Thoracic and Respiratory Flashcards
What is the timeframe for an acute vs chronic cough?
- Less than 3 weeks = acute
- More than 8 weeks = chronic
What, besides asthma/COPD causes wheezing? (5)
- FB
- PE
- CHF
- LRI
- Allergies
What is singultus?
Hiccups
What are the three major causes of persistent hiccups?
Cancer
CNS
Metabolic
What are the three major causes of acute, self-limiting hiccups?
- Distended stomach
- Smoking
- EtOH
What is the usual cause of death with massive hemoptysis?
Asphyxiation, not exsanguination
What is the general treatment for massive hemoptysis?
- Intubation (mainstem)
- Bad side down
- Correct coagulopathy
What is the definition (in mL and in clinical terms) of frank hemoptysis?
- 200 mL in 24 hours
- If spitting up whole, frank blood
Where is the bleeding from (which arteries) with massive hemoptysis?
Bronchial arteries that come directly off aorta to feed lungs
What is the primary cause of dyspnea/hypoxia 2/2 neuromuscular disorders?
Hypoventilation
What causes death with Guillain-barre syndrome?
Respiratory failure
How many grams of Hb are needed to be desaturated to cause central cyanosis?
5 grams
Can you have cyanosis and be profoundly anemic?
No
What two times is a tracheo-innominate fistula most likely to occur?
If new trach site, and if recently changed sizes/position/brand
Who investigates a trach bleed?
Surgeon in the OR where bleeding can be controlled. NOT in the ED.
What three techniques can be done to stop bleeding from a tracheo-innominate fistula?
- Hyperinflate the trach tube
- Lever the trach tube to apply pressure to the innominate artery
- Digital pressure
What is the problem with airway management for an expanding neck hematoma? How do you manage these?
- If paralyzed, strap muscles relax and may allow hematoma to move airway
- Ketamine without paralytic, or awake intubation
What is the disposition for a child that you suspect has/had choking episode due to foreign body?
Admit for bronchoscopy
What is the most sensitive film for determining for a FB obstruction? What will these show if a FB is present?
- Lateral decubitus views.
- If FB present dependent lung will NOT deflate as it should normally
What is the most common cause of isolated right and left sided pleural effusions respectively?
RIght = CHF Left = Aortic dissection or Boerhaave's
What are the three major risk factors for reexpansion pulmonary edema?
- Large PTX
- PTX present for long periods
- PTX rapidly expands
What is the typical cause of an empyema?
Parapneumonic effusion from pneumonia
What is the role of anesthetic gases in asthma exacerbations?
Very potent bronchodilators
Do you put a chest tube into a COPD bleb?
No–will cause PTX, worsen breathing
How can you differentiate lobar collapse from PNU?
Lobar collapse will cause an elevated diaphragm, and appear like a well demarcated consolidation
What is the reason to put a blue bloater on home oxygen?
To prevent lung scarring from chronic hypoxia
What is ARDS? (3 elements)
- PaO2 less than 60 mmHg with FiO2 over 0.5.
- Normal heart function
- Diffuse infiltrates on CXR
What are the two most common causes of ARDS?
- Trauma
- Sepsis
What is the treatment for ARDS?
supportive with permissive hypercapnia
What organism classically causes pneumonia in a COPD/smoker?
Haemophilus influenzae
Who gets gram negative pneumonias?
People at risk for aspiration
What is the classic HR finding with atypical pneumonias?
Relative bradycardia
Which atypical organism can cause guillain -barre syndrome, Raynaud’s phenomenon, and/or associated with ramsay hunt syndrome?
Mycoplasma
Staccato cough in a 6 week old = ?
Chlamydia pneumonia
What extrapulmonary symptoms happen with legionella?
- GI s/sx
- Hyponatremia
Name the organisms and the abx for outpatient pneumonia.
Strep pneumo/atypicals
Macrolide
Name the organisms and the abx for inpatient pneumonia.
Gram negatives
Fluoroquinolone
Name the organisms and the abx for ICU pneumonia.
Pseudomonas/MRSA
Cefepime/vanco
What is the course of disease with fungal pneumonia? Classic CXR finding?
- Slowly progressive
- Bilateral infiltrates with perihilar nodes
Where are the following fungal infections founds: coccidioidomycosis, Blastomycosis, histomycosis
- Coccidioidomycosis = Southwest US
- Blasto = southeast
- Histo - mississippi river valley
Pneumonia + skin lesion = what sort of organism?
Fungal
Pneumonia + sheep/cow = ?
Q fever
Pneumonia + parrots = ?
Chlamydia psittaci
Pneumonia + mouse exposure in SW US = ?
Hantavirus
Under what CD4 count can patients with AIDS get PCP pneumonia?
200
Under what CD4 count can patients with AIDS get MAC pneumonia?
50
Under what CD4 count can patients with AIDS get CMVpneumonia?
50
Under what CD4 count can patients with AIDS get TB pneumonia?
over 200
What do all patients with HIV and a CD4 count less than 200 get treated for regardless of CXR findings? Why?
TB
Can be asymptomatic
What lab will be elevated with PCP pneumonia?
LDH
What is the classic exam finding with PCP pneumonia? CXR appearance?
Exam = desat with exertion CXR = batwing
Why are steroids so important to add with PCP pneumonia, and why does oxygen not improve sats well?
Unlike other pneumonias, the interstitium is inflamed and causes diffusion issue.
What is the stain that classically shows PCP pneumonia?
silver stain
What are the three abx used to treat PCP pneumonia?
- Bactrim
- Pentamidine
- Dapsone
What are the two classic side effects with pentamidine?
- hypotension
- hypoglycemia
What is the treatment for anthrax?
PCN or Doxycycline
What are the skin manifestations of anthrax?
Necrotizing black eschar
What animal is known to carry SARS?
Civet cat
What are scrofula?
Lymphatic TB
Why are pts with nephrotic syndrome and HIV more prone to PE/DVTs?
Lose antithrombin III and other anticoagulant proteins
