Pulmonology Bastyr Flashcards

Idiopathic pulmonary fibrosis
Terms Definitions
What are the signs of asthma
• Cough, SOB, wheezing, chest discomfort often associated with triggering factor
• Wheezing, diminished breath sounds, hyperinflated lung fields bilaterally, hyperresonance to percussion
• Improvement in airflow following bronchodilator therapy (histamine or methacholine challenge)
What is the Goal of MD tx for Asthma
to manage inflammatory response with:
• ß-agonists
• antileukotrienes,
• cortico-steroids - most common one is prednisone
• cromolyn
How does asthma appear in plain film
Hyper radiolucancy
flattened diaphram
Hyperinflation

Can be normal looking
What are the two phases of an asthma rxn
Phase I - IgE (1st hour)

Phast II - IgG (4-6 hours)
How does asthma effect FEV1 adn FEV1/FVC Ration
- DECREASED FEV1SEC
- DECREASED FEV1/FVC RATIO
What should be on a DDX for wheezing?
- Chronic bronchitis
- Emphysema
- CHF
- Pneumonia - can be unilateral or B/L
- Pulmonary embolism - usually unilateral unless they have thrown two clots.
- Airway tumor
- Foreign body - usually unilateral
What is a good botanical formula for asthma tx
• Glycyrrhiza (4) + Lobelia (1) + Euphorbia (3) + capsaicin or Scutt (3), Gly (2), Lobi (1), Euphorbia (2)
What does spirometry assess
Obstructive vs Restrictive airway dz.
Assess severity and progression of obstructive dz
1. A PA CXR of a 25yo woman with asthma is most likely to show the following:
a. Patchy infiltrates
b. Ground-glass opacity
c. Hyperlucency
d. Increased diaphragmatic dome
e. Pleural stripe
c. Hyperlucency
2. Bilateral pulmonary infiltrates associated with pulmonary edema is suggestive of which condition:
a. Asthma
b. CHF
c. Acute respiratory distress syndrome (ARDS)
c. Acute respiratory distress syndrome (ARDS)
3. Ground-glass appearance of lung parenchyma on CXR is suggestive of:
a. Interstitial infiltrates
b. Pneumothorax
c. Lobar pneumonia
d. Metastatic lung CA
a. Interstitial infiltrates
4. Which of the following is an indication for endotrachial intubation:
a. Hypoxemia despite supplemental oxygen
b. Unconscious pt in respiratory distress
c. Rigid bronchoscopy
d. Flexible bronchoscopy
e. a and b
e. a and b
5. Your patient pages you saying that her 19yo daughter fainted today after experiencing SOB; she tells you that the ER doctor told her that she has an accentuated second heart sound, which diagnosis is most likely
a. Pneumothorax
b. Pulmonary arterial hy
b. Pulmonary arterial hypertension (PAH)
6. Pulmonary pressure > 30 with exercise suggests:
Pulmonary arterial hypertension
7. Which of the following patients are at risk of pulmonary embolism:
a. Patients with Hx of DVT
b. Post-surgical patients
c. Cancer patients
d. All of the above
d. All of the above
8. Select one of the following Tx plans for a cancer patient Dx with pulmonary embolism this morning:
a. Unfractionated heparin – 80IU/kg bolus iv
b. Low molecular weight heparin 1mg/kg sq
c. Lovanox
d. Unfractionated heparin
e. Low molecular weight war
a. Unfractionated heparin – 80IU/kg bolus iv
***never use the LMW heparin upfront, use the unfractionated heparin first
9. A patient with mesothelioma seems to have pleural effusion on CXR, it is most likely:
a. Exudates
b. Transudate
a. Exudates
10. Progression of consolidation on lobar pneumonia is typically
a. A to P
b. Central to peripheral
c. Peripheral to central
d. Along lobar margins
e. c and d
e. c and d
11. Amphotericin B is used to treat which of the following disease:
a. Pneumococcal pneumonia
b. Histoplasmosis
c. Pulmonary candidiasis
d. All of the above
d. All of the above
12. The 5 year survival for metastatic lung cancer has not improved significantly over the last 50 years
a. True
b. False
True
13. Doctors grossly underestimate survival on hospice patients, in other words, doctors will overestimate how long a hospice patient is going to live
a. True
b. False
a. True
14. A person qualifies for hospice if in the doctor’s opinion the patient has a life expectancy of _____ months:
6 months
How does FEV1 and FVC change with obstructive lung dz?
