[...]... from "Stepwise Approach to Managing Asthma for Adults and Children More than 5 Years of Age." NIH publication o 99- 40S SA 3·10 Pulmonary Medicine , © 2007 MedStudy-Please Report Copyright Infringements to 800-841-0547 option 7 strength See the General Internal Medicine section for treatment of theophylline overdose Theophylline is no longer a first-line drug for asthma or COPD management-now more... pneumococcal sepsis, antibiotics do not make a difference as to whether the patient lives or dies in the first 24 hours! The pneumococcal vaccine indications are discussed under Preventive Medicine in the General Internal Medicine section Gram stain is positive if there are lancet-shaped Gram-p iuve diplococci in a sputum sample that also have many PMNs and < 10 epi's per low-power field-best if organisms... a big risk factor for increased mortality Other viral causes of pneumonia include adenoviruses (also frequent) and CMV Influenza vaccination and prophylaxis is covered under Preventive Medicine in the General Internal Medicine section Diagnose influenza A and B with rapid antigen detection assay-especially recommended is an assay that distinguishes between influenza A and B Amantadine and rimantadine... promise It can view up to 8th-order vessels It is not available on all MRI machines Score I , Alternative diagnosis is at least as likely as DVT -2 I 3 or higher = high probability of DVT 1-2 = moderate probability o = low probability Note: if symptoms are in both legs, use the more symptomatic one © 2007 MedStudy Pulmonary Medicine 3·25 TREATMENT OF PE Table 3-6 : Wells Criteria for PE CRITERIA Points... Long-term studies have not been done on this group Transtracheal catheters are inconspicuous and, by administering oxygen directly into the trachea, use a lower flow rate Con- • © 2007 MedSludy Pulmonary Medicine 3-13 sider these in patients on chronic O 2 Acceptance by the patient may be an issue Associated pulmonary hypertension may develop with as little as 6 hours per day of hypoxia-suspect this entity... insufficiency with occasional portal hypertension, and 2° clubbing In infants, it causes meconium ileus (10%) and intussuscep- Image 3-5: Cystic fibrosis &.~II.l~tl~~~:: - 3-14 Pulmonary Medicine I • © 2007 Me d St u d y-Please Report Copyright Infringements to 800-841-0547, option 7 1) A 30-year-old smoker presents with COPD and emphysematous bullae in the bases What disease should you... stage has regular chest tightness toward , he end of the first day of the workweek ("Monday t chest tightness") The frequency of symptoms slowly increases to include more days • © 2007 MedStudy Pulmonary Medicine 3-15 Inorganic Dusts that Cause ILO Overv~w These ILDs are : asbestosis, silicosis, coal workers ' pneumoconiosis, and berylliosis Asbestos Asbestos exposure (not asbestosis) causes bilateral,... calcification"), and increased susceptibility 10 TB You should do yearly PPDs in these patients Silica ingested by alveolar macrophages renders them ineffective- so a +PPD in Image 3-6: Asbestosis 3-16 Pulmonary Medicine , these patients should receive prophylaxis no matter what the patient's age or duration of +PPD No specific treatment for silicosis but, if symptoms are rapidly worsening, think TB Note: Asbestosis... response to corticosteroids is the best prognostic indicator available The best test for determining improvement is measurement of lung function-lung volumes, OLCO, and ABGs (A-a gradient), in- Pulmonary Medicine 3-17 c1uding the A-a gradient response to exercise Cor pulmonale is treated symptomatically, but new treatments under investigation include y-interferon b;[entan, and pirfenidone Single-lung transplantation... lymphomatoid, Churg-Strauss, bronchocentric, and PAN • eosinophilic [LOs: eosinophilic pneumonia, ABPA • alveolar proteinosis • idiopathic pulmonary hemosiderosis • Goodpasture syndrome 3-18 Pulmonary Medicine , Sarcoidosis : "noncasealing granuloma" is a multisystem disease Chest x-ray findings are variable Usually, there is bilateral hilar and/or mediastinal adenopathy +/- reticulonodular or alveolar . beta2-agonists. It may improve diaphragmatic muscle . - © 2007 MedStudy strength. See the General Internal Medicine section for treatment of theophylline overdose. Theophylline is no longer. diag- nosable by a characteristic high-resolution chest CT. CT scan is used extensively in pulmonary medicine and will also be discussed along with the diseases. High-resolution CT (HRCT -c ross. = Mixed venous oxygen saturation. Mixed venous blood is in the pulmonary artery. Pulmonary Medicine 3-1 ~ ypoxemla has 6 causes: I) V/Q mismatch: The main cause of hypoxemia in chronic