Respiratory 4 Flashcards
a risk factor for allergic rhinitis is if serum IgE is >100 before what age?
age 6
what is the most common allergic dz in the US
allergic rhinitis
what class of allergic rhinitis is symptoms <4 weeks
intermittent
what class of allergic rhinitis is symptoms >4 days/ week AND >4 weeks
Persistent (primary perennial)
allergic rhinitis is considered moderate-severe if what at least 1 of what three symptoms are found
Sleep disturbances, Troublesome symptoms
Impairment of daily activities, leisure, and/or sport
Impairment of school or work
a central mediator in both the early and late allergic response
Released from presensitized mast cells upon allergen exposure and causes acute symptoms of allergic rhinitis: sneezing, rhinorrhea, itchy nose, nasal congestion
Histamine
when is histamine released from basophils?
Late phase
Who is at greatest risk of asthma?
65 years and above
What are some symptoms of asthma?
Recurrent wheeze
recurrent shortness of breath
cough
recurrent chest tightness
what is the inflammation like in asthma?
histamine release
basophil release
what cells produce mucous and cause plugging
goblet cells
does normal spirometry to lack of reversibility rule out asthma?
No
will asthmatics have low diffusion capacity?
No (will be abnormal with emphysema)
what are leukotriene meds used for?
add to albuterol for exercise induced
add if they have allergies
indicated in for adults and adolescents (12 years of age and above)
with moderate to severe asthma who have a positive skin test or in vitro reactivity to a perennial aeroallergen
whose symptoms are inadequately controlled on inhaled corticosteroids.
Omalizumab
may be more beneficial in children, exercise induced
mast cell stabilizers (cromolyn, nedocromil)
patients with nasal polyps are more likely to be sensitive to what?
ASA and NSAIDs
in an asthma exacerbation, what is the pH initially?
respiratory alkalsosis
if the pH is decreased in an asthma exacerbation what can that indicate?
impending respiratory failure
is wheezing a good sign in asthma?
Yes, because silent chest is worse during exacerbation
most common cancer for men?
prostate
exposure to what can cause lung cancer?
Asbestos
Radon
uranium
Tumors that originate in the _______ can attain a very large size before producing symptoms
periphery
When tumors arise in a _______ region of the lung symptoms arise early.
central
what is the most common type of histology of central tumors?
squamous cell
most common symptoms of lung cancer
hemoptysis
chest pain
dyspnea (COPD association)
weight loss
Edema in the face, neck, arms, JVD
Superior Vena Cava Syndrome
first thing for evaluation of lung cancer
CXR (can’t see lesions <5 mm)
CT with or without contrast is best for lung cancer.
With contrast and look at liver and adrenals (metastasis)
what is the most common classification of lung cancer?
Non-small cell
small cell is the worst though
Stage one is a tumor less than what size?
<3 cm
only way to cure lung cancer?
removal of the cancer
what do you do for stage III NSCLC
Non-resectable Stage IIIa and IIIb
Combined chemo-radiation improves survival
Tx for stage IV NSCLC
Chemotherapy improves survival (by 20-40% at 12 months) and QOL if good performance status
Small Cell Cancer is very _________, surgery usually not an option.
chemosensitive
which type lung cancer do you do surgery on?
non small cell
Isolated rounded lesion in the lung parenchyma, usually < 3 cm
Solitary pulmonary nodule
when is a pulmonary nodule more likely to be malignant
> 3cm
older age
smoking history
increasing in size
where are lymphomas seen?
anterior or middle mediastinum
what is a slow growing malignant tumor with a good survival rate?
Carcinoid tumor
If a lesion is stable in size for _________ years, it is likely not malignant.
2-3 years
Benign causes of pulmonary nodules
Granulomas (tb, spores from forest)
hamartomas
If it is metastasis to the lung, what will you usually see
multiple cancers
