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Pulmonology General


lung ausc: long expiratory phase COPD
bronchitis vs pneumonia bronch: prior URI; cough, low fever, clear lungs or ronchi, nl CXR; pneumo: acute cough/fever/tachypnea, CP, WBCs, pulmo infilt on CXR
intermittent asthma sx <2/week, noc <2/mo; FEV1 > 80%; SABA
Cough DDx URI, allergies, asthma, COPD, ca, GERD
Anticholinergic effects: s/s, causative meds dry mouth, dry eyes, mydriasis, urinary retention, constipation; ipratropium, tiotroprium
mild persistent asthma sx >2/wk, noc >2/mo; FEV1 >80%; tx low dose ICS (rhinocort, flovent, nasonex, nasocort)
moderate persistent asthma sx daily, noc >1/week; FEV1 60-80%; tx low-med ICS, LABA (serevent)
severe persistent asthma continual sx, freq noc, FEV1 <60%; tx HD ICS, LABA, and oral CS
most aggressive lung ca; not surgically treated; highest rate of mets; usu systemic dz small cell lung cancer
most common type of lung cancer non-small cell 80%
2 most common types of non-small cell lung cancer squamous, adenocarcinoma
squamous cell lung cancer is usually where in the lung central
adenocarcinoma lung cancer is usually where in the lung peripheral
what are the most frequent symptoms associated with advanced lung cancer cough, wt loss, dyspnea, chest pain, hemoptysis, bone pain, lymphadenopathy, hepatomegaly, clubbing, horseness, SVC syndrome
initial imaging modality for suspicion of lung cancer chest x-ray
a __ lesion on chest x-ray is considered malignant until proven otherwise non-calcified
imaging used to evaluate for lung mets pet, brain ct, mr
imaging modality considered the standard of care in proper staging of lung tumors bronchoscopy
gold standard for lymph node evaluation with lung cancer cervical mediastinoscopy
lower respiratory tract starts below what anatomic structure vocal chords
diagnosed by new infiltrate on exam or x-ray pneumonia
No. 1 cause of death from infectious disease in the US is from pneumonia
hospital aquired pneumonia is defined as symptom onset >___ hours after hospital admission 48
most common bacterium associated with pneumonia world wide Streptococcus pneumoniae
pneumococcus colonizes ____% of healthy adults 5-10
May have associated non-respiratory syndromes (CNS, immune hemolytic anemia) Mycoplasma pneumoniae
‘Discovered’ in 1976; found in aquatic environments Legionella pneumophilia
50% of 20 yo have serologic evidence of past infxn; assoc w/ chronic inflammatory dz (atherosclerosis) Chlamydia pneumonia
may cause necrotizing infiltrates or pneumatoceles GN org or Staph pneumonia; aspiration pneumonia
Inhalation of oropharyngeal or gastric contents (volume-dependent) aspiration pneumonia
RF for infxn with drug resistant pneumococci recent beta lactam tx (within the past 3 months); >65 yo
RF for GN pneumonia infxn residence in a nursing home
RF for enteric GN pneumonia infection underlying cardiopulmonary dz
RF for pseudomonas aeruginosa infxn Corticosteroid tx (> 10 mg/d of prednisone); Structural lung dz (bronchiectasis); Broad-spectrum abx (> 7 d in past month)
Respiratory quinolone Moxifloxacin, gatifloxacin, levofloxacin, or gemifloxacin
Outpatient therapy for pneumonia in otherwise healthy patients Advanced generation macrolide (azithro or biaxin); doxycycline if allergic
Outpatient tx for pneumonia in pts w/ cardiopulmonary dz and/or other modifying factors Anti-pneumococcal FQ: macrolide PLUS b-Lactam (oral cefpodoxime, cefuroxime, high-dose amoxicillin, amox/clavulanate; or parenteral ceftriaxone followed by oral cefpodoxime)
rate of influenza has _____ cf to previous decade, poss d/t aging popn and/or change in predominating viral strains (H3N2) doubled
influenza has an incubation period of ___ days 1-4
Fever, myalgia, headache, malaise, nonproductive cough, sore throat, rhinitis are all symptoms of influenza
Influenza: resolution in ___ days, though cough and malaise can persist for over 2 weeks 3-7
Children with influenza may present with otitis media, nausea, vomiting
Viral cultures are optimal from ______ specimens and require specific viral culture media nasopharyngeal
Only _______ effective against both Influenza A and B ostelmavir and zanamivir
Who needs annual influenza vaccinations 6 mo-18 yo & >50 yo; LT aspirin tx; PG; chronic med conditions (pulmo, cardiac, metabolic, renal, neuro, immunodef, hemoglobinopathy); nursing home res
Radiographic findings include infiltrates in mid or lower lung fields, hilar adenopathy, cavitation tuberculosis
Cough, weight loss, fever, night sweats, hemoptysis, fatigue, decreased appetite, chest pain can be the clinical presentation of _____ reactivated tuberculosis
CXR with upper lobe infiltrates, particularly the apical and posterior segments, cavitation common reactivated tuberculosis
