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Emergency Medicine EOR > Pulmonology > Flashcards

Pulmonology Flashcards

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1
Q

What is acute bronchiolithis?

A

most often caused by RSV - commonly in fall and winter months

  • infants and young children
  • tachypnea, respiratory distress, wheezing
  • diagnosed by nasal washing for RSV culture and antigen assay; CXR = normal
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2
Q

What is the tx for acute bronchiolitis?

A
  • hospitalization if O2 saturation < 95-96%, age < 3 months, RR > 70, nasal flaring, retractions, or atelectasis on CXR
  • supportive = humidified O2, antipyretics, beta-agonist, nebulized racemic epinephrine, and steroids
  • the only treatment demonstrated to improve bronchiolitis is oxygen
  • ribavirin is given if severe lung or heart disease and in immunocompromised patients
  • palivizumab prophylaxis (once per months for five months beginning in November) for special populations (immunocompromised, premature infants, neuromuscular disorders)
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3
Q

What is acute bronchitis?

A

defined by a cough > 5 days, can last 1-3 weeks

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4
Q

What are the organisms causing acute bronchitis?

A
  • most common - viral (95%)
  • common bacterial = M. catarrhalis
  • chronic lung patients: H. influenzae, S. pneumoniae, M. catarrhalis
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5
Q

What is the presentation of acute bronchitis?

A
  • cough, fever (unusual), constitutional symptoms
  • typically less severe than pneumonia, normal vital signs, no rales, no egophony
  • obtain CXR if the diagnosis is uncertain or symptoms persist despite conservative treatment
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6
Q

What is the treatment for acute bronchitis?

A

symptomatic and supportive - hydration, expectorant, analgesic, B2 agonist, cough suppressant

  • corticosteroids if a history of underlying reactive airway disease
  • ribavirin if severe lung or heart disease and in immunocompromised patients
  • if O2 < 96% on room air the patient should be hospitalized
  • antibiotics are indicated in elderly, underlying cardiopulmonary disease, cough > 7-10 days, or immunocompromised
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7
Q

What is acute epiglottitis?

A

supraglottic inflammation and obstruction of airway due to infection with Haemophilus influenzae type B (Hib)

  • this is a medical emergency
  • caused by Hib - usually unvaccinated children (Hib vaccine at 2, 4, 6, 12-15 mo)
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8
Q

What are the signs and symptoms of acute epiglottitis?

A

triad positioning = the Ds of epiglottitis

  • dysphagia
  • drooling
  • respiratory distress
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9
Q

What is the classic finding on x-ray for epiglottitis?

A

thumbprint sign on x-ray lateral neck film, secure airway then culture for H. flu

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10
Q

What is the tx for epiglottitis?

A

involves intubating if necessary, supportive care, ceftriaxone, may treat as an outpatient if stable

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11
Q

What is acute respiratory distress syndrome?

A

a type of respiratory failure characterized by fluid collecting in the lungs depriving organs of oxygen

  • increase permeability of alveolar-capillary membranes = development of protein-rich pulmonary edema (non-cardiogenic pulmonary edema)
  • ARDS can occur in those who are critically ill or who have significant injuries = sepsis (most common), severe trauma, aspiration of gastric contents, near-drowning
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12
Q

What are the signs and symptoms of ARDS?

A

severe shortness of breath and often are unable to breath on their own without support from a ventilator

  • rapid onset of profound dyspnea occurring 12-24 hours after the precipitating event
  • tachypnea, pink frothy sputum, crackles
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13
Q

What do radiographs show when a patient has ARDS?

A

air bronchograms and bilaterally fluffy infiltrate

-normal BNP, pulmonary wedge pressure, left ventricle function and echocardiogram

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14
Q

What is the tx of ARDS?

A

identifying and managing underlying precipitation and secondary conditions

  • tracheal intubation with the lowest level PEEP to maintain PaO2 > 60 mmHg or SaO2 > 90
  • ARDS is often fatal, the risk increases with age and severity of illness
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15
Q

What is asthma?

