Pulmlecture4 asthma Flashcards
(38 cards)
Which lung cancer has the least favorable prognosis?
Small call lung cancer (15% of lung cancers)
Can NSCLC be cured?
Yes, surgical resection is favorable for
When is NSCLC surgery contraindicated?
when distant metastasis is present(stage 4), malignant pleural effusion, or when the tumor is in an area close to other important structures or if the patientís health is generally poor
When are most small cell lung cancers diagnosed? prognosis?
70% dx when there is extensive dz/ most live for only one year- generally poor prognosis d/t late dx
Can SCLC be cured?
No, surgery is not an option(usually). Chemotherapy is best treatment
When do patients receiving chemotherapy have the most side effects?
N/V starts about 3rd day of each cycle
When you see a mass on you patients CT: what are some benign tumor types that you could reassure your patient with?
Benign: Granulomas, Hamartoma(peripheral lung nodule), Bronchial gland adenoma(can present as tracheobronchial obstruction) Low- grade malignant:Carcinoid tumor(95% cure rate), Bronchial gland carcinoma(can reoccur)
You found a solitary nodule on your patients lung field: what would be some reassuring characteristics that you might see?
smooth, calcified and less than 3 cm–or if the lesion has not changed in 2 years
Same patient: What are you going to do?
you can ìwatch and waitî or do aggressive diagnostics for pathology ìwatch and waitî is good for a pt who cannot tolerate a procedure, have few rests for lung cancer.
Same patient: Pt is ambivalent about next step to take. What are some statistics that would help you educate your pt?
> 65yo = 65% chance malignant cancer , >3cm =75% chance lung cancer, spiculated mass in upper lobe=75% lung cancer
When should you proceed to order a PET scan for a solitary pulmonary nodule?
if the mass is greater than 1cm
Allergic rhinitis is pretty common: What are some clues that your patient might have it (history/PE/comorbidities)?
History: atopy, allergic asthma, parent with allergies, male, living environment with triggers, PE: sneezing, ITCHY, post nasal drip/throat clearing, rhinorrhea, ìallergic faciesî, dennie-Morgan lines, allergic siners, cobblestoning comorbidities: OSA, allergic conjunctivitis, otitis media w/ effusion, NASAL POLYPsis, ASTHMA, sinusitis, URI
Your patient does have allergic rhinitis- how do you manage this patient?
allergy avoidance(dust mites, pets, cockroaches, indoor molds, outdoor allergens), Antihistamines, nasal corticosteroids, decongestants, mast cell stabilizer, anticholinergics, leukotriene- receptor antagonist HEPA filter,
You give your patient with allergic rhinitis a H1 blocker, but it isn’t resolving the symptoms. What do you do?
Step up the therapy, add decongestant, then add intranasal CS, then increase doses, and if that all this still fails(refractory AR) send for surgical referral
A parent brings their 1 year old into your clinic and she is displaying the typical ìallergic faciesî. How do you manage this patient?
Refer out- patients under 2 yo donít have allergic sensititzation developed yet- something bigger happening….
What are the 2 components of asthma you treat?
smooth muscle dysfunction(bronchocontriction-SABA and LABA) and airway inflammation (ICS)
What WBC are involved with Asthma versus COPD
Asthma=eosinophils COPD=neurtophils
You are taking on a new patient with asthma and are worried about potential for adverse events. What history increases risk for adverse events like fatal asthma?
> 2 ER or hospitalizations in past year for asthma, prior ICU admission or prior intubation in past 5 years, recent oral steroid usage, use of >2 canisters of SABA a month, pt with denial about perceived airflow obstructions, history of sudden severe exacerbations,
What are some triggers of asthma?
VIRAL infections, mold, animals, GERD, nighttime, smoke,
What is the gold standard for diagnosing asthma?
spirometry with bronchodilator- should show reversibility= FEV1 increase by 12-15% or >200ml
Your patient has a NSAID allergy and asthma, what do you want to look for?
Nasal polyps
What are some differing symptoms of asthma versus COPD?
asthma: 40 yo, PROGRESSIVE, frequent sputum
What symptoms present with VocalCordDysfunction?
throat symptoms, inspiratory stridor, dysphonia, no response to SABA,
Your asthma patient seems to have some sort of infection, the symptoms include fever, brown mucus plugs and eosinophilia on blood smear. What is your diagnosis?
Allergic bronchopulmonary aspergillosis(ABPA). Tx with prednisone and itraconazole (antifungal)
