M2 Pulmonary Week 2 - Key Facts Flashcards
Meta-Relative Risk - Interpretations (3) + Calculation
Interpretation
1 = No Difference Between Groups
> 1 = Event more likely to occur in the experimental group (e.g. drug causes risk increase)
< 1 = Event less likely to occur in the experimental group (e.g. drug causes risk reduction)
Key = What is the outcome measure - If you are looking at readmission you want it to be less in experimental
% of Events in Experiemental
/
% of Events in the Control
E.g. 5 of 100 have relapse in experimental vs. 10 of 100 in control
0.05 / 0.1 = Relative Risk Reduction of 50%
Absolute Risk Reduction
% Events in Experimental - % Events in Control
E.g. 5 of 100 have relapse in experimental vs. 10 of 100 in control
0.05 - 0.1 = Absolute Risk Reduction of 5%
Number Needed to Treat
Number needed to treat to help one person
1 / ARR
E.g. 5 of 100 have relapse in experimental vs. 10 of 100 in control
ARR = 5% ///// NNT = 20
Indoor Exposures Increasing Risk of Asthma Development - Causal (1) + Association (1)
Causal - Dust Mites
Association - Second Hand Smoke
Indoor Exposures Increasing Risk of Asthma Exacerbation - Causal (4) + Association (4)
Causal
1) Cat
2) Cockroach
3) Dust Mite
4) Second Hand Smoke
Association
1) Dog
2) Fungus
3) Rhinovirus
3) NO2
Ozone in Asthma
Ozone Increases Asthma
Dust Mite Management in Asthma - Key Points ()
Removal not found to be clinically significant but largely influenced by one large study that was to short and poorly controled
Forest Plot = Key
Funnel Plot - Definition + Example (2)
A funnel plot is a graph used designed to check for the existence of publication bias; funnel plots are commonly used in systematic reviews and meta-analyses. In the absence of publication bias, it assumes that the largest studies will be plotted near the average, and smaller studies will be spread evenly on both sides of the average, creating a roughly funnel-shaped distribution. Deviation from this shape can indicate publication bias.
Largest Study (Biggest y) should be closest to the middle (average) while smaller studies are more likely to be scattered Large Studies = Pyramid Tip
Big Bite in one Bottom Corner = Missing studies that show one effect - pushes the mean the other way
Missing Most of the Bottom = Low Methodological Quality of small studies = smaller bias vs. leaving studies out
Methods of Pneumonia Acquisition (4)
1) Inhalation
2) Aspiration
3) Hematogenous Spread
4) Spread from a contiguous Foci
Factors that Impair Respiratory Immune Defense (2) + Causes (5)
Impaired Cough Reflex
1) EtOH
2) Drugs
3) Neuro-Muscular Disease
Impaired Mucociliary Escalator
1) COPD
2) Influenza
3 Major Ways to Organize Pneumonia
1) Community (S. Pneumoniae) vs. Nosicomial (Gram Negative)
2) Rapid Onset (Bacterial) vs. Slow Onset (Fungi/TB/Anaerobic)
3) Lobar vs. Bronciolar (Scattered Patch Infiltrates Around Bronchioles) vs. Interstitial (Atypical/Walking)
Major Bronchopneumonia Pathogens (5)
1) S. Aureus
2) H. Influenzae
3) Pseudomnas Aeruginosa
4) Moraxella Calarrhalis
5) Legionella
Major Atypical Pneumonia Pathogens (6)
1) Mycoplasma Pneumoniae
2) Chlamydia Pneumoniae
3) RSV
4) CMV
5) Influenza
6) Coxiella burnetti
Consolidation Exam Findings (4) + Differential for Bronchial Breath Sounds + Crackles/Rales + Wheezing (1)
Consolidation
1) Dullness on Percusion
2) Egophany (E-A)
3) Bronchial Breath Sounds
4) Decreased Tactile Fremitous
DDx - Bronchial
1) Obstructive + Pleural Effusion + Pneumonia
DDx - Crackles/Rales
1) Pneumonia + CHF + Pulmonary Fibrosis
DDx - Wheezing (Expiratory)
1) Asthma
Viral Pneumonia - Keys (3)
Causes - Influenza (Main) + CMV (Immunocompromised)
Type - Atypical
Sympomts - Dry Cough + Dyspna + Unremarkable Exam
Streptococcus Pneumoniae - Bacteria + Key Features (2)
Gram + Diplocci - Lancet Shaped + Alpha Hemolytic
Most Common Cause of Pneumonia Stages (4) 1) Congesiton 2 Red Hepatization 3) Gray Hepatazation 4) Resolution
Streptococcus Pneumoniae - Signs/Symptoms (6) + Risk Factors (4)
Signs/Symptoms
1) Acute
2) High Fever
3) Pleuritic Chest Pain
4) Shacking Rigor
5) Rusty Color Sputum
6) Lobar Examination Findings
Risk Factors
1) Asplenia
2) Post-Influenza
3) Arthritis (Septic Joints)
4) Smoking/EtOH
Hemophilius Influenzae - Bacteria + Key Facts (2) + Risk Factors (2)
Gram (-) Coccobaccilus
Key Facts
1) Community Acquired
2) Hard to differentiate vs. chronic bronchitis - look for changes in cough/fever
Risk Factors
1) COPD
2) Infants
Staph Aureus - Bacteria + Key Facts (2) + Risk Factors (3)
Gram (+) Cocci in Clusters
Key Facts
1) Purulent yellow sputum
2) High risk of necrosis, cavitation and abscess
Risk Factors
1) Rare Community
2) High Nosocomial
3) High Post Influenza
Nosocomial/Rare Bacterial Pneumonia (3) + Key Facts (2-3-3)
Klebsiella - Gram Negative Rod
1) Lobar Aspiration in Alcoholoic + Diabetes
2) Currant Jam Sputum
Legionella - Gram Negative Rod with Silver Stain
1) Water sources
2) Hyponatremia from renal disease
3) Atypical
Pseudomonas Aeurginosa - Aerobic Gram (-) Rod
1) Most common CF
2) Coagulative Necrosis with vessel invasion
3) Green Sputum
Rhinopharyngitis - Definition + Causes
Common Cold - Communicable with Nasal Stuffiness
Causes
1) Rhinovirus
2) Coronavirus
3) Parainfluenza Virus
Rhinopharyngitis - Pathophysiology + Signs/Symptoms (3)
Patho - Inoculation - Epithelial cells infected + spreads to respiratory mucous - Submucosal Edema = Increased Risk for Bacterial Suprainfection
Signs
1) Nasal Discharge
2) Sore Throat
3) Worse in Infants
Tonsillophyaryngitis - Definition + Causes (5)
Inflammation of the mucous membranes of the throat without nasal signs/symptoms
Causes
1) Group A Beta Hemolytic Strep (Strep. Pyrogens)
2) Adenovirus
3) Parainfluenza
4) EBV
5) Enterovirus (Summer)
Tonsillophyaryngitis - Signs/Symptoms (6)
1) Petechia in Throat
2) Inflamed Uvula/Tonsils
3) Fever
4) Sore Throat
5) Abdominal Pain (Worse in Kids)
6) Tender Anterior Cervical Nodes
7) Can Cause Acute Rheumatic Fever + Scarlet Fever