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Respiratory Disease Dr. Naum > Test 2 > Flashcards

Test 2 Flashcards

1
Q

what is the 6th leading cause of death in the US

A

community acquired pneumonia

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2
Q

What is the number one cause of CAP world wide?

A

Streptococcus pneumoniae

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3
Q

Signs and symptoms of CAP

A

fever, pleuritic chest pain, cough with purulent sputum, rales, diminished breath sounds, tachypnea, tachycardia, inc leukocytosis (WBC), parapneumonic effusion (pleural effusion around area of infection)

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4
Q

chest xray in CAP

A

gold standard, lobar consolidation, infiltrates, cavitation

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5
Q

Risk factors of pneumococcal pneumonia

A

advanced age, smoking, dementia, malnurished, chronic illness, HIV, previous pneumonia, spleen removed

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6
Q

Treatment of pneumococcal pneumonia

A

penicillin (resistance), beta lactam and macrolide, quinolone (give when pts are allergic to beta lactams)

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7
Q

in CAP what patients have the H flu and Moraxella cararrhalis bacteria in them?

A

patients with lung disease, produce beta lactamase

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8
Q

Anaerobic organisms in CAP are common cause of what?

A

common cause of aspiration pneumonia and lung abcess

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9
Q

Moraxella cararrhalis bacteria characteristics

A

in oral cavity, no human transmission, infection from direct mucosal spread, common pathogen in upper and lower resp. tracts

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10
Q

how do you treat moraxell catarrhalis

A

2nd generation cephalosporins, erythomycin, clarithromycin, azithromycin, amoixicillin-clavulanic acid, or trimethoprim-sulfamethoxazole

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11
Q

H flu characteristics

A

incapsulated organisms, common disease of ear infections and meningitis in kids, upper airway, gram negative rod, causes sinusitis and lower resp tract infections

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12
Q

staph pneumonia characteristics

A

treat with vacomycin when suspected, commonly causes cavitation or empyema, usually seen after flu infection

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13
Q

atypical pneumonia

A

nonproductive cough, mild symptoms, nonlobar infiltrates

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14
Q

mycoplasma pneumonia is commonly called what?

A

walking pneumonia

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15
Q

being immunosuppressed helps protect you from what bacteria?

A

mycoplasma pneumonia

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16
Q

how do you diagnose mycoplasma pneumonia?

A

cold agglutinins (+ in 50% of cases), culture

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17
Q

how do you treat mycoplasma pneumonia?

A

macrolides (azithromycin..), quinolones (cipro..), and tetracycline

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18
Q

Legionella pneumonia characteristics

A

person to person transmission does not occur, bacteria comes from waters

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19
Q

Treatment of legionella

A

macrolides for 14-21 days or quinolones

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20
Q

Nosocomial pneumonia is the leading cause of death in what?

A

leading cause of death due to hospital acquired infections

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21
Q

What patients are at high risk for developing nosocomial pneumonia?

A

vent patients

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22
Q

do gram + or - cause nosocomial pneumonia?

A

usually gram neg, except for staph

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23
Q

how can you prevent nosocomial pneumonia?

A

drugs that help reduce the acid in the stomach, use of local and IV antibiotics to dec. bacterial colonization, patient posistioning HOB up 30 degrees (#1 thing we can do), subglottic drainage

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24
Q

How do you treat nosocomial pneumonia?

A

broad antibiotic then go narrow, anti pseudomonal penicillin, 3rd/4th generation cephalosporin, imipenem, aztreonam, aminoglycoside, quinolone, plue vacomycin

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25
Q

what is post obstructive pneumonia?

A

infected area of the lung where the bronchus to the area is obstructed (lung cancer, foreign body), hard to treat

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26
Q

How do you diagnose post obstructive pneumonia?

A

bronchoscopy

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27
Q

lung abscess

A

necrosis of the pulmonary parenchyma due to a microbial infection, mostly from aspiration

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28
Q

Symptoms of lung abscess

A

fever, cough, weight loss, smelly sputum, night sweats, anemia, sour taste

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29
Q

Treatment of lung abscess

A

empiric antibiotics chosen for the predominant organism plus anaerobes for 6-8 weeks

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30
Q

umcomplicated parapneumonic effusion

A

form when fluid and neutrophils leak into pleural space in a patient with pneumonia

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31
Q

complicated parapneumonic effusion

A

bacterial invasion of pleural space, pockets of fluid develop

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32
Q

empyema

A

collection of pus and the pus is aspirated on thoracentesis,

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33
Q

Empyema treatment

A

antibiotics, thoracentesis, tube thoracostomy, decortication (surgery to pull off infected pleural space)

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34
Q

pulmonary manifestation of TB include what?

