``` S. pneumo (MC) H. flu M. cat same as sinusitis & AOM Lobar consolidation/ air bronchograms ```

Pulm Flashcards by Claire Wilsey

CAP

Pt hasn’t been hospitalized w/in the last 14 days

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CAP pathogen

S. pneumo (MC) 
H. flu
M. cat 
*same as sinusitis &amp; AOM
*Lobar consolidation/ air bronchograms

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PE finding for consolidated PNA

1) dec chest movements
2) Inc vocal fremitus
3) dull to percussion
4) BS are bronchial (normally vesicular)
5) Vocal resonance (not hyperresonance) is increased
6) Whispering pectoriloquy is present

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what tool estimates mortality for patients w/ CAP?

PSI/ PORT score

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ddx RML and RLL PNA

RML can see diaphragm, heart border not seen

RLL “white out” of the lower diaphragm

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what tool estimates inpt vs outpt tx of CAP?

CURB 65 
Confusion
Urea (renal dysfun)
RR > 30 
BP < 90 
Age +65

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DDx Typical vs Atypical CAP

Atypical PNA

Legionella- PNA w/ GI sxs and relative low HR (should be tachy! with fever)
Patchy infiltrates on CXR

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Tx for Legionella

Fluoroquinolones

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HAP definition

PNA 48-72 hrs after admission

New sxs w/in 4 days after d/c

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Tx for HAP

3 ANTIBIOTICS

1) Pseudomonas (Tobramycin, Ceftazidime)
2) MRSA (Vancomycin)
3) ESBL (amp/sulbactam or pipericillin/tazobactam)

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History of travel to….w/ incompetent immune system

1) MS/ OH river valeey
2) Midwest
3) Desert Southwest

PNA (FUNGAL)

1) Histoplasmosis
2) Blastomycosis
3) Coccidiomycosis

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Prevention of Atelectasis post-op?

Incentive spirometry (10-15x day)

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When does a ppd get read? What does it tell?

48-72 hours
Indicates infection when INDURATED (not active vs latent) …need CXR
Dx made by AFB Sputum (takes 3 wks)

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3 TB drugs

INH - needs pyridoxine
Rifampin- hepatitis, orange
Ethambutol- optic neuritis

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First goal in dx pulmonary nodules

1) Comparison films
(Popcorn = always benign)
2) CT scan +3cm

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Bronchogenic Carcinoma: CHRONIC cough:
associated findings -
SPHERE of lung CA

SVC compression 
Pancoast tumor (apical)
Horner syndrome
Endocrine 
Recurrent laryngeal n. 
Effusion (Exudative)

Lung CA work up

CXR
CT Chest
Sputum cytology
Lung Bx

TLC in obstructive vs restrictive

Obstructive- inc TLC

Restrictive- dec TLC

FEV1 in obstructive vs restrictive

Obstruction- dec FEV1 (<80%)

Restrictive- nml FEV1

Ex’s of restrictive pulm dz’s

Primary pulmonary fibrosis
Pneumoconioses
Sarcoidosis

Types of Pneumoconiosis

1) Asbestosis- ships/ insulation
2) Silicosis- sandblasting
3) Black lung- coal

Black Scandinavian/ Norweign with lung problem =

Sarcoidosis 
non caseating granulomas 
Ant/ Post uveitis
Erythema nodosum 
20-40 yo F

Hypercalemia
Increased serum ACE
Nodular lesions w/ hilar lymphadenopathy

Sarcoidosis

Dx Sarcoid

Transbronchial biopsy

Tx Sarcoid

Steroids only for symptoms

How much can FEV1 increase with beta agonists when doing PFT's

+12 %

1) "intermittent" 2) "Mild persistent" 3) "Mod persistent" 4) "severe persistent"

1) SABA 2) SABA + LOW dose inhaled steroid 3) SABA+ HIGH dose inhaled steroid 4) SABA+ HIGH dose inhaled+ PO steroids

If you give a LABA (Salmeterol)

YOU NEED inhaled steroids

Indication for of Mast Cell Stabilizers (Cromolyn) ....

1) Cold induced asthma 2) Grandma has a cat *NEVER for acute asthma; only PREVENTATIVE

Chronic Bronchitis Tx

Stop smoking Vaccinate (Flu & Pneumococcal) Inhalers: Anticholinergics/ SABA/Inhaled Steroids Home O2

COPD Exacerbation

O2 DuoNebs Prednisone PO Antibiotics (purulence, productive sputum, fever)

Emphysema Signs

``` Pink Skin Cachectic Breathing thorough pursed lips Barrel chest Dec breath sounds ``` CXR: bullae

Spont PTX

Marfans- Tall thin healthy male smoker | COPD-Ruptured bleb

PE for pneumothorax

- ipsilateral dec chest wall movement | - ipsilateral dec BS

Non-tension pneumo

<15% + asymp - WW | +15%- CT w/ water seal

Tx for ARDS

TREAT underlying dz

Dx OSA

Polysomnography (sleep study)