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Pulm Flashcards

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1
Q

Diagnosis of Asthma

A

spirometry
-> decrease FEV1/FVC ratio <80%
Bronchodilator response
-> greater than 12% increase in FEV1 after SABA
Bronchoprovocation
->hyperresponsiveness = >20% decrease in FEV1 after methacholine challenge

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2
Q

night time cough + hyperresonance to percussion + eosinophil containing suptum should make you think of?

A

Asthma, IgE mediated type hypersensitive.
Hyper-resonance to percussion occurs because there is air trapping.

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3
Q

Atopic triad

A

1)asthma
2) allergic rhinitis
3) eczema

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4
Q

Samter’s triad

A

asthma, nasal polyps, ASA sensitivity.

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5
Q

how does the methacholine challenge test work?

A

Methacholine is a muscarinic agonist that causes bronchoconstriction in the lungs. Should a greater than >20 decrease in FEV1

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6
Q

Why is SAMA (short-acting muscarinic antagonist) contraindicated in myasthenia gravis?

A

Because in Myasthenia gravis the immune system attacks the acetylcholine receptors at the neuromuscular junction.

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7
Q

What can be used in life threatening exacerbation or severe excerbation asthma with no improvement 1 hour after intensive bronchodilator therapy.

A

IV magnesium

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8
Q

What is a common side-effect of short-acting beta-agonists?

A

Tachycardia because it is systemically absorbed and acts on the beta 1 receptors in the heart.

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9
Q

What is SAMA (short-acting muscarinic antagonist)

A

Ipratropium is a SAMA it blocks the constricting action of acetylcholine at the muscarinic receptor = bronchodilator and decrease mucus secretion. Can be added to SABA to treat severe asthma excerbations.

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10
Q

T/F: LABA (long-acting beta agonist) such as salmeterol and formoterol can be used as monotherapy to treat asthma.

A

False. LABA should always be used with a ICS to address both the inflammation and bronchoconstriction of the airway . If LABA is used alone can lead to asthma related death.

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11
Q

Name some Inhaled corticosteriods

A

Fluticasone
budesonide
Beclomethasone
Note: high dose can cause adrenal supression & oral candidiaisis

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12
Q

What is the best medication to use for exercise-induced asthma & aspirin induced asthma?

A

Leukotriene receptos antagonist such as montelukast or Zafirlukast
associated with increased aggression, hallucinations and depression

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13
Q

Which medication can be used to treat high levels of IgE medicated bronchospasms

A

Anti-IgE monoclonoal antibody (omalizumab)
associated with anaphylaxis

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14
Q

What is the step-wise treatment for asthma?

A

step 1: SABA
Step 2: add low dose ICS
Step 3: add moderate dose ICS OR low dose ICS + LABA
Step 4: Moderate dose ICS + LABA
Step 5: high dose ICS + LABA
Step 6: add oral steriod + HIGH dose ICs + LABA

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15
Q

What are the risk factors for COPD?

A

Smoking MCC
Alpha-1 antitrypsin deficiency ( alpha 1 antitrypsin protects the elastin in the lungs. deficiency = break down of elastin = damage).
Smoking increase the production of elastase = break down of elastin.

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16
Q

The Ghon complex of tuberculosis is a combination of hilar lymphadenopathy and a______ on chest X-ray.

A

ghon focus

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17
Q

Mycobacterium tuberculosis is transmitted via _______________ from the respiratory tract.

A

airbrone droplets

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18
Q

__________Mycobacterium tuberculosis infection affects the middle to lower lung segments.

A

Primary Mycobacterium tuberculosis infection affects the middle to lower lung segments.

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19
Q

A hilar lymphadenopathy with a peripheral granulomatous lesion in the middle or lower lung lobes which can calcify is diagnosti

A

primary tuberculosis

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20
Q

____________is a second-line anti-tuberculous drug that can cause ototoxicity and nephrotoxicity.

A

Streptomycin

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21
Q

The interferon-γ release assay for tuberculosis is usually (positive/negative) if a patient has had previous immunization.

A

The interferon-γ release assay for tuberculosis is usually (positive/negative) negative if a patient has had previous immunization.

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22
Q

_________is an anti-tuberculous drug that can sometimes cause optic neuropathy

A

Ethambutol

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23
Q

The anti-tuberculous drug ___________________ can cause a benign red-orange discoloration of body fluids like tears and urine.

A

rifampin

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24
Q

A fibrocaseous cavitary lesion on chest X-ray is seen in (primary/secondary) tuberculosis.

