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pt w/ chest infxon
Patient with chest infection
| Question | Answer |
|---|---|
| What lymph nodes are involved in latent TB | Perihilar LN. Remains dormant there unless pt becomes IC'd |
| What bone/vertebral disease is implicatd with post-primary TB | Potts disease. |
| What is the criteria for initiation of TB therapy regimen. | Positive PPD + CXR suggestive of TB. Sputum culture is also taken but it takes 5 wka to grow, so tx is initiated while culture results are pending. |
| How long does a TB pt need to be quarantined for? | Roughly 2 months, if they are compliant (ensure compliace with direct observed therapy (DOT) |
| What is the tx of a pt who only has a postiive PPD with no symptoms. | Isoniazid therapy only (4 drug regimen is not indicated for post-exposure prophylaxis) |
| In a pt who received BCG vaccination the PPD will be positive, even if they haven't been exposure to TB, what is the protocol for tx in this situation? | Tx is the same as for all assymptomatic positive PPD pts. Treat prophylactically with isioniazid |
| When do most pt with CF present with symptoms? | In childhood, but 10% of pts do not show symptoms till they are adults. |
| What is the abnormality in CF | Mutation in a channel for Cl- ion. Gene is in long arm of chr 7 in the cystic fibrosis transmembrane conductance regulator. (allow Cl- to move from IC to EC. Cl- goes in and Na+ goes out, trapping cl-inside |
| what bacteria is most often involved in CF chest infxon | Staph and pseudomonas |
| tx of CF? | prophylactic abx, physiotherapy, bronchodilators, and lung xpant. |
| Major cause of death in CF | Cor pulmonale and bronchiectasis |
| What is bronchiectasis? | Dialation of the bronchi (as opposed to emphysema which is dlation of the alveoli) |
| Possible causes of bronchiectasis? | may be congenital in asso with kartagener's syndrome or secondary to chronic severe bacterial infection (most common: TB, CF, etc) |
| What is the presentation of of bronchiectasis? | Chronic cough productive of large amount of purulent sputum that is **worse in the mornings**, hemoptysis, fever |
| What radiograph is most evident of bronchiectasis | CT scan (CXR doesn't give good visualization of this) |
| Tx of bronchiectasis? | aerosolized Abx, postural drainage, surgery. Severity based on amt of sputum produced per day (severe = >150 ml/day) |
| Major complications of bronchiectasis? | Cor pulmonale, respiratory failure, and massive hemoptysis |
| What bacteria is most commonly seen in pneumonia | Streptococcus(2nd most common is haemiphilus influenza |
| What region of lung would most likely produce altered percussion sounds in a patient with pneumonia? What is the landmark for this to us during PE? | The middle right lobe. This region is located on the ANTERIOR chest, below the nipple line |
| What is the criteria for admission of a pt with pneumonia? | Pt with extremes in age (very young or very old), confusion/impaired consciousness w/ dz onset, hypotension, hypoxia, comorbid conditions |
| What is the criteria for reporting a case of TB to the health department? | Must have positive sputum culture. |
| What kind diseases give bronchiectasis as a complication. | SEVERE chronic infections. TB, CF, etc. Kartenegers |
Created by:
rkirchoff
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