A

a chronic, reversible inflammatory airway disease with recurrent attacks of breathlessness and wheezing

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16
Q

How do you diagnosis?

A

monitor with peak flow

  • spirometry with pre and post-therapy (albuterol inhalation) readings
  • decreased FEV1/FVC (75-80%)
  • > 10% increase of FEV1 with bronchodilator therapy
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17
Q

What would you expect with a FEV1 to FVC ratio <80%?

A

(you would expect the amount of air exhaled during the first second (FEV1) to be the greatest amount
-in asthma, since there is an obstruction (inflammation) you will have a decreased FEV1 and therefore a reduced FEV1 to FVC ratio

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18
Q

What is the tx for mild intermittent asthma?

A

(<2x/week or <2 night/month) - SABA prn

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19
Q

What is the tx for mild persistent asthma?

A

(>2x per week or 3-4 night/month) - low dose ICS daily

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20
Q

What is the tx for moderate persistent asthma?

A

(daily sx or >1 night/week)

  • low dose ICS + LABA daily
  • medium dose ICS + LABA daily
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21
Q

What is the tx for severe persistent asthma?

A

(sx several times/day + nightly)

  • high dose ICS + LABA daily
  • high dose ICS + LABA + oral steroids
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22
Q

What is the acute treatment for asthma?

A

oxygen, nebulized SABA, ipratropium bromide, and oral steroids

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23
Q

What is croup?

A

refers to an infection of the upper airway, which obstructs breathing and causes a characteristic barking cough

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24
Q

What are the characteristics of croup?

A
  • caused by the parainfluenza virus
  • common in children 6 mo - 3 years, fall and early winter months (same time of year as bronchiolitis)
  • barking cough and stridor
  • steeple sign on PA CXR (narrowing trachea in the subglottic region)
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25
Q

What is the tx of croup?

A
  • supportive (air humidifier), antipyretics

- severe: IV fluids and nebulized racemic epinephrine, steroids

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26
Q

What is a foreign body aspiration?

A

when a foreign body enters the airway and causes choking

  • objects can enter the esophagus through the mouth, or enter the trachea through the mouth or nose
  • most often food and can be life-threatening, 80% in mainstem or lobar bronchus right > left
  • risk factors include institutionalization, advanced age, poor dentition, alcohol, sedative use
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27
Q

What is the presentation of foreign body aspiration?

A

(depends on the location of obstruction)

-inspiratory stridor (if high in the airway) or wheezing and decreased breath sounds (if low in the airway)

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28
Q

What does a CXR show when there is a foreign body aspiration?

A

(expiratory radiograph) may reveal regional hyperinflation of the affected side
-ABG - necessary for appropriately evaluating ventilation, may be useful for following the progression of respiratory failure when it is of concern

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29
Q

What is the tx of foreign body aspiration?

A

remove foreign body with a bronchoscope

  • rigid bronchoscopy preferred in children while flexible is diagnostic and therapeutic in adults
  • complications include pneumonia, acute respiratory distress syndrome, asphyxia
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30
Q

What is hemoptysis?

A

coughing up of blood or blood-stained mucus from the bronchi, larynx, trachea, or lungs
-in other words, it is the airway bleeding

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31
Q

What is the presentation of hemoptysis?

A
  • coughing up of blood or blood-stained mucus from the bronchi, larynx, trachea, or lungs
  • bronchial capillaries in the mucosa of the tracheobronchial tree rupture as a result of acute infection (viral or bacterial bronchitis, bronchiectasis, cigarette smoke)
  • it can occur when tiny blood vessels that line the lung airways are broken massive hemoptysis can be seen with lung cancers and other serious abnormalities
  • vascular engorgement with erosion such as in pulmonary hypertension or masses
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32
Q

What are the most common causes of hemoptysis?

