pulmonary Flashcards
silicosis
cxr egg shell pattern and hilar node calcification
asbetos
pleural plaques and reticular patterns
can cause mesothelioma (pleura based mass)
sacrcoidosis
non caseating granulomas and hilar adenopathy
wegners granulomas
caseating granulomas and positive anca
pulmonary fibrosis
progressive fibrosis
cxr of foreign body aspiration
ipsilateral hyperlucency and ipsilateral hyper expansion of hemithorax
asthma 3 components
airway hyperactivity
airflow obstruction
chronic airway inflammation
IgE mediated. inflammatory disease
most common finding on cxr for asthma
normal
immune mediators in asthma
inhaled steroid
leukotriene modifiers- montelukast (singulair) (zyflo-ziluton)
mast cell stabilizer- cromolyn (nedocromil) (take 4 weeks to work)
bronchodilator
short/long beta agonist (long- salmeterol)
anticholinergic-ipratropium
magnesium
epi
intermittent
mild persistent
> 2 days/week
3-4 times per month at night
minor limitation
severe persistent
multiple times per day
every night
severe limitation
moderate persistent
daily
>1 time week but not nightly
some limitation
step wise approach to asthma
1- saba 2- low dose ICS 3- low dose ics + laba or med dose ics 4- med dose ics + laba 5- high dose ics + laba 6- high dose ics + laba + oral steroid
see patients every 4-6 weeks to see if controlled
if pt controlled well for 3 months then try to step down
follow every 1-6 months
side effects of inhaled steroids
kids- might be a little shorter
adults- can get recurrent canadiasis
theophyline
methylxanthine
phosphodiesterase inhibitor
bronchial dilate
omalizumab (xolair)
last resort- tried everything else
anaphylaxis- must give shot at clinic
samters triad
nasal polyps
asthma
aspirin/nsaid sensitivity
atopy
eczema (atopic dermatitis), rhino sinusitis (allergies), asthma
tx for mycoplasma pneumonia
azithromycin
causes of asystole
patch 4 md
pneumo, acidosis, thromobosis, cardiac tamponadue, 4 h’s, massive mi/pe, drug toxicities
what organism do cystic fibrosis get
pseudomonas
organs cystic fibrosis affects
lungs, pancreas, intestines
what causes a young person to have emphysema and liver problems
alpha 1 antitrypsin disease
difference between asthma and copd
asthma- primary cells eosinophils- cause hypertrophy over time
copd- primary cells neutrophils- carry proteases and oxidases that destroy lung
can you put o2 on chronic bronchitis (blue bloater)
no because they are so use to having high c02 that the body stops using co2 as the determinant to breathe and starts using o2 instead. These pts usually have low o2 so if you put o2 on them their body doesn’t think it needs to breathe.
what kills pts with copd
cor pulmonale
the chronic low o2 causes pulmonary vasoconstriction (chronic constriction causes the vessels to scar down) and causes pulmonary htn causes right sided heart failure
this is why o2 can increase the life expectancy in these pts
most common lung cancer
adenocarcinoma (one type of lung cancer that NON SMOKERS get)
worst lung cancer
small cell (oat cell)
usually occurs centrally
paraneoplastic (siadh, lambert eaton (like Myasthenia graves except getter better throughout day), cushing syndrome, clubbing, dermatomyositis)
metastasizes to adrenal, brain, bone, liver
complications- SVC obstruction (dilated veins in upper body, swollen face), horners syndrome (pan coast tumor-pressure on sympathetic nerves- ptosis, miosis)
squamous cell cancer
hypercalcemia (stones, bones, groans, psychiatric overtones) (due to PTh-rp production)
metastasize to same sites as small cell
carcinoid syndrome
flushing, diarrhea, wheezing, bronchospasm
due to serotonin and histamine release
octreotide scintigraphy
tx- remove
most common type of ovarian cancer
epithelial
best med for dilated cardiomyopathy with ef
ace inhibitor
most common cause of bells palsy
herpes
bilateral hilar lymphadenopathy
hodgkins or sarcoidosis
most common cause of ards
sepsis
other cause- trauma, overdose, near drowning, etc
ards tx
small tv (4-6) permissive hypercapnia; o2 90%
foreign body cxr lateral
expect the lung that is on the ground to collapse due to gravity but if obstruction then it won’t collapse
different pleural effusions
transudative: chf, cirrhosis, PE
edudative: malignancy, infection, trauma, empyema
lights criteria: >.5 protein ratio of pleura fluid vs serum
>.6 ldh ratio of pleura to serum
>2/3 of upper limits of normal of ldh
increase in tactile fremitus
consolidation
fibrosis
decrease tactile fremitus
pneumothorax
copd
pleural effusion
what do you need to be careful with when using beta blocker
pulmonary disease
diabetes
htn emergency
bp >220/125.
end organ damage encephalopathy, nephropathy, intracranial hemorrhage, aortic dissection, pulmonary edema, unstable angina, MI
dark field microscopy
syphillis
tzanck smear
herpes
multinucleated giant cells
acid fast bacilli
TB
TB tx
2 months RIPE
4 months RI
what can rsv cause in ppl
apnea
most common bacteria causing pneumonia after viral
Staph aureus
TB drug side effects
INH- injures nerves and hepatocytes- pyridoxine b6
ethambutol- optic neuritis
rifampin- orange body fluid
pyrazinamide- hyperuricemia
strep pneumona
gram positive diplococci
what is flu vaccine contraindicated in
ppl older then eggs
can’t give live virus to immune suppressed
give to ppl >6 months
tx for pneumonia
outpatient healthy- azithromycin, doxy, fluoroquinolone
CA inpatient- ceftriaxone + azithromycin or fluroquinolone
Nosocomial- same as inpatient + zosyn, cefepime, meropenem (pseudomonas and gram -)
college student pneumonia
mycoplasma
chlamydia
alcoholic pneumonia
klebsiella (currant jelly sputum)
less then 2 yr old pneumonia
RSV
cystic fibrosis
pseudomonas
immigrants
TB
most common pneumonia
strep pneumonia (rust colored sputum)
copd pneumonia
haemophilus influenzae
exposure to air conditioner and aersolized water
legionella
bird droppings pneumonia
histoplasmosis
chlamydia psittaci
restrive lung disease sxs
dry crackles is big
cough
sob
wheezes
idopathic fibrosis
erythema nodosum
uveitis
dry crackles
sarcoidosis
african american
bilar hilar adenopathy
sarcoid skin lesions
hypercalcemia, high alp, decreased hgb
drugs that can cause stiff lungs
nitrofurontoin
amiodarone
