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step II > amboss respiratory > Flashcards

amboss respiratory Flashcards

1
Q

what is the treatment of choice for legionella

A

levofloxacin

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2
Q

second line therapy for legionella

A

macrolide such as azithromycin

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3
Q

what is beta-D glucan

A

PCP

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4
Q

what is the treatment for PCP

A

Bactrim and prednisone

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5
Q

what do you treat PCP with if the person has an allergy to Sulfa

A

IV clindamycin and oral primaquine are the first-line treatment for patients with PCP who are allergic to sulfa drugs and therefore cannot be given trimethoprim-sulfamethoxazole.

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6
Q

what is the presentation of epiglottitis

A

This patient’s high fever, respiratory distress, muffled voice, drooling, and tripod positioning strongly suggest epiglottitis, especially given the fact that his immunization history is unknown. In the tripod position (leaning forward with hands on knees), patients are able to reduce the work of breathing by extending the neck.

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7
Q

what is the treatment for epiglottis

A

third-generation cephalosporin (e.g., cefotaxime, ceftriaxone) or a beta-lactam with a beta-lactamase inhibitor (e.g., ampicillin/sulbactam, amoxicillin/clavulanate, piperacillin/tazobactam)

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8
Q

characteristics of squamous cell carcinoma

A

Squamous cell lung carcinoma (SCC) is the most likely diagnosis in this patient, as it is the most common lung cancer in smokers. SCC typically affects the central parts of the lung and may present with hypercalcemia as a result of the production of parathyroid hormone-related protein (PTHrP). On histology, SCC is a solid, epithelial tumor that can have intercellular bridges and keratin pearls.

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9
Q

treatment for croup

A

cool mist and dexamethasone

if deecompensating then use racemic epinephrine

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10
Q

what causes croup

A

parainfluenza virus

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11
Q

suggests acute bronchitis

A

a cough and mild dyspnea on exertion following symptoms of an upper respiratory tract infection. The absence of fever, yellow-greenfish sputum, or signs of consolidation on exam (negative egophony) , which is usually caused by a virus.

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12
Q

what is the treatment for acute bronchitis

A

supportive treatment only

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13
Q

what does pp65 antigen and cough, fever dyspnea indicate

A

CMV pneumonia

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14
Q

treatment for CMV penumonia

A

gancyclovir

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15
Q

treatment of pertusis

A

macrolides such as erythromycin, azithromycin clarithromycin for all close contacts as well regardless of immunization status

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16
Q

complications of pertusis

A

pneumothorax

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17
Q

what causes whooping cough

A

pertusis

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18
Q

The pertussis vaccination is recommended for all children at

A

2, 4, 6, and 15–18 months, as well as 4–6 years and is routinely administered together with the diphtheria and tetanus vaccine (see ACIP immunization schedule).

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19
Q

alternative to penicillin for tonsillitis

A

macrolide

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20
Q

what is the presentation of pertusis

A

this is whooping cough. violent coughing spells with inspiratory stridor or loud/high-pitched breathing sound. can also cause petechial bleeds in the eyes that presents like conjunctivits with foreign body sensation

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21
Q

treatment of peritonsilar abscess

A

I and D with ampicillin sulbactam

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22
Q

what is given for prevention of RSV

A

palivizumab

short acting monoclonal antibody that provides passive immunity

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23
Q

what is the therapy for tuberculosis

A

Isoniazid, rifampin, pyrazinamide, and ethambutol are antibiotic agents used as standard treatment for active TB. Treatment consists of an initiation phase lasting 2 months, using the 4 antibiotics simultaneously (to increase serum concentration, optimize killing of the bacteria, and minimize the risk of developing antibiotic resistance), followed by a continuation phase with only isoniazid and rifampin use for at least 4 months (to reduce the risk of relapse).

