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Clinical Pearls > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Asthma?

A

Start with Symbicort PRN and up to 8 puffs a day as a scheduled or PRN medication (can be used as a rescue medication).

Asthma - needs ICS to improve. LABA now first line. SABA not so much.

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2
Q

COPD Tx?

A

Start with a LAMA - often Spiriva, can move to a LAMA/ LABA combo and then add on a ICS if needed

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3
Q

3 pillars of CAP Dx?

A

Evidence of infection (fever/ malaise)
Sx localized to the respiratory system (cough/ sputum)
Chest imaging (infiltrates)

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4
Q

When should you get a gram stain and culture in CAP

A

Inpatients, severe, empiric MRSA pseudomonas tx, or risk of HCAP.

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5
Q

Should you get blood cultures on a patient with CAP?

A

Not routinely, no

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6
Q

Prediction of severity of pneumonia?

A

PSI or CURB-65, with evidence for PSI

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7
Q

Should this patient with CAP go to the ICU?

A

IDSA 2007 major criteria or 3 minor warrants ICU admission

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8
Q

Tx for CAP for outpatients?

A

Outpatient, for no comorbidities - Amoxicillin 1g TID, or Doxycycline 100mg BID, AZT is not so strongly recommended

Comorbidities: combo Amox/clav + macrolide or quinolone (moxiflox/levoflox)

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9
Q

Inpatients without risk of MRSA/pseumonas tx?

A

Ceftriaxone or quinolone

No need to add on add on anaerobic coverage for aspiration pneumonia unless lung abscess/ very severe

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10
Q

CAP with positive for flu - still give antibiotics?

A

Yes, usually a co-infection.

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11
Q

Bronchiectasis managment?

A

Get a sputum sample, and start empiric abx

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12
Q

Treat lung abcess with?

A

21-48 days of Amox-clav or other beta lactam - inhibitor combos or penems?

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13
Q

Empyema tx?

A

Thoracentesis or chest tube drainage need to control the source and IV abx - 3rd gen cephalosporins +metronidazole

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14
Q

Risk factors for lung CA?

A

Smoking (duration more important than amount)
Occupational exposures
Genetic predisposition
Radiation exposure

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15
Q

Types of Lung CA?

A 
Small cell 
Pancoast (location in the upper part of the lung) 
NSLC: 
- Adenocarcinoma 
- Squamous cell 
- Large Cell
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16
Q

Features of Adenocarcinoma?

A

Not necessarily related to smoking
Diffuse and might be more peripheral
Subtype in bronchioles - might present as an unrelenting pneumonia
Female

17
Q

Squamous cell CA features?

A

Hilar findings more like a cavitary lung lesion

Associated with smoked

18
Q

Small cell features?

A

Very aggressive, lots of Mets, smokers centrally located

Can measure chromogranin - this is a neuroendocrine tumour

19
Q

Carcinoids of the lung?

A

Like pre-small cell CA, endobrachial can be removed easily

20
Q

Common Mets location for Lung CA?

A

Liver, brain, bone, adrenals

21
Q

Pancoast lung ca presentation?

A

More likely to show SVC occlusion symptoms (edema of the neck) and hoarseness and dysphagia (recurrent laryngeal, esophagus), horner’s syndrome , brachial plexus involvement, horner’s syndrome

22
Q

What is paraneoplastic syndrome?

A

The effect of the cancer on the immune system or hormonal signalling

  • SIADH
  • Etopic Cushing
  • Neurological (MG, Eaton- Lambert, dementia)
  • Hypercoagulation
  • Hypercalcemia
23
Q

Horner’s syndrome?

A

Mitosis (constriction), ptosis, and anhidrosis (no face sweat)

24
Q

Pemberton sign?

A

SVC occlusion, raise arm above the head, face turns bright red

25
Q

Screening for Lung CA

A

Low dose CT - 3 consecutive years then stop
Over 55-74, with 30 pack year, who smoke or quit less than 15 years ago

Diagnosis pathway:
https://www.cancercareontario.ca/en/pathway-maps/lung-cancer

26
Q

CXR findings suspicious for lung CA

A

Nodule - less than 3cm
Mass - more than 3cm

Both can be indicative for lung CA (the bigger the more concerning)
Pleural effusion
Hilar and mediastinal adenopathy
Elevated hemidiaphragm

27
Q

Questions to ask if suspicious of lung CA

A

COPD, Pulmonary fibrosis, radiation exposures, past CA, family history, TB

Can think of like this:
Constitutional Sx, Metastatic sx, Local sx and risk factor

*Also drug coverage.

Try to r/out PE/ ACS

28
Q

Cancer performance status measure?

A

ECOG

29
Q

Hamman’s sign?

A

A crunching, rasping sound in time with heart beat - heart beating against the air filled mediastinum.

Hamman syndrome - pneumomediastinum after excessive pressure such as childbirth, asthma, valsalva

30
Q

Airway sizes and adventitious sounds

A

Wheezes (smaller), Ronchi (medium), Stridor (large airway)

31
Q

Legionella?

A

Dyspnea, cough, diarrhea - order an legionella urinary antigen disease.

32
Q

Milliary TB

A

Acute, severe TB

33
Q

Causes of Pulmonary HTN?

A 
Group 1 (directly on vasculature): Idiopathic, Genetic, drugs, HIV, sickle cell disease, Porto pulmonary, connective tissue disease 
Tx: with pulmonary vasodilators

Group 2 (more pressure): Left heart failure, valvular disease, Congenital heart disease

Group 3 (hypoxia): COPD, interstitial lung disease, sleep apnea (increases risk factors),

Group 4 (obstructive): PE/VTE, malignancy can cause this too, chronic thromboembolic pulmonary hypertension

Group 5: misc weird stuff

34
Q

Criteria for pulmonary hypertension

A

Mean pulmonary artery pressure of >20mmHg
Measure the Right ventricular systolic pressure >40mmHg (echo) and then follow up with a right heart catheter to get the mean PAP, PVR >3 and PCWP <15

35
Q

Work up for Pulmonary Hypertension

A

Should test for HIV, examine joints, ANA/RF/anti-CCP, ECHO (and treat any heart disease), give O2, work up for sleep apnea, get a V/Q scan (for pulmonary embolism)

If all negative become concerned for pulmonary arterial hypertension- need right heart cath. Check Pulmonary capillary wedge pressure (should be less than 15mmHg)

36
Q

Treatment of Pulmonary arterial HTN

A

1) phosphodiesterase 5
2) endothelin antagonists
3) prostacyclin agonists

37
Q

One of the first signs of diabetic kidney disease?

A

High urine protein, long before there is a Cr rise, this counts as chronic kidney disease

Clinical Pearls (17 decks)

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