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Undeleted > Exam 2 Clinical > Flashcards

Exam 2 Clinical Flashcards

1
Q

Pneumonia sputum types and bug causing it

A

rust colored- strep pneumo
currant jelly-klebsiella
scant,watery-mycoplasma
foul smelling-anaerobic

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2
Q

CXR and findings/bug causing it

A 
lobar-bacterial
diffuse-viral/legionella/pneumocystis
interstitial-mycoplasma
multiple nodules-staph aureus
cavitation-staph aureus
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3
Q

Abnormal labs with legionnaires disease

A

hyponatremia

hypophosphatemia

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4
Q

Mycoplasma pneumo demographic

A

college students

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5
Q

Nosocomial acquired pneumonia definition

A

after 48hrs of being admitted

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6
Q

Risks for acquiring pseudomonas pneumonia

A

structural lung disease
steroids
recent broad spectrum antibiotics

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7
Q

Use of pneumovax

A

over 65 y/o

2-64 y/o with chronic illness

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8
Q

Use of influenza vaccine

A

over 50 y/o
6mo-64 yrs with chronic illness
pregnancy with flu season

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9
Q

Pattern of idiopathic pulmonary fibrosis damage

A

usual interstitial pneumonia

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10
Q

Sx of idiopathic pulmonary fibrosis

A

progressive respiratory failure (3-8yrs)
velco rales
paroxysmal cough

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11
Q

CXR with idiopathic pulmonary fibrosis

A

honeycombing

infiltrates at base of the lung

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12
Q

Cause of desquamative interstitial pneumonitis

A

inhaled stimulants

dense macrophages in airspace

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13
Q

Demographics for sarcoidosis

A

blacks

females

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14
Q

Abnormal labs with sarcoidosis

A

hypercalcemia

increased ACE levels in serum

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15
Q

Tx for sarcoidosis

A

corticosteroids

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16
Q

Cause of hypersensitivity pneumonitis

A

repeated exposure to organic dust

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17
Q

Cause of increased TB since the 1980’s

A

AIDS

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18
Q

Tuberculin skin test

A

type IV hypersenitivity

48-72hrs

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19
Q

TST positivity and pt

A

> 5mm for AIDS/immunosuppressed/abn CXR
10mm for healthcare/under 4 yrs/foreign born or increased risk (silicosis/DM/cancer)
15mm for healthy people

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20
Q

Dx of TB

A

culture is gold standard (7wks)

interferon-gamma for latent TB (BCG does not effect)

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21
Q

1st line tx for TB

A 
RIPE(S)
Rifampin
Isoniazid
Pyrazinamide
Ethambutol
Streptomycin
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22
Q

Immune reconstitution inflammatory syndrome

A

AIDS pt with TB
antivirals reactivate immune system
causes pt to have sx of illness

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23
Q

Abnormal labs seen in miliary TB

A

pancytopenia

hyponatremia

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24
Q

Selecting tidal volume for a pt

A

6-8cc of air/kg

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25
Q

What is SIMV in regards to ventilation?

A

synchronous intermittent mechanical ventilation
used for weaning pts off the ventilator
is uncomfortable for pt

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26
Q

Best way to wean pt off ventilator

A

pressure support

helps pt open alveoli during initial inspiration

27
Q

What is automatic flow on ventilators?

A

computer continually finds most optimal tidal volume pattern for pt

28
Q

Problems arising from ventilators

A 
overdistention of lung (birds beak on flow/volume)
flow starvation (decreased airway pressure)
ineffective triggering (wasted efforts)
29
Q

Use of peak end expiratory pressure and possible problem with it

A

Keep alveoli open at end of expiration

air trapping/increased FRC

30
Q

Drug used for rapid awakening

A

propofol

31
Q

Drugs used for acute agitation

A

lorazepam/diazepam

32
Q

Adverse effects of propofol

A

lactic acidosis
renal failure
decicated line needed
pancreatitis (monitor TG’s)

33
Q

Lung adenocarcinoma location/risk

A

peripheral location
metastasizes to brain
most common type

34
Q

Lung SSC location/lab finding

A

central location

hypercalcemia

35
Q

Small cell lung carcinoma location/findings

A

central location
SIADH
Eaton-Lambert syndrome

36
Q

Bronchalveolar cell carcinoma

A 
lepidic growth (along alveoli)
peripheral location
37
Q

Limitations of CT/PET scans for cancer of the lung

A

must be over 1cm
false (-) with diabetics
false (+) with infection

38
Q

Management of nodules under 8mm in lung for low risk pts

A

under 4mm-no follow up
4-6mm-follow up CT in 1 yr
6-8mm-follow up CT 6-12mo and 18-24mo
over 8mm-CT at 3,9 and 24 mo, bx

39
Q

Management of nodules under 8mm in lung for high risk pts

A

under 4mm-CT in 12 mo
4-6mm-CT 6-12mo, then 18-24 mo
6-8mm-CT 3-6mo, then 9-12, then 24mo
over 8mm-CT 3,9,24mo, bx

40
Q

Findings with cystic fibrosis

A

decreased FEV1/FEV ratio

41
Q

Best tx for cystic fibrosis

A 
tobramycin (pseudomonas)
human DNase (decrease mucus thickness)
hypertonic saline (increase hydration)
42
Q

Worst bug for cystic fibrosis

A

Burkholderia cepacia
cannot get rid of once acquired
low survival

43
Q

Goal antibiotic use in CF

A

eradicate pseudomonas early

44
Q

Contraindication for lung transplant with CF

A

Burkholderia cepacia infection

45
Q

What can cause false readings on pulse oximetry?

A

carboxyhemoglobin

methemoglobin

46
Q

Measurement of oropharyngeal airway

A

center of mouth to angle of mandible

47
Q

Measurement of nasopharyngeal airway

A

nostril to pts ear lobe

48
Q

Bag valve mask ventilation flow/timeframe

A

oxygen flow at 12L/min

ventilation every 5 seconds

49
Q

Rapid sequence induction

A

for pts with intact gag reflex
lidocaine pretx
succinylcholine + versed (or etomidate if hypotensive)

50
Q

Endotracheal size/depth for peds

A

age/4 + 4mm

depth is 3x size in cm

51
Q

Surgical airway procedure

A

not for children under 12 y/o

piece the cricothyroid cartilage

52
Q

Endotracheal intubation in peds requirement

A

only use Miller blade

53
Q

Tension pneumothorax tx

A

decompression: 2nd midclavicular intercostal space

chest tube in 4/5th mixaxillary intercostal space

54
Q

Tx for open pneumothorax

A

airtight dressing taped on 3 sides (flutter valve)

55
Q

Sx seen with cardiac tamponade

A

Kussmaul’s sign
pulsus paradoxus
Beck’s Triad

56
Q

Tx for cardica tamponade

A

pericardiocentesis

1-2cm inf xiphoid on L at 45 degree angle toward scapula

57
Q

Common site for aortic disruption

A

ligamentum arteriosus

58
Q

Cause of transudate in pleura space

A

cardiac/renal/liver problems

59
Q

What needs to be done on all fluid analysis?

A

cell count/differential
culture
chemistry
cytology

60
Q

Crackles in the lung

A

from opening of alveoli

inspiration

61
Q

Rhonchi in the lung

A

excess secretions in large airways

inspiration and expiration

62
Q

Wheezes in the lung

A

from narrowing of small airways
musical/high pitched
expiration mostly

63
Q

Pleural friction rub in the lung

A

harsh/scratching sound

inspiration and expiration

64
Q

Stridor in the lungs

A

stenosis of the large airways
high pitched
inspiration only

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