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Pulmonology

DIT

QuestionAnswer
What are the diagnostic features of peritonsillar abscess? Caused by? Infection between the tonsil and pharyngeal constrictors- -Severe sore throat, fever, muffled, "hot potato voice -Obvious abscess on the tonsil or deflection of uvula to opposite side -Trismus, drooling caused by S.pyogenes, S.aureus, Bacteroides spp.
What is the treatment for peritonsillar abscess? 1. Needle aspiration or I&D 2. Pain meds 3. ABX Augmentin, Clindamycin
what are the diagnostic features of acute bacterial sinusitis? Rhinosinusitis - sx lasting >7 days and -Purulent nasal discharge -Maxillary tooth or facial pain -Unilateral Maxillary sinus tenderness -Worsening sx after initial improvement
What is the treatment of acute bacterial sinusitis? Observation and sx relief in healthy pt mild pain and temp <101 ABX -First line: Amoxicillin > Augmenting -Second: Cephalosporins > Fluoroquinolones or Bactrim >Macrolide
What is the treatment of chronic bacterial sinusitis? > 3 months of sx -Combined therapy: Oral steroids + Oral abx (Augmentin/Clindamycin) -Intranasal saline irrigation -Intranasal steroids -If underlying allergies- Antihistamines -If nasal polyp refractory to steroids surgical debulking
What are the complications of sinusitis? 1. Meningitis 2. Abscess 3. Orbital infection 4. Osteomyelitis
What is the classic presentation of allergic fungal rhinosinusitis? Chronic rhinosinusitis -Sinuses are opacified with thick "allergic mucin" that is colonized with fungus (not to be confused with invasive fungal disease)
What the most common causes of pneumonia and tx in Newborn? GBS> E.coli, Listeria, C. trachomatis Tx: Ampicillin + gentamycin +/- Vancomycin for MRSA +/- Erythomycin for Chlamydia
What the most common causes of pneumonia and tx in 1-4 month? RSV, C. trachomatis, Parainfluenza, Bordetella, S. pneumo, S. aureus Tx: Macrolides +/- Cefotaxime
What the most common causes of pneumonia and tx in 4m- 4 years? RSV or other virus, S.pneumo, H. influenza, Mycoplasma, S.aureus Tx: Amoxicillin or Ampicillin
What the most common causes of pneumonia and tx in 5- 15 years? S.pneumo > Mycoplasma, C. pneumo, other viruses Treatment: 1) Amoxicillin + Clarithromycin/erythromycin 2) Azithromycin 3) Amoxicillin + doxycycline
What are the indications for pneumococcal vaccination in adults? -65 years or older -Immunocompromised -Cigarette smokers 19 - 54
What ABX can be used in the treatment of Pseudomonas pneumonia? Antipseudomonal beta-lactam (piperacillin-tazobactam, cefepime, imipenem, meropenem, aztreonam) must be added to the following for at least 2 week coverage: Antipseudomonal quinolone (cipro/levo) Aminoglycoside + Azithromycin Aminoglycoside + Cipro/levo
What XR finding suspects PCP pneumonia as respiratory distress? CXR: diffuse, b/l, interstitial infiltrates CD4 < 200 LDH level usually >220
What is the treatment for PCP? 21 days of ABX TMP-SMX Pentamadine Primaquine +clindamycin
What is moderate to severe disease in PCP? What is the treatment Mod to severe disease: PaO2 <70 mmHg or A-a gradient >35 Hospitalize + prednisone 40mg PO BID x 5 days,40 mg qd x 5, then 20mg PO qd x 11
What is the DDX for ground glass opacities (diffuse hazy infiltrates) of lung on CXR? Interstitial pneumo PCP pneumo Pulmonary edema Pulmonary hemorrhage Hypersensitivity pneumonitis
What is the most common cause of pneumonia in immunocompromised patient? PCP
What is the most common cause of atypical/walking pneumonia? Mycoplasma, Chlamydia
What is the most common cause of pneumonia in alcoholic? Klebsiella
What is the most common cause of interstitial pneumonia in bird handlers? Chlamydia psittaci
What is the most common cause of pneumonia in pts with exposure to bats and bat droppings? Histoplasmosis
What is the most common cause of pneumonia in Southern California, New Mexico, West Texas? Coccidio
What is the most common cause of pneumonia with "currant jelly" sputum Klebsiella
What is the most common cause of pneumonia associated with air conditioners? Legionella
What is the most common cause of pneumonia in children and young adults (college students, military) Mycoplasma
What is the most common cause of pneumonia in pts with other health problems? Klebsiella
What is the most common cause of viral pneumonia? RSV
What is the most common bacterial cause of COPD exacerbation? H. influenza
What is the most common cause of pneumonia in ventilator patients and those with cystic fibrosis? Pseudomnas
What causes pontiac fever? Legionella
Gram + cocci clusters Staph aureus
Gram + cocci pairs Strep. pneumo
Gram - rods in 80 year olds E.coli
Gram + cocci in neonate GBS
Gram - rods in neonate E.coli
How to manage ARDS? 1) Treat underlying disease 2) Mechanical Ventilation with low tidal volume (to minimize injury) and adequate PEEP (to recruit collapsed alveoli) Conservative fluid mgmt to reduce pulmonary edema. Goal CVP 4-6 h2o. Furosemide and albumin may help