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24
Q

what is a contraindication for the PPD test

A

BCG vaccine

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25
Q

if someone has a positive PPD what is the next step

A

chest xray to determine if this is latent or active

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26
Q

what are lights criteria for pleural effusion

A

For exudates
Pleural fluid protein / Total serum protein >0.5;
Pleural fluid LDH / serum LDH >0.6;
Pleural fluid LDH > (2/3 x upper limit of normal serum LDH).

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27
Q

Exudates usually occur due to

A

inflammation, which leads to leaky capillaries, resulting in protein-rich pleural fluid

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28
Q

what is the outpatient treatment for CAP

A 
Monotherapy with one of the following:
Amoxicillin
Doxycycline
A macrolide (only in areas with a pneumococcal macrolide resistance < 25%)
Azithromycin
Clarithromycin
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29
Q

what puts people with CAP at risk for resistant bacterial CAP

A

E.g., chronic disease of the lung, heart, kidneys, or liver; conditions leading to impaired immune function (e.g., diabetes, malignancy, asplenia, alcohol use disorder); treatment with parenteral antibiotics in the past 90 days

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30
Q

what is the treatment for a CAP with likely resistant bacteria

A 
Combination therapy
An antipneumococcal β-lactam:
Amoxicillin-clavulanate
Cefuroxime
Cefpodoxime
PLUS one of the following:
A macrolide
Azithromycin
Clarithromycin
Doxycycline
Monotherapy: with a respiratory fluoroquinolone 
Gemifloxacin
Moxifloxacin
Levofloxacin
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31
Q

does ertepenem treat Pseudomonas

A

no

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32
Q

treatment of choice for CAP with high suspicion of pseudomonas

A

cefepime and levo.

can use zosyn, meropenem, imipenem and fluoroquinolone

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33
Q

Fever, productive cough, pleuritic chest pain, and crackles are all common features of this postoperative complication, which typically occurs 3–5 days after surgery.

A

pneumonia

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34
Q

what is the managment of a CAP patient with a CURB score of greater than or equal to 2

A

inpatient management
macrolide and antipseudomonal.
or a respiratory fluoroquinolone (levofloxacin

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35
Q

when do we send someone with CAP to the ICU

A

septic shock or acute respiratory failure

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36
Q

what is the presentation of tuberculosis

A

cough, fever, weight loss, productive sputum

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37
Q

what is the best and least invasive way to determine tuberculosis infectino

A

sputum stain

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38
Q

what is the gram description of strep pneumo

A

gram positive diplococcus

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39
Q

what is the gram description o f staph aureus

A

gram positive cocci in clusters

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40
Q

what is the treatment for diaphragmatic rupture

A

emergency surgery if they are unstable

if they are stable then they need to go to CT scan to rule out other injuries.

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41
Q

what is the definition of acute respiratory distress syndrome

A

acute dyspnea, hypoxemia, alveolar or interstitial infiltrates. usually occurs in the context of systemic inflammatory response

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42
Q

what are the immediate measures for epistaxis

A

Fluid resuscitation if the patient is hemodynamically unstable
Keep the patient calm.
Elevate the upper body and bend the patient’s head forward.
Apply cold packs and sustained, direct pressure by pinching the nose at the nostrils for 5–10 minutes in order to occlude the bleeding vessel.
Apply topical vasoconstrictors (e.g., oxymetazoline, phenylephrine)

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43
Q

what is the last step for posterior epistaxis

A

ligation of the sphenopalantine

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44
Q

what is the last step for anterior epistxis

A

ligation of the anterior ethmoidal artery

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45
Q

if epistaxis continues after 10–15 minutes

A

First-line: cauterization of the bleeding vessel using silver nitrate or electrocautery.
Second-line: nasal packing using gauze impregnated with paraffin and antibiotics (covering for Staphylococcus aureus).
Anterior epistaxis: anterior nasal packing
Posterior epistaxis: posterior nasal packing

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46
Q

when laying on your side which lung is better perfused

A

the dependent lung

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47
Q

In pneumonia, there is decreased ventilation of the

A

consolidated portion of the lung due to alveolar inflammation (↓ V).

