JB Pulm Flashcards
Acute bronchitis MCC
Adenovirus
Acute epiglottitis MCC, dx
Hib
laryngoscopy definitive
ARDS sx
Critically ill pts
severe refractory hypoxemia hallmark
CXR: bilateral pulmonary infiltrates (white out pattern), spares costophrenic angles
ARDS tx
intubation
BiPAP
Alpha 1 antitrypsin deficiency
linked to COPD in young adults
associated with pan lobular emphysema
Aspergillosis complication
Produces aflatoxin B1- increased risk of hepatocellular carcinoma
Aspergillosis dx
Increased IgE and eosinophilia if allergic
Bx: dusky necrotic tissue, septate hyphae
Aspergillosis tx
Allergic: CS, chest physiotherapy, itraconazole
Severe: voriconazole DOC, itraconazole, amphotericin B, caspofungin
Aspergilloma: surgical resection
Asx: observation
Asthma dx
PFT gold standard
12% improvement in FEV1 after SABA administration or 20% worse with methacholine challenge test
Asthma Tx
Acute: SABA anticholinergics, PO steroids
Chronic: ICS, LABA, ICS/LABA (Symbicort. Advair diskus)
Bacterial tracheitis sx
inspiratory stridor, deep/barking croup cough, post URI
Bronchiectasis dx
High resolution CT: TOC. tram tracking
signet ring sign
Chronic bronchitis PE
Chronic cough 6mo/2yrs. Obese w/ leg edema (blue bloaters)
Chronic bronchitis/COPD health maintenance
Vaccines: pneumococcal and flu
Acute exacerbation: azithromycin
Chronic bronchitis tx
Combo therapy: anticholinergics + B2 agonists
LABA + ICS
O2- decrease mortality
COPD tx
Oxygen- decrease mortality
Bronchodilators (anticholinergics/B2 agonists)
CS (ICS + LABA)
Abx w/ exacerbations
Cystic fibrosis sx
Young pt with bronchiectasis and recurrent respiratory infections.
Pancreatic insufficiency, steatorrhea, infertility. Meconium ileus at birth
Cystic fibrosis sx
Young pt with bronchiectasis and recurrent respiratory infections.
Pancreatic insufficiency, steatorrhea, infertility. Meconium ileus at birth
Cystic fibrosis labs
Sweat chloride >60 on 2 occasions with pilocarpine CXR: bronchiectasis PFT: obstructive DNS analysis: definitive Sputum cultures: pseudomonas
Cystic fibrosis tx
airway clearance (bronchodilators, mucolytics, abx, decongestants)
pancreatic enzyme replacement (ADEK)
lung/pancreatic transplant
vaccines (flu and pneumococcal)
emphysema tx
bronchodilators (anticholinergics + B2 agonist)
ICS+ LABA
O2
Emphysema dx
Hyperinflation of lungs
Barrel chest
Respiratory alkalosis
pink puffer
empyema dx
xray/CT confirm
thoracentesis TOC
Flu vaccines
Given annually
Trivalent vaccine: CI if allergy to eggs, gelatin, or thimerosal
Intranasal (live): CI if preg or >50yo
Legionella pneumonia sx
GI sx
increased LFT
hyponatremia
Legionella pneumonia tx
Levoquin or azithromycin
MC type of lung cancer
Adenocarcinoma
Pertussis due to
Bordetella pertussis
Pertussis sx
Catarrhal phase: URI sx 1-2 wks (contagious)
Paroxysmal phase: cough, inspiratory whoop
Convalescent phase
Pertussis tx
supportive
Abx within 7d of sx onset. Macrolide (erythromycin/azithromycin), bactrim if allergic
Pertussis dx
nasopharyngeal swab PCR gold standard
Pleural effusion dx/tx
thoracentesis: TOC and gold standard
MCC CAP
Pneumococcal pneumonia (Gram positive cocci in pairs)
pneumococcal pneumonia tx
B lactam (ceftriaxone/amoxicillin/augmentin) + macrolide (azithromycin)
Pneumocystis jiroveci pneumonia (PCP) tx
bactrim DOC, add prednisone if hypoxic
Sulfa allergy: dapsone-trimethoprim
PCP prophylaxis in HIV pts: bactrim when CD4 <200
Pneumothorax PE
chest pain, hyper resonance
Tension: increased JVP, pulses paradoxus, hypotension
Pneumothorax tx
tube thoracostomy
if shock: needle thoracostomy
Pulmonary embolism PE
Homans sign
Pulmonary embolism dx
Helical CT BIT
Angiogram gold standard
Pulmonary embolism tx
Stable: anticoags or IVC filter
Unstable: thrombolytics or embolectomy
Silicosis tx
supportive
Smoke inhalation tx
100% O2 nonrebreather
