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Respiratory > EXAM #2: REVIEW > Flashcards

EXAM #2: REVIEW Flashcards

1
Q

In a previously healthy patient with no comorbidities, what is the recommended treatment for CAP?

A

1) Macrolide i.e.
- Erythromycin
- Azithromycin
- Clindamycin

OR
2) Doxycycline

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2
Q

What organisms most commonly cause a lobar pneumonia?

A

1) S. pneumoniae

2) K. pneumoniae

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3
Q

What organisms are most commonly associated with atypical pneumonia?

A

1) Mycoplasma pneumoniae
2) Chlamydia pneumoniae
3) RSV
4) CMV
5) Influenza
6) Coxiella burnetii

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4
Q

If a patient has comorbidities associated with CAP, what is the recommended treatment?

A

1) Oral respiratory fluoroquinolone

OR
2) Macrolide + Beta-lactam antibiotic

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5
Q

What are the four circumstances when identification of the causative organism in pneumonia is critical?

A

1) Legoniella pneumophila
2) Influenza A/B virus
3) MRSA
4) Agents of bioterrorism

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6
Q

What are the treatment recommendations for a patient with CAP that requires ICU admission?

A

1) Antipseudomonal beta-lactam PLUS azithromycin

OR
2) Antipseudomonal beta-lactam PLUS respiratory fluroquinolone

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7
Q

List the organisms associated with bronchopneumonia.

A

1) S. aureus
2) H. influenza
3) P. aeruginosa
4) M. catarrhalis
5) L. pneumophila

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8
Q

List the situations in which a sputum culture and gram stain are a good idea in CAP.

A

1) ICU admission
2) Failed outpatient therapy
3) Cavitary changes seen on x-ray
4) Immunocompromised patient
5) Alcoholic

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9
Q

If primary TB is symptomatic, what are the most common symptoms?

A

1) Fever

2) Chest pain w/ pleural effusion

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10
Q

What stain is used to diagnose tuberculous mengintitis?

A

Ziehl Neelsen stain

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11
Q

What medical conditions are considered high risk for TB?

A

1) Silicosis
2) DM
3) Chronic renal failure
4) S/p gastrectomy/jejuoileal bypass

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12
Q

If a patient is immunocompromised from organ transplant versus HIV, how does their predisposition to CMV related illnesses differ?

A

Transplant= pneumonitis and gastritis

HIV= retinitis

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13
Q

What is FluBlock? What is unique about FluBlock?

A

FluBlock= IM recombinant flu vaccine from INSECT eggs

*Vaccine of choice for patients with an egg allergy

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14
Q

What is unique about Flucelvax?

A

Innactivated flu vaccine made from Madin Darby Canine Kidney cell line, BUT not the BEST vaccine to give to patient with egg allergy

*See Flublock

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15
Q

What five symptoms are associated with CMV pneumonitis?

A

1) Spiking fever
2) Malaise
3) Lethargy
4) Myalgia
5) Arthralgia

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16
Q

What five viruses are responsible for the more severe lower respiratory tract infections?

A

1) RSV
2) Parainfluenza virus
3) Influenza
4) HSV
5) CMV

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17
Q

What physical exam findings are associated with CMV pneumonitis?

A

1) Pneumonitis
2) Leukopenia
3) Hepatitis
4) Thrombocytopenia

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18
Q

What are the physical exam findings associated with histoplasmosis?

A

Rales and possible consolidation

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19
Q

What are the two species of Coccidioides? How does their geographic distribution differ?

A

C. immitis= CA

C. posadasii= Non-CA southwestern US states

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20
Q

In symptomatic cases of histoplasmosis, what it the typical presentation?

A

Subacute non-specific respiratory symptoms

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21
Q

What are the specific types of serology used to diagnose histoplasmosis?

A

1) Complement fixation

2) Immunodiffusion

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22
Q

What are the expected CXR findings in histoplasmosis?

A

1) Hilar and mediastinal lymphadenopathy

2) Calcified granulomas

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23
Q

What is the classic presentation of pulmonary coccidioides?

A

CAP with erythema nodosum and erythema multiforme

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24
Q

List five clinical syndromes associated with histoplasmosis.

A

1) Brconholithiasis
2) Mediastinal granulomas
3) Fibrosing mediastinitis
4) Pericarditis
5) RA

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25
Q

What is the pulmonary presentation of diffuse Scleroderma?

A
  • Inspiratory crackles

- Restrictive lung pathology

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26
Q

What are the two most common presentations with Sjogren’s Syndrome involving the lung?

