Pulm PANCE review Flashcards
(173 cards)
1
Q
Acute bronchitis= inflammation of _______
A
large and small airways
2
Q
Acute Bronchitis: Etiology?
A
MOSTLY viral!! 90% viruses; atypical bacterial infection (Mycoplasma, Chlamydia Pneumoniae, B. Pertussis)
3
Q
Acute Bronchitis:
S/Sx?
A
Cough, +/- Wheezing
4
Q
Acute Bronchitis: CXR will show?
tx?
A
CXR: Neg for PNA
Tx: Antitussive, expectorants, albuterol, +/- abx to cover atypical infx
5
Q
Acute Bronchiolitis is a major cause of ______ infections in which population?
A
lower respiratory infections of newborns and children -very contagious! Mostly occurs in kids <2
6
Q
Acute Bronchiolitis: etiology is mostly _____
s/sx?
A
viral – mostly **RSV
S/Sx: Low-grade fever, cough, respiratory distress. Preceded by 1-3 days of URI sx (ie: nasal discharge)
7
Q
Acute Bronchiolitis:
dx?
tx?
A
clinical
Tx: supportive
Humidified air, oxygen, nasal suction
+/- albuterol, fluids, ribavirin **(STEROIDS NOT BENEFICIAL)
8
Q
steeple sign is assoc with:
A
CROUP
9
Q
Croup= inflammation of the _________
A
upper and lower respiratory tracts, mostly subglottic region
10
Q
Croup: age group?
etiology?
A
Typically 3 months-5 yrs old
Etiology: Viral (**Parainfluenza), adenovirus, RSV
paracrouper
11
Q
Croup: S/sx
A
Barking cough, inspiratory stridor, hoarseness
12
Q
Croup: x-ray signs?
A
“Steeple sign” (subglottic narrowing)
13
Q
Croup: Tx?
A
Palliative – Rest, hydration, calm child
- Steroids – Single dose of dexamethasone (IM or PO)
- Nebulized racemic epinephrine–> Reduces stridor and work of breathing
14
Q
Influenza:
Etiology?
A
Viruses (A, B, C)
15
Q
Influenza: S/sx
A
HA, F/C, myalgias, coryza, +/- sore throat
16
Q
Influenza: dx
A
Rapid antigen test with nasal swab
17
Q
Influenza: tx?
A
Consider antivirals (oseltamivir, rimantadine, zanamivir) within 48 hours of sx onset Supportive Care
Prevent: Annual vaccination
18
Q
Pertussis aka _______
A
whooping cough
19
Q
Pertussis: etiology?
-contagious- Y or N?
A
Bordetella pertussis
Highly contagious airborne disease that lasts ~6 weeks before subsiding
20
Q
Pertussis: S/Sx (describe the 3 stages)
A
Catarrhal Stage: mild cough, sneezing, runny nose (similar to any URI)–> 1-2 weeks
Paroxysmal Stage: uncontrollable coughing spells. Inspiratory whoop. May have post-tussive vomiting–>2-6 weeks
Convalescent Stage: cough subsides over weeks to months
21
Q
Pertussis: dx?
A
Clinical diagnosis, though nasopharyngeal cultures can confirm (PCR, bacterial cx, or serology)
22
Q
Pertussis: tx?
A
Macrolides (erythromycin, azithromycin, clarithromycin) preferred or Bactrim (alternative for those who can’t take a macrolide)
Pertussis: vaccine-prevents
23
Q
A 14 yo male presents with exudative tonsillitis, fever, and adenopathy for the last 5 days. Her primary care provider placed her on amoxicillin when her rapid strep test was positive. She developed a non-pruritic rash maculopapular rash. What is the most likely cause?
A
Mononucleosis
24
Q
CAP is a _______ infection
A
Parenchymal lung infection
25
CAP: risk factors?
Inc. Age, ETOH/Tobacco use, asthma/COPD, Immunosuppression
26
CAP: Etiology? typical vs atypical (list ex's)
Bacteria > Viruses
Typicals: S. Pneumo > H. flu , M. Catarrhalis
Atypicals: Mycoplasma, Chlamydia, Legionella, Kleb, S. Aureus, Viruses
27
CAP: S/Sx:
cough, sputum, dyspnea, tachycardia, pleuritic CP, +/-Fever/chills
28
CAP: labs
Leukocytosis with possible left shift
29
CAP: CXR?
