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Sophin Rai 775 class preparation > Respiratory system > Flashcards

Respiratory system Flashcards

1
Q

Define lung cancer

A

Bronchogenic carcinoma

involves multiple malignancies involving lung or airways

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2
Q

TYPES OF Lung cancer?

A

non small cell lung cancer (85%)

small cell lung cance(13%)r

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3
Q

___________–most common type of lung camcer

A

Adenomacarcinoma

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4
Q

Which lung cancer progress faster

A

SCLC progesses faster ( within 8 to 12 weeks)

NCLS ( over months)

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5
Q

___________ primary risk factors for lung cancer

A

smoking

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6
Q

_______________other risk factor of lung cancer

A

second hand smoke, air pollution, radiation, family history of lung cancer, occupational exposure.

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7
Q

Most common symptoms of lung cancer

A

Cough( 75%)

weight loss ( 68%)

dyspnea (60%)

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8
Q

Other symptoms of lung cancer are

A

DVT ( unilateral pain in one leg)

fever

Hemoptysis

headache

extremity weakness

chest pain

discomfort

changes im cough texture

larger the lymph node, more chances of malignancy

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9
Q

___________is mostly seen in squamous cell carcinoma and small cell carcinoma as it involves central airway

A

Cough

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10
Q

Common sites of metastasis are

A

liver

bone

adrenal gland

brain

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11
Q

Which lung cancer is associated with SIADH?

A

SCLC

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12
Q

Diagnostic test

A

Ct of chest

Chest xray

PET ( position emission tomography) to find the spread of lymph node

MRI of the brain if change in neurological status

Cbc

cmp

Biopsy

thoracocentesis

Sputum cytology

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13
Q

Management of Stage 1 and II NSCL cancer

A

Stage 1 and II : Surgery

Lobectomy ( removal of one lung)

Pneumonectomy ( removal of all lung)

They need to pass PFT ( pulmonary function test)

If they fail, Chemotherapy or conventional radiaiton

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14
Q

Stage III NSCL A

Stage III NSCL B

A

Stage III NSCL A: surgical resection

Stage III NSCL B: no surgery, chemoradiation

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15
Q

Stage IV nscl

A

2 years ( survival)

chemothrapy ( carboplatin and paclitaxel)

no surgery

paliative

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16
Q

SCLC lung cancer

A

no surgery

paliativ care

8 to 13 months survival

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17
Q

How oftend do you do lung cancer screening

A

Annually with low dose of CT scan for 50 to 80 year old men, whose last smoke was less than 15 years, 20pack a year, currently smoke

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18
Q

When to stop annual lung cancer screening

A

quit smoking for more than 15 years

health comorbidities

willing to have curative lung surgery

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19
Q

________screeing for those who are heavy smoker

A

los dose of Ct scan of lungs every three years

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20
Q

Pleural effusion

A

abnormal amount of fluid in pleural space

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21
Q

What is the length of pleural space?

A

10 to 20 mm width between visceral and parietal pleurae

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22
Q

Pleural effusion is the manifestation of pulmonary and systemic disease, and most commonly caused by _______

A

CHF

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23
Q

Other cause of pleural effusion?

A

Pulmonary TB

PE

Pancreatitis

chest injury trauma

lung breast lymphoma

rheumotoid arthritis

lupus

medication such as nitrofurontoin and amiadarone

RSV

CYTOMEGALO VIRUS

herpex simplex virus

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24
Q

90% of the Pleural effusion is caused by

A

CHF

Pneumonia

Malignancy

PE

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25
Q

Pathophysiology of pleural effusion

A

Rate of fluid present is increased than the absorption

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26
Q

Clinical presentation of Pleural effusion

A

Asymptomatic initially

When symptoms occur; they have dyspnea

non productive cough

pleuretic chest pain and activity intolerance

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27
Q

Most common symptoms of pleural effusion

A

Dyspnea in recumbent position

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28
Q

how is the pain of pleural effusion

A

unilateral

localised to affected area

ipsilateral shoulder and abdomen

intermittent/sharp

Dull, steady pain- when malignant is the cause of pleural effusion

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29
Q

Pain is exacerbated in Pleural effusion by

A

activities

taking deep breathe

cough

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30
Q

what do you find in physical examination for pulmonary effusion

A

Decreased or absent breath sound

dullness to percussion

reduced or absent tactile fremitus

decreased or absent bronchial breath sound

Egophony (E TO A) at the upper border

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31
Q

Small effusion ( less than 500)

A

No symptoms

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32
Q

Effusion ( more than 1500 cc)

A

Uses accessory ms

inspiratory lag

cyanosis

bulging intercoastal margin

jugular vein distension

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33
Q

Diagnostic test for pleural effusion

A

pleural fluid analysis

chest xray

ultrasound

ct scan

thoracoscopy

thoracocentesis

pleural biopsy

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34
Q

Management of pleural effusion

A

Thoracocentesis to remove 300 to 500 ml of fluid- symptoms relief

indomethacin for pain management

pleural effusion caused by advanced malignant – comfort measure

viral pleural effusion- no managemnt it will subside itself

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35
Q

Pleurisy

A

inflammation of pleura

pleural layers rub against each other and pain fiber in parietal pleura is stimulated

not a diagnosis but a symptoms

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36
Q

Pathophysiology of pleurisy?

