pulmonology Flashcards
What virus causes acute bronchiolitis?
RSV
What seasons would you expect a kiddo to get bronchiolitis
Fall and winter
What is the only tx demonstrated to improve bronchiolitis?
Oxygen
What age group is most likey to get acute bronchiolitis?
Children under the age of 2
What kind of symptoms would you suspect in an infant with bronchiolitis?
- Tachypnea, respiratory distress, WHEEZING
When would you admit a kiddo with bronchiolitis to the hospital, I.E what oxygen level?
if there Sp02 is less than 95-96, If they are less than 3 months old, if their RR >70
What physical exam findings would make you nervous in a kiddo with bronchiolitis?
nasal flaring, retractions, or atelectasis on CXR
What is the Tx for acute bronchiolitis?
humidified O2, antipyretics, beta-agonist, nebulized racemic epinephrine, and steroids
What medication should be given to a kiddo who is immunocompromised or has severe lung disease or heart disease?
Ribavirin
Palivizumab, what is this medication used for?
This can be used for prophylaxis tx of bronchiolitis in special populations
(immunocompromised, premature infants, neuromuscular disorders)
Acute bronchitis is defined as a cough greater than how many days
5 days
what is the most common cause of acute bronchitis?
usually viral
what bacteria is the most common to cause acute bronchitis?
M. Catarrhalis
What are some of the common bacteria to cause acute bronchitis in patients with chronic lung problems?
H. influ, S. Pneu, M. Cat
What is the tx for acute bronchitis?
symptomatic and supportive - hydration, expectorant, analgesic, B2 agonist, cough suppressant
What O2 sat would you admit a patient at with acute bronchitis?
O2 less than 96% seems high to me but thats according to smartypance
Would you expect to hear rales or egophony in a patient with acute bronchitis?
No
When would antibiotics be indicated in bronchitis?
indicated in elderly, underlying cardiopulmonary disease, cough >7-10 days, or immunocompromised
What is the usual cause of epiglottitis?
HIB, usually unvaccinated children are the ones that get it
What is the mechanism behind ARDS
This is a type of respiratory distress characterized by the accumulation of fluid in the lungs depriving organs of oxygen
Describe the presentation of ARDs
Acute rapid onset 12-24 hours and patient will be in severe respiratory distress almost unable to breath on their own, they will have tachypnea, PINK FROTHY SPUTUM, and crackles
What will a CXR show in a patient experiencing ARDs
- Air bronchograms
2. bilateral fluffy infiltrates
would you expect any abnormalities in any of the following tests when a patient is in ARDs. BNP, pulmonary wedge pressure, left ventricle function and echocardiogram
All these will actually be normal
What is the treatment for ARDs?
Tracheal intubation with the lowest level PEEP to maintain PaO2 >60 mmHg or SaO2 >90
How do diagnose asthma and how do you monitor asthma?
diagnosed with spirometry and monitored with peak flow
Someone comes in complaining of asthma symptoms about once a week and 2 nights a month. What severity of asthma do they have and how would you treat it?
This is mild asthma and treat with SABA prn
A patient who is already taking a SABA is having symptoms daily and about 2 nights a week. What severity of asthma do they have and how would you change their meds?
this moderate persistent and they should be on
- Low dose ICS + LABA
- medium dose ICS + LABA
Mother brings her child in to see you and says her son seems to be having coughing episodes at night and when its cold outside. She says they seem to happen about 3 times a week and about 3-4 times at night per month. You diagnose them with _________ and tx them with __________
Mild persistent and low dose ICS
Some who already has asthma uses and albuterol inhaler and is experiencing an acute asthma attack should be treated with what?
oxygen, nebulized SABA, ipratropium bromide, and oral steroids
You just diagnosed a child with Croup they have inspiratory stridor and retractions at rest. What should their tx be?
a one time IM of 0.6mg dexamethasone and nebulized racemic epi for severe cases
A 1 year old child who prevously had a running nose, low grade fever and nasal congestion presents to your office with a 4 day cough that is harsh sounding and worse at night. You notice on exam stridor and retractions at rest. What does the kiddo have?
Croup
Is rigid or flexible bronchoscopy preferred in children?
rigid is preferred in children, flexible is better in adults
What type of lung cancer is most common? small cell or non small cell?
non small cell makes up about 85% of them
Which type of lung cancer to smokers get? small or non-small
small 99% of smokers, its centrally located and very aggressive
What are the subtypes of cancers in non-small cell cancers?
