Week 4

Question 1

acute inflammation of the lung parenchyma caused by a microbial agent

Answer 1

pneumonia

Question 2

3 methods of contracting pneumonia?

Answer 2

1. Aspiration
2. inhalation of microbes from the air
3. Hematogones spread from a primary infection elswhere in the body

Question 3

Lower respiratory tract infection of the lung parenchyma with onset in the community

Answer 3

Community acquired pneumonia

Question 4

Hospital acquired pneumonia occurs?

Answer 4

48 hours or longer after the admission

Question 5

Predisposing factors to hospital acquired pneumonia?

Answer 5

immunosuppressive therapy, general debility (elderly or malnourished) and endotracheal intubation

Question 6

Usual clinical manifestations of pneumonia?

Answer 6

sudden onset of fever, chills, productive cough with purulent sputum and pleuritic chest pain

Question 7

Atypical presentation of pneumonia?

Answer 7

headache, myalgias, fatigue, sore throat and nausea

Question 8

Manifestations of viral pneumonia?

Answer 8

Highly variable but may be characterized by chills, fever and dry, non productive cough.

Question 9

Complications of pneumonia?

Answer 9

pleurisy, pleural effusion, atelectasis, emphyema, pericarditis and bacteremia.

Question 10

Pluerisy

Answer 10

inflammation of the plurae

Question 11

plueral effusion

Answer 11

abnormal collection of pleural fluid that usually absorbs within 1-2 weeks. Can occur from not doing deep breathing exercises

Question 12

atelectasis

Answer 12

collapse of the alveoli. Usually clears with effective coughing and deep breathing.

Question 13

Emphyma

Answer 13

pus that needs to be drained

Question 14

pericarditis

Answer 14

the spread of the infecting organism from the pleura to the pericardium

Question 15

bacteremia

Answer 15

sepsis, can occur with pneumococcal pneumonia and more so with elderly patients

Question 16

Pneumonia physical exam

Answer 16

signs of pulmonary consolidation, such as dullness to percussion, increased fremitus, bronchial breath sounds and crackles may be heard

Question 17

What is the number one tool to diagnose pneumonia?

Answer 17

chest X-ray

Question 18

When should cultures be collected?

Answer 18

before initiating antibiotic therapy because the antibiotics could alter the results

Question 19

what does an ABG test for pneumonia?

Answer 19

if there is hypoxia

Question 20

Why would a CBC be performed in a patient with pneumonia?

Answer 20

because leukocytosis is often found in patients with pneumonia

Question 21

treatment of choice for otherwise healthy adults with CAP?

Answer 21

a macrolide (erythromicin, clarithromycin or azithromycin) PO for

Question 22

patients with COPD who have had oral steroids or antibiotics in the last 3 months have an increased risk for gram negative infection requiring?

Answer 22

FQs (levofloxacin or moxifloxacin) 750mg IV

Question 23

Fluid intake of at least ______ is important in the treatment of pneumonia

Answer 23

3L/day

Question 24

intake of at least ______ calories per day should be maintained to provide energy for a pneumonia patient

Answer 24

1500

Question 25

better oxygenation is achieved when?

Answer 25

the patient is lying with the good lung facing down

Question 26

the patient should be repositioned every?

Answer 26

2 hours

Question 27

M.tuberculosis is a?

Answer 27

gram positive acid fast bacillus

Question 28

how is TB spread?

Answer 28

via airborne droplets

Question 29

systemic manifestations of TB?

Answer 29

fatigue, malaise, weight loss, low-grade fevers and night sweats

Question 30

pulmonary manifestations of TB?

Answer 30

cough that becomes frequent and produces mucoid or mucopurulent sputum. Could also have hemoptysis

Question 31

Diagnosis of TB?

Answer 31

three consecutive sputum samples collected on different days and sent for smear and culture

Question 32

A patient infected with TB should receive treatment for?

Answer 32

at least 6 months beyond the conversion of sputum cultures to a negative status (total is about 9 months)

Question 33

Direct observation therapy

Answer 33

involves someone who is not a family member observing the ingestion of every dose of medication for TB for the entire course of treatment

Question 34

The TB patient should be placed in isolation until?

Answer 34

they are considered non-infectious

Question 35

when is a TB patient considered non-infectious?

Answer 35

three negative AFB smears

Question 36

Pulmonary embolism

Answer 36

the blockage of pulmonary arteries by a thrombus, or a fat or air embolus. The embolus travels with the blood flow through small vessels until it becomes lodged and obstructs perfusion of the alveoli

Question 37

Most PEs arise from?

Answer 37

Deep vein thrombosis

Question 38

Lethal PEs most commonly arise from the?

Answer 38

femoral or iliac veins

Question 39

Classic triad of PE symptoms?

Answer 39

dyspnea, chest pain and hemoptysis

Question 40

Massive emboli may produce?

Answer 40

abrupt hypotension, pallor, severe dyspnea and hypoxemia

Question 41

Causes of PEs?

Answer 41

venous stasis, trauma or hypercoagubility

Question 42

what is the most frequently used test to diagnose PE?

Answer 42

CT scan

Question 43

Prevention of PE begins with?

Answer 43

Prevention of venous thromboembolism

Question 44

VTE prophylaxis (prevention)?

Answer 44

the use of sequential compression devices, early ambulation and prophylactic use of anticoagulant medications (enoxoparin, a low molecular weight heparin)

Question 45

tissue plasminogen activator

Answer 45

a fibrinolytic drug that can be used for PEs to dissolve the clot

Question 46

indications for TPA include

Answer 46

hemodynamic instability and right ventricular dysfunction

Question 47

Best anticoagulation therapy for patients at risk of recurrent PEs?

Answer 47

Heparin and TPA to prevent and dissolve clots

Question 48

pneumothorax

Answer 48

presence of air in the pleural space

Question 49

when should pneumothorax be suspected?

Answer 49

after any blunt trauma to the chest wall

Question 50

Open pneumothorax

Answer 50

occurs when air enters the pleural space through an opening the in the chest wall

Question 51

open pneumothorax is commonly referred to as?

Answer 51

a sucking chest wound

Question 52

what can cause an open pneumothorax?

Answer 52

gunshot wounds, surgical thoracotomies and when patient rips chest tube out

Question 53

emergency treatment for open pneumothorax?

Answer 53

cover with a vented dressing taped on 3 sides, this allows air to escape and decreases the likelihood of tension pneumothorax from developing

Question 54

closed pneumothorax

Answer 54

has no external wound

Question 55

most common form of closed pneumothorax?

Answer 55

spontaneous pneumothorax which is caused by the rupture of blebs.

Question 56

spontaneous pneumothorax occurs most commonly in?

Answer 56

tall, underweight male ciggarette smokers between the ages of 20 and 40

Question 57

Tension pneumothorax

Answer 57

a medical emergency caused by rapid accumulation of air in the pleural space causing severely high intraplueral pressures with resultant tension on the heart and great vessels

Question 58

tension pneumotorax can develop if?

Answer 58

chest tubes are clamped or blocked in a patient with pneumothorax

Question 59

clinical manifestations of small pneumothorax?

Answer 59

mild tachycardia and dyspnea may be the only manifestations

Question 60

clincal manifestations of large pneumothorax

Answer 60

respiratory distress, shallow rapid respirations, dyspnea, air hunger and decreased oxygen saturation

Question 61

what would you find upon auscultation over pneumothorax

Answer 61

absent breath sounds

Question 62

most definitive and common treatment for pneumothorax?

Answer 62

insert chest tube and connect to a water seal drainage