Pulm Flashcards
What presents with signs/symptoms such as fever, chills, productive cough, dyspnea, pleuritic chest pain (on inhalation), generalized weakness, malaise, tachycardia, tachypnea, hypoxia, wheezes, rhonchi, crackles, increased tactile fremitus, bronchophony, egophony?
Pneumonia
What labs/imaging are you getting in a pneumonia work up?
Chest x-ray or chest CT
Sputum stain & culture
Blood cultures (inpatient)
Procalcitonin
C-reactive protein
How is pneumonia classified?
By source of infection; either community acquired or nosocomial (hospital acquired) or viral
How do you treat community acquired pneumonia?
Healthy patient w/stable vitals: treated at home with high dose amoxicillin, doxycycline, or macrolide (if local resistance <25%)
Patient with comorbidities & outpt treatment: combo amox-clav PLUS macrolide or doxy
Hospital admission: IV ABX; beta lactam or 3rd gen cephalosporin PLUS macrolide or doxy
ICU admit: 3rd gen cephalosporin PLUS macrolide
How do you treat nosocomial (hospital acquired) pneumonia?
Combo for gram negs, pseudomonas, & MRSA
4th gen cephalosporin PLUS vanc. PLUS fluoroquinolone
How do you treat pneumonia that is caused by a virus?
Rest, fluids, antipyretics
Influenza: neuraminidase inhibitors
COVID: Paxlovid or Molnupiravir
What is caused by strep pneumo and is common in pts with HIV?
Pneumocystis jirovecii (PCP)
What are the signs/symptoms of pneumocystis jirovecii (PCP)?
CD4 count < 200
Elevated LDH
Progressive SOB
How do you treat pneumocystis jirovecii (PCP)?
Bactrim (1st line)
Bactrim PLUS dapsone or clindamycin (2nd line)
Prednisone if PaO2 < 70
What is the leading cause of cancer-related deaths worldwide?
Pulmonary neoplasm
How are pulmonary neoplasms classified?
Small cell or non-small cell
What is the prognosis of small cell and non-small cell lung cancer?
Small cell: poor prognosis
Non-small cell: varies by stage
What are possible signs/symptoms of pulmonary neoplasm?
Can be asymptomatic, weight loss, cough, hemoptysis, pain
Local spread: Atelectasis, pneumonia, PE, SOB
Metastatic spread: pain that is non-specific or in bones, weight loss and weakness, neurologic symptoms
What is the treatment for a pulmonary neoplasm?
Varies by cell type and stage
Surgery, chemo., radiation, immunotherapy, radiofrequency ablation, palliative care
What condition is characterized by granulomas in the lungs and lymph nodes that can also be present in eyes, heart, kidneys, liver, and other organs that presents with signs/symptoms of hilar lymphadenopathy, cough, dyspnea, pulm. HTN?
Sarcoidosis
How do you stage sarcoidosis?
Stages based on chest x-ray:
0: normal
1: Bilateral hilar lymphadenopathy
2: Stage 1 PLUS parenchymal infiltrates
3: Parenchymal infiltrates alone
4: Pulmonary fibrosis
What is the treatment for sarcoidosis?
No cure
May spontaneously resolve
Systemic corticosteroids (1st line)
What condition is caused by exposure to noxious particles/gases and characterized by airflow limitation resulting from airway/alveolar abnormalities?
COPD
What are general signs/symptoms of COPD?
Chronic/daily cough
Chronic wheezing
Chronic sputum production
Dyspnea
What might be noted during a physical exam in someone with COPD?
Pursed lips
Use of accessory muscles
Wheezes
Rhonchi
Diminished breath sounds
Perioral/peripheral cyanosis
What test is required for diagnosing COPD?
Spirometry
What FEV1/FVC is indicative of COPD?
FEV1/FVC < or = 0.7
What are the GOLD grades of COPD?
1: mild FEV1 > or = to 80% predicted
2: moderate FEV1 between 50-80% predicted
3: severe FEV1 between 30-50% predicted
4: very severe FEV1 < 30% predicted
What is the treatment for COPD?
SABA (Albuterol), LABA (Formoterol, Salbutamol), SAMA (Ipratropium), LAMA (Tiotropium)
Supplemental O2 if O2 sat. of 88% or lower at rest
What are the signs/symptoms of a COPD exacerbation?
Increase in chronic symptoms
Increase rescue inhaler use
Increase sputum/color change
Possible hypoxia
What is the treatment for an acute COPD exacerbation?
ICS
Oral corticosteroids
Combo ICS/LABA
ABX
Should you combine SAMA/LAMA treatment for COPD?
No, because they have increase risk of cardiovascular death, MI, or stroke
What is a chronic inflammatory obstructive pulmonary disease w/reversible factors that can be triggered by behaviors (exercise, stress, cold) or environmental factors?
Asthma
What are signs/symptoms of asthma?
Cough
Wheezing
SOB
Expiratory wheezes & rhonchi
Allergic shiners
Boggy nasal mucosa
Cyanosis if O2 sats are < 88%
What diagnostic testing is done in asthma?
Asthma Control Test (ACT)
Spirometry
What is the treatment for asthma?
General: SABA, SAMA, systemic corticosteroids, supplemental O2 & magnesium sulfate (in more severe cases)
Long term: ICS (fluticasone), Cromolyn sodium, immunomodulators, Leukotriene modifiers (Singulair), LABA (Advair, Symbicort), Methylxanthines (Uniphyl)
What are the steps to asthma treatment?
Step 1: SABA PRN
Step 2: Low-dose ICS
Step 3: Low-dose ICS + LABA or medium-dose ICS
Step 4: Medium-dose ICS + LABA
Step 5: High-dose ICS + LABA AND Omalizumab for pts w/allergies
Step 6: High-dose ICS + LABA + oral corticosteroid AND Omalizumab for pts w/allergies
What is Samter’s triad?
Pt w/history of asthma, inflammation of the sinuses, & recurrent nasal polyps (Aspirin induced asthma)
What is the treatment for URI and acute (uncomplicated) bronchitis?
Supportive care
No ABX
If you have a pt that presents with the following, what is your suspected diagnosis?
< 2 yo, fussy, not eating, low grade fever, rhinitis, congestion, wheezing, crackles, respiratory distress (intercostal retractions, nasal flaring, grunting)
Acute bronchiolitis (caused by RSV)
What is the treatment for acute bronchiolitis?
Mild: supportive care
Severe: supportive care PLUS albuterol, steroids, and Ribavirin (confirmed RSV)
Hospitalize pts that are hypoxic, lethargic, increased RR, or resp. distress
When can you give antivirals to a patient with confirmed influenza?
If it’s within 48 hrs of symptom onset
What is a medical emergency that is characterized by drooling, dysphagia, distress, fever, stridor, and muffled voice?
Epiglottitis
What is the treatment for epiglottitis?
Keep pt calm
Protect airway
Consult ENT or anesthesiologist
IV fluids
Rocephin + Vanc
Consult ID
What are the stages of pertussis?
Catarrhal stage (7-14 days): URI symptoms
Paroxysmal stage: whooping cough, coughing so much it induces vomiting
Convalescent stage: symptoms diminish at approx. 4 weeks, average illness lasts 7 weeks
What is the treatment for pertussis?
Macrolide (Azithromycin or Clarithromycin)
Bactrim (2nd line)
Prophylaxis treatment for close contacts
Treat cough
What pulm diagnosis can be prevented with vaccines?
Pertussis: Tdap
Influenza
COVID
Pneumonia