Lobar or segmental infiltrates
30
CAP: tx? outpatient?
Tx: oxygen, abx, neb tx
Outpatient: (usually 5-7 days )
<65 and otherwise healthy: amoxicillin + macrolide (azithromycin or clarithromycin) or doxycycline
If comorbidities, amoxicillin/clavulanate (Augmentin) instead of amoxicillin
If can’t take amox: cephalosporin + macrolide or doxy
Or respiratory fluoroquinolone (levofloxacin, moxifloxacin, or gemifloxacin)
31
CAP: in patient tx? (list ex meds)
Beta lactam (penicillins, cephalosporins, carbapenems, monobactams) + macrolide –or- monotherapy with a respiratory fluoroquinolone
32
CAP--> pseudomonas infxn tx?
(currently or previously) or recent hospitalization with IV abx:
Pip/taz, or cefepime, or ceftazidime, or meropenem or imipenem + ciprofloxacin or levofloxacin
33
CAP: tx for MRSA positive or strongly suspected?
Add vancomycin or linezolid to the above regimens
34
Atypical Pneumonia: Sx? Pt population?
Milder sx’s in presentation ie low grade fever, nonproductive cough, myalgia, fatigue, mild pulmonary sx’s
vs CAP
--Usually occur in young healthy adults
35
Atypical Pneumonia: etiology?
**Mycoplasma MC, Chlamydia, Legionella,
36
Atypical Pneumonia: labs
| CXR?
Minimal Leukocytosis
-Not reliable with differentiating typical vs atypical findings – use clinical picture
37
Atypical Pneumonia: tx?
Macrolides (ie: azithromycin), fluoroquinolones (ie: Levaquin), tetracyclines (ie: doxycycline)
38
Hospital Acquired Pneumonia: occurs _____ hours after hospital admission
>48
39
Hospital Acquired Pneumonia: etiology
Organisms that colonize ill patients, staff and equipment
| S. Aureus, P. Aeruginosa, Klebsiella, Enterobacter, Acinetobacter, E. coli
40
Hospital Acquired PNA: Dx?
New CXR opacity
-Fever, leukocytosis, purulent sputum
Lab: Sputum culture, blood cultures
41
Hospital Acquired Pneumonia: tx?
culture sensitive antibiotics (depends on local resistance rates, patient risk factors for MDR pathogens)
42
Viral Pneumonia: etiology?
Influenza A or B, RSV, adenovirus, Herpes (newborns), CMV (immune deficient)
43
Viral Pneumonia: S/Sx?
Fever, rhinitis, myalgia, HA, nonproductive cough
44
Viral Pneumonia: Tx?
RSV: Ribavirin
HSV: acyclovir
CMV: ganciclovir
45
Fungal Pneumonia: increased incidence in ______ PTs
immunocomp
46
Fungal Pneumonia: Etiology?
| -Histoplasmosis?
Histoplasmosis: “Caves, Ohio Valley, & Lower Mississippi region”, grows in soil with bird/bat droppings.
tx: Itraconazole (mild-mod) or Amphotericin B (mod-severe)
47
Fungal Pneumonia: Etiology?
| Coccidiomycosis?
“California desert, valley fever”, SW US
Tx: Fluconazole or itraconazole
48
Fungal PNA:
| PCP?
Pneumocystis jirovecii (PCP): ↑ HIV
49
Fungal Pneumonia: Blastomycosis?
Endemic around Great lakes, Ohio River Basin and Mississippi River.
50
Fungal PNA: Blastomycosis
- Sx?
- Tx?
Can have extrapulmonary lesions: skin (verrucous lesion with irregular borders), bone (osteomyelitis), prostatitis, CNS involvement
Tx: oral itraconazole (mild-mod), amphotericin B (mod-severe)
51
Fungal Pneumonia: Cryptococcus? is it fatal?
tx for mild mod?
tx for severe?
Potentially fatal, most patients immunocompromised. (OI in AIDS)
Mild-mod: fluconazole 6-12 months. Alternatives: itraconazole or voriconazole.
Severe: Amphotericin B + Oral Flucytosine
52
```
HIV Pneumonia (PJP): etiology?
S/Sx?
