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msn 626 > msn 626 exam 1 > Flashcards

msn 626 exam 1 Flashcards

1
Q

What are the three categories of pneumonia?

A
  • Community acquired
  • Atypical pneumonia
  • Healthcare associated
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2
Q

Hospitalization for over (__) days in the last (__) days is suspicious for healthcare associated pneumonia.

A

2

90

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3
Q

IV therapy, wound care, or chemo in the last (__) days is suspicious for pneumonia

A

30 days

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4
Q

Treatment in a dialysis clinic in the last (__) days is suspicious for pneumonia

A

30

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5
Q

Who is the typical pneumonia patient?

A

elderly black males

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6
Q

What is the all cause mortality for hospital acquired pneumonia

A

28%

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7
Q

What are the internal predisposing factors for developing pneumonia?

A

Hypoxemia
Acidosis
Pulmonary edema
Uremia

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8
Q

Why is it important to ask about altered level of consciousness with pneumonia?

A

aspiration pneumonia

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9
Q

What is the most common infectious pneumonia? What is this associated with?

A

Strep. Pneumoniae

Smoking

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10
Q

How does smoking predispose to pneumonia?

A

Impairment of cilia

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11
Q

How does EtOH predispose to pneumonia?

A

Impairment of cilia/immune system

Aspiration

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12
Q

How does hypoxemia and acidosis predispose to pneumonia?

A

lowered immune system

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13
Q

Typical or atypical cause of pneumonia: strep pneumonia

A

typical

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14
Q

Typical or atypical cause of pneumonia: HiB

A

typical

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15
Q

Typical or atypical cause of pneumonia: Staph Aureus

A

typical

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16
Q

Typical or atypical cause of pneumonia: mycoplasma pneumonia

A

atypical

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17
Q

Typical or atypical cause of pneumonia: legionella

A

atypical

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18
Q

What are the four most common infectious agents found to cause pneumonia?

A
  1. Strep pneumonia
  2. viruses
  3. Mycoplasma pneumoniae
  4. Legionella
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19
Q

What are the bacteria that you should consider with pneumonia post influenza?

A 
Staph aureus (MRSA)
Enterobacteriaceae
Pseudomonas
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20
Q

SVC obstruction is usually pathognomonic for what?

A

lung CA

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21
Q

What is the test that can be run to detect Legionella (besides a culture/PCR)?

A

Urine antigen test

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22
Q

What is the bacteria that causes hospital acquired pneumonia?

A

staph aureus

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23
Q

What are the common associations with legionella?

A

Water sources (air conditioners, showers, etc)

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24
Q

True or false: gram negative bacilli are uncommon causes of CAP, with the exception of patients requiring ICU treatment

A

true

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25
Q

What are the two most common infectious agents of CAP in the ICU?

A

S. pneumoniae

Gram negative

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26
Q

What are the usual ssx of typical pneumonia?

A

Productive cough
Fever
Pleuritic chest pain
Dyspnea

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27
Q

What is the CBC finding of typical pneumonia?

A

Leukocytosis with a L shift

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28
Q

What is the gold standard for diagnosing pneumonia?

A

CXR

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29
Q

True or false: establishing the specific pathogen for CAP is essential in the treatment of pneumonia

A

False–usual empiric therapy is sufficient

30
Q

What organisms should be cultured, if suspected?

A

Legionella
Flu or MERS
MRSA

31
Q

What bacterial infections do we have urinary antigen tests for? Are these valid after abx treatment?

A

Legionella
Strep pneumoniae

Still valid even after abx treatment

32
Q

What is the treatment for CAP?

A

Macrolide or doxycycline

33
Q

What is the treatment for pneumonia in patients with comorbidities? (2)

A

Oral fluoroquinolone (floxacins) or beta lactam plus a macrolide

34
Q

What is the treatment for inpatient pneumonia?

A

Fluoroquinolone

or

anti-pseudomonal beta lactam + a macrolide

35
Q

What is the ICU treatment for pneumonia?

A

Antipseudomonal + beta lactam

OR

Azithromycin

36
Q

What is the ICU treatment for pneumonia if pt has a PCN allergy?

A

Quinolone plus aztreonam

37
Q

How long should abx treatment for CAP be?

A

5 days

38
Q

What are the criteria for discontinuation of abx with CAP?

A

afebrile for 47-72 hours

39
Q

When are corticosteroids indicated for CAP?

A

Seriously ill patients, especially those in the ICU

40
Q

What are the risk factors for developing pneumonia secondary to an aerobic bacterial infection?

A

Alcohol use
Seizures
Stroke

41
Q

HIV patient who develops pneumonia leading to a pneumothorax should be suspected of having what infection?

A

pneumocystis

42
Q

Which of the following is NOT an early sign of HIV/AIDS?

A

Fatigue/vague abdominal pain

43
Q

Your HIV patient has Cytomegalovirus (CMV) . What is the appropriate treatment?

A

Gemcyclovir (pick the ‘vir’)

44
Q

Know HIV testing:

A

ELISA confirmed with Western Blot. AIDS = CD4 <200 (800 is WDL) or <20%. Ideal viral load (by PCR) < 5000

45
Q

HIV pt with petechiae on legs (bone marrow suppression) and leg weakness (malaise) What should you test for?:

A

cytomegalovirus (CMV)

46
Q

What does allopurinol prevent in Non-Hodgkin Lymphoma?

A

tumor lysis syndrome

47
Q

pneumonias - Tx

A
  • rest, fluids, humidified inhalations, percussion massages of thorax, mucolytis and expectorants, antitussives in irritative cough and artifical ventilation in respiratory distress
  1. CA penumonia: penicillin, cephalosporins
  2. G- suspected: quinolones 3rd gen +/- cephalosporins
  3. atypical pneumonia: doxycycline, macrolides
  4. legionella: macrolides, quinolones - parenterally
  5. symptomatic: antivirotics
  6. PCP: cotrimoxazole
48
Q

Catheter related UTI

A

TREATMENT
- PCN/Amoxicillin

always resistant to bactrim and cephalosporins

49
Q

C. Diff treatment

A

TREATMENT

  • PO vancomycin or fidaxomicin
  • IV metronidazole if severe
50
Q

C. Diff

A

watery diarrhea, cramping, megacolon

usually after ABX use or a hospital stay

51
Q

C. diff Initial Infection (mild-moderate) tx

A

PO Vanc. 125mg Q6H x 10-14 days
OR
-Fidaxomicin 200mg PO Q12H x 10 days
-2nd line Metronidazole 500mg PO Q8H x 10-14 days

52
Q

C. Diff Severe Infection (w/o complications) Tx

A

Vancomycin 125mg PO Q6H x 10-14 days
OR
-Fidaxomicin 200mg PO Q12H x 10 days

53
Q

C. diff sever infection with complications Tx

A

Vancomycin 500mg PO Q6H
PLUS -Metronidazole 500mg IV Q8H
-Vancomycin 250mg Q6H per rectal retention enema
-Surgical consult for possible subtotal colectomy

54
Q

1st Reoccurrence (same as initial infection based on severity) C. Diff tx

A

Fidaxomicin 200mg PO Q12H x 10 days
OR
-Vancomycin 125mg PO Q6H x 10-14 days followed by taper

55
Q

> 2 Reoccurrences (within 30-90 days or if worsens after initial tx cessation) C. Diff tx

A

Vancomycin 200mg Q12H x 10 days followed by taper
OR
-Fidaxomicin 200mg PO Q12H x 10 days followed by taper
OR
-Fecal microbiota transplant (FMT)

56
Q

What are the presenting symptoms of cord compression?

A

Pain - along the dermatome, progressive, worse on moving, coughing, sneezing

57
Q

What are the findings on examination for spinal cord compression

A

Spinal tenderness
UMN - hypertonia, hyper-reflexia, clonus and upper plantars
LOS
Urinary incontinence and reduced anal tone

58
Q

What is the GOLD standard investigation for spinal cord compression

A

MRI spine

59
Q

When is a CT indicated rather than an MRI for cord compression?

A

If the patient has a pacemaker of if not previously know to have a malignancy

60
Q

What specific blood test should you do? (spinal cord compression)

A

serum calcium

61
Q

what is supportive management for spinal cord compression

A 
Keep the patient flat until the stability of the spine is determined
Urinary catheter if retention
Monitor bowel function - laxatives
Physiotherapy
Daltepatin if bed-bound
62
Q

what is the medical management for spinal cord compression

A

Dexamethasone - 8mg - reduces the oedema around the lesion
Give omeprazole with it
Monitor blood sugar

63
Q

causes of superior vena cava obstruction (SVC)

A

Bronchogenic carcinoma - small cell Lung Ca
Lymphoma
Metastatic tumors
SVC thrombosis and mediastinal fibrosis

64
Q

S/S of SVC

A
  1. Raised and fixed JVP
  2. Swollen face/arm
  3. Dilated, tortuous veinsDistention of neck and chest wall veins
    Fixed (i.e. non-pulsatile) elevated JVP
    Facial oedema/puffiness
    Oedema of the arms
    Plethora of face
    Peripheral cyanosis
65
Q

What are the 5 main investigations for SVC?

A

If new presentation of malignancy then station, biopsy etc
CXR
CT
Superior venogram
Bronchoscopy if primary lung cancer suspected

66
Q

what are management options for SVC

A

Sterior and supportive
Radio/chemotherapy
Stenting of SVC for benign cuases
Thrombolysis and anticoagulation if thrombosis of SVC
Remove catheter if catheter induced SVC thrombosis

67
Q

causes or tumor lysis syndrome

A

Breakdown of large tumour by chemotherapy causes release of electrolytes

68
Q

what are expected lab results with tumor lysis syndrome

A
  1. Increased : K, Na, bicarbonate, urea

2. Decreased: Ca

69
Q

pre-hospital mx of meningitis

A

IM benzylpenicillin

70
Q

Hospital mx of meningitis (no signs of septicaemia)

A

ABC: IV fluids
Cefotaxime 2g (+ ampicillin if >55yo)
Dexamethasone 4-10mg/6h IV

71
Q

Tumor lysis syndrome?

A

Electrolyte + metabolic disturbance due to breakdown of large number cancer cells (common in leukaemia)

Hyperuricaemia, hyperphosphataemia, hyperkalaemia, hypocalcaemia, +/- renal impairment)

72
Q

Mx of tumor lysis syndrome?

A

IV fluids

Allopurinol in chemo reigime

+/- Haemodialysis

msn 626 (2 decks)

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