pulmonary diseases Flashcards
bronchiolitis in child usually caused by RSV
symptoms: wheezing that won’t respond to B agonist, SOB
Tx:
- mild to moderate: supportive care, suction, oxygen, trial of b agonist
- severe: give O2 and consider epi neb
Pulmonary embolism: what are the symptoms/risk factors ?
triad- chest pain, dyspnea, hemoptysis
other symptoms: tachypnea, RR > 16, rales, second heart sound, tachycardia, fever, diaphoresis, cough
risk factors: long travel, smoking, cancer, previous clot, COPD, OCP
PE suspicion example patient:
has dyspnea, tachypnea, chest pain. BUT is 43, HR: 75, O2 sat 96%, no prior history of DVT, no recent trauma, no hemoptysis, no exogenous estrogen, no clinical signs of DVT then what is next appropriate treatment ?
Discharge this patient because they meet all the PERC rules. If patient had not met all criteria, could do D dimer
Massive/submassive PE Patient with hypotension, syncope, cyanosis OR low sat, echo shows heart failure, or 50% of occlusion
Tx: Heparin (unfractionated) Bolus is the mainstream accepted treatment for Large PE 80mg/kg loading then 18mg/kg/hr otherwise….
submassive PE with stable vitals, no hypoxemia, no difficulty breathing etc
TX: May be able to give LMWH (lovenox) with close follow up
tension pneumothorax
Tx: immediate decompression with needle in anterior axillary line or mid clavicular
small stable pneumothorax
Tx: can receive O2 for 4 hours then repeat cxr, d/c with 24 hr repeat cxr
latent TB
before initiating treatment for LTBI, rule out TB disease by:
-obtaining a negative cxr
-obtaining X3 negative sputum cultures on 3 separate days
Tx: mainstay treatment is rifampin (4R) daily for 4 months
alternatives:
-isoniazid/rifampin (3R) daily for 3 mo
-isoniazid (6H/9H) for 6/9 mo -moving away from this because the patient has to be directly observed
For which patients is Rifampin contraindicated ?
patients with HIV and can interfere with OCP or birth control implants
Rifampin causes patients’ urine to turn orange, but what color would be abnormal and indicate bilirubin release?
dark urine. It could also cause numbness in hands/feet, rash, N/V, fatigue, anorexia
what lab value would you be looking for in patients that are on isoniazid that would indicate they need to stop treatment?
elevating in liver enzymes 4X higher than baseline. They may need to stop alcohol consumption
active tuberculosis
-directly observed treatment is federally mandated
Tx:
-first line meds: isoniazid, rifampin, pyrazinamide, ethambutol, rifabutin (when can’t tolerate rifampin), rifapentine
-second line drugs: streptomycin, cycloserine, ethionamde, capreomycin, levofloxacin, moxifloxacin, gatifloxacin
Treatment regimens:
**standard INH, RIF, PZA, EMB for 2 mo (daily) with continuation of 4 additional mo of isoniazid and rifampin (2-3 X weekly) OR
-INH, RIF, PZA, EMB for 2 wks (daily), then twice weekly for 6 wks, then INH/RIF twice a week X 4 mo OR
-INH, RIF, PZA, EMB 3 times weekly for 6 mo
which TB drugs would you not use in pregnant patients?
streptomycin or pyrazinamide
what is the treatment for a CF patient with a Stenotrophomonas maltophilia infection?
Bactrim!!
diphtheria: caused by Corynebacterium dipheria that causes low grade fever, sore throat, loss of appetite, malaise and HALLMARK- fleshy gray pseudomembrane that can be fatal airway obstruction
Tx: equine antitoxin- available from CDC
+ erythromycin or Penicillin
prevent with tDAP /dpT
which are the main causative pathogens in AECB?
1st H. influenza, 2nd S. pneumo
which are the main causative pathogens in acute bacterial sinusitis?
in order of most to least common: S. pneumonia, H. influenza, M. catarrhalis, S. aureus
which are the main causative pathogens in CAP?
S. pneumonia by and large
