Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

AGPC 4!!!!!! > Lecture 2: Pulmonary Infections > Flashcards

Lecture 2: Pulmonary Infections Flashcards

1
Q

Egophony

A

E –> A on auscultation due to solids. “Solids transmit sound better”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Bronchophony

A

Ask the patient to say “99” several times while auscultating the chest walls. Over consolidated areas “99” is understandable. This is because acoustic filtering is reduced in consolidated lung tissue, which allows better sound transmission.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Tactile Fremitis

A

tactile fremitus is a vibration that you can feel with the palm of your hands when someone says “blue moon” or “99”. increased fremitus is a sign of consolidation. decreased fremitus is a sign of pneumothorax or pleural effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Hemoptysis is usually this condition

A

viral bronchitis, due to irritation of airways producing hemoptysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Conditions leading to solids in lungs

A

Pneumonia, abscess, blood, mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Conditions causing hyperresonant

A

Empysema, COPD, pneumothorax, asthma attack

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Pleuritic pain

A

Process involving the pleura leading to pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Normal lung sounds

A

Resonant on percussion, Vesicular on periphery, No adventitious breath sounds, Symmetric tactile fremitus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Hypoinflation pulmonary findings

A

Bronchial sounds on periphery, Dull on percussion, Increased Tactile Fremitus, Egophony, Whispered pectoriloquoy, Rhonchi, crackles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Hyperinflation pulmonary findings

A

Hyper-resonant on percussion, decreased tactile fremitus, adventitious sounds like wheezing (asthma is hyperinflation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

CAP physical exam

A

fever, cough, sputum. If elderly may just be confused, lethargic, loss of appetite

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

TB physical exam

A

night sweats, fatigue, usually an immigrant/prisoner/HIV+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Bronchitis physical exam

A

normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pertussis physical exam

A

prolonged cough, coughing spells/paroxysms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Legionella physical exam

A

gram - bacteria, likes dirty water, cannot be passed person to person, AC units, hot tubs, epidemic needs to be reported. SOB, fever, cough, N/V/D, ask for travel history

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

PE physical exam

A

sudden, hypoxic, blood, NO fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Pneumonia unlikely if

A

< 60 y/o with normal VS, normal physical exam, no comorbid conditions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Most common cause of pneumonia

A

Strep pneumoniae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Best initial test for pneumonia

A

Chest XRay – radiographic diagnosis. Will show infiltrates. If no infiltrates then it is not pneumonia, or too early to dx.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Why is a sputum stain and culture inappropriate to order in a r/o pneumonia case?

A

Only positive in 50% of patients (atypical bacteria cannot be stained – mycoplasma, chlamydia, legionella) You can obtain this in a hospitalized patient.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Why is a blood culture inappropriate to order in pneumonia?

A

Only 5% have invasive disease – pneumonia is not invasive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What will a CBC show with pneumonia?

A

Increased neutrophils/Polymorphic nuclear/bands –> all means bacteria. If viral –> + lymphocytes. Nonspecific.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Dehydration may cause this

A

A negative xray despite having pneumonia, why – it increases antidiuretic hormone leading to water reabsorption and a dilated Na

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Negative Chest XRay but high suspicion of pneumonia then

A

Need a Chest CT Scan - will show a greater definition of abnormalities

25
Q

BUN/Cr

A

Obtain only in a hospitalized patient to determine severity

26
Q

When to admit to the hospital w pneumonia

A

Next step after dx is to assess for severity… SOB, confusion, hypotension, not perfusing, hyponatremia?

