Exam 2 Clinical Flashcards
Pneumonia sputum types and bug causing it
rust colored- strep pneumo
currant jelly-klebsiella
scant,watery-mycoplasma
foul smelling-anaerobic
CXR and findings/bug causing it
lobar-bacterial diffuse-viral/legionella/pneumocystis interstitial-mycoplasma multiple nodules-staph aureus cavitation-staph aureus
Abnormal labs with legionnaires disease
hyponatremia
hypophosphatemia
Mycoplasma pneumo demographic
college students
Nosocomial acquired pneumonia definition
after 48hrs of being admitted
Risks for acquiring pseudomonas pneumonia
structural lung disease
steroids
recent broad spectrum antibiotics
Use of pneumovax
over 65 y/o
2-64 y/o with chronic illness
Use of influenza vaccine
over 50 y/o
6mo-64 yrs with chronic illness
pregnancy with flu season
Pattern of idiopathic pulmonary fibrosis damage
usual interstitial pneumonia
Sx of idiopathic pulmonary fibrosis
progressive respiratory failure (3-8yrs)
velco rales
paroxysmal cough
CXR with idiopathic pulmonary fibrosis
honeycombing
infiltrates at base of the lung
Cause of desquamative interstitial pneumonitis
inhaled stimulants
dense macrophages in airspace
Demographics for sarcoidosis
blacks
females
Abnormal labs with sarcoidosis
hypercalcemia
increased ACE levels in serum
Tx for sarcoidosis
corticosteroids
Cause of hypersensitivity pneumonitis
repeated exposure to organic dust
Cause of increased TB since the 1980’s
AIDS
Tuberculin skin test
type IV hypersenitivity
48-72hrs
TST positivity and pt
> 5mm for AIDS/immunosuppressed/abn CXR
10mm for healthcare/under 4 yrs/foreign born or increased risk (silicosis/DM/cancer)
15mm for healthy people
Dx of TB
culture is gold standard (7wks)
interferon-gamma for latent TB (BCG does not effect)
1st line tx for TB
RIPE(S) Rifampin Isoniazid Pyrazinamide Ethambutol Streptomycin
Immune reconstitution inflammatory syndrome
AIDS pt with TB
antivirals reactivate immune system
causes pt to have sx of illness
Abnormal labs seen in miliary TB
pancytopenia
hyponatremia
Selecting tidal volume for a pt
6-8cc of air/kg
What is SIMV in regards to ventilation?
synchronous intermittent mechanical ventilation
used for weaning pts off the ventilator
is uncomfortable for pt
Best way to wean pt off ventilator
pressure support
helps pt open alveoli during initial inspiration
What is automatic flow on ventilators?
computer continually finds most optimal tidal volume pattern for pt
Problems arising from ventilators
overdistention of lung (birds beak on flow/volume) flow starvation (decreased airway pressure) ineffective triggering (wasted efforts)
Use of peak end expiratory pressure and possible problem with it
Keep alveoli open at end of expiration
air trapping/increased FRC
Drug used for rapid awakening
propofol
Drugs used for acute agitation
lorazepam/diazepam
Adverse effects of propofol
lactic acidosis
renal failure
decicated line needed
pancreatitis (monitor TG’s)
Lung adenocarcinoma location/risk
peripheral location
metastasizes to brain
most common type
Lung SSC location/lab finding
central location
hypercalcemia
Small cell lung carcinoma location/findings
central location
SIADH
Eaton-Lambert syndrome
Bronchalveolar cell carcinoma
lepidic growth (along alveoli) peripheral location
Limitations of CT/PET scans for cancer of the lung
must be over 1cm
false (-) with diabetics
false (+) with infection
Management of nodules under 8mm in lung for low risk pts
under 4mm-no follow up
4-6mm-follow up CT in 1 yr
6-8mm-follow up CT 6-12mo and 18-24mo
over 8mm-CT at 3,9 and 24 mo, bx
Management of nodules under 8mm in lung for high risk pts
under 4mm-CT in 12 mo
4-6mm-CT 6-12mo, then 18-24 mo
6-8mm-CT 3-6mo, then 9-12, then 24mo
over 8mm-CT 3,9,24mo, bx
Findings with cystic fibrosis
decreased FEV1/FEV ratio
Best tx for cystic fibrosis
tobramycin (pseudomonas) human DNase (decrease mucus thickness) hypertonic saline (increase hydration)
Worst bug for cystic fibrosis
Burkholderia cepacia
cannot get rid of once acquired
low survival
Goal antibiotic use in CF
eradicate pseudomonas early
Contraindication for lung transplant with CF
Burkholderia cepacia infection
What can cause false readings on pulse oximetry?
carboxyhemoglobin
methemoglobin
Measurement of oropharyngeal airway
center of mouth to angle of mandible
Measurement of nasopharyngeal airway
nostril to pts ear lobe
Bag valve mask ventilation flow/timeframe
oxygen flow at 12L/min
ventilation every 5 seconds
Rapid sequence induction
for pts with intact gag reflex
lidocaine pretx
succinylcholine + versed (or etomidate if hypotensive)
Endotracheal size/depth for peds
age/4 + 4mm
depth is 3x size in cm
Surgical airway procedure
not for children under 12 y/o
piece the cricothyroid cartilage
Endotracheal intubation in peds requirement
only use Miller blade
Tension pneumothorax tx
decompression: 2nd midclavicular intercostal space
chest tube in 4/5th mixaxillary intercostal space
Tx for open pneumothorax
airtight dressing taped on 3 sides (flutter valve)
Sx seen with cardiac tamponade
Kussmaul’s sign
pulsus paradoxus
Beck’s Triad
Tx for cardica tamponade
pericardiocentesis
1-2cm inf xiphoid on L at 45 degree angle toward scapula
Common site for aortic disruption
ligamentum arteriosus
Cause of transudate in pleura space
cardiac/renal/liver problems
What needs to be done on all fluid analysis?
cell count/differential
culture
chemistry
cytology
Crackles in the lung
from opening of alveoli
inspiration
Rhonchi in the lung
excess secretions in large airways
inspiration and expiration
Wheezes in the lung
from narrowing of small airways
musical/high pitched
expiration mostly
Pleural friction rub in the lung
harsh/scratching sound
inspiration and expiration
Stridor in the lungs
stenosis of the large airways
high pitched
inspiration only