What methods of providing O2 to a pt can be used in order to deliver a specified percentage of FiO2? by Nasal Cannula 24-40% FiO2 (FiO2 increase by 3% for every 1L/min up to 6L/min)
What methods of providing O2 to a pt can be used in order to deliver a specified percentage of FiO2? By Face Mask? 50- 60% FiO2
What methods of providing O2 to a pt can be used in order to deliver a specified percentage of FiO2? By Non-rebreather? 60-95% FiO2
What methods of providing O2 to a pt can be used in order to deliver a specified percentage of FiO2? CPAP? 80% FiO2
What methods of providing O2 to a pt can be used in order to deliver a specified percentage of FiO2? By Mechanical Vent up to 100% FiO2
In a pt with pulmonary edema, how can PCWP distinguish ARDS from cardiogenic edema? PCWP <12-noncardiogenic pulmonary edema (ARDS) PCWP >18-cardiogenic edema (heart failure)
What are the diagnostic characteristics of ARDS? acute onset of respiratory distress PaO2/Fio2 <200 mmHg B/l pulmonary infiltrates on imaging consistent with pulmonary edema No evidence of cardiac origin
What is a normal A-a gradient? 5-15
What causes high A-a gradient? PE Pulmonary edema ARDS R to L shunt
What is the empiric treatment for pneumonia in a 2 month old? Macrolide
What is the empiric treatment for pneumonia in a 2 year old? Amoxicillin or Ampicillin
COPD Management Stage 0 Stage 0- Risk factor reduction and annual influenza vaccine
COPD Management Stage 1 Risk factor reduction and annual influenza vaccine + PRN SABA (albuterol)
COPD Management Stage 2 Risk factor reduction and annual influenza vaccine +PRN SABA (albuterol) +LABA or anticholinergic
COPD Management Stage 3 Risk factor reduction and annual influenza vaccine + PRN SABA + LABA or anticholinergic + inhaled steroids
COPD Management Stage 4 Risk factor reduction and annual influenza vaccine + PRN SABA + LABA or anticholinergic + inhaled steroids +/- theophylline + home O2 if pulse ox <88%, pulm HTN, peripheral edema, or polycythemia. To goal of 90% pulse ox
How is interstitial fibrosis diagnosed? CXR possible findings- normal in 10%, reticular pattern, nodular pattern, honeycomb lung (poor prognosis) HRCT PFT show restrictive lung disease, with decreased TLC, FRC, RV Lung bx is required to make the diagnosis and determine the stage of disease
What is the next step in workup of the patient with a solitary pulmonary nodule? Obtain prior CXR to compare appearance
Which type of lung cancer is associated with the following paraneolplastic syndrome? Elevated ACTH, glucocorticoid excess, Cushing Syndrome Small Cell Carcinoma
Which type of lung cancer is associated with the following paraneolplastic syndrome? Elevated PTHrpeptide, hypercalcemia, Squamous Cell Carcinoma
Which type of lung cancer is associated with the following paraneolplastic syndrome? Elevated ADH, SIADH, Hyponatremia Small Cell Carcinoma
Which type of lung cancer is associated with the following paraneolplastic syndrome? Antibodies to presynaptic Ca Channels, Lambert Eaton Syndrome Small Cell Carcinoma
What is the initial treatment of localized non-small cell lung cancer? Surgical resection
What are the classical radiological findings in idiopathic pulmonary fibrosis Reticular/honeycomb
What is the the treatment of idiopathic pulmonary fibrosis? Steroids, azathioprine, cyclophosphamide, NAC
What type of pneumoconiosis matches the following description? Progressive fibrosis Silicosis and coal worker disease
What type of pneumoconiosis matches the following description? Increased risk of TB Silicosis
What type of pneumoconiosis matches the following description? Associated with electronics, increased lung cancer risk Berylliosis
What type of pneumoconiosis matches the following description? Malignant mesothelioma and bronchogenic carcinoma Asbestosis
A pt chronically has an FEV1 of 40%. What medications are used in the daily management? Inhaled steroids LABA PRN SABA Risk Factor reduction Flu and pneumococcal vaccine
Patient with chronic sinusitis + Hemoptysis + hematuria. What is the treatment? Cyclophosphamide Corticosteroids
Patient with anti-glomerular basement membrane antibodies. What is the treatment? Plasmapheresis Corticosteroids Immunosuppressive agent
A smoker has rapid onset JVD, facial swelling, and altered mental status. What is the treatment? SVC syndrome, Steroids, endovascular stent.
What are the vasodilators used in pulmonary HTN? Prostanoids- epoprostenol, treprostinil, iloprost Endothelin receptor antagnoists- bosentan, ambrisentan cGMP phosphodiesterase inhibitor- sildenafil CCB- Nifdedipine
What is the tx for obstructive sleep apnea? Wt loss if overweight Avoid alcohol and other CNS depressants or sedatives CPAP at night- first line, poor compliance Excessive daytime sleepiness- modanafil
What are the surgical options for OSA? Tonsillectomy & Adenoidectomy Uvulopalatopharyngoplasty (UPPP) MC surgery in adults for OSA Genioglossus advancement Maxillary-mandibular advancement
What are the components of rapid sequence intubation? Rapid sequence intubation
Created by: skylyntv