Pulmonary Part 2

Question 1

How much pulmonary vascular most be occluded during a PE to by symptomatic

Answer 1

20-30%

Question 2

Most PEs come from

Answer 2

a large proximal vein in the proximal leg

Question 3

What are Risk Factors for PE

Answer 3

Age >50
Bed Rest >48hrs
Splinting or ortho immobilization
Sx
Trauma
Malignancy
Pregnancy

Question 4

What criteria is used to score likelihood of PE

Answer 4

Well’s Criteria

Question 5

What does the Well’s Criteria include?

Answer 5

SXS DVT
PE #1 ddx
HR>100
Immob 3 day or Sx past 4 weeks
Previous PE or DVT
Hemoptysis
Malignancy w/tx within 6m

Question 6

Hallmark signs to PE

Answer 6

Dyspnea unexplained by auscultatory findings
EKG findings
-only 15% S1Q3T3-pathognomic
-MC is sinus tacchy
-common is RAD
CXR

Question 7

Typical Vital Signs of PE include

Answer 7

NO predictable alteration
tachycardia, tachypnea, hypoxia
~S3 or S2 split
~rales
(wheezes and others decrease likelihood)

Question 8

rust colored sputum with patchy infiltrate. What is the causative organism

Answer 8

Strep pneumonia

Question 9

“currant jelly” sputum and CXR with upper lop infiltrate

Answer 9

Klebsiella

Question 10

Purulent gram + cocci in clusters from sputum culture, CXR showing patchy multi lobar infiltrate
+/- empyema
causative organism

Answer 10

Staph aureus

Question 11

CXR showing cavitary legions in hilar regions during PNA. Most likely causative organism

Answer 11

Klebsiella

Question 12

Tx bullous myringitis with

Answer 12

A Macrolide

-Azithromycin

Question 13

Pt with complaints of cough, fatigue, fever, and sputum production. ENT exam shows nodular structure on ear drum. Most likely causative organism is

Answer 13

Mycoplasm

Question 14

Poorer prognosis for PNA

Answer 14

Multilobar involvement
Leukopenia
Bacteremia
Jaundice
Splenectomized pts
- Sickle Cell pts
CHF
COPD
Alcoholism
Diabetes

Question 15

Consider pseudomonas in what types of patients

Answer 15

Cystic fibrosis, hospitalized, central venous catheters, burn wounds, bronchiectasis, and HIV

Question 16

Pt who is an IVDU has PNA. Most likely organism is

Answer 16

Staphlococcal

Question 17

Mucoplasma is confirmed by

Answer 17

“cold agglutinin”

Question 18

Nursing home patieint with PNA most likely organism is

Answer 18

H flu, S pneumo

Question 19

Diabetic pt with PNA is

Answer 19

S aureus

Question 20

Outpatient PNA uncomplicated pt tx is

Answer 20

Macrolide- clarithromycin or azithromycin
-flouroquinolones for those who can not tolerate or failed therapy

Tetracycline- doxycycline

Question 21

Outpatient PNA tx for pt with co-morbidities

Answer 21

Fluoroquinolone- levofloxacin, moxifloxacin, gatifloxacin

Beta lactamase inhib + macrolide- Augmentin

Question 22

Treatment for lung abscess

Answer 22

Clindamycin with flagyl (anaerobes)
or
Clindamycin with cephalosporin or zosyn