PULM PANCE Flashcards
Tactile fremitus is what in pneumonia
increased
Tactile fremitus is what in pleural effusion
Decreased
Pneumonia and egophony
Consolidation would make an AY sound when you speak EE
Contraindications for lung resection in lung cancer
Distant metastasis
Klebsiella Pneumonia treatment
Cefotaxime
DM, Drinker
Mycoplasma pneumonia findings
Cold agglutinin Positive
Bilateral hilar infiltrates
When to give a Patient with COPD ABX
with an increase in sputum production
(indicates likely infection)
Immunocompromised patient with Legionella pneumonia Tx
First line Macrolide
If failed
Rifampin
Pneumo vax 23 Dosage Age
They get it at 65 once
If they received it prior to 65, must wait five years and get a second dose
i.e. if got it at 64, then they get second dose at 69
ABG’s How to
7.4
40
Use Ph and CO2
Down and down is Metabolic acidosis
Up and Up is Metabolic Alkalosis
Always test for TB prior to beginning what med
Enbrel
(Etanercept)
What can reduce theophylline Levels in the body
Smoking
What is a side effect of bleomycin
Pulmonary fibrosis
Physical exam finding of pleural effusion
Unilateral Chest lag on inspiration
What PFT is decreased in COPD chronic bronchitis
FEV1/FVC ratio
What is Ghon complex associated with
TB
Key bronchiectasis finding
Dilated thickened airways
Tram track
What is seen in hypersensitivity pneumonitis
Diffuse nodular densities
HIV positive TB patient treatment
If PPD positive and CXR negative
Latent
Isoniazid and Rifampin only
If PPD and CXR are both positive
Active
RIPE
Pertussis Contacts prophylaxis
Macrolides
Everyone
Next step when new pleural effusion with no cause appears
Diagnostic Thoracentesis
Spirometry findings in Obstructive lung disease
Increased TLC
Decreased Vital capacity
Prolonged FEV1
Decreased FEV1/FVC ratio
Increased residual volume
If received the BCG TB vax what screening test is used
Blood test
PJP pneumonia with HIV tx
Bactirm
Acute Bronchiolitis
MCC Viral (RSV),
Viral symptoms for 1-2 days followed by Respiratory distress
usually under 2 years of age
Expiratory wheeze
Inflamed Tubes = Air bronchograms
Supportive, humid O2, Fluids
Hand Washing is key prevention
Epiglottitis ABX Tx
3rd Gen Cef
or
Vanc
After airway management
Bronchiectasis
MC Cystic Fibrosis - Pseudomonas
Non CF is H Flu
Lots of mucous
Cough
Hemoptysis
Thickened and dilated bronchioles
Tram track sign
Signet sign (Compressed pulmonary artery nex tot dilated bronchus)
High Res CT is preferred
Chest Physiotherapy
ABX - Macrolides, Cef, Augmentin, Fluoroquinolones
Surg
Multi Lobular Emphysema marker
Alpha Anti Trypsin
Sarcoidosis
Black
Hypercalcemia
Elevated ACE
Bilateral Lymphadenopathy
Non Caseating Granulomas
Honeycombing, Ground Glass
Lupus Perino - Violaceous Nodules on face (Chronic)
Pulmonary HTN
Right Heart Strain
Pulm Artery Pressure normal is 12
Over 25 is Pulm HTN
Swanz Ganz
RVH on EKG
Leads to Cor Pulmonale
Lasix and Nitro (redistributes fluid)
Bronchial Carcinoid Tumors
Flushing
Wheezing
Diarrhea
Cystic Fibrosis
Steatorrhea
ADEK Fat solubles (Not absorbed)
Chloride sweat test
Meconium ileus
Growth delays, lots of illness, sinusitis
Bronchiectasis
Pseudomonas
Pulmonary Fibrosis
Clubbing
Inspiratory crackles
Honeycombing
Ground Glass
Ventilators
Bleomycin
Amiodarone
Atypical Pneumonia
Legionella
Mycoplasma
Chlamydia
Coxiella
Psittoci
Slow Onset
Typical Pneumonia
MCAT
Strep Pneumo
Hemophilus Influenza B (HIB)
Staph A
Acute onset
Legionella
Atypical pneumonia
Hyponatremia
Diahrrea
Coxiella
Atypical Pneumonia
Q Fever
Livestock
Elevated LFTs’
MC Smoker pneumonia
Hemophilus Influenza B (HIB)
Urine tests for pneumonia
Legionella
