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AAFP videos > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

Most common CAP Pediatric patients

A

Pediatric patients

• Age 4 mo to 4 yrs

– Most common pathogen

• RSV

– Peak incidence • 2-7 mo of age

• Age 5-18 yrs

– Most common pathogen • Mycoplasma pneumoniae – Treat with a macrolide

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2
Q

Score for Pneumonia Severity

Estimates mortality of community-acquired pneumonia to help determine inpatient vs. outpatient treatment.

A
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3
Q

CAP Treatment for Outpatient, previously healthy, no risk for DRSP infection

A

Outpatient, previously healthy, no risk for DRSP infection

– Macrolides (SOR A) • Azithromycin • Clarithromycin • Erythromycin

OR

– Doxycycline (SOR B)

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4
Q

CAP treatment for Outpatient with comorbidities or recent abx

A
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5
Q

CAP treatment for Inpatient (Non-ICU)

A
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6
Q

CAP treatment for Inpatient (ICU)

A
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7
Q

HCAP Treatment - Outpatient or inpatient

A
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8
Q

HCAP Treatment - ICU

A
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9
Q

Pneumococcal Vaccines

A

PPSV23—Pneumococcal Polysaccharide vaccine (Pneumovax)

– 23 serotypes that cause 80% of invasive pneumococcal disease in US – B-cell response – 96% drop in pneumonia caused by susceptible strains

PCV-13—Pneumococcal Conjugate vaccine (Prevnar 13)

– T-cell response

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10
Q

Conjugate Vaccine (PCV13)

A
  • Primary series 2, 4, 6 months, booster 12-15 months
  • All adults > 65
  • Adults > 19 with CSF leaks, cochlear implants, functional asplenia or immunosuppression
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11
Q

Polysaccharide Vaccine (PPSV) 23

A
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12
Q

How to Give Both PCV13 and PPSV23

A

CDC now recommends 2 pneumococcal vaccines for adults >65 years

  • Age 2-18– Give 1 dose of PPSV23 at least 8 weeks after the final dose of PCV13. (If immune compromise or asplenia, should receive a 2nd dose of PPSV23 5 years after the first PPSV23)
  • Age 19-64 at high risk – give PCV13 first followed by PPSV23 at least 8 weeks later
  • Age > 65 give PCV13 first, followed by PPSV23 6 to 12 months later (min 8 weeks if immunocompromised)
  • If your patient has received any doses of PPSV23, the dose of PCV13 should be given at least 1 year later
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13
Q

TB Skin Testing > 5 mm is considered positive if:

A
  • HIV sero-positive
  • Recent TB direct contact
  • CXR shows prior inactive TB
  • Immunosuppressed patients – Prednisone > 15 mg/day – TNF-a antagonists – Organ transplant recipients
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14
Q

TB Skin Testing

> 10 mm is considered positive if:

A

Long-term care facility – Resident or employee • Inmate • IV drug user • Children < 4 yrs of age • Mycobacteriology lab personnel • Diabetic • Renal failure • Cancer • Recent immigrant (< 5 yrs) from high-risk country • High-prevalence area

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15
Q

TB Skin Testing > 15 mm is considered positive if:

A

• Any person with no known risk factors – Even if prior BCG vaccination

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16
Q

Booster Phenomenon

A
  • Some people infected with M. tuberculosis may have a negative reaction to the TST if many years have passed since they became infected.
  • They may have a (+) reaction to a subsequent TST because the initial test “stimulates” their ability to react to the test. – This may incorrectly be interpreted as a skin test conversion
  • The two-step test is indicated for serial testing situations, to avoid thinking that this latent “wake up” is a new infection or conversion
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17
Q

Two-Step Skin Testing

A
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18
Q

Workup of Positive TST or IGRA

A
  • Check CXR for active disease – If CXR Negative (latent tuberculosis)
  • Isoniazid (INH) for 6-9 months (9 mo is preferred) – Daily or intermittently (twice weekly) – Use directly observed therapy (DOT) for intermittent regimen
  • Rifampin daily for 4 months, consider adding Pyridoxine
  • Monthly exams for signs of hepatitis and medication adherence, check liver transaminases if indicated
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19
Q

Workup of Positive TST or IGRA

A
  • If CXR positive (Active tuberculosis)
  • Aggressive Combination therapy indicated to decrease mortality, transmission, and resistance • Four-drug treatment initially: – Isoniazid (INH) – Rifampin (RIF) – Ethambutol (EMB) – Pyrazinamide (PZA)
  • Treatment regimen modified once culture results received
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20
Q

Post-Treatment Follow-Up

A

Regardless of whether Rx for LTBI was completed, serial or repeat CXRs are not indicated unless signs or symptoms of TB develop

21
Q

Fungal Lung Infections

A

Opportunistic (more likely in immunocompromised)

• Aspergillosis • Candidiasis

Endemic (farm workers, etc)

  • Mississippi/Ohio Valley: Histoplasmosis and Blastomycosis
  • Southwest: Coccidiodomycosis
22
Q

What percentage of airway reversibility and change in FEV1 do you need in order to confirm the diagnosis of asthma?

