Pulmonary 1 (Step up son) Flashcards
What is an A-a gradient? What is the normal range?
Alveolar [O2] - arterial [O2]
Normal is 5-15mmHg
What causes an increased A-a gradient?
Things that would decrease arterial [O2]
Right to left shunt (mixes deoxygenated into oxygenated) PE (decreased pulmonary capillary perfusion --> less blood can become oxygenated) Pulmonary edema (increased barrier to diffusion)
What are two scenarios in which a person would have decreased arterial [O2], but a ‘normal’ A-a gradient?
Things that would decrease Alveolar [O2]
Hypoventilation
High altitudes
How is Alveolar [O2] determined? what is the normal range?
150mmHg - arterial [CO2] = ~110mmHg
arterial [CO2] via ABG (usually ~40mmHg)
How is arterial [O2] determined? what is the normal range?
ABG
90-100mmHg
What viruses typically cause the common cold?
Rhinovirus
Coronavirus
Adenovirus
Why do you treat strep throat if it is often self limited?
To prevent RHD
Does NOT help to prevent poststrep glomerulonephritis
A patient comes in complaining of sore throat, ear pain, and a fever. You try to look at the throat, but he won’t open his mouth very wide, but you get a glance and see that one tonsil is larger than the other and the uvula is pointing away from the larger tonsil. What is the concern? How is it treated?
Peritonsillar abscess
IV Abx and I&D…tonsillectomy after resolution
What are the common causes of acute sinusitis? How is it treated?
Strep pneumo
H. influ
Moraxella catarrhalis
Viral infection
Amoxicillin x 2wks
What is a possible complication of acute sinusitis if untreated?
Meningitis
When is sinusitis deemed ‘chronic’? What causes chronic sinusitis? How is it treated?
Sinus symptoms for 3+ months
Obstruction + anaerobic infection
Amoxicillin x 6-12wks +/- surgery
Patient comes in with a fever and the entire workup is negative. Blood, CSF, urine, CXR, no GI symptoms…nothing. What else could be considered?
Sinus CT…could show fluid levels and/or opacification
A nonsmoker comes in with a productive cough, fever, and wheezing. What does she have? What is likely causing it?
Acute bronchitis
Virus (most likely) Mycoplasma pneumonia (Dx: Cold agglutinin titer Tx: tetracycline, fluoroquinolone, or macrolide)
A smoker comes in with an acute bronchitis. What is the likely cause? What else could cause it?
Viral is most likely
Strep pneumo and H. influ are also common
What is the most common cause of pneumonia in kids?
Viral (nonproductive cough…self-limited)
What is the most common cause of pneumonia in adults?
Strep pneumo (productive cough…beta-lactam or macrolide)
Which bacteria commonly infect sickle cell patients?
Strep pneumo
H. influ
Klebsiella
What is a common cause of pneumonia in COPD patients?
H. influ (slow onset…beta-lactam or TMP-SMX)
Patient has “currant jelly” sputum. What is the likely bug? What risk factors could the patient have?
Klebsiella (cephalsporin AND aminoglycoside [gentamicin, trobramycin])
Increased risk of aspiration (alcoholic)
Prolonged hospitalization
Sickle cell disease
What type of pneumonia are cystic fibrosis patients at increased risk of contracting? Who else is more likely to contract?
Pseudomonas (fluoroquinolone, aminoglycoside, or 3rd gen cephalosporin)
Chronically ill (nosocomial) Immunocompromised
What type of bacteria causes pneumonia in neonates/infants?
Group B Strep (beta-lactam)
Who is at increased risk of contracting enterobacter pneumonia? How is it treated?
Old people in hospitals
TMP-SMX
A young adult comes in with a mild pneumonia and a rash. What should be checked? How should it be treated?
Cold agglutinin test (+ = mycoplasma pneumonia)
Macrolide (azithromycin, clarithromycin, erythromycin)
A patient comes in with a slowly progressing pneumonia with some GI and CNS symptoms. What is the likely bug? What was the likely exposure?
Legionella (macrolides; fluoroquinolone)
Aerosolized water (air conditioner)
