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PANCE/EOC > Pulm #4 > Flashcards

Pulm #4 Flashcards

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1
Q

What is a pleural effusion?

A

Abnormal accumulation of fluid in the pleural space

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2
Q

What is an empyema?

A

-Direct infection of the pleural space

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3
Q

What are the two types of pleural effusion?

A

-Transudate and Exudate

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4
Q

Explain some causes of Transudate pleural effusion

A
  • CHF (MCC)
  • Nephrotic syndrome
  • Cirrhosis
  • Atelectasis
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5
Q

Explain some causes of Exudate pleural effusions

A
  • Any condition associated with infection or inflammation
  • Pulmonary embolism
  • Malignancy
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6
Q

Symptoms of pleural effusion

A
  • Dullness to percussion
  • Decreased fremitus
  • Decreased breath sounds
  • Pleural friction rub
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7
Q

What is the initial test of choice for pleural effusion? What does it show?

A
  • Lateral decubitus CXR films

- Blunting of the costophrenic angles (meniscus sign)

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8
Q

However, what is the gold standard to diagnose a pleural effusion?

A

Thoracentesis (can be diagnostic and therapeutic)

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9
Q

What diagnostic is done to confirm an empyema?

A

CT scan

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10
Q

What is Light’s Criteria?

A
  • If any of these three are present, it is exudative
    1) Pleural fluid protein: serum protein > 0.5
    2) pleural fluid LDH: serum LDH > 0.6
    3) Pleural fluid LDH > 2/3 upper limit of normal LDH
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11
Q

Treatment for pleural effusion

A
  • Treat underlying condition
  • Thoracentesis (gold standard)
  • Chest tube fluid drainage for empyema
  • Pleurodesis (Talc used) if chronic or malignant
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12
Q

What is the pathophysiology of Tuberculosis

A

After inhalation, Mtb goes to the alveoli, gets incorporated into macrophages and can disseminate from there

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13
Q

Pulmonary Symptoms of TB

A
  • Cough
  • Hemoptysis
  • Fever
  • Night sweats, chills, chest pain
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14
Q

Extrapulmonary symptoms of TB

A
  • Can affect any organ
  • -Cervical lymph nodes (Scrofula)
  • -Pott’s Disease (TB of the spine)
  • -Pericarditis
  • -Adrenal gland involvement
  • -Genitourinary
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15
Q

What three things do you need to show infected with TB but not infectious?

A
    • PPD
  • No symptoms of infection
  • No imaging findings of active infection
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16
Q

What is the initial test ordered for TB?

A

Chest radiograph

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17
Q

Different findings of TB on chest xray

A
  • Reactivation: apical (upper) lobes
  • Primary: middle/lower lobe
  • Miliary: millet-seed lesions
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18
Q

What other diagnostics can be done for TB?

A
  • Sputum cultures: at least 3 samples on 3 consecutive days

- NAAT: more sensitive than sputum smears

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19
Q

Management of active TB

A

-Initiate 4 drug therapy: RIPE for 2 months followed by 4 months of RI (6 month duration)

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20
Q

Side effects of TB drugs

A
  • Rifampin: orange colored secretions
  • Isoniazid: Hepatitis, peripheral neuropathy
  • Pyrazinamide: Hepatitis, Hyperuricemia
  • Ethambutol: Optic neuritis, red/green color blindness
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21
Q

What should be given with Isoniazid?

Study These Flashcards
A

Pyridoxine (B6)

22
Q

Treatment for Latent TB

Study These Flashcards
A

-INH + Pyridoxine x 9 months

23
Q

What drug can be given in TB instead of Ethambutol?

24
Q

However, what are the side effects of Streptomycin?

Study These Flashcards
A

Ototoxicity (CN8)

Nephrotoxicity

25
Any positive PPD should be followed by a ____ to rule out active disease
CXR
26
What are the reaction sizes to be positive with a PPD test for TB?
> 5 mm: HIV or immunosuppressed, close contact with person with active TB, CXR with old/healed granuloma > 10 mm: healthcare workers, all other high risk people > 15 mm: Everyone else, no known risk factors
27
What is parrot fever (Psittacosis)?
infection with Chlamydophila Psittaci due to exposure to infected birds
28
Treatment for Psittacosis
Tetracyclines (tetracycline, doxycycline, minocycline)
29
What happens in silo filler disease?
It is a hypersensitivity pneumonitis from nitrogen dioxide gas exposure released from plant matter stored in silos as they ferment (gas is converted to nitric acid in the lungs when inhaled)
30
Management of Silo Filler Disease
- Occupational reduction of exposure - Entering at the top of the silo - Use of N95 masks
31
Risk factors for Berylliosis
- Aerospace - Electronics - Ceramics - Tool and dye manufacturing - Jewelry making - Fluorescent light bulbs (Exposure to nickel, aluminum, and copper)
32
Treatment for Berylliosis
- Corticosteroids, oxygen | - Methotrexate if corticosteroids fail
33
Coal Worker's Lung is a lung disease from inhalation of coal dust particles. What is Caplan Syndrome?
-Coal worker pneumoconiosis + Rheumatoid Arthritis
34
Diagnostics for coal workers lung
- Chest radiograph: small nodules in upper lung and hyperinflation of lower lobes in an obstructive pattern - PFT: obstructive pattern - Lung biopsy: dark, black lungs
35
Management for coal worker's lung
Symptomatic management
36
Risk factors for sarcoidosis
-Females, AA, Northern Europeans
37
Symptoms of Sarcoidosis
- 50% asymptomatic - Dry nonproductive cough, dyspnea, rales - Erythema nodosum (on shins), lupus pernio (on face) - Hilar LAD (near xiphoid process)
38
What is Lofgren Syndrome?
-Erythema Nodosum + Bilateral hilar LAD + polyarthralgias with fever
39
best initial test for sarcoidosis
CXR
40
What other diagnostics can be done for sarcoidosis?
- PFT: restrictive in pattern - Tissue Biopsy: Most accurate (noncaseating granulomas) - Labs: elevated ACE levels
41
Treatment for sarcoidosis
- Asymptomatic: observation (spontaneous remission in 2 years in most cases) - Symptomatic: oral corticosteroids - Methotrexate, Hydroxychloroquine for skin lesions
42
What two things that are associated with Sarcoidosis are associated with a poorer prognosis?
- Interstitial lung disease | - Lupus pernio
43
PCP PNA is the most common opportunistic infection in HIV patients with a CD4+ < ____
200
44
Clinical manifestations of PCP PNA
- Dyspnea on exertion (MC) - Fever - Nonproductive cough - Oxygen desaturation with ambulation!!!
45
CXR for PCP PNA
-Diffuse bilateral interstitial infiltrates
46
Labs for PCP PNA
-Increased LDH
47
What is the definitive diagnostic for PCP
Lung biopsy (rarely done though)
48
Treatment for PCP PNA
- Bactrim x 21 days | - If HIV + --> add Prednisone if hypoxic
49
What medications should you give if the patient has PCP and a sulfa allergy?
- Dapsone-Trimethoprim | - Clindamycin-Primaquine
50
What fungus causes PCP?
Pneumocystic Jirovecii

PANCE/EOC (63 decks)

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