A

12% and 200 mL

Spirometry in Asthma

  • FEV1 is decreased to < 80% predicted
  • TLC is normal to elevated • FRC is usually elevated • Significant reversibility after inhaling a SABA – Increase by ≥ 12% and – 200 mL in FEV1
23
Q

Asthma Classification – NHLBI

A
24
Q

Asthma During Pregnancy

A
  • Albuterol is the preferred SABA
  • ICSs are preferred controller medication – Budesonide has the most reliable safety profile
  • Comorbid allergic rhinitis can be managed with intranasal steroids
25
Q

Stepwise Treatment Approach for asthma

A
26
Q

What is true regarding COPD and mortality in the U.S?

A

It is the 3rd leading cause of death

27
Q

COPD Common Symptoms

A

Cough (85%)

Dyspnea, exertional (70%)

Wheezing (40%)

28
Q

What proportion of active smokers are likely to develop COPD?

A

25%

29
Q

COPD Diagnosis

A
  • Single best variable for identifying adults is a history of > 40 pack yrs of smoking
  • Combination of all 3 of the following almost ensures the presence of obstruction

– > 55 pack yr hx

– Wheezing on auscultation

– Patient self-reporting of wheezing

  • Absence of all 3 essentially rules it out
  • Spirometry is the key test – Recommended for all symptomatic adults • USPSTF recommends against screening asymptomatic adults for COPD using spirometry (Grade D)

– Not recommended to track disease progression or modify Rx after it has been initiated

30
Q

COPD Workup

A
  • If abnormal spirometry:
  • CXR to evaluate for – Lung nodules – Masses – Fibrotic changes
  • Alpha-1 Antitrypsin Deficiency Screening: Perform when COPD develops in patients of Caucasian descent under 45 years, or with a strong family history of COPD
31
Q

COPD staging

A
32
Q

What is true concerning nicotine replacement therapy (NRT) for smoking cessation?

A

NRT will double the chance of quitting

33
Q

What are the only interventions proven to prolong survival of patients with COPD?

A

Tobacco cessation and O2 therapy

34
Q

Tobacco Cessation

A
  • Proven interventions (may double chance of quitting!) • Counselling*
  • Nicotine replacement therapy (NRT)
  • Patch, gum, lozenge, inhaler, nasal spray all equally effective
  • Nicotine vapor (“vaping”) not proven to help
  • Varenicline (Chantix) – nicotine blockade
  • Bupropion SR (Zyban)

*Counselling and meds more effective together than either one alone

35
Q

COPD Management immunization

A

Immunization status monitoring:

– Pneumococcal – Influenza (yearly) – others

36
Q

COPD Management

A
37
Q

Inhaled corticosteroid therapy is associated with an increased risk of

A

Inhaled corticosteroid therapy is associated with an increased risk of pneumonia

38
Q

Classification of COPD Exacerbations

A

Mild Can be controlled with an increase in dosage of regular medications

Moderate Requires treatment with systemic corticosteroids or antibiotics

Severe Requires hospitalization or evaluation in the emergency department

39
Q

Antibiotics should be given in exacerbation of COPD with all three symptoms:

A

Antibiotics should be given in exacerbation of COPD with all three symptoms: (SOR B)

– Increased dyspnea

– Increased sputum volume

– Increased purulence or

– If hospitalized for COPD and mechanical ventilation (invasive or non-invasive) is required

40
Q

Acute COPD Exacerbations: Treatment Options

A

Oxygen: titrate to target O2 saturation of 88-92%.

Bronchodilators: Short-acting inhaled beta2-agonists with or without short-acting anticholinergics are preferred.

Systemic Corticosteroids: 40 mg prednisone per day for 5 days is recommended.

Nebulized magnesium – No (Ann Thoracic Med 2014).

41
Q

1 cancer in men and women

A

Lung Cancer

42
Q

Lung Cancer Screening

A

• USPSTF recommendation

The USPSTF recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years.

Screening should be discontinued once a person has not smoked for 15 years

43
Q

Sarcoidosis Symptoms

A
  • Shortness of breath, cough
  • Reddish bumps or patches on the skin
  • Enlarged lymph nodes in the chest, neck, axillae
  • Fever, weight loss, fatigue, night sweats, general feeling of ill health
  • Lofgren’s syndrome – acute form of sarcoid – erythema nodosum, fever, arthritis, self-limited
44
Q

Lofgren’s syndrome

A

acute form of sarcoid

– erythema nodosum, fever, arthritis, self-limited

45
Q

Sarcoidosis Diagnosis

A
  • Granulomas in lung tissue biopsy
  • Typical signs and symptoms of sarcoidosis like picture
  • Abnormal CXR or lung CT
46
Q

Extra Pulmonary Manifestations of Sacaridosis

A
  • 90% confined to lung, but may involve:
  • Eye – acute anterior uveitis
  • Skin – cutaneous involvement, erythema nodosum
  • Neurosarcoidosis – may have intracranial lesions or peripheral neuropathy
  • Cardiac granulomas – cardiomyopathy
  • Symptoms may resolve in 2-3 years, or may persist indefinitely
47
Q

Sarcoidosis Treatment

A
  • No specific treatment or cure; Focus is on management of symptoms, anti-inflammatory meds, reduced lung exposure to toxins, and nutrition
  • Follow angiotensin-converting enzyme (ACE) levels in the blood to follow disease activity
  • Corticosteroids are mainstay of treatment (start 20-40 mg a day, 5-10 mg a day maintenance)
  • Also used: methotrexate, azathioprine, chloroquine, etanercept (Enbrel), infliximab (Remicaide) – consult Pulmonary
48
Q

Wegener’s Granulomatosis

A

AAFP videos (10 decks)

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