Restrictive?
Obstructive: fev1 low; fvc normal
Restrictive: fev1 normal; fvc low
asthma (<0.7)
2. Which of the following is most likely to cause bronchiectasis:
a. copd
b. asthma
c. small cell lung cancer
d. cystic fibrosis
e. a & d
CYSTIC FIBROSIS AND COPD (both have bronchiectasis)
3. Which of the following medicines would you first consider for a pt with idiopathic pulmonary fibrosis?
a. bromelaine and colchicine
b. ganoderma and vit D
c. beta agonist and ampicillin
d. iv ascorbic acid and ____
e. refampin and vit E
a. bromelaine and colchicine
these are our main antifibrotics
4. Pt complains of dyspnea, increased pleuritic pn, fever, chest pn, respiratory distress, loud S2…
a. Meothelioma
b. pulmonary embolism
c. bacterial pneumonia
d. pneumothorax
e. PCP
pulmonary embolism
5. If you suspect PE, which test?
a. Edoscopy
b. pulmonary angiography
c. d dimmer
d. b & c
e. flexible broncoscopy
b. pulmonary angiography
c. d dimmer
d. b & c
6. Pt with mesothelioma is seen to have PE on chest xray. it is most likely:
a. Infection
b. Exudate
c. Transudate
d. the result of CHF
Exudate
7. T/F: DVTs usually symptomatic and typically present as calf pain.
FALSE: more than 50% are asymptomatic
8. Your pt pages you to say that her 19 yo daughter fainted after experienceing SOB…the ER doctor said there was an accentuated 2nd heart sound. Most likely diagnosis is?
a. viral pneumonia,
b. sarcoidosis
c. split S2
d. status asthmaticus
e. pulmonary
e. pulmonary arterial htn (pah)
9. Pulmonary pressure greater than 30 with exercise suggests:
a. CHF
b. Pneumothorax
c. PAH (pulmonary arterial htn)
d. step 4 asthma
c. PAH (pulmonary arterial htn)
12. Which type of lung CA is likely to have a hilar mass?
a. Non-Small Cell Carcinoma
b. small cell
c. kaposi’s sarcoma
b. small cell
13. Avastin is a trade name of:
a. egrf receptor
b. veg-f receptor
b. veg-f receptor
15. If pts peak flow improves after in office beta agonist, most likely dx is...
asthma
Which radiology diagnostic technique exposes patients to the highest dose of radiation?
a. CT scan
b. MRI
c. PET/CT
d. Chest xray
e. Gamma knife radiation
c. PET/CT
Why is ultrasound rarely used in pulmonary medicine?
a. sound waves are unable evaluate air containing structures
b. The chest wall is too thick
c. It provides no more data that a CXR
d. Ultrasound has been supplanted by CT
e. MRI is more anatomically pre
a. sound waves are unable evaluate air containing structures
A PA chest xray of a 25-year-old woman with asthma is most likely to show the following:
a. patchy infiltrates
b.ground glass opacity
c.hyperlucency
d.increased diaphragmatic dome
e.pleural stripe
c.hyperlucency
Your 72 year old cancer male patient’s peak flow meter best reading is 440? Is this normal?