A

1) Bronchiectasis

2) Bronchiolitis

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27
Q

List the seven indications for systemic steroids in Sarcoidosis.

A

1) Cardiac involvement
2) Ocular disease
3) Neurologic disese
4) Hypercalcemia
5) Lupus pernio
6) Symptomatic stage II
7) Stage III

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28
Q

What will biopsy of Wegener’s Granulomatosis reveal?

A

Large necrotizing granulomas with adjacent necrotizing vasculitis

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29
Q

What is the expected CXR in RLD?

A

1) Cavity nodules (ddx. TB)

2) Interstitial disease

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30
Q

What is the triad of Churg-Strass Syndrome?

A

1) Asthma
2) Hypereosinophilia
3) Necrotizing vasculitis

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31
Q

Aside from serositis, what other pathologies are associated with SLE involving the lung?

A

1) Pneumonitis
2) Alveolar hemorrhage
3) Diaphragmatic dysfunction
4) DVT/PE*****

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32
Q

What is the classic presentation of a patient with Wegener’s Granulomatosis?

A

A middle aged male that presents with:

1) Sinusitis
2) Hemoptysis
3) Bilateral nodular lung infiltrates
4) Hematuria

*This is a necrotizing granulomatous vasculitis involving the nasopharyx, lungs, and kidneys

33
Q

What are five sigs/sx. of RLD?

A

1) Non-productive cough
2) Dyspnea on exertion
3) Clubbing
4) Fine inspiratory crackles
5) Pleural rub

34
Q

What typically causes pneumonitis?

A

Viruses and fungi

35
Q

What major factors diminish host resistance to infection/pnuemonia?

A

1) Chronic disease
2) Immunodeficiency
3) Immunosuppression/ leukopenia
4) Lifestyle i.e. smoking

36
Q

What are the indications for hospitalization in CAP?

A

1) Severe dyspnea or hypoxemia
2) Empyema
3) Significant underlying disease
4) Systemic manifestation of infection e.g delirium

37
Q

What is the treatment of choice for mycoplasma or chlamydia pneumonia?

A

Erythromycin

38
Q

What are the four typical causes of chronic pneumonia?

A

1) TB
2) Fungi
3) Parasites
4) Atypical bacteria

39
Q

What are Schaumann bodies? What disease are they associated with?

A

Calcifications usually seen in giant cells

*Seen in Sarcoidosis

40
Q

Describe the pathogenesis of Silo fillers lung.

A

This is pulmonary edema and bronchiolitis obliterans associated with breathing toxic gas from silos

41
Q

How does Sarcoidosis appear microscopically?

A

Stellate inclusions with multi-nuclear giant cells

42
Q

What are Asteroid bodies? What are they associated with?

A

Star-shaped eosinophilic intermediate filaments in multi-nuclear giant cells

*Associated with Sarcoidosis

43
Q

List four signs of laryngotracheobronchitis.

A

1) Stridor
2) Retractions of the chest wall
3) Nasal flaring
4) Barking cough

44
Q

What is the definition of severe sinusitis?

A

1) Fever over 102.2 for 3x days

2) Mucus that is thick, cloudy, or colored

45
Q

What is the criteria for hospital admission in the patient with croup?

A

Stridor refractory to racemic epinephrine

46
Q

How do you tell the difference between a coin the trachea vs. the esophagus?

A

asdf

47
Q

What bacterial species most commonly cause a retropharyngeal abscess?

A

1) S. pyogenes
2) Oral anaerobes
3) S. aureus

48
Q

What are four signs of a retropharyngeal abscess>

A

1) Torticollis
2) Trismus
3) Drooling
4) Stridor

49
Q

What age group is a retropharyngeal abscess most common in?

A

kids less than 3 y/o

50
Q

What symptoms are associated with a retropharyngeal abscess?

A

1) Fever
2) Sore throat
3) Neck pain
4) Progressive dysphagia
5) Respiratory distress

51
Q

If a child is under ____, they should be admitted for pertussis.

A

6 months

52
Q

Describe the classic presentation of chlamydia trachomatis pneumonia.

A

1) Conjunctivitis
2) Pneumonia
3) Repetitive staccato cough
4) No fever, no wheezing

*All under 4 months old

53
Q

How is mycoplasma pneumonia diagnosed?

A

1) Cold agglutinins

2) Mycoplasma titers

54
Q

Outline the presentation of RSV.

A
  • Rhinorrhea
  • Sneezing
  • Coughing
  • Moderate respiratory distress
  • Nasal flaring
55
Q

What is the treatment of choice for outpatient management of mycoplasma pneumonia? What about inpatient?

