Respiratory Treatments Exam 4 Flashcards
ASTHMA
acute - SABA , oral steroids
chronic intermittent - SABA
chronic persistent - Low dose ICS, Low Dose ICS w/ LABA, Medium dose ICS w/ LABA, High dose ICS w/ LABA, High dose ICS w/ LABA w/ oral steroids
DO NOT GIVE LABA W/O A STEROID BBW OF DEATH
obstruction, bronchial hypersensitivity, inflammation
Atopic triad and GERD = comorbids
Drugs - NSAIDS, ASA, ACE, beta agonists
Acute Symptom Treatment of Bronchiolitis Obliterans
Corticosteroids
Azithromycin
Typical treatment of pneumoconiosis
Supportive Care
Typical treatment for Sarcoidosis
Long term Corticosteroids
Immunosurpressive therapy for sarcoidosis
Methotrexate
Azathioprine
Infliximab
Typical treatment for Idiopathic Pulmonary Fibrosis
Corticosteroids
Only definitive treatment for Idiopathic Pulmonary Fibrosis
Lung transplant (50% 5 year survival)
CXR of Bronchiolitis obliterans
Bilateral ground glass infiltrates
Will see Small opacities in upper lung upon CXR
Coal Worker (Pneumoconiosis)
CXR findings for silicosis
Hilar egg shell opacities, silicotic nodules
CXR findings of Asbestosis
Linear streaking at lung base and honeycombing
ACE- elevation
Lung Crackles
Uveitis
Malar rash (Lupus pernio)
Sarcoidosis
Bilateral hilar adenopathy
Sarcoidosis
Amiodarone, bleomycin, and nitrofurantoin are etiologies of…..
Idiopathic pulmonary fibrosis
CXR findings: Idiopathic pulmonary fibrosis
Diffuse patchy fibrosis, and pleural based honey coming
esosinphillic response to helminth larvae
Loffler syndrome
NPPAR: med causes Nitrofurantoin Phenytoin Ampicillin Acetaminophen Ranitidine
Pulmonary eosinophilia
Best diagnostic tool for pulmonary eosinophilia
Bronchial lavage
Treatments for pulmonary eosinophilia
- remove offending agent
- treat helminth infxn= albendazole, praziquantel
- Prednisone ONE YEAR TO LIFE
Main Differential diagnosis:
- unintentional weight loss
- Fever
- Night sweats
CANCER
CXR findings of Pulmonary Eosinophilia
Peripheral infiltrates
Does pulmonary eosinophila occur more in men or women??
Bitches
Asthma patient education
improve symptoms
avoid triggers (dust, dander, cold air, drugs)
hydrate!!!
Asthma short term control (asthma attack)
first line - SABA - albuterol
if significant - CS - oral prednisone or IM/IV methylprednisolone
Optional - ipratropium - muscarinic agonist
Asthma long term control
first line - ICS (budesonide, fluticasone)
second line - add a LABA ( salmeterol)
Advair
Asthma additional treatment
leukotriene inhibitors - montelukast
Mass Cell Stabilizers - Cromolyn - for exercise
Theophylline ( methylxathine) small TI, like caffeine
MAB - omalizumab
COPD treatment
Ipratropium
Albuterol
Oral prednisone
ABS frequently needed: azithromycin and tetracycline
mucolytics and theophylline
Only interventions that naturally alter the course of COPD
smoking cessation
oxygen
lung volume reduction
COPD symptomatic control
ipratropium
SABA
ICS
Patient education with COPD
smoking cessation
pneumococcal and influenza vaccine
exercise
COPD genetic risk factor?
alpha 1 antitrypsin deficiency
What PE do we see with chronic bronchitis?
productive cough obese mild dyspnea EXPIRATORY RONCHI cyanotic resonant on percussion
CXR - not flattened Diaphragm, large heart
Emphysema PE?
enlarged air sacs and decreased perfusion thin, weight loss exertion dyspnea rare cough no edema Barrel chest - AP diameter is increased Pursed lips Hyperresonance EXPIRATORY RONCHI inspiratory crackles
CXR: Small heart
flattened diaphragm
hyperinflation, bullae and decreased apical lung
Bronchiectasis Tx
For acute exacerbations: bronchodilators, ABS for 10-14 days = amoxicillin, augmentin, bacterium (TMP-SMX) and cipro for pseudomonas
Long term:
bronchodilators
chest physiotherapy
lung transplant
What is Bronchiectasis?
injury or destruction of the bronchi and bronchial walls causing permanent dilation
What is mot diagnostic test for Bronchiectasis?
CT chest we will see dilated tortuous airways
CXR - tram tracks, crowded bronchial, honey combing
foul smelling sputum
clubbing and crackles
Most common pathogen for non CF patients?
pseudomonas
Most common pathogen for non-CF patients?
H. flu
Cystic Fibrosis
autosomal recessive, caucasians
abnormal CFTR protein results in alter of chloride ions and water creating mucus from exocrine glands and tissue destruction
Diagnosis study for CF?
sweat chloride (> 60)
PFT - mixed
ABG - hypoxia
50% cases of _____________ are CF?
bronchiectasis
CF CXR shows?
hyperinflation
peribronchial cuffing
bronchiectasis
blebs
CF associated symptoms?
