Thoracic Respiratory Disorders Flashcards
What is pulsus paradoxus?
- Increased intrathoracic or right heart pressure inhibits venous return during deep inspiration causing a drop in blood pressure
- Generally >10 mm Hg
- **pic Q766713
Conditions associated with pulsus paradoxus
- Obstructive lung disease
- Cardiac tamponade
- Constrictive pericarditis
- Vena cava thrombus
- Pulmonary embolism
What are three complications of acute sinusitis?
- Cavernous sinus thrombosis
- Meningitis
- Orbital cellulitis
Most common cause of developing empyema?
Pneumonia with parapneumonic effusion
Diagnosis of empyema
Aspiration of grossly purulent material or one of the following:
- positive gram stain or culture
- pleural glucose <60
- pH <7.2
- LDH >1,000
Tx of empyema
- Zosyn or imipenem with addition of vanc if MRSA is a concern
- Fibrinolytics administered intrapleurally may be necessary if empyema is loculated
Most common organisms that cause empyema
Strep pneumo and staph aureus
Phases of pertussis
- Catarrhal phase (1-2 weeks)
- Mild fever, cough, rhinorrhea
- Conjunctival injection
- Excessive lacrimation - Paroxysmal phase (2-6 weeks)
- “whooping” cough
- Inspiratory stridor - Convalescent phase (1-2 months)
- Gradual reduction in symptoms
Diagnosis clues to pertussis
- lymphocytosis
- radiograph showing peribronchial thickening, atelectasis, pulm consolidation
Bugs that are the culprit in cystic fibrosis infections
- Staph aureus
- H. Flu
- Pseudomonas
- Burkholderia
- Stenotrophomonas
Most common cause of bacterial superinfection complicating influenza virus infection
Strep pneumo (staph aureus is second most common)
Light Criteria for Pleural Effusion
Transudate:
Pleural:Serum protein = 0.5
Pleural:Serum LDH = 0.6
Pleural fluid LDH <2/3 upper limit of normal
Exudate:
Pleural:Serum protein >0.5
Pleural:Serum LDH >0.6
Pleural fluid LDH >2/3 upper limit of normal
Causes of transudative pleural effusion
- Heart Failure
- Cirrhosis
- Nephrotic Syndrome
- Pulmonary Embolism
Causes of Exudative Pleural Effusion
- Malignancy
- Bacterial/Viral PNA
- TB
- Pancreatitis
- Esophageal Rupture
- Collagen Vascular Disease
- Chylothorax/hemothorax
- Pulmonary Embolism
How many mLs of a pleural effusion can be detected on x-ray?
200mL
Differences between aspiration pneumonitis vs. aspiration pneumonia: Mechanism
Pneumonitis: aspiration of sterile gastric contents
Pneumonia: aspiration of colonized oropharyngeal material
Differences between aspiration pneumonitis vs. aspiration pneumonia: pathophysiologic process
Pneumonitis: acute lung injury from acidic and particulate gastric material
Pneumonia: acute pulmonary inflammatory response to bacterial and bacterial products
Differences between aspiration pneumonitis vs. aspiration pneumonia: Bacteriologic findings
Pneumonitis: Initially sterile, with subsequent bacterial infection possible
Pneumonia: Gram-positive cocci, gram-negative rods, and anaerobic bacteria
Differences between aspiration pneumonitis vs. aspiration pneumonia: chief predisposing factors
Pneumonitis: Markedly depressed level of consciousness
Pneumonia: Dysphagia and gastric dysmotility
Differences between aspiration pneumonitis vs. aspiration pneumonia: Age group affected
Pneumonitis: any age group, usually young
Pneumonia: usually elderly
Differences between aspiration pneumonitis vs. aspiration pneumonia: Clinical features
Pneumonitis: No sx or symptoms ranging from a nonproductive cough to tachypnea, bronchospasm, bloody or frothy sputum, and respiratory distress 2-5 hours after aspiration
Pneumonia: Tachypnea, cough, signs of pneumonia
In patients with COPD, best changes in vent settings?
Increase tidal volume over increasing respiratory rate as this would increase expiratory phase, resulting in a buildup of pressure prior to the lungs emptying completely
Which lung cancer causes paraneoplastic hypercalcemia?
Squamous cell carcinoma
What type of lung cancer is associated with SIADH?
Small cell lung cancer
Causes of ARDS
- Sepsis
- High-altitude pulmonary edema
- Re-expansion pulmonary edema s/p large volume thoracentesis
- Drugs and toxins
- Inhalation injuries
- Aspiration syndromes
- Fat emboli
What drugs/toxins can cause ARDS?
- Meprobamate
- Opioids
- Naloxone
- Phencyclidine
- Salicylates
What pulmonary artery wedge pressure indicates non-cardiogenic pulmonary edema?
<18 mm Hg
Extrapulmonary findings that support diagnosis of asthma
- Pharyngeal cobblestoning - suggests allergic rhinitis
- Atopic dermatitis with lichenified plaques in flexural areas such as antecubital fossa
Spectrum of diseases associated with EVALI (e-cigarette and vaping associated lung injury)
- Fibrinous pneumonitis
- Diffuse alveolar hemorrhage
- Eosinophilic or lipoid pneumonia
What is the typical CXR finding in EVALI?
Diffuse bilateral hazy opacities
Tx of EVALI in ED?
Supportive care with O2 vs. need for mechanical ventilation
Empiric abx coverage for potential bacterial pneumonia
Systemic glucocorticoids are controversial
Most common sites of metastasis of breast cancer?
Bone, liver, and lungs
Two common pediatric respiratory illnesses RSV is known to cause?
Bronchiolitis and Laryngotracheitis (croup)
What is the typical presentation of familial Mediterranean fever?
Recurrent fever lasting 1-4 days with associated pleuritic chest pain
What are the three stages of ARDS?
- Exudative
- Fibroproliferative
- Fibrotic
Which medications can lead to lactic acidosis?
Metformin
Salicylates
Propylene glycol
Community-Acquired Pneumonia Tx Guidelines
Q292953
OUTPATIENT:
Healthy adult, no co morbidities or RF for MRSA or P. Aeruginosa -> amoxicillin (high dose) OR doxy OR macrolide (in areas with <25% resistance)
Adult with comorbidities: Augmentin or cephalosporin AND doxy or macrolide OR respiratory fluoroquinolone monotherapy
INPATIENT:
Standard: Beta-lactam + macrolide OR respiratory monotherapy in nonsevere; beta-lactam + macrolide OR beta-lactam + respiratory fluoroquinolone in severe
Add vanc for prior respiratory MRSA
Add zosyn or cefepime or other coverage if prior pseudomonas