No
Your asthma patient is a 16 year boy who weighs 160 lbs and is 5’11”. His PFT report indicates that his FEV1 is 64% of predicted value. Into which of the following diagnostic category does he fall?
a. severe restriction
b. moderate restriction
c. mild
b. moderate restriction
Your 16 year old male patient has been diagnosed with asthma by a pulmonologist. Which diagnostic test did this patient likely undergo?
a. flexible bronchoscopy
b. endoscopy
c. albuterol challenge with spirometry
d. cromlyn challenge with peak flow test
e
c. albuterol challenge with spirometry
Your 63 year old jazz singer female patient goes for PFTS. The report reads ‘scooped appearance to the expiratory flow-volume loop’. Her most likely diagnosis is:
a. an obstructive pulmonary disorder
b. emphysema
c. pulmonary fibrosis
d. mycoplasma pn
a. obstrucitve pulmonary disorder
You receive the following PFT report on your patient facing pulmonary resection. The report reads, “In this patient, the forced expiratory volume in 1 second (FEV1) is 2.26 L after bronchodilators, which is 80% of predicted. The carbon monoxide diffusin
d. a left pneumonectomy would not be functionally well tolerated
A methylcholine challenge is a method used in conventional pulmonology to:
a. evaluate COPD emphysema patients
b. evaluate cystic fibrosis patients
c. evaluate hypersensitivity pneumonitis patients
d. evaluate lupus patients
e. evaluate asthma patients
e. Evaluate asthma pts
With a patient whose lungs are sensitive to methylcholine and the FEV1/FVC ratio dropped following inhalation of methylcholine the most likely diagnosis is:
a. COPD
b. Sarcoidosis
c. Pneumonitis
d. Asthma
e. Pulmonary fibrosis
d. Asthma
A 70 year old woman in otherwise good health has a peak flow best of 340. She is 5’ 5 inches. Which category of diagnosis is correct?
a. severe
b. moderate
c. mild
d. normal
e. not enough information to know
d. normal
If your patient’s peak flow improves significantly after an in-office therapeutic trial with a beta agonist inhaler the diagnosis is likely:
a. emphysema
b. sarcoidosis
c. SLE
d. Asthma
e. Pneumonia
d. Asthma
Your asthma patient has asthma most every day, with nighttime symptoms several 4-6 times/month. His peak flow in your office is 79% of predicted. You classify him as:
a. Step 1
b. Step 2
c. Step 3
d. Step 4
e. Status asthmaticus
b. Step 2
In the first phase of an acute asthma attack it is better to consider corticosteroids rather than antihistamines. True of false?
a. True
b. False
b. false
Beta agonist inhalers work by which of the following mechanisms?
a. anti-leukotriene
b. anti-histamine
c. smooth muscle relaxant
d. mucolytic
e. anti-adrenergic
c smooth muscle relaxant
Asthma is considered a(n) ________ immunologic disorder.
a. auto-immune
b. immune deficiency
c. TH1
d. TH2
e. T regulatory cell
c. TH1
Which of the following are appropriate naturopathic therapies for an acute asthma attack?
a. lobelia tincture
b. lomatia tincture
c. nebulized magnesium
d. nebulized calcium carbonate
e. A and C
e. A & C
The most appropriate emergency medical response to a severe allergy-related asthma attack is:
a. atropine
b. benedryl
c. belladonna
d. glutathione
e. epinephrine
e. epinephrine
Which WBC is most involved in the acute phase of an asthma attack?
a. neutrophils
b. lymphocytes
c. CD8 cells
d. Mast cells
e. Goblet cells
d. Mast cells
Leukotrienes are ____ more potent bronchial constrictors compared to histamine.
a. 1X
b. 100X
c. 1000X
d. 1 million X
e. all of the above are incorrect because histamine is more potent that leukotrine
c. 1000x
Asthmatics tend to have imbalance of arachadonic acid and for this reason NDs prescribe
a. ascorbic acid
b. magnesium
c. EFA/DHA
d. Lobelia
e. DHEA
c. EFA/DHA
Psychoneuroimmunological influences in asthmatic bronchoconstriction are most likely mediated via the _______________.
