Pulm Flashcards
Spontaneous Pneumothorax
- treatment
- stable and >3 cm or symptomatic : needle aspiration
- persistent leak: tube thoracostomy
Foreign body aspiration
- Classic triad of sx
- coughing
- diminished breath sounds
- wheezing
Foreign body aspiration
- mgmt
removal with rigid bronchoscopy
Acute asthma exacerbation
- mgmt
- O2 and inhaled bronchodilators/anticholinergics (beta agonist, ipratroprium)
- systemic glucocorticoids
- if still sx: 2 grams IV mg
- then consider intubation
RSV
- RF for developing lower respiratory tract infection
- down syndrome
- significant asthma
- chronic pulm disease
- immunocompromised
- institutionalized
RSV
- RF for increased risk of bronchiolitis
- born <36 weeks gestation
- cardiopulmonary dz
- older siblings
- second hand smoke exposure
RSV
- treatment
- Nonsevere: nasal suctioning, hydration
- Severe: ? bronchodilator, heated humidified high-flow nasal cannula, CPAP, intubation
Pneumonia
- PE
- increased tactile fremitus
- diminished lung sounds
- bronchial lung sounds
- crackles
- egophany
Pneumonia
- XR findings
- patchy lung infiltrate
- lung consolidation
Pneumonia
- CAP treatment
- doxycycline or macrolide
- abx in 3 months or comorbidities: augmentin + macrolide or doxy
Aspiration pneumonia
- prevention for those at risk (stroke, etc.)
- thickened fluids
- feeding upright
- proper oral hygiene to reduce oral bacteria present
- don’t rush feeding time
Pulmonary nodule
- dx first line
- dx next steps
- CXR
- CT without contrast
Solitary pulmonary nodule
- size
- <3 cm
> 3 cm is considered pulmonary mass
Most common cause of hemoptysis
bronchitis
TB
- dx
- screening with PPD
- definitive with positive acid-fast bacillus sputum stain
TB
- mgmt
- 2 months 4 drugs
- 4 months 2 drug (isoniazid and rifampin)
What vitamin is co-administered with isoniazid to reduce risk of peripheral neuropathy?
Pyridoxine (B6)
Legionella pneumonia
- mgmt
Abx: azithromycin, levofloxacin, doxy
Bordetella pertusus
- what kind of bacteria
gram-negative coccobacillus
Blastomycosis
- describe
- Widespread, systemic pyogranulomatous infection due to the inhalation of fungal Blastomyces dermatitidis and Blastomyces gilchristii.
- midwest and souther US
Blastomycosis
- three most common clinical presentations
- Pneumonia (MC)
- Skin - verrucous lesions, irregular border, gray/violet color (looks like squamous cell)
- Osteomyelitis
Blastomycosis
- dx
- culture
- histopathology
- serologic testing
- PCR
Blastomycosis
- tx
- amphotericin B
- Itraconazole
Who should be tested for lung cancer
- Adults 55-80
- 30 year hx smoking who currently smoke or quit within last 15 years
- dc screening once has not smoked in 15 years or health problem that diminishes their life expectancy
Pneumocystis jirovecii pneumonia
- mgmt
Bactrim
PCV13
- recommended for whom?
- children <2
- adults >=65
- 2-64 with issues
PPSV23
- recommended for whom
- Adults >=65 (one year after PCV13)
- Children >2 with RF for pneumonia
- 19-64 who smoke, chronic disease
Coin in trachea
- appearance on XR
AP: sliver
Coin in esophagus
- appearance on XR
AP: circle
Histoplasmosis
- location
- Ohio and Mississippi river valleys
- spelunkers, caves, bat and bird droppings
Histoplasmosis
- clinical
- usu asx
- disseminated infection in immunocompromised
- primary infection: flu like
- chronic infection: TB like
Histoplasmosis
- Dx
- Tx
- culture
- itraconazole, amphotericin B
Nosocomial PNA
- org to consider
- abx
- pseudomonas
- imipenem, gentamicin, vancomycin
Outpatient CAP
- pharm
Macrolide or doxy
CAP with chronic dz, immunocompromised, abx in last 3 months
- pharm
- Resp FQ
- Beta-lactam + macrolide/doxy
HAP Pharm
- no multi drug resistance RF
- yes multi drug resistance RF
- MRSA RF
- beta-lactam, ertapenem, resp FQ
- antipseudomonal beta-lactam or carbapenem + resp FQ
- add vanc
Coccidioidomycosis
- location
SW USA (arizona, New Mexico, central/souther CA, western TX)
Coccidioidomycosis
- clinical
- acute pulm infection
- CP, cough, dyspnea, hemoptysis, fever, fatigue
- hilar and mediastinal lymphadenopathy
- HA, pharyngitis, arthralgia, erythema nodosum
Coccidioidomycosis
- mgmt
- azoles
Lung abscess
- RF
- aspiration
- reduced level of consciousness (etoh, drugs, general anesthesia, head trauma)
- dysphagia
Lung Abscess
- sx
- indolent that develop over weeks/months
- fever, cough, SOB, foul smelling sputum
- systemic sx (night sweats, weight loss)
Lung abscess
- imaging
- XR: pulm infiltrates with cavity and air fluid level
- CT for more detail
Lung abscess
- dx
- imaging
- sputum gram stain/culture
lung abscess
- mgmt
- ampicillin-sulbactam
- carbapenem
- betalactam allergy: clindamycin
