Final Flashcards
Pass
1
Q
What drug is linked to PH?
A
Fen-Phen
2
Q
What are the CXR findings in PH?
A
peripheral hypervascularity, prominent central pulmonary artery, RV enlargement, prominent right descending pulmonary artery
3
Q
Describe the PFT in patients with PH?
A
classicly: normal except reduction in DLCO, as well as findings of the primary cause(i.e., COPD)
4
Q
What findings would be seen on the echo of a PH patient?
A
increased estimated PA preasures, RA & RV enlargement
5
Q
What is the common treatment of PH?
A
treat the underlying cause
6
Q
Is idiopathic PH common or uncommon?
A
uncommon
7
Q
What is group 1 PH related to?
A
idiopathic and cumulative trauma disorder (CTD)
8
Q
What is group 2 PH related to?
A
heart disease
9
Q
What is group 3 PH related to?
A
lung disease
10
Q
What is group 4 PH related to?
A
pulmonary emboli
11
Q
What is group 5 PH related to?
A
all others besides 1-4
12
Q
How are PH and IHD similar?
A
exertional dyspnea, elevated BNP, lack of asociated Sx
13
Q
How are PH and IHD different?
A
PAH has increased P2, difference on CXR, echo and ECG
14
Q
What tests can be done for PH?
A
6-minute walk test at the beginning and periodically after, serial echos and right heart caths as well
15
Q
What history findings give clues for OSA?
A
Impaired daytime attention(MVAS, memory issues, sleepiness) snoring, witnessed apnea, mood changes
Must screen obese patients with depression
16
Q
What clinical presentation is seen in OSA patients?
A
obesity, large neck circumference, nasal obstruction, enlarged tonsils, narrow oropharynx, large tongue, small jaw, short jaw
don’t rule out non-obese patients
17
Q
What DDx should you include for OSA?
A
COPD, asthma, hypothyroidism, depression, narcolepsy, central sleep apnea, poor sleep hygiene, meds, pickwickian syndrome, laryngospasms(GERD)
18
Q
What are the management goals for OSA?
A
improve daytime sleepiness and cognitive performance, prevent long-term sequelae
19
Q
What tools can manage OSA?
A
Lifestyle modifications, CPAP
20
Q
How does treating daytime sleepiness improve OSA?
A
decreased daytime somnolence, improved mood and depression, high QOL scores, lowered traffic accidents
21
Q
Why should long term sequelae be treated?
A
OSA increases CA 2.5x, four times more likely to have CVA or die over non-OSA patients
22
Q
What lifestyle changes are effective for OSA?
A
losing 10% or more of BW, avoid EtOH and sedatives 3-4 prior to bed, lateral decubitus sleeping position(protect airway), intranasal steroids for congestion
23
Q
When should nocturnal CPAP be used and why?
A
if Sx persist after modifications, works to prop airway open with air and increases intraluminal pressure and FRC
24
Q
What do you consider if nocturnal CPAP is not tolerated or working?
A
BiPAP has two pressures, one for inhalation and another for exhalation, improves comfort and adherence
25
What other tools can be used outside of PAP to treat OSA?
mandibular assist device, upper airway surgery: UPPP
26
How does mandibular assist work?
pulls lower jaw and tongue forward, can eliminate PAP machines
27
What are features of uvulopalatopharyngoplasty?
removes obstruction to airway, most common of upper airway surgeries, cut out the uvula and palate
28
Where is the spectrum of COPD?
between emphysema and chronic bronchitis
29
What is the Medical Research Council Dyspnea Scale?
describes breathlessness and grades the disease, part of BODE
30
What are MRCDS grades 0 & 1?
0: i only get breathless with exercise- 0 points
1: SOB hurrying on ground level or slight hill- 0 points
31
What are MRCDS grades 2 & 3?
2: slower then people own age or stopping to breath at normal pace- 1 point
3: stop for breath at 100yds or after a few minutes on level ground- 2 points
32
What makes up the BODE index for COPD survival and what does it predict?
FEV1 after bronchodilator, BMI, 6-minute walk distance, MRCDS dyspnea score
4 year survival rate
33
What is the scoring for BODE FEV1?