a. frontal cortex
b. mediastinal pressure
c. vagus nerve
d. phrenic nerve
e. leukotriene upregulation
C. vagus nerve
Which of the following are known factors in the etiology of asthma?
a. hyperthyroidism
b. hyperchlorhydria
c. hypochlorhydria
d. later weaning
e. influenza vaccine
c. hypo stomach acid
what are the 4 types of pulmonary dz
Immunologic
Infectious
Vascular
Trauma
What are the 4 types of Inflammatory pulmonary dz
Asthma
COPD
Pneumonitis
Bronchiectasis (CF)
What are the 5 types of Autoimmune pulmonary dz
SLE
Scleraderma
RA
Sarcoidosis
Polymyositis Dermatomyositis
What are the 2 types of Fibrotic pulmonary dz
Idiopathic Pulmonary fibrosis
Idiopathic Interstitial pneumonia
What are the 3 forms of malignant transformations in the lungs
Lung cancer
2ary mets
Pleural malignancy
What are the 4 Infectious types of pulmonary dz
Bacterial pneumonia
Viral pneumonia
Fungal pneumonia
Myobacterium
What are the 2 types of vascular pulmonary dz
PAH
PE
What are the 3 types of pulmonary trauma
Pneumothorax
Pleural effusion
Sleep apnea
What are the 4 types of Immunological pulmonary dz
Inflammatory
Fibrotic
Autoimmune
Malignancy
How does COPD effect FEV1
FEV1 will be < 80%
How does COPD present on Chest xray
hyper lucency
flat diaphragm
vascular markings increased
Marginally increased heart size
How does pneumonitis present clinically
difficulty breathing
Cough
How does Bronchiectasis present clinicaly
chronic cough
productive purulent sputum
How does bronchiectasis present in chest xray
dilated airway
mucous pluggin ring/finger shadow
air filled cystic space
How does SLE present clinically
pleuritic sx
How does SLE present on labs
Positive ANA
how does Scleraderma effect the lungs
excessive deposition of extacellular matrix and small vessel vasculopathy, fibrosis and basilar pulmonary fibrosis
How does RA effect the lungs
pleuritis, airway inflammation, RA pulmonary nodules, interstitial pulmonary fibrosis, drug induced pneumonitis.
In what direction is the TH shift in sarcoidosis
TH1
How does sarcoidosis present clinically
Hilar LAD, dyspnea on exertion, chest pn
Describe polymyositis dermatomyositis
aberrant cell-mediated inflammatory myopathy process muscle weakness, & diaphragm weakness
How does Idiopathic pulmonary fibrosis present clinically
Chronic progressive dyspnea & cough
How does Idiopathic pulmonary fibrosis present on CT
basilar, subpleural, reticular abd w/ honeycomb & minimal ground glass appearance
How does Idiopathic interstitial pneumonia present in xray
Ground glass appearance on
What types of primary tumor lung cancer are there
Small cell, squamous cell, broncheoalveolar adenocarcinoma, large cell
How do 2ary lung mets present in the lungs
multiple B/L nodules
How do Pleural malignancies present
Mesothelioma, Nonexertional chest pain & dyspnea, Pleural effusion, Pleural thickening & pulmonary nodules on CT
Describe Bacterial
Pneumonia
Dyspnea, cough w/ w/o sputum production, fever or hypothermia, chest pain & chills, Cx-Ray: parenchymal infiltrate
What test is best for Viral pneumonia?
