Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical Prep > PNA, Tuberculosis > Flashcards

PNA, Tuberculosis Flashcards

1
Q

Most common cause of Typical PNA

A

Strep PNA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Atypical causes of PNA

A

Mycoplasma PNA, Chlamydophila PNA, Legionella, Viral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Sx of Typical PNA

A

Fever
Productive cough
Pleuritic CP
Dyspnea

Severe chills with violent shaking is assoc w: STREP PNA (the most common type)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Sx of Atypical PNA

A

low grade fever
dry cough
extrapulm sx: muscle ache, n/v/d, pharyngitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

H. influenza
Klebsiella
Staph aureus are all types of

A

Typical PNA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

PE of Typical PNA (classic)

A

Tachypnea, tachycardic

Consolidation: bronchial breath sounds, dull to percussion, increased tactile fremitus, egophony, rales

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

PE of Atypical PNA

A

often normal!! may have crackles/rales

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Keep in mind when taking PE of a Diabetic, Immunocomp, or old pt in which you suspect PNA

A

Physical exam may be normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

With an effusion, PNX, or obstructive pattern..

what will Fremitus and Breath sounds be like?

A

Decreased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

H flu
Klebsiella
Staph

and STREP PNA

A

Typical PNA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Most common cause of CAP
Chills and violent Rigor
Blood rusty sputum

gram + diplococci

A

Strep PNA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Extremes of Age: SUPER YOUNG or SUPER OLD
immunocomp
underlying pulm dz

A

H. influenzae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Superimposed infection AFTER a VIRAL infection
or Hospital acquired
CXR: bilateral, multi-lobar, abscesses- cavitary lesions YIKES

A

Staph Aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Severe alcoholism
super sick pt, chronic illness- DM

Purple colored sputum!!! (currant jelly)
CXR cavitary lesions hallmark (not specific)

A

Klebsiella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which two types of Typical PNA can show cavitary lesions on CXR?

A

Staph Aureus

Klebsiella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Most common cause of Atypical “walking” PNA

A

Mycoplasma PNA

what Pap had!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Mycoplasma PNA (atypical) sx

A

HA, fatigue, fever then —-> dry cough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Complication of Mycoplasma PNA

A

Cold Autoimmune hemolytic ANEMIA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Dx of Mycoplasma PNA

A

CXR: Reticulonodular, diffuse, patchy, interstitial infiltrates

PCR: cold agglutinins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Tx for PNA

A

Z pack most common- Azithromycin (a macrolide)

or

Doxy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Tx for PNA

A

Azithromycin “Z pack” or

Doxy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Legionella PNA

atypical

A

assoc with WATER sources
not spread person to person

fever, chills, sob, DRY cough, and GI SX !!! this is unique- watery diarrhea

other complications: Low NA, increased LFT, Neuro sx (HA, confusion)

Tx: Azithromycin or FluoroQ (Levofloxacin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Legionella unique traits

A

Water
no person to person spread
GI SX!!- diarrhea
Hyponatremia, Liver fx test, Neuro sx

Treat with Azithro or FluoroQ (Levofloxacin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the cutoff of someone going into hospital to determine if its Community Acquired “CAP” or Hospital Acquired?

A

CAP: outside of hospital or within 48 hrs
HAP: after 48 hrs of being in hospital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

If hospital acquired, what are common organisms?

A

Pseudomonas and MRSA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Most common pathogens causing diff types of PNA

A

Typical: Strep
Atypical: Mycoplasma
Hospital: Pseudomonas, MRSA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Beta lactams

A

PCNS

Cephalosporins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Beta lactam used to treat PNA

A

Ceftriaxone (Rocephin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Anti-pseudomonal beta lactams used to treat PNA

remember pseudomonas is a common cause of Hospital acquired PNA

A

Need Anti pseudomonal beta lactam
+
Aminoglycoside or FluoroQ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Example of tx for Hospital acquired PNA

with anti-pseudomonal coverage

A

Piperacillin/Tazobactam (anti-pseud beta lactam)
+
Levofloxacin (fluoroQ)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Anti-pseudomonal Beta lactams

A

Piperacillin/Tazobactam
Ceftazadime
Cefepime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Aminoglycosides

A

Amikacin
Gentamicin
Tobramycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

CURB65 criteria- when deciding whether to admit a PNA patient or not

A 
Confusion
Uremia >30
Resp rate >30
BP low, systolic <90 or diastolic <60
Age >65

If at least 2 are present, ADMIT!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Histoplasmosis (caused by oval yeast) tx

A 
Itraconazole (mild-mod dz) or
Amphotericin B (severe)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Pneumococcal vaccines

PCV13 and PPSV23

A

PCV13: part of 4 dose series–> 2, 4, 6, and 12 mo

PPSV23: all adults 65 and older, and younger pts with inc risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

If you are over the age of 65, which Pneumococcal vaccine should you receive?

