Pulm Flashcards
Etio Epiglottitis
Hib
Thumb sign
Epiglottitis (thumb sign is enlarged epiglottis)
Tx Epiglottitis
3rd gen Ceph: Ceftriaxone or Cefotaxime + anti staph abx
Steeple sign
Laryngotracheobronchitis (narrowing of the trachea)
Influenza antivirals
Oseltamivir infants and adults
Zanamivir age 7+ only
Stages of Pertussis
Catarrhal: URI sx
Paroxysmal: progressively worsening cough
Convalescent: gradually improves
Tx: Macrolide only in the first few weeks. Pt no longer contagious after 5d of tx or after 3 weeks no tx
PNA pathogen: Currant jelly sputum + alcoholic
Klebsiella
Decision to hospitalize for PNA
CURB-65 (1 pt each) Confusion Uremia (BUN > 19) Respirations >30 Blood pressure (hypotension) 65: age over 65
2 pts: outpatient with close observation
3+ inpatient
Outpatient tx PNA
Macrolides or Doxy
Inpatient PNA
Levaquin OR Macrolide + Ceftriaxone
CXR findings in TB
Hilar adenopathy
Infiltrates/cavities middle and lower lobes
TX active TB
RIPE x2 months then continue INH and Rifampin x 4 mo for total of 6 months Rifampin INH Pyrazinamide Ethambutol
+ PPD
> 5mm: HIV, Close contacts with active TB, Immunosuppression, CXR shows healed TB
10mm: recent immigrants, drug use, healthcare workers, prisoners, malignancy, DM
15mm no risk factors
Tx options for latent TB
If negative CXR:
INH + Pyrodixne (B6) x 9 mo
Alternative first line is 3 months of once weekly INH +Rifapentine if DOT
Sx Carcinoid syndrome
Flushing
Diarrhea
Bronchospasm
CXR shows pulmonary nodule: definitive dx biopsy
Small cell lung CA
Very aggressive
Associated with SIADH and Cushings
Poor prognosis so usually not surgical candidates, tx with chemo and radiation
Etio bronchiectasis
Repeated infections that causes permanent dilation of bronchioles. Cystic fibrosis.
Dx bronchiectasis
CXR: Tram lines
PFTs: obstructive pattern
CT for dx
What tx shown to have benefit in reducing exacerbations and improve lung function in bronchiectasis?
Long term azithromycin
CXR: increased A/P ratio and flattened diaphragm
COPD (hyperinflation)
PFTs in COPD
Obstructive pattern:
FEV1
EKG change in pt with COPD?
MAT
When to offer O2 in COPD pt?
Sat
Cystic fibrosis: sx in pediatric pt
Absent vas deferens
Bowel obstruction/failure to pass meconium
What other organ associated with cystic fibrosis?
Pancreas (adults will have steatorrhea)
Dx cystic fibrosis
Sweat chloride test >60
Surfactant deficiency
Hyaline membrane disease
Abdominal exam finding most consistent with sarcoidosis
HSM
3 phases of pertusiss
Catarrhal: URI sx; most infectious stage
Paroxysmal: cough with vomiting
Convalescent: resolving
What is positive PPD in an HIV positive pt?
> 5mm
Positive ppd in a Diabetic?
> 10mm
Positive ppd in a recent immigrant?
> 10mm
Positive ppd in a pt who has had close contact with TB?
> 5mm
Positive ppd in pt without risk factors?
> 15mm
Sx carcinoid syndrome
Diarrhea, flushing, bronchospasm
Most aggressive lung CA?
Small cell
Pharmacology Cromolyn?
Mast cells inhibitor
Most common paraneoplastic finding in lung CA?
Hypercalcemia
ABG: Normal pH?
7.35-7.40
ABG: normal PC02
40
ABG: normal HCO3
24-28
