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PANCE > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

what is atopy

A

wheezing, eczema, and seasonal rhinitis

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2
Q

what is the pathophysiology of ASTHMA

A

it is an overproduction of IGE which results in there beta 2 receptors.
This leads to inflammation and mucus production and bronchial smooth muscle contraction

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3
Q

Clinical features of asthma

A

FEV1/FVC

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4
Q

what is bronchitis

A

infection and inflammation of the bronchial tree

there is also mucous formation

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5
Q

what is the most common cause of bronchitis

A

80% viral

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6
Q

who is at risk of acute bronchitis

A

smokers, COPD, DM and immunocompromised

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7
Q

what test should you order for acute bronchitis and why

A

cxr to rule out pneumonia

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8
Q

how do you treat acute bronchitis

A

albuterol and an antitussive and hydration

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9
Q

what is the most common infection with cystic fibrosis

A

pseudomonas

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10
Q

what is the etiology of COPD

A

smoking

it can also be due to alpha 1 antitrypsin

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11
Q

what pattern is seen on PFT in a patient with COPD

A

FEV1

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12
Q

what is the pattern for PFT in a patient with restrictive pattern

A

FEV1 is normal or slight decreased
FVC decreased more than FEV1
FEV1/FVC ratio is increased
TLC is decreased

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13
Q

people with emphysema are know as

A

pink puffers
they are thin due to increased energy expenditure during breathing
patient tend to lean forward
Patients have a barrel chest increased AP diameter
accessory muscle use

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14
Q

people with chronic bronchitis are know as

A

blue bloaters
they are over weight and cyanotic due to hypercapnia and hypoxemia
chronic cough and sputum production

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15
Q

what is bronchiectasis

A

irreversible dilation of the airways due to inflammatory destruction of the airway walls

Secondary infection with Pseudomonas aeruginosa

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16
Q

etiology of bronchiectasis

A 
Cystic fibrosis most common
Mechanical obstruction, tumor, mucus
Infectious, TB, Pneumonia, MAC
hypogammaglobulinemia
Chronic aspiration
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17
Q

signs and symptoms of bronchiectasis

A

chronic cough mucopurulent sputum (foul smelling)
hemoptysis due to rupture of blood vessels near bronchial walls
wheezing
digital clubbing
recurrent or persistent pneumonia

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18
Q

how is bronchiectasis diagnosed?

A

High rest CT
PFT shows obstructive pattern
CXR is normal in most cases

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19
Q

what is the treatment for bronchiectasis?

A 
Abx for acute exacerbations
Bronchial hygiene 
hydration
chest PT
Bronchodilators
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20
Q

what is Cystic Fibrosis

A

defect in chloride channel protein causes impaired chloride and water transport which leads to thick viscous secretions in the respiratory tract, exocrine pancreas, sweat glands, intestines and GU

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21
Q

who is affected by CF

A

autosomal recessive condition predominantly affecting caucasians

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22
Q

what happens with patients who have CF

A

typically get obstructive lung disease with chronic pulmonart infections (pseudomnonas), pancreatic insufficiency and other GI problems

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23
Q

what is the treatment for CF

A

pancreatic enzyme replacement, fat soluble vitamins, chest PT, vaccinations for influenza and pneumococcal and ABX for infections

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24
Q

what is emphysema

A

permanent enlargement of air spaces distal to terminal terminal bronchioles due to destruction of alveolar walls from protease.
Elastase is released from PMN and macrophages and digest human lung. This is inhibited by alpha1-antitrypsin

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25
Q

what is the pathogenesis of chronic bronchitis

A

excess mucus production narrows the airways; patients often have a productive cough
Inflammation and scarring of the airways, enlargement in mucous glands and smooth muscle hyperplasia lead to obstruction

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26
Q

signs of COPD

A 
prolonged forced expiratory time
during auscultation, end expiratory wheezes on forced expiration, decreased breath sounds and inspiratory crackles
Tachypnea, Tachycardia
Cyanosis, accessory muscle use
hyperresonance on percussion
signs of cor pulmonale
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27
Q

