Pulmonary Flashcards

Question

S/S of pneumonia

Answer 1

Fever, shaking chills, purulent sputum, lung consolidation on physical exam, malaise, increased fremitus.

Answer 2

Elevated WBC (may be low in immunocompromised or eldery) Infiltrates on CXR Consider sputum culture

Answer 3

PORT scoring: 1-2: score <70, low risk, <1% mortality, treat outpt 3: score 71-90, low risk, 2.8% mortality, brief inpatient 4: score 91-130, moderate risk, 8.2% mortality, inpatient stay 5: score >130, high risk, 29.2% mortality, ICU stay**

Answer 4

**C**onfusion with abbreviated mental test score <8 B**U**N >19 **R**R >30 S**B**P <90 or D**B**P <60 Age>**65**

Answer 5

**Low severity** * Pathogen: S. pneumoniae, M. pneumoniae, H. influenzae, C. pneumoniae, M. catarrhalis * Amoxicillin OR doxycycline OR macrolide **Moderate to high severity** * Pathogen: all above plus multiple drug resistance S. pneumoniae * Amoxicillin/clavulanate or cephalosporin PLUS macorlide or doxycycline OR monotherapy with respiratory fluroquinolone.

Answer 6

**Nonsevere** * Pathogen: S. pneumoniae, H. influenzae, M. pneumoniae, C. pneumoniae, legionella * Betalactam + macrolide OR monotherapy with respiratory fluroquinolone * Severe * S. pneumoniae, S. aureus, legionella, gram-negative bacilli, H. influenzae * Beta-lactame + IV fluroquinolone or IV azithromycin **If P. aeruginosa suspected:** * piperacillin/tazobactam or meropenem or cefepime+azithromycin **If MRSA suspected:** * Above+ vanco or linezolid

Answer 7

HAP is pneumonia that occurs 48 hours after admission, which was not incubating at the time of admission (includes VAP) Common organisms: Staphyococcus aureus, streptococcus pneumoniae, haemophilus influenzae. **If not at high risk of mortality and no factors for likelihood of MRSA:** * Piperacillin/tazobactam OR * Cefepime OR * Levofloxacin OR * Imipenem or meropenem **If not at high risk of mortality but has factors likelihood of MRSA:** * Same as above PLUS vancomycin or linezolid **High risk for mortality or IV antibioitcs within 90 days:** Two of these agents * Piperacillin/tazobactam * Cefepime or ceftazidine * Levofloxacin or ciprofloxacin * Imipenem or meropenem * PLUS vancomycin or linezolid

Answer 8

Pneumonia that arises more than 48-72 hours after intubation. Psudomonas is the most likely pathogen. MRSA and double antipeudomonal coverage are appropriate. **Antibiotics with MRSA activity:** * Vancomycin or linezolid **Antiboitics with antipseudomonal activity: beta lactam based agents:** * Piperacillin/tazobactam OR * Cefepime and ceftazidime OR * Iipenem and meropenem OR * Aztreonam **Antibiotics with antipseudomonal activity: NON-beta lactam based agents:** * Levofloxacin and ciprofloxacin OR * Amikacin and gentamicin and tobramycin OR * Colistin and polymyxin B

Answer 9

Gas in the pleural space that raises pleural pressures and can impair respiration, resulting in collapsed lung. **S/S:** * Chest pain, dyspnea, cough * Hyperresonance on affected side * Diminished breath sounds and diminished fremitus on affected side * Mediastinal shift toward the unaffected side (tension) * Hypotension **Lab/diagnostics:** * CXR is diagnostic **Management:** * <20% pneumo requires no intervention as the pt is asymptomatic * Chest tube is used first if available (4th or 5th ICS MAL) * In emergency, needle thoracostomy (2nd ICS MCL)

Answer 10

A disease of unknown etiology characterized by interstitial lung disease and non-caseating granulomas. More common in females ages 20-40 **S/S:** * Progressive dyspnea * Nonproductive cough * Rales (velcro crackles) may be noted **Lab/diagnostics:** * CXR for staging * PFTs * Routine blood work * Bronchoscopy with transbronchial biopsy of the lung parenchyma for diagnosis **Management:** * Corticosteroids are mainstay of treatment