A

Wet pleurisy ( excess fluid in between pleural cavity

Dry pleurisy ( no fluid )

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37
Q

Most common cause of pleurisy

A

TB

Bacterial and viral infection

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38
Q

Less common cause of pleurisy

A

Trauma

malignancy

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39
Q

Other common cause of pleurisy

A

connective ts ds

pulmonary infarction

connective ts ds such as lupus erythmatous

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40
Q

Clinical presentation of pleurisy

A

stabing

shooting pain

localised and radiating to shoulder

complains “stitch in the side”

relief while lying on the affected side due to restrictive movement

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41
Q

Physical examination finding for pleural effusion

A

deep palpation- tenderness and inflammation

rapid and shallow breathing - due to limited chest expansion

percussion- dull

increased or decreased fremitus

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42
Q

What PE confirm the diagnosis

A

Loud creek sound

But, when it have fluid, no creak sound is heard

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43
Q

When and where do you hear pleural friction rub?

A

lateral posterior inferior thorax

when taking deep breathe

not audile- when patient is taking shallow, rapid breathing

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44
Q

Pluerisy- what are other associated symptoms?

A

TB, pneumonia, pneumothorax: productive cough

Infectious disease: Fever chils

Joint pain and rashes- connective tissue problem

45
Q

Management of pleurisy

A

pleura effusion- remove fluid

Associated with connective ts: Corticosteroid, Anti-inflammatory drugs

Associated with infection- treat underlying cause

46
Q

Pneumonia

A

infection of lung parenchyma

47
Q

types of pneumonia

A

Community acquired

ventilator associated

hospital acquired

health associated

48
Q

Community acquired

A

no hospitalization and nursing home for last 14 days before the onset of pneumonia

49
Q

hospital acquired

A

Pneumonia after 48 hours of hospitalization/nursing home

50
Q

VAP

A

pneumonia 48 hours after ventilator

51
Q

health care associated

A

no hospitalization/nursing home

however,needs care for wound, iv medication, hemodialysis clinic, chemotherapy

52
Q

Types of pneumonia

A

Typical : Bacterial pneumonia such as streptococcus pneumoniae ( most common bacteria)

Gram neg

gram pos

Atypical : May not be bacteria , if bacteria they donot share the same characterstics

Such as myoplasma pneumonia

virus- para virus, RSV

53
Q

pneumonia related to smoking

A

hemophilus influenza ( gram neg)

54
Q

pneumonia related with cystic fibrosis

A

pseudomonas aeroginusa

55
Q

What is the gold standard for CAP?

A

Chest Xray ; Repeat after 6 months

CBC- wbc increased

sputum c/s and sensitivity

56
Q

Diagnosis of CAP is based on

A

presentation

Chest xray

sign and symptoms

CBC is not required for diagnosis; However we can do it, WBC will be elevated

57
Q

Classic case

A

T: 100.4

sputum purulent ( rust colored( strep pneumonia)

pleuritic chest pain with coughing and dyspnea

Elderly may have atypical symptoms (afebrile, low grade fever, no cough or mild cough, confuse, weakness)

58
Q

Physical examination what do you find

A

Auscultation- rhonchi, crackles, wheezing

​Percussion: Dullness over affected lobe ​

Tactile fremitus and egophony: Increased ​

Abnormal whispered pectoriloquy (whispered words louder)

59
Q

Treatment plan for pneumonia

A

No comorbidity (previously healthy and no risk factors for drug-resistant S. pneumoniae infection): ​Macrolides are preferred. •​Azithromycin (Z-Pack) daily × 5 days •​Clarithromycin (Biaxin) BID × 7 days

​If patient had an antibiotic in previous 3 months or macrolide-resistance (>25%): •​Doxycycline 100 mg BID × 5 to 7 days •​Levofloxacin (Levaquin) 750 mg × 5 days •​Azithromycin or clarithromycin plus amoxicillin or Augmentin With comorbidity (i.e., alcoholism; congestive heart failure [CHF]; chronic heart, lung, liver or kidney disease; antibiotics in previous 3 months; diabetes; splenectomy/asplenia; others) or high rates (>25%) of macrolide-resistant S. pneumoniae: ​Respiratory fluoroquinolone as one-drug therapy (duration 5–7 days) •​Moxifloxacin (Avelox) 400 mg PO once a day •​Levofloxacin (Levaquin) 750 mg daily (minimum dose 750 mg/d) •​Gemifloxacin (Factive) 400 mg PO once a day or ​Beta-lactam plus macrolide (duration 7 days)

