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Pulm Flashcards

1
Q

CAP- Eti

A
  • Strept pneumo MC
  • H. flu 2nd MC
  • Ambulatory or inpt
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2
Q

CAP- Sx

A
  • Sudden onset of fever
  • Rigors
  • Purulent productive cough
  • Lobar CXR
  • Bronchial breath sounds, dullness to percussion
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3
Q

CAP- Dx

A

CXR: consolidation, + sputum

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4
Q

CAP- Tx

A
  • Macrolide + b lactam

- Doxycycline

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5
Q

CAP- atypical- Eti

A

Mycoplasma MC

- Chlamydia, legionella

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6
Q

CAP- atypical- Sx

A
  • Low grade fever, ear pain
  • Normal PE
  • Pharyngitis
  • Myalgia, malaise
  • “walking pneumonia”
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7
Q

CAP- atypical- Dx

A

CXR: Diffuse, patchy infiltrates

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8
Q

HAP- Eti

A
  • Pseudomonas
  • Gram - rods
  • Inpt > 48 hrs
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9
Q

HAP- Sx

A
  • Green sputum

- Fevers, chills, consolidation

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10
Q

HAP- Tx

A
  • Beta lactam (cefepime, imipenem or pip-tazo) + aminoglycoside (gent or tobra) or FQ (floxacins)
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11
Q

Aspiration pnenumo- Eti

A
  • Anaerobes

- Penumonitis d/t gastric contents

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12
Q

Aspiration pnenumo- Sx

A
  • Foul smelling sputum
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13
Q

Aspiration pnenumo- Tx

A
  • Clinda

- Augmentin

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14
Q

Tb- Eti

A
  • Chronic myco tuberculosis infxn -> granuloma formation
  • Airbone droplets
  • HC workers, immigrants, immunodeficient
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15
Q

Tb- Sx

A
  • Chronic, productive cough
  • Chest pain
  • Night sweats, fever, chills, wt loss
  • Consolidation
  • Latent Tb not infectious
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16
Q

Tb- Dx

A
  • AFB Sputum culture x 3 days (gold standard)
  • AFB stain
  • CXR: primary v reactivation
  • PPD & quanterferon gold
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17
Q

Tb PPD screening

A

> 5 mm in immunocomp, contacts, CXR with granuloma

  • > 10 high risk pop: exposure, immigrants, homeless, HC
  • > 15 NK risk factors
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18
Q

Tb- Tx

A
  • RIPE x 2 mo, ttl tx x 6 mo
  • PZA d/c’ed after 2 mo
  • Rifampin
  • Isoniazid
  • pyrazinamide
  • Ethambutol
  • No longer infectious after 2 weeks
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19
Q

Acute COPD- Sx

A
  • Emphysema: Dyspnea on exertion, hyperinflation, resp alkalosis
  • Bronchitis: Productive cough, rales, rhonchi, cor pulmonale, resp acidosis
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20
Q

Acute COPD- Dx

A
  • ABGs- PaO2
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21
Q

Acute COPD- Tx

A
  • O2- only tx to improve mortality
  • Anticholinergic- Ipratropriam
  • Short acting Beta agonists (albuterol, terbutaline)
  • Systemic steroids- 40 mg pred x 5 d
  • Abx (amox, TMP-SMX)
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22
Q

Cystic fibrosis- Patho

A
  • Autosomal recessive
  • Prevents chloride transport, thick viscous mucus- lungs, pancreas, GI
  • Obstructive lung dz
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23
Q

Cystic fibrosis- Sx

A
  • GI: Meconium ielus, pancreatic insufficiency- bulky, pale foul smelling stools, vit deficiencies
  • Pulm: Recurrent infxn- pseudomonas & s. aureus
  • Infertility
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24
Q

