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
acute bacterial sinusitis tx in adults?
1st line: amoxicillin/clavulanate 500/125 mg po tid or 875/125 mg po bid or if allergic doxycycline 100 mg po bid 5-7 days
ABS tx in children?
amox/clavulanate 45 mg/kg/day po bid
- levofloxacin 10-20 mg/kg/day po q 12-24 hrs (B lactam allergy
- clindamycin 30-40 mg /kg for non type 1 hypersensitivity
treatment for S. pneumonia pneumonia?
-will cause rusty colored sputum
tx: penicillin, or macrocodes and fluoroquinolone
which patients should receive pneumonia immunization (prenvar 13 or pneumovax 23) ?
age > or equal to 65, splenic patients, immunocompromised age 19-64
which antibiotics can be used to treat H. influenzae
amox/clavulinic acid, macrolides, cephalosporins, fluoroquinolones
which pathogens are atypical organisms that cause CAP?
Mycoplasma (‘“walking pneumonia”) , Chlamydia, Legionella
Which antibiotics could you treat atypical organisms with?
macrolides, fluoroquinolones, tetracyclines
treatment of CAP as of the new updates in oct 2019?
symptoms: fever, cough, chills, dyspnea, tachypnea, tachycardia, O2 defat, thick mucus coughed up, SOB on minimal exertion, inspiratory rates, wheezing , rigors, sweats, hemoptysis, fatigue, myalgias
- no comorbidities/risk factors for MRSA/ Pseudo aeruginosa –> amoxicillin 1 g bid OR doxycycline 100 mg bid OR macrolide (if local pneumococcal resistance < 25%)
- with comorbidities: combo therapy with amox/clav or cephalosporin AND macrolide OR doxy OR mono therapy with respiratory fluoroquinolone
treatment for influenza?
symptoms: acute onset of high fever, body aches, runny nose
Tx: oseltamivir (Tamiflu), zanamivir (Relenza), baloxavir (xofluza)
which medications would you absolutely NOT treat the flu with?
amantadine and rimantadine. Can show up on the PANCE
Treatment for aspiration pneumonia?
- *tends to be right sided**
- typically seen in neurological disorders, esophageal disorders, alcohol or drugs, sputum is foul smelling and are caused by anaerobic organisms:
- peptostrep
- prevotella
- fusobacterium
- bacteroides
tx: pipericillin/tazo or clindamycin
Treatment for MRSA pneumonia?
is hemorrhagic, children particularly vulnerable
- vacomycin is historic drug of choice
- newer agent is linezolid (zyvox)
treatment for empyema?
symptoms include: chills, high fever, loss of apetite, pleuritic pain, SOB
tx: surgical drainage / antibiotics tailored to organism
Which 2 pathogens cause 70% of acute exacerbation of chronic bronchitis ?
H. infuenzae and S. pneumoniae
what are the 3 cardinal symptoms of diagnosing acute exacerbation of chronic bronchitis
- increased shortness of breath
- increased sputum volume
- increased sputum purulence
- if 2/3 present –> may be bacterial
treatment of acute exacerbation of chronic bronchitis?
amoxicillin/clavulanic acid
-covers for H. flu, S. pneumo and M. catarrhalis
which abx would you use to treat moraxella catarrhalis, which is a gram negative coccobacilli?
macrolides, trimeth/sulfa, amox/clav, or fluoroquinolone as your last resort
treatment for fungal lung infections that are usually caused by Aspergillus, but can also be caused by candida albicans ?
-tip: xr finding is usually a round lesion
tx: fluconazole or voriconazole
what are the 3 stages of disease of pertussis (aka whooping cough)? which is caused by bordetella pertussis
- catarrhal: (avg length: 7-10 days ) coryza, low grade fever, mild occasional cough, gradually worsens
- paroxysmal: avg length: 1-6 wks, paroxysms of numerous rapid coughs - difficult to expel thick mucus, long aspiratory effort w/ high pitched whoop at end, cyanosis, vomiting/exhaustion
- convalescent : avg 7-10 days, gradual recovery, cough, disappear in 2-3 wks
what is the treatment for pertussis?
this slide was starred
1st line: macrolides –>
Erythromycin
Azithromycin (Zpak)
Clarithromycin (Biaxin)
**bactrim as an alternate
what is most common opportunistic infection in HIV patients?
pneumocystis jerovecii, classified as a fungus
Treatment for pneumocystis jeroveci AKA pneumocystis pneumonia (PCP)?
symptoms: fever, dry cough, fatigue, night sweats, hypoxia out of proportion to clinical presentation
Dx: sputum for silver stain-gold standard yes but PCR testing is replacing, LDH elevated, CXR showing bilateral diffused hilarity opacification
- smoking cessation
- bactrim for prophylaxis (HIV patients with CD4 count < 200) and treatment
chronic bronchitis
-symptoms: productive cough, dyspnea, fatigue, cyanosis, hypoxia, coarse rhochi and wheezes, peripheral edema, abnormal lung excursion
OR
emphysema
-symptoms: progressive dyspnea, mild dry cough, cachectic, hypoxia, fatigue, tachypnea, prolonged expiration, hype resonant chest on percussion, diminished breath sounds, barrel chest
tx:
- for patients with 0-1 moderate exacerbations + mMRC 0-1 CAT < 10 –> bronchodilator : 1st line is a LAMA aka spiriva, ellipta
- for patients with 0-1 moderate exacerbations + mMRC > or equal to 2 CAT > or equal to 10 –> LABA or LAMA (severent or spiriva or ellipta )
- basically if it gets bad enough to where the patient has had a hospitalization or 2 or more exacerbations + high mMRC and CAT treat with LAMA + LABA OR ICS + LABA (serevent + spiriva or ellipta)
treatment for idiopathic interstitial pneumonia? which is the most common cause of interstitial lung disease
only definitive tx is lung transplant, can give O2 supplementation
treatment for sarcoidosis?
prednisone 20-40mg QD 4-6 wks then taper if effective to 5 mg QD X 12 months
treatment for pneumoconiosis ?
-caused by inhaled damage to the alveoli by dust exposure
exposure avoidance, supportive care with O2, smoking cessation, vaccines
treatment for pulmonary hypertension? characterized by pulm HTN > 25 mmHg at rest or > 30 mm Hg with exertion
- diuretics
- vasodilators
- oxygen
- anticoagulation
- digoxin -to improve cardiac output
- exercise
- transplants
URI treatment?
-symptoms: sore throat, runny nose, nasal congestion, sneezing sometimes conjunctivitis, myalgia and fatigue
alternate 1 g Tylenol every 4 hrs with 400 mg IBU, decongestants, rest and fluids
