Pulmonology Flashcards
> 12% increase in FEV1 after bronchodilator tx indicates…
Asthma
FEV1:FVC < 80% indicates…
asthma
Asthma would show a ____ FEV1 and ______ FEV1:FVC ratio
decreased
3 staples of asthma…
inflammation
hyperresponsiveness
reversible obstruction
Steps 1-6 of asthma Tx…
1: SABA
2: low dose ICS
3: low dose ICS + LABA + SABA
4: medium dose ICS + LABA
5: High dose ICS + LABA
6: high dose ICS + LABA + PO Steroids
cough > 5 days lasting 2-3 weeks
bronchitis
COPD = chronic cough that is productive of phlegm occurring on most days for _____ months of the year for ______ or more consecutive years
3 months
2+ years
3 hallmarks of COPD…
cough
sputum production
dyspnea
Dx of COPD (4)
PFTs
CXR
alpha antitrypsin
ABGs
PFTs in COPD show FEV1/FVC ratio…
< 0.7
CXR findings in COPD
perivascular markings
CBC findings in COPD…
increased H & H due to chronic hypoxia
Tx for mild COPD…
SABA
Tx for moderate/severe COPD
LABA +/- ICS
Inahler of choice for COPD…
ipratropium
single most important medication and lifestyle factor for COPD
Oxygen and smoking cessation
2 mandatory vaccines for COPD
pneumococcal, flu
Pt p/w:
Recurrent PNA
constitutional sxs
Hx of smoking
small cell lung CA
4 complications associated with small cell lung cancer
SVC syndrome
phrenic nerve palsy
recurrent laryngeal nerve palsy
horner syndrome
which lung CA complication?
obstruction of SVC by a mediastinal tumor, facial fullness, facial and arm edema, dilated veins over the anterior chest, arms, face; JVD
SVC syndrome
which lung CA complication?
hemidiaphragmatic paralysis…
phrenic nerve palsy
which lung CA complication?
p/w hoarseness
recurrent laryngeal nerve palsy
which lung CA complication?
invasion of the cervical sympathetic chain by apical tumor → unilateral facial anhidrosis (no sweating), ptosis, miosis
horner syndrome
which lung CA complication?
proximal muscle weakness/fatigue, diminished DTRs, paresthesias (lower extremity
eaton-lambert syndrome
Which lung CA?
Central mass, very aggressive 99% smokers 15% of cases do not respond to surgery mets at presentation
small cell
Diagnostics for lung CA
CXR
Contrast CT
Bx
This diagnostic is used to diagnose central tumors
fiber-optic bronchoscopy
Which lung CA diagnostic?
suspicious masses, highly accurate for peripheral lesions
transthoracic needle bx
3 types of non-small cell lung CA
SCC
Large Cell
adenocarcinoma
Which lung CA?
most common (peripheral mass)
35-40% of cases of lung cancer
Associated with smoking and asbestos exposure
Location: Periphery
Paraneoplastic syndrome: Thrombophlebitis
adenocarcinoma
Which lung CA?
fast doubling rates - responds to surgery
rare (only 5%)
Location: Periphery 60%
Paraneoplastic syndrome: Gynecomastia
Large cell
Which lung CA?
hemoptysis
25-35% of lung cancer cases
Location: central mass
Paraneoplastic syndrome: hypercalcemia
Elevated PTHrp
squamous cell
Tx for non-small cell lung CA…
surgery
Which lung CA association?
shoulder pain
horner’s syndrome
brachial plexus compression
pancoast tumor
MC cause of CAP…
S. pneumo
Patient presents with:
fever then gradual onset of cough
SOB on exertion
sweats/chills/rigors
chest discomfort
CAP
Outpatient CAP tx if no recent use of Abx w/in 90 days…
azithromycin 500 mg dose 1, then 250 mg x 4 days
or
Doxycycline 100mg PO BID x 5 days
Outpatient CAP tx if Abx last 90 days, Age > 65, immunosuppression, comorbid illness
Moxifloxacin 400 mg PO daily, levofloxacin 750 mg PO daily x 5 days
OR
azithromycin + beta lactam
ICU CAP tx if no recent use of Abx w/in 90 days…
Azithromycin or respiratory FQ (moxifloxacin, levofloxacin) plus Antipneumococcal β-lactam: cefotaxime, ceftriaxone
Inpatient CAP tx if Abx last 90 days, Age > 65, immunosuppression, comorbid illness
IV macrolide plus IV β lactam (HD ampicillin 1-2 g q 4-6 h or Cefotaxime 1-2 g q 4-12 h or Ceftriaxone 1-2 g q 12-24 h)
Inpatient CAP tx if no recent use of Abx w/in 90 days…
IV levofloxacin 750 mg daily or IV ciprofloxacin 400 mg q 8-12 h
Pt. p/w:
fatigue, productive cough, night sweats, weight loss, post-tussive rales
TB
Dx of TB…
sputum Cx
CXR of TB…
cavitary lesions, ghon complex in apex of lungs
Bx of TB
caseating granuloma
Tx of TB: (+) PPD, CXR Neg
Isoniazid x 9 mo
Tx of TB: (+) PPD and CXR
4 drugs x 8 weeks (RIPE) then RI x 16 weeks
SFx of isoniazid and what can help prevent?
peripheral neuropathy
prevent with pyridoxine 25-50 mg QD
SFx of Pyrazinamide
hyperuricemia, caution Gout
SFx of ethambutol
optic neuritis
red-green blindness
((E = eye changes)
What should be monitored during TB treatment?
serum creatininte
TB prophylaxis for household members?
INH x 1 year