```
>65% = 0
64-50 = 1
49-36 = 2
<36 = 3
```
34
What is the BODE 6-minute walk score?
>350 meters = 0
349-250 = 1
249-150 = 2
<150 = 3
35
What is the BODE BMI score?
```
>21 = 0
<21 = 1
```
36
What percentages correlate to MRCDS/BODE scores?
0-2 points= 80% 4 year survival
3-4 poionts= 67%
5-6 points= 57%
7-10 points= 18%
37
How does increased dead space cause dyspnea in COPD?
increases PaCO2
38
How does airway obstruction affect COPD?
causes dyspnea by limiting ability to meet increased demands
39
What is a byproduct of reduced mechanical advatnage of the diaphragm?
hoover sign, accessory respiratory muscle use, paradoxical respiratory motion
40
What is the outcome of altered V/Q ratio in COPD?
dyspnea and hypoxemia
41
What is description of the flow-volume loop in COPD?
obstructive, with a scooped out expiratory phase
42
What are similarities between asthma and COPD?
weather exacerbations, perennial Sx, cough/sputum, wheeze, prolonged expiratory phase
43
What are the differences in COPD and asthma?
complete reversibility, seasonal variants, associated ENT allergic Sx, younger onset in asthma
44
How is LVF similar to COPD?
progressive dyspnea, orthopnea, wheeze, cough, dyspnea
45
Name the differences between COPD and LVF.
Paroxysmal nocturnal dyspnea, heart disease Hx, crackles, edema, S3 gallop, JVD/HJR
46
What are the suffixes of medication classes?
SAMA/LAMA: -ium
SABA: -ol
LABA: -terol
ICS: -asone, -ide
47
What are the drug delivery methods?
metered dose inhaler(MDI) or dry powder inhaler(DPI)
48
Describe the MDIs.
non-breath activated- released by activation
| breath activated- activated when you breath
49
Describe the DPIs.
single dose-uses a capsule
| multiunit/multidose-dose built into device
50
What is respimat?
propellant free liquid inhaler that creates a cloud
51
What else can treat COPD outside of inhalers?
ABx, OCS-prednisone, prednisolone, Methyxanthines-theophylline, PDE-4 inhibitors- roflumilast, daliresp
52
What specific Tx is key for tounger patients?
```
FEV1>50%, <65yo
doxycycline(macrolides are increasing)
TMP-SMX
Cephalosporins
advanced macrolides
```
53
What should older, sicker COPD patients be treated with?
amoxicillin-clavulunate
| Fluoroquinolones(tendon rupture)
54
What steroids are most common to Tx COPD?
prednisone-common, cheap, range of dosing, usually 40-60mg/day
also, methylprednisolone
55
What parameters decide if O2 should be administered supplementally?
PaO2<56 or SpO2<89% twice per week over 3 wks
| PaO2 56-60 with PH, CHF, erythrocytosis Hct>55%
56
What is GOLD I staging?
mild disease
| Tx with SABA or SAMA, not usually together but can be as combivent
57
What makes up GOLD II staging?
moderate disease
| Tx with LABA/LAMA
58
How does one treat GOLD III staging?
severe disease
ICS+LABA or ICS + LAMA
never use ICS alone in COPD
59
What is the treatment for GOLD stage IV and what is it?
very severe disease
ICS+LABA or LAMA or both
with or without roflumilast or theophylline
60
What tests should be used to monitor progression of COPD?
6-minute walk test, pulmonary rehab, PFT
61
What is involved in pulmonary rehabilitation?
exercise training-intensity and duration matter
education
psychosocial training- depression/anxiety
nutrional support
breathing training, inspiratory muscle training and CPT
vaccination-flu, PNA
62
What is are three typical identities of COPD patients?
A1AT, smokers, ex-smokers
63
When should you think A1AT?
young, unexplained dyspnea and cough
64
How is chronic bronchitis diagnosed?
chronic productive cough for 3 months a year in 2 consecutive years
65
How is emphysema diagnosed?
pathologically
66
Weird COPD/asthma treatment?
smoking lol
67
What will patients present with in ILD?
dyspnea, cough, crackles in bases, digital clubbing(not specific), exercise induced hypoxemia
68
Describe PFTs in ILD patients
```
FRC-reduced
FVC- reduced
TLC- reduced
FEV1/FVC- normal
DLCO-reduced
```
69
What agents are linked to causing ILD?
