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Pulmonology Exam > PNA and ARDS (and Pleural Effusions) > Flashcards

PNA and ARDS (and Pleural Effusions) Flashcards

1
Q

what are some of the major risk factors for CAP?

A

lifestyle factors and previous episode of PNA

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2
Q

what are some of the risk factors for HAP?

A

male sex, malnutrition, burns, trauma, and post surgery

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3
Q

who is at risk for aspiration PNA?

A

impaired swallowing, impaired consciousness, stroke patients

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4
Q

what are the factors that lead the transition from colonization to infection?

A

host factors: defenses impaired, chronic lung disease, preceding infection, abnormal lung microbiota; pathogen factors: large inoculum, highly virulent microorganism

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5
Q

once a LRTI has occurred the maintenance of lung homeostasis depends on an adequate balance between what?

A

immune resistance and tissue resilience

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6
Q

what are the most frequent pathogens causing HAP and VAP?

A

p. aeruginosa and s. aureus

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7
Q

what is the main concern in HAP and VAP?

A

antibiotic resistance is the main concern

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8
Q

what pathogens are most likely to cause aspiration PNA?

A

anaerobes and gram negative bacilli (e.coli, k. pneumoniae, and p. aeruginosa)

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9
Q

symptom burden does not predict outcome nor etiology in pna. What are the exceptions to this statement?

A

delirium: increased risk of mortality; pleuritic chest pain: increased risk of pleural effusion

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10
Q

what are the steps of diagnosing PNA?

A
  1. pt has acute onset of symptoms of LRTI 2. New infiltrates on CXR 3. microbiology tests/influenza test/ COVID-19 test/ CBC/CMP/ CRP/ procalcitonin
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11
Q

what kind of microbiology tests are performed in patients with PNA admitted to the ward?

A

gram stain, sputum culture and urinary antigen test

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12
Q

what kind of microbiology tests are performed in ICU patients with PNA?

A

gram stain, sputum culture, blood culture, urinary antigen tests, and PCR for respiratory viruses

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13
Q

how do you treat non-severe CAP?

A

b-lactam +macrolide
or
respiratory fluoroquinolone

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14
Q

how do you treat severe CAP?

A

b-lactam + macrolide
or
b-lactam + respiratory fluroquinolone

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15
Q

what happens if you have a patient with severe CAP and they were recently hospitalized, on parenteral antibiotic, and they are at risk for MRSA infection?

A

add mrsa coverage like vancomycin

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16
Q

what would you do if you had a patient with severe CAP, they were recently hospitalized, on parenteral antibiotic, and at risk for pseudomonas infection?

A

add pseudomonas coverage like piperacillin-tazobactam

17
Q

how would you treat a patient if you are concerned for aspiration?

A

same agents, but if they have poor dentition- then we also want to add a broad coverage b-lactam like ampicillin-sulbactam or a quinolone

18
Q

what are the complications associated with PNA?

A

cardiovascular disease–> new or worsening heart failure, new or worsening arrhythmias, and acute coronary syndromes

19
Q

how do you manage severe cases of covid-19 PNA?

A

dexamethasone, remdesivir, and cytokine inhibitors

20
Q

what is the normal amount of fluid that should be in the pleural space?

A

.1 mL per kg

21
Q

what are the 6 most common conditions associated with pleural effusions?

A

heart failure, bacterial PNA, pulmonary embolism, malignancy, viral disease, post-cardiac surgery

22
Q

how might a pleural effusion caused by heart failure present?

A

hypoxia, pulmonary/peripheral edema

23
Q

what might the physical look like in a patient with a pleural effusion?

A

decreased breath sounds at the base of the affected lung; dullness to percussion is sensitive and specific for diagnosing effusion

24
Q

what physical exam finding would be diagnostic of a pleural effusion?

A

dullness to percussion

25
Q

what imaging modality is used to diagnose a pleural effusion?

A

CXR: PA 200 mL and lateral: 50 mL

26
Q

what is pleural fluid routinely tested for?

A

protein, lactate dehydrogenase, gram staining and culture, cytology, pH level, glucose

27
Q

what is light’s criteria used for?

A

99.5% sensitive for diagnosing exudative effusion and differentiate exudative from transudative effusions

28
Q

what are light’s criteria? (3)

A

pleural fluid protein to serum protein ratio >.5
pleural fluid LDH to serum LDH ratio >.6
pleural LDH >.67 x upper limit of normal for serum LDH

29
Q

what is ARDS?

A

rapidly progressive noncardiogenic pulmonary edema

30
Q

what are some of the major risk factors for ARDS?

A

older age, alcohol abuse, cigs, air pollution, hypoalbuminemia, trauma, disparities in gender and ethnicity

31
Q

what is the treatment for ARDS?

A

supportive; oxygen and positive pressure ventilation

32
Q

what are the rescue therapies used to treat ARDS?

A

nitric oxide, ECMO or CO2 removal, glucocorticoids

Pulmonology Exam (11 decks)

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