A
  • bronchitis (50%): hemoptysis, dry cough, cough with phlegm
  • tumor mass (20%): hemoptysis, chest pain, rib pain, tobacco history, weight loss, clubbing
  • tuberculosis (8%): hemoptysis, chest pain, sweating
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33
Q

How is hemoptysis dx?

A
  • examining the expectoration may help localize the source of bleeding
  • cytology (especially when worried about lung cancer)
  • fiberoptic bronchoscopy is preferred for CA tissue biopsy, bronchial lavage, or brushing
  • rigid bronchoscopy for cases of massive bleeding because of its greater suctioning and airway maintenance capabilities
  • high-resolution CT gives a greater positive yield of pathology
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34
Q

What is the tx of hemoptysis?

A
  • massive hemoptysis warrants a more aggressive early consultation with a pulmonologist
  • ABCs = airway maintenance is vital because the primary mechanism of death is asphyxiation, not exsanguination
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35
Q

What are the pearls of hemoptysis?

A
  • the most common presentation of acute or mild hemoptysis is bronchitis
  • older smokers with hemoptysis lung cancer must be ruled out with HIGH - RESOLUTION CT of the chest
  • NEGATIVE CXRs DO NOT RULE OUT LUNG CANCER
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36
Q

What is influenza?

A

a viral respiratory infection caused by orthomyxovirus resulting in fevers, coryza, cough, headache, and malaise
-three strains exist: A, B, and C

37
Q

Who should receive an annual influenza vaccine?

A

everyone > 6 months
-avoid vaccination: severe egg allergy, previous reaction, Guillain-Barre syndrome (GBS) within 6 weeks of previous vaccination, GBS in the past 6 weeks, < 6 months old, avoid FluMist in patient with asthma

38
Q

How is influenza dx?

A

rapid antigen test in the clinic, rapid serology test more accurate
-CXR in primary influenza pneumonia will show bilateral diffuse infiltrates

39
Q

What is the tx of influenza?

A

symptomatic (for most) or with antivirals = ideally < 48 hours - tamiflu (oseltamivi), inhaled relenza (zanamivir), IV rapivab (peramivir), and oral baloxavir (Xofluza)

  • zanamivir and oseltamivir both treat influenza A and B = (think Dr. “OZ” treats the flu)
  • indications for antiviral treatment: hospitalized, outpatient with severe/progressive illness, an outpatient at high risk for complications (immunocompromised, pt with chronic medical conditions, > 65 yo, pregnant women/ 2 weeks postpartum)
40
Q

What are the two categories of lung cancer?

A
  • small cell lung cancer (SCLC), about 15% of cases (poor prognosis)
  • non-small cell lung cancer (NSCLC), about 85% of cases, four subtypes include adenocarcinoma, squamous cell carcinoma, large cell carcinoma and carcinoid tumor
41
Q

What are the characteristics of small cell carcinoma?

A

15% of cases

  • 99% smokers; doesn’t respond to surgery; metastases common at presentation
  • central location, very aggressive
  • associated with paraneoplastic syndromes; Cushing’s, SIADH
42
Q

What is the tx of small cell carcinoma?

A

can’t have surgery, need chemo

-associated manifestations: SVC syndrome, pancoast tumor, horner’s syndrome, carcinoid syndrome

43
Q

What are the characteristics of non-small carcinoma?

A

85%

  • adenocarcinoma (35-40%): MOST COMMON, peripheral mass; smoking/asbestos exposure; thrombophlebitis
  • squamous cell (central mass 25-35%): presents with hemoptysis, central location, hypercalcemia, elevated PTHrp
  • large cell (5%): rarely responds to surgery; periphery location, gynecomastia
  • carcinoid tumor (1-2%): lack glandular and squamous differentiation
44
Q

What is the tx of non-small cell?

A

stage 1-2 = surgery
stage 3 = chemo
stage 4 = palliative

45
Q

What is carcinoid tumors?

