-
-
CAP at hospital
Rocephin & azithromycin
-
Nosocomial vent pneumonia (pseudomonas)
3rd gen cephalosporin & fluoroquinolone (cipro, levaquin)
-
Nosocomial atypical pneumonia
Erythromycin or azithromycin
-
Aspiration pneumonia
Clindamycin or vanc
-
Fungal pneumonia
Amphotericin B
-
Diagnostic features of peritonsilar abscess:
Infxn b/t tonsil & pharyngeal constrictors
- Severe sore throat
- Fever
- Hot potato voice
- Deflection of uvula
- Trismus
- Drooling
-
Treatment of peritonsilar abscess
- Needle aspiration or I & D
- Pain meds
- Amoxicillin/clavulunate x 10
- Or
- Clindamycin x 10 days
-
Viral Influenza high amount of
Arthralgia and myalgia
-
Sinusitis most common effects what sinus?
Maxillary
-
Treatment for acute bacterial sinusitis
- Symptoms: nasal saline irrigation, anagesic, decongestant
- Intranasal glucocorticoid
- Antibiotic:
- 1st-amoxillin
- 2nd-cephalosporin or bactrim
-
Treatment of chronic bacterial sinusitis
- Oral steriods
- Oral antibiotics (clinda or augmentin)
- Intranasal saline irrigation
- Intranasal steriods indefinitely
- If allergies: antihistamine, antileukotriene, allergy immunotherapy
- If polyps refractory: surgery
- If allergic fungal sinusitis: sinus sx & prolonged steriods
-
Complications of sinusitis
- Meningitis
- Abscess
- Orbital infxn
- Osteomyelitis
-
Allergic fungal rhinosinusitis
- Chronic rhinosinusitis
- Opacified thick allergen mucin
-
Newborn tx for PNA
- Amp & Gent
- +\- Vanc (if MRSA)
- Erythromycin (if chlamydia)
-
PCP treatment
- Bactrim or pentamide
- Prednisone
-
Xray/lab for PCP
- CXR: diffuse, bilateral, interstital infiltrates
- CD4: <200
- LDH: >220
-
Differential for ground glass opacitied
- Interstital pna
- PCP pna
- Pulmonary edema
- Pulmonary hemorrhage
- Hypersensitivity pneumonitis
- RDS
-
PNA atypical/walking & tx
Mycoplasma
Macrolides (azithromycin, erythromycin, clarithromycin)
-
PNA in alcoholic & treatment, currant jelly sputum
Klebsiella
Cephalosporin & aminoglycosides (gentamycin, tobramycin)
-
PNA pt with hx of bat & bird droppings & treatment
Histoplasmosis
Amphotericin B or ketoconazole
-
Q fever, livestock
Coxiella burnetti
-
PNA with air conditioners & tx
Legionella
Macrolides or fluoroquinolones
-
-
Woolsorters disease
Antrax
-
-
Gram + cocci in clusters
Staph aureua
-
Gram + cocci in pairs
Strep pneumo
-
Gram - rods in 80 yr old
E coli
-
Gram + cocci in neonate
Group B strep
-
Gram - rod in neonate
E coli
-
How do you dx active TB
- Sputum AFB
- Sputum culture for TB
- Bronch with BAL or biopsy
-
Treatment of TB
RIPE (2mos)RI(4 more mos)
-
Asysmptomatic + PPD: immunocompromised, IVDA, <35 yrs, close contact with TB, indigent treat?
Prophylactically with INH & B6
-
ARDS tx
- Underyling cause
- Vent- low TV & adequate PEEP
- Fluids with goal CVP 4-6, furosemide, albumin
- Prone
-
-
4 criteria for ARDS
- PCWP 18
- B Pulm infiltrated (edema)
- PaO2/FiO2 200
- Symptoms if respiratiry distress
-
Mild intermittent asthma: Symptoms & meds
-
Mild persistent asthma: Symptoms & meds
- Prn albuterol
- Low dose INH Steriod
- +/- singular
- +/- cromolyn
-
Moderate persistent asthma: Symptoms & meds
- Daily daytime episode
- >1nt/wk
- Prn albuterol
- mod dose INH steriod
- +/- long acting b2 agonist
- +/- Singular
- +/- Theophylline
-
Severe persistent asthma Symptoms & meds
- Continuois day episodes
- Frequent night episodes
- Prn albuterol
- + high dose INH steriod
- + long acting B2 agonist
- + po steriod
- +/- singular
- +/- theophylline
-
COPD staging
- 0: chronic cough-nml spiro
- 1: mild FEV1/FVC 70%
- FEV 80%
- 2: mod FEV1 50-80%
- 3: severe FEV1 30-50%
- 4: very severe FEV1 30%
-
COPD tx by staging
- 0: risk factors & flu vac.