•​Amoxicillin clavulanate (Augmentin) 1,000/62.5 mg PO BID × 7 days or •​Cefdinir (Omnicef) 300 mg PO every 12 hours × 7 days plus azithromycin or clarithromycin

60
Q

Poor prognosis? How do you know

A

Curb 65:

If score more than 1. patient needs to be hospitalized

C ( confusion)

u ( Blood urea nitrogen more than 19.6)

R Respiration is more than 30

Blood pressure is less than 90/60

65 years and older.

61
Q

Who have poor prognosis and needs to be transferred to hospital?

A

Elderly 60 y

multiple lobe invol

AMS

Alcoholic ( risk for aspiration pneumonia)

62
Q

How to prevent pneumonia

A

influenza

pneumococcal polysaccaride vaccine ( pneumovax) if older than 65

63
Q

PCV23 when to give?

A

65 yrs

start giving after 19 years of age if high risk

64
Q

Dosing of PCV13 * pneumococcal conjugate vaccine Prevnar 13

and PPSV23 * Pnuemococcal polysaccaride vaccine 23)

A

13 is given first and after 1 year 23 IS GIVEN

If, 23 was taken early, after 1 year, 13 can be taken

if PCV13 is given only one time, no double dose

PCV23 if given early, next dose within 5 years

PCV23 at 65 if healthy, that is enough for lifetime

65
Q

What is high risk?

A

impaired immunity- splenectomy, spleen problem, alcoholics, cirhosis of liver, HIV, CKD, ASTHMA, CHF, emphysema, sickle cell, multiple myeloma

66
Q

Which demographic mostly get atypical pneumonia?

A

Children

young adult

67
Q

what is the other name of atypical pneumonia

A

walking pneumonia

Breakout at summer and fall

68
Q

classic case of atypical pneumonia

A

Fatigue several week

cough nonproductive

cold like symptoms such as sorethroat, clear rhinitis, low grade fever

Continue to go school despite symptoms, coworker have the same symptom

69
Q

Physical examination of atypical pnuemonia

A

Ausculation : Wheezing, crackles and rhales

Nose: Clear mucus

thorat: Erythematous without pus, exudates

Chest xray: Diffuse interstitial infiltrate ( pleural effusion in 20%)

CBC: looks normal

70
Q

Treatment for Atypical pnuemonia

A

Doxicycline

Azithomycin

levofloxacin

Antitusive * dextromethorphan

increased fluid and rest

71
Q

tuberculosis

A

Infection caused by Mycobacterium tuberculosis

72
Q

Most common place where you get mycobacterium tuberculi

A

lungs (85%

Kidney

brain

lymph nodes

adrenals

bones

Tranferred from one organ to other by blood or lymphnode

73
Q

How TB is spread?

A

aerosol droplets, airborne precuation

74
Q

What do you see in chest xray of Tb?

A

Cavitation, adenopathy, granulomas on the hila of the lungs

75
Q

Who are at risk of getting Tb?

A

Immigrants from high prevalence country

illegal drug user

nursing hom e

adult home resident

HIV

immunocompromised

Prolonged corticosteroid use

silicosis ( inhalling silica drug)

Chest xray ( showing previous tb infection

chronic malabsorption syndrome

low body wt

ESRD

Cancer of head and neck

76
Q

Clinical manifestation of TB?

A

Symptoms are gradual

low-grade fever, cough night sweats, fatigue, anorexia, and weight loss, chest pain, irregular menses

Both type of cough may be present- productive and non productive

uHemoptysis

asymptomatic on initial presentation

77
Q

Clinical case for Tb

A

night sweats

immigration

weight loss

productive( later sign)

non productive ( early sign)

78
Q

Physical examination of TB patient

A

Diminished bronchial sound

crackles

fremitus

79
Q

Diagnosis of TB?

A

Acid fast bacili/sputum C/s X 3 to find out mycobacterium

Chest xray- lesion in the upper lobes

tuberculin test

80
Q

management of TB?

A

Screening is the first thing

81
Q

What is the preferred and standard method to screen TB?

A

Mantoux tuberculin skin test (

82
Q

How to do Mantoux test

A

0.1 ml of purified protein derivative is injected intradermally in dorsal or volar forearm, create skin elevattion

well demarcated wheel of 6 to 10 mm

positive is when you see induration and redness after 48 to 72 hours

83
Q

interpretation of Monteux test?

