Integration and Review of Respiratory Medicine (2) Flashcards
Be able to make a chart comparing and contrasting the different types of pneumonia.
All forms of pneumonia present with what?
fever and cough
How would you treat a patient with pneumonia?
symptomatic treatment using appropriate antibiotics
What is pneumonia?
an infection that inflames the air sacs ofW one or both lungs
Is effusion LDH high are low when there is exudative pleural effusion? (Explain)
high
Effusion LDH / Serum LDH >0.6
Is protein effusion high in exudative pleural effusion?
yes
effusion protein/serum protein > 0.5
> 3gm/dl of protein rich fluid
What is a hallmark feature of lung abscess?
round 3D cavity with air-fluid levels
Difference between P. jirovecii and P. carinii?
P. carinii infects rats whereas P. jirovecii infects humans
Clinical Features of Pneumocystis pneumonia to remember.
opportunistic fungal pulmonary pathogen
patient with AIDS presenting with dyspnea on exertion, dry cough, and fever.
CD4 count is low (below 200/μl)
Best diagnostic tool for pneumocystis pneumonia.
sputum stain
Treatment for pneumocystis jirovecii.
Trimethoprim/sulfamethoxazole (TMP/SMX) is the best therapy both for treatment and for prophylaxis. Other drugs-dapsone, pentamidine
What should make you suspicious that individual may have TB?
cough for more than 15 days
How would you diagnose someone with TB?
sputum microscopy, culture, radiology, blood investigations
How would you treat a patient with TB?
INH prophylaxis (TST positive, no disease-LTBI), ATT(REST OTHERS)
PPD testing iw not useful for what population of patients?
those who are symptomatic or those with abnormal chest x-rays. These patients should have sputum acid fast testing done
List type of patients who would be considered as having a positive PPD test if they have an induration larger than 5 mm.
HIV-positive patients
* Glucocorticoid users
* Close contacts of those with active TB
* Abnormal calcifications on chest x-ray
* Organ transplant recipients or other immunosuppressed pts.
List the type of patients who would be considered as having a positive PPD test if their induration is larger than 10 mm.
Recent immigrants from high prevalence countries.
iv drug users,
Healthcare workers
Residents and employees of high-risk congregate settings (e.g., prisons, nursing homes, hospitals, homeless shelters, etc.)
Close contacts of someone with TB
Hematologic malignancy, alcoholics, diabetes mellitus, ESRD,
Children ≤4 yrs age.
Children and adolescents exposed to adults in high-risk categories
List the patients who would have a positive PPD test if induration ins larger than 15 mm.
those with no risk factors
What are some safety concerns related to the treatment of TB by anti-TB meds?
hepatotoxicity
What are the regimens recommended by WHO for the treatment of LTBI?
6-month or 9-month isoniazid daily,
3-month rifapentine plus isoniazid weekly,
3- or 4-month isoniazid plus rifampicin daily,
3– or 4-month rifampicin alone daily
Be able to draw out flow diagram fro the algorithm for diagnosing Pulmonary thromboembolism.
What is the principal imaging test for diagnosis of pulmonary thromboembolism?
CT angiogram
What is becoming an important 2nd line diagnostic test for PE?
Lung scanning (V/Q) area that is ventilated with decreased perfusion (V/Q-infinity)
Be able to create flow diagram on algorithm fro PE management.
What is sleep apnea?
sleep breathing disorder characterized by repeated cessation of breathing during sleep
What are the different types of sleep apnea?
obstructive sleep apnea (OSA)
central sleep apnea (CSA)
What is OSA?
most common form characterized by the relaxation of throat muscles leading to a reduced/cessation of airflow despite a respiratory drive
What is CSA
decreased central nervous system respiratory drive leading to decreased airflow and ventilatory effort during sleep
What are the main clinical features of sleep apnea?
loud snoring
excessive daytime fatigue/sleepiness
What is the gold standard test for sleep apnea?
laboratory Polysomnography
What is a major lab finding in those with sleep apnea?
polycythemia