Shell viral culture is the most sensitive and specific test
Describe Mycobacterium
TB, Unilateral look like pneumonia on a chest X-Ray
Describe Fungal pneumonia
May cause acute or chronic pneumonia
Chronic cavitary pneumonia in smoker with emphysema infected w/ histoplasmosis
Pulmonary embolism
Hypoxia, Pleuritic chest pain, Dyspnea,, Increased RR, Loud S2,
S3 gallop, Mild fever
Pleural friction rub
Pulmonary arterial hypertension
Dyspnea on exertion, syncope & chest pn, accentuated 2nd heart sounds, systolic murmur of tricuspid regurgitation, right heart failure, hypoxemia, see in young adult
Pneumothorax
Chest pain & dyspnea, ↓ or absent breath sounds, Cx-RAY: peripheral absence of lung markings & pleural striping
Pleural effusion
Exudate from cancer, infection (increased protein; from lung or pleural dz)
Sleep apnea
Period of apnea during sleep cycle, insomnia, snoring & daytime sleepiness & fogginess
This is evidence published in 1994 that the pertussis vaccine is related to asthma incidence in the U.S.
a. True
b. False
A. True
Dihydroepiandosterone might be considered in treating chronic asthma based on the following rationale:
a. growth hormone is deficient in asthmatics
b. adrenergic stimulation will relax smooth muscle
c. cortisol is primer for beta adrenergic receptors
d. B
E or C
If your patient asks if ‘allergy shots’ help for asthma what is the best reply.
a. allergy shots are ineffective because they address only the IgE component of asthma
b. There is only scattered and inconsistent research on allergy shots
c. Meta analys
C
When would belladonna in tincture form be appropriate?
a. for a mild acute asthma attack
b. for food allergy related asthma attack
c. for severe asthma attack
d. for severe COPD
e. c and d are both correct
E. C & D are both correct
Which is the correct dose and sig of belladonna tincture?
a. 250 mg of solid extract
b. 30-40 gtt of leaf tincture every 15 minutes
c. 6-8 gtt of leaf tincture tid. Ceiling dose is when patient has mild nausea.
d. 6-8 gtt of leaf tincture tid. Ceiling dos
d. 6-8 gtt of leaf tincture tid. Ceiling dose is when patient has dry mouth.
Which of the following is (are) reasonable acute tincture formula(e) for an acute asthma attack?
a. Lomatia: Khella: Curcumin: Camilla sinensis : Echinacea (1:1:1:1) 1 tsp qid
b. Ephedra: Ammi visnaga: Viburnum: Scuttelaria (or Passiflora); (1:1:1:5); Sig
d. B and C are correct
The ‘hygiene hypothesis’ is best summarized as
a. Skewed TH2 response leads to propensity to develop allergic airway inflammation
b. Skewed TH1 response leads to propensity to develop allergic airway inflammation
c. Skewed immunoglobulin therapy has l
A or B
A decreased FEV1/FVC is indicative of
a. asthma
b. COPD
c. Emphysema
d. Allergic airway disease
e. All of the above
e. All of the above
Which are the CXR hallmarks of chronic asthma?
a. pleural striping
b. hyperlucency
c. rounded diaphragm
d. ground glass infiltrates
e. bronchiectasis
b. Hyperluicency
Which are the following known possible long term consequences of corticosteroid treatment?
a. a disease accelerating effect
b. growth acceleration in children
c. hypoglycemia
d. hyperglycemia
e. autoimmunity
c. hypoglycemia
Methylxanthines are known for their
a. narrow therapeutic range in pulmonary fibrosis
b. wide therapeutic range in asthma
c. narrow therapeutic range in asthma
d. wide therapeutic range in COPD
e. B and D
c. narrow therapeutic range in asthma
Your patients asks you ‘Does a vegan diet help asthma?. The best answer is
a. Yes, and results take about 2 weeks to notice
b. Yes, but results take 3 months to notice
c. Yes, but results take 1 year to notice
d. A vegan diet is a good idea but it has n
c. Yes, but results take 1 year to notice
Pyridoxine therapy is useful in asthma because:
a. vitamin B6 can correct a tyrosine metabolism defect
b. vitamin B12 can correct a tryptophan metabolism defect
c. vitamin B6 can correct a tryptophan metabolism defect
d. asthmatics tend to have low dopami
e. A and C
Quercetin is an important asthma medicine because
a. Inhibits phospholipase A2 in neutrophils
b. Inhibits lipoxygenase
c. Inhibits smooth muscle
d. Inhibits phosphodiesterase in lung
e. All of the above
e. All of the above
Selenium is an important therapy for asthma because
a. Asthma pts have lower selenium levels
b. Glutathione peroxidase is se-dependent
c. Asthma pts tend to have lower levels of glutathione peroxidase
d. All of the above
e. None of the above
D. All of the above
According to some natural medicine physicians ______ is the mainstay of childhood asthma treatment.
