Pulmonary Geriatrics Flashcards
MCC CAP
strep pneumonia
gram stain strep pneumo
gram positive diplococci
second MCC CAP
haemophilus flu
characteristics of klebsiella pneumo
occurs in alcoholics and DM
currant jelly sputum
cavitary lesions
PE for pneumonia
bronchial breath sounds
dullness to percussion
increased tactile fremitus
admission for pneumonia
CURB 65 - admit if 2
confusion
uremia > 30
RR >/= 30
BP low (SBP < 90 or DBP < 60)
age > 65
sx PCP pneumonia
DOE on exertion
fever
nonproductive cough
what type of bacteria is mycobacterium tuberculosis
acid-fast bacillus
where in the lungs is primary TB located
middle portion of the lungs – ghon focus
sx TB
prolonged fever
cough
chills
night sweats
fever
dx TB
isolation of TB from a body secretion or fluid or tissue
CXR
tx for TB plus ADE
RIPE
Rifampin - red/orange secretions
Isoniazid - peripheral neuropathy
Pyrazinamide - hyperuricemia
Ethambutol - optic neuritis
what cancers are included in non-small cell lung CA
adenocarcinoma
large cell
squamous cell
lung CA screening
annual low dose CT 55-80 if sx + 30 PPY smoking history who currently smoke or have quit within 15 years
MC CA in nonsmokers
adenocarcinoma
CXR and CT biopsy for adenocarcinoma
CXR - peripherally located
Bx - gland formation with mucin production
characteristics of squamous cell lung CA
CCCP
centrally located
cavitary lesions
hypercalcemia
pan coast syndrome
bx squamous cell CA
keratinization by tumor cells and/or intracellular desmosomes
MC CA to present with paraneoplastic syndromes
small cell (oat cell) lung CA
CXR and histology for small cell lung CA
CXR - centrally located
histology - sheets of small dark blue cells with rosette formation
sx and PE for superior vena cava syndrome
facial, neck, or UE edema, chest pain
dyspnea = MC
dilated and prominent neck and chest veins
what is Lambert-eaton myasthenic syndrome
antibodies against presynaptic voltage-gated calcium channels to prevent acetylcholine release –> muscle weakness
sx and PE for lambert-eaton myasthenic syndrome
proximal muscle weakness that improves with repeated muscle use
dry mouth
hyporeflexia
sluggish pupillary response
sx for superior sulcus (pan coast) tumors
shoulder and arm pain MC
Horner syndrome - ipsilateral ptosis, miosis, anhidrosis
weakness and atrophy of the muscles in the hand/arm
ulnar neuropathy
what is emphysema
abnormal permanent enlargement of the terminal airspaces distal to the terminal bronchioles with no obvious fibrosis
sx emphysema
dyspnea - hallmark
chronic cough
PE emphysema
hyperinflation - decreased/distant breath sounds, increased AP diameter (barrel chest), hyper resonance to percussion
cachectic and non-cyanotic - pink puffer
pursed lip expiration
CXR emphysema
flattened diaphragms
increased AP diameter
decreased vascular markings
bullae/blebs
PFTs emphysema
normal or decreased FVC
post bronchodilator decreased FEV1/FVC < 70% predicted
decreased FEV1
decreased DLCO
increased volumes - RV, TLC, RV/TLC, FRC
chronic bronchitis
chronic productive cough for at least 3 months a year for 2 consecutive years
sx chronic bronchitis
chronic cough
sputum production
DOE
PE chronic bronchitis
crackles, rhonchi, wheezing
cyanosis, peripheral edema, obesity = blue bloaters
PFT chronic bronchitis
decreased FEV1
normal or decreased FVC
postbronchodilator decreased FEV1/FVC < 70%
increased volumes - RV, TLC, RV/TLC, FRC
normal DLCO
what is bronchiectasis
chronic lung disease characterized by permanent and irreversible dilation of the bronchial airways with weakening of the mucociliary transport mechanism
MCC bronchiectasis
CF
MC colonizer in bronchiectasis
if CF - pseudomonas
if no CF - H flu
sx bronchiectasis
productive cough + thick sputum
hemoptysis
dx bronchiectasis
CXR
high resolution CT scan - preferred
PFTs
what is the preferred imaging for bronchiectasis
high resolution CT
CT bronchiectasis
thickened bronchial walls
airway dilation
lack of tapering airways - tram-track appearance
PFTs bronchiectasis
decreased FEV1
decreased FEV1/FVC < 70%
causes of transudative pleural effusion
CHF MC
nephrotic syndorme
cirrhosis
sx and PE for pleural effusion
asx
dyspnea
pleuritic chest pain
cough
dullness to percussion
decreased fremitus
decreased breath sounds
dx pleural effusion
CXR - initial - blunting of costophrenic angles (positive menisci sign); lateral decubitus is the best film!
thoracentesis - gold standard
light’s criteria for pleural effusion
transudate:
pleural: serum protein </= 0.5
pleural:serum LDH </= 0.6
pleural fluid LDH <2/3 ULN
exudate:
pleural: serum protein > 0.5
pleural: serum LDH > 0.6
pleural fluid LDH > 2/3 ULN
tx pleural effusion
treat underlying
thoracentesis - diagnostic and therapeutic
chest tube fluid drainage - if empyema
