Pulmonology 3

selective, reversible inhibitor of the cysteinyl luekotriene-1 receptor

allows for modest reductions in doses of beta2 agonists and corticosteroids

zafirlukast and zileuton are both inhibitors of

elevations of serum hepatic enzymes have occurred with

Pretreatment with ____ blocks allergen and exercise induced bronchoconstriction

cholinergic antagonist

useful in patients unable to tolerate adrenergic agonists

blocks vagally mediated contraction of airway smooth muscle and mucus secretion

not traditionally effective in the treatment of asthma unless COPD is also present

previously the mainstay of asthma therapy _____ has been replaced by beta2 agonists due to its narrow therapeutic window

recombinant DNA derived monoclonal antibody that selectively binds to human immunoglobulin E

may be particularly useful in patients with moderate to severe asthma that are poorly controlled with conventional therapy

the foundation of therapy for COPD

anti-inflammatory medications that reduce airway hyperresponsiveness, inhibit inflammatory cell migration and activation, and block late phase reaction to allergen

stabilize mast cells and interfere with chloride channel function

liver function monitoring is essential for

inhaled bronchodilators that have a duration of bronchodilation of at least 12 hours after a single dose

is the preferred therapy to combine with ICS in youths 12 years of age and adults.

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

are the most consistently effective anti-inflammatory therapy for all age groups, at all steps of care for persistent asthma

____ used shortly before exercise may be helpful for 2–3hours

Frequent or chronic use of ____ as pretreatment for EIB is discouraged, as it may disguise poorly controlled persistent asthma

Clinicians who administer omalizumab are advised to be prepared and equipped for the identification and treatment of

the preferred ICS for pregnancy

the preferred SABA for pregnancy

consult with asthma specialist if step __ or higher is required in children 0-4 years of age

consult with asthma specialist if step __ or higher is required in children 5-11 years of age

Preferred Step 1 treatment for patients 12 and up

Preferred Step 2 treatment for patients 12 and up

Preferred step 3 treatment for patients 12 and up

Preferred step 4 treatment for patients 12 and up

preferred step 5 treatment for patients 12 and up

preferred step 6 treatment for patients 12 and up

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

long term treatment with ______ is not recommended in patients with COPD

reduces serious illness and death in COPD patients by 50%

initiate oxygen therapy for very severe COPD if PaOx is at or below ___ kPa or SaO2 is at or below __%

antibiotics should be given to COPD patients

antibiotics should be given to COPD patients

tell patients to rinse and spit when using ICS to reduce

Only prescribe in combination with ICS in pts with moderate to severe persistent asthma

carry a black box warning for asthma (especially when used as monotherapy)

contains fluticasone and salmeterol

contains budesonide and formoterol

Leukotriene modifier

Approved for allergic rhinitis

effective for seasonal asthma and for prevention of exercise induced bronchospasm

effective for seasonal asthma and for prevention of exercise induced bronchospasm

treatment of choice for management of EIB

> __ canister/month indicates need to intensify anti-inflammatory therapy

Anticholinergic for COPD

Anticholinergic for asthma

Turn liquid medication into a fine mist that is easily inhaled

used for patients who can't use metered dose inhalers

Should be done in the am and between noon and 2:00pm for 2-3 weeks to establish personal best, then QD

ultimate goal of COPD therapy

oxygen, consider surgery

inhaled corticosteroids in COPD

Bronchodilator of choice for acute exacerbations of COPD

dry powder anticholinergic inhaler used for COPD

Combination of albuterol and ipratropium-used in treatment for COPD

use in pts inadequately controlled on optimal bronchodilatory therapy in COPD

60% of pts experience adverse effects at serum concentrations of 20-30 mg/L-N,V,D, headache, nervousness,

