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year 2 > Gen Med- Respiratory problems > Flashcards

Gen Med- Respiratory problems Flashcards

1
Q

Common Cold

A
  • Rhinovirus (2% complicated by bacterial infection
  • Symptoms not localized
  • treat symptoms (stuffy head, tender sinuses, clear purulence)

-NO ABX unless complicated by bacterial infection

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2
Q

Influenza

A
  • Viral
  • more prominent constitutional symptoms
  • -Fever, malaise, myalgias
  • -seasonal
  • Rapid test available; nasopharyngeal swab

First 2 days → treat w/ Oseltamvir (2x day 5 days)
Prophylaxis → Oseltamvir & Flu shot (1x day 6 days)

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3
Q

Acute Pharyngitis

A
  • usually Viral
  • 15% due to Strep Pyogenes
  • -exudate w/ fever and ANTERIOR cervical adenopathy
  • -strep screen test

–Tx: Penicillin or Erythromycin

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4
Q

Mononucleosis

A
  • Viral (EBV)
  • POSTERIOR cervical adenopathy
  • dull white exudate
  • Monospot test, ATL on CBC
  • RASH if given Amoxicillin
  • Tx w/ steroids
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5
Q

Acute Sinusitis

A
  • usually caused by sinus ostial (opening) obstruction
  • usually viral or bacterial
  • <4 weeks
  • -(Strep. pneumonia, H. influenza, M. Catarrhalis)
  • can be noninfectious (allergies, polyps, irritants, tumor)

Narrow Spectrum:
-Amoxicillin or TMP/SMX

7+ days and purulence
-Ampicillin / Sulbactam, Oxyquinolone

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6
Q

Chronic Sinusitis

A

-results from sinus ostial obstruction
>12 weeks
-usually bacterial or fungal
-Sinus CT scan to see extent

  • Culture guided treatment w/ nasal saline lavage
  • and/or nasal steroids
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7
Q

Otitis externa

A

-P. aeruginosa & occasionally S. Aureus

  • *Ciprofloxacin
  • HC drops, debridement
  • avoid Q tips
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8
Q

Otitis media

A
  • Red TM, post. cervical adenopathy, fever
  • Children t drain well
  • Usually bacterial, following URI
  • *Strep Pneumoniae, H. influenza, M. Catarrhalis
  • *Amoxicillin (1/3 resistant)
  • -treatment debatable
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9
Q

Recurrent otitis media

A

-Red TM, post. cervical adenopathy, fever
>4 in 1 year OR 3 in <6 months

TX:

  • beta-lactams (amoxicillin?)
  • TMP/SMX maintenance
  • Myringotomy tubes
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10
Q

Serous otitis media

A
  • someone who has a cold and then flies
  • almost always self-limited

-Abx and/or myringotomy tubes if significant hearing lost and effusion >3 months

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11
Q

Chronic otitis media

A
  • Recurrent purulent drainage w/ chronic TM perforation

- Mastoidectomy and typanoplasty

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12
Q

Laryngitis

A

nearly always viral

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13
Q

Acute epiglottitis

A
  • H. influenza ?
  • potentially fatal

DX: lateral neck films
-cherry red epiglottis (rhino-larygoscopy)

RX: Ampicillin / sulbactam

  • -hospitalization and IV abx
  • Hib vaccine
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14
Q

Acute Bronchitis

A
  • inflammation of the AIRWAYS
  • usually viral
  • cough w/ sputum production
  • absence of abnormalities on CXR differentiates from Pneumonia

SEVERE Bronchitis:

  • ↑ AMOUNT of sputum
  • change in COLOR of sputum
  • ↑ shortness of breath
  • Abx (esp w/ lung disease i.e. COPD)
  • -Azithromycin or Levofloxacin
  • may need to treat bronchospasm (albuterol, steroids)
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15
Q

Pleurisy

A
  • inflammation of lung SURFACE
  • chest pain; worse w/ INSPIRATION

-usually viral

TX symptomatically- NSAIDs, narcotics if severe

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16
Q

Pneumonia: Previously healthy outpatient (Group 1)

A
  • S. pneumonia, H. influenza
  • Mycoplasma, Chlamydia (atypical pneumonia/walking)
  • Viral (RSV, adenovirus, influenza?)
  • Coccidiodmycosis
  • Uncommon: Legionella, Mycobacterium