How is COPD diagnosed

A

with PFT i s definitive diagnostic test
Decreased FEV1 and Decreased FEV1/FVC ratio
Increased total lung capacity and functional reserve capacity (indicates air trapping)

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28
Q 
Obstructive lung disease 
FEV1, FEV1/FVC
PEFR, Residual volume
TLC
Vital lung capacity
A 
FEV1-low
FEV1/FVC-low
PEFR-Low
Resid Vol-High
TLC-High
Vital cap-low
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29
Q 
Restrictive lung disease 
FEV1, FEV1/FVC
PEFR, Residual volume
TLC
Vital lung capacity
A 
FEV1-normal to slightly low
FEV1/FVC-normal to high
PEFR-Normal
Resid Vol-low,norm,high
TLC-low
Vital cap-low
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30
Q

CXR in COPD

A

low sensitivity fir diagnosing COPD
Hyperinflation, flattened diaphragm and enlarged retrosternal space
decreased vascular markings
Useful in acute exacerbation to rule out pneumonia

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31
Q

what is the most important intervention for COPD

A

smoking cessation

it prolongs survival rate but does not reduce it to the level of someone who has never smoked.

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32
Q

what two interventions for COPDers has lowered mortality

A

smoking cessation and oxygen therapy

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33
Q

what is the treatment of COPD

A 
-Inhaled Beta2-agonists (albuterol)
long active agents   like salmeterol
Inhaled
-anticholinergics like ipatropium bromide
-combo of albuterol and ipatropium
-Inhaled steroids like fluticasone or budesonide  
-Theophylline
-O2 therapy
-vaccination influenza and pneumococcal
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34
Q

what is contraindicated in COPD and asthma as far as medication goes?

A

beta blockers because they can mask brochospam

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35
Q

what is the criteria for continuous or intermittent long term oxygen therapy in COPD

A

PaO2 55mm HG
or
O2 sat

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36
Q

acute COPD excerbation definition

A

a persistent increase in dyspnea not relieved with bronchodilators
Increased sputum production are common

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37
Q

what is first line treatment in acute COPD excerbation

A

Broncodilator alone or in combo with anticholinergic

supplemental O2 to keep

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38
Q

When do you use systemic steroid in a COPD exacerbation

A

for patient requiring hospitalization usually methylprednisolone

DO Not use inhaled steroid with acute exacerbation

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39
Q

asthma triad

A
  1. air way inflammation
  2. Airway hyperresponsiveness
  3. reversible airflow obstruction
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40
Q

when does asthma start?

A

can start at any age

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41
Q

extrinsic asthma

A

patients are atopic produce immunoglobulin E to environmental antigens
May be associated with eczema and hay fever

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42
Q

intrinsic asthma

A

not related to atopy or environmental factors

triggers include pollen, house dust, mold and cockroaches, cats, dogs, cold air, tobacco smoke

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43
Q

clinical features of asthma

A

intermittent SOB, wheezing, chest tightness, and cough
Symptoms are worse at night
Wheezing during inspiration and expiration

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44
Q

how is asthma diagnosed

A

PFT
they will show a obstructive patter
Decrease in FEV1, and FEV1/FVC
Spirometry before and after bronchodilator can confirm diagnosis by proving reversible air way obstruction
If there is an increase in FEV1 or FVC by at least 12% it is considered reversible

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45
Q 
Peak Expiratory flow rate
Normal
mild
mod-sev
severe
A

norm:450-650
mild>300
mod-sev:100-300
sev

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46
Q

what is bronchoprovocation test

A

used when asthma is suspected but PFT are nondiagnostic.

measures lung function before and after inhalation of mathacholine

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47
Q

what is the most common finding of asthma on CXR

A

normal

can show hyperinflation

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48
Q

ABGs in asthma

A

should be considered if patient is in significant respiratory distress
Hypercarbia is common

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49
Q

what id the PaCO2 is normal or increased

A

respiratory failure may ensue.
When respiratory rate is increased that should cause PaCO2 to decrease but Increased PaCO2 is a sign of respiratory muscle fatigue or severe air way obstruction.
Pt should be hospitalized and mechanical vent should be considered

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50
Q

what is the treatment for acute attacks

A

albuterol inhaler onset is 2 to 5 minutes and last 4to6 hours

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51
Q

what is the treatment of acute severe asthma excarbation?

