PULMONARY Flashcards
Abx tx of peritonsillar abscess
Augmentin or Clindamycin
Abx tx of acute bacterial sinusitis
Amox or Augmentin
Cephalosporins > FQ or Bactrim > Macrolides
MCC of PNA in newborn
GBS > E. coli
Tx of PNA in newborn
Amp + gent +/- vanco
Tx of chlamydia PNA
Erythromycin
MCC of PNA in 1-4 month old
RSV, Chlamydia
Tx of PNA in 1-4 month old
Macrolide +/- cefotaxime
MCC of PNA in 4m-4yr old
RSV or other virus, S. pneumo
Tx of PNA in 4m-4yr old
Amox or amp
MCC of PNA in 5-15 yr old
S. pneumo > Mycoplasma
Tx of PNA in 5-15 yr old
Amox + clarithro/erythro
Azithro
Amox + doxy
Populations more likely to get PNA
Alaskan Native or from certain native american populations
Tx for pseudomonas PNA
Antipseudomonal beta lactam for at least 2 weeks along with:
Antipseudomonal quinolone (cipro or levo)
Aminoglycoside + azithro
Aminoglycoside + cipro/levo
Antipseudomonal beta lactams
pip-tazo, cefepime, imipenem, meropenem, aztreonam
Random lab level that should point you to possible PCP PNA
LDH level usually >220, and a rising LDH despite appropriate tx portends a poor prognosis
PCP PNA tx
21 days of: TMP SMX Pentamidine Trimetrexate + leucovorin Primaquine + Clinda
DDX for ground glass opacities (diffuse hazy infiltrate)
Interstitial PNA PCP Pulm edema Pulm hemorrhage Hypersensitivity pneumonitis
Common cause of PNA in immunocompromised pts
PCP
Often cause of PNA in a pt with hx of exposure to bats and bat droppings
Histoplasma
Often cause of PNA in pt who has recently visited SC, New Mexico, or West Texas
Coccidioides
MCC of PNA in children
RSV
Common cause of PNA in pts with other health problems
Klebsiella
MCC of viral PNA
RSV, H influ is #2
Common bacterial cause of COPD exac
H. influenzae
Common PNA in ventilator pts and those with CF
Pseudomonas
Pontiac fever
Legionella
Cause of PNA in 80 y/o with gram - rods
E. coli
Cause of PNA in neonate with gram + cocci
GBS
Goal CVP in patient with ARDS
4-6 H2O
Hb level that you’d transfuse blood in ARDS patient
Only if drops below 7 as transfusion may increase risk of death in ARDs patient
Tx for atypical pneumo
Macrolide
Causes of a high A-a gradient
Having a hard time getting oxygen to alveoli.
PE, pulm edema, R–>L vasc shunt, high inspiratory O2 fraction
In a patient with pulm edema, how can PCWP distinguish dx of ARDS from cardiogenic edema?
PCWP 18, likely cardiogenic.
What should you look for in patient with pulm hemorrhage?
Most likely due to drug use
Drug that has been known to cause hypersensitivity PNA
Methotrexate
3 conditions that cause acidic pH in pleural effusion
empyema, TB, malignancy
When do you see high TG levels in pleural effusion?
Thoracic duct rupture
Lights criteria
Serum: effusion protein ratio >0.5
Serum: effusion LDH ratio >0.6
Effusion LDH > 2/3 ULN LDH
Which portion of breathing cycle is ventilator driven?
Inspiration
MCC of croup
Parainfluenzae viruses 1 and 2
Steeple sign
“subglottic narrowing” .. seen in Croup
In cases of suspected epiglottitis, when should you examine throat?
ONLY in places where immediate intubation is available as examination can cause further resp distress and resulting occlusion.
Swollen, opacified epiglottis that partially obstructs airway
Thumbprint sign seen in epiglottitis
Kiddos with bronchiolitis are at increased risk for developing?
Asthma
Most common fatal autosomal recessive disorder in US?
CF
Rx that aids in decreasing viscosity of secretions in CF
DNase
What is the CURB 65 crieteria
Confusion Urea > 20 mg/dL Respiratory rate >30 BP Age > 65
Scores ranging from 0-1 are low risk, treated outpatient.
2 is considered appropriate for hospitalization
3-5 considered for ICU care.
2 meds used in ARDs to help prevent pulmonary edema
Furosemide, albumin
Placing a patient in what position helps to improve oxygenation in ARDs
Prone. DOESNT IMPROVE SURVIVAL.
Dx characteristics of ARDS
Bilateral fluffy interstitial infiltrates (due to pulm edema)
PCWP
Grade the asthma: 80%
Mild intermittent.
Grade the asthma: 3-6 daytime episodes/week or 3-4 nighttime episodes/month. FEV
Mild persistent
Grade the asthma: daily daytime episodes or >1 nighttime episode/week. FEV 60-80%
Moderate persistant
Grade the asthma: continual daytime episodes of frequent nighttime symptoms. FEV
Severe [ersostemt
Stage of COPD at FEV1/FVC 80%
Stage 1, mild
Stage of COPD at FEV1 30-50%
Stage 3, severe
When do you add home O2
Pulse ox
What is young syndrome
Bronchiectasis
Rhinosinusitis
+
Infertility
Serum markers for interstitial fibrosis
SP-A
SP-B
MCP-1
KL-6
Treatment for idiopathic pulmonary fibrosis
Steroids
Azathioprine or cyclophosphamide
N-acetylcysteine
2 pneumoconiosis that cause progressive fibrosis
Coalminers or silicosis
Which pneumoconiosis is a/w working with electronics and has increased cancer risk
Berryliosis
Tx of SVC syndrome
Steroids. Also treat the underlying cause.
Most common EKG finding in PE
Sinus tach
Most common surgery in adults for OSA
Uvulo palato pharyngo plasty
Pretreatment for rapid sequence intubation
Lidocaine which blunts ICP elevations
Fentanyl to blunt the pain response and BP elevations
Atropine to decrease airway secretions and prevent bradycardia in children during intubation
Rapid induction agents (for intubation)
Etomidate
Ketamine
Midazolam
Propofol
Rapid paralytic agents (for intubation)
Succinylcholine
Rocuronium