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Medical Studies 1 > Module 6b > Flashcards

Module 6b Flashcards

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USMLE® Step 1 flashcards
1
Q

How is pneumonia broadly categorised into 2 ways of acquisition?

A

• Community-acquired: usually due to Streptococcus pneumoniae, atypical bacteria (such as Mycoplasma, Chlamydia and Legionella), or viral pathogens. In approximately 50% of community-acquired pneumonia cases
no organism is identified.

• Hospital-acquired: associated with a much greater spectrum of pathogens, particularly bacterial pathogens that are usually more difficult to treat.

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2
Q

What are the four classifications of pneumonia categorised by the causative agent?

A

Viral: Influenza A is most common type of viral pneumonia.
• Often occurs as an ‘epidemic’ in small population groups such as
schoolchildren and nursing home residents
• Infection caused by virus predisposes patient to secondary bacterial
pneumonia

Bacterial: until 2000, Streptococcus pneumoniae accounted for 90% of
bacterial pneumonias
• Decline in cases is related to vaccination of infants against pneumococcus bacteria
• Peak incidence is in winter and early spring
• Vaccine now available and is effective against this type of pneumonia in adults

Mycoplasmal: caused by infection with mycoplasma pneumoniae
• Causes mild URTI in school-age children and young adults
• Transmission occurs by means of infected respiratory secretions: spreads quickly among family members
• Can be treated effectively with antibiotics

Aspiration type: inflammation of lung tissue (parenchyma)
• Results when foreign material enters tracheobronchial tree
• Common in patients who:
• Have altered level of consciousness
• Are intubated
• Have aspirated foreign bodies

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3
Q

What are the signs and symptoms of pneumonia?

A 
‘Classic’ S/S of pneumonia include:
• Productive cough
• Pleuritic chest pain
• Fever that produces “shaking
chills” (usually associated with
bacterial infection)
• Nonspecific complaints: eg:
non-productive cough, headache,
fatigue, and sore throat
• Dyspnoea
• Occasionally haemoptysis
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4
Q

What is the treatment for pneumonia?

A

• Primary survey
• A to E with Respiratory status assessment- including
extensive auscultation
• Vital signs: GCS, HR, RR, BP, SPO2, ECG
• Focused history using OPQRST
• Bronchodilators (can be effective for some patients) and oxygen therapy
• Advanced airway management – intubation if required; assisted ventilations
• Gain IV access and consider fluid infusion
• Monitor TREND of medications

Long-term:
• Antibacterial medications
• Lifestyle support

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5
Q

What is the Pneumonia Severity Index (PSI)?

A

A validated risk stratification instrument which can help in identifying community acquired pneumonia patients who can safely be treated with outpatient antibiotics.

The PSI involves calculating a score, which places a given patient into one of 5 risk classes.

Classes I, II, and III are at low risk for death, and may be considered for
outpatient treatment.

Risk classes IV and V should usually be hospitalised.

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6
Q

What is (ARDS) Acute Respiratory Distress Syndrome?

A

a sudden and severe form of respiratory failure characterised by acute lung inflammation and diffuse alveolar-capillary injury.

All disorders that result in ARDS cause severe noncardiogenic pulmonary oedema

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7
Q

What can cause the development of

(ARDS) Acute Respiratory Distress Syndrome?

A
  • Trauma
  • Gastric aspiration
  • Cardiopulmonary bypass surgery
  • Gram-negative sepsis
  • Multiple blood transfusions
  • O2 toxicity
  • Toxic inhalation
  • Drug overdose
  • Pneumonia
  • Infections
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8
Q

What are the 3 clinical presentations that indicates Acute Respiratory Distress Syndrome (ARDS)?

A
  • Lungs are ‘wet’, heavy, congested, haemorrhagic, and stiff
  • Decreased perfusion capacity across alveolar membranes
  • Lungs become noncompliant- this requires patient to increase pressure in airways to breathe
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9
Q

Pulmonary oedema associated with ARDS leads to…?

A
  • Severe hypoxaemia
  • Intrapulmonary shunting
  • Reduced lung compliance
  • In some cases, irreversible damage to lung tissue
Complications:
• Respiratory failure
• Cardiac dysrhythmias
• Disseminated intravascular coagulation
• Barotrauma
• Congestive heart failure
• Renal failure
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10
Q

What are the signs and symptoms of ARDS?

A

Tachypnoea
• Laboured breathing
• Impaired gas exchange 12 to 72 hours after initial injury or medical crisis

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11
Q

What is the treatment of ARDS?

A
  • High-concentration O2 and ventilatory support
  • Fluid replacement to maintain cardiac output and peripheral perfusion
  • Drug therapy to support mechanical ventilation
  • Pharmacological agents (e.g., corticosteroids) to stabilise pulmonary, capillary, alveolar walls
  • Diuretics
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12
Q

What conditions fall under the category of an Upper Respiratory Tract Infections (URTI)?

A
  • Sinusitis
  • Laryngotrachobronchitis (coup)
  • Epiglottitis
  • Scarlet Fever
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12
Q

What conditions fall under the category of an Upper Respiratory Tract Infections (URTI)?

A
  • Common cold (infectious rhinitis)
  • Sinusitis
  • Laryngotrachobronchitis (coup)
  • Epiglottitis
  • Scarlet Fever
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13
Q

What condition presents with “strawberry tongue”?

A

Scarlet fever

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14
Q

What is a pulmonary embolism?

A

is a blood clot or mass that obstructs

the pulmonary artery or any of its branches.

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15
Q

Where do 90% of pulmonary emboli originate from?

A

Deep vein thromboses in the legs

16
Q

What are the signs and symptoms of pulmonary embolism?

A

Signs and symptoms:
• Transient chest pain, cough, dyspnoea—small emboli
• Larger emboli—increased chest pain with coughing or deep breathing; tachypnoea and dyspnoea develop suddenly.
• Later—haemoptysis and fever
• Hypoxia—causes anxiety, restlessness, pallor, tachycardia
• Localised wheezing
• Massive emboli
• Severe crushing chest pain, low blood pressure, rapid weak pulse,
loss of consciousness
• Distended neck veins

17
Q

What information in the patient assessment may help distinguish PE from other conditions that can cause similar signs and symptoms?

A
18
Q

What is the treatment for pulmonary embolism?

A
  • Mainly supportive:
  • Supplemental high-concentration O2
  • Cardiac monitor and pulse oximeter applied
  • IV access and fluids if indicated
  • Transport in position of comfort

Definitive care
• Requires hospitalisation and in-hospital treatment with
fibrinolytic or heparin therapy

19
Q

What is Mesothelioma?

A

a cancer typically related to exposure to asbestos that affects the mesothelium- a thin tissue membrane that covers internal organs of the body including the thoracic cavity (pleura), the heart sac
(pericardium) and the abdominal cavity (peritoneum).

20
Q

What is Pleural mesothelioma?

A

a cancer that affects the pleura, the
outer lining of the lung. Formed when small asbestos fibres remain in the lung.

• The human body is usually able to remove foreign particles but
the asbestos fibres are very small and embed themselves into the
mesothelium.
• As the body’s immune system tries to rid the body of the
asbestos fibres it causes permanent scarring and hardening of the
surrounding tissue.
• As the disease progresses the lining of the lungs, in the affected
area(s), thickens.

21
Q

What are the mesothelioma signs/symptoms and treatment?

A 
Signs and Symptoms include:
• Breathlessness
• Dry cough
• Pain in the chest or ribs area
• Fatigue
• Unexplained weight loss
• Night sweats or fever

Treatment:
• There is currently no known treatment.
• Treat presenting s/s.

22
Q

Tuberculosis is a disease caused by an infection caused by what bacteria?

A

Mycobacterium Tuberculosis

23
Q

What is a tuberculosis infection?

A

• TB Infection: the TB bacteria are in the body but they are “inactive”. The body’s defences control the germs, but these germs can stay alive in an inactive state.
• While the TB bacteria are inactive, they cannot do any damage, or be spread to other people.
• The patient is “infected”, but not sick. For 90%of people the germs will always be inactive.
Infection can be detected by a positive result to a Tuberculin Skin Test.

24
Q

What is a tuberculosis disease?

A

• TB Disease: TB can become active when the body’s defences are weakened.
• Due to ageing, serious illness, stressful event, drug or alcohol misuse, HIV infection (the virus
that causes AIDS) or other conditions.
• When inactive TB becomes active, TB disease can develop.
• Only about 10 % of people who are infected with TB bacteria will get TB disease.
• People with TB of the lungs or throat can be infectious to others.

25
Q

What are the signs/symptoms and treatment of tuberculosis?

A 
Signs and Symptoms:
• A cough that lasts for more than three weeks
• Fevers
• Unexplained weight loss
• Night sweats
• Always feeling tired
• Loss of appetite
• Blood stained sputum
• Pain/ swelling in the affected area when TB is
outside the lungs.

Treatment:
• Pre-hospital treat symptomatically.
• High level of infection control
• Long-term: AB’s

26
Q

What are the signs and symptoms of smoke inhalation?

A 
• Facial burns
• Singed nasal or facial hairs
• Carbonaceous sputum
• Oedema of the face, oropharyngeal
cavity, or both
• Signs of hypoxaemia
• Hoarse voice
• Stridor
• Brassy cough
• Grunting respirations
27
Q

What is the treatment of smoke inhalation?

A
  • Directed at maintaining patent airway
  • Providing high-concentration oxygen
  • Ventilatory support
  • Specific airway and ventilatory management
  • Bronchodilators
28
Q

What are the 3 characteristics of carbon monoxide?

A
  • Colourless
  • Odourless
  • Tasteless
29
Q

What are the signs and symptoms of CO2 poisoning?

A
  • Dizziness
  • Headache
  • Disorientation
  • Impairment of the cerebral function
  • Coma
  • Visual disturbances
  • Muscle weakness
  • Muscle cramps
  • Seizures
30
Q

What is the treatment for carbon monoxide poising?

A

• Ensuring patent airway, providing adequate ventilation
• Administering high-concentration oxygen
• Half-life of carbon monoxide at room air is about
4 hours
• Can be reduced to 30 to 90 minutes if 100 percent
oxygen and adequate ventilation are provided

31
Q

What are the categories of poising by inhalation?

A

Simple asphyxiants: methane, propane, inert gases
• Cause toxicity by displacing or lowering amount of O2 in air

Chemical asphyxiants: CO, cyanide
• Cause number of local and pulmonary reactions
• Toxic systemic effects prevent uptake of O2 by blood
• Can interfere with tissue oxygenation

Irritants/corrosives: chlorine, ammonia
• Cause cellular destruction and inflammation as they contact moisture

32
Q

What is the treatment for poisoning by inhalation?

A

• Adequate airway, ventilatory and circulatory support
• Initial assessment and physical examination
• Irrigation of eyes as needed
• IV line with saline solution
• Regular monitoring of vital signs, ECG, and pulse
oximetry
• Rapid transport

33
Q

What are the 5 steps in the life cycle of SARS CoV-2?

A
  • Attachment - bind to host receptors
  • Penetration - enter host cells through endocytosis or membrane fusion
  • Viral contents are released inside the host cells and viral RNA enters the nucleus for replication
  • Biosynthesis - Viral mRNA is used to make viral proteins
  • Maturation - New viral particles are made
  • Release

Medical Studies 1 (11 decks)

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