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48
Q

what is the treatment strategy for flail chest

A

noninvasive positive pressure ventilation or endotracheal intubation

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49
Q

A FEV1 > 1.5L and < 2L with a DLCO of > 60 % of predicted indicates

A

sufficient preoperative lung function.

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50
Q

what is the gold standard for diagnosing bacterial tonsillitis

A

throat culture.

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51
Q

when is tracheostomy used over cricothyroidotomy

A

when the passage is needed long term.

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52
Q

what is bronchiectasis

A

mainly seen in patients with cystic fibrosis and/or recurrent pulmonary infections. It is characterized by copious mucopurulent sputum, characteristically appears as “tram track” lines due to chronic inflammation and fibrosis of bronchial walls, which can progress to honeycombing.

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53
Q

where can aspiration pneumonia present

A

can be anywhere in the lung but usually present in the right lower lobe

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54
Q

what is the next step when suspecting oropharyngeal cancer

A

panendoscopy.

55
Q

what is the most common cause of epiglottis in adults

A

Hib

56
Q

treatmetn for epiglottis

A 
Most sources recommend monotherapy with a third-generation cephalosporin (e.g., cefotaxime, ceftriaxone) or a beta-lactam with a beta-lactamase inhibitor (e.g., ampicillin/sulbactam, amoxicillin/clavulanate, piperacillin/tazobactam
or fluoroquinolone (levofloxacin) for sensitive

also consider steroids

57
Q

bronchopulmonary dysplasia

A

due to barotrauma and oxygen toxicity is a complication of prolonged mechanical ventilation in premature infants, persistent tachypnea, labored breathing (intercostal and subcostal retractions), FiO2 > 30% to maintain peripheral saturation > 90%, and diffuse granular densities with basal atelectasis on x-ray.

58
Q

Treatment of bronchopulmonary dysplasia primarily focuses

A

on limiting oxygen toxicity and preventing complications (specifically pneumothorax, cardiovascular collapse, and neonatal sepsis).

59
Q

what is galactomannan antigen

A

aspergillosis

60
Q

what is the cause of transient tachypnea of the newborn

A

this is due to delayed resorption of lung fluid

61
Q

what is the cause of neonatal respiratory distress syndrome

A

lack of surfactant.
without sufficient surfactant, increased surface tension of alveolar air sacs results in their collapse. The result is respiratory distress (e.g., nasal flaring, expiratory grunting, costal retractions, decreased breath sounds) and bilateral lung opacity on x-ray with low lung volumes and air bronchograms.

62
Q

what is the first step in management of neonatal respiratory distress syndrome

A

continuous positive airway pressure ventilation

63
Q

why is surfactant therapy not initiated immediately for NRDS and intubation

A

because there is increased risk for bronchopulmonary dysplasia.

64
Q

coanal atresia presents how

A

blueish discoloration while feeding with improvement while crying.
there is complete blockage of the bilateral nasal cavities and thus the child cannot breath while feeding

65
Q

what is the confirmatory test for coanal atresia

A

CT scan or supine contrast rhinography

66
Q

what is the treatment for a child with a positive interferon gamma release assay

A

isoniazid

67
Q

what is the presentation and localization of croup

A

raspy voice, barking or unusual cough, high-pitched stridor

inflammation of the subglottic airway

68
Q

what is the localization of laryngiomalacia

A

supraglottic larynx

69
Q

what is the diagnostic test for asthma

A

spirometry

70
Q

what is the atopic triad

A

eczema, asthma, and allergic rhinitis

71
Q

what is the presentation of acute decompensating asthma

A

child presents in an acute asthma attack with subcostal retractions and is given albuterol, steroids, and ipitrpoium. then an hour becomes unresponsive, hypercapnic, lethargic

72
Q

The cardinal symptoms of asthma are

A

intermittent dyspnea, coughing, and high-pitched expiratory wheezing.