A

PPSV23

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

SOB on exertion (and O2 sat drops)
Dry cough
Fever

Most common HIV opportunistic infection

A

PCP

Pneumocystis PNA

38
Q

Tx of PCP

A

Bactrim x 21 days

if HIV+, can add Prednisone if pt is hypoxic

39
Q

Primarily Rapidly progressive TB (tuberculosis)

A

often Children
Contagious
Clinical progression

40
Q

Chronic- Latent infection

A

not contagious

41
Q

Secondary Reactivation of TB

A

waning immune defenses
Old, HIV, Steroid use, CA

Localize in Apex/upper lobes with Cavitary lesions

CONTAGIOUS

42
Q

Clinical sx of TB

A

cough, fever, night sweats, CP, HEMOPTYSIS

Extrapulm (can affect any organ): Scrofula (irritated and inflamed lymph nodes), Pott’s dz (Tb of spine, arthritis), pericarditis, adrenal gland

43
Q

CXR of Primary TB

A

middle/lower lobe consolidation

44
Q

CXR of Reactivated TB

A

upper lobe (apical) fibrocavitary dz

45
Q

Tx of TB

“RIPE!”

A

Rifampin
Isoniazid
Pyrazinamide
Ethambutol for 2 months

followed by 4 mo continued Rifampin and Isoniazid

46
Q

How long total is tx for Active TB?

A

6 months

2 mo with the 4 drugs
4 mo with the 2 drugs (Rifampin and Isoniazid)

47
Q

What 2 drugs do you continue for the last four mo of TB treatment?

A

Rifampin

Isoniazid

48
Q

Tx of Latent TB

A

Isoniazid and Pyridoxine x 9 months

49
Q

SE of Rifampin

A

Orange colored secretions

50
Q

Classic Primary TB on CXR

A

Lower lobe consolidation

51
Q

Classic Reactivation TB on CXR

A

Infiltrates and cavitation in upper lobe/apices

52
Q

Most common cause of Acute Bronchitis

A

VIRAL

53
Q

Often ppl with Acute Viral Bronchitis

A

appear better than they feel

really feel like crap (cough, no fever, chest wall tender, wheezing, mild dyspnea)

54
Q

When to get CXR if pt is coming in with Bronchitis like sx?

A

if any are present:

  • fever
  • tachy x2
  • consolidation on chest exam

OR

cough >3 weeks

55
Q

Symptomatic tx for Acute Viral Bronchitis

A

Hydrate and rest

  • NSAIDs
  • Ipratropium “Atrovent” (SAMA)
  • Antitussive
  • Albuterol inhaler
  • OTC stuff like cough drops, hot tea, honey
56
Q

Pertussis WHOOPING cough is an example of when Bronchitis is bacterial

A

URI 1-2 wks

WHOOP cough 2-6 wks, posttussive emesis

cough gradually resolves, up to 6 wks

57
Q

Pertussis “whooping cough” tx is NOT TO IMPROVE PTS CONDITION, but rather decrease transmission

(make sure pt knows this)

A

Azithromycin “Z pack”

or

Bactrim

58
Q

Complicated CAP

A

Beta lactam (Amox-Clav “Augmentin”)
+
Macrolide (Azithro “Z pack”)

OR

FluoroQ (Levofloxacin)

59
Q

PCP tx

A

Bactrim

and Prophylaxis Bactrim recommended in HIV pts with CD4 count <200

60
Q

Aspiration will likely be seen in what lobe?

A

Right LOWER lobe d/t leaking down from R main bronchus

61
Q

Tx for Aspiration PNA

A

Piperacillin/Tazobactam

62
Q

Lung Anatomy

A 
Trachea
Primary bronchi
Secondary bronchi
Tertiary bronchi
Bronchioles
63
Q

Solitary Pulmonary Nodule

A

Small <3 cm
“coin lesion”
most are benign, smooth, well defined edges

64
Q

4 Main types of Lung CA

A

Small cell
-Oat cell

Non-small cell

  • Adeno
  • Squamous cell
  • Large cell
65
Q

Small cell Lung CA
“Oat cell”

Oat Cell is Highly Aggressive

A

Central airway
Large hilar mass with BULKY mediastinal adenopathy

cough, SOB, weight loss

HIGHLY AGGRESSIVE- often METS

66
Q

Large hilar mass w bulky adenopathy
Compression on central airway
HIGHLY AGGRESSIVE

A

Small/ Oat cell

67
Q

If Non-small cell Lung CA, what type is the most common?

