Pulmonology 3

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Pulmonology 3
2011-07-18 16:53:59
DPAP2012 Pulmonology

Pulmonology flashcards made by previous students
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  1. selective, reversible inhibitor of the cysteinyl luekotriene-1 receptor
    montelukast and zileuton
  2. allows for modest reductions in doses of beta2 agonists and corticosteroids
    leukotriene antagonists
  3. zafirlukast and zileuton are both inhibitors of
    cytochrome P450
  4. elevations of serum hepatic enzymes have occurred with
    leukotriene antagonists
  5. Pretreatment with ____ blocks allergen and exercise induced bronchoconstriction
  6. cholinergic antagonist
  7. useful in patients unable to tolerate adrenergic agonists
  8. blocks vagally mediated contraction of airway smooth muscle and mucus secretion
  9. not traditionally effective in the treatment of asthma unless COPD is also present
  10. previously the mainstay of asthma therapy _____ has been replaced by beta2 agonists due to its narrow therapeutic window
  11. recombinant DNA derived monoclonal antibody that selectively binds to human immunoglobulin E
  12. may be particularly useful in patients with moderate to severe asthma that are poorly controlled with conventional therapy
  13. the foundation of therapy for COPD
    inhaled bronchodilators such as anticholinergic agents
  14. anti-inflammatory medications that reduce airway hyperresponsiveness, inhibit inflammatory cell migration and activation, and block late phase reaction to allergen
  15. stabilize mast cells and interfere with chloride channel function
    Cromolyn sodium and nedocromil
  16. liver function monitoring is essential for
    leukotriene modifiers
  17. inhaled bronchodilators that have a duration of bronchodilation of at least 12 hours after a single dose
    long acting beta2 agonist (LABA)
  18. is the preferred therapy to combine with ICS in youths 12 years of age and adults.
    long acting beta2 agonist (LABA)
  19. Increasing use of SABA treatment or the use of SABA > __ days a week for symptom relief (not prevention of EIB) generally indicates inadequate asthma control
  20. are the most consistently effective anti-inflammatory therapy for all age groups, at all steps of care for persistent asthma
    Inhaled corticosteroids
  21. ____ used shortly before exercise may be helpful for 2–3hours
    short acting beta2 agonist
  22. Frequent or chronic use of ____ as pretreatment for EIB is discouraged, as it may disguise poorly controlled persistent asthma
    long acting beta2 agonist (LABA)
  23. Clinicians who administer omalizumab are advised to be prepared and equipped for the identification and treatment of
  24. the preferred ICS for pregnancy
  25. the preferred SABA for pregnancy
  26. consult with asthma specialist if step __ or higher is required in children 0-4 years of age
  27. consult with asthma specialist if step __ or higher is required in children 5-11 years of age
  28. Preferred Step 1 treatment for patients 12 and up
  29. Preferred Step 2 treatment for patients 12 and up
    low dose ICS
  30. Preferred step 3 treatment for patients 12 and up
    low dose ICS plus LABA or medium dose ICS
  31. Preferred step 4 treatment for patients 12 and up
    medium dose ICS plus LABA
  32. preferred step 5 treatment for patients 12 and up
    high dose ICS plus LABA and consider omalizumab for patients with allergies
  33. preferred step 6 treatment for patients 12 and up
    high dose ICS plus LABA plus oral corticosteroids, and consider omalizumab for patients with allergies
  34. regular treatment with _____ does not modify the long term decline in FEV1, but has been shown to reduce the frequency of exacerbations in COPD patients with an FEV1 of <50%, and repeated exacerbations
    inhaled glucocorticosteroid
  35. long term treatment with ______ is not recommended in patients with COPD
    oral glucocorticosteroid
  36. reduces serious illness and death in COPD patients by 50%
    influenza vaccine
  37. initiate oxygen therapy for very severe COPD if PaOx is at or below ___ kPa or SaO2 is at or below __%
    7.3, 88
  38. antibiotics should be given to COPD patients
    with increased dyspnea, increased sputum volume, increased sputum purulence
  39. antibiotics should be given to COPD patients
    who require mechanical ventilation
  40. tell patients to rinse and spit when using ICS to reduce
    systemic absorption
  41. Only prescribe in combination with ICS in pts with moderate to severe persistent asthma
    long acting beta2 agonist (LABA)
  42. carry a black box warning for asthma (especially when used as monotherapy)
    long acting beta2 agonist (LABA)
  43. contains fluticasone and salmeterol
  44. contains budesonide and formoterol
  45. Leukotriene modifier
  46. Approved for allergic rhinitis
  47. effective for seasonal asthma and for prevention of exercise induced bronchospasm
    mast cell stabilizers
  48. effective for seasonal asthma and for prevention of exercise induced bronchospasm
