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PANCE/EOC > Pulm #4 > Flashcards

Pulm #4 Flashcards

1
Q

What is a pleural effusion?

A

Abnormal accumulation of fluid in the pleural space

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2
Q

What is an empyema?

A

-Direct infection of the pleural space

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3
Q

What are the two types of pleural effusion?

A

-Transudate and Exudate

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4
Q

Explain some causes of Transudate pleural effusion

A
  • CHF (MCC)
  • Nephrotic syndrome
  • Cirrhosis
  • Atelectasis
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5
Q

Explain some causes of Exudate pleural effusions

A
  • Any condition associated with infection or inflammation
  • Pulmonary embolism
  • Malignancy
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6
Q

Symptoms of pleural effusion

A
  • Dullness to percussion
  • Decreased fremitus
  • Decreased breath sounds
  • Pleural friction rub
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7
Q

What is the initial test of choice for pleural effusion? What does it show?

A
  • Lateral decubitus CXR films

- Blunting of the costophrenic angles (meniscus sign)

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8
Q

However, what is the gold standard to diagnose a pleural effusion?

A

Thoracentesis (can be diagnostic and therapeutic)

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9
Q

What diagnostic is done to confirm an empyema?

A

CT scan

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10
Q

What is Light’s Criteria?

A
  • If any of these three are present, it is exudative
    1) Pleural fluid protein: serum protein > 0.5
    2) pleural fluid LDH: serum LDH > 0.6
    3) Pleural fluid LDH > 2/3 upper limit of normal LDH
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11
Q

Treatment for pleural effusion

A
  • Treat underlying condition
  • Thoracentesis (gold standard)
  • Chest tube fluid drainage for empyema
  • Pleurodesis (Talc used) if chronic or malignant
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12
Q

What is the pathophysiology of Tuberculosis

A

After inhalation, Mtb goes to the alveoli, gets incorporated into macrophages and can disseminate from there

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13
Q

Pulmonary Symptoms of TB

A
  • Cough
  • Hemoptysis
  • Fever
  • Night sweats, chills, chest pain
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14
Q

Extrapulmonary symptoms of TB

A
  • Can affect any organ
  • -Cervical lymph nodes (Scrofula)
  • -Pott’s Disease (TB of the spine)
  • -Pericarditis
  • -Adrenal gland involvement
  • -Genitourinary
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15
Q

What three things do you need to show infected with TB but not infectious?

A
    • PPD
  • No symptoms of infection
  • No imaging findings of active infection
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16
Q

What is the initial test ordered for TB?

A

Chest radiograph

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17
Q

Different findings of TB on chest xray

A
  • Reactivation: apical (upper) lobes
  • Primary: middle/lower lobe
  • Miliary: millet-seed lesions
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18
Q

What other diagnostics can be done for TB?

A
  • Sputum cultures: at least 3 samples on 3 consecutive days

- NAAT: more sensitive than sputum smears

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19
Q

Management of active TB

A

-Initiate 4 drug therapy: RIPE for 2 months followed by 4 months of RI (6 month duration)

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20
Q

Side effects of TB drugs

A
  • Rifampin: orange colored secretions
  • Isoniazid: Hepatitis, peripheral neuropathy
  • Pyrazinamide: Hepatitis, Hyperuricemia
  • Ethambutol: Optic neuritis, red/green color blindness
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21
Q

What should be given with Isoniazid?

A

Pyridoxine (B6)

22
Q

Treatment for Latent TB

A

-INH + Pyridoxine x 9 months

23
Q

What drug can be given in TB instead of Ethambutol?

A

Stretomycin

24
Q

However, what are the side effects of Streptomycin?

A

Ototoxicity (CN8)

Nephrotoxicity

25
Q

Any positive PPD should be followed by a ____ to rule out active disease

A

CXR

26
Q

What are the reaction sizes to be positive with a PPD test for TB?

A

> 5 mm: HIV or immunosuppressed, close contact with person with active TB, CXR with old/healed granuloma

> 10 mm: healthcare workers, all other high risk people

> 15 mm: Everyone else, no known risk factors

27
Q

What is parrot fever (Psittacosis)?

A

infection with Chlamydophila Psittaci due to exposure to infected birds

28
Q

Treatment for Psittacosis

A

Tetracyclines (tetracycline, doxycycline, minocycline)

29
Q

What happens in silo filler disease?

A

It is a hypersensitivity pneumonitis from nitrogen dioxide gas exposure released from plant matter stored in silos as they ferment (gas is converted to nitric acid in the lungs when inhaled)

30
Q

Management of Silo Filler Disease

A
  • Occupational reduction of exposure
  • Entering at the top of the silo
  • Use of N95 masks
31
Q

Risk factors for Berylliosis

A
  • Aerospace
  • Electronics
  • Ceramics
  • Tool and dye manufacturing
  • Jewelry making
  • Fluorescent light bulbs

(Exposure to nickel, aluminum, and copper)

32
Q

Treatment for Berylliosis

A
  • Corticosteroids, oxygen

- Methotrexate if corticosteroids fail

33
Q

Coal Worker’s Lung is a lung disease from inhalation of coal dust particles. What is Caplan Syndrome?

A

-Coal worker pneumoconiosis + Rheumatoid Arthritis

34
Q

Diagnostics for coal workers lung

A
  • Chest radiograph: small nodules in upper lung and hyperinflation of lower lobes in an obstructive pattern
  • PFT: obstructive pattern
  • Lung biopsy: dark, black lungs
35
Q

Management for coal worker’s lung

A

Symptomatic management

36
Q

Risk factors for sarcoidosis

A

-Females, AA, Northern Europeans

37
Q

Symptoms of Sarcoidosis

A
  • 50% asymptomatic
  • Dry nonproductive cough, dyspnea, rales
  • Erythema nodosum (on shins), lupus pernio (on face)
  • Hilar LAD (near xiphoid process)
38
Q

What is Lofgren Syndrome?

A

-Erythema Nodosum + Bilateral hilar LAD + polyarthralgias with fever

39
Q

best initial test for sarcoidosis

A

CXR

40
Q

What other diagnostics can be done for sarcoidosis?

A
  • PFT: restrictive in pattern
  • Tissue Biopsy: Most accurate (noncaseating granulomas)
  • Labs: elevated ACE levels
41
Q

Treatment for sarcoidosis

A
  • Asymptomatic: observation (spontaneous remission in 2 years in most cases)
  • Symptomatic: oral corticosteroids
  • Methotrexate, Hydroxychloroquine for skin lesions
42
Q

What two things that are associated with Sarcoidosis are associated with a poorer prognosis?

A
  • Interstitial lung disease

- Lupus pernio

43
Q

PCP PNA is the most common opportunistic infection in HIV patients with a CD4+ < ____

A

200

44
Q

Clinical manifestations of PCP PNA

A
  • Dyspnea on exertion (MC)
  • Fever
  • Nonproductive cough
  • Oxygen desaturation with ambulation!!!
45
Q

CXR for PCP PNA

A

-Diffuse bilateral interstitial infiltrates

46
Q

Labs for PCP PNA

A

-Increased LDH

47
Q

What is the definitive diagnostic for PCP

A

Lung biopsy (rarely done though)

48
Q

Treatment for PCP PNA

A
  • Bactrim x 21 days

- If HIV + –> add Prednisone if hypoxic

49
Q

What medications should you give if the patient has PCP and a sulfa allergy?

A
  • Dapsone-Trimethoprim

- Clindamycin-Primaquine

50
Q

What fungus causes PCP?

A

Pneumocystic Jirovecii

PANCE/EOC (63 decks)

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