a. vitamin B12
b. folic acid
c. vitamin B6
d. vitamin E
e. Vitamin C
a. vitamin B12
Other important vitamins are B6 and C
i.v. magnesium is well proven to halt an acute asthma attack or COPD exacerbation. The correct dose is
a. 2000 mg infused/hr
b. 20 mcg infused/hr
c. 2000 IU infused/hr
d. 2.0 mg infused/hr
e. 250 mg infused over three hours
A. 2000 mg infused/hr
1. What do all collagen vascular dz’s have in common?
They are all autoimmunologic in etiopathophysiology
What are ND tx for autoimmune pulmonary conditions?
• Bromelain: prevent fibrosis
• Herbs to induce TH2 shift, ganoderma, beta sistosterols
• Evaluate GI
• NAC 600 mg bid for acute Sxs
What is the most common brochiectasis?
CF
How is CF Tx’d?
Enzymes
Mucolytics: NAC (not useful on it’s own)
Does idiopathic pulmonary fibrosis have a poor response to medical Tx?
Yes and it has poor survival
9. What is the FEV1/FVC ratio criteria for restrictive dz?
>0.7
What are the ND Tx for pulmonary fibrosis?
• Fish oil 1 tsp bid
• Bromelain: 1000-9000 mg/d (antifibrotic)
• Colchicine: 0.6 mg bid 5d/wk (watch for thrombocytopenia)
• Nebulized glutathione/NAC
• AOX
What are indications for Endotracheal intubation and mechanical ventilation?
• Hypoxemia (PaO2<60 mmHg)
• Alveolar hypoventilation w/ hypercapnic respiratory acidosis (pH<7.25)
• Hemodynamic instability, shock, cardiopulmonary arrest
• Flow limiting airway obstruction
• General anesthesia
• Inability to cough copious secretions
• Post op pt
• Major trauma
What is the pressure criteria pulmonary HTN?
>25 @ rest and > 30 w/ exercise
How does pulmonary HTN present?
• Dyspnea on exertion
• Syncope
• Chest pn
• Accentuated 2nd heart sound
• systolic tricuspid regurg murmur
• R heart failure sns: ↑ jugular venous pressure, hepatic congestion, ascites, peripheral edema
• Hypoxemia
• Cardiomegaly and enlarged central pulmonary As
• Enlarged R side cardiac chambers
What are the presenting Sxs for thromboembolism?
Pleuritic chest pn, dyspnea, ↑RR, loud S2, S3 gallop, mild fever, pleural friction rub
What labs would you run if you suspect thromboembolism?
• Serum D-dimer: breakdown product of fibrin
• Lower extremity Doppler (DVT)
• Pulmonary angiography (gold standard)
• Ventilation perfusion scanning w/ Technium labeled albumin; amt of ventilation and perfusion B/L
What are the ND Tx options for thromboembolism?
• Don’t do anything while on heparin tx
• Garlic ext 3200 allicin mcg/d
• Green tea ext
• Gingko biloba
• Vit E mixed tocopherol 400IU qd
• Nattokinase
• Movement education
When to refer out for infectious pulmonary dz?
HIV/AIDS, TB, pneumonias not responding to Tx
How does consolidation in lobar pneumonia progress?
Peripheral to central
Most likely organism in community acquired pneumonia include
Strep pneumo, mycoplasma, Chlamydia
How is histoplasmosis tx’d in immune compromised?
Amphotericin B IV
What is the tx for PCP?