-1% mortality

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17
Q

Pneumonia: Outpatient, Older (65+) or w/ cardiopulmonary disease (Group 2)

A
  • S. pneumonia
  • Pseudomonas, Klebsiella sp., E. coli
  • Aspiration pneumonia (anaerobes)

-5% mortality

18
Q

Pneumonia: Hospitalized Patients (Group 3)

A
  • S. pneumonia
  • Pseudomonas, Klebsiella
  • Aspiration pneumonia (anaerobes)
  • *Staph. Aureus

-5-20% mortality

19
Q

Severe Pneumonia- ICU (Group 4)

A
  • S. pneumonia
  • Klebsiella, Pseudomonas (E. coli?)
  • Staph. Aureus *(MRSA)
  • *Legionella
  • *Unusual pathogen (Pneumocystis) in unsuspected HIV

-25-30% mortality

20
Q

Pneumonia in Immuno-Suppressed patient

A
  • Bacterial Pathogen
  • Pseudomonas, Nocardia
  • Fungal: Coccidioidomycosis, Aspergillus
  • Mycobacterial: TB, atypical mycobacteria
  • Viral: CMV
  • Protozoal: Pneumocystis
21
Q

Pneumonia treatment & symptoms: severely ill patient

A 
At risk patients for SEVERE pneumonia: 
-w/ Lung disease (COPD, asthma, ILD)
-*history of alcohol/drug abuse
-*Immunocompromised
(-*Older age & ↑ *risk of aspiration)
* are normal predisposing factors)

-Ceftriaxone w/ Levofloxacin (quinolone)

SIGNS:

  • Hypoxemia (SaO2 < 92%)
  • Hypotension
  • Tachycardia
  • Altered mental status: obtundation or confusion
22
Q

Pneumonia treatment: immuno-suppressed patient

A

-brochoscopy w. lavage to look for atypical pathogens

23
Q

Pneumonia treatment: usual outpatient

A
  • Mild symptoms:
  • -Azithromycin (empiric macrolide)
  • Moderate symptoms
  • -Levofloxacin (quinolone)
  • Severe: Ceftriaxone w/ Levofloxacin
  • Nutrition very important
24
Q

Coccidioidomycosis

A
  • presents as community acquired
  • dust exposure
  • causes cavity in lung
  • sever constitutional symptoms
  • blood test can indicated recent infection
  • Eosinophilia w/ pneumonia
  • Fluconazole
  • Amphotericin B (sever cases)
25
Q

Treatment of Latent TB

A
  • Isoniazid w/ vit. B6 for 9 months (first line drug)
  • -caution w/ liver disease/ alcohol use
  • -impairs B6 absorption
  • Rifampin for 4 months
  • -potentially hepatotoxic

-MONITOR LFT

26
Q

Treatment of Active TB

A 
For 2 months:
-Isoniazide w/ B6
\+Rifampin
\+Pyrazinamide
\+Ethambutol

then Isoniazid & Rifampin for 4 months

-MONITOR LFT

27
Q

3 primary presentation of PE

A

1) Pleuritic pain or hemoptysis
2) Isolated dyspnea
3) Circulatory collapse

-Dyspnea not present in 1/4 of cases

28
Q

Major risk factors of PE

A
  • Recent surgery
  • trauma to LE
  • cancer
  • prior history of DVT or PE
  • -stasis
  • -smoking
  • -coagulopathy
  • -hormone replacement therapy
29
Q

Treatment of PE

A

Initial therapy: Heparin
Long term therapy: Warfarin
–1st episode → 6 months
–2nd episode → lifelong

30
Q

5 mechanism of reduced oxygenation

A

1) V/Q inequality (↓ ventilation or perfusion)
2) Shunt (V/Q = O b/c ventilation = O)

3) Hypoventilation (causes ↑ CO2 which displaces O2)
- -advanced COPD/Asthma, ALS, Parkinsons

4) Diffusion defect: thick alveolus
- -Interstitial lung disease

5) ↓ oxygen in inspired air (FIO2): altitude effect

PaO2 → measures OXYGENATION
paCO2 → measure VENTILATION
–directly proportional

31
Q

Obstructive lung disease PFTs

A

Spirometry:

  • low FEV1/FVC (<0.7)
  • -**asthma shows improvement w/ bronchodilator

Lung Volumes: (TLC)