```
drug induced
inorganic dusts
lympangitic metastases
hypersensitivity pneumonitis
radiation
Idiopathic pulmonary fibrosis
smoking
connective tissue disorders
sarcoidosis
```
70
What are important topics to cover for H&P of ILD?
occupation, hobbies, environment, travel, Rx and non-Rx drug use
71
What are the inorganic dusts involved with ILD development?
silicosis, asbestosis, coal worker's pneumoconiosis, berylliosis
72
What tests are indicated for ILD evaluation?
chest CT-specify Dx
PFTs
ANA/RF factor
73
What is seen in scleroderma and similar diseases?
pulmonary fibrosis
pulmonary HTN-due to fibrosis
aspiration-esophageal disease
74
What will rheumatoid arthritis present with?
```
Interstitial pulmonary fibrosis
bronchiectasis
pulmonary rheumatoid nodules
pulmonary vasculitis
pleural disease ( very low pleural glucose)
```
75
What are the findings in Systemic Lupus Erythematous?
interstitial lung disease
extra-pulmonary restriction: shrinking lung disease
pulmonary HTN
pleural disease
76
What Autoantibodies are found in scleroderma?
anticentromere: 20-40%
SCL-70L 30-70%, more common in ILD
antinucleolar: 10-20%, with worse prognosis
77
What drugs can lead to lung disease?
chemotherapeutic agents- largest category
amiodarone-cardiac drug, dose related
nitrofurantoin- UTI ABx
78
What is the course of radiation induced lung disease?
early: 1-3 months after radiation
late: 6-12 months
newer radiation techniques have reduced occurence
79
What are the two courses of hypersensitivity pnuemonitis?
acute: abrupt dyspnea, cough, fever +/- myalgias
chronic: pulmonary fibrosis
80
What are the differences in CHF and ILD?
specific history differences in onset
CXR and CT findings
exam: clubbing, edema, S3 gallops in LVF
81
What are the similarities between ILD and CHF?
progressive dyspnea, exercise induced hypoxemia,
CXR infiltrate findings,
crackles in bases, pulmonary HTN
82
What is found in ILD compared to COPD and vice versa?
ILD- more rapid decline, non productive cough
| COPD- slower decline with more frequent exacerbations, weather & NSAIDs make it worsen Sx, productive cough
83
What are the treaments in ILD?
treat or remove the cause
OCS are the mainstay of non-IPF causes
Tx of IPF only: pirfenidone and nintedanib
both of which reduce inflammation and fibrosis
84
What is characteristic of ILD presentation?
sudden, dyspnea, rapid respiratory failure.
| difuse alveolar damage on histo
85
What is another name for acute interstitial pneumonia?
Hamman-Rich Syndrome
86
How does AIP present?
```
all age groups, mostly adults
no specific etiology
diffuse, bilateral, symmetrical pattern
abrupt onset-flu-like
Dx with biopsy
```
87
How does IPF present?
exclusively adults
prior causative exposure
asymmetrical pattern favoring upper and lower lobes
gradual onset, afebrile
Dx based on PFT, history, imaging, biopsy not needed
88
What is the treatment of choice for sarcoidosis?
prednisone
89
What characteristics are found in sarcoidosis?
asymptomatic or mild
incidental finding
symmetrical CXR, no true with CT
leads to death and debilitation in some people
90
What are the similarities between PTX and effusion on exam?
diminished BS on auscultatio
91
What are the differences between PTX and effusion?
effusion is dull, PTX is hyperresonant
| positional changes of BS, improve in effusion, not PTX
92
What are the potential causes of PTX?
spontaneous in young males
traumatic: post-procedural and direct trauma
disease related
93
Describe the lungs in open and tension PTX.
open: the trachea corrects slightly on expiration
tensions: the trachea deviates more on expiration to the normal side
94
How can exudate be confirmed in effusion?
pleural protein/serum protein of >0.5
pleural LDH/serum LDH > 0.6
Pleural fluid LDH >2/3 upper limit of serum LDH
95
What are the differentials for low pleural glucose?
