Flashcards in MTB Resp Deck (24):
Allergic bronchopulmonary aspergillosis
ABPA is hypersensitivity of the lungs to fungal antigens that colonize the bronchial tree. ABPA occurs almost exclusively in patients with asthma and a history of atopic disorders.
Gastrointestinal Involvement of CF
• Meconium ileus in infants with abdominal distention
• Pancreatic insufficiency (in 90%) with steatorrhea and vitamin A, D, E, and K malabsorption
• Recurrent pancreatitis
• Distal intestinal obstruction
• Biliary cirrhosis
Recent viral infection (influenza)
Poor dentition, aspiration
Young, healthy patients
Contaminated water sources, air conditioning, ventilation systems
Animals at the time of giving birth, veterinarians, farmers
Hemoptysis from necrotizing disease, "currant jelly" sputum
Foul-smelling sputum, "rotten eggs"
Dry cough, rarely severe, bullous myringitis
Gastrointestinal symptoms (abdominal pain, diarrhea) or CNS symptoms such as headache and confusion
AIDS with <200 CD4 cells
Infections often with a "dry" or non-productive cough
Atypical pneumonia pathogens
Mycoplasma, Chlamydophila, Legionella, Coxiella, and viruses
Pneumonia admission criteria
CURB65 = admission
Exudate versus Transudate
Pleural effusion with pH 60% of serum (0.6) or protein >50% of serum (0.5) suggest an exu-date. Exudates are caused by infection and cancer.
Difference in hospital acquired pneumonia
These patients have a much higher incidence of Gram-negative bacilli such as E. coli or Pseudomonas as the cause of their infection. The main difference in management is that macrolides (azithromycin or darithromycin) are not acceptable as empiric therapy. Instead, treatment of HAP is centered around therapy for Gram-negative bacilli such as:
Antipseudomonal cephalosporins: cefepime or ceftazidime
Antipseudomonal penicillin: piperacillin/tazobactam
Carbapenems: imipenem, meropenem, or doripenem
Acid-base bacilli 3x
PDD skin is never good for active TB
Biopsy, most accurate
Rifampin, Isoniazid, Pyrazinamide, and Ethambutol (RIPE). You do not need the ethambutol if it is known at the beginning of therapy that the organism is sensitive to all TB medications. Ethambutol is given as part of 4-drug empiric therapy prior to knowing the sensitivity of the organism.
After using RIPE for the first 2 months, stop ethambutol and pyrazinamide and continue rifampin and iso-niazid for the next 4 months. The standard of care is 6 months total of therapy.
RIPE side effects
R. Red color to body secretions - None, benign finding
I. Peripheral neuropathy - Use pyridoxine to prevent
P. Hyperuricemia - No treatment unless symptomatic
E. Optic neuritis/color vision - Decrease dose in renal failure
Decrease dose in renal failure
PPD positive non active TB treatment
9 month isoniazid with pyridoxine
Malignant feature of pulmonary nodule
Age > 40
Large, >2 em
Sparse, eccentric calcification
Abnormal PET scan
SOBoE, crackles, erythema nodosum, lymphadenopathy, hilar adenopathy
Parotid gland enlargement • Facial palsy • Heart block and restrictive cardiomyopathy • CNS involvement • Iritis and uveitis
Spiral CT negative
V/Q or LE Doppler negative
withhold therapy with heparin
Acute respiratory distress syndrome (ARDS) is respiratory failure from over-whelming lung injury or systemic disease leading to severe hypoxia with a chest x-ray suggestive of congestive failure but normal cardiac hemodynamic measurements. ARDS decreases surfactant and makes the lung cells "leaky" so that the alveoli fill up with fluid.
Asthma The best initial test in an acute exacerbation:
peak expiratory flow (PEF) or arterial blood gas (ABG).
The most accurate diagnostic test is pulmonary function testing (PFTs).
Asthma Chest x-ray is used to:
ncrease the dose of the ICS
Oral corticosteroids such as prednisone
The role of ipratropium and tiotropium in asthma management is
not clear. Anticholinergic agents will dilate bronchi and decrease secretions. They are very effective in COPD.