GI CA osteopenia Pancreatitis Infertility Arthorpathies
CF PE?
clubbing
increased Ap diameter
hyper resonant
nasal polyps
Hypersensitivity pneumonitis Tx: (extrinsic inflammatory alveolitis)
avoid the source
tapered oral steroid for 4-6 WEEKS! (not as long as pulmonary eosinophilia which is 1 year to life)
PE for acute hypersensitivity pneumonitis?
4-8 hrs after exposure bibasilar crackles sudden onset cough chills malaise
Diagnostic test for hypersensitivity pneumonitis?
hypersensitivity pneumonitis ANS panel or biopsy which will show interstitial infiltrates of lymphocytes and plasma cells w/ noncaseating granulomas in the interstitial air spaces.
what is hypersensitivity pneumonitis?
non atopic, non asthmatic inflammation disease from inhaled antigen ( bird feces)
PE for subacute hypersensitivity pneumonitis?
weight loss
dyspnea
anorexia
Churg-Strauss
Vasculitis/ashtma
Common sites of metastasis; cancer
Liver
Bone
Brain
Adrenal glands
Tumors that produce hormones create what kind of symptoms
Flushing and diarrhea
Octreotide Scintigraphy
Indium labeled hormones bind to somatostatin hormone receptors
Most carcinoid tumors are resistant to chemo or radiation Why???
They are slow growing
What lobes and lung is most common for cancer?
Right lung
Upper lobes
Top three causes of lung cancer
Tobacco
Radon
Environmental smoke exposure
What is more common SCLC or NSCLC
NSCLC
What are peripheral tumors?
Adenocarcinoma/large cell carcinoma
What are central tumors?
Squamous cell/ small cell
SCLC good or bad?
Terrible prognosis, metastasis before we even know we have it
NSCLC: Squamous cell
Central
SLOWER metastasis
What is the most common lung cancer and where is it located?
Adenocarcinoma Bone Brain Liver Adrenal glands
Large cell
Mostly from smoking
Not very common
Peripheral
symptoms of central tumors
Cough Dyspnea Wheezing Hemoptysis pain
Symptoms of Peripheral tumors
Cough
Chest wall pain
Pleural effusions
Pulmonary abscess
Horners syndrome: where are tumors and fun facts about it
MAP
Tumors in Apex
Thoracic outlet syndrome= compression of the neurovascular bundle as it traverses the thoracic outlet.
Pancoast tumor
Horners syndrome + Bony destruction 1st /2nd ribs Vertebral bodies Atrophy of hand muscles NSCLC Lung cancers arising in the superior sulcus Pain (usually in the shoulder)
Lambert-Eaton Myasthenic Syndrome
Myasthenia gravis type symptoms: Ab against voltage gated calcium channel and creates myasthenia gravis like symptoms
- Hip and shoulder Girdle weakness
- Muscle stiffness
Superior Vena Cava Syndrome
- SVC traverses the right side of the mediastinum
- Incomplete obstruction or complete
- Caused by extrinsic pressure or intravascular thrombosis
- Venous distention of the neck and chest wall
- Dyspnea
- Bending forward or lying down exacerbates sxs
Diagnosis for central tumors
Sputum cytology
Bronchoscopy
Diagnosis for peripheral tumors
Fine-needle aspiration cytology
For tumors CT scan of….
- Upper abdomen (liver and adrenal glands)
- Upper chest (mediastinum)
Staging for SCLC
- Limited-Stage: limited to one lung and regional lymph nodes
- Extensive-Stage: both lungs or other areas of the body
Chemotherapy treatment
1st line is usually platinum-based drugs:
- Paclitaxel
- Docetaxel
- Gemcitabine
- Vinorelbine
Surgical treatment options for tumors
- Thoracotomy: large incision (5-10 in) in the chest is made for tumor removal
- VATS: video assisted thorascopic surgery:
- Wedge resection: removal of tumor as well as small amount of normal lung tissue
- Segmentectomy: removal of segment of the lung (left=8, right=10)
- Pneumonectomy: removal of entire lung
Maintenance therapies for tumors:
- Erlotinib (Tarceva) – locally advanced or mets NSCLC
- Pemetrexed (Alimta) – non-squamous NSCLC
Pearls: Adenocarcinoma
- peripheral
- most common
- lung cancer from a non smoker think this
Pearls: Pearls of Squamous cell
- Central
- 2nd most common
Pearls: Large Cell
- rare (5-10%)
- Increased risk with smoking
Small cell lung cancer fun facts:
- Aggressive cancer
- Usually metastasis by time of dx
- Poor prog.
- Chemo for treatment
- Surgical intervention: poor
Pearls Metastasis
liver
bone
brain
adrenal glands
Pearls Metastasis work up
CT scan:
- Thorax
- Abdomen
- Pelvis
- +/- PET scan
What virus causes ARDS?
Coronavirus
CXR findings of ARDS?
Initial: unilateral peripheral consolidation
Followed by: b/l pathcy infiltrates