A

Adenocarcinoma

Arise frm Mucous glands or any Epithelial cell in/distal to terminal bronchioles

Mets to distant organs

68
Q

Squamous cell carcinoma

A

Central or Main bronchus

more likely to cause HEMOPTYSIS (bloody cough)

Mets to REGIONAL lymph nodes

can cavitate

69
Q

Large cell lung CA

A

Mets to distant organs

AGGRESSIVE w rapid doubling times

70
Q

CA a/w:

SVC syndrome and Paraneoplastic syndrome? (SIADH, Cushings, Eaton-lambert)

A

Small Cell lung CA/ Oat cell

pushing on the central stuff
highly aggressive

71
Q

Adenocarcinoma

A

peripherally
distant METS
Thrombophlebitis, clubbing

72
Q

Squamous cell

SLOW GROWING

A

CENTRAL BRONCHI
Hemoptysis (blooody cough)
SLOWER growing
May cavitate

73
Q

Large cell

A

Aggressive, fast growing

dx of exclusion

74
Q

Sx of Lung CA

A 
Cough
Weight loss
SOB
CP
Hemoptysis (squamous cell)
75
Q

Sx that Lung CA has spread Intrathoracically

A

Pleural effusion
Pericardial effusion
Hoarseness to voice
SVC syndrome

76
Q

SVC syndrome- compression of the vena cava

Small/Oat cell

A 
SOB
Facial swelling
Head fullness
Dilated neck veins
Prominent vein pattern on chest
Dysphagia
77
Q

Gold standard to diagnose SVC syndrome

A

Superior veno cavogram

78
Q

Pancoast syndrome

A

Tumor in superior sulcus

compressing Brachial plexus and Cervical sympathetic nerves

Shoulder > forearm, scapula, and finger pain

SAME SIDE of tumor

79
Q

Horner’s syndrome

A

Injury of sympathetic nerves of face

Miosis-pupil constriction
Anhidrosis- lack sweating
Ptosis-droopy

80
Q

Pancoast syndrome

shoulder

A

Rib destruction
Atrophy of hand muscles
Pain in C8, T1, T2 nerve roots

81
Q

Paraneoplastic syndrome

side effect of having CA

A

Altered immune response to the tumor

  • bood
  • endocrine
  • neuro
82
Q

Blood effects of Paraneoplastic syndrome

A 
HyperCa2+ (bone destruction)
Anemia
Leukocytosis (too much)
Thrombocytosis (too much)
Hypercoag
83
Q

Endocrine effects of Paraneoplastic syndrome

A

HyperCa2+

Excess HCG production (gynecomastia, milky nipple discharge)

84
Q

SIADH

often w small/oat cell

A

Hyponatremia

Irritable, restless, personality change, confusion, coma, seizure, respiratory arrest

85
Q

Cushing’s syndrome

often w small/oat cell

A

Muscle weakness, weight loss, HTN, Hirsutism, oseoporosis

86
Q

Neuro effects of Paraneoplastic syndrome

A

Eaton Lambert

Immune mediated at the NMJ
defective release of Ach, muscle weakness, decreased DTRs

87
Q

Most common site of Lung CA METS

A

Liver #1

Bone
Adrenal glands
Brain

88
Q

TMN staging system

A

T- primary tumor
N- node involvement
M- distant mets

89
Q

Tx of Small cell/Oat cell lung CA

A

Chemo regardless of stage

relapse is common

90
Q

Non-small cell lung CA

A

SURGERY until get to Stage 4, then need to consider Palliative radiation or Combo chemo

91
Q

Who to screen for Lung CA

A

Low density Chest CT

  • Current smoker age 55-74 with 30 pack yr hx
  • quit within 15 yr
  • 20 pack yr hx and 1 additional risk factor
92
Q

Rx drugs for Smoking cessation

A

Zyban (wellbutrin)
Chantix (varenicline)
Nicotine replacement
OTC nicotine (gum)

Clinical Prep (41 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions