Brainscape's Knowledge GenomeTM

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


See full index

Clin Med II Final - PULM and Critical Care > PULM Neoplasms and FB, VTE, Pulm HTN and cor Pulmonale, Pneumonia > Flashcards

PULM Neoplasms and FB, VTE, Pulm HTN and cor Pulmonale, Pneumonia Flashcards

1
Q

Explain the components of Virchow’s Triad

A
    1. Venous stasis
    1. Hypercoagulability (alterations in the constituents of the blood)
    1. Endothelial injury

–> Recruitment of activated platelets which release microparticles containing proinflammatory mediators that bind neutrophils stimulating them to release their nuclear material and form prothrombotic networks

–> Clot can embolize from the leg to the lung to form pulmonary embolism

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

Name some of the common risk factors associated with VTE

A
  • Post-operative (recent surgery – especially orthopedic)
  • Total hip arthroplasty (THA)
  • Total knee arthroplasty (TKA)
  • Hip fracture surgery (HFS)
  • Pelvic fractures
  • Multiple fractures from severe trauma
  • Sedentary state (Hospitalized/bedrest, Prolonged travel, lifestyle )
  • Malignancy
  • Hx VTE in the past
  • Pregnancy
  • Oral Contraceptives
  • Obesity
  • Heavy cigarette smoking (>25 cigarettes per day)
  • Hypertension
  • Inherited hypercoagulable disorders (Inherited Thrombophilia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Hereditary conditions that predispose to hypercoagulability

A

(Inherited Thrombophilia)

_•Factor V Leiden Mutatio_n – causes resistance to activated protein C

•Prothrombin Gene Mutation – increases plasma prothrombin concentration

•Deficiency of proteins C and S

•Antithrombin III deficiency

•Anticardiolipin antibodies (antiphospholipid syndrome) **Antithrombin, Protein C and Protein S are naturally occurring coagulation inhibitors.

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

Surgerys that are risk factors for VTE

A
  • Total hip arthroplasty (THA)
  • Total knee arthroplasty (TKA)
  • Hip fracture surgery (HFS)
  • Pelvic fractures
  • Multiple fractures from severe trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe Well’s Criteria for PE

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

Decribe Well’s Criteria for DVT

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

Name the common symptoms associated with:

DVT

PE

A

DVT:

Unilateral LE swelling (calf)

Pain

Cramping

tenderness

Erythema

Warmth

PE

Tachypnea, hypoxia, tachycardia***

Sudden SOB

Pleuritic chest discomfort

Heart palpitations

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

Recognize the EKG features of a patient with right heart strain secondary to massive pulmonary embolism

A

S1, Q3, T3 and R ventricular strain pattern

I – S wave in lead I is seen, should be an R wave

•(none should be going down)

III – pathologic Q wave seen and inverted T wave

V1-V3 – down going T wave, dip very low

* R ventricular strain pattern – T wave inversions in R & anterior precordial leads (V1-V4) +/- inferior leads (II, III, aVF) – associated w/ high pulm pressures – most specific *Complete or incomplete RBBB

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

Identify patients for whom the PERC rule is appropriate

A

rule out very low risk pts to avoid unnecessary testing / imaging

MUST HAVE ALL 8

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

D-Dimer is used in ____ probability patients to rule out DVT.

______-______ probability in PE.

A

Low probability patients to r/o DVT

Low-Moderate probability in PE

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

What are the gold standard imaging tests for both DVT and PE

A

DVT -

Venous duplex ultrasound -> Looking for loss of vein compressibility

PE

CT angiogram w/ contrast **

(CI in kidney failure, contrast allergy and pregnancy)

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

what is the Imaging test of choice to diagnose PE in patients with kidney failure?

A

V/Q Scan -

used when CTA is contraindicated

(kidney failure, contrast allergy and pregnancy)

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

what imaging test is helpful when trying to differentiate MI from PE?

