8 Pulmo Patalim Pearls

Question 1

TRUE or FALSE
angioedema is an immediately-life threatening condition to rule out in dyspnea

Answer 1

TRUE
it may cause upper airway obstruction

Question 2

In influenza, testing should be performed in

Answer 2

hospitalized patients
pregnant women
patients at higher risk of complications

Question 3

persons at higher risk for compolications of influenza infection

Answer 3

children <5y
adults ≥65y
persons with chronic conditions
persons with immunosuppresion
women who are pregnant or postpartum (within 2 weeks of delivery)
persons <18y receiving long-term aspirin therapy
rsidents of nursing homes and other chronic care facilities
persons who are morbidly obese (bmi ≥40kg/m2)

Question 4

these organisms cause consolidation of dependent portion of lung

Answer 4

anaerobic organisms
- can also cause abscess formation

Question 5

initial treatment for mild-to-moderate asthma

Answer 5

oxygen to achieve SpO2 ≥90%
inhaled SABA by nebulizer or MDI + valved holding chamber, up to 3 doses in first hour
oraly systemic corticosteroids if no immediate response or if patient recently took oral systemic corticosteroids

Question 6

initial traetmentfor severe asthma

Answer 6

oxygen to acheive SpO2 ≥90%
high-dose inhaled SABA by MDI plus ipratropium by nebulization every 20 minutes or continuous for 1 hour
oral systemic corticosteroids

Question 7

initial treatment for life-threatening asthma

Answer 7

Intubation and mechanical ventilation with 100% oxygen
nebulized SABA and ipratropium
IV corticosteoids

Question 8

physical findings of COPD

Answer 8

tachypnea
accessory respiratory muscle use
pursed-lip exhalation

Question 9

goals in COPD

Answer 9

paO2 ≥60 mm Hg
SpO2 ≥90 mm Hg

Question 10

criteria for long-term O2 therapy in COPD

Answer 10

PaO2 ≤55 mmHg
SpO2 ≤88%
PaO2 bet 56 and 59 when pulmonary hypertension, or cor pulmonale (sustained right ventricular failure) or polycythemia is present

Question 11

Diagnosis of pneumonia is unlikely if there’s absence of

Answer 11

Fever
Tachycardia
Tachypnea
Hypoxia
Abnoramalities in chest auscultation

Question 12

Treatment of pertussis

Answer 12

Azithromycin 500 mg PO on D1, then 250 mg PO on D2-5
tx is best started early in the first week. after that, antibiotic treatment does not alter the duration of cough
no antitussive agent has been shown to be clearly effective in reducing the symptoms of the spasmodic (whooping) cough

trimetoprim sulf 160-800 mg 2x/day for 14 days