```
PCP- Pneumocystis jiroveci pneumonia
| S/Sx: fever, dry cough, fatigue, night sweats, hypoxia
53
HIV Pneumonia (PJP):
- PE:?
- Labs?
50% normal exam
| -Lab: **Sputum for silver stain is gold standard, but PCR testing replacing this. LDH increased in 90%
54
HIV Pneumonia (PJP)
- CXR/CT classic finding?**
- Tx?
Classic finding is bilateral diffuse hilar opacification.
Tx: Bactrim (for prophylaxis and treatment) KNOW that it's bactrim!!!!!!
55
Aspiration Pneumonia is caused by ______
Exogenous substances or endogenous secretions end up in the lower airways
56
Aspiration Pneumonia:
| Requirements?
Compromise in usual defenses for lower airway
--Cough reflex, glottis closure
-Bacterial infection, obstruction (from uncleared fluid/particles), or irritant (ie: gastric fluid) in the lower airway
57
Aspiration Pneumonia: common bacteria?
Peptostreptococcus
Fusobacterium nucleatum
Prevotella
Bacteroides
58
Aspiration Pneumonia: clinical features?
```
Cough
Fever
Dyspnea
Purulent sputum
***Putrid-smelling sputum considered diagnostic of anaerobic infection**
Crackles, wheezes, or rhonchi
```
59
Aspiration PNA: dx?
CXR: Infiltrates
-If chemical pneumonitis
Bronchoscopy could show erythema of bronchi
60
Aspiration PNA: tx?
-If aspiration was observed: suction ASAP
Antibiotic Therapy:
--Parenteral: Pip/taz (Zosyn) or Ampicillin/sulbactam (Unasyn)
--PO: Augmentin –or-
Flagyl + amoxicillin (or pen G [IV])
61
TB= Pulmonary infx caused by_____
inhaling aerosol droplets containing Mycobacterium tuberculosis
62
TB: ___% form immune response to prevent progression of dz
95%
5% → Active TB within 2 years
63
TB: S/Sx
Cough, F/C, night sweats, anorexia, fatigue, wt. loss, hemoptysis
64
Primary TB tx:
New TB infection. Fever most common (and often only sx)
65
CXR finding: cavitary infiltrate in posterior apical segment of upper lobe, patchy or nodular infiltrates,
dx=?
TB****
66
TB skin test: is called?
Skin: Mantoux test (+PPD);
quantiferon gold Sputum: +/- acid-fast bacilli
67
TB:
**calcified nodules=
active infection**
68
Reactivation TB/LATENT TB is a previous focus of mycobacterial containment that was ______
seeded at the time of primary TB gets reactivated
69
Latent TB: ______ segments of the lung are MC involved
apical segments
70
Reactivation TB/LATENT TB:
| S/Sx?
Insidious, vague symptoms: fatigue, weight loss, cough
| --May develop CP, dyspnea, hemoptysis
71
How to dx latent TB?
positive skin test, but no s/s or xray findings of disease. Not contagious.
72
Latent TB w/ HIV negative:
| tx?
Isoniazid 300 mg QD for 6-9 months
73
Latent TB w/ HIV + tx:
Isoniazid 300mg QD for 12 months
74
Active TB initial phase tx (2 months)
Isoniazid 5mg/kg/d
Rifampin 10mg/kg/d
Pyrazinamide 15-30 mg/kg/d
Ethambutol 5-25 mg/kg/d
75
Active TB: continuation tx
**at least 4 months--> Isoniazid 300mg /d AND Rifampin 600mg/d
76
Isoniazid S/E?
causes peripheral neuropathy. Coadminister Vitamin B6 to decrease risk
77
Rifampin: S/E?
thrombocytopenia
78
Ethambutol: S/E?
can cause color vision changes/ocular toxicity
79
Before initiation of TB tx, must check the following labs:
LFTs, creatinine, platelet count, visual acuity and color vision tests
80
Pneumothorax=
Accumulation of air in pleural space
81
Pneumothorax:
| etiology?
Spontaneous, traumatic, or iatrogenic
82
Pneumothorax:
S/Sx?
PE?
Acute onset of ipsilateral CP with SOB
Exam: Decreased BS, unilateral chest expansion, **hyperresonance
83
Pneumothorax:
| Dx?
CXR – air in pleural space
84
Pneumothorax: tx?
