1) Pulmonology Flashcards
Abx for acute bronchitis
MOST = viral
But if: elderly, underlying cardiopulm dz, or cough >7-10 days, or immunocompromised
-2nd generation cephalosporin (cefuroxime, cefoxitine, cefotetan)
Acute Epiglottitis tx
#1 Secure airway #2 Broad spectrum 2nd or 3rd gen cephalosporin (cefotaxime or ceftriaxone 7-10 days)
Croup Tx
Mild = supportive only Severe = hospitalization
(corticosteroids, humidified air/oxygen, nebulized epi)
Stages of Pertussis
1) Catarrhal (insidious onset of coryza, HACKING cough, worse at night)
2) Paroxysmal (rapid coughing fits w/ WHOOP)
3) Convalescent sage (decrease in freq and paroxysms)
Treatment of Choice for Pertussis
Erythromycin
(treat close contacts too)
Prophylaxis: Dtap 7y/o
Most common cause of pneumonia
S. pneumo
Low grade fever
Cough
Bullous myringitis
**Cold Agglutins (confirm)
Manifestations of M. Pneumo pneumonia
Slower onset, immunosuppression
Increased LDH
More hypoxemic than appears on CXR
Interstitial infiltrates
Manifestations of pneumocysitis jiroveci
chronic cardiac or respiratory disease
hyponatremia
diarrhea or other system sump
longer prodrome
Legionella pneumoniae
Single rigor
rust colored sputum
s. pneumo
currant jelly sputum
Chronic illness, including alcohol abuse
k. pneumo
Pathogen most likely to cause pneumonia in: Alcohol abuse
Klebsiella pneumoniae
Pathogen most likely to cause pneumonia in: COPD
haemophilus pneumoniae
Pathogen most likely to cause pneumonia in: Cystic Fibrosis
Pseudomonas
Pathogen most likely to cause pneumonia in: Young adults, college settings
- Mycoplasma pneumoniae
- Chlamydia penumoniae
Pathogen most likely to cause pneumonia in: Air conditioning/aerosolized water
Legionella pneumoniae (treatment of choice = levofloxacin alt = azithrom)
Pathogen most likely to cause pneumonia in: Post-splenectomy
Encapsulated Organisms:
- s. pneumo
- h. pneumo
Pathogen most likely to cause pneumonia in: Leukemia/Lymphoma
Fungus
Pathogen most likely to cause pneumonia in: children <1yr
RSV
Pathogen most likely to cause pneumonia in: Children <2yr
Parainfluenza
Healthcare associated pneumonia
Presents w/ symptoms > 48h after admission to hospital
-s. aureus, pseudomonas
(pseudomonas is most likely in ICU)
Tx of HAP
- Cefepime
- Ticarcillin/clavulanic acid
- Piperacillin/tazobactam
- Meropenem
Most common fungus in pneumonia
Aspergillus
Missisippi valley
histoplasmosis
also has worldwide distribution
Southwestern US
coccidiomycosis
Southeast and midwest
blastomycosis
CXR in pneumocysitis jiroveci
Diffuse or perihilar infiltrates w/ no effusion
CXR is the cornerstone of DX
Tx of pneumocysitis jiroveci
TMP/SMX
Primary TB
- 10% of those infected
- CXR: homogenous infilt, hilar/paratracheal lymph node enlargment, segmental atelectasis
- TX: INH/RIF/PZA/EMB x 2 mo then INH/RIF for 4mo
Progressive Primary TB
- Def: 5% of those infected fail to contain the infection and progress to active TB in 2yrs
- CXR: homogenous infilt, hilar/paratracheal lymph node enlargment, segmental atelectasis AND cavitary lesions
- Tx: INH/RIF/PZA/EMB x 2 mo then INH/RIF for 4mo
Latent TB
- **95% of infected people contain the bacterial w/o becoming symptomatic
- TX: INH for 9mo or RIF for 4mo OR RIF+PZA for 2mo
Reactivation TB
Develops from latent TB in the setting of immune compromise
- CXR:
- fibrocavitary apical disease nodules, infiltrates posterior and apical segments of the Right upper lobe, apical posterior segments of the left upper lobe, superior segments of the lower lobes
A TB skin test is positive if > or = 5mm in:
HIVpts, recent contacts of TBpt, people w/ TB on cxr, immunocomp pts on steroids
A TB test is positive if > or = 10mm in:
recent immigrants, HIV neg inject drug users, mycobact lab workers, people in high congregate settings, people w/ chronic medical conditions like DM, silicosis, CRF
A TB test is positive if > or = 15mm in:
pts w/ no RF for tuberculosis
Definitive dx of TB
Identification of m.tuberc on cultures or by DNA/RNA amp technicques
- *demonstration of acid-fast bacilli on sputum supports but doesn’t confirm TB
