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PANCE > Pulmonology -10% > Flashcards

Pulmonology -10% Flashcards

1
Q

Acute Bronchiolitis

eti, sxs, dx

A

MCC RSV - fall and winter months

Infants and young children

Sxs:

  • tachypnea
  • respiratory distress
  • expiratory wheezing

Dx:

  • nasal washing for RSV culture antigen assay
  • CXR - normal
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2
Q

Acute Bronchiolitis

Tx

A

Hospitalization if

  • O2 Sat < 95-96%
  • < 3mos old
  • RR > 70
  • nasal flaring
  • retractions
  • atelectasis on CXR

Supportive Tx —>

  • humidified O2,
  • antipyretics,
  • B agonist (albuterol),
  • neb racemic epinephrine, and
  • steroids

O2 is only tx to improve

Ribavirin for severe lung or heart dz in IMC pts

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3
Q

Acute Bronchitis

A

Cough > 5 days; lasts 1-3 wks

MC Viral/Rhinovirus or Coronavirus, Bacterial - M catarrhalis

Chronic Lung pt - H influ, S pneumo, M. catarrhales

Sxs:

  • Cough NO fever ( if + then consider PNA) w/ sputum
  • concurrent URI

Dx - clinical - diffuse lung sounds

  • if focal lung sounds = CXR

Tx:

  • Supportive - NSAIDs, nasal decongestants (Afron), inhaled ipratropium analgesics
  • NO ABX
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4
Q

Acute Epiglottitis

dx, tx

A

X ray lateral film - Thumbprint sign

Secure airway - get cultures for H influ

Tx:

  • intubation
  • supportive care
  • Ceftriaxone* Tx as outpatient if stable
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5
Q

Acute Epiglottitis

eti, sxs

A

EMERGENCY - Supraglottic inflammation

airway obstruction d/t H. influenzas type B (Hib)

MC unvaccinated children

Sxs: 3 Ds of epiglottis

  • Dysphagia
  • Drooling
  • Respiratory Distress
  • tripoding
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6
Q

ARDS

dx

A

ABG PaO2 and FIO2 ratio - not responsive to 100% O2

  • mild 200-300
  • mod 100-200
  • severe <100

CXR

  • bilateral infiltrates => white out pattern
  • spares CP angles

Cardiacs Cath of plum artery

  • Pulm cap wedge pressure (PCWP) < 18 mmHg = ARDS
  • if > 18 mmHg - Cardiopulm edema
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7
Q

Acute Respiratory Distress Syndrome

eti

A

ARDS - respiratory failure characterized by fluid collecting in lungs = no O2

incr permeability of alveolar-capillary membrane -> development of protein rich pulp edema (non cariogenic pulm edema)

can also be d/t critically ill pts or those with significant injuries I.e. sepsis, severe trauma, aspiration of gastric contents, near drowning

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8
Q

ARDS

sxs

A
  • Severe SOB - unable to breath independently w/o ventilator
  • rapid onset of profound dyspnea occurring w/in 12-24 hrs after precipitating event
  • Tachypnea
  • pink frothy sputum crackles
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9
Q

ARDS

tx

A

Tx underlying cause

PEEP lowest setting to maintain PaO2 > 60 mmHg and keep O2 sat > 90%

often fatal

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10
Q

Asthma dx

A
  • PFT - dec FEV1, decr FEV1/FVC ratio
  • Methacholine challenge test >/= 20% dec in FEV1 Bronchodilator test >= 12% incr in FEV1
  • Peak Expiratory Flow Rate used in ED (nl is 400-600) PEFR >15% from initial attempt = response to tx

Severity

  • Intermittent
    • Daytime < 2/wk but <1d; nocturnal = 2/mo
    • FEV1 > 80%
  • Mild Persistent
    • Daytime > 2/wk but <1d; nocturnal > 2/mo
    • FEV1 > 80%
  • Mod Persistent
    • Daily sx; exacerbation >/=2 / wk, nocturnal > 1/mo
    • FEV1 > 60% < 80%
  • Severe Persistent - cont daytime sxs, limited physical activty
    • FEV1< 60%
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11
Q