Small resolved spontaneously; Large +/- chest tube
85
Tension Pneumothorax= air in pleural space causes ______
**mediastinal shift to contralateral side and impaired ventilation leading to CV compromise
86
Tension Pneumothorax:
| tx for unstable Pt?
Immediate insertion of large-bore needle to decompress
| 14-16g needle, 2nd ICS Space, mid clavicular line
87
Tension Pneumothorax:
| tx for stable Pt?
Chest tube placement
88
Pleural effusion= accumulation of fluid in the ______
pleural space
89
Pleural Effusion: etiology
| transudative=
Transudative (thin): CHF, cirrhosis, nephrotic syndrome
90
Pleural Effusion: etiology
| exudative=
Exudative: Blood (Trauma), malignancy, infection, RA
91
Pleural Effusion: s/sx
Dyspnea, +/- Fever
92
Pleural effusion: PE?
Dullness to percussion lower lung, decreased breath sounds, decreased tactile fremitus
93
Pleural effusion: dx
-CXR findings?
vs
U/S findings
CXR: White out in lower lung field blunting costophrenic angle
U/S: Localize effusion
94
Pleural effusion: tx?
- Thoracentesis
| - Pleurodesis (Chronic effusions)
95
Pleural Fluid Analysis:
Light's criteria-- Transudative vs Exudative
--exudative if at least 1 of the following is present: (list)
- Effusion protein/serum protein >0.5
- Effusion LDH/Serum LDH > 0.6
- Effusion LDH > 2/3 UNL of lab’s serum LDH
96
Asthma is a chronic inflammatory disorder with airway obstruction.
Triad=
**Triad: Airflow obstruction, Bronchial hyperreactivity, inflammation
97
Asthma: etiology?
| sx?
genetics, allergens, exercise, smoke, GERD
-Wheezing, dyspnea, dry cough, chest tightness
98
Status Asthmaticus=
Prolonged, severe attack that does not respond to tx with pt at risk for ventilator failure
99
Asthma: PE findings?
dx?
tachycardia, tachypnea, prolonged expiration, expiratory wheezing
Dx:
PFT: ↓FEV1, ↓ FEV1/FVC, ↑RV, TLC
ABG: Hypoxemia & hypocarbia (initially)
100
Intermittent asthma definition
Sx: < or equal to 2 days/week
FEV1: >80%
FEV1/FVC: normal
- 1 exacerbation per year
tx: step 1= SABA PRN
101
Persistent-mild asthma definition
>2 days/week
FEV1 >80%
FEV1/FVC: normal
2 or more exacerbations per year
tx: step 2= low dose ICS + SABa
102
Persistent-moderate asthma definition
daily Sx
FEV1 60-80%
FEV1/FVC: reduced 5%
2 or more exacerbations per year
tx: step 3= medium dose ICS + SABA PRN
OR
low dose ICS + LABA
103
Persistent-severe asthma definition
Sx throughout the day
FEV1: <60%
FEV1/FVC: reduced > 5%
2 or more exacerbations per year
tx: step 4= medium dose ICS+ LABA
104
Asthma Treatment – Quick Relief
-SABA- ex's
-anticholinergic: Ex's
Systemic corticosteroids: Ex's
SABA: Albuterol, Levalbuterol, etc.--Most effective bronchodilators w/ rapid onset and few S/E. Scheduled daily use NOT recommended.
Anticholinergics: Ipratroprium bromide (Atrovent)
Systemic Corticosteroids: Methylprednisolone, prednisone, prednisolone
105
Asthma Treatment – Long Term
- ICS?
- Combo of ICS + LABA? (Ex's)
ICS- QVAR, Pulmicort, Aerobid, Flovent, Asmanex, Azmacort
Combinations of ICS + LABA:
Symbicort= Budesonide + Formoterol
Advair= Fluticasone + Salmeterol
Dulera=Mometasone + Formoterol
*Preferred, 1st Line Agents for all patients with persistent asthma
Adverse Effects: cough, dysphonia, oropharyngeal candidiasis
106
Asthma Treatment: Long Term
LABA: ex's?
Leukotriene modifiers: ex's?
Mast cell stabilizers?
