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Internal Medicine > Chest Medicine > Flashcards

Chest Medicine Flashcards

1
Q

Triad of Lofgren Syndrome

A

Sarcodosis with fever

Migratory joint pain

Erythema nodosum

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2
Q

Important information for Sarcodosis

A

Pts with incidental b/l hilar lymph nodes without symptoms are monitored without biopsy unless symptoms develop

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3
Q

Name the cardiac condition occur due to Sarcodosis

A

AV blocks

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4
Q

What will be elevated in BAL of Sarcodosis?

A

CD4/CD8 ratio

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5
Q

Name the condition in which fremitus is increased

A

Condition/s which causes “Consolidation”

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6
Q

Important information

A

Only consolidation causing conditions will have increased breath sound (Bronchial Breath sound)

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7
Q

Important information

A

Cough lasting more than 5 days following URTI is characteristic of Acute Bronchitis

Usually due to Viral cause

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8
Q

What factors would alter PaO2 level?

A

FiO2

And PEEP

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9
Q

What factors would alter PaCO2 level?

A

RR
And Tidal volume

PaCO2 measure of ventilation

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10
Q

Name the gradient which determines the cause of Hypoxemia

A

A-a gradient

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11
Q

Name the condition in which supplemental Oxygen would not recorrect the condition

A

Shunt (must check the table page number 11)

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12
Q

Risk factors for Obs sleep Apnea

A

Obesity
Small mandible

Increase Soft tissues
Tonsillar hypertrophy

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13
Q

Diagnostic criteria for Obs sleep apnea

A

> /=15 obstructive respiratory events (apnea or hypopnea) per hour is diagnostic

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14
Q

What are the causes of Central sleep apnea?

Remember 3Cs

A

CNS toxicity viz opioid
Congestive heart failure
Cheyne Stokes respiration

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15
Q

What changes occur due to OSA and Obesity hypo ventilation syndrome?

A

Compensatory metabolic alkalosis
Pulmonary and systematic HTN

Cor pulmonale

Secondary erythrocytosis
Arrhythmia

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16
Q

What is the first line t/m for Obesity hypo ventilation syndrome?

A

Nocturnal positive pressure ventilation

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17
Q

What is the feature which help in distinguish pulmonary embolism occur before death or after death in post Mortem cases?

A

Lines of Zahn formed before death

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18
Q

Triad of Pulmonary embolism due to fat?

A

Trauma of long bones viz femur

Hypoxemia with petechial rash

Neurological SxS

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19
Q

Plus one point in modified Well’s criteria

A

Cancer

Hemoptysis

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20
Q

Plus 1.5 points in modified Well’s criteria

A

HR>100

Previous PE or DVT

Recent surgery Or Immobilisation

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21
Q

Plus 3 point in modified Well’s criteria

A

Clinical Signs of DVT

Alternate dx less likely PE

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22
Q

Patient with PE has contraindications for Anticoagulation would be t/m via;

A

IVC filter

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23
Q

What acid base balance occur in pulmonary embolism?

A

Respiratory alkalosis

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24
Q

Name the obstructive lung disease in which FEV1/FVC is less than normal but FEV1 is increased?

A

Asthma

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25
Q

Triad of Aspirin induced asthma

A

Chronic sinusitis

Nasal polyp

Asthma SxS

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26
Q

What is Charcot Leyden crystal in asthma?

A

Eosinophilic Hexagonal double pointed crystal formed from breakdown of eosinophil in sputum

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27
Q

What is curschmann spirals in asthma?

A

Shed epithelium forms whorled mucous plugs

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28
Q

Describe mild Intermittent asthma?

A

SxS less than 2 days/wk with night time awakening less than 2 times per month and less than 2 times/wk use of Beta agonist

No limitations of activities
Normal spirometry

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29
Q

How to t/m mild intermittent asthma

A

Only short acting beta agonist

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30
Q

Describe mild persistent asthma?

