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