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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
what is post obstructive pneumonia?
infected area of the lung where the bronchus to the area is obstructed (lung cancer, foreign body), hard to treat
26
How do you diagnose post obstructive pneumonia?
bronchoscopy
27
lung abscess
necrosis of the pulmonary parenchyma due to a microbial infection, mostly from aspiration
28
Symptoms of lung abscess
fever, cough, weight loss, smelly sputum, night sweats, anemia, sour taste
29
Treatment of lung abscess
empiric antibiotics chosen for the predominant organism plus anaerobes for 6-8 weeks
30
umcomplicated parapneumonic effusion
form when fluid and neutrophils leak into pleural space in a patient with pneumonia
31
complicated parapneumonic effusion
bacterial invasion of pleural space, pockets of fluid develop
32
empyema
collection of pus and the pus is aspirated on thoracentesis,
33
Empyema treatment
antibiotics, thoracentesis, tube thoracostomy, decortication (surgery to pull off infected pleural space)
34
pulmonary manifestation of TB include what?
primar, reactivation, endobronchial, lower lung field infection
35
Primary TB
seen in childhood but since the 1950s it is more commonly seen in adults probably because of HIV
36
symptoms of primary TB
fever very common, and chest pain
37
What is the most common radiographic finding in primary TB
hilar adenopathy
38
Reactivation TB
occur usually in non HIV patients, apical/posterior segments of upper lobes are most commonly affected
39
symptoms of reactivation TB
cough, weight loss, fatigue, fever, night sweats, chest pain, dyspnea, hemoptysis
40
What do you hear or see in the physical exam of reactivation TB
clear lung field, dullness in areas of effusions, crackles throughout inspiration, clubbing
41
What do the xrays look like in a patient with reactivation TB
apical/post upper lobe infiltraties, cavitives
42
Endobronchial TB
commonly seen before antibiotics were available
43
symptoms of endobronchial TB
loud barking cough with sputum, cough up calcified material, hemopytsis, wheezing, SOB with bronchial obstuction
44
Lower lung field TB
occurs below hila
45
complications of TB
hymoptysis, pneumothorax, bronchiectasis, extensive pulmonary destruction, maligancy
46
Diagnosis of TB
Sputum exam, 3 consecutive mornings, bronchoscopy should be used when induced sputum is ineffective
47
Latent TB infection
not contagious, 2nd leading cause of infectious disease
48
How do you diagnose latent TB
skin testing (only to see if you have been exposed)
49
how do you read a skin test?
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
How do you treat latent TB
isoniazid for 9 months, Rifampin for 4 months is an alternative
51
Treatment of TB
INH, rifampin, PZA, ethambutol (streptomycin)
52
In a high risk area what is the drug regimen like?
start at with 4 drugs and can go down to 2 drugs if the bacteria is susceptible to those drugs
53
nontuberculous mycobacteria (NTM)
inhabit body surfaces and secretions without causing disease,
54
NTM causes what 4 distinct clinical symptoms
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
symptoms of NTM
cough, fatigue, malaise, weakness, dyspnea, chest discomfort
56
MAC is the most common what worldwide?
NTM
57
what are the 3 common clinical entities with MAC
elderly WM with underlying lung disease, patients with bronchiectasis, nonsmoking females over 50 (lady Windomeres disease)
58
how do you treat NTM
12 to 24 months with clarithromycin or azithromycin and rifampin and ethambutol, streptomycin, possibly quinolones
59
how does histoplasmosis present itself?
penumonia, hilar masses, pulmonary nodule, cavitary lung disease, pericarditis, dysphagia, superior vena cava syndrome
60
How to you diagnose histo?
serologic testing
61
how does histo replicate?
by budding
62
Treatment of acute histo?
majority are self limiting and require no therapy, Itraconazole and amphotericin B are both effective
63
what are the 4 types of Aspergillosis
invasive (very sick), aspergilloma (fungus growing in cavity), chronic/semi invasive aspergillosis, allergic bronchopulmonary aspergillosis (cause of bronchiectasis)
64
Invasive pulmonary aspergillosis symptoms
acute, fever, chest pain, cough, SOB, xray shows nodules and patchy infiltrates
65
how do you diagnose invasive pulmonary aspergillosis
stain and culture, clinical judgement
66
How do you treat invasive pulmonary aspergillous
recovery of bone marrow, antifungal therapy, surgery to remove necrotic tissue
67
Aspergilloma
needs a cavity, rarely invades surrounding tissue, usually asymptomatic
68
chronic or semi invasive aspergillosis symptoms
fever, chest pain, hemoptysis
69
treatment of aspergilloma
surgery, antifungals
70
Allergic bronchopulmonary aspergillosis
complex hypersensitivity reaction in patients with asthma
71
Diagnostic features of aspergillosis
asthma, bronchiectasis, fever, malaise, mucous plugs
72
Treatment of allergic bronchopulmonary aspergillosis
acute flares with steroids, intraconazole, specific IgE therapy
73
Coccidioidomycosis is found where?
