EXAM #2: REVIEW Flashcards
In a previously healthy patient with no comorbidities, what is the recommended treatment for CAP?
1) Macrolide i.e.
- Erythromycin
- Azithromycin
- Clindamycin
OR
2) Doxycycline
What organisms most commonly cause a lobar pneumonia?
1) S. pneumoniae
2) K. pneumoniae
What organisms are most commonly associated with atypical pneumonia?
1) Mycoplasma pneumoniae
2) Chlamydia pneumoniae
3) RSV
4) CMV
5) Influenza
6) Coxiella burnetii
If a patient has comorbidities associated with CAP, what is the recommended treatment?
1) Oral respiratory fluoroquinolone
OR
2) Macrolide + Beta-lactam antibiotic
What are the four circumstances when identification of the causative organism in pneumonia is critical?
1) Legoniella pneumophila
2) Influenza A/B virus
3) MRSA
4) Agents of bioterrorism
What are the treatment recommendations for a patient with CAP that requires ICU admission?
1) Antipseudomonal beta-lactam PLUS azithromycin
OR
2) Antipseudomonal beta-lactam PLUS respiratory fluroquinolone
List the organisms associated with bronchopneumonia.
1) S. aureus
2) H. influenza
3) P. aeruginosa
4) M. catarrhalis
5) L. pneumophila
List the situations in which a sputum culture and gram stain are a good idea in CAP.
1) ICU admission
2) Failed outpatient therapy
3) Cavitary changes seen on x-ray
4) Immunocompromised patient
5) Alcoholic
If primary TB is symptomatic, what are the most common symptoms?
1) Fever
2) Chest pain w/ pleural effusion
What stain is used to diagnose tuberculous mengintitis?
Ziehl Neelsen stain
What medical conditions are considered high risk for TB?
1) Silicosis
2) DM
3) Chronic renal failure
4) S/p gastrectomy/jejuoileal bypass
If a patient is immunocompromised from organ transplant versus HIV, how does their predisposition to CMV related illnesses differ?
Transplant= pneumonitis and gastritis
HIV= retinitis
What is FluBlock? What is unique about FluBlock?
FluBlock= IM recombinant flu vaccine from INSECT eggs
*Vaccine of choice for patients with an egg allergy
What is unique about Flucelvax?
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
What five symptoms are associated with CMV pneumonitis?
1) Spiking fever
2) Malaise
3) Lethargy
4) Myalgia
5) Arthralgia
What five viruses are responsible for the more severe lower respiratory tract infections?
1) RSV
2) Parainfluenza virus
3) Influenza
4) HSV
5) CMV
What physical exam findings are associated with CMV pneumonitis?
1) Pneumonitis
2) Leukopenia
3) Hepatitis
4) Thrombocytopenia
What are the physical exam findings associated with histoplasmosis?
Rales and possible consolidation
What are the two species of Coccidioides? How does their geographic distribution differ?
C. immitis= CA
C. posadasii= Non-CA southwestern US states
In symptomatic cases of histoplasmosis, what it the typical presentation?
Subacute non-specific respiratory symptoms
What are the specific types of serology used to diagnose histoplasmosis?
1) Complement fixation
2) Immunodiffusion
What are the expected CXR findings in histoplasmosis?
1) Hilar and mediastinal lymphadenopathy
2) Calcified granulomas
What is the classic presentation of pulmonary coccidioides?
CAP with erythema nodosum and erythema multiforme
List five clinical syndromes associated with histoplasmosis.
1) Brconholithiasis
2) Mediastinal granulomas
3) Fibrosing mediastinitis
4) Pericarditis
5) RA
What is the pulmonary presentation of diffuse Scleroderma?
- Inspiratory crackles
- Restrictive lung pathology
What are the two most common presentations with Sjogren’s Syndrome involving the lung?
1) Bronchiectasis
2) Bronchiolitis
List the seven indications for systemic steroids in Sarcoidosis.
1) Cardiac involvement
2) Ocular disease
3) Neurologic disese
4) Hypercalcemia
5) Lupus pernio
6) Symptomatic stage II
7) Stage III
What will biopsy of Wegener’s Granulomatosis reveal?
Large necrotizing granulomas with adjacent necrotizing vasculitis
What is the expected CXR in RLD?
1) Cavity nodules (ddx. TB)
2) Interstitial disease
What is the triad of Churg-Strass Syndrome?
1) Asthma
2) Hypereosinophilia
3) Necrotizing vasculitis
Aside from serositis, what other pathologies are associated with SLE involving the lung?
1) Pneumonitis
2) Alveolar hemorrhage
3) Diaphragmatic dysfunction
4) DVT/PE*****
What is the classic presentation of a patient with Wegener’s Granulomatosis?
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
What are five sigs/sx. of RLD?
1) Non-productive cough
2) Dyspnea on exertion
3) Clubbing
4) Fine inspiratory crackles
5) Pleural rub
What typically causes pneumonitis?
Viruses and fungi
What major factors diminish host resistance to infection/pnuemonia?
1) Chronic disease
2) Immunodeficiency
3) Immunosuppression/ leukopenia
4) Lifestyle i.e. smoking
What are the indications for hospitalization in CAP?
1) Severe dyspnea or hypoxemia
2) Empyema
3) Significant underlying disease
4) Systemic manifestation of infection e.g delirium
What is the treatment of choice for mycoplasma or chlamydia pneumonia?
Erythromycin
What are the four typical causes of chronic pneumonia?
