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27 Cards in this Set
- Front
- Back
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Epidemiology of pneumonia
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Most deadly infectious disease in the U.S.
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Major criteria for severe community-acquired pneumonia (CAP).
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Septic shock with need for vasopressor support
Respiratory failure with need for mechanical ventilation. |
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Minor criteria for severe community-acquired pneumonia (CAP).
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Respiratory rate > 30 breaths/min
Hypoxemia PaO2 < 250 Hypothermia < 36 C Hypotension requiring aggressive IV fluids Confusion/disorientation Multilobar pulmonary opacities Leukopenia, thrombocytopenia Uremia > 7.1 mmol/L Metabolic acidosis or elevated lactate level |
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How do you treat non-severe pneumonia patients?
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Start with empirical coverage
- don't delay treatment waiting for cultures Doxycycline Macrolides (clarithromycin, azithromycin) |
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Hospitalization criteria of pneumonia patients
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PSI
CURB-65 - Confusion, Uremia, Respiratory rate, Blood pressure, over the age of 65 |
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Physical exam findings of pneumonia
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Fever
Hypothermia Tachypnea Tachycardia Decreased arterial saturattion |
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Currant jelly sputum
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An endobronchial plug of blood, sputum, mucus, and debris, typical of untreated Klebsiella pneumoniae pneumonia.
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What is the most common cause of fungal pneumonia in Oklahoma?
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Histoplasmosis
Usually resolves on own, treat severe cases with Itraconazole. |
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How is cancer staged?
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Using the TNM international staging system, on a I-IV scale.
- Determines the course of treatment a provider will recommend. - Helps predict the prognosis and 5-year survival rate for cancer patients. - Standardizes the entry criteria for clinical trials. |
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What does the T in the TNM system represent?
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The size and location of primary tumor.
Evaluated 1-4. - TX – tumor cannot be evaluated - T1-4 - increasing size and location of tumors - T0 – evaluated and no evidence of primary tumor - Ts – in situ tumor |
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What does the N in the TNM system represent?
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Describes presence and location of nodal metastases.
Evaluated 1-3 - N0 – no regional lymph node involvement - N1-3 - increasing number of lymph nodes involved |
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What does the M in the TNM system represent?
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Refers to the presence or absence of distal metastases.
Evaluated 0-1 - M0 - no distal metastasis - M1 - distal metastasis present |
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What is a cancer patient's prognosis based on histology of cancer?
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Small cell lung cancer (SCLC) has a much poorer prognosis than non-small cell lung cancer (NSCLC).
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Basic concepts of lung cancer treatment
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NSCLC – surgical resection is treatment of choice
SCLC - chemotherapy is treatment of choice |
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Warning signs of lung cancer.
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C: change in bowel/bladder habits
A: a sore that does not heal U: unusual bleeding T: thickening or lump in breast/elsewhere I: indigestion or difficulty swallowing O: obvious change in wart/ mole N: nagging cough or hoarseness |
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Is lung cancer screening recommended?
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Screening is not recommended because evidence doesn’t show any benefit due to:
- Generalizability to community practice - Duration of screening - Overdiagnosis - Cost effectiveness |
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How should solitary pulmonary nodules be managed?
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Lesions with low probability of malignancy (less than 5%) can be observed with serial imaging studies.
High malignancy probability (over 60%) – surgical resection is indicated. |
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What it palliative care and what are its goals?
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Designed to improve symptoms and quality of life at any stage of a serious illness.
Includes management of pain, dyspnea, nausea, vomiting, constipation and agitation. |
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General characteristic of COPD
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Associated with an enhanced chronic inflammatory response to noxious particles or gases.
Associated with significant extrapulmonary effects and important comorbid conditions. |
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Presentation of chronic bronchitis
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Chronic cough, mucopurulent sputum, presents in 30-40s, patients overweight, cyanotic, mild dyspnea, noisy chest with rhonchi and wheezing
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Presentation of emphysema
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Severe dyspnea, cough rare, clear sputum, presents after 50, patients are thin, use accessory muscles to breath, quiet chest, no peripheral edema
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Treatment of COPD
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Guided by severity of symptoms, standards provided by Global Initiative for Obstructive Lung Disease (GOLD).
Stop smoking, oxygen therapy, inhaled bronchodilators, corticosteroids, theophylline, antibiotics, pulmonary rehab, positive pressure ventilation, improve exercise tolerance |
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COPD X-ray findings
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Non-specific peribronchial and perivascular markings.
Hyperinflation with flattening of the diaphragm or peripheral arterial deficiency in about half of cases. |
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Presenting symptoms of sarcoidosis
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Malaise, fever, dyspnea of insidious onset
Skin involvement (erythema, lupus pernio, iritis, peripheral neuropathy, arthritis or cardiomyopathy). Symptoms related to the lung, skin, eyes, peripheral nerves, liver, kidney, heart and other tissues. |
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Chest x-ray findings of sarcoidosis
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Radiographic findings are variable and include:
Stage I - bilateral hilar adenopathy alone Stage II - adenopathy and parenchymal involvement (infiltrates, acinar shadows, nodules) Stage III - parenchymal involvement alone |
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Associated lab findings of sarcoidosis
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- Leukopenia, elevated ESR, hypercalcemia, hypercalciuria
- ACE levels are elevated in 40-80% - Skin test anergy is present in 70% - ECG may show conduction disturbances and dysrhythmias |
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Diagnosis of sarcoidosis
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Histologic demonstration of noncaseating granulomas in biopsies, preferably from transbronchial lung tissues.
Other granulomatous diseases must be excluded. |