out west
74
Symptoms of cocci
chest pain, cough, fever, hemoptysis, join pain, rash
75
cryptococcus
infects lungs and CNS, cough, chest pain, sputum production, fever, weight loss, hemoptysis, effects patients with HIV
76
How do you treat with cryptococcus
fluconazole
77
Blastomycosis
usually affects the lungs, seen in patients who have outdoor occupations hunting
78
how do you treat bastomycosis
fluconazole, itraconazole, or ketoconazole
79
Pneumocystis carinii pneumonia (PCP) incidence
increases as patients CD4 count decreases (<200)
80
Symptoms of PCP
cough, fever, SOB, gradual onset, crackles on exam, bilateral alveolar and interstitial infiltrates
81
How do you diagnose PCP
sputum induction, bronchoscopy**
82
Treatment of PCP
trimethoprim-sulfamethoxazole is the initial drug of choice, steroids
83
RSV
common in children, doesnt effect adults much
84
infants RSV
pneumonia, bronchiolitis, or croup
85
adults RSV
prominent cough with some have resp. disease, fever
86
how do you diagnose RSV
clinical, xray, and virologic results
87
herpes simplex virus (HSV)
localized infiltrates, fever, cough, SOB, little red dots in airways
88
how do you diagnose HSV
index of suspicion, infiltrates, isolation of HSV
89
Cytomegalovirus (CMV)
acquired by blood transfusion or contact with saliva, upper resp tract disease, live enzymes are elevated, xray shows bilateral patchy, affects immunocompromised
90
How do you diagnose CMV
BAL or lung tissue culture. presence of inclusions on cytology
91
How do you treat CMV
gangciclovir, valgangciclovir, foscarnet
92
Passive immunity
performed antibodies from external source
93
Active immunity
immune system encounters antigen
94
Who do you test for HIV?
MSM, IDU, multiple sex partnets, exchanged money for drugs, STD, sexual contact with persons with HIV, request, occupational exposure, sexual assault, organ donors
95
HIV clinical manifestations
fever, chills, rash, sore throat, adenopathy, headache, malaise, diarrhea
96
Infections in HIV with CD4 count of 500-1000mm
yeast vaginits, shingles, dermatophytic skin
97
infections in HIV with CD4 count of 200-500mm
pneumo pneumonia, genital herpes, vaginitis, salmonellosis, TB, histo, oral hairy leukoplakia
98
infections in AIDS with CD4 count of 100-200mm
pneumo carinii pneumonia, candida esophagitis, kaposis sarcoma, histo
99
infections in AIDS with CD4 count <100mm
toxoplasmic encephalitits, disseminated MAC, meningitis, JC virus (dimentia)
100
prevention of opportunistic infection in AIDS with CD4 count <200mm
TMP/SMX, and azithromycin (<100)
101
what is respiratory failure
lungs fail to provide adequate oxygenation or ventilation for the blood
102
Oxygenation failure is when what?
pO2 less than 60 on an FiO2 of 50%
103
ventilatory failure is when what?
inadequate ventilation between the lungs and atmosphere resulting in an increase in PCO2
104
What is the most common cause of hypoxemia
ventilation-perfusion mismatch
105
What is a shunt
movement of blood from the right side of the heart to the left without participating in gas exchanged
106
What happens when you have oxygenation failure
stimulates pulmonary capillaries to constrict, pulmonary vascular resistance in increased, right heart work in increased, right heart failure, cor pulmonale
107
Ventilatory failure may occur for what?
depression of the resp. center, brain diseases, spinal cord abnormalities, muscle disorders, thoracic abnormalities, airway obstruction
108
Signs and symptoms of acute resp. failure
inc. breathing, tachycardia, shallow breathing, accessory muscle use, abdominal paradox, confusion, hypercapnia, cyanosis, terminal fall in breathing frequency and minute ventilation
109
treatment of oxygenation failure
oxygen, CPAP, intubation/mechanical ventilation with PEEP, inverse I:E
110
Benefits of mechanical ventilation
improves gas exchange, dec WOB, improve V/Q mismatch, dec shunt
111
guidelines for mechanical ventilation
resp rate >35, vital capacity 10, max insp pressure 50, and PaO2 <60
112
noninvasive ventilation
reduces work of breathing and rests resp. muscles, dec auto PEEP, dec rate of intubation, dec in mortality and infection
113
Intubation ABCs
airway, breathing, circulation
114
Ventilator settings
support patients breathing, at least 80% of work load, sedation/paralysis if needed, match resp. rate, volume or assist control
115
Weaning for mechanical ventiation
stable patient, awake and following commands, vital capacity >10, resting minute ventilation -20, oxygenation of 50%, resp. rate <105
116
How long should the spontaneous breathing trial be?
30 minutes

Respiratory Disease Dr. Naum (1 decks)

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