    Cromolyn sodium and nedocromil
  49. treatment of choice for management of EIB
    short acting beta2 agonist
  50. > __ canister/month indicates need to intensify anti-inflammatory therapy
  51. Anticholinergic for COPD
    tiotropium (Spiriva)
  52. Anticholinergic for asthma
    Ipratropium (Atrovent®)
  53. Turn liquid medication into a fine mist that is easily inhaled
  54. used for patients who can't use metered dose inhalers
  55. Should be done in the am and between noon and 2:00pm for 2-3 weeks to establish personal best, then QD
    peak flows
  56. ultimate goal of COPD therapy
  57. oxygen, consider surgery
    very severe COPD (stage 4)
  58. inhaled corticosteroids in COPD
    severe (stage 3), and very severe (stage 4)
  59. Bronchodilator of choice for acute exacerbations of COPD
    short acting beta2 agonist
  60. dry powder anticholinergic inhaler used for COPD
    tiotropium (Spiriva)
  61. Combination of albuterol and ipratropium-used in treatment for COPD
  62. use in pts inadequately controlled on optimal bronchodilatory therapy in COPD
  63. 60% of pts experience adverse effects at serum concentrations of 20-30 mg/L-N,V,D, headache, nervousness,
  64. Withdrawal of ____ can precipitate exacerbation in COPD
  65. not recommended in COPD
    expectorants, mucolytics, antitussives, respiratory stimulants
  66. only therapy to show mortality benefit in COPD
  67. goal of oxygen therapy
    increase Pao2 to > 60 mmHg
  68. H. influenzae is antibiotic resistant to ampicillin because it secretes
  69. nearly all M. catarrhalis bacterium secrete
  70. excellent bioavailability is an advantage of
  71. good activity against typical and atypical respiratory tract pathogens including PRSP, BLPHI
  72. can be used in penicillin allergic patients is an advantage of
  73. not approved in pediatrics (13-14)
  74. rare tendon rupture is a possible adverse reaction
  75. possible CNS toxicity is a possible adverse reaction
  76. not considered a respiratory fluoroquinolone
  77. good activity against typical pathogens and atypical pathogens
  78. a lot of safety data available for use in pediatrics
  79. the grandfather of macrolides, that has a lot of GI effects, doesn't have good activity against H. flu, and is seldom used anymore
  80. can be used in penicillin allergic patients is an advantage of
  81. good activity against typical respiratory pathogens
    penicillins with or without beta-lactamase inhibitor
  82. inexpensive is an advantage of
    penicillins with or without beta-lactamase inhibitor
  83. a lot of safety data available for use in pediatrics
    penicillins with or without beta-lactamase inhibitor
  84. no activity against atypical respiratory pathogens
    penicillins with or without beta-lactamase inhibitor
  85. low potential for drug interactions is an advantage for
    penicillins with or without beta-lactamase inhibitor
  86. productive cough greater than or equal to 3 months in 2 consecutive years
    chronic bronchitis
  87. this patient should receive no antibiotics
    acute bronchitis
  88. Short-term cough, producing mucoid sputum, Persistent cough after 5 days of URI, usually viral in etiology
    acute bronchitis
  89. smokers get
    chronic bronchitis
  90. cephalosporins
    cefpodoxime, cefuroxime
  91. macrolides
    azithromycin, clarithromycin
  92. fluoroquinolones
    levofloxacin, moxifloxacin
  93. there is no evidence that shows that _____ has a role in therapy for chronic bronchitis
    long term antibiotic prophylaxis
  94. therapy for pertussis
    macrolides, trimethoprim-sulfamethoxazole
  95. if risk factors or there is a high incidence locally of MRSA
    vancomycin or linezolid
  96. treatment for legionella pneumophila
    combination should include a macrolide (e.g., azithromycin) or a fluoroquinolone (e.g., ciprofloxacin or levofloxacin) rather than an aminoglycoside
  97. Fever to 104º F, chills, myalgias, headache, ~3 days, Clear nasal discharge, not much congestion, Onset abrupt, Hoarseness, cough, sore throat become more symptomatic over 3 to 4 days after fever
  98. Oseltamivir, zanamivir and peramivir belong to this class
    neuraminidase inhibitor
  99. never add a single drug to a failed regimen when trying to treat
  100. Fever, Chills, Night sweats, Appetite loss, Weight loss, Productive, prolonged cough > or equal to 3 weeks, Chest pain, Hemoptysis, Easy fatigability are all symptoms for
  101. clinically significant drug interactions with all
  102. can cause color blindness
  103. 5 year survival rate for patients with lung cancer is less than __%
  104. leading cause of lung cancer
  105. packs per day X years smoked
    pack year
  106. most common form of bronchogenic carcinoma
  107. includes squamous cell carcinoma, adenocarcinoma, and large-cell carcinoma
  108. account for less than 20% of all bronchogenic carcinomas
  109. localized pleuritic chest pain suggests
    chest wall invasion
  110. hoarseness indicates
    involvement or compression of the left recurrent laryngeal nerve, and suggest mediastinal or hilar involvement