- 1: above & short bronchodil
- 2: above & long bronchodil
- 3: above & INH steriods
- 4: above & theo & home O2
-
Home O2 for COPD if
- 1. Pulse Ox 88%
- 2. Pulmonary HTN
- 3. Periph Edema
- 4. Polycythemia
-
-
Tx theophylline OD
- BB/verapamil
- Benzo
- Phenytoin
- Dialysis
-
Define COPD
Prod cough for 3 mo's of yr for 2 yrs
-
CXR/CT tram tracking, multiple cysts & bronchial crowding, dilation of bronchi
Bronchiectasis
-
Honeycomb lung
Idiopathic pulmonary fibrosis
-
Serum markers for interstitial fibrosis
-
Lung cancer with ACTH
Small Cell
Cushings
-
Lung cancer with PTH related peptide
Squamous Cell
Hypercalcemia
-
Lung cancer with ADH
Small cell
SIADH: hyponatriemia
-
Lung cancer with antibodies to presynaptic Ca channels
Small cell
Lambert eaton
-
Initial treatment for small cell lung cancer
Chemo
-
Initial treatment for non small cell lung cancer
Surgery then chemo
-
Treatment for idiopathic pulmonary fibrosis
- Steriods
- Azathioprine (cyclophosphamide)
- Mucomyst
-
Pneumoconiosis with progressive fibrosis
Coal worker or silicosis
-
Pneumoconiosis with Inc risk of TB
Silicosis
-
Pneumoconiosis with working with electronics & Inc cancer risk
Berylliosis
-
Pneumoconiosis with malignant mesothelioma & bronchogenic carcinoma
Asbestosis
-
Chronic sinusitis, hemolysis, hematuria
Wegeners
-
Treatment of sarcoidosis
- Seld resolving
- Steriods if chronic
-
Lab of sarcoidosis
- ACE
- Ca
- Hypercalciuria
- ALP
- ESR
- WBC
- DLCO
-
PE on EKG
- S1Q3Q3
- Sinus tachycardia-MC
-
Studies for PE
- CT with contrast if CI
- V/Q scan
-
Gold standard for PE
Pulmonary angiogram
-
ABG of PE
Respiratory Alkalosis
-
Best way to dx DVT
Compressive venography-US
-
Pulmonary Edema CXR
- Fluid throughout lungs
- Cephalization of vessels
- Kerley B lines
-
Indications for Chest Tube in Empyema
-
Treatment of PTX
- Small: 15% O2 only
- Larger: 15% Chest Tube
- Tension: immediate needle decompression & chest tube
- Reccurent: pleurodesis
-
Hemothorax causes, radio, treatment
Causes: trauma, malignancy, TB, pulmonary infarction
CXR: like pleural effusion, blunting of costophrenic angles
Treat: O2, CT, underlying cause
-
Drugs that make CSA worse
-
Treatment of OSA
- Wt loss
- Stop sedatives
- CPAP
- Sx-tonsils, polyps, trach
-
Treatment CSA
- Stimulants
- Azetazolamide
- Theophylline
- CPAP
- Phrenic nerve pacemaking
-
Croup cause, symptoms, radiology, treatment
Parainfluenza
Barking seal cough, inspiratory stridor, worse
Steeple sign
- Supportive
- Epinephrine
- Steriods: INH
-
Epiglottis cause, symptoms, radio, treatment
H. Influenza
Dsyphagia, sniffing dog, muffled voice, hot potato voice
Thumb print sign
Calm, intubate, antibiotics
Pen/vanc/clinda & 3 gen cephalosporin
-
Bronchiolitis cause, symptoms, CXR, treatment
RSV > parainfluenza
Respiratory distress, wheezing, mild URI, nasal flaring, tachypnea, grunting, retractions
Hyperinflated lungs
- Hydrate
- Albuterol or racemic epi
- Steriods
- Ribavirin
-
Lungs mature at what time?
35 wks
-
2 ways to determine lung maturity:
- L:S ratio of 2
- + phosphatidyl glycerol
-
RDS vs transient tachypnea of newborn:
RDS: lung volumes, diffuse ground glass infiltrate, air bronchograms
TTN: lung volumes, flat diaphragms, prominent vasc markings, fluid in interlobular fissures
-
Meconium aspiration consequences
-
Sweat chloride test in CF
>60 Cl-
-
Treatment of Cystic Fibrosis
- DNase: decrease viscosity
- CPT: clear secretions
- Bronchodilators:
- NSAIDs:
- Antibiotics: pulm infxn
- Pancreatic enzyme:
- Vit: K, A, D, E
-
What antibiotics give to CF fir pseudomonas
- Azithromycin
- Fluroquinolones ok here
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