respi Flashcards
bola que se ve en radiografia y se mueve al reposicionar al pt?
Aspergilloma (one of the forms of chronic pulmonary aspergillosis)
presenta con eosinofilia
Aspergillus colonizes preexisting cavities and forms a fungal ball, which is not attached to the surrounding tissue and can, therefore, be moved by repositioning the patient. CPA is most commonly seen in individuals who are immunocompromised (e.g., due to HIV infection) and those with previous pulmonary pathologies, especially cavitary lung disease (e.g., resulting from tuberculosis).
Chronic pulmonary aspergilloma should be treated with itraconazole or voriconazole, and surgical resection is indicated in patients with aspergilloma.
copious amounts of sputum y cuales son los signos radioogicos
bronchiectasis
x ray: signo del anillo de sello y opacidades lineales paralelas
confirmar dx con TAC
heterophile agglutination test aka monospot test is positive in?
epstain barr virus ( infectious mononucleosis)
which increases risk of nasopharyngeal carcinoma, Burkitt lymphoma, and Hodgkin lymphoma.
EPV shows petequias en paladar
serotonin syndrome sx?
“HARMED”
Hipertermina
Autonomic instability (hipertension, midriasis)
Rigidity
Myoclonus
Encephalopathy
Diaphoresis
foreign body aspiration
2-3 y.o
unilateral wheezing+hyperlucency lung unilateral
acute onset cough, Shortness of breath
80% of cases involve the right main bronchus.
tx: rigid bronchoscopy
fever, foul smelling sputum, lung cavity?
lung abscess
tos ferina sintomas
paroxysmal coughing spells with deep, whooping breaths and posttussive vomiting
un paciente con tos ferina, que se le hace a los contactos?
macrolidos (azitromicina, claritromicina) para:
- todos en la casa
- all exposed individuals who are at high risk of developing severe pertussis (e.g., pregnant individuals in their third trimester, infants < 12 months, persons with immunodeficiency)
- and all exposed individuals who are in close contact with high-risk persons
Tdap vacuna para todos los adultos
atypical pneumonia+target lesions on skin?
eritema multiforme x mycoplasma pneumonia
en algunos casos afecta membranas mucosas
atypical pneumonia (mild respiratory symptoms and diffuse reticular opacities on x-ray)
retropharingeal abscess cual se drena?
drenar si:
- airways compromised (drooling, accesroy mucles of respiration usage, hipoxia, stridor)
- > 2.5 cm
- no mejora a pesar del uso de atb (clinda, ampi-sulbactam)
se ve como posterior pharingeal swealling, si es uvular deviation to contralateral side is peritonsillar abscess
thumb sign on x ray?
epiglottitis
drooling + muffled voice
Since the introduction of the Haemophilus influenzae type b (Hib) vaccine, epiglottitis no longer mainly manifests as a life-threatening illness in children and is now predominantly seen in adults, particularly those with a BMI > 25, a history of diabetes mellitus, coexistent pneumonia, or a preceding upper respiratory infection.
Empiric IV ceftriaxone is used to treat acute epiglottitis, which is usually caused by Haemophilus influenzae type b (Hib) or gram-positive cocci (e.g., Streptococcus pyogenes or Streptococcus pneumoniae).
recurrent sinusitis+hemoptisis+nasal ulcers. Dx?
granulomatosis con poliangitis
c-ANCA
Classic GPA triad: necrotizing vasculitis of small arteries (palpable purpura), upper/lower respiratory tract manifestations, and glomerulonephritis
Features of a high-risk solitary pulmonary nodule?
size ≥ 2 cm, age > 60, and smoking cessation within the last 5 years (or current smoker)
do excision quirurgica
Features of an intermediate-risk solitary pulmonary nodule?
size 0.8 - 2 cm, age 40 - 60, and smoking cessation within the last 5 - 15 years (or current smoker)
do pet scan-biopsy
pleural effusion symptoms?
unilateral percussion+ unilateral decreases on auscultation.
pneumotorax sx?
unilateral hiperresonante+decreased breath sounds
pt con pneumonia lobar como lo acuestas?
“good lung down”
decubito lateral del lado bueno, o sea si tiene neumonia izquierda entonces lo pones en el decubito lateral derecho, mejora la perfusion al lado bueno
dimorphic fungus, exists in a yeast form in body tissue (37°C) and in a hyphal form at room temperature (20–30°C)?
Histoplasma capsulatum
Mississippi, Ohio
Bird or bat droppings.
Sx: atypical pneumonia (e.g., dry cough, dyspnea) and systemic symptoms (e.g., low-grade fever, malaise, joint pain) can occur.
The best initial test in the case of suspected histoplasmosis, especially for patients who are acutely ill, is a urine or serum test for the galactomannan antigen of H. capsulatum.
fungal culture of bronchoalveolar lavage is more specific but takes longer (up to 6 weeks).