Withdrawal of ____ can precipitate exacerbation in COPD

not recommended in COPD

only therapy to show mortality benefit in COPD

goal of oxygen therapy

H. influenzae is antibiotic resistant to ampicillin because it secretes

nearly all M. catarrhalis bacterium secrete

excellent bioavailability is an advantage of

good activity against typical and atypical respiratory tract pathogens including PRSP, BLPHI

can be used in penicillin allergic patients is an advantage of

not approved in pediatrics (13-14)

rare tendon rupture is a possible adverse reaction

possible CNS toxicity is a possible adverse reaction

not considered a respiratory fluoroquinolone

good activity against typical pathogens and atypical pathogens

a lot of safety data available for use in pediatrics

the grandfather of macrolides, that has a lot of GI effects, doesn't have good activity against H. flu, and is seldom used anymore

can be used in penicillin allergic patients is an advantage of

good activity against typical respiratory pathogens

inexpensive is an advantage of

a lot of safety data available for use in pediatrics

no activity against atypical respiratory pathogens

low potential for drug interactions is an advantage for

productive cough greater than or equal to 3 months in 2 consecutive years

this patient should receive no antibiotics

Short-term cough, producing mucoid sputum, Persistent cough after 5 days of URI, usually viral in etiology

smokers get

cephalosporins

macrolides

fluoroquinolones

there is no evidence that shows that _____ has a role in therapy for chronic bronchitis

therapy for pertussis

if risk factors or there is a high incidence locally of MRSA

treatment for legionella pneumophila

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

Oseltamivir, zanamivir and peramivir belong to this class

never add a single drug to a failed regimen when trying to treat

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

clinically significant drug interactions with all

can cause color blindness

5 year survival rate for patients with lung cancer is less than __%

leading cause of lung cancer

packs per day X years smoked

most common form of bronchogenic carcinoma

includes squamous cell carcinoma, adenocarcinoma, and large-cell carcinoma

account for less than 20% of all bronchogenic carcinomas

localized pleuritic chest pain suggests

hoarseness indicates

most common sites of metastases

because of their slow growth rate these tumors are the least likely to be metastatic

has a high propensity for metastases and is usually found in the lung periphery

has a poor response to therapy, a poor prognosis, and is prone to malignant pleural effusions

found in the central regions of the lung and rapidly metastasize

a spheric lesion in the lung that is less than 3cm

about 50% of these are malignant

solitary pulmonary nodules with smooth edges and calcifications are usually

solitary pulmonary nodules with irregular edges and without calcifications are usually

in the case of a solitary pulmonary nodule with low probability of malignancy what approach may be warranted

usually neurologic syndromes that are elicited by a patient's immune response to tumors

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

include stiff person syndrome, encephalomyelitis, cerebellar degeneration, neuromyotonia, and sensory neuropathy

retinopathies, certain visual-loss syndromes, hyponatremia, hypercalcemia, and Cushing’s syndrome can all be manifestations of

these tumors may be cavitating with thick walls

most common lung cancer in non-smokers and young people.

is a subset of adenocarcinomas

can develop as a lung infiltrate or as a solitary nodule and can be accompanied by bronchorrhea

A ____ is recommended when evaluating a solitary lung nodule

A _____ should be performed for patients with a solitary lung nodule if they have contraindications for thoracotomy

in general patients with lung nodules suggestive of malignancy should undergo ____ unless there are contraindications

frequently develops as a peripheral lesion and may be associated with pneumonitis and hilar adenopathy

an anaplastic tumor that has a median survival of less than one year. subtype of large-cell carcinoma

subset of large cell carcinoma that resembles a renal cell carcinoma and has fewer malignant features

over 70% of patients with this type of lung cancer have metastases on clinical presentation

most common cause of pleural effusion

when the cause for a pleural effusion is not evident

frank pus defines an ______

blood in an effusion suggests

the life expectancy of a patient with pleural effusions from a malignancy is ____

accumulation of air in the pleural space

physical exam may show decreased breath sounds, hyperresonance, limited lateral excursion, and tracheal shift to the opposite side

