Pulm Flashcards
Pleural Fluid Analysis:
exudative?
fluid protein/serum protein > 0.5
fluid lactate dehydr > 2/3 UL of normal OR
fluid/serum lactate dehydr > 0.6
What leukocyte value implies transudative process?
<1000
What does a predominance of neutrophils in pleural fluid suggest?
an acute inflammatory or infectious process
What is pleural fluid glucose level of <60 most commonly caused by?
TB, parapneumonic effusion, malignant effusion, or rheumatoid disease
What is normal pleural fluid pH?
7.6-7.66
What does pleural fluid of <7.2 indicate?
complicated parapneumonic effusions (empyema), esophageal rupture, rheumatoid and TB pleuritis, malignant pleural disease, systemic acidosis, paragonimiasis, lupus pleuritis, or urinothorax.
What kind of pleural effusion is seen in malignancy?
exudative w/ predominance of lymphocytes!
How to distinguish TB from bacterial effusion?
TB has predominance of lymphocytes
What 2 characteristics of pleural effusions indicate a poor prognosis for a pt?
low glucose and pH
How to tell the difference between a pleural effusion and lobar consolidation on exam?
decreased fremitus in pleural effusion. increased fremitus in consolidation.
What is atopy?
excema
how to induce asthma?
Ach-agonist: methylcholine
How to rescue pt with asthma?
albuterol- beta agonists
Asthma stabilizers?
nedocromyl/cromolyn. Only for athletic asthma when certain of cause
Bronchodilator response in COPD?
- response of FEV1/FVC to less than 70% of predicted
- FEV1 can be relatively preserved in mild disease
Which lung disease should be considered in pts with tuberous sclerosis?
lymphangioleiomyomatosis
The following findings in a young woman with dyspnea should prompt consideration of what condition? spontaneous pneumothorax, chylothorax, CXR that shows hyperinflation
lymphangioleiomyomatosis
What findings on CXR are present in cryptogenic organizing pneumonia (COP)?
alveolar opacification almost always bilateral and show varied distribution. migrate to diff lung regions.
COP is the idiopathic form of what?
bronchiolitis obliterans organizing pneumonia (BOOP)
What gram positive rod causes meningitis in babies/elderly?
Lysteria monocytogenes
How do you treat lysteria monocytogenes meningitis?
Ampicillin or Penicillin G. Use Bactrim in peeps allergic to penicillin
What gram positive diplococci causes meningitis in babies/elderly?
strep pneumo
How to treat presumed strep pneumo meningitis?
ceftri and vanc until sensitivities come back
What type of meningitis is associated with HSV2 genital infection?
aseptic meningitis
What sx are associated with aseptic meningitis?
recurrent episodes of fever, vomiting, and photosensitivity
Leuk count in bacterial meningitis?
1000-5000
What type of leuks found in bacterial meningitis?
predominance of neutrophils
What glucose level ass w/ bacterial meningitis? CSF to plasma glucose ratio?
= to 40. = to 0.4
Rash ass w/ acute HIV infection?
diffuse maculopapular eruption across chest, face, back, and UEs. could also affect palms and soles.
What disease has sx of recurrent painful oral & genital apthous ulcers, skin lesions, and uveitis, along with neurologic manifestations in 25% of pts?
Behcet’s disease
What leuk level ass. with Behcet’s disease?
<100 cells
What 2 agents are appropriate to administer within 48 hrs of ischemic stroke onset if pts don’t meet criteria for thrombolytic therapy?
325 mg aspirin and dipyridamole
What is time window AFTER SYMPTOM ONSET in acute ischemic stroke to see a benefit from rTPA admin?
4.5 hours
What is time window AFTER HOSPITAL ARRIVAL in ischemic stroke to see a benefit from rTPA admin?
1 hour (withhold antiplatelet agents for 24 hours post)
What’s the word for when the muscles you use for speech are weak or you have difficulty controlling them? comes with slurred/slowed speech
dysarrthria
What scoring system to eval peeps with probable TIA for admission?
A- >60 yo B- BP > 140/90 C- clinical sx (hemiparesis) D^2- duration, presence of DM >3 --> hospital admission
BP level required before thrombolytic therapy for stroke administered?
185/110 (180/105 goal for 24 hrs after that)
What is it called when damage to posterior parietal cortex causes individual to have difficulty with the motor planning to perform tasks or movements when asked?
apraxia
What is the name for the reflexive rolling upwards of the globe during eye closure?
bell phenomenon
How to treat bell palsy?
prednisone, 40 mg/day, pref initiated in first 72 hrs
What glucose level w/ 2-hour glucose tolerance test is diagnostic for impaired glucose tolerance?
140-199
What glucose level w/ 2-hour glucose tolerance test is diagnostic for diabetes?
> 200
What test to perform in pts with acute/progressive neuropathy or polyradiculoneuropathy, and also in pts with severe weakness, sensory loss, or absent DTRs?
LP to R/O guillain barre and chronic inflamm polyradiculopathy; also infectious viral causes
What does CSF look like in Guillain barre?
normal cell count, elevated CSF protein
Initial tx for essential tremor?
“lifestyle modifications”
Pharmacologic management of essential tremor?
beta-blockers, anti-convulsants like primidone
Pharmacologic order of operations in status epilepticus?
IV lorazepam –> fospheny–>phenobarb if the others don’t work. Can substitute Valproate for fospheny, but has infusion rate limitations and longer onset of action
