8. Pulmonary EOR: ARDS, FBA, TB, Lung cancer – Flashcards
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A potential complication of DKA treatment where fluid overload decreases plasma oncotic pressure and favoring a fluid shift across the pulmonary capillary membrane
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acute respiratory distress syndrome protein rich pulmonary edema
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The most common cause of ARDS is...?
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sepsis Other causes include trauma, aspiration pneumonia and dkq fluid overload in treatment
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DX of ARDS requires these three things:
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1. refractory PaO2/FIo2 ration that is not responsive to 100% O2 2. b/l pull infiltrates on car 3. Absence of cariogenic pulm edema
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Symptoms of ADRS
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begins 12-24 hours after event. dyspnea, tachypnea, red or pink sputum, diffuse crackles, cyanosis
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A key treatment of ARDS IS
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1. TREATING UNDERLYING CAUSE 2. POSITIVE end expiratory pressure ventilation
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What are likely findings on CXR of ARDS?
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Bilateral opacities consistent with pulmonary edema must be present
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What is the main DDX for ARDS?
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Cardiogenic pulmonary edema is the primary alternative that needs to be excluded. This may require diagnostic testing (eg, brain natriuretic peptide [BNP] levels, echocardiography, and/or right heart catheterization)
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TX and dx of for foreign body aspiration is?
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bronchoscopy
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___________should be suspected in children who have sudden onset of lower respiratory symptoms, or those who do not respond to standard management of other suspected etiologies such as pneumonia, asthma, or croup.
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Foreign body aspiration (FBA)
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For high suspicion of FBA in a stable patient, the first step in dx is...?
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evaluation is to perform plain radiography of the chest
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T/F Most foreign bodies are radiolucent on imaging and require direct visualization, usually bronchoscopy for diagnosis
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T
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Match FBA bronchoscopy: flexible bronchoscopy rigid bronchoscopy children adults
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children -rigid bronchoscopy adults - flexible bronchoscopy
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Acid fast stain erobic rod...
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mycobacterium tuberculosis
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Transmission of TB is through...?
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respiratory droplet
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What are goon complexes?
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calcified nodules in the lungs due to macrophages and t lymphocytes
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High risk of TB?
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immigrants jailed population prison drug users elderly and nursing home
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The skin PPD test becomes positive when?
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1-2 months after exposure
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If the body doesn't contain the primary TB then its called?
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active TB (progressive primary)
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What are some symptoms of TB
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progressive cough +- hemoptysis
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SX of TB?
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fevers, chills, nights sweats, anorexia, weight loss, chest pain,
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Reactivation TB affects what part of lungs on CXR?
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apices
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T/F Acid fast sputum confirms diagnosis of TB
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F it supports. DX is definitively by culture
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Primary TB will show what on CXR?
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hilar lad, homogeneous infiltrates, cavitations
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Positive skin test TB reactions: 1. HIV, close + contacts 2. Immigrants, healthcare workers 3. normal population
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1. HIV, close + close contacts ;=5 2. Immigrants, healthcare workers ;=10 3. normal population ;=15
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How long should active TB patients be isolated?
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for at lease two weeks of treatment
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What are the four drugs for for active TB?
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INH RIF PZA ethambutol for eight weeks, continue rif/inh for 18 weeks
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Main SE of INH?
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hepatitis/hepatotoxicty
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T/F Anti-TB meds aren't generally started in the ED
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T
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If someone is suspected of TB or active TB person is admitted what should be done?
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respiratory precautions. negative pressure room
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This TB med causes orange body fluids, hepatitis and flu like symptoms?
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rifampin
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This TB med can cause optic neuritis (red-green vision loss)?
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Ethambutol
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This vaccine is available for TB in endemic areas but is not used in US
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bacille palmette guerin (BCG)
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Two types of bronchogenic neoplasm? MC type?
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1) NON-small cell carcinoma = 85% =local spread -adenocarcioma= m/c in smokers & women & nonsmokers = spread peripheral -SCC- typically central spread; associated w/ inc ca, cavity lesions, and pancoast syndrome -large cell (anapestic) - peripheral- VERY aggressive -bronchoalveolar = BEST prognosis = interstital lung pattern **surgery tx FIRST line 2) small cell (OAT cell) carcinoma (SCLC) = met early on, inc chance if smoker, typically central and very aggressive **SCLC is m/c associated w/ paraneoplastic syndrome ***chemo and/or radiation
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Which bronchogenic carcinoma has the best prognosis, amenable to surgery? Small Cell Non-Small Cell (Adeno, Sqamous, Large)
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Non small cell small cell (oat) is very aggressive and not responsive to surgery
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Which type of bronchogenic cancer is associated with non smokers and spreads peripherally? Small Cell Non-Small Cell (Adeno, Sqamous, Large)
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adenocarcinoma
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These two lung cancers are centrally growing?
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small squamous
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What is a pan coast tumor?
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squamous tumor at the apex of lung that leads to pain and horner's syndrome Miosis (constriction) Anhydrous Ptosis
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Which pneumonia? ear pain; bulls myringitis + resp symptoms
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mycoplasma pneumonia
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FBA swallowed by adults is most likely to lodge where?
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LES
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FBA swallowed by children is most likely to lodge where?
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proximal esophagus at cricopharngeal narrowing
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Which FBA aspiration just be removed immediately
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button batteries
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The preferred method of FB removal is mostly
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endoscopy
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Stridor on inspiration suggest
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Obstruction above the vocal chords
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Stridor in exhale or mixed inhale/exhale
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Obstruction below vocal chords
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FBA occurs on which side of the lungs more commonly
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right side
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Which of the following TB are contagious: 1. primary TB 2. Chronic latent 3. Secondary (reactivation)
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1. primary TB - contagious 2. Chronic latent -NOT CONTAGIOUS 3. Secondary (reactivation) -contagious
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This TB drug can cause liver tox
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PXA