73
Q

To remember the meds for asthma exacerbations, think ASTHMA

A

Albuterol, Steroids, Theophylline (rare), Humidified O2, Magnesium (severe exacerbations), Anticholinergics.

74
Q

when do inhaled steroids take effect

A

one week to work

75
Q

The mildest stage of bronchial asthma characterized by symptoms

A

(or the need to use an inhaler) on ≤ 2 days per week, ≤ 2 nighttime awakenings per month, the ability to perform all routine activities, and normal lung function tests in between the exacerbations.

76
Q

what are the pulmonary function test results for asthma

A

Shows signs of obstructive lung disease with increased airway resistance → ↓ FEV1, ↓ Tiffeneau index (FEV1/FVC ratio)
Obstruction is reversible with bronchodilators → diagnostic confirmation via post-bronchodilator test

77
Q

difference between chronic bronchitis and asthma

A

bronchitis cough is chronic and progressive, where asthma is episodic.

bronchitis usually has sputum production that occurs in the morning.

78
Q

diagnosis of chronic bronchitis

A

usually present with (exertional) dyspnea, cough, end-expiratory wheezes, and an obstructive lung pattern on spirometry, which is the case here. must be present for at least 3 months each year for 2 consecutive years

79
Q

what is samter’s triad

A

Samter’s triad is a feature of aspirin-exacerbated respiratory disease (AERD).
symptoms resembling those of a type 1 hypersensitivity reaction (e.g., wheezing, decreased breath sounds, cutaneous flushing) following the administration of aspirin or NSAIDs.
this is a pseudoallergic reaction

80
Q

what is the difference between OSA and obesity hypoventilation syndrome

A

obesity syndrome will occur during the day. There will be hypoercapnea and decreased O2 stats
otherwise they present almost exactly the same.
OHS can be diagnosed in patients with BMI ≥ 30 kg/m2 with symptoms similar to OSA (excessive daytime sleepiness, restless sleep, snoring with apneic episodes) and evidence of daytime alveolar hypoventilation on ABG that cannot be otherwise explained.

81
Q

what is the mechanism of obesity hypoventilation sydnrome

A

diurnal alveolar hypoventilation

82
Q

what is the differential for persistent cough

A

GERD, upper airway cough syndrome and asthma

83
Q

if someone has a persistent cough that does not improve with diphenhydramine what’s on the differential

A

GERD and asthma

84
Q

what is th best first line therpay for upper airway cough syndrome

A

try and antihistamine

can use cetirizine, diphenhydramine

85
Q

ground glass opacity on CXR

A

indicative of infectious process

86
Q

patients with suspected upper air way cough should be empirically treated with what

A

first-gen antihistamine for 2 weeks

87
Q

what is vasomotor rhinitis

A

condition characterized by an increase in blood flow to the nasal mucosa, which results in nasal congestion, rhinorrhea, and postnasal drip. Not attributable to a known allergic process. Triggers include drugs (e.g., NSAIDs), emotional stimuli (e.g., anxiety, excitement), strong odors (e.g., cigarette smoke, perfume), and cold, dry air.

88
Q

what does bilateral calcified pleural plaques indicate

A

asbestosis

89
Q

what is the most likely cancer to be caused by asbestosis

A

bronchogenic carcinoam

90
Q

what are the two most common exposures that cause bronchogenic carcinoma

A

asbestos and smoking

91
Q

Decreased lung compliance is a common finding in individuals with

A

pulmonary fibrosis, pneumothorax, pneumonia, or absence of surfactant (e.g., premature infants).

92
Q

COPD, which is typically associated with increased lung, due to loss of

A

compliance elastic alveolar tissue.

