pulm Flashcards
when do you NOT tap a pleural effusion
too small ( <1 cm)
loculated
CHF
exudative effusion assoc with…..
malignancy
TB
PNA
asthma diagnosis with PFTs
FEV1 inc by 12% with albuterol (200 ml inc)
FEV1 dec by 20% with methacholine
TLC is inc in COPD because of…..
inc in residual volume
how would you treat an asthma and COPDer not controlled on albuteral differently?
asthma –> ICS
COPD –> anticholinergic (ipratropium, tiotropium) –> ICS
most likely presentation of bronchiectasis
- recurrent episodes of very high volume purulent sputum production
- mostly related to CF
MUST be dx with CXR or CT –> “tram tracks”= thickened bronchi
bugs not gram stainable in PNA
mycoplasma
chlamydophila
legionella
coxiella
**also generally assoc with DRY COUGH and BILATERAL infiltrates
PNA tx for previously healthy/ no recent abx use?
macrolide or doxy
PNA tx for comorbidities or abx in last 3 months?
resp FQ –> levo or moxi
how can you use vitals to quikcly differentiate croup from epiglotitis?
croup= dec O2 sat (if mild, give steroids; if severe, give raecemic epi)
epiglottitis= impending dec O2 sat
management of epiglottitis
INTUBATE
- -> ceftriaxone 7-10 days
- —–> rifampin for close contacts
empiric therapy for retropharyngeal abcess
iv amp sul
MOST COMMON CAUSE OF CAP INCLUDING HIV PATIENTS (WITH GOOD CD4 COUNT)
strep pneumo
ludwigs angina
rare, often fatal, soft tissue neck infx (cellulitis)
predisposing factors: otodontic infx and diabetes
when should you get a PET for lung nodule?
> 1cm
pulm nodules are evaluated with Chest CT!! no xray.
most common lung cancer in smokers
Squamous
sCuamous cell –> Ca!!
what skin finding can be associated with mycoplasma PNA
erythema multiforme
positive PPD with negative chest xray?
9 months INH
when do you do sx tx in croup vs racemic epi?
racemic for moderate to severe –> stridor at rest, retractions
most common bugs in bacterial rhinosinusitis
h flu
strep pneumo
pavalizumab
monoclonal RSV antibody that supplies passive immunity to AT RISK babies (premies with BPD)
pseduomonas is a grem negative rod?
yes
hyponatremia, patchy bilat cxr, diarrhea?
legionella
tx with FQ or macrolide
tissue dense upper lobe mass seen on CXR that can be moved with change in position?
chornic pulmonary aspergilloma that has seeded in an old TB cavity
+galactomannin test
erythromycin in infants less than one?
can cause hypertrophic pyloric stenosis
***ie use azithromycin for pertussis
Pleural effusion: ADA, Triglycerides
TB, chylothorax
three things that can acutely change plateau pressure in ICU?
pneumo (deep sulcus sign on CXR)
pulm edema
abdominal compartment syn
what are CURB65 criteria
Confusion Urema (BUN>30) Resp distress BP (systolica < 90) >65 yo
define HAP
PNA 48 hours after admission or with in 90 days of hospitalization
more likely to be GNR rods!! –> e coli, PSA
best antibiotics for lung abscess
clinda, pen
PCP PNA
- dx
- tx
- alt tx
dry cought, bilat infiltrates in patient with CD4 <200
-dx: LDH is always elevated!!
tx: TMP/SMX
- –> add steroids if severe
- ——–> use atovaqonue, dapsone or clinda/ primaquine if sulfa allergy
* *cannot use dapsone in G6PD
what are adverse effects of TB tx?
rifampin –> red body secretions (benign)
isoniazid –> peripheral neuropathy (use pyridoxine)
pryainamie –> hyperuricemia (tx if symptomatic)
ethambutol –> optic neuritis/ color vision (decrease dose in renal failure)
***they all raise LFTs! only d/c if 3-5x upper limit of normal
most approp next step in the high risk or “intermediate” pulm nodule
high risk= resect!!
intermediate –> sputum cytology, bronchoscopy (central), transthoracic needle bx (peripheral)
pres and work up for restrictive lung dz
look for PE signs like loud P2
clubbing of the fingers
high resolution CT scan is better than Xray but lung bx is the best
in ILD, granulomas are seen in bx of…..
berylliosis (assoc with electronics)
tx with steroids!! this is the most likely pneumoconiosis to respond (albeit just a little)
you can also try azathioprine
sarcoidosis can present with and is best treated by?