Asthma

eti

A

Chronic, reversible, hyperresponsiveness, inflammatory airway disease w/ recurrent attacks of breathlessness and episodic wheezing

Sxs:

  • Atopy - eczema
    • asthma’s triad
    • nasal polyps
    • ASA/NSAID allergy
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12
Q

Asthma

sxs

A

SXS: triad of dyspnea, wheezing, cough chest tightness

PE

  • prolonged expiration with wheezing
  • hyperresonance to percussion
  • tachycardia
  • tachypnea

Early Phase

  • Bronchospasm - mucosal edema - minutes to 1-2hrs, responds to bronchodilators

Late Phase

  • mucosal inflammation and incr mucus production, recurrent sxs
  • occurs 4-6 hrs
  • nebs no response
  • need CS tx
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13
Q

Asthma

tx

A

Categorization

Mild intermittent - (<2x/wk or < 2n/mo) -

  • SABA PRN - Albuterol

Mild Persistent (>2x/wk or 3-4 n/mo)

  • low dose ICS daily = Albuterol + Fluticasone (or budesonide - only neb one)

Mod Persistent - (Daily sx or > 1n/wk)

  • Low dose ICS + LABA Daily Med dose ICS + LABA daily
  • Salmeterol or Formoterol (LABA) = never use as monotherapy, usu added to ICS (advair)

Severe Persistent (sx sev x / d and nightly)

  • High dose ICS + LABA qd High dose ICS + LABA + PO steroids

Acute exacerbations O2 Neb SABA Ipatropium bromide PO steroids (5-7 days)

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14
Q

COPD

dx, tx

A

Dx

  • CXR - hyperinflation, parenchymal bullae, blebs are pathogno
  • Spirometry - smokers >45yo, or >10yrs pack year
    • FEV1 / FVC ratio < 0.7, non reversible
  • Gold criteria - all FEV1/FVC < 0.7
    • Gold 1 - FEV1 >80%
    • Gold 2 - FEV 1 > 50 & <79
    • Gold 3 - FEV1 > 30 & < 49
    • Gold 4 - FEV1 <30

Tx - assessment test - CAT <10 (Group A and C)

  • Group A - SAMA or SABA =
    • albuterol or ipatropium = both Atrovent, Combivent
  • Group B - LAMA or LABA or both =
    • Triotropium or Salmeterol - LABA can be used as monotherapy or + LAMA
  • Group C - LAMA > LABA or BOTH or ICS/LABA
  • Group D - LAMA/LABA +/- ICS

Oxygen therapy - only treatment that prolong survival****

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15
Q

COPD

Eti, sxs

A

Chronic Bronchitis - cough > 3 mos for at least 2 years

  • blue bloaters
  • purulent sputum, cyanotic (R sided HF)
  • wheezes common

Emphysema - destruction of alveolar-capillary membrane; thin, smoker

  • *doesn’t smoke (pure emphysema from alpha trypsin deficiency 20-50yo)
  • pink puffers, barrel chested
  • clear sputum, no breath sounds, no cough

Sxs

  • Early dz - tobacco smoke, prolonged expiration, wheezes
  • Late dz - inr AP chest diameter
  • decr tactile fremitus
  • hyperresonance
  • decr breath sounds
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16
Q

Croup

A

Eti:

  • Infection of upper airway - obstructs breathing causing barking cough
  • MCC - parainfluenza virus
  • Children 6mos-3yo, fall - early winter mos

sxs

  • barking cough
  • stridor

dx

  • Steeple sign on PA CXR

tx

  • supportive - air humidifier
  • antipyretics
  • Severe - IV Fluids, neb racemic epi, steroids (Dexamethasone)
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17
Q