```
parapnuemonic effusion
malignant effusion
TB
hemothroax
RA
```
96
What is the normal cell count in pleural fluid?
75% macrophages, 25% lymphocytes
97
When will you see increased eosinophils in the pleural fluid?
```
>10%
air in the space
idiopathic
parapnuemonic
malignancy
```
98
When are increased lymphocytes seen in pleural fluid?
>50%
| malignancy & TB
99
What causes trasudative pleural fluid?
LVF or CHF
misplaced central line
massive cirrhosis
nephrosis
anything else is exudative
100
How can a chronic effusion be managed?
PleurX cath allows for at home drainage
pleurodosis closes the potential space between pleura
via talc, tetracycline through thorascope or IR
101
What major diseases can occur in the mediastinum?
masses, fluid or air and infection/inflammationWhat
102
What are the 4 Ts of the anterior mediastinum?
thymoma, teratoma, thyroid mass, T cell lymphoma or B cell
103
What are the middle mediastinal diseases?
VAC
vascular masses
adenopathy
cysts- pleuropericardial, bronchogenic
104
What diseases are more typical of the posterior mediastinum?
nerves and guts
neurogenic tumors
meningoceles, meningomyeloceles
gastroenteric cysts and esophageal diverticula
105
Which type of cancer is most common in the head and neck
Squamous cell carcinoma in the upper aerodigestive tract
death is more common in AA
typically males in 50-60s
106
What is field cancerization?
entire upper aerodigestive tract is exposed to cancers due to its structure
investigate entire area when malignancy is identified
107
What is the clinical presentation of head and neck cancer patients?
swallowing or intermittent choking, prompt work-up
trismus
ear pain-needs evaluation
weight loss
108
What is trismus?
inability to op jaw due to CN V compression by mass or muscle invasion
109
Should you assess nuritional and performance status in patients with head and neck cancer?
yes, to assess treatment efficacy, activity level and burden on family
110
What are the available H/N cancer Tx's?
radiotherapy, surgery: laryngectomy(removes vocal cords)
| systemic therapy: chemo
111
What are therapies available for those with laryngectomy to improve life?
electrolarynx: submandibular region, uses vibrations for speech
talking tracheostomy: provides synthetic vocal cords
112
What is the#1 risk factor for lung cancer?
smoking- #1 cause, increase 10x for M, 5x for F
113
What increases the risk of lung cancer in smokers?
number of years, PPD, length of cigarette, depth of inhalation, tar content
114
What are the occupational risk factors for lung cancer?
uranium miners: radon gas, alpha particles damage DNA
Coal miners: CWP
Nickel, arsenic, mustard gas
petrochemical exposure
passive second hand smoking 3-10,000 lung CAs/year
115
What is the origin of most lung CA?
epithelial
| small and non-small cell carcinomas
116
What are the Sx of pancoast syndrome and how?
superior sulcus tumor, lung apex
| invade brachial plexus and cause shoulder pain or paresthesias along C7-T1 dermatomes
117
What is the description and cause of Horner's syndomre in CA?
compression of sympthatetic ganglion (stellate)
| anhydrosis of face, ptosis of eye and pupillary constriction
118
What category of conditions is hypertrophic pulmonary osteoarthropathy and what are the Sx?
paraneoplastic syndrome
HPO-> clubbing of digits and hypertrophy of joints
arthralgias, synovitis and periostitis
furrowing of brow, characteristic facies
119
What causes HPO?
unknown, possibly humoral mediators, PDGF, TNF-a, TGF-B
| hypoxia alone is not sufficient for development
120
What is the category and what are the causes of superior vena cava syndrome?
extrinsin compression of SVC by mass
| distension of superficial neck vv., face/neck edema
121
What is the easiest diagnostic imaging used for lung CA suspicions?
CXR
identifies primary lesions and possibly lymph node metastases
serial XR are important, especially for nodular evaluation
122
What are secondary imaging techniques for lung CA evaluation?
