Pulmonology Flashcards
Mycoplasma Pneumonia
Dx ?
Rx ?
flu-like illness (dry cough, headache, myalgia).
hemolysis (increase retic, increase bilirubin),
Coomb’s test (+) - AIHA
low Na+ (due to SIADH)
……………………………….
Quinolones, macrolides - both good options for Rx but the pt is already taking Amitriptyline - both increase QT interval.
So, use Doxy as treatment
Legionella Pneumonia
Dx ?
Rx ?
Increase Neutrophils
low Na+
deranged LFTs
proteinuria, hematuria, myoglobinuria
Urine antigen test (increase IgM, IgG)
……………….
Rx: Macrolides (azithro, clarithro)
Eosinophilic Granulomatosis with Polyangitis
Triad: Asthma, Eosinophilia, systemic vasculitis
CXR - pulmonary infiltrates B/L
Mononeuritis multiplex (Foot/wrist drop) +/-
pANCA (+) 40%
Renal involved (Rare)
……………………….
Rx: Steroids + cyclophosphamide/azathioprine.
ABPA
Diagnostic criteria (7 points)
1) Asthma (most cases)
2) High Eosinophils (blood/sputum)
3) CXR (Abnormal)
4) Positive skin test/RAST to an extract of A. Fumigatus
5) A. Fumigatus IgG serum-precipitating Ab
6) Total IgE > 1000
7) Fungal hyphae of A. fumigatus on microscopy of sputum
V/Q Scan
Differ PPH vs Multiple pulmonary emboli ?
PPH: V/Q scan = patchy filling defects
Multiple pulmonary emboli = multiple perfusion defects
(V/Q negative = PPH most likely cause)
Community-Acquired Pneumonia in COPD pt (Penicclin allergy)
Rx ?
*Macrolide (Clarithro)
if pt also taking theophylline, hold it till Abx course complete
*other option, Doxy
Bronchial carcinoid
Rx ?
surgery
OSA
Dx ?
Not a clinical Dx.
sleep apnea studies require to make Dx.
Obesity Hypoventilation syn
Dx ?
3 features…
1) BMI > 30
2) Daytime pCO2 > 6
3) Absence of other features of hypoventilation. e.g., opiods overdose
Aspiration Pneumonia vs
Klebsiella pneumonia ?
(By luck, both Alcoholic pts)
Aspiration pneumonia - Right lower lobe pneumonia
Klebsiella pneumonia - cavitation & abscess formation.
LTOT > 15 hrs
Offer to those ?
stable COPD with PaO2 < 8 with evidence of any1:
*peripheral edema,
*polycythemia (HCT > 55)
*Pulmonary HTN
B Cepacia
which individuals get this ?
Rx ?
CF (2 - 3% pts)
Rx: Ceftazidime + Aminoglycoside (Genta/Amika)
Which pts need CXR ?
1) 6Weeks as someone have S/S
2) High risk malignancy (age > 50, smoker)
left hilar mass with mild L-sided pleural effusion.
Next step ?
CT with contrast
Bronchoscopy (next step)
GBS pt
Increase intervention at what stage ?
Poor prognostic factors ?
20ml/kg FVC (1 Liter)
………………..
Poor prognostic factors:
1) advance age
2) Rapid progression of symptoms
3) prolong ventilation > 1 month
4) Severe Action Potential Reduction on NM testing
Secondary Pulmonary HTN
Dx ?
result of:
1) pulmonary fibrosis (Idiopathic/CT disease)
2) Chronic venous thromboembolism
HIV (+) chest infection.
How to diagnose PCP ?
Indirect IF of BAL Fluid
(avoid - bronchoscopy with biopsy - risk of pneumothorax)
CXR may be normal in PCP.
Intervention to improve survival in Idiopathic Pulmonary fibrosis and GERD ?
PPI
Nephrogenic DI
(Not responding to fluid restriction). Next step?
Demeclocycline
Pleural Fluid suggestive of
1) Infection
2) Malignancy
1) Infection:
*Turbid fluid
*High Neutrophil count
*Abnormal LFTs
*LDH (raised level - infection/malignancy). Ratio s/LDH to Pleural fluid LDH > 0.6 exudative
…………………………..
2) malignancy:
*Uniform blood staining
*Protein > 30 g/l.
*pH - Low (Infection/inflammation/malignancy)
Bronchiolitis obliterans
Dx ?
*hyperinflation
*attenuation of vascular markings
*reticulonodular shadowing
(no pleural effusion)
