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102 Cards in this Set
- Front
- Back
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Organism for TB infection
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Mycobacterium tuberculosis
Tubercle bacillus aerobic bacteria |
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Does TB have antigens for an Ig response?
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No
It is a delayed type cell mediated immune response |
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Forms in infected lymph nodes
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Granulomas
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Positive PPD=
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pt has been infected and may have latent or active TB
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What causes more deaths worldwide than any other single infectious agent?
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TB
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How long does it take to see a positive PPD
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6 weeks
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Common areas of survival of TB
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Apical and posterior segments of upper lobes
Renal cortex Meninges Vertebre Epiphyses of long bones |
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Most common extrapulmonary site for TB
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lymphatic system
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Common sign of extrapulmonary TB
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painless lymphadenitis
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Most useful and inexpensive test for TB
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PA/Lateral CXR
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Treatment for Primary TB
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INH and Rifampin daily for 9mo
Must have negative cell cultures at the end |
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Treatment of Primary Extrapulmonary TB
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6 mo of INH and Rifampin may be enough
However In children and infants with TB meningitis, military TB, bone or jt involvment need 12 mo. |
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What do you use if the pt is resistant to INH?
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Rifampin, ethambutol, pyrazinamide for 6 mo
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What do you use if the pt is resistant to rifampin?
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INH and Ethambutol for 18 mo
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Tx of primary TB in HIV pts
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Same tx but sub Rifabutin for Rifampin (less interaction with meds)
PLUS B6 or pyridoxine to prevent neuropathy |
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Test results with Latent TB
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+ PPD
- CXR No sx |
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Tx for latent TB
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9 mo of INH
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Interrupted tx of latent TB
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Take INH for 3 more mo
If stopped more than 3 mo, restart the 9mo course |
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Secondary TB
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reactivation of latent disease
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Pt who secondary TB would occur in
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very young, very old, immune comprimised
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Systemic sx for secondary TB
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Fever**
Night sweats Fatigue Anorexia Wt loss |
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Most common systemic sx of secondary TB
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Fever
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Pulmonic sx for secondary TB
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Productive cough **
Hemoptysis Dyspnea Pleuritic chest pain |
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most common pulmonic sx of secondary Tb
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Productive cough
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What does a CXR show in secondary TB?
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scarring, atelectasis, upper lobe or upper part of lower lobe disease
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DDx for hemoptysis
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PE, TB
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Miliary TB
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massive dissemination in the lung
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CXR in Miliary TB
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diffuse nodular infiltrates, increased lung markings all over
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Tx for Miliary TB
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12 mo INH and Rifampin
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False + PPD
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HIV, aged, lymphoreticular malignancies, immunosupressive therapy
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SE of pyrazinamide (TB drug)
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Increases Uric Acid -- watch for gout
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Most commonly used screening test for TB
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PPD
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Acute asthma
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reversible airflow obstruction assocaited with increased responsiveness of the tracheobronchial tree to stimuli
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Most common sx of acute asthma
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Bronchospasm
edema mucous production |
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Drug triggers for asthma
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ASA
Beta blockers NSAIDs |
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Minimum PEF to D/C asthma pt
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300 minimum
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Asthma development more common in younger or older pts?
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50% develop before age 10
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Asthma pulmonary function
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V/Q imbalance (hypoxic, hypercarbic)
Pulsus paradoxus >10 Increased airway resistance Decreased max expiratory flow |
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Sx of acute asthma
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Dyspnea
Chest tightness Wheezing Coughing Loud rapid breathing Accessory breathing Retractions Fatigue Paradoxical respiration Altered mental status |
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Signs in asthma
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Bilateral hyperresonance
Decd breath sounds Prolonged expiratory phase |
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CXR findings in asthma
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hyperinflation
flat diaphragm thickened bronchial markings atelectasis |
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Treatment of acute asthma
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100% O2
IV fluids Beta agonists Beta 2 selectives: albuterol IV steroids Anticholinergics- Atrovent Long acting B2 agonists- prevention not acute Inhaled steroids- not acute |
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FEFR Changes in Asthma
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Mild Attack: 80%
Moderate Attack: 50-80% Severe: <50% |
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Status Asthmaticus
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Low O2 Sats
Struggling to breathe Need to be admitted |
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most common source of massive hemptysis
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Bronchial arteries
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Infectious Causes of hemoptysis
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TB, bronchiectasis, fungal, pheumonia, abscess
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Other causes of hemptysis
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CA (smoker)
Trauma (cracked rib) Cardiogenic (vessel swelling) Alveolar hemorrhage |
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actue cough and bloody sputum with or without fever
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pneumonia or bronchitis
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Chronic productive cough and hemoptysis
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bronchitis, bronchiectasis
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Fever weight loss and sweats
with hemoptysis |
TB
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Anorexia, wt loss, change in cough and hemoptysis
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CA
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Dyspnea, minor hemoptysis
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alveolar hemorrhage syndrome (goodpastures)
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Essentials of Dx for Thromboembolism
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predisposition of VTE usually of LE
Dyspnea, chest pain, hemptysis, syncope Widened alveolar-arterial PO2 difference |
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Age of pts that usually get DVTs
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over 60 years old -- usually sedentary
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90% of clincially significant PEs arise from...
