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Flashcards in MTB Resp Deck (24):
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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.

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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

2

Haemophilus influenzae
Staphylococcus aureus
Klebsiella pneumoniae
Anaerobes
Mycoplasma pneumoniae
Chlamydophila pneumoniae
Legionella
Chlamydia psittaci
Coxiella burnetii

COPD
Recent viral infection (influenza)
Alcoholism, diabetes
Poor dentition, aspiration
Young, healthy patients
Hoarseness
Contaminated water sources, air conditioning, ventilation systems
Birds
Animals at the time of giving birth, veterinarians, farmers

3

Klebsiella pneumoniae
Anaerobes
Mycoplasma pneumoniae
Legionella
Pneumocystis

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

4

Infections often with a "dry" or non-productive cough

• Mycoplasma
• Viruses
• Coxiella
• Pneumocystis
• Chlamydia

5

Atypical pneumonia pathogens

Mycoplasma, Chlamydophila, Legionella, Coxiella, and viruses

6

Pneumonia admission criteria

CURB65 = admission
Confusion
Uremia
Respiratory distress
BP low
Age >65

7

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.

8

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
or
Antipseudomonal penicillin: piperacillin/tazobactam
or
Carbapenems: imipenem, meropenem, or doripenem

9

Pneumocystis pneumonia

AIDS
P.g
Trimethoprim/sulfamethoxazole (TMP/SMX)

10

TB diagnosis

X-ray
Acid-base bacilli 3x
PDD skin is never good for active TB
Biopsy, most accurate

11

TB treatment

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.

12

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

13

PPD positive non active TB treatment

9 month isoniazid with pyridoxine

14

Malignant feature of pulmonary nodule

Age > 40
Enlarging
Smoker
Spiculated (spikes)
Large, >2 em
Atelectasis
Yes adenopathy
Sparse, eccentric calcification
Abnormal PET scan

15

Sarcoidosis presentation

SOBoE, crackles, erythema nodosum, lymphadenopathy, hilar adenopathy
Parotid gland enlargement • Facial palsy • Heart block and restrictive cardiomyopathy • CNS involvement • Iritis and uveitis

16

PE investigation

Spiral CT negative
V/Q or LE Doppler negative
withhold therapy with heparin

18

ARDS

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.

19

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).

20

Asthma Chest x-ray is used to:

• Excludepneumoniaasacauseofexacerbation
• ExcludeotherdiseasessuchaspneumothoraxorCHPincasesthatarenot
clear

21

Asthma treatment

SABA Albuterol
Beclomethasone, fluticasone
LABA salmeterol
ncrease the dose of the ICS
Oral corticosteroids such as prednisone

22

Anticholinergics
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.

23

"Barrelchest"fromincreasedairtrapping

COPD

24

Bronchiectasis is an

uncommon disease from chronic dilation of the large bronchi. This is a permanent anatomic abnormality that cannot be reversed or cured.