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Terms in this set (79)
What is a normal A-a gradient?
When would you see an increased A-a gradient?
PE, pulmonary edema and right-to-left shunts
What is FiO2 at room air?
is the treatment for strep pharyngitis? PCN allergic?
Penicillin X 10 days, erythromycin if PCN allergic
Does treatment of strep pahryngitis eliminate the risk of poststrep glomerulonephritis?
What are the centor criteria?
For strep pharyngitis. Absence of cough, positive for exudates and cervical lymphadenopathy. Modified centor-age <15 add 1 point, >65 subtract 1 point.
Infant is blue at rest but pinks up when crying, think of what?
Choanal atresia. Large tonsils create a disconnect between the nasal passage and the oropharynx.
What are some signs of peritonsillar abscess?
Difficulty opening mouth, asymmetric tonsil, and displacement of the uvula AWAY from the abscess.
Pseudomembrane covering the pharynx, think of what?
Cornybacterium diphtheriae. Treat with erythromycin + penicillin
Annual flu vaccine is recommended for EVERYONE starting at what age?
Sinusitis most commonly involves which sinus?
What is a possible complication of sinusitis?
Orbital cellulitis, cavernous sinus thrombosis, osteo, empyema
What is the most common bacterial cause of acute bronchitis in non smokers?
Mycoplasma pneumoniae, will have a positive cold agglutinin titer
What is the most common bacterial cause of acute bronchitis in smokers?
Strep pneumo and H flu
What is the most common cause of CAP? Empiric treatment?
Strep pneumo, azithromycin if outpatient, azithromycin and a 3rd generation for inpatient OR FQ like moxi.
What is the most common cause of HCAP? Empiric treatment?
Staph aureus, GNR. Now we need coverage for MRSA and Pseudomonas, so 3rd gen cephalosporin plus vanc and zosyn.
What should you do if you have an HIV patient with a CXR showing consolidation?
Do a bronchioalveolar lavage or induced sputum for silver stain looking for PCP. Treat with bactrim and IV steroids.
What are Ghon complexes?
Calcified granulomas seen in TB
What is the treatment for asymptomatic positive PPD?
INH for 9 months, add B6
What is Pott disease?
TB in the bone
What is the most common cause of pneumonia in patients with COPD?
What is the most common cause of pneumonia in patients with a recent influenza infection?
What is the most common cause of pneumonia in nursing home patients?
What is the most common cause of pneumonia in neonates?
What is the most common cause of pneumonia in transplant patients?
Legionella, order a urine Ag
What is the most common cause of pneumonia in people who have been in caves?
What is the most common cause of pneumonia in central america?
What are two gram-positive rods that form long branching filaments resembling fungi, and how do you differentiate them?
Actinomyces and Nocardia, both weakly acid-fast. Nocardia is weakly acid fast, causes pneumonia in immunocompromised patients, treat with sulfa. Actinomyces causes oral/facial abscesses that may drain through sinus tracts in skin, treat with penicillin. SNAP.
What would you expect to see on the ABG in ARDS?
Respiratory alkalosis. Oxygen is diffusion limited but CO2 is perfusion limited. Patient is hyperventilating trying to get oxygen in and is blowing off CO2.
Does the hypoxemia of ARDS correct with supplemental O2?
No, the hypoxemia is due to intrapulmonary shunting of blood.
What will you see on CXR in ARDS?
Bilateral fluffy infiltrates
What is the A-a gradient in ARDS?
Increased. Interstitial edema increases the distance O2 has to travel from the alveoli to the arteriole.
What is the first line treatment for asthma? COPD?
Asthma is treated first with SABA (albuterol), COPD is treated first with inhaled steroids (it's an inflammatory problem)
What defines mild intermittent asthma?
<2 exacerbation/wk and <2 nighttime awakenings/month. FEV/FVC 80%. Treat with SABA (albuterol)
What defines mild persistent asthma?
<1 exacerbation/day, <1 nighttime awakening/wk. Treat with SABA plus low dose corticosteroid (beclamethasone)
What defines moderate persistent asthma?
Daily symptoms, >1/wk nighttime awakening. Treat with SABA, inhaled steroid plus LABA (salmeterol). FEV/FVC 60-80%
What defines severe asthma?
Awake multiple times/night. FEV/FVC <60%. Treat with high dose inhaled steroid, LABA, consider systemic steroids.
If someone is having an asthma exacerbation when is it ok to send them home?
SpO2>92%, PEFR >90% of their best. If <50%-->ICU.
What is a normal pCO2 during an asthma exacerbation?
Low, normal indicates impending respiratory failure.
Why are patients with chronic bronchitis "blue bloaters?"
Secondary development of cor pulmonale causes cyanosis and peripheral edema.
What defines chronic bronchitis?
Productive cough for 3 months of the year for >2 years.
How can you differentiate between emphysema and chronic bronchitis?
DLCO is normal in chronic bronchitis but decreased in emphysema
What causes panacinar destruction?
A1-antitrypsin deficiency. Emphysema is centrilobular
What are the only two interventions that have been shown to decrease mortality in COPD?
Smoking cessation and supplemental oxygen
At what point should patients with COPD be considered for home oxygen?
SpO2<88 or PaO2<55
What is bronchiectasis?
Permanent dilation of small and medium bronchi because of destruction of elastic components. Cough >100ml/day
Squamous cell lung cancer paraneoplastic syndrome?
Small cell lung cancer paraneoplastic syndrome?
ACTH and ADH, Lambert-Eaton
What is Pancoast syndrome?
Horner syndrome plus brachial plexus involvement (C8-T1)
What lung cancer is associated with asbestos?
What are the most common sites for lung cancer mets?
BLAB; brain liver, adrenals, bone
What is the diff for anterior mediastinal mass?
Thymoma, Teratoma, Terrible lymphoma, Thyroid
What is a Bochdalek hernia?
Congenital diaphragmatic hernia, presents as a posterior mediastinal mass
What is a common presenting symptom of laryngeal cancer?
What will you see on CXR in idiopathic pulmonary fibrosis? On CT?
Reticulonodular pattern, ground glass appearance on CT.
What medications can cause pulmonary fibrosis?
Amiodarone, bleomycin, penicillamine, gold, nitrofurantion
What other findings are associated with sarcoidosis besides pulmonary?
Erythema nodosum, anterior uveitis.
What is the most common cause of death in sarcoidosis?
What will labs show with sarcoidosis?
Increased ACE, hypercalcemia
What should you think of if you see pleural plaques on CT?
What should you think of if you see eggshell calcification on CT?
Berylliosis is seen in workers of what industry?
Electronics, ceramics, die
Hemoptysis and crescentic glomerulonephritis, ToW?
Goodpasture, treat with plasmapheresis
Noncaseating granulomas of the lung and kidney, ToW?
What is a possible finding on EKG of PE?
What is the definition of pulmonary HTN?
Pulmonary a pressure >25 at rest or >30 during exercise.
What affect does CREST syndrome have on the lungs?
Causes increased resistance in the arterioles-->Pulmonary HTN.
What heart sound is indicative of pulmonary edema?
S3 or S4
Kerley B lines on CXR are indicative of what?
What defines an exudate vs transudate?
Exudate has LDH >2/3 upper limit of normal, pleural LDH/serum LDH>0.6 and pleural protein/serum protein>0.5. pH<7.2 is indicative of parapnemonic effusion or ampyema
What should you think of if you get bloody fluid on thoracentesis?
When is pleural fluid glucose low?
TB, malignancy, autoimmune
When is pleural fluid amylase high?
Pancreatitis, esophageal rupture
What does a loculated pleural effusion indicate?
Empyema, need chest tube
JVD, hypotension, tracheal deviation and resipratory distress are indicative of what?
Tension pneumo, emergent needle decompression
Where do you do needle decompression in tension pneumo?
4th or 5th ICS mid-axillary or 2nd or 3rd ICS midclavicular
What is the definitive test for sleep apnea?
Polysomnography which measures the apnea index.
Stridor that worsens in the supine position and improves with prone position?
Stridor that improves with neck extension?
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