93
Q

what is the cause of cor pulmonale

A

COPD causes hypoxic respiratory vasoconstriction and pulmonary artery hypertension. this eventually causes right heart hypertrophy and failure leading to increased JVD and peripheral edema

94
Q

what is the initial therapy for COPD exacerbation

A

prednisone and albuterol

95
Q

positive polysaccharide antigen test, silver/PAS-staining of tissue samples that show macrophages filled with dimorphic fungi with septate hyphae.

A

histoplasmosis

96
Q

blastomyces infection

A

a fungal infection that is often asymptomatic, but can cause cough, chest pain, and flulike symptoms. endemic to the Mississippi River area
sputum samples stained with KOH show a broad-based fungus without septate hyphae.

97
Q

Aspergillus fumigatus infections cause aspergillosis, which may also present with symptoms of

A

a cough, fever, and malaise.

chronic exposure to the fungus, symptoms usually show a gradual progression rather than the fast onset seen in this patient. Tissue samples further show septate hyphae with a characteristic 45° angle

98
Q

coccidiodes immitis infection

A

symptoms of acute pneumonia (e.g., fever, cough, chest pain). the fungus presents with spherules filled with endospores on KOH stain. the disease is most commonly present in the Southwestern US.

99
Q

Adenocarcinoma is

A

the most common type of lung cancer seen in non-smokers, is much more common in women (6:1), and is usually located peripherally. A solid lesion ≥ 8 mm with irregular margins in a patient > 40 years of age is highly suspicious for this diagnosis.

100
Q

next step after a solitary pulmonary nodule found on X ray that is less than 8mm

A

CT scan to assess for risk of malignancy

101
Q

Radiologic factors that increase the risk for malignancy include

A

large nodule size (> 8 mm), location in the upper lung fields, and irregular, spiculated, or scalloped borders.

102
Q

Clinical risk factors for lung malignancy include

A

age > 40 years, history of smoking or asbestos exposure, and a positive family or personal history of malignancy.

103
Q

what does procalcitionin levels suggest

A

can help differentiate between viral and bacterial causes of illness.
if levels are low then this suggests viral etiology

104
Q

Patients with acute asthma exacerbation generally initially present with respiratory alkalosis (decreased Pco2) due to tachypnea. what are the poor prognostic signs in asthma attack which are usually indicative of pending respiratory failure

A

With worsening airway obstruction and increasing respiratory fatigue, Pco2 increases and pH decreases. The absence of wheezing is also a clue regarding the severity of his condition: wheezing is not heard because there is not enough air movement to generate it.

105
Q

OSA arterial blood gas should be what

A

Borderline low pH, elevated pCO2, elevated serum bicarbonate concentration, and decreased serum chloride concentration are consistent with compensated respiratory acidosis.

106
Q

abdominal pain, dyspnea, alcohol use disorder, and Cullen sign (periumbilical hematoma) suggest

A

acute pancreatitis.

107
Q

what pulmonary issues can be caused by acute pancreatitis

A

acute respiratory distress syndrome

108
Q

what is bronhciolitis obliterans

A

which occurs as a result of repeated cycles of inflammation and scarring in the small airways, is typically due to inhalation of toxic fumes, graft-versus-host disease in lung transplant patients, or chronic lung infections.

109
Q

what is the treatment for asymptomatic sarcoidosis

A

observation. no treatment has to be initiated. the disease has a high rate of remission and can be completely asymptomatic

110
Q

penetrating inijuries below what level get ex lapo

A

below 4th intercostal space

111
Q

clustered air spaces and reticular opacities in the basal lung is indicative of what

A

pulmonary fibrosis

112
Q

what is a SE of amiodarone

A

pulmonary fibrosis

scarring of the extracellular lung matrix

113
Q

what is the first line therpay for vasomotor rhinitis

A

intranasal antihistamine

114
Q

what is the presentation of vasomotor rhinitis

A

rhinorrhea in response to a nasal irritant like perfume or strong emotional trigger

115
Q

indicate bronchiectasis

A

The features of a chronic cough with copious sputum production in a patient with recurrent respiratory tract infections . This diagnosis is confirmed by the CT scan of the chest that shows multiple dilated bronchioles as well as the signet ring sign.