A

primar, reactivation, endobronchial, lower lung field infection

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35
Q

Primary TB

A

seen in childhood but since the 1950s it is more commonly seen in adults probably because of HIV

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36
Q

symptoms of primary TB

A

fever very common, and chest pain

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37
Q

What is the most common radiographic finding in primary TB

A

hilar adenopathy

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38
Q

Reactivation TB

A

occur usually in non HIV patients, apical/posterior segments of upper lobes are most commonly affected

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39
Q

symptoms of reactivation TB

A

cough, weight loss, fatigue, fever, night sweats, chest pain, dyspnea, hemoptysis

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40
Q

What do you hear or see in the physical exam of reactivation TB

A

clear lung field, dullness in areas of effusions, crackles throughout inspiration, clubbing

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41
Q

What do the xrays look like in a patient with reactivation TB

A

apical/post upper lobe infiltraties, cavitives

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42
Q

Endobronchial TB

A

commonly seen before antibiotics were available

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43
Q

symptoms of endobronchial TB

A

loud barking cough with sputum, cough up calcified material, hemopytsis, wheezing, SOB with bronchial obstuction

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44
Q

Lower lung field TB

A

occurs below hila

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45
Q

complications of TB

A

hymoptysis, pneumothorax, bronchiectasis, extensive pulmonary destruction, maligancy

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46
Q

Diagnosis of TB

A

Sputum exam, 3 consecutive mornings, bronchoscopy should be used when induced sputum is ineffective

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47
Q

Latent TB infection

A

not contagious, 2nd leading cause of infectious disease

48
Q

How do you diagnose latent TB

A

skin testing (only to see if you have been exposed)

49
Q

how do you read a skin test?

A

diameter of induration (only what you can feel), 5mm considered positive in patients that are very likely to have TB, 10 mm moderate likelihood of having TB, and 15 mm no risk for TB

50
Q

How do you treat latent TB

A

isoniazid for 9 months, Rifampin for 4 months is an alternative

51
Q

Treatment of TB

A

INH, rifampin, PZA, ethambutol (streptomycin)

52
Q

In a high risk area what is the drug regimen like?

A

start at with 4 drugs and can go down to 2 drugs if the bacteria is susceptible to those drugs

53
Q

nontuberculous mycobacteria (NTM)

A

inhabit body surfaces and secretions without causing disease,

54
Q

NTM causes what 4 distinct clinical symptoms

A

progressive pulmonary disease in elderly with underlying lung disease, superficial lymphadenitis, disseminated disease in immunocompromised patients, skin and soft tissue infection caused by direct inoculation

55
Q

symptoms of NTM

A

cough, fatigue, malaise, weakness, dyspnea, chest discomfort

56
Q

MAC is the most common what worldwide?

A

NTM

57
Q

what are the 3 common clinical entities with MAC

A

elderly WM with underlying lung disease, patients with bronchiectasis, nonsmoking females over 50 (lady Windomeres disease)

58
Q

how do you treat NTM

A

12 to 24 months with clarithromycin or azithromycin and rifampin and ethambutol, streptomycin, possibly quinolones

59
Q

how does histoplasmosis present itself?

A

penumonia, hilar masses, pulmonary nodule, cavitary lung disease, pericarditis, dysphagia, superior vena cava syndrome

60
Q

How to you diagnose histo?

A

serologic testing

61
Q

how does histo replicate?

A

by budding

62
Q

Treatment of acute histo?

A

majority are self limiting and require no therapy, Itraconazole and amphotericin B are both effective

63
Q

what are the 4 types of Aspergillosis

A

invasive (very sick), aspergilloma (fungus growing in cavity), chronic/semi invasive aspergillosis, allergic bronchopulmonary aspergillosis (cause of bronchiectasis)

64
Q

Invasive pulmonary aspergillosis symptoms

A

acute, fever, chest pain, cough, SOB, xray shows nodules and patchy infiltrates

65
Q

how do you diagnose invasive pulmonary aspergillosis

A

stain and culture, clinical judgement

66
Q

How do you treat invasive pulmonary aspergillous

A

recovery of bone marrow, antifungal therapy, surgery to remove necrotic tissue

67
Q

Aspergilloma

A

needs a cavity, rarely invades surrounding tissue, usually asymptomatic

68
Q

chronic or semi invasive aspergillosis symptoms

A

fever, chest pain, hemoptysis

69
Q

treatment of aspergilloma

A

surgery, antifungals

70
Q

Allergic bronchopulmonary aspergillosis

A

complex hypersensitivity reaction in patients with asthma

71
Q

Diagnostic features of aspergillosis

A

asthma, bronchiectasis, fever, malaise, mucous plugs

72
Q

Treatment of allergic bronchopulmonary aspergillosis

A

acute flares with steroids, intraconazole, specific IgE therapy

73
Q

Coccidioidomycosis is found where?

