
Intermittent asthma: night time awakenings
<2 x / month
Intermittent asthma: SABA
2 or less d/wk
Intermittent asthma: interfernece
none
Intermittent asthma: lungs
FEV1 >80%
Intermittent asthma: exacerbations
0-2 year
Mild asthma: symptoms
> 2 d/wk
Mild asthma: night time awakeneings
3-4 x month
Mild asthma: SABA
> 2 d/ wk
Mild asthma: Interference
minor
Mild asthma: lungs
> 80%
Mild asthma: exacerbations
> 2 yr
moderate asthma: symptoms
daily
moderate asthma: night time awakenings
> 1 x weekly
moderate asthma: SABA
daily
moderate asthma: interference
some
moderate asthma: lungs
60-80%
moderate asthma: exacerbations
> 2 years
severe asthma: symptoms
throughout day
severe asthma: nighttime awakenings
7x-week
severe asthma: SABA
several x day
severe asthma: interference
extreme
severe asthma: lungs
<60%
severe asthma: exacerbation
> 2 year
Asthma treatment progression:
SABA –> ICS –> LABA or LD ICS OR MD ICS –> MD ICS + LABA –> HD ICS + LABA
What should not be used as a monotherapy in asthma?
LABA
Procalcitonin of X should encourage abx use?
> 0.25
What arrythmia is associated with COPD?
MAT
MC type of emphysema?
Proximal acinar (centrilobular)
What type of emphysema is more common in upper lobes?
proximal acinar (centrilobular)
What type of emphysema is described as “moth-eaten”?
proximal acinar (centrilobular)
What type of emphysema is associated with alpha 1?
panacinar
What emphysema is more peripheral?
paraseptal
What type of emphysema is described as saw-toothed?
paraseptal
MC symptom of emphysema?
dyspnea
MC symptom of chronic bronchitis?
cough
FEV1/FVC < x = COPD
<0.70
FEV1 is used to categorize severity of COPD: GOLD 1
> 80%
FEV1 is used to categorize severity of COPD: GOLD 2
<80%
FEV1 is used to categorize severity of COPD: GOLD 3
<50%
FEV1 is used to categorize severity of COPD: GOLD 4
<30%
What type of COPD is assoc with decreased vascular markings?
emphysema
What type of COPD is assoc with increased vascular markings?
chronic bronchitis
Gold guideline tx: A
SABA or short-acting anti-C
Gold guideline tx: B
LABA or long acting anti-C
Gold guideline tx: C
inhaled ICS + LABA or long-acting anti-c
Gold guideline tx: D
inhaled ICS + LABA or long-acting anti C
COPD treatment progression
SABA –> SABA + antic C or LABA –> SABA + anti C + LABA –> SABA + anti C + LABA + ICS
What should not be used as a monotherapy in COPD?
ICS
What treatment prolongs life in COPD?
02 if administered 15 hours a day
lung nodule if
3 cm
lung mass if >
3 cm
Location of lung nodule more likely to be malignant
upper lobe
MCC of malignant lung nodule
primary lung CA
MC primary lung CA
adenocarcinoma
MC benign cause of of SPN?
infectious granuloma
Nodule tx: <6 mm
annual CT every two years
nodule tx: 6-8 mm
LDCT in 3 months; if no increase repeat in 3 months.
- No increase: annual LDCT
- Increase: resect
Nodule tx: >8 mm
PET/CT
- -> low suspicion: LDCT 3 months, resect if increases
- -> high supsion, biopsy
MC site of bronchial carcinoid tumor?
GI
2nd MC site of bronchial carcinoid tumor?
lungs
Tx for NSCLC?
sx
Tx for SCLC?
chemo
MC type of bronchogenic carcinoma?
non-small cell
MC type of non-small cell lung cancer?
adenocarcinoma
Types of non-small cell cancer?
adenocarcinoma; squamous
Type of lung cancer assoc with pancoast tumor?
squamous
Lung cancer that has early mets?
small cell
Pancoast syndrome mneumonic?
CCCP: central, cavitary, hyper C, pancoast
SVC syndrome is MC with?
SCLC
Lambert-Eaton?
like MG, but weakness improves with use; associated with lung cancer
Pancoast has shoulder pain down what distribution of arm?
ulnar
Aspiration is MC in which lobe?
Right
Pneumonia CM quad?
cough + fever + dyspnea + pleuritic CP
MCC of bacterial pneumonia
Strep pneumo
Gram + cocci in pairs
strep pneumo
MCC of CAP
strep pneumo
yellow, green, blood tinged sputum
strep pneumo
gram + cocci in clusters
staph aureus
gram - bacilli (3)
klebsiella, h. flu, legionella
Pneumonia associated with cavitary lesions in upper lobes
klebsiella
currant jelly sputum
klebsiella
MCC of atypical “walking” pneumonia
mycoplasma
Pneumonia bug that’s hard to stain
Legionella
Pneumonia assoc. with GI symptoms
legionella
Pneumonia assoc. with contaminated water
legionella
MCC HAP
pseudomonas
MCC of viral pneumonia in infants?
RSV, parainfluenza
MCC viral pneumonia in adults?
influenza
HAP criteria?
> 48 hours after admission
VAP criteria?
48-72 hours after intubation
gold standard for diagnosis of pneumonia?
CXR
Urinary testing is available for what pneumonia bugs?
strep pneumo and legionella
CAP tx:
macrolide or doxy
CURB-65:
confusion Urea (BUN) >19 respiratory 30+ BP <90/<60 Age: 65+
CURB-65: 0-1
outpatient
CURB-65: 2
inpatient vs. outpatient
CURB- 3+
inpatient
Reactivation TB is found in what aspect of lungs?
apical
Primary TB is found in what aspect of lungs?
middle/lower
If your two-step TB comes back positive, what do you have?
latent TB
If you have a positive TB, what is the next step?
get CXR –> 3 acid fast smears
Gold standard for TB
acid fast bacilli cultures
CXR TB
hillar adenopathy
Active TB tx:
- Phase 1: Rifampin + Isoniazid + Pyrazinamide + Ethambutol x 2 months
- Phase 2: INH + RIF x 4 months
TB: HIV
5+ mm
TB: organ transplant
5+ mm
TB: IC
5+ mm
TB: contact with TB
5+ mm
TB: fibrotic changes on CXR consistent with TB
5+
TB: Recent immigration (<5 years) from high prevalence country
10+
TB: IVDA
10+
TB: residence and employees of high risk congregate settings
10+
TB: Mycobacteriology lab
10+
TB: children <4 y/o
10+
TB: infants, children, adolescents exposed to adults in high-risk categories
10+
TB: those without RF
15+ mm
SE of INH?
increased LFTS, hepatitis
Purpose of latent TB tx?
helps decrease reactivation
Latent TB tx?
INH x 9 months; Rifampin x 4 months
-Isoniazide + Rifapentine under DOT