CT-most common for bronchogenic CA, evaluautes mediastinal tumors, nodes, vertebra and parynchema of lungs
MRI- expensive but no better than CT
PET scan- when fused with CT is better for malignancy vs. benign differentiation
123
How is sputum cytology used in lung CA evaluation?
positive in 60-90% of lung CA and abnormal CXR
124
What does bronchoscopy tell you in lung CA patients?
allows for airway visualization down to subsegmental bronchi
can use brushings and washings for DX
required if resection is considered
125
How can mediastinoscopy be beneficial?
evaluates mediastinum for tumor expansion and can obtain lymph nodes
valuable for resection
126
What are the uses of fine needle aspiration in CA patients?
plain film or CT guidance
used in peripheral lung lesions-90% accurate
risk of PTX is 20-25% but chest tubes in only 5%
127
What is the staging system for small cell lung cancer?
based on VA staging
limited disease: tumor confined to one hemithorax and lymph nodes, single radiation field
extensive disease: disease outside of limited region
128
What is the pediatric assessment triangle?
PAT, first general assessment
| appearance, breathing circulation
129
What is the appearance of a child in respiratory distress and what is the importance of the signs?
restless, anxious, combative: suggests hypoxia
SOMNOLENCE/LETHARGY: suggest severe hypoxia, hypercapnia or respiratory fatigue
vigorous movement: reassuring
poor tone, lethargy, listlessness: not reassuring
130
What is an ominous sign in a child with respiratory Sx?
development of slower, irregular breathing pattern, in the setting of respiratory distress, arrest will develop without intervention
131
What is Beck's triad?
JVD, muffled cardiac sounds, hypotension--> cardiac tamponade
132
What is the significance of a peritonsillar abscess?
EMERGENCY
| hoarse voice with sore throat on swallowing, swelling and local pain
133
What are the signs and symptoms of croup?
acture laryngotracheobronchitis
most common infectious airway obstruction in kids 6-36 months
usually viral, can be allergic
not only in children
trecheitis is a secondary bacterial infection
kid with stridor-> croup
134
What are characteristics of asthma in children?
inflammation, edema, bronchospasms, mucous
| triggers: infection, exercise, irritants, stress, GERD can rapidly worsen due to atelectasis or alveolar disease
135
Describe anaphylaxis in children.
```
commonly due to food or meds
life threatening pharyngeal edema,
urticaria and facial edema
lower airway bronchospasm
ask what happens with reported allergies
```
136
What is the immediate intervention in anaphylaxis?
assess: airway, breathing, circulation, consciousness
| give epinephrine IM
137
How do kids with tracheal/esophageal FB present?
trach: sudden dramatic coughing
stridor, drooling and choking
esophagus: drooling, dysphagia
40% of FB ingestions are not witnessed
138
What is the presentation of a lower airway FB?
coughing, choking on ingestion
| recurrent pneumonia, chronic cough
139
What is Dr. Newman's worst nightmare with FB?
button batteries
140
What neurological Sx are associated with respiratory distress?
neuomuscular-secondary to hypoventilation
infection
trauma
medication effects
141
What systemic diseases can lead to respiratory distress?
Cystic fibrosis, asthma, neuromusclar disease
| sickle cell disease-> acute chest syndrome
142
What is characteristic of acute chest syndrome?
SSD
sudden onset respiratory distress and CP
new infiltrate on CXR
fever
143
What are the characteristics/histo aspects of asthma?
reversible airflow obstruction, spontaneously or with meds
limited airflow on PFT or methacholine challenge
thick inflammed walls and tight muscles
144
What is a trigger for asthma?
allergens
145
What are two histomorpholgical findings in prolonged status asthmaticus?
Curschmann spirals- in sputum of BAL, mucus plugs from glands or bonchioles
charcot-leyden crystals: in sputum of BAL specimen, coposed of galectin-10
146
What is the major pathogenesis of asthma?
atopy(strongest predisposing factor)
| allergen exposre: dust mites, cockroaches, seasonal
147
What are key indications of asthma?
wheezing, cough, dyspnea
| worse with exercise, weather changes, and at night
148
What is the PFT loop for asthma?
obstructive pattern, scooped out
149
What is the medication for quick asthma relief?
