Pulmo 1 Flashcards
Treatment of lung abscess
- Ampicillin-sulbactam is considered first-line therapy.
- Clindamycin is reserved for those with beta-lactam allergy due to high risk of subsequent Clostridioides (formerly Clostridium) difficile infection.
- A prolonged course is indicated; surgical intervention (eg, pneumonectomy, lobectomy) may be required in the rare cases that do not improve with antibiotic therapy.
Lung abscess diagnosis made by
Chest x-ray and CT scan typically reveal cavitary infiltrates, often with air-fluid levels in the superior lower lobe or posterior upper lobe (sections that are dependent with recumbency).
Oxygenation in mechanically ventilated patients may be improved by increasing the __________
fraction of inspired oxygen (FiO2) or increasing positive end-expiratory pressure (PEEP).
If high levels (>60%) of FiO2 are required to maintain oxygenation, _____ should be increased to allow for reductions in the FiO2 as oxygenation improves.
PEEP levels
Metabolic abnormalities in obesity hypoventilation syndrome
chronic hypoxia and hypercapnia.
the kidneys increase bicarbonate retention and decrease chloride reabsorption (via bicarbonate-chloride exchangers in intercalated cells of the distal nephron) to create a compensatory metabolic alkalosis.
______ and _____ are associated with poor prognosis in PE.
Low oxygen saturation and atrial fibrillation
_________ are the most common symptoms of Pulmonary embolism
Acute-onset dyspnea and pleuritic chest pain
classic findings of PE on ECG and chest x-ray
(prominent S in lead I, Q in lead III, and inverted T in lead III [S1Q3T3])
(Hampton hump, Westermark sign)
_______ is associated with PE;
Pathopgysiology:
Atrial fibrillation
some cases may result from atrial strain due to increased right atrial pressure
________ may occur in the post-ictal state.
Hypoventilation → respiratory acidosis
A _____ year interval is generally recommended for screening colonoscopy in hyperplastic polyp
10-year as there is no increased risk of it being converted into cancer
Recommendation for screening for abdominal aortic aneurysm
One-time screening for abdominal aortic aneurysm with an abdominal ultrasound is recommended for men age 65-75 who have ever smoked (lifetime tobacco use ≥100 cigarettes).
Recommendations for lung cancer screening
Recommended test
Recommended interval
Low-dose chest CT scan
Yearly
Recommendations for lung cancer screening
Age for screening
55-80
Recommendations for lung cancer screening
Eligibility
Patient has ≥30-pack-year smoking history
AND
Patient is a current smoker or quit smoking within the last 15 years
Invasive pulmonary aspergillosis is characterized by the classic triad of .
fever, pleuritic chest pain, and hemoptysis
Invasive pulmonary aspergillosis Diagnostic testing includes
serum biomarkers for cell wall components (eg, galactomannan assay)
and
sputum stain/culture.
bronchoscopy with bronchoalveolar lavage (BAL) and biopsy are required if noninvasive testing (eg, sputum stain/culture) is inconclusive.
Invasive pulmonary aspergillosis treatment
Patients are treated with 1-2 weeks of intravenous voriconazole plus an echinocandin (eg, caspofungin)
and then
transitioned to prolonged therapy with oral voriconazole alone.
______ is the second most common cause of adrenal insufficiency worldwide
Tuberculous adrenalitis
If an immunocompromised patient (on prednisone) with community acquired pneumonia has a normal CXR then what is next best step?
high-resolution CT scan of the chest to identify pulmonary infiltrate.
__________is characteristic of bronchiectasis due to CF and helps differentiate it from bronchiectasis due to other causes.
upper lung lobe involvement
pleuritic chest pain and hemoptysis in PE is due to
Pulmonary infarction - inflammation and irritation of the lung parenchyma and adjacent visceral and parietal pleura
A 2/6 midsystolic murmur is heard at the left upper sternal border
Fever induces a hyperdynamic state, which most likely accounts for this murmur (flow murmur).
Pneumonia causes hypoxemia due to __________
right-to-left intrapulmonary shunting, a form of ventilation/perfusion (V/Q) mismatch
The criteria for initiating long-term home oxygen therapy (LTOT) in patients with COPD include:
Resting arterial oxygen tension (PaO2) <55 mm Hg or pulse oxygen saturation (SaO2) <88% on room air
PaO2 <59 mm Hg or SaO2 <89% in patients with cor pulmonale, evidence of right heart failure, or hematocrit >55%
The dose of supplemental oxygen should be titrated so that SaO2 is maintained at
> 90% during sleep, normal walking, and at rest.
Survival benefits of home oxygen therapy are significant when it is used for
> 15 hours a day.
Tidal volumes should be about
6 mL/kg of ideal body weight
In patients taking diuretics, ________ is often used as an indicator of decreased renal perfusion.
low fractional excretion of urea (eg, <35%)
Chest x-ray is not diagnostic for bronchiectasis but can reveal suggestive findings such as
linear atelectasis, dilated and thickened airways, and irregular peripheral opacities
A high-resolution CT (HRCT) scan of the chest, the best diagnostic test for bronchiectasis, can demonstrate
characteristic bronchial dilation, lack of airway tapering, and bronchial wall thickening.
