List the most common extrapulmonary manifestations of tuberculosis.
- Vertebral osteomyelitis (Potts)
What disease is characterized by impaired chloride ion movements and decreased exocrine function?
Name 5 main systems affected by cystic fibrosis.
--Male reproductive tract: missing epididymis, vas deferens
--Pancreas: obstruction & destruction
--Sinuses: polyps, opacification, abnormalities
--Intestines: decreased fluid secretion -> constipation
--Lungs: thicker mucus; affects conducting airways not alveoli
Top 3 organisms of typical community-acquired pneumonia:
Top 3 organisms of atypical community-acquired pneumonia:
Organisms of aspiration pneumonia:
Organisms of hospital-acquired pneumonia:
Treatment of community-acquired pneumonia:
If healthy & no abx < 3 months:
macrolide or doxycycline
If comorbidities or abx < 3 months:
respiratory fluoroquinolone or ceftriaxone + azithromycin
Treatments for aspiration pneumonia:
Treatments for hospital-acquired pneumonia:
(antipseudomonal ceph, carbapenem, or PCN) + (fluoroquinolone or amikacin) + vancomycin
inpatient handout or purple book 6-2
What is Light's Criteria for classifying pleural effusions?
Fluid is exudative (vs. transudative) if one of the following Light’s criteria is present:
- (Effusion protein) / (serum protein) ratio greater than 0.5
- Effusion lactate dehydrogenase (LDH)/serum LDH ratio greater than 0.6
- Effusion LDH level greater than 2/3 the upper limit of the laboratory's reference range of serum LDH
List some of the common pathogens associated with acute exacerbations of cystic fibrosis.
How is cystic fibrosis definitively diagnosed?
BOTH of the following criteria must be met to diagnose cystic fibrosis (CF):
● Clinical symptoms consistent with CF in at least one organ system, AND
● Evidence of cystic fibrosis transmembrane conductance regulator (CFTR) dysfunction (any of the following):
• Elevated sweat chloride ≥60 mmol/L (on two occasions)
• Presence of two disease-causing mutations in CFTR from each parental allele
What is the most common type of lung cancer?
Non-Small Cell Lung Cancer
This is the most common type of lung cancer. About 85% of lung cancers are non-small cell lung cancers. Squamous cell carcinoma, adenocarcinoma, and large cell carcinoma are all subtypes of non-small cell lung cancer.
Small Cell Lung Cancer
Small cell lung cancer is also called oat cell cancer. About 10%-15% of lung cancers are small cell lung cancers. This type of lung cancer tends to spread quickly.
Lung Carcinoid Tumor
Fewer than 5% of lung cancers are lung carcinoid tumors. They are also sometimes called lung neuroendocrine tumors. Most of these tumors grow slowly and rarely spread.
How are the pulmonary manifestations of CF managed?
1. Antibiotics, esp. azithromycin
3. Inhaled hypertonic saline
4. Chest physiotherapy, e.g. postural drainage and percussion
6. Double lung transplant
How is the pancreatic insufficiency of CF managed?
pancreatic enzyme replacement therapy
What are the risk factors for lung cancer?
The primary risk factor for the development of lung cancer is cigarette smoking, which is estimated to account for approximately 90 percent of all lung cancers.
Other factors: radiation therapy, pulmonary fibrosis, HIV infection, genetic factors
What is the standard treatment for stage I and stage II non-small cell lung cancer?
Surgery (lobectomy), followed by adjuvant chemotherapy
If patient cannot undergo surgery due to significant comorbidities, then radiation therapy
What is the prognosis for non-small cell lung cancer?
The overall five-year survival in non-small cell lung cancer (NSCLC) is between 10 and 15 percent, primarily because approximately 70 percent of patients present with either locally advanced (stage III) or distant metastatic (stage IV) disease.
What is the general treatment approach for advanced non-small cell lung cancer?
Advanced non-small cell lung cancer (NSCLC) generally requires the sequential use of systemic chemotherapies in an effort to prolong overall survival while maintaining quality of life.
What is the general treatment approach for small cell lung cancer?
Chemotherapy is the mainstay of treatment for patients with SCLC because of the high frequency of early dissemination.
In addition to chemotherapy, there is a significant role for radiation therapy (RT) in the treatment of LS-SCLC.
What is the prognosis for the patient with small cell lung cancer?
The most important prognostic factor in patients with SCLC is the extent of disease (stage) at presentation.
Limited stage disease:
--Median survival ranges from 15 - 20 months
--Five-year survival rate is 10 - 13%.
Extended stage disease:
--Median survival is 8 - 13 months
--Five-year survival rate is 1 - 2%.
What is the top cause of transudative pleural effusion?
And 2 other causes?
HEART FAILURE (>90% of cases)
cirrhosis with ascites
What is the top cause of exudative pleural effusions?
Describe the classification system for pulmonary hypertension.
- NO limitation of physical activity
- NO DOE, chest pain, or near-syncope
- SLIGHT limitation of physical activity
- NO symptoms at rest but ordinary activity -> dyspnea, chest pain, near-syncope
- MARKED limitation of physical activity
- NO symptoms at rest but less than ordinary activity -> dyspnea, chest pain, near-syncope
- Inability to perform any physical activity without symptoms
- At rest, dyspnea, fatigue
- Evidence of right heart failure
What are the normal ranges for the components of an ABG?
- pH: 7.38 - 7.44
- PaCO2: 35 - 40 mm Hg
- PaO2: 95 - 100 mm Hg
- bicarb/total CO2 (calculated): 24 - 30 mEq/L
Basic Skills in Interpreting Lab Data
What are some indications for ABG?
Indications for ABG sampling include the following:
- Identification of respiratory, metabolic, and mixed acid-base disorders
- Measurement of the partial pressures of respiratory gases involved in oxygenation and ventilation
- Monitoring of acid-base status, as in patient with diabetic ketoacidosis (DKA) on insulin infusion
- Assessment of the response to therapeutic interventions such as mechanical ventilation in a patient with respiratory failure
- Determination of arterial respiratory gases during diagnostic evaluations
- Quantification of oxyhemoglobin, which, combined with measurement of arterial oxygen tension (PaO2), provides useful information about the oxygen-carrying capacity of the patient
- Quantification of the levels of dyshemoglobins (eg, carboxyhemoglobin and methemoglobin)
- Procurement of a blood sample in an acute emergency setting when venous sampling is not feasible (many blood chemistry tests could be performed from an arterial sample)
What is this?
What is this?
blunted costophrenic angles
What is this?
in very bad CHF