SABA
| albuterol, levalbuterol
150
How is asthma controlled long-term?
ICS, leukotriene modifiers
151
What Sx are present when respiratory arrest is imminent?
breathlessness at rest, not talking, drowsy/confused
increased respirations, cannot recline, paradoxical movements of chest wall, no wheeze, low HR, low FEV1 and PaO2 with high PaCO2
152
What are thes steps in treating an asthma attack at home?
inhaled SABA,
if good: repeat for 48 hours if needed
if incomplete response: add OCS, call doc
if poor response: add OCS, in nothing go to ED
153
What is the classification of intermittent asthma?
<2 days/week of Sx and SABA use, minimal to no night time wakings, 0-1x per year with OCS
154
How does well controlled asthma present?
0-4 years or >12 years: <2 days/week
5-11 years: same, not more than one/day
no activity interference,<2 days/week of SABA use
155
What is a sign of good response to SABA?
decreased wheezes moving to increase, indicating more airflow
156
Should Huter miss any CF questions?
Nah
157
What is the etiology of CF?
AR, CFTR protein which functions as cAMP mediated Cl channel on mucosal surfaces, chromosome 7
exocrine gland dysfunction
158
What ethnicities have the highest risk of being a CF carrier?
Ash Jews: 1/24
caucasian: 1/25
lower in others
159
Why does CF not present the same way in all patients?
poor penetrance
commonly chronic, progressive ling disease
pancreatic insufficiency
160
What other factors lead to CF presentation besides the mutation itself?
non-genetic factors: level of care, nutritional status, age of onset
modifier genes: mannose binding lectin-p. aeruginosa
161
What are the main infections in CF patients?
S. aureus, H. influenzae
| P. aeruginosa-older patients
162
What is the major GI Sx in neonates with CF?
meconium ileus, abdominal distension, vomiting, no meconium passed
163
What are the major GI Sx in all CF patients?
pancreatic insuffiency, malsborption, failure to thrive, low ADEK, jaundice or GI bleed as result of hepatobiliary disease, DM-insulin
164
What is the cause of liver disease in CF patients?
epithelial lining biliary ducts get plugged by mucous and obstuctive cirrhosis occurs
165
What is a common GU Sx in CF patients?
CBAVD, infertility
166
What finding on nasal exam would put CF on the DDx?
nasal polyps
167
What is the diagnostic criteria for CF?
a positive newborn screen AND elevated sweat chloride test on 2+ occasions
168
What test is used in the neonatal screen for CF?
(immunoreactive trypsinogen)IRT levels are higher in babies with CF
if elevated repeat or do sweat test
169
What is the importance of a CXR in a patient with breathing trouble?
rule out all causes, PNA, ILD, asthma or other
170
What are characteristics of mycoplasma pneumoniae?
no cell wall, cold agglutinin positive, microcytic anemia
| atypical, obligate IC, bullous myringitis, self-limiting, dry cough
171
What treatment is not effective in M. pnuemoniae
cell wall synthesis inhibitors
172
What is the empiric treatment for CAP in ambulatory patients?
macrolide or doxycycline
173
What is CAP empiric treatment for drug resistant strains?
Fluoroquinolone or macrolide + beta-lactam
174
Name with CAP empiric treatment in hospitalized patients.
fluoroquinolones
175
What do you use for empirical treatment of ICU patients with CAP?
fluoroquinolone + antipneumococcal beta lactam
| add piperacillin-tazobactam for P aeruginosa coverage
176
What is the presentation of chlamydia pneumoniae?
atypical but with hoarse voice
177
How dose legionella pneumoniae present?
more severe than other atypical pneumonias
178
What is the atypical presentation of pneumonia?
younger adults, mild Sx, F/C, dry cough
| follows URI like Sx-rhinitis, sinusitis etc
179
What random lab finding can be elevated in penumonias?
procalcitonin-
| high in proinflammatory stimuli, especially bacterial
180
What is the CURB-65 score?
determines how to proceed in PNA cases
1 point for confusion, BUN>20, respirations>30
BP<60 or >90, age<65
total score 0-1 low risk
2 moderately severe
3-5 severe
181
What are characteristics of P. aeruginosa?
