Pneumo Flashcards

1
Q

Ddx epanchement pleural

A
  • augm perm surface (exs): inflam, neo, idiopath
  • Ascite (trans)
  • augm Ph caps (trans): IC, EP, Pericardite constrictive, Synd VCS, atelectasie
  • dim Po caps (trans): hypoalb, cirrhose, Synd nephrotique
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2
Q

Critères de Light

A

Epanchement pleural (>25 mL dans espace pleural)

Exsudat

  • PROTpl/PROTsr >0.5
  • LDHpl/LDHsr >0.6
  • qte LDHpl >2/3 qte serique (max: 200 UI/L)
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3
Q

Analyse epanchement pleural

A
# Absolu
Amylase
Bactéries 
Cytologie
/
Glycemie
pH
LDH
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4
Q

Epanchement sanguin

A

Trauma

Neo

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5
Q

Epanchement pleural blanc vs noir

A

Blanc = chylothorax, empyème

Noir = aspergillose, abcès foie

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6
Q

Epanchement pleural jaune-verts vs visqueux

A

Jaune-vert = pleurésie rheumatoïde

Visqueux = mésothéliome malin

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7
Q

Test fonction pulmonaire syndrome obstructif

A

Dim DEP
VEMS/CVF < 0.70

Augm VR, CPT, VR/CPT

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8
Q

Test fctn pulmonaire

Synd restrictif

A

Hallmark = dim volumes pulmonaires

- dim CPT, VR, CV

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9
Q

Pouls paradoxal

A

Dim >15% TAs à l’inspi

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10
Q

Ddx insuffisance respiratoire hypoxemique

-GAaO2 N

A

1) dim PiO2: hte altitude, bonbonne mal calibré

2) hypoventilation alveolaire
- obst VRS: corps etranger, oedeme laryngé, laryngite/epiglottite, tumeur
- Tr commande respi: neuro, musc, cage, plèvre

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11
Q

Ddx insuf respi hypoxemique

Augm GAaO2

A

1) aN V/Q:
- dim: consolidation alveolaire(atelectasie, oedeme), obst VRI (MPOC, SDRA, asthme)
- augm: obst vasc (EP)

2) shunt D-G: poumon (oedeme) ou coeur (CIA, CIV)
3) dim diffusion: fibrose pulmonaire, pneumoconiose, OAP, emphysème pure

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12
Q

Test fctn pulmo

Asthme

A

C bronchodilat (salbutamol)

  • augm VEMS >12%
  • augm DEP >20% ou >60 mL/min
  • changement DEP >20% dans la journée
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13
Q

Complications MPOC

A
  • polycythemie 2r a hypoxemie
  • hypoxemie chronique
  • HTpulmo 2r a VC
  • coeur pulmonaire
  • Pneumothorax 2r rupture bulle emphysemateuse
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14
Q

Tx exacerbation aigue MPOC

A
  • ABC
  • Cible O2: 88-92% SaO2
  • Bronchodil c nébulisation: SABA (salbutamol = ventolin) + Anti-Cholinergique (ipratropium bromide = Atrovent)
  • Cortico systemique (PO/IV)
  • ATB si augm crachat/purulent: simple = amox/Ceph 2G/3G vs complexe = fluroquinolone
  • readapt
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15
Q

Infection complexe MPOC

A
FeV1 < 50%
>= 4 exacerb/an
Maladie cardiaque ischemique
O2 a domicile
Cortico chronique
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16
Q

Tx prolongeant survie MPOC

A

Cesser tabac
Vaccin (influenza + pneumocoque)
O2 maison

17
Q

Indication O2 a domicile context MPOC

A

1) PaO2 <55
2) PaO2 <60 avec maladie pulmonaire ou polycythemie (Ht >56%) ou desat a l’exercice dans contexte de greffe
3) SaO2 <88% (vise 92-94%)

18
Q

Cancer pulmonaire plus commun chez fumeurs va non-fumeurs

A

Fumeurs = neo a petite cellule

Non-fumeurs = addnocarcinome

19
Q

Nodule pulmonaire a apparence maligne

A

> 3 cm, spiculé, irregulier, marges: mal-defini/notched
Double: en >1 mo mais <2 ans
Caract: non-calcifié ou calcification eccentrique, pas de lesion satellite, ulceration c mur epais, possible effusion pleurale/lymphadenopathie, signe corona radiate (CT), hyperdensité (CT)

20
Q

Investigation nodule pulmonaire

A
RXP
CT c et sans contraste
Cytologie sur crachat
Biopsie
Pet scan (ddx malin et benin)
21
Q

Pneumonid atypique

A

Mycoplasma
Legionella
Chlamydophila

22
Q

Pneumonie frequente

A

Strept pneumonie
Mycoplasma pneumonie
Chlamydophila pneumonia
Haemophilid influenza

23
Q

Contexte pneumonie a staph doré

A

Post-iVRS à influenza

24
Q

Contexte pneumonie a klebsiella vs BGN

A

Klebsiella = ROH chronique

BGN = pt deja hospitalisé

25
Q

Contexte pneumonie virale

A

Virus du tractus respiratoire = influenza A et B, adenovirus

Contexte pediatrique

26
Q

Investigations pneumonie

A
  • SaO2
  • Fsc, electrolytes, u-C,
  • tropo, Ck
  • gaz artériel si detresse respi
  • TFP
  • RXP +- CT
  • Bronchoscopie +- washing si 1)refractaire au tx ou 2) immunosup
27
Q

Seule test investigation pour pneumonie traité en externe

A

RXP

28
Q

Critères majeurs score de fine

A
  • FR >30/min
  • confusion recente
  • hypotas <90
  • T>40
  • SaO2 <90%
  • age avancé
29
Q

Principe generaux de Tx pneumonie

A
  • Tx initial = tjrs empirique
  • FR principal resistance S pneumo = prise ATB depuis <3 mois
  • amelioration etat en <72h
  • vaccin pneumovax = previent les infections invasives a pneumocoque
30
Q

Tx 1ere intention pneumonie

A

Clarithromycine (Biaxin) 500 mg PO BID x 7 jours

31
Q

Tx 1ere intention pneumonie si comorbidités/CHSLD/hospit/USI

A

Moxifloxacine (Avelox) 400 mg PO/IV die x10 jours (ou ad 14 contexte hospitalisé ou USI)

32
Q

Tx Tb

A

2 mois: INH + RMP + PZA + EMP die

4 mois: INH + RMP die

33
Q

Effets secondaires INH

A

Allergie
Tr hepatique/GI
Interaction Rx
Tr SNc, neuropathie peripherique - admin pyridoxine en prophylaxie

34
Q

Effets secondaires RMP (rifampicine)

A
Allergie
Tr articulaire
Photosensibilité
Tr foie/GI
Saignement
Coloration orange liquides corporels
Interaction Rx
35
Q

Effets secondaires EMB (ethambutol)

A

Allergie

Tr vision

36
Q

Effets sexondaires pyrazinamide (pzm)

A

Tr foie/GI

Tr articulations