A 
Inhaled beta2 agonist via MDI or neb
assess patients response to bronchodilators with peak expiratory flow and clinically
Corticosteroids
third line agenst include iv magnesium
supplemental O2 to keep sats >90%
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52
Q

intermittent asthma symptoms and night time symptoms
rescue med usage
interfere with normal activity

A

symptoms

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53
Q 
severe persistent asthma
sypmtoms
night symptoms
rescue med use
interfer activity
lung function
A 
symptoms
throughout the day
night
7times/week
rescue med use
several time/day
activity inter
extereme
FEV1
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54
Q 
Mild persistent asthma
symptoms
night symptoms
rescue med use
activity interfe
lung function
A 
symptoms
>2days/week
night symptoms
3-4 times/month
rescue med use
> 2 days/week but not daily
activity interference
minor
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55
Q

what are typical cardiopulmonary pattern in restrictive lung disease

A

RVH
RAD
right heart strain pattern

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56
Q

what is the key to pnemoconosis?

A

exposure

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57
Q

what are the types of pneumoconiosis related to environmental exposure

A

Asbestosis (ships, insulation, pleural plaquing)
Silicosis (sandblasting, foundry work
Black lung coal miners lung

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58
Q

Interstitial lung disease with granulomas

A

Sarcoidosis
Histocytosis
Wegners’s granulomatosis
churg-strauss

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59
Q

alveolar filling disease

A

good pasture
Idopathic hemosiderosis
alveolar proteinosis

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60
Q

what is sarcoidosis?

A

non infectious granulomatous disease
90% lung involvement
they are noncaseating granulomas

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61
Q

who does sarcoidosis usually affect?

A

young to middle age

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62
Q

what is the work up for sarcoidosis and what do the results look like

A 
Leukopenia, eosinophilia
Hypercalcemia/hypercalciureia
Increased ESR/CRP
\+RF
Increased serum ACE
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63
Q

what does a CXR look like for sarcoidosis

A

nodular lesions with bilateralhilar lymphadenopathy

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64
Q

how is sarcoidosis dxed

A

transbronchial biopsy

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65
Q

what is the treatment for sarcoidosis

A

steroids only for symptoms

most cases resolve or significantly improve in 2 years

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66
Q

what is erythema nodosum

A

is a reddish painful tender lumps commonly located on the front of legs below the knees
found in sarcoidosis

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67
Q

what are symptoms of sarcoidosis

A 
anterior and posterior uveitis
erythema nodosum
conjunctivitis
heart arrhythmias
bells palsy
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68
Q

what do PFT look like for sarcoidosis

A

decreased VC and TLC decreased diffuse lung capacity

decreased FEV1/FVC

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69
Q

what is asbestosis?

A

diffuse interstitial fibrosis of the lung caused by inhalation of asbestos fibers

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70
Q

when does asbestos develop

A

15 to 20 years after exposure

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71
Q

what does asbestos look like on a CXR

A

honey combing with pleaural plaques

hazy infiltrates with bilateral linear opacities

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72
Q

what causes silicosis

A

exposure to sandblasting, mining, stone cutting and glass manufacturing

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73
Q

What are people who have silicosis at risk of getting

A

TB

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74
Q

What does silicosis look like on CXR

A

egg shell calcifications

localized and nodular peribronchial fibrosis most common in upper lobes

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75
Q

what is the treatment for silicosis

A

removal from exposure

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76
Q

what causes berylliosis?

A

exposure to beryllium from fluorescent lightbulbs and aerospace engineering

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77
Q

how is berylliosis diagnosed

A

beryllium lymphocyte proliferation test

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78
Q

how is berylliosis treated

A

steroids

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79
Q

what causes idiopathic pulmonary fibrosis

A

its unknown

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80
Q

what is the presentation of IPF

A

gradual onset of progressive dyspnea, nonproductive cough

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81
Q

what is the mean survival of ITP

A

3-7 years

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82
Q

what does the CXR look like with IPF

A

ground glass or honeycomb or normal

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83
Q

how is IPF diagnosed

A

open lung biopsy

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84
Q

what is the treatment of IPF

A

no effective treatment but supplemental oxygen, steroids and lung transplant have shown to be beneficial

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85
Q

what is acute respiratory failure?

