Pulm Flashcards
self-limited upper airway infxn
cough > 5 days
myalgia + low fever
prolonged expiration
acute bronchitis
MC viral
bacterial - pertussis, mycoplasma, chlamydia
tx: supportive
kid < 2 w/ wheezing
bronchiolitis (RSV) nasal suction \+/- bronchodilator steroids Ribavirin
HIGH fever
sore throat out of proportion to phayngititis
odynophagia, muffled voice
epiglotitis
stridor, tripoding, retractions
“thumb sign”
tx: rocephin + vanc
inspiratory stridor worse at night
low grade fever
abrupt barking cough
croup
parainfluenza
“steeple sign”
tx: glucocorticoids, epi
single-stranded RNA
high fever + chills + myalgia
winter months
flu
can cause atypical pneumonia in pts w/ pre-existing dz
rapid flu - low sensitivity, high specificity
tx: neuroaminidase inhibitors (tamiflu, zanamivir kids > 7)
cough > 14D
no fever
post-tussive vomit
whoop
pertussis: gram- coccobacillus
tx: macrolide
bacterial causes PNA
s pneumo
h flue
klebsiella
m cat
atypical causes PNA
legionella
mycoplasma
chlamydia
fungal PNA southeast US
blastomycosis
fungal PNA San Joaquin Valley/California
caoccidiodes
fungal PNA Mississippi River Valley
histoplamsa
MCC PNA COPD
Haemophilus
MC PNA w/ exposure to birds
chlymdia psittaci
MC PNA post viral infxn or IV drug use
S aureus
CXR typical vs atypical PNA
typical - lobar
atypical - interstitial
outpt tx PNA
macrolide
doxycycline
outpt tx PNA recent abx or chronic dz
levofloxacin, moxifloxacin
amoxicillin + azith
inpt tx PNA non-ICU
levo, moxi
amoxicillin + azith or doxy
inpt tx PNA ICU
levo, moxi + azith
tx PNA + allergy to PCN
levo + aztreonam
obligate intracellular acid fast bacillus
cavitary lesions in lung apices
TB
sputum smear AFB, confirm w/ PCR
BCG vaccine testing
interferon gamma release assay (IGRA)
tx latent TB w/ negative CXR
isoniazid x 9mon
skin flushing + exposive diarrhea + PNA/coughing/hemoptysis
carcinoid tumors
check 5HIAA urine
serum tumor marker chromogranin A
tx: antidiarrhea, avoid trytophan foods
humoral hypercalcemia of malignancy
squamous cell makes PTH-related protein
lung mass vs nodule
mass > 30mm
serial CT chest scans
Fleishener guidelines determines CT follow up
reversibility on PFT
improves by 12% AND increases by 200mL
gold staging
mild: FEV1> 80
moderate: FEV1 50-80
severe: FEV1 30-50
very severe: FEV1 < 30
when to use O2
sats below 88% or desats on 6 min walk test
tx COPD
mild: SABA
moderate: anti-cholinergic (tiotropium)
severe: inhale steroid
very severe: lung transplant/O2
3 hallmarks of asthma
outflow obstruction
bronchial hyper-reactivity
inflammation of airway
tx asthma
SABA –> ICS –> ICS + LABA –> higer dose ICE/LABA –> steroid
permanent and abnormal dilation of bronchial walls from chronic infxn/inflamation
bronchiectasis
CT = tram tracks
chronic cough
tx: guiafinesin, CPT
autosomal recessive
chronic cough, clubbing
pancreas cysts = malabsorption/constipation
infertility in men
CF
pilocarpine sweat test
tx: CPT, digestive enzymes, insulin
ssx pleural effusion
fullness to percuession
diminished breath sounds
decreased tactile fremitus
DOE/orthopnea, PND
transudate vs exudate cause effusion
transudate = high hydrostatic forces or low oncotic pressure exudate = capillary permeability s/t inflammation
light’s criteria
P/S protein > 0.5
P/S LDH > 0/6
LDH > 2/3 upper normal limit for serum
unilateral CP
hyper-resonance
tachy
SOB
pneumo
sx 6mon-2 years progressive SOB non-productive cough velcro-like crackles clubbing
idiopathic pul fibrosis
CXR = honeycombing + reticulonodular infiltrates
tx: O2, steroids - nor real good txl mean survivial 3-7 years
caused by build up of mineral dust in the lungs
pneumoconiosis
pleural plaquex on CXR
asbestos
egg shell calcifications on CXR
silicosis
skin lesions + granulomas + hypercalcemia
berylliosis
tx: steroid
diffuse lung injury
PaO2/FiO2 < 300
bilateral infiltrates
respiratory infiltrates not explained by cardiac failures
ARDS
causes: PNA, aspiration, inhalation injuries, sepsis, pancreatitis, drug OD
tx ARDS
low TV, high PEEP