Salmeterol & Formoterol
-->Bronchodilation up to 12 hours. NOT monotherapy – NO Anti-inflammatory effects
-Leukotriene Modifiers: Montelukast, zileuton, zafirlukast--> Alternatives to low-dose ICS with mild persistent asthma
Cromolyn sodium--> Useful if taken before exposure or exercise
107
Asthma Treatment: Long Term
Phosphodiesterase inhibitors (methylxanthines): Ex's?
Immunomodulators?
Vaccinations?
-Theophylline – narrow therapeutic-toxic range
Immunomodulators:Omalizumab (Xolair)=>Recombinant Ab that binds Ig
**Pneumococcal & Influenza vaccines recommended
108
Theophylline S/E?
Insomnia, GERD, HA, N/V, Seizures, hyperglycemia, hypokalemia, arrhythmias
**narrow therapeutic-toxic range
109
COPD:
| Emphysema?
pink puffers
| *Destruction of alveolar walls produces widely dilated air spaces
110
COPD:Emphysema
etiology?
S/Sx?
Smoking, α-1 antitrypsin deficiency
S/Sx: Exertional dyspnea, wt. loss, minimal cough
111
Risk factors for COPD:
and PE findings?
Risks: Smoking, pollution, infections, occupational dusts/chemicals
--α-1 Antitrypsin Deficiency (genetic)
Sx: Dyspnea, pursed lip breathing, grunting expirations, asthma
Exam: ↑ AP dimension, decreased BS, may have crackles or rhonchi, +/-wheezing, prolonged expiratory phase
112
COPD:Chronic bronchitis
describe?
-s/sx?
=Excessive mucus secretion in bronchial tree causing mucus plugging and inflammation
- *Productive cough for at least 3 months during each of 2 successive years
- S/Sx: Chronic cough, sputum production, episodic dyspnea, wheezing, wt. gain
Aka: “Blue Bloaters”
etiology: smoking!!
113
COPD: dx
- CXR findings?
- labs?
- late PFT findings?
- CXR: +/- hyperinflation, flat diaphragms
- CBC: polycythemia from hypoxemia
PFT: (later findings)
↓ FEV1 and ↓ Ratio of FEV1/FVC--> Ratio is <70% of that predicted for matched control
-RV and TLC are increased
114
COPD: complications?
Cor pulmonale, polycythemia, infx, resp failure, bronchogenic carcinoma, disability and PUD
115
COPD: list main treatments
Stop Smoking
Anticholinergics: Ipratropium (Atrovent), tiotropium (Spiriva)
B-Adrenergic Agents: Albuterol, formoterol, salmeterol
Corticosteroids
Oral Theophylline
116
When is supplemental O2 indicated with COPD pts?
Oxygen: PaO2<55mm or SaO2 <88% RA
117
COPD exacerbations:
| Uncomplicated: Abx tx?
Doxy, Macrolides, Cephalosporins
118
COPD exacerbations:
complicated: abx tx?
Surgery?
Quinolone, Amox/clav
- Steroids for exacerbations
- Vaccination against influenza/pneumococcal
Surgery: Lung Transplant, lung volume reduction surgery
119
Bronchiectasis is abnormal dilation of the bronchi.
Etiology?
S/Sx?
**irreversible
E: Bronchial Injury (often from infx), CF 50%
Sx: Chronic purulent sputum, +/- hemoptysis
120
Bronchiectasis:
PE findings?
Dx?
Exam: Crackles, clubbing
Dx: CXR/CT – Tortuous airways
121
Bronchiectasis: tx?
Bronchodilators, +/- abx, O2, chest physiotherapy
122
Upper lobe findings ddx:
cystic fibrosis and TB
123
Lower lobe ddx:
aspirations, PNA,
124
Cystic fibrosis is an ________ recessive dz with dysfxn of exocrine glands
autosomal
Lungs: ↑ Mucus, Airway obstruction
125
Cystic fibrosis:
- MC pathogens?
- pancreas ?
- GI tract issues?
P. aeruginosa or S. Aureus
Pancreas: Pancreatic insufficiency
GI Tract: malabsorption
126
Cystic fibrosis:
| dx lab test?
+Sweat Chloride Test > 60 mEq/L****
127
Cystic fibrosis:
| tx?
Hydration, Humidification, O2, abx, chest physiotherapy, possible lung transplantation
128
Idiopathic Pulmonary Fibrosis= inflammation & fibrosis of alveolar walls and air spaces w/o known cause
s/sx?
