Pulm Flashcards by Sam smith

Etio Epiglottitis

Hib

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Thumb sign

Epiglottitis (thumb sign is enlarged epiglottis)

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Tx Epiglottitis

3rd gen Ceph: Ceftriaxone or Cefotaxime + anti staph abx

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Steeple sign

Laryngotracheobronchitis (narrowing of the trachea)

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Influenza antivirals

Oseltamivir infants and adults

Zanamivir age 7+ only

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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

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PNA pathogen: Currant jelly sputum + alcoholic

Klebsiella

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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

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Outpatient tx PNA

Macrolides or Doxy

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Inpatient PNA

Levaquin OR Macrolide + Ceftriaxone

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CXR findings in TB

Hilar adenopathy

Infiltrates/cavities middle and lower lobes

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TX active TB

RIPE x2 months then continue INH and Rifampin x 4 mo for total of 6 months
Rifampin
INH
Pyrazinamide
Ethambutol

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+ 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

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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

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Sx Carcinoid syndrome

Flushing
Diarrhea
Bronchospasm
CXR shows pulmonary nodule: definitive dx biopsy

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Small cell lung CA

Very aggressive
Associated with SIADH and Cushings
Poor prognosis so usually not surgical candidates, tx with chemo and radiation

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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

ABG: normal HCO3

24-28