  • -HIGH in emphysema
  • -Normal / slightly elevated: chronic bronchitis & asthma

Diffusing Capacity: (DLCO)

  • **LOW in emphysema
  • Normal in chronic bronchitis & asthma
32
Q

Restrictive lung disease PFTs

A

Spirometry:
-normal or increased FEV1/FVC

Lung volumes: (TLC)
-DECREASED

Diffusing Capacity: (DLCO)
-usually decreased (IPF)

33
Q

Asthma

A

FEV1/FVC < .70

  • FEV1 **(improves w/ dilator)
  • TLC & DLCO normal

Airway *BRONCHOSPASM & INFLAMMATION

  • Inflammation→ ↑ responsiveness→ *spasm→ symptoms
  • Bronchospasm: triggered & usually worse at night

Symptoms: (worse at night & awakening)

  • episodic shortness of breath
  • wheezing (↓ breath sounds on exam)
  • sensitive to specific triggers
  • signs of sinusitis/rhinitis

Made worse by:
-β-Blockers, Aspirin, IV contrast

Poor control:

  • rescue meds 2x/week
  • nighttime awakening due to breathing 2x/month
34
Q

Asthma treatment

A
  • Mild → avoid triggers
  • Short-acting inhaler as needed
  • Inhaled corticosteroids / long-acting bronchodilator
  • Leukotriene receptor antagonist
  • Anti-IgE therapy, oral steroids
35
Q

COPD drug therapy

A

BRONCHODILATORS

  • Short acting
  • -β2-agonist: Albuterol
  • -Anti-ACh: Ipra-tropium, Oxi-tropium* (not in US)
  • Long acting
  • -β2-agoinist: Salmeterol, Formoterol
  • -Anti-ACh: Tio-tropium
  • -Theophylline (Methylxantine)

ANTI-INFLAMMATORY
-Inhaled steroids: Fluticasone & Budesonide

(Bronchodilators → O2 therapy → Exercise training)

36
Q

Factors Increasing preoperative pulmonary risk

A
  • Obesity (obstructive sleep apnea)
  • Cigarette smoking w/in 8 wks of surgery
  • Productive cough w/in 5 days of surgery
  • Diffuse wheezing w/in 5 days of surgery
  • -current URI
  • FEV1/FV 45 mmHg (↓ ventilation)
  • Age >70yrs
  • poor general health
37
Q

Known Causes off ILD

A

DRUGS

  • chemotherapeutic agents (years later)
  • Amiodarone (cardiac patients)
  • Methotrexate (arthritis patients)
  • Nitrofurantoin (UTI)

DUSTS/OCCUPATIONAL

  • asbestos (construction, military, ships)
  • silica (miners, metal/glass worker, sand-blasting)

HYPERSENSITIVITY:

  • moldy hay, cotton dust, sugar cane (Agriculture)
  • Birds (Animals)
  • moldy humidifier/hot tub (others)
38
Q

ARDS

A

CAUSES:
-Direct lung injury: severe pneumonia, gastric aspiration, smoke inhalation, lung contusion

-Systemic Injury: Shock/Trauma, sepsis, drug OD, pancreatitis, burn injury

↑ permeability of alveoli → fill w/ fluid → collapse → SHUNT (V = O)

Characteristic feature:
-Low oxygen that does NOT respond to supplemental O2. (A-a gradient >200)

Treatment:

  • Endotracheal tube, mask
  • Positive Pressure throughout ventilation
  • Positive end-expiratory pressure:
  • -opens alveoli, ↓ shunt
  • -low lung volumes to prevent over-expansion

Death usually related to infectious complications
-High PEEP may complicate; pneumothorax w/ atelectasis

39
Q

Causes of Hypercapnic Respiratory Failure

A
  • Advanced COPD → respiratory muscles fatigue
  • Sever asthma → Status asthmaticus
  • Neuromuscular disease
  • Hypoventilation → traume, stroke, drug-effect, over sedation
40
Q

Most common sites of Lung cancer & Mesothelioma metastasis

A

LUNG CANCER

  • Bone
  • Brain
  • Liver
  • Adrenal glands

(TB: Brain, bone, kidney)

MESOTHELIOMA

  • lungs
  • breast
  • colon
  • kidney
  • Melanoma

year 2 (15 decks)

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