TMP/SMX (bactrim, Cotrim, septra)
Dapsone
Dapsone +pyrimethamine + folinic acid
Aerosolized pentamidine
Atovoquone
What are some the natural anti-viral Tx’s?
• Se 1000 mcg x 3ds for Sxs
• Allicin 3200 mcg qid if sxs
• NAC po
• Vit C po
• Nebulized GSH and NAC
• Constitutional Hydro
• Thuja steam inhalation
• Licorice 500 mg bid x 5d
What is the 5 yr survival rate in local dz compared with distant dz?
59% vs 2%
What lesion is typical of lung CA?
Coin lesion
What is the most common pleural malignancy?
Mesothelioma
What are the radiographic characteristics of mesothelioma?
Lobulated pleural base mass, pleural effusion (exudate)
What virus is assoc’d w/ mesothelioma?
Simian virus 40 (SV40); a contaminated polio virus
6. What’s the difference between stage 3a and 3b?
3a: T3(invades chest wall, >3 cm)N1M0
3b: any TN3(Supraclavicular or hilar nodes)M0
What are the immune effects of radiation therapy as shown by Bastyr University?
• Lymphopenia not recovering by 6 wks
• Low NK cells
• Low TNF alpha
• Low phagocytic activity
• NO leucopenia or neutropenia
What is the chemoTx for SCLC?
Cisplatin (leads to neuropathy)
Etoposide: orally bioavailable, but given IV
What herb is etoposide derived from?
Podophyllum peltatum
What is the major complication w/ Pemetrexed use?
Radiation recall rxn: erythema, exfoliative dermatitis, pn, buring, muscle and skin necrosis
What supplementation is required w/ Pemetrexed?
Folate and B12 to ↓ toxicity
What are endocrine syndromes associated w/ lung tumors?
• Hypercalcemia: parathyroid
• Hyponatremia: arginine vasopressin, atrial natriuretic peptide
• Ecotopic ACTH: adrenocorticotropic hormone, corticotropin releasing hormone
• Acromegaly: growth hormone
• Granulocutosis:
• Thrombocytosis
• Thyromboembolis
What herb is contraindicated with Erlotinib?
Hypericum since it is a CYP3A4 inducer (also grapefruit and garlic)
What are the LuCA conventional Tx strategies?
• Cytotoxic Chemo Tx
• Apoptotic Chemo Tx
• Angiogenesis inhibitor
• Monoclonal Ab
• Tyrosine kinase inhibitors
How is bromelain affective in CA Tx?
• Induce differentiation
• Degrade fibrin
• Inhibit metastasis
• Inhibit cell migration
• Inhibit platelet aggregation
• Stimulate or regulate immune system
• ↑ Rx absorption
What are other natural tx options?
• Melatonin (20 mg hs)
• Vit A,
• PSK, PSP,
• EPA/DHA (1 tsp-tbsp bid)
• B complex IM prevent anemia, leucopenia, neuropathy
• l- glutamine 3000-8000 mg/d prevent mucositis and peripheral neuropathy
• alpha lipoic acid 300 mg bid prevent nephropathy
• Glutathione prevent cisplatin nephrotoxicity
• Vit E topical for apthous ulcers
• Symphytum homeopathic: bone pn d/t neulasta (bone marrow stim)
• Sea weed poultices: for RT burns
• Eleuthrococcus senticosis: fatigue d/t RT
• Cratageus prevent bronchial wall bleeding, 1-2 tsp/d
• Trametes versicolor
• NAC
• Probiotics: GI
What testing would you run to evaluate relapse prevention?
• CBC w/dif, NK cell fxnal activity, serum cytokines
• Vit D levels, AOX status
• Metametrix pesticide panels
• Spirometry and peak flow
What ND Txs help to prevent relapse?
modified citrus pectin, bromelain (1500 mg bid), curcumin (1500 mg), green tea, Vit A (10,000IU/mo), Vit D, NAC
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