Resp Flashcards
UTPTF:
what patients should undergo lung cancer screening?
Adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years:
Screen for lung cancer with low-dose computed tomography (CT) every year.
Stop screening once a person has not smoked for 15 years
Percussion
in which conditions would you find tympany/hyperresonance?
dullness?
Tympany or hyperresonance: with COPD, emphysema
Dull: with lobar consolidation, pleural effusion, solid organ
What is normal FEV1/FVC ratio?
• FEV1/FVC ratio: proportion of vital capacity that a person can exhale in 1 second
○ Normal - 75% and higher
Post-bronchodilator FEV1/FVC < 0.7 is cutoff for COPD
What are examples of conditions that can cause obstructive dysfunction?
asthma
COPD
bronchiectasis
What are examples of conditions that can cause restrictive dysfunction?
pulmonary fibrosis
pleural disease
diaphragm obstruction
What is the role of PCV13 and PPV 23 vaccines in COPD?
- PCV 13 (Prevnar): prevent bacteremia and invasive pneumococcal disease
- PPV 23 (Pneumovax): prevent CAP
what is the definition of chronic bronchitis?
chronic productive cough for 3+ months for 2 or more consecutive years
Physical exam findings for COPD
Percussions:
Tactile fremitus:
Egophony:
CXR:
Percussion: hyperresonance
Tactile fremitus and egophony: decreased
CXR: flattened diaphragms with hyperinflation, sometimes bullae
what is the role of phosphodiesterase-4 inhibitors in COPD?
Roflumilast (Daliresp)
once daily medication, reduces risk of COPD exacerbation if severe COPD, NOT bronchodilator.
Side effects: diarrhea, nausea, anorexia, abdo pain, sleep disturbance, headache. AVOID if moderate-severe liver disease
What are the conditions where home O2 would be considered for COPD?
-chronic hypoxemia (PaO2 < 55 mmHg) or PaO2 < 88%
situations to avoid use of SABA (eg albuterol)?
situations to avoid use of SAMA (eg ipratropium)?
SABA: caution in CV disorder (CAD, arrhythmia, angina), hyperthyroidism
SAMA: avoid if narrow angle glaucoma, BPH (risk of urinary retention)
Community acquired pneumonia:
- most common bacterial pathogen? (gram pos or neg?)
- most common pathogen in COPD and smokers?
- most common pathogen in cystic fibrosis?
S.Pneumoniae (gram positive) most common in CAP
H.Influenza (gram negative): more common in smokers, COPD
Atypical: mycoplasma pneumoniae
Cystic fibrosis: Pseudomonas aeruginosa (gram negative)
Findings in community acquired pneumonia:
- auscultation:
- percussion:
- tactile fremitus:
- egophony:
- pectoriloquy:
Auscultation: rhonchi, crackles, wheezing
Percussion: dullness over affected lobe
Tactile fremitus and egophony: increased
Pectoriloquy: whispered words sound louder
Examples of organisms responsible for atypical pneumonia
Mycoplasma pneumoniae: non-pulmonary complications (eg hemolytic anemia, meningo-encephalitis)
Chlamydophila pneumoniae: school-age kids, develops into bronchitis or mild pneumonia
Legionella pneumoniae: air conditioned spaces, causes Legionnaires’ disease with fatality rate 10%. Risk factor: smoking, COPD, immunocompromised, comorbidities
Chlamydia psittaci: zoonotic from pet birds and poultry
if Legionella is suspected, what diagnostic tests should be done?
urinary antigen test for Legionella pneumoniae
how is legionella spread?
inhalation of contaminated water or soil
what is the median duration of cough in acute bronchitis?
18 days
Range 1-3 weeks)
Bordetella pertussis is a gram _____ bacteria
negative
what level of precaution is needed for pertussis? (airborne vs droplet vs contact)
droplet
Postexposure prophylaxis of close contacts to pertussis should occur within _____(time frame) of onset of cough in index case?
3 weeks
which lymph nodes are involved in URTI?
small shotty nodes in submandibular and anterior cervical chain
which lymph nodes are involved in pulmonary TB?
anterior or posterior cervical and supraclavicular nodes
which TB medication causes saliva, sweat, urine, feces and tears to become orange/red in colour?
rifampin
which TB medication causes optic neuropathy (change in visual acuity, red green colour blindness)?
ethambutol
which TB medication can cause asymptomatic hyperuricemia and non-gouty polyarthralgia?
pyrazinamide?
which TB medication can cause peripheral neuritis and neuropathy?
isoniazid
*give with 25-50 mg B6 daily
Mantoux result of 5 mm or larger is positive in:
- HIV positive
- recent contact with TB case
- immunocompromised
- CXR sign of previous untreated TB
(US specific:)
Mantoux result of 15 mm or larger is positive in:
people with no risk factors for TB
what is the gold standard test for diagnosis of TB?
mycobacterial culture with AFB x 3 samples
timeframe for when TST will become positive after infection
2-8 weeks after infection
booster phenomenon for TB testing:
-two step TB test: when is second test done?
1-3 weeks after
what is the role of phosphodiesterase 4 inhibitors (eg roflumilast aka Daliresp) in severe COPD?
side effects?
reduces risk of COPD exacerbation
*not a bronchodilator
side effects:
- unintended weight loss
- change in mood/thinking/behaviour
CDC.gov
Contacts to confirmed TB: should be retested in ______ (time frame) after exposure
do TST, if initial test neg then retest 8-10 weeks after end of exposure
if child <5 years or immunosuppressed AND has neg initial TST –> do CXR
if CXR normal –> start treatment, second test in 8-10 weeks
CDC.gov
How should contact tracing be done for positive TB case?
3 months from first symptom onset/first presumed symptom
initial interview with index case within 1 business day of diagnosis
CDC.gov
What size/measurement of TST is considered positive for contacts of confirmed TB case?
5 mm or more
which bacteria in CAP produces beta-lactamase?
which antibiotics are effective against this?
- macrolides
- fluoroquinolones
- cephalosporins
*addition of clavulanate inactivates beta-lactamase
CAP
what is the risk of using macrolides?
Clarithro and erythro especially?
Risk: QT prolongation
Clarithro and erythro are potent CYP4503A4 inhibitors
CAP
what is the risk of using clarithro/erythro with CCB?
increased risk for profound hypotension
CAP
what is the risk of using clarithro with select statins (lova, simva, atrovastatin)?
increased risk of myositis and rhabdomyolysis
Acute bronchitis
Predominantly bacterial or viral?
Top 3 bacterial organisms?
Bordetella pertussis
Mycoplasma pneumoniae
Chlamydia pneumoniae
what class of antibiotics is first line for treatment of pertussis?
macrolides