A

Outpatient= macrolides

Inpatient= macrolide plus cephalosporin

56
Q

What are six possible physical signs associated with a pleural effusion?

A

1) Hypoxia
2) Tachypnea
3) Dullness to percussion
4) Decreased breath sounds
5) Bronchial breathing
6) Mediastinal shift

57
Q

List five hallmark symptoms associated with lung cancer. What is the most important?

A

1) Cough
2) Hemoptysis
3) Dyspnea
4) Various paraneoplastic syndromes
5) Weight loss*

58
Q

Describe the gross appearance of squamous cell lung cancer.

A

Cavitary mass with extensive central necrosis

59
Q

Grossly, how does large cell lung cancer appear when it presents?

A

Large peripheral necrotic mass

60
Q

Aside from smoking, what other exposures are associated with lung cancer?

A

1) Asbestos
2) Industrial hazards
3) Aromatic hydrocarbons

61
Q

What are the two types of adenocarcinoma in the lung?

A

1) Bronchial

2) Bronchioalveolar

62
Q

According to Dr. Carnevale, what is the most common benign lesion of the lung?

A

Granuloma from TB or fungus e.g. histoplasmosis in Iowa

63
Q

What are the top four causes of pleural exudate?

A

1) Microbial invasion
2) Cancer
3) Pulmonary infarction
4) Viral pleuritis

64
Q

What are the four major causes of hypercapnia?

A

1) Hypoventilation e.g.
- Neuromuscular disorder
- CNS depression
2) Increased CO2 production from sepsis, trauma, burns…etc.
3) Airway obstruction
4) Impairment of respiratory muscles

65
Q

What are four causes of an increased A-a gradient?

A

1) Shunting
2) V/Q mismatch
3) Aging
4) Diffusion impairment

66
Q

What are five clinical indications of chronic respiratory failure?

A

1) Polycythemia
2) Elevated CO2
3) Normal pH with elevated PaCO2
4) Elevated bicarbonate
5) Clubbing

67
Q

List four drawbacks to increased airway pressure.

A

1) Increased deadspace from overdistended alveoli
2) Increased intrathoracic pressure decreased venous return, CO, and oxygen delivery
3) VALI from overstretching the alveoli
4) Barotrauma

68
Q

What are the indications for oxygen via high flow nasal cannula?

A

1) Hypoxic respiratory failure
2) Claustrophobia
3) Intolerant of NIV
4) Palliation

69
Q

What are the contraindications for oxygen via high flow nasal cannula?

A

1) Shock
2) Hypercapnia
3) NM respiratory failure
4) Tachypnea
5) Inability to protect the airway

70
Q

What are the contraindications to NIV?

A

1) Comatose/somnolent
2) Increased secretions
3) Bleeding
4) Vomiting
5) Unstabile/ shock
6) ARDS
7) Cannot wear mask

71
Q

What are four indications for NIV?

A

1) AECOPD
2) CHF
3) Neuromuscular failure
4) Immunocompromised with pneumonia

72
Q

What the contraindications to ECMO/ ECLS?

A

1) Condition that is incompatible with life after recovery
2) Pre-existing conditions
3) Age/size
4) Futility
5) Lethal chromosome abnormalities
6) More than 60% TSA grade III burns

73
Q

What are the indications to liberate a patient from the ventilator?

A

1) Improved clinical status
2) Stable
3) Awake and interactive patient
4) Secretions are well controlled
5) Normal oxygenation

74
Q

With exposure to 100% oxygen for 12-24 hours, what is the physiologic response of the body?

A

Decreased vital capacity

75
Q

With exposure to 100% oxygen for 24-36 hours, what is the physiologic response of the body?

A

1) Decreased lung compliance

2) Increased A-a gradient

76
Q

What are four very ominous signs in hypoxia?

A

1) Cyanosis
2) Bradycardia/ arrhythmia
3) Hypotension
4) Somnolence

77
Q

With exposure to 100% oxygen for 30-72 hours, what is the physiologic response of the body?

A

Decreased diffusion capacity

78
Q

What are the major risk factors for OSA?

A

1) Obesity
2) Family history
3) Treatment resistant HTN
4) CHF
5) A-fib
6) CVA
7) DM-II

79
Q

What are five basic interventions that can be done to help alleviate the symptoms of OSA?

A

1) Weight loss
2) Exercise
3) Lateral body position
4) Smoking cessation
5) Avoidance of sedatives

Respiratory (35 decks)

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