51-100 Flashcards
Klebsiella pneumoniae (B) risk group? X ray findings?
It is typically seen in people with substance use disorder, diabetes, or severe COPD. Common X-ray findings include lobar pneumonia in the right upper lobe with a bulging fissure sign.
What respiratory disease has an association with Chlamydia pneumoniae?
Asthma.
how to tdifferentiate C. pneumoniae from Streptococcus pneumoniae ?
challenging to differentiate C. pneumoniae from Streptococcus pneumoniae since both patients present with classic pneumonia symptoms of fever, cough, and shortness of breath. However, patients with C. pneumoniae tend to also exhibit upper respiratory involvement (sinusitis, pharyngitis, laryngitis). Symptom onset is usually gradual, with few cases requiring inpatient treatment. Chest X-ray findings are nonspecific, with the most common being unilateral alveolar opacities.
Chlamydia pneumoniae treatment?
include azithromycin, doxycycline, and a respiratory fluoroquinolone
Which obligate intracellular bacteria can cause human disease?
Chlamydia psittaci, rickettsiae, Coxiella, Mycobacterium leprae, and Mycobacterium tuberculosis.
Psittacosis
History of exposure to birds
High fevers, severe headache, myalgias, nonproductive cough
PE will show hepatosplenomegaly
CXR will show patchy perihilar or lower lobe infiltrates
Most commonly caused by Chlamydia psittaci
Treatment is doxycycline
when do you see Aortoenteric fistula?
a primary process where an abdominal aortic aneurysm (AAA) erodes into the GI tract, or as a late complication of AAA repair, where a communication between the site of surgery and the GI tract develops.
Aortoenteric Fistula history? clinical?
History of AAA, aortic repair, aortic graft replacement
Reports rectal bleeding
PE will show signs of shock
Management includes blood transfusion or resuscitation and emergent surgical consultation
Aortoenteric Fistula types?
Aortoenteric Fistula triad? clinical? managemnt
What other type of fistula can develop as a complication of AAA?
Aortocaval fistula.
is an emergent surgical procedure performed to rescue both a potentially viable fetus and the mother during cardiopulmonary arrest. It is essential for adjuvant resuscitative efforts to be continued on the mother (e.g., cardiopulmonary resuscitation, left lateral-tilting position, manual displacement of the uterus), but once resuscitative hysterotomy is decided, the physician’s primary focus will be to perform it safely, quickly, and efficiently. Delivery provides the mother with improved cardiac venous return and upwards of one-third increase to cardiac output, which supports the increased likelihood of achieving a return of spontaneous circulation.???
Resuscitative hysterotomy, historically also known as the perimortem cesarean section
Resuscitative hysterotomy indications?
The two most critical indications in deciding to pursue the procedure are a patient experiencing arrest after at least 24 weeks gestation (uterine size extending superior to the umbilicus or ≥ 24 cm beyond the symphysis pubis) and the time passed since the maternal onset of arrest. Without the near-immediate return of spontaneous circulation, the literature supports that the emergency medicine physician should perform the resuscitative hysterotomy and deliver the neonate within 4 minutes of cessation of circulation to maximize the chances of a positive outcome.
should resuscitative hysterotomy be delayed to perform endotracheal intubation?
NO
PECARN algorithm for trauma?
pertussis symptoms? phases? treatment?
History of nasal congestion, cough, and low-grade fever
Rapid-fire repetitive coughing followed by an inspiratory whoop and post-tussive emesis
Most commonly caused by Bordetella pertussis
Treatment is a macrolide: azithromycin
What is most common cause of croup?
Human parainfluenza virus.
difference between croup and pertussis?
presents with an acute barking cough and inspiratory stridor that typically resolves within 1 week
A scuba diver returns to the surface and is unconscious. Which of the following is the likely diagnosis?
mechanism?
Air embolism
occurs when air bubbles cross the alveolar-capillary membrane and move into the pulmonary venous circulation. From the pulmonary venous circulation, the bubbles move into the left heart and into the arterial circulation. The air emboli may travel to any organ, but the coronary and cerebral arteries are at particular risk. Divers who lose consciousness on ascent are presumed to have a cerebral gas embolism. Additionally, the diagnosis is considered in any diver who loses consciousness within ten minutes of surfacing. The treatment for arterial gas embolism is recompression through a hyperbaric chamber. Persons with gas emboli will have symptoms related to the organ system involved (coronary ischemia, stroke syndromes, hemoptysis).
A 19-year-old woman without significant past medical history has three days of low-grade fever, fatigue, and myalgias followed by the development of cough, dyspnea, and chest pain. Vital signs are HR 135 and BP 80/60. On physical examination she has jugular venous distension, diffuse rales on lung auscultation, a third heart sound (S3) on cardiac auscultation and peripheral edema. ECG shows sinus tachycardia. Which of the following findings is likely to be seen on echocardiogram?
what does she have?
Diffuse hypokinesis and regional wall motion abnormalities
myocarditis
myocarditis clinical? managment?
Patient presents with fatigue, fever, chest discomfort, dyspnea, and palpitations
PE will show tachycardia disproportionate to fever or discomfort
Echocardiogram will show decreased ventricular ejection fraction with hypokinesis and wall motion abnormalities
Gold standard for diagnosis is an endomyocardial biopsy
G6PD genetics? lab? diagnostic? medications that cause problems?
History of taking antimalarials, sulfonylureas, quinolones, nitrofurantoin, fava beans
Infection is also a cause for the hemolysis
Labs will show Heinz bodies, presence of bite cells on the smear
Consider testing prior to starting potential agents in patients who may be at risk
X-linked recessive
Aortic Dissection
Risk factors: advancing age, male sex, HTN, Marfan syndrome
Sx: acute onset of “ripping” or “tearing” chest pain or back pain
PE: asymmetric pulses or SBP difference of > 20 mmHg
CXR: widened mediastinum
Dx: CT angiography or transesophageal echocardiogram (TEE)
Treatment: reduce BP and HR (beta-blockers), pain control, emergency surgery (Type A dissection)
Type A: involves ascending aorta
Type B: involves only descending aorta
Once shoulder dystocia is recognized during delivery, what should you do?
the mother’s legs should be hyperflexed and pulled up by the abdomen (McRoberts maneuver) and firm suprapubic pressure applied. This rotates the pelvis and facilitates release of the trapped shoulder. If this fails to deliver the infant, the mother should be placed in the all-fours position and gentle downward traction applied to the fetal head (Gaskin maneuver). Rotational maneuvers such as the Rubin and Woods corkscrew maneuver can also be attempted. These methods are usually done with an episiotomy and involve rotating the infant to allow for delivery.
two laundry detergent pods ingested, indications for endoscopy?
Which of the following is the most appropriate technique to obtain a lateral soft tissue neck radiograph when evaluating a patient for suspected retropharyngeal abscess?
Influenza is a key infection that can lead to postviral pneumonia (though any viral organism that causes pneumonia may cause this). Overall, the most common cause of postviral pneumonia is
streptococcus pneumoniae. However, the presence of necrotizing pneumonia and cavitary lesions on chest imaging (plain films or CT scans) is more suggestive of Staphylococcus aureus. This patient is presenting with postinfluenza pneumonia. Given the cavitary lesions on chest imaging, the most likely organism is Staphylococcus aureus, thus vancomycin would be an appropriate initial antibiotic.