A

A fibrocaseous cavitary lesion on chest X-ray is seen in secondary tuberculosis.

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25
rifampin, _____________ , pyrazinamide, and ethambutol are the four antimycobacterial drugs used to treat tuberculosis.
isoniazid
26
___________ is an agent that is co-administered with isoniazid to decrease the chance of a peripheral neuropathy or sideroblastic anemia developing
Pyridoxine (B6)
27
______ is the name given to tuberculous arthritis and osteomyelitis of the spine.
Pott Disease
28
Mycobacterium tuberculosis is a mycobacterial species that thrives in high oxygen environments, flourishes in the apex of the lung during_
Reactivation
29
_________is an anti-tuberculous drug that can cause hyperuricemia and thus increase the chance for gout in susceptible patients.
Pyrazinamide
30
Which drug is used to treat latent TB?
Isoniazide + pyridoxine (B6)
31
What is used to treat active or primary TB?
RIPE for 2 months Rifampin Isoniazide Pyrazinamide Ethambutol Then Rifampin + Isoniazide for an additional 4 months.
32
Extrapulmonary tuberculosis sites
Kidneys are the most common site Meningitis Vertebral Tuberculosis Peri-carditis
33
TB diagonsis
pulmonary sputum or bronchoalveolar lavage get acid-fast culture.
34
Target SpO2 for COPD
88-92%
35
3 cardinal symptoms of acute excerbation of COPD
1) worsening dyspnea 2) increase severity/frequency of cough 3) increased volume purulence of sputum
36
Emphysema what is
Permanent enlargement & destruction of terminal airspace making it hard to get air out
37
Emphysema presentation
Dyspnea is the most common CC prolonged expiration use of accessory muscles decreased tactile fremitus (decreased vibration due to increased air in the lungs) hyper-resonance
38
Chrontic bronchitis what is it?
productive cough >/=3months for 2+ consecutive years
39
Severe v/q mismatch in chronic bronchitis can stimulate
severe V/Q mismatch results in hypoxemia & hypercapnia leading to erythopoieses
40
Chronic productive cough is the most common presentation of
Chronic bronchitis
41
FEV1/FVC ratio of <70% indicates?
obstruction commonly seen in COPD
42
What is FVC & FEV1
FVC (forced vital capacity) is the max amount of air forcibly exhales from lungs after max inhalation FEV1: the volume of air exhaled during the 1st second of the forced exhalation.
43
In treating COPD groups B & E what medications should be given?
Group B: LABA (salmeterol) + LAMA (Tiotropium) Group E: LABA (salmeterol) + LAMA (Tiotropium) +/- ICS if blood eos >/= 300
44
What is used to treat patient that falls into Group A of COPD
bronchodilators such as SAMA (Ipratropium) Or SABA (albuterol)
45
How should an acute COPD excarbation be managed ?
1) SABA +/- SAMA 2) systemic glucocorticoid steroids (prednisone) 3) Abx (macrolide, FQ) if 2+ cardinal sxs changed. 4) Oxygen therapy target SpO2 88-92%
46
People with COPD should get what vaccines yearly?
Influenza & pneumococcal vaccine
47
COPD is associated with
1) MAT 2) Cor pulmonale
48
What is acute bronchitis
Inflammation of the upper bronchi and trachea following and upper respiratory tract infection
49
What is the most common cause of acute bronchitis?
adenovirus
50
Most common presentation of acute bronchitis
persistent cough (+/-) sputum 1-3 weeks
51
What is community acquired pneumonia?
infection of one or both of the lungs outside the hospital or within 48 hours of hospital admission
52
Hospital aqcuired pneumonia
infection acquired>48 hours after admission. Often caused by Pseudomonas aeruginosa or MRSA
53
Typical Community acquire pnemonia is caused by which pathogens
1) strep pneumoniae (mcc) 2) Haemophilus influenzae 3) Moraxella catarrhalis 4) Klebsiella pneumoniae 5) Staphylococcus aureus
54
Atypical CAP (walking pneumonia) is caused by which pathogens?
Mycoplasma penumoniae (MCC) Chlamydophila pneumoniae Legionella spp.
55
What are the presentations of typical CAP?
acute fever, cough +/- sputum, dyspena
56
What are the physical exam findings of typical CAP?
evidence of consolidation: increased tactile fremitus, egophony, dullness to percussion Crackles, tachypnea & tachycardia
57
What are the presentations of atypical CAP?
gradual onset of HA, malaise, low-grade fever +/- sore throat, dry non productive cough URI sxs physical exam normal
58
CXR finding for typical pneumonia
Lobar consolidations