A

SxS more than 2 days/wk but less than daily with night time awakening 3 to 4 times/month

Normal spirometry
Mild limitation of activities

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31
Q

How to t/m mild persistent asthma?

A

Short acting beta agonist with use of low dose inhaled steroid as controller med

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32
Q

Describe moderate persistent asthma?

A

SxS daily with night time awakening weekly and FEV1 60-80% predicted

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33
Q

How to t/m moderate persistent asthma?

A

Short acting beta agonist with low dose steroid inhaler

Long acting beta agonist inhaler

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34
Q

Describe severe persistent asthma?

A

SxS throughout day with frequent nighttime awakening and FEV1 <60% predicted

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35
Q

T/m of severe persistent asthma?

A

Short acting beta agonist with high dose inhaler steroid

And long acting beta 2 inhaler

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36
Q

How to dx asthma if patient has only nocturnal SxS?

A

Nocturnal or early morning peak expiratory flow rates measurement

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37
Q

How to t/m mild to moderate asthma exacerbation?

A

Oxygen and SABA

If no response then used systemic steroid

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38
Q

How to t/m severe asthma exacerbation?

A

Initial SABA with NEBS and systematic steroid

No improvement after one hour use MgSO4
SxS of Respiratory failure; admit in ICU and ETT

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39
Q

Important information for asthma

A

Asthma + acidosis + with CO2 = Respiratory failure admit the patient in ICU

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40
Q

Important information

A

COPD—mainly treated by long-acting anti-cholinergic inhalers

And asthma—mainly treated by long-term steroid inhalers

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41
Q

CXR findings of chronic bronchitis

A

prominent bronchovascular markings,

mildly flattened diaphragm

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42
Q

CXR findings of Emphysema

A

hyperinflated chest,

↓ vascular markings

And Increased AP diameter

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43
Q

What is Reid index in chronic bronchitis?

A

Thickness of mucosal gland layer to thickness of wall b/w Of Epithelium and cartilage

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44
Q

Indications for Long term Oxygen Therapy in COPD if patient have significant chronic hypoxemia

A
  • Resting PaO2 less than 55 mmhg Or SaO2 less than 88% on room air
  • PaO2 less than 59mmHg Or SaO2 less than 89% in patients with cor pulmonale, RH failure or Hematocrit>55%
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45
Q

Name the drug which is given Chronic COPD as a maintenance therapy

A

Roflumilast—phosphodiesterase inhibitor

Also long acting beta agonist

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46
Q

Triad of Acute Exacerbation of COPD

A

Increase SOB
Increase cough
Sputum production

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47
Q

Test to dx Acute Exacerbation of COPD

A

CXR shows Hyperinflation

ABG report shows Hypoxia with CO2 retention

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48
Q

Initial management of Acute Exacerbation of COPD

A

Oxygen and Inhaled bronchodilator
Systematic Steroids
AbX if more than 2 cardinal Symptoms

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49
Q

Name the bacteria would cause infection in Acute Exacerbation of COPD.

A

S. pneumonia,

Moraxella cattarhalis,

H. influenza

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50
Q

Important information

A

No role of Inhaled Steroids in Acute Exacerbation of COPD

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51
Q

Important information

A

COPD is associated with formation of blebs, which can rupture and cause spontaneous pneumothorax

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52
Q

What is the preferred method of ventilatory support in pts with acute exacerbation of COPD?

A

NPPV

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53
Q

Triad of Bronchiectasis
Cough with purulent sputum production
Digital clubbing
Hemoptysis with positive hx of URTI

A

Cough with purulent sputum production

Digital clubbing

Hemoptysis with positive hx of URTI

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54
Q

What are CXR and HRCT finding of Bronchiectasis?