Answer 11

* Diagnosed based on clinical suspicion (history very important) and the results of specific diagnostic studies. * Predisposing risk factors are often in the history. * Leading cause of hospital deaths due to right ventricular failure. **Risk factors:** * Prolonged best rest/immbolity * Oral contraceptives * Surgery to long bones * Venous stasis * Hypercoagulabe states * Cardiac thrombi **S/S:** * Usually occur abruptly * Unexplained dyspnea and tachycardia are most common * Chest pai (retrosternal or lateralized and pleuritic) * Hemoptysis * Low grade fever * Hypotension * Cyanosis **Lab/Diagnostics:** * VQ scan should be performed in all clinically stable pts. * If VQ unable to be performed or inconclusive, do a pulmonary angiography * ABG will show hypoxemia and hypocapnia **Management:** * Supplemental O2 * IV fluids for hypotension and reduced CO * Worsening hypercapnia with obtubdation is indicative for intubation * Heparin bolus, 80u/kg followed by conyinuous infusion of 18u/kg/hr to maintain PTT of 1.5-2xnormal. Begin coumadin simultaneously to an INR of 2-3 * Fibrinolytics in those with hemodynamic compromise or shock

Answer 12

A form of acute lung injury attributable to a wide variety of insults. Massive pulmonary edema with shunting. **S/S:** * Severe dyspnea and respiratory distress * Cyanosis * Tachycardia * Rales and wheezes **Lab/Diagnostics:** * Refractory hypoxemia is a hallmark feature. No matter how much O2 given, the body doesn't use it. * CXR may be "whited out" or have diffuse bilateral infiltrates. **Management:** * Mechanical ventilation with PEEP * TV 4-6ml/kg IBW (normal 6-8) * PEEP about 10cmh20 * Treatment of underlying infection *SVO2 will be high d/t the body not using O2)

Answer 13

* Forced vital capacity; volume of gas forcefully expelled from the lungs after maximal inspiration. * Forced expiratory volume in 1 second; volume of gas expelled in the first second of the FVC maneuver. The ratio of FEV1/FVC is diagnostic for obstructive lung disease (<70%) * FEV25-75- maximal mid-expiratory airflow rate * PEFR- maximal sirflow rate achieved in FVC maneuver * Total lung capacity; Volume of gas in lung after maximal inspiration. * Functional residual capacity * Residual volume; volume of gas remaining in lungs after maximal expiration

Answer 14

* Obstructive diseases are characterized by reduced airflow rates and lung volumes are within normal range or larger. * Airway issue, COPD, asthma, bronchitis * Values <70%=normal * Values >120=air trapping and hyperinflation -FVC -FEV1 -FEV25-75 -PEFR

Answer 15

* Restrictive diseases are characterized by reduced volume and increased expiratory flow rates. * Lung cpacity issues; obesity, sarcoidosis, pulm fibrosis. * Values >70%=normal * Values >120=air trapping and hyperinflation -TLC -FRC -RV

Answer 16

Increased amount of fluid in the pleural space. Classified as exudates or transudates to help in differential diagnosis. Exudate is pleural fluid that have one more more of the following: (cream) -Pleural fluid protein to serum protein ration >0.5 -Pleural fluid LDH to serum LDH >0.6 -Pleural fluid LDH greate than 2/3 the upper limit of normal serum LDH Transudates have none of these feaures, they're clear and have equal glucose levels, pH 7.40-7.55 and WBC <1000 * Empyema-infection and puss accumulate in pleural space * Hemothorax- blood accumulation in pleural space * Chylothorax-Due to injury of the thoracic ducts and accumulation of chyle in pleural space. (milky with high triglyceride count). * Parapneumonic effusion: pleural effusion that form in the pleural space adjacent to the pneumonia.

Answer 17

Right heart failure. Enlarged right ventricle due to lung disease S/S: * Right ventricular heave * Pulmonary diastolic murmur * Cyanosis