59
CXR findings for atypical pneumonia
interstitial infiltrates
60
Strep pneumoniae CAP assoications
Most common cause of CAP -> Gram-positive cocci -> rust color/blood-tinged sputum -> common in young adults, post influenza
61
Haemophillus influenza CAP assoications
2nd most common cause of CAP common in COPD & Elderly -> Gram negative rod
61
Kiebsiella pneumoniae CAP assoications
Common in alcoholics & diabetics, aspiration (affects upper lobe) & abscess formation Gram neg rod Current jelly sputum
62
Staphylococcus aureus CAP assoications
Most commonly develops after the flu (post influenza) associated with elderly, IVDU, immunocompromised Gram + in clusters salmon colored sputum Bilateral lobe pneumonia
63
Mycoplasma pneumoniae CAP assoications
Most common cause of atypical pneumoniae associated with young health people living in close quarters such as college, military
64
Legionella CAP assoications
transmission via aerosolized contaminated water Nausea vomiting hyponatremia elevated Liver enzymes
65
CURB 65
Confusion U: BUN Respiratory B: SBP <90 or DBP<60 65: >/= age 65
66
Pneumocystis pneumonia is caused by
pneumocystis jirovecii, aids defining illness in patient with CD4 count <200
67
Pneumocystis pneumonia treatment
Bactrim
68
Treatment for CAP outpatient
Macrolide or doxy
69
CAP inpatient treatment
beta lactam (ceftrixaone) + macrolide
70
Hospital aquired pnuemonia treatment
antipseudomonal beta lactam: piperacillin-tazobactam (Zosyn), imipenem vancoymcin or linezolid if MRSA
71
The most common type of lung cancer is
adenocarcinoma associated with asbestos exposure. MC seen in non-smokers Peripheral located
72
Non small cell carcinoma includes
adenocarcinoma squamous cell carcinoma Large cell carcinoma
73
Squamous cell carcinoma
centrally located associated w 1) pancoast syndrome (arm/ shoulder pain) 2)honrner's syndrome (miosis, ptosis & anhidrosis) hypercalcemia
74
Large cell carcinoma
very aggressive doubles in sie quickly peripherally located associated with gynecomastia
75
Carcinoids tumors
slow growing centrally located secrete serotonin, histamine & bradykinin most commonly affects the GI tract, lungs 2nd common site
76
Small cell lung cancer
Very aggressive centrally location, Mets at presentation
77
Small cell lung cancer is associated with
Cushing syndrome SIADH Lambert-eaton (proximal muscle weakness that improves with continued use)
78
Small cell lung caner treatment
chemo +/- radiation
79
Non small cell lung cancer
surgery +/- chemo and radiation
80
What are the 2 types of sleep apnea?
Obstructive sleep apea: decreased air flow due to upper airway obstruction. Most common type. Central sleep apnea: when the breathing repeatedly stop and start during sleep
81
What are the risk factors for obstructive sleep apnea?
obesity (neck circumference >40cm) alcohol or drug use before bed can cause increased snoring but not sleep apnea.
82
What does STOP-BANG stands for?
it is used to diagnose sleep apnea Snoring Tired (daytime sleepiness Observed pnea Pressure (HTN) BMI >35 Age >50 Neck >43 Gender: male
83
complication of of sleep apnea
pulmonary HTN/cor pulmonale
84
treatment for tobacco use
Chantix wellbutrin (bupropion)
85
Lung cancer screening
annual screening, 50-80 years old with a hx of smoking (20 yr pack hx, currently smoking or quit within past 15 years) -> low dose computed tomography
86
AAA screening
abdominal ultrasound to screen for abdominal aortic aneurysm in men 65-75 years when they have any smoking history
87
Bone density scan
screen for osteoporosis in women at average risk starting at age 65 years
88
Fecal immunochemical test
colorectal cancer screening 50–75 years old annual for anyone who does not want to do a colonoscopy
89
Which smoking cessation medication is contraindiacted in patient with a history of seizure
bupropion lowers the seizure threshold and so is contraindicated in patients with a history of seizures
90
What is the most effection treation for smoking cessation
Varecniline
91
Recommened pneumococcal vaccine for all patient >65 yrs old and who have never received the vax in the past
PCV15 or PCV20 if PCV 15 is given, a dose of pneumococcal polysaccharide vaccine (PPSV23) should be administered 1 year later.
92
Which pneumococcal vaccine is used in ped population
PCV13

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