Exertional dyspnea and dry
non-prod cough
Crackles on exam
Digital clubbing
Fever, fatigue, anorexia, wt. loss
129
Idiopathic Pulmonary Fibrosis:
dx CXR ?
PFT?
CXR: Diffuse ground-glass, nodular or reticular infiltrates
PFT: Restrictive pattern with ↓ FVC & ↓ FEV1
130
Idiopathic Pulmonary Fibrosis:
| tx?
+/- Steroid, Immunosuppressive agents
131
Pneumoconioses=
Group of interstitial lung disease caused by inhalation of certain dusts and lung tissue reaction
Environmental lung dz**
132
Pneumoconioses:
etiology dusts: ?
noxious gases?
```
Silicosis
Asbestos
Coal Mine Dust (“black lung”)
Berylliosis
Byssinosis (Cotton)
Talcosis
Siderosis
```
Nitrogen oxides
Chlorine
Sulfur oxides
Metal fumes
133
```
Pneumoconioses:
-MUST get occupational hx
-Dx:
--PFTs?
CXR?
CT scan?
```
PFTs (Multiple measurements over time)
CXR – Not sensitive or specific
CT Scan – Helps earlier dx
134
Pneumoconioses: tx?
Prevent Respiratory Protection (Masks i.e. N95 Respirator)
STOP SMOKING!!!!
Closely monitor pathologic findings (Abnormal PFTs/CT Scans)
Treat airway inflammation (ICS, trial of bronchodilators)
Always Document thoroughly (Disability/Compensation)
135
Sarcoidosis is a multi-organ disease of unknown cause
__________ granulomatous inflammation in affected organs
**noncaseating
136
Sarcoidosis:
s/sx?
associated with?
Nonproductive cough, dyspnea of insidious onset, chest discomfort, +/- fever, malaise
Assoc: erythema nodosum, parotid gland enlargement, HSM, LAD, arthritis, cardiomyopathy, uveitis
137
Sarcoidosis: KEY CXR finding?
***Bilateral hilar and right paratracheal adenopathy
138
Sarcoidosis:
dx?
tx?
Dx: Transbronchial bx confirms
Tx: 90% respond to corticosteroids
139
Pulmonary Embolism:
etiology?
S/Sx?
E: Thrombi from venous circulation or tumors (90% from DVTs)
S/Sx: Dyspnea, cough, CP, hemoptysis, diaphoresis
140
Pulmonary Embolism:
PE?
RF: ?
tachycardia, tachypnea, crackles, low grad fever
RF: ↑ Age, Surgery/Trauma/ Immobility, OCP use, malignancy, hypercoagulable States
141
Pul. Embolism:
| Virchow's triad**
Venous Stasis, hypercoagulability, endothelial damage
142
```
PE: dx?
-ABG?
EKG?
CXR?
VQ scan?
```
ABG: Resp alkalosis, hypoxia
EKG: Tachycardia, Ant ST-Seg changes/TWI, RBBB, RAD, S1Q3T3
CXR: Usually Normal;
Hampton's hump, Westermark’s sign
VQ Scan: Shows defects--Normal exam r/o clinically significant thromboembolism
143
PE: first choice diagnostic test** ?
CT**
144
Pulmonary Embolism - Tx?
-O2 if needed
```
-Anticoagulants:
Heparin
Warfarin
INR goal 2-3
NOAC
```
-Thrombolytics
-Surgery:
IVC filter
Thromboembolectomy
145
Cor Pulmonale=
Failure of right ventricle resulting from pulmonary disease
R ventricular dilatation, hypertrophy and eventual right sided HF
146
Cor pulmonale:
| Acute vs chronic?
Acute (PE, ARDS)
Chronic (COPD, Restrictive Lung Dz)
147
Cor Pulmonale:
CXR findings?
-tx?
Widening of pulmonary arteries
Tx:
Medical: Correct hypoxemia/acidosis, O2, diuretics, vasodilators
Surgical: VAD, biventricular pacing, transplan
148
Pulm. HTN= ________ effects in pulmonary arteries
vasoconstrictive
149
Pulm. HTN:
Etiology?
Dx?