A

• HRCT—-> bronchial wall thickening with dilation

• CXR—> linear atelectasis with IRREGULAR peripheral opacities
And dilated thickened airway

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55
Q 
What are the causes of Bronchiectasis?
Remember RICH (H = A)
A

Rheumatic disease like RA ; Sjogren

I Immunodeficiency like low immunoglobulin Or Inhalation of toxin

Chronic or prior Infection like TB or Aspergillus Or cystic fibrosis

A airway obs (cancer)

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56
Q

HRCT findings Of Interstitial Lung disease

A

Fibrosis
Honey combing
Traction Bronchiectasis

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57
Q

Name the drugs causing Restrictive lung diseases

A

Bleomycin
Busulfan
Amiodarone
Methotrexate

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58
Q

Sources of Asbestosis

A

Shipyard
Mining

Construction workers
Pipe fitters

Carpenter
Insulation workers

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59
Q

Pathognomonic imaging finding of Asbestosis

A

Pleural plaques

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60
Q

HRCT findings of Asbestosis

A

subpleural linear densities

and parenchymal fibrosis

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61
Q

Important information of Asbestosis

A

Asbestos (Ferruginous) bodies are golden brown fusiform rods resembling “Dumbbells”

Found in alveolar sputum sample visualise via Prussian Blue stain

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62
Q

Sources for silicosis

A

Mines
Sandblasting
Foundries

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63
Q

CXR findings of silicosis

A

Eggshell calcification of hilar lymph nodes

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64
Q

Important information of Silicosis

A

Silica disrupts phagolysosome and impair macrophages increases the susceptibility of getting TB

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65
Q

Sources for berylliosis

A

Aerospace

Manufacturing industries

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66
Q

Why berylliosis responds to steroid?

A

B/c of formation of non caseating granuloma

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67
Q

Important information for mesothelioma

A

U/L pleural abnormality typically
Hemorrhagic exudative pleural effusion
Psammoma bodies seen on histology

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68
Q

Tumor marker positive in mesothelioma

A

Calretinin

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69
Q

Name the condition/s in which there is normal spirometry but DLCO is increased

A

Pulmonary Hemorrhage

Polycythemia

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70
Q

Name the condition/s in which there is normal spirometry but DLCO is low

A

Anemia
Pul HTN
Pulmonary embolism

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71
Q

Name the condition in which there is restrictive pattern on spirometry but DLCO is increased

A

Morbid obesity

72
Q

Name the condition in which there is restrictive pattern on spirometry but DLCO is normal

A

Musculoskeletal deformity

Neuromuscular disorders

73
Q

Name the condition in which there is restrictive pattern on spirometry but DLCO is
Low

A

All restrictive pulmonary Diseases

Heart failure

74
Q

Name the condition in which there is obstructive pattern on spirometry but DLCO is increased

A

Asthma

75
Q

Name the condition in which there is obstructive pattern on spirometry but DLCO is low

A

Emphysema

76
Q

Name the condition in which there is obstructive pattern on spirometry but DLCO is normal

A

Chronic bronchitis

Asthma

77
Q

What does mean normal DLCO?

A

Intact pulmonary capillaries and alveolar structures

78
Q

Normal pulmonary arterial pressure

A

10-14mmhg

79
Q

Value in pulmonary HTN

A

More than 25mmhg at rest and more than 30mmhg at exertion

80
Q

Name the gene which mutated resulting in Pulmonary arterial HTN

A

BMPR2 GENE which normal inhibits vascular smooth muscle proliferation

81
Q

Name the parasite which can cause Pul aterial HTN

A

Schistosomiasis

82
Q

Chest X ray findings of Pulmonary arterial HTN

Clear lung fields

A

Enlargement of pulmonary arteries with rapid tapering of distal vessels (pruning)
Enlarged right ventricle

83
Q

How chronic thromboembolic cause Pul HTN?