A

GI tract cancer metastasized to lung (CA of appendix = MC; appendix - liver - lung)

  • presentation: hemoptysis, cough, focal wheezing, recurrent pneumonia
  • carcinoid syndrome = cutaneous flushing, diarrhea, wheezing, hypotension (telltale sign)
  • adenoma = MC type of carcinoid tumor (slow-growing, rare)
  • Dx: bronchoscopy - pink/purple central lesion, well-vascularized; elevated 5-HIAA
  • treatment is with surgery
46
Q

What is a pulmonary nodules?

A

< 3 cm is a nodule (coin lesion) > 3 cm = mass

47
Q

What are the steps to deal with pulmonary nodule?

A
  1. incidental finding on CXR
  2. send for CT
  3. if suspicious (depending on radiographic findings below) will need a biopsy
    - ill-defined lobular or spiculated suggests cancer
  4. if not suspicious < 1 cm it should be monitored at 3 mo, 6 mo, and then yearly for 2 yr
    - calcification, smooth well-defined edges, suggests benign disease
48
Q

What is pertussis?

A

whooping cough (pertussis) is a highly contagious respiratory tract infection marked by a severe hacking cough followed by a high-pitched intake of breath that sounds like a whoop

49
Q

What are the characteristics of pertussis?

A

gram-negative bacteria Bordetella pertussis - high contagious

  • consider in adults with cough > 2 weeks, patients < 2 year old
  • catarrhal stage: cold-like symptoms, poor feeding, and sleeping
  • paroxysmal stage: high-pitched “inspiratory whoop”
  • convalescent stage: residual cough (100 days)
50
Q

How is pertussis dx?

A

by a nasopharyngeal swab of nasopharyngeal secretions - culture

51
Q

What is the tx for pertussis?

A

macrolide (clarithromycin/azithromycin); supportive care with steroids/beta2 agonists

  • vaccination: 5 doses - 2, 4, 5, 15-18 mo, 4-6 years (DTap)
  • 11-18 yo = 1 dose Tdap
  • expectant mother should get Tdap during each pregnancy, usually at 27-36 weeks
52
Q

What is a pleural effusion?

A

accumulation of excess fluid between the layers of the pleura outside the lungs (pleural space)
-presents with dyspnea, and a vague discomfort or sharp pain that worsens during inspiration

53
Q

How do you differentiate between exudate and transudate with pleurocentesis?

A
  • determine if the pleural fluid is exudative by meeting at least one of the light’s criteria (increased protein, increased LDH)
  • pleural fluid protein/serum protein >0.5
  • pleural fluid LDH/serum LDH >0.6
  • pleural fluid LDH >2/3
54
Q

What is transudate pleural effusion?

A

transient - from changes in hydrostatic pressure: cirrhosis, CHF, nephrotic syndrome, ascites, hypoalbuminemia

55
Q

What is exudative pleural effusion?

A

protein ratio increase, LDH increase: infection, malignancy, immune; MC cause = pneumonia, cancer, PE, TB

56
Q

How do you dx a pleural effusion?

A

lateral decubitus CXR, chest CT, U/S

  • thoracentesis is the gold standard
  • PE shows decreased tactile fremitus and dullness to percussion in pleural effusion
  • Isolated left-sided pleural effusion likely exudative
  • right-sided = transudative
57
Q

What is the tx of pleural effusion?

A

throacocentesis
-effusions that are chronic or recurrent and causing symptoms can be treated with pleurodesis (pleural space is artificially obliterated) or by intermittent drainage with an indwelling catheter

58
Q

What is pleuritic chest pain?

A

caused by inflammation of the tissues that line the lungs and chest cavity (pleura)

59
Q

What are the characteristics of pleuritic chest pain?

A
  • characterized by sudden and intensely sharp, stabbing, or burning pain in the chest when inhaling and exhaling
  • It is exacerbated by deep breathing, coughing, sneezing, or laughing
  • common causes include pneumonia, pericarditis, pericardial effusion, pancreatitis
60
Q

What is viral pneumonia?