E: Hypoxia, acidosis, Lung resection, emphysema, PE, sickle cell, Mitral stenosis, LV failure
Dx: Right heart cath > ECHO
150
Pulm HTN:
| Tx?
- O2, diuretics, anticoagulants, exercise
| - Epoprostenol, prostacyclin, CCB, NO, sildenafil
151
Acute Respiratory Distress Syndrome (ARDS)= acute onset of resp failure due to _______
↑ permeability of alveolar capillary membranes → Pulm Edema, hypoxia and dyspnea
-High Mortality (30-40%)
152
ARDS: Criteria (list)
- PaO2: FIO2 Ratio <200
- B/L pulm infiltrates
- PCWP (≤18 mmHg)
153
ARDS: etiology and Sx
Sepsis, multiple trauma, DIC, aspiration, shock, pancreatitis
-Sx: tachypnea, frothy pink or red sputum, diffuse rales, dyspnea, severe hypoxemia
154
ARDS: CXR?
| ABG?
CXR: bilateral patchy, diffuse infiltrates
ABG: Resp acidosis
155
ARDS: tx?
-Tx etiology (if possible)
Sepsis: Broad spectrum abx
O2: High flow with positive pressure
Diuretics
156
Hyaline Membrane Disease occurs 2/2 ______
surfactant deficiency, minutes to hours after birth
| Incidence: Weeks gestation
157
Hyaline Membrane Disease: Incidence weeks gestation
<28 weeks= ___%
32-36 weeks- ___%
>37 weeks= ___%
<28 weeks – 70%, 32-36 weeks – 20%, >37 weeks – 5%
158
Hyaline Membrane Disease
| S/Sx?
Tachypnea, nasal flaring, grunting, retractions
159
Hyaline Membrane Disease: tx?
Dexamethasone given to mom prior to delivery, O2, ventilation, exogenous surfactant
160
Foreign Body Aspiration:
-MC age?
Sx?
Exam findings?
Typically <4y/o
Sx: Coughing, wheezing, choking, dyspnea
Exam: decreased breath sounds on FB side, localized wheezing, or normal exam (40%)
161
Foreign body aspiration:
Dx?
tx?
- Get CXR, but only ~15% are radiopaque
| - **Definitive Dx and Tx is direct laryngoscopy and rigid bronchoscopy
162
Solitary Pulmonary Nodule=
- % benign=
- % malignant=
Round, oval, sharply circumscribed pulmonary lesion (up to 5cm)
90% benign: usu <2 cm, distinct margins and may be calcified-->Most are infectious granulomas – chronic inflammatory lesion
-10% malignant: >45y/o, >2cm, indistinct margins, rarely calcified
163
Solitary Pulmonary Nodule: tx?
Observation vs thorascopy or thoracotomy w/ bx
164
Bronchogenic Carcinoma:
- etiology?
- MC one?
E: Smoking, asbestos, radon gas, metals
-**Adenocarcinoma (MC)--> Typically found in lung periphery
165
Bronchogenic Carcinoma:
| -SCC originates?
Squamous Cell Carcinoma (metastasizes)--> Typically originates in central bronchi → regional LN
166
Bronchogenic Carcinoma:
| LCC occurs?
Large Cell Carcinom-->Large peripheral mass with central necrosis
167
Bronchogenic Carcinoma:
SCC mets ______
-SCC can cause _____
**Very aggressive, fast growing and mets quickly
-Cause SIADH and paraneoplastic syndromes
168
Bronchogenic Carcinoma: S/Sx
Cough, dyspnea, LAD, clubbing, hemoptysis, hepatomegaly, clubbing
169
Bronchogenic Carcinoma: CXR findings
Hilar or peripheral mass with cavitation, +/- pleural effusion
-CT helpful in differentiating malignant features
170
Bronchogenic Carcinoma: Dx?
| tx?
Bronchoscopy with bx and cytology
Tx: Surgery, Radiation therapy, Chemotherapy
171
Mesothelioma= a primary tumor of _______
-risk factor?
pleural surfaces
~75% malignant
-RF= asbestos**
172
Mesothelioma:
S/Sx?
Dx?
S/Sx: Dyspnea, CP, fevers, wt. loss, pleural effusions
Dx: Bx and cytology
173
Mesothelioma:
| tx?
Tx: radiation and chemotherapy
Prognosis is very poor, 75% die in 1-2 years