116
Q

what is a risk of bronchiectasis

A

bronchial vessel damage leading to hemoptysis

117
Q

what is the glucose measurement for a pleural exudate

A

< 60 indicates exudative

118
Q

what is the screening system for PE

A

wells score

119
Q

what is the wells score

A 
Clinical symptoms of DVT	3
PE more likely than other diagnoses	3
Previous PE/DVT	1.5
Tachycardia (Heart rate > 100/min)	1.5
Surgery or immobilization in the past 4 weeks	1.5
Hemoptysis
1
Malignancy 	1
120
Q

what effusion does PE cause

A

exudative pleural effusion

121
Q

what is the best management for COPD

A

In patients with COPD, continuous oxygen therapy for ≥18 hours/day reduces the risk of developing pulmonary hypertension and prevents complications that may arise from pulmonary hypertension. Tobacco cessation and oxygen therapy are the only interventions proven to prolong the survival of patients with COPD.

122
Q

what should be administered after an inhalation injury, such as a fire, and why

A

hydroxycobalamin, for cyanoide toxicity
Burning household items (e.g., plastics, furniture, rubber) can release cyanide, which causes toxicity seconds after inhalation. Cyanide binds to the mitochondrial cytochrome complex, which increases anaerobic metabolism and causes lactic acidosis.

123
Q

Features of cyanide toxicity include

A

neurologic symptoms (e.g., confusion, agitation, headache), cardiovascular symptoms (e.g., dysrhythmias, atrioventricular block), and skin flushing.

124
Q

what does increased whispering pectoryloquy indicate

A

a lung consolidation

125
Q

what is the treatment for emyema

A

broad spec antibiotics and chest tube placement t

126
Q

when do you place a chest tube for empyema

A

A pleural fluid pH < 7.20 or glucose < 60 mg/dL indicates that effusion very likely requires drainage because these are signs of empyema formation, and empyemas are unlikely to resolve spontaneously.

127
Q

what to look for if after intubation someone comes bak complaining of progressive dyspnea

A

laryngoscope to see if there damage/infalmmation due to intubation

128
Q

clinical features of atelectasis

A

Large number of affected alveoli or rapid onset → acute dyspnea, chest pain, tachypnea, tachycardia, and cyanosis
Dull percussion note, diminished breath sounds, and decreased fremitus over the affected lung
Possibly tracheal deviation towards the side of lesion

129
Q

arterial blood gas for atelectasis

A

Arterial blood gas analysis: hypoxemia, potentially low PaCO2, and respiratory alkalosis
Alveoli that are unable to participate in gas exchange → increased alveolar dead space → increased physiologic dead space

130
Q

Chest x-ray and CT for atelectasis:

A

evidence of lobar collapse
Direct signs: displacement of fissures and homogeneous opacification of the collapsed lobe
Indirect signs
Elevation of ipsilateral diaphragm
Displacement of the hilum and mediastinal structures towards the affected side
Loss of volume in the affected side of the chest
Increased lucency and overinflation of the unaffected lung; silhouetting of the diaphragm or the heart border

131
Q

treatment for atelectasis

A

Adequate analgesia
Early mobilization
Lung expansion maneuvers that increase positive end-expiratory pressure (PEEP)
Deep breathing exercises
Directed coughing
Intermittent incentive spirometry
Continuous positive airway pressure (CPAP) for patients unable to perform deep breathing exercises.

132
Q

what is bronchiectasis

A

irreversible and abnormal dilation in the bronchial tree that is generally caused by cycles of bronchial inflammation in addition to mucous plugging and progressive airway destruction

133
Q

The most important clinical finding in bronchiectasis is

A

a chronic cough with copious mucopurulent sputum.

Other symptoms may include dyspnea, rhinosinusitis, and hemoptysis.

step II (22 decks)

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