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40 Cards in this Set
- Front
- Back
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Acute bronchitis PE |
No evidence of lung consolidation: clear to auscultation Resonance rhonchi clear with cough afebrile to low grade temp - viral higher temp - bact |
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Tx for acute bronchitis |
Viral - MOST - supportive bacterial: macrolide doxy TMP/SMX |
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Asthma manifestations |
narrowing of airways hypertrophy of smooth muscle mucosal edema thickeninc of epithelial basement membrane hypertrophy of mucusglands acute inflammation plugging of airways by thick,viscid mucus |
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Pulses paradoxus |
decrease in systolic B/P with inspiration >12 mmHg |
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SS Asthma |
resp rate>28 pulse>110 pulses parodoxus hyperresonance cough |
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Ominous signs asthma |
fatigue absent breath sounds paradoxical chest wall movement inability to maintain recumbency cyanosis |
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PFT changes after bronchodialator Asthma |
15% improvement in FVC or FEV1 25% improvement of FEF 25/75 Consider hospitalization: initial FEV1 <30% predictive improvement after bronchodilator, but still < 40% predicted |
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Peak flows |
measure FEV at home |
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Stepwise management of asthma |
1. SABA (albuterol) PRN 2. ICS (Budesonide/Pulmocort triamsinolone/Azmacort) 3. SABA (albuterol) for breakthrough 4. Increase ICS (pulmicort Azmacort) or LABA (Salmeterol/Serevent) 5. Inhaled anticholinergics (Ipratropium/Atrovent) 6. Orals - antileukotrienes |
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SABA |
Short acting B2 adrenergic agonist SABA = Albuterol |
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Inhaled corticosteroid (ICS) |
ICS = cort budesonide - Pulmicort triamcinolone - Azmacort |
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LABA |
long acting B2 Adrenergic agonist LABA = salmeterol - serevent |
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Inhaled anticholinergic |
inhaled anticholinergic = ipratropium/atrovent |
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Chronic bronchitis dx |
excessive secretion of bronchial mucus productive cough for 3 months or more in 2 consecutive years |
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Emphysema def |
abnormal permanent enlargement of alveoli |
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Chronic bronchitis ss |
Intermittent copious sputum (purulent) stocky percussion normal younger hyperinflation on CXR |
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Emphysema ss |
Progressive, constant older mild sputum (clear) thin/wasted Percussion hyperresonant |
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OP tx COPD |
anticholinergic = ipratropium to help manage secretions |
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CAPnumonia agent |
strep pneumoniae |
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Typical pneumonia ss |
shaking chills purulent sputum lung consolidation malaise increased fremitus |
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Atypical pneumonia ss |
cough (unrelenting) headache sorethroat excessive sweating fever soreness in chest |
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atypical pneumonia pathogen |
legionella mycoplasma chlamydophilapheumoniae |
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Mgmt CAP young/healthy |
Macrolides: azithromycin clarithromycin erythromyicn doxycycline |
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Mgmt CAP older/sicker |
Resp Flouroquinolone: Levofloxacin Moxifloxacin Gemifloxacin |
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Night sweats - think: |
TB menopause lymphoma AIDS Endocarditis |
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TB definitive dx |
Culture of M. Tuberculosis X3 |
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Confirmatory test TB |
+ CXR +Culture |
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TB labs |
culture (definitive) AFB (presumptive of active) small homogeneous infiltrate upper lobes PPD shows exposure Not diagnostic! |
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Meds for TB |
INH Pyrazinamide ethambutol or streptomycin if fully susceptible to INH and RIF, can d/c ethambutol or strepto |
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TB treatment duration |
Two months: INH Rifampin Pyrazinamide
Additional four months: INH RIF minimum 6 months HIVs for 9 months |
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monitoring TB therapy |
weekly sputum smears for 6 weeks watch for resistance |
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TB treatment monitoring |
labs: LFT, CBC, cr ethambutol: visual acuity red/green color blindness |
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PPD |
5 mm - HIV, contacts, + CXR 10 mm - immigrants, high risk groups, health care workers 15 mm - everyone else |
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FVC FEV1 FEV 25-75 PEFR |
Measure airflow Obstructive disease asthma chronic bronchitis emphysema |
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TLC FRC RV |
measure volumes restrictive diseases: pneumonia pulmonary fibrosis sarcoid lung resection |
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Pleural effusions: |
transudates - clear exudates - cream (high protein) empyema - pus hemorrhagic - blood |
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Most common pathogens in pneumonia in elderly |
s. pneumoniae h. influenza M. catarrhalis Klebsiella staph aureus |
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CXR findings in elderly - bacterial |
Bronchopneumonia lobar pneumonia other locations |
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CXR findings in elderly - viral |
bilateral interstitial infiltrates |
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Aspiration pneumonia CXR findings |
localized to Right middle lobe or diffuse involvement |