SOB with non productive cough
- erythema nodosum and lymphadenopathy!!
- parotid enlargment
- faicla palsy
- heart block, restrictive cardiomyopathy
- CNS
- uveitis
tx with prednisone
indicatoins for IVC filter
- CI to to use of anticoagulants (CNS bleed, GI bleed)
- reccureent emboli on NOAC
- RV dysfunciotn on echo
indications for thrombolytics in PE?
hemodynamically unstable
acute RV dysfunction
parameters sufficient for lobectomy in lung cancer?
FEV1 >1.5L
DLCO >60% of predicted
consider wedge resection if above are below cut offs
unilateral foul smelling nasal discharge with no other sx in a young child
foreign body
order of surgical W’s
w1nd (12-48 hours)
wa2er (day 3 UTI)
wound
walking (7-10 days)
order of mechincal ventilation vs surgery in CDH
intubate, stabilize, operate at 24-48 hours
in V/q mismatch, Aa grad…….
in alveolar hypovent, Aa grad…..
increase!
stays the same
signs and sx of hemothorax
dullness to percussion, tracheal dev to other side, tachy, hypotension, FLAT neck veins
initial steps to take in hemoptysis
place bleeding lung in dependent position
–> bronch to locate/ stop bleed
penetrating trauma with object still in place:
surgery
60% of patients with flail chest who are NOT responding to O2 supplement
intubate –> PPV!
PPV has a splint effect on the flail segment, and pain prevents deep adequate resps
diffuse patchy infiltrate on CXR after blunt trauma to chest that gets WORSE with fluids
pulmonary contusion –> damaged vasculatre
physical location of croup
narrowing of subglottic larynx
how to tell OHS from OSA
elevated bicarb!! with diurnal hypercapnia and resp acidosis suggests that the problem is chronic
explain mech for cor pulomale
in COPD, chronic hypoxia leads to hypoxic vasoconstriction which increases PVR and overtime leads to R heart failure
lung disease pattern seen in diffuse systemic sclerosis?
restrictive! decreased diffusion capacity
asbestosis
shipyard workings
FIRST BRONCHOGENIC CARCINOMA
then mesothelioma
first step in management of RDS in neonate
CPAP to inc peep!!
if that fails, intubate and give surfactant
magnesium in asthma?
only used in acute exacerbations after several FAILED rounds of albuterol while you wait for steroids to kick in
it helps relax muscles and reduce vasoscpasm
samter’s triad
astham/bronchosinusitus + nasal polyps + ASPIRIN!!! ghat causes a PSEUDO allergic (pseudo type 1 hypersensitivity)
hypercalcemia in SqCC of the lung?
paraneoplastic syndrome –> PTHrP –> inc PTH –> inc Calcium, decreased phosphate
**this is the only paraneoplastic syn assocaited with SQUAMOUS. the others are assoc with small cell
non allergic asthma
gnerally presents >age 40, triggered by viral illnesses and exercise
probably in a COPD like picture
infant that turns blue with feeding and pink when crying?
think choanal atresia (bony or membranous obstruction of nasal passages) –> can only breathe through their mouth
bilateral presents immediately!!
unilateral can come in childhood
when does surfactant completely develop?
34 weeks –> on CXR, see diffuse reticular opacities with air bronchograms
non smoker women are most likely to get what cancer
adenocarcinoma
describes correlations of glucose levels in pleural effusions
> 60= normal
30-60= TB, malignant effusion, etc
<30= empyema or rheumatoid pleurisy
paraneoplastic syndrome of SMALL cell lung cancer
SIADH
ACTH
Lambert Eaton
Cerebellar degeneration
diagnostic confirmation of sarcoidosis is with…?
lung bx showing non caseating granulomas