Curb-65 Score

A

Hospitalization for Pneumonia Severity

  • Confusion
  • Urea > 7 or BUN > 20
  • RR > 30
  • BP < 90/60
  • Age > 65yo

0-1 = low risk

2 = probable admission vs close outpt mgmt

3-5 = admission & manage as severe

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18
Q

Cystic Fibrosis

A

Autosomal recessive = abn chloride ch transport = altered water andchloride across cells = produce abn mucus that obstructs glands and ducts

Sxs

  • Sinusitis in infancy, nasal polyposis**
  • bronchitis & pneumonia -> bronchiectasis** Pseudomonas
  • Meconium ileus
  • FTT
  • pancreatic insufficiency - steatorrhea
  • infertility M>W

Dx

  • Newborn Screening for CF
    • Quantitative pilocarpine iontophoresis aka Sweat test = incr sodium and chloride levels > 60 mmol/L
    • confirm w/ genetic testing

Tx

  • CF regional center
  • Mucociliary clearance = mucolytics - hypertonic saline and Dnase
    • Chest PT
    • clear pulm infx aggressively
  • pancreatic enzyme replacement
  • psychological support
  • Transplant - option but NOT a cure
  • Spec meds = Ivacaftor, Lumacaftor, Tezacaftor
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19
Q

Foreign Body Aspiration

A

MC in mainstem or lobar bronchus R>L and d/t food

RFs - institutionalization, advanced age, poor dentition, etoh, sedative use

Sxs: Presentation depends on location of obstruction

  • Inspiratory stridor - high in airway
  • wheezing and decr breath sounds - low in airway

Dx

  • Expiratory CXR - hyperinflation to affected side
  • ABG - eval ventilation

Tx

  • Remove foreign body with bronchoscope
  • Rigid bronchoscopy in children
  • Flexible is diagnostic and therapeutic in adults
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20
Q

Hemoptysis

eti, sxs

A

Coughing up blood - airway bleeding

MCC

  • Bronchitis - hemoptysis, dry cough, cough with phlegm
  • Tumor mass - hemoptysis, chest pain, rib pain, tobacco hx, wt loss, clubbing
  • Tuberculosis - hemptysis, chest pain, sweating

Sxs:

  • blood stained mucus or blood from bronchi, larynx, trachea, or lungs
  • Bronchial capillaries rupture d/t acute infx (viral/bacterial bronchitis, bronchiectasis, cig smoking)
  • Tiny blood vessles broken
  • Vascular engorgement w/ erosions in Pulm HTN or masses
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21
Q

Hemoptysis

dx, tx

A

Dx

  • Cytology
  • Sputum/expectorant examination
  • Fiberoptic bronch - for CA tissue
    • biopsy
    • bronchial lavage
    • brushing
  • Rigid bronch - massive bleeding - better suctioning and airway maintenance capabilities
  • High Res CT - pathophys

Tx

  • massive hemoptysis - aggressive early consult with pulmnologist
  • ABCs - airway maintenance is vital - primary COD d/t aspyhixation
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22
Q

Horner’s Syndrome (Lungs CA)

A

Cervical sympathetic chain

  1. unilateral facial anhidrosis (no sweating)
  2. ptosis
  3. miosis
23
Q

Hyaline Membrane Disease

A

Premature infants - babies born before lungs are producing enough surfactant.

MCC respiratory disease in preterm babies < 30wks

Sxs

  • tachypnea
  • intercostal retractions
  • SOH w/ grunting sounds
  • nasal flarings

Dx

  • resp acidosis
  • CXR - ground glass appearance, diffuse bilat atelectasis

Tx

  • antenatal steroids 24-48 hrs of birth - bethametasone IM x 2
  • artificial surfactant through endotrach tube
  • Mech vent PP
24
Q

Idiopathic Pulmonary Fibrosis

Restrictive Pulm diseases

A

Chronic progressive lung disorder from increase scarring = reduces Lung capacity

MC all interstitial lung disease

Sxs

  • DOE
  • Thoracic pain + dry cough
  • Inspiratory crackles, clubbing of fingers