- squamous cell- centrally located, can cause hypercalcemia and elevated PTHrp
- large cell- in the periphery can cause gynecomastia
- adenocarcinoma (most common)- peripheral mass; smoking/asbestos exposure; thrombophlebitis
- carcinoid cancer
How large is a pulmonary nodule and how large is a coin lesion
nodule is <3cm, Coin lesion is considered a mass and is >3cm
What is the tx for pertussis?
Macrolide (clarithromycin or azithromycin)
is pertussis gram negative or gram positive
its gram negative
an adult who has had a persistent cough for greater than 2 weeks should make you consider what?
Pertussis
The following symptoms fall into what stage of pertussis? Poor feeding, cold like symptoms, and poor sleeping
catarrhal stage
The paroxysmal stage of pertussis consists of what?
This is the whooping cough stage
What can you do to try and differentiate an exudative vs transudative pleural effusion?
pleurocentesis
What will a exudative pleurocentesis show?
Should have an increase in LDH or Protein
Lights Criteria
Pleural fluid protein / Serum protein >0.5
Pleural fluid LDH / Serum LDH >0.6
Pleural fluid LDH > 2/3
What kind of imaging should you get to diagnose a pleural effusion?
lateral decubitus CXR
What is the gold standard to diagnose a pleural effusion?
Thoracentesis
PE on a pt suspected to have a pleural effusion with show __________ tactile fremitus and ____________ to percussion
- Decreased
2. Dullness
MCC of exudative pleural effusion?
pneumonia, cancer, PE, TB
At what CD4 count do prophylax for PJP?
CD4 <200
What medication is used for prophylaxis of PJP in HIV patients?
Bactrim
What are the CURB65 criteria to admit a pt with pneumonia?
- Confuison
- Urea >7
- RR>30
- Systolic BP <90 or diastolic <60
- Age >65
Each is one point, a score of 3-5 requires admission
A westernmark or hampton hump on CXR suggests what?
PE
What EKG changes do you see in someone with a PE
S wave lead 1, Q wave lead 3 and inverted t-wave lead 3
A homemans sign is what and what is it indicative of?
- Dorsiflexion of the foot causes calf pain
2. Indicative of a DVT
What is the minimum duration someone with a PE should be anticoagulated?
3 months
What is the acute treatment of a PE?
Heparin paired with a factor Xa inhibitor like (Xarelto or Eliquis) then oral direct thrombin inhibitors like Pradaxa
What is the gold standard/definitive dx for PE
Pulmonary angiography
Tx for RSV?
Supportive measures include albuterol via nebulizer, antipyretics and humidified oxygen, steroids (controversial), resolves in 5-7 days
Indications to hospitalize a child with RSV?
tachypnea with feeding difficulties, visible retractions, oxygen desaturation < 95-96%
How do diagnose RSV?
Nasal washing
a TB induration that is 6 cm will be positive for what types of people?
- people at high risk
- fibrotic changes on CXR, immunocompromised HIV/drugs, steroids/TNF antagonists daily, or close contact with pt with infectious TB
A TB induration thats 11cm will be positive for what group people?
in patients age < 4 or some risk factors = hospitals and other healthcare facilities, IVDU, recent immigrants from high prevalence area, renal insufficiency, prison, homeless shelter, diabetes, head/neck cancer, gastrectomy/jejunoileal bypass surgery
A TB induration thats 16 cm will be positive for who?
everyone
CXR of TB will show what?
cavitary lesions, infiltrates, ghon complexes in the apex of lungs
treatment for someone PPD positive but CXR negative?
latent TB ⇒ Isoniazid for 9 months (+ B6 to prevent neuropathy)
Treatment for someone who is PPD and CXR positive
active TB ⇒ Quad therapy (RIPE): rifampin, isoniazid, pyrazinamide, ethambutol – all are hepatotoxic
How long do patients take the four drugs for TB (RIPE) ? How long with the two drugs (RI)?
8 weeks and then 16 weeks
Side effects of rifampin?
- red-orange urine
2. Hepatotoxic
Side effect of isoniazide?
peripheral neuropathy
side effects of pyrazinamide?
hyperuricemia (gout)
side effects of ethambutol?
optic neuritis
red green blindness
What should household member be treated with if someone who lives there has TB?
isoniazide for 1 year
What supplement should pts who are on Isoniazid take?
B6 = pyridoxine 25-50mg/day)