lower respiratory tract is normally sterile if directly sampled
Acceptable sputum spec: <__ squamous epithelial cells/low power field 10
Macrophages: Activated phagocytic cells common in ____ fungal, acid-fast & some atypical bacterial infections
Most common cause of bacterial pneumonia (70%) Streptococcus pneumoniae
Lancet shaped gram positive cocci in pairs Streptococcus pneumoniae
Culture is never indicated in chronic bronchitis
TB infection spread person to person via ____ respiratory droplets in air (cough)
Positive PPD Zone Size >= __ mm if no risk factors 15
Positive PPD Zone Size >= __ mm if co-morbid RF (DM, CKD, ca, IVDA, congregate setting, immigrant <5yrs from endemic area (Asia, Africa, Latin America), Mycobacteriology lab tech, gastrectomy 10
Positive PPD Zone Size >= __ mm if HIV+, contact of TB+ person, organ TP/immunosuppression, fibrotic CXR, on 15 mg prednisone/day, or TNF alpha inhibitor 5
substance used for control in PPD test candida albicans antigen
the inability to react to skin tests because of a weakened immune system anergy
more specific test for LTBI & can help exclude BCG or Mycobacterium not TB reactions. Interferon Gamma Release Assay
vaccine against tuberculosis Bacille Calmette-Guérin (BCG)
onset of action 5-30 minutes, with relief for 4-6 hours SABA
Beta 2 agonists have no anti-inflammatory effects and therefore should not be use as the sole therapeutic agent for management of persistent asthma
patients achieving ____ consecutive months of improved asthma control may be considered for a reduction in inhaled corticosteroid dosing 3-6
patients with severe exacerbation of asthma may require IV injection of methylprednisolone or oral prednisone
allows for modest reductions in doses of beta2 agonists and corticosteroids leukotriene antagonists
Pretreatment with ____ blocks allergen and exercise induced bronchoconstriction cromolyn
blocks vagally mediated contraction of airway smooth muscle and mucus secretion ipratropium
not traditionally effective in the treatment of asthma unless COPD is also present ipratropium
may be particularly useful in patients with moderate to severe asthma that are poorly controlled with conventional therapy omalizumab
the foundation of therapy for COPD inhaled bronchodilators such as anticholinergic agents
liver function monitoring is essential for leukotriene modifiers
inhaled bronchodilators that have a duration of bronchodilation of at least 12 hours after a single dose LABA
the preferred ICS for pregnancy budesonide
Preferred Step 1 treatment for patients 12 and up SABA PRN
Preferred Step 2 treatment for patients 12 and up low dose ICS
Preferred step 3 treatment for patients 12 and up low dose ICS plus LABA or medium dose ICS
Preferred step 4 treatment for patients 12 and up medium dose ICS plus LABA
preferred step 5 treatment for patients 12 and up high dose ICS plus LABA and consider omalizumab for patients with allergies
preferred step 6 treatment for patients 12 and up high dose ICS plus LABA plus oral corticosteroids, and consider omalizumab for patients with allergies
regular tx with _____ does not modify long term decline in FEV1, but reduces frequency of exacerbations in COPD pts w/ FEV1 of <50%, and repeated exacerbations inhaled glucocorticosteroids
long term treatment with ______ is not recommended in patients with COPD oral glucocorticosteroids
reduces serious illness and death in COPD patients by 50% influenza vaccine
initiate oxygen therapy for very severe COPD if PaOx is at or below ___ kPa or SaO2 is at or below __% 7.3, 88
antibiotics should be given to COPD patients with: increased dyspnea, increased sputum volume, increased sputum purulence, or who require mechanical ventilation
carry a black box warning for asthma (especially when used as monotherapy) LABA
Leukotriene modifier Singulair
Approved for allergic rhinitis Singulair
effective for seasonal asthma and for prevention of exercise induced bronchospasm mast cell stabilizers
effective for seasonal asthma and for prevention of exercise induced bronchospasm Cromolyn sodium and nedocromil
Anticholinergic for COPD tiotropium (spiriva)
Anticholinergic for asthma Ipratropium (Atrovent)
Should be done in the AM and between noon and 2PM for 2-3 weeks to establish personal best, then QD peak flows
ultimate goal of COPD therapy prevention
oxygen, consider surgery very severe COPD (stage 4)
inhaled corticosteroids in COPD severe (stage 3), and very severe (stage 4)
not recommended in COPD expectorants, mucolytics, antitussives, respiratory stimulants
only therapy to show mortality benefit in COPD oxygen
goal of oxygen therapy increase PaO2 to > 60 mmHg
Short-term cough, producing mucoid sputum, persistent cough after 5 days of URI, usually viral in etiology acute bronchitis
Created by: Adam Barnard Adam Barnard