gram - bacillus, capusle, pyocyanin and pyoverdine, grape smell, loves water, CF and bronchiectasis
182
What are characteristics of H. influenzae
gram - diplococci, capsule(types), no capsule
| (no type), chocolate agar(factors V and X), smokers, immmunocompromised
183
What are the characteristics of Moraxella catarrhalis?
gram - coccobacillus, fastidious anaerobe, big time for smokers, COPD, asthmatics, malignancy
exacerbates pre-existing conditions then forms PNA
184
What are characteristics of L. pneumophilia?
gram - bacillus, aerobic, flagellate, water lover, urinary antigen, does not ferment, yeast charcoal media, hyponatremia, bradycardia, multiple people
185
What is MaConkey agar?
selectsfor G- bacteria, especially enteric, and fermentors due to lactose
186
What are the characteristics for yersinia pestis?
G-, non fermenting, comes with pulmonary hemorrhage, severe presentation
187
What is the presentation of Klebsiella pneumoniae?
capsule, G-. fermenter, mucoid colonies, bulging fissure, currant jelly sputum, immunocompromised and EtOH use
188
What are the lactose fermenters and their speed?
Fast: oh, KEE
klebsiella, E. coli, enterobacter
slow: CS
citrobacter, serratia
189
What are characteristics of strep pneumoniae?
gram + diplococci, capsule, alpha-hemolytic, optochin sensitive, urinary Ag, most common cause of CAP(& meningitis), lobar PNA, rust colored sputum, lancet shaped
190
What are the characteristics of staph aureus?
G+, catalase and coagulase +, follows viral penumonia, necrotizing, hemorrhages, salmon colored sputum
191
What vaccines exist for strep pneumoniae?
pneumovax-23 strains
Prevnar 13- 13 strains
for pts over 65, immunocompromised, asplenia, 2-64 with risk factors
can cause anaphylaxis
192
What is characteristic of orthomyxovirus?
8 segments, -ssRNA, HN spikes, PCR test
193
What is characeristic of adenovirus?
non-enveloped, dsDNA, icosahedral, common cold, conjunctivitis, overlapping Sx, direct assay or enzyme immunoassay
194
What are the characteristics of MERS?
coronavirus, ssRNA, middle east respiratory syndrome, GI Sx, fecal-oral transmission, ARDS presentation
195
What are characteristics of SARS?
severe acute respiratory syndrome, coronavirus, travel to east Asian countries, flu-like but progress to ARDS
196
What is Reye syndome?
flu and ASA combined
197
What are characteristics of H5N1?
similar to orthomyxovirus, exposure to dead or sick poultry, RT-PCR to detect, start oseltamavir
198
What is the difference in antigenic shift and drift?
shift is pandemics
| drift is epidemics
199
What are characteristics of histoplasmosis?
micronidia in caves with bat/bird droppings, dimorphic yeast in body, fungi outside, mild PNA unless immunocompromised, ohio river valley, coin lesions
200
What are characteristics of coccidioidomycosis?
valled fever, San Juaquin valley, SW USA, chronic PNA, erythema nodosum, self-limiting
201
What are characteristics of blastomycosis?
chronic PNA, soil with decomposing matter, broad based budding yeast, skin, bone and CNS changes
202
What are characterstics of burkholderia cepacia?
G- bacillus, catalase +, non- fermenter, BC agar, blue crystal, colonies pearly gray, CF or bronchiectasis, hard to Tx, multi-resistance
203
What are characteristics of bunyavirus?
hantavirus, zoonotic, infected rodents and urine, feces, saliva, profromal phase mimics flu, rapidly progresses to hanta CP with resp distress, increased LDH
204
What are characteristics of coxiella burnetti?
obligate IC, G- small, endospore, hepatitis, endocarditis, maculopapular rash, shepards, farmers, cattle birthers
205
What are characteristics of enterobacter?
