Pulm - Blueprint

pneumocystis jivorecii pneumonia sx

HIV or CD4 < 200

bilateral ground-glass opacity

caused by a fungus and can present with PTX

pneumocystis jivorecii pneumonia dx

confirm with staining or PCR of respiratory specimen

pneumocystis jivorecii pneumonia tx**

bactrim or steroids

which TB med causes optic neuritis

ethambutol

→ discontinue immediately

isoniazid SE

hepatitis

peripheral neuropathy

pyrazinamide SE

hepatotoxicity

polyarthralgia

rifampin SE

orange discoloration to body fluid (urine, tears, sweat)

Idiopathic pulmonary fibrosis (IPF)

progressive dry cough

inspiratory fine crackles

fingernail clubbing

ct = honeycombing (small cystic spaces enveloped with thick defined walls at the bases)

croup scoring

moderate → stridor at rest and retractions

= oral steroids, nebulized epinephrine, observe in ed for 3 hours, discharge if sx go away

you were bit by a bird. what med do you get

doxy (psittacosis)

macrolide abx MOA

irreversibly binding to the 50S subunit of bacterial ribosomes, thereby blocking translocation during protein synthesis

tetracyclines MOA

binds to the 30s ribosomal subunit

FLQ MOA

inhibiting DNA gyrase

sulfonamides MOA

inhibit folic acid synthesis by blocking dihydropteroate synthase

normal d dimer level

< 500

COPD + seasonal flu ( muscle aches, headache, and malaise)

→ oseltamivir

Löfgren syndrome

sarcoidosis - hilar adenopathy, erythema nodosum (tender reddish-violet subcutaneous nodules on the anterior aspects of the lower extremities)

women

for pulm embolism, when do you give V/Q scan instead of CT?

HIGH creatinine

pregnancy

abdnormal chest radiograph results

central = sputum cytology

peripheral = CT-guided transthoracic biopsy

(if one is negative, test the other)

when does asthma become moderate persistent?

waking up at night more than 1 time (but not everyday)

acute chest syndrome

fever, chest pain, wheezing, cough, hypoxia, and a new lung infiltrate in someone with sickle cell disease (vaso-occlusive cause)

tall and thin, breathlessness (but PTX does NOT have fever)

common complications in sickle cell disease

1. vaso-occlusion

2. acute chest syndrome

3. splenic crisis

4. aplastic crisis

5. stroke

6. leg ulcers

7. sepsis

8. cholelithiasis

9. osteonecrosis

10. priapism

what kind of bronchoscopy for foreign body aspiration?

rigid

(flexible is for PNA)

first step for foreign body aspiration

bronchoscopy

(heimlich only if they can’t breathe)

croup tx

support

corticosteroids (dexamethasone)

mod-severe = racemic epi

first line med for epiglottitis*

ceftriaxone

you find a well-defined solid lesion in the lung but no pulmonary symptoms at all. what’s your next step?

low dose chest CT w/o contrast (low risk)

if nodule >8 mm → PET

coughing → syncope =

pertussis

lung abscess

cough with putrid sputum, pleuritic chest pain, weight loss, and night sweats, crackles

cavitry lesion and air fluid level

lung abscess tx

augmentin or carbapenem (imipenem, meropenem)

atypical PNA

gradual onset, cough, fever

course breath sounds

Chest film is likely to reveal perihilar and interstitial infiltrates

atypical PNA tx*

azithromycin

tension PTX tx*

Thoracostomy with chest tube placement**

if not → needle decompression

thoracentesis is for what condition?

pleural effusion

what is this

bilar hilar adenopathy → sarcoidosis

(granulomatous disease that can have nodules/erythema nodosum)

( lupus pernio and erythema nodosum)

you see ferruginous bodies =

asbestosis

Mucocutaneous ulcers that are recurrent and usually painful =

behcets disease

Cryptococcus meningitis

Cryptococcus neoformans (dried animal droppings - pidgeons)

cough with scant sputum and pleuritic pain

molluscum contagiosum

tachycardia

high diastolic BP and encapsulated yeast organisms upon India ink staining

tx: intravenous amphotericin B and oral flucytosin → fluconazole

ARDS

accumulation of fluid in the alveolar wall

(happens FAST, like 1 day)

latent TB tx

just rifampin and isoniazid

silicosis

chronic, fibrotic lung diseases

inhalation of free silica particles

small (< 1 cm), diffuse, round opacities “eggshell calcifications” on periphery

tx = stop exposure and support

coal miners lung is located primarily where

upper lobes

shipyard construction

asbestosis

lower lobes on lungs

nodular interstitial fibrosis, primarily at the lung bases, and plaques on the parietal and diaphragmatic pleura

pneumomediastinum

“hamman sign = crunching sound on auscultation”

dx = CT scan

self limited

Mesothelioma cause

exposure to asbestos (pleura)

latent tuberculosis (TB) tx

rifampin daily for 4 months

rifampin and isoniazid for 3 months