  111. most common sites of metastases
    lymph nodes, liver, brain, adrenal glands, kidneys and lungs
  112. because of their slow growth rate these tumors are the least likely to be metastatic
    squamous cell carcinoma
  113. has a high propensity for metastases and is usually found in the lung periphery
  114. has a poor response to therapy, a poor prognosis, and is prone to malignant pleural effusions
  115. found in the central regions of the lung and rapidly metastasize
  116. a spheric lesion in the lung that is less than 3cm
    solitary pulmonary nodule
  117. about 50% of these are malignant
    solitary pulmonary nodule
  118. solitary pulmonary nodules with smooth edges and calcifications are usually
  119. solitary pulmonary nodules with irregular edges and without calcifications are usually
  120. in the case of a solitary pulmonary nodule with low probability of malignancy what approach may be warranted
    2 years of observation
  121. usually neurologic syndromes that are elicited by a patient's immune response to tumors
    paraneoplastic syndromes
  122. symptoms develop over weeks and may include difficulties in walking, swallowing, loss of muscle tone, loss of fine motor coordination, slurred speech, memory loss, vision problems, dementia, sleep disturbances, seizures and vertigo
    paraneoplastic syndromes
  123. include stiff person syndrome, encephalomyelitis, cerebellar degeneration, neuromyotonia, and sensory neuropathy
    paraneoplastic syndromes
  124. retinopathies, certain visual-loss syndromes, hyponatremia, hypercalcemia, and Cushing’s syndrome can all be manifestations of
    paraneoplastic syndromes
  125. these tumors may be cavitating with thick walls
    squamous cell carcinoma
  126. most common lung cancer in non-smokers and young people.
    alveolar or bronchoalveolar cell carcinoma
  127. is a subset of adenocarcinomas
    alveolar or bronchoalveolar cell carcinoma
  128. can develop as a lung infiltrate or as a solitary nodule and can be accompanied by bronchorrhea
    alveolar or bronchoalveolar cell carcinoma
  129. A ____ is recommended when evaluating a solitary lung nodule
    chest CT
  130. A _____ should be performed for patients with a solitary lung nodule if they have contraindications for thoracotomy
    transthoracic needle aspiration biopsy
  131. in general patients with lung nodules suggestive of malignancy should undergo ____ unless there are contraindications
    thoracotomy for surgical resection
  132. frequently develops as a peripheral lesion and may be associated with pneumonitis and hilar adenopathy
    large-cell carcinoma
  133. an anaplastic tumor that has a median survival of less than one year. subtype of large-cell carcinoma
    giant cell carcinoma
  134. subset of large cell carcinoma that resembles a renal cell carcinoma and has fewer malignant features
    clear cell carcinoma
  135. over 70% of patients with this type of lung cancer have metastases on clinical presentation
  136. most common cause of pleural effusion
    congestive heart failure
  137. when the cause for a pleural effusion is not evident
    obtain pleural fluid for examination
  138. frank pus defines an ______
  139. blood in an effusion suggests
    malignancy, trauma, tuberculosis, collagen vascular disorder, or thromboembolism
  140. the life expectancy of a patient with pleural effusions from a malignancy is ____
    a few months
  141. accumulation of air in the pleural space
  142. physical exam may show decreased breath sounds, hyperresonance, limited lateral excursion, and tracheal shift to the opposite side
  143. ______ infection can lead to pneumothorax
    Pneumocystis carinii
  144. refers to pneumothorax during time of menstruation
    catamenial pneumothorax
  145. accumulation of air in the pleural space creating positive pressure
    tension pneumothorax
  146. medical emergency requiring immediate decompression
    tension pneumothorax
  147. for a small pneumothorax _____ alone may be indicated
  148. larger pneumo's require ____
    aspiration, or chest tube placement
  149. _____ can cause a pneumothorax because of the development of thin-walled cyst like lesions
    Pneumocystis carinii
  150. pneumothorax can be caused by ____ in the setting of mechanical ventilation
  151. typically occurs in individuals over 55 years of age with a history of exposure to asbestos in the distant past
    malignant mesothelioma
  152. overall prognosis is poor with mean survival of 1-2 years
    malignant mesothelioma
  153. when obesity is associated with hypoventilation
    pickwickian syndrome
  154. paradoxic inward motion of the abdominal wall during inspiration is a classic finding of
    bilateral diaphragmatic paralysis
  155. is rarely idiopathic and is usually a manifestation of an acute or chronic generalized neuromuscular disease
    bilateral diaphragmatic paralysis
  156. aka "coin lesion"
    solitary pulmonary nodule
  157. with solitary pulmonary nodule a doubling time of < __ suggests infection