A

when there is inadequate oxygenation of blood or ventilation or both

86
Q

hypoxia is defined as

A

PaO250mm hg

87
Q

hypercapnia is defined as

A

PCO2>50

88
Q

how is ARDS diagnosed

A

hypoxemia that is refractory to oxygen therapy ratio of PaO2/FiO20.5

89
Q

what are the causes of ARDS

A

Sepsis most common
trauma
overdose
near drowning

90
Q

what does pertussis look like under a microscope

A

gram negative coccobacillus

91
Q

how is pertussis diagnosed

A

clinical suspicion

patients will have severe or prolonged cough or post tussive vomiting

92
Q

how are kids treated who have pertussis

A

supportive therapy and hospitalization

Positive tests are

93
Q

how are adults treated

A

azithromycin or clarithromycin
Tdap booster
Vaccinate pregnant women

94
Q

what are the two types of lung cancers

A

Small Cell lung cancer

Non-small cell lung cancer

95
Q

which lung cancer is more common?

A

non-small cell

96
Q

non small cell cancer involves which cancers?

A

squamous cell
adenocarcinoma
large cell
bronchoalveloar cell carcinoma

97
Q

what are risk factors for lung cancer?

A 
Cigarette smoke accounts for >85%
2nd hand smoke
Asbestos
Radon
COPD
there is a linear relationship between pack years and risk of lung cancer
98
Q

when cancer has the lowest association with smoking of all lung cancers

A

adenocarcinoma

99
Q

how is NSCLC staged

A

TNM system

100
Q

how is SCLC staged

A

Limited- which is confined to chest plus supraclavicular nodes but not cervical or axillary
Extensive which is outside of the chest

101
Q

what symptoms are most common of squamous cell

A

cough, hemoptysis, obstruction, wheezing and dyspnea

recurrent pneumonia

102
Q

what are lung cancer constitutional symptoms?

A

anorexia, weight loss, weakness

103
Q

What do symptoms of local invasion by lung cancer present like

A
  1. superior vena cava syndrome which cause facial fullness, face and arm edema, dilated veins over the anterior chest and arms
  2. Phrenic nerve palsy causing hemidiaphtagmatic paralysis
  3. Hoarsness
  4. Horners Syndrome lack of sweating, ptosis and miosis
  5. Pancoast tumor causes shoulder pain upper extremity weakness and horners syndrome
104
Q

what is the treatment for NSCLC?

A

Surgery is the best option
you need to make a definitive pathological diagnosis before surgery
If patient has metastatic disease they are not candidates for surgery
Radiation is important adjunctive therapy

105
Q

what is the treatment for SCLC for limited disease

A

chemo and radiation are initially used

106
Q

what is the treatment for SCLC for extensive disease

A

chemo alone is used as initial tretment

107
Q

what features favor a benign vs malignant nodules

A

Age- the older the patient the more likely it is to be malignant 50% chance over age 50
Smoking- smokers have higher risk of malignancy
Size of nodule- larger the nodule the more likely it is to be malignant >2cm
Borders- malignant nodules have more irregular borders
Calcifications-eccentric asymmetric calcification suggest malignancy. Dense central calcification suggest benign
Change in size

108
Q

what cancers are usually peripherally located

A

Adenocarincoma

Large cell carcinoma

109
Q

which lung cancers are centrally located

A

SCLC

Squamous

110
Q

A person presents with flushing, diarrhea and bronchospasm. What type of cancer do they have

A

the person has pulmonary carcinoid

they are presenting with carcinoid syndrome

111
Q

what is a pleural effusion?