Strep Pneumo
Curb 65
Confusion
Uremia (BUN >19mg/dl, >7mmol)
Resp >30
SBP <90, DBP <60
over 65
2 points iffy
3 is admitted
1 point for each
CAP ABX
No comorbidities
single treatment
Outpatient is Amoxicillin
can use doxy or macrolide
High risk or comorbidities ie DM
Dual treatment
Amoxicillin and macrolide (both)
Inpatient ABX is CEF
PJP Pneumonia Treatment
Bactrim
21 days
If CD4 count is low, can use prophylactically (<200)
Fungal Pneumonias
Coccidiomycosis Southwest
Blastomycosis NE Great lakes
Histoplasmosis Mississippi South east
Coccidiomycosis Location
Southwest
Erythema Nodosum
Fluconazole
Itraconazole
Blastomycosis Location
NE Great lakes
Skin verrucous lesions
Osteomyelitis
Itraconazole
Ampho B
Histoplasmosis Location
Mississippi South east
Bird/Bats
Can mimic Tuberculosis
Itraconazole
Ampho B
Pneumonia vaccine for peds
PCV 13
Pulmonary nodules under 3 cm
Usually Benign
(Can be Cx, if Cx MCC is adeno)
Small cell lung cancer
Central, Oat cell, paraneoplastic, Neuroendocrine
Can cause SIADH and Lambert Eaton
Hemoptysis
Tx
Radiation chemo combo
no surg
Non small cell cancers
MC is adeno
Squamous cell, large cell
SVC syndrome, Horner syndrome (both are large cell)
Pancoast
Smoking (squamous cell)
Lung cancer marker
CEA
Paraneoplastic
Lung nodule
endocrine problems
Carcinoid Syndrome
Flushing
Diarrhea
Lung nodule
Pan coast
Pain in shoulder
Mass in upper lobe
Lights criteria tranudative
Clear (transparent=transudative)
Protein under 0.5
LDH under 0.6
MCC’s HF, Cirrhosis, Nephrotic, PE
Lights Criteria Exudative
Cloudy (WBC)
Protein over 0.5
LDH over 0.6
Infection, cancer, PE, TB
Empyema imaging
CT
Usually post op day 4
Glucose number in pleural fluid likely autoimmune
under 60
under 0.5
Cor pulmonale
Lung problem causing right heart failure
RVH
PPD positive with Positive CXR
Active TB
RIPE 4 months
then R and I for 6 months
Active TB that is aymptomatic
Ghon complex
Secondary (reactivated) TB
Upper cavitary lesions
Night Sweats
Fever
Latent TB
Asymptomatic
Positive PPD
Negative CXR
R - 4 months
I - 3months
RIPE SIde effects
R - Orange secretions
I - Peripheral neuropathy (give B6)
P - Liver
E - Eyes
COPD exacerbation with worsening mucous
Give ABX
Macrolide
BB acceptable for asthma patients
B1
Esmolol
Atenolol
Metoprolol
Acute bronchitis
MCC Viral
5 days of cough
supportive care ( no steroids or abx)
Self limiting
MCC Adenovirus
Pertussis Phases
Catarrhal Phase 1-2 weeks (night cough)
Paroxysmal phase (cough,cough,cough, vomit) (whoop)
Convalescent
Pertussis diagnosis
PCR nasal pharyngeal wash swab
Pertussis peds under 4
Admit
Pertussis Peds over 4
Isolate until 5 days of abx
or
21 days of symptoms
Pertussis ABX
Azithromycin
can use bactrim if allergic
Pertussis contact prophylaxis
Azithromycin for all household contacts
CPAP/BIPAP containdication
Cannot protect airway
Cannot cooperate
RSV typical age
Under 5
Smoker Screening age
ages 50-80
with 20 pack history
currently smoke or quit with 15 years
Low dose CT annually
Basic asthma tx first 3 lines
Albuterol
ICS
LABA (salmeterol)
Squamous cell lung cx location
central
Often involves bronchus
Associated with smokers
Loeffler syndrome
Pulmonary symptoms
Low grade fever
Sputum
Wheezing
Cough
Increased IGE and eosinophilia
Seen in hookworm
(recent Travel to endemic countries)
Churg Strauss
Eosinophilic Granulomatous Polyangitis
Males over 40
Necrotizing granulomatous
Upper airway, Asthma
Eosinophils
Asthma
P-ANCA
Tx Steroids
Cyclophosphamide
AZA
Wegeners
Granulomatous Polyangitis
Upper airway Necrotic
AGN
C-ANCA
elevated CRP, ESR, Anemia
Tx Steroids
Cyclophosphamide
Emphysema is destuction of what