Dx

  • PFT = decr lung volume and normal FEV1/FVC ratio; restrictive
  • CXR - fibrosis
  • CT = diffuse patchy fibrosis, honey combing, ground glass opacities

Tx

  • Corticosteroids, O2
  • eventually lung transplant * only cure
25
Q

Influenza

A

Viral respiratory infx by orthomyxovirus (three strains A, B, C)

sxs

  • fever, coryza, cough, headache, malaise
  • uncomplicated - body aches and fever
  • complicated - dyspnea + above

Dx

  • rapid antigen test in clinic
  • rapid serology more accurate
  • CXR - bilateral diffuse infiltrates

Tx

  • symptomatic for most
  • antivirals w/in < 48 hrs
    • Tamiflu/Oseltamivir or Zanamivir/Relenza for influ A & B
      • Zanamivir - c/i in kids < 7yo powder
  • Prevent yearly vaccine - trivalent/quadvalent killed or live attenuated intranasal
    • Gullain Barre or egg allergy
26
Q

Light’s Criteria

A

Pleurocentesis to determine if Pleural fluid is exudative:

  1. Pleural fluid protein / serum protein >0.5
  2. Pleural fluid LDH / Serum LDH >0.6
  3. Pleural fluid LDH > 2/3 ULN serum LDH

Exudative - infection, malignancy, immune,

MCC - pna, CA, PE, TB

27
Q

Lung Cancer - Adenocarcinoma

A

35-40% of cases

MC type of bronchogenic carcinoma 30-40%

MC mucous cells

non-smoker w/ incidental finding and small peripheral lesion

28
Q

Lung Cancer - Carinoid

A

1-2%

tumor that produces excess serotonin (niacin B3 deficiency)

Pink purple leasion in the central airway

resistant to chemo/radiation

surgical excision

29
Q

Lung Cancer

eti, sxs, dx

A

Two major categories

  1. Small Cell Lung Cancer (SCLC) - 15% and poor prognosis
  2. Non-Small Cell Lung Cancer (NSCLC) - 85%
  • Ad
  • adenocarcinoma​
  • squamous cell carcinoma
  • large cell carcinoma
  • carcinoid tumor

Sx

  • Cough
  • Dyspnea,
  • chest pain
  • hemoptysis - airway involvement
  • Wt loss - B signs - weight loss, fever, nt swts

Dx

  • CXR to screen
  • Bronchoscopy and biopsy or FNA - gold standard
    • Squamous Cell or SCLC - central mass
    • Adenocarcinoma - peripheral mass
    • LC and Carcinoid - throughout lungs
  • TNM Staging
30
Q

Lung Cancer - Large Cell

A

rare 5%

rapid doubling time

rarely response to surgery

peripheral

31
Q

Lung Cancer - SCLC

A

15% ; Highly aggressive

always occurs in smokers

rapidly growing, mets by dx ; mediastinal mass

cannot be tx with sx, needs chemo/XRT

a/w

  • ACTH and ADH - hyponatremia and hypercalcemia
  • Lambert-Eaton myasthenic syndrome - muscle weakness of limbs d/t ACTH/ADH
  • SVC syndrome
  • Horner syndrome
  • SIADH - decr Na
32
Q

Lung Cancer - Squamous Cell Carcinoma

A

25-35% of cases

Bronchial in origin and centrally located mass

MC in smokers

likely to have persistent cough, recurrent PNA, hemoptysis,

central bronchus solitary tumor

** Hypercalcemia ** paraneoplastic syndrome

33
Q

Lung Cancer

Treatment

A

NSCLC

Surgical resection

Adj chemo and Radiation if advanced (Stage 4 = palliative (mets)

SCLC

chemo only

5 year prognosis = 15%

34
Q

Pancoast Syndrome

A

A/w Squamous Cell Carcinoma

tumor at lung apex, apical mass

crushes brachial plexus + cervical sympathetic chain

  • Shoulder pain
  • UE weakness
  • Horner’s syndrome - miosis, anhidrosis, ptosis
35
Q

