Pulm Flashcards
CHF, cirrhosis, nephrotic syndrome cause this type of pleural effusion
Transudative
Local infx/ inflammation causes this type of pleural effusion
Exudative
Lights criteria for exudative pleural effusion:
Pleural fluid protein : serum protein > 0.5
Pleural fluid LDH : serum LDH > 0.6
Or
Pleural fluid LDH > 2/3 the upper limit of normal LDH
Other findings with exudative effusion:
Glucose < 60
Protein >3
WBC < 1000
LDH > 200
Findings with transudative effusion :
Glucose > 60
Protein < 3
WBC < 1000
LDH < 200
MC sx of pleural effusion
What do you hear on heart/lung PE
What do you see on XR
Pleuritic CP
Dec breath sounds, dull to percussion, friction rub
+ menisci, blunting of costophrenic angles
Best XR for pleural effusion
Lat decubitus
Gold standard tx for pleural effusion
Thoracentesis
Where do you place a chest tube
2nd ICS at MCL
Typical pneumonia organisms X4
S pneumo
H inf
Klebsiella
S aureus
Atypical pneumonia organisms X4
Mycoplasma (assoc w ear infx)
Chlamydia
Legionella
Viral
Rusty blood sputum
S pneumo
Currant jelly sputum
Klebsiella
Green sputum
H inf, pseudomonas
Foul sputum
Anaerobes
Outpatient tx of CAP
Macrolide or doxy
Inpatient tx of CAP
Macrolide or doxy
+
B-lactam
OR
FQ
ICU tx of CAP
Macrolide
+
B-lactam
OR
Macrolide
+
FQ
5 Blactams with pseudomonal coverage (*use if hospital acquired pneumonia)
Cefepime Imipenem Meropenem Piper/tazo Piperacillin
2 other classes for pseudo tx?
FQ
AG
How to treat aspiration pneumonia
Think: anaerobes usually
Clinda or augmentin
+- flagyl
TB treatment course in depth
4 drugs x 2 months
Then
2 drugs x 4 months
RIF + INH + PZA + ETH/STM
then
RIF + INH
Decreased platelets
Orange secretions
S/E of
Rifampin
Hepatitis, neuropathy
S/e of
Isoniazid
What vitamin do you give with isoniazid
B6
Hepatitis, gout, GI sx, sun rash
S/e of
Pyrazinamide
Optic neuritis
S/e of
Ethambutol
Ototoxic
Nephrotoxic
S/e of
Streptomycin
What is the tx for latent TB
INH + PZA x 9-12 mos
What sort of a patient would you treat for latent TB
No sx
PPD+
CXR -
TB skin test mm with no risks
15mm
PPD is >5mm induration. In what populations is that +
HIV+
Recent contact with TB
Evidence of TB on cxr
Immunecompromised on steroids
> 10mm PPD is positive with??
Immigrants IVDU Lab personnel/HCP Group settings/prisons Certain med conditions or <4yo