A

adults - flu = MC; kids = RSV, comes on fast

  • Dx: CXR = bacterial interstitial infiltrates; rapid antigen testing for flu, RSV nasal swab, cold agglutinin titer negative
  • tx: flu with Tamiflu (A and B) if sx’s began < 48 hours; symptomatic tx = beta 2 agonists, fluids, rest
61
Q

What is bacterial pneumonia?

A

fever, dyspnea, tachycardia, tachypnea, cough, +/- sputum

  • Dx: patchy, segmental lobar, multipolar consolidation; blood cultures x 2, sputum gram stain
  • tx: outpatient = doxy, macrolides; inpatient = ceftriaxone + azithromycin/respiratory FQs
62
Q

What is fungal pneumonia?

A

common in immunocompromised patients (AIDs, steroid use, organ transplant)

  • coccidioides (valley fever): non-remitting cough/bronchitis non-responsive to conventional tx
  • fungal inhalation in western states; test with EIA for IgM and IgG
  • tx: fluconazole/itraconazole
  • Pulmonary aspergillosis: usually those with healthy immune systems
  • tx: fluconazole/itraconazole
  • Cryptococcus: found in soil; can disseminate and a meningitis
  • lumbar puncture
  • tx: amphotericin B
  • histoplasma capsulate: pulmonary lesions that are apical and resemble cavitary TB; worsening cough and dyspnea, progression to disabling respiratory; no dissemination
  • bird or bat droppings (caves, zoo, bird); Mississippi Ohio river valley
  • signs: mediastinal or hilar LAD (looks like sarcoid)
  • tx: amphotercin B
63
Q

What is PJP?

A

HIV: pneumocystis jiroveci

  • common in HIV patient with CD4 count < 200
  • CXR: diffuse interstitial or bilateral perihilar infiltrates
  • Dx: bronchoalveolar lavage PCR, labs, HIV test; low O2 sat despite supplemental oxygen
  • tx: bactrim and steroids; pentamidine for allergy
  • prophylaxis for high risk patients with CD4 < 200 = daily bactrim
64
Q

What is CURB-65 score for pneumonia severity?

A

estimates mortality of community-acquired pneumonia to help determine inpatient vs. outpatient treatment

  • confusion; urea>7;RR>30, systolic BP <90 mmHg or diastolic BP <60 mmHg, age >65
  • 0-1 = low risk, consider home tx
  • 2 = probable admission vs close outpatient management
  • 3-5 admission, manage as severe
65
Q

What is a pneumothorax?

A

a collapsed lung caused by an accumulation of air in pleural space
-presents with acute onset ipsilateral chest pain and dyspnea with decreased tactile fremitus, deviated trachea, hyper resonance, diminished breath sounds

66
Q

What is primary and secondary pneumothrorax?

A

can be spontaneous or traumatic

  • primary: occurs in absence of underlying disease (tall, thin males age 10-30 at greatest risk)
  • secondary: in present of underlying disease (COPD, asthma, cystic fibrosis, interstitial lung disease)
67
Q

What is a tension pneumothorax?

A

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

  • a mediastinal shift to the contralateral side and impaired ventilation
  • CXR = pleural air; ABG shows hypoxemia
68
Q

What is the tx for a pneumothorax?

A
  • small - <15% diameter of hemithorax will resolve spontaneously without the need for chest tube placement
  • large - >15% diameter and symptomatic pneumothoraces require chest tube placement
  • serial CXR every 24 hours until resolved
  • tension pneumothorax is a medical emergency
  • large bore needles to allow the air out of the chest; chest tube for decompression
69
Q

What is a pulmonary embolism?

A

a blockage in one of the pulmonary arteries in the lungs

  • more than 90% originate from cots in the deep veins of the lower extremities
  • presents with dyspnea (most common) and pleuritic chest pain
  • R/F: Virchow’s triad = hyper coagulable state, trauma, venostasis (surgery, cancer, oral contraceptives, pregnancy, smoking long bone fractures/fate emboli)
  • homan’s sign: (Dorsiflexion of the foot causes pain in calf) indicative of deep vein thrombosis
  • EKG: TACHYCARDIA (most common), S1Q3T3 (rare), non-specific ST wave changes
70
Q

How is a pulmonary embolism dx?

A

Well’s score is used to assess the probability of pulmonary embolism

  • spiral CT = initial method of identifying
  • pulmonary angiography = gold standard definitive
  • CXR: Westermark sign or Hampton hump (triangular or rounded pleural base infiltrate adjacent to hilum)
  • VQ scans are “old school” = perfusion defects with normal ventilation (normal VQ rules out PE; abnormal - non-specific)
  • venous duplex ultrasound of lower extremities (normal test does not exclude PE)
  • ABG = respiratory alkalosis secondary to hyperventilation
  • d-dimer
71
Q

What is the tx of a pulmonary embolism?

A

heparin is the anticoagulant of choice fo the acute phase with factor Xa inhibitors (eg, rivaroxaban, apixaban, edoxaban) and oral direct thrombin inhibitors (dabigatran) thereafter

  • warfarin for patients in whom factor Xa or direct thrombin inhibitors are no available and for patients with severe renal insufficiency (target INR range 2.0-3.0)
  • duration of treatment: minimum of anticoagulation 3 months with reversible risk factor
  • unprovoked: anticoagulation recommended for at least 6 months then reevaluate
  • two episodes unprovoked, long term with anticoagulation
72
Q

What is respiratory syncytial virus?

A

MC cause of lower respiratory tract infection in children worldwide - virtually all get it by age 3; the leading cause of pneumonia and bronchiolitis

  • rhinorrhea, wheezing/coughing that persists for months, low-grade fever, nasal flaring/retractions, nail bed cyanosis
  • diagnosed with nasal washing, RSV antigen test; CXR can show diffuse infiltrates
73
Q

What is the tx for respiratory syncytial virus?

A

indications for hospitalization = tachypnea with feeding difficulties, visible retractions, oxygen desaturation < 95-96%

  • supportive measures include albuterol via nebulizer, antipyretics and humidified oxygen, steroids (controversial), resolves in 5-7 days
  • vaccine for children with lung issues or born premature/immunocompromised at birth should get Synagis prophylaxis (palivizumab) = once per month for five months beginning in November
74
Q

What is the presentation of shortness of breath?

A
  • most common diagnoses among older adult patients
  • a complaint of acute shortness of breath/respiratory distress
  • respiratory rate >25 or <10
  • oxygen saturation of less than 92%
  • lungs maintain homeostasis with respect to gas exchange and acid-base status
  • changes in oxygenation can lead to SOB
75
Q

What are the most common causes of shortness of breath?

A
  • asthma
  • chronic obstruction pulmonary disease
  • CHF
76
Q

What are the other causes of shortness of breath?

A
  • pneumonia
  • pneumothorax
  • pulmonary embolus
  • pleural effusion
  • pregnancy
  • metabolic acidosis
  • aspirin poisoning
  • renal failure
77
Q

What are the DDX of shortness of breath?

A

foreign body aspiration, interstitial lung disease, obesity, pulmonary hypertension, sarcoidosis, TB, anemia, cardimyopathy, pericarditis, epiglottis, GAD, myasthenia gravid, fracture rib, sudden blood loss

78
Q

How is shortness of breath dx?

A
  • respiratory rate <10 or >25
  • weak respiratory effort
  • oxygen saturation <92% on room air or <95% on high concentration oxygen
  • hypercapnia (elevated CO2 in ABG)
  • decrease level of consciousness
  • exhaustion
79
Q

What is the tx of shortness of breath?