______ infection can lead to pneumothorax

refers to pneumothorax during time of menstruation

accumulation of air in the pleural space creating positive pressure

medical emergency requiring immediate decompression

for a small pneumothorax _____ alone may be indicated

larger pneumo's require ____

_____ can cause a pneumothorax because of the development of thin-walled cyst like lesions

pneumothorax can be caused by ____ in the setting of mechanical ventilation

typically occurs in individuals over 55 years of age with a history of exposure to asbestos in the distant past

overall prognosis is poor with mean survival of 1-2 years

when obesity is associated with hypoventilation

paradoxic inward motion of the abdominal wall during inspiration is a classic finding of

is rarely idiopathic and is usually a manifestation of an acute or chronic generalized neuromuscular disease

aka "coin lesion"

with solitary pulmonary nodule a doubling time of < __ suggests infection

with solitary pulmonary nodule a doubling time of > __ days suggests a benignity

the first step in evaluation of a chest x-ray in the presence of a solitary pulmonary nodule is to

sputum production is minimal, fine late inspiratory crackles at the lung bases, about 25-50% of the time clubbing is present

ground glass, reticular, or reticulonodular infiltrates on x-ray

localized, sharp, fleeting, made worse by sneezing, coughing, deep breathing, movement

_____ should be performed whenever there is a new pleural effusion and no apparent clinical cause (CHF)

>90% of the cases of transudates are caused by

the top three causes of exudates

occur in the setting of normal capillary integrity and suggest the absence of local pleural disease

form as a result of pleural disease associated with increased capillary permeability or reduced lymphatic drainage

2/3 of new lung cancer cases are in ___

lung cancers come in 2 general forms which are

small cell carcinomas make up __% of all lung cancers

Non-small cell carcinomas make up __% of all lung cancers

small cell carcinomas are notorious for

examples of paraneoplastic syndromes

small cell cancers are generally ___ in origin

small cell cancers are generally treated with ___

non-small cell cancers are generally treated with ____

associated with very early metastasis

>95% of patients with ____ are smokers

tend to be more central in origin

most likely cancer to create cavitation

may be associated with hypercalcemia

resectable if caught early, if not are radiosensitive, chemotherapy resistant

most common form of lung cancer at 30-40%

weakest association with tobacco smoke

bronchoalveolar subtype of adenocarcinomas may resemble ___

resectable if caught early

start in the periphery

start in the periphery

rapidly growing; aggressive

poorer prognosis than other non-small cell tumors

breast cancers will spread to the lungs ____

generally unresectable

the component of cigarette smoke that has been identified as the major carcinogen

occupational exposures that may cause lung cancer

when a lung is irritated it doesn't hurt it ___

lung pain comes from involvement of the ___

tumors on the left are more associated with ____ than tumors on the right

ptosis, miosis, anhidrosis

lung cancer spread to the brachial plexus can lead to

a paralyzed hemidiaphragm can signal tumor involvement of the _____

most common paraneoplastic syndrome

amount of lung cancers discovered on CXR or CT as an incidental finding

large randomized studies show ___ difference in survival from lung cancer when CXR screening is used

the incidence of false positive lung nodules with CT scan is ____

if a central tumor is found on CT the next step is a

A histological specimen showing abnormal cell with pink cytoplasm and the presence of a keratin pearl is indicative of

A histological specimen with atypical cells that appear purple is indicative of

multiple nodules have a better chance of being ____ than solitary nodules

a spiculated nodule is likely to be

uptake of radioactive sugar is taken up by metabolically active sites

lesions <__ cm may lead to false negative PET scans

contralateral mediastinal or hilar nodes, any scalene or supraclavicular node, generally non-resectable

ipsilateral peribronchial or hilar nodes

ipsilateral mediastinal or subcarinal nodes

tumor <3cm

7cm>tumor>3cm or involves mainstem bronchus ro visceral pleura

>7cm, tumor invading chest wall, diaphragm, mediastinal pleura, pericardium or <2 cm from carina

tumor invading mediastinum, heart, trachea, carina, or satellite lesion in same lobe of lung

any T or N with M1

carcinoma in situ

hot spots on a PET scan are ______ indicative of cancer

Non-small cell treatment for stages I and II

small cell treatment