A

fluid in the plural space

112
Q

what are symptoms of pleural effusion

A

SOB
cough
chest pain

113
Q

what are signs of pleural effusion

A

decreased air entry
dullness
wheezes and crackles

114
Q

what does a pleural effusion look like of a CXR

A

meniscus
blunting of costophrenic angle
Bilateral pleural effusion would be more likely CHF

115
Q

what causes transudative effusion

A

due to either elevated capillary pressure in visceral or parenteral pleura or decreased plasma oncotic pressure

116
Q

what causes a exudative effusion

A

causes by increased permeability of pleural spaces

117
Q

what should you do if you suspect a exudative effusion

A

test pleural fluid for cell count, glucose, pH, amylase, triglycerides

118
Q

what is found in exudative effusions?

A

Protein >0.5
LDH>0.6
LDH> 2/3 upper limit of normal serum LDH

119
Q

what is the most common cause of a Pleural effusion

A

CHF

120
Q

what causes exudative effusions

A

Malignancy
Bacterial Pneumonia
Viral infection
Pulmonary embolism

121
Q 
what will the results of 
Protein
LDH 
Glucose 
look like in exudative effusions
A

Protein-high
LDH-high
glucose-low because bacteria and cells are in the fluid and are using the glucose

122
Q 
what will the results of 
Protein
LDH 
Glucose 
look like in transudative effusions
A

Protein-low
LDH-low
glucose-high

123
Q

how are exudative effusions treated

A

surgical drainage or removal

124
Q

how is transudative effusions treated

A

drugs

125
Q

causes of transudative effusions

A

CHF
Cirrhosis
Nephrotic syndrome
Peritoneal dialysis

126
Q

what does a bilaterally effusions suggestive of

A

CHF

127
Q

isolated left sided pleural effusion

A

pneumonia, cancer, boerhaave (esopaheal) rupture

aortic dissection

128
Q

lsolated right sided effusion

A

pneumonia, cancer, CHF, PE

129
Q

what is a parapneumonic effusion

A

pleural effusion in the presence of pneumonia

this can lead to

130
Q

what is a pneumothorax

A

air in the pleura space

131
Q

what causes a traumatic pneumothorax

A

iatrogenic
always get CXR after the procedure of Transthroacic needle aspiration
thoracentsis
central line placement

132
Q

what causes a spontaneous pneumothorax

A

occurs with out any trauma

133
Q

what is a primary simple pneumothorax

A

occurs in a healthy individual without any underlying lung disease
which is causes by bleb ruptures into pleural space
common in tall young men

134
Q

what is secondary complicated pneumothorax

A

occurs as complication of underlying lung disease COPD, asthma, TB

135
Q

what are symptoms of pneumothorax

A

ipsilateral chest pain with sudden onset
dyspnea
cough

136
Q

what are physical signs of pneumothorax

A

decreased breath sounds over affected side
hyperresonance over chest
decreased or absent tactile fremitus on affected side
mediastinal shift towards side of pneumothorax.

137
Q

what is the treatment for a primary pneumothorax

A

if small pneumothorax and patient is asymptomatic:
Observation and should resolve in 10days
If larger pneumo administer supplemental oxygen
chest tube insertion

138
Q

what is the treatment for secondary pneumo

A

chest tube and drainage

139
Q

what is a tension pneumothorax

A

accumulation of air within the pleural space that tissues surrounding the opening to the pleural cavity act as a valve and allow air to enter but not escape

140
Q

what causes a tension pneumothorax

A

Mechanical ventilation
CPR
Trauma

141
Q

what are clinical features of tension pneumothorax

A

hypotension
distended neck veins
shift of trachea away from tension pneumo
decreased breath sounds on affected side
hyperresonance to percussion on side of pneumo

142
Q

how is tension pneumothorax treated

A

treated as medical emergency due to hemodynamic compromise

large bore needle in second or third intercostal space MCL followed by chest tube placement

143
Q

what is pulmonary hypertension

A

mean arterial pressure greater than 25 mmHg at rest of 30mm Hg during exercise

144
Q

how is pulm hypertension diagnosed

A

ECG shows right ventricle hypertrophy
echo will show dilated pulmonary artery
dilation and hypertrophy of RA and RV
Right heart Cath