1) TB
2) Fungi
3) Parasites
4) Atypical bacteria
What are Schaumann bodies? What disease are they associated with?
Calcifications usually seen in giant cells
*Seen in Sarcoidosis
Describe the pathogenesis of Silo fillers lung.
This is pulmonary edema and bronchiolitis obliterans associated with breathing toxic gas from silos
How does Sarcoidosis appear microscopically?
Stellate inclusions with multi-nuclear giant cells
What are Asteroid bodies? What are they associated with?
Star-shaped eosinophilic intermediate filaments in multi-nuclear giant cells
*Associated with Sarcoidosis
List four signs of laryngotracheobronchitis.
1) Stridor
2) Retractions of the chest wall
3) Nasal flaring
4) Barking cough
What is the definition of severe sinusitis?
1) Fever over 102.2 for 3x days
2) Mucus that is thick, cloudy, or colored
What is the criteria for hospital admission in the patient with croup?
Stridor refractory to racemic epinephrine
How do you tell the difference between a coin the trachea vs. the esophagus?
asdf
What bacterial species most commonly cause a retropharyngeal abscess?
1) S. pyogenes
2) Oral anaerobes
3) S. aureus
What are four signs of a retropharyngeal abscess>
1) Torticollis
2) Trismus
3) Drooling
4) Stridor
What age group is a retropharyngeal abscess most common in?
kids less than 3 y/o
What symptoms are associated with a retropharyngeal abscess?
1) Fever
2) Sore throat
3) Neck pain
4) Progressive dysphagia
5) Respiratory distress
If a child is under ____, they should be admitted for pertussis.
6 months
Describe the classic presentation of chlamydia trachomatis pneumonia.
1) Conjunctivitis
2) Pneumonia
3) Repetitive staccato cough
4) No fever, no wheezing
*All under 4 months old
How is mycoplasma pneumonia diagnosed?
1) Cold agglutinins
2) Mycoplasma titers
Outline the presentation of RSV.
- Rhinorrhea
- Sneezing
- Coughing
- Moderate respiratory distress
- Nasal flaring
What is the treatment of choice for outpatient management of mycoplasma pneumonia? What about inpatient?
Outpatient= macrolides
Inpatient= macrolide plus cephalosporin
What are six possible physical signs associated with a pleural effusion?
1) Hypoxia
2) Tachypnea
3) Dullness to percussion
4) Decreased breath sounds
5) Bronchial breathing
6) Mediastinal shift
List five hallmark symptoms associated with lung cancer. What is the most important?
1) Cough
2) Hemoptysis
3) Dyspnea
4) Various paraneoplastic syndromes
5) Weight loss*
Describe the gross appearance of squamous cell lung cancer.
Cavitary mass with extensive central necrosis
Grossly, how does large cell lung cancer appear when it presents?
Large peripheral necrotic mass
Aside from smoking, what other exposures are associated with lung cancer?
1) Asbestos
2) Industrial hazards
3) Aromatic hydrocarbons
What are the two types of adenocarcinoma in the lung?
1) Bronchial
2) Bronchioalveolar
According to Dr. Carnevale, what is the most common benign lesion of the lung?
Granuloma from TB or fungus e.g. histoplasmosis in Iowa
What are the top four causes of pleural exudate?
1) Microbial invasion
2) Cancer
3) Pulmonary infarction
4) Viral pleuritis
What are the four major causes of hypercapnia?
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
What are four causes of an increased A-a gradient?
1) Shunting
2) V/Q mismatch
3) Aging
4) Diffusion impairment
What are five clinical indications of chronic respiratory failure?
1) Polycythemia
2) Elevated CO2
3) Normal pH with elevated PaCO2
4) Elevated bicarbonate
5) Clubbing
List four drawbacks to increased airway pressure.
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
What are the indications for oxygen via high flow nasal cannula?
1) Hypoxic respiratory failure
2) Claustrophobia
3) Intolerant of NIV
4) Palliation
What are the contraindications for oxygen via high flow nasal cannula?
1) Shock
2) Hypercapnia
3) NM respiratory failure
4) Tachypnea
5) Inability to protect the airway
What are the contraindications to NIV?
1) Comatose/somnolent
2) Increased secretions
3) Bleeding
4) Vomiting
5) Unstabile/ shock
6) ARDS
7) Cannot wear mask
What are four indications for NIV?
1) AECOPD
2) CHF
3) Neuromuscular failure
4) Immunocompromised with pneumonia
What the contraindications to ECMO/ ECLS?
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
What are the indications to liberate a patient from the ventilator?
1) Improved clinical status
2) Stable
3) Awake and interactive patient
4) Secretions are well controlled
5) Normal oxygenation
With exposure to 100% oxygen for 12-24 hours, what is the physiologic response of the body?
Decreased vital capacity
With exposure to 100% oxygen for 24-36 hours, what is the physiologic response of the body?
1) Decreased lung compliance
2) Increased A-a gradient
What are four very ominous signs in hypoxia?
1) Cyanosis
2) Bradycardia/ arrhythmia
3) Hypotension
4) Somnolence
With exposure to 100% oxygen for 30-72 hours, what is the physiologic response of the body?
Decreased diffusion capacity
What are the major risk factors for OSA?
1) Obesity
2) Family history
3) Treatment resistant HTN
4) CHF
5) A-fib
6) CVA
7) DM-II
What are five basic interventions that can be done to help alleviate the symptoms of OSA?
1) Weight loss
2) Exercise
3) Lateral body position
4) Smoking cessation
5) Avoidance of sedatives
