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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
Q

what is the best test for TB?

A

quantiferon gold, blood test

no false neg from BCG

26
Q

how to treat TB

A

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
Q

whooping cough (pertussis) presentation in adults vs kids

A

-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
Q

how to diagnose pertussis

A

nasal swab

29
Q

pertussis tx

A
  • supportive care
  • tdap for family
  • Azithromycin, Erythromycin, clarithromycin, Bactrim
30
Q

what should you order if you suspect flu?

A

CBC
CMP
CXR(r/o pneumonia)
Nasal Swab

31
Q

flu treatment

A

-oseltamavir (shortens duration of flu slightly) if taken within 48 hours of symptoms beginning

32
Q

SS of epiglottitis

A
  • drooling

- tripod position

33
Q

how to dx epiglottitis

A
  • PE
  • blood culture
  • thumb sign xray
34
Q

how to treat epiglottitis

A
  • seat pt upright and give O2
  • possible intubation
  • ADMINISTER NEBULIZED RACEMIC OR L-EPINEPHRINE for severe cases
  • steroid
35
Q

common causes of spontaneous pneumo

A

-SMOKERS
-males
-marfans
Spontaneous pneumothorax most likely result from subpleural bulla rupture

36
Q

iatrogenic pneumothorax

A

-Iatrogenic happens secondary to invasive procedures. get CXR after procedures

37
Q

tension pneumo

A

progressive build-up of air within the pleural space(lung laceration)
Trachea deviated to opposite side
More concerning

38
Q

how to dx a pneumothorax

A
  • PA CXR

- US

39
Q

how to treat a pneumo

A
  • 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
Q

massive hemoptysis is defined as

mild is

A

bleeding rate that exceeds 600 mL per 24 hours

<5 ml in 24 hours

41
Q

how to treat hemopytysis

A

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
Q

admit or discharge hemoptysis?

A

discharge minimal bleeding, admit everybody else

43
Q

PE signs of asthma/COPD

A

wheezing w/prolonged expiratory phase

44
Q

asthma/COPD tx

A
  • ABCD
  • albuterol
  • ipatropium
  • prednisone
45
Q

SS of PE

A
  • tachypnea
  • dyspnea
  • chest pain
46
Q

gold standard test for a PE

A

-CT angiography aka pulmonary angiography

47
Q

MC EKG finding for PE

A

-sinus tachy

48
Q

how to treat a PE

A
  • ABCD
  • IVF
  • vasopressin for hypotension
  • heparin IV bolus
49
Q

For persistent hypotension despite medical management with other measures for a possible PE consider…

A

thrombolytic therapy(tPA, streptokinase) CONSULT ICU BEFORE USING

50
Q

PE pts must be….

A

admitted!!

51
Q

MC FB aspirations

A

food in adults

toys in kids

52
Q

how to treat possible FB

A
  • ABC

- laryngoscopy

Emed 1 (8 decks)

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