  158. with solitary pulmonary nodule a doubling time of > __ days suggests a benignity
  159. the first step in evaluation of a chest x-ray in the presence of a solitary pulmonary nodule is to
    review old radiographs
  160. sputum production is minimal, fine late inspiratory crackles at the lung bases, about 25-50% of the time clubbing is present
    interstitial lung disease
  161. ground glass, reticular, or reticulonodular infiltrates on x-ray
    interstitial lung disease
  162. localized, sharp, fleeting, made worse by sneezing, coughing, deep breathing, movement
  163. _____ should be performed whenever there is a new pleural effusion and no apparent clinical cause (CHF)
    diagnostic thoracentesis
  164. >90% of the cases of transudates are caused by
    Congestive heart failure
  165. the top three causes of exudates
    pneumonia, cancer, pulmonary embolism
  166. occur in the setting of normal capillary integrity and suggest the absence of local pleural disease
  167. form as a result of pleural disease associated with increased capillary permeability or reduced lymphatic drainage
  168. 2/3 of new lung cancer cases are in ___
  169. lung cancers come in 2 general forms which are
    small cell, and non-small cell
  170. small cell carcinomas make up __% of all lung cancers
  171. Non-small cell carcinomas make up __% of all lung cancers
  172. small cell carcinomas are notorious for
    paraneoplastic syndromes
  173. examples of paraneoplastic syndromes
    SIADH, Cushing's, CNS dysfunction, Eaton-Lambert
  174. small cell cancers are generally ___ in origin
  175. small cell cancers are generally treated with ___
  176. non-small cell cancers are generally treated with ____
  177. associated with very early metastasis
    small cell
  178. >95% of patients with ____ are smokers
    squamous cell
  179. tend to be more central in origin
    squamous cell
  180. most likely cancer to create cavitation
    squamous cell
  181. may be associated with hypercalcemia
    squamous cell
  182. resectable if caught early, if not are radiosensitive, chemotherapy resistant
    squamous cell
  183. most common form of lung cancer at 30-40%
  184. weakest association with tobacco smoke
  185. bronchoalveolar subtype of adenocarcinomas may resemble ___
  186. resectable if caught early
  187. start in the periphery
  188. start in the periphery
    large cell carcinomas
  189. rapidly growing; aggressive
    large cell carcinomas
  190. poorer prognosis than other non-small cell tumors
    large cell carcinomas
  191. breast cancers will spread to the lungs ____
  192. generally unresectable
    metastatic disease
  193. the component of cigarette smoke that has been identified as the major carcinogen
  194. occupational exposures that may cause lung cancer
    asbestos, benzene, nickel, ionizing radiation
  195. when a lung is irritated it doesn't hurt it ___
  196. lung pain comes from involvement of the ___
  197. tumors on the left are more associated with ____ than tumors on the right
  198. ptosis, miosis, anhidrosis
    Horner's syndrome
  199. lung cancer spread to the brachial plexus can lead to
    Horner's syndrome
  200. a paralyzed hemidiaphragm can signal tumor involvement of the _____
    phrenic nerve
  201. most common paraneoplastic syndrome
    systemic-weight loss, fatigue, fever, anorexia
  202. amount of lung cancers discovered on CXR or CT as an incidental finding
  203. large randomized studies show ___ difference in survival from lung cancer when CXR screening is used
  204. the incidence of false positive lung nodules with CT scan is ____
  205. if a central tumor is found on CT the next step is a
  206. A histological specimen showing abnormal cell with pink cytoplasm and the presence of a keratin pearl is indicative of
    squamous cell
  207. A histological specimen with atypical cells that appear purple is indicative of
    small cell
  208. multiple nodules have a better chance of being ____ than solitary nodules
  209. a spiculated nodule is likely to be
  210. uptake of radioactive sugar is taken up by metabolically active sites
    PET scan
  211. lesions <__ cm may lead to false negative PET scans
  212. contralateral mediastinal or hilar nodes, any scalene or supraclavicular node, generally non-resectable
  213. ipsilateral peribronchial or hilar nodes
  214. ipsilateral mediastinal or subcarinal nodes
  215. tumor <3cm
  216. 7cm>tumor>3cm or involves mainstem bronchus ro visceral pleura
  217. >7cm, tumor invading chest wall, diaphragm, mediastinal pleura, pericardium or <2 cm from carina
  218. tumor invading mediastinum, heart, trachea, carina, or satellite lesion in same lobe of lung
  219. any T or N with M1
    stage IV cancer
  220. carcinoma in situ
    stage 0
  221. hot spots on a PET scan are ______ indicative of cancer
    not always
  222. Non-small cell treatment for stages I and II
    resection, some chemo
  223. small cell treatment
    combination chemo, prophylactic brain irradiation or if mets are present