Pulm Flashcards
CAP
Pt hasn’t been hospitalized w/in the last 14 days
CAP pathogen
S. pneumo (MC) H. flu M. cat *same as sinusitis & AOM *Lobar consolidation/ air bronchograms
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
what tool estimates mortality for patients w/ CAP?
PSI/ PORT score
ddx RML and RLL PNA
RML can see diaphragm, heart border not seen
RLL “white out” of the lower diaphragm
what tool estimates inpt vs outpt tx of CAP?
CURB 65 Confusion Urea (renal dysfun) RR > 30 BP < 90 Age +65
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
Tx for Legionella
Fluoroquinolones
HAP definition
PNA 48-72 hrs after admission
New sxs w/in 4 days after d/c
Tx for HAP
3 ANTIBIOTICS
1) Pseudomonas (Tobramycin, Ceftazidime)
2) MRSA (Vancomycin)
3) ESBL (amp/sulbactam or pipericillin/tazobactam)
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
Prevention of Atelectasis post-op?
Incentive spirometry (10-15x day)
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)
3 TB drugs
INH - needs pyridoxine
Rifampin- hepatitis, orange
Ethambutol- optic neuritis
First goal in dx pulmonary nodules
1) Comparison films
(Popcorn = always benign)
2) CT scan +3cm
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)