A

out west

74
Q

Symptoms of cocci

A

chest pain, cough, fever, hemoptysis, join pain, rash

75
Q

cryptococcus

A

infects lungs and CNS, cough, chest pain, sputum production, fever, weight loss, hemoptysis, effects patients with HIV

76
Q

How do you treat with cryptococcus

A

fluconazole

77
Q

Blastomycosis

A

usually affects the lungs, seen in patients who have outdoor occupations hunting

78
Q

how do you treat bastomycosis

A

fluconazole, itraconazole, or ketoconazole

79
Q

Pneumocystis carinii pneumonia (PCP) incidence

A

increases as patients CD4 count decreases (<200)

80
Q

Symptoms of PCP

A

cough, fever, SOB, gradual onset, crackles on exam, bilateral alveolar and interstitial infiltrates

81
Q

How do you diagnose PCP

A

sputum induction, bronchoscopy**

82
Q

Treatment of PCP

A

trimethoprim-sulfamethoxazole is the initial drug of choice, steroids

83
Q

RSV

A

common in children, doesnt effect adults much

84
Q

infants RSV

A

pneumonia, bronchiolitis, or croup

85
Q

adults RSV

A

prominent cough with some have resp. disease, fever

86
Q

how do you diagnose RSV

A

clinical, xray, and virologic results

87
Q

herpes simplex virus (HSV)

A

localized infiltrates, fever, cough, SOB, little red dots in airways

88
Q

how do you diagnose HSV

A

index of suspicion, infiltrates, isolation of HSV

89
Q

Cytomegalovirus (CMV)

A

acquired by blood transfusion or contact with saliva, upper resp tract disease, live enzymes are elevated, xray shows bilateral patchy, affects immunocompromised

90
Q

How do you diagnose CMV

A

BAL or lung tissue culture. presence of inclusions on cytology

91
Q

How do you treat CMV

A

gangciclovir, valgangciclovir, foscarnet

92
Q

Passive immunity

A

performed antibodies from external source

93
Q

Active immunity

A

immune system encounters antigen

94
Q

Who do you test for HIV?

A

MSM, IDU, multiple sex partnets, exchanged money for drugs, STD, sexual contact with persons with HIV, request, occupational exposure, sexual assault, organ donors

95
Q

HIV clinical manifestations

A

fever, chills, rash, sore throat, adenopathy, headache, malaise, diarrhea

96
Q

Infections in HIV with CD4 count of 500-1000mm

A

yeast vaginits, shingles, dermatophytic skin

97
Q

infections in HIV with CD4 count of 200-500mm

A

pneumo pneumonia, genital herpes, vaginitis, salmonellosis, TB, histo, oral hairy leukoplakia

98
Q

infections in AIDS with CD4 count of 100-200mm

A

pneumo carinii pneumonia, candida esophagitis, kaposis sarcoma, histo

99
Q

infections in AIDS with CD4 count <100mm

A

toxoplasmic encephalitits, disseminated MAC, meningitis, JC virus (dimentia)

100
Q

prevention of opportunistic infection in AIDS with CD4 count <200mm

A

TMP/SMX, and azithromycin (<100)

101
Q

what is respiratory failure

A

lungs fail to provide adequate oxygenation or ventilation for the blood

102
Q

Oxygenation failure is when what?

A

pO2 less than 60 on an FiO2 of 50%

103
Q

ventilatory failure is when what?

A

inadequate ventilation between the lungs and atmosphere resulting in an increase in PCO2

104
Q

What is the most common cause of hypoxemia

A

ventilation-perfusion mismatch

105
Q

What is a shunt

A

movement of blood from the right side of the heart to the left without participating in gas exchanged

106
Q

What happens when you have oxygenation failure

A

stimulates pulmonary capillaries to constrict, pulmonary vascular resistance in increased, right heart work in increased, right heart failure, cor pulmonale

107
Q

Ventilatory failure may occur for what?

A

depression of the resp. center, brain diseases, spinal cord abnormalities, muscle disorders, thoracic abnormalities, airway obstruction

108
Q

Signs and symptoms of acute resp. failure

A

inc. breathing, tachycardia, shallow breathing, accessory muscle use, abdominal paradox, confusion, hypercapnia, cyanosis, terminal fall in breathing frequency and minute ventilation

109
Q

treatment of oxygenation failure

A

oxygen, CPAP, intubation/mechanical ventilation with PEEP, inverse I:E

110
Q

Benefits of mechanical ventilation

A

improves gas exchange, dec WOB, improve V/Q mismatch, dec shunt

111
Q

guidelines for mechanical ventilation

A

resp rate >35, vital capacity 10, max insp pressure 50, and PaO2 <60

112
Q

noninvasive ventilation

A

reduces work of breathing and rests resp. muscles, dec auto PEEP, dec rate of intubation, dec in mortality and infection

113
Q

Intubation ABCs

A

airway, breathing, circulation

114
Q

Ventilator settings

A

support patients breathing, at least 80% of work load, sedation/paralysis if needed, match resp. rate, volume or assist control

115
Q

Weaning for mechanical ventiation

A

stable patient, awake and following commands, vital capacity >10, resting minute ventilation -20, oxygenation of 50%, resp. rate <105

116
Q

How long should the spontaneous breathing trial be?

A

30 minutes

Respiratory Disease Dr. Naum (1 decks)

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