Pulmonology Flashcards
Primary indications for mechanical ventilatory support
Hypoxemic respiratory failure refractory to supplemental oxygen
Hypercapnic respiratory failure (most frequently caused by severe exacerbations of obstructive lung disease)
Poor airway protection, such as in coma or in the context of a large upper gastrointestinal hemorrhage and vomiting, or due to processes leading to large airway obstruction, such as laryngeal edema
Adjunct therapy for shock and multiorgan system failure.
Pulmonary involvement of primary TB infection
Middle and lower lung zones
Primary TB lesion which is peripheral and accompanied by transient hilar or paratracheal lymphadenopathy; may or may not be visible on CXR
Ghon focus
Ghon focus +/- pleural reaction + thickening + regional lymphadenopathy
Ghon complex
Standard regimens for DS-TB (# of pills by wt)
25-37kg: 2
38-54kg: 3
55-70kg: 4
>70kg: 5
TB treatment in HIV co-infection
- TB treatment initiated first, followed by ART as soon as possible within the first eight weeks of treatment.
- If with profound immunosuppression (e.g. CD4 counts less than 50 cells/mm3), HIV-positive TB patients should receive ART within the first two weeks of initiating TB treatment.
- Should also receive co-trimoxazole as prophylaxis for other infections.
- Antiretroviral treatment (ART) should be started in all TB patients living with HIV, regardless of CD4 cell count.
Schedule of sputum follow-up examinations for PTB on DS-TB regimen
New CDTB:
2nd month; if positive, test again on 5th and 6th month
New BDTB/Retreatment:
2nd, 5th, 6th
**If positve at 5th and 6th months, declare as treatment failure
When can TB patients be cleared for work?
CDTB: After one week of treatment
BDTB: After a negative follow-up SM or if with urgency to go back to work, repeat SM after two weeks
Management of TB cases who interrupted treatment
Less than 1 month – continue and compensate for missed doses
More than 1 month, less than 2 months:
- Negative SM: continue and compensate for missed doses
- Positive SM:
a. Treated less than 5 months: continue and compensate for missed doses
b. Treated more than 5 months: Treatment failure
More than 2 months: Lost to follow-up
Timing of ART in profoundly immunosuppressed (CD4 <50u/L) patients
ART should be started within the first 2 weeks of TB treat- ment for profoundly immunosuppressed patients with CD4+ T-cell counts of <50/μL
TB preventive treatment regimen
6 months INH
The most common ILD of unknown cause
Idiopathic Pulmonary Fibrosis
- commonly diagnosed in the fifth or sixth decade in life, affects men more than women, and is frequently associated with a history of smoking or other environmental exposures.
HRCT findings of IPF
subpleural reticulation with a posterior basal predominance usually including more advanced fibrotic features, such as honeycombing and traction bronchiectasis (collectively referred to as a UIP pattern)
Treatment for IPF
antifibrotic therapy (pirfenidone and nintedanib)
HRCT findings in Nonspecific Insterstitial Pneumonia (NSIP)
Diffuse subpleural, symmetric, ground-glass, and reticular opacities