145
Q

how is pulm HTN treated

A

oxygen
vasodilators (sildenafil, epoprstenol) CCB
anti coagulation
lung transplant

146
Q

what is primary pulmonary hypertension

A

HTN in the absence of disease of heart and lung

147
Q

what establishes the diagnosis of primary pulm htn

A

cardiac cath

148
Q

what is Cor pulmonale

A

RVH with eventual RV failure from pulmonary HTN secondary to pulmonary disease

149
Q

what is the most common cause of Cor pulmonale

A

COPD

150
Q

what are signs of Cor pulmonale

A

decreased exercise tolerance
cyanosis and digital clubbing
JVD, hepatomegaly, edema

151
Q

how is cor pulmonale diagnosed

A

CXR will show enlargement of RA,RV and pulmonary arteries
ECG will show right axis deviation, Peaked P waves, RVH
ECho RVH dilitation but normal LV size and function

152
Q

treatment for cor pulmonale

A

treat pulmonary disorder
use diuretic cautiously
long term oxygen

153
Q

what is a pulmonary embolism

A

occurs when a thrombus in another region of the body embolizes to the pulmonary vascular tree via RV and pulmonary artery

154
Q

what are risk factors for DVT

A 
age >60
malignancy
prior DVT/PE
cardiac disease 
obesity
trauma/surgery
pregnancy/estrogen use
155
Q

sypmtoms of PE

A 
dyspnea
pleuritic chest pain
cough
hemoptysis 
syncope
156
Q

signs of PE

A 
tachypnea
rales
tachycardia
S4
Increased P2
shock
low grade fever
157
Q

what do ABGs look like on a patient with a PE

A

PaO2 low

PaCO2 low and pH is high

158
Q

what does the A-a gradient look like in a PE

A

increased A-a gradient

Low pO2 despite high FiO2

159
Q

how to diagnosed a PE if low suspicion

A

D dimer
if negative PE ruled out
if positive then do a CT-PA

160
Q

how to diagnose a PE if high suspicion

A

CT PA if positive PE ruled in

CT PA negative consider U/S VQ scan

161
Q

causes of elevated D-dimer

A 
aortic dissection
MI
Preg
surgery
trauma
infection/inflammation
162
Q

treatment for PE

A

oxygen to fix hypoxemia
anticoagulation therapy start immediately if suspicion is high
give a bolus followed by continuous infusion for 5 to 10 days with a goal INR of 1.5-2.5
start warfarin on day 1 and continue for 3 to 6 months or more
thrombolytic therapy
Inferior vena cava filter if anticoag is Contraindicated

163
Q

which lung is most commonly involved with pulmonary foreign body

A

the right lung because of the anatomy where the right bronchus is more straight

164
Q

how does foreign body aspiration present?

A

some develop acute respiratory distress
most often patient appear well but later develops respiratory disfunction
SOB, fever, tachypnea, hypoxemia

165
Q

how is a foreign body diagnosed?

A

CXR

166
Q

what are symptoms of TB

A

cough, weight loss, fatigue, fever, night sweats, chest pain, hemoptysis
typically happens over weeks

167
Q

how does primary TB show up on CXR

A

homogeneous infiltrates, hilar/paratracheal lymph nose enlargement, segmental atelectasis, cavitations with progressive disease

168
Q

what does reactivation TB look like on CXR

A

fibrocavitiy apical disease, nodules, infiltrates, posterior apical segment of the right upper lobe

169
Q

what is a gohn complex

A

calcified primary focus

170
Q

what is a ranke complex

A

calcified primary focus and calcified hilar lymphnodes represent healed infection

171
Q

how is TB diagnosed

A

identification of Mycobacterium tuberculosis from cultures or by DNA or RNA amplification techniques

172
Q

what is the histological hallmark of TB

A

caseating granulomas

173
Q

what is the treatment for active TB

A 
RIPE 
Rifampin, Isoniazid, Pyrazinamide, ethambutol
for 2 months 
then 
RI 
for 4 months
watch LFTs
174
Q

what are the side effects of Isoniazid

A

hepatitis, peripheral neuropathy

175
Q

side effects of Rifampin

A

hepatitis, flu, orange body fluid

176
Q

side effects of ethambutol

A

red-green vision loss

177
Q

a PPD is considered positive at >5mm for what patients?

