Regular Pulmonary--- Flashcards
MCC of bronchiolitis
RSV
best predictor of dz for bronchiolitis
pulse ox
tx bronchiolitis
supportive
immunoprophylaxis for Pavilizumab
cardinal sx of acute bronchitis
cough
what is a rare sx in acute bronchitis
fever
tx bronchitis
supportive
another name for pertussis
whooping cough
different phases pertussis
catarrhal phase - URI sx
paroxysmal phase - severe coughing fits with high inspiratory whooping sound after cough; may have posttussive vomiting
convalescent phase – resolution of cough
tx pertussis
Macrolides
Doxy if allergy
where is inflammation in epiglottis
supraglottic structures
MCC epiglottitis
HIB
sx epiglottitis
3 D’s
drooling, dysphagia, distress
high fever
inspiratory stridor
tripoding
dx epiglottitis
lateral neck XR - thumbprint sign
laryngoscopy - definitive; cherry red epiglottis
tx epiglottitis
airway maintenance
supportive
abx - cephalosporin
can add dexamethasone for swelling
another name for croup
laryngotracheitits
inflammation in croup
subglottic region
MCC croup
parainfluenza
sx croup
seal like barking cough
inspiratory stridor
hoarseness
dx croup
frontal cervical XR - steep sign
Westley croup score - classifies severity of croup
tx croup
steroids in all stages of croup (IV or IM)
supportive
nebulizer epinephrine - for severe croup (if it doesn’t work, it’s likely bacterial tracheitis)
tx CAP
axocillin
or augmentin or cephalosporin + macrolide
sx pneumonia
sudden onset fever
productive cough + purulent sputum
pleuritic chest pain
rigors
tachycardia, tachypnea
PE for pneumonia
bronchial breath sounds
dullness to percussion
increased tactile fremitus
egophony
sx for PJP
triad - progressive DOE, fever, nonproductive cough
PE for PJP
nearly all patients with have either hypoxemia at rest or with exertion
where in the lungs is primary TB typically located
middle portion - Ghon focus
where in the lungs is secondary/reactive TB typically located
apices
sx TB
prolonged fever
cough
chest pain
dyspnea
hemoptysis
fever/chills/night sweats
dx TB
isolation of TB from a body secretion or fluid or tissue
place in respiratory isolation
how many sputum specimens should bobtailed for TB
3
histology for TB
caseating granulomas
any positive PPD for TB should be followed with
CXR
people considered to have positive PPD test >/= 5 mm
HIV or immunosuppressed
close contacts of patients with active TB
CXR consistent with old/healed TB (calcified granuloma)
people considered to have positive PPD test >/= 10 mm
People recently arriving (< 5 years) from high-prevalence countries
* People who use injection drugs
Mycobacteriology laboratory workers
* Residents/employees of high-risk congregate settings
* Those with comorbid conditions (e.g., diabetes, severe kidney disease,
Hodgkin disease, lymphoma, malnutrition)
People with < 90% ideal body weight
* Children < 4 years old
* Infants, children, and adolescents exposed to adults in high-risk categories
* Children born in high-prevalence regions of the world
people considered to have positive PPD test >/= 15 mm
everyone else
acute respiratory distress syndrome is characterized by
rapid onset of severe dyspnea
refractory hypoxemia
diffuse pulmonary infiltrates, leading to respiratory failure
when should ARDS be suspected
acute onset of progressive sx of profound dyspnea
hypoxemia with increasing requirement for oxygen
alveolar infiltrates on chest imaging within 6-72 hours of inciting event
CXR ARDS
bilateral diffuse pulmonary inflaters - classically spares the costophrenic angles
PCWP ARDS vs pulmonary edema
ARDS - < 18
pulmonary edema > 18
tx ARDS
PEEP
low tidal volume ventilation - 6ml/kg
supplemental oxygen
MCC cancer related death in US
lung CA
MCC lung CA
smoking
smoking and asbestosis are synergistic
what lung CA are included in non-small cell
adenocarcinoma
large cell
squamous cell
lepidic pattern
MCC cancer in smokers in nonsmokers
adenocarcinoma
DX adenocarcinoma of the lung
CXR - peripherally located
biopsy - gland formation/glandular with mucin production
second MCC lung CA
squamous cell
characteristics of squamous cell lung CA
CCCP
centrally located
cavitary lesions
hypercalcemia
pan coast syndrome
dx squamous cell lung CA
perform cytology and bronchoscopy
histology - keratinization by tumor cells and intracellular desmosomes - intercellular bridges
large cell carcinoma characteristics
large peripheral mass with prominent necrosis
histology large cell carcinoma
pleomorphic giant cells - sheets of round or polygonal cells with prominent nuclei
which lung CA is most aggressive
small cell
which lung CA is most likely to present with paraneoplastic syndromes
small cell
dx small cell lung CA
CXR - centrally located
histology - sheets of small dark blue cells w rosette formation
transudative effusions are due to
increased hydrostatic or decreased oncotic
etiologies of transudative pleural effusions
HF
cirrhosis
nephrotic syndrome
pulmonary embolism
etiologies of exudative pleural effusions
malignancy
pneumonia/TB
pulmonary embolism
pnacreatitis
esophageal rupture
hemothorax
sx and PE for pleural effusion
dyspnea
pleuritic chest pain
cough
dullness to percussion
decreased fremitus
decreased breath sounds
Dx pleural effusions
CXR - blunting of costophrenic angles
lateral decubitus films - best - detect smaller effusions
thoracentesis - gold standard; determine cause
light’s criteria for pleural effusion
transudate:
pleural: serum protein </= 0.5
pleural:serum LDH </= 0.6
pleural fluid LDH <2/3 ULN
exudate:
pleural: serum protein > 0.5
pleural: serum LDH > 0.6
pleural fluid LDH > 2/3 ULN
types of pneumothorax
primary spontaneous - atraumatic; no underlying cause
secondary spontaneous - underlying lung disease
traumatic - trauma or iatrogenic
tension - any type of pneumothorax where the air pressure pushes the trachea to the contralateral side
sx pneumothorax
sudden onset dyspnea and chest pain - pleuritic, ipsilateral, unilateral
PE pneumothorax
hyper resonance to percussion
decreased fremitus
decreased breath sounds
tension - increased JVD
CXR pneumothorax
CXR - decreased peripheral markings; deep sulcus sign; visible visceral pleural sign
tx pneumothorax
small - observe
large - needle or small bore catheter aspiration
secondary - chest tube
tension - needle aspiration –> chest tube
sx pulmonary embolism
triad - dyspnea, pleuritic chest pain, hemoptysis
what is highly suspicious for PE
normal CXR in the presence of hypoxia
classic findings in CXR for PE
Westermark’s sign - start cut off of pulmonary vessels
Hampton’s hump - wedge-shaped opacification at the periphery of the lung
EKG pulmonary embolism
S1Q3T3
deep S in lead I
isolated Q inversion in lead III
isolated T inversion in lead III
what level for DDimer makes PE unlikely
< 500
dx PE
CTPA - criterion standard
VQ scan - test of choice in pregnancy
Duplex US
Tx PE
stable - anticoagulation - UFH, LMWH, fondaparinux
unstable (SBP < 90 or R HF) - thrombolysis; embolectomy if thrombolysis fails
preferred anticoagulant in malignancy and pregnancy for PE
LMWH