A

Recurrent microthrombi–> decreases cross sectional area of pulmonary vascular beds

84
Q

MCC of Cor pulmonale

A

COPD

85
Q

Gold standard test to dx Cor pulmonale

A

Right heart Catheterization
Which shows Right heart catheterization shows:
↑ CVP,
right ventricular end diastolic pressure and mean pulmonary artery pressure >25mmHg without left heart disease

86
Q

Chest X rays findings of Cor pulmonale

A

central pulmonary artery enlargement and loss of retrosternal airspace due to right ventricular enlargement

87
Q

Important information

A

Both COPD and cor pulmonale have distant heart sounds buy former is chronic and latter is acute

COPD have hyperinflated lungs that’s why distant heart sounds

88
Q

Important information for pleural effusion

A

Before doing thoracocentesis, check if patient has heart failure or not

89
Q

What to do it cytology of pleural effusion is unclear and there is lung mass?
Bronchoscopy

A

Bronchoscopy

90
Q

Normal pH of pleural fluid

A

7.60

91
Q

pH of pleural fluid in transudative pleural effusion

A

7.45-7.55

92
Q

pH of pleural fluid in Exudative pleural effusion

A

7.30-7.45
to excessive acid production by pleural fluid cells and bacteria (eg empyema) or decreased hydrogen ion efflux from pleural space (e.g. pleuritis, pleural fibrosis, tumor)

93
Q

Causes of Exudative pleural effusion if amylase found in pleural fluid

A

Pancreatitis and Esophagus rupture

94
Q

What is the cause if glucose is less than 30mg/DL in pleural fluid?
Empyema

A

Empyema

95
Q

Important information for pleural fluid

A

In CHF—can meet exudative criteria in 25% cases if pt has received excessive diuretic therapy prior to thoracocentesis. Mostly B/L (61%), can be U/L on right side in 27% cases and on left side in 12% cases

96
Q

CURB 65 score is zero what is it indicate?

A

Low mortality

T/m As outpatient

97
Q

CURB 65 score is 1-2 what is it indicate?

A

Intermediate mortality

Likely t/m as inpatient

98
Q

CURB 65 score is 3-4 what is it indicate?

A

High mortality
Urgent inpatient admission
Possible ICU if score more than 4

99
Q

Outpatient t/m of CAP in healthy patient

A

Macrolide Or Doxycycline

100
Q

Outpatient t/m of CAP in patients who have co morbids

A

Quinolones

Or Beta lactam plus macrolide

101
Q

Non ICU inpatient t/m of CAP

A

Quinolones

Or Beta lactam plus macrolide

102
Q

ICU patient t/m of CAP

A

Quinolones plus Beta lactam

Or Beta lactam plus macrolide

103
Q

Triad of Uncomplicated parapneumonic effusion

Occur due to increased flow of STERILE exudates into pleural space

A

Pleural fluid gram stain and culture comes negative

Pleural fluid analysis (((shows pH>7.20
LDH ratio>0.6 Or LDH <1000u/L
glucose >60mg/dl
WBC <50k)))

T/m is Abx

104
Q

Triad of Complicated parapneumonic effusion

(Occur due to inflammation with pleural membrane disruption and contiguous bacterial spread from the pneumonia into the pleural space)

A

Pleural fluid gram stain and culture comes negative

Pleural fluid analysis ((shows pH<7.20
LDH ratio>0.6 Or LDH >1000u/L
Glucose <60mg/dl
WBC >50k)))

T/m is Abx and usually require chest tube drainage

105
Q

Triad of Empyema

A

Pleural fluid gram stain and culture come positive

Pleural fluid analysis shows pH<7.20/ LDH ratio>0.6 / glucose low

T/m is Abx and chest tube drainage

106
Q

Important information

A

Drug induced lupus cause Exudative effusion

With pH <7.2 and glucose<60mg/dl

107
Q

Important information

A

Pulmonary embolism causes both exudative and transudative pleural effusion

Bloody pleural effusion but doesn’t cause low pH Or Glucose

108
Q

What are the causes of Recurrent pneumonia involved d/f region of lungs?

A 
Sinopulmonary disease (cystic fibrosis / Immotile cila)
Immunodeficiency 
Non infectious ( vasculitis/ cryptogenic pneumonia)
109
Q

What are the causes of recurrent pneumonia involved same region of lungs?

