Interstitial Lung diseases
These are three physical exam findings of interstitial lung disease
What are crackles, clubbed fingers, and tachycardia?
Tuberculosis infection that does not have active disease and cannot transmit the organism to others
What is Latent Tuberculosis?
The most common cause of bacterial pneumonia in the outpatient setting, and the diagnostic tests can be used to guide therapy.
What are Streptococcus pneumoniae and a sputum gram stain and culture and a urinary antigen test?
Note: these tests have lower levels of sensitivity and specificity, but they can be helpful in either broadening or narrowing antibiotic therapy
Three types of idiopathic interstitial lung disease.
What are Sarcoidosis, Pulmonary Fibrosis, Cryptogenic organizing pneumonia?
Interpret this ABG and anion gap:
pH 7.34
pCO2 45
HCO3 20
AG 22
What is elevated anion gap metabolic acidosis and metabolic acidosis?
This is the definitive diagnostic test for interstitial lung disease.
What is a lung biopsy?
The traditional approach to testing for latent tuberculosis infections
What is the Mantoux test?
The recommended treatment for aspiration pneumonia and empyema noted on chest CT.
What are a thoracostomy tube and a thoracic surgery consult if an abscess cannot be ruled out?
Common exam findings for Pulmonary Hypertension.
What are JVD, Right sided S3 or S4 gallop, Hepatomegaly, Lower extremity edema?
In this mode of mechanical ventilation, the tidal volume is at a set level and the respiratory rate is set, but allows the patient to breathe spontaneously to the set volume.
What is volume control?
The most common cause of interstitial lung disease.
What is idiopathic pulmonary fibrosis ?
The 4 drugs, in HIV negative patients, used to initially treat tuberculosis.
What are rifampin, isoniazid, pyrazinamide, and ethambutol?
On his fourth day in the ICU, a pt on mechanical ventilation with a positive MRSA screen develops fever, has an increased white count on the morning labs, and the respiratory therapist reports purulent secretions from inline suction and an increased oxygen demand on the ventilator. These are treatments based on likely HAP pathogens.
What are piperacillin-tazobactam 4.5g iv q 6 hours and vancomycin 15mg/kg iv q 8-12 hours are recommended in a likely case of MRSA HAP?
Cefepime, levofloxacin, and meropenem can also be used in combination with vancomycin or linezolid.
Commonly prescribed medications that may lead to ILD.
What are Amiodarone, Sulfonamides, Methotrexate, Phenytoin?
These are methods to reduce auto PEEP.
What are decrease the rate, decrease Vt (VC mode), decrease driving pressure (PC mode), and adjust I:E ratio?
The two classifications of interstitial lung disease.
What are secondary causes and idiopathic?
In pregnant persons with tuberculosis, this drug is contraindicated.
What is pyrazinamide?
A 45 yo female with no PMH visits your urgent care clinic with complaints of a productive cough for the last week, fever, chills, and some mild difficulty breathing. The patient’s oxygen saturation is 96% on room air.This is the recommended treatment and plan.
What are amoxicillin 1 gram PO 3 times a day or Doxycycline 100 mg PO twice a day as first line treatment options in an otherwise healthy outpatient. Additionally, diagnostic testing for ambulatory patients is generally not recommended unless they have a likely exposure to a nontypical organism?
This is the gold standard for the diagnosis and quantification of Pulmonary Hypertension.
What is right sided cardiac catheterization?
Interpret this ABG and list possible causes:
pH 7.21
pCO2 66
HCO3 14
What are mixed respiratory and metabolic acidosis related to intoxication, cardiac arrest, and/or multi-organ failure?
True or False. Supplemental oxygen, pulmonary rehab, lung transplant, prevention of pulmonary infection and exacerbation, and vaccination against respiratory infections are the treatment and management options for patients with interstitial lung disease.
What is true?
Small unilateral infiltrates, hilar and paratracheal lymph node enlargement, segmental atelectasis, and pleural effusions are often seen in this disease state?
What is primary tuburculosis?
A 76 yo female with a PMH of end-stage COPD and an admission for bacterial pneumonia two months ago has reported to the ED with the following vital signs: T 37.2; HR 105; BP 135/82; RR 34; O2 87 on RA. The pt is oriented. These are the appropriate actions based on CRP-65 guidelines.
What is inpatient treatment?
rationale: At a CRP-65 score of +2 inpatient treatment is recommended. The full CURP-65 assigns 1 point each for confusion, uremia, a RR above 30, hypotension, and an age above 65. This scale can be used to guide admission decisions and acuity placement
The treatment for Group 2 pulmonary hypertension.
What is administration of diuretics to reduce pulmonary venous pressure and volume overload?
This would be an appropriate ventilator setting adjustment to address this ABG:
pH 7.52
pCO2 20
HCO3 22
AG 10
What is reducing the rate?