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Deep veins of the lower extremities
NOT THE CALVES |
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Major risk factor for DVT
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Central venous cath
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Major risk factors for venous thromboemboli
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Virchow's Triad
vascular intimal injury blood stasis hypercoagulability |
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% of people with high risk factors that will get a DVT
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20%
Risk factors: prior DVT Obesity CHF, MI Age >65 Major surgery |
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Treatment for DVT in a pt with stable vitals
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IV heparin
Coumadin 3-6 mo |
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Treatment for DVT in a pt with unstable vitals
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Thrombolytics
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Definitive diagnostic test for PE-- not done often!
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pulmonary angiogram
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Dx of pt with high probability of DVT..
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Go directly to chest CT
if negative do US of the LE |
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EKG findings in DVT
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S1Q3T3, RBBB, Right axis deviation
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Most common dysrthymia in DVT
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Sinus tach
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CXR Findings for VT
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Hamptoms sign
Westermark Sign |
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Pleural effusions
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Abnormal accumulation of fluid in the pleural space
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Pleural effusions caused by..
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1) increase in pleural fluid
2) decrease in pleural fluid lymphatic drainage 3) combination of 1 & 2. |
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most common transudative effusions
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CHF
thinner fluid |
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3 cardnal sx of pleural effusion
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Dyspnea
Chest Pain Non-productive cough |
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Do you tap a pleural effusion caused by CHF?
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no... treat underlying cause
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Tap Pleural effusion...
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if cause is unknown
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Cardinal manifestation of bronchietasis
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purulent sputum in amounts that can total several hundred milliliters daily
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Bronchietasis
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Permanent abnormal dilation and destruction of one or more bronchi due to chronic inflammation
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Hallmark signs of bronchietasis
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Frequent raspy cough
Copious purulent sputum |
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Localized bronchiectasis
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secondary to obstruction or infection of the bronchi
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Causes of localized bronchiectasis
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Old: Measles, whooping cough
Current: RSV and adenovirus |
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Diffuse bronchiectasis
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Secondary to inherited or aquired defects in defenses against inflamm/infx
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Causes of diffuse bronchietasis
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neuormuscular impairment, GI incompetence, NG tube, chronic bronchitis, asthma
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Most common type of congential bronchietasis
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cystic fibrosis
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Study of choice for bronchietasis
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CT
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Foul odor of sputum in bronchietasis
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anaerobic bacteria
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Most common type of lung cancer
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Adenocarcinomas
Invades blood and lymph vessels early and may first present with metastasis |
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Most common type of adenocarcinoma in nonsmokers
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Bronchioalveolar cell CA
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Can adenocarcinoma be found via sputum
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Nope
CEA is usually positive |
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Squamous cell carcinomas
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arise from surface epithelium
Metaplasia and dysplasia show before tumor |
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Can squamous cell carcinoma be found via sputum
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yes because its found in the central bronchi near hilum
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Large cell carcinoma
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peripheral or central origin
Large cells on cytology |
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Can large cell carcinoma be found via sputum
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Nope!
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Small Cell Carcinoma
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Centrally occuring with diffuse mets
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Most aggressive form of lung cancer
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Small cell carcinoma
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Found with small cell carcinoma
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SYMPTOMATIC AT DX
Postobstructive pneumonias SVC syndrome |
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S&S of SmallCell Carcinoma
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Seizures
Brain mets Horners syndrome Hoarseness Paraneoplastic syndromes |
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Will Small cell carcinoma response to surgery
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No
Untreated survival is 6-18wk |
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Dx of Small Cell Carcinoma
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CXR, CT, CBC, Chem 7, LFTs, Alk phosphatase
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most common cause of ARDS
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Sepsis
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Found with ARDS
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Respiratory failure
Hypoxemia Refractory to tx Non-cardiogenic pulmonary edema |
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Upper airway due to smoke inhilation
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thermal injury
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Lung damage due to smoke inhilation
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Chemical injury
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Biggest concern for thermal injury of smoke inhilation
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edema
occurs quickly w/i 24 hours |
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Treatment for smoke inhilation
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EARLY INTUBATION
O2- humidified Bronchodilators Suction PEEP DO NOT GIVE STEROID |
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Drug that causes bothersome, loud, persistant cough
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ACEi
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Causes for drug induced lung disease
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Bblockers
ASA NSAIDS ACEi Crack Heroin Methotrexane |