A

Echo

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

VTE Prophylaxis in High risk orthopedic patients

A

UFH for hospitalized patients

LMWH

Oral Factor Xa inhibitors (lower dose than treatment dose)

Pradaxa (direct thrombin inhibitor)

Aspirin should not be used as the sole agent***

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

What are the primary and secondary therapies for patients with VTE?

A

Primary therapy – clot dissolution

  • thrombolysis (tPA) or
  • removal of PE by embolectomy
  • (reserved for high risk of adverse clinical outcome)

Secondary therapy – anticoagulation

  • with anticoagulants OR
  • placement of IVC filter – removed after 2-3 weeks*
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the indications for placement of an IVC filter?

Complications?

A
  1. Active bleeding precludes anticoagulation
  2. Recurrent venous thrombosis despite intensive anticoagulation
  3. High risk patients who are not candidates for fibrinolysis

Complications:

Caval thrombosis causing marked bilateral leg swelling

•Double the DVT rate****

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

What are the causes of a provoked vs unprovoked clot?

what is the difference in duration of anticoagulation?

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

What anticoagulants would be appropriate for the following specialty groups:

Renal Failure (CrCl <30)

High Bleeding Risk

Malignancy

Pregnancy

A
  • Renal failure (CrCl <30) UFH drip bridge to warfarin
  • High bleeding risk - reversal agent may be needed use warfarin
  • Malignancy - LMWH long-term
  • Pregnancy - LMWH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the most common EKG finding with PE?

A

sinus tachycardia

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

Define pulmonary HTN?

Diagnostic Criteria: Mean pulmonary artery pressure ≥ ____ mmHg at rest with a pulmonary vascular resistance ≥ ___ wood units

A
  • Abnormal elevation in mean pulmonary artery pressure (mPAP)
  • Mean pulmonary artery pressure ≥ 20 mmHg at rest with a pulmonary vascular resistance ≥ 3 wood units
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

In regards to pHTN: Normal mPAP is __-__mmHg which is measured by right heart catheterization.

A

8-20 mmHg

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

Most common cause of pHTN in adults is ?

A

lung disease

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

What is the result of longstanding pulm HTN?

A

Chronic increase in either flow and/or pulmonary venous pressure can increase PVR

pHTN leads to decreased compliance of pulmonary vasculature which causes:

  1. Progressive increase in the RV afterload -> RV hypertrophy
  2. •Eventually RV dilated -> decreased contractility -> decreased cardiac output
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what are the classes of pHTN?

A

Class I: pHTN without limitations of physical activity

Class II: pHTN resulting in slight limitations of physical activity. No rest symptoms (Gets symptoms with activity, but only mildly limits the patient)

Class III: pHTN resulting in marked limitations of physical activity. No rest symptoms (Get symptoms with activity and severely limits them)

Class IV: pHTN with inability to perform any physical activities. Evidence of right heart failure. Symptoms at rest.

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

Group 1 pHTN is caused by?

What do we note about the PAP?

A

Idiopathic, heritable (caucasions 75%)

parasitic infections (schistomiasis) – most common cause worldwide

SEVERELY elevated PAP >25

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

what is the diagnostic criteria for Group 1 pHTN?

A
  • Mean PAP > 25 mmHg at rest
  • Mean PCWP < 15 mmHg
  • Chronic lung disease is mild or absent
  • Venous thromboembolic disease is absent
  • Other disorders are absent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Treatment for Group 1 pHTN?

A

ONLY advanced therapy – no underlying cause

Anticoagulation may be warranted in select patient population among Group 1 (idiopathic, hereditary, or drug induced)

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

Left sided HF most common cause of group __ pHTN.

How do we treat this group?

A

Group 2 - Caused by Left Heart Diseases

Treat underlying heart disease (ACE, ARBs, BBs, Inotropes, etc)

Treat volume overload (diuretics)

Fix underlying heart valve disease

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

What is the cause of Group 3 pHTN?

What are the most common causes?

A

Chronic Lung Dz – most common cause of pHTN

  • Obstructive (COPD) / restrictive
  • Obstructive sleep apnea
  • Hypoxia w/o lung dz
  • Developmental lung disorders

Most common causes: COPD & Interstitial lung disease

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

Treatment of Group 3 pHTN

A

Supplemental O2

Inhaled bronchodilators

Digoxin

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

Which pHTN group is caused by pulmonary artery occlusion?

How do we treat this group?

A

Group 4

Long term anticoagulation

Thromboendarterecty is recommended if treatment fails

Prostanoid agents (IV or inhaled epoprostenol or SQ treprostinil) can be considered

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

Group 5 pHTN is due to unknown causes. Name some disorders that are noted in this group.

A

Hematologic disorders – myeloproliferative disorders

Metabolic disorders – Glycogen storage diseases

Systemic disorders – sarcoidosis

Sickle cell dz

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

Treatment for Group 5 pHTN

A

Prostanoid agents (IV or inhaled epoprostenol or SQ treprostinil) have been shown to have a good response in Sarcoidosis

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

Gold standard for the diagnosis and quantification of pHTN?

A

Right-sided cardiac catheterization

mPAP ≥25 mmHg at rest -> diagnosis of pHTN can be given

mPAP 20-24 mmHg at rest -> further clinical data is needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Right-sided cardiac catheterization measures?

(4 things)

A

•RA pressure

RV pressure

  • mPAP
  • Pulmonary capillary wedge pressure(PCWP) – indirect measurement of the left heart pressure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Echocardiography with Doppler Flow is a useful tool to estimate the?

A

Estimate the right ventricular systolic pressure

  • pHTN is likely if PASP is > 50 mmHg and tricuspids regurgitation velocity (TRV) is > 3.4 m/s
  • pHTN is unlikely if PASP < 36 mmHg and TRV ≤ 2.8 m/s
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is one of the most important prognostic factors in regards to pHTN?

A

Right ventricular function is one of the most important prognostic factors

Worsening RV failure = worsening prognosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What medications would we use to treat class I symptoms of pHTN?

A

CCBs

(should only be given to patients who showed response to vasodilation test in cath lab)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What medications would we use to treat class II symptoms of pHTN?

A

Vasodilate pulmonary system:

Endothelin receptor antagonists

(Ambrisentan, Bosentan, Macitentan)

Phosphodiesterase inhibitors (Sildenafil, Tadalafil)

Guanylate cyclase stimulators (Riociguat)

40
Q

What medications would we give to patients w/ class III or IV pHTN symptoms (or failed other therapies)?

A

Prostanoid agents:

(IV or inhaled epoprostenol or SQ treprostinil)

41
Q

Idiopathic pHTN patients have a poor prognosis and a median survival of ___-___ years.

A

2-4 years

42
Q

What is Cor Pulmonale?

What causes it?

A

Altered structure and/or impaired function of the right ventricle that results from pulmonary hypertension

•systolic and diastolic failure

•Isolated Right sided heart failure due to pulmonary causes **

  • COPD
  • Idiopathic pulmonary fibrosis
  • Pneumoconiosis
  • Kyphoscoliosis
43
Q

What are some Si/Sx of Cor Pulmonale

A
  • Dyspnea at rest
  • Finger clubbing
  • JVD
  • Tricuspid regurgitation
  • Right sided S3
  • Narrow split S2
  • RV heave
  • RUQ pain
  • Hepatomegaly
  • Ascites
44
Q

Pathophysiology of Cor Pulmonale

A

Right heart failure results from long standing pulmonary hypertension

Right ventricular hypertrophy develops due to the high pulmonary pressure that it pumps against

Eventually right ventricle loses its contractility

Main cause of death in patients with pulmonary artery hypertension (group 1) is circulatory collapse

45
Q

What must patients with Cor Pulmonale show on an echocardiogram?

