Resp Flashcards

1
Q

UTPTF:

what patients should undergo lung cancer screening?

A

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

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2
Q

Percussion

in which conditions would you find tympany/hyperresonance?
dullness?

A

Tympany or hyperresonance: with COPD, emphysema

Dull: with lobar consolidation, pleural effusion, solid organ

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3
Q

What is normal FEV1/FVC ratio?

A

• 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

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4
Q

What are examples of conditions that can cause obstructive dysfunction?

A

asthma
COPD
bronchiectasis

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5
Q

What are examples of conditions that can cause restrictive dysfunction?

A

pulmonary fibrosis
pleural disease
diaphragm obstruction

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6
Q

What is the role of PCV13 and PPV 23 vaccines in COPD?

A
  • PCV 13 (Prevnar): prevent bacteremia and invasive pneumococcal disease
  • PPV 23 (Pneumovax): prevent CAP
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7
Q

what is the definition of chronic bronchitis?

A

chronic productive cough for 3+ months for 2 or more consecutive years

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8
Q

Physical exam findings for COPD

Percussions:
Tactile fremitus:
Egophony:
CXR:

A

Percussion: hyperresonance
Tactile fremitus and egophony: decreased
CXR: flattened diaphragms with hyperinflation, sometimes bullae

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9
Q

what is the role of phosphodiesterase-4 inhibitors in COPD?

A

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

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10
Q

What are the conditions where home O2 would be considered for COPD?

A

-chronic hypoxemia (PaO2 < 55 mmHg) or PaO2 < 88%

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11
Q

situations to avoid use of SABA (eg albuterol)?

situations to avoid use of SAMA (eg ipratropium)?

A

SABA: caution in CV disorder (CAD, arrhythmia, angina), hyperthyroidism

SAMA: avoid if narrow angle glaucoma, BPH (risk of urinary retention)

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12
Q

Community acquired pneumonia:

  • most common bacterial pathogen? (gram pos or neg?)
  • most common pathogen in COPD and smokers?
  • most common pathogen in cystic fibrosis?
A

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)

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13
Q

Findings in community acquired pneumonia:

  • auscultation:
  • percussion:
  • tactile fremitus:
  • egophony:
  • pectoriloquy:
A

Auscultation: rhonchi, crackles, wheezing
Percussion: dullness over affected lobe
Tactile fremitus and egophony: increased
Pectoriloquy: whispered words sound louder

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14
Q

Examples of organisms responsible for atypical pneumonia

A

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

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15
Q

if Legionella is suspected, what diagnostic tests should be done?

A

urinary antigen test for Legionella pneumoniae

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16
Q

how is legionella spread?

A

inhalation of contaminated water or soil

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17
Q

what is the median duration of cough in acute bronchitis?

A

18 days

Range 1-3 weeks)

18
Q

Bordetella pertussis is a gram _____ bacteria

19
Q

what level of precaution is needed for pertussis? (airborne vs droplet vs contact)

20
Q

Postexposure prophylaxis of close contacts to pertussis should occur within _____(time frame) of onset of cough in index case?

21
Q

which lymph nodes are involved in URTI?

A

small shotty nodes in submandibular and anterior cervical chain

22
Q

which lymph nodes are involved in pulmonary TB?

A

anterior or posterior cervical and supraclavicular nodes

23
Q

which TB medication causes saliva, sweat, urine, feces and tears to become orange/red in colour?

24
Q

which TB medication causes optic neuropathy (change in visual acuity, red green colour blindness)?

A

ethambutol

25
which TB medication can cause asymptomatic hyperuricemia and non-gouty polyarthralgia?
pyrazinamide?
26
which TB medication can cause peripheral neuritis and neuropathy?
isoniazid | *give with 25-50 mg B6 daily
27
Mantoux result of 5 mm or larger is positive in:
- HIV positive - recent contact with TB case - immunocompromised - CXR sign of previous untreated TB
28
(US specific:) Mantoux result of 15 mm or larger is positive in:
people with no risk factors for TB
29
what is the gold standard test for diagnosis of TB?
mycobacterial culture with AFB x 3 samples
30
timeframe for when TST will become positive after infection
2-8 weeks after infection
31
booster phenomenon for TB testing: | -two step TB test: when is second test done?
1-3 weeks after
32
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
33
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
34
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
35
CDC.gov What size/measurement of TST is considered positive for contacts of confirmed TB case?
5 mm or more
36
which bacteria in CAP produces beta-lactamase? which antibiotics are effective against this?
- macrolides - fluoroquinolones - cephalosporins *addition of clavulanate inactivates beta-lactamase
37
CAP what is the risk of using macrolides? Clarithro and erythro especially?
Risk: QT prolongation Clarithro and erythro are potent CYP4503A4 inhibitors
38
CAP what is the risk of using clarithro/erythro with CCB?
increased risk for profound hypotension
39
CAP what is the risk of using clarithro with select statins (lova, simva, atrovastatin)?
increased risk of myositis and rhabdomyolysis
40
Acute bronchitis Predominantly bacterial or viral? Top 3 bacterial organisms?
Bordetella pertussis Mycoplasma pneumoniae Chlamydia pneumoniae
41
what class of antibiotics is first line for treatment of pertussis?
macrolides