PULMONARY Flashcards
(49 cards)
tactile fremitus and percussion findings for: 1 consolidation/pna 2 pleural effusion 3 pneuothorax 4 emphysema 5 atelectasis
1 increased TF, dull to P 2 decreased TF, dull to P 3 decreased TF, hyperresonant to P 4 same as 3 5 decreased TF, dull to P
best initial test for acute asthma exxacerbation?
most accurate?
peak expiratory flow or ABG
most accurate = PFTs (decreased FEV1/FVC ratio)
if asx, best test to evaluate asthma is
methacholine challenge (20% decrease in FEV1)
if asthma, PFT will show an increase of ____ in response to albuterol
> 12%
stepwise asthma treatment
6 steps
1 inhaled SABA (albuterol)
2 low dose ICS (beclomathasone, budenoside, fluticasone) OR cromolyn/theophylline/leukotriene mods
3 add LABA (salmeterol, formeterol) OR increase ICS
4 increase ICS to maximum and cont LABA + SABA
5 add omalizumab
6 oral corticosteroids (prednisone)
**never use LABA first or alone
tx of acute asthma attack
oxygen
albuterol
steroids
if they dont respnd, intubate
young patient and nonsmoker who has air trapping and copd picture. think
alpha 1 antitrypsin deficiency
best initial test for copd is
most accurate?
cxr
look for increased ap diameter and flattened diaphragm/air trapping
most accurate is PFTs = FEV1 and FVC decreased, FEV1/FVC <70%, increased TLC, incomplete improvement with albuterol (not reversible)
copd treatment
1) things that improve mortality and delay progression
2) improves sx but no change in progression or mortality
3) no benefit
1 - smoking cessation, oxygen therapy, and flu/pneumococcal vaccines
2 - albuterol (SABA), anticholinergics (ipratropium, tipropium), steroids, LABA (salmeterol), and pulmonary rehab
3 cromolyn, leukotriene mods (monteleukast)
criteria for oxygen use in copd
pO2 below 55 or ox sat below 88%
OR
signs of right sided heart failure or elevated hematocrit with pO2 <60 or sat <90%
cxr for bronchiectasis
most accurate test?
thickened dilated bronchi, tram tracks
most accurate test is high res CT
allergic bronchopulmonary aspergillosis
mech?
dx?
tx?
hypersensitivity of the lungs to fungal antigens (patient with asthma and atopy)
brown flecked sputum and infiltrates on cxr
dx: peripheral eosinophilia, skin test reactivity to aspergillus ag, serum IgE elevated, CXR/CT infiltrates
tx: oral prednisone (inhaled DOES not work for ABPA)
+ itraconazole orally for recurrent cases
most accurate test for CF is
increased sweat chloride test (cl>60)
CF treatment
routine abx (inhaled aminoglycosides)
recombinant human deoxyribonuclease
bronchodilators (albuterol)
vaccinations (pneumococcal and influenza)
lung transplant when unresponsive to above therapy
CAP is defined as
pna occuring before hospitalization or within 48 hours of admission
what organism is associated with CAP with reference t contaminated water or ventilation?
legionella
pneumonia presentations:
1 hemoptysis and currant jelly sputum
2 foul sputum “rotten eggs”
3 dry cough, rarely severe, bullous myringitis
4 GI upset (n/v, diarrhea) or CNS (ha/confusion)
5 AIDS with <200 cd4
1 klebsiella 2 anaerobes 3 mycoplasma pneumoniae 4 legionella 5 pneumocytis (PCP)
best initial test (but not most accurate) for pna?
cxr
4 pneumonia orgs not visible on gram stain
coxiella
chlamydia
legionella
mycoplasma
sputum gram stain is “adequate” if ….
there are more than 25 white blood cells and less than 10 epithelial cells
how to diagnose legionella?
urine antigen
or
culture on charcoal yeast agar
outpatient vs inpatient tx for CAP
outpatient is macrolide (azithromycin or clarithromycin) or doxycycline
—if comorbidities do resp fluoroquinolone (levo or moxi)
inpatient is levo or moxi OR ceftriaxone + azithromycin
exudate/empyema is suggested by what labs
LDH >60% of serum
protein >50% of serum
pH <7.2
do healthcare workers need pneumococcal vaccine?
NO