(Think right vs left heart)

A

•Normal LV function **** (or not cor pulmonale)

  • RV and RA dilation
  • RV dysfunction
46
Q

Treatment of Cor Pulmonale

A
  • Therapy is directed at underlying cause
  • Oxygen
  • Salt and fluid restriction
  • Diuresis (loop diuretics, thiazides, and spironolactone)
  • Digoxin & Inotropic support (Improve RV failure)
47
Q

In patients with Cor Pulmonale:

Once signs of heart failure appear, the average life expectancy is ___-___ years

•Survival is even lower when ______ is the cause

A

2-5 yrs

emphysema

48
Q

In patients with Cor Pulmonale these tests will show:

CBC

ABG

CXR

A

CBC - hemoconcentrated (everything decreased)

ABG - Saturation < 85%

CXR - Prominent or enlarged RV and PA

49
Q

Why is a tenion pneumothorax a medical emergency?

A

•Progressive build-up pushes the mediastinum to the opposite hemithorax and obstructs venous return to the heart causing cardiac arrest.

50
Q

Primary pneumothorax occurs in people (with / without) lung disease, while secondary pneumothorax occurs in people (with / without) lung disease.

A

primary - occurs in people w/out lung disease

secondary - occurs in people w/ lung disease

51
Q

this type of pneumothorax is:

Caused by rupture of small pulmonary blebs*.

•Patient’s are typically aged 18-40 years, tall, thin and are often smokers

A

primary pneumo

52
Q

the most common cause of secondary pneumothorax?

A

COPD

53
Q

what treatment is ALWAYS given to pts who have had a pneumothorax?

A

Supplemental O2 – given in order to maintain oxygenation

•Lowers partial pressure of nitrogen -> accelerate the rate of absorption of air from the pleural cavity and hasten lung expansion

54
Q

what are the treatments for pneumothorax?

both conservative and surgical?

A

conservative - Chest decompression via chest tube or pigtail catheter.

surgery - VATs blebectomy

Pleurodesis

supplemental o2

55
Q

Physical exam findings noted in a moderate to large Pleurall effusion.

A

Dullness to percussion

  • Decreased tactile fremitus
  • Diminished or inaudible breath sounds
  • Egophony (E to A transition)
  • ***Little physical findings for effusions smaller than 250 cc.***
56
Q

Pleural effusions can either be transudative or exudative.

What criteria helps distingish this? - outline the criteria

A

Lights Criteria

  • Ratio of pleural fluid to LDH is >0.6
  • Pleural fluid level of LDH is more then 2/3 the upper limit of reference range for LDH
  • Ratio of pleural fluid level of protein to serum is >0.5

Exudative if more then 1 criteria is met

57
Q

Transudative effusions are due to…?

what is the most common cause?

A

Largely due to imbalances in hydrostatic and oncotic pressures in the chest:

CHF - #1 cause

  • Atelectasis
  • Nephrotic syndrome
  • Cirrhosis
58
Q

Exudative Effusions are caused by?

A

Disease in any organ can cause an exudative effusion, however, more commonly a result from pleural/lung inflammation or impaired lymphatic drainage.

  • Pneumonia
  • Malignancy
  • Pulmonary embolism
59
Q

what is an infection of the pleural space most commonly seen as a complication of pneumonia, where bacteria escape into the pleural space.**

A

empyema

60
Q

how do we treat pleural effusions

A

DRAIN -thoracentesis and abx

Intrapleural fibrinolytic/antibiotic infusion

VATs thoracoscopy with tube drainage

Clagett Window- open drainage of the empyema cavity

Decortication and pulmonary resection

61
Q

Pleural fluid analysis most noteably shows what 2 findings?

A

protein

LDH

62
Q

when is thoracentesis indicated in the setting of pleural effusions?

what are the contraindications?

A

Thoracentesis: Effusion of unknown cause

CI:

Systemic anticoagulation

Area of infected skin on chest wall

63
Q

what are the features of pleural effusion seen on CXR

A

Pleural effusions of >150 ml are usually seen on CXR = blunting of the costophrenic angle.