Pertussis

A

Whooping cough - severe hacking cough followed by high pitched intake of breath (sounds like whoop)

Gram neg bacteria = Bordetalla pertusis

Consider in adults with cough > 2 wks, patients < 2yo

  1. catarrhal stage - cold like sxs, poor feeding, sleeping
  2. Paroxysmla stage - high pitched inspiratory whoop
  3. Convalescent stage - residual cough (100 days)

Dx - Nasopharyngeal swab of secretions and culture

Tx - with Macrolide (clarithomycin/azithromycin)

  • supportive care w/ steroids + B2 agonists
  • vaccinations
  • 5 doses - 2, 4, 6, 15-18mos, 4-6 yrs (DTap)
  • 11-18 yo = 1 dose Tday
  • Expectant mothers Tdap each pregnancy at 27-36 wks
36
Q

Pleural Effusion

A

Accumulation of excess fluids in pleura space

Sxs

  • dyspnea
  • vague discomfort or sharp pain that worsens during inspiration
  • decrease tactile fremitus, decr absent breath sounds

Dx

  • Determine whether pleurocentesis
    • exudative (infection, malignancy, immune) or
    • transudative (transient changes in hydrostatic pressure - cirrhosis, MCC CHF, nephrotic syndrome, ascites, hypoalbuminemia
  • Lateral decubitis CXR
    • Isolated L Pleural effusion = exudative
    • R sided = transudative
  • Chest CT
  • US - guided thoracentesis - gold

Tx

  • Thoracentesis
37
Q

Pleuritic Chest Pain

A

Inflammation of tissues that line lungs and chest cavity (pleura)

sudden, intensely sharp , stabing, burning pain in chest when inhaling and exhaling

exacerbated by deep breathing, coughing, sneezing, or laughing

MCC - PNA, pericarditis, pericardial effusion, pancreatitis

38
Q

Pneumonia - Bacterial

A

S pneumo > H influ > Moraxella catarrhalis = show on gram stain

Atypical - Legionella, Mycoplasma pneumo, Chlamydophila pneumo

Sxs

  • fever, dyspnea, cough, myalgias, rigors/sweat, new cough
  • +/- sputum - rust - pneumococcal
  • S pneumo - single rigor, pleurisy
  • H influ - underlying COPD
  • Legionella - high fever, hypoNa, bad abd pain + diarrhea, appears more ill than CXR
  • M. pneumo - walking pneumo, extrapulm sxs bullous myringitis (bloody TM)

Dx

  • CXR - Patchy, segmental lobar, multilobar consolidation
  • Blood cultures x 2 - only inpatient
  • Sputum gram stain

Tx

  • Outpatient - macrolides (azithromycin), Doxy, resp FQ (Levofloxacin)
    • Pneumococcal => ​tx until pts afebrile for 72 hrs (x5d)
    • atypical pna (legionella, pertussis) => x 2-3 wks
  • Inpt - Ceftriaxone + azithromycin, or resp FQs
  • Prevnar and Pneumovax - vaccines
39
Q

PNA - Fungal

A

Common in IMC pts (AIDS, steroid use, organ transplant)

Coccidiodes (valley fever)

  • non remitting cough/bronchitis non responsive to conventional tx
  • Fungal inhalation in Western States
  • Dx with ELISA for IgM and IgG
  • Tx with fluconazole/itraconazole

Pulmonary aspergillosis - health immune systems

  • fluconazole/itraconazole

Cryptococcus - soil, disseminate and amenintitis

  • LP for meningitis
  • Tx with amp B

Histoplasmosis - apical pulmonary lesions resembling cavitary TB, worsening cough and dyspnea, progression to disabling respiratory dysfx

  • bird or bat droppings - Mississippi Ohio River Valley
  • Signs - mediastinal or hilar LAD (sarcoid)
  • tx with amp B

