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Clinical Medicine Lecture - Professor Kramer > Respiratory Treatments Exam 4 > Flashcards

Respiratory Treatments Exam 4 Flashcards

1
Q

ASTHMA

A

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

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2
Q

Acute Symptom Treatment of Bronchiolitis Obliterans

A

Corticosteroids

Azithromycin

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3
Q

Typical treatment of pneumoconiosis

A

Supportive Care

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4
Q

Typical treatment for Sarcoidosis

A

Long term Corticosteroids

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5
Q

Immunosurpressive therapy for sarcoidosis

A

Methotrexate
Azathioprine
Infliximab

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6
Q

Typical treatment for Idiopathic Pulmonary Fibrosis

A

Corticosteroids

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7
Q

Only definitive treatment for Idiopathic Pulmonary Fibrosis

A

Lung transplant (50% 5 year survival)

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8
Q

CXR of Bronchiolitis obliterans

A

Bilateral ground glass infiltrates

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9
Q

Will see Small opacities in upper lung upon CXR

A

Coal Worker (Pneumoconiosis)

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10
Q

CXR findings for silicosis

A

Hilar egg shell opacities, silicotic nodules

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11
Q

CXR findings of Asbestosis

A

Linear streaking at lung base and honeycombing

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12
Q

ACE- elevation
Lung Crackles
Uveitis
Malar rash (Lupus pernio)

A

Sarcoidosis

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13
Q

Bilateral hilar adenopathy

A

Sarcoidosis

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14
Q

Amiodarone, bleomycin, and nitrofurantoin are etiologies of…..

A

Idiopathic pulmonary fibrosis

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15
Q

CXR findings: Idiopathic pulmonary fibrosis

A

Diffuse patchy fibrosis, and pleural based honey coming

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16
Q

esosinphillic response to helminth larvae

A

Loffler syndrome

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17
Q 
NPPAR: med causes 
Nitrofurantoin
Phenytoin
Ampicillin
Acetaminophen
Ranitidine
A

Pulmonary eosinophilia

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18
Q

Best diagnostic tool for pulmonary eosinophilia

A

Bronchial lavage

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19
Q

Treatments for pulmonary eosinophilia

A
  • remove offending agent
  • treat helminth infxn= albendazole, praziquantel
  • Prednisone ONE YEAR TO LIFE
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20
Q

Main Differential diagnosis:

  • unintentional weight loss
  • Fever
  • Night sweats
A

CANCER

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21
Q

CXR findings of Pulmonary Eosinophilia

A

Peripheral infiltrates

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22
Q

Does pulmonary eosinophila occur more in men or women??

A

Bitches

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23
Q

Asthma patient education

A

improve symptoms
avoid triggers (dust, dander, cold air, drugs)
hydrate!!!

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24
Q

Asthma short term control (asthma attack)

A

first line - SABA - albuterol

if significant - CS - oral prednisone or IM/IV methylprednisolone

Optional - ipratropium - muscarinic agonist

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25
Q

Asthma long term control

A

first line - ICS (budesonide, fluticasone)
second line - add a LABA ( salmeterol)

Advair

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26
Q

Asthma additional treatment

A

leukotriene inhibitors - montelukast
Mass Cell Stabilizers - Cromolyn - for exercise
Theophylline ( methylxathine) small TI, like caffeine
MAB - omalizumab

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27
Q

COPD treatment

A

Ipratropium
Albuterol
Oral prednisone
ABS frequently needed: azithromycin and tetracycline

mucolytics and theophylline

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28
Q

Only interventions that naturally alter the course of COPD

A

smoking cessation
oxygen
lung volume reduction

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29
Q

COPD symptomatic control

A

ipratropium
SABA
ICS

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30
Q

Patient education with COPD

A

smoking cessation
pneumococcal and influenza vaccine
exercise

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31
Q

COPD genetic risk factor?

A

alpha 1 antitrypsin deficiency

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32
Q

What PE do we see with chronic bronchitis?

A 
productive cough
obese
mild dyspnea
EXPIRATORY RONCHI 
cyanotic 
resonant on percussion

CXR - not flattened Diaphragm, large heart

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33
Q

Emphysema PE?

A 
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

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34
Q

Bronchiectasis Tx

A

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

35
Q

What is Bronchiectasis?

A

injury or destruction of the bronchi and bronchial walls causing permanent dilation

36
Q

What is mot diagnostic test for Bronchiectasis?

A

CT chest we will see dilated tortuous airways

CXR - tram tracks, crowded bronchial, honey combing

foul smelling sputum

clubbing and crackles

37
Q

Most common pathogen for non CF patients?

A

pseudomonas

38
Q

Most common pathogen for non-CF patients?

A

H. flu

39
Q

Cystic Fibrosis

A

autosomal recessive, caucasians

abnormal CFTR protein results in alter of chloride ions and water creating mucus from exocrine glands and tissue destruction

40
Q

Diagnosis study for CF?

A

sweat chloride (> 60)

PFT - mixed
ABG - hypoxia

41
Q

50% cases of _____________ are CF?

A

bronchiectasis

42
Q

CF CXR shows?

A

hyperinflation
peribronchial cuffing
bronchiectasis
blebs

43
Q

CF associated symptoms?