64
Q

Malignant Pleural Effusions (MPE) are caused by?

A

Increased capillary permeability

Disruption of capillary endothelium Impaired lymphatic drainage

Direct invasion of pleural space by tumor

Malnourishment/hypoalbuminemia

**mostly exudative

RECCURRENT!!!

65
Q

Primary sites of Malignant Pleural Effusions (MPE)

A

Primary sites:

Lung 36%

Lymphoma 16%

Breast 15%

Ovary 8%

66
Q

What are the 2 ways to manage recurrent pleural effusions?

When are the indicated?

A
  • Recurrence of effusion or pneumothorax.
  • Symptomatic improvement after thoracentesis*.

Inability to control effusion with chemotherapy

Pleurodesis - Lung re-expansion after thoracentesis*.

Indwelling Catheters - Failure of lung re-expansion after thoracentesis*.

67
Q

Pleurodesis is considered successful if?

A
  • Apposition of the pleural membranes.
  • Adequate pleural drainage from the chest tubes.
  • Ability of the lung to re-expand fully.
  • Uniform distribution of the sclerosing agent
68
Q

what are the pros and cons of using an indewlling catheter to treat recurrent pleural effusions?

A
  • Pros:
  • Less pain
  • Shorter hospital stay
  • Cons:
  • Obstruction of catheter
  • Risk of infection
  • Loculation of the effusion
69
Q

What is Pleurodesis and what are the common sclerosing agents used?

A
  • medical procedure in which the pleural space is artificially obliterated by causing the visceral and parietal pleural to stick together.
  • Instillation of a chemical sclerosant
  • Pleural abrasion (mechanical)

Sclerosing agents:

  • Talc
  • Doxycycline
  • Bleomycin
  • Quinacrine
  • Minocycline
70
Q

what is the most commonly aspirated foreign body?

what are the most common objects involved in fatal childhood FBA.

A

most common - nuts

fatal childhood FBA - Toy balloons, rubber gloves, and marbles

71
Q

where do most FBA occur?

A

right Lung

72
Q

how do we treat a FBA?

A

Rigid/Flexible Bronchoscopy

Surgey needed if FBs cannot be removed.

73
Q

Si/Sx of a FBA

A
  • Severe respiratory distress, cyanosis, mental status change = medical emergency
  • Stridor
  • Hoarseness
  • Dyspnea
  • Wheezing
74
Q

Typical Bacterial causes of Pneumonia

A

strep pneumonias - rust colored sputum

h. influenzae

M. catarrhalis - most common w/ COPD pts

staph auerus - IVDU or after viral illness

Group A strep

75
Q

Aerobic gram-negative bacteria associated with pneumonia?

A
  • Klebsiella pneumoniae - currant jelly hemoptysis, red sputum
  • EtOH, COPD
  • bed bound, associated with cavitary lesions (necrosis of lung)
76
Q

Atypical bacterial causes of pneumonia include:

A
  • Legionella species - contaminated water - hot tubs, cruise, travel (GI sx – N/V diarrhea)
  • Mycoplasma pneumoniae- Most common of atypical
  • walking pneumonia, young, college students

(bullous myringitis)

  • Chlamydia pneumoniae
  • Chlamydia psittaci - bird exposure

Coxiella burnetiid - exposure to farm animals (sheep)

77
Q

•Histoplasma capsulatum (fungi) is found in???

A

•bat or bird droppings

78
Q

•Francisella tularenis (Tularemia) would infect someone who..??

A

•rabbit exposure/hunter

79
Q

Abnormal lab findings such as LFT abnormalities are usually seen with what pathogen?

A

•Legionella species

80
Q

what are the most common respiratory viruses that cause the flu in adults?

in children??

A
  • Influenza A and B viruses - main cause in adults
  • Rhinoviruses

Respiratory syncytial virus/Parainfluenza viruses - main cause in infants/small children

81
Q

what is gold standard for diagnosing pneumonia?