A

HIV positive person
Recent contact with active TB carrier
Person with evidence of TB on CXR
Immunocompromised on steroids

178
Q

a PPD is considered positive at >10mm for what patients?

A

recent immigrants from high TB areas
HIV neg injection drug users
mycobaerioogy lab peopel
residents and employees in high risk settings
Pts with certain med conditions like DM, sillicosis

179
Q

a PPD is considered positive at >15mm for what patients?

A

people with no risk factors

180
Q

what is the Bacille Calmette guerin

A

vaccine administered to a Tb neg person in cases with high risk for intense prolonged exposure

181
Q

what is the most common cause of respiratory disease in preterm infant

A

hyaline membrane disease

182
Q

what causes hyaline membrane disease

A

deficiency in surfactant

183
Q

how is hyaline membrane disease treated

A

intermitten ventilation

exogenous surfactant

184
Q

how does hyaline membrane disease present

A

rapid labored breathing, grunting, retractions, fast heart rate

185
Q

what is community acquired pneumonia

A

occurs in community or within first 48-72 hours of hospitalization

186
Q

what is the most common CAP

A

streptococcus pneumonia

187
Q

what is nosocomial pneumonia

A

occurs during hospitalization after first 48-72 hours

188
Q

what is the classic presentation of CAP

A

sudden chill followed by fever pleuritic chest pain and productive cough
crackles
increased tactile fremitus

189
Q

what is the presentation of atypical pneumonia

A

sore throat, headache followed by nonproductive cough and dyspnea
low to no fever
less severe lung exam

190
Q

which bacteria are the typical bugs

A 
SHaKeM
Strep pneumo
Haemophilius infl
Klebsiella
Moraxella
191
Q

which bugs cause atypical pneumona

A 
MC LIRP
Mycoplasma
Chlamydophilia
Legionella
RSV
parainfluenza
192
Q

what are the two recommendation to prevent pneumonia

A

Flu shot

pneumococcal vaccine

193
Q

who should receive pneumococcal vaccine

A

patients >65
young patients with high risk like heart disease, sickle cell, pulmonary disease, diabetes, alcoholic cirrhosis and asplenic individual

194
Q

how is pneumonia diagnosed

A

PA and Lateral CXT

195
Q

when do you admit a patient with CAP

A

hypotension

hypoxic

196
Q

how is CAP treated

A

patients with out comorbid conditions are treated with azithromycin or clarithromycin
If comorbid condition treat with fluroquinolone

197
Q

what is the treatment for HAP

A

cephalosporins with pseudomonal coverage
ceftazidome or cefepime
carbapenems: imipenem
pipercillin/tazobactam

198
Q

how is ventilator pneumonia treated

A

Ceftazidime or cefepime
Or zosyn or inapenem
aminoglcoside or fluroquinolone
vanco or linezolid

199
Q

what antivirals are used for the flu

A

zanamivir or oseltamivir

200
Q

what type of pneumonia are HIV patients at risk for

A

PCP

pneumocystis jiroveci

201
Q

what is the treatment for PCP

A

bactrim

202
Q

what is the most common pneumonia in HIV patients

A

Strep pneumo

203
Q

patient has rust colored sputum rigors, high WBC,

A

strep pneumo

gram positive encapsulated diplococci

204
Q

elederly, alcoholic with COPD, currant jelly sputum

A

klebsiella

205
Q

pneumonia seen in COPD, smokers, elderly

A

Haemophilus influenza

gram neg encapsulated coccobacillus

206
Q

patients invaded with plastic like nursing home, G-tube/ET tube, CF, hot tubs

A

pseudomonas

gram neg coccobacillus

207
Q

neonate with staccato cough

A

chlamydophilia

208
Q

sick old men, COPD, out breaks associated with air conditioning

A

Legionella

209
Q

alcoholics have high risk of aspiration with abscess formation

A

Anaerobic

210
Q

flea from rodents can cause this pneumonia

A

yersinia pestis

PANCE (8 decks)

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