A

Erythema with out induration ( soft)- nothing

a reaction of 0 to 4 mm : nothing

84
Q

In montauk test, 5 mm or greater induration for this type of patient to be pos for TB

A

immunocompromised

Child who had close contact with Tb or person who have TB for more than 5 years

Person who had old TB Or fibrosis on chest xray

85
Q

In montauk test, 10 mm or greater induration for this type of patient to be pos for TB

A

health care worker

resident of nursing home/jail

jail worker , health care worker, immigrant from high prevalent country

children younger than 4 years of age

who have received BCG

Alcoholic

IV drug user

diabetic patint

steroid therapy

86
Q

In montauk test, 15 mm or greater induration for this type of patient to be pos for TB

A

no risk factor

87
Q

Cause of false negative tuberculin test ?

A

new born

age more than 45 years

immunosuppresive

vira. fungal and bacteria infection

live vaccines ( mmr, polio)

malnutrition, cachexia, zinc def

CKD

Hematological disorder ( hodgkins ds)

Sarcoidosis

stress

improper storage

alcoholism

bypass surgery

88
Q

Old or young people, who gets life threatening form of TB?

A

Young

89
Q

How quantiferon work?

A

Enzyme linked immunoobserbent essay (ELISA) that detect the release of interferon gamma by white blood cells when the blood of a patient with TB is incubated with peptide similar to those of M. Tuberculosis.

90
Q

Does quantiferon resulr are affected by bcg?

A

No

91
Q

Clinical classification of Tb

A

0: No exposure
1: exposure; no evidence of infection
2: latent infection; no active infection ( PPD_ POS, NO clinical evidence of active TB
3. D

92
Q

What if quantiferon is pos?

A

Has previous infection with TB

does not say anything about active progression of the ds

93
Q

How does the chest xray look like in TB?

A

Nodules/cavitation in upper lobes with or with out fibrotic changes ( Scar)

94
Q

Chest xray on RT Middle lobe pneumonia?

A

Consolidation ( white colored area) on the right middle lobe,

95
Q

TB management

A

Anti- tb for 6 to 12 months

consider- drug resistance, therefore, needs four or more medication to ensure completion of therapy

needs development of new anti-Tb medication

96
Q

First four first line medication for Tb?

A

isoniazid ( INH),

rifampin ( Rifadin)

INH pyrazanamide ( PZA)

Rifampin ( Rifater)

Above 4 medicaiton is given every day for 8 weeks and, then we can give

INH and Rifampin or INFand Rirfapentine for 4 to 7 months.

Rifapentine ( Priftin) are given twice a week to improve adherence

4 months only for most people

7 months only for those who have sputum C/S positive after 2 months, for thos initial treatment did not include PZA, after initial phase, sputum C/s is positive.

97
Q

Second line medication for TB?

A

Capreomycin ( Capastat)

ethionamide ( Trecator)

para aminosalicyclate sodium,

cycloserine ( seromycin)

98
Q

Potential effective medication for TB?

A

Aminoglycoside

quinoles

rifabutin

clofazimine ( lamprene)

99
Q

Which medication is taken to prevent peripheral neuropathy caused by INH?

A

Vitamin B ( pyridox

100
Q

Which medication can be used as prophalyctic?

A

INH ( Preventive) for 6 to 12 months

for high risk people

hiv/iv drug user.

active tb household

high risk comorbid condition and PPD with 10 mm of induration or more

35 years

fibrotic lesion due to old tb

PPD with 5 mm or more

PPD shows change from previous

35 years and older who are high risk such as foreign born, homeless, jail, with PPD result is 10 mm,

101
Q

When is the Tb patient non infectious

A

after 2 to 3 weeks of continues medication therapy

102
Q

How do you check pt adherence

A

liver enzyme

BUN

Cr

AFB

103
Q

Who needs referal for TB?

A

Clinically active

MDR TB - infectious ds or pulmologist

immunocompromised patient with active TB

disseminated ds and active TB

104
Q

Side effect of INH

A

Hepatotoxicity- Jaunice, LFT, peripheral neuritis, ( numbness and tingling), anemia, agranulocytosis

hypersensitivity.

105
Q

Side effect of Rifampin

A

low toxicity as compared with INH

orange color discoloration fo body fluids

monitor LFT and RFT

106
Q

Pyrazanamide SE?

A

hepatotoxicity

elevate uric acid level/ gout/joint pain

same monitoring

107
Q

Ethambutal SE?

A

Optic neuritis - loss of vision, red/green color discrimination.

obtain baseline vision screening

108
Q

Streptocmycin SE

A

Ototoxicity and nephrotoxicity

monitor 2.5 to 3 l of fluids per day , LFT/RFT/hearing test.

Sophin Rai 775 class preparation (22 decks)

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