A

Recurrent aspirations (fits/ alcohol / GERD / Achalasia/ dysphagia)

Local Anatomic Obs viz bronchial compression Or Intrinsic bronchial Obs

110
Q

Difference b/w Aspiration pneumonia and aspiration pneumonitis

A

Pneumonia due to aspiration of oral cavity anaerobes

Pneumonitis due to aspiration of gastric contents with subsequent acid injury

111
Q

Triad of Aspiration pneumonia

A

Present days after aspiration event

SxS are fever, cough, increases sputum and can progress to abscess

T/m Augmentin Or Clindamycin

112
Q

Triad of Aspiration pneumonitis

A

Present hours after aspiration events

Range from No SxS to non productive cough and respiratory distress

Supportive t/m with no Abx

113
Q

How to define Solitary lung nodule?

A

Round in opacity with less than 3cm and completely surrounded by pulmonary parenchyma

With associated lymphadenopathy, pleural effusion Or atelectasis

114
Q

What to do if patient has solitary lung nodule on CXR and previous CXR doesn’t show any change in nodule?

A

No further testing

115
Q

What to do if patient has solitary lung nodule on CXR and previous CXR (not taken) or shows changes?

A

Do CT scan chest
If shows benign changes just do serial CT

If shows highly suspicious for malignancy do surgical excision

116
Q

What to do if patient has solitary lung nodule on CXR and previous CXR (not taken) or shows changes?

A

Do CT scan chest

If shows intermediate or Suspicious for malignancy then investigate with biopsy Or PET

117
Q

Important information for lung nodule suspicious for malignancy

A

Percutaneous biopsy preferred than bronchoscopy

Do bronchoscopy if lesion is more than 2cm

118
Q

What to do if the size of lung nodule is ≥8mm?

A

If FDG-PET Or biopsy shows;
- Suspicious of malignancy do surgical excision

  • not Suspicious of malignancy do surgical excision » do serial CT scan » if CT shows growth then do surgical excision
119
Q

What to do if the size of lung nodule is ≤8mm?

A

If size is b/w 5-7mm » do serial CT scan » shows growth then do surgical excision

If size is ≤4mm » No risk of malignancy » no follow up OR intermediate risk of malignancy » do serial CT scan » if CT shows growth then do surgical excision

120
Q

What are the Risk factors for high malignancy risk for solitary lung nodule?

A

If nodule size >2cm with corona radiata or spiculate margins
60 years old
Smoker Or cessation of smoking less than 5 yrs

121
Q

What are the Risk factors for low malignancy risk for solitary lung nodule?

A

If nodule size <0.8cm with smooth margins
40 years old
Never smoke Or cessation of smoking more than 15 yrs

122
Q

What are the risk factors for intermediate malignancy risk for solitary lung nodule?

A

If nodule size b/w 0.8-2 with smooth scalloped margins
40-60 years old
Smoker Or cessation of smoking b/w 5-15yrs

123
Q

Test to screen lung cancer

A

Low dose CT chest

124
Q

Recommended age to screen lung cancer

A

55-80

125
Q

To whom to screen for lung cancer on the basis on smoking?

A

Patient has ≥30yr pack year Hx of smoking
Or
Currently smoking Or quit smoking within the last 15 years

126
Q

At what age screening of lung cancer is terminated?

A

Age more than 80 yrs

127
Q

Indications to terminate screening of lung cancer

A

Quit smoking ≥15 yrs

Or

Co morbid which limit life expectancy Or ability/willing to undergo for surgery

128
Q

Important information

.

A

COPD (causing hypoxemia) alone in the absence of occult malignancy DOES NOT cause clubbing.

COPD + clubbing search for occult malignancy

129
Q

Most common causes of digital clubbing

shunt

A

lung malignancies
cystic fibrosis
and right to left cardiac shunt

130
Q

Traid of Pancoast tumor

A

Shoulder pain

Horner syndrome SxS

Sensorimotor SxS due to compression of brachial plexus C8-T2

131
Q

How Horner syndrome occurs due to Pancoast tumor?