A

CXR

2 views - PA and Lateral

82
Q

CXR findings in:

typical

atypical

Bronchopneumonia

A

typical - lobar consolidations

atypical - Interstitial infiltrates – around alveoli

Bronchopneumonia - Worse patchy infiltrate, Bilateral at bases

83
Q

describe the tools used to assess severity of pneumonia?

A

•Clinical judgment is most important**

CURB-65

  • 1 or more think admission, except of only positive is age
  • 2 or more -> admit
  • 3,4 or 5 -> admit, think ICU?

PSI (Pneumonia severity index): Better tool but very cumbersome

84
Q

Describe how to use the CURB 65

A
  • 1 or more think admission, except if only positive is age
  • 2 or more à admit
  • 3,4 or 5 à admit, think ICU?
85
Q

How would we treat pneumonia in an outpatient setting?

A

Beta- Lactam (amoxicillin, amoxi-clav, cefepodoxime, cefuroxime)

OR

Macrolide (azithromycin)

OR

Doxycycline

Comorbidities or abx w/in the last 3 mo:

Combo beta lactam reg (beta lactam + macrolide or tetracycline)

OR

Respiratory Fluoroquinolone (Levofloxacin) monotherapy

86
Q

Inpatient abx treatment for pneumonia

A

Start abx w/in 4 hours of presentation - assess MRSA & pseudomonas risk

If no risk for either: antipneumo BL + macrolide or tetracycline OR respiratory FQ

MRSA risk: same as above add MRSA agent * (vanco)

Pseudo Risk: Antipseudomonal/antipneumococcal beta-lactam + antipseudomonal FQ (Piperacillin-tazobactam + Levofloxacin)

MRSA & Pseudo risk: Vancomycin + piperacillin-tazobactam + levofloxacin

87
Q

abx treatment for patient w/ pneumonia in the ICU

A
  • Start Abx within 1 hour of presentation
  • Adjunctive glucocorticoids +/-
  • Respiratory depression requiring mechanical ventilation
  • Sepsis or pressors
  • some may need follow up chest x-ray 7-12 weeks later********
88
Q

what is a risk factor for both HAP and VAP?

A

•IV antibiotics within the past 90 days

89
Q

HAP diagnosis criteria?

A

Must have CXR abnormality and at least one of these:

New lung infiltrate and sign that it’s infectious

New onset of fever

Purulent sputum

Leukocytosis

Decline in oxygenation

90
Q

treatment for aspiration pneumonia?

A

First line IV: Ampicillin-sulbactam (unasyn) -> covers anaerobes

_First line PO: A_moxicillin-clavulanate

Alternative

•Metronidazole (PO/IV) + amoxicillin or PCN G

91
Q

Most common opportunistic infection associated with HIV/AIDs with a low CD4 count???

A

Opportunistic Pneumonia (PCP)

92
Q

pathogen that causes Opportunistic Pneumonia (PCP)

A

Pneumocystis jirovecci pneumonia (PCP)

93
Q

Without HIV infection the most common risk factor for Opportunistic Pneumonia (PCP) is _______ use

A

Glucocorticoid use

94
Q

most common risk factor for pulmonary infection in immunocompromised pts

A

Neutropenia

95
Q

Labs and imaging studies to diagnose PCP

A

CD4 count <200 cells

•ABG

•1-3-beta-d glucagon levels – confirm fungal infection

  • PCR
  • Sputum

Imaging

•CXR – diffuse, bilateral, interstitial infiltrate

•Chest CT – ground glass appearance

96
Q

Tx of PCP

A

Mild dz -TMP-SMX

Moderate dz - TMP-SMX + prednisone PO

Severe dz - TMP-SMX + methylprednisolone (IV)

Alternatives

•Atovaquone - use if Bactrim allergy

97
Q

immunocompromised patients can take what antibiotic to prevent PCP?

A

TMX-SMX

Alt: Atovaquone (if allergy)

Clin Med II Final - PULM and Critical Care (3 decks)

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