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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
What are the two most common infectious agents of CAP in the ICU?
S. pneumoniae | Gram negative
26
What are the usual ssx of typical pneumonia?
Productive cough Fever Pleuritic chest pain Dyspnea
27
What is the CBC finding of typical pneumonia?
Leukocytosis with a L shift
28
What is the gold standard for diagnosing pneumonia?
CXR
29
True or false: establishing the specific pathogen for CAP is essential in the treatment of pneumonia
False--usual empiric therapy is sufficient
30
What organisms should be cultured, if suspected?
Legionella Flu or MERS MRSA
31
What bacterial infections do we have urinary antigen tests for? Are these valid after abx treatment?
Legionella Strep pneumoniae Still valid even after abx treatment
32
What is the treatment for CAP?
Macrolide or doxycycline
33
What is the treatment for pneumonia in patients with comorbidities? (2)
Oral fluoroquinolone (floxacins) or beta lactam plus a macrolide
34
What is the treatment for inpatient pneumonia?
Fluoroquinolone or anti-pseudomonal beta lactam + a macrolide
35
What is the ICU treatment for pneumonia?
Antipseudomonal + beta lactam OR Azithromycin
36
What is the ICU treatment for pneumonia if pt has a PCN allergy?
Quinolone plus aztreonam
37
How long should abx treatment for CAP be?
5 days
38
What are the criteria for discontinuation of abx with CAP?
afebrile for 47-72 hours
39
When are corticosteroids indicated for CAP?
Seriously ill patients, especially those in the ICU
40
What are the risk factors for developing pneumonia secondary to an aerobic bacterial infection?
Alcohol use Seizures Stroke
41
HIV patient who develops pneumonia leading to a pneumothorax should be suspected of having what infection?
pneumocystis
42
Which of the following is NOT an early sign of HIV/AIDS?
Fatigue/vague abdominal pain
43
Your HIV patient has Cytomegalovirus (CMV) . What is the appropriate treatment?
Gemcyclovir (pick the ‘vir’)
44
Know HIV testing:
ELISA confirmed with Western Blot. AIDS = CD4 <200 (800 is WDL) or <20%. Ideal viral load (by PCR) < 5000
45
HIV pt with petechiae on legs (bone marrow suppression) and leg weakness (malaise) What should you test for?:
cytomegalovirus (CMV)
46
What does allopurinol prevent in Non-Hodgkin Lymphoma?
tumor lysis syndrome
47
pneumonias - Tx
- 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
Catheter related UTI
TREATMENT - PCN/Amoxicillin always resistant to bactrim and cephalosporins
49
C. Diff treatment
TREATMENT - PO vancomycin or fidaxomicin - IV metronidazole if severe
50
C. Diff
watery diarrhea, cramping, megacolon usually after ABX use or a hospital stay
51
C. diff Initial Infection (mild-moderate) tx
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
C. Diff Severe Infection (w/o complications) Tx
Vancomycin 125mg PO Q6H x 10-14 days OR -Fidaxomicin 200mg PO Q12H x 10 days
53
C. diff sever infection with complications Tx
Vancomycin 500mg PO Q6H PLUS -Metronidazole 500mg IV Q8H -Vancomycin 250mg Q6H per rectal retention enema -Surgical consult for possible subtotal colectomy
54
1st Reoccurrence (same as initial infection based on severity) C. Diff tx
Fidaxomicin 200mg PO Q12H x 10 days OR -Vancomycin 125mg PO Q6H x 10-14 days followed by taper
55
>2 Reoccurrences (within 30-90 days or if worsens after initial tx cessation) C. Diff tx
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
What are the presenting symptoms of cord compression?
Pain - along the dermatome, progressive, worse on moving, coughing, sneezing
57
What are the findings on examination for spinal cord compression
Spinal tenderness UMN - hypertonia, hyper-reflexia, clonus and upper plantars LOS Urinary incontinence and reduced anal tone
58
What is the GOLD standard investigation for spinal cord compression
MRI spine
59
When is a CT indicated rather than an MRI for cord compression?
If the patient has a pacemaker of if not previously know to have a malignancy
60
What specific blood test should you do? (spinal cord compression)
serum calcium
61
what is supportive management for spinal cord compression
``` 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
what is the medical management for spinal cord compression
Dexamethasone - 8mg - reduces the oedema around the lesion Give omeprazole with it Monitor blood sugar
63
causes of superior vena cava obstruction (SVC)
Bronchogenic carcinoma - small cell Lung Ca Lymphoma Metastatic tumors SVC thrombosis and mediastinal fibrosis
64
S/S of SVC
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
What are the 5 main investigations for SVC?
If new presentation of malignancy then station, biopsy etc CXR CT Superior venogram Bronchoscopy if primary lung cancer suspected
66
what are management options for SVC
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
causes or tumor lysis syndrome
Breakdown of large tumour by chemotherapy causes release of electrolytes
68
what are expected lab results with tumor lysis syndrome
1. Increased : K, Na, bicarbonate, urea | 2. Decreased: Ca
69
pre-hospital mx of meningitis
IM benzylpenicillin
70
Hospital mx of meningitis (no signs of septicaemia)
ABC: IV fluids Cefotaxime 2g (+ ampicillin if >55yo) Dexamethasone 4-10mg/6h IV
71
Tumor lysis syndrome?
Electrolyte + metabolic disturbance due to breakdown of large number cancer cells (common in leukaemia) Hyperuricaemia, hyperphosphataemia, hyperkalaemia, hypocalcaemia, +/- renal impairment)
72
Mx of tumor lysis syndrome?
IV fluids Allopurinol in chemo reigime +/- Haemodialysis

msn 626 (2 decks)

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