A 
GI CA
osteopenia
Pancreatitis
Infertility
Arthorpathies
44
Q

CF PE?

A

clubbing
increased Ap diameter
hyper resonant
nasal polyps

45
Q

Hypersensitivity pneumonitis Tx: (extrinsic inflammatory alveolitis)

A

avoid the source

tapered oral steroid for 4-6 WEEKS! (not as long as pulmonary eosinophilia which is 1 year to life)

46
Q

PE for acute hypersensitivity pneumonitis?

A 
4-8 hrs after exposure
bibasilar crackles
sudden onset
cough
chills
malaise
47
Q

Diagnostic test for hypersensitivity pneumonitis?

A

hypersensitivity pneumonitis ANS panel or biopsy which will show interstitial infiltrates of lymphocytes and plasma cells w/ noncaseating granulomas in the interstitial air spaces.

48
Q

what is hypersensitivity pneumonitis?

A

non atopic, non asthmatic inflammation disease from inhaled antigen ( bird feces)

49
Q

PE for subacute hypersensitivity pneumonitis?

A

weight loss
dyspnea
anorexia

50
Q

Churg-Strauss

A

Vasculitis/ashtma

51
Q

Common sites of metastasis; cancer

A

Liver
Bone
Brain
Adrenal glands

52
Q

Tumors that produce hormones create what kind of symptoms

A

Flushing and diarrhea

53
Q

Octreotide Scintigraphy

A

Indium labeled hormones bind to somatostatin hormone receptors

54
Q

Most carcinoid tumors are resistant to chemo or radiation Why???

A

They are slow growing

55
Q

What lobes and lung is most common for cancer?

A

Right lung

Upper lobes

56
Q

Top three causes of lung cancer

A

Tobacco
Radon
Environmental smoke exposure

57
Q

What is more common SCLC or NSCLC

A

NSCLC

58
Q

What are peripheral tumors?

A

Adenocarcinoma/large cell carcinoma

59
Q

What are central tumors?

A

Squamous cell/ small cell

60
Q

SCLC good or bad?

A

Terrible prognosis, metastasis before we even know we have it

61
Q

NSCLC: Squamous cell

A

Central

SLOWER metastasis

62
Q

What is the most common lung cancer and where is it located?

A 
Adenocarcinoma
Bone
Brain
Liver
Adrenal glands
63
Q

Large cell

A

Mostly from smoking
Not very common
Peripheral

64
Q

symptoms of central tumors

A 
Cough
Dyspnea
Wheezing
Hemoptysis
pain
65
Q

Symptoms of Peripheral tumors

A

Cough
Chest wall pain
Pleural effusions
Pulmonary abscess

66
Q

Horners syndrome: where are tumors and fun facts about it

A

MAP
Tumors in Apex
Thoracic outlet syndrome= compression of the neurovascular bundle as it traverses the thoracic outlet.

67
Q

Pancoast tumor

A 
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)
68
Q

Lambert-Eaton Myasthenic Syndrome

A

Myasthenia gravis type symptoms: Ab against voltage gated calcium channel and creates myasthenia gravis like symptoms

  • Hip and shoulder Girdle weakness
  • Muscle stiffness
69
Q

Superior Vena Cava Syndrome

A
  • 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
70
Q

Diagnosis for central tumors

A

Sputum cytology

Bronchoscopy

71
Q

Diagnosis for peripheral tumors

A

Fine-needle aspiration cytology

72
Q

For tumors CT scan of….

A
  • Upper abdomen (liver and adrenal glands)

- Upper chest (mediastinum)

73
Q

Staging for SCLC

A
  • Limited-Stage: limited to one lung and regional lymph nodes
  • Extensive-Stage: both lungs or other areas of the body
74
Q

Chemotherapy treatment

A

1st line is usually platinum-based drugs:

  • Paclitaxel
  • Docetaxel
  • Gemcitabine
  • Vinorelbine
75
Q

Surgical treatment options for tumors

A
  • 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
76
Q

Maintenance therapies for tumors:

A
  • Erlotinib (Tarceva) – locally advanced or mets NSCLC

- Pemetrexed (Alimta) – non-squamous NSCLC

77
Q

Pearls: Adenocarcinoma

A
  • peripheral
  • most common
  • lung cancer from a non smoker think this
78
Q

Pearls: Pearls of Squamous cell

A
  • Central

- 2nd most common

79
Q

Pearls: Large Cell

A
  • rare (5-10%)

- Increased risk with smoking

80
Q

Small cell lung cancer fun facts:

A
  • Aggressive cancer
  • Usually metastasis by time of dx
  • Poor prog.
  • Chemo for treatment
  • Surgical intervention: poor
81
Q

Pearls Metastasis

A

liver
bone
brain
adrenal glands

82
Q

Pearls Metastasis work up

A

CT scan:

  • Thorax
  • Abdomen
  • Pelvis
  • +/- PET scan
83
Q

What virus causes ARDS?

A

Coronavirus

84
Q

CXR findings of ARDS?

A

Initial: unilateral peripheral consolidation

Followed by: b/l pathcy infiltrates

Clinical Medicine Lecture - Professor Kramer (28 decks)

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