UW 2 Flashcards
Invasive aspergiolsis - risk factors
immune
invasive aspergillosis - findings
- triad of fever, chest pain, hemoptysis
- pulm nodules with halo
- positive cultures
- positive cell wall biomarkers (galactomannan, betal D glucam
invasive aspergillosis -management
voriconazole +/- caspofungin
chronic pulmonary aspergilosis - risk factors
lung disease/damage (cavitary TB)
chronic pulm aspergilosis - findings
- more than 3 months: weight loss, hemoptysis, fatique
- cavitary lesion +/- funfus ball
- positive aspergillus IgG seology)
Chronic pulm aspergilosis - management
resect aspergilloma (if possible)
- azole (vorizonazole)
- embolization (if severe hemoptysis)
tumors of the mediastinum - location
anterior: thymoma, thyroid, teratoma, lymphoma
middle: bronchogenic cysts
posterior: neurogenic, esoph leiomyomas
hospitalized vs ventilator acquired pneumonia - definition
hosptial: 48 or more hours after admission
ventilator: 48 or more hours after intubation
Acute exacerbation of COPD - management
- O2 (target 88-92)
- inhaled bronchodilators
- systemic glucocrticoids (β2 or anticholinerg)
- antibiotics if at least 2 of dyspnea, more frequent cough, change in colore or volume of sputum)
- oselramivir if evidence of flu
- noninvasive (+) pressure ventilation
- intubation
pulm nodule sorrounded by ground glass
invasive aspergilosis (halo sign)
causes of obstructive pattern (and their DLCO)
asthma: normal/increaed
emphysema: decreasd
chronic bronchitis: normal
causes of increased DLCO
- asthma
- morbit obesity
- polycythemia
- pulm hemorrhage
increased PCWP is an indicator of
LA pressure
lung problems - PCWP?
not affected
asbesotis exposure - when develop disease
after 20 years of initial exposure
aspiration syndromes - types and mechansim
pneumonia: parenchyma infection, anaerobes microves
pnemonitis: parenchyma infl, aspiration of gastric acid
aspiration syndrome - types and clinical features
- pnemonia: daus after aspiration, fever, cough, sputum. CXR infiltrates, can progress to abscess
- pneumonitis: hours after event, from asymptomatic to resp distress, CXR infiltrates (1 or both lower lobes)
aspiration syndrome - types and management
pneumonia: clindamycin or b lactam + lactamase inh
pneumonitis: supportive (no antibiotics)
negative pressure pulm edema
when a atient has upper airway obstruction that results in large negative intrathoracic pressure (due to inspiration against obstruction)
the 3 MCC of clubbing
- Lung ca
- Cystic fibrosis
- R –> L cardiac shunts
Clubbing in COPD
copd does not cause
if there is, search for ca
TB endemic areas
Mexico, philippnes, china, vietnam, india, Dominican Republic, Haiti
management of PE if more than 4 wells
first antigoagulant, and after diagnostic tests
classic ECG in PE
prominent S in lead I, Q in lead III, and inverted T in head III (S1Q3T3)
management after Wells criteria
- PE likley –> CT pulm angiography –> if (-) is excluded, if (+) is confirmed
- PE unlikely –> D dimers –>: if more more than 500 –> CT pulm angiography, if less excluded
Modified Wells criteria
- 3 points: Clinical signs of DVT, alternate diagnosis is less likley
- 1.5 points: previous PE or DVT, herat rate more than 100, Recent surgery or immobilazation
- 1 point: hemoptyisis, cancer
MORE THAN 4 –> LIKELY
4 OR LESS –> UNLIKELY
fat embolism - time after event
12-78 h
pulm contusion - symptoms can be worsen by
fluid overvolume
COPD indications for O2 at home
- resting PaO2 55 or lower
- SaO2: 88 or less
- Those with RHF or HCT higher than 55 should be started if Pao2 lower than 60 or Sao2 lower than 90
the 3 MCC of chronic cough are
- upper airway cough syndrome (postnasal drip_
- asthma
- GERD
POSTNASAL SYNDROME
caused by rhinosinus conditions including allergic, perennial nonallergic and vasomotor rhinitis –> mechanical stimulation of cough reflex
treatment: chlorpheniramine
COPD exacerbation - when to give antibiotics
if 2/3 of:
- increaed dyspnea
- increased cough (more frequent o sever
- sputum production (change in color or volume)
anaphylaxis - IV vs IM epinephrine?