A

Due to involvement of Paravertebral Sympathetic chain and inferior cervical ganglion

132
Q

Important information regarding Pancoast tumor

A

Pt can also develop ↑ sympathetic activity ↑ flushing and sweating on contralateral side of face during exercise (Harlequin sign)

133
Q

Why hoarseness occurs in Pancoast Tumor?

A

Due to Involvement of Recurrent larnygeal nerve

134
Q

Causes of Lung abscess

A

Aspiration of Oropharyngeal contents

Bronchial Obstruction

135
Q

What will be seen on CXR of lung abscess?

A

Air fluid level which might suggest cavitation

136
Q

Name the bacteria which would cause Pancoast Tumor

A

Anaerobes (bacteroides, Fusobacterium, Peptostreptococcus)

S aureus

137
Q

Triad of pulmonary aspergillosis

A

Fever
Hemoptysis
Pleuritic chest pain

138
Q

Imaging findings of lungs in Aspergillosis

A

Single Or Multiple nodules
Cavities
Consolidation
Peribronchial Infiltrates

139
Q

How to t/m invasive aspergillosis?

A

Caspofungin Or

Voriconazole

140
Q

What is the T/m of Aspergilloma?

A

Surgical resection

141
Q

Risk factors for invasive Aspergillosis

A

Immunocompromised due to;
Low neutrophil
HIV
Steroids

142
Q

Risk factors for pulmonary aspergillosis

A

Pre existing lung Diseases like tb Or Lung damage

143
Q

DDx of masses in Anterior mediastinum

Remember 4Ts

A 
T = Thymoma 
T = Thyroid
T = Teratogenic
T = Terrible lymphomas
144
Q

DDx of masses in Posterior mediastinum

A

Neurogenic tumor like neurofibroma

Multiple myeloma

145
Q

DDx of masses in middle mediastinum

A

Esophageal Carcinoma
Hiatal hernia
Bronchogenic cysts
Mets

146
Q

Name the organism could cause chronic mediastinitis

A

Histoplasma capsulatum

147
Q

Causes of Mediastinitis

A

Post operative Cardio thoracic procedures
Esophageal perforation
Contiguous spread of Retropharyngeal infection Or odontogenic infection

148
Q

What is Hamman signs?

A

Crepitus on cardiac auscultation

149
Q

How Pulmonary arterial HTN occur in ARDS?

A

Low O2 leads to hypoxic vasoconstriction

Destruction of lung parenchyma

Compression of vessels due to Positive airway pressure

150
Q

Name the medicine which are contraindicated in Pul-Embolism if patient has deranged Renal function test

A

LMWH like enox

Factor Xa direct inhibitor “xaban”

Fondaparinux

151
Q

Name the 3 famous cause of Chronic cough

A

Chronic cough

Upper airway cough syndrome
GERD

Asthma

152
Q

Triad of Non allergic rhinitis (Vasomotor rhinitis)

A

Erythematous nasal mucosa

Late onset after 20 yrs of age

Nasal congestion with rhinorrhea and postnasal drainage

153
Q

How to manage Non allergic rhinitis?

A

Mild—> Intranasal antihistamine or steroid

Moderate to severe—> combination therapy

154
Q

Triad of Allergic rhinitis

A

Pale / bluish nasal mucosa

Positive allergic disorder

Sneezing with water rhinorrhea and eye sxs

155
Q

How to t/m allergic rhinitis?

A

Intranasal steroid

Antihistamine

156
Q

Important point of Acute Exacerbation of COPD

A

There is no role of Inhaled steroid (use Oral or IV)

157
Q

What are the cardinal sxs of Acute Exacerbation of COPD?

A

Increase SOB

Increase cough frequency or severity

Increase sputum production

158
Q

How to manage Acute Exacerbation of COPD?