- Biposy revelaing CASEATING granulomas = histologic hallmark
SE of INH
hepatitis, peripheral neuropathy (supplement w/ B6 to reduce the risk)
SE of RIF
hepatitis, flu syndrome, orange-red bodily fluid
SE of EMB
optic neuritis (red/green vision loss)
SCLC
25-35% of all
- originates at the central bronchi and mets to regional lymph nodes
- early mets, aggressive course
- Tx: Chemo
NSCLC
1) Squamous Cell carcinoma (centrally located mass)
2) Adenocarcinoma (periphery of lungs) MOST COMMON
3) Large Cell Carcinoma
Tx: Surgery
Lung Cancer Complications
SPHERE
- SVC syndrome
- Pancoasts Tumor
- Horner Syndrome
- Endocrine
- Recurrent laryngeal nerve (hoarseness)
- Effusions (exudative)
SVC syndrome
Plethora, headache, mental status changes
Pancoasts Tumor
Tumor of the lung apex
causes horner syndrome and shoulder pain, affects brachial plexus and cervical sympathetic nerve
Horner’s syndrome
U/L facial anhidrosis, ptosis, myosis
Endocrine
Carcinoid syndrome: flushing, diarrhea, telangiectasias
Causes of exudates
Infection, Malignancy, Trauma
most common irritants are doxycycline and talc
Causes of transudates
CHF, atelectasis, renal or liver dz/cirrhosis
Light’s Criteria
EFFUSION if one of these is met:
- pleural fluid protein to serum protein ration >0.5
- pleural fluid LDH to serum LDH ration >0.6
- pleural fluid LDH >2/3 the upper limit of normal for serum LDH
Asbestosis
- Occupation: Insulation, Demolition, Construction
- Dx: linear opacities at bases and pleural plaques
- Bx: Asbestos bodies
- Complications: Increased risk of lung cancer and mesothelioma, especially if smoker
Coal Workers’ Pneumoconiosis
- Occupation: Coal Mining
- Dx: Nodular opacities at upper lung fields
- Complications: Progressive massive fibrosis
Silicosis
- Occupation: Mining, sand-blasting, quarry work, stone work
- Dx: nodular opacities at upper lung fields
- Complications: Increased risk of TB, progressive massive fibrosis
Berryliosis
- Occupation:high technology fields, aerospace, nuclear power, ceramics, foundries, tool and dye manufacturing
- Dx: diffuse infiltrates and hilar adenopathy
- Complications: requires chronic steroids
Tx of pneumoconioses
Usually supportive because no effective tx is available
oxygen, vaccinations, rehab
Sarcoidosis
- Multiple organ disease of idiopathic cause (90% have lung involvement)
- extrapulmonary findings are common and include erythema nodosum or enlargement of the parotids, lymphnodes, liver, or spleen
- Blood Tests: leukopenia, eosinophilia, elevated ESR, hypercalcemia, hypercalciuria -Angiotensin-converting enzyme is elevated in 40-80% of patients
- CXR: symettric bilateral hilar and right paratracheal adenopathy and b/l diffuse reticular infiltrates -Dx: via biopsy of lung or find needle biopsy that shows non-caseating granulomas
- Tx: 90% are responsive to corticosteroids and maintained w/ modest doses
Cause of ARDS
- increased permeability of the alveolar capillary membranes which leads to development of protein rich pulmonary edema
- 75% of ARDS = #1 Sepsis syndrome, severe multiple trauma, and aspiration of gastric contents
(other: shock, toxic inhalation, near-drowning, multiple transfusions)
Symp of ARDS
- rapid onset of profound dyspnea 12-24h after the precipitating even
- tachypnea, frothy pink-red sputum, diffuse crackles
- cyanosis w/ increasingly severe hypoxemia refractory to administration of oxygen -CXR: may be normal at first, may have peripheral infiltrates, 80% = air broncograms
- *pleural effusions may be small or absent -PCWP: normal
- Multiorgan failure is common
Tx of ARDS
- Tx: identify and treat precipitating and secondary conditions
- Oxygen via intubation (positive pressure ventilation and low levels of PEEP) -Mortality rate is high (1/3 die w/in first 3 days)
Most common cause of respiratory distress in the preterm infant
Hyaline membrane dz
-caused by deficiency of surfactant
(air bronchograms, diffuse b/l atelectasis causing ground glass appearance)
Tx of Hyaline membrane dz
-Tx: synchronized intermittent mandatory ventilation; exogenous surfactants as prophylaxis or as rescue
