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Emed 1 > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

what to do when pt complains of dyspnea?

A

look at vitals first….ABC

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2
Q

tx of dyspnea

A
  • maintain the PaO2 above 60 mm Hg or Oxygen saturation above 90%
  • admit any pt with an unclear cause
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3
Q

hypoxia is defined as

hypercapnia is defined as

A

PaO2<60

PaCO2>45 due to hypoventilation

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4
Q

Patients with severe airflow obstructions may actually have no wheezing but

A

decreased breath sounds

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5
Q

acute bronchitis is MCC by…

A

virus

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6
Q

SS acute bronchitis

A

Cough lasting more than five days (typically one to three weeks), which may be associated with sputum production

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7
Q

how to work up acute bronchitis?

A
  • vitals, pulse ox
  • PFT
  • CXR not req, only to r/o pneumonia
  • no sputum culture necesary
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8
Q

when to consider anbx for acute bronchitis?

A

cough lasting >3 weeks

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9
Q

MCC typical/atypical pneumonia in all age groups….

in children <5 years

A

Strep Pneumo/mycoplasma pneumo

viral

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10
Q

lobar pneumo presents with

bronchopenumoina may sound

A

rales

normal

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11
Q

tests to order for suspected pneumonia

A
  • CXR first
  • CT is the best
  • blood cultures, never sputum
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12
Q

when to consider HAP?

A
  • Pts hospitalized over 48 hours within the prior 90 days
  • outpt chemo, dialysis, wound care
  • nursing home
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13
Q

tx of outpt uncomplicated CAP

A

azithromycin or doxy

save fluoros in case these don’t work

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14
Q

tx of CAP with significant comorbities

A

levofloxacin or augmentin+azithromycin

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15
Q

tx of inpt mgmt of CAP not requiring ICU

A

levofloxacin IV or ceftriaxone IV+azithromycin IV

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16
Q

tx of inpt mgmt of CAP requiring ICU

A

levofloxacin IV + ceftriaxone IV

if suspected MRSA add vanco

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17
Q

tx of inpt mgmt of HAP

A

pipercillin/tazobactam IV + vanco

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18
Q

tx of possible aspiration pneumo

A

levofloxain IV + clindamycin IV

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19
Q

tx of lung abscess pneumo

A

clindamycin IV + ceftriaxone IV

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20
Q

tx of empyema pneumo

A

pipercillin/tazobactam IV + vanco if MRSA suspect

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21
Q

lung abscess vs empyema

A

Lung abscess is in the lung while an empyema is usually pus filled also but in the pleural space

22
Q

MC location of TB

A

upper lobes

23
Q

extrapulmonary TB SS

A

Lymphadenitis, with painless enlargement is the most common presentation

24
Q

hwo to work up possible TB?

A

CXR first
acid fast stain
sputum culture is gold standard, but takes 4-6 weeks

25
what is the best test for TB?
quantiferon gold, blood test | no false neg from BCG
26
how to treat TB
INH, rifampin, pyrazinamide, ethambutol(time period dependent on patients history) Multidrug resistant TB- start the four oral drugs but add an injectable agent(spectinomycin, amikacin, capreomycin)
27
whooping cough (pertussis) presentation in adults vs kids
-adults have an atypical presentation w/cough persisting >2 weeks -children undergo 3 stages that last about 6 weeks 1.Catarrhal stage-sneezing, hacking cough that starts at night then begins to happen during the day 2.Paroxysmal stage-burst of coughs (whoops) 3.Convalescent stage-decrease in freq of cough around 4 weeks into illness
28
how to diagnose pertussis
nasal swab
29
pertussis tx
- supportive care - tdap for family - Azithromycin, Erythromycin, clarithromycin, Bactrim
30
what should you order if you suspect flu?
CBC CMP CXR(r/o pneumonia) Nasal Swab
31
flu treatment
-oseltamavir (shortens duration of flu slightly) if taken within 48 hours of symptoms beginning
32
SS of epiglottitis
- drooling | - tripod position
33
how to dx epiglottitis
- PE - blood culture - thumb sign xray
34
how to treat epiglottitis
- seat pt upright and give O2 - possible intubation - ADMINISTER NEBULIZED RACEMIC OR L-EPINEPHRINE for severe cases - steroid
35
common causes of spontaneous pneumo
-SMOKERS -males -marfans Spontaneous pneumothorax most likely result from subpleural bulla rupture
36
iatrogenic pneumothorax
-Iatrogenic happens secondary to invasive procedures. get CXR after procedures
37
tension pneumo
progressive build-up of air within the pleural space(lung laceration) Trachea deviated to opposite side More concerning
38
how to dx a pneumothorax
- PA CXR | - US
39
how to treat a pneumo
- Unstable vitals with clinical signs IMMEDIATE Needle thoracostomy followed by tube thoracostomy(before xray) - Small primary pneumothoraces may be observed for 6 hours and d/c with surgical follow up if you repeat the xray and no enlargement
40
massive hemoptysis is defined as | mild is
bleeding rate that exceeds 600 mL per 24 hours | <5 ml in 24 hours
41
how to treat hemopytysis
Oxygen and NS/LR for hypotension Transfusion Decubitus position for patients with massive hemoptysis to prevent aspiration Hydrocodone for cough suppression Endotracheal intubation(8.0mm) tube (facilitates bronchoscopy) Antibiotics?
42
admit or discharge hemoptysis?
discharge minimal bleeding, admit everybody else
43
PE signs of asthma/COPD
wheezing w/prolonged expiratory phase
44
asthma/COPD tx
- ABCD - albuterol - ipatropium - prednisone
45
SS of PE
- tachypnea - dyspnea - chest pain
46
gold standard test for a PE
-CT angiography aka pulmonary angiography
47
MC EKG finding for PE
-sinus tachy
48
how to treat a PE
- ABCD - IVF - vasopressin for hypotension - heparin IV bolus
49
For persistent hypotension despite medical management with other measures for a possible PE consider...
thrombolytic therapy(tPA, streptokinase) CONSULT ICU BEFORE USING
50
PE pts must be....
admitted!!
51
MC FB aspirations
food in adults | toys in kids
52
how to treat possible FB
- ABC | - laryngoscopy

Emed 1 (8 decks)

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