27
Q

CURB-65

A

0-1 Go home, 2-4 go to hospital. Confusion. Uremia (BUN > 19) Resp distress (>30) BP low (systolic < 90), >65

28
Q

CAP mgmt if no comorbidities, no previous antibiotics

A

Macrolides (azithromycin, clarithromycin, erythromycin) OR Doxy x 5 days ( can lead to QT prolongation) Do not stop until afebrile for 48 hours

29
Q

CAP mgmt if comorbidities, treated with abx in 3 months

A

Respiratory FQ (levafloxacin 750mg. moxifloxacin, gemifloxacin) OR Beta-Lactam (high dose amox, augmentin, cefuroxime PLUS Macrolide

30
Q

At intermediate risk for pneumonia get this vax

A

PPSV 23 those who are younger than 65 w/ these conditions: cigarettes, chronic heart disease, chronic lung disease, asthma, DM, chronic liver disease, alcoholism

31
Q

At high risk for pneumonia get this vax

A

PCV 13 followed by PPSV23 > 65 with immunocompromise HIV, cancer, anatomic asplenia, CSF leak

32
Q

Mycobacterium tuberculosis

A

aerobe, slow growing bacilli, inhaled through droplets. 3/100,000 people in the US get TB. Majority in foreign born individuals.

33
Q

Who are at increased risk for contracting TB?

A

Recent < 5 years from developing countries. HIV+. Prisoners. Homeless. IV Drug users. Healthcare workers. Impaired cell immunity - DM, organ transplant, cancer

34
Q

95% of people with TB have

A

Contained not infectious, but infected

35
Q

5-10% Have

A

active disease –> transmission

36
Q

Reactivation risk

A

10% in a lifetime

37
Q

Latent TB granulomas can break and spread to

A

bones, brain, kidney, liver, lungs – from stress on immune system leading to reactivation

38
Q

TB spread through

A

droplet like sneezing coming from the lungs

39
Q

Best initial test to dx TB?

A

CXR is suggestive not diagnostic of TB

40
Q

xray is + plus s/s of TB you need to do this

A

isolate, then get a sputum gram acid fast

41
Q

sputum acid fast stain

A

not very sensttive or specific makes a PRESUMED dx and reflects high infectivity, initiate tx pending culture

42
Q

sputum culture

A

gold standard, takes 4-6 weeks required for CONFIRMATION of TB and for drug suseptibility

43
Q

PPD

A

Screening of asymptomatic individuals at risk only, not to diagnose

44
Q

Treatment for TB

A

Need tx for 6 months. Isolate until 3 negaqtive acid fast cultures as it flares intermittently and can be missed on one. RIPE. Rifampin. Isoniazid. Pyraazinamide. Ethambutol –> all are hepatotoxic

45
Q

Rifampin (RIF)

A

=R, Red color of body secretions

46
Q

Isoniazid (INH)

A

=N neuro, peripheral neuropathy (give pyridoxine, B6)

47
Q

Pyrazinamide (PZA)

A

hepatotoxic

48
Q

ETM Ethambutol

A

e= eye, Optic neuritis/color vision

49
Q

Who needs a PPD

A

Asympomatic at risk patients for latent TB. Immigrants (5 years recent), immunosuppressed, prisoners, health care workers, homeless, nursing home, alcoholics, close contact w tb patient

50
Q

When is the PPD + at > 5mm

A

hiv, organ transplant, steroid users, close contact with an active tb patient

51
Q

PPD+ at > 10mm

A

recent immigrants, prisoners, healthcare workers, homeless, nursing home, alcoholiics

52
Q

> 15mm

A

no risk factors

53
Q

+PPD next step?

A

CXR to confirm or r/o TB

54
Q

+PPD and -XRay

A

dormant/latent TB –> treat brings risk from 10% to 1% to reactivate

55
Q

+PPD and +Xray

A

active TB

56
Q

dorment/latent TB treatment

A

Only INH for 9 months (esp if converted from negative to positive within 2 years) No need to repeat PPD in those with a positive PPD.

57
Q

tb gold IGRA is indicated when

A

exposed to TB. Measures the bodys response to TB instead of a intradermal PPD this is blood work and can only determine exposure not active v latent. If + then CXRay to determine active or latent

58
Q

PPD

A

Skin test, 2 visits, may cross react with BCG

59
Q

IGRA TB Gold

A

Blood, one visit, Specific, no cross rxn w BCG, Not for kids < 5

AGPC 4!!!!!! (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions