Pulmonology Review FINAL Flashcards
What can be given as prevention of bronchiolitis?
Palivizmab during first year of life for children < 29 weeks or immunodeficiency
What antibiotics can be given for patients with epiglottitis?
What can be given as prevention to all close contacts?
-Ceftriaxone or Cefotaxime
-Rifampin and the Hib vaccine
What shape is Strep Pneumo?
Gram positive diplococci
What shape is Staph Aureus?
Gram positive cocci in clusters
Two common causes of hospital-acquired PNA?
Pseudomonas and MRSA (Staph Aureus)
Aspiration PNA Treatment
Ampicillin-Sulbactam or Amoxicillin-Clavulanate
Treatment for PNA
-CAP Outpatient
-CAP Inpatient
Outpatient: Macrolides (Azithromycin) or Doxycycline
Inpatient: Ceftriaxone + Macrolide or Doxycycline
HAP PNA (Pseudomonas Infection Risk) Treatment
-Piperacillin/Tazobactam or Cefepime + Aminoglycoside (Gentamicin) OR Fluoroquinolone (Levofloxacin, Moxifloxacin)
With HAP, what should you add if Legionella is suspected?
If MRSA is suspected?
Legionella: Levofloxacin or Azithromycin
MRSA: Vancomycin or Linezolid
Explain PNA vaccination rules
-PCV13: 4 doses (2, 4, 6, 12-15 months of age)
-PPSV23: adults 65 years or older
-If patient had no prior vaccination, give one dose of PCV13 then 8 weeks later one dose of PPSV23.
-Pregnancy is ok!
MCC of acute bronchiolitis?
RSV
Histoplasmosis is an AIDS-defining illness if CD4 <
CD4 < 150
PCP Pneumonia is the most common opportunistic infection in HIV, especially if CD4 <
CD4 < 200
Symptoms of PCP PNA
What labs are shown?
What does CXR show?
-Dyspnea on exertion, fever, nonproductive cough, oxygen desaturation on ambulation
Increased LDH and beta-D-glucan
diffuse bilateral interstitial infiltrates
PCP Treatment
Bactrim x 21 days
If HIV+, add Prednisone if hypoxic
What is the difference between Costochondritis and Tietze Syndrome?
Both have reproducible chest wall tenderness (MC involving 3rd, 4th, and 5th sternocostal joints)
-Tietze Syndrome has palpable edema, whereas Costochondritis does not.
Etiologies of a Pleural Effusion
-Transudate
-Exudate
-Transudate: CHF MCC, Nephrotic syndrome, Cirrhosis (due to increased hydrostatic pressure or decreased oncotic pressure)
-Exudate: any infection or inflammation. Pulmonary embolism, malignancy (due to increased vascular permeability)
What is the best XR view and what does it show for a pleural effusion?
Lateral decubitus films: blunting of the costophrenic angles (menisci sign)
Light’s Criteria for a pleural effusion
-An exudate is present if any of these 3 present:
–serum protein > 0.5
–serum LDH > 0.6
–LDH > 2/3 upper limit of normal LDH
With a primary spontaneous pneumothorax (PSP), who does it affect most commonly, and what is the pathophysiology behind it?
-No underlying lung disease, tall thin men 20-40 years old, smokers
-Apical sub pleural blebs rupture
Pneumothorax Types
-PSP
-SSP
-Traumatic
-Tension
-Catamenial
-PSP: atraumatic and idiopathic
-SSP: underlying lung disease
-Traumatic: iatrogenic (CPR, PEEP ventilation, MVA, subclavian line placement)
-Tension: positive air pressure pushes the trachea, great vessels, and heart to contralateral side
-Catamenial: occurs during menstruation
Pneumothorax Treatments
-Small PSP < 3 cm from chest wall
-Large PSP > 3 cm from chest wall
-Stable SSP
-Tension
-Small: observation and supplemental oxygen
-Large: Needle or catheter aspiration vs. chest tube or catheter thoracostomy
-Stable SSP: Chest tube or catheter thoracostomy + hospitalization
-Tension: Needle aspiration followed by chest tube thoracostomy
Where should the needle be placed for needle thoracostomy?
Between 2nd and 3rd rib, mid-clavicular line
What is seen on exam in a patient with pulmonary hypertension and why?
Accentuated S2, signs of RHF (increased JVP, peripheral edema, ascites)
Increased pulmonary vascular resistance leads to RVH, increased RV pressure, and RHF eventually