HIV - PJP (Pneumocystis jiroveci) -Common in HIV pts with CD4 count < 200

  • CXR - diffuse interstitial or bilateral perihilar infiltrates
  • dx - bronchoalveolar lavage PCR, labs, HIV tests, low O2 despite supplemental oxygen
  • Tx with bactrim and steroids
40
Q

PNA - Viral

A

Adults - Flu MC

Kids - RSV

quick onset

Dx

  • CXR - bilateral interstitial infiltrates
  • rapid antigen testing for flu
  • RSV nasal swab
  • cold agglutinin titer negative

Tx

  • Flu with Tamiflu (A & B) if sxs < 48hrs onset
  • symptomatic tx = B2 agonists, fluids, rest
41
Q

Pneumoconiosis

Restrictive Lung Diseases

A

Pulmonary fibrosis with a known cause

Abestosis

  • Insulation, demolition, construction
  • CXR - reticular, linear pattern, w/ basilar predominancy, opacities, honeycombing
  • can turn into mesothelioma

Coal Workers

  • coal mining,
  • Nodular opacity in upper lung fields; hilar adenopathy not necessarily prominent

Silicosis

  • mining, sandblasting, stone or quarry work
  • eggshell calcification of hilar nodes
  • incr risk of TB and progression to massive fibrosis

Berylliosis

  • high tech fields, nuclear power, ceramics, foundries
  • diffuse infiltrates, hilar adenopathy
  • req’s chronic steroids
42
Q

Pneumothorax

A

Collapsed lung caused by accumulation of air in pleural space

Spontaneous vs traumatic

  • primary - abs of underlying dz (tall, thin, male age 10-30 at greater risk), smoker
  • Secondary - presence of underlying dz (COPD, asthma, CF, ILD)

Acquired

  • Iatrogenic
  • Traumatic -> penetrating or blunt trauma
  • Barotrauma - mechanical ventilation

SXS:

  • Acute onset ipsilateral chest pain and dyspnea - decreased tactile fremitus
  • deviated trachea
  • hyperresonance
  • Diminished breath sounds

Tx - depends on size

  • small < 15% of diameter of hemithorax - resolves spontaneously w/o chest tube placement
  • large > 15% diameter & symptomatic - chest tube placement
  • Serial CXR q 24 hrs until resolve
43
Q

Pulmonary Embolism

eti, sxs

A

blockage in one of pulmonary arteries in lungs

MCC - deep veins of LEs

RF:

  • Virchow’s Triad
    • Hypercoagulable state (sx, CA, OCP, preg, smoking, long bone fracture)
    • Venous stasis
    • Epithelial injury

Sxs

  • Dyspnea MC
  • pleuritic chest pain
  • Tachycardia –> EKG with S1Q3T3, non spec ST waves
  • Tachypnea
44
Q

Pulmonary Embolism

Treatment

A

Hemodynamically stable

  1. Anticoags
    • UFH or LMWH => Warfarin - 3 mos bridge with heparin 3-5 days
      • INR range 2-3
      • LMWH and hep for cancer and pregnant patients**
    • factor Xa inhibitors Rivaroxaban or PO Direct Thrombin Inhibitors Dabigatran
  • Minimal antigoag for 3 mos w/ reversible RFs
  • if unprovoked - 6 mos then reeval
  • If two eps unprovoked - long term anticoag
  1. IVC filter - stable pt who can’t take anticoags or unsuccessful

UNSTABLE

  1. Thrombolectomy - if unstable or massive PE
45
Q

Respiratory Syncytial Virus

A

MCC LRTI in children - get by age 3

leading cause of PNA and bronchiolitis

sxs

  • Rhinorrhea
  • wheezing/coughing that persists for months
  • low grade fever
  • nasal flaring/retractions
  • nail bed cyanosis