G- bacillus, fermenter, oxidase negative, anaerobe, oppurtunistic, mechanical ventilation, coliform, motile
206
What are characteristics of leptospirosis?
spirochete, high fevers, HA, aseptic menigitis, hepatitis, reanl failure, subconjunctival hemorrhage, rodents, cattle, sheep, goats, aborted animals
207
What are characteristics of francisella tularensis?
G- aerobe, abrupt nonspecific Sx, tick bite, pulmonary tularemia-infiltrates and effusion
208
What are characteristics of chlamydia psittacosis?
obligate IC anaerobe, G-. no cell wall. resevoir-birds, pet shop owners, inhaled feather dust/feces, history is key
209
What are CAP Sx?
fever cough w/ or w/o sputum, CXR with consolidation, urinary Ags, sputum Cx, blood Cx, elevaetd procalcitonin
210
What bacteria are seen in neutropenia and CF?
P. aeruginosa
211
What infections are seen in asplenia?
klebsiella, S. pneumonia, H. influenzae, nisseria spp
212
What infections are seen in smokers/COPD?
moraxella, H. influenzae
213
What infections are seen in EtOH?
klebsiella
214
What infections are seen after the flu?
S. aureus
215
What infection is seen in bird handlers?
C. psittaci
216
What infections are seen in animal breeders?
coxiella burnetti- Q fever
217
What infections are seen in hunters, lawn care and rabbit exposure?
francisella tularensis
218
What are the bacteria and their sputum colors?
```
currant jelly- klebsiella
rust- p. pnuemoniae
salmon- s. aureus
greeb tinge- p. aeruginosa
foul smelling- anaerobes
```
219
What bacteria are encapusulated?
some killers have pretty nice capsules
220
What is the definition of Hospital acquired PNA?
over 2 days in hospital
221
What is the definition of health care assocaied PNA?
2 days in hospital in last 90 days
dialysis, nursing home, infusions in last 30 days
family member with multidrug resistanct organism
222
What is the definition of ventilator associated PNA?
ET intubation with 2 of: F, leukocytosis, purulent sputum
| new/progressive opacity on CXR
223
How do you treat nosocomial PNA?
CBC, CMP, 2 anitpsuedomonal + MRSA coverage
224
What is the description of mycobacterium tuberculosis?
weakly G+, non-motile, aerobe
225
What is primary TB?
typically becomes latent, new TB in naive patient, air transmission, hilar lymphadenopathy, calcifications
226
What is primary progressive TB?
if no fibrosis and calcification from primary TB, caseous-gohn complex expands
TB bronchopneumonia- spreads to entire lung, patchy foci
miliary TB- spread over entire organ, seed appearance, hematogenous spread
227
What is secondary TB?
reactivation TB, insidious, most common TB presentation, apical posterior segments on CXR, F/C, weight loss, hemoptysis possible, cough
228
What tests should you run with TB possibility?
CXR, morning sputum, PPD-mantoux test
229
What does a positive PPD test indicate?
currently or previously infected with TB, false positive from BCG vaccine
230
Know the induration levels for positive PPD.
>5 immunocomprosised, positive CXR and close contact with TB, <10 everything except healthy people, >15 healthy people
231
What type of hypersensitivity reaction is PPD?
type IV- delayed T cells
232
What tests screen and confrim TB?
Ziehl-Neelsen(Kinyon) stain confirms, SPECIFIC
| Auramine-Rhodamine- screens, SENSITIVE
233
What does NAAT-R testing screen for?
detects resistance to Rifampin and INH, positive test confirms multi drug resistance
234
Where do you admit TB patients?
negative pressure ventilation room, RIPE therapy
235
What is the next step after positive PPD and negative CXR?
IFN-gamma release assay, if positive begin IH for 9 months
236
What pleural fluid component is positive in TB?
adenosine deaminase
237
What spinal disease can occur in TB?
Pott's syndome, TB spondylitis
238
What are extra-pulmonary manifestations of TB?
```
lymphadenitis-scrofula-most common
pleural effusions w/ ADA and IFN-Gamma
meningitis
Pott's syndrome
intestinal TB w/ milk ingestion- M. bovis
```
239
What is see with M. kansasii?
from the enviroment not people, midwest and southwest US, long course, older smokers apical cavitation
50% mortality if untreated,
