Pulmonology Flashcards
(48 cards)
Positive bronchial (meta choline) challenge is : if FEV1 falls by ___ or more from the baseline value, the test is considered positive.
20%, good NPV for asthma, but can be positive also for COPD
A positive bronchodilator response is increase by 12%
Treatment of aspirin exacerbated asthma/respiratory disease_____
Prednisone
The diagnostic criteria of _________are debated but include the presence of asthma, elevated IgE levels, positive skin tests to Aspergillus antigens, increased pulmonary Aspergillus-specific IgE and IgG levels, and either central bronchiectasis or infiltrates
ABPA
_____ vs asthma
Vocal cord dysfunction should be considered in the differential diagnosis of asthma, particularly if patients complain of prominent inspiratory breathlessness, with throat tightness or voice dysfunction during attacks
Asthma stepwise model
1) Level 1: SABA as needed (Albuterol)
2) Level 2: low dose ICS steroid + SABA as needed (Albuterol)
3) Level 3: ______ + low dose ICS
4) Level 4: medium ICS /LABA or LAMA
5) Level 5:
6) Level 6: High dose ICS/LABA + ____
LABA (formoterol), can also do Low dose ICS/LAMA (Tiotropium)
High dose ICS LABA/LAMA, SABA as needed
Systemic prednisone, plus adjuvant omalizumab (Ige), Mepolizumab (IL-5) etc
*backbone started is low dose steroid inhaler
*Although expensive, omalizumab reduces emergency department visits and may be cost-effective in eligible patients with moderate to severe atopic asthma not well controlled with other therapies.
Bronchial thermoplasty is a radiofrequency airway treatment administered using bronchoscopy that can reduce exacerbations and improve quality of life. Candidates are patients with an FEV1 above 60% and severe asthma that is poorly controlled despite high-dose inhaled glucocorticoid/LABA combination therapy.
Asthma management during pregnancy____________
Continue as normal
*The risks to the fetus of untreated asthma are significantly greater than the risks of asthma medications.
Biggest risk factor for COPD________________
Smoking
An α1-antitrypsin level should be obtained in patients with COPD under the age of ___who have a strong family history of COPD or who are without identifiable COPD risk factors.
45
Backbone of COPD therapy______
SABA –> LABA/LAMA, glucorticoid is asthma backbone
In patients with severe COPD and frequent exacerbations, ______ has been shown to decrease COPD exacerbations
chronic macrolide therapy (azithromycin)
Lung volume reduction surgery improves quality of life and survival for patients with upper-lobe predominant emphysema and significant exercise limitations.
Sinusitis + Gastro + Pulm symptoms is hinting at ____
CF
A characteristic radiographic finding of the emphysema associated with _______ is bullous changes most prominent at the bases, which are not present in this patient.
a1 antitrypsin deficiency
American Thoracic Society guidelines recommend screening all patients with____ with an antinuclear antibody (ANA), rheumatoid factor, and anti-cyclic citrullinated peptide antibodie
Restrictive lung disease DPLD
Best test for diagnosis pulm sarcoid_____
Bronchoscopy
Respiratory bronchiolitis–associated interstitial lung disease is found in _____
Active smokers, smokers can get both restrictive and obstructive lung disease
First line therapy for connective tissues disease (Systemic sclerosis: CREST) associated restrictive lung disease____
As a result, mycophenolate mofetil is considered first-line therapy for those with progressive DPLD and systemic sclerosis
Medications associated with restrictive lung disease
1)Amiodarone
2)________
3)Nitrofurantoin
3)________
4)_______
MTX, bleomycin, busulfan
Treatment of radiation pneumonitis_____
Treatment of severe forms of radiation pneumonitis typically is glucocorticoids, whereas observation may be appropriate for those with mild disease.
IPF Treatments
1)Anti fibroblast_____
Pirfenidone, nintedanib, specifically if UIP pattern
Disease in smokers
1) COPD
2) Respiratory Bronchiolitis associated interstitial lung disease
3)__________________
Classic IPF with UIP pattern
Respiratory bronchiolitis–associated interstitial lung disease is used to describe disease in active smokers who have imaging findings of centrilobular micronodules with a pathologic finding of respiratory bronchiolitis on biopsy. - image findings are key
Autoimmune lung disease does not typically follow UIP pattern, it would be NSIP (non specific interstitial pneumonia)
Sarcoid associated syndromes
1)Hilar lymphadenopathy, polyarthralgia, erythema nodosum, fever ________
2)Anterior uveitis, parotiditis, facial nerve palsy (Cranial-Bulbar symptoms)_________
Lofgren Syndrome
Heerfordt Syndrome
Tx: Steroids, if PAH lung transplant eval
Occupation
1) Upper lobe predominant disease____
Silicosis, must also consider TB
The most common causes worldwide of lymphocyte-predominant effusions are ________
TB and cancer