Localized pulmonary histoplasmosis is typically treated with itraconazole and disseminated histoplasmosis with amphotericin B.
antigeno en orina de histoplasmosis
galactomanann
sarcoidosis como esta el bronchoalveolar lavage?
increased CD4 T cell in bronchoalveolar lavage
atb para pseudomonas (bacilo gram -)
Drugs effective against Pseudomonas aeruginosa “CAMPFIRE”
Carbapenems:
Aminoglycosides
Monobactams (aztreonam)
Polymyxins (polymyxin B, colistin)
Fluoroquinolones (cipro, levofloxacin)
thIRd and fourth gen cefalosporijnes: 3ra y 4ta gen: ceftazidime, cefepime
Extended spectrum (antipseudomonal) penicillins:(piperacillin)
pp65+ dx y tx?
citomegalovirus pneumonia
tx: galanciclovir iv ( si hay resistencia se usa forscanet iv)
Cytomegalovirus (CMV) is a common cause of atypical pneumonia in post-transplant patients on immunosuppressive therapy
enfisema en pt <50 y.o. posible dx y asociacionismo?
deficiencia a1 antitripciona
enfisema+cirrosis hígado/carcinoma hepatocelular
peumonia atipica+diarrea+hiponatremia.
dx?
legionella
urine antigen
cultivo con agar carbon
tx:fluoroquinona (levofloxacin/moxifloxacina) o macrolidos
non productive cough+low grade fever+ hiv+
dx? radiografia q se ve? tx?
pneumonitis jirovecii
bilateral symmetrical diffuse infiltrates
tx:
principal: tmp smx
alergia sulfas? IV clindamycin and oral primaquine
malignidad asociada a asymmetric chest expansion?
mesothelioma
asymmetric chest expansion happens due to diffuse pleural thickening with decreased ipsilateral lung volumes,
por que la suplementacion excesiva de O2 en EPOC es un problema?
increased arterial pCO2 > oxigen induced hipercapnia y co2 narcosis
reduced vasoconstricción pulmonar > perfusion of poorly ventilated alveoli > increased dead space
intersticial lung disease en mineros/sandblasters/glass factory?
silicosis
Silica is typically found below the earth’s surface and most commonly affects the UPPER lobes of the lungs
Patients with silicosis are at increased risk for Mycobacterium tuberculosis infection and should have an annual TB skin test.
“eggshell” calcification of the hilar lymph nodes
intersticial lung disease in shipbuilding, roofing, or plumbing industries.
asbestosis
affects LOWER lobes
increases risk of mesothelioma
dyspnea and hypoxia that worsens after giving fluids
dx? x ray?
contusion pulmonar
Damage to the capillaries in the lung parenchyma results in pulmonary edema and/or bleeding within contused lung tissue, which appears as a patchy infiltrate on chest x-ray. Excessive fluid administration worsens pulmonary edema, as the damaged capillaries leak fluid into the lungs.
unilateral decreased breath sounds and patchy, irregular alveolar infiltrate on imaging
x ray: diffuse unilateral opacities
What diagnosis should be considered in a patient with uncontrollable pain, flail chest, and diffuse unilateral opacity on chest x-ray who develops deteriorating blood gases following blunt trauma?
contusion pulmonar
nasal mass+recurrent epistaxis in an adolescent boy
dx?
juvenile nasopharyngeal angiofibroma
tac con contraste de cabeza
paciente que semanas/meses después de estar intubado desarrolla disnea, estridor, signs of respiratory distress (i.e., tachypnea, accessory muscle use). Dx? diagnostico?
dx: estenosis lanringotraqueal, laringoscopia
es una complicación de long term intubation que produce fixed upper airway obstruction
Pressure from the endotracheal tube causes local tissue ischemia, inflammation, necrosis, and fibrosis, leading to laryngeal stenosis
pnuemocitis jirovecii tx
tmp smx + glucocorticoides (si pt es hiv + y PaO2 <70 o A-a gradient ≥ 35 mm Hg o sat <92%)
beta-D-glucan assay
pinpoint pupils and decreased respiratory effort
dx? desorden acido base?
opioid overdose
Acidosis respiratoria (debido a hipoventilacion):
- ph disminido
-pco2 aumentado
-hco3 normal debido a the acute nature of an opioid overdose, only minimal metabolic compensation
pneumonia atipica asociada a pájaros/loros. agente causal? tx?
Chlamydia psittaci
domiciling
acute COPD exacerbation manejo?
Usar en conjunto
- SABA (albuterol..) + bromuro ipatropio NEBULIZADO
- Esteroide oral o IM
- ATB ( amoxi/ac clay, azitromicina, doxiciclina) si se cumple: incremento en disnea, incremento en esputo, incremento en tos, el incremento en esputo es lo mas importante
strep pneumonie, descripcion microbiologica?
gram + diplococo
poseudominas aeruginosa, e. coli, klebsiella
descripcion micro?
gram - bacilo
cuales intervenciones aumentan la expectativa de vida en COPD?
Long term o2 therapy + smoking cessation
indicaciones para long term o2 therapy en COPD?
- SaO2 ≤ 88% at rest despite optimal medication
- PaO2 ≤ 55 mm Hg
- PaO2 of 55–60 mm Hg if there is evidence of ICC, hipertension pulmonar, policitemia.
target range of oxygen saturation should be 90–92%
Patients with long standing COPD who are administered excessive oxygen can develop hypercapnia caused by an increase in the amount of physiologic dead space generated by the excess oxygen
cuales son las 4 características de aspirin-exacerbated respiratory disease ?
- asthma,
- chronic rhinosinusitis
- nasal polyps
- hypersensitivity to aspirin or other cyclooxygenase-1 inhibitors.
AERD is a pseudoallergic reaction caused by the inhibition of cyclooxygenase (COX). Inhibition of the COX pathway increases the conversion of arachidonic acid to leukotrienes via the lipoxygenases pathway. Leukotrienes cause flushing and bronchial inflammation.
causa bacteriana de neumonia en NIÑOS con fibrosis quistica?
Staph aureus
causa bacteriana de neumonia en ADULTOS con fibrosis quistica?
Pseudomonas aeruginosa