Cystic fibrosis- Dx

A

Chloride sweat test- > 60 mmol/L 2 occasions

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25
Cystic fibrosis- Tx
- Bronchodilators, mucolytics, abx | - Pancreatic enzyme replacement, Vit supplementation
26
Asthma exacerbation- Sx
- Resp alkalosis | - Decreased peak expiratory flow rate
27
Asthma exacerbation- Tx
- SABA 1st line (albuterol, terbutaline, epinephrine) - Ipratroprium in 1st hour - Systemic steroids
28
Pleural effusion- Patho
- Abn accumulation of fluid in pleura d/t pus, blood or high cholesterol
29
Pleural effusion- Sx
Dyspnea - Pleuretic chest pain - Cough - Decreased fremitus, breath sounds, dullness
30
Pleural effusion- Dx
CXR- >175 cc with menisci - Blunting of costophrenic angles, locations - Lat decub- fluid moves
31
Pleural effusion- Tx
- Thoracentesis = gold standard
32
Hemothroax
- Gross blood d/t trauma | - Stop bleeding, chest tube or thoracotomy
33
Chylothorax
High cholesterol in pleural space d/t trauma - Thoracentesis = Milky fluid, persistently turbid - Drain + octreotide
34
Transudates
- Increased hydrostatic or decreased oncotic pressures - CHF MC cause - Not d/t local pleural dz - Cirrhosis, dialysus, obstruction
35
Exudates
- Increased vascular permeability d/t local factors - Infxn & inflammation - Pneumonia, Tb, CA - Lights criteria
36
Light's criteria
- Exclusive to exudates - Pleural fluid protein: serum protein > 0.5 - Pleural LDH: serum LDH >0.6 or >2/3 upper normal
37
Pneumothorax- Eti
- Air in pleural space - + pressure causes lung collapse - Spontaneous, Traumatic or tension
38
Spont pneumo
- Ruptured bleb - 1- no underlying dz, tall thin, smokers - 2: lung dz w/o trauma
39
Tension pneumo
- + pressure in lungs, trach and heart to contralateral side | - Trauma, mech vent MC
40
Pneumothorax- Sx
- Unilateral, pleuritic chest pain - Hyperresonance - Decreased fremitus, breath sounds,
41
Pneumothorax- Dx
CXR: companion lines (lack of vascular markings)
42
Pneumothorax- Tx
- Needle aspiration- 2nd ICS if tension | - Thoracostomy
43
Lung CA: Types
- Non- Small cell: Adenocarcinoma MC, squamous, large cell bronchoalveolar - Small cell = early METS,
44
Lung CA: Risks
- Cigarette smoking, 2nd hand smoke
45
Lung CA: Prognosis
- Small cell = worst prognosis | - Bronchoalveolar = best
46
PE: Eti
- Arise from lower extremity - Stasis, hypercoaguability, intimal damage - Thrombus in pulm artery or branch - Hx of DVT or factor V leiden
47
PE: Sx
- Dyspnea & tachypnea - Pleuretic chest pain, hemoptysis - Apprehension
48
PE: Dx
- Helical CT = initial screen - Pulm angiography = gold standard - ECG: S1Q3T3 - D -dimer to RO
49
PE: Tx
- Heme stable: IV heparin and PO warfarin x 5-7 days, warfarin x 6 mo - Heme unstable: Embolectomy or thrombolytics (CI in CVA)
50
PE: Wells criteria
- Sx of DVT - Alt dx less likely - HR > 100 - Surg in 4 wks or imob x 3 d - Hx PE or DVT - CA >4 = likly
51
Pulm HTN- Classification, groups
- Group 1: Idiopathic, heritable - Group 2: L heart dz - Group 3: lung dz or hypoxemia - Group 4 chronic thromboembolism - Group 5: hematologic dz
52
Pulm HTN- Severity class
1: No limitation, sx 2: Slight phys limitation, no sx at rest 3: Marked limitation, no sx at rest 4: sx at rest
53
Pulm HTN- Eti
Increased pulm vas resistance, R sided HF - Primary= middle aged, young women - Secondary = COPD, pulm dz
54
Pulm HTN- Sx
- Dyspnea - Increased JVP, edema, ascites - R sided HF
55
Pulm HTN- Dx
- Right sided cath | - CXR: enlarged pulm arteries, edema
56
Empyema- Eti
- Pus in pleura d/t underlying suppurative lung dz (MC) | - D/t staph
57
Empyema- Sx
- Tachycardia, tachypneia | - Dullness to percussion
58
Empyema- Dx, Tx
CXR & thoracentesis | - Tube thoracostomy
59
Alpha 1 antitrypsin deficiency- Eti
- Genetic risk factor for COPD | - Early onset of COPD
60
Alpha 1 antitrypsin deficiency- Sx
- Emphysema of lungs | - Liver cirrhosis with jaundice, ascites, edema
61
Alpha 1 antitrypsin deficiency- Dx
- AAT deficiency testing
62
Alpha 1 antitrypsin deficiency- Tx
IV augmentation tx
63
Acute resp failure- Eti
- Po2
64
Acute resp failure- Sx
Dyspnea - Hypoxemia - HA d/t hypercapnia
65
Acute resp failure- Dx
ABG | - Tx: O2
66
Chronic resp. failure-Eti
- Hypoxia or hypercapnia - Develops over days - Spinal cord, nerve damage, alcohol abuse
67
Chronic resp. failure- Sx
- Dyspnea, cyanosis | - Tachypnea
68
Chronic resp. failure- Dx
ABG | - Tx: Outpt mgmt w/ O2

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