A
  • oxygen (high flow nasal canal or rebreathing mask)
  • albuterol for asthma and COPD
  • lasix for CHF
  • BIPAP for respiratory difficulty and low O2 saturations
  • Intubation for severe cases
80
Q

What are the pearls of shortness of breath?

A
  • vital signs should be addressed first
  • shortness of breath initial treatment is oxygen (nasal, rebreather, etc.)
  • must rule out pulmonary and cardiac etiologies
  • CXRs, CBC, CMP, BNP, troponin, EKG on all patients
  • ABGs can help uncover how the respiratory system is truly functioning
81
Q

What is tuberculosis?

A

a disease caused by bacteria called mycobacterium tuberculosis (acid-fast bacilli)

82
Q

What are the characteristics of tuberculosis?

A
  • presentation: fatigue, productive cough, night sweats, weight loss, post-tussive rales
  • RF: endemic area, immunocompromised (HIV), recent immigrants (<5 y/o), prisoners, healthcare worker
  • transmission: inhalation of aerosolized droplets
83
Q

What is the screening for tuberculosis?

A

tuberculin skin test (TST) or interferon-gamma release assays IGRAs

84
Q

What is the mantoux test rules?

A

test is positive if induration

  • > 5 mm at high risk, fibrotic changes on CXR, immunocompromised HIV/drugs, steroids/TNF antagonists daily, or close contact with pt with infectious TB
  • > 10 mm in patients age <4 or some risk factors = hospital and other healthcare facilities, IVDU, recent immigrants from high prevalence area, renal insufficiency, prison, homeless shelter, diabetes, head/neck cancer, gastrectomy/jejunoileal bypass surgery
  • > 15 mm if there are no risk factors
85
Q

How do you diagnosis tuberculosis?

A

sputum for AFB smears and mycobacterium tuberculosis cultures - have to be 3 AFB negative

  • NAAT helps diagnosis better and sooner
  • CXR: cavitary lesions, infiltrates, ghon complexes in the apex of lungs
  • biopsy = creating granulomas
  • miltary TB = spread outside lungs = vertebral column: Pott disease; scrofula (TB to cervical lymph nodes)
86
Q

What is the tx of tuberculosis?

A

start empiric treatment in those who likely have it

  • PPD positive + CXR negative: latent TB = isoniazid for 9 months (+B6 to prevent neuropathy)
  • PPD positive + CXR positive: active TB = quad therapy (RIPE): rifampin, isoniazid, pyraninamide, ethambutol - all are hepatotoxic
87
Q

What are the side effects of the drugs?

A

Four drugs x 8 weeks (RIPE) then two drugs x 16 weeks (RI)

  • rifampin - red organe urine, hepatitis
  • Isoniazid - peripheral neuropahty (B6 = pyridoxine 25-50 mg/day)
  • pyrazinamide - hyperuricemia (gout)
  • ethambutol - optic neuritis (eye changes), red-green blindness
88
Q

What do patients with TB need to have for treatment cessation?

A

patients with active TB will need two negative AFB smears and cultures in a row negative for therapy cessation

  • prophylaxis for household members = isoniazid for 1 year
  • D/C therapy if transaminases > 3-5 x ULN
  • Pt’s on INH should supplemental Vitamin B6 (pyridoxine 25-50 mg/day) to prevent neuropathy
  • monitor serum creatinine, take meds on an empty stomach since can reduce absorption, watch for hepatotoxicity, aware of drug interactions especially with HIV meds
89
Q

What are the ddx for wheezing?

A

asthma, chronic bronchitis, COPD, carcinoid tumors, RSV, acute bronchiolitis, foreign body aspiration, transfusion reaction, heartburn/dyspepsia, ingestion of toxic substances/ foreign bodies, pulmonary neoplasm, for pulmonate, photosensitivity reaction, food allergies, influenza, pneumonia, emphysema, anaphylaxis

Emergency Medicine EOR (12 decks)

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