IM –> if no response –> IV
NO IMMEDIATELY IV DUE TO SE (arrhythmia)
the most effective way to differentiate asthma from COPD
spirometry before and after administration of a bronchodilator (usually albuterol)
COPD - factors that decrease mortality
- smoking cessation
- Long term supplemental 02 decreases mortality if:
- SpO2 under 88%
- SpO2 under 89% + RHF or erythrocytosis (HCT more than 55)
solitary pulm nodule - definition
round opacity up to 2 cm in diameter within and surrounded by pulm parenchyma
by convention: no pleural effusion, adenopathym atelectasis
solitary pulm nodule - DDX
- 1ry lung Ca
- Metastatic ca
- Benigh infect granulomas (TB, histopl, other fungus)
- Benign neolasm (lipomas, hamartomas, fibroma)
- vascular (AV malformation)
Solitary pulm nodule on routine chest X-ray - management
previous chest x-ray:
- stable over 2-3 years –> no further testing
- No previous imaging or possible nodule growth –>
CT:
1. Benign features –> serial CT scans
2. High suspicious for malignancy –> surgery
3. indeterminate or suspicious for malignancy –> biopsy or PET
high risk vs low risk for solitary pulm nodule
low: smaller than 0.8 cm, younger than 40, never skomed or smoking cessation more than 15 years, smooth margins
high: larger than 2 cm, older than 60, current smoker or cessation less than 5 years before, corona radiata or spiculated margins
Causes of recurrent pneumonia
- involving same region: local airway obstruction, aspiration –> CT
- involving different regions of lung: immunoddef, sinopulm disease, noninfectious (Vasculitis, etc)
antitryps def - smoking
COPD 10 years earlier compare to nonsmoking
empiric treatment of CAP
- outpatient:macrolide or doxycycline (healthy)
resp quinolone or beta lactam + macrolide (comorbitities) - inpatients: quinolone (IV) or betal lactam + macrolide
- ICU: beta lactam + macrolide or quinolne + beta lactam
resp quinolones
levo-, moxifloxacin
CURB-65
Confusion Urea more than 20 Respiration more than 30 Blood pressure lessthan 90/60 Age 65 or more
CURB-65 interpretation
0-1: low mortality –> outpatient
1-2 intermediate –> likley inpatient
3-4 urgent inpatient –> possibly ICU if socre more than 4
initial drug in stable PE in patient with RF
unfractionated heparin (if severe: GFR lower than 30) (the others are contraindicated)
SIADH - treatment
Fluid restrition (best initial) +/- salt tablets
hypertonic (3%)saline for severe
- DEMECLOCYCLINE ONLY IF THE OTHERS FAIL
PE - Aa gradient
increased
anemia - Aa gradient
low
dead space ventilation?
air in non-perfused areas
subacute vs chronic cough
subacute: 3-8 wks
chronic: more than 8 wks
evaluation of subacute or chronic cough
evaluate and treat as indicated (stop ACEi, H1 for upper airway cough, OFT for asthma, PPI for GERD) –> if no improvement –> Cest X-ray
- parenchymal disease, purulent sputum, immune, no specific etiology –> chest x-ray
atelectasi - PCO2
low
upper airway obstruction - graph
decrease the airflow rate during insipration and expiration –> flattening both the top and bottom of the flow - volume loop
FRC in ankylosing spond
normal or increased due to fixation of a rib in the inspiratory position