A

IV bronchodilator with systematic Steroid (IV or Oral)

Supplemental O2

Give Abx if more than 2 cardinal Sxs
If fail—>Give NIV–>FAIL —-> tracheal intubation

159
Q

Important point of GRANULOMATOSIS WITH POLYANGIITIS

A

narrowing and ulceration of trachea involved

160
Q

What to do if patient has positive screening test of TB?

A

Get CXR and decide Latent Vs active Tb

161
Q

What does mean by latent TB?

A

Positive screening test with negative CXR and asymptomatic Patient

162
Q

Triad of Lung Abscess

A

Fever with night sweats and Wt loss

Putrid sputum in cough

Cavitary imaging with air fluid levels on imaging

163
Q

How to treat lung abscess?

A

Mero / sulbactum / Imipenem

Alternative—-> Clindamycin
No use of culture as condition cause by multiple bacteria

164
Q

Important point of Pulmonary embolism

A

Increase minute ventilation due to increase RR

165
Q

Important point of Obesity hypoventilation syndrome (Obesity related restrictive pattern)

A

There will be Restrictive pattern in PFT

Vital capacity and tidal volume Decrease result decrease Minute ventilation

166
Q

How extra-pulmo restrictive lung disease affect pft?

A

Due to dimished chest wall and spinal mobility there will be mild reduced VC and TLC but FEV1/FVC normal

Whereas in Pulmo-restrictive lung disease, reduce volume and capacity just increase in FEV1/FVC ratio

167
Q

How to Approach proximal DVT treatment along with pulmonary embolism with unstable vitals OR Massive proximal DVT with severe swelling or limb threatening ischemia?

A

Give Thrombolytics if no CI

If contraindications or no response—>mechanical or surgical thrombectomy OR iliac stenting

168
Q

How to Approach proximal DVT treatment WITHOUT pulmonary embolism with unstable vitals OR Massive proximal DVT with severe swelling or limb threatening ischemia?

A

Give anticoagulant If no CI

If CI or no response—-> IVC filter

169
Q

Triad of Pul fat embolism

A

Petechiae

Pulmonary Infiltrates with hypoxia

Alter mentation

170
Q

What patient are at risk for lung abscess and how to dx it?

A

Fits or dysphagia or substance abuse –> chance of aspiration

X-ray chest shows —> Cavitary Infiltrates with air fluid level
Culture rarely useful

171
Q

How patient with lung abscess present?

A

Subacute Fever with night sweat
Wt loss

Cough with putrid sputum

172
Q

How to treat lung abscess?

A

Augmentin or Imipenem or Meropenem

Alternative—> Clindamycin

173
Q

How to manage suspected Or confirmed flu Infection?

A

1) If w/o risk Factor for it complications—>no testing and symptomatic tx
2) If with risk Factor ( like age ≥65 yrs, Comorbids, pregnancy) or those without riskf factor reach hospital within 48 hrs —> Osetlamivir

174
Q

How Decrease in Interpleural pressure leads to transudative effusions?

Decreases inter pleural pressure seen in atelectasis

A

Reduced peri vascular pressure pull fluid across the vascular membrane into the pleural space

175
Q

What Parameters are required to extubate patient from vent (or undergo spontaneous breathing trial)?

Use Rapid shallow breathing index (also use for spontaneous breathing trial)

A

pH>7.25

PO2>60mmHg on minimal support like fiO2 and PEEP less than (40 and 5) respectively

Intact Respiratory effort and sufficient mental alertness to protect the airway

176
Q

How Lemierre Syndrome present?

Cause is fusobacterium Necrophorum

A

Oropharyngeal sxs sore throat, dysphagia, fever or neck pain and swelling
(due non exudative tonsillitis or pharyngitis)

Follow by involvement of neurovascular structures like internal jugular vein thrombosis—>septic emboli form which particularly involved lungs

177
Q

How to dx and t/m Lemierre Syndrome?

A

Culture of Blood or pus

Tx:
IV Abx with airway secured
Surgery incase of refractory to Abx

Internal Medicine (14 decks)

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