Tx

  • hospitalization if
    • tachypnea w/ feeding difficulties
    • visible retractions
    • O2 Sat <95%
  • Supportive care
    • albuterol via neb
    • antipyretics
    • humidified O2
    • Steroids (controversial)
    • Resolves in 5-7 days

Vaccines for children with lung issues or premature –> synagis prophylaxis (palivizumab) 1x/m for 5 mos in Nov

46
Q

Sarcoidosis

Restrictive Lung Disease

A

Granulomatous disease => noncaseating granulomas that affects multiple organ systems

20-40yo, Northern europeans or AAs

Sxs

  • fever, weight loss, arthralgias, erythema nodosum

Dx

  • Hypercalcemia; ACE levels x 4 UNL
  • ele ESR
  • Biopsy of peripheral lesions or fiberoptic bronch for central pulm lesions
  • Serial PFT for progression

Tx

  • Corticosteroids, methotrexate, immunosuppressive meds
  • ACE-I for periodic HTN
47
Q

Screening for Lung Cancer

A

USPSTF

Annual low dose CT, if

  • 55-80 yo
  • >30 pack year hx
  • current smokers or
  • quit within last 15 years

Incidental finding on CXR

  • send for CT
  • if suspicious - need bx
    • Ill defined borders, lobular or spiculated = cancer
  • If not suspicious < 1cm
    • monitor q 3mos, 6 mos, yearly for two years
    • calcifications, smooth, well defined edges = benign

Mets- Adeno and Small cell = BRAIN METS

bone

48
Q

SVC Syndrome

A

a/w SCLC

obstruction of SVC by tumor resulting in

  • facial fullness
  • JVD
  • dilated veins in anterior chest
49
Q

Tension PTX

A

penetrating injury -> air in pleural space increasing and unable to escape

Mediastinal shift leading to TRACHEAL deviation to contralateral side or severe JVD

CXR = pleural air

ABG = hypoxemia

medical emergency - large bore needles to allow air out of chest

Needle decompression - 2nd ICS, midclavicular line, above rib

50
Q

Tuberculosis

eti, sxs, dx

A

Mycobacterium tuberculosis

RF - endemic area, IMC (HIV), recent immigrants (<5yo), prisoners, health care workers

transmission - inhalation of aerosolized droplets

Sxs:

  • fatigue, productive cough, bloody sputum
  • night sweats, wt loss, post tussive rales
  • miliary TB = spread outside lungs - neuro or GI
  • vertebral column (Pott disease)

Dx:

  • Sputum for AFB smears - have to be 3 AFB negatives
  • NAAT - quicker dx
  • CXR - cavitary lesions, infiltrates, ghon complexes in apex of lungs
  • Bx - caseating granulomas
51
Q

Tuberculosis

Treatment

A

Empiric tx

PPD + & CXR negative - latent TB => Isoniazid 9 mos +B6 for neuropathy

PPD + & CXR positive - active TB => quad therapy (RIPE) x2 mos, then 2 drugs for 4 mos

  • Rifampin - red orange urine, hepatitis
  • Isoniazid - perip neuropathy (B6 pyridoxine 25-50mg/day)
  • Pyrazinamide - hyperuricemia (gout)
  • Ethambutol - optic neuritis (eye changes), red green blindedness

Need two negative AFB smears and cultures to stop therapy

Prophy isoniazid for household members - for 1 year

dc therapy if transaminases > 3-5 x ULN

52
Q

Tuberculosis

Screening

A

PPD - Tb skin test

Mantoux Test Rules - tests positive if

  • >5mm at high risk, fibrotic changes on CXR, IMC HIV/Drugs, steroids/TNF antagonist daily, or close contact w/ infectious TB
  • > 10mm in pts < 4yo, and risk factors = health care facilities, IVD, recent immigrants with high prevalence, renal insufficiency, prison, homeless shelter, bypass surgery
  • > 15mm if no other risk factor
53
Q

Well’s Criteria

A
54
Q

PE - dx

A

Negative suspicion - rule out

PANCE (15 decks)

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