Alveoli
DLCO and empysema
used to distinguish between Chronic Bronchitis and emphysema
decreased in emphysema
number of exacerbations in year
gold spirometry score
MMRC
Cat score
COPD Class A
1 exacerbation in year
Cat score minimal
Gold spirometry Mild
SABA albuterol
or Ipratropium SAMA
COPD Class B
1 exacerbation in year
High symptoms
low exacerbation
Gets LAMA (tiotropium)
or LABA with ICS (Salmeterol +ICS or Formoterol +ICS)
(ICS - Mometasone, Budesonide, Fluticasone)
Should already be on
SABA
ICS
COPD Class C
Low daily symptoms
Severe exacerbations
Gets LAMA (tiotropium)
or LABA with ICS (Salmeterol +ICS or Formoterol +ICS)
(ICS - Mometasone, Budesonide, Fluticasone)
Should already be on
SABA
ICS
COPD Class D
2 or more exacerbation in year
high symptoms = CAT >10
Severe = Gold score of 4
Class D Gets LAMA (tiotropium)
or LABA with ICS (Salmeterol +ICS or Formoterol +ICS)
(ICS - Mometasone, Budesonide, Fluticasone)
Should already be on
SABA
ICS
Trelegy
COPD Medications
-SABA
Albuterol
Not for peds under 4
COPD Medications
-SAMA
Ipratropium
COPD Medications
-LABA
Formoterol (quicker)
Salmeterol
Must have ICS also
COPD Medications
- ICS
Mometasone
Budesonide
Fluticasone
COPD Medications
-LAMA
Tiotropium
COPD Medications
-Combivent
Albuterol (SABA)
Ipratropium (SAMA)
COPD Medications
-Advair diskus
Fluticasone (ICS)
Salmeterol (LABA)
COPD Medications
-Symbicort
Budesonide (ICS)
Formoterol (LABA)
COPD Acute exacerbation
Quick - SAMA, SABA, or combivent (together)
Albuterol, Ipratropium
Oral prednisone
BIPAP
ABX if increased sputum production
Theophylline contraindication
don’t use for Acute exacerbation
O2 for COPD
under 88%
PAO2 under 55
Long term O2
Gold standard for COPD
PFT (FEV1 or ratio)
PFT FEV Under 70 methacholine challenge
then give albuterol
if increase by 12 or more
not COPD
COPD Exacerbation ABX
> 65
Looks sick
Increased sputum
gets azithromycin and prednisone
Metabolic disorder associated with Chronic emphysema
Respiratory Alkalosis
ARDS
Diffuse inflammation of lung
Trauma, Drowning, Aspiration, Pancreatitis, Sepsis (gram neg)
Can lead to Multi system organ failure and death
Severe hypoxia refractory to O2
CXR Diffuse bilateral Pulmonary infiltrates
(similar to CHF but Spares costophrenic angles)
PCWP <18 = ARDS
PCWP >18 Cardiac pulmonary edema (CHF)
CPAP/BIPAP (low tidal volume)
Hospital Acquired Pneumonia treatment
Cover pseudomonas
Piper taz
or Fluoroquinolone
Cryptococcus
Pacific Northwest
India Ink Stain
HIV positive
Bird droppings
Meningoencephalitis MCC fungal meningitis
Ampho B + Fluconazole
SVC syndrome
Fat face (plethora)
JVD
Lump obstruction SVC
CT
Diuretics to reduce fluid in SVC
Surgery, Radiation Etc
Paraneoplastic syndorme
Cancer plus endocrine problems
Small cell
SIADH, Clubbing, Hypercalcemia, Cushings
Treat underlying cause
Lambert Eaton
Lung cancer plus neuromuscular dysfunction
Bad DTR’s get better with exercise
Treat underlying cause
Pancoast
Shoulder pain
Upper lobe mass (Superior sulcus of lung)
Horner (ptosis)
weakness and atrophy of hand and arm
Non Small Cell
What is 5 HIAA used to diagnose
Carcinoid syndrome
2 most common causes of hempotysis
Acute bronchitis
Bronchogenic Carcinoma
C ANCA is associated with what Vasculitis
Wegeners
Granulomatous with poly angitis
P ANCA is associated with what Vasculitis
Churg Struass
Eosinophils
Endospores are associated with what fungal pneumonia
Coccidomicies
Paramyxovirus - disease
Measles
Togavirus - disease
German measles
Herpes virus - Disease
Roseola
Parvovirus - Disease
Fifth disease
Parvovirus - Disease
Fifth disease